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Ambulatory heart failure management in private practice in France.

UNLABELLED: Management of ambulatory heart failure was assessed in a group of 600 patients, mean age 73, 64% males, NYHA I: 9%; II: 52%; III: 33%; IV: 6%; followed up by a representative sample of private cardiologists. Fifty-two percent of patients had been previously hospitalised for worsening heart failure with a mean duration of stay of 13.1 days, for those hospitalised in the year preceding the survey (26%). First diagnosis of heart failure had been performed by a cardiologist (57%), a general practitioner (37%) or another category of physician (6%). Seventy percent of patients received three or more different classes of heart failure medications. Diuretics were prescribed to 71%, angiotensin converting enzyme inhibitors to 54% and digitalis to 35% of the population. Beta-blockers were given to only 14% of the patients. In patients aged over 80 years, only 45% received angiotensin converting enzyme inhibitors. CONCLUSION: This survey of ambulatory heart failure patients confirms that the disease is predominantly observed in elderly patients, and associated with prolonged and recurrent hospitalisations. The underuse of recommended therapeutic classes including angiotensin converting enzyme inhibitors and beta-blockers deserves further investigation.

Age Distribution↗

Outpatient treatment: community and private practice support systems.

Support systems and psychosocial techniques in the outpatient care of schizophrenia are discussed. Such approaches as social skills training, behavior modification, major role therapy, and family management can be used in both the public and private sectors to foster treatment adherence and increase patients' ability to function in the community. Steps in establishing an effective aftercare program are outlined, and it is suggested that the development of community coordination centers can enhance efforts to reduce rehospitalization and improve vocational and social functioning.

Aftercare↗

Activity-based costing management in a private practice setting.

Activity-based costing is a method of calculating cost of a service, focusing on operations. It gives quick and tangible cost information to operations and financial managers. While this method has be used more in the manufacturing area, it is gaining acceptance in the medical practice. This article describes activity-based costing and illustrates how to start utilizing it in a practice.

Cost Allocation↗