ABSTRACT
OBJECTIVE: The development of an effective therapeutic equivalence program (TEP) through the collaborative support of medical staff, using the principles of disinvestment. DESIGN AND SETTING: A TEP was introduced at Southern Health, a metropolitan health service in Melbourne, in the 2006-07 financial year. Therapeutic classes were selected for the TEP by stakeholder consensus, and a preferred medication for each class was selected on the basis of cost considerations and therapeutic equivalence. New patients were commenced on preferred medicines, but patients receiving another medicine from a therapeutic class included in the program were not automatically switched to the preferred medicine. For the first 4 years of the program, prescribing patterns were monitored, and savings achieved (due to lower prices for and increased use of preferred medicines) were calculated on a monthly basis. MAIN OUTCOME MEASURES: Prescribing trends for preferred medicines, as a measure of acceptance of the TEP, and savings produced by the program. RESULTS: Over the 4-year study period, 11 therapeutic classes were targeted. The use of all preferred medicines increased once they become part of the TEP and a total of $3.16 million was saved. The annual savings increased each year, and the rate of increase was six times that of the increase in patient separations. CONCLUSIONS: The TEP at Southern Health resulted in significant savings. It showed that, by using a collaborative and evidence-based approach, the principles of disinvestment can be applied to use of medicines.
Subject(s)
Practice Patterns, Physicians' , Therapeutic Equivalency , Cost Control/methods , Drug Costs , Education, Medical, Continuing/methods , Humans , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/statistics & numerical data , VictoriaSubject(s)
Cause of Death , Helicobacter Infections/diagnosis , Helicobacter pylori/isolation & purification , Peptic Ulcer Hemorrhage/diagnosis , Peptic Ulcer Hemorrhage/mortality , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Female , Helicobacter Infections/drug therapy , Helicobacter Infections/epidemiology , Hemostasis, Endoscopic/adverse effects , Hemostasis, Endoscopic/methods , Hospitals, University , Humans , Incidence , Male , Middle Aged , Multicenter Studies as Topic , Netherlands/epidemiology , Peptic Ulcer Hemorrhage/surgery , Retrospective Studies , Risk Assessment , Severity of Illness Index , Sex Distribution , Survival AnalysisABSTRACT
OBJECTIVES: To study an individual's experience of either flexible sigmoidoscopy (FS) or colonoscopy in a colorectal cancer prevention programme. METHODS: Consecutive individuals in a Bowel Cancer Prevention Programme, who had either an unsedated FS or a colonoscopy with sedation, participated in a prospective cross-sectional questionnaire-based study. RESULTS: A total of 447 responses were obtained for 256 colonoscopies and 191 FSs (200 men [45%] and 247 women [55%]). The overall experience of colonoscopy was more comfortable than FS (75% versus 18%; P<0.001). Embarrassment was low for both procedures (8%). There was no pain associated with colonoscopy and most individuals had a pain score of less than 3 (11-point scale) for FS: 72% of men, 55% of women (P<0.001). Most individuals did not have a gender preference for the endoscopist. For colonoscopy, the worst part of the procedure was the preparation (78%) and for FS the preparation and the procedure ranked equally worst (30%). CONCLUSIONS: We have shown that colonoscopy with sedation is a very comfortable procedure. FS is more uncomfortable than colonoscopy; however, for the majority it is a tolerable experience. Women found FS only slightly more painful than men. The worst part of either procedure was the preparation. Embarrassment with either procedure was minimal. Both procedures are well tolerated and suitable for colorectal cancer screening.
Subject(s)
Colonoscopy/methods , Colorectal Neoplasms/prevention & control , Sigmoidoscopy/methods , Colonoscopes , Colonoscopy/psychology , Colorectal Neoplasms/diagnosis , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Mass Screening , Pain Threshold , Patient Acceptance of Health Care , Patient Satisfaction , Sex Factors , Sigmoidoscopes , Sigmoidoscopy/psychology , Surveys and QuestionnairesABSTRACT
BACKGROUND: This study compared the experiences of women who underwent endoscopic screening for colorectal cancer vs. their experiences with breast and cervical cancer screening by mammography and Pap smear, respectively. METHODS: Women who had either flexible sigmoidoscopy or colonoscopy as a screening procedure for colorectal cancer were asked to return a questionnaire by mail. In the questionnaire, they were asked about the procedure they had just undergone and to compare it with recent mammograms and Pap smears. Flexible sigmoidoscopy was performed without sedating the patient; colonoscopy was performed with the patient under deep sedation (midazolam, fentanyl, and propofol administered by an anesthesiologist). RESULTS: Responses were obtained from 258 women (88%). Of these, 152 had colonoscopy and 106 had flexible sigmoidoscopy. A total of 72% of respondents found colonoscopy to be a comfortable test. Only 26% found flexible sigmoidoscopy uncomfortable, which was similar to mammography and Pap smear, at 22%. In terms of the test considered to be the most embarrassing, the highest response rate (38%) was for the Pap smear. Most women had no preference as to the gender of the endoscopist, but 46% preferred a woman doctor for a Pap smear (p < 0.001). Preparation was regarded as the worst part of the colonoscopy procedure; for flexible sigmoidoscopy, the procedure itself and the preparation were equivalent. CONCLUSIONS: Women found flexible sigmoidoscopy or colonoscopy comfortable and less embarrassing than a Pap smear or a mammography. There was no preference with respect to the gender of the physician who performed the colorectal screening procedures, unlike the Pap smear. Most respondents would have the procedure again and would recommend it to others.
