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Biomedical subjects

J Rehm

Publications and source records attributed to J Rehm.

100 records · Page 6Linked to original sources
PubMed1985

Cost containment (DRGs): a new source for litigation?

The DRG prospective payment program has been instituted primarily to contain health care costs. These cost controls will affect how medicine is currently practiced. Cost efficiency does not necessarily equal medical safety. Premature discharge and manipulation of diagnoses to improve hospital reimbursement may occur. Such practices could lead to increased physician professional liability, varying standards of care, and hospital negligence liability.

Cost Control↗
PubMedDate not supplied

[Pilot study on prescription of benzodiazepines in Switzerland: does cognitive availability of legal rules affect medical prescribing behavior].

All 481 prescriptions of benzodiazepines from five Zurich pharmacies during a 6 week period were evaluated with respect to their compliance with the Swiss Law on Narcotics, which was formulated to prevent benzodiazepine dependence. Three weeks into the study, all 17 physicians with prescriptions of benzodiazepines practising in the catchment areas of two of the five pharmacies randomly selected were faxed an information sheet explaining formal juridical requirements for benzodiazepine prescription stipulated by the law. 28 % of all prescriptions were not compliant with the law. The older a patient, the greater his/her risk of receiving a non-compliant prescription. Neither sex of patients nor professional specialization of the prescribing doctor did impact prescription compliance. The preventive intervention, i. e. information on legal requirements, also had no significant impact on the compliance of prescriptions with the law. As other studies with soft interventions and educational measures directed to the prescribing physician also failed to reduce inappropriate prescription of benzodiazepines, it is concluded that sanctions against incompliant prescription behaviour should be considered as a preventive alternative.

Awareness↗
PubMedDate not supplied

Predictors of health risk behaviours among young adults: analysis of the National Population Health Survey.

This paper examines the individual and social determinants of physical inactivity, daily smoking, heavy drinking, and overall risk behaviour among 1,395 Canadians aged 20-24 in the 1994 National Population Health Survey. Logistic regression was used to estimate models of risk behaviour using the following variables: sex, mastery, self-esteem, sense of coherence, chronic stress, psychological distress, social support, income adequacy, education, and main activity (working, looking for work, attending school, other). Results of the analysis indicate that the most consistent predictors were chronic stress and main activity. Thus, social context appears to be an important influence on risk-related behaviour, and should be taken into account in approaches designed to promote health behaviours.

Adolescent↗
PubMedDate not supplied

Low-risk drinking guidelines: the scientific evidence.

In 1997 the Addiction Research Foundation of Ontario and Canadian Centre on Substance Abuse released updated guidelines for low-risk alcohol consumption. This paper presents the scientific rationale behind this statement. Important comprehensive overviews on the consequences of alcohol use were studied. Formal meta-analyses on morbidity and mortality were examined wherever possible. Individual elements from similar guidelines were investigated for their scientific foundation. Limited original analyses defined risk levels by average weekly consumption. The evidence reviewed demonstrated that placing limits on both daily intake and cumulative intake over the typical week is justifiable for the prevention of important causes of morbidity and mortality. Gender-specific limits on weekly consumption were also indicated. In these updated guidelines intended for primary prevention, days of abstinence are not necessarily recommended. Intoxication should be avoided and abstinence is sometimes advisable. Available evidence does not strongly favour one alcoholic beverage over another for cardiovascular health benefits.

Adult↗
PubMedDate not supplied

Comparing opiate users in methadone treatment with untreated opiate users: results of a follow-up study with a Toronto opiate user cohort.

Untreated opiate use is correlated with major social harms and costs in Canada. While methadone treatment has existed in Canada since the 1960s, there is little specific Canadian research on its effects. This paper reports on the one-year follow-up results of a Toronto cohort study of opiate users (N = 114) who were not in treatment at baseline. Sixty-nine people were recruited for re-interviewing. A number of these individuals (N = 29) had entered methadone treatment during the year between baseline and follow-up interviews. Comparisons with respect to social functioning, health status and health care utilization, drug use and related risks, and criminal justice system involvement were made between the follow-up subsample who remained untreated, and the subjects who entered methadone treatment. Differences were found with respect to illegal income generation, illicit opiate and other drug use, illicit drug market activities and emergency care and aspects of socio-economic integration, but no major effects on health and criminal justice status could be shown. Research and policy implications are discussed.

Crime↗
PubMedDate not supplied

The case for a heroin substitution treatment trial in Canada.

Illicit opiate use in Canada causes considerable harm and social cost. Methadone substitution treatment, which has been proven effective in reducing the negative effects associated with opiate use, has been used in Canada, but so far only on a small scale. Recent research suggests that, while expanding the availability of methadone substitution is certainly in the public health interest, it would not be sufficient in itself to reduce to a minimum the harms from illicit opiate use. On the basis of the epidemiology of opiate use and of related harms, and building on the experience of intervention efforts currently underway elsewhere, this paper argues for the establishment of a heroin substitution trial in Canada. Such a trial should have the goal of investigating the potential of heroin substitution to significantly reduce the health and social costs to Canadians from illicit opiate use.

Canada↗
PubMedDate not supplied

Review of Canadian low-risk drinking guidelines and their effectiveness.

This study compared 18 low-risk drinking guidelines that were gathered from Canadian government agencies, non-government agencies, medical bodies, and public and private agencies involved in the treatment of addictions. The results show that two sets of guidelines are predominantly used in Ontario. The formulation of these guidelines was entirely independent and their intended audiences are also different. However, a direct comparison of the two guidelines shows that differences are more apparent than real. This study also examines the literature evaluating low-risk drinking guidelines Very little literature exists on evaluating low-risk drinking guidelines as vehicles for primary prevention and it is not known to what extent such guidelines influence knowledge and drinking behaviour. Future low-risk drinking recommendations should be evaluated for knowledge about standard drink units, awareness of the guidelines, use of materials and aids included in the dissemination program, and changes in behaviour from campaign exposure.

Adult↗