Search

Objective: Estimate health care resource utilization and costs associated with medication overuse headache and potential acute medication overuse. Methods: A retrospective analysis was conducted with Clinformatics Data Mart data (1 January 2019–31 December 2019) that included continuously enrolled commercially insured adults with migraine (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] code G43.xxx). Medication overuse headache was defined as ≥1 inpatient or ≥2 outpatient claims with an ICD-10-CM code G44.41/40 (drug-induced headache). Potential acute medication overuse was defined as possessing sufficient medication for >10 mean treatment days/month for ergots, triptans, opioids, or combination analgesics or >15 mean cumulative days/month for simple prescription analgesics (e.g., acetaminophen, aspirin, other non-opioid analgesics) for >6 consecutive months. All-cause and migraine-related health care resource utilization and costs were compared after adjusting for demographic and clinical characteristics. Results: Among 90,017 individuals with migraine, the frequency of medication overuse headache/potential acute medication overuse was 12.6% (diagnosed medication overuse headache: 0.6%; potential acute medication overuse: 12.1%). Adjusted all-cause total costs ($31,235 vs $21,486; difference: $9,749 [ P < 0.001]) and adjusted migraine-related total costs ($9,770 vs $6,207; difference: $3,563 [ P < 0.001]) were higher in the medication overuse headache/potential acute medication overuse group versus those without medication overuse headache/potential acute medication overuse. Conclusions: Individuals with diagnosed medication overuse headache/potential acute medication overuse had higher all-cause and migraine-related health care resource utilization and costs versus individuals without medication overuse headache/potential acute medication overuse, suggesting that improved migraine management is needed to reduce associated costs. [ABSTRACT FROM AUTHOR]

Health care delivery often focuses on treatments over provider and payment attributes, which also impact care delivery. This study describes the procedures, allowed charges, submitted charges, and payments for orthopaedic providers that accept Medicare Part B in the US. Additionally, the study investigated regional and gender differences in charges and payments. We used the national Medicare Part B Provider Utilization and Payment data released from the CMS in April 2014. Analyses were conducted on US providers that identified as orthopaedic surgeons. There was a major gender disparity in orthopaedic providers and charges. Average allowed charges, submitted charges, and payments were generally the same across all regions except for region 6. Extreme differences between allowed charges and submitted charges were evident. The most frequent procedures across all regions were x-ray exams and raises questions about overutilization of diagnostic imaging in orthopaedics. [ABSTRACT FROM AUTHOR]

This study aimed to develop and implement an intervention, delivered via a website and Web app, to increase the uptake of sexual health services by young people. The intervention was co-designed with a group of 10 young people. Intervention mapping was used to guide development. To identify barriers and facilitators of access to sexual health services, three focus groups with 24 young people aged 13 to 19 years, and interviews with 12 professionals recruited from across a range of health and social services, were conducted. Data were analyzed using content analysis. Evidence was supplemented through a literature review. Barriers and facilitators were categorized as theoretical determinants and then suitable behavior change techniques (BCTs) for targeting them were selected. Targeted determinants were attitude, subjective norm, perceived behavioral control, and knowledge. Selected BCTs included “information about others’ approval,” “framing/reframing,” and “credible source.” The website/app enable users to search for services, access key information about them, watch videos about what to expect, and have key concerns removed/addressed. This is the first known digital evidence-based intervention to target this behavior described in the literature. A clear and full description of intervention development and content, including of theorized causal pathways, is provided to aid interpretation of future outcome evaluations. [ABSTRACT FROM AUTHOR]

Objectives: The Mental Health Act 2007 (NSW) ( MHA) was recently reformed in light of the recovery movement and the United Nations Convention on the Rights of Persons with Disabilities. We analyse the changes and describe the impact that these reforms should have upon clinical practice.Conclusions: The principles of care and treatment added to the MHA place a strong onus on clinicians to monitor patients' decision-making capacity, institute a supported decision-making model and obtain consent to any treatment proposed. Patients competently refusing treatment should only be subject to involuntary treatment in extraordinary circumstances. Even when patients incompetently refuse treatment, clinicians must make every effort reasonably practicable to tailor management plans to take account of any views and preferences expressed by them or made known via friends, family or advance statements. [ABSTRACT FROM AUTHOR]

Background: Headache is a common condition, and a common complaint leading patients to emergency departments (ED). There have been a number of studies of the effect of environmental factors on headache, such as weather and air pollutants.Methods: This retrospective cohort study included data on daily ED visits with a chief complaint of headache in Soroka University Medical Center (SUMC) during 2002-2012. Data on weather and air pollutants were obtained from monitor station in Be'er-Sheva. To estimate the short-term effects of air pollution and temperature on number of daily headache ED visits, we applied generalized linear mixed models (GLMM).Results: A total of 22,021 ED visits were included in the analysis. An increase in 5℃ in temperature was associated with an increase in ED visits, relative risk (RR) = 1.042, (95% CI 1.009; 1.076). RR for headache was associated with an increase in 10 units of nitrogen dioxide (NO2), RR = 1.110 (95% CI 1.057; 1.167), with a higher effect for older patients.Discussion: The current findings give evidence of an association between air pollution, weather and ED visits for headache, especially for NO2. Short-term increases in air pollution exposure may trigger headache by increasing pulmonary and systemic inflammation, increasing blood coagulability or altering endothelial function. [ABSTRACT FROM AUTHOR]

It is well known that the differences-in-differences (DD) estimator is based on the assumption that in the absence of treatment, the average outcomes for the treated group and the control group will follow a common trend over time. That can be problematic, especially when the selection for the treatment is influenced by the individual’s unobserved behavior correlating with the medical utilization. The aim of this study was to develop an index for controlling a patient’s unobserved heterogeneous response to reform, in order to improve the comparability of treatment assignment. This study showed that a DD estimator of the reform effects can be decomposed into effects induced by moral hazard and by changes in health risk within the same treated/untreated group. This article also presented evidence that the constructed index of the price elasticity of the adjusted clinical group has good statistical properties for identifying the impact of reform. [ABSTRACT FROM AUTHOR]

Objective. We identified factors associated with retention in oral health care for people living with HIV/AIDS (PLWHA) and the impact of care retention on oral health-related outcomes. Methods. We collected interview, laboratory value, clinic visit, and service utilization data from 1,237 HIV-positive patients entering dental care from May 2007 to August 2009, with at least an 18-month observation period. Retention in care was defined as two or more dental visits at least 12 months apart. We conducted multivariate regression using generalized estimating equations to explore factors associated with retention in care. Results. In multivariate analysis, patients who received oral health education were 5.91 times as likely (95% confidence interval 3.73, 9.39) as those who did not receive this education to be retained in oral health care. Other factors associated with care retention included older age, taking antiretroviral medications, better physical health status, and having had a dental visit in the past two years. Patients retained in care were more likely to complete their treatment plans and attend a recall visit. Those retained in care experienced fewer oral health symptoms and less pain, and better overall health of teeth and gums. Conclusions. Retention in oral health care was associated with positive oral health outcomes for this sample of PLWHA. The strongest predictor of retention was the receipt of oral health education, suggesting that training in oral health education is an important factor when considering competencies for new dental professionals, and that patient education is central to the development of dental homes, which are designed to engage and retain people in oral health care over the long term. [ABSTRACT FROM AUTHOR]

The article reports a study which was conducted to examine the usefulness of geographic information systems (GIS) in aiding the Jefferson County Department of Health (JCDH) for administrative decision making at the local public health level. The results revealed that GIS provided valuable information to JCDH that helped in facilitating primary care center management and organizational change. This indicates that GIS has the potential to serve as a valuable tool for decision making.

This study investigates conventional medicine utilization by wellness-motivated, complementary and alternative medicine (CAM) consumers. While CAM consumers are typically characterized as high health care utilizers, negative correlations have been found between CAM-based wellness programs and the consumption of conventional medical care. We use a nationally representative sample to analyze both illness- and wellness-motivated CAM users, with an interest in whether CAM therapies used for wellness replace conventional medicine, thus potentially offering cost offsets. Results indicate that motivation for CAM use is neither associated with a lower probability nor a lower rate of conventional medicine utilization. Increasingly, individuals, workplaces, and governments incorporate wellness programs involving CAM modalities into health care and policy; as the conventional and unconventional medical spheres begin to integrate and influence one another, understanding our pluralistic medical environment and its consumers will better enable policy makers to balance health and wellness initiatives with economic imperatives. [ABSTRACT FROM PUBLISHER]

Indexes of prenatal care adequacy distinguish care that includes more than the recommended number of visits because extra visits may signal a high-risk pregnancy. Using Natality files from 1985 to 2004, the authors found such "superadequate" care increased from 19.5% of pregnancies in 1985 to 30.0% in 2004. Although there were dramatic changes in the demographics of childbearing over the same 20 years, those changes do not explain the increase in extra prenatal visits: Superadequate care increased within every stratum defined by maternal birthplace, race, age, education, gravidity, marital status, and multiple birth. Had the demographics of childbearing not changed since 1985, the superadequate rate would be just as high in 2004. Although randomized controlled trials have found that reduced visit schedules for low-risk women do not lead to worse maternal or perinatal outcomes, the cost-effectiveness of more intense visit schedules is not known. [ABSTRACT FROM AUTHOR]

Since the late 1990s, the use of advanced diagnostic imaging modalities has increased by double-digit rates, outpacing the rate of increase of medical spending overall. In an attempt to assure the appropriate use of advanced imaging procedures, private insurers are increasingly contracting with radiology benefit management programs (RBMs) to reduce overall use and expenditures for radiology services. This article describes the services offered by RBMs and then presents trends in utilization of advanced imaging procedures from three health plans that adopted RBM prior authorization protocols. The implementation of prior authorization protocols by each plan was associated with declines in use of advanced imaging procedures, especially during the first year of the program. Although more rigorous empirical analysis is required in order to draw definitive conclusions, these trends suggest that RBM prior authorization initiatives may be a viable approach for addressing concerns about appropriate use of advanced imaging. [ABSTRACT FROM AUTHOR]

Objective: To document the prevalence of psychiatric disorders in Quebec's older adult population.Method: Data came from the Enquête sur la santé des aînés study conducted in 2005--2006 using a representative sample (n = 2798) of community-dwelling older adults.Results: Our results indicate that 12.7% of the respondents met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for depression, mania, anxiety disorders, or benzodiazepine dependency. The 12-month prevalence rate of major depression was 1.1% and the prevalence of minor depression 5.7%. A total of 5.6% of the respondents reported an anxiety disorder. The most prevalent anxiety disorders were specific phobia (2.0%), obsessive-compulsive disorder (OCD) (1.5%), and generalized anxiety disorder (GAD) (1.2%). Agoraphobia without panic disorder and panic disorder were reported by 0.3% and 0.6% of the respondents, respectively. The prevalence rate of benzodiazepine dependency was 2.3%. The 12-month comorbidity prevalence rate between any psychiatric disorders was 2.2%. Among those with depressive disorder, the most frequent comorbidity was observed between minor depression and specific phobia (4.3%), GAD (4.3%), OCD (3.7%), and mania (1.3%). Further, only 39% of those having at least one active DSM-IV diagnosis reported having used health services for their psychological distress symptoms during the previous 12 months. Among those who consulted health services, 85% visited a general practitioner.Conclusions: Our results indicate that a large proportion of the elderly population in Quebec presents mental health needs. Longitudinal research focusing on the individual and social consequences of mental health problems reported by older adults is needed to avoid misinterpretation of this finding. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare the validity and reliability of 2 sampling methods for measuring immunization rates to a reference standard in a national sample of pediatric office practices. The consecutive method involved patients seen consecutively in the office for any reason; the random record was a random selection of medical records; and the reference standard active method, data of a randomly selected subgroup of children in the random record survey were supplemented with information from a telephone interview. The consecutive method of assessing immunization rates results in rates that are, on average, higher and closer to the reference standard, but also more variable. The random record method rates are lower and further from the study reference standard compared with the consecutive method, but more precise. The consecutive method for measuring practice immunization rates could be a useful quality improvement tool as practices seek to improve immunization delivery and quality of care. It is inexpensive, simple, and easy to implement. [ABSTRACT FROM AUTHOR]

Primary liposarcoma of the liver is extremely rare. We report here on a case of primary well-differentiated liposarcoma in the left hepatic lobe of a 63-year-old woman. Abdominal ultrasonography showed a well-defined, echogenic, round mass. Abdominal computed tomography (CT) and magnetic resonance (MR) images showed an almost fatty, lobulated mass with a few, random distributed vascular structures and a small area of nodular enhancement. The resected tumor appeared as a well-defined, round, tan-yellow mass. Histological analysis showed a well-differentiated liposarcoma. [ABSTRACT FROM AUTHOR]

This paper presents an evidence-based update about clinical audit for ultrasound practitioners. Clinical audit is defined as a dynamic quality-assurance tool that is used to sample the performance in a department for comparison against the desired standard. The identification and explicit definition of a relevant evidence-based target standard at the start facilitates the evaluation of the department's performance. There are many challenges to introducing change to the usual clinical practice of a department, if it is required. One of the most important barriers to introducing change is disproportionate workload. The traditional view that feedback after clinical audit is effective in changing practice is questioned. The role of clinical audit is re-defined as one of checking standards against the agreed norms for a profession. Changing clinical practice will require multifaceted strategies that should not rely on feedback after clinical audit. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of mental illness in older adults and its effect on home care and personal care home (PCH) use.Methods: Using nonidentifying administrative records (fiscal years 1997-1998 to 2001-2002) from the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy, we determined the 5-year period prevalence for individuals aged 55 years and over (119 539 men and 145 752 women) for 3 mental illness categories: cumulative mental disorders (those having a diagnosis of depression, anxiety disorder, personality disorder, schizophrenia, and [or] substance abuse), any mental illness, and dementia. We calculated age-specific and age-adjusted rates of home care and PCH use and the prevalence of mental illness in PCH residents.Results: From the group aged 55 to 59 years to the group aged 90 years or older, the prevalence of mental illness increased with the population's age. The prevalence of any mental illness rose from 32.4% to 45.0% in men and from 42.6% to 51.9% in women, and dementia prevalence rose from 2.0% to 33.6% in men and from 1.3% to 40.3% in women. The age-adjusted annual rates of open home care cases per 1000 population aged 55 and older varied by mental illness grouping (no mental disorder, 57 for men and 91 for women; cumulative mental disorders, 162 for men and 191 for women; dementia, 300 for men and 338 for women). The age-adjusted rates of PCH use per 1000 population aged 75 years and older also varied by mental illness grouping (no mental disorder, 53 for men and 78 for women; cumulative mental disorders, 305 for men and 373 for women; dementia, 542 for men and 669 for women). Among patients admitted to (or resident in) a PCH in 2002-2003, 74.6% (87.1%) had a mental illness, and 46.0% (69.0%) had dementia.Conclusions: Mental illness affects the use of home care and nursing homes profoundly. Individuals with dementia used home care at 3 times the rate of those having no mental illness diagnosis, and they used PCHs at 8 times the rate. [ABSTRACT FROM AUTHOR]

In the absence of a biological marker and expert consensus on the best approach to classify chronic migraine (CM), recent revised criteria for this disease has been proposed by the Headache Classification Committee of the International Headache Society. This revised criteria for CM is now presented in the Appendix. Herein we field test the revised criteria for CM. We included individuals with transformed migraine with or without medication overuse (TM+ and TM–), according to the criteria proposed by Silberstein and Lipton, since this criterion has been largely used before the Second Edition of the International Classification of the Headache Disorders (ICHD-2). We assessed the proportion of subjects that fulfilled ICHD-2 criteria for CM or probable chronic migraine with probable medication overuse (CM+), as well as the revised ICHD-2 (ICHD-2R) criteria for CM (≥15 days of headache, ≥8 days of migraine or migraine-specific acute medication use—ergotamine or triptans). We also tested the ICHD-2R vs. three proposals. In proposal 1, CM/CM+ would require at least 15 days of migraine or probable migraine per month. Proposal 2 required ≥15 days of headache per month and at least 50% of these days were migraine or probable migraine. Proposal 3 required ≥15 days of headache and at least 8 days of migraine or probable migraine per month. Of the 158 patients with TM–, just 5.6% met ICHD-2 criteria for CM. According to the ICHD-2R, a total of 92.4% met criteria for CM ( P < 0.001 vs. ICHD-2). The ICHD-2R criterion performed better than proposal 1 (47.8% of agreement, P < 0.01) and was not statistically different from proposals 2 (87.9%) and 3 (94.9%). Subjects with TM+ should be classified as medication overuse headache (MOH), and not CM+, according to the ICHD-2R. Nonetheless, we assessed the proportion of them who had ≥8 days of migraine per month. Of the 399 individuals with TM+, just 10.2% could be classified as CM+ in the ICHD-2. However, most (349, 86.9%) had ≥8 days of migraine per month and could be classified as MOH and probable CM in the ICHD-2R ( P < 0.001 vs. ICHD-2). We conclude that the ICHD-2R addresses most of the criticism towards the ICHD-2 and should be adopted in clinical practice and research. In the population where use of specific acute migraine medications is less common, the agreement between ICHD-2R CM and TM may be less robust. [ABSTRACT FROM AUTHOR]

This report presents information on the state of the U.S. health system in the spring of 2006. It includes data on the uninsured and underinsured and their access to health care, on socioeconomic inequality in health care, and on the rising costs of the U.S. health system. It also presents information on the role of corporate money in health care, focusing on the pharmaceutical industry, Medicare HMOs, and corporate-government conflicts of interest. The author includes a survey of recent public opinion polls on health care and health system reform and an update on the U.S. national health insurance legislation. The article ends by reviewing recent data on international health systems and international system comparisons. [ABSTRACT FROM AUTHOR]

The call for practice improvement in substance abuse treatment is motivated by the ultimate goal of achieving consistently positive post-treatment outcomes. A central hypothesis of the empirical investigation in this study is that consumer-level outcomes are affected either directly or indirectly through clinical practice, by factors originating at the policy and organizational level. Four broad categories of policy and, program administration (funding, service technology and delivery, organizational structure, and leadership) that facilitate or hinder the implementation of practice improvements are investigated. Models hypothesizing that the effects of policy and program administration will vary according to the treatment goals and corresponding measurement of outcomes are tested. Using newly available data that link program- and consumer-level measures, the empirical analysis shows statistically significant direct effects of program and policy factors on outcomes as well as effects of these variables on treatment practices that have significant implications for treatment outcomes. [ABSTRACT FROM AUTHOR]

The research-to-practice gap in substance abuse treatment, particularly with regard to pharmacological innovations, necessitates the consideration of organizational characteristics that facilitate the adoption of innovations. Using data from a nationally representative sample of 394 privately funded substance abuse treatment centers, this study examines variation in the adoption of disulfiram in terms of organizational structure, workforce professionalism, and treatment philosophy. Logistic regression results indicated that hospital-based centers were significantly more likely to use disulfiram than freestanding treatment programs. In addition, the percentage of counselors with master's degrees and the percentage of certified/licensed counselors were positively associated with the likelihood of disulfiram utilization. Treatment centers that emphasized confrontational group therapy and spirituality were less likely to use disulfiram, while the adoption of disulfiram was more likely in centers that emphasized a medical model of addiction. [ABSTRACT FROM AUTHOR]

Objective: To examine the rate and characteristics of seclusion among a group of patients admitted to an adult acute psychiatric unit as a precursor to planning an audit cycle and quality improvement project.Methods: A retrospective chart review of all inpatient admissions to an adult acute unit over a 12 month period was undertaken with the use of a specially developed proforma. A comparison of secluded and non-secluded patients was described, and, where possible, statistically analysed.Results: Four hundred and fifty admissions occurred during the study period, resulting in 140 episodes of seclusion. This represented a seclusion rate of 31% per admission. In contrast to patients who were not secluded, those secluded were more likely to be young, admitted involuntarily and with a diagnosis of schizophrenia. The most common indicator of seclusion was risk to others (74%) followed by risk to self (61%) and risk of absconding (55%). Length of time in seclusion ranged from 1 to 49 h with a mean of 9 h. Thirty-nine per cent of secluded patients were secluded on two or more occasions. Interventions including counselling, time out and medication were used in 71% prior to seclusion; however, in 29% no intervention was documented. Seclusion was more likely to occur in the evenings, when staff/patient ratios were lower.Conclusion: Seclusion remains an important part of psychiatric practice. As expected, the use of seclusion in an adult acute unit reflected indirect measures of illness severity. Its use needs to be carefully reviewed and monitored, representing as it does the greatest restriction on a person's freedom. [ABSTRACT FROM AUTHOR]

Background: Scarce attention has been paid to establishing benchmarks for tertiary care for adults with severe mental disorders. Yet, the availability and efficient utilization of residential resources partly determines the capacity of a comprehensive system of care to avoid clogging ever-shrinking acute care bed facilities.Objectives: To describe the actual utilization of and projected needs for residential resources, one part of tertiary care, in the catchment area of a psychiatric hospital in east-end Montreal. To compare results obtained against actual utilization and projected needs evaluated in other Canadian provinces and in other countries, with a view to establishing national benchmarks.Methods: Two surveys were undertaken to establish the number of places in these facilities that were utilized and needed for adults aged 18 to 65 years with severe mental disorders, without a primary diagnosis of mental retardation or organic brain syndrome, and originally from the catchment area. A first survey ascertained the number of places utilized and of those needed for residential care among all long-stay inpatients and all adults in supervised residential facilities. A second survey identified the need for such long-stay hospitalization, nursing homes, and supervised facilities as an alternative or as a complement to hospitalization among acute care inpatients.Results: The actual ratio of places in long-stay hospital units, nursing homes, and supervised residential facilities was 150:100,000 inhabitants. The ideal ratio, according to estimated needs, is 171:100,000. The figure breakdown is as follows: 20:100,000 for long-stay hospital units, 20:100,000 for nursing homes, 40:100,000 for group homes, 40:100,000 for private hostels or foster families, and 51:100,000 for supervised apartments. The needs of this urban, blue-collar population for supervised residential places hovered in the upper range of utilization and standards for European countries and within the proposed standards for Canadian provinces.Discussion: Needs for long-stay hospitalization or for supervised residential facilities cannot be treated as absolute. For example, evaluation conducted in this hospital-led system of psychiatric care may produce higher estimates of institutional care. Comparing actual utilization and projected needs in this urban catchment area with current utilization in other jurisdictions in Canada and Europe should contribute to establishing sound national benchmarks within ranges.Conclusions: It is possible to establish benchmarks that guide the development of supervised residential settings to best meet the needs of the population of adults with severe and persistent mental disorders. The methods used here to assess needs should serve as guidelines for future research, because they were designed to contain the bias of over- or underprovision of care in the current utilization. [ABSTRACT FROM AUTHOR]

Objective: This study examined the relationship between language acculturation of disabled Puerto Rican elderly and their caregivers, their length of residence in mainland United States, and the utilization of formal services. Methods: Language acculturation was measured by language use, understanding, and preferences. The sample of this study consisted of 194 dyads of disabled Puerto Rican elders 60 years and older, and their primary caregivers in an urban center in the northeast. Results: Length of residence in the United States, but not language acculturation, of the disabled Puerto Rican elder and the caregiver was related to elder 's use of formal services. Caregivers, whose own children were born in Puerto Rico as opposed to mainland United States, were more likely to use formal services. Discussion: Language acculturation, although a commonly used measure of acculturation, may be of decreasing importance in explaining service utilization, as bilingual services become increasingly available. Practice implications are discussed. [ABSTRACT FROM AUTHOR]

Videoconferencing was introduced in the Queensland health service in 1995. By the end of 1999, there were more than 150 videoconferencing units in health facilities around the state. Six audits of videoconferencing usage were conducted using similar methodology at six-month intervals from November 1997 to May 2000. Between November 1997 and November 1999, the number of calls more than doubled, from 566 to 1378. Hours of usage almost trebled, from 671 to 1724. The average duration of calls remained similar, at about 1 h 12 min. The proportion of calls involving more than two sites (multipoint videoconferences) increased from 44% to 65%. The majority of the activity was for education (including training). Videoconferencing was also used for administration and clinical care. Mental health staff were the heaviest users, but use by health professionals from other specialty areas increased during the study period. The Queensland health service has realized a number of important benefits from telehealth. [ABSTRACT FROM AUTHOR]

Palliative care services have developed rapidly over the past 30 years, with little evaluation as to how needs have been met by these new services. As part of a systematic review of palliative care, evidence of the needs of patients and carers has been evaluated from the current literature. Of the total of 673 articles related to the 10 areas within the main review, 64 provided evidence on the need for palliative care services over the period from 1978 to 1997. A further nine articles were added in November 1998 after the end of the study to update the review with more recent research. Need can be assessed in one of two ways: either by adopting an epidemiological approach or by examining health service usage. In the former, evidence is provided on disease-specific mortality, and related to the duration of symptoms prior to the patient's death. As an example of this, it is suggested that services may need to provide pain control for 2800 patients per million (p/M) population dying from cancer each year and 3400 p/M with noncancer terminal illness. Using health service usage as an indicator of need, 700-1800 p/M with cancer and 350-1400 p/M with noncancer terminal illness would require a support team or specialist palliative home care nurse, with 400-700 cancer p/M and 200-700 noncancer p/M requiring inpatient terminal care. Studies indicate that at present usage, palliative care is being provided by 40-50 hospice beds/M. Despite this provision, there remains evidence that in certain areas of care such as pain control, there still remains a high degree of unmet need. [ABSTRACT FROM AUTHOR]

Describes the demographic characteristics of persons receiving eye-care from ophthalmologists and other physicians and patterns of use of eye care services and physician contact among different population groups. Use of the 1990 National Ambulatory Medical Care Survey data; Study methods and results; Information on diagnostic codes.

Presents an examination of utilization review services and tips on what to look for from a good utilization review provider of a managed care program. Information about Pre-admission certification and continued stay review; The second surgical opinion program; Discharge planning services; Medical case management; Aim of outpatient procedure review; Goal of the health maintenance organization/preferred provider organizations (HMO/PPO); More.

The new system for hospital reimbursement, called "reimbursement by diagnosis-related group" (DRG), offers a unique opportunity for the development of novel approaches to quality assurance. Groups of medically similar patients with stable patterns of resource use have been defined. These groups form the basis of the new payment system. Patients whose care deviates from the norm of resource consumption for their group, so-called outliers, will need to be reviewed by the hospital's administrative and medical staff. Such outliers are likely to constitute different types of patients than those in their assigned group: (1) patients whose medical complexity precludes grouping because of limitations in the abstracted clinical data; (2) patients whose medical care deviated because of complications of therapy or inappropriate diagnostic and/or therapeutic interventions; (3) patients whose medical course is so unique that they would never fit any classification system. The DRG-based reimbursement system, then, will compel hospitals to review the care of these outliers. The rigorous examination of these patients and their care, although just a first step, should be a major boon to quality of care evaluations. [ABSTRACT FROM AUTHOR]

Evaluations of medical information systems (MIS) often compare one or more dependent variables between experimental patients having the MIS available and control patients. Typically, physicians who are exposed to and therefore are potentially influenced by the MIS during visits with experimental patients also see control patients, thus possibly weakening the internal validity of subsequent comparisons between the MIS and the control conditions. The present study examines the possible bias due to carry-over of MIS influence to control patients in the context of a prospective, randomized design. [ABSTRACT FROM PUBLISHER]

The author reflects on the engagement of stakeholder and community in public health to support the European Antibiotic Awareness Day (EAAD). The author cites the important role of guardianship in protecting or conserving the repertoire of antibiotics available for treating life-threatening infections. The author highlights several pledges of the Antibiotic Guardianship including to prevent infections, to share personal knowledge to colleagues and to drive effective action to prevent infection.

Rural Yoruba and Fulani residents of two local governments in Oyo State, Nigeria, were surveyed to determine differences in health-seeking behaviour. Fulani residents weremore likely to use private facilities during a recent illness,while Yoruba residents more commonly used government facilities: a fact reflected in the overall attitudes of those surveyed. The need for greater outreach and involvement of minority populations is recommended to enhance public service utilization. [ABSTRACT FROM AUTHOR]

The author reflects on the feasibility of home telehealth system in terms of the quality and cost effectiveness from the available evidence. The difficulty in assessing the contribution of the telehealth system to the total medical care is discussed. The author mentions that less data and improper funding are insufficient evidence. The author suggests a stronger assessment process with clear presentation of data and longterm evaluation for the success of telehealth system survey.

This study was designed to evaluate the pattern of malignant diseases seen at the University of Benin Teaching Hospital over a 20-year period (January 1980–December 1999). A total of 2258 histologically confirmed malignant diseases were seen with the predominant tumours comprising carcinoma of the cervix (20.59%), breast (18.25%), prostate (7.13%), endometrium (6.47%) and colon and rectum (5.71%). We believe that the figure reported here represents an underestimate of the frequency of malignant tumours seen in the hospital and recommend the establishment of hospital- and population-based cancer registries to ensure proper documentation of malignant diseases within the region. [ABSTRACT FROM AUTHOR]