Nursing and midwifery education using mobile technologies.
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Computers, Handheld↗
Biomedical subjects
Maureen Farrell
Publications and source records attributed to Maureen Farrell.
Health care leadership in an age of change.
This study examined the leadership practices of a sample of network and hospital administrators in metropolitan Victoria, Australia. It was undertaken in the mid-1990s when the State Liberal-National (Coalition) Government in Victoria established Melbourne's metropolitan health care networks. I argue that leadership, and the process of leading, contributes significantly to the success of the hospital in a time of turmoil and change. The sample was taken from the seven health care networks and consisted of 15 network and hospital administrators. Bolman and Deal's frames of leadership--structural, human resource, political and symbolic--were used as a framework to categorize the leadership practices of the administrators. The findings suggest a preference for the structural frame--an anticipated result, since the hospital environment is more conducive to a style of leadership that emphasizes rationality and objectivity. The human resource frame was the second preferred frame, followed by the political and symbolic. These findings suggest that network and hospital administrators focus more on intellectual than spiritual development, and perhaps this tendency needs to be addressed when educating present and future hospital leaders.
Delivery of Health Care↗
Does self-management education benefit all populations with arthritis? A randomized controlled trial in a primary care physician network.
OBJECTIVE: Studies have suggested that the Arthritis Self-Management Program (ASMP) course is effective at reducing arthritis pain and health care costs in volunteer participants. There have been no reports of trials of the ASMP in the context of primary care physicians' practices, where the potential for spreading the program may be greatest. We conducted a randomized controlled trial of the ASMP course in a large primary care physician network. METHODS: Patients with osteoarthritis, rheumatoid arthritis, or fibromyalgia were recruited for the study. Subjects in the intervention practices received the 6 week course and those in the control practices received only the ASMP book, without course. Disability, pain, self-efficacy, mental health, and satisfaction were measured using validated instruments at baseline and at 4 months. RESULTS: One hundred thirteen patients were recruited for the ASMP course (intervention) and completed baseline and 4 month followup questionnaires. Eighty-four percent completed at least 4 of 6 classes. Seventy-four patients received the ASMP manual (controls) and completed both questionnaires. Patients in the intervention and control groups had similar baseline pain (p = 0.94), self-efficacy to control pain (p = 0.90), mental health (p = 0.10), and vitality scores (p = 0.21), but those in the intervention arm had slightly less disability (p = 0.04). At 4 months, there was no significant improvement from baseline in any endpoint and no difference between patients in the intervention and control groups (all p > 0.2). Patient satisfaction with arthritis care and outcomes was no different for intervention and control patients (all p > 0.3). All types of health care resource use were similar at baseline and followup for both intervention and control groups (all p > 0.2). CONCLUSION: While the ASMP course has been found to be effective in other patient groups, there were no significant clinical benefits noted at 4 months in patients recruited from primary care practices.
Aged↗
Evaluation of a monthly coverage maximum (drug-specific quantity limit) on the 5-HT1 agonists (triptans) and dihydroergotamine nasal spray.
BACKGROUND: Ensuring the appropriate use of migraine therapies is an important consideration for care providers, patients, employers, and managed care organizations (MCOs) because of the high cost of treatment for this fairly prevalent disabling disease. A review of utilization of serotonin 5-HT1 receptor agonists (triptans) in an MCO determined that about 24% of the patients who received triptan therapy exceeded the manufacturers. recommendations regarding the maximum daily dose and safe treatment guidelines in a 30-day period. An initiative was designed to manage the coverage of migraine abortive therapies with the anticipated outcome of decreasing potential misuse or overuse of the medications. OBJECTIVE: The objective of this retrospective, observational study was to determine the impact of a monthly drug-specific milligram coverage maximum (quantity limit) on serotonin 5-HT1 receptor agonists (triptans) and dihydroergotamine (DHE) nasal spray on the utilization and costs of migraine care in an MCO with approximately 600000 covered members. METHODS: A longitudinal, retrospective cohort analysis was conducted. All migraine-related services were analyzed, including outpatient medical visits, emergency department utilization, inpatient hospitalizations, and outpatient prescription drug use. The analysis was conducted using medical and pharmacy administrative claims. Analysis of data was performed for the period 12 months prior (October 1999 to September 2000) and 18 months postimplementation of the monthly drug-specific milligram coverage maximum (October 2000 through March 2002). RESULTS: Imposition of a monthly coverage maximum for migraine-abortive therapies was associated with a 26.1% reduction in overall per- patient-per-month (PPPM) medical costs for migraine care, from US dollars 55.52 PPPM to US dollars 41.02 PPPM (P<0.01). Utilization of serotonin 5-HT1 receptor agonists and DHE nasal spray declined by 16.7%, from 0.18 prescriptions PPPM to 0.15 prescriptions PPPM (P=0.039), and direct drug costs declined by 28.8%, from US dollars 29.18 PPPM to US dollars 20.78 PPPM (P<0.001). Utilization and costs of outpatient and inpatient migraine-related medical services declined by 40% from US dollars 16.58 PPPM in the preperiod to US dollars 9.94 PPPM in the postperiod (P<0.001). CONCLUSION: A monthly drug-specific milligram coverage maximum was associated with significant reduction in drug costs and utilization of serotonin 5-HT1 receptor agonists (triptans) and DHE nasal spray. Utilization and costs of migraine-related medical services also declined after implementation of the coverage maximum for triptans and DHE nasal spray. The monthly drug-specific milligram coverage maximum appeared to have been successful in managing utilization of triptans and DHE nasal spray, including reduction of overall costs of migraine-related medical services and direct drug costs.
Adolescent↗