Access to clinically indicated genetic tests for pediatric patients with Medicaid: Evidence from outpatient genetics clinics in Texas

PurposeLittle is known about how Medicaid coverage policies affect access to genetic tests for pediatric patients. Building upon and extending a previous analysis of prior authorization requests (PARs), we describe expected coverage of genetic tests submitted to Texas Medicaid and the PAR and diagnostic outcomes of those tests.MethodsWe retrospectively reviewed genetic tests ordered at 3 pediatric outpatient genetics clinics in Texas. We compared Current Procedural Terminology (CPT) codes with the Texas Medicaid fee-for-service schedule (FFSS) to determine whether tests were expected to be covered by Medicaid. We assessed completion and diagnostic yield of commonly ordered tests.ResultsAmong the 3388 total tests submitted to Texas Medicaid, 68.9% (n = 2336) used at least 1 CPT code that was not on the FFSS and 80.7% (n = 2735) received a favorable PAR outcome. Of the tests with a CPT code not on the FFSS, 60.0% (n = 1400) received a favorable PAR outcome and were completed and 20.5% (n = 287) were diagnostic. The diagnostic yield of all tests with a favorable PAR outcome that were completed was 18.7% (n = 380/2029).ConclusionMost PARs submitted to Texas Medicaid used a CPT code for which reimbursement from Texas Medicaid was not guaranteed. The frequency with which clinically indicated genetic tests were not listed on the Texas Medicaid FFSS suggests misalignment between genetic testing needs and coverage policies. Our findings can inform updates to Medicaid policies to reduce coverage uncertainty and expand access to genetic tests with high diagnostic utility.     

Gynopia in nursing practice: the case of urethral catheterization

• ? A pilot study of catheterized women was designed to investigate their perceptions of pain and discomfort during the procedure.
• ? The study aimed to test the feasibility of conducting a larger randomized controlled trial.
• ? Problems were encountered during the execution of the study, due to the need to conform to established principles in clinical research.
• ? Restrictions on access to patients impinged upon the opportunity to ‘cast the net wide’ in order to generate meaningful data.

     

脉动真空灭菌柜对组装注射器灭菌效果的研究

本文为探讨注射器组装后在脉动真空灭菌柜灭菌的效果,使用了嗜热脂肪芽胞杆菌菌片及染菌法进行了监测。结果表明,注射器组装后在脉动真空灭菌柜灭菌达到了无菌要求。组装后与分开包装灭菌无差异,为供应室在今后的工作中使用此法提供了理论依据     

Pilot study of a visitor volunteer programme for community elderly people receiving home health care

There is a need to evaluate community support programmes for elderly people. In this randomized control trial (RCT), we determined the effectiveness of 'friendly visitors' in a volunteer programme of a visiting nurses organization in Southern Ontario, Canada. The Volunteer Friendly Visitor Programme was developed to support elderly people receiving homemaking and nursing care in the community. Volunteers are screened, trained, interviewed and matched to homebound elderly clients for general interest, visit expectations and personality. Volunteers spend three to four hours on average per week with clients socializing in mutually agreed-upon ways. The nursing staff identified clients who were lonely for this additional support. These newly-referred clients were randomly allocated to receive a friendly visitor or not for six weeks. Those receiving the volunteer visitor improved in life satisfaction and two social support measures: worth and social integration. Thus, the addition of volunteer visitors to planned homemaking and nursing care made a difference for elderly in the community.     

Exposure to nicotine enhances acquisition of ethanol drinking by laboratory rats in a limited access paradigm

 Observations in humans suggest that the initial use of tobacco occurs in close temporal proximity to experimentation with alcohol. There have been relatively few research reports, however, examining possible interactions between these two agents. The present experiments examined the effect of nicotine exposure on the acquisition of ethanol drinking behavior in a limited access procedure. In experiment 1, rats were presented with 1-h access to ethanol solutions of increasing concentration for a period of 20 days. Subcutaneous injections of nicotine (0.6 or 1.2 mg/kg salt) or vehicle were administered 30 min prior to each ethanol presentation. Experiment 2 used a similar method, but rats were presented with water along with ethanol during the 1-h test session. Mecamylamine, a nicotinic receptor antagonist, was administered 30 min prior to the nicotine treatment. Nicotine was seen to produce a dose-dependent increase in ethanol drinking behavior which commenced at the 5% ethanol concentration and continued at 8% and again at 10%. In the second experiment, mecamylamine was observed to block completely the nicotine-induced increase in ethanol drinking behavior. The findings suggest that exposure to nicotine can facilitate the acquisition of ethanol drinking behavior in naive rats and that this effect is mediated by nicotine’s interaction at the nicotinic-cholinergic receptor. Received: 11 June 1998 / Final version: 1 October 1998     

Age and sex differences in the management of ischaemic heart disease

Objective

To investigate age and sex differences in the utilisation of hospital services for ischaemic heart disease.

Design

Analysis of routine mortality data and hospital activity data.

Setting

South West Thames Regional Health Authority.

Subjects

Residents of the South West Thames Regional Health Authority who in 1991 either died from ischaemic heart disease or were admitted to an NHS hospital in England and Wales with a main diagnosis of ischaemic heart disease.

Main outcome measures

Ratio of consultant episodes to deaths from ischaemic heart disease (as a proxymeasure of the utilisation of hospital care), and the percentages of consultant episodes in which further investigation (angiography or catheterisation) or revascularisation treatment (coronary artery bypass grafting or angioplasty) were carried out.

Results

The ratio of episodes to deaths was similar in men and women (odds ratio for men vs. women 0.96, 95% confidence intervals 0.90 to 1.03). The percentage of episodes in which further investigation was carried out was higher in men than women (odds ratio for men vs. women 1.46, 95% confidence intervals 1.25 to 1.70) as was the percentage of episodes in which revascularisation treatment was carried out (odds ratio for men vs. women 1.46, 95% confidence intervals 1.20 to 1.77). The ratio of episodes to deaths, the percentage of episodes in which further investigation was carried out, and the percentage of episodes in which revascularisation treatment was carried out all declined with age (all p values <0.001).

Conclusions

Women with ischaemic heart disease are as likely as men to be admitted to hospital, but afteradmission are less likely to undergo further investigation and revascularisation treatment. Elderly patients with ischaemic heart disease are less likely than younger patients to be admitted to hospital; after admission, they are also less likely to undergo further investigation and revascularisation treatment. Further research is needed to determine whether these age and sex differences in the use of hospital services are clinically justified.     

Direct and indirect acquisition of syringes from syringe exchange programmes in Baltimore, Maryland, USA

Syringe exchange programmes (SEPs) are a fundamental source of sterile syringes and other health services for injection drug users (IDUs). However, various obstacles prevent many individuals from obtaining syringes from this source. As a result, some IDUs acquire syringes from “secondary exchangers”. The current study assessed the acquisition of syringes from the Baltimore City Needle Exchange Program (BNEP) as well as factors associated with obtaining syringes from the BNEP. Participants were asked to identify the colour of the cap of the most recently obtained syringe (red or grey cap suggested BNEP origins). In addition, support and risk network variables were examined. Although 38% reported using a syringe with a grey or red cap, only 7% reported that the BNEP was their primary source of syringes. Multivariate analyses showed that reporting the most recent syringe cap as red or grey was associated with obtaining syringes from the BNEP, obtaining syringes from a spouse, obtaining syringes from friends/neighbours, and number of drug users in their network. Based on these findings, encouraging secondary exchange is an effective method of providing injectors with syringes.