Search PubMed⌕ Search

PubMed · 669625

Creative responses needed in controlled environment.

Abstract

Faced with an increasingly regulatory environment, hospitals must find innovative ways by which, first, to survive and, then, to respond constructively to externally applied constraints. Decertification of beds and a move to ambulatory care programs are only two of many possible responses. The key to success will be the measure of cooperation between health care providers, insurers, and government.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

P Rogatz. 1978-08-01. Creative responses needed in controlled environment.. https://pubmed.ncbi.nlm.nih.gov/669625/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

[Are bonus systems applicable to guideline-oriented depression treatment provided by general practitioners and neurologists?].

In the outpatient treatment of depression, the potential of diagnostic and therapeutic methods is seldom exhausted resulting in variable quality of treatment and partly insufficient cost effectiveness. Implementation of a guideline-oriented reimbursement system seems to be an option to improve quality of treatment. Corresponding incentive systems have been outlined and evaluated for the health care of somatic diseases such as diabetes. Acting on these experiences, an attempt was made to utilize them for the area of psychiatric disorders. Taking depression as an example, a model for a quality-oriented, guideline-based reimbursement system for general and specialist practice is presented.

Ambulatory Care↗

Provision of rheumatology services in New Zealand.

AIMS: To measure equity of access to rheumatology services and to assess the adequacy of the rheumatology workforce-compared with published recommended levels, United Kingdom levels, and previous New Zealand data; and to provide data to assist in workforce planning. METHODS: Data from of the central North Island of New Zealand were obtained during a review of rheumatology services in the Midland region. Complete national public-sector rheumatology workforce data were obtained in a separate survey. RESULTS: This study demonstrates wide geographical variation in outpatient (more than three-fold variation) and inpatient (more than six-fold variation) service volumes per capita between the District Health Boards of the Midland region. Outpatient waiting lists were not higher in underserviced areas. Nationally, there were 251,211 people for each full time equivalent (FTE) rheumatologist, compared with the 1999 level of 235,593 population per FTE, and well behind the UK recommendation of 85,000 people per FTE. CONCLUSIONS This study has demonstrated marked variation in access to rheumatology services based on geographical location, as well as evidence of a worsening shortage of rheumatologists in New Zealand.

Ambulatory Care↗

How can we improve adherence to blood pressure-lowering medication in ambulatory care? Systematic review of randomized controlled trials.

BACKGROUND: Lack of adherence to blood pressure-lowering medication is a major reason for poor control of hypertension worldwide. The objective of this study was to determine the effectiveness of interventions to increase adherence to blood pressure-lowering medication. METHODS: We performed a systematic review of randomized controlled trials and searched for all-language publications in the Cochrane Controlled Trials Register, MEDLINE, EMBASE, and CINAHL in April 2002. RESULTS: We included 38 studies testing 58 different interventions and containing data on 15 519 patients. The studies were conducted in 9 countries between 1975 and 2000. The duration of follow-up ranged from 2 to 60 months. Because of heterogeneity between studies in terms of interventions and the methods used to measure adherence, we did not pool the results. Simplifying dosing regimens increased adherence in 7 of 9 studies, with a relative increase in adherence of 8% to 19.6%. Motivational strategies were partly successful in 10 of 24 studies with generally small increases in adherence up to a maximum of 23%. Complex interventions comparing more than 1 technique increased adherence in 8 of 18 studies, ranging from 5% to a maximum of 41%. Patient education alone seemed largely unsuccessful. CONCLUSIONS: Reducing the number of daily doses appears to be effective in increasing adherence to blood pressure-lowering medication and should be tried as a first-line strategy, although there is so far less evidence of an effect on blood pressure reduction. Some motivational strategies and complex interventions appear promising, but we need more evidence on their effect through carefully designed randomized controlled trials.

Ambulatory Care↗