The report, New Directions for State Long-Term Care Systems Volume III: Supportive Housing, provides definitions of several types of supportive housing options and outlines some of the issues states face in regulating this growing market.
The report distinguishes among several types of supportive housing:
The Drug Information Network consists of the Chesapeake, Virginia-based Center for Health Information, the Medical University of South Carolina, North Carolina Baptist Hospital, and the University of Maryland School of Pharmacy. The four centers currently answer more than 10,000 drug and health information requests annually.
The target customer base of the new network includes hospitals, managed care organizations, long-term care pharmacy providers, physician practice management companies, pharmacy benefit organizations, demand management companies, contract research organizations, and pharmaceutical companies.
The Drug Information Network hopes to become "the premier drug information training program for students and residents," according to CHI Chief Operating Officer Steven F. Bauwens. The network has established three drug information residency programs to provide training for students and residents in both an academic medical center and a practice-based pharmaceutical care management company.
For more information, contact Bauwens at 757-483-6117, or visit the Center for Health Information web site at www.ctr4healthinfo.com.
Results of a ten-year study of 181 patients showed a strong statistical relationship between early morning blood pressure readings and the size of the left ventricle, the part of the heart that pumps blood to most of the critical parts of the body. Enlargement of the left ventricle is often associated with serious cardiovascular events such as heart attack, stroke, or death.
Researchers at the Hospital Saint Andre in Bordeaux, France, followed 128 men and 53 women with hypertension who were previously untreated from 1986 to 1996. Blood pressure was measured three times in a physician's office, and then echocardiography was performed to measure the weight and wall thickness of the left ventricle.
Patients were fitted with ambulatory blood pressure monitoring devices to automatically record blood pressure throughout the day and were instructed to trigger their device immediately upon awakening and standing.
Though almost all people experience a rise in blood pressure and heart rate when they wake up, researchers reported that the blood pressure of patients with enlarged left ventricles was strikingly higher, by an average 19 mm Hg systolic and 16 mm Hg diastolic.
"We found a highly significant correlation between blood pressure measured immediately after arising in the morning and left ventricular mass in untreated hypertensive patients," the researchers said.
Nearly 50 million Americans have high blood pressure, sometimes called the silent killer because it prematurely ages the body's arteries and can lead to strokes, heart attacks, and kidney failure, often without warning.
A recent report, titled "Achieving Mental Health of Nursing Home Residents: Overcoming Barriers to Mental Health Care," reviews policy, relevant research, and current recommendations based on a national consensus conference of the same name addressing the mental health of nursing home residents.
The 56-page report examines prevalence, current treatment options, examples of model programs, reimbursement and policy issues, funding, and quality management.
For more information, contact the Hebrew Rehabilitation Center for the Aged, one of the support sponsors, at 617-325-8000.
Though discontinuation symptoms are usually mild and transient, they pose the risk of misdiagnosis and may lead to inappropriate treatment, said symposium chairman Chris Thompson.
Reports regarding the discontinuation of SSRIs suggested that adverse events occurred most frequently with paroxetine, and rarely with fluoxetine.
Jerrold Rosenbaum, MD, of Boston, Massachusetts, described a study in which intermittent patient non-compliance was mimicked by interrupting treatment with a placebo phase in a double blind study of continuing antidepressant therapy with fluoxetine, paroxetine, and sertraline.
Fluoxetine was found to cause significantly fewer discontinuation symptoms than either of the other two antidepressants.
Symposium participants recommended that pharmacists support patients in the following ways:
Number of Nursing Homes by Ownership, Affiliation, and Certification Status: United States, 1995
| ________________Certification______________ |
|---|
| Ownership and Affiliation | Total | Certified by Medicare and Medicaid | Certified by Medicare Only | Certified by Medicaid Only | Not Certified |
| All Facilities | 16,700 | 11,600 | *1,000 | 3,400 | *700 |
| Ownership | |||||
| Proprietary | 11,000 | 8,100 | * | 2,200 | 300 |
| Voluntary nonprofit | 4,300 | 2,700 | * | *800 | 300 |
| Government and other | 1,300 | 800 | * | * | * |
| Affiliation | |||||
| Chain | 9,100 | 7,100 | *600 | 1,200 | * |
| Independent | 7,600 | 4,500 | * | 2,100 | *600 |
CenterWatch reports that the PPMs' deep resources, including private research centers, physicians, patients, capital, and information systems, will make them important competitors for academic medical centers, private research centers, and contract research organizations.
PPMs that are becoming involved in clinical trials say their physicians want the chance to participate in clinical trials, they want to provide their patients with promising investigational drugs, and they believe that participating in clinical trials will complement their own outcomes research.
In June, the governor of Missouri signed into law a statute requiring managed-care companies to pay for emergency-room visits whenever a "prudent layperson" would judge that immediate care is needed, regardless of whether a managed-care administrator would agree.
In Texas, a law enacted this summer allows consumers to sue managed-care plans for malpractice. In New York, an unusual coalition of doctors, lawyers, hospitals, consumers, and labor groups is backing a bill allowing consumers to sue health insurance companies for medical malpractice if a decision to deny or delay treatment causes injury. And in Connecticut, lawmakers approved a bill allowing consumers to appeal to the state insurance commissioner if their managed-care plan refuses to pay for medical treatment.
The movement is being fueled by "horror stories" such as that of Leon Hand, a Texas resident whose experience was reported in the May 31 issue of USA Today. Hand arrived at the emergency room of a hospital run by a managed-care company complaining of a headache which had persisted for three days. Hand was sent home, despite a history of high blood pressure, a family history of aneurysms, and a recommendation that he be hospitalized. Three hours later, Hand suffered a stroke.
Many managed-care executives remain upbeat in the face of this growing unrest, citing unrealistic consumer expectations and pointing to polls reflecting high rates of consumer satisfaction with their managed-care plans. A recent survey conducted by Sachs/Scarborough/ Health Plus showed that more than 80% of consumers in eight major U.S. cities are happy with their health maintenance organizations.
Why the discrepancy? According to a group of activist physicians in Boston who have drafted a petition calling for an end to for-profit takeovers of medical facilities and an open discussion of the deteriorating quality of medical care, the reasons are clear: "For the public, who are mostly healthy and use little care, awareness of the degradation of medicine builds slowly; it is mainly those who are expensively ill who encounter the dark side of market-driven health care," says their statement.
Some statistics appear to back them up. Sachs Scarborough survey participants in Florida, where many elderly people live, were among those least satisfied with their HMOs.
When the team conducted a random analysis of one thousand medication order sheets during a six-week period, they discovered that approximately half of the sheets contained a source for possible error, such as illegible handwriting or incomplete dosage instructions. It also found a remarkably high incidence of unapproved abbreviations, including "trademark" abbreviations and symbols that incorporated Latin or Greek.
Twenty-seven percent of the error-prone order sheets contained an unapproved symbol or some other "creative" notation. Instructions included such things as "IVP" for IV push, "Neb" for nebulizer, "H/A" for headache, "MSO4" for morphine sulfate, and an asterisk or degree mark to signify "hour."
Unfortunately, the hospital's attempt to rectify the problem was less than successful. "We isolated the top 20 'stylistic' practitioners," said Charles A. Krivenko, MD, vice president for system clinical services. "We sent them a letter. I called each one." A subsequent audit of 350 order sheets, however, revealed no significant improvement.
Krivenko has come to the conclusion that automation may provide the only real solution for overly individualistic prescription writers. In the meantime, Promina Gwinnett's tactic for dealing with its creative writers is one of direct confrontation: For example, if a physician writes 1 mg of Coumadin as 1.0 mg, the pharmacist will immediately let the physician know that the 1.0 could have been mistaken for a 10, and a patient might have died as a result.
Newton, Massachusetts-based NEWMED Corporation's DOSER, which has received U.S. Food and Drug Administration 510K clearance, uses a self-contained microcomputer to count and display the number of inhalations taken in a current day and the number of inhalations remaining in the MDI. The device also stores information on the number of inhalations taken in each of the last 30 days and alerts the user when the MDI is nearly empty. With its self-contained battery, the DOSER lasts up to a year.
A three-part validation study presented at the American Lung Association-American Thoracic Society International Conference in May concluded that the DOSER is "reliable and accurate for measuring MDI usage." Data showed that accordance between the DOSER and tracking diaries ranged from 85%-98%, with the device performing well in both controlled laboratory situations and actual usage studies with asthma patients.
For additional information, visit the NEWMED web site at www.DOSER.com, or call 800-863-9633.
Healthfinder employs an easy-to-use format to link the user to medical news, new drug information, research studies, and frequently asked questions on a wide variety of health-related subjects.
Greenstone Health Care Solutions, the disease management subsidiary of Pharmacia & Upjohn, Inc., now offers consumers a free, confidential health risk assessment via the World Wide Web.
"You First" (www.youfirst.com) analyzes answers to questions about family history, health habits, and lifestyle behaviors, then creates a personalized report with tips for avoiding future problems and maximizing health.
Recently, when a pharmacist received an order for "CPT 200 mg in 500 mL over 90 minutes," he thought that cisplatin (Platinol) had been prescribed. Wisely, he consulted with another pharmacist, who remarked that a cisplatin dose that high could prove toxic for this patient.
The pharmacists also considered that CPT might represent carboplatin (Paraplatin), but the dose seemed low for that drug. They decided to check with the prescriber and learned that CPT was an acronym for irinotecan.
Given the dosage ranges for the above agents, as well as numerous
reports of dosing errors on file at the United States Pharmacopoeia
and at FDA, it's clear that confusion between these could lead
to patient harm or death, notes ISMP. Their recommendation: Where
irinotecan is available, take action now to ensure that all regimens
and protocols properly refer to Campostar. For safety reasons,
only generic and/or brand names should be acceptable for chemotherapy
prescriptions. The acronym "CPT" is extremely dangerous
and should never be used.