摘要:

Clinical knowledge and information technology play a major role in the success of disease management programs in achieving improvements in financial and clinical outcomes. The multi-dimensionality and complexity of data needed to run these programs efficiently make information management an important aspect to consider.Disease management clinicians, case managers, nurses, other providers, analysts, managers, and medical directors are constantly using financial, clinical, operational and other data, increasing significantly the demand for information in organizations. Also, with the Internet disseminating critical information among healthcare providers and patients in a more efficient way, careful adoption of new technologies and ideas is required.Consequently, disease management programs are constantly presenting new technical challenges for healthcare companies. Lacking the proper information systems structure to meet these demands can result in business productivity losses reflected in disease management programs not achieving their goals of cost savings and patient health quality improvements. An efficient disease management data warehouse is an important tools to organising and distributing information.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

ObjectiveTo determine the importance of specific health utility attributes that comprise overall utility scores for a number of chronic health state conditions.Study designCross-sectional study using data from a prospective national survey of the health of community-dwelling Canadians.Study population47 534 individuals who answered both health questions and utility questions (51.8% male).MethodsThe attributes making up the Health Utilities Index (HUI-Mark III) scores (i.e. vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain) for 21 chronic conditions were examined from the National Population Health Survey (NPHS) 1996 to 1997. Conditions included Alzheimer's disease, arthritis/rheumatism, asthma, back problems excluding arthritis, bowel disorder, chronic bronchitis or emphysema, cancer, cataracts, diabetes, epilepsy, food allergies, glaucoma, heart disease, hypertension, migraine headaches, other allergies, sinusitis, stroke, stomach/intestinal ulcers, thyroid conditions and urinary incontinence. HUI-Mark III scores for patients without an NPHS-defined chronic condition were also collected. All conditions were mutually exclusive.ResultsThe mean HUI-Mark III score for patients without a chronic health state was 0.953 ± 0.060. Individuals with Alzheimer's disease (0.846 ± 0.168), stroke (0.869 ± 0.163) and arthritis/rheumatism (0.883 ± 0.132) had the lowest overall HUI-Mark III scores. Individuals with Alzheimer's disease (28.6%), epilepsy (23.1%) and urinary incontinence (19.8%) reported higher scores on the emotional impairment attribute. Individuals with arthritis/rheumatism (24.7%) and back problems (20.6%) had high levels of pain/discomfort. Patients with stroke (16.4%) had low mobility scores.ConclusionBy determining which attributes are important to chronic health conditions, this study provides health economists, researchers and policy makers with a reference of health state attributes for various chronic conditions.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

ObjectiveTo compare various strategies for antibacterial administration in terms of patient outcomes, overall costs and quality of care provided.DesignProspective, nonblind, randomized, clinical study.SettingTertiary care hospital in Greece from November 1995 to June 1996.Patients and participants458 patients admitted to the internal medicine department who received antibacterial therapy for infectious diseases.MethodsPatients were randomized into 4 different antibacterial administration policies defined by various levels of restriction control. Efficacy and resource use data were obtained from clinical study case report forms, the hospital financial database and physician expert opinion. Outcomes included complete infection control, disease improvement, unchanged patient condition, infection needing surgical treatment, and death. Direct medical costs were estimated. The perspective adopted was that of the healthcare system (hospital budget; third-party payor). Cost-minimisation analysis was based on cost per patient treated.Results382 eligible patient records examined showed no significant difference in clinical outcomes among patient groups. Baseline analysis showed the strict antibacterial control policy to produce statistically significant differences (p < 0.05) in various resource parameters. Accordingly, compared with all other patient groups, total cost per patient for that strategy was reduced by 26 to 30%. Also, patients in that group received fewer drug doses and underwent fewer treatment days, and antibacterial treatment was modified in fewer cases for these patients.ConclusionStrict control of antibacterial administration in this hospital setting achieved lower direct medical costs with no harmful effect on patient outcomes or quality of care provided. Such a policy appears to be a useful option for both physicians and administrators.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

ObjectiveTo present the pattern of self-report and diagnosis of erectile dysfunction in the US over the time period 1990 through 1998 and examine whether the introduction of sildenafil in March 1998 influenced these findings.Study design and methodsRetrospective database analysis. Data from the National Ambulatory Medical Care Survey (NAMCS) for the years 1990 through 1998 were used. Data from office-based physician-patient encounters for which either a complaint of erectile dysfunction as one of the reasons for requesting an encounter [National Center for Health Statistics (NCHS) code 1160.3] or a diagnosis of erectile dysfunction [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 302.72 or 607.84] was documented were extracted for men aged ≥40 years. National estimates per year were derived for:the number of office-based physician-patient encounters for which a complaint of erectile dysfunction was documented as a reason for requesting an encounter and the number of office-based physician-patient encounters for which a diagnosis of erectile dysfunction was documented;the rate per 1000 office-based physician-patient encounters for which a complaint of erectile dysfunction as a reason for requesting the encounter was documented and the rate per 1000 office-based physician-patient encounters for which a diagnosis of erectile dysfunction was documented; andthe rate per 1000 US male population aged ≥40 years with a complaint of erectile dysfunction as a reason for requesting an encounter and the rate per 1000 US male population aged ≥40 years with a diagnosis of erectile dysfunction.ResultsThe number of office-based physician-patient encounters for which a complaint of erectile dysfunction was documented increased from 764 682 in 1990 to 1 273 730 in 1998. The number of office-based physician-patient encounters with a recorded diagnosis of erectile dysfunction more than doubled over the time period examined, from 647 418 in 1990 to 1 495 793 in 1998. Office-based encounters for which a complaint of erectile dysfunction was documented as a reason for requesting an appointment increased from 5.7 per 1000 in 1990 to 7.0 per 1000 in 1998; the rate of diagnosis of erectile dysfunction increased from 4.8 per 1000 in 1990 to 8.2 per 1000 in 1998. The population-adjusted rate of complaint of erectile dysfunction increased from 17.5 per 1000 in 1990 to 24.2 per 1000 in 1998; the rate of diagnosis increased from 14.9 per 1000 in 1990 to 28.4 per 1000 in 1998. In 1998, 2 142 776 office-based physician-patient encounters documented the prescribing of sildenafil; of these, 41% were for patients with a recorded diagnosis of erectile dysfunction.ConclusionsThe introduction of sildenafil was found not to have influenced the established upward trend in the documented rate of self-report of erectile dysfunction or the diagnosis of erectile dysfunction. However, the prescribing of sildenafil appears to offer greater insight into the actual magnitude of the problem erectile dysfunction represents in the US. Findings suggest there is a reluctance on the part of patients to discuss concerns about erectile dysfunction with their physician and a reluctance on the part of physicians to document patients' expressed concerns regarding erectile dysfunction and/or to record a diagnosis of erectile dysfunction.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality worldwide and places a large burden on medical and economic resources, particularly if hospitalization is required. Indeed, it has been estimated that annual costs of inpatient treatment of patients with CAP currently exceed $US6 billion in the US; a large proportion of this cost is directly related to the duration of hospital stay. Initial antibacterial therapy for CAP is usually empirical, as culture and antibacterial sensitivity test results are rarely available at initial diagnosis. Importantly, treatment must be initiated promptly to achieve the best patient outcome thereby potentially reducing healthcare costs, largely as a result of a decrease in hospitalisation. Any agent selected for empirical therapy should have good activity against pathogens associated with CAP, a favorable tolerability profile and be administered in a simple dosage regimen for good compliance.Streptococcus pneumoniaeremains the most common causative pathogen in nonsevere and severe CAP, although the incidence of this organism varies widely.S. pneumoniaestrains with decreased susceptibility to penicillin have become increasingly prevalent over the past 30 years and are now a serious problem worldwide. In addition, an increase in the prevalence of pneumococci resistant to macrolides has been observed in Europe over recent years.Mycoplasma pneumoniaeandChlamydia pneumoniaeare among the most common atypical pathogens isolated from patients with CAP.Haemophilus influenzae,Staphylococcus aureusandMoraxella catarrhalisare less commonly identified as causative organisms.Because the spectrum of antibacterial activity of levofloxacin includes the pathogens associated with CAP, including penicillin-resistantS. pneumoniae, it is included in US guidelines as an option for the empirical therapy of patients with mild or more severe disease. Levofloxacin is recommended for the initial treatment of outpatients and inpatients with suspected penicillin-resistantS. pneumoniaeinfection and is particularly useful in geographical areas where there is a high incidence of drug-resistant pneumococci. Nevertheless, β-lactam antibacterial agents, in particular penicillin, remain agents of first choice for the treatment of CAP (caused by penicillin-susceptible pathogens) in many European countries.Levofloxacin monotherapy shows good efficacy in the treatment of patients with CAP and is generally well tolerated. Phototoxicity has been infrequently reported with levofloxacin (incidence 0.03% in 1 study) and occurs less commonly than with sparfloxacin (reported incidence 8%). In addition, the drug has a pharmacokinetic profile that allows a simple administration schedule and offers the potential for intravenous to oral sequential therapy. In randomized comparative trials, intravenous or oral levofloxacin was more effective than intravenous ceftriaxone and/or oral cefuroxime axetil, at least as effective as azithromycin plus ceftriaxone and similar in efficacy to both amoxicillin/clavulanic acid and gatifloxacin. Data comparing the efficacy of levofloxacin with other newer fluoroquinolones, such as moxifloxacin, are as yet unavailable.Levofloxacin was also a beneficial treatment for CAP from a pharmacoeconomic perspective. A critical pathway that used levofloxacin for the treatment of patients with CAP led to a decrease in healthcare resource costs compared with conventional management in a randomized controlled trial conducted in Canada. As a treatment for CAP, levofloxacin was less costly than intravenous ceftriaxone and was more cost effective than cefuroxime plus erythromycin, or ceftriaxone or ciprofloxacin.ConclusionsLevofloxacin monotherapy is efficacious and shows pharmacoeconomic benefits when used as empirical treatment for adult patients with CAP. The drug has a broad spectrum of antibacterial activity, is administered in a simple dosage regimen and offers the potential for intravenous to oral sequential therapy; it is also well tolerated and is an option for patients allergic to penicillin or macrolides. Levofloxacin has a particularly useful role in the empirical treatment of patients with infections caused byS. pneumoniaein geographical areas where penicillin-resistant strains of pneumococci are prevalent.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS