A comprehensive influenza campaign in a managed care setting

Group Health Cooperative, a large, membership-governed, staff model health maintenance organization (HMO), has designed a comprehensive influenza campaign for identifying, recruiting and vaccinating enrollees at increased risk for influenza-related complications. The Cooperative's Centre for Health Promotion is responsible for the overall planning, implementation and evaluation of the influenza campaign. The model for delivering influenza immunizations has been designed to build on the strengths and capabilities of a staff model HMO with sophisticated automated information systems. The model permits area medical centres (AMCs) and physicians to use the materials and intervention strategies generated by the Centre for Health Promotion, while at the same time allowing them flexibility to design and use their own intervention strategies to increase compliance. More importantly, the model reduces resource requirements on AMCs and physicians to plan and maintain internal immunization efforts. Recommendations for improving the influenza campaign are discussed.     

Pharmacists' role in a smoking-cessation program at a managed health care organization

A smoking-cessation program at a managed health care organization and the involvement of pharmacists are described. Kaiser Permanente Northwest Region is a prepaid group-practice managed health care organization serving more than 380,000 members in Oregon and southwest Washington. A multidepartmental team at Northwest Region designed and implemented a stepped-care approach to smoking cessation in March 1992. The program progresses from advising and helping patients to quit on their own to enrolling patients in a behavioral-modification course to referring them to nicotine-replacement therapy to be given concurrently with the behavioral modification. The program was established with the help of pharmacists, and pharmacists are deeply involved in its operation. They work closely with each patient, the health educator instructing the patient, and the prescribing physician. Pharmacists attend 5 of the 10 behavioral modification/nicotine-replacement course sessions and take responsibility for enrollees throughout the program. Pharmacists prescribe and monitor nicotine-replacement therapy by protocol. They also monitor each patient for the dose-response effect, adverse drug reactions, drug interactions, concurrent medical conditions, and progress and outcome. The physician is informed about any important changes in the patient's status. In 1992, more than 80 courses were held with nearly 1000 participants, and rates of long-term abstinence achieved compare favorably with literature rates for community-based group smoking-cessation programs. Satisfaction of patients, pharmacists, and physicians with the program has been high. Pharmacists at a managed health care organization participate in a smoking-cessation program by helping with behavioral modification, educating patients about nicotine-replacement therapy, and prescribing and monitoring therapy by protocol.     

Getting at the management of care within managed care

Although inhaled nitric oxide (INO) improves oxygenation in critically ill neonates, the neurodevelopmental outcome of premature neonates with severe hypoxemic respiratory failure treated with INO has not been reported. Mortality and prospective neurodevelopmental assessment in early childhood were studied in a cohort of 24 very low birth weight neonates (相似文献   

Developing and implementing a community intergenerational program

Although intergenerational programs are becoming increasingly popular, there has been little documentation linking independent yet isolated seniors with children. This article discusses the development and implementation of a community intergenerational program. Elementary school students interacted with seniors at a nearby senior citizen apartment complex during eight 2-hr after-school meetings. Various recruitment strategies were needed to reach this vulnerable senior population, and activities had to be carefully monitored to promote intergenerational exchange. Evaluation of the program showed both the value of such interaction to the students and seniors and the importance of the nurse's role in ensuring that the program's benefits were realized.     

The impact of managed care on clinical research: a preliminary investigation

Rapid growth in managed care enrollment is likely to affect clinical research at the nation's academic medical centers (AMCs). Our site visit interviews indicate that managed care has not markedly reduced coverage for research-related care. However, market competition in some areas has limited AMCs' ability to subsidize research activities with clinical revenues. As they gain market share, managed care organizations will have a growing influence on research priorities. Therefore, it is important for the academic community to work with managed care leaders to identify areas for collaboration and an agenda for moving forward in the future.     

Role of an outpatient clinic in screening chronic complications of diabetes: a model for diabetes managed care

The purpose of this study was to evaluate the need for an outpatient clinic for screening chronic complications of diabetes mellitus and to explore the major risk factors for such complications. A total of 558 patients (293 men and 265 women, aged 61.4 +/- 10.0 yr) with non-insulin-dependent diabetes mellitus were recruited. All examinations were performed in all patients except for those with previously known complications. A nonmydriatic fundus camera was used to detect retinopathy. Microalbuminuria was detected with a semiquantitative method. A monofilament, semiquantitative tuning fork and neurometer were used to detect peripheral neuropathy. The relationships of demographic and metabolic factors with diabetic complications were analyzed. Among the 558 patients, 443 (79.3%) were found to have at least one chronic complication. Less than half (41.5%) of patients had been identified as having a complication(s) before screening. The rates of undiagnosed complications ranged from 46.7% to 83.4% for each complication. The duration of diabetes, hemoglobin A1c (HbA1c), and systolic blood pressure (BP) were strongly associated with microvascular complications (p = 0.009, 0.018 and 0.037, respectively). The microvascular complication rates reached a plateau when HbA1c reached 8.0% at least among patients with a systolic BP of less than 130 mmHg. Our findings indicate that undiagnosed complications (average, 58.5%) can be found with routine screening, increasing the chances for prompt attention and early intervention. The duration of diabetes, HbA1c, and systolic BP were strongly associated with microvascular complications. Diabetes care can be improved by the implementation of a screening clinic in daily practice. Identification of the specific risk factors in a defined population in specific clinical settings will allow early modification of interventions for optimal diabetes care.     

State regulation of managed care: the impact on children

As more and more children enroll in managed care, states have responded to concerns expressed by their constituents by passing legislation and developing credentialing requirements to assist families with children in receiving appropriate care from managed care plans. Although most of the legislation and credentialing requirements apply to the population generally, a few provisions apply specifically to children. The legislation and credentialing requirements attempt to improve both access to medical care and the quality of care by enacting access-to-care and quality-of-care provisions, reducing the financial incentives for providers to offer inappropriate care, and providing families with more information about their choices and opportunities to redress their grievances. Although there is no empirical evidence, analysis of similar types of legislation suggests that certain approaches will be more successful than others; one obvious indicator of success is the ability of the regulatory agency to develop clear, unambiguous, enforceable rules. Existing legislation varies widely across states in terms of the issues addressed and the specificity of the laws. For the most part, this legislation has been piecemeal, addressing specific issues as they arise. In the long run, state legislatures may not have the time or the expertise to regulate the managed care industry, and other regulatory bodies may be better equipped to address concerns about managed care. If utilized, however, existing regulatory bodies, which historically monitored fee-for-service medicine, will need to be redesigned to monitor managed care.     

Tennessee's failed managed care program for mental health and substance abuse services

In July 1996, Tennessee initiated a managed mental health and substance abuse program called TennCare Partners. This publicly funded "carve-out" experiment started chaotically and soon deteriorated into a crisis. Many patients did not receive care or lost continuity of care, and the traditional "safety net" mental health system nearly disintegrated. This qualitative case study sought to ascertain the impact of the TennCare Partners program. It points out that the program's difficulties stemmed directly from a flawed design that spread funds previously earmarked for severely mentally ill patients across the entire Medicaid population. States contemplating similar reforms should strive to protect vulnerable patients by risk-adjusting capitation payments and by focusing resources on care for severely mentally ill persons. States should also minimize program complexity and ensure the accountability of managed care networks for their patients' behavioral health care needs.     

AIDS, hemophilia, and prevention efforts within a comprehensive care program.

Approximately 92% of persons with severe hemophilia A in the United States have been exposed to the human immunodeficiency virus (HIV), the cause of acquired immune deficiency syndrome (AIDS), from contaminated blood products. This article describes HIV prevention efforts initiated by the federally funded comprehensive hemophilia program. Comprehensive care centers are useful for the delivery and evaluation of educational and preventative efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost-effectiveness of case management: experiences of a university managed health care organization

Primary seborrhoea was diagnosed in 14 English springer spaniels over a 17-year period. Seven of the dogs developed clinical signs by two years of age. The dermatosis began as a generalised non-pruritic dry scaling which gradually worsened. Some dogs remained in this dry (seborrhoea sicca) stage, but in most cases the dermatosis became greasy and inflamed (seborrhoea oleosa and seborrhoeic dermatitis). Eight of the dogs suffered from recurrent episodes of superficial or deep bacterial pyoderma. Histological findings in skin biopsy specimens included marked orthokeratotic hyperkeratosis of surface and infundibular epithelium, papillomatosis, parakeratotic capping of the papillae, and superficial perivascular dermatitis in which lymphocytes and mast cells were prominent. The dogs with seborrhoea sicca responded more satisfactorily to therapy with topical emollient-humectant agents or oral omega-3/omega-6 fatty acid supplementation. Dogs with seborrhoea oleosa and seborrhoeic dermatitis did not respond satisfactorily to topical therapy. One dog, however, responded well to etretinate and omega-3/omega-6 fatty acid administration. No dog was cured.     

Evaluation of a pharmaceutical care model on diabetes management

PURPOSE: To determine the value of spiral CT during arterial portography (SCTAP) in detecting and localising focal liver lesions we compared the SCTAP findings to those gained by conventional CT during arterial portography (CTAP). MATERIAL AND METHODS: We evaluated a total of CT scans of 128 patients with 162 malignant lesions of the liver. 45 patients underwent SCTAP and 83 patients CTAP. Results of radiological studies were compared with surgical and pathological findings. RESULTS: The overall sensitivity of SCTAP was 93% with a sensitivity of 80% for lesions of less than 1 cm diameter. For CTAP the overall sensitivity was 88%, but the sensitivity for lesions smaller than 1 cm was only 53%. Although with SCTAP examination of hepatic vasculature and liver parenchyma was continuous, we found no advantage in the localisation of lesions to the liver segments compared to CTAP, and the sensitivity of localisation did not correlate with the size of lesions. CONCLUSION: In our study SCTAP turned out to be a reliable radiological method in the preoperative detection of focal liver lesions, with a high overall sensitivity. SCTAP showed improved sensitivity in the detection of small malignant lesions (< 1 cm) in comparison to CTAP.     

Ethical responsibilities in a managed care system

Managed care is becoming increasingly important in health care. A number of ethical questions arise in this system. This paper examines the ethical responsibilities of four players in a managed care system: i) the insurance company; ii) the patient; iii) the primary care provider; and iv) the specialist.