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Biomedical subjects

W M Baluch

Publications and source records attributed to W M Baluch.

7 recordsLinked to original sources
PubMed1999

Therapeutic interchange of conjugated and esterified estrogens in a managed care organization.

A program designed to curb increases in drug costs in an HMO by substituting esterified for conjugated estrogens was developed and studied. Patients were voluntarily switched from conjugated to esterified estrogens at an HMO in Washington State. Women were informed about the conversion through newsletters and during clinic and pharmacy visits and received physician and pharmacist counseling. Cost savings were estimated, and patient acceptance was evaluated by interviewing women in four groups, including women who were switched from conjugated to esterified estrogens and then switched back (C-E-C group), women who were not switched (C-C group), and women who were switched to esterified estrogens and not switched back (C-E group). During the first six months, 14,601 (89.2%) of 16,364 women taking conjugated estrogens were switched to esterified estrogens; of these, 13,654 (93.5%) continued taking esterified estrogens for at least six months. The HMO avoided $653,119 of an expected $750,000 cost increase for oral estrogen therapy during the first year of the program. A total of 754 women were interviewed; 65.8% in the C-E-C group and 78.4% in the C-E group reported being satisfied with the information they received. The conversion experience was rated as positive by 28.3% of women in the C-E-C group and 41.5% of women in the C-E group, negative by 25.1%, and 8.9%, and neutral by 46.6% and 49.6%. An HMO avoided a large increase in drug costs by substituting esterified for conjugated estrogens; only 6.5% of patients were switched back to conjugated estrogens at their physicians' or their own request; most patients thought the conversion was a neutral or positive experience.

Adult↗
PubMed1995

Pharmacists' role in a smoking-cessation program at a health maintenance organization.

A comprehensive smoking-cessation program sponsored by a health maintenance organization (HMO) and the role of pharmacists in the program are described. Group Health Cooperative of Puget Sound is an HMO serving more than 385,000 enrollees in western Washington State. Group Health established a smoking-cessation program in 1985. The smoking-cessation benefit consists of interventions by providers to determine smoking status, a formal behavioral modification program, and nicotine-replacement therapy (beginning in 1993) for patients undergoing behavioral modification. The behavioral modification program is offered in group or individualized format. A team of trained nursing, medical, and pharmacy staff members provides consultative support to the program's smoking-cessation specialists. A tobacco-use road-map team has been created as part of the quality-improvement effort at Group Health; a pharmacist serves on this team. The ultimate goal of the team is to reduce the percentage of adult enrollees who smoke from the current 20% to 12.5% by 2000. A procedure for promoting smoking cessation was presented to all the pharmacists, along with continuing-education sessions. The pharmacists are encouraged to be brief but consistent in their antismoking message and to apply the "four A's" (ask about the patient's smoking status, advise the patient to quit smoking, assist in the patient's efforts to quit, and arrange follow-up). The inclusion of nicotine-replacement products in the smoking-cessation program in 1993 provided pharmacists with a key role in determining dosages and monitoring patients. Although the program is leading many smokers to quit, efforts will have to be intensified if program goals are to be realized by 2000.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗
PubMed1995

A chronic disease score with empirically derived weights.

Different types of medication prescribed during a 6-month period for the treatment and management of chronic conditions were utilized in the refinement and validation of a chronic disease score. Prescription data, in addition to age and sex, were utilized to develop a chronic disease score based on empirically derived weights for each of three outcomes: total cost, outpatient cost, and primary care visits. The ability of the revised chronic disease score to predict health care utilization, costs, hospitalization, and mortality was compared to an earlier version of the chronic disease score (original) that was derived through clinical judgments of disease severity. The predictive validity of the chronic disease score is also compared to ambulatory care groups, which utilize outpatient diagnoses to form mutually exclusive diagnostic categories. Models based on a concurrent 6-month period and a 6-month prospective period (ie, the 6-month period after the chronic disease score or ambulatory care group derivation period) were estimated using a random one half sample of 250,000 managed-care enrollees aged 18 and older. The remaining one half of the enrollee population was used as a validation sample. The revised chronic disease score showed improved estimation and prediction over the original chronic disease score. The difference in variance explained prospectively by the revised chronic disease score versus the ambulatory care groups, conversely, was small. The revised chronic disease score was a better predictor of mortality than the ambulatory care groups. The combination of revised chronic disease score and ambulatory care groups showed only marginally greater predictive power than either one alone. These results suggest that the revised chronic disease score and ambulatory care groups with empirically derived weights provide improved prediction of health care utilization and costs, as well as hospitalization and mortality, over age and sex alone. We recommend the revised chronic disease score with total cost weights for general use as a severity measure because of its relative advantage in predicting mortality compared to the outpatient cost and primary care visit weights.

Adult↗