The purpose of the qualitative evaluation study discussed in this article was to examine the AIDS case management model tinder which five nonprofit AIDS service organizations (ASOs) in Midcity were operating. The stud...
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The purpose of the qualitative evaluation study discussed in this article was to examine the AIDS case management model tinder which five nonprofit AIDS service organizations (ASOs) in Midcity were operating. The study was organized around 40 qualitative interviews with executive directors, directors, and case managers. The finding was that AIDS case management is evolving to accommodate the changing environmental/contextual conditions that have resulted from combination drug therapies (protease inhibitors) introduced in 1996. The agencies ave responding to the changes individually rather than as a network, and responses vary among the agencies. Institutional theory, an examination of the interconnectedness of clients, the ASOs, and their environmental context guided the analysis of the findings.
There has been much research on and debate about the appropriate length of acute treatment for alcohol problems. In the United States, the lengthy and costly treatment programs of only a few years ago have been suppla...
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There has been much research on and debate about the appropriate length of acute treatment for alcohol problems. In the United States, the lengthy and costly treatment programs of only a few years ago have been supplanted by ever-shorter and less intensive protocols, with little evidence that this trend will end soon. In this paper, we argue that, because of the chronic, recurrent nature of alcohol problems, an optimal system for delivering treatment services to alcoholics needs to focus on long-term engagement with clients. There is evidence from studies on research reactivity and telephone follow-up protocols that a low-intensity long-term protocol for maintaining contact with clients over time spans measured in years may result in better long-term clinical outcomes and reduced long-term health care utilization and costs. We describe a flexible long-term low-intensity follow-up protocol for alcohol abusers we call "case monitoring." This protocol is specifically designed to minimize long-term health-care use. We predict that such an intervention should be especially efficacious for women. persons with comorbid Axis I disorders, and persons lower in sociopathy. The design of a study to determine the clinical and health service effects of this intervention is also described. (C) 1998 Elsevier Science Ltd.
Since syndromic management of STDs requires treatment with at least two antibiotics per patient, one of the concerns raised by adoption of the syndromic approach is the cost of drugs, especially for developing countri...
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Since syndromic management of STDs requires treatment with at least two antibiotics per patient, one of the concerns raised by adoption of the syndromic approach is the cost of drugs, especially for developing countries with limited drug budgets. The objective of the current study is to compare the cost-effectiveness of syndromic management to current national practice for the management of STDs in Malawi. The actual cost of observed antibiotic treatment for 144 patients receiving same day treatment for two STD syndromes in Malawi was determined using prices from the Malawi government supply catalogue. This was then compared to the calculated cost of treatment had the same patients been managed syndromically according to national guidelines. The cost of drug treatment under current practice was similar to the cost of syndromic treatment. However, at least one-third of observed patients did not receive effective treatment for either likely cause of their STD syndrome and wastage accounted for 54% of total observed drug cost. Overall, syndromic management of STDs in Malawi would result in more effective treatment of STDs at no additional cost. Since the indirect costs of low treatment efficacy were not taken into account in this analysis, a net saving is likely to be realized with the adoption of syndromic management.
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