Family practice-friendly guidelines. Anti-infective guidelines (1994-2005).
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Anti-Infective Agents↗
Biomedical subjects
J Pilla
Publications and source records attributed to J Pilla.
Pilot study for appropriate anti-infective community therapy. Effect of a guideline-based strategy to optimize use of antibiotics.
OBJECTIVE: To determine whether a community-wide, multi-intervention educational strategy (CoMPLI model) could enhance adoption of clinical guidelines and improve the use of antibiotics. DESIGN: Before-after trial using baseline and study periods with a control group. SETTING: A small community in central Ontario. PARTICIPANTS: Health professionals, the general public, and the pharmaceutical industry. INTERVENTIONS: The educational strategy (CoMPLI), carried out during 6 winter months, consisted of continuing medical education sessions for health professionals and pharmaceutical representatives and a parallel public education campaign that included town hall meetings and pamphlets distributed by local pharmacists. The two main messages were: do not use antibiotics for viral respiratory infections, and use drugs recommended in the publication, Anti-infective Guidelines for Community-Acquired Infections. MAIN OUTCOME MEASURES: Total number of antibiotic claims and adjusted odds ratios (OR) were used to measure the likelihood of physicians prescribing first- or second-line agents compared with the previous year and compared with control physicians. RESULTS: Claims in the study community decreased by nearly 10% during the 6-month study period compared with the baseline period from the previous year. Study physicians were 29% less likely (OR-1 = 0.71, range 0.67 to 0.76) to prescribe second-line antibiotics during the study period than physicians in the rest of the province. CONCLUSIONS: Physicians participating in the pilot study were more likely to follow drug recommendations outlined in published guidelines.
Adult↗
A casemix for mental health services: the development of the mental health and substance abuse components of the Australian national diagnosis-related groups.
OBJECTIVE: To describe the development of the mental health and substance abuse sections of the version of the Australian casemix system, Australian national diagnosis-related groups 3 (AN-DRG 3), released in July 1995. METHOD: The guiding principles and data sources used to construct the mental health and substance abuse components of AN-DRG 3 are described by the group who undertook that task. The group used data sets of patients separating from hospitals throughout Australia, and from hospitals in South Australia, to examine the capacity of existing and revised diagnosis-related groups (DRGs) to predict patients' lengths of hospital stay. They also reviewed the lists of conditions allowed as complicating and comorbid conditions within the AN-DRG system. RESULTS: A variety of recommendations were made including: moving organic mental disorder DRGs to a neuroscience area of the AN-DRG; completely reorganising the mental health section of the casemix; creating a number of narrowly defined DRGs covering areas such as schizophrenia, major affective disorders, anxiety disorders and eating disorders, while allowing for a limited number of more heterogenous DRGs and simplifying substance abuse DRGs into groups covering alcohol and other substances, and differentiating intoxication and withdrawal from abuse and dependency. CONCLUSIONS: A casemix dialect based on clinical diagnosis, which describes mental health and substance abuse problems in terms which should be familiar to clinicians, has been developed. Its applications and limitations are briefly discussed.
Australia↗
Development of AN-DRGs: meeting the concerns of clinicians.
The diagnosis-related group (DRG) classification has been the centre of Commonwealth and various State initiatives to modify significantly the basis for funding of public hospitals in Australia. The classification has been extensively criticised by Australian clinicians as being out of date and inappropriate for several areas of medicine. Developments in Australia to improve the DRGs classification have led to the Australian national version, AN-DRGs. The differentiating features of AN-DRGs are summarised and priority areas for further development are suggested. Further substantial improvement in the classification can be obtained only if new approaches to classification design are considered and if it is supplemented by measures of severity of illness.
Adolescent↗
Adapting DRGs: the British, Canadian and Australian experiences.
The DRG classification was developed in the United States, and has been widely used there for analytical and resource allocation purposes. Its utility has been recognised in other countries. Some have adopted US versions without change, and others have chosen to develop their own adaptations. This paper discusses the processes and outcomes of adaptation in Canada, Britain and Australia. An attempt is made to generalise the trends. It is concluded that there is a high degree of similarity of intent, although different solutions have been adopted in some cases. Where major differences remain, they are mostly a consequence of the lack of resources to pursue all opportunities for refinement at the same time. All three countries have correctly focused on involvement of their own clinician groups. However, they have tended to restrict their view to US experiences when looking overseas. It is argued that greater attention should be paid to sharing their ideas with countries with which they have a greater degree of similarity.
Australia↗
Where are DRGs going?
The diagnosis related groups (DRG) classification of acute inpatient episodes was developed in the United States to meet the perceived needs of the U.S. hospital sector. Thus far, it has been used in Australia without significant modification. In this paper, we assess the DRG system in terms of basic principles of classification design and suggest some possible revisions which might be considered if there were reason to contemplate major changes for Australia. We conclude by making some suggestions on the process of managing the development of DRGs in Australia.
Acute Disease↗
Consultant pharmacists to assist with cost-containment and enhanced drug use management.
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Consultants↗
Which hospital admissions are appropriate?
The Appropriateness Evaluation Protocol (AEP) is a criterion audit tool used extensively in the USA to assess the appropriateness of admission to hospitals. This study evaluated the utility of the AEP in an Australian teaching hospital, and recommends minor modifications to the criteria to improve the efficiency of the audit process. Six per cent of admissions in the sample were inappropriate according to the AEP criteria. These cases could have been managed in an alternate facility providing a lower level of care, or care provided on an outpatient or day-patient basis. The additional cost of the inappropriate admissions to an acute hospital is estimated at $A1750 per case.
Clinical Protocols↗
Evolution of the D-ribose operon on Escherichia coli B/r.
The D-ribose operon (rbs) of Escherichia coli K-12 maps at 83 min and is inducible. The rbs operon of E. coli B/r maps at 2 min and is constitutive. Evidence is presented showing that a second inducible copy of the rbs operons is present in E. coli B/r mapping at 83 min. The data indicated that the duplication of the rbs operon represented a transposition of the 83-min region to 2 min. The identification of a second copy of the rbs operon in B/r and the determination of its inducibility were based on the reactivation, through mutagenesis, of inducible rbs expression, mapping by P1 transduction of the mutation site to 83 min, and merodiploid complementation analysis of the D-ribokinase expression in E. coli B/r. We also show that the rbs transposition to 2-min continued to generate transposable elements coding for the 1- to 2-min region of the chromosome and transposing onto extrachromosomal DNA target molecules such as pBR322.
Chromosome Mapping↗