摘要:

The reality of everyday asthma care differs substantially from guidelines. The fact that better possibilities for asthma care do not result in better outcomes remains an enigma and harms professional pride. Patient self-management has been presented as a tool to improve outcome of care. Based on published work thus far, it can be concluded that self-management of asthma can be beneficial from both the family physicians' and the patients' perspective and, under certain conditions, proves to be an efficient method of incorporating both interests. Health professionals play an important role in implementing self-care, but several barriers should be solved first: attitudes of health professionals and patients need to shift towards shared responsibilities and be patient-centered and organization of care should change accordingly. As reviewed in this article, the typical features of self-management of asthma may provide the means to overcome these barriers.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Disease Management (DM) organizations are facing incredible challenges from outside and inside the industry. A focus on costs can help both managed care organizations and self-insured employers to be more open to the potential of DM in the US.The steep increase in spending for covered medical services has been the most disturbing development over the past 2 years. This trend is largely reflected by the average premium growth. Provider revenues per privately insured person (a proxy for spending on services) increased 6.6% in 1999, compared with 5.1% in 1998, and 3.3% in 1997. At the same time, consumer demand for quality service, easy access, and reasonable deductibles and co-payments has risen nationally. There is demand for greater accountability from the medical and administrative areas. Common challenges for DM entities mandate demonstrated quality, cost of care, outcomes and access to capital markets. Public debate over healthcare models and services has increased consumer awareness of issues that were previously internal matters. Government leaders are responding to consumer pressure with an increasing focus on healthcare issues, as evidenced by the Health Insurance Portability and Accountability Act enacted in 1996 by the US. The end result of all these changes has been an extremely competitive marketplace which requires increasingly sophisticated methods for sharing and tracking of information on patients, members, services, costs and quality.Today, DM executives increasingly view information technology as an essential tool for addressing these challenges and ensuring the survival of the DM industry. Disease managers have always understood the need for sophisticated systems to collect and track disease specific data, but the cost was a hindrance. As DM organizations evolve, there is a critical need for new technologies capable of cost effectively linking all the various providers, and ultimately the patient. Recent technological advancements include the Intranet, an Internet-related technology that has the potential to dramatically improve a DM organization's ability to meet the needs of the marketplace. This technology and its implications for DM are discussed in this article.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Pain has recently become the focus of attention as a major health problem in the US. The implementation of a pain management strategy in a rural not-for-profit federal hospital is described in this article. The strategy heightened awareness and changed the practice behaviors of clinicians in recognizing, assessing, treating and following patients with pain. Quality improvement initiatives monitored the performance of the healthcare staff regarding use of the assessment and documentation tools. Reduction of pain was surveyed in both transitional care patients and outpatients. Outpatients were also interviewed for satisfaction with their pain management plan. The efforts are ongoing as healthcare professionals continue to focus on reducing pain and suffering in their patients. Additional work is directed toward meeting both the objectives in the strategic plan and standards set by the health systems organization accrediting body described for pain management.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Migraine is a common, chronic headache disorder affecting about 26 to 28 million Americans. It is notable for the variability of diagnostic testing, therapeutic interventions and costs, as well as high utilization of healthcare resources, its considerable impact on quality of life and its economic impact for both patients and employers. Moreover, there appears to be low patient satisfaction with migraine care, a wide variability in utilization of physician and emergency department services and increasing pharmacy costs for migraine therapies. Standards of care and clinical guidelines for migraine are now available. For these reasons, migraine represents an ideal disorder for a disease management (DM) program.The suggested steps in developing a DM program for migraine include setting appropriate goals, identifying suitable patients, providing components of care and using continuous quality improvement methods to reach targets.A DM management program for migraine in a managed care organization which was developed and implemented is overviewed in this article. Medicaid and commercial enrollees were included. Members with migraine who had ≥1 migraine-related encounter(s) in the previous year, or query of the pharmacy claims database for members who filled one or more prescriptions for migraine specific medication(s) during the 12-month period, were eligible. The objectives were: an increased proportion of patients with symptom relief and returning to normal activities within 2 hours after taking medication; taking prophylactic medications (if experiencing ≥3 migraine attacks/month) and reporting knowledge of potential migraine triggers; decreased utilization of emergency care for migraine and increased patient satisfaction with migraine treatment and health plan and /or provider. Improved health-related quality of life and reduced level of migraine-related disability compared with baseline were also anticipated. Patient satisfaction with overall migraine treatment was selected as the primary endpoint in the evaluation of the program.Early feedback on outcomes from patients and providers has been very positive. There have been no major unexpected problems to date.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

The health of the international workforce has been an increasing area of concern for the last two decades. Globalization of the world economy and rapid technological changes continue to change the nature of work and employment practices, exposing employees to new and serious health risks. These challenges are inescapable in any workplace, therefore it is important that employers examine how they can best fulfill their legal and leadership roles to protect and promote the health and well-being of their employees.This paper explores employer roles in employee health in the context of global and local challenges. A strategy is suggested for employers to deal with the multifaceted workplace pressures and health impacts on employees i.e. implementing an integrative holistic model of workplace health management (workplace health management is an approach to workplace health that includes health promotion, disease prevention, safety management and organizational development). Workplace health management has emerged from the latest developments in the settings approach to workplace health promotion.The changing world of work and the implications on employee health in the current climate of globalization and technological changes is also examined. In particular, it highlights mental health issues associated with the emerging epidemic of work stress from increased workplace pressures.The paper reviews the changing conceptions of the role of employers and contemporary approaches to management practices in a range of disciplines, drawing out the common principles and strategies to respond to changes. One essential message which has emerged from the review is that employers need to become change agents and visionary leaders who adopt a proactive, interdisciplinary and integrative system approach to formulate and develop company policies and workplace culture that facilitates employee participation, professional growth and team work.These contemporary management principles and strategies form the basis of the integrative model for workplace health management presented in this paper. In essence, the integrative model of workplace health management uses a participatory problem solving cycle to identify and address the numerous issues associated with health promotion and disease prevention, occupational safety and hazard reduction, and organizational improvement and human resource management. Specifically this involves the employees and employer participating in a needs-based program development and implementation cycle: identifying health priorities and addressing environmental, organizational, occupational and lifestyle determinants of employee health. The paper concludes with an overview of international development of workplace health management and reports on successful examples from European, Western Pacific and Pan American regions.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

ObjectiveTo understand how patients with chronic illness use the Internet to manage their health.Design and ParticipantsAn online survey was conducted among 10 069 patients with chronic illnesses. Survey results were obtained from patients with 35 separate chronic conditions, with at least 50 respondents for each condition. The survey was administered online at a dedicated, password-protected web site. Data were analyzed to identify how online behavior varied by disease state and other demographic variables, as well as to determine what kinds of information were preferred or viewed as most credible. Results were also weighted to correct bias introduced by nonresponse from under-represented groups.ResultsThe most frequently represented conditions were allergies (n = 4749), arthritis (n = 2841) and hypertension (n = 2561). Respondents complaining of a gynecological condition, chronic sinusitis, arthritis, migraine, or a thyroid condition reported spending the most time online. Patients who spent the most time seeking health information online also described themselves as being in poorer health than other respondents. Those who were more skeptical about healthcare, were dissatisfied or experienced problems with access to healthcare, reported being more likely to go to the Internet as a source of health information.The Internet appears to be used as a surrogate for medical advice among patients who lack insurance coverage or otherwise find it difficult to obtain care. Individuals with a gynecological condition, depression, diabetes mellitus, or a gastrointestinal disorder were more likely to use online news groups, bulletin boards, or lists that are designed specifically for health topics. Direct online communication with clinicians was very rare, as was online fulfillment of medication prescriptions. Women, in general, spent more time looking for health-related information than men did. Major Internet portals with health-specific content were viewed as the most desirable sources of information, followed by medical or academic web sites. Web sites sponsored by health insurance plans were the least favored sources of information. Overall, 42% of respondents felt that the Internet has had a major impact on understanding their health problems.ConclusionsThese results further detail the emergence of an activist health consumer who uses the Internet to help manage their health. This type of individual is likely to be in poorer health, female, more inclined to engage in self-care, and may lack access to professional care. As Internet usage becomes increasingly widespread, this group may become increasingly relevant. Future research will document the impact of these changes with successive samples of at least 10 000 participants.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Piperacillin/tazobactam is a β-lactam/β-lactamase inhibitor combination with a broad spectrum of antibacterial activity against most Gram-positive and Gram-negative aerobic bacteria and anaerobic bacteria. Piperacillin/tazobactam is effective and well tolerated in patients with lower respiratory tract infections (LRTI), intra-abdominal infections, skin and soft tissue infections, and febrile neutropenia. In comparative clinical trials against various other antibacterial regimens, piperacillin/tazobactam has shown higher clinical success rates, particularly in the treatment of patients with intra-abdominal infections and febrile neutropenia.Cost analyses of piperacillin/tazobactam have been variable, in part, because of differences in specific costs included. Three US cost analyses found that piperacillin/tazobactam had lower total medical costs than clindamycin plus gentamicin or imipenem/cilastatin in intra-abdominal infections, and ticarcillin/clavulanic acid in community-acquired pneumonia. Piperacillin/tazobactam plus amikacin had lower total costs than ceftazidime plus amikacin in another cost analysis of patients with febrile neutropenic episodes modeled in nine European countries. However, piperacillin/tazobactam plus tobramycin was more costly than ceftazidime plus tobramycin in hospital-acquired pneumonia in a US cost analysis.In cost-effectiveness analyses, all studies of intra-abdominal infections, pneumonia and febrile neutropenic episodes consistently reported lower costs per unit of effectiveness versus comparators. Piperacillin/tazobactam was dominant (greater efficacy and lower costs) versus imipenem/cilastatin in intra-abdominal infections and ceftriaxone, ciprofloxacin or meropenem in pneumonia. Piperacillin/tazobactam plus amikacin was dominant over ceftazidime plus amikacin in the treatment of febrile neutropenic episodes. In a cost-effectiveness analysis of skin and soft tissue infection, piperacillin/tazobactam had lower costs per successfully treated patient than ceftriaxone or cefotaxime, but a slightly higher cost-effectiveness ratio than amoxicillin/clavulanic acid. All cost-effectiveness analyses were based on decision-analytical models.ConclusionsPiperacillin/tazobactam is likely to reduce overall treatment costs of moderate to severe bacterial infections by increasing initial treatment success, thereby reducing the length of hospital stay and the use of additional antibacterials. Piperacillin/tazobactam has shown clinical and economic advantages over standard antibacterial regimens in the treatment of intra-abdominal infections, LRTIs, febrile episodes in patients with neutropenia, and skin and soft tissue infections, although more complete published data are needed to confirm these results. Present data regarding clinical efficacy, bacterial resistance and costs would support the use of piperacillin/tazobactam as an empirical first-line option in moderate to severe bacterial infections.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS