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At least 973 records · Page 54Linked to original sources
PubMed1988

Paediatric drug therapy. I--Medication use in hospitalized patients.

Medication use was studied prospectively in 97 hospitalized paediatric patients at a children's hospital. An average of 4.8 scheduled drugs were used per patient. Antibiotics and anticonvulsants were the two most commonly used drug classes. Penicillins, anticonvulsants, aminoglycosides, cephalosporins, and theophylline were most frequently prescribed in our patients. A wide range of doses was used for drugs with narrow therapeutic indices. Most potential drug-drug interactions involved an anticonvulsant with another drug. These data may assist in targeting drug utilization review studies and educational programs justifiably to retain existing positions or create new opportunities within the departments of pharmacy to optimize patient care.

Adolescent↗
PubMed1982

Professional review of laboratory utilization.

Overutilization of laboratory procedures is a significant problem, particularly in teaching institutions. The purpose of this study was to assess laboratory utilization patterns on the medical service of a university hospital, comparing data from implicit peer review by a pathologist with those from a group of practicing primary care physicians. Also, utilization of the most frequently ordered laboratory tests was compared with that of less common procedures. For charts reviewed both by the pathologist and by a panel of primary physicians, the pathologist found 26.5 per cent of tests unnecessary, while the primary physicians found 42.8 per cent unnecessary. The ten most frequently ordered tests had a significantly higher rate of overutilization than all other tests. Attempts to modify physicians' laboratory utilization should include concomitant peer review of the most commonly ordered procedures.

Clinical Laboratory Techniques↗
PubMed1993

Users and uses of patient records. Report of the Council on Scientific Affairs. Council on Scientific Affairs, American Medical Association.

At present, there is significant momentum for developing and implementing computer-based patient records systems. It is essential that their development be guided by the functional requirements of the users and uses of patient records. Users can be grouped into seven categories: providers, patients, educators, researchers, payers, managers and reviewers, and licensing and accrediting agencies and professional associations. Uses of patient records include fostering continuity of care, supporting diagnosis and choice of therapy, assessing and managing health risks, documenting the services provided, maintaining accurate medical histories, billing and verifying payment, documenting professionals' experience, teaching students, preparing conferences and presentations, conducting research, formulating practice guidelines, and providing data to support utilization review, quality assurance, accreditation, and licensure. Patient records can be classified as primary records used by professionals while providing health care services or secondary records derived from primary records to aid nonclinical users. Protecting the confidentiality of patient information will restrict access to primary records for some users and should prevent inclusion of sensitive data in secondary records. The design features to be incorporated into computer-based record systems should expand the record's function from that of a simple device for documenting events into a powerful tool for providing and managing care.

American Medical Association↗
PubMedDate not supplied

[Factors conditioning primary care services utilization. Empirical evidence and methodological inconsistencies].

INTRODUCTION: In Spain, the degree and characteristics of primary care services utilization have been the subject of analysis since at least the 1980s. One of the main reasons for this interest is to assess the extent to which utilization matches primary care needs. In fact, the provision of an adequate health service for those who most need it is a generally accepted priority. FACTORS CONDITIONING USE: The evidence shows that individual characteristics, mainly health status, are the factors most closely related to primary care utilization. Other personal characteristics, such as gender and age, could act as modulators of health care need. Some family and/or cultural variables, as well as factors related to the health care professional and institutions, could explain some of the observed variability in primary care services utilization. Socioeconomic variables, such as income, reveal a paradox. From an aggregate perspective, income is the main determinant of utilization as well as of health care expenditure. When data are analyzed for individuals, however, income is not related to primary health utilization. METHODOLOGICAL INCONSISTENCIES: The situation is controversial, with methodological implications and, above all, consequences for the assessment of the efficiency in primary care utilization. Review of the literature reveals certain methodological inconsistencies that could at least partly explain the disparity of the empirical results. Among others, the following flaws can be highlighted: design problems, measurement errors, misspecification, and misleading statistical methods.Some solutions, among others, are quasi-experiments, the use of large administrative databases and of primary data sources (design problems); differentiation between types of utilization and between units of analysis other than consultations, and correction of measurement errors in the explanatory variables (measurement errors); consideration of relevant explanatory variables (misspecification); and the use of multilevel models (statistical methods).

Adolescent↗
PubMedDate not supplied

U.S. Army air ambulance operations in El Paso, Texas: a descriptive study and system review.

OBJECTIVES: To analyze a high-volume military air ambulance unit and review the U.S. Army air medical transport system and Military Assistance to Safety and Traffic (MAST) program. METHODS: The setting was a remote medical system with numerous ground emergency medical services. All patients transported between January 1, 1996, and February 28, 1998, were included. Patients who were dead on scene or for whom records were unavailable were excluded. A retrospective review of transport and available inpatient records was conducted. RESULTS: Five hundred seventeen patients were transported during the study period; 461 patients met inclusion criteria (89%). Of these, 70% were classified as trauma; 30% possessed medical or other surgical diagnoses. Prehospital responses numbered 71.6%, while 28.4% were interhospital transfers. Missions averaged 23.4 minutes per flight, with no major aircraft mishaps. Prehospital utilization review showed appropriate use; 35% of interhospital trauma and 11% of interhospital nontrauma missions were staffed inadequately by these criteria. Time intervals, procedures, and program impact are discussed. CONCLUSION: This and similar units participating in the MAST program provide effective air transport in settings underserved by civilian programs. Quality and wartime readiness could be improved by centralized medical direction, treatment and transfer protocols, and enhanced training of medics. Further investigations of the clinical impact of advanced training and a two-medic aircrew model are warranted.

Adolescent↗
PubMedDate not supplied

"Trade-off" between medical cost controls and quality of care? Maybe, maybe not! Part II.

In Part I of this article, published in the last issue of the JQA (February/March 1990, Vol. 12, No. 1), Majors Varney and Schroeder reviewed the issues surrounding the impact of the Medicare prospective pricing system (PPS). After defining "quality health care" and discussing indicators of quality, the authors presented several arguments by anti-cost containment advocates. In Part II, research is presented on the effects of cost containment on access to health care, substance abuse programs, improved care, severity indexing, alternative care, and utilization review programs.

Cost Control↗
PubMed1999

Drug use and prescribing problems in four state Medicaid programs.

In this article the authors present population-level prevalence rates for 61 specific drug-related problems occurring in three State Medicaid programs (Maryland, Iowa, and Washington) from 1989 through 1996 and a fourth (Georgia) from 1994 through 1996. The findings represent the first application of a consistent drug utilization review (DUR) screener program to Medicaid data across States. The study finds major differences in DUR failure rates among the four States with the lowest rates in Georgia and the highest in Washington. Only Iowa showed any population-level reduction in DUR failure rates during the study period, however, rates for community-dwelling elderly fell in most States.

Drug Therapy↗
PubMed1986

Further observations in the ultrasound evaluation of renal allograft rejection.

In order to determine whether sonographic parenchymal changes and volume changes are reliable predictors of acute transplant rejection, 36 recipients of renal allografts were studied. The significance of graft volume changes was evaluated, since most previous studies have not utilized routine immediate postoperative baseline scans for comparison to follow-up scans. All patients had baseline scans within 24 hours of the transplant. All 24 acute rejection patients had biopsy proof of rejection within three days of the follow-up scans. Seven clinically normal and five clinically designated acute tubular necrosis (ATN) patients were studied for comparison. A retrospective blind review utilizing three sonologists and previously described criteria combined with calculated volume changes demonstrated an overall sensitivity of 85 per cent and specificity of 94 per cent for the detection of acute rejection. The kidneys with acute rejection had an average volume increase of 73 per cent vs. 27 per cent for ATN patients and 24 per cent for normal patients, a statistically significant difference.

Acute Disease↗
PubMed1992

Observations and effects of educational consults on allopurinol prescribing.

Allopurinol has been used in the management of hyperuricemic states for several years. Despite its efficacy for these indications, recent concerns have been raised regarding the unnecessary morbidity and mortality occasionally associated with its inappropriate use. In an effort to assess the utilization of allopurinol, a concurrent drug utilization review was undertaken. Fifty patients who were prescribed allopurinol were entered into the study and underwent health record review and patient interview, to determine appropriateness of therapy and the need for educational intervention. A number of inconsistencies with regard to established guidelines were identified. As well, 11 of 50 patients (22%) required intervention because of either lack of indication or excessive dose. Fifty-five percent of the educational interventions, performed by the pharmacist, were accepted as written. The current utilization of allopurinol at our facility differs substantially from guidelines developed for optimal utilization of allopurinol. Further, a pharmacy based intervention program can improve prescribing practices of allopurinol.

Aged↗
PubMed2001

The Wal-Marting of American psychiatry: an ethnography of psychiatric practice in the late 20th century.

OBJECT: U.S. psychiatry has been radically reorganized by changes in the way the psychiatric hospital, the asylum, is funded. The imposition and internalization of cost control measures are major elements of this reorganization. This paper traces the ways in which cost control methods associated with managed care have produced new ways of organizing and patterning clinical work and clinical knowledge. METHODS: Participant observation, used in qualitative sociological research, was undertaken in three settings: a public hospital, a private hospital with roots in the history of the asylum, and a for-profit hospital chain. The research consisted of observation of usual clinic practices and interviews with clinicians and ancillary staff, such as utilization reviewers, concerning their construction of and understandings about their work experience. In addition, interviews with personnel at a number of managed care companies was arranged although actual ethnographic experience was not performed in these companies due to declined permission. Interviews included clinicians whose experiences bridged the pre- and post-managed care eras. RESULT: This paper argues that the widespread adoption of Quality Assurance and Utilization Management procedures has created new standards of evaluation and treatment. These standards grow out of a transition from a person-centered to a population-based data base. They are justified by a conviction on the part of managed care proponents that good clinical treatment is equivalent to efficient cost control. This epistemological change results in the development of a clinical knowledge patterned along algorithmic pathways rather than subjective understanding. An increased and more rapid rationalization of psychiatry is the result. This rationalization process has produced moral dilemmas for practicing clinicians as they struggle to redefine their professional purposes and identities within a new order. CONCLUSION: The rise of the 'Quality Movement' has led to the reconstruction of clinical knowledge as a result of the imposition of social practices influenced by the cultural consequences of capitalism. A peculiarly American psychiatry is the result.

Algorithms↗
PubMed2006

Minimizing symptoms in patients with ureteric stents.

PURPOSE OF REVIEW: The current approaches for minimizing symptoms in patients with ureteric stents were reviewed utilizing a literature search on Pubmed using the keywords stent, symptom, and ureter. RECENT FINDINGS: Ureteral stents are widely used in urological procedures for maintaining upper urinary tract drainage to relieve obstruction, pain, or infection. Indwelling stents, however, are associated with significant morbidity such as infection, encrustation, hematuria, and bothersome symptoms. Minimizing these issues has become paramount in the design of new ureteral stents. This article will review current and novel ways to minimize stent-related morbidity. SUMMARY: Currently, there is no ideal stent that relieves obstruction, is resistant to infection and encrustation, and is comfortable for patients. Advances in biomaterials and design will result in a more biocompatible stent that also has patient comfort in mind.

Humans↗
PubMed1996

Physician-run health plans and antitrust. American College of Physicians.

As the health care system changes and large managed care entities gain greater control in some markets, proponents of antitrust reform have expressed concern that physicians could lose their autonomy. To respond to this concern, the American College of Physicians has consistently argued that physicians should be allowed to establish their own health plans and networks to provide high-quality and cost-effective care. Moreover, the College has advocated utilization review reform and due process protections to empower physicians in their dealings with insurers. Under current antitrust law, as interpreted by the federal enforcement agencies, physicians already have the legal authority to form their own health plans and networks, and many state medical societies are sponsoring such plans. The law also allows physicians to operate the clinical components of a health plan, regardless of who owns it. Moreover, physicians can share information about quality, utilization, and, in some circumstances, fees. An examination of federal enforcement agency actions since the mid-1970s shows that physician networks have rarely been challenged. In light of market developments, however, the College has urged the federal antitrust agencies to analyze the effect of their current enforcement policies on physician activities and adopt a more flexible approach. Further monitoring and analysis of the changing health care marketplace are necessary to ensure that physicians are being treated fairly and to determine which factors spur or inhibit the development of physician-run health plans and networks.

Antitrust Laws↗
PubMed1994

Prescribing practices of outpatient child psychiatrists.

OBJECTIVE: This study was designed to assess outpatient child psychiatrists' prescribing practices. METHOD: Of 1,422 outpatients in two public, university affiliated settings in New York and Ohio, the charts of 146 medicated and 126 nonmedicated randomly selected patients were reviewed for demographic variables, DSM-III-R diagnoses, medications prescribed, and charted prescription rationales. RESULTS: Fifteen percent of the 800 outpatients seen in a 1-month period in New York, and 19% of the 626 outpatients seen in a 1-year period in Ohio were prescribed medication. Patients medicated by clinic psychiatrists were significantly more likely than nonmedicated patients to be psychotic and to have been hospitalized previously, and significantly less likely to have adjustment disorder. Using standards employed by drug utilization review committees, medications were prescribed appropriately in approximately 90% of cases. Of concern, 65% of patients given antipsychotics in New York and 67% in Ohio were not psychotic; the primary target symptom in such cases was aggression. CONCLUSIONS: Prescribing practices appeared to be appropriate, although the use of antipsychotic medications in nonpsychotic children is a concern for the field of child psychiatry. The strong similarity of practices in two independent and geographically remote sites suggests the findings are generalizable to providers in other public, university affiliated settings.

Adolescent↗
PubMed1986

Plasma protein fraction and albumin use: the effect of medical staff education.

A 6-week audit evaluating the use of plasma protein fraction and albumin was conducted and study data demonstrated that these colloids were being inappropriately prescribed. The P & T Committee decided to use educational rather than restrictive methods to improve colloid prescribing. Follow-up audits were performed, one immediately following staff education and another 1 year after the first audit. Although the educational actions employed in this drug utilization review appeared to have an immediate impact, the effect was not sustained long-term, indicating the need for periodic medical staff education. Methods of effective educational intervention as reported in the literature are discussed.

Colloids↗
PubMedDate not supplied

How pharmacists respond to on-line, real-time DUR alerts.

OBJECTIVE: To quantify the type and frequency of drug utilization review (DUR) alerts sent by one claims processor to pharmacists; identify how pharmacists respond to these on-line, real-time DUR messages; and quantify the interventions taken by these pharmacists as a result of these alerts. DESIGN: Retrospective analysis of Medicaid claims from July 1, 1995, through June 30, 1996. SETTING: State of Delaware. PARTICIPANTS: 55,000 Medicaid recipients served by 170 participating pharmacies and 2,000 physicians. INTERVENTIONS: All on-line DUR alerts sent to pharmacists and the pharmacists' responses were categorized by alert type and analyzed by drug class. MAIN OUTCOME MEASURES: Pharmacists' response (dispensed prescription, contacted prescriber, talked with patient, consulted own reference sources) and drug classes. RESULTS: During the study period, 807,017 claims generated 83,260 DUR alerts involving 73,554 (9.1%) prescriptions. Prescriptions were not dispensed in 20.9% of cases because of the DUR message. Prescriptions were dispensed 17.7% of the time after the pharmacist contacted the prescriber, in 20.6% of cases after the pharmacist talked with the patient, and 37.2% of the time after reviewing internal resources. Action taken by pharmacists varied among and within DUR criteria categories. Specific examples of alerts generated in high-frequency and high-profile areas are reviewed, some of which generated inconsistent responses. CONCLUSION: Among Delaware Medicaid providers, drug alerts resulted in pharmacists not dispensing prescriptions in a surprising percentage of situations. Pharmacists' responses varied according to the drug class involved and the type of alert received.

Drug Interactions↗
PubMed1987

Reviewing the quality of care: priorities for improvement.

Rapid and substantial change in our health care system has prompted careful analysis of the quality of health care and the effectiveness of the methods used to review and improve quality. Although welcome, those applying this scrutiny must recognized that improvement in the quality of health care will take the concerted and cooperative efforts of health policymakers, health care practitioners, health care organizations, consumers of care, purchasers of care, and those organizations that define the state of the art and monitor the quality of care. Particular attention should be devoted to: Gaining a common understanding of the definition of high quality care. Utilizing review programs that are continuous, priority-oriented, and effective. Assuring that the indicators and criteria used in monitoring care are consistent with the practical state of the art. Recognizing the importance of and improving the effectiveness of peer review. Investing in improved diffusion of current clinical knowledge to practitioners. Being properly circumspect about how one best achieves improvement in areas of substandard care.

Evaluation Studies as Topic↗