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PubMed2000

Progress in national control and assurance programs for bovine Johne's disease in Australia.

Cattle strains of Mycobacterium paratuberculosis are known to infect cattle, goats and alpaca in southeastern Australia, where there are also significant numbers of farmed deer. Although sheep strains have recently been identified in some cattle in Australia, epidemiological evidence to date supports the distinction (between bovine Johne's disease (JD), caused by cattle strains in cattle, goats and alpaca, and ovine JD, caused by sheep strains in sheep and goats) for the purposes of control and assurance programs. The National Johne's Disease Control Program is coordinated by the Australian Animal Health Council, working with the livestock industries and with the Commonwealth, state and territory governments. The council also brokers industry and government funding for the program. The National Johne's Disease Market Assurance Program for Cattle was launched in 1996 as the first of a suite of voluntary national market assurance programs (MAPs) to assess and certify herds as negative for JD. By December 1998, over 550 herds had achieved an assessed negative status. A MAP was also launched for alpaca in 1998 and a program for goats should be finalized in early 1999. National standards for state control of JD through zoning, movement controls and procedures in infected and suspect herds have also been developed. The paper covers factors affecting development and implementation, uptake of and improvements to national control and assurance programs for bovine JD in Australia.

Animal Husbandry↗
PubMed2001

Verification of good production practices that reduce the risk of exposure of pigs to Trichinella.

Control of Trichinella infection in swine has traditionally been accomplished by inspection of individual carcasses or by post-slaughter processing to inactivate parasites. Recent declines in prevalence of this parasite in domestic swine, coupled with improvements in swine management systems, offer the opportunity to document pork safety during the production phase. We report here on a certification pilot study using an audit to document good production practices for swine relative to the risk of exposure to trichinae. Based on the results, improvements in the program have been made and further studies will be undertaken prior to launching a voluntary trichinae herd certification program in the United States.

Abattoirs↗
PubMed1996

Day hospital/crisis respite care versus inpatient care, Part I: Clinical outcomes.

OBJECTIVE: The authors investigated the clinical feasibility and the outcome for patients of a program designed as an alternative to acute hospitalization. METHOD: This was a random-design study comparing a conventional inpatient program for urban, poor, severely ill voluntary patients who usually require hospitalization to an alternative experimental program consisting of a day hospital linked to a crisis residence. Patients were assessed with standardized measures of symptoms, functioning, social adjustment, quality of life, and satisfaction with clinical services upon admission to the study, at discharge from the index admission, and at follow-ups 2, 5, and 10 months after discharge. RESULTS: One hundred ninety-seven patients were enrolled in the 2-year research program and followed for 10 months. Of the voluntary patients who would have been admitted to the hospital, 83% were appropriate for the experimental program. The clinical, functional, social adjustment, quality of life, and satisfaction outcome measures were not statistically different for the patients in the two treatment conditions; however, there was a slightly more positive effect of the experimental program on measures of symptoms, overall functioning, and social functioning. CONCLUSIONS: The experimental condition, a combined day hospital/crisis respite community residence, seems to have had the same treatment effectiveness as acute hospital care for urban, poor, acutely ill voluntary patients with severe mental illness.

Community Mental Health Services↗
PubMed2006

Evaluating the effectiveness of a Senior Mentor Program: the University of Missouri-Columbia School of Medicine.

At the University of Missouri-Columbia School of Medicine, we developed a voluntary senior-mentor program, the Senior Teacher Educator Partnership (STEP), for first- and second-year medical students. Using qualitative research methods, we examined the impact of STEP on medical students' attitudes and then assessed the congruence of what is learned through STEP with the knowledge, skills, and attitudes needed to provide care to the elderly patient. STEP was found to be a successful strategy for teaching themes of recognizing the elderly within an ecological context, enhancing sympathy and empathy, emphasizing respect for elderly persons, and gaining an appreciation that aging is an individualized process. New areas identified for student learning experiences included understanding the complexity of the health care system and its impact on elderly patients, understanding the payment system, and developing skills in assessment and care coordination. A model is described for continuous enhancement of educational programs to be used to improve educational experience in geriatrics.

Adult↗
PubMed1979

An analysis of nonconfirmation rates. Experiences of a surgical second opinion program.

A review was conducted of the first 12 months' experience with a voluntary second opinion surgery consultation program. The program covers approximately 950,000 persons: employees of the city of New York, retirees, and their dependents. On a simple yes or no basis, the program's surgical nonconfirmation rate was 25%. More detailed analysis of consultants' narrative suggestions for patient care showed that a firm rejection of surgical intervention occurred in only 8% of the cases reviewed. Nonconfirmation rates were found to be unsatisfactory measures of program success in preventing potentially unnecessary surgery. Data from second surgical opinion programs should not be used to estimate the prevalence of unnecessary surgery in a community. The key benefit of such programs may be to facilitate and to encourage patient-physician communication.

Cost Control↗
PubMed2000

Volunteer bias in nonrandomized evaluations of the efficacy of needle-exchange programs.

OBJECTIVE: Nonrandomized comparisons of the incidence of HIV and hepatitis B and C between injection drug users (IDUs) who do and do not attend voluntary needle-exchange programs may be subject to bias. To explore possible sources of bias, we examined characteristics associated with voluntarily beginning or ceasing to participate in the Seattle needle exchange. METHODS: In a cohort of 2,879 IDUs, a standardized questionnaire measured characteristics present at enrollment. We examined the relation of these characteristics to the proportion of IDUs who began to use the program during the ensuing 12-month follow-up period and to the proportion of current exchangers who dropped out during that period of time. RESULTS: Of the 494 never-exchangers at baseline, 32% attended the exchange program during follow-up; those who reported sharing syringes or who were homeless at enrollment were more likely to become new exchange users (adjusted risk ratio [ARR] for becoming an exchange user = 1.8 for those who shared syringes, and ARR = 2.2 for those who were homeless). Of 1,274 current exchangers, 16% stopped using the exchange during followup, with daily injectors (ARR = 0.6) and those who reported backloading (ARR = 0.6) being relatively less likely to drop out of the exchange. CONCLUSIONS: The analysis suggests that IDUs participating in needle-exchange programs at a given point in time may include a particularly high proportion of those injectors whose pattern of drug use puts them at elevated risk of blood-borne viral infections.

Adult↗
PubMed1994

Measuring second-order selection bias in a work site health program.

Magnitude and direction of second-order self-selection bias were assessed in a sample of 93,807 IBM employees who participated in the company's Voluntary Health Assessment (VHA) Program, by comparing repeat participants with one-time participants and by simulating selection into the repeat sample. One-time and repeat VHA participants differed systematically but not uniformly in several health characteristics. Repeat participants improved significantly in risk-relevant behaviors and health risk measures. Simulation of selection bias by excluding healthier or less healthy participants from the repeat VHA sample showed findings of gain to be robust. In studies of gain, second-order selection bias cannot automatically be assumed to inflate gain nor to be of sufficient magnitude to affect conclusions about program effects. Simulation is a useful tool for gauging direction and magnitude of selection bias.

Adult↗
PubMed1999

Critical incident stress management and the assaulted staff action program.

Critical Incident Stress Management (CISM; Everly & Mitchell, 1999) is a clinical and administrative approach to address the psychological sequelae in the aftermath of critical incidents. CISM is a comprehensive, multicomponent crisis intervention procedure that spans pre-incident preparedness to acute crisis to post-crisis follow up. The Assaulted Staff Action Program (Flannery, 1998) is a voluntary, system-wide, peer-help, CISM crisis intervention program for employee victims of patient assault. ASAP's crisis intervention procedures and empirical results are used to illustrate the potential power and effectiveness of CISM approaches. The implications are discussed.

Crisis Intervention↗
PubMed2005

Medicare program; Medicare prescription drug benefit. Final rule.

This final rule implements the provisions of the Social Security Act (the Act) establishing and regulating the Medicare Prescription Drug Benefit. The new voluntary prescription drug benefit program was enacted into law on December 8, 2003 in section 101 of Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173). Although this final rule specifies most of the requirements for implementing the new prescription drug program, readers should note that we are also issuing a closely related rule that concerns Medicare Advantage organizations, which, if they offer coordinated care plans, must offer at least one plan that combines medical coverage under Parts A and B with prescription drug coverage. Readers should also note that separate CMS guidance on many operational details appears or will soon appear on the CMS website, such as materials on formulary review criteria, risk plan and fallback plan solicitations, bid instructions, solvency standards and pricing tools, plan benefit packages. The addition of a prescription drug benefit to Medicare represents a landmark change to the Medicare program that will significantly improve the health care coverage available to millions of Medicare beneficiaries. The MMA specifies that the prescription drug benefit program will become available to beneficiaries beginning on January 1, 2006. Generally, coverage for the prescription drug benefit will be provided under private prescription drug plans (PDPs), which will offer only prescription drug coverage, or through Medicare Advantage prescription drug plans (MA PDs), which will offer prescription drug coverage that is integrated with the health care coverage they provide to Medicare beneficiaries under Part C of Medicare. PDPs must offer a basic prescription drug benefit. MA-PDs must offer either a basic benefit or broader coverage for no additional cost. If this required level of coverage is offered, MA-PDs or PDPs, but not fallback PDPs may also offer supplemental benefits through enhanced alternative coverage for an additional premium. All organizations offering drug plans will have flexibility in the design of the prescription drug benefit. Consistent with the MMA, this final rule also provides for subsidy payments to sponsors of qualified retiree prescription drug plans to encourage retention of employer-sponsored benefits. We are implementing the drug benefit in a way that permits and encourages a range of options for Medicare beneficiaries to augment the standard Medicare coverage. These options include facilitating additional coverage through employer plans, MA-PD plans and high-option PDPs, and through charity organizations and State pharmaceutical assistance programs. See sections II.C, II.J, and II.P, and II.R of this preamble for further details on these issues. The proposed rule identified options and alternatives to the provisions we proposed and we strongly encouraged comments and ideas on our approach and on alternatives to help us design the Medicare Prescription Drug Benefit Program to operate as effectively and efficiently as possible in meeting the needs of Medicare beneficiaries.

Aged↗
PubMed2003

Newborn urine screening programme in the province of Quebec: an update of 30 years' experience.

The introduction of our voluntary mass screening programme in 1971, in the province of Quebec, has permitted us to detect different inborn errors of metabolism in the newborn population using a thin-layer chromatographic (TLC) technique with sequential use of different sprays on the same plate. Abnormalities in amino acids and organic acids are detected in urine filter paper specimens of 21-day-old babies. Initial parental compliance is 90% and climbs to 99.25% for repeat sample requests. Screening is centralized in one laboratory, while diagnosis, counselling, management and follow-up are done in four regional centres. Over 25 inherited Mendelian disorders can be identified. There have been certain modifications in our programme throughout the years in order to increase efficiency, screen for a larger number of disorders, improve the quality of the collection of the urine filter paper samples, increase parental compliance and better manage the data bank. However, one goal has remained a priority: early prevention of genetic diseases. We present an overall view of our screening programme with an add-on technique to detect different organic acidurias, our recent statistics and the modifications implemented over the years.

Amino Acid Metabolism, Inborn Errors↗
PubMed2000

Impact of interventions designed to increase market share and prescribing of fexofenadine at HMOs.

The impact of interventions designed to shift prescribing from loratadine to fexofenadine at HMOs was studied. Pharmacy claims data for a six-month preintervention period at four HMOs were analyzed to identify all new and refill prescriptions for loratadine, fexofenadine, astemizole, and cetirizine. The interventions consisted of a mandatory lockout of loratadine in favor of fexofenadine (at HMO A), a voluntary switch to fexofenadine promoted through letters to both physicians and members (HMO B), and a voluntary switch promoted through letters to physicians only (HMO C). There was no intervention at HMO D. Pharmacy claims data for the six months after each intervention program was implemented were analyzed to determine changes in the market share and prescribing of the study drugs. After the intervention programs were implemented, the market share of fexofenadine increased from 18.9% to 65.2% at HMO A, from 14.8% to 21.0% at HMO B, and from 20.7% to 23.8% at HMO C. Loratadine's market share decreased from 62.3% to 8.7% at HMO A, from 67.5% to 58.6% at HMO B, and from 70.5% to 65.3% at HMO C. HMOs A, B, and C each had greater shifts in market share for fexofenadine and loratadine than the control HMO. Changes in prescribing followed a similar pattern for the 25 physicians at each HMO who had most frequently prescribed loratadine during the preintervention period. The average cost per antihistamine prescription decreased 22.3% at HMO A. Prescription costs continued to rise at HMOs B, C, and D. Mandating the use of fexofenadine produced a significant increase in its market share, reduced the cost of nonsedating antihistamines, and successfully influenced prescribing behavior. Voluntary programs had a more modest impact on market share and did not stop increases in prescription costs.

Analysis of Variance↗