RESUMEN
YES. MONTHLY EXTENDED-RELEASE INJECTABLE NALTREXONE (XR-NTX) TREATS OPIOID USE DISORDER AS EFFECTIVELY AS DAILY SUBLINGUAL BUPRENORPHINE-NALOXONE (BUP-NX) WITHOUT CAUSING ANY INCREASE IN SERIOUS ADVERSE EVENTS OR FATAL OVERDOSES. (STRENGTH OF RECOMMENDATION: A, 2 GOOD-QUALITY RCTS).
Asunto(s)
Administración Sublingual , Combinación Buprenorfina y Naloxona/administración & dosificación , Combinación Buprenorfina y Naloxona/uso terapéutico , Preparaciones de Acción Retardada/administración & dosificación , Inyecciones Intramusculares , Antagonistas de Narcóticos/administración & dosificación , Trastornos Relacionados con Opioides/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Combinación Buprenorfina y Naloxona/economía , Preparaciones de Acción Retardada/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antagonistas de Narcóticos/uso terapéutico , Noruega , Estados UnidosAsunto(s)
Corticoesteroides/uso terapéutico , Osteoartritis de la Rodilla/tratamiento farmacológico , Dolor/tratamiento farmacológico , Actividades Cotidianas , Corticoesteroides/administración & dosificación , Humanos , Inyecciones Intraarticulares , Dolor/etiología , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
INTRODUCTION: Opioid use disorder (OUD) affects 2 million Americans, yet many patients do not receive treatment. Lack of team-based care is a common barrier for office-based opioid treatment (OBOT). In 2015, we started OBOT in a family medicine practice. Based on our experiences, we developed a financial model for hiring a team member to provide nonbillable OBOT services through revenue from increased patient volume. METHODS: We completed a retrospective chart review from July 2015 to December 2016 to determine the average difference in medical visits per patient per month pre-OBOT versus post-OBOT. Secondary outcomes were the percentage of visits coded as a Level 3, Level 4, and Level 5, and the percentage of patients with Medicaid, private insurance, or self pay. With this information, we extrapolated to build a financial model to hire a team member to support OBOT. RESULTS: Twenty-three patients received OBOT during the study period. There was a net increase of 1.93 visits per patient per month (P < .001). Fourteen patients were insured by Medicaid, 7 had private insurance, and 2 were self pay. Twenty-three percent of OBOT visits were Level 3, 69% were Level 4, and 8% were Level 5. Assuming all visits were reimbursed by Medicaid and accounting for 20% cost of business, treating 1 existing patient for 1 year would generate $1,439. Treating 1 new patient would generate $1,677. CONCLUSIONS: In a fee-for-service model, the revenue generated from increased medical visits can offset the cost of hiring a team member to support nonbillable OBOT services.
Asunto(s)
Medicina Familiar y Comunitaria/economía , Tratamiento de Sustitución de Opiáceos/economía , Trastornos Relacionados con Opioides/terapia , Buprenorfina/uso terapéutico , Medicina Familiar y Comunitaria/organización & administración , Planes de Aranceles por Servicios , Humanos , Antagonistas de Narcóticos/uso terapéutico , Tratamiento de Sustitución de Opiáceos/métodos , Estudios RetrospectivosAsunto(s)
Antiulcerosos/efectos adversos , Antiulcerosos/uso terapéutico , Hipercolesterolemia/etiología , Hipertensión/etiología , Magnesio/sangre , Inhibidores de la Bomba de Protones/efectos adversos , Inhibidores de la Bomba de Protones/uso terapéutico , Defectos Congénitos del Transporte Tubular Renal/etiología , Relación Dosis-Respuesta a Droga , Humanos , Factores de TiempoRESUMEN
Chronic medical and common behavioral health conditions have been shown to benefit from team-based care approaches that include integrated behavioral health providers. Team-based integrated care can promote the Quadruple Aim, encompassing health care outcomes, patient satisfaction, provider work/life experience, and the cost of care.
Asunto(s)
Prestación Integrada de Atención de Salud , Implementación de Plan de Salud , Servicios de Salud Mental/organización & administración , Atención Dirigida al Paciente , Atención Primaria de Salud , Humanos , North Carolina , Estados UnidosRESUMEN
One nonfatal myocardial infarction (MI) will be avoided for every 126 to 138 adults who take daily aspirin for 10 years (strength of recommendation [SOR]: A, systematic reviews and meta-analyses of multiple randomized controlled trials [RCTs]). Taking low-dose aspirin for primary prevention shows no clear mortality benefit. A benefit for primary prevention of stroke is less certain. Although no evidence establishes increased risk of hemorrhagic stroke from daily low-dose aspirin, one gastrointestinal hemorrhage will occur for every 72 to 357 adults who take aspirin for longer than 10 years (SOR: A, systematic reviews and meta-analyses of multiple RCTs and cohort studies).
Asunto(s)
Aspirina/efectos adversos , Aspirina/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Hemorragia Gastrointestinal/inducido químicamente , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Prevención Primaria/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de RiesgoRESUMEN
Osteoporosis imposes a significant burden of morbidity, mortality, and cost on patients and the health care system. Compliance with existing screening and treatment recommendations is low. There are multiple barriers to treatment including complexity of medical management, cost of medications, real and perceived side effects of medications, and nonadherence.
Asunto(s)
Absorciometría de Fotón/métodos , Tamizaje Masivo , Administración del Tratamiento Farmacológico , Osteoporosis , Fracturas Osteoporóticas/prevención & control , Manejo de la Enfermedad , Conocimientos, Actitudes y Práctica en Salud , Humanos , Tamizaje Masivo/métodos , Tamizaje Masivo/organización & administración , Osteoporosis/complicaciones , Osteoporosis/diagnóstico , Osteoporosis/terapiaRESUMEN
Three beta-blockers--carvedilol, metoprolol succinate, and bisoprolol--reduce mortality equally (by about 30% over one year) in patients with Class III or IV systolic heart failure. Insufficient evidence exists comparing equipotent doses of these medications head-to-head to recommend any one over the others.