Changes in Canadian women's mammography rates since the implementation of mass screening programs.
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OBJECTIVES: This study reports on Canadian mammography rates between 1990, when mass screening programs were launched, and 1994/95. METHODS: Mammography rates from 2 national surveys were compared according to the presence of a provincial screening program. RESULTS: Mammography rates among women aged 50 to 69 years (the targeted group) increased significantly, by 16%; increases were twice as high in provinces with screening programs. Among women in their 40s (nontargeted group), the changes were insignificant and independent of screening program status. CONCLUSIONS: Screening programs appear to have influenced the mammography rates of targeted women aged 50 to 69 years. (+info)
Impact of arthritis and other rheumatic conditions on the health-care system--United States, 1997.
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Arthritis and other rheumatic conditions are the leading cause of disability in the United States, affecting approximately 43 million persons and costing $65 billion in 1992. By 2020, these numbers will increase as the population ages. This report examines several measures of the impact of arthritis on the U.S. health-care system; the findings indicate that arthritis and other rheumatic conditions have a large impact on hospitalizations, ambulatory-care visits, and home health care, with women accounting for most of this impact and all persons aged <65 years accounting for a substantial portion. (+info)
Medicaid recipients' experiences under mandatory managed care.
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OBJECTIVE: To describe Medicaid recipients' experiences with the outcomes of access, quality, and satisfaction in a mandatory managed care (MC) program. STUDY DESIGN: A qualitative case study design with content analysis of narrative focus group (FG) data, which was part of a comprehensive program evaluation that also involved pre- and postsurveys and analyses of cost and utilization data. PATIENTS AND METHODS: Six FG interviews were conducted in the autumn of 1997 with 31 women on the Aid to Families with Dependent Children program. Participants were recruited from a randomly ordered list of women who had responded to a 1996 premanaged care survey regarding their or their child's healthcare experiences under traditional Medicaid. RESULTS: There was general consensus across all focus groups on a range of issues, including improvements in access to primary care and continuity of care. Overall, few participants expressed discontent with restriction of choice of provider and on MC policies regarding use of the emergency room. There was no consensus on what factors influenced choice of MC plan, although convenience of location was named most frequently. An unanticipated outcome was the recurrent theme across all focus groups of disrespectful treatment by healthcare personnel, especially under traditional Medicaid, which had declined somewhat under managed care. CONCLUSIONS: These contextual accounts identify specific features of a mandatory Medicaid MC program that are viewed as improvements over traditional Medicaid. Specific features that were dissatisfying can be addressed to improve both enrollee satisfaction and the transition to managed care for Medicaid recipients. (+info)
Is prior authorization of topical tretinoin for acne cost effective?
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OBJECTIVE: To determine whether prior authorization of topical tretinoin for acne is in the best interest of health insurers and, if so, to determine the optimal prior authorization age for topical tretinoin. STUDY DESIGN: A retrospective, cross-sectional study of data from the National Ambulatory Medical Care Survey was performed. PATIENTS AND METHODS: We performed a sensitivity analysis using published data on the age distribution for topical tretinoin prescriptions for acne and nonacne indications to estimate the cost of topical tretinoin and the cost of performing prior authorizations as a function of the prior authorization age. RESULTS: A prior authorization age of 25 for topical tretinoin is not cost effective for health insurers. If prior authorization is required, an age threshold of 35 or older is most cost effective. The total cost of topical tretinoin (the sum of the drug costs plus the prior authorization costs) changes little with changes in the prior authorization age; if the prior authorization age is set too low, total costs increase (because the number of prior authorizations increase). CONCLUSIONS: Prior authorization for topical tretinoin is of no great benefit to insurers. As the prior authorization age decreases, the cost of requiring prior authorization increases. Eliminating prior authorization altogether would result in at most a small increase in costs and would be balanced by the benefits to both patients and physicians. (+info)
The role of the ECHO model in outcomes research and clinical practice improvement.
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In the articles that follow in this Special Report supplement to The American Journal of Managed Care, the reader will note that various types of outcomes--humanistic and economic, as well as clinical--are measured to achieve a balanced picture of the comprehensive impact of the healthcare interventions implemented. Clinical research has only recently evolved to a state in which a balanced-systems approach to outcomes measurement is moving to the forefront. It is therefore important to understand the historical context of the outcomes movement within which the multidimensional approach developed. A description of this historical context is provided below, followed by an overview of the ECHO (Economic, Clinical, and Humanistic Outcomes) Model and case examples of the balance-of-outcomes model as implemented in a large integrated delivery system. (+info)
A randomised controlled trial of postal versus interviewer administration of a questionnaire measuring satisfaction with, and use of, services received in the year before death.
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STUDY OBJECTIVES: To develop a short form of an interview schedule used successfully in previous national surveys of care for the dying, and to investigate the effect of administering it by post on response rate, response bias and on the nature of responses to questions. DESIGN: Randomised controlled trial. SETTING: An inner London health authority. PARTICIPANTS: Informants (person registering death) of random sample of cancer deaths between June 1995 and July 1996. MAIN RESULTS: The shortened questionnaire (VOICES) has 158 questions. Response rate did not differ significantly between postal and interview groups (interview; 56% (69 of 123), postal: 52% (161 of 308). Responders in the two groups did not differ in terms of their sociodemographic characteristics. Postal questionnaires had significantly more missing data, particularly on questions about service provision and satisfaction with services. Responses to questions differed between the groups on 11 of 158 questions. Interview group respondents were more likely to give top ranking responses to questions on service satisfaction and symptom control. CONCLUSIONS: Postal questionnaires are an acceptable alternative to interviews in retrospective post-bereavement surveys of care for the dying, at least in terms of response rate and response bias. However, the increased costs of interview surveys need to be balanced against the fact that postal questionnaires result in more missing data, and possibly less reliable answers to some questions. Caution is needed in combining results from the two data collection methods as interview respondents gave more positive answers to some questions. (+info)
Perceptions on the influence of cost issues on quality improvement initiatives: a survey of Saudi health care managers.
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OBJECTIVE: To determine (i) the cost issues which Saudi health care managers perceive to influence overall quality improvement initiatives, and (ii) the relationship between health care managers' satisfaction with such initiatives and their perceptions regarding the influence of different cost issues on the overall quality improvement initiatives. DESIGN: Data were collected through a self-administered questionnaire in August and September 1996 in the Western Region of the Kingdom of Saudi Arabia. The participants were 236 health care managers of private hospitals. Data was analysed using the chi2 test. RESULTS: Less than one-half of the health care managers surveyed were satisfied with their hospitals' overall quality improvement initiatives. The issue that was rated to have the most influence on such initiatives was the 'cost of malpractice lawsuits' followed by the budget for the quality assurance programme'. The issue that was perceived to have the least influence on overall quality improvement initiatives was 'data on cost allocation'. Of the 17 cost issues included in the study, eight had statistically significant influence on the health care managers' satisfaction with their hospitals' overall quality improvement initiatives. The most statistically significant was the 'measurement of the costs of quality-related actions'. (+info)
Use of inhaled medications and urgent care services. Study of Canadian asthma patients.
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OBJECTIVE: To determine asthma patients' patterns of disease and knowledge of asthma. DESIGN: Telephone survey of patients with diagnosed asthma. SETTING: Residences in 10 Canadian provinces. PARTICIPANTS: Patients with asthma diagnosed by a doctor: 829 men and women with a mean age of 38 +/- 7 years. MAIN OUTCOME MEASURES: Classes of asthma medications, patterns of use, frequency and severity of asthma symptoms use of emergency departments and urgent medical services, participation in asthma education programs, presence of environmental triggers, and knowledge of asthma pathophysiology and treatment. RESULTS: Four hundred fifty-six patients (55%) reported daily symptoms of asthma; 431 patients (52%) used inhaled beta 2-agonists daily. Only 340 patients (41%) used inhaled corticosteroids (IC), and many used them irregularly. A total of 579 (72%) respondents reported no unscheduled visits to a family physician for worsening asthma, but one third of patients had been to an emergency department for uncontrolled asthma in the last 5 years, and most of these visits had occurred during the last year. As to knowledge, 406 patients (49%) disagreed with the statement that asthma is a lifelong condition that cannot be cured. Among IC users, only 101 (30%) knew that IC reduced airway inflammation; among beta 2-agonist users, only 33% agreed that beta 2-agonists opened the bronchial tubes. Two hundred forty patients (29%) reported being current cigarette smokers, and 381 (46%) reported having pets at home. CONCLUSIONS: Daily symptoms and daily use of beta 2-agonists are common among Canadian asthma patients, and this is in excess of what is considered acceptable by current asthma care guidelines. Underuse of IC, inadequate knowledge of asthma symptoms and treatments, and failure to avoid asthma triggers were common in the population studied. (+info)