Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.690
Filtrar
1.
Gen Dent ; 68(1): 56-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31859664

RESUMO

The purpose of this retrospective, observational study was to characterize the amounts and types of healthcare industry payments made to dental care providers in 2017. Data were collected from the Open Payments database of the US Centers for Medicare & Medicaid Services. Dentists were classified as providing general services or services in 1 of 9 specialties recognized by the American Dental Association (prior to the recognition of dental anesthesiology). The value and nature of each payment made to providers were recorded, and descriptive statistics were calculated. Distributions across dental specialties were compared with analyses of variance. In 2017, US dentists received a total of 321,627 industry payments totaling $110,750,601. The most money was spent on service fees ($37,333,870; 33.7%), followed by consulting fees ($12,983,013; 11.7%) and royalties and licenses ($11,426,776; 10.3%). Each provider received a median payment of $63.27 (range, $0.21-$22,931,027.12) spread over 2 payments (range, 1-285). Participation rates among dental specialists ranged from 19% to 62%, and the highest rates were found among orthodontists (61.8%), oral and maxillofacial surgeons (55.7%), and periodontists (54.6%). The greatest median payments per provider were made to specialists in oral and maxillofacial radiology ($187.52), periodontics ($127.31), and oral and maxillofacial surgery ($123.39). The mean number (P < 0.01) and amount of payments (P < 0.01) per provider differed significantly across all specialties. The majority of dentists in this study received less than $200; however, the distribution of payments was positively skewed by a few top earners. The effect of these payments on clinical practice remains to be determined.


Assuntos
Conflito de Interesses , Economia em Odontologia , Indústrias/economia , Idoso , Odontologia , Honorários e Preços , Setor de Assistência à Saúde , Humanos , Indústrias/ética , Medicare , Padrões de Prática Médica/economia , Estudos Retrospectivos , Estados Unidos
2.
BMJ ; 367: l6015, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690553

RESUMO

OBJECTIVE: To evaluate the association between gifts from pharmaceutical companies to French general practitioners (GPs) and their drug prescribing patterns. DESIGN: Retrospective study using data from two French databases (National Health Data System, managed by the French National Health Insurance system, and Transparency in Healthcare). SETTING: Primary care, France. PARTICIPANTS: 41 257 GPs who in 2016 worked exclusively in the private sector and had at least five registered patients. The GPs were divided into six groups according to the monetary value of the received gifts reported by pharmaceutical, medical device, and other health related companies in the Transparency in Healthcare database. MAIN OUTCOME MEASURES: The main outcome measures were the amount reimbursed by the French National Health Insurance for drug prescriptions per visit (to the practice or at home) and 11 drug prescription efficiency indicators used by the National Health Insurance to calculate the performance related financial incentives of the doctors. Doctor and patient characteristics were used as adjustment variables. The significance threshold was 0.001 for statistical analyses. RESULTS: The amount reimbursed by the National Health Insurance for drug prescriptions per visit was lower in the GP group with no gifts reported in the Transparency in Healthcare database in 2016 and since its launch in 2013 (no gift group) compared with the GP groups with at least one gift in 2016 (-€5.33 (99.9% confidence interval -€6.99 to -€3.66) compared with the GP group with gifts valued at €1000 or more reported in 2016) (P<0.001). The no gift group also more frequently prescribed generic antibiotics (2.17%, 1.47% to 2.88% compared with the ≥€1000 group), antihypertensives (4.24%, 3.72% to 4.77% compared with the ≥€1000 group), and statins (12.14%, 11.03% to 13.26% compared with the ≥€1000 group) than GPs with at least one gift between 2013 and 2016 (P<0.001). The no gift group also prescribed fewer benzodiazepines for more than 12 weeks (-0.68%, -1.13% to -0.23% compared with the €240-€999 group) and vasodilators (-0.15%, -0.28% to -0.03% compared with the ≥€1000 group) than GPs with gifts valued at €240 or more reported in 2016, and more angiotensin converting enzyme (ACE) inhibitors compared with all ACE and sartan prescriptions (1.67%, 0.62% to 2.71%) compared with GPs with gifts valued at €1000 or more reported in 2016 (P<0.001). Differences were not significant for the prescription of aspirin and generic antidepressants and generic proton pump inhibitors. CONCLUSION: The findings suggest that French GPs who do not receive gifts from pharmaceutical companies have better drug prescription efficiency indicators and less costly drug prescriptions than GPs who receive gifts. This observational study is susceptible to residual confounding and therefore no causal relation can be concluded. TRIAL REGISTRATION: OSF register OSF.IO/8M3QR.


Assuntos
Indústria Farmacêutica/economia , Prescrições de Medicamentos/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Doações , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Indústria Farmacêutica/estatística & dados numéricos , Prescrições de Medicamentos/economia , Medicamentos Genéricos/economia , Feminino , França , Clínicos Gerais/economia , Humanos , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Padrões de Prática Médica/economia , Medicamentos sob Prescrição/economia , Estudos Retrospectivos , Adulto Jovem
4.
Health Serv Res ; 54(6): 1214-1222, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31742688

RESUMO

IMPORTANCE: It is critical to develop a better understanding of the strategies provider organizations use to improve the performance of frontline clinicians and whether ACO participation is associated with differential adoption of these tools. OBJECTIVES: Characterize the strategies that physician practices use to improve clinician performance and determine their association with ACOs and other payment reforms. DATA SOURCES: The National Survey of Healthcare Organizations and the National Survey of ACOs fielded 2017-2018 (response rates = 47 percent and 48 percent). STUDY DESIGN: Descriptive analysis for practices participating and not participating in ACOs among 2190 physician practice respondents. Linear regressions to examine characteristics associated with counts of performance domains for which a practice used data for feedback, quality improvement, or physician compensation as dependent variables. Logistic and fractional regression to examine characteristics associated with use of peer comparison and shares of primary care and specialist compensation accounted for by performance bonuses, respectively. PRINCIPAL FINDINGS: ACO-affiliated practices feed back clinician-level information and use it for quality improvement and compensation on more performance domains than non-ACO-affiliated practices. Performance measures contribute little to physician compensation irrespective of ACO participation. CONCLUSION: ACO-affiliated practices are using more performance improvement strategies than other practices, but base only a small fraction of compensation on quality or cost.


Assuntos
Organizações de Assistência Responsáveis/economia , Organizações de Assistência Responsáveis/estatística & dados numéricos , Compensação e Reparação , Planos de Pagamento por Serviço Prestado/economia , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Padrões de Prática Médica/economia , Padrões de Prática Médica/estatística & dados numéricos , Humanos , Medicare/economia , Medicare/estatística & dados numéricos , Estados Unidos
5.
BMC Health Serv Res ; 19(1): 703, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619229

RESUMO

BACKGROUND: In the United States, there is well-documented regional variation in prescription drug spending. However, the specific role of physician adoption of brand name drugs on the variation in patient-level prescription drug spending is still being investigated across a multitude of drug classes. Our study aims to add to the literature by determining the association between physician adoption of a first-in-class anti-diabetic (AD) drug, sitagliptin, and AD drug spending in the Medicare and Medicaid populations in Pennsylvania. METHODS: We obtained physician-level data from QuintilesIMS Xponent™ database for Pennsylvania and constructed county-level measures of time to adoption and share of physicians adopting sitagliptin in its first year post-introduction. We additionally measured total AD drug spending for all Medicare fee-for-service and Part D enrollees (N = 125,264) and all Medicaid (N = 50,836) enrollees with type II diabetes in Pennsylvania for 2011. Finite mixture model regression, adjusting for patient socio-demographic/clinical characteristics, was used to examine the association between physician adoption of sitagliptin and AD drug spending. RESULTS: Physician adoption of sitagliptin varied from 44 to 99% across the state's 67 counties. Average per capita AD spending was $1340 (SD $1764) in Medicare and $1291 (SD $1881) in Medicaid. A 10% increase in the share of physicians adopting sitagliptin in a county was associated with a 3.5% (95% CI: 2.0-4.9) and 5.3% (95% CI: 0.3-10.3) increase in drug spending for the Medicare and Medicaid populations, respectively. CONCLUSIONS: In a medication market with many choices, county-level adoption of sitagliptin was positively associated with AD spending in Medicare and Medicaid, two programs with different approaches to formulary management.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/economia , Medicaid/economia , Medicare/economia , Padrões de Prática Médica/economia , Fosfato de Sitagliptina/economia , Administração Oral , Idoso , Diabetes Mellitus Tipo 2/economia , Planos de Pagamento por Serviço Prestado , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Hipoglicemiantes/administração & dosagem , Masculino , Pessoa de Meia-Idade , Pennsylvania , Fosfato de Sitagliptina/administração & dosagem , Estados Unidos
6.
Int J Equity Health ; 18(1): 159, 2019 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623613

RESUMO

BACKGROUND: The human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide. Gay, bisexual, and other men who have sex with men (GBM), and GBM living with HIV in particular, are disproportionately impacted by HPV-associated cancers. The HPV vaccine, given early enough in life, may markedly reduce the likelihood of such cancers. In Canada, most provincial insurance programs only cover HPV vaccination for GBM up to the age of 26. Our objective was to understand physicians' everyday experiences and challenges in recommending HPV vaccination to older GBM patients. METHODS: As part of the HPV Screening and Vaccine Evaluation (HPV-SAVE) Study, we conducted semi-structured interviews with 25 HIV-positive GBM patients who had received anal cancer screening and 15 service providers, including 13 physicians, who had arranged for anal cancer screening in the Canadian provinces of Ontario and British Columbia. In this analysis, we draw upon the 13 physician interviews, which were coded following Grounded Theory. RESULTS: Physicians strongly supported the HPV vaccine for all GBM and considered it to be important for the management of HIV-related care. However, the overall support for HPV vaccination among physicians did not translate into consistent recommendation practices. There were two overarching factors that limited the strength/frequency of physicians' vaccine recommendation practices. First, cost/insurance coverage for some older patients impacted if and how the HPV vaccine was discussed. Second, physicians had diverse perspectives on both the prevention and therapeutic benefits of vaccinating older GBM and the reality that national guidelines are incongruent with publicly funded vaccine programs for vaccinating patients over 26 years old. These two interrelated factors have co-produced an apparent economic-evidentiary conundrum for many physicians regarding how and for whom to offer HPV vaccination. CONCLUSION: Economic barriers coupled with evidentiary and guideline gaps have created clinical practice challenges for physicians and has resulted in different messages being communicated to some older GBM patients about how important HPV vaccination is for their health.


Assuntos
Homossexualidade Masculina , Vacinas contra Papillomavirus/administração & dosagem , Médicos/psicologia , Padrões de Prática Médica , Minorias Sexuais e de Gênero , Adulto , Canadá , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Vacinas contra Papillomavirus/economia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/economia , Padrões de Prática Médica/ética , Pesquisa Qualitativa , Minorias Sexuais e de Gênero/estatística & dados numéricos , Fatores Socioeconômicos
7.
Vasc Health Risk Manag ; 15: 429-437, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31632047

RESUMO

Objectives: 1) To evaluate anticoagulation treatment patterns and health care resource use in adult patients with a discharge diagnosis of non-valvular atrial fibrillation (NVAF) in an Italian real-world setting and 2) to describe the characteristics of NVAF patients in relation to treatment. Design: A retrospective cohort study in a "real-world" setting. Setting: Data were analysed by integrating administrative databases that included approximately 2,000,000 individuals assisted by the National Health System from two Italian Local Health Units. Participants: All adult patients with at least one hospital discharge or ≥2 outpatient visits with a diagnosis code for NVAF from 1/01/2011 to 31/12/2015 were included. Main outcome measures: Anticoagulation treatment patterns, health care resource use and major bleeding events that occurred during the follow-up period were evaluated. Results: 32,863 NVAF patients were included, of whom 7,831 had at least one prescription of oral anticoagulants. Among them, 6,876 patients were vitamin K antagonists (VKA) users and 955 were non-vitamin K antagonist oral anticoagulant (NOAC) users at index date (ID). During the follow-up period, the use of antiplatelet drugs was higher among VKA-naïve users than the NOAC-naïve users. Among NOAC users, 76.1% showed an adherence level ≥80% during follow-up. The rate of bleeding events resulted higher for VKA patients compared to NOAC patients. The unadjusted incidence rate was 10.46 per 1000 person-year for VKA patients and 4.55 per 1,000 person-years for NOAC patients. The overall annual cost (in term of drugs, hospitalisations and outpatient specialist services) was € 5,156.13 for VKA and € 4,630.57 for NOAC. Conclusion: This unselected cohort study, on NVAF patients being prescribed oral anticoagulants, highlights that VKA was largely prescribed and the great majority of patients on NOACs were adherent to treatment. Most of the OAC patients still received antiplatelet agents in combination, and in NOAC patients, we registered a lower number of bleeding events compared with VKA.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Padrões de Prática Médica , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Anticoagulantes/economia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/economia , Fibrilação Atrial/epidemiologia , Bases de Dados Factuais , Custos de Medicamentos , Prescrições de Medicamentos , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Incidência , Itália/epidemiologia , Masculino , Adesão à Medicação , Inibidores da Agregação de Plaquetas/administração & dosagem , Padrões de Prática Médica/economia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
BMC Health Serv Res ; 19(1): 560, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409369

RESUMO

BACKGROUND: Implementing adequate strategies to assess the value of health services plays a central role in the effort to deal with the financial pressures faced by health care systems worldwide. This study aimed to understand which approaches to value assessment have been used in developed countries. METHODS: We conducted a rapid review and a gray literature search to identify value assessment frameworks. A two-stage screening process was utilized to identify existing approaches and cluster similar frameworks. In addition, we developed an interpretive classification system to make sense of existing approaches. RESULTS: One thousand one hundred seventy-six references were identified and 38 papers were selected for full-review. Among these 38 articles, 22 distinct approaches to assess value of health care interventions were identified and classified according to four points: 1) use of single or multiple considerations to base value estimates; 2) use of disease-specific or generic criteria; 3) reliance on process-based or outcomes-based consideration; and 4) type of input and evidence considered. CONCLUSIONS: The contextual nature of value assessment in health care becomes evident with the diversity of existing approaches. Despite the predominance of cases relying on the Incremental cost-effectiveness ratio as the measure of value, this approach has not been sufficient to meet the needs of decision-makers. The use of multiple criteria has become more and more important, as well as the consideration of patient-reported measures. Considerations of costs are not always explicit and consistent.


Assuntos
Assistência à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Padrões de Prática Médica/economia , Análise Custo-Benefício , Tomada de Decisões , Assistência à Saúde/normas , Humanos , Padrões de Prática Médica/normas
9.
J Manag Care Spec Pharm ; 25(9): 966-972, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31456497

RESUMO

BACKGROUND: Opioid prescription patterns, including long-term use, multiple prescribers, and high opioid doses, increase the risk for adverse outcomes; however, previous research in older adult populations has primarily described opioid dose patterns using average daily dose measures or using very high thresholds (i.e., > 100 morphine milligram equivalents [MME] per day). OBJECTIVE: To describe prescription patterns by peak dose among older adults who have newly initiated opioid use in 2014 and describe long-term opioid use and the use of multiple pharmacies and prescribers among those with peak opioid doses over 50 and over 90 MME per day. METHODS: This was a retrospective cohort study of Medicare Part D prescription claims data (5% sample) for beneficiaries aged 65 years and older who were prescribed ≥ 1 opioid prescription in 2014 and did not have an opioid prescription in the preceding 180 days. Within a 1-year period of follow-up, we used prescription claims to characterize individuals' opioid exposure, measuring long-term opioid use (≥ 90 days of continuous opioid supply), unique opioid prescribers, and unique opioid-dispensing pharmacies. Peak MME was defined as the maximum daily MME received across all overlapping opioid prescriptions in the observation period. RESULTS: 144,127 beneficiaries without an opioid prescription in the previous 6 months filled ≥ 1 opioid prescription in 2014. During the 1-year follow-up period, 6.5% of beneficiaries transitioned to long-term opioid use; 39.5% received opioid prescriptions from > 1 prescriber; 18.1% filled opioid prescriptions from > 1 pharmacy; and 21.8% had a peak MME of 50-89. Among the 28.1% of beneficiaries exposed to a peak MME > 50, 8.6% developed long-term opioid use; 7.0% had 3 or more opioid dispensing pharmacies; and 28.0% had 3 or more opioid prescribers. Among the 6.2% of beneficiaries exposed to a peak MME ≥ 90, 18.5% developed long-term opioid use; 13.0% had 3 or more opioid dispensing pharmacies; and 39.6% had 3 or more opioid prescribers. CONCLUSIONS: High doses of opioids were prescribed for about one quarter (28%) of Medicare beneficiaries with new opioid use in 2014. Having multiple opioid prescribers or multiple opioid dispensing pharmacies was common, especially among those prescribed higher doses. These prescription patterns can be particularly helpful to identify older adults with increased opioid-related risk. DISCLOSURES: No funding supported this study. Raman reports research grants from GlaxoSmithKline not related to this study. Roberts was supported by a CTSA grant from NCATS awarded to the University of Kansas Medical Center for Frontiers: The Heartland Institute for Clinical and Translational Research (#KL2TR000119). The other authors have no potential conflicts to report.


Assuntos
Analgésicos Opioides/economia , Analgésicos Opioides/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/efeitos adversos , Feminino , Humanos , Masculino , Medicare , Transtornos Relacionados ao Uso de Opioides/economia , Transtornos Relacionados ao Uso de Opioides/etiologia , Assistência Farmacêutica/economia , Farmácias/economia , Padrões de Prática Médica/economia , Uso Indevido de Medicamentos sob Prescrição/economia , Estudos Retrospectivos , Estados Unidos
10.
BMC Pregnancy Childbirth ; 19(1): 226, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272397

RESUMO

BACKGROUND: There is global concern for the overuse of obstetric interventions during labour and birth. Of particular concern is the increasing amount of mothers and babies experiencing morbidity and mortality associated with caesarean section compared to vaginal birth. In high-income settings, emerging evidence suggests that overuse of obstetric intervention is more prevalent among wealthier mothers with no medical need of it. In Australia, the rates of caesarean section and other obstetric interventions are rising. These rising rates of intervention have been mirrored by a decreasing rate of unassisted non-instrumental vaginal deliveries. In the context of rising global concern about rising caesarean section rates and the known health effects of caesarean section on mothers and children, we aim to better characterise the use of obstetric intervention in the state of Queensland, Australia by examining the characteristics of mothers receiving obstetric intervention. Identifying whether there is overuse of obstetric interventions within a population is critical to improving the quality, value and appropriateness of maternity care. METHODS: The association between demographic characteristics (at birth) and birth delivery type were compared with chi-square. The percentage of mothers based on their socioeconomic characteristics were reported and differences in percentages of obstetric interventions were compared. Multivariate analysis was undertaken using multiple logistic regression to assess the likelihood of receiving obstetric intervention and having a vaginal (non-instrumental) delivery after accounting for key clinical characteristics. RESULTS: Indigenous mothers, mothers in major cities and mothers in the wealthiest quintile all had higher percentages of all obstetric interventions and had the lowest percentages of unassisted (non-instrumental) vaginal births. These differences remained even after adjusting for other key sociodemographic and clinical characteristics. CONCLUSIONS: Differences in obstetric practice exist between economic, ethnic and geographical groups of mothers that are not attributable to medical or lifestyle risk factors. These differences may reflect health system, organisational and structural conditions and therefore, a better understanding of the non-clinical factors that influence the supply and demand of obstetric interventions is required.


Assuntos
Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Sobremedicalização/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Parto Obstétrico/economia , Feminino , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/etnologia , Humanos , Modelos Logísticos , Sobremedicalização/economia , Padrões de Prática Médica/economia , Gravidez , Queensland , Saúde da População Rural/economia , Saúde da População Rural/etnologia , Saúde da População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Saúde da População Urbana/economia , Saúde da População Urbana/etnologia , Saúde da População Urbana/estatística & dados numéricos
11.
J Cardiovasc Med (Hagerstown) ; 20(8): 531-541, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31259858

RESUMO

AIMS: The aim of this survey was to assess the management and organization of cardiac implantable electronic device (CIED) replacement in Italy. METHODS: A questionnaire consisting of 24 questions on organizational aspects and on the peri-procedural management of anticoagulant therapies and antibiotic prophylaxis was sent via the Internet to 154 Italian arrhythmia centers. RESULTS: A total of 103 out of 154 centers completed the questionnaire (67% response rate). In 43% of the centers, the procedures were performed under day-case admission, in 40% under ordinary admission, and in 17% under either day-case or ordinary admission. The most frequent reason (66%) for choosing ordinary admission rather than day-case admission was to obtain full reimbursement. Although warfarin therapy was continued in 73% of the centers, nonvitamin K oral anticoagulants were discontinued, without bridging, 24 h or less prior to replacement procedures in 88%. Prophylactic antibiotic therapy was systematically administered in all centers; in 97%, the first antibiotic dose was administered 1-2 h prior to procedures. Local antibacterial envelopes were also used in 43% of the centers in patients with a higher risk of device infection. CONCLUSION: This survey provides a representative picture of how CIED replacements are organized and managed in current Italian clinical practice. The choice of the type of hospitalization (short versus ordinary) was more often motivated by economic reasons (reimbursement of the procedure) than by clinical and organizational factors. Peri-procedural management of anticoagulation and prophylactic antibiotic therapy was consistent with current scientific evidence.


Assuntos
Antibioticoprofilaxia/tendências , Anticoagulantes/administração & dosagem , Estimulação Cardíaca Artificial/tendências , Desfibriladores Implantáveis/tendências , Remoção de Dispositivo/tendências , Cardioversão Elétrica/tendências , Marca-Passo Artificial/tendências , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Ambulatórios , Estimulação Cardíaca Artificial/economia , Desfibriladores Implantáveis/economia , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/economia , Esquema de Medicação , Cardioversão Elétrica/economia , Cardioversão Elétrica/instrumentação , Custos de Cuidados de Saúde , Pesquisas sobre Serviços de Saúde , Humanos , Itália , Tempo de Internação , Marca-Passo Artificial/economia , Admissão do Paciente , Padrões de Prática Médica/economia , Falha de Prótese , Fatores de Tempo , Resultado do Tratamento
12.
J Clin Pharm Ther ; 44(4): 579-587, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31152684

RESUMO

WHAT IS KNOWN AND OBJECTIVE: The use of generic oral contraceptives (OCPs) can improve adherence and reduce healthcare costs, yet scepticism of generic drugs remains a barrier to generic OCP discussion and prescription. An educational web module was developed to reduce generic scepticism related to OCPs, improve knowledge of generic drugs and increase physician willingness to discuss and prescribe generic OCPs. METHODS: A needs assessment was completed using in-person focus groups at American College of Physicians (ACP) Annual Meeting and a survey targeting baseline generic scepticism. Insights gained were used to build an educational web module detailing barriers and benefits of generic OCP prescription. The module was disseminated via email to an ACP research panel who completed our baseline survey. Post-module evaluation measured learner reaction, knowledge and intention to change behaviour along with generic scepticism. RESULTS AND DISCUSSION: The module had a response rate of 56% (n = 208/369). Individuals defined as generic sceptics at baseline were significantly less likely to complete our module compared to non-sceptics (responders 9.6% vs non-responders 16.8%, P = 0.04). The majority (85%, n = 17/20) of baseline sceptics were converted to non-sceptics (P < 0.01) following completion of the module. Compared to non-sceptics, post-module generic sceptics reported less willingness to discuss (sceptic 33.3% vs non-sceptic 71.5%, P < 0.01), but not less willingness to prescribe generic OCPs (sceptic 53.3% vs non-sceptic 67.9%, P = 0.25). Non-white physicians and international medical graduates (IMG) were more likely to be generic sceptics at baseline (non-white 86.9% vs white 69.9%, P = 0.01, IMG 13.0% vs USMG 5.0% vs unknown 18.2%, P = 0.03) but were also more likely to report intention to prescribe generic OCPs as a result of the module (non-white 78.7% vs white 57.3%, P < 0.01, IMG 76.1% vs USMG 50.3% vs unknown 77.3%, P = 0.03). WHAT IS NEW AND CONCLUSION: A brief educational web module can be used to promote prescribing of generic OCPs and reduce generic scepticism.


Assuntos
Anticoncepcionais Orais/economia , Medicamentos Genéricos/economia , Médicos de Atenção Primária/economia , Médicos de Atenção Primária/educação , Padrões de Prática Médica/economia , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internet , Masculino , Pessoa de Meia-Idade
13.
Inquiry ; 56: 46958019854965, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31179800

RESUMO

As health systems seek to incentivize physicians to deliver high-value care, the relationship between physician compensation and health care delivery is an important knowledge gap. To examine physician compensation nationally and its relationship with care delivery, we examined 2012-2015 cross-sectional data on ambulatory primary care physician visits from the National Ambulatory Medical Care Survey. Among 175 762 office visits with 3826 primary care physicians, 15.4% of primary care physicians reported salary-based, 4.5% productivity-based, and 12.9% "mixed" compensation, while 61.4% were practice owners. After adjustment, delivery of out-of-visit/office care was more common for practice owners and "mixed" compensation primary care physicians, while there was little association between compensation type and rates of high- or low-value care delivery. Despite early health reform efforts, the overall landscape of physician compensation has remained strongly tethered to fee-for-service. The lack of consistent association between compensation and care delivery raises questions about the potential impact of payment reform on individual physicians' behavior.


Assuntos
Motivação , Médicos de Atenção Primária/economia , Padrões de Prática Médica/economia , Salários e Benefícios , Adulto , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Estados Unidos
14.
Anticancer Res ; 39(6): 3137-3140, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177159

RESUMO

BACKGROUND/AIM: Because aggressive oncological management just prior to death constitutes a substantial proportion of end-of-life (EOL) costs, we investigated patterns of EOL oncologic care for stage IV non-small cell lung cancer (NSCLC) in USA to better determine at which point in the patient's management new treatments were being initiated. MATERIALS AND METHODS: The National Cancer Database was queried for stage IV NSCLC patients who received any cancer-directed therapy with known timing thereof. RESULTS: A total of 281,990 stage IV NSCLC patients were analyzed. Of all patients, 10.8% commenced any first-course cancer therapy within four weeks of death, and 24.5% within eight weeks of death. CONCLUSION: 10-15% of stage IV NSCLC patients start cancer therapy within four weeks of death, and 25-30% within eight weeks. This represents a population for whom cancer therapy may not be required, which has implications on reducing EOL healthcare costs.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Oncologia/tendências , Oncologistas/tendências , Cuidados Paliativos/tendências , Padrões de Prática Médica/tendências , Assistência Terminal/tendências , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/economia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Bases de Dados Factuais , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Neoplasias Pulmonares/economia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Oncologia/economia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Oncologistas/economia , Cuidados Paliativos/economia , Padrões de Prática Médica/economia , Assistência Terminal/economia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
16.
Yakugaku Zasshi ; 139(4): 547-550, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30930386

RESUMO

The "Choosing Wisely" campaign is an activity to promote conversations between patients and doctors about unnecessary examinations, treatments, or procedures. A "Top five list" published by a number of specialty societies consists of five evidence-based recommendations in their own fields. Choosing Wisely Japan was launched in 2016; the campaign soon became widespread among primary care physicians. To make wiser choices in prescriptions of any medicine, it is necessary to consider the balance between its efficacies, risks, and costs. The purpose of this campaign is not only to publish recommendations to reduce waste in health care resources but also to disseminate and implement the recommendations contents. To put them into practice, it is necessary to think about interprofessional and interdisciplinary approaches.


Assuntos
Análise Custo-Benefício , Prática Clínica Baseada em Evidências , Recursos em Saúde/economia , Prescrição Inadequada/prevenção & controle , Sobremedicalização/prevenção & controle , Médicos de Atenção Primária , Padrões de Prática Médica , Medição de Risco , Recursos em Saúde/estatística & dados numéricos , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Japão , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Padrões de Prática Médica/economia , Prescrições/estatística & dados numéricos
17.
Urology ; 130: 65-71, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31029672

RESUMO

OBJECTIVE: To investigate the impact of urologist practice structure on health care spending for men with prostate cancer. We hypothesize that 3 elements of urologist practice structure may influence spending for prostate cancer care: urologist participation within a multispecialty group (MSG), practice size among single specialty urology groups, and intensity-modulated radiation therapy (IMRT) ownership. MATERIALS AND METHODS: We used a 20% sample of fee-for-service Medicare beneficiaries to identify men newly diagnosed with prostate cancer between 2011 and 2014. We identified each man's urologist and used data from the Healthcare Relational Spheres provider files to identify practice type, size, and IMRT ownership for each urologist. We then fit generalized linear mixed models to estimate the association between these practice features and Medicare payments in the year after diagnosis. All models were adjusted for patient and healthcare market characteristics. RESULTS: We identified 35,929 men with newly diagnosed prostate cancer who were treated by 6381 urologists. Medicare payments for men with newly diagnosed prostate cancer were significantly lower in MSGs ($19,181 v. $22,366 large single specialty group, P < 0.001) and significantly higher among practices with IMRT ownership ($23,801 v. $20,162 for non-owners, P < 0.001). These differences persisted in sensitivity analyses including only men treated with radiotherapy and examining only prostate cancer-related claims. CONCLUSION: Urologist practice structure is associated with payments for prostate cancer care. MSGs had the lowest Medicare payments per episode of prostate cancer care while groups with IMRT ownership had the highest.


Assuntos
Padrões de Prática Médica/economia , Neoplasias da Próstata/economia , Urologia/economia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Medicare , Padrões de Prática Médica/organização & administração , Neoplasias da Próstata/terapia , Estados Unidos
18.
Tex Med ; 115(2): 28-31, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30817836

RESUMO

The Texas Medical Association supports allowing physicians to dispense out of their offices, and TMA and the Texas Academy of Family Physicians (TAFP) are supporting business groups and other leaders as they mount a legislative effort to bring the practice to Texas. Proponents are wielding data that illustrates potential benefits like reduced medication costs and increased patient adherence to their drug regimens.


Assuntos
Padrões de Prática Médica/organização & administração , Medicamentos sob Prescrição/provisão & distribução , Humanos , Padrões de Prática Médica/economia , Padrões de Prática Médica/legislação & jurisprudência , Medicamentos sob Prescrição/economia , Texas
19.
Pediatr Radiol ; 49(4): 486-492, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30923880

RESUMO

Clinical decision support has been identified by the United States government as a method to decrease inappropriate imaging exams and promote judicious use of imaging resources. The adoption of this method will be incentivized by requiring appropriate use criteria to qualify for Medicare reimbursement starting in January 2020. While Medicare reimbursement is unlikely to directly impact pediatric imaging because of largely disparate patient populations, insurance providers typically use Medicare to benchmark their reimbursement guidelines. Therefore soon after their adoption these guidelines could become relevant to pediatric imaging. In this article we discuss how pediatric imaging was initially underrepresented in the clinical decision support realm, and how this was addressed by a subcommittee involving both American College of Radiology and Society for Pediatric Radiology members. We also present the experience of implementing clinical decision support software at two standalone pediatric hospitals and summarize the lessons learned from these deployments.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Hospitais Pediátricos , Radiologia/normas , Software , Medicina Baseada em Evidências , Humanos , Uso Significativo/economia , Medicare/economia , Padrões de Prática Médica/economia , Radiologia/economia , Sociedades Médicas , Estados Unidos , Interface Usuário-Computador
20.
JAMA Netw Open ; 2(3): e190932, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901047

RESUMO

Importance: Although physician sex is known to influence salary even after controlling for productivity, sex-based differences in clinical activity and reimbursement among radiation oncologists are poorly understood. Objectives: To evaluate differences by sex in productivity, breadth of practice, and payments and to characterize Medicare reimbursement by sex among similarly productive groups of radiation oncologists. Design, Setting, and Participants: A retrospective cohort study was conducted using the January 1 to December 31, 2016, Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use File (POSPUF) to identify charge and payment information for individual radiation oncologists. Clinicians were part of a population-based sample of US radiation oncologists who bill Medicare in both non-facility-based (NFB) and facility-based (FB) practice settings. Analysis was conducted from June 5 to 25, 2018. Main Outcomes and Measures: Outcome measurements included physician productivity (measured by number of Medicare charges), physician payments (reported as total Medicare payments as well as mean payments per charge submitted and per beneficiary treated), and physician breadth of practice (measured by number of unique Medicare billing codes) in NFB and FB settings. Results: A total of 4393 radiation oncologists (1133 women and 3260 men) were included in the POSPUF in 2016. Compared with their male counterparts, female physicians in the NFB setting submitted a mean of 1051 fewer charges (95% CI, -1458 to -644; P < .001), collected a mean of $143 610 less in revenue (95% CI, -$185 528 to -$101 692; P < .001), and used a mean of 1.32 fewer unique billing codes (95% CI, -2.23 to -0.41; P = .004). Compared with their male counterparts, female radiation oncologists in the FB setting submitted a mean of 423 fewer charges (95% CI, -506 to -341; P < .001), collected a mean of $26 735 less in revenue (95% CI, -$31 910 to -$21 560; P < .001), and submitted a mean of 1.28 fewer unique billing codes (95% CI, -1.77 to -0.78; P < .001). Women represented 46 of the 397 most highly productive radiation oncologists in the FB setting (11.6%) and collected a mean of $33 026 less (95% CI, -$52 379 to -$13 673; P = .001) than men who were similarly productive. In the NFB setting, women represented 54 of the 326 most highly productive radiation oncologists (16.6%) and collected $345 944 (95% CI, -$522 663 to -$169 225; P < .001) less than similarly highly productive men. Women collected a mean of $8.49 less per charge (95% CI, -$14.13 to -$2.86; P = .003) than men in the NFB setting. Conclusions and Relevance: This study suggests that female radiation oncologists submit fewer Medicare charges, are reimbursed less per charge they submit, and receive lower Medicare payments overall compared with male radiation oncologists. Even among similarly productive radiation oncologists, women in this study still collected less revenue than men. Further research is required to understand the sex-based barriers to economic advancement within radiation oncology.


Assuntos
Honorários e Preços/estatística & dados numéricos , Medicare/economia , Padrões de Prática Médica , Radio-Oncologistas , Feminino , Humanos , Masculino , Padrões de Prática Médica/economia , Padrões de Prática Médica/estatística & dados numéricos , Radio-Oncologistas/economia , Radio-Oncologistas/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA