PubMed · 13872125
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C van BOXTEL. 1961-12-08. [The EEC and pharmacy].. https://pubmed.ncbi.nlm.nih.gov/13872125/
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The history of nurse practitioners, their efforts to achieve provider status, and lessons learned from their activism are discussed. The nurse practitioner profession arose out of a need to meet a rising demand for primary care services, especially in rural areas. Some nurses and physicians vehemently opposed the nurse practitioner model, but studies documented the value of nurse practitioner services, and the utilization of these practitioners continued to grow. Compensation was provided via salary or per-member-per-month agreements. Nurse practitioners recognized that direct federal reimbursement (provider status) was needed to recognize them as independent health care providers and assign specific monetary values to their services, so they undertook an aggressive lobbying campaign. Contacts on Capitol Hill were exploited, and nursing organizations encouraged nurse practitioners to get involved in grass-roots activism. Nurse practitioners discussed their patients during meetings with their representatives in Congress, and legislators were invited to make site visits. In 1993, the American College of Nurse Practitioners was formed to unite the profession and move the campaign forward. Ultimately, the Balanced Budget Act of 1997 granted nurse practitioners provider status and authorized them to bill Medicare directly for services furnished in any setting. The key strategies that contributed to this victory were (1) gaining recognition that nursing had the potential to expand its role, (2) documenting nurse practitioners' value, (3) establishing standards in education and credentialing, (4) using professional organizations to empower individuals, and (5) being willing to accept small, incremental gains over time. The experience of nurse practitioners in obtaining Medicare provider status offers valuable lessons for pharmacists as they pursue the same goal.
Pharmacoeconomic analyses can be readily applied to the study of venous thromboembolism (VTE) in the orthopedic postsurgical setting. The cost of VTE to the health care system and a cost-effectiveness trial that utilized a factor Xa inhibitor for VTE prophylaxis are discussed. The rationale for preventing VTE can be justified by its high frequency, asymptomatic nature, and high morbidity and mortality that result from unprevented thromboemboli. However, the economic burden that results from VTE is indeed significant. More effective antithrombotic prophylaxis would reduce the occurrence of VTE, the incidence of complications, and subsequent costs. Previous pharmacoeconomic analyses underscore the financial burden VTE places on the health care system in terms of increased length of hospital stay, time spent in the intensive care unit, and mean total cost. Trial-based and effectiveness-based analyses were utilized to compare the cost-effectiveness of a 7-day regimen of fondaparinux (2.5 mg once daily) and enoxaparin (30 mg twice daily). In the trial-based analysis, fondaparinux was estimated to prevent 15.1 thromboembolic events per 1000 patients at three months compared with enoxaparin; fondaparinux produced cost savings per patient at 30 days, 3 months, and 5 years postdischarge. In the effectiveness analysis, fondaparinux was estimated to prevent 17.7 thromboembolic events per 1000 patients at 3 months compared with enoxaparin; fondaparinux produced cost savings per patient at discharge, 1 month, 3 months, and 5 years postdischarge. These analyses demonstrate fondaparinux to be cost-effective for the prophylaxis of VTE in the orthopedic postsurgical setting.
Opioids have demonstrated efficacy and often are drugs of choice in the management of postoperative pain. However, their use is often limited by adverse drug events (ADEs). The objective of this study was to determine the ADE rate in adult surgical patients who received opioids and the impact of opioid ADEs on length of stay (LOS), costs, and mortality. A hospital-based computerized system detected potential ADEs. Adult patients were selected if they received at least one dose of opioid medication during a surgical hospitalization between 1 January 1990 and 31 December 1999. Control patients were matched based on matching length of stay ([LOS] at least as long as time to ADE), age (within 10 years), sex, admission year, major disease category (MDC), and without an ADE. Linear regression models were used to determine the predictors of increased LOS, total hospital costs, and log-transformed total hospital costs. 60,722 patients received opioid medication during their surgical hospitalization and 2.7% experienced an opioid-related ADE. The most common clinical manifestations were nausea and vomiting (67%), and rash, hives, or itching (33.5%). No statistically significant difference was seen in mortality between ADE/non-ADE patients. ADE patients had statistically significant increases in LOS (0.53 days) and in log-transformed cost (16%). The estimated log cost difference of 16%, if applied to the median cost patient in the non-ADE group, averaged US$ 840. Opioid-related ADEs are common in hospitalized patients and increase LOS and total hospital costs.