ABSTRACT
Bacterial resistance to antibiotics continues to grow, and inappropriate diagnoses and prescriptions are to blame. The authors report on a pilot program undertaken in California that seeks to decrease the unnecessary use of antibiotics for viral-based ailments.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Utilization , Health Services Misuse , Virus Diseases/drug therapy , California , Drug Resistance, Microbial , Drug Utilization Review , Humans , Pilot ProjectsABSTRACT
The drug benefits of most health plans do not include reimbursement for over-the counter (OTC) drugs. However, one PMB found that significant savings could be obtained if the OTC option was encouraged.
Subject(s)
Health Maintenance Organizations/economics , Insurance, Pharmaceutical Services , Nonprescription Drugs/economics , Anti-Inflammatory Agents, Non-Steroidal/economics , Histamine H1 Antagonists/economics , Humans , Models, Organizational , Nasal Decongestants/economics , United StatesSubject(s)
Akathisia, Drug-Induced , Carbamazepine/adverse effects , Adult , Humans , Male , Mood Disorders/drug therapyABSTRACT
Environmental stress may contribute to the clinical morbidity of established cases of schizophrenia treated with optimal neuroleptic drugs. A family-based approach that aimed to enhance the problem-solving capacity of the index patient and his family caregivers was compared with a patient-oriented approach of similar intensity over a two-year period. Thirty-six patients who returned to stressful parental households after florid episodes of schizophrenia (CATEGO and DSM-III) were stabilized with optimal neuroleptics before being randomly assigned to family or individual therapy in a comprehensive community management program. After nine months, family-managed patients had fewer exacerbations of schizophrenia, lower ratings of schizophrenic psychopathology, fewer hospital admissions, and a trend toward lower deficit symptoms and reduced neuroleptic dosage. This reduced clinical morbidity was sustained throughout the second year of less intensive follow-up. The relative efficacy of the family approach in this clinical management study did not appear to be due to prognostic factors, rater bias, stressful life events, or the effectiveness of pharmacotherapy. Definitive tests of these findings with respect to efficacy require further well-designed studies.
Subject(s)
Family Therapy , Schizophrenia/therapy , Adolescent , Adult , Aftercare , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/therapeutic use , Community Mental Health Services , Family , Female , Hospitalization , Humans , Life Change Events , Longitudinal Studies , Male , Outcome and Process Assessment, Health Care , Patient Compliance , Psychiatric Status Rating Scales , Psychotherapy , Schizophrenia/drug therapy , Schizophrenia/rehabilitation , Schizophrenic Psychology , Social AdjustmentABSTRACT
Environmental stress has been implicated as an important factor in the relapse of schizophrenic patients receiving optimal drug therapy. In a randomized controlled study, we compared at-home family therapy with clinic-based individual supportive care in the community management of schizophrenia in 36 patients taking neuroleptic maintenance medications. The family-treatment approach sought to enhance the stress-reducing capacity of the patient and his or her family through improved understanding of the illness and training in behavioral methods of problem solving. The results at the end of nine months revealed the superiority of this approach in preventing major symptomatic exacerbations. Only one family-treated patient (6 per cent of all patients) was judged to have had a clinical relapse, as compared with eight patients (44 per cent) treated individually. Family-treated patients averaged 0.83 days in the hospital, as compared with 8.39 days for the comparison group. Significantly lower levels of schizophrenic symptomatology on blind rating-scale assessments supported these clinical observations of the superiority of family management.