ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Disease management is a systematic population-based approach to identifying those at risk, intervening using information from the growing field of evidencebased medicine, and measuring patient outcomes once an intervention is in effect. Operationally, this is a challenging series of tasks, and a vulnerability for this field. Important aspects include the development of clear clinical guidelines, agreement on the part of providers and patients to participate, a sophisticated information architecture, well-designed and tested interventions and a logical measurement plan for the collection of outcomes. While there is a clear need for evidence of its benefit, the field is expanding rapidly and incorporating many other disciplines and aspects of healthcare delivery as well.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Although it may seem odd to medical professionals to state that disease management is a new concept, it represents a sea change in medical care delivery. Because of the dramatic increases in technologies that do not cure diseases, but improve them, and the costs we pay for using these technologies, we are finding that medical delivery models based on cure are no longer viable. Evidence for better strategies that coordinate care across populations of persons with similar diseases is at hand. As financial pressures mount, organised approaches to disease management will become more widespread. Along the way, the existing roles of key players, such as hospitals, physicians and pharmaceutical companies, will change.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Disease management involves a holistic approach in which healthcare professionals work together to effect an optimal outcome for a particular patient with a particular disease. The environment needed for optimal disease management programmes includes a multidisciplinary culture of cooperation, communication and coordination, a clinical champion, an administrative champion, enough time to do disease management correctly, enough support to do it right, computerised information systems, examination of the total patient continuum and not component management, and use of multiple sites to obtain bigger sample sizes. Disease management goes beyond outcomes research, it goes beyond guidelines development, and it goes beyond randomised controlled trials (RCTs).

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

This article reviews the early experience of organisations in the US who have attempted to design, develop and implement disease management programmes. A systems approach is recommended and outlined as a solution to the obstacles that have hindered the success of ‘first generation’ disease management programmes. The authors focus on important considerations and specific components needed to build a solid foundation for the successful implementation of disease management systems.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Different methods for the development of review criteria have been used during the introduction of quality assurance into health services. However, recent advances in methods for undertaking systematic literature reviews, developing guidelines and interest in evidence based medicine, have emphasised the need to derive criteria so that they are explicitly linked to the findings of research. If criteria of this type become available, they will increasingly be used by health professionals to improve the quality of care, and by the managers in response to health service reforms. Greater attention needs to be paid to methods for the systematic development of criteria. In particular, if they are to be useful, criteria must be based on research evidence, prioritised according to the strength of the evidence and impact on outcome, measurable, and appropriate to the setting in which they will be used.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Disease prevention and management (DPM) represents a relatively recent paradigm shift in the provision of healthcare, from a focus on individual components of healthcare, to a more holistic view of patient care.The purpose of this article is to provide practical guidelines that can be used in designing, implementing and evaluating DPM programmes. There are 6 steps in the design phase: (i) conducting an epidemiological diagnosis; (ii) reviewing the scientific literature; (iii) identifying the goal and outcome objectives; (iv) specifying strategy objectives and strategy activities; (v) selecting a study design; and (vi) considering the characteristics of effective outcomes measures. The implementation and evaluation phases include collecting the data, examining the data and reporting the results. Concepts and principles presented here are based on key methodological features of population research.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Patients with non-insulin-dependent diabetes mellitus (NIDDM) can present with an array of symptoms and complications directly or indirectly related to the disease. These impair the quality of life of the patient and also result in higher morbidity and mortality rates relative to the general population.Although diet and lifestyle measures are the cornerstone of management of NIDDM, the vast majority of patients will require pharmacological therapy.Metformin is an oral biguanide antihyperglycaemic agent which has been shown to be as effective as the sulphonylureas in lowering blood glucose levels in patients with NIDDM. Because it does not increase bodyweight and tends to improve the serum lipid profile, metformin can be considered a first-line therapy for NIDDM in patients who are obese or overweight (although it appears equally effective in nonobese patients) and those with dyslipidaemia. It may also be used in combination with sulphonylureas in cases of secondary failure. Thus, metformin should be considered an important drug for inclusion in the management protocols for NIDDM in all care facilities involved with such patients.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS