摘要:

Health plans are committed to the advancement of disease management (DM). They believe DM is crucial to the successful management of care, and actively promote a variety of DM initiatives. However, the political climate in the US in recent years has not been conducive to the advancement of managed care, and thus threatens the advancement of DM as well. On the other hand, voters have recently demonstrated a lack of sympathy with critics of managed care, and despite a contentious debate over patients' rights, there is growing awareness of the benefits of evidence-based care, particularly in managing chronic conditions to improve quality of life and productivity. This awareness, although perhaps overshadowed by the current political scene, creates important opportunities for DM advocates.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Diabetes mellitus has considerable and increasing importance in England. The burden of illness is concentrated in ethnic minority groups and socioeconomically deprived areas. Evidence for effective clinical care has increased following the results of the UK Prospective Diabetes Study but current diabetes care services are variable in quality. These inequalities and inequities are being actively addressed through current national policies to improve access and quality of care through agreed national standards. These standards encourage a shift towards a patient-centered, primary-care led service working closely with multidisciplinary diabetes specialists.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

ObjectiveTo identify common features of primary care clinics that have successfully achieved improvement in chronic disease care.MethodsWe analyzed seven primary care practices that have achieved significant improvement in chronic disease care provided to adults with diabetes mellitus, hypertension, lipid disorders, or heart disease. Strategies used to improve care were mapped across categories of the Enhanced Primary Care (EPC) model, and common features were identified.ResultsThe seven practices achieved significant improvement in health outcomes of adults with diabetes mellitus, hypertension, or lipid disorders within 1 to 2 years. Outcome measures typically included all people in the practice with the conditions of interest. Improvement was sufficient to substantially reduce risk of major cardiovascular events by over 20% on a population basis. In the majority of successful primary care practices, combinations of ten key strategies were used: leadership; resources; clinical guidelines; organized care teams; patient activation; information systems; identification of population at risk; monitoring; prioritization; and active outreach to patients.ConclusionsThe results support the existence of an EPC model capable of achieving significant improvements in chronic disease care over a relatively short period of time. Health systems and primary care practices interested in improving the care of patients with chronic diseases may consider simultaneous use of the various improvement strategies identified in this study.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

ObjectiveTo contain costs, the US Department of Defense instituted a mandated statin formulary conversion program, designating cerivastatin and simvastatin as the ‘preferred statins’. This study examines the effectiveness, safety, and statin cost effectiveness following conversion to cerivastatin and simvastatin.DesignRetrospective analysis.SettingMadigan Army Medical Center (MAMC), Tacoma, Washington, USA.PatientsMen and women treated and filling their statin prescriptions at MAMC with records of statin conversion between October 1999 and April 2000 (n = 1303).MethodsAge, gender, and lipid parameter measurements assessed pre-conversion (earliest measurement prior to conversion) and ≥21 days post-conversion were recorded. Pre- and post-conversion attainment of National Cholesterol Education Program Adult Treatment Panel II (NCEP-ATP II)/American Diabetes Association (ADA) goals, lipid parameters, and estimated statin cost per patient attaining NCEP-ATP II/ADA goals, were analysed.ResultsConversion to cerivastatin (n = 1038) elevated goal attainment (18.2%), and reduced low-density lipoprotein and cholesterol (LDL-C) levels by 15.4 mg/dl, total cholesterol (TC) by 13.5 mg/dl and triglycerides (TG) by 10.2 mg/dl, and elevated high-density lipoprotein and cholesterol (HDL-C) levels by 3.8 mg/dl (all p < 0.002). Similar results occurred in NCEP-ATP II patient subgroups [secondary prevention; primary prevention: with diabetes mellitus, ≥2 risk factors (RF), and <2 RF]. Patients receiving simvastatin (n = 265) exhibited improvement in NCEP-ATP II/ADA goal attainment and LDL-C, TC, and HDL-C levels [all p < 0.05, except HDL-C in the <2 RF subgroup (nonsignificant)]. The estimated pre-conversion annual pharmacy statin cost per patient attaining and NCEP-ATP II/ADA goals was $US681 ($US56.77 per patient per month), compared with the post-conversion annual cost of $US355 ($US29.62 per patient per month), driven primarily by the cerivastatin conversion (2000 values). Post-conversion adverse events [rash (n = 3), dizziness (n = 1), and gastrointestinal upset (n = 1)] were rare. There were no reported clinically significant elevations of liver function tests or creatine kinase, or cases of myositis or myalgia.ConclusionsStatin conversion at MAMC to cerivastatin and simvastatin is an effective and well tolerated method for improving NCEP-ATP II/ADA goal attainment and lipid parameters while containing pharmacy costs.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Diabetes mellitus is a common metabolic disorder characterized by high blood glucose levels resulting from an insulin deficiency (type 1 diabetes mellitus) or a combination of insulin deficiency and insulin resistance (type 2 diabetes mellitus). The chronic hyperglycemia associated with diabetes mellitus can cause damage to the eyes, kidneys, heart and peripheral circulation, resulting in substantial morbidity, premature mortality and considerable healthcare costs.In both type 1 and type 2 diabetes mellitus, quality of glycemic control has been shown to be a major factor in the prevention of microvascular complications, and tight blood glucose control is the primary goal for all patients with diabetes mellitus.In patients with type 1 diabetes mellitus, multiple daily injections of exogenous insulin and frequent monitoring of blood glucose levels are required to achieve tight glycemic control. Patients with type 2 diabetes mellitus may achieve initial glycemic control with diet and lifestyle interventions alone; however, a large percentage of patients will require pharmacological therapy, first with an oral antidiabetic agent and, ultimately, with insulin.Premixed insulin formulations, consisting of fixed ratios of short- and intermediate-acting insulins, are a convenient and effective treatment option which account for ≈40% of insulin use worldwide. Until recently, the only premixed formulations available contained varying proportions of human regular insulin and human isophane insulin suspension (NPH). However, new premixed formulations containing insulin lispro (a rapid-acting insulin analog) and insulin lispro neutral protamine suspension (NPL) [an intermediate-acting insulin analog] are now available.Insulin lispro mix75/25 (Humalog®Mix75/25™) is a premixed formulation containing 25% insulin lispro and 75% NPL which has been investigated for use in patients with type 1 and with type 2 diabetes mellitus. Administered twice daily immediately before breakfast and dinner, insulin lispro mix75/25 provides better control of postprandial blood glucose, provides similar overall glycemic control, appears to be preferred by patients and may reduce nocturnal hypoglycemia compared with a similar premixed formulation containing 30% human regular insulin and 70% NPH (human insulin 70/30; Humulin® 70/30, Novolin®70/30). Insulin lispro mix75/25 has a rapid onset of action, allowing for administration immediately before a meal, whereas patients need to administer human insulin 70/30 30 to 60 minutes prior to meals. Insulin lispro mix75/25 also improves glycemic control in patients whose type 2 diabetes mellitus is not well controlled by oral agents.ConclusionInsulin lispro mix75/25 is suitable for patients wishing to use premixed insulin formulations and may offer several benefits over human insulin 70/30.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS