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PubMed2004

Principles for development of multi-disciplinary, mental health learning modules for undergraduate, postgraduate and continuing education.

BACKGROUND: People experiencing mental health problems have greater contact with health and welfare professionals in generalist settings than with specialist mental health services. Yet the capacity for generalist professionals to respond effectively to mental health problems is often compromised by inadequate mental health training. The Discipline of Psychiatry at the University of Newcastle developed a series of CD-Rom mental health learning modules for professionals working in non-mental health settings. The paper describes the principles that guided the development of a series and how those principles were applied. DEVELOPMENT PRINCIPLES: The following development principles were adopted. The series should: (i) have a multi-disciplinary application; (ii) be adaptable for presentation in multiple educational domains; (iii) be accessible for rural and remote practitioners; (iv) combine structured solutions-focused lessons (directed learning) with elements of problem-based learning; (v) include working problems that are authentic and relevant; and (vi) describe normal, abnormal and cross-cultural manifestations of problems. APPLICATION OF PRINCIPLES: The model guided the development of a short course series on professional engagement with people who have personality problems. The learning modules provide generic, multi-disciplinary training for a range of practitioners, including nurses, primary care physicians, social workers, psychologists and magistrates. The modules have been adapted for use in undergraduate medical education, postgraduate programs (in population health, nursing, psychology and drug and alcohol studies) and continuing education. CONCLUSION: In contrast to traditional diagnostic-focussed psychiatry training, the model directly addresses the mental health training needs of health and welfare professionals using a multi-disciplinary, problem-based approach.

CD-ROM↗

PubMed2002

Unmet need among rural Medicaid beneficiaries in Minnesota.

Given the vulnerabilities of rural residents and the health care issues faced by the Medicaid population generally, the combined effects of being on Medicaid and living in a rural area raise important questions about access to health care services. This study looks at a key dimension of health care access: unmet needfor health care services. The study relies on data from a 1998 survey of rural Minnesota Medicaid beneficiaries. An overall response rate of 70% was obtained. For this study, the sample is limited to women who were on Medicaid for the full 12 months prior to the survey, resulting in 900 respondents. The study finds that the rural Medicaid beneficiaries face high levels of unmet need: more than 1 in 3 reported either delaying or not getting doctor, hospital, or specialist care that theyfelt they needed. Although the study lacks direct measures of the consequences of the high levels of unmet need, there is evidence that greater emergency room use is associated with unmet need. The survey data cannot necessarily be generalized to other rural areas, and like all surveys, this one is subject to nonresponse bias as well as potential biases because of respondent recall and self-assessment of medical needs. Nevertheless, thesefindings are suggestive of negative consequences of unmet need for both Medicaid beneficiaries and program costs.

Adult↗

PubMed2001

Improving oral health to enhance general health in elderly people in Uruguay.

A review of ways in which the oral health and general health of elderly people in Uruguay is presented. The dental profession has not yet understood the real dimension an ageing population brings with it, nor its responsibility for general and psychosocial health of older adults. Generally, Uruguay as a developing country, is increasing its social policies, therefore there is much to be done. Specifically, dentists and specialists in gerodontology are not sufficiently conscious of the role they play in this process. However, to be successful in this endeavour, dental professionals really need the support of their country, without which no changes can take place. An accurate management of gerodontology is not enough, some aspects of older adult's lifestyles must be studied such as the psychological and social profile. The objective is not to work in several specialties but to work properly as a team co-ordinated by the national authorities.

Aged↗

PubMedDate not supplied

[Supply of health care in the Australian bush: human resources and government policy].

The Australian bush--the heart of Australian folklore and a fascinating attraction for tourists, whether from within Australia or other countries--does not enjoy the same attraction for professionals across a range of industries including health, where there is a chronic shortage of human resources. Whilst data vary considerably between regions, in many cases, Australians from rural and remote regions have a lower health status than the overall population. This is particularly true of the population of Indigenous origin. There are about 250 medical practitioners for 100,000 people in Australia. This number varies between about 300 in the capital cities and just over 100 in the remote areas, the latter being mostly general practitioners as there are hardly any hospitals and specialists in those remote areas. The data change across professions--for example the number of nurses is about the same in capital cities and in remote areas: about 1000 full time equivalent for 100,000 people. They change too when we consider rural regions that are less or not isolated: in some instances, these are less supplied than remote areas, where access to care however remains more critical because of distance. The demographic profile of the professions examined in this paper also vary between regions, giving more urgency to workforce planning issues. The Australian government has embarked on the delivery of a major rural health strategy aimed at increasing access to health care in the rural and remote regions--through the provision of more and better services (specialist services; multipurpose centres); attracting more health professionals (scholarships for health students; setting up of rural universities); and retaining and supporting those professionals in rural and remote areas (on-going training; support programs for families and overseas trained doctors; practice management and financial incentives).

Australia↗

PubMed2004

[Implementation of the Active Nosocomial Infections Surveillance System in Polish hospitals].

Characteristics the organisation of infection control in hospitals participating in the Active Nosocomial Infections Surveillance System in Poland. Analysis of the data obtained from a questionnaire on organization of nosocomial infections surveillance in hospitals participating in the Active Nosocomial Infections Surveillance System coordinated by the Polish Society of Hospital Infections. Analyzed data were obtained from 32 hospitals of different size number of hospital beds) and type of reference. Most questions focused on the structures of infection control, postdischarge surveillance and role of microbiological laboratory. NIs surveillance system is based on the work of infection control team consisting of epidemiological nurse and physician representing different specializations, but there is no specialist or doctor specializing in medical microbiology. Additionally, the Infection Control Committee exists in 25 hospitals. Only in 37.5% of those hospitals the postdischarge surveillance is performed, but related only to surgical site infections. There is no microbiological surveillance in 25% of the hospitals, which means that neither registration nor collecting of drug-resistant strains are performed. Implementation of the Active Nis Surveillance System is based on the common organizational structure, programme and definitions of infections. The postdischarge surveillance and microbiological surveillance are the main activities which still need improvement.

Attitude of Health Personnel↗

PubMed2001

The role of specialist nurses in multiple sclerosis: a rapid and systematic review.

BACKGROUND: Multiple sclerosis (MS) is a disease of the central nervous system. The cause is unknown. There are about 80-160 people with MS per 100,000 population, with twice as many women affected as men. The management of individuals with MS includes treatment of acute relapses and chronic symptoms. The care of MS patients is provided by various healthcare professionals, such as general practitioners (GPs), neurologists, physiotherapists, occupational therapists and nurses. Some MS patients have access to an MS specialist nurse, although this provision varies geographically. OBJECTIVES: The aim of this report is to assess the effectiveness and relative cost-effectiveness of MS specialist nurses in improving care and outcomes for patients with MS. METHODS: A systematic review of the literature, involving a range of databases, was performed. Full details are described in the main report. RESULTS: Only one study was identified that tried to evaluate the benefit of MS specialist nurses. The study concluded that MS patients and their carers found the MS specialist nurse to be helpful, particularly in improving their knowledge of MS, ability to cope, mood and confidence about the future. GPs also reported finding the nurse to be helpful with their MS patients, and 40% of the GPs stated they would purchase the services of an MS specialist nurse if their practices became fundholding. However, there were considerable methodological weaknesses inherent in the study design, and it was unclear whether the results of the study could be extrapolated to other settings or to other MS patient groups. RESULTS - ONGOING RESEARCH: There are two ongoing research studies regarding MS specialist nurses. One of these studies involves the provision of MS nurses to several areas, but also has two control populations to allow evaluation of the health benefits of the nurses to MS patients and their carers. This study will help to fill the evidence gap. RESULTS - COSTS: The costs of providing MS specialist nurses consist of their yearly salary (usually NHS grade G), as well as additional costs for travelling, administration, computer and telephone use, a pension scheme, National Insurance and study leave. The MS Society of Great Britain and Northern Ireland allows a generous total yearly cost to the employer of 40,000 pounds. CONCLUSIONS: The present evidence does not make it possible to comment with any certainty on the value of specialist nurses in MS. The best evidence available to the authors is specialist opinion from neurologists and nurses, and comments from patients with MS; this opinion supports the provision of MS specialist nurses. CONCLUSIONS - RECOMMENDATIONS FOR RESEARCH: Further research is needed before it will be feasible to make firm recommendations on the value of MS specialist nurses relative to other possible uses of funds.

Diabetes Mellitus↗

PubMed2000

The pattern of diabetes care in New South Wales: a five-year analysis using Medicare occasions of service data.

OBJECTIVE: To use Medicare occasions of service data to establish the pattern and standard of care received by people with diabetes. METHOD: Information about visits to medical practitioners as well as utilisation of diabetes related procedures for people living in New South Wales (NSW) for the individual years between 1993 to 1997 was retrieved using a Health Insurance Commission data file. Individuals were deemed to have diabetes if an HbA1c which can only be ordered for a person with known diabetes, had been performed over the five-year period. RESULTS: On average over the study period, persons with diabetes accounted for 3.1% of the population but they used 5.5% of general practitioner services. A large proportion of patients also received care at the specialist and consultant physician level, 51.2% and 38.6% respectively, a three to four fold increase when compared with their non-diabetic counterparts. There was also a 1.3 to 1.8 fold increase in the mean number of attendances to the various medical practitioners. Surveillance of diabetes parameters was inadequate but small improvements were seen over the 5 year study period (proportion of persons with diabetes with a HbA1c performed: 48.8% to 56.8%; Lipids: 49.4% to 52.0%; HDL cholesterol: 18.3% to 18.8%; microalbuminuria: 4.7% to 11.6%). CONCLUSION: This study has highlighted the heavy burden imposed by diabetes on our health care system. IMPLICATIONS: The use of Medicare occasions of service data represents a cost efficient way of monitoring health service utilisation.

Diabetes Mellitus↗

PubMed2001

Developing palliative care services in regional areas. The Ipswich Palliative Care Network model.

BACKGROUND: Although there are over 350 palliative care services present in Australia and New Zealand, the distribution of these is patchy. Patients in some regional and rural areas have little or no access to specialist services, and manage with the enthusiasm and general expertise of local practitioners. OBJECTIVE: This paper discusses the problems encountered in maintaining skills in palliative care in the face of small patient numbers and poor resources, and describes a solution that was developed in Ipswich, Queensland. DISCUSSION: The twin problem of GP skills maintenance and adequate community service provision in palliative care can be overcome by developing a general practice based service in conjunction with local health authorities and the community. Highlighting the benefits to the health authority and the community of maximal general practitioner involvement is the most important lever in securing cooperation.

Australia↗

PubMed2004

[Complaints and health care system utilisation of ethnic German migrants from the former Soviet Union to Germany and their families].

OBJECTIVES: The aim of the study is the description of subjective morbidity, health care system utilisation and complaints of ethnic German migrants from the former Soviet Union at the beginning of migration. At present no data are available concerning aspects of health behaviour among this largest immigrant population in Germany. METHODS: 300 ethnic German migrants and their families (mean age 37.2 and 51% female) were interrogated shortly after migration to Germany. They answered questions about prevalence of diseases, health care system utilization, actual health status and completed the Giessen Subjective Complaints List (GSCL-24). German standards exist for all questionnaires. RESULTS: 237 ethnic German migrants report to have suffered from at least one disease during the course of the last year. They see the gynaecologist and dentist as often as the German population, pay fewer visits to practitioners and specialists but seek more medical advice from the medical lay system. The majority of subjects are satisfied with their health. Migrants describe their health status as lower than the German population compared to which they also report more complaints (Overall distress in GSCL-24 : 17.2 for migrants and 14.0 for Germans) and different complaints (headaches, fatigue). CONCLUSIONS: The different medical care system and differences in the treatment of patients could account for the less frequent use of medical services by ethnic German migrants. Actual stressors like language differences and acculturation problems are discussed as possible reasons for the increased rate of complaints among ethnic German migrants. Although they suffer from more complaints the German migrants do not seem to modify their help-seeking behaviour.

Acculturation↗

PubMedDate not supplied

Using buzz marketing to promote ideas, services, and products.

OBJECTIVE: To (1) discuss buzz marketing, contrast it with traditional forms of promotional communications, and provide guidelines for use and (2) describe a successful buzz-marketing program used by Sentara Healthcare to decrease overuse and inappropriate use of antibiotic medications. DATA SOURCES: An English-language-only literature search of ABI Inform, Lexus-Nexus, InfoTrac, and university library databases from 1980 to the present using the keywords buzz, word of mouth, opinion leader, and thought leader. Articles and books were cross referenced for other works of interest. STUDY SELECTION: Performed by the author for their contribution to an exploratory analysis of this topic. DATA EXTRACTION: Performed by the author. DATA SYNTHESIS: Buzz marketing is an indirect communications method that has been used successfully in the promotion of a wide variety of products, services, and ideas. By identifying and cultivating nonmedia opinion leaders, the technique generates word-of-mouth communications between these early adopters of products and services and the early and late majority of people who tend to follow their lead. Opinion leaders can be categorized as ordinary or extraordinary, technical or social, and specialist or generalist, depending on the nature of their communications, expertise, and range of knowledge. Buzz marketing is most useful for ideas that are memorable, produce small changes in behavior that have big effects over time, and have the potential to reach a "tipping point" in terms of momentum among a target population. Pharmacists can use buzz marketing for promoting innovative services such as pharmaceutical care. A case study is presented on the use of buzz marketing by a health system for decreasing antibiotic resistance through lessening of public demand for antibiotics and support of physicians in prescribing the agents appropriately. CONCLUSION: Buzz marketing is a potent force in the promotion of pharmaceuticals and can be used by pharmacists. It works best when patients perceive the benefits of innovations. Providing samples and demonstrations of the innovation will foster positive perceptions. Innovations also spread better when they are compatible with the needs, desires, and preferences of individuals and can be adapted to the unique situation of the adopter.

Advertising↗

PubMed2001

Primary care physicians in Israel: self-perception of their role in the healthcare system and policy makers' and patients' perception of them as gatekeepers.

BACKGROUND: The rapidly increasing costs of healthcare pose a major challenge to many governments, particularly in developed countries. Health policy makers in some Western European countries have adopted the policy of a strong primary healthcare system, partly due to their recognition of the value of primary care medicine as a means to restrain costs while maintaining the quality and equity of healthcare services. In these countries there is a growing comprehension that the role of the family physician should be central, with responsibility for assessing the overall health needs of the individual, for coordination of medical care and, as the primary caregiver, for most of the individual's medical problems in the framework of the family and the community. OBJECTIVES: To describe primary care physicians in Israel from their own perception, health policy makers' opinion on the role PCPs should play, and patients' view on their role as gatekeepers. METHODS: The study was based on three research tools: a) a questionnaire mailed to a representative sample of all PCPs employed by the four sick funds in Israel in 1997, b) in-depth semi-structured interviews with key professionals and policy makers in the healthcare system, and c) a national telephone survey of a random representative sample of patients conducted in 1997. RESULTS: PCPs were asked to rank the importance of 12 primary functions. A total of 95% considered coordination of all patient care to be a very important function, but only 43% thought that weighing economic considerations in patient management is important, and 30.6% thought that 24 hour responsibility for patients is important. Also, 60% of PCPs have undergone specialty training and 94% thought that this training is essential. With regard to the policy makers, most preferred highly trained PCPs (board-certified family physicians, pediatricians and internists) and believed they should play a central role in the healthcare system, acting as coordinators, highly accessible and able to weigh cost considerations. Yet, half opposed a full gatekeeper model. They also felt that the general population has lost faith in PCPs, and that most have a low status and do not have adequate training. Regarding the patients' viewpoint, 40% preferred that the PCP function as their "personal physician" coordinating all aspects of their care and fully in charge of their referrals; 30% preferred self-referral to sub-specialists, and 19% preferred their PCP to coordinate their care but wanted to be able to refer themselves to specialists. CONCLUSIONS: In order to maintain high quality primary care, it is important that all PCPs have board certification. In addition, PCP training systems should emphasize preventive medicine, health promotion, health economy, and cost-effectiveness issues. Efforts should be made to render PCPs a central role in the healthcare system by gradually implementing the elements of the gatekeeper model through incentives rather than regulations.

Adult↗

PubMed2004

Influenza vaccination of persons with cardiovascular disease in the United States.

People who have cardiovascular disease are at increased risk of hospitalization or death associated with influenza infection, and are included among the high-risk groups for whom annual influenza vaccination is recommended. To measure the progress toward the national year 2000 and 2010 objectives of a 60% annual influenza vaccination of adults with high-risk conditions aged 18 to 64 years, we analyzed data from the 1997 to 2001 National Health Interview Surveys (NHIS) regarding persons with cardiovascular disease. The NHIS is an annual, cross-sectional survey representative of the U.S., noninstitutionalized, civilian population. Estimated percentages of persons with heart disease reporting influenza vaccination were relatively stable during the 1996-97 through 2000-2001 influenza seasons, with the highest levels in most groups occurring in 1999-2000: 49.2% (95% confidence interval [CI], 44.1%-54.3%) among persons aged 50 to 64 years; and 22.7% (95% CI, 18.2%-27.2%) among persons aged 18 to 49 years. Influenza vaccine coverage among adults aged 18 to 64 years with cardiovascular disease is substantially below the national objective. Multiple strategies are needed to improve vaccination coverage, such as increasing the awareness of and demand for vaccination by persons with heart disease; increasing implementation by providers of practices that have been shown to increase vaccination levels; and adopting of influenza vaccination by primary care providers and specialists as a standard of care for persons diagnosed with cardiovascular disease.

Adolescent↗

PubMed2002

Primary care at a crossroads.

The author explains why primary care is especially beleaguered today (e.g., growth in specialization and widening income gaps between specialists and generalists, growth of managed care, cutbacks in Medicare and Medicaid payments to academic medical centers, and pro-technology biases in fee-for-service payment). Medical students sense primary care's troubles; primary care residency matches continue to decline. Attempts to encourage generalist practice cannot compete with such forces as pro-specialist reimbursement policies, the way research is funded, the dominance of specialist role models, and the daunting knowledge demands of the generalist mandate. Can generalists find a niche in the current health care marketplace? How will the under-65 population influence the future of primary care practice? (The author predicts a scenario based on patients' degrees of affluence.) Will consumers be willing to pay for the services that primary care is uniquely well positioned to offer? The author explains why increasingly important issues of cost, quality, and convenience could help create a niche for primary care. He also maintains that academic medicine must rededicate itself to producing well-trained generalists, despite all the pressures not to, and discusses the challenges that family practice, internal medicine, and pediatrics must face if they are to flourish. He concludes that if generalism fails the market test, something very precious will be lost-and that generalist physicians would be so badly missed that they might have to be reinvented.

Humans↗

PubMed2002

Overview of cancer control programs in Japan.

Japan has a population of about 127 million, with an average life expectancy that is one of the highest in the world. Cancer has been the leading cause of death in Japan since 1981. The incidence of cancer for all sites in 1994 was estimated to be 440 000; crude incidence rates per 100 000 for males and females were 416.3 and 299.4, respectively. In 1997, the number of cancer deaths was 275 413; crude death rates for males and females per 100 000 were 273.0 and 169.9, respectively. Projections for 2015 indicate that 890 000 people will develop cancer and 450 000 will die as a result. It is not too much to say that Japan is now amid a 'Cancer Era'. Meanwhile, the progress in medical sciences is improving survival in cancer patients; in cancer patients diagnosed during 1987-89, relative 5-year survival was reported to be 41.2% for all sites and cancer survivorship research estimated the number of cancer survivors for all sites in 1998 who have lived for between 5 and 24 years after diagnosis to be 1.5 million. The Ministry of Health and Welfare is focusing on five different measures in the implementation of its cancer control programs: public health education, nationwide cancer screening programs, development and support of specialized medical institutions, training of specialists and promotion of basic and clinical cancer research. As a tool for public health education, the Ministry published in 2000 a 10-year health promotion program entitled 'Healthy Japanese in the 21st Century'. In the plan, seven particular goals are enumerated with regard to cancer. In practice, issues of concern include the development of new modalities, telling the truth to cancer patients, clinical trials and bioethical issues.

Female↗

PubMedDate not supplied

[Problem of bioterrorism under modern conditions].

It is practically impossible to discuss the problem of bioterrorism (BT) and to develop effective programs of decreasing the losses and expenses suffered by the society from the BT acts without evaluation of the threat and prognosis of consequences based on research and empiric data. Stained international situation following the act of terrorism (attack on the USA) on September 11, 2001, makes the scenarios of the bacterial weapon use (the causative agents of plague, smallpox, anthrax, etc.) by international terrorists most probable. In this connection studies on the analysis and prognostication of the consequences of BT, including mathematical and computer modelling, are necessary. The authors present the results of initiative studies on the analysis and prognostication of the consequences of the hypothetical act of BT with the use of the smallpox causative agent in a city with the population of about 1,000,000 inhabitants. The analytical prognostic studies on the operative analysis and prognostication of the consequences of the BT act with the use of the smallpox causative agent has demonstrated that the mathematical (computer) model of the epidemic outbreak of smallpox is an effective instrument of calculation studies. Prognostic evaluations of the consequences of the act of BT under the conditions of different reaction of public health services (time of detection, interventions) have been obtained with the use of modelling. In addition, the computer model is necessary for training health specialists to react adequately to the acts of BT with the use of different kinds of bacteriological weapons.

Bioterrorism↗

PubMed1981

Tonsillectomy in Maine: regulation versus education as modulators of medical care.

The reduction in the rate of tonsillectomy, using the state of Maine as an example, and the causes thereof are addressed. Are federal and state regulations required to change the behavior of physicians and the public, or is education of greater importance? A study of tonsillectomy in the state of Maine was based on data covering a period of approximately 30 years. The data were based on direct contact with hospitals, in which we achieved the cooperation of virtually all of the hospitals of Maine, encompassing 98% of the hospital beds. These data were placed in context by information provided by the Maine Health Data Service, and by information for the northeastern United States, for the eastern United States, and for the entire United States, from the Department of Health, Education and Welfare. The operation of tonsillectomy and its variants, including adenoidectomy, has declined remarkably in the past 30 years, most drastically in the past eight years. It now occupies only 4.5% of the total operative admissions for the State, where it formerly was 17%. It now has a populational incidence for the State of 3.3 operations per thousand population per year, whereas it formerly was at a level of about 10.0. From this study, as well as from physicians in Maine, to whom an informal questionnaire was sent, it is clear that this reduction has come about largely because of education of physicians and the public. Increased awareness by the public, pediatricians and general practitioners of the limitations of this operation has been significant. In addition, there is a general sense of improved general health of young people in Maine, with fewer chronic respiratory infections. Some negative opinions were expressed, including the possibility that peritonsillar abcesses may be more frequent in the future and that some pediatricians and general practitioners overuse antibiotics. Federal regulations, state regulations, Medicare, Medicaid, Blue Cross or Blue Shield regulations concerning tonsillectomy were not instituted at any point in the State of Maine, during the period under study. There were no alterations in payment, second opinion programs or other restrictions or constraints placed on the operation at any level of official or hospital regulation. Formerly performed in large numbers by general practitioners, family practitioners, and general surgeons, the operation(s) is now predominantly carried out by trained otolaryngologists, largely board certified. Evidence is presented to support the view that concentration of this operation in the hands of fewer, more highly trained surgical specialists has been positively associated with its sharper indications and declining frequency. The conclusion is offered that increased education of physicians, both specialists and general practitioners as well as family doctors, and of the public as a whole, is the most important single factor in producing this significant alteration in the behavior of the health care system in the State of Maine. Effective limitation of the operation to specialists has been an important feature both of this educational process and of the more rational use of the operation(s).

Adenoidectomy↗

PubMed1999

Dual provision or duplication? A survey of family planning provision.

BACKGROUND: Family planning has been delivered through dual provision by general practice and community based clinics since its inception. This may be perceived as duplication of services and can be regarded as an area of possible disinvestment in a climate of rising health care costs. AIM: A survey of family planning service provision across a health district was carried out to establish the potential to rationalise current service provision by studying the pattern of service provision in the district and the links between family planning clinics and general practices. METHOD: A postal questionnaire and covering letter were sent to all practices and clinics in May 1997. Following analysis, results were,fed back to clinic staff and general practitioners through accredited meetings. RESULTS: Basic family planning was universally available to the population at all practices and clinics. Clinics offered a wider range of services, especially specialist services for psychosexual counselling and hormonal implants. Very few separate services for young people were identified. Within the primary care sector there was little 'out-of-hours' provision of contraceptive services. Half of the practices responding had used or would use family planning services as referral centres; implants and psychosexual services attracted most referrals. CONCLUSION: An understanding of the complementary nature of the services in primary care and community FP clinics was achieved and agreement was reached that disinvestment in clinics locally was not appropriate. The need to raise public awareness of availability of all contraceptive services was identified. Services in general practice and community clinics are complementary and need to develop a joint strategy to ensure an effective, comprehensive service. Quality of care needs to be examined in future work.

Family Planning Services↗

PubMed1999

The changing healthcare market and how it has influenced the treatment of cardiovascular disease--Part 1.

The dramatic transformations taking place in the healthcare environment have created a new paradigm for healthcare and pose far-reaching changes for cardiovascular care. This 2-part paper reviews these changes and discusses the major implications for cardiovascular specialists, based on literature reviews and summaries of legislative initiatives. The new healthcare paradigm focuses on a continuum of care, wellness maintenance and promotion, accountability for the healthcare of defined populations, and provider differentiation based on ability to add 'value' to the patient's healthcare outcome. This paradigm will become 'standard operating procedure' in the cardiovascular market. As a result, major areas of change in the cardiovascular environment include: continuing growth of managed care arrangements, expanding physician and other payment reforms, growing influence of state and private payer initiatives, expanding role of 'centers of excellence,' continuing surplus of physicians, growth in pharmaceuticals and new technologies, and extension of evidence-based guidelines. Practice guidelines, in particular, will become an integral part of medical practice and will represent the standards against which medical practice will be measured. Given the prominent position of cardiovascular disease in healthcare, cardiovascular specialists will remain in the forefront of these developments.

Cardiac Surgical Procedures↗