Abstract:
BACKGROUND:Managed care organizations use a variety of strategies to reduce the cost and improve the quality of medication use. The effectiveness of such policies is not well understood. The objective of this research was to update a previous systematic review of interventions, published between 1966 and 2001, to improve the quality and efficiency of medication use in the US managed care setting. METHODS:We searched MEDLINE and EMBASE for publications from July 2001 to January 2007 describing interventions targeting drug use conducted in the US managed care setting. We categorized studies by intervention type and adequacy of research design using commonly accepted criteria. We summarized the outcomes of well-controlled strategies and documented the significance and magnitude of effects for key study outcomes. RESULTS:We identified 164 papers published during the six-year period. Predominant strategies were: educational interventions (n = 20, including dissemination of educational materials, and group or one-to-one educational outreach); monitoring and feedback (n = 22, including audit/feedback and computerized monitoring); formulary interventions (n = 66, including tiered formulary and patient copayment); collaborative care involving pharmacists (n = 15); and disease management with pharmacotherapy as a primary focus (n = 41, including care for depression, asthma, and peptic ulcer disease). Overall, 51 studies met minimum criteria for methodological adequacy. Effective interventions included one-to-one academic detailing, computerized alerts and reminders, pharmacist-led collaborative care, and multifaceted disease management. Further, changes in formulary tier-design and related increases in copayments were associated with reductions in medication use and increased out-of-pocket spending by patients. The dissemination of educational materials alone had little or no impact, while the impact of group education was inconclusive. CONCLUSION:There is good evidence for the effectiveness of several strategies in changing drug use in the managed care environment. However, little is known about the cost-effectiveness of these interventions. Computerized alerts showed promise in improving short-term outcomes but little is known about longer-term outcomes. Few well-designed, published studies have assessed the potential negative clinical effects of formulary-related interventions despite their widespread use. However, some evidence suggests increases in cost sharing reduce access to essential medicines for chronic illness.
journal_name
BMC Health Serv Resjournal_title
BMC health services researchauthors
Lu CY,Ross-Degnan D,Soumerai SB,Pearson SAdoi
10.1186/1472-6963-8-75subject
Has Abstractpub_date
2008-04-07 00:00:00pages
75issn
1472-6963pii
1472-6963-8-75journal_volume
8pub_type
杂志文章abstract:BACKGROUND:Measurement of healthcare spatial access over a network involves accounting for demand, supply, and network structure. Popular approaches are based on floating catchment areas; however the methods can overestimate demand over the network and fail to capture cascading effects across the system. METHODS:Optim...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-015-0919-8
更新日期:2015-07-17 00:00:00
abstract:BACKGROUND:Access to health care is a particular concern given the important role of poor access in perpetuating poverty and inequality. South Africa's apartheid history leaves large racial disparities in access despite post-apartheid health policy to increase the number of health facilities, even in remote rural areas...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-014-0541-1
更新日期:2014-11-04 00:00:00
abstract:BACKGROUND:Clinical practice improvements based on quality-register data are influenced by multiple factors. Although there is agreement that information from quality registers is valuable for quality improvement, practical ways of organising register use have been notoriously difficult to realise. The present study so...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-4944-x
更新日期:2020-02-11 00:00:00
abstract:BACKGROUND:Decentralization through the establishment of hospital governing boards has been touted as an effective way to improve the quality and efficiency of hospitals in low-income countries. Although several studies have examined the process of decentralization, few have quantitatively assessed the implementation o...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-14-178
更新日期:2014-04-17 00:00:00
abstract:BACKGROUND:E-mental health is a promising medium to keep mental health affordable and accessible. For consumers with severe mental illness the evidence of the effectiveness of e-health is limited. A number of difficulties and barriers have to be addressed concerning e-health for consumers with severe mental illness. On...
journal_title:BMC health services research
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12913-016-1267-z
更新日期:2016-01-19 00:00:00
abstract:BACKGROUND:In low- and middle-income countries (LMICs), addressing the high prevalence of mental disorders is a challenge given the limited number and unequal distribution of specialists, as well as scarce resources allocated to mental health. The Mental Health Gap Action Programme (mhGAP) and its accompanying Interven...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-017-1992-y
更新日期:2017-01-17 00:00:00
abstract:BACKGROUND:The implementation of strategic health system change is often complicated by the informal politics and power of health systems, such as competing interests and resistant groups. Evidence from other industries shows that strategic leaders need to be aware of and manage such 'organisational politics' when impl...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-018-3728-z
更新日期:2018-12-03 00:00:00
abstract:BACKGROUND:In Mexico, patients with hematologic malignancies (HMs) are characterized by being at high risk and advanced stages at diagnosis and by having a low cure rate; yet information on their experiences with health care and health-related quality of life (HRQL) is scarce. We aimed to evaluate experiences with heal...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-05498-7
更新日期:2020-07-10 00:00:00
abstract:BACKGROUND:Electronic medical records contain valuable clinical information not readily available elsewhere. Accordingly, they hold important potential for contributing to and enhancing chronic disease registries with the goal of improving chronic disease management; however a standard for diagnoses of conditions such ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-10-347
更新日期:2010-12-23 00:00:00
abstract:BACKGROUND:The involvement of mental health service users and their caregivers in health system policy and planning, service monitoring and research can contribute to mental health system strengthening, but as yet there have been very few efforts to do so in low- and middle-income countries (LMICs). METHODS:This syste...
journal_title:BMC health services research
pub_type: 杂志文章,评审
doi:10.1186/s12913-016-1323-8
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:Ensuring access to timely and appropriate primary healthcare for people living in poverty is an issue facing all countries, even those with universal healthcare systems. The transformation of healthcare practices and organization could be improved by involving key stakeholders from the community and the heal...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-13-92
更新日期:2013-03-11 00:00:00
abstract:BACKGROUND:The rapid HIV antibody test is the diagnostic tool of choice in low and middle-income countries. Previous evidence suggests that rapid HIV diagnostic tests may underperform in the field, failing to detect a substantial number of infections. A research study inadvertently discovered that a clinic rapid HIV te...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-10-73
更新日期:2010-03-22 00:00:00
abstract:OBJECTIVE:This online cross-sectional survey assesses the signs/symptoms, the protective measures taken and the awareness and risk perception regarding COVID-19 among Italian dental hygienists. All Italian dental hygienists were invited to participate. The ad hoc online questionnaire was divided into four domains: pers...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-05842-x
更新日期:2020-10-31 00:00:00
abstract:BACKGROUND:The ineffective implementation of evidence based practice guidelines can mean that the best health outcomes are not achieved. This study examined the barriers and enablers to the uptake and implementation of the new bi-national (Australia and New Zealand) antenatal corticosteroid clinical practice guidelines...
journal_title:BMC health services research
pub_type: 杂志文章,多中心研究
doi:10.1186/s12913-016-1858-8
更新日期:2016-10-28 00:00:00
abstract::In the original publication of this article [1], the authors missed that reverse coding was necessary for the item "Do you work separate from your colleagues?" before calculating the scale 'social relations'. So they corrected the analysis accordingly. The results with the revised scale show that there are no longer a...
journal_title:BMC health services research
pub_type: 已发布勘误
doi:10.1186/s12913-019-4838-y
更新日期:2020-01-22 00:00:00
abstract:BACKGROUND:Out-of-hospital emergency care (OHEC), also known as prehospital care, has been shown to reduce morbidity and mortality from serious illness. We sought to summarize literature for low and low-middle income countries to identify barriers to and key interventions for OHEC delivery. METHODS:We performed a syst...
journal_title:BMC health services research
pub_type: 杂志文章,评审
doi:10.1186/s12913-018-3091-0
更新日期:2018-04-19 00:00:00
abstract:BACKGROUND:The aim of this study was to compare the expressed levels of career satisfaction of three groups of comparable dental healthcare professionals, working in Trinidad, the United Kingdom and New Zealand. METHODS:Three questionnaire surveys were carried out of comparable dental healthcare professionals. Dental ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-6-32
更新日期:2006-03-14 00:00:00
abstract:BACKGROUND:Several previous studies conducted on cancer registry data and hospital discharge records (HDR) have found an association between hospital volume and the recourse to breast conserving surgery (BCS) for breast cancer. The aim of the current study is to depict concurrent time trends in the recourse to BCS and ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-7-167
更新日期:2007-10-18 00:00:00
abstract:BACKGROUND:Patient experience with primary health care services can vary markedly between different types of health care facilities, even within the same country setting. Given known benefits of high quality primary health care, the performance of these facilities may significantly impact population health. The aim of ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-019-4089-y
更新日期:2019-05-02 00:00:00
abstract:BACKGROUND:In response to long waiting lists and problems with access to primary care physiotherapy, several Primary Care Trusts (PCTs) (now Clinical Commissioning Groups CCGs) developed physiotherapy-led telephone assessment and treatment services. The Medical Research Council (MRC) funded PhysioDirect trial was a ran...
journal_title:BMC health services research
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12913-016-1349-y
更新日期:2016-03-28 00:00:00
abstract:BACKGROUND:Health services research is a well-articulated research methodology and can be a powerful vehicle to implement sustainable health service reform. This paper presents a summary of a five-year collaborative program between stakeholders and researchers that led to sustainable improvements in the maternity servi...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-14-241
更新日期:2014-06-02 00:00:00
abstract:BACKGROUND:This study aims at gathering evidence about the relation between 30-day mortality and 30-day unplanned readmission and patient and hospital factors. By definition, we refer to 30-day mortality and 30-day unplanned readmission as the number of deaths and non-programmed hospitalizations for any cause within 30...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-019-4818-2
更新日期:2019-12-30 00:00:00
abstract:BACKGROUND:Swiss ambulatory care is characterized by independent, and primarily practice-based, physicians, receiving fee for service reimbursement. This study analyses supply sensitive services using ambulatory care claims data from mandatory health insurance. A first research question was aimed at the hypothesis that...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-10-315
更新日期:2010-11-23 00:00:00
abstract:BACKGROUND:To examine key factors influencing chronic kidney disease (CKD) patients' total expenditure and offer recommendations on how to reduce total cost of CKD care without compromising quality. METHODS:Using the 2002-2011 Medical Expenditure Panel Survey (MEPS) data, our cross-sectional study analyzed 197 patient...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-016-1922-4
更新日期:2016-12-28 00:00:00
abstract:BACKGROUND:Home blood pressure (BP) is closely linked to patient outcomes. However, the prevalence of its documentation has not been examined. The objective of this study was to analyze the prevalence and factors affecting documentation of home BP in routine clinical care. METHODS:A retrospective study of 142,973 enco...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-10-139
更新日期:2010-05-27 00:00:00
abstract:BACKGROUND:The increasing number of patients co-affected with Diabetes and TB may place individuals with low socio-economic status at particular risk of persistent poverty. Kyrgyz health sector reforms aim at reducing this burden, with the provision of essential health services free at the point of use through a State-...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-016-1369-7
更新日期:2016-04-05 00:00:00
abstract:BACKGROUND:This study aims to gain insight into the international development of GP incomes over time through a comparative approach. The study is an extension of an earlier work (1975-1990, conducted in five yearly intervals). The research questions to be addressed in this paper are: 1) How can the remuneration system...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-9-26
更新日期:2009-02-09 00:00:00
abstract:BACKGROUND:Massive efforts in Canada have been made to renew primary healthcare. However, although early evaluations of initiatives and research on certain aspects of the reform are promising, none have examined the link between patient assessments of care and health outcomes or the impacts at a population level. The g...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-10-258
更新日期:2010-09-03 00:00:00
abstract:BACKGROUND:For a patient, drug switches are not desirable (either between a brand-name drug and a generic drug, or between two generic drugs of the same active substance). Research into the causes of drug switches, and related adverse drug reactions, is hampered by the absence of quantitative data on drug switches. ME...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-05494-x
更新日期:2020-07-13 00:00:00
abstract:BACKGROUND:While previous research establishes an association between social relations, health and use of healthcare services among older people, how to implement this knowledge in real-life settings has received much less attention. This study will explore the relationship between social relations, health and use of h...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-017-2650-0
更新日期:2017-11-15 00:00:00