The combination of collaborative drug therapy management and E-prescribing.

Many discussions regarding electronic prescribing (E-prescribing) continue to focus on "who" should be responsible for building the communication platform: retail pharmacy or managed care. National pharmacy practice experts were interviewed to discuss a broader question: Given the potential for E-prescribing to reduce medication errors and improve communication between pharmacists and physicians, and given the increasing trend toward formal arrangements between pharmacists and physicians to establish collaborative drug therapy management (CDTM) practice settings, what are the implications for the practice of pharmacy? Specifically, how can technology for E-prescribing assist in the expansion of CDTM opportunities for the pharmacy profession?

Functional status and somatization as predictors of medical offset in anxious and depressed patients.

OBJECTIVE: Certain anxious/depressed primary care patients decrease medical utilization after mental health treatment. Previous research has established demo-graphic and medical comorbidities as distinguishing these patients. We asked whether characteristics such as symptom severity, somatization, or health-related quality of life (HRQoL) could also distinguish patients who reduce or increase primary care utilization after mental health care. METHODS: Primary care patients in a mixed-model HMO were screened for untreated anxiety with and without depression, using the Symptom Checklist (SCL-90-R) and medical records abstractions, and also for HRQoL (SF-36). We identified 165 symptomatic patients who subsequently received mental health treatment and then defined two subgroups: 1) offset patients (reduced medical utilization the year after initiation of mental health treatment) (N=97); and 2) no-offset patients (increased utilization) (N =68). RESULTS: Three HRQoL domains (general health perceptions, physical functioning, and role functioning- physical) predicted increased offset savings in the year after initiation of mental health treatment. Each point of improved functioning in these domains was associated with 4 dollars to 10 dollars of additional offset savings. Somatization-related comorbidities were predictive of greater additional costs (230 dollars). CONCLUSION: Using models to predict individual patient costs, we found that HRQoL and somatic comorbidities did not predict by anxiety/depression symptom severity or medical comorbidities, but by increasing or decreasing utilization after mental health care. Patients with higher functioning levels and no somatic comorbidities were most likely to reduce utilization. These findings support growing evidence for the need of inclusion of reliable indicators of somatization and patients' functioning in offset research and inpatient care.

A second and more promising round of E-health enterprises.

After several years of false starts and failed enterprises, E-medicine is starting to generate practical applications in health care. The new generation of E-businesses is benefiting from the dot-com bust, which has driven away expectations of high financial returns from enterprises based on overblown, ill-fitting models taken from non-health care industries. The more successful new models are adapted to hospital operations and practice patterns, and are backed by money and management indigenous to medicine. However, they are also fragmented, in thus far unconnected pieces of E-network services for discrete clinical activities, such as scripting, lab-testing, patient monitoring, and condition-specific diagnostics and treatment. The new question about E-medicine practice may be not "When will it happen?" but "when will the fragmented E-health systems be connected?"