摘要:

Diabetes mellitus is the subject of a great many case management programs around the world as it is a prevalent disease with modifiable risk factors and potentially preventable severely disabling complications. Diabetes mellitus represents even greater challenges in the context of mental illness. Patients with psychological complications of diabetes mellitus or with psychiatric disease and comorbid diabetes mellitus present a unique set of problems with which the physician and other care providers must contend. These challenges include: problems with treatment regimens; inability to manage self-care programs; difficulties with negotiating appointments, referrals, and follow-up care; confusion over competing care instructions; potential drug interactions and/or complications which exacerbate diabetes mellitus; and many social difficulties which undermine the effective care of diabetes mellitus.Lack of control of either diabetes mellitus or mental health problems may complicate or exacerbate one or the other of these diseases. Case management for these individuals is one potential way of improving care. Management needs to be team based, coordinated between specialties, simplified, and in one location of care when possible. Excellent coordination and communication is paramount and social factors and supports require special attention.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

The Internet's information capabilities and benefits to commerce have been proven but these results have an uncertain relationship to healthcare, managed care and disease management. The highly fragmented structure of the US healthcare industry presents strategic and operational issues, which will challenge universal Internet implementation. Furthermore, a significant concern in implementing an Internet tie-in with healthcare is safeguarding patient confidentiality.The US healthcare industry is long overdue for an overhaul. It is hoped that the Internet will go far beyond simply providing medical information and become the link between doctors, insurers and hospitals. Disease management is ideally structured to deal with the myriad of issues concerning patients, doctors and payors. Implementation of an Internet strategy in a disease management setting could provide the answer to improved quality of care, demand for outcomes information and payors demand for controlled costs.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

This article describes the critical ingredients of the assertive community treatment (ACT) model for people with severe mental illness and then reviews the evidence regarding its effectiveness and cost effectiveness. ACT is an intensive mental health program model in which a multidisciplinary team of professionals serves patients who do not readily use clinic-based services, but who are often at high risk for psychiatric hospitalization. Most ACT contacts occur in community settings. ACT teams have a holistic approach to services, helping with medications, housing, finances and everyday problems in living. ACT differs conceptually and empirically from traditional case management approaches.ACT is one of the best-researched mental health treatment models, with 25 randomized controlled trials evaluating its effectiveness. ACT substantially reduces psychiatric hospital use, increases housing stability, and moderately improves symptoms and subjective quality of life. In addition, ACT is highly successful in engaging patients in treatment. Research also suggests that the more closely case management programs follow ACT principles, the better the outcomes.ACT services are costly. However, studies have shown the costs of ACT services to be offset by a reduction in hospital use in patients with a history of extensive hospital use.The ACT model has been hugely influential in the mental health services field. ACT is significant because it offers a clearly defined model, and is clinically appealing to practitioners, financially appealing to administrators and scientifically appealing to researchers.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

ObjectivesTo identify the asthma prevalence rate, the total healthcare and asthma-related treatment costs, and the medical and pharmacy costs associated with different asthma medication usage patterns in a managed-care organisation (MCO).Study design and participantsThe medical and pharmacy claims databases from a 400 000 member MCO were used. The medical claims database was searched from 1994 to 1996 for patients having at least one asthma medical claim in either the first or second diagnosis field of the medical claims, and the total healthcare and asthma-related costs were determined. A subpopulation with a more restrictive asthma definition was identified and their costs were also determined. In addition, the patterns of drug treatment were identified.Study perspectiveMCO perspective.ResultsThe mean total healthcare cost of caring for patients with asthma was significant and approximately twice the mean cost of all patients enrolled in the MCO. Using a broad definition of asthma, the mean (± standard deviation) annual total per patient healthcare cost was $US2511 ± 7314 and the annual asthma-related cost was $US679 ± 2247 (1996 values). Using a more restrictive definition of asthma, the mean annual total per patient healthcare cost was $US2653 ± 5268 and the asthma-related cost was $1026 ± 2447. There appeared to be a low overall use of asthma medications, especially anti-inflammatory formulations; <3% of patients with asthma were high users of anti-inflammatory inhalers.ConclusionsPatients with asthma are costly to managed-care organizations. Asthma-related costs constitute a minority (<30%) of the costs of caring for these patients, and under utilization of anti-inflammatory products by patients is widespread. Further research is needed to assess the cost impact of different asthma treatment patterns.

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