Subject(s)
Health Care Reform/organization & administration , Insurance Coverage/organization & administration , Universal Health Insurance/organization & administration , Delivery of Health Care/organization & administration , Female , Health Policy , Humans , Louisiana , Male , Medically Uninsured/statistics & numerical data , Needs Assessment , Policy Making , Program Development , Program Evaluation , Quality of Health CareABSTRACT
This retrospective study examines the effect of a medication assistance program (MAP) on HbA1c levels in an uninsured, low-income, type 2 diabetes population. It also examines the degree to which improvement in HbA1c level varied with adherence to medication regimens among those patients using the MAP. The MAP was found to have a mean effect of -0.60% on HbA1c levels. However, MAP users differed in how strictly they adhered to medication regimens, as measured by number of refill opportunities taken. The MAP's effect on HbA1c varied monotonically with adherence level, with greater adherence leading to greater HbA1c improvement. Never refilling the prescription (complete nonadherence) led to no change in HbA1c, while complete adherence led to an estimated -0.88% improvement in HbA1c. Further study is needed to investigate factors related to non-adherence within medication assistance programs and the effect of such programs on other patient outcomes.
Subject(s)
Black or African American/psychology , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/therapeutic use , Medical Assistance/organization & administration , Medically Uninsured/statistics & numerical data , Patient Compliance/statistics & numerical data , Pharmacy Service, Hospital/statistics & numerical data , Uncompensated Care/economics , Adult , Aged , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/economics , Female , Glycated Hemoglobin/analysis , Hospitals, Public , Humans , Hypoglycemic Agents/economics , Hypoglycemic Agents/supply & distribution , Louisiana , Male , Medically Uninsured/ethnology , Middle Aged , Outcome Assessment, Health Care , Patient Compliance/ethnology , Pharmacy Service, Hospital/economics , Program Evaluation , Retrospective StudiesABSTRACT
Hurricanes Katrina and Rita were the latest disasters involving trauma to individuals and displacement of significant populations. As a consequence, those of us in health care fields often are affected both as professionals with critical skills and as individuals with families under intense stress. This Commentary, which appears in the January 2006 issue of The Journal of Clinical Psychiatry (2006;67:7-14), provides first-hand insight into the "at-the-front" realities faced by primary care professionals as disasters evolve, as well as the preparations we can make with our families and the key priorities to be addressed in our professional roles with individuals, affected groups of people, and response systems. While it is rare for us to dually publish material, we deem the importance of this information to merit joint publication in The Journal of Clinical Psychiatry and The Companion.-Larry Culpepper, M.D.
Subject(s)
Altruism , Disasters , Rescue Work , Anecdotes as Topic , Emergency Medical Services , Humans , Louisiana , Public Health Administration , VolunteersABSTRACT
BACKGROUND: Heart failure (HF) produces significant morbidity and mortality. Although HF disease management (HFDM) programs have been shown to decrease this morbidity, there is still a paucity of data on their effect on mortality. The objective of this study was to determine whether participation in an HFDM program would reduce mortality in an indigent population from rural Louisiana. METHODS: Proportional hazards modeling was used to determine whether patients participating in the HFDM program had improved survival compared with patients receiving traditional outpatient care at the same institution. Inclusion criteria consisted of an index hospitalization with discharge occurring between July 1, 1997, and May 30, 2002, hospital discharge diagnosis of HF, left ventricular systolic dysfunction documented during hospitalization, and at least 1 subsequent outpatient visit. Data from patients having participated in the HFDM program before their index hospitalization were excluded. RESULTS: Compared with patients who were given traditional care (n = 100), HFDM patients (n = 156) were younger (56.7 vs 60 years, P = .031), more likely to be African American (48.7% vs 33.0%, P = .014), more likely to be uninsured (47.4% vs 27%, P = .001), and more likely to have an ejection fraction of < or = 25% (73.1% vs 36%, P < .001). Overall comorbidity did not differ significantly between the groups. After controlling for differences in demographics, ejection fraction, and comorbidities, participation in the HFDM program was associated with a significant reduction in mortality compared with traditional care (adjusted hazard ratio .33, P < .001). CONCLUSION: In this indigent population, participation in an HFDM program was associated with decreased mortality compared with traditional follow-up care.
Subject(s)
Disease Management , Heart Failure/mortality , Poverty/statistics & numerical data , Ventricular Dysfunction, Left/mortality , Adrenergic beta-Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Female , Heart Failure/drug therapy , Heart Failure/economics , Humans , Louisiana/epidemiology , Male , Middle Aged , Odds Ratio , Program Evaluation , Proportional Hazards Models , Retrospective Studies , Survival Analysis , Ventricular Dysfunction, Left/drug therapy , Ventricular Dysfunction, Left/economicsSubject(s)
Disaster Planning , Disasters , Mental Health Services/organization & administration , Community Psychiatry/methods , Delivery of Health Care/methods , Delivery of Health Care/organization & administration , Government Programs/organization & administration , Grief , Humans , Louisiana , Needs Assessment/organization & administration , Relief Work/organization & administration , Rescue Work/organization & administration , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/therapyABSTRACT
Physician-assisted suicide is a controversial practice that is gaining favor in some segments of today's society. I will analyze the proponents' arguments for physician-assisted suicide and discuss why I believe this is a practice that physicians should shun.
