Effects of managed care on alcohol and other drug (AOD) treatment

The article represents the proceedings of a symposium at the 2001 RSA Meeting in Montreal, Canada. The organizer/chair was Stephen Magura. The presentations examined: (1) How managed care organization policies may affect enrollees' use of alcohol and other drug (AOD) treatment, by Constance Horgan and associates; (2) The determinants of patients' access to and utilization of AOD treatment in a large health maintenance organization, by Jennifer R. Mertens and Constance Weisner; (3) The impact on treatment access and costs of a statewide carve-out for AOD treatment for Medicaid, by Donald Shepard and associates; and (4) The predictive validity of a new patient assessment technology developed, in part, to better justify AOD treatment in response to the demands of managed care, by Stephen Magura and associates.     

A gap in formal long-term care use related to characteristics of caregivers and households,under the public universal system in Japan: 2001–2010

We investigated whether the universal provision of long-term care (LTC) under Japan's public system has equalized its use across households with different socio-economic characteristics, with a special focus on the gender and marital status of primary caregivers, and income. We used repeated cross-sectional data from national household surveys (2001, 2004, 2007, and 2010) and conducted multiple logistic regression analyses to obtain odds ratios of caregiver and household characteristics for service use, adjusting for recipients’ characteristics. The results showed that the patterns of service use have been consistently determined by caregivers’ gender and marital status over the period despite demographic changes among caregivers. The gap in service use first narrowed, then widened again across income levels after the global economic recession. The results indicate that the traditional gender-bound norms and capacity constraints on households’ informal care provision remained influential on decisions over service use, even after the universal provision of formal care. To improve equality of service utilization, the universal LTC system needs to meet diversifying needs of caregivers/recipients and their households, by overcoming barriers related to gender norms and economic disparity.     

贵州省医学科研人员对查新报告利用现状调查

采用问卷调查结合访谈形式,对贵州省主要医疗机构的的科研人员进行查新咨询信息利用状况及影响因素的调查,指出影响查新报告利用的相关因素,并提出针对性的改进对策,以提高医学科研人员对查新报告的利用,提升查新服务水平,更好地为科研工作服务。     

从文献计量看信息组织与医学生信息素养教育

信息化社会对医学人才提出了更高的要求,医学教育除了专业知识与技能,还必须进行包括信息检索、组织与利用等内容的信息素养教育。本文采用文献计量学方法对国内医学生信息素养教育内容进行分析,发现在医学生信息素养教育方面关于信息组织培养的内容普遍较少。而在大数据环境下,信息组织与利用能力对新一代医学人才的培养及医学科学发展具有重要意义。由此,本文提出应加强对医学生的信息组织教育,发挥信息组织在医学生信息素养培养中的作用。     

2011年-2013年某院清洁切口手术围手术期抗菌药物使用分析

目的评价通过采取多种管理手段对清洁切口手术围手术期抗菌药物使用合理性的影响。方法通过强化医生培训、加强医院感染管理、加大质控力度等多项措施进行控制管理。结果抗菌药物使用率从43.62%下降到19.6%,品种选择合理率从80.66%上升到97.63%;术前合理使用率从91.7%上升到98.83%;疗程合理率从77.73%上升到98.83%;杜绝了两种及以上抗菌药物联合用药作为预防使用。结论通过有效的管理手段可以规范围手术期的抗菌药物使用,保障患者安全。     

The use of rheumatoid arthritis health‐related quality of life patient questionnaires in clinical practice: Lessons learned

Objective

The utilization of health‐related quality of life (HRQOL) patient questionnaires by clinical rheumatologists is limited. Yet, considerable literature exists defining the value of such data. In an effort to understand this apparent paradox, we performed a literature review and conducted a survey to describe what has been learned over the past 2 decades concerning the use of these measures in clinical care and explore the reasons for their underutilization.

Methods

A panel of rheumatologists with extensive clinical experience was convened to review the relevant literature pertaining to the use of HRQOL patient instruments in clinical practice. Additionally, a survey of all American College of Rheumatology practicing clinicians was conducted to assess the use of and beliefs about these measures.

Results

The literature provided evidence to support the use of HRQOL patient measures in clinical practice. Forty‐seven percent of the responding rheumatologists stated that none of their patients complete HRQOL patient questionnaires. The majority of respondents (63%) reported that such information is “somewhat valuable.” The most frequently reported reason for the underutilization was that such instruments “require too much staff time.”

Conclusions

The literature supports the potential value of HRQOL patient questionnaires in clinical practice. Few rheumatologists routinely gather such information as part of patient care. Reasons for this discrepancy between utility and use are given along with recommendations intended to help increase their utilization in clinical care.

     

Neoplastic and non‐neoplastic complications of solid organ transplantation in patients with preexisting monoclonal gammopathy of undetermined significance

Monoclonal gammopathy of undetermined significance (MGUS) occurs in 3–7% of the elderly population, with higher prevalence in renal failure patients, and is associated with a 25‐fold increased lifetime risk for plasma cell myeloma (PCM), also known as multiple myeloma. Using the California State Inpatient, Emergency Department, and Ambulatory Surgery Databases components of the Healthcare Cost and Utilization Project (HCUP), we sought to determine whether patients with MGUS who undergo solid organ allograft (n = 22 062) are at increased adjusted relative risk (aRR) for hematologic malignancy and other complications. Among solid organ transplant patients, patients with preexisting MGUS had higher aRR of PCM (aRR 19.46; 95% CI 7.05, 53.73; p < 0.001), venous thromboembolic events (aRR 1.66; 95% CI 1.15, 2.41; p = 0.007), and infection (aRR 1.24; 95% CI 1.06, 1.45; p = 0.007). However, when comparing MGUS patients with and without solid organ transplant, there was decreased aRR for PCM with transplant (aRR 0.34; 95% CI 0.13, 0.88; p = 0.027), and increased venous thromboembolic events (aRR 2.33; 95% CI 1.58, 3.44; p < 0.001) and infectious risks (aRR 1.44; 95% CI 1.23, 1.70; p < 0.001). While MGUS increased the risk of PCM overall following solid organ transplantation, there was lower risk of PCM development compared to MGUS patients who did not receive a transplant. MGUS should not preclude solid organ transplant.     

北京市东城区基层全科医生对糖尿病中医指南的利用和需求调查

背景　中医药具有“简、便、效、廉”的特点,在糖尿病防治领域被广泛研究应用,尤其在糖尿病前期及并发症治疗方面优势明显。目的　了解北京市东城区基层全科医生对《糖尿病中医药临床循证实践指南》（《指南》）的应用和需求情况。方法　于2018年7-8月,采用整群抽样法选取北京市东城区7个社区卫生服务中心和34个社区卫生服务站的全体基层卫生人员共304例为研究对象,其中中医138例,西医166例。自行设计《指南》应用及需求状况调查问卷,内容涉及医师对患者进行中医健康教育情况、中成药使用情况、对本指南的知晓情况及培训需求状况。结果　中医全科医生年龄、文化程度、工作年限、职称低于西医全科医生,差异有统计学意义（P<0.05）。138例中医全科医生中,133例（96.4%）对患者进行中医健康教育,127例（92.0%）使用中成药进行社区糖尿病防治;166例西医全科医生中,134例（80.7%）对患者进行中医健康教育,112例（67.5%）使用中成药进行社区糖尿病防治,两者比较,差异有统计学意义（χ2=17.274,P<0.001;χ2=27.038,P<0.001）。138例中医全科医生中,25例（18.1%）没听说过《指南》,94例（68.1%）听说过但未学习,19例（13.8%）了解并认真学习过;166例西医全科医生中,33例（19.9%）没听说过,108例（65.1%）听说过但未学习,25例（15.0%）了解并认真学习过,两者比较,差异无统计学意义（χ2=0.316,P=0.854）。中医全科医生中,男性《指南》学习率高于女性（P<0.05）;随年龄增长、学历降低、职称升高、工作年限增长,《指南》学习率增高（P<0.05）。138例中医全科医生中,126例（91.3%）有《指南》培训需求;166例西医全科医生中,144例（86.7%）有《指南》培训需求,两者比较,差异无统计学意义（χ2=1.576,P=0.209）。138例中医全科医生中,50例（36.2%）希望采用面对面培训《指南》,63例（45.7%）希望采用视频培训,25例（18.1%）认为两者兼可;166例西医全科医生中,59例（35.5%）希望采用面对面培训,69例（41.6%）希望采用视频培训,38例（22.9%）认为两者兼可,两者比较,差异无统计学意义（χ2=1.129,P=0.569）。结论　北京市东城区基层全科医生《指南》知晓率、学习率较低,应加强《指南》社区推广,尤其在年龄低、职称低、工作年限短的中医全科医生群体中推广。