Integrating peer support initiatives in a large healthcare organization.

The Veterans Health Administration (VHA) adopted a strategic plan for mental health that emphasizes implementation of recovery-oriented services, including peer support. To provide a baseline for assessing change, a national survey was conducted of peer service delivery for veterans with mental illness, including those with comorbid substance abuse or homelessness. The number of participating programs was small. However, responses indicate that existing VHA peer services can be categorized as partnership services. Program and position structures, such as goals and training requirements are each described. Role and administrative or systems processes, such as acquiring staff buy-in and liability are also described. Future areas of consideration include dissemination of peer support in VHA and other healthcare systems, with specific efforts to increase training protocols, evaluation, and payment options for peers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

APA and the FTC: New adventures in consumer protection.

The evolution of attitudes and practices with respect to psychologists' public announcements of their services over the past few decades is reviewed. Special attention is focused on interactions between the American Psychological Association (APA) and the Federal Trade Commission (FTC). Particular notice is paid to the direct impact this interaction had on the development of the current Ethical Principles of Psychologists and Code of Conduct with respect to advertising issues. Changes in these aspects of the ethics code are reviewed, and recommendations for ethical advertising of services are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The costs of healthcare worker respiratory protection and fit-testing programs

OBJECTIVE: We studied hospital costs associated with healthcare worker (HCW) respiratory protection and respirator fit-testing programs recommended by the Centers for Disease Control and Prevention (CDC) and mandated by the Occupational Safety and Health Administration to decrease nosocomial or occupational Mycobacterium tuberculosis (TB). DESIGN: The number and cost of high-efficiency particulate air (HEPA)-filter and dust-mist (DM) respirators for 1989 to 1994 were obtained from study hospital purchasing departments, and the costs of HCW fit-testing and education programs for 1994 were estimated from information provided by infection control practitioners. Costs of N-class respirator programs were estimated for study hospitals using retrospective cost analysis and an observational study. SETtING: Four urban hospitals with, and one rural community hospital without, documented nosocomial or occupational transmission of multidrug-resistant TB. RESULTS: During the study period, four of five hospitals introduced HEPA and DM respirators and respirator education and fit-testing programs. Median costs in 1994 were $83,900 (range, $2,000-$223,000) for respirators and $17,187 (range, $8,736-$26,175) for respiratory fit-testing programs. The projected median annual cost of N95 respirators was $62,023 (range, $270-$422,526). CONCLUSIONS: Compliance with CDC TB guidelines may require a substantial investment. However, outlays for respirators and education and fit-testing programs are more reasonable than would be suggested by analyses that estimated the costs of preventing one case of nosocomial TB.     

Managed care or mangled care?: Treating eating disorders in the current healthcare climate.

The challenge of treating patients with eating disorders, together with the increasing intrusion of 3rd-party payers into the healthcare system, presents a dual dilemma for mental health clinicians. Although there are potent treatments for patients with anorexia nervosa and bulimia nervosa, most therapies require substantially more than a brief number of sessions in order to be effective. This article provides guidelines to clinicians who treat patients with eating disorders under the constraints of managed care. Practical suggestions for treatment approaches as well as strategies for negotiating with 3rd-party payers are offered to assist clinicians in providing efficient, effective, and compassionate care to patients with eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In praise of alternative medicine: views of a healthcare consumer and college health employee

The blood flow property is one of the factors determining blood perfusion and oxygen supply. The viscosity of the blood is primarily related to the hematocrit, but also to the amount of fibrinogen and other macromolecules present in the blood. Patients with ischemic heart disease have shown a rapid and safe improvement in their hemorheological state when treated with heparin-induced extracorporeal low-density lipoprotein (LDL) precipitation (HELP). In this study we used two extracorporeal hemapheresis methods, plasmapheresis (PP) and immunoadsorption (IA), in 15 patients (eight patients treated with PP and seven patients with IA) with various diseases. Hemorheological variables and plasma fibrinogen were measured before and after the first and before the third treatment performed at 3 consecutive days. The aim of our study was to investigate the immediate effects of these two treatment modalities on the flow properties of blood. Immediately after the first PP and IA session statistically significant declines in plasma fibrinogen concentration, plasma viscosity, whole blood viscosity, and erythrocyte aggregation tendency were found. These changes persisted before the third treatment session. The erythrocyte fluidity and hematocrit remained unchanged. We conclude that extracorporeal hemapheresis therapy, with plasmapheresis or immunoadsorption, affects the blood rheology by decreasing the plasma viscosity and erythrocyte aggregation tendency. The decrease in plasma fibrinogen is probably the main factor underlying that, but other factors such as a decrease in immunoglobulins may also be of importance.     

Managed cost

We report a case of acalculous cholecystitis in an AIDS patient, that appeared with insidious onset, abdominal right upper quadrant pain and fever. Cholecystectomy was performed and CMV inclusions were observed in tissue sections. CMV acalculous cholecystitis is an uncommon condition associated to the acquired immunodeficiency syndrome. It should be considered, especially when abdominal pain and fever are present in marked immunosuppressed AIDS patients. Unfortunately, a limited experience in treatment, either medical or surgical, was reported. In our case, the response to surgical procedure was successful, disappearing the abdominal pain and the fever. The patient refused both ganciclovir and foscarnet therapy.     

Managed obstetrical care

BACKGROUND: Infertility is common in Africa, but virtually no data exist on HIV prevalence among infertile women. Mainly anthropological studies in Africa have shown that infertile women have higher risks of marital instability and possibly also have more sexual partners than fertile women. METHOD: This study was conducted in a hospital in northwest Tanzania during 1994 and 1995. Women presenting themselves with infertility problems to the outpatient clinic were interviewed, examined and blood was drawn. Women who came to deliver in the hospital, excluding primiparae, were taken as a control group. The analysis was limited to women > or = 24 years. In total 154 infertile and 259 fertile women were included in the study. RESULTS: HIV prevalence was markedly higher among infertile women than among fertile women: 18.2% and 6.6% respectively (adjusted odds ratio [OR] for age, residence and occupation 2.7; 95%-confidence interval [CI]: 1.4-5.3). Data on past sexual behaviour showed that infertile women had more marital breakdowns, more lifetime sexual partners and a higher level of exposure to sexually transmitted diseases (STD). CONCLUSION: Women with fertility problems appear to have higher HIV prevalence, which justifies more attention for such women in the context of AIDS programmes. In addition, caution is needed when using sentinel surveillance data from antenatal clinics to monitor HIV prevalence.     

Managed care liability update

As the volume of litigation involving managed care grows, the liability issues become clearer. For example, recent decisions demonstrate that failure to provide access to qualified physicians, failure to process claims appropriately, denial of claims and undue delay of treatment can and do lead to liability. Moreover, the federal Employment Retirement Income Security Act of 1974 (ERISA) won't protect the managed care providers, and physicians may sue the managed care organization if its policies or agents open them to liability.     

Diabetes initiatives: hospital education

This article is the first of two which concentrate on training initiatives in diabetes care for nurses. The articles focus on two initiatives--one hospital-based, the other for community nurses--which aim to improve nurses' knowledge and skills in relation to this important area of practice. The first article describes a programme introduced into a major hospital to improve and develop staff skills in measuring patients' blood glucose levels.     

Managed care and unintended pregnancy

This article assesses the adequacy of coverage of contraceptive services and supplies for US women in the various types of managed care plans, with special attention to Medicaid. Between 1993 and 1995, the percent of insured private-sector employees enrolled in managed care plans rose from 51% to 73%. By 1996, the health care of 40% of low-income Medicaid recipients was also under managed care administration. Although 84% of managed care plans cover oral contraceptives--a rate substantially higher than that for traditional indemnity plans, several logistic factors impede access to this and other reproductive health benefits. The requirement of preauthorization may delay access to care when timely presentation is essential to the prevention of unwanted pregnancy. Some plans restrict members to one visit per year with an obstetrician-gynecologist. Coordination of an enrollee's total health care through the primary care physician can raise confidentiality problems for those who seek sensitive reproductive health services. There are fewer restrictions on the access of Medicaid recipients to family planning providers and services, but treatment of sexually transmitted diseases may not be part of the reproductive health package. The explosion of managed care onto the US health care market has led to public sector regulation legislation--a process that is proceeding in a piecemeal rather than comprehensive way. Because of the importance of reproductive health care to the lives of women, communities, and the broader society, more systematic action on this front is essential.     

Managed care contracts and negotiations

This article examines the key provisions which should be focused on when reviewing managed care contracts. It offers guidance on how gastroenterologists can negotiate more favorable terms and avoid common contracting pitfalls. The article also highlights specific issues applicable to capitated and other risk-sharing arrangements.     

Managed care and reproductive health

Managed care poses special challenges to midwives providing reproductive health care. This is owing to the sensitive nature of issues surrounding reproductive health and aspects of managed care that may impede a woman's ability to obtain continuous, confidential, and comprehensive care from the provider of her choice. Variations across payers (ie, Medicare, Medicaid, and commercial insurers) regarding covered benefits and reimbursement of midwifery services also may create obstacles. Furthermore, some physicians and managed care organizations are embracing policies that threaten the ability of midwives to function as primary health care providers for women. Despite these hurdles, midwives have the potential to remain competitive in the new marketplace. This article underscores the importance of being knowledgeable about legislation and policy issues surrounding the financing of midwifery services, quality performance measurement for HMOs as they pertain to reproductive health, and discussions regarding which clinicians should be defined as primary care providers.