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Biomedical subjects

M Hannaford

Publications and source records attributed to M Hannaford.

3 recordsLinked to original sources
PubMed1997

Role of new selective aromatase inhibitor in therapy for metastatic breast cancer in postmenopausal women.

Anastrozole offers a new option for many postmenopausal women with metastatic breast cancer who no longer respond to antiestrogen therapy. It has a lower side effect profile for weight gain and peripheral edema and equivalent efficacy to the current second-line therapy, megestrol acetate, which may improve quality of life. Due to its selectivity and lack of clinically significant effects on cortisol metabolism, it does not have the toxicity problems of other aromatase inhibiting agents such as aminoglutethimide. Long-term studies are needed to adequately evaluate the impact of this degree of estrogen suppression on cardiovascular and bone mass risk factors [12]. Cost of therapy will certainly have an impact on the choice of second-line endocrine therapy in those with limited income sources and lack of prescription coverage. In summary, there is likely to be an increased use of nonsteroidal aromatase inhibitor agents for second-line hormonal therapy of breast cancer. Due to increased length of survival, these individuals will not be seen exclusively by oncologists; their care will be shared with their primary care provider [21]. Providers must have an understanding of these agents and their potential impact on the long-term health care of the individual in order to provide knowledgeable and comprehensive care.

Anastrozole↗
PubMed1996

Randomized controlled trial of residents as gatekeepers.

BACKGROUND: Managed care advocates suggest that primary care gatekeepers may improve patient care and reduce costs. Training internal medicine residents in these gatekeeping functions has not been emphasized in most internal medicine programs. OBJECTIVE: To determine if residents could perform gatekeeper functions and if patient costs and satisfaction would be favorable. METHODS: Patients (n = 254) followed up by residents (n = 26) in continuity clinics at the Denver Veterans Affairs Medical Center in Denver, Colo, were divided into 2 groups. A control group of 128 was followed up by residents with no restrictions on appointments made for them. An intervention group of 126 patients were followed up by residents who had to approve all referrals made for their patients. A research nurse assisted with the approvals when the residents were rotating through other institutions. Utilization of resources, satisfaction with care, and health status were monitored over a 1-year period. RESULTS: A minor reduction of resource utilization was found in the intervention group, particularly in medication use. Significantly more visits were made to primary care providers in the intervention group (3.01 vs 2.59; P = .03). Patient satisfaction and health status were similar in both groups with a trend toward better satisfaction in the intervention group in some areas. CONCLUSIONS: Our study showed that residents can function as gatekeepers of highly complex patients and that satisfaction with care and utilization of resources does not suffer. Drug utilization and costs may be less when a gatekeeper exists.

Ambulatory Care↗