The cost effectiveness of patient-applied versus provider-administered intervention strategies for the treatment of external genital warts.
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OBJECTIVE: External genital warts are one of the fastest growing sexually transmitted diseases in the United States today. Two forms of therapy are available: provider-administered and patient-applied. In the most widely used provider-administered ablative therapies, sustained clearance rates range from 18.5% to 40.1%. With nonablative, patient-applied therapies, which are typically more acceptable to patients, sustained clearance rates range from 19.6% with podofilox gel to 44.0% with imiquimod cream. The purpose of this study, given the range of therapies available, their cost differences, and clinical trial-reported differences in rates of sustained clearance, is to determine which therapy modalities, from the providers' perspective, are the most cost effective and which are likely to be the most acceptable to the patient population. STUDY DESIGN: We consider the cost effectiveness of the two patient-applied therapies as first-line therapy followed by provider-administered ablative treatment as second-line therapy. A decision-analytic model framework is developed, with data drawn both from clinical trials and from previously published studies. RESULTS: When considering a two-stage therapy model, with an average sustained clearance rate of 30% assumed for provider-administered ablative therapies, estimated costs per sustained cleared patient are $1265 for patients initially treated with imiquimod and $1304 for patients initially treated with podofilox gel. CONCLUSIONS: Initial treatment with imiquimod is the preferred intervention option as it yields a 39% greater sustained clearance rate than podofilox gel while being 3% less costly per successful outcome. (+info)
Effects of a medicine review and education programme for older people in general practice.
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AIMS: To determine whether a medicine review and education programme influences the compliance and knowledge of older people in general practice. METHODS: Older people taking at least three medicines were randomly allocated to a control or intervention group. Both groups received three visits from a clinical pharmacist: Visit 1: Assessment and patients' medicines rationalized in intervention group. Visit 2: Intervention group given medicines education. Visit 3: Knowledge and compliance in both groups assessed by structured questionnaire RESULTS: Compliance in the intervention group was 91.3%, compared with 79.5% in the control group (P < 0.0001). The number of intervention group patients correctly understanding the purpose of their medicines increased from 58% to 88% on the second visit, compared with 67% to 70% in the control group (P < 0.0005). CONCLUSIONS: A general practice based medication review and education programme improved medicine compliance and knowledge of older people in the short term. (+info)
Self-care program for inpatients in a mental hospital.
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SUMMARY: A self-care program for selected inpatients in a mental hospital has been developed and has been in operation for more than a year. The 12-bed unit operates without any nursing or other professional staff during the night and weekend. Certain factors, including the mental hospital as an organization, tend to hamper the development of this type of program as well as the progress and growth of other programs in psychiatric hospitals. It is suggested that the much needed progress in the mental hospital would be facilitated by an open-systems approach to its organization. Mental hospitals should consider the introduction of self-care programs for selected patients, mainly in view of their therapeutic potential, but also because of the financial savings such programs offer. (+info)
Medication lists for elderly patients: clinic-derived versus in-home inspection and interview.
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OBJECTIVE: To determine how often the lists of regular medications derived in geriatric clinics by examination of "medication bags" and interview matched those found during in-home inspections and interviews. DESIGN: Prospective cross-sectional study. SETTING: Geriatric clinics at three university-affiliated hospitals. PARTICIPANTS: Consecutive community-dwelling outpatients 65 years or older who were newly referred. METHODS: The in-home medication inspection used a semistructured interview followed by a room-to-room search. The medications identified in the home were compared with the medication list derived in clinic by examination of the "medication bag" and interview. MAIN RESULTS: Fifty patients with a mean age of 78.9 years participated. The mean number of regular medications (prescription and nonprescription) was 6.3, and the mean number of regular prescription medications was 3.6. A comparison of clinic versus in-home medication lists revealed that 48% (95% confidence interval [95% CI], 34% to 62%) of patients had at least 1 omission of any regular medication and 19% (95%, CI 10% to 32%) of patients had at least 1 omission of a regular prescription medication. CONCLUSION: The clinic-derived medication list resulted in a complete listing of all regular medications in only 52% taking regular medications. More specific instructions to patients to bring all prescription and nonprescription medications and all vitamins, herbal, and natural remedies, and more directed questions by physicians may result in more complete clinic medication lists. (+info)
Patterns of drug consumption in relation with the pathologies of elderly Mexican subjects resident in nursing homes.
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PURPOSE: To describe the patterns of drugs consumed by the male and female elderly living in Mexican private and public nursing homes. METHODS: Three hundred and fifty elderly participants from four nursing homes (2 private and 2 public) were selected for the six month study: 108 subjects were excluded; the remaining 242 were between 65 and 100 years old; 123 were females and 119 males. A complete clinical history was taken and clinical files were reviewed. RESULTS: Of the 242 elderly studied, 193 took diverse medications and 28.5% were at risk of some type of drug interaction. The groups of drugs more frequently consumed were vitamins and anti-anemic medications, followed by cardiovascular drugs. Females consumed greater number of drugs. They also consumed more drugs simultaneously. CONCLUSIONS: There is a need to monitor the elderly for their drugs pattern use. (+info)
Making health care safer: a critical analysis of patient safety practices.
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OBJECTIVES: Patient safety has received increased attention in recent years, but mostly with a focus on the epidemiology of errors and adverse events, rather than on practices that reduce such events. This project aimed to collect and critically review the existing evidence on practices relevant to improving patient safety. SEARCH STRATEGY AND SELECTION CRITERIA: Patient safety practices were defined as those that reduce the risk of adverse events related to exposure to medical care across a range of diagnoses or conditions. Potential patient safety practices were identified based on preliminary surveys of the literature and expert consultation. This process resulted in the identification of 79 practices for review. The practices focused primarily on hospitalized patients, but some involved nursing home or ambulatory patients. Protocols specified the inclusion criteria for studies and the structure for evaluation of the evidence regarding each practice. Pertinent studies were identified using various bibliographic databases (e.g., MEDLINE, PsycINFO, ABI/INFORM, INSPEC), targeted searches of the Internet, and communication with relevant experts. DATA COLLECTION AND ANALYSIS: Included literature consisted of controlled observational studies, clinical trials and systematic reviews found in the peer-reviewed medical literature, relevant non-health care literature and "gray literature." For most practices, the project team required that the primary outcome consist of a clinical endpoint (i.e., some measure of morbidity or mortality) or a surrogate outcome with a clear connection to patient morbidity or mortality. This criterion was relaxed for some practices drawn from the non-health care literature. The evidence supporting each practice was summarized using a prospectively determined format. The project team then used a predefined consensus technique to rank the practices according to the strength of evidence presented in practice summaries. A separate ranking was developed for research priorities. MAIN RESULTS: Practices with the strongest supporting evidence are generally clinical interventions that decrease the risks associated with hospitalization, critical care, or surgery. Many patient safety practices drawn primarily from nonmedical fields (e.g., use of simulators, bar coding, computerized physician order entry, crew resource management) deserve additional research to elucidate their value in the health care environment. The following 11 practices were rated most highly in terms of strength of the evidence supporting more widespread implementation. Appropriate use of prophylaxis to prevent venous thromboembolism in patients at risk; Use of perioperative beta-blockers in appropriate patients to prevent perioperative morbidity and mortality; Use of maximum sterile barriers while placing central intravenous catheters to prevent infections; Appropriate use of antibiotic prophylaxis in surgical patients to prevent postoperative infections; Asking that patients recall and restate what they have been told during the informed consent process; Continuous aspiration of subglottic secretions (CASS) to prevent ventilator-associated pneumonia; Use of pressure relieving bedding materials to prevent pressure ulcers; Use of real-time ultrasound guidance during central line insertion to prevent complications; Patient self-management for warfarin (Coumadin) to achieve appropriate outpatient anticoagulation and prevent complications; Appropriate provision of nutrition, with a particular emphasis on early enteral nutrition in critically ill and surgical patients; and Use of antibiotic-impregnated central venous catheters to prevent catheter-related infections. CONCLUSIONS: An evidence-based approach can help identify practices that are likely to improve patient safety. Such practices target a diverse array of safety problems. Further research is needed to fill the substantial gaps in the evidentiary base, particularly with regard to the generalizability of patient safety practices heretofore tested only in limited settings and to promising practices drawn from industries outside of health care. (+info)
Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users.
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Despite a burgeoning literature on adherence to HIV therapies, few studies have examined the impact of ongoing drug use on adherence and viral suppression, and none of these have utilized electronic monitors to quantify adherence among drug users. We used 262 electronic monitors to measure adherence with all antiretrovirals in 85 HIV-infected current and former drug users, and found that active cocaine use, female gender, not receiving Social Security benefits, not being married, screening positive for depression, and the tendency to use alcohol or drugs to cope with stress were all significantly associated with poor adherence. The strongest predictor of poor adherence and, in turn, failure to maintain viral suppression, was active cocaine use. Overall adherence among active cocaine users was 27%, compared to 68% among subjects who reported no cocaine use during the 6-month study period. Consequently, 13% of active cocaine users maintained viral suppression, compared to 46% of nonusers. Interventions to improve adherence should focus on reducing cocaine use, developing adaptive coping skills, and identifying and treating depression. (+info)
Trends in antimalarial drug deployment in sub-Saharan Africa.
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Antimalarial drug resistance is forcing newly developed pharmaceuticals into widespread use at an accelerating pace. To have the greatest public health impact, new pharmaceuticals will need to be deployed effectively in sub-Saharan Africa. Achieving effective antimalarial drug deployment over the short- to medium-term will require an appreciation of how drugs are currently used in Africa and the development of innovative approaches to optimize that use. Over the long-term, fundamental changes in the way that drugs are deployed will probably be required. There are many new strategies and initiatives that, to a greater or lesser degree, will influence how drugs are used. These influences may have a positive or negative effect on reducing malaria morbidity and mortality. The concept of analyzing and monitoring programmatic effectiveness allows for a more holistic understanding of these influences and allows for more unbiased, evidence-based decision making related to drug policy and deployment. (+info)