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Biomedical subjects

E S Fernandez

Publications and source records attributed to E S Fernandez.

5 recordsLinked to original sources
PubMed1997

The need for comprehensive data on educational affiliations between academic health centers and managed care organizations.

Because of the emerging dominance of managed care, it is important to encourage the development of partnerships and affiliations between academic health centers (AHCs) and managed care organizations (MCOs) to train tomorrow's physicians to operate effectively in the new health care environment. But to what extent do such relationships exist now. In 1996, the authors sought to identify existing databases on the availability and extent of existing education partnerships and affiliations between AHCs and MCOs and the availability of such information to policymakers, the educational community, students, and residents. Despite a thorough search of the literature and interviews with representatives of education and practice organizations and with other experts in the medical education and managed care fields, the authors found no centralized or even partly centralized database on opportunities for training in managed care settings or on AHC-MCO partnerships. However, anecdotal evidence revealed eight such partnerships, each different from the others, that can serve as models for future partnerships; these are described. The authors speculate about why there are not more data describing AHC-MCO partnerships. They conclude by stating that the health care and health education industries have a variety of professional associations that could work together to assemble and make available such data to help build the educational and information infrastructure needed to train future physicians.

Academic Medical Centers↗
PubMed1997

Cost of medication therapy in ambulatory HIV-infected patients.

OBJECTIVE: To examine the use and cost associated with prescribed medications as well as the use of over-the-counter medications and nontraditional therapies among ambulatory HIV-infected patients at Ryan White Title IIIb grantee centers. METHODS: Study participants (n = 223) were enrolled from eight centers across the US and Puerto Rico. Data were collected by a nurse, pharmacist, or physician through review of medical records and medication profiles. Information on the use of over-the-counter drugs and alternative therapies was obtained from the patients. RESULTS: Two hundred eleven (94.6%) patients received a mean +/- SD of 5.3 +/- 3.8 prescription medications during a consecutive 90-day period. The cost of medication was $1237.62 +/- $1751.49 per patient. Patients with a diagnosis of AIDS received a greater number of prescription drugs: an average of 6.6 compared with 3.4 among HIV-positive patients and 3.5 among asymptomatic patients. Antiretroviral agents were used by 143 (68.7%) patients. Zidovudine and stavudine had the highest cost ($611.81 +/- $254.10 and $596.96 +/- $352.80, respectively). Eighty-one (40.9%) patients reported the use of at least one over-the-counter product (range 0-11) and 11.8% reported use of alternative therapies. CONCLUSIONS: This study shows the cost of drug treatment for HIV-infected patients has remained stable since the early 1990s. However, it is anticipated this will change due to the introduction of new anti-HIV agents, greater use of combination therapies, greater use of prophylactic therapies, and increased survival times.

AIDS-Related Opportunistic Infections↗
PubMed1993

The HIV-infected house officer: residency training issues.

Efforts to fully integrate physicians infected with the human immunodeficiency virus (HIV) into residency programs have been complicated by concerns of the potential risks of viral transmission from physician to patient. Despite numerous studies, this potential risk has not been quantified. This article addresses the issue of HIV-infected interns and residents, classifying HIV as a potential disability. The suggested recommendations emphasize routine monitoring and evaluation of professional competence and compliance with proper infection control procedures, as delineated by the Centers for Disease Control and Prevention. The need for hospitalwide guidelines and adequate health and disability insurance are also discussed.

Female↗
PubMedDate not supplied

Downsizing the physician workforce.

OBJECTIVE: To estimate the need for downsizing the physician workforce in a changing health care environment. METHODS: First assuming that 1993 physician-to-population ratios would be maintained, the authors derived downsizing estimates by determining the annual growth in the supply of specialists necessary to maintain these ratios (sum of losses from death and retirement plus increase necessary to parallel population growth) and compared them with an estimate of the number of new physicians being produced (average annual number of board certificates issued between 1990 and 1994). Then, assuming that workforce needs would change in a system increasingly dominated by managed care, the authors estimated specialty-specific downsizing needs for a managed care dominated environment using data from several sources. RESULTS: To maintain the 1993 199.6 active physicians per 100,000 population ratio, 14,644 new physicians would be needed each year. Given that an average of 20,655 physicians were certified each year between 1990 and 1994, at least 6011 fewer new physicians were needed annually to maintain 1993 levels. To maintain the 132.2 ratio of active non-primary care physicians per 100,000 population, the system needed to produce 9698 non-primary care physicians per year, because an average of 14,527 new non-primary care physicians entered the workforce between 1990 and 1994, downsizing by 4829, or 33%, was needed. To maintain the 66.8 active primary care physicians per 100,000 population ratio, 4946 new primary care physicians were needed per year, since primary care averaged 6128 new certifications per year, a downsizing of 1182, or 20% was indicated. Only family practice, neurosurgery, otolaryngology, and urology did not require downsizing. Seventeen medical and hospital-based specialties, including 7 of 10 internal medicine subspecialties, needed downsizing by at least 40%. Less downsizing in general was needed in the surgical specialties and in psychiatry. A managed care dominated-system would call for greater downsizing in most of the non-primary care specialties. CONCLUSION: These data support the need for downsizing the nation's physician supply, especially in the internal medicine subspecialties and hospital support specialties and to a lesser extent among surgeons and primary care physicians.

Health Services Needs and Demand↗