scholarly journals Pharmacist Clinical Interventions and Discharge Counseling in Medical Rehabilitation Wards in a Local Hospital: A Prospective Trial

Geriatrics ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 53 ◽  
Author(s):  
Rosanna Nga Suet Ip ◽  
Justin Wade Tenney ◽  
Angus Chun Kwok Chu ◽  
Pauline Lai Ming Chu ◽  
Grace Wai Man Young
Keyword(s):  
Health Care ◽  
Medication Adherence ◽  
Health Care Utilization ◽  
Usual Care Group ◽  
Medication Reconciliation ◽  
Intervention Group ◽  
Medical Rehabilitation ◽  
Care Group ◽  
Care Utilization ◽  
Utilization Rate

Patients undergoing rehabilitation experience numerous changes in medication regimens during care transitions, exposing these patients to an increased risk of drug-related problems (DRPs). A prospective, non-randomized, quasi-experimental study was conducted in medical rehabilitation wards to evaluate the impact of pharmacist-delivered interventions and counseling on 30-day unplanned health care utilization and medication adherence for selected rehabilitation patients. A pharmacist provided medication reconciliation and counseling before discharge. Phone follow-up was completed 30 days after discharge to assess for unplanned health care utilization rate and medication adherence. A total of 85 patients (n = 43 in prospective intervention group and n = 42 in historical usual care group) were included. Among the intervention group, 23 DRPs were identified in 14 (32.6%) patients, resulting in 51 interventions. The intervention group had a significantly lower unplanned health care utilization rate than the usual care group (25.6% vs. 47.6%, p = 0.035). The risk of unplanned health care utilization was reduced by over 60% (Odds ratio (OR) = 0.378; 95% CI = 0.15–0.94). Patients reporting medium to high medication adherence increased from 23.6% to 88.4% 30 days after counseling (p < 0.05). Pharmacist medication reconciliation and discharge counseling reduced unplanned health care utilization 30 days after discharge and improved medication adherence.

scholarly journals Effectiveness of Public and Co-operative Health Insurance Models in Nepal: A Concurrent Mixed Study

2016 ◽  
Author(s):  
Chhabi Ranabhat ◽  
Chun-Bae Kim ◽  
Myung-Bae Park
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Utilization ◽  
Health Care Service ◽  
Large Population ◽  
High Income ◽  
Care Utilization ◽  
Utilization Rate ◽  
Religious Minority ◽  
Mixed Study

Background: Health insurance (HI) run by government is providing health care service to large population. Due to poor accountability, participation and sustainability, cooperative health insurance is becoming more popular and effective in low and middle income and some high-income countries too. In Nepal, there are public and cooperative HI is in practice. The aim of this study is to compare the effectiveness of public (government) and cooperative HI in relation to benefit packages, population coverage, inclusiveness, health care utilization, and promptness for treatment in these two health insurance models in Nepal. Method: This is an institution based concurrent mixed study consists of qualitative and quantitative variables from public and cooperative groups. We included all public HI operated by government hospitals and cooperatives groups those purchased hospital service in contract. Two separate study tools were applied to access the effectiveness of insurance models. The key questions were asked for the representatives of government and private health insurance. The numeric information consisted of in quantitative data and subjective response was included in qualitative approach. Descriptive statistics and Mean Whitney U test was applied in numeric data and qualitative information were analyzed by inductive approach Results: The study revealed that new enrolment was not increased, health care utilization rate was increased and the benefit package was almost same in both groups. The overall inclusiveness was higher for the government HI, but enrolment from the religious minority, proportion of negotiated amount during treatment were significantly higher (p&lt;0.05). During illness, the response time to reach hospital was significantly faster in cooperative health insurance than government health insurance. Qualitative findings showed that level of participation, accountability, transparency and recording system was better in cooperative health insurance than public. Conclusion: Cooperative HI could be more sustainable and accountable to the community for all; low, middle and high-income countries.

Longitudinal Medication Adherence in Older Adults With Multimorbidity and Association With Health Care Utilization: Results From the Irish Longitudinal Study on Ageing

2020 ◽  
Vol 55 (1) ◽  
pp. 5-14 ◽  
Author(s):  
Caroline A. Walsh ◽  
Caitriona Cahir ◽  
Kathleen E. Bennett
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Longitudinal Study ◽  
Medication Adherence ◽  
Health Care Utilization ◽  
Negative Binomial ◽  
Care Utilization ◽  
Multiple Chronic Conditions ◽  
Visit Rate ◽  
Management Interventions

Background: The association between objectively measured nonadherence and health care utilization in multimorbid older people is unclear. Objective: To measure medication adherence across multiple chronic conditions, identify adherence patterns, and estimate the association between adherence and self-reported health care utilization. Methods: This is a retrospective cohort study of multimorbid participants aged ≥70 years in the Irish LongituDinal Study on Ageing (TILDA). Eligible participants had linked pharmacy claims data and completed TILDA wave 2 (2 years after wave 1). The RxRisk-V tool was used to identify multimorbidity. Average adherence (AA) across RxRisk-V conditions was estimated using the CMA7 function (AdhereR). Group-based trajectory models (GBTMs) identified adherence patterns in the 12 months following wave 1. Negative binomial regression was used to estimate the association between adherence and the rate of subsequent self-reported general practitioner [GP] visits, emergency department (ED) visits, outpatient visits, and hospitalizations in the 12 months following adherence measurement (reported at wave 2). Adjusted Incident Rate Ratios (aIRR) and 95% CIs are presented. Results: Higher AA (CMA7) was associated with a small significant decrease in GP visit rate (aIRR = 0.70; CI = 0.53-0.94) and outpatient visit rate (aIRR = 0.44; CI = 0.23-0.81). GBTM identified 6 adherence groups (n = 1050). Compared with high adherers, group 1 (rapid decline, modest increase) membership (aIRR = 1.72; CI = 1.09-2.73) and group 4 (high adherence, delayed decline) membership (aIRR = 1.92; CI = 1.19-3.05) significantly increased ED visit rate. Conclusion and Relevance: Suboptimal medication adherence in multimorbid older adults is associated with increased health care utilization. Identification of suboptimal adherence groups for medication management interventions may help decrease the health system burden and health care costs.

scholarly journals Evaluating the Impact of a Risk Assessment System With Tailored Interventions in Germany: Protocol for a Prospective Study With Matched Controls (Preprint)

2019 ◽  
Author(s):  
Marten Pijl ◽  
Jorn op den Buijs ◽  
Andreas Landgraf
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Intervention Group ◽  
Case Manager ◽  
The Elderly ◽  
Risk Scores ◽  
Care Utilization ◽  
Hospital Transport ◽  
Care Costs

BACKGROUND With a worldwide increase in the elderly population, and an associated increase in health care utilization and costs, preventing avoidable emergency department visits and hospitalizations is becoming a global priority. A personal emergency response system (PERS), consisting of an alarm button and a means to establish a live connection to a response center, can help the elderly live at home longer independently. Individual risk assessment through predictive modeling can help indicate what PERS subscribers are at elevated risk of hospital transport so that early intervention becomes possible. OBJECTIVE The aim is to evaluate whether the combination of risk scores determined through predictive modeling and targeted interventions offered by a case manager can result in a reduction of hospital admissions and health care costs for a population of German PERS subscribers. The primary outcome of the study is the difference between the number of hospitalizations in the intervention and matched control groups. METHODS As part of the Sicher Zuhause program, an intervention group of 500 PERS subscribers will be tracked for 8 months. During this period, risk scores will be determined daily by a predictive model of hospital transport, and at-risk participants may receive phone calls from a case manager who assesses the health status of the participant and recommends interventions. The health care utilization of the intervention group will be compared to a group of matched controls, retrospectively drawn from a population of PERS subscribers who receive no interventions. RESULTS Differences in health care utilization and costs between the intervention group and the matched controls will be determined based on reimbursement records. In addition, qualitative data will be collected on the participants’ satisfaction with the Sicher Zuhause program and utilization of the interventions offered as part of the program. CONCLUSIONS The study evaluation will offer insight into whether a combination of predictive analytics and case manager-driven interventions can help in avoiding hospital admissions and health care costs for PERS subscribers in Germany living at home independently. In the future, this may lead to improved quality of life and reduced medical costs for the population of the study. CLINICALTRIAL Deutsches Register Klinischer Studien (DRKS), DRKS00017328; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&amp;TRIAL_ID=DRKS00017328 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17584

Do Postpartum Nursery Visits by the Primary Care Provider Make a Difference?

PEDIATRICS ◽  
1991 ◽  
Vol 88 (3) ◽  
pp. 444-449
Author(s):  
Janet R. Serwint ◽  
Modena H. Wilson ◽  
Anne K. Duggan ◽  
E. David Mellits ◽  
Rosemary A. Baumgardner ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Care Provider ◽  
Primary Care Provider ◽  
Intervention Group ◽  
Maternal Anxiety ◽  
Care Utilization ◽  
Control Group ◽  
Maternal Knowledge

A prospective, randomized, clinical trial was conducted to investigate whether a postpartum visit between a mother and her neonate's future primary care provider combined with telephone access would improve health care utilization, enhance identification of the provider as a source of advice, increase maternal knowledge of infant care, and decrease maternal anxiety and depression. Of 251 mother-neonate pairs, 122 were randomized to the control group and 129 to the intervention group. Outcome variables included health care utilization and results of maternal interviews. More mothers in the intervention group made a scheduled clinic visit in the first 30 days (P = .003), were more likely to seek some form of care at the clinic (P = .006), and tried to reach their physician by phone more often than the control group (P &lt;.001). There were no differences between the groups' emergency room utilization, the percent who received immunizations by 90 days of age, maternal knowledge of infant care, maternal anxiety, or postpartum depression. The intervention succeeded in improving some measures of health care utilization and results suggest that the relationship between the mother and clinician was strengthened.

scholarly journals Home-Based Kidney Care, Patient Activation, and Risk Factors for CKD Progression in Zuni Indians

2018 ◽  
Vol 13 (12) ◽  
pp. 1801-1809 ◽  
Author(s):  
Robert G. Nelson ◽  
V. Shane Pankratz ◽  
Donica M. Ghahate ◽  
Jeanette Bobelu ◽  
Thomas Faber ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Confidence Interval ◽  
Usual Care ◽  
Usual Care Group ◽  
Short Form ◽  
Intervention Group ◽  
Patient Activation ◽  
Care Group ◽  
Home Based

Background and objectivesThe burden of CKD is greater in ethnic and racial minorities and persons living in rural communities, where access to care is limited.Design, setting, participants, & measurementsA 12-month clinical trial was performed in 98 rural adult Zuni Indians with CKD to examine the efficacy of a home-based kidney care program. Participants were randomized by household to receive usual care or home-based care. After initial lifestyle coaching, the intervention group received frequent additional reinforcement by community health representatives about adherence to medicines, diet and exercise, self-monitoring, and coping strategies for living with stress. The primary outcome was change in patient activation score, which assesses a participant’s knowledge, skill, and confidence in managing his/her own health and health care.ResultsOf 125 randomized individuals (63 intervention and 62 usual care), 98 (78%; 50 intervention and 48 usual care) completed the 12-month study. The average patient activation score after 12 months was 8.7 (95% confidence interval, 1.9 to 15.5) points higher in the intervention group than in the usual care group after adjusting for baseline score using linear models with generalized estimating equations. Participants randomized to the intervention had 4.8 (95% confidence interval, 1.4 to 16.7) times the odds of having a final activation level of at least three (“taking action”) than those in the usual care group. Body mass index declined by 1.1 kg/m2 (P=0.01), hemoglobin A1c declined by 0.7% (P=0.01), high-sensitivity C-reactive protein declined by 3.3-fold (P<0.001), and the Short-Form 12 Health Survey mental score increased by five points (P=0.002) in the intervention group relative to usual care.ConclusionsA home-based intervention improves participants’ activation in their own health and health care, and it may reduce risk factors for CKD in a rural disadvantaged population.

Seizure Action Plans for Pediatric Patients With Epilepsy: A Randomized Controlled Trial

2019 ◽  
Vol 34 (11) ◽  
pp. 666-673 ◽  
Author(s):  
Dara V. F. Albert ◽  
Jennifer J. Moreland ◽  
Ann Salvator ◽  
Melissa Moore-Clingenpeel ◽  
Babitha Haridas ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Standard Care ◽  
Pediatric Patients ◽  
Action Plan ◽  
Care Group ◽  
Care Utilization ◽  
Standard Care Group ◽  
Patients With Epilepsy ◽  
The Impact

Objectives: Seizure action plans help patients and caregivers better self-manage their epilepsy. We hypothesized that providing pediatric patients and their caregivers with a seizure action plan would reduce unplanned health care utilization and decrease the impact of epilepsy. Methods: We developed a seizure action plan for use in pediatric epilepsy patients. A prospective cohort was randomly assigned to receive a seizure action plan in addition to standard epilepsy care or to standard epilepsy care alone. All caregivers were surveyed using the Modified Impact on Families (MIF) questionnaire at enrollment, 3 months, and 12 months. Health care utilization measures and Modified Impact on Families questionnaire scores were compared between the 2 groups. Results: Fifty-four patients received a seizure action plan and standard care, whereas 48 received standard care alone. The groups had similar demographics. There was a significantly higher proportion of overall clinic appointment no shows in the standard care group vs the seizure action plan group ( P = .04); however, other significant differences in health care utilization were not found. Among patients with low seizure frequency (12 or fewer seizures per year), Seizure comfort scores on the Modified Impact on Families questionnaire were significantly higher at 12 months among the seizure action plan group compared to the standard care group. Significance: Caregivers for patients with epilepsy receiving a seizure action plan were more comfortable regarding seizure care and missed fewer appointments. However, differences in health care utilization were not present. The seizure action plan appears to have more impact in patients who experience lower seizure frequencies. Further studies evaluating the impact as well as assessing caregivers’ perceptions of the seizure action plan using a larger sample are needed.

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