Assessing Student Pharmacists’ Ability to Identify Drug-Related Problems in Patients Within a Patient-Centered Medical Home

Objective. To quantify, describe, and categorize patient drug-related problems (DRPs) and recommendations identified by fourth-year (P4) student pharmacists during a live medication reconciliation activity within a patient-centered medical home (PCMH).Methods. Fourth-year student pharmacists conducted chart reviews, identified and documented DRPs, obtained live medication histories, and immediately provided findings and recommendations to the attending physicians. Documentation of DRPs and recommendations were analyzed retrospectively.Results. Thirty-eight students completed 99 medication reconciliation sessions from June 2011 to October 2012 during their advanced pharmacy practice experience (APPE). The students obtained 676 patient medication histories and identified or intervened on 1308 DRPs. The most common DRPs reported were incomplete medication list and diagnostic/laboratory testing needed. Physicians accepted 1,018 (approximately 78%) recommendations.Conclusion. Student pharmacists successfully identified and reduced DRPs through a live medication reconciliation process within an academic-based PCMH model. Their medication history-taking skills improved and medication use was optimized.     

Frequency and erroneous usage of temporary medical exemptions and knowledge of immunization guidelines among some Miami-Dade County Florida providers

Objective

We assessed knowledge and practices regarding immunization guidelines and the Florida Certificate of Immunization (DH-680) based on FL-DOH and CDC recommendations, to identify the cause of the increasing number of erroneously issued temporary medical exemptions (TME) among selected health care providers in Miami-Dade County Florida.

Methodology

After reviewing immunization certificates from all public schools, a list of physicians who improperly issued 3 or more TMEs, defined as one given to a child who was up to date for their kindergarten and seventh grade requirements, was compiled. The DOH-Miami-Dade developed educational materials and questionnaires, and conducted face-to-face interviews and interventions during site visits to these providers (n = 134). Data was analyzed using SAS 9.2.

Results

Of the 104 questionnaires completed, 4 (3.85%) had correct answers to all 10 vaccine knowledge and practice related questions, while 10 (9.62%) had 7 or more incorrect answers. Frequently missed questions included: the required doses of varicella vaccine for seventh grade students entering the 2011–12 school year (86, 82.7%) and the proper scenario for issuing a TME (57, 54.8%).

Conclusions

In order to eliminate the improper use of TMEs, long-term efforts are needed to provide immunization-related educational materials and trainings to the medical community regarding vaccinations. These findings also suggest a need for enhanced explanation in multiple languages on the current Florida Immunization Certificate. Due to enhanced surveillance and education, the number of TMEs for kindergarten and seventh grade students was reduced by 12% and 4.9%, respectively, during the 2011 and 2012 school year.     

新医改前后新型农村合作医疗基金生产率变化研究

目的:研究新医改前后,山东省某市7个县新型农村合作医疗基金的生产率变化。方法:选取年参合人数、年筹资总额指标作为投入指标,选取各级医疗机构补偿总人次和补偿总额作为产出指标。利用Excel 2010建立数据库,使用DEAP2.1软件,分析7个县市的新型农村合作医疗基金全要素生产率变化、技术效率变化和技术进步变化。结果:在新医改后,新型农村合作医疗基金的全要素生产率呈降低趋势(tfpch改革前=1.314,tfpch改革后=1.103,t=3.533,P=0.006);新型农村合作医疗基金的技术效率变化不明显(effch改革前=1.037,effch改革后=1.001,t=1.560,P=0.085);新型农村合作医疗基金的技术进步显著降低(tech改革前=1.278,tech改革后=1.112,t=4.856,P=0.001);结论:山东省某市7个县新型农村合作医疗基金在新医改前后生产率变化明显,诸多新医改政策的层叠效应有效抑制了医疗服务供需双方的行为,不断攀升的次均住院补偿费用影响了基金的受益面,从而影响了新型农村合作医疗基金的使用效率。     

医疗质量与费用之间的复杂关系：基于美国医疗卫生服务的分析

提高医疗质量、降低费用是各国医疗卫生发展的重点。各国都在努力实现医疗资源的最大化利用,以提高医疗服务的成本效益,但结果并不理想,尤其是美国。文章首先论述了医疗质量与费用的相关研究及理论框架,然后分析了美国的医疗质量与费用的关系及其所做的努力,为今后的政策制定提供了依据。     

城镇职工基本医疗保险住院费用拒付原因及对策——以昆明市某三甲医院为例

随着城镇职工基本医疗保险覆盖范围的不断扩大,医保病人数量呈逐年上升趋势,医保拒付问题已成为困扰医保定点医院的一大难题。笔者以昆明市某三甲医院为例,分析了城镇职工基本医疗保险住院费用拒付原因并给出相应对策。