Stakeholders in recovery: demands, expectations, and research opportunities.

A broad array of agencies, institutions, and individuals interact with community-based substance abuse treatment programs, providing resources or services and asserting demands and expectations in return. These relationships shape the environment in which treatment and community-based research take place, and themselves raise issues worthy of research attention. This article enumerates the stakeholders in one well-established program and describes the scope of the program's efforts to accommodate these stakeholders, along with some of the complications and difficulties programs confront in their attempts to satisfy stakeholders, especially when their demands are unrealistic or their interests conflict.

Impact of a Medicaid copayment policy on prescription drug and health services utilization in a fee-for-service Medicaid population.

Background: Copayments (copays) for prescription drugs are a common policy among state Medicaid programs. Research exploring the effects of copays on pharmacy and health care utilization in Medicaid patients is limited, especially among patients with chronic disease.

Objectives: The goal of this research was to quantify the impact of a copay policy for prescription drugs on medication and health services utilization overall and among subjects with several common chronic diseases enrolled in a state Medicaid program.

Kaiser Permanente's manifesto 2005 demonstration: the promises and limits of devolution.

In 1996, the eight-million member Kaiser Permanente HMO adopted a vision statement that said by 2005 it would expand its services to include home- and community-based services for its members with disabilities. It funded a 3-year, 32-site demonstration that showed that it was feasible to link HMO services with existing home-and community-based (HCB) services and that members appreciated the improved coordination and access. This private-sector project showed that devolution can produce innovative and feasible models of care, but it also showed that without federal financial and regulatory support, such models are unlikely to take hold if they are focused on "unprofitable" populations, for example, those who are chronically ill, poor, and/or disabled.

Incidence of fecal incontinence after childbirth.

Objective: Fecal incontinence is an embarrassing and disabling condition of which the epidemiology is poorly understood. Our goal is to estimate the incidence of fecal incontinence after childbirth.

Methods: A population-based survey was mailed to all women who delivered a liveborn infant in the state of Oregon between April 2002 and September 2002.

Health policy roundtable--view from the state legislature: translating research into policy.

This roundtable examines the role of health services research from the perspective of the state legislature. Four research and policy experts-each of whom is a current or former legislator-explore how research can be translated effectively into state health policy, and how researchers and legislators can communicate clearly with one another and engage in productive collaborations.

A summary of results of the Dietary Intervention Study in Children (DISC): lessons learned.

Prevention of cardiovascular disease must begin in childhood, preferably before risk factors develop. Elevated low-density lipoprotein cholesterol levels in children are likely to track over time and become high-risk levels in adults. The Dietary Intervention Study in Children (DISC) was a multicenter, collaborative randomized trial in pre-adolescent children designed to test the efficacy and safety of a dietary intervention to lower saturated fat and cholesterol intake among growing children with elevated low-density lipoprotein cholesterol.

A systematic review of the efficacy of telemedicine for making diagnostic and management decisions.

We conducted a systematic review of the literature to evaluate the efficacy of telemedicine for making diagnostic and management decisions in three classes of application: office/hospital-based, store-and-forward, and home-based telemedicine. We searched the MEDLINE, EMBASE, CINAHL and HealthSTAR databases and printed resources, and interviewed investigators in the field. We excluded studies where the service did not historically require face-to-face encounters (e.

The impact of a community-wide self-care information project on self-care and medical care utilization.

This study assesses the effects of the Healthwise Communities Project (HCP) on use of self-care resources and health care utilization. The intervention included the distribution of the Healthwise Handbook, the provision of a telephone advice line, and a Web site. All of these products use a symptom-based approach and are aimed at a general population.

Risk factors for self-reported visual symptoms with Intacs inserts for myopia.

Objective: Potential risk factors and visual performance measures were evaluated for relationship to self-report of clinical visual symptoms after the refractive procedure for placement of Intacs microthin prescription inserts for myopia.

Design: Retrospective nonrandomized comparative study.

Participants/intervention: Patients were participants in the U.

Clinical outcomes resulting from telemedicine interventions: a systematic review.

Background: The use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based.

Methods: Data sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field.

Telemedicine for the Medicare population: pediatric, obstetric, and clinician-indirect home interventions.

Background: This report is a supplement to an earlier evidence report, Telemedicine for the Medicare Population, which was intended to help policymakers weigh the evidence relevant to coverage of telemedicine services under Medicare. That report focused on telemedicine programs and clinical settings that had been used with or were likely to be applied to Medicare beneficiaries. While we prepared that report, it became apparent that there are also telemedicine studies among non-Medicare beneficiaries--e.

When parents are given greater access to health information, does it affect pediatric utilization?

Objective: Most studies assessing the effects of consumer health information on medical utilization have used randomized controlled clinical trials with the chronically ill. In this paper, we analyze the effect of the Healthwise Communities Project, a natural experiment that provided free self-care resources, on reported pediatric utilization.

Research Design: Random household surveys were collected before and after the intervention in Boise, Idaho and in two control communities.

Does providing consumer health information affect self-reported medical utilization? Evidence from the Healthwise Communities Project.

Objective: To determine whether providing health information to residents of Boise ID had an effect on their self-reported medical utilization.

Research Design: The Healthwise Communities Project (HCP) evaluation followed a quasi-experimental design.

Subjects: Random households in metropolitan zip codes were mailed questionnaires before and after the HCP.

Mode of payment, practice characteristics, and physician support for patient self care.

Purpose: The purpose of this study was to assess the influence of payment mode and practice characteristics on physicians' attitudes toward and support of self-care among their patients. It is a common practice for health plans and health insurance companies to distribute and make available various self-care services and products to members. These self-care products are generally part of a larger demand-management strategy.

Long-term safety and efficacy of a cholesterol-lowering diet in children with elevated low-density lipoprotein cholesterol: seven-year results of the Dietary Intervention Study in Children (DISC).

Objective: Diets reduced in fat and cholesterol are recommended for children over 2 years of age, yet long-term safety and efficacy are unknown. This study tests the long-term efficacy and safety of a cholesterol-lowering dietary intervention in children.

Methods: Six hundred sixty-three children 8 to 10 years of age with elevated low-density lipoprotein cholesterol (LDL-C) were randomized to a dietary intervention or usual care group, with a mean of 7.

Prevalence and predictors of the use of self-care resources.

Health care reform goals are to reduce costs and increase access while maintaining quality of care. A potentially effective avenue for achieving these difficult goals is to activate the untapped potential of consumers in managing their own health care. This study focuses on three Northwest communities and examines the prevalence of the use of self-care resources and the correlates of use.

Elimination of over-the-counter medication coverage in the Oregon Medicaid population: the impact on program costs and drug use.

Objectives: To reduce program costs, the Oregon Medicaid program eliminated reimbursement for over-the-counter (OTC) medications. Considering that physicians might substitute more expensive prescription-only products for eliminated OTC therapy, this investigation evaluates the policy's impact on medication costs.

Methods: This retrospective investigation examines pharmacy claims for adult Medicaid eligible recipients between March 1992 and February 1994 using an interrupted time-series analysis.

Effects of diet and sexual maturation on low-density lipoprotein cholesterol during puberty: the Dietary Intervention Study in Children (DISC).

Background: The Dietary Intervention Study in Children (DISC) is a multicenter, randomized, controlled clinical trial designed to examine the efficacy and safety of a dietary intervention to reduce serum LDL cholesterol (LDL-C) in children with elevated LDL-C.

Methods And Results: The effects of dietary intake of fat and cholesterol and of sexual maturation and body mass index (BMI) on LDL-C were examined in a 3-year longitudinal study of 663 boys and girls (age 8 to 10 years at baseline) with elevated LDL-C levels. Multiple linear regression was used to predict LDL-C at 3 years.

Nutrient intake and blood pressure in the Dietary Intervention Study in Children.

Delineating the role that diet plays in blood pressure levels in children is important for guiding dietary recommendations for the prevention of hypertension. The purpose of this study was to investigate relationships between dietary nutrients and blood pressure in children. Data were analyzed from 662 participants in the Dietary Intervention Study in Children who had elevated low-density lipoprotein cholesterol and were aged 8 to 11 years at baseline.

Physician and plan effects on satisfaction of Medicaid managed care patients with their health care and providers.

As many Medicaid patients move into managed care, it is important that physicians competing to serve these patients understand the factors that lead to patient satisfaction. This study uses survey data from 7,313 Oregon Medicaid managed care patients to create a model describing how provider effects and health plan effects relate to patients' satisfaction with their medical care and provider. Path analysis was used to test the explanatory power and strength of relationships in the model.

Firearm ownership and health care workers.

Objective: Health professionals have increasingly become aware of the public health hazards caused by firearms. This study was designed to determine the firearm ownership and storage practices of a group of health care workers.

Methods: All 6436 nonphysician employees of a large health maintenance organization were surveyed as part of an ongoing effort to enhance the organization's effectiveness.

The contribution of group- and staff-model HMOs to American medicine.

Although group- and staff-model prepaid health plans were the original model of HMOs, they now represent a minority of HMOs and their enrollees. Nevertheless, these models made, and continue to make, important public contributions through their demonstration of alternative methods of delivering care and their support of population-based research on specific diseases, utilization of services, and styles of medical practice. The limited number of such plans, however, makes it difficult to ascertain whether these contributions are attributable to the type of HMO per se, with their largely nonprofit ownership, their unique organizational histories, and their key leaders, among other factors.