Race differences in long-term diabetes management in an HMO.

Objective: We examined race differences in diabetes outcomes over 4-8 years in a single HMO.

Research Design And Methods: We identified black and white adult diabetic patients who were continuously enrolled (1992-2001) and in whom diabetes was 1) diagnosed before 1994 (n = 1,686) or 2) newly diagnosed in 1994-1997 (n = 1,280). We used hierarchical models to estimate the effect of race on average annual HbA(1c) (A1C) controlling for baseline A1C, BMI, and age, as well as annual measures of type of diabetes medications, diabetes-related hospitalization, time and the number of A1C tests, physician visits, and nondiabetes medications.

A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home.

Objective: Good hand hygiene may reduce the spread of infections in families with children who are in out-of-home child care. Alcohol-based hand sanitizers rapidly kill viruses that are commonly associated with respiratory and gastrointestinal (GI) infections. The objective of this study was to determine whether a multifactorial campaign centered on increasing alcohol-based hand sanitizer use and hand-hygiene education reduces illness transmission in the home.

Effect of switching antipsychotics on antiparkinsonian medication use in schizophrenia: population-based study.

Background: The extent to which atypical antipsychotics have a lower incidence of extrapyramidal symptoms than typical antipsychotics has not been well-evaluated in community practice.

Aims: To examine the effects of switching antipsychotics on antiparkinsonian medication use among individuals with schizophrenia in UK general practices.

Method: We included those switched from typical to atypical antipsychotics (n=209) or from one typical antipsychotic to another (n=261) from 1994 to 1998.

Antibiotic use following a Korean national policy to prohibit medication dispensing by physicians.

This study investigated whether a Korean national policy prohibiting doctors from dispensing drugs as of 2000 selectively reduced inappropriate antibiotic prescribing in viral illness compared with bacterial illness. We assessed the proportions of episodes prescribed an antibiotic and the number of different antibiotics prescribed for patients with viral and bacterial illness episodes before and after the policy. The nationally representative sample consisted of 50,999 episodes (18,656 viral and 7758 bacterial pre-policy, 16,736 viral and 7849 bacterial post-policy) from 1372 primary care clinics.

Patterns, appropriateness, and predictors of antimicrobial prescribing for adults with upper respiratory infections in urban slum communities of Bangkok.

Upper respiratory tract infections (URIs) are the most common infections worldwide. Their frequent inappropriate treatment with antibiotics is likely to increase antibiotic resistance, contribute to morbidity and mortality, and waste scarce resources. Using data from registration books and prescriptions, we measured patterns and assessed appropriateness and predictors of antibiotic prescribing for viral and bacterial URIs treated in health centers located in two slum communities in Bangkok, Thailand.

Controlled trial of interventions to increase testing and treatment for Helicobacter pylori and reduce medication use in patients with chronic acid-related symptoms.

Background: Many symptomatic patients take proton pump inhibitors or histamine-2 blockers for years and those without gastro-oesophageal reflux disease might benefit from Helicobacter pylori eradication.

Aim: To increase testing and treatment of H. pylori and reduce chronic use of proton pump inhibitors and histamine-2 blockers.

Illness transmission in the home: a possible role for alcohol-based hand gels.

Objectives: The widespread use of child care has altered the epidemiology of respiratory and gastrointestinal (GI) infection in the community. Our primary objective was to measure transmission of respiratory and GI illnesses among families with children enrolled in child care. We also sought to examine potential predictors of reduced illness transmission in the home in a secondary analysis.

A controlled study of the effects of state surveillance on indicators of problematic and non-problematic benzodiazepine use in a Medicaid population.

Objective: Benzodiazepines (BZs) are safe, effective drugs for treating anxiety, sleep, bipolar, and convulsive disorders, but concern is often expressed about their overuse and potential for abuse. We evaluated the effects of physician surveillance through a Triplicate Prescription Program (TPP) on problematic and non-problematic BZ use.

Method: This study uses interrupted time series analyses of BZ use in the New York (intervention) and New Jersey (control) Medicaid programs for 12 months before and 24 months after the New York BZ TPP.

Benzodiazepine use and hip fractures in the elderly: who is at greatest risk?

Background: It remains unclear whether benzodiazepine use increases hip fracture incidence. We studied this relationship in a large cohort, controlling for multiple potential confounders.

Methods: We analyzed 42 months of New Jersey Medicaid health care claims data for all enrollees.

Impact of an educational intervention to improve prescribing by private physicians in Uganda.

Introduction: Private physicians in urban Uganda treat a large percentage of common adult illnesses. Improving their prescribing would not only encourage more rational drug use, but also reduce costs to patients. Interventions to improve drug use are generally more successful when face-to-face educational methods are included.

A comparison of prescribing practices between public and private sector physicians in Uganda.

Introduction: Previous studies in the public sector in Uganda have demonstrated major prescribing problems due to polypharmacy and irrational use of antibiotics and injections. Little is known about prescribing in the private sector although there is little government regulation influencing practice in this sector. The introduction of policies such as the Uganda National Standard Treatment Guidelines (UNSTG) was expected to improve prescribing practices in the public and private sectors.

Attitudes and perceptions of stakeholders on decentralization of health services in Uganda: the case of Lira and Apac districts.

Background: In Uganda, the decentralization of administrative functions, management, and responsibility for health care to districts, which began in 1994, resulted in fundamental changes in health care delivery. Since the introduction of the policy in Uganda, little information has been available on stakeholders' perceptions about the benefits of the policy and how decentralization affected health care delivery.

Objectives: To identify the perceptions and beliefs of key stakeholders on the impact and process of decentralization and on the operations of health services in two districts in Uganda, and to report their suggestions to improve future implementation of similar policies.

Impact of decentralization on health services in Uganda: a look at facility utilization, prescribing and availability of essential drugs.

Introduction: Uganda began implementation of a structural adjustment programme (SAP) in July 1994 in order to improve social services. The decentralization of health services administration to district level was intended to improve the quality of health services and pharmaceutical supplies in the hospitals, with resultant increase in the level of utilization of health facilities.

Objective: This study evaluated the impact of the decentralization policy on health facility utilization; availability of essential drugs, and prescribing patterns for acute respiratory infections (ARI), diarrhoea, and malaria in two district hospitals in Uganda.

A retrospective data analysis of the impact of the New York triplicate prescription program on benzodiazepine use in medicaid patients with chronic psychiatric and neurologic disorders.

Background: Benzodiazepines are treatment mainstays for several disorders, but there is often concern about dependency and addiction. In January 1989, New York implemented regulations requiring physicians to order benzodiazepines using state-monitored triplicate prescription forms.

Objective: The purpose of this study was to assess the effects of the triplicate prescription program (TPP) on changes in use of benzodiazepines and other psychoactive drugs in clinically vulnerable Medicaid populations.

Effects of health maintenance organization coverage of self-monitoring devices on diabetes self-care and glycemic control.

Background: Increasingly, government mandates require insurance coverage of blood glucose monitors and test strips for patients with type 1 and type 2 diabetes. No data exist on the effects of such coverage on self-monitoring of blood glucose (SMBG), medication compliance, or blood glucose control. We evaluated whether a policy providing free blood glucose monitors increased SMBG and whether initiating SMBG was associated with increased regularity of medication use and improved glucose control (hemoglobin A(1c) [HbA(1c)] level).

Length-of-stay policies and ascertainment of postdischarge problems in newborns.

Objective: The purpose of this study was to evaluate the effects of an early postpartum discharge program and a subsequent legislative mandate for 48 hours of hospital coverage on incidence of newborn jaundice and feeding problems. We tested the hypothesis that heightened postdischarge ascertainment (rather than short stays) is responsible for apparent increases in these outcomes.

Methods: Interrupted time series analysis was conducted on retrospective data from the automated medical records of a large Massachusetts health maintenance organization (HMO).

Chronic acid-related disorders are common and underinvestigated.

Objectives: The aims of this study were as follows: to establish the prevalence of chronic acid-related disorders in a managed care population; to describe these patients; and to examine rates of adherence to current guidelines for investigation of dyspepsia and peptic ulcer disease.

Methods: The design was a population-based cohort study. The sample was drawn from 216,720 adult (aged >18 yr) members of a managed care organization that had an electronic medical record linked to administrative and pharmacy databases.

Changing medication use in managed care: a critical review of the available evidence.

Objective: To review the effectiveness of strategies to improve the quality and efficiency of medication use in managed care organizations (MCOs).

Study Design: Systematic review of published intervention studies.

Methods: Studies were identified by using computerized and manual literature searches and personal contacts, and were categorized by intervention type and adequacy of research design according to commonly accepted criteria.

Effects of state surveillance on new post-hospitalization benzodiazepine use.

Background: Benzodiazepines (BZD) effectively treat anxiety and insomnia accompanying major health events, including hospitalizations. Prescribing regulations to decrease BZD misuse may negatively impact therapeutic uses.

Objective: To assess the impact of a Triplicate Prescription Program (TPP) on initiation of post-hospitalization BZD prescribing, both overall and among cardiac and cancer patients in the United States.

Reduced risk of neonatal respiratory infections among breastfed girls but not boys.

Objective: The effect of breastfeeding on community-acquired neonatal infections has not been well studied, although the neonatal period is one of special vulnerability to infectious pathogens. Respiratory tract infections are the neonatal infection most commonly diagnosed after nursery discharge. We therefore chose respiratory tract infections diagnosed after nursery discharge as representative of neonatal community-acquired infection and studied the impact of breastfeeding on this neonatal infection syndrome.

Lack of relationship between long-term use of benzodiazepines and escalation to high dosages.

Objective: The objective of this study was to determine whether long-term benzodiazepine use is associated with dose escalation.

Methods: The authors examined changes in dose and the frequency of dose escalation among new and continuing (at least two years) recipients of benzodiazepines identified from a database containing drug-dispensing and health care use data for all New Jersey Medicaid patients for 39 months. Independent variables included age; Medicaid eligibility category; gender; race or ethnicity; neighborhood socioeconomic variables; chronic illnesses, such as schizophrenia, bipolar illness, panic disorder, and seizure disorder; and predominant benzodiazepine received.

Barriers to self-monitoring of blood glucose among adults with diabetes in an HMO: a cross sectional study.

Background: Recent studies suggest that patients at greatest risk for diabetes complications are least likely to self-monitor blood glucose. However, these studies rely on self-reports of monitoring, an unreliable measure of actual behavior. The purpose of the current study was to examine the relationship between patient characteristics and self-monitoring in a large health maintenance organization (HMO) using test strips as objective measures of self-monitoring practice.

Beliefs and expectations of women under 50 years old regarding screening mammography: a qualitative study.

Objective: Because shared decision making has been recommended for screening mammography by women under age 50, we studied women's decision-making process regarding the procedure.

Design: Qualitative research design using in-depth semi-structured interviews.

Patients: Sixteen white and African-American women aged 38 to 45 receiving care at a large New England medical practice.

Effects on breastfeeding of changes in maternity length-of-stay policy in a large health maintenance organization.

Objective: The purpose of this study was to evaluate the effects on breastfeeding rates of a private-sector early discharge program and a subsequent government mandate guaranteeing 48 hours of hospital coverage.

Methods: Interrupted time-series analyses were conducted on retrospective data from the automated medical records of a large health maintenance organization in eastern Massachusetts. A population of 20 366 mother-infant pairs with normal vaginal deliveries between October 1990 and March 1998 was identified.

Misconceptions about colds and predictors of health service utilization.

Objective: Colds accounted for 1.6 million emergency department (ED) visits and 25 million ambulatory visits by children and adults in 1998. Although most colds are caused by viruses and do not require medical intervention, many families seek health care for the treatment of colds.