The relationship and tensions between vertical integrated delivery systems and horizontal specialty networks.
This activity is designated for physicians, medical directors, and healthcare policy makers. GOAL: To clarify the issues involved with the integration of single-specialty networks into vertical integrated healthcare delivery systems. OBJECTIVES: 1. Recognize the advantages that single-specialty networks offer under capitated medical care. 2. Understand the self-interests and tensions involved in integrating these networks into vertical networks of primary care physicians, hospitals, and associated specialists. 3. Understand the rationale of "stacking" horizontal networks within a vertical system. (+info)
Hospitals and managed care: catching up with the networks.
Although the growth of managed care is having a significant impact on hospitals, organizational response to managed care remains fragmented. We conducted a survey of 83 hospitals nationwide that indicated that most hospitals now have at least one person devoted to managed care initiatives. These individuals, however, often spend most of their time on current issues, such as contracting with managed care organizations and physician relations. Concerns for the future, such as network development and marketing, although important, receive less immediate attention form these individuals. Hospital managed care executives must take a more proactive role in long range managed care planning by collaborating with managed care organizations and pharmaceutical companies. (+info)
Effectiveness and economic impact of antidepressant medications: a review.
This article reviews the existing literature on the pharmacoeconomics and effectiveness of antidepressant medications. Although selective serotonin reuptake inhibitors (SSRIs) have not proved to be more efficacious than the older tricyclics, and their prescription costs are significantly higher, they provide superior effectiveness; ie, patients are less likely to discontinue taking them or switch antidepressants. Pharmacoeconomic studies consistently demonstrate a relationship between this superior effectiveness and reductions in overall treatment costs, often through decreased utilization of medical and hospital services. The most conservative study found a cost offset that more than negated the extra cost of drugs, although the cost savings were not statistically significant. Other studies found statistically significant lowering of utilization costs by using SSRIs rather than tricyclics. Studies comparing SSRIs with each other present conflicting findings, although fluoxetine appears to have an edge over sertraline and paroxetine with regards to effectiveness and pharmacoeconomics. More studies employing a prospective outcome design and naturalistic study setting need to be conducted with SSRIs and other new antidepressants. (+info)
Managing asthma care.
This activity is designed for physicians, medical directors, and healthcare policy makers. GOAL: To provide the reader with the tools needed to monitor and manage the care of all enrollees with asthma. OBJECTIVES: 1. Become familiar with a health maintenance organization (HMO)-wide data collection system. 2. Learn the essential elements of asthma care for patients. 3. Learn how to track the implementation of these elements in various HMO settings. (+info)
Diagnosis and treatment of chronic renal failure in children.
This activity is designed for primary care and specialist physicians. GOAL: To provide an overview of the unique features and treatment of chronic renal failure in children. OBJECTIVES: 1. Describe the diagnosis of chronic renal failure in children. 2. Discuss the medical treatment of chronic renal failure in children. 3. Understand the treatment of end-stage renal disease in children. 4. Discuss the financial impact of caring for a child with chronic renal failure. (+info)
The diagnosis, classification, and management of asthma according to severity.
This activity is designed for primary care and specialist physicians. GOAL: To provide prompt and appropriate treatment for asthma of all levels of severity resulting in improved level of activity and decreased need for urgent care and hospitalization with a possible reduction in the annual decline of lung function, degree of permanent airway damage, and mortality. OBJECTIVES: 1. To provide a framework on the basis of history, physical findings, and laboratory results for the diagnosis of asthma. 2. To improve the ability to classify asthma by degree of severity. 3. To describe an incremental therapeutic approach to asthma by degree of severity. 4. To provide a systematic approach with regard to periodic reevaluation of asthma severity and modification of the treatment plan. (+info)
Osteoporosis: review of guidelines and consensus statements.
This activity is designed for physicians, pharmacists, nurses, health planners, directors of managed care organizations, and payers of health services. GOAL: To understand current guidelines and consensus statements regarding the prevention, diagnosis, and treatment of osteoporosis. OBJECTIVE: List four national or international organizations involved in the development of consensus statements regarding the prevention, diagnosis, and treatment of osteoporosis. 2. Discuss the significant differences among different countries regarding the prevention and treatment of osteoporosis. 3. List the major risk factors for osteoporosis. 4. Describe the differences in the application of bone mineral density scans, biochemical markers, and ultrasound in evaluating patients with suspected osteopenia and osteoporosis. 5. Distinguish between and briefly discuss therapeutic modalities used in primary prevention, secondary prevention, and treatment of osteoporosis. 6. Discuss the advantages and disadvantages of estrogen/hormone replacement therapy. 7. Describe alternatives to estrogen/hormone replacement therapy. (+info)
Injury prevention training: is it effective.
The aim of this controlled follow-up study was to assess the effectiveness of a multi-disciplinary training programme in increasing knowledge, changing attitudes and practice in injury prevention amongst primary health care professionals. All primary health care team members in Nottinghamshire were invited to participate in the training programme. Thirty-one health visitors, 11 general practitioners and 16 practice nurses attended the training programme, and completed the study questionnaire 3-4 months before and after the training. A comparison was made with a professional of the same status, who had not attended the training session who had also completed both questionnaires, and who was matched with a trained participant on the basis of pre-training attitude and knowledge scores (to within 1 point of each score). A significant increase in the number of individuals answering correctly to questions on accidental injury epidemiology was demonstrated in the trained group (Wilcoxon matched-pairs signed rank, health visitors P = 0.002, practice nurses P = 0.0004, general practitioners P = 0.02), but no significant change was demonstrated in the control group. Changes in attitude scores were only significant for the practice nurses (Wilcoxon matched-pairs signed rank, P = 0.01). Increases were also demonstrated in the frequency of health visitors identifying hazards on home visits and discussing them with parents (chi 2 = 6.19, d.f. = 2, P = 0.04) and in the number of health visitors who, on receiving notification of a child attending the A&E department following an injury, carried out a home visit to discuss injury prevention (chi 2 = 9.19, d.f. = 2, P = 0.01). The number of general practitioners displaying posters in the surgery waiting rooms also increased significantly (chi 2 = 9.21, d.f. = 2, P = 0.002). The number of contacts with representatives of other agencies and individuals concerning child safety significantly increased in the trained group (Wilcoxon matched-pairs, P = 0.02). We conclude that education and training with regard to injury prevention was effective in increasing knowledge and some injury prevention practices. Although training did not appear to change the attitudes of health visitors and general practitioners to a significant extent, a marked change was unlikely due to high baseline attitude scores. (+info)