The Internet and managed care: a new wave of innovation.
(41/1189)
Managed care firms have been under siege in the political system and the marketplace for the past few years. The rise of the Internet has brought into being powerful new electronic tools for automating administrative and financial processes in health insurance. These tools may enable new firms or employers to create custom-designed networks connecting their workers and providers, bypassing health plans altogether. Alternatively, health plans may use these tools to create a new consumer-focused business model. While some disintermediation of managed care plans may occur, the barriers to adoption of Internet tools by established plans are quite low. Network computing may provide important leverage for health plans not only to retain their franchises but also to improve their profitability and customer service. (+info)
Financing the health care Internet.
(42/1189)
Internet-related health care firms have accelerated through the life cycle of capital finance and organizational destiny, including venture capital funding, public stock offerings, and consolidation, in the wake of heightened competition and earnings disappointments. Venture capital flooded into the e-health sector, rising from $3 million in the first quarter of 1998 to $335 million two years later. Twenty-six e-health firms went public in eighteen months, raising $1.53 billion at initial public offering (IPO) and with post-IPO share price appreciation greater than 100 percent for eighteen firms. The technology-sector crash hit the e-health sector especially hard, driving share prices down by more than 80 percent for twenty-one firms. The industry now faces an extended period of consolidation between e-health and conventional firms. (+info)
Networking health: learning from others, taking the lead.
(43/1189)
The Internet provides one of the most compelling examples of the way in which government research investments can, in time, lead to innovations of broad social and economic impact. This paper reviews the history of the Internet's evolution, emphasizing in particular its relationship to biomedical computing and to the nation's health care system. Here I summarize current national research programs, emphasizing the need for greater involvement by the medical research community and leadership from federal health care agencies. (+info)
Reporting and dissemination of industry versus non-profit sponsored economic analyses of six novel drugs used in oncology.
(44/1189)
PURPOSE: Our prior study found that pharmaceutical-sponsored and non-profit sponsored analyses differed in their published assessments of the economic value of six new oncology drugs. In this study, we expand on our earlier findings and evaluate the association between funding source and 1) characteristics of the published study report and 2) journal type for dissemination of the previously evaluated economic studies. METHODS: We reviewed the published cost-effectiveness literature for hematopoietic colony stimulating factors, 5-HT3 antagonist antiemetics. and taxanes. Two blinded investigators rated specific aspects of study reporting based on the US Public Health Service Panel on Cost-effectiveness in Health and Medicine criteria. Dissemination strategies were evaluated using impact factor scores from the Science Citation Index. RESULTS: The operational aspects of pharmaceutical-sponsored study reporting were better overall than those associated with non-profit sponsored studies. Specifically, pharmaceutical-sponsored studies were more likely to be reported based on data obtained from randomized clinical trials or detailed cost-models (90% vs. 70%), to include descriptions of the source of cost differences (90% vs. 79%), to state whether the study was carried out from a societal, governmental, or insurer perspective (70% vs. 42%), and to clearly indicate the time-period over which costs were evaluated (65% vs. 50%). Nonprofit sponsored studies were more likely than pharmaceutical sponsored studies to report the generalizability of the findings, including being more likely to include information about how the data could be extrapolated to other clinical settings (58% vs. 35%), to include statements on the statistical significance of the findings (38% vs. 20%), and to clearly outline the cost per unit and data sources for the cost analyses (67% vs. 45%). A similar percent of pharmaceutical and non-profit sponsored studies reported background and conclusions with about 80% providing literature comparisons of the results (about 80%) and two thirds to three fourths discussing the limitations of the finding (75% for pharmaceutical-sponsored and 67% for non-profit sponsored studies). Most studies were published in low impact factor peer-reviewed journals, and journal impact factor scores were similar between pharmaceutical and nonprofit sponsored studies. CONCLUSIONS: Upon reviewing the entire pharmacoeconomic literature for six new oncology drugs, we identified differences in study reporting, but not in types of journals where studies were published, between pharmaceutical-sponsored and non-profit sponsored studies. These results, particularly the observed differences in data generalizability, may account in part for our previous finding of lower likelihood of reporting unfavorable conclusions in pharmaceutical-sponsored studies. (+info)
Strengthening environmental and educational nutrition programmes in worksite cafeterias and supermarkets in The Netherlands.
(45/1189)
The purpose of this study was to assess conditions for the adoption and continued implementation of different healthy nutrition programmes in worksite cafeterias and supermarkets, i.e. an educational programme and two environmental programmes (a food labelling programme and a food supply programme). Twenty semi-structured interviews were conducted with representatives of worksite cafeterias and supermarkets. Concepts of theories of diffusion were used as a framework for the study. Questions were formulated about the attributes of the innovation, and organizational and personal characteristics that might influence programme adoption and implementation. Results indicated that educational and environmental programmes in both worksite cafeterias and supermarkets should meet specific requirements regarding programme design, methods and materials in order to be adopted and implemented. Besides, some important implementation strategies of the educational and environmental programmes were identified. It is concluded that it seems feasible to conduct educational and environmental intervention programmes in worksite cafeterias and supermarkets, but that certain conditions for adoption and continued implementation have to be met. Based on the implications of this study, the development of an educational programme, a labelling programme and a food supply programme was completed. (+info)
Anti-bullying interventions at school: aspects of programme adaptation and critical issues for further programme development.
(46/1189)
Recently, a growing interest in problems at school of peer aggression and victimization was observed. As a result, intervention strategies appropriate for this kind of problem were required. The Norwegian anti-bullying intervention that was developed and evaluated by Olweus (1992) in the region of Bergen was considered to be a good model for other countries to implement interventions against peer aggression within the school environment. It was therefore adapted to the educational settings of other countries. This paper aims to discuss the adaptation processes of the Bergen anti-bullying programme and to give guidelines to advance further programme development. For this, the DFE Sheffield Bullying Project (Smith and Sharp, 1994), the Anti-bullying Intervention in Toronto schools (Pepler et al., 1994) and the Flemish anti-bullying project (Stevens and Van Oost, 1994) were considered in the analyses. Discussion of the adaptation processes of the Bergen model programme revealed that the adapted interventions largely succeeded in incorporating the core components of the Bergen model programme, taking into account the characteristics of the implementation environment. This suggests that for bully/victim interventions, the dilemma of programme fidelity and programme adaptation could be solved adequately. However, from a health promotion perspective, some critical issues for programme improvement were observed. Three suggestions for change were made, indicating that anti-bullying actions at schools may benefit from: (i) a clear overview of the learning objectives, specified per target population; (ii) more attention to parental involvement and family interventions; and (iii) additional information about the adoption processes of the anti-bullying interventions within schools. (+info)
Strategies for risk assessment and control in welding: challenges for developing countries.
(47/1189)
Metal arc welding ranges from primitive (manual) to increasingly complex automated welding processes. Welding occupies 1% of the labour force in some industrialised countries and increasing knowledge of health risks, necessitating improved assessment strategies and controls have been identified by the International Institute of Welding (IIW), ILO, WHO and other authoritative bodies. Challenges for developing countries need to be addressed. For small scale production and repair work, predominantly by manual metal arc on mild steel, the focus in developing economies has correctly been on control of obvious physical and acute health affects. Development introduces more sophisticated processes and hazards. Work pieces of stainless steel and consumables with chromium, nickel and manganese constituents are used with increasingly complex semi-manual or automated systems involving variety of fluxes or gasses. Uncritical adoption of new welding technologies by developing countries potentiates future health problems. Control should be integral at the design stage, otherwise substantive detriments and later costs can ensue. Developing countries need particular guidance on selection of the optimised welding consumables and processes to minimise such detriments. The role of the IIW and the MFRU are described. Applications of occupational hygiene principals of prevention and control of welding fume at source by process modification are presented. (+info)
Evidence-based dentistry: an overview of the challenges in changing professional practice.
(48/1189)
A great deal of effort and resources are currently being directed at developing an evidence-based approach to healthcare delivery. The success of the evidence-based movement will depend upon the provision of necessary support to help GDPs achieve change. This paper aims to give an overview of current knowledge on what types of interventions are most effective at changing health professionals' clinical practices. Barriers to change are highlighted and the implications for the development of evidence-based dentistry are considered. Further research on organisational, social and personal influences affecting the application of evidence-based practice is necessary. (+info)