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PubMed1988

Utilization review of psychiatric care: building a program that works.

Since the early 1970s the federal government, private insurers, and employers have searched for ways to control health care costs. In 1972, Congress, dissatisfied with hospitals' utilization review efforts under the Medicare program created Professional Standards Review Organizations (PSROs). Ten years later when the Medicare reimbursement system underwent radical changes, the utilization review system remained more or less intact but had its name changed to Professional Review Organizations (PROs). The insurance industry has developed and employed, with varying levels of success, several cost-saving tactics, including deductibles and copayments for specialized care, limitation of benefits by diagnosis or facility type, exclusion of specific disorders, inclusion of dollar limits, pre-payment claims review for specific types of service, and post-payment review with retroactive denial of claims. Case management is the latest development in the ever-widening search to put a lid on health care costs. These attempts to measure the effectiveness of care vis a vis the dollar spent for it have been especially difficult for psychiatry, a less measurable science than other fields of medicine. Because psychiatry straddles the disciplines of sociology, psychology, and medicine, it is not easily understood. Inadequate documentation of care, a paucity of outcome studies, and confidentiality issues all combine to make utilization review particularly difficult in psychiatry. This paper will describe a collaboration between Blue Cross and Blue Shield of Maryland and four private psychiatric hospitals in the state that resulted in a workable, effective utilization review program acceptable to providers, payers, and patients.

Adolescent↗
PubMedDate not supplied

One-year clinical performance of a resin-modified glass ionomer and a resin composite restorative material in unprepared Class V restorations.

This study evaluated the clinical performance and appearance of a resin-modified glass ionomer and a resin composite over one year. Thirty-seven pairs of restorations of Fuji II LC and Z250/Single Bond were placed in caries-free cervical erosion/abfraction lesions without tooth preparation. Restorations were clinically evaluated at baseline and 6 and 12 months, using modified Ryge/USPHS criteria. No significant difference (p>0.05) was observed in performance of both materials, although retention of the Z250 restorations was below the minimum specified in the ADA Acceptance Program for Dentin and Enamel Adhesives. Little difference in the restorations' appearance was observed.

Adult↗
PubMed2002

Comparative effectiveness of an essential oil mouthrinse and dental floss in controlling interproximal gingivitis and plaque.

PURPOSE: To compare the effectiveness of rinsing with an essential oil-containing antimicrobial mouthrinse with that of dental floss in reducing interproximal gingivitis and plaque in an unsupervised 6-month clinical trial designed in accordance with ADA Acceptance Program Guidelines. MATERIALS AND METHODS: 319 qualifying subjects, aged 18-63, were randomized into one of three groups: essential oil mouthrinse (Listerine Antiseptic); dental floss (Reach Dental Floss); or a negative control rinse. At baseline, subjects received a complete oral soft tissue examination and scoring of the Modified Gingival Index (MGI), modified Quigley-Hein Plaque Index (PI), and bleeding index (BI). Following a complete dental prophylaxis and receiving flossing or rinsing instructions, subjects started on their respective regimen. They continued on their assigned regimen unsupervised at home, in addition to toothbrushing, and were reexamined at 3 and 6 months. The treatment groups were compared with respect to baseline demographic and clinical variables. The primary efficacy variables were mean interproximal MGI and PI at 6 months. Intergroup differences at 3 and 6 months were tested using a one-way analysis of covariance model with treatment as a factor and the respective baseline value as the covariate. In addition, the essential oil mouthrinse was compared to floss for interproximal gingivitis reduction using "at least as good as" statistical criteria. RESULTS: 301 subjects were considered evaluable. There were no statistically significant differences among the 3 groups at baseline, with the exception of the essential oil mouthrinse group having significantly fewer AfroAmerican subjects than the other two groups. For the interproximal MGI, the essential oil mouthrinse and flossing were both significantly more effective than the negative control (P < 0.001) at 3 and 6 months. The essential oil mouthrinse was shown to be "at least as good as" dental floss for the control of interproximal gingivitis. For the interproximal PI, the essential oil mouthrinse was significantly more effective than the negative control at 3 and 6 months (P < 0.001) while flossing was significantly more effective than the negative control at 3 months (P < 0.05) but not at 6 months. The essential oil mouthrinse was significantly more effective than floss (P < 0.001) at both these time periods.

Adolescent↗
PubMedDate not supplied

Two-year clinical performance of Class V resin-modified glass-lonomer and resin composite restorations.

While a one-year report had been previously published, this study was undertaken to evaluate the clinical performance and appearance of a resin-modified glass ionomer and a resin composite over two years. Thirty-seven pairs of restorations of FujI II LC and Z 250/Single Bond were placed in caries-free cervical erosion/abfraction lesions without tooth preparation. Restorations were clinically evaluated at baseline, 6, 12, 18 and 24 months using modified Ryge/USPHS criteria. No statistically significant difference (p = 0.13) was observed in the overall performance of the materials. Retention was 96% for the resin-modified glass ionomer and 81% for the resin composite, with no additional restorations of either material lost after one year. As previously reported, retention of the Z 250 restorations at six months was below the minimum specified in the ADA Acceptance Program for Dentin and Enamel Adhesives. The resin composite restorations generally had a better appearance, with a 100% alpha rating in color match, versus 85% for the resin-modified glass ionomer.

Adult↗
PubMed2003

Clinical effectiveness of a triclosan/copolymer/sodium-fluoride dentifrice in controlling oral malodor: a three-week clinical trial.

The purpose of this study was to compare the effectiveness of a commercially available, clinically proven, American Dental Association (ADA)-Accepted dentifrice containing 0.30% triclosan, 2% polyvinylmethylether/maleic acid (PVM/MA) copolymer, and 0.243% sodium fluoride in a 10% high-cleaning silica base (Colgate Total Advanced Fresh) to a commercially available, clinically proven, ADA-Accepted control dentifrice containing 0.243% sodium fluoride in a silica base (Colgate Cavity Protection Winterfresh Gel) for the management of oral malodor in a 3-week, randomized, double-blind longitudinal clinical trial. A panel of four expert judges used a nine-point hedonic scale to evaluate breath odor using a protocol designed in concordance with the ADA Draft Acceptance Program Guidelines for Products Used in the Management of Oral Malodor. After a baseline evaluation, prospective study subjects who scored above the threshold value for unpleasant breath odor were stratified by score and randomized into two treatment groups. Subjects were provided with a soft-bristled toothbrush and brushed their teeth thoroughly in their regular and customary manner for 1 minute with their assigned dentifrice, twice daily. Before oral-malodor evaluations, the subjects refrained from eating odorigenic foods and did not use dental hygiene procedures, breath mints, or mouth rinses. Eighty-one adult men and women from Chengdu, China, completed the study. Throughout the study, the mean breath-odor scores observed in the Colgate Total Advanced Fresh toothpaste group for both daytime and overnight were within the range of values associated with pleasant breath odor, were statistically significantly lower than the corresponding mean scores for the control group, and also represented statistically significant reductions from baseline. Relative to the baseline score, more than 80% of the subjects in the Colgate Total Advanced Fresh toothpaste group demonstrated a 3.2 or more unit reduction in organoleptic scores at every postbaseline breath-odor evaluation. Thus, the overall results of the double-blind clinical study support the conclusions that Colgate Total Advanced Fresh toothpaste is efficacious for the control of oral malodor for up to 12 hours in the daytime and up to 12 hours overnight.

Adolescent↗
PubMed1991

Porcelain repair materials. Council on Dental Materials, Instruments and Equipment.

Porcelain repair materials, when properly chosen and used, provide some bond strength in bonding to porcelain. The bond strength is decreased by thermocycling and long-term storage in water. Currently available products are affected differently by these conditions. Surface roughening by rotary instruments and chemical etching by hydrofluoric acid or APF enhances the bond strength. The long-term clinical performance of the porcelain repair materials is not well documented. The council is preparing guidelines to evaluate these materials under the Acceptance Programs of the council. These guidelines will include requiring information on the laboratory and chemical data on these products to demonstrate their safety and efficacy.

Acid Etching, Dental↗
PubMedDate not supplied

An assessment of contraceptive need in the inner city.

A survey of low-income areas of Los Angeles County indicates that 41 percent of nonsterile women in their childbearing years who had not made a family planning visit in three years were using some means of birth control, 21 percent were not, 25 percent were not sexually active and 13 percent were pregnant or trying to become pregnant. Given that approximately 10 percent of the respondents were using unreliable means of contraception, at least one-third of respondents were in need of effective contraception. This proportion corresponds roughly to the percentage of respondents who expressed a desire to receive family planning care from a doctor or clinic (34 percent). The percentage of women who were at risk of unwanted pregnancy but not using any method of contraception was greatest among those with incomes below poverty level and among black and Hispanic women. A comparison of survey respondents to a parallel sample of low-income women who had made a family planning visit shows that those who utilized formal family planning services were substantially more likely than those who did not to be married (40 percent vs. 32 percent) and to belong to a health maintenance organization (24 percent vs. 14 percent), whereas nonusers of formal family planning services were slightly older, on average (29.6 years vs. 28.0 years), and more likely to have other types of private health insurance (47 percent vs. 25 percent).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Access to health care in urban areas of developing societies.

Emphasis on rural health problems has led to a relative neglect of urban health issues in developing societies. Yet the fact that a large proportion of the limited financial and human resources is allocated to urban health care makes it imperative for researchers and health planners to evaluate the effectiveness of the urban health care system. This paper examines data on health care utilization from a sample survey of 1500 households conducted in three areas of Accra, Ghana in 1982. The factors that influence the use of three types of health care services (clinics, drug vendors, and traditional healers) are examined. Suggestions are made for increasing the effectiveness of the health care system in Accra, with the aim of making medical care more accessible to all families.

Community Health Services↗
PubMed1989

A new look at traditional medicine in Morocco.

Traditional medicine is still popular in Morocco since it is an important form of health care for many people. Its positive aspects could be encouraged if it were officially recognized and given a place in the health system.

Attitude to Health↗
PubMed1989

Risk groups and risk areas.

The risk approach to health management usually relates to groups of people. An alternative method is to concentrate on the areas at risk, which may sometimes be more useful in decision-making.

Health Planning↗
PubMed1988

Interviews or postal questionnaires? Comparisons of data about women's experiences with maternity services.

Surveys by personal interview are often assumed to be superior to those conducted by mail questionnaire. An experimental study of experiences and attitudes of 800 newly delivered mothers revealed surprising advantages to postal surveys: they are cheaper, more easily repeatable, and minimize interviewer effects. While response rates differed, the quality of responses was similar, except between middle- and working-class mothers. Postal surveys can be used with considerable assurance in national studies of fairly intimate experiences of pregnancy and delivery.

Asia↗