Disease Management : Dm最新文献

Our objective was to investigate the utilization, drug, and clinical outcomes of a telephonic nursing disease management (DM) program for elderly patients with diabetes. We employed a 24-month, matched-cohort study employing propensity score matching. The setting involved Medicare + Choice recipients residing in Ohio, Kentucky, and Indiana. There were 610 intervention group members over the age of 65 matched to a control group of members over the age of 65. The DM diabetes program employed a structured, evidence-based, telephonic nursing intervention designed to provide patient education, counseling, and monitoring services. Measurements consisted of Medical service utilization, including hospitalizations, emergency department visits, physician evaluation and management visits, skilled nursing facility days, drug utilization, and selected clinical indicators. Among the results, the intervention group had considerably and significantly lower rates of acute service utilization compared to the control group, including a 17.5% reduction in hospitalizations, 22.4% reduction in bed days, 12.3% increase in physician evaluation and management visits, 23.7% increase in angiotensin-converting enzyme (ACE) inhibitor use, 13.3% increase in blood glucose regulator use, 11.8% increase in hemoglobin A1c (HbA1c) tests, 10.3% increase in lipid panels, 26.0% increase in eye exams, and 35.5% increase in microalbumin tests. In conclusion, the study demonstrates that a commercially delivered diabetes DM program significantly reduces hospitalizations and bed-days while increasing the use of ACE inhibitors and blood glucose regulators along with selected clinical procedures such as HbA1c tests, lipid panels, eye exams, and microalbumin tests.

Generic substitution of antiepileptic drugs (AEDs) may increase pharmacy utilization, thus counterbalancing per-pill savings. The purpose of our study was to analyze the economic impact of government-mandated switching from branded to generic lamotrigine. Patients in a Canadian public pharmacy claims database using branded lamotrigine (Lamictal GlaxoSmithKline, UK) in 2002 converted to generic lamotrigine in 2003 and were observed from July 2002 to March 2006. Patients used branded lamotrigine for >or=90 days pre-generic entry and had >or=1 claim for generic lamotrigine post-generic entry. For the generic period, observed per-patient monthly drug costs were calculated as the sum of costs for lamotrigine, other AEDs, and non-AEDs. Expected per-patient drug costs were estimated assuming lamotrigine dose and other prescription drug utilization in the generic period were identical to those observed during the brand period. Differences between observed and expected costs were compared. Among 1,142 branded lamotrigine users, overall average monthly drug costs per person were expected to decrease by $30.55 due to lower pill costs. Instead, they fell by $11.98 from the brand to the generic periods (p < 0.001). Because of dosage changes, lamotrigine costs decreased by $29.92 instead of the anticipated $33.87 (p < 0.001). Increased pharmacy utilization caused other AED costs to rise by $6.29 versus the expected $0.36 (p < 0.001), while non-AED drug cost increased by $11.64 rather than by $2.95 (p < 0.001). We concluded that conversion to generic lamotrigine resulted in lower than expected cost savings. Further research is necessary to determine whether this is due to reduced effectiveness and/or tolerability. Payers may weigh smaller-than-expected cost reductions against a possible decrease in effectiveness to assess the relevance of mandatory generic switching of lamotrigine.

Integration of health information is critical to the provision of effective, quality care in today's fragmented health care system. The increasing prevalence of chronic conditions and the demand for a comprehensive understanding of patient health on the part of providers are driving the need for the integration of health information through electronic health information systems. Two distinct health information systems currently utilized in the health care field include electronic medical records (EMR) and chronic disease management systems (CDMS). The integration of these systems is likely to enable the efficient management of health information and improve the quality of health care as it would provide real-time patient information in a coordinated manner. The lack of real-time information may result in delayed treatment, uninformed decisions, inefficient resource use, and medical errors. Despite their importance and widespread support, these systems have slow provider adoption rates. Our understanding of how health information technology may be used to improve health care is limited by the relative paucity of research on the adoption, integration, and implementation of these 2 types of systems. This paper documents the use of an EMR at Marshfield Clinic, a multidisciplinary group practice in the United States. We review the concomitant use of an EMR for clinical data capture and the implementation of a proprietary CDMS, InformaCare, for care management of chronic diseases. These 2 systems allow providers to deliver health care using evidence-based guidelines that meet the Institute of Medicine's aim of providing safe, efficient, patient-centered, and timely care.

Disease Management (DM) first appeared in the United States in the early 1990s. Since then its incorporation into health plans has increased dramatically, yet proof of its effectiveness in terms of quality improvement and cost reduction remains to be seen. The following review provides an exploratory analysis of the basic principles of DM, its evolution and differences from traditional managed care, the ways in which programs are currently being used in the private and public sectors, and the challenges to determining a payment structure for incorporating DM into the current health insurance system.