scholarly journals Managing depression in older people

1996 ◽  
Vol 2 (4) ◽  
pp. 178-185 ◽  
Author(s):  
Cornelius Katona
Keyword(s):  
Patient Outcome ◽  
Health Care ◽  
Clinical Practice ◽  
High Risk ◽  
Elderly Patients ◽  
Old Age ◽  
Clinical Presentation ◽  
Psychological Treatment ◽  
Treatment Options ◽  
Care Costs

Although common and disabling, depression in old age remains both underdetected and under-treated. This is particularly regrettable in view of its high risk of chronicity, recurrence and suicide, as well as the considerable burden of associated health care costs. Despite the availability of a variety of physical and psychological treatment options of well-established efficacy, there is little recent evidence of improvement in either clinical practice or patient outcome. An understanding of the principles of management of depression in elderly patients requires some knowledge of the differences between such patients and their younger counterparts. The clinical presentation and diagnosis of depression in old age, its epidemiology and prognosis are reviewed briefly below, before focusing on the practicalities of treatment.

scholarly journals Clinical Practice Guidelines andHelicobacter pyloriInfection in Children

1999 ◽  
Vol 13 (7) ◽  
pp. 560-562 ◽  
Author(s):  
Colin Macarthur ◽  
Liisa Jaakkimainen
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Guideline Development ◽  
Guideline Implementation ◽  
Key Steps ◽  
Evidence Based Guidelines ◽  
Care Costs

The objective of this paper is to review the principles, methods and issues behind the development of clinical practice guidelines. Practice guidelines have been defined as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. The ultimate goal of guidelines is to improve patient outcomes; however, they may also be used as tools to decrease health care costs, improve medical education and enhance quality assurance. Evidence-based guidelines use explicit methods to link recommendations to the quality of the underlying research. Following development of the guideline, implementation and evaluation are key steps. The ultimate aim of guideline development is to influence physician knowledge, attitudes and behaviour.

scholarly journals Institutionalization-Free Survival and Health Care Costs among Quebec Community-Dwelling Elderly Patients with Dementia

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Sarah-Gabrielle Beland ◽  
Antoine Pariente ◽  
Yola Moride
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Health Care Costs ◽  
Reference Population ◽  
Community Dwelling ◽  
Third Party ◽  
Published Data ◽  
Administrative Claims ◽  
Free Survival ◽  
Care Costs

Background. Published data on burden of dementia mainly include patients of third-care facilities. Economic consequences in an outpatient setting remain poorly examined. Objectives. To evaluate institutionalization-free survival and direct health care costs of dementia in the Quebec community-dwelling elderly population. Methods. A retrospective cohort study was conducted using the Quebec administrative claims databases. The cohort included a random sample of patients with treated dementia between January 1, 2000, and December 31, 2009 (n=37,138). The reference population included elderly patients without dementia matched in age group, gender, and index date. Using a third-party payer perspective, direct costs over 5 years were assessed. Results. Institutionalization-free survival at 5 years was lower in patients with dementia than in elderly without dementia (38.9% and 72.2%, resp.). Over 5 years, difference in mean total direct health care costs per patient was CAD$19,159, distributed into institutionalizations (CAD$13,598), hospitalizations (CAD$3,312), and prescribed medications (CAD$2,320). Costs of medical services were similar (−CAD$96). In the first year of followup, cost differentials were mainly attributable to hospitalizations, while in the last year (year 5) they were due to institutionalizations. Conclusion. This study confirms that dementia is an important socioeconomic burden in the community, the nature of which depends on disease progression.

scholarly journals A unique partnership between a health system’s insurance plan and the Integrative Medicine Department benefits patients and helps control costs

2016 ◽  
Vol 5 (4) ◽  
pp. 61
Author(s):  
Maureen M Anderson ◽  
Karen Armstrong ◽  
Katherine Nori Janosz ◽  
Michael Tocco ◽  
Nancy A DeVore ◽  
...  
Keyword(s):  
Health Care ◽  
Integrative Medicine ◽  
Health Care Costs ◽  
Treatment Options ◽  
Cost Savings ◽  
Clinical Results ◽  
Insurance Plan ◽  
Effective Care ◽  
Wide Range ◽  
Care Costs

Health care costs continue to increase, affecting patients and insurance providers. Complementary health approaches are increasingly used to augment traditional medicine, and integrative medicine (IM) incorporates these complementary approaches into traditional patient care. The IM Department was established in our institution in 2004 and now offers a wide range of services to patients. Our institution offers health care coverage to all benefit-eligible hospital personnel and their eligible dependents. The use of IM has had a surprising and beneficial effect on the health care costs of this small, self-insured health plan. We found that the coverage of certain IM modalities for specific conditions had positive clinical results and resulted in significant cost savings to the insurance plan. At the same time, this partnership supports patients by providing appropriate and effective care, and we have seen success in terms of patient recovery and patient satisfaction. Here, we present the history of the relationship between the insurance plan and the IM Department, how the coverage of IM modalities has expanded, and the current practice at our institution. We demonstrate that this innovative relationship has benefitted patients and resulted in cost-savings for the insurance provider. Therefore, this partnership will continue to expand, thus providing patients with a wide range of treatment options and effective care.

scholarly journals Primary Care in Supplementary Health: impact on care costs of elderly patients with heart disease

2020 ◽  
Author(s):  
Geórgia Silva Marques ◽  
Alessandra Maciel Almeida ◽  
Isabel Cristina Gomes ◽  
Michele Renata Barbosa da Silva ◽  
Bruno Almeida Rezende
Keyword(s):  
Health Care ◽  
Heart Disease ◽  
Elderly Patients ◽  
Population Aging ◽  
Health Spending ◽  
Vulnerability Index ◽  
Cost Of Care ◽  
Sample Mean ◽  
One Year ◽  
Care Costs

Abstract Introduction: Population aging has been changing the epidemiological profile in the World. Cardiovascular diseases are the leading cause of death in many countries and have an impact on health spending. Objectives: To identify factors that influence health care costs in elderly patients with heart disease treated at a Supplementary Primary Health Care (PHC) unit in Brazil. Methods: Retrospective cohort of 223 patients with heart disease aged ≥ 60 years from one year before and one year after PHC implantation. Data were obtained from electronic medical records and the costs in the total cost of care database (hospital, outpatient and home). Patients were classified according to the Clinical-Functional Vulnerability Index (CFVI-20). Results: There was no reduction in total costs, but it occurred in hospitalization expenses after the implementation of PHC for the whole sample (mean ± SD, US$ 698.43 ± US$ 3,500.76, p=0.011), with a significant reduction among (p=0.023), pre-diagnosis of acute myocardial infarction (AMI) (p=0.023), eutrophic BMI (p=0.027), non-smokers (p=0.020), and robust according to the CFVI-20 (p=0.013). There was a decrease in the frequency of hospitalization for the whole sample (p=0.006), among males (p=0.014), age between 71 and 80 years (p=0.001), robust (p=0.025) and AMI (p= 0.027). There was a reduction in the frequency of consultations in the Emergency Department among fragile elderly (p=0.011). Conclusions: There was a reduction in the frequency and cost of hospitalization in elderly patients with heart disease in follow-up at PHC, in addition to reducing the frequency of consultation in PHC in the fragile elderly.

Clinical presentation and management of liver lobe torsions in domestic rabbits

2021 ◽  
Vol 12 (9) ◽  
pp. 420-425
Author(s):  
Abigail Edis
Keyword(s):  
Clinical Practice ◽  
Nursing Care ◽  
Oryctolagus Cuniculus ◽  
Clinical Presentation ◽  
Treatment Options ◽  
Liver Lobe ◽  
Successful Case ◽  
Domestic Rabbits

Rabbits (Oryctolagus cuniculus) are common household pets, and make endearing companions for both the young and old. Rabbit medicine has advanced greatly in recent years, and we are now able to recognise, diagnose and treat many conditions and presentations that may have previously been poorly understood. One of the conditions that is increasingly recognised is liver lobe torsion, which can prove difficult to recognise in clinical practice, especially if the team has not encountered the condition before. The purpose of this article is to highlight liver lobe torsions in rabbits, their presentation and treatment options and nursing care, and describe a successful case seen at the clinic.

Community Care Management: Advanced Practice Nurses as Care Managers

2000 ◽  
Vol 2 (3) ◽  
pp. 148-152 ◽  
Author(s):  
Christine M. Waszynski ◽  
Wendy Murakami ◽  
Mary Lewis
Keyword(s):  
Health Care ◽  
High Risk ◽  
Primary Care Physicians ◽  
Advanced Practice Nurses ◽  
Advanced Practice ◽  
Model Of Care ◽  
Practice Nurses ◽  
Coordination Model ◽  
Hospital Days ◽  
Care Costs

A group of advanced practice nurses partnered with a major insurer in the design and implementation of a care coordination model for high-risk older adults. This article will discuss the process of such an undertaking, highlighting the successes and barriers encountered. The key elements of this program included early identification and regular reassessment of each member’s acuity level; fostering close partnerships between individual or teams of APRNs and groups of physicians; and uninterrupted clinical management of high-risk members across the health care continuum. This model was designed to achieve the following outcomes: to support the physician management of high-risk, chronic individuals; to increase or maintain the health of members; and to reduce health care costs. Outcome studies have demonstrated a substantial net savings by decreasing acute care admissions by 54%, reducing hospital days by 42%, and trimming primary care physicians’ and specialists’ visit costs by 37%. There was a 33% reduction in the overall costs of health care for members enrolled in this program. Physicians and members both rated their satisfaction with the APRN-based model of care as very high.

Disease-Related and All-Cause Health Care Costs of Elderly Patients With Gout

2008 ◽  
Vol 14 (2) ◽  
pp. 164-175 ◽  
Author(s):  
Eric Q. Wu ◽  
Pankaj A. Patel ◽  
Andrew P. Yu ◽  
Reema R. Mody ◽  
Kevin E. Cahill ◽  
...  
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Health Care Costs ◽  
Care Costs
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