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At least 937 records · Page 52Linked to original sources
PubMed2006

Patient-reported underuse of prescription medications: a comparison of nine surveys.

Nine national surveys documenting patient underuse of prescription medications were examined to describe the variation and trends in that underuse and identify possible reasons for the substantially different rates that were reported. Underuse includes unfilled prescriptions, delayed therapy, reduced frequency, and lowered dosage. Rates of cost-related patient underuse in the studies ranged from 1.6 to 22 percent. Insurance coverage, level of wealth, age, and health status were the sociodemographic variables most strongly related to underuse. Seven additional factors in the design and administration of the surveys were identified as providing plausible explanations for the variance across surveys. The most conspicuous variation was between three government-sponsored periodic surveys and six generally one-time assessments, with the latter yielding higher rates and greater variance in underuse. Understanding the factors contributing to the variation in reported rates of underuse of medications is an important prerequisite for the design of effective prescription-drug benefit programs.

Adolescent↗
PubMed1997

The effects of gender on primary care physician attitudes and practice orientations.

What gender-related differences are there among primary care physicians, and what are the implications of the similarities and differences among male and female physicians for health care reform? This study delineates the similarities and differences between male and female physicians. There is a statistically significant relationship between gender and physicians' ages, years in practice, medical practice organization, practice location, and concerns for professional autonomy and the paperwork demands of an alternative health care plan (AHP). There are no significant gender-related differences in physicians' concerns for reimbursement, support for the ongoing innovations in the health care delivery system, support for government involvement in health care delivery and financing, and in physicians' attitudes toward Medicaid beneficiaries. Although the majority of the female subjects of this study practice in public medical institutions, there are no statistically significant differences in male and female physicians' Medicaid caseloads, and in their participation in a government-sponsored alternative health care delivery plan for Medicaid beneficiaries. The study concludes by exploring the implications of the findings for health care reform.

Attitude of Health Personnel↗
PubMed1990

Living with NHI.

Our current healthcare delivery system is failing, and a number of health policy leaders have proposed some version of a national health insurance (NHI) program to reform it. Lawmakers, the nation's business community, unions, and the uninsured and underinsured are all pursuing ways to reduce the nation's healthcare expenditures. Most proposed NHI plans would be federally sponsored and state administered and funded by a combination of employer contributions and general revenues. If the government were the sole entity collecting premiums and making payments, the arrangement would reduce the nation's healthcare costs by an estimated 10 percent. NHI would eventually assign hospitals a "global budget," rather than reimburse them for specific services rendered. Although NHI as a whole will mean a loss of revenue for most hospitals, it may actually strengthen efficient and effective geographically linked healthcare systems (and thus could be an advantage to many healthcare systems). NHI would also allow hospitals to shift focus from the bottom line to patient care. Although NHI would mean less revenue for physicians, it would mean greater access to healthcare for members of communities.

Catholicism↗
PubMed1999

The Americans with Disabilities Act: implications for managed care for persons with mental illness and addiction disorders.

This Issue Brief, prepared for the Substance Abuse and Mental Health Services Administration, examines the Americans with Disabilities Act ("the ADA") and its application to managed care. The ADA provides important protections for persons with disabilities who are members of managed care arrangements, regardless of whether their membership is sponsored by an employer, Medicare, or Medicaid or is purchased privately. The interaction between the ADA and managed care is complex, and different issues can arise under publicly and privately sponsored plans.

Adult↗
PubMed2005

Contemplating the assessment of great river ecosystems.

The science and practice of assessing the status and trends of ecological conditions in great rivers have not kept pace with perturbation wrought on these systems. Participants at a symposium sponsored by the U.S. Environmental Protection Agency (USEPA) and the Council of State Governments concluded that useful and efficient assessments of great river ecosystems require thoughtful alignment of sampling designs, spatial and temporal scales, indicators, management needs, and ecosystem characteristics. Site-specific physical, chemical, and biological data long accumulated by monitoring programs have value but fail to provide the integrated system-wide perspective required for adaptive management and the Clean Water Act. Use of existing data may be limited by methodological incompatibilities, access difficulties, and the exclusive applicability of data to specific habitats or sites. The transition from site-specific to system-wide assessments benefits from research being done by USEPA's Environmental Monitoring and Assessment Program (EMAP) and other programs that use probability surveys and biological indicators. Indicators of various taxa (in particular fish, algae, and benthic invertebrates) have been successfully developed for great rivers. However, optimizing the information these ecological indicators convey to managers and the public is the subject of ongoing research.

Conservation of Natural Resources↗
PubMed2002

State Children's Health Insurance Program.

Despite a number of efforts by states and the federal government over several years, millions of low-income children still lack health insurance coverage and, therefore, have limited access to healthcare services. To address these problems, Congress has created, and states are now implementing, the new State Children's Health Insurance Program (SCHIP). Policymakers and agency officials who design, operate, and sponsor health coverage programs such as SCHIP must determine what constitutes an effective program. Efforts to maximize the number of children with coverage are important. The challenge for each state and its communities is to effectively identify and enroll eligible low-income children. They must create outreach strategies to find and enroll children in Medicaid and SCHIP. However, a truly effective program must go beyond simply enrolling children in health coverage programs. They must also assure that newly enrolled children receive quality comprehensive health care.

Child↗
PubMed2006

Improving awareness of mercury pollution in small-scale gold mining communities: challenges and ways forward in rural Ghana.

This paper critiques the approach taken by the Ghanaian Government to address mercury pollution in the artisanal and small-scale gold mining sector. Unmonitored releases of mercury-used in the gold-amalgamation process-have caused numerous environmental complications throughout rural Ghana. Certain policy, technological and educational initiatives taken to address the mounting problem, however, have proved marginally effective at best, having been designed and implemented without careful analysis of mine community dynamics, the organization of activities, operators' needs and local geological conditions. Marked improvements can only be achieved in this area through increased government-initiated dialogue with the now-ostracized illegal galamsey mining community; introducing simple, cost-effective techniques for the reduction of mercury emissions; and effecting government-sponsored participatory training exercises as mediums for communicating information about appropriate technologies and the environment.

Awareness↗
PubMed2002

Development of family medicine education in Moldova with Carelift International.

BACKGROUND: As in other former Soviet republics, Moldova's health system has been dependent upon multispecialty and hospital care. The government has undertaken a planning process to develop a primary care-based system utilizing family physicians. Carelift International and Moldova State Medical and Pharmaceutical University joined together to design an educational program to help create a family medicine specialty in the country. METHODS: Introductory concepts were incorporated into a workshop co-sponsored by the World Health Organization, Carelift International, UNICEF and Moldova Ministry of Health. Faculty teams participated in Carelift's 8-week US program, comprising a range of topics in family medicine: educational development at all levels, public health applications, health care organization, insurance, financing, and technology. Training also included 1 week in Finland, a fellowship in Lithuania, an in-country workshop on rural health, and a supplemental 5-week US immersion program. OUTCOMES: A Department of Family Medicine was established, and a residency program instituted. It has already been strengthened with a 2-week introduction to the specialty, and rotations in family practice centers. Continued improvements and updates are planned. Urban and rural model family practice centers serve concurrent purposes of teaching, demonstrating and health care. Carelift shipped equipment for the principal center and a department library, and is equipping a teaching family practice center near the university. The Society of Family Physicians of Moldova was founded. The introduction of family medicine as a discipline into the health system of Moldova could be a valuable model for other former Soviet republics.

Journal Article↗
PubMed1991

The AIDS research agenda at the National Institutes of Health.

The foundation, goals, and components of the research strategy developed by the National Institutes of Health to combat AIDS and HIV infection are discussed. The AIDS research agenda, based on systems originally designed to coordinate cancer research, involves a national effort to study various aspects of the disease, disseminate information, and rapidly develop and test drugs and vaccines to treat and prevent AIDS and HIV disease. AIDS research makes up approximately 10% of the total NIH budget of $7.6 billion, and the largest portion of that allocation goes to improving current treatments and developing new agents. Drug discovery efforts are supported by the National Institute of Allergy and Infectious Diseases (NIAID) through the Division of Intramural Research, in which biomedical and clinical research is conducted, and the Division of AIDS, which coordinates extramural research in university-based centers and community programs. By providing educational materials and sponsoring conferences, NIAID also helps to disseminate the results of the research it coordinates. Pharmacists support AIDS research through their involvement with study drug products and their role in protocol development, regulatory affairs, product development, and accumulation and distribution of drug information. Research initiatives sponsored by the federal government combine resources of investigators from government, academia, and the pharmaceutical and biotechnological industries to meet the challenges posed by the AIDS epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Child and Adult Care Food Program: improved targeting of day care home reimbursements--Food and Consumer Service, USDA. Final rule.

This final rule amends the Child and Adult Care Food Program regulations governing reimbursement for meals served in family day care homes by incorporating changes resulting from the Department's review of comments received on a January 7, 1997, interim rule. These changes and clarifications involve: The appropriate use of school and census data for making tier I day care home determinations; documentation requirements for tier I classifications; tier II day care home options for reimbursement, including use of child care vouchers; calculating claiming percentages/blended rates using attendance and enrollment lists; and procedures for verifying household applications of children enrolled in day care homes. This final rule also amends the National School Lunch Program regulations to facilitate tier I day care home determinations by requiring school food authorities to provide elementary school attendance area information to sponsoring organizations. These revisions implement in final form the provisions of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to target higher CACFP reimbursements to low-income children and providers.

Adult↗
PubMed2002

Gene therapy coming of age in Latin America.

"Gene Therapy in Latin America: From the Bench to the Clinic," a meeting sponsored by the Wellcome Trust and the United Nations University through the Biotechnology Program for Latin America and the Caribbean, took place in Buenos Aires, Argentina from May 20 to 22. This symposium, which was hosted by Osvaldo Podhajcer and Fernando Pitossi,had more than 150 basic scientists and physician-scientists from academia, government and industry in Latin America, similar to the first meeting of the Asociacion Iberoamericana de Terapia Génica (Iberoamerican Society of Gene Therapy, AITG) held in Guadalajara, México, two years ago. Participants represented Argentina, Mexico, Brazil, Chile, Uruguay, Costa Rica, Colombia, Venezuela, and Guatemala, with guests from the United States and Europe. All came together to discuss the latest developments in this field in the region. A primary objective of this gathering was to bring together Latin American scientists involved in gene therapy to strengthen continental collaborations and to further disseminate the scientific expertise available in Latin America. The symposium was followed by a 10-day practical course for 25 students from all over Latin America.

Animals↗
PubMedDate not supplied

The notion of grace.

Catholic Healthcare West (CHW), San Francisco, which either sponsors or participates in three separate leadership development programs, sees the formation of new ministry leadership as a matter of the first importance. For the past four years, CHW has participated in CHA's Ecclesiology and Spiritual Renewal Program for System Leaders, the annual pilgrimage to the Vatican City in which ministry executives, board members, and sponsors get an opportunity to learn about the church's institutional structure and immerse themselves in its spiritual atmosphere. In 2002 the system established its CHW Learning Institute, which offers all employees training in leadership, clinical, governance, and employee development. Among other things, the institute has developed CHW's Competency Standards for Leadership. In 2004 CHW, with four other Catholic health care systems in the western United States, created the Ministry Leadership Center, Sacramento. This spring, 49 CHW managers were among the students enrolled in the center's inaugural classes. Among other subjects, they studied the distinctive competencies-intellectual, affective, and spiritual-required to lead a health care ministry in its operations and governance.

California↗
PubMed1986

State-sponsored primary health care in Africa: the recurrent cost of performing miracles.

In this paper the author suggests that the design and execution of ongoing and future primary health care (PHC) interventions in Africa could be improved by more comprehensive and realistic assessments of the recurrent costs of alternative approaches to providing given levels of health care benefits. He develops the distinction between development and recurrent cost elements; distinguishes between marginal and average costs of interventions; identifies elements of social opportunity cost that are frequently overlooked in assessing project costs and shows how their inclusion magnifies the aggregate social cost of interventions featuring recurrent involvement of state agents; suggests that the perception of benefits conveyed by state-sponsored PHC programs to rural populations is limited, especially in relation to the true social costs; and discusses the implications of the above analysis for future PHC strategy.

Community Health Workers↗
PubMed1998

The AIDS pandemic: changes in the believability and use of information sources.

Over 20,000 Americans under 25 years old are infected with HIV every year. In 1994, AIDS was the number one killer of adults between the ages of 25 and 44 years old. Education concerning HIV is critical to the prevention of AIDS. Both the public and private sectors, including government agencies, cause-related organizations, medical professionals, and promotion specialists must determine the best information sources to educate young people. However, with many television shows that appeal to young adults condoning casual sex, it is increasingly difficult to generate motivation to act responsibly. This paper examines the effectiveness of information sources, sponsored by both the government and private organizations, about HIV. Given the impact of media publicity regarding the AIDS virus and the "hard-hitting" messages and public service announcements about AIDS, implications about ethical issues, public policy issues, and media strategies to educate the public about AIDS are discussed. While publicity and specific types of television programming were found to be the most believable and most often used information sources for health issues, there are many strategic implications concerning promotion strategies, targeting, and positioning for both the public and private sectors.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

A procedure for assessing a contract testing facility: one sponsor's perspective.

The government agencies responsible for Good Laboratory Practices (GLP) place accountability for assuring compliance of studies intended for submission on the sponsor. An initial step toward meeting these legal obligations includes a comprehensive assessment of the candidate testing facility. Literature review has substantiated that the initial evaluation may be best accomplished through both technical and compliance-focused inspections (O'Brien-Pomerleau, 1991; Schroeder, 1989). Combined technical and compliance inspections have also been reported as an effective auditing approach for long-term studies (Hoover and Baldwin, 1984). However, for the purposes of the initial qualifying assessment inspection, personal experiences and published literature indicate that these two equally important evaluations are commonly conducted independently of one another (Scozzie, 1995). A collaborative approach utilized by Dow Corning Corporation in the preliminary assessment of a contract testing facility builds upon those methods just mentioned. Coupling this evaluation with a program of actively monitoring the testing facility's performance in study conduct provides continued assessment and has proven to be beneficial to all stakeholders (sponsor, testing facility, and regulatory agency). Details of the process practiced by this sponsor to assure that studies conducted by a contract testing facility meet GLP requirements are presented.

Contract Services↗
PubMed2004

Medicare and state health care programs; fraud and abuse: OIG civil money penalties under the Medicare prescription drug discount card program. Final rule.

In accordance with section 1860D-31 of the Social Security Act, this rule finalizes OIG's new authority for imposing civil money penalties (CMPs) against endorsed sponsors under the Medicare prescription drug discount card program that knowingly engage in false or misleading marketing practices; overcharge program enrollees; or misuse transitional assistance funds.

Centers for Medicare and Medicaid Services, U.S.↗