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Prevalence of dyspepsia, heartburn, and peptic ulcer disease in veterans

AMERICAN JOURNAL OF GASTROENTEROLOGY 1999年第8期94卷 2086-2093页

作者： Dominitz, JA Provenzale, D VA Puget Sound Hlth Care Syst Seattle Div 111GI Dept Med Div Gastroenterol Seattle WA 98108 USA Univ Washington Sch Med Seattle WA USA Vet Affairs Med Ctr Hlth Serv Res & Dev Durham NC 27705 USA Duke Univ Med Ctr Dept Med Div Gastroenterol Durham NC 27710 USA

OBJECTIVE: Medications used to treat gastrointestinal symptoms account for a substantial share of pharmacy expenses for veterans affairs medical centers. Prior studies have shown that the prevalence of peptic ulcer disease is higher in veterans than in nonveterans. Our aim was to determine the prevalence of upper gastrointestinal symptoms among patients seeking health care in the Department of Veterans Affairs outpatient clinics. METHODS: A total of 1582 veterans completed a previously validated bowel symptom questionnaire in the following clinics: gastroenterology (n = 693), walk-in (n = 403), general medicine (n = 379), and women's health (n = 107). RESULTS: Overall response was 78%. Dyspepsia was reported in 30%, 37%, 44%, and 53% of patients in general medicine, walk-in, women's health, and gastroenterology clinics, respectively. Heartburn, at least weekly, was reported in 21%, 21%, 28%, and 40% of patients in general medicine, walk-in, women's health, and gastroenterology clinics, respectively. Prior peptic ulcer disease (PUD) was reported in 29%, 26%, 22%, and 44% of patients in general medicine, walk-in, women's health, and gastroenterology clinics, respectively. Dyspepsia, heartburn, and PUD were significantly associated with increased physician visits and lower general health. CONCLUSIONS: Dyspepsia and heartburn are common symptoms among veterans. Lifetime prevalence of PUD is high among veterans. Gastrointestinal symptoms have a significant impact on health care utilization and general health. These prevalence estimates provide a basis for studies of resource utilization and for cost-effectiveness analyses of the treatment of gastrointestinal disorders in the veteran population. Moreover, the high prevalence of symptoms helps to explain the high utilization of gastrointestinal medications. (Am J Gastroenterol 1999;94:2086-2093. (C) 1999 by Am. Coll. of Gastroenterology).

关键词：费用效益分析横断面研究消化不良/经济学消化不良/流行病学卫生资源/经济学卫生资源/利用胃灼热/经济学胃灼热/流行病学发病率北卡罗来纳消化性溃疡/经济学消化性溃疡/流行病学转诊和会诊/经济学转诊和会诊/利用退伍军人/统计学和数值数据成年人老年人女(雌)性人类男(雄)性中年人

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A cost analysis of outpatient care for patients with Barrett's esophagus in a managed care setting

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AMERICAN JOURNAL OF GASTROENTEROLOGY 1999年第8期94卷 2033-2036页

作者： Eloubeidi, MA Homan, RK Martz, MD Theobald, KE Provenzale, D Duke Univ Med Ctr Dept Med Div Gastroenterol Durham NC 27710 USA Vet Affairs Med Ctr Informat Resources Management Serv Serv Pharm Inst Clin & Epidemiol Res Durham NC 27705 USA

OBJECTIVES: Although Barrett's esophagus (BE) may be associated with severe gastroesophageal reflux disease (GERD), there are currently no studies that evaluate resource utilization in Barrett's patients. The aims of this study were 1) to determine the cost and number of endoscopies and clinic visits to the GI clinic for GERD or its complications in patients with BE;2) to determine the pattern and cost of medication use in patients with BE;and 3) to compare medication use by patients with BE to that of patients with insulin-requiring diabetes mellitus (DM). METHODS: Using the cost distribution report data and the pharmacy acquisition costs from the Durham VAMC, we calculated the monthly cost of endoscopies, clinic visits related to GERD, and medication use in 53 patients with BE between 1/1/94 and 1/1/97. We also calculated the average cost of medication use for 55 patients with insulin-requiring DM. RESULTS: All patients with BE were male. Their median age was 64.0 yr (IQR 57-68). Of them, 92% were white;23% had low-grade dysplasia (LGD). Patients with LGD were more likely to have more than three endoscopies in 3 yr than were those with no LGD (OR 6.3, 95% CI 1.11-35.67). There was no difference in clinic visits in the patients with and without dysplasia (OR 0.335, 95% CI 0.093-1.206). A total of 139 endoscopies and 172 clinic visits were observed. Outpatient care for patients with BE costs approximately $103/month or $1241/yr. Endoscopies and clinic visits accounted for 31.1% and 5.9% of the monthly medical cost, respectively. Medications accounted for 63% of the total cost of care. Prokinetic agents accounted for 0.8% of the total cost of medications, whereas histamine receptor antan onists (H2 blockers) and proton pump inhibitors (PPIs) accounted for 34.6% and 64.6%, respectively. Medication cost per month in patients with BE was approximately $65, similar to that of patients with insulin-requiring DM ($63). CONCLUSIONS: Our conclusions were as follows: 1) Outpa

关键词：门诊医疗/经济学 Barrett食管/药物疗法 Barrett食管/经济学队列研究成本及成本分析糖尿病 1型/经济学药费支出/统计学和数值数据食管镜检查/经济学胃食管反流/药物疗法胃食管反流/经济学胃肠病用药/经济学胃肠病用药/治疗应用管理医疗规划/经济学北卡罗来纳转诊和会诊/经济学老年人女(雌)性人类男(雄)性中年人

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Reimbursement for pharmacists' cognitive services in the inpatient setting

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 2001年第2期58卷 164-166页

作者： Michalets, EL Williams, E Mission St Josephs Hlth Syst Dept Pharm Asheville NC 28801 USA Univ N Carolina Sch Pharm Community Based Practice Fac Chapel Hill NC USA Mt Area Hlth Educ Ctr Asheville NC USA

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OPTIMAL PAYMENT SYSTEMS FOR HEALTH-SERVICES

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JOURNAL OF HEALTH ECONOMICS 1990年第4期9卷 375-396页

作者： ELLIS, RP MCGUIRE, TG BOSTON UNIV DEPT ECONBOSTONMA 02215 USA

Demand-side cost sharing and the supply-side reimbursement system provide two separate instruments that can be used to influence the quantity of health services consumed. For risk-averse consumers, optimal payment systems — pairs of insurance and reimbursement plans — are characterized by conflict rather than consensus between patient and provider about the quantity of treatment. A model of conflict resolution based on bargaining theory is used to represent the outcome when the payment system creates divergences between desired demand and desired supply. Using that model, we describe the optimal combination of insurance and reimbursement systems that maximize consumer welfare.

关键词：冲突(心理学) 绝对免赔额与共同保险卫生服务需求/统计学和数值数据保险健康/组织和管理模型统计学劝导交谈权力(心理学) 转诊和会诊/经济学偿还途径/组织和管理危险美国人类

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THE EFFECTS OF MARKET-STRUCTURE AND BARGAINING POSITION ON HOSPITAL PRICES

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JOURNAL OF HEALTH ECONOMICS 1992年第3期11卷 217-233页

作者： MELNICK, GA ZWANZIGER, J BAMEZAI, A PATTISON, R UNIV CALIF LOS ANGELES SCH PUBL HLTHLOS ANGELESCA 90024 UNIV ROCHESTER ROCHESTERNY 14627 A&N TECH SERV INC SANTA MONICACA PATTISON & ASSOC BERKELEYCA BLUE CROSS CALIF OAKLANDCA

PPOs and HMOs have pined widespread acceptance due in part to the belief that excess capacity and competitive market conditions can be leveraged to negotiate lower prices with health care providers. We investigated prices obtained in different types of markets by the largest PPO in California. Our findings indicate that greater hospital competition leads to lower prices. Furthermore, as the importance of a hospital to the PPO in an area increases, the price rises substantially. Our testing of alternative methods for defining hospital geographic markets reveals that the common practice of using counties to define the market leads to an underestimate of the price-increasing effects of a merger.

关键词：蓝十字蓝盾保险计划/经济学蓝十字蓝盾保险计划/统计学和数值数据加利福尼亚卫生服务范围/经济学卫生服务范围/统计学和数值数据合同业务/经济学经济竞争费用和收费/统计学和数值数据财务管理医院/经济学财务管理医院/统计学和数值数据卫生服务研究模型经济计量学优先提供医疗服务组织/经济学优先提供医疗服务组织/统计学和数值数据转诊和会诊/经济学回归分析

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INFORMATION ASYMMETRY AND SEARCH IN THE MARKET FOR PHYSICIANS SERVICES

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JOURNAL OF HEALTH ECONOMICS 1989年第1期8卷 53-84页

作者： ROCHAIX, L UNIV LYON 1 F-69622 VILLEURBANNEFRANCE

This paper offers an integrated approach to the physician-patient interaction based on the notion of a conditional demand function where the physician 'proposes' and the patient 'disposes'. The model specifies the information asymmetry between the physician and the patient mainly in terms of a differential in uncertainty about the patient's health status. An imperfect agency may result, leading some physicians to recommend more (less) treatment than the patient would have chosen, had the patient been fully informed. But patients are shown to exert pressure on their physician by potentially seeking a second opinion. In effect, patients' search for an adequate treatment becomes an ex ante monitoring technique, which induces physicians to act as 'better agents'. We further show, by means of a simulation, that it is enough for a small number of patients to be well informed for this result to hold.

关键词：决策知情同意模型统计学病人接受卫生保健的程度/统计学和数值数据医生病人关系转诊和会诊/经济学

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Technology‐Driven Referrals, A Fundamental Problem for Small Rural Hospitals

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The Journal of Rural Health 1991年第2期7卷 95-100页

作者： Bateman, Kim A. Ephraim Utah 84627 United States

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The demand for physician services in a changing health care system: a synthesis.

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Medical care review 1993年第4期50卷 411-449页

作者： Weiner, J.P. School of Public Health Johns Hopkins University Baltimore 21205. MD United States

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Child and adolescent psychiatry in general children's hospitals : A survey of chairs of psychiatry

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PSYCHOSOMATICS 2000年第2期41卷 128-133页

作者： Campo, JV Kingsley, RS Bridge, J Mrazek, D Childrens Hosp Pittsburgh Behav Sci Div Pittsburgh PA 15213 USA Univ Pittsburgh Sch Med Western Psychiat Inst & Clin Pittsburgh PA USA Alfred I DuPont Hosp Children Div Behav Hlth Wilmington DE USA George Washington Univ Sch Med Dept Psychiat & Behav Sci Washington DC USA

This article characterizes the academic, administrative, clinical service, and fiscal characteristics of departments of psychiatry in traditional children's hospitals to determine the characteristics of fiscally successful programs. A survey of chairs of psychiatry from short-term general children Is hospitals was conducted based on 38 questions addressing the descriptive characteristics of their respective departments. The characteristics of psychiatry programs identified as fiscally succcessful were compared to those of programs that required subsidy. Nine of 45 eligible children's hospitals (20%) did not have a department or section of psychiatry, and surveys were returned by 35 of 36 department chairs (97% response). Considerable variation exists in the academic, administrative, clinical services, and fiscal characteristics of programs, although over half are operating at a deficit. Fiscal success was associated with availability of inpatient and intermediate levels of psychiatric care, better integration of the psychiatry program within the children's hospital, and adequate fiscal information being provided to the psychiatry chair: Additional research regarding the potential of psychiatric services to generate clinical success and cost savings is warranted. pediatric health care professionals and third-party payers should be educated regarding the relevance of psychiatric services within children's hospitals and in physically ill children.

关键词：青春期精神病学/经济学预算儿童精神病学/经济学费用效益分析医院费用/统计学和数值数据医院儿科/经济学病人医疗小组/经济学转诊和会诊/经济学美国青少年儿童人类

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A single consultation cerebrovascular disease clinic is cost effective in the management of transient ischaemic attack and minor stroke

JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON

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JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON 2000年第5期34卷 452-455页

作者： Blight, A Pereira, AC Brown, MM UCL Inst Neurol Dept Clin Neurol London WC1N 3BG England Univ London St Georges Hosp Sch Med Div Clin Neurosci London SW17 0RE England

Aim: We examined the cost effectiveness of a single consultation strategy to manage patients referred with TIA or stroke to our cerebrovascular disease (CVD) clinic, where all relevant investigations (blood tests, CT brain scan and carotid Dopplers) were obtained prior to the clinic appointment. Design: Retrospective study of patients referred to the CVD clinic at St George's Hospital, London between October 1995 and 1996. Results: Of 211 new patients seen in the clinic, 73% had CVD;146 (68%) patients had imaging studies prior to clinic attendance. Of these, 132 (90%) were managed with a single consultation, This strategy cost pound5,700 less than if these patients had been followed up. Conclusion: Performing all relevant investigations prior to clinic attendance allowed a fully informed discussion with the patient at a single consultation and was cost effective.

关键词：门诊医疗设施/经济学门诊医疗设施/组织和管理费用效益分析诊断鉴别脑缺血发作短暂性/诊断伦敦转诊和会诊/经济学回顾性研究老年人女(雌)性人类男(雄)性

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