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PubMed1995

National Immunization Coverage Survey Saudi Arabia, 1991.

A nationwide survey was carried-out aiming at determination of immunization coverage level against the six killer diseases of childhood (tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, and measles). Variations between geographical zones, urban-rural settings, age, education and mother's employment, father's education, and child's birth order were studied. The standard WHO cluster technique was used. The sample (1102 children) was restricted to Saudi children 1-2 years old. Interviewers were exposed to training and methods of calibration, and involved in a pilot survey. Nationally, the survey showed very high coverage levels, BCG was the highest (99 per cent), measles was the lowest (90 per cent), whereas the three doses of DPT (diphtheria, pertussis and tetanus) and TOPV (trivalent oral polio vaccine) were in between (98, 96 and 94 per cent, respectively). There was no marked differences between urban-rural settings. The western zone showed the lowest coverage by all vaccines. The national coverage by the six vaccines reached 86 per cent correctly immunized (according to WHO standards), 14 per cent partially immunized and 1 per cent non-immunized. Immunization coverage was higher for children to younger mothers. The non-immunized group belonged exclusively to illiterate mothers (1 per cent). Children to mothers with basic education showed the highest coverage (88 per cent). Birth order had negative effect on coverage. Nationally, 88 per cent of children had immunization certificate while 12 per cent had not. The eastern and central zones had the highest percentages of children with certificates (92 and 91 per cent, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Order↗
PubMed1998

Managed health care coverage for infertility services: understanding adverse selection.

Insurance is an economic tool that individuals can use to reduce or eliminate financial risk. Health insurance provides risk reduction for economic loss caused by the need to pay for health care services. Insurance for any circumstance makes economic sense provided that administrative expenses to the insurer (insurance company or health plan) are no larger than the risk-premium or the value to the insured of having economic risk reduced or eliminated. Infertility has generally been regarded as a social problem rather than a medical one. Insurance companies and health plans have been reluctant to cover infertility services because of a lack of societal agreement that these services should be included and because accurate information about both the appropriate sequence of care and its cost effectiveness has not been available. Some health plans that have extended coverage for infertility services have experienced poor economic outcomes because of adverse selection. Adverse selection occurs when asymmetrical information exists, i.e. when those insured have privately held information about whether they will need the covered services or not. There are ways that the private sector can reduce or eliminate adverse selection without government mandates. These include limited coverage, experience rating, exclusion for pre-existing conditions, mandatory wait provisions, medical examinations and group coverage. When private sector efforts to control for adverse selection fail, government intervention may make sense. Governmental mandates are favoured by some because they compel wide coverage, which reduces overall economic risk. Even this can fail to eliminate adverse selection if individuals or couples who are higher risk for infertility move to areas where coverage is mandated. Given societal acceptance of the need for universal coverage for infertility services, the private sector should be able to create an economically beneficial insurance market for this coverage provided that they avoid adverse selection.

Female↗
PubMed2006

Model projections on the required coverage of syringe distribution to prevent HIV epidemics among injecting drug users.

BACKGROUND: Although syringe distribution is effective in preventing HIV transmission among injecting drug users (IDUs), there is little evidence on the required coverage to substantially reduce HIV transmission. METHODS: A mathematical model is developed to explore the relationship between the endemic HIV prevalence among IDUs and the coverage of syringe distribution. Data from IDU populations in the United Kingdom and Belarus are used to explore the implications of increasing coverage and the effect of changes in other behaviors. RESULTS: Projections suggest that there is a coverage threshold, which, if reached, could lead to substantial decreases in HIV prevalence. The threshold largely depends on the frequency that IDUs inject and (safely) reuse their syringes, and corresponds to less than 4 syringe-sharing events per IDU per month. Other factors, such as the injecting cessation rate and efficacy of syringe cleaning, only have substantial impact near threshold coverage levels. CONCLUSIONS: Our results support a policy of increasing the coverage of syringe distribution but highlight the difficulty in producing a universal coverage target. Great public health benefit could be conferred by encouraging the safe reuse of an IDU's own syringes and small stable injecting groups. Policies that discourage this will negate the impact of syringe distribution interventions.

HIV Infections↗
PubMed2004

Newspaper coverage of a violent assault by a mentally ill person.

The media is an important source of public information on mental ill-health. A man with a serious psychiatric illness attacked a minister with a knife at a Remembrance Sunday service in a remote, rural part of the Highlands, inflicting a severe facial wound. We aimed to identify lessons for the National Health Service (NHS) from the media coverage of the incident and of a subsequent court case and NHS Highland inquiry and in addition to explore how newspaper reporters approached reporting such incidents. We searched local and regional, national Scottish, and the Scottish editions of three UK newspapers for relevant coverage. We also conducted structured telephone interviews with eight reporters who had attended the inquiry press conference. Most of the media coverage was associated with the assault and the court case, rather than the inquiry results. Only three of 10 inquiry recommendations were mentioned in any reports. Coverage largely dealt with identified shortfalls, rather than proposed solutions. The NHS had made little comment in advance of the announcement of the inquiry results. Most of the newspaper coverage had already occurred. The NHS therefore limited its opportunity to influence newspaper coverage. The interpretation of the results is limited by the size of the study, but the coverage of such events forms part of the discourse on mental health in the media episodes and may have some affect on public perception of mental health issues. We conclude that, without providing confidential information, the NHS should take a more active stance in providing information on the nature and treatment of mental illness in such instances, even in advance of court cases.

Attitude↗
PubMed2003

Immunisation coverage in Australia corrected for under-reporting to the Australian Childhood Immunisation Register.

OBJECTIVE: To assess the level of under-reporting to the Australian Childhood Immunisation Register (ACIR) and the resulting underestimation of national immunisation coverage using ACIR data, and to correct national immunisation estimates for under-reporting. METHODS: A national population-based telephone survey was conducted in May-July 2001 of two random samples of children born in 1998 and 1999 who were recorded on the ACIR as incompletely immunised at either 12 months or 24 months of age. Parents were asked whether and when their child had received the vaccinations required to qualify as fully immunised. Survey data were then used to correct ACIR-derived coverage estimates at 12 and 24 months of age. RESULTS: Of 640 surveyed children in the 12-month group, 258 (40%) met the study definition of 'definitely immunised'. This adjusted the ACIR coverage estimate upwards by 2.7% to 94% (95% CI 93.6-94.1). Of 698 surveyed children in the 24-month group, 387 (55%) met the study definition of 'definitely immunised' at the second birthday. Adjusted coverage for doses due by 24 months was 89.8% (95% CI 89.6-90.1), 5% higher than recorded on the ACIR. CONCLUSIONS: Immunisation coverage in Australia for all scheduled vaccines due by 12 months of age is 94% and for all vaccines due by two years of age is almost 90%. The ACIR underestimates coverage by up to 5%. As the ACIR database relies on provider notification, published estimates of immunisation coverage are unlikely to rise significantly above current levels, unless mechanisms are put in place to further improve notification to the ACIR.

Australia↗
PubMed2005

Medicare beneficiaries and the impact of gaining prescription drug coverage on inpatient and physician spending.

OBJECTIVE: To assess whether gaining prescription drug coverage produces cost offsets in Medicare spending on inpatient and physician services. DATA SOURCE: Two-year panels constructed from 1995 to 2000 Medicare Current Beneficiary Survey, a dataset of Medicare claims and health care surveys from the Medicare population. STUDY DESIGN: We estimated a series of fixed-effects panel models to calculate adjusted changes in Medicare spending as drug coverage was acquired (Gainers) relative to the spending of beneficiaries who never had drug coverage (Nevers). Explanatory variables in the model include age, calendar year, income, and health status. PRINCIPAL FINDINGS: Assessments of inpatient and physician services spending provided no evidence of overt selection behavior prior to the acquisition of drug coverage (i.e., there were no preswitch spikes in Medicare spending for Gainers). After enrollment, the medical spending of Gainers resembled those of beneficiaries who never had drug coverage. Overall, the multivariate models showed no systematic postenrollment changes in either inpatient or physician spending that could be attributed to the acquisition of drug coverage. CONCLUSIONS: We found no consistent evidence that drug coverage either increases or reduces spending for hospital and physician services. This does not necessarily mean that drug therapy does not substitute for or complement other medical treatments, but rather that neither effect predominates across the Medicare population as a whole.

Aged↗
PubMed2006

An analysis of California Assembly Bill 2185: mandating coverage of pediatric asthma self-management training and education.

OBJECTIVE: To summarize for the California Legislature the evidence on the medical effectiveness of pediatric asthma self-management training and education (PASMTE), including the use of peak flow meters, spacers, and nebulizers and the impact that mandated coverage of these services and devices under Assembly Bill (AB) 2185 would have on total health care expenditures, monthly premiums, health services utilization, and the public's health. MEDICAL EFFECTIVENESS FINDINGS: The review of the literature finds that PASMTE is medically effective and has favorable effects on the health of children with symptomatic asthma, as well as reduces asthma-related emergency room visits and hospitalizations. There was inadequate evidence to assess the effectiveness of the three medical devices independently of PASMTE. COST AND UTILIZATION FINDINGS: One-hundred percent of children in health maintenance organization (HMO) plans in California are already covered for PASMTE, with fewer having coverage for the specific medical devices. However, despite full coverage of PASMTE in HMOs, these services are underutilized. We expect that the enactment of AB 2185 would increase utilization of PASMTE among children who are currently covered by 10 percent as a result of increased awareness of current coverage by all HMOs and increased awareness of the importance of these services. We estimate that this increased utilization by children who are already covered may result in a total statewide premiums increase of $170,000 or 0.006 percent, equal to one to two cents per member per month (PMPM). PUBLIC HEALTH FINDINGS: It is estimated that the public health impact of the mandate, as a result of new utilization of PASMTE by 10 percent of children who are already covered, would reduce the number of school days missed because of asthma per year by 158,000; the number of children reporting restricted activity days by 6,020; the number of emergency department visits by 350; and the number of hospitalizations by 1,105. LEGISLATIVE ACTION: AB 2185 passed the legislature after being amended six times. The bill as it was signed into law did not mandate coverage for PASMTE, as all HMOs in California presently reported covering these services. However, the bill retained the mandate for coverage of the three medical devices, as their coverage was not as universal across health plans.

Asthma↗
PubMed2006

The relationship between older adults' knowledge of their drug coverage and medication cost problems.

OBJECTIVES: To determine whether chronically ill patients have gaps in knowledge about their prescription drug coverage and establish the relationship between gaps and medication cost problems. DESIGN: Nationwide, cross-sectional survey. SETTING: Nationwide survey conducted via the Internet. PARTICIPANTS: Three thousand one hundred nineteen adults aged 50 and older (1,400 of whom were aged > or = 65) who had prescription drug coverage and at least one chronic illness. MEASUREMENTS: Patients were asked about features of their drug benefits and whether they had experienced problems due to medication costs in the prior year. RESULTS: Twenty-five percent of respondents reported not knowing their usual prescription copayments, and 41% did not know whether there were caps on their drug coverage. Nonwhite race and lower income were independent risk factors for lack of knowledge about these aspects of pharmacy benefits. Lack of knowledge regarding the limits of coverage was associated with a greater likelihood of cutting back on medication use because of cost pressures, forgoing basic needs because of medication costs, borrowing money to pay for prescriptions, and worrying about medication costs (all P<.05). CONCLUSION: Many older adults with prescription drug coverage do not know important features of their pharmacy benefits. Racial minorities and those with low incomes may have the greatest difficulty understanding coverage and as a result may be at greatest risk for underusing their benefits. Education about Medicare reforms and other efforts to increase prescription coverage should accompany these policies.

Aged↗
PubMed2006

US news media coverage of tobacco control issues.

OBJECTIVE: To characterise the relative amount and type of daily newspaper, local and national TV newscast, and national news magazine coverage of tobacco control issues in the United States in 2002 and 2003. DESIGN: Content analysis of daily newspapers, news magazines, and TV newscasts. SUBJECTS: Items about tobacco in daily newspapers, local and national TV newscasts, and three national news magazines in a nationally representative sample of 56 days of news stratified by day of week and season of the year, from 2002 and 2003. MAIN OUTCOME MEASURES: Story theme, tobacco topics, sources, story prominence, story valence (orientation), and story type. RESULTS: Tobacco coverage was modest over the two-year period as estimated in our sample. Only 21 TV stories, 17 news magazine stories, and 335 daily newspaper stories were found during the two-year sampling period. Noteworthy results for the newspaper data set include the following: (1) government topics predominated coverage; (2) government action and negative health effects topics tended not to occur together in stories; (3) tobacco stories were fairly prominently placed in newspapers; (4) opinion news items tended to favour tobacco control policies, while news and feature stories were evenly split between positive and negative stories; and (5) tobacco coverage in the southeast, which is the country's major tobacco producing region, did not differ from the rest of the country. CONCLUSION: Results suggest mixed support in news coverage for tobacco control efforts in the United States. The modest amount of news coverage of tobacco is troubling, particularly because so few news stories were found on TV, which is a more important news source for Americans than newspapers. When tobacco was covered, government themed stories, which often did not include mentions of negative health effects, were typical, suggesting that media coverage does not reinforce the reason for tobacco control efforts. However, some results were encouraging. For example, when newspapers did cover tobacco, they accorded the stories relatively high prominence, thus increasing the chance that readers would see tobacco stories when they were published.

Humans↗
PubMed1999

Utility of three-dimensional planning for axillary node coverage with breast-conserving radiation therapy: early experience.

PURPOSE: To examine the dosimetric axillary nodal coverage with standard tangential breast radiation fields and determine the utility of three-dimensional treatment planning for such coverage. MATERIALS AND METHODS: Six consecutive patients who were to undergo whole-breast irradiation underwent computed tomographic scanning with 5-mm sections at the time of treatment simulation. Contours were made with a commercial workstation for the lower axillary tissues, lungs, and heart. Axillary coverage was examined with three-dimensional isodose visualization and dose-volume histograms for four plans for each patient: (a) standard tangential radiation fields designed to cover only the breast, with clinical setup; (b) standard tangential fields with beam's-eye-view optimization of collimator angles for axillary and breast coverage; (c) standard tangential fields with adjustment of field width and collimator angles; and (d) customized fields, by adjusting width, collimator angle, and gantry angle and by using customized blocks. RESULTS: With plan a, only one patient had a simulated mean axillary dose greater than 90% of that prescribed. Underdosing occurred primarily in the posterior-superior axillary nodal region. Plan b improved axillary coverage; five patients had a simulated mean axillary dose of 89% or more of the prescribed dose, with adequate whole-breast coverage and no increased pulmonary or cardiac doses. Adjusting the field width and gantry angle further improved simulated mean axillary doses; however, customized blocking was then required to avoid increased mean pulmonary and cardiac doses and unacceptable contralateral breast doses. CONCLUSION: When coverage of lower axillary nodal tissue is desired at breast irradiation, three-dimensional planning with beam's-eye-view adjustment of tangential fields should be considered.

Axilla↗
PubMed1994

The relationship between insurance coverage and psychiatric disorder in predicting use of mental health services.

OBJECTIVE: This study investigated how insurance coverage for mental health services affects outpatient mental health service utilization among those with and among those without a DSM-III psychiatric diagnosis. The authors used a representative community sample to compare the regression effects of insurance coverage on utilization of mental health services among these subjects. METHOD: Data are from the second wave of the Piedmont, North Carolina, site of the Epidemiologic Catchment Area project. These data contain DSM-III diagnostic measures derived from the National Institute of Mental Health Diagnostic Interview Schedule as well as measures of insurance coverage and utilization. Responses from 2,889 community residents were analyzed using both ordinary least squares and logistic regression. RESULTS: In both models, insurance coverage was strongly associated with care among those with as well as among those without a psychiatric disorder. The association between coverage and the probability of care was strongest among those with a disorder. CONCLUSIONS: The findings are not consistent with the claim that failing to provide insurance coverage will reduce discretionary but not necessary mental health care utilization. They provide evidence that failing to provide insurance coverage will reduce utilization as much or more among those with a psychiatric disorder as among those without. This result has important implications for health care reform.

Adult↗
PubMed2006

Comparison of gene coverage of mouse oligonucleotide microarray platforms.

BACKGROUND: The increasing use of DNA microarrays for genetical genomics studies generates a need for platforms with complete coverage of the genome. We have compared the effective gene coverage in the mouse genome of different commercial and noncommercial oligonucleotide microarray platforms by performing an in-house gene annotation of probes. We only used information about probes that is available from vendors and followed a process that any researcher may take to find the gene targeted by a given probe. In order to make consistent comparisons between platforms, probes in each microarray were annotated with an Entrez Gene id and the chromosomal position for each gene was obtained from the UCSC Genome Browser Database. Gene coverage was estimated as the percentage of Entrez Genes with a unique position in the UCSC Genome database that is tested by a given microarray platform. RESULTS: A MySQL relational database was created to store the mapping information for 25,416 mouse genes and for the probes in five microarray platforms (gene coverage level in parenthesis): Affymetrix430 2.0 (75.6%), ABI Genome Survey (81.24%), Agilent (79.33%), Codelink (78.09%), Sentrix (90.47%); and four array-ready oligosets: Sigma (47.95%), Operon v.3 (69.89%), Operon v.4 (84.03%), and MEEBO (84.03%). The differences in coverage between platforms were highly conserved across chromosomes. Differences in the number of redundant and unspecific probes were also found among arrays. The database can be queried to compare specific genomic regions using a web interface. The software used to create, update and query the database is freely available as a toolbox named ArrayGene. CONCLUSION: The software developed here allows researchers to create updated custom databases by using public or proprietary information on genes for any organisms. ArrayGene allows easy comparisons of gene coverage between microarray platforms for any region of the genome. The comparison presented here reveals that the commercial microarray Sentrix, which is based on the MEEBO public oligoset, showed the best mouse genome coverage currently available. We also suggest the creation of guidelines to standardize the minimum set of information that vendors should provide to allow researchers to accurately evaluate the advantages and disadvantages of using a given platform.

Animals↗
PubMed2002

The coverage of cancer patients by designated palliative services: a population-based study, South Australia, 1999.

Our aims were to determine the extent of coverage by designated palliative care services of the population of terminally ill cancer patients in South Australia, and to identify the types of patients who receive these services and the types who do not. All designated hospice and palliative care services in South Australia notified to the State Cancer Registry the identifying details of all their patients who died in 1999. This information was cross-referenced with the data for all cancer deaths (n=3086) recorded on the registry for 1999. We found that the level of coverage by designated palliative services of patients who died with cancer in 1999 was 68.2%. This methodology was previously used to show that the level of coverage had increased from 55.8% for cancer deaths in 1990 to 63.1% for those in 1993. Patients who died at home had the largest coverage by palliative services (74.7%), whereas patients who died in nursing homes had the lowest coverage (48.4%). Patients who did not receive care from these palliative services tended to be 80 years of age or older at death, country residents, those with a survival time from diagnosis of three months or less, and those diagnosed with a prostate, breast, or haematological malignancy. Gender, socioeconomic status of residential area, and race were not related to coverage by a designated palliative service, whereas migrants to Australia from the UK, Ireland, and Southern Europe were relatively high users of these services. We conclude that the high level of palliative care coverage observed in this study reflects widespread support for the establishment of designated services. When planning future care, special consideration should be given to the types of patients who most miss out on these services.

Aged↗
PubMedDate not supplied

Trends in Medicare supplemental insurance and prescription drug coverage, 1996-1999.

Medicare Current Beneficiary Survey (MCBS) Access to Care data indicate a five-percentage-point decline in the share of Medicare beneficiaries having Medigap coverage between 1996 and 1999; this was matched by a commensurate rise in the share enrolled in Medicare HMOs, contributing to an increase in the percentage with drug coverage. During this period, high-income beneficiaries, and to a lesser extent healthier and rural beneficiaries, experienced greater net declines in supplemental coverage and smaller relative gains in drug coverage, compared with others. By fall 1999, 38 percent of beneficiaries lacked drug coverage, based on point-in-time estimates. This is much higher than previous estimates that measured beneficiaries' drug coverage at any time during the calendar year. Many of Medicare's most vulnerable beneficiaries--rural (50 percent), near-poor (44 percent), and oldest old (45 percent)--were most likely to lack drug coverage in the fall of 1999.

Aged↗
PubMed1998

Persistent low immunization coverage among inner-city preschool children despite access to free vaccine.

OBJECTIVE: To compare vaccination coverage among children 19 to 35 months of age from public housing developments where a free vaccine outreach program was in place with children residing elsewhere in the city. DESIGN: A household survey using a multistage cluster sampling method to compare community areas which accounted for 80% of measles cases during 1989 (high-risk stratum), areas which accounted for the remaining 20% of cases (low-risk stratum), and public housing developments (public housing stratum) having free, on-site vaccination services. SETTING: Inner-city Chicago households, April to May 1994. OUTCOME VARIABLES: Antigen-specific and series-specific coverage based on written records. RESULTS: Based on evaluation of 1244 children, citywide coverage for four doses of diphtheria-tetanus-pertussis vaccine, three doses of polio vaccine, and one dose of measles-containing vaccine (4:3:1) was 47% [95% confidence interval (CI), 40% to 55%]. Coverage was significantly lower among children residing in public housing (23%; 95% CI, 18% to 28%) compared with those residing in high-risk strata (45%; 95% CI, 38% to 52%) and low-risk strata (51%; 95% CI, 43% to 60%). Compared with white children (53%), coverage for the 4:3:1 series was lower among African-American children in public housing (29%) or outside public housing (36%). Moreover, 11% (95% CI, 8% to 14%) of children residing in public housing had never received any immunizations. CONCLUSIONS: African-American children throughout Chicago, particularly in public housing, remain at increased risk for vaccine-preventable diseases and should be targeted further for vaccination services. Vaccination coverage remains low several years after a major outbreak of measles and implementation of a free vaccine outreach program. Cluster surveys may be useful for monitoring vaccination coverage in high-risk urban settings.

Chicago↗
PubMed2004

[Using surveys of schoolchildren to evaluate coverage with and opportunity for vaccination in Costa Rica].

OBJECTIVE: To identify differences in the level of coverage of and opportunity for vaccination among schoolchildren in three areas in Costa Rica with different characteristics: an urban area (with the highest level of socioeconomic development of the three areas), a rural area (with a medium level of socioeconomic development), and a border area (a rural area in northern Costa Rica, on the border with Nicaragua, with the lowest level of socioeconomic development and the highest proportion of foreign immigrants). METHODOLOGY: Following selection of schools by proportional probability, surveys were used with children chosen at random from the first and second grades of elementary schools in the three areas: urban (961 students), rural (544 students), and border (811 students). The data on the vaccines that had been administered were obtained from the children's vaccination cards. Differences among the three areas were evaluated: (1) in the coverage with BCG; with three doses of diphtheria-tetanuspertussis vaccine (DTP3); with three doses of oral polio vaccine (OPV3); with the first dose of measles-mumps-rubella vaccine (MMR1); and with the second dose of MMR vaccine (MMR2) and (2) in the "opportunity" for the children having received DTP1 + OPV1 before 3 months of age, DTP3 + OPV3 before 7 months of age, and DTP4 + OPV4 + MMR1 before 24 months of age. RESULTS: Out of all the students who had been selected, 80% of them in the urban area had a vaccination card, 73% did in the rural area, and 72% did in the border area (P < 0.05). The coverage levels for BCG, DTP3, and OPV3 were each over 95% in both the urban area and the rural area; however, the coverage levels were significantly lower (P < 0.05) in the border area: BCG, 83%; OPV3, 88%; and DTP3, 88%. Coverage with MMR1 and MMR2 was similar in the three areas. The percentage of schoolchildren with two or more doses of measles vaccine was 98% in the urban area, 92% in the rural area, and 85% in the border area (P < 0.05). In terms of opportunity, 90% of the children had received DTP1 + OPV1 before 3 months of age in the urban area, 89% had in the rural area, and 80% had in the border area (P < 0.05). The percentage of application of the complete basic schedule (DTP4 + OPV4 + MMR1) before 24 months of age was 93% in the urban area, 95% in the rural area, and 84% in the border area (P < 0.05). CONCLUSIONS: The border area had lower coverage of and opportunity for the basic schedule of vaccines, except for MMR. Follow-up campaigns for measles eradication have increased the coverage of the initial and booster doses in all three areas, but the increase has been greatest in the urban area. A greater effort should be made to identify children with an incomplete schedule of vaccinations, with priority going to areas that have a high proportion of immigrants.

Adolescent↗
PubMedDate not supplied

Evaluation of a monthly coverage maximum (drug-specific quantity limit) on the 5-HT1 agonists (triptans) and dihydroergotamine nasal spray.

BACKGROUND: Ensuring the appropriate use of migraine therapies is an important consideration for care providers, patients, employers, and managed care organizations (MCOs) because of the high cost of treatment for this fairly prevalent disabling disease. A review of utilization of serotonin 5-HT1 receptor agonists (triptans) in an MCO determined that about 24% of the patients who received triptan therapy exceeded the manufacturers. recommendations regarding the maximum daily dose and safe treatment guidelines in a 30-day period. An initiative was designed to manage the coverage of migraine abortive therapies with the anticipated outcome of decreasing potential misuse or overuse of the medications. OBJECTIVE: The objective of this retrospective, observational study was to determine the impact of a monthly drug-specific milligram coverage maximum (quantity limit) on serotonin 5-HT1 receptor agonists (triptans) and dihydroergotamine (DHE) nasal spray on the utilization and costs of migraine care in an MCO with approximately 600000 covered members. METHODS: A longitudinal, retrospective cohort analysis was conducted. All migraine-related services were analyzed, including outpatient medical visits, emergency department utilization, inpatient hospitalizations, and outpatient prescription drug use. The analysis was conducted using medical and pharmacy administrative claims. Analysis of data was performed for the period 12 months prior (October 1999 to September 2000) and 18 months postimplementation of the monthly drug-specific milligram coverage maximum (October 2000 through March 2002). RESULTS: Imposition of a monthly coverage maximum for migraine-abortive therapies was associated with a 26.1% reduction in overall per- patient-per-month (PPPM) medical costs for migraine care, from US dollars 55.52 PPPM to US dollars 41.02 PPPM (P<0.01). Utilization of serotonin 5-HT1 receptor agonists and DHE nasal spray declined by 16.7%, from 0.18 prescriptions PPPM to 0.15 prescriptions PPPM (P=0.039), and direct drug costs declined by 28.8%, from US dollars 29.18 PPPM to US dollars 20.78 PPPM (P<0.001). Utilization and costs of outpatient and inpatient migraine-related medical services declined by 40% from US dollars 16.58 PPPM in the preperiod to US dollars 9.94 PPPM in the postperiod (P<0.001). CONCLUSION: A monthly drug-specific milligram coverage maximum was associated with significant reduction in drug costs and utilization of serotonin 5-HT1 receptor agonists (triptans) and DHE nasal spray. Utilization and costs of migraine-related medical services also declined after implementation of the coverage maximum for triptans and DHE nasal spray. The monthly drug-specific milligram coverage maximum appeared to have been successful in managing utilization of triptans and DHE nasal spray, including reduction of overall costs of migraine-related medical services and direct drug costs.

Adolescent↗
PubMed1992

The connective tissue and partial thickness double pedicle graft: a predictable method of obtaining root coverage.

Obtaining predictable root coverage has been a goal of periodontal therapy for sometime. The purpose of this study is to present a technique for obtaining root coverage. This study reports the results of 20 patients (30 defects) treated with a connective tissue and partial thickness double pedicle graft. Root coverage of 100% was obtained in 24 of 30 defects, or 80% of the time. In all the treated defects the root coverage obtained was to within 0.5 mm of the cemento-enamel junction. The mean percent root coverage was 97.4%. The mean amount of exposed root surface initially was 3.6 mm. At the final postoperative appointment the mean exposed root surface was 0.1 mm. This change represents a net root coverage of 3.5 mm or 97.2%. The number of sites with bleeding on probing and plaque present decreased. The esthetics, both color match and tissue contours, were acceptable to all the patients in all cases. With this technique root coverage can be accomplished in a predictable manner.

Adolescent↗