ABSTRACT
Payers, regulators and physicians are battling over who best defines and controls medical quality. Esse Health, St. Louis, believes physicians should be in charge of quality. To make it possible, Esse has implemented an electronic medical record (EMR) system. This article outlines the reasons it choose an EMR, its process for putting the system in place and its drawbacks and benefits.
Subject(s)
Ambulatory Care Information Systems , Decision Support Systems, Clinical , Group Practice/standards , Medical Records Systems, Computerized/organization & administration , Quality Assurance, Health Care/methods , Computer Security , Contract Services , Decision Making, Organizational , Family Practice/organization & administration , Group Practice/organization & administration , Information Services , Job Description , Missouri , Planning Techniques , SoftwareABSTRACT
BACKGROUND: A 2-year self-help manual smoking cessation intervention was conducted among a panel of middle-aged Finnish men (n = 265) who were recruited proactively in a longitudinal cardiovascular risk factor surveillance study. METHODS: Intervention utilized the stages of change concept of the transtheoretical model. The stages were assessed in the treatment condition at baseline of the cessation study and after that by mail every sixth month. Assessments were followed by an immediate mailing of a stage-based self-help manual matching the stage of change at that time. A usual care group was assessed annually but received no treatment. RESULTS: A significant time x intervention effect (P < 0.05) and time x baseline stage effect (P < 0.001) on quit rates were observed in the panel data over the 2-year period. An analysis of changes in the stages of change also revealed an accelerated cessation process in the treatment condition. CONCLUSIONS: We conclude that mailed stage-matched self-help smoking cessation manuals were able to accelerate the smoking cessation process but manuals alone may not constitute a sufficient long-term intervention. The effects of differential exposure to intervention, subject characteristics, measurement reactivity, and secular trends are discussed as potential confounds.
Subject(s)
Manuals as Topic , Self Care , Smoking Cessation , Adult , Analysis of Variance , Chi-Square Distribution , Confounding Factors, Epidemiologic , Finland , Humans , Longitudinal Studies , Male , Middle Aged , Risk FactorsABSTRACT
The prevalence rates and correlates of antihypertensive drug use among individuals with hypertension were determined using data derived from five biennial population-based surveys conducted between 1981 and 1990 in two New England communities. Point prevalence estimates were determined for nine categories of antihypertensive agents at five time points, and were analyzed by age and sex using multiple logistic regression. In the first cross-sectional survey, the prevalence of use per 1000 individuals with hypertension was 235.4 for diuretics, 57.1 for beta-blockers, 65.5 for combination products, 29.2 for central alpha-agonists, 2.8 for peripheral alpha-antagonists, and 8.4 each for adrenergic blockers and direct vasodilators. The prevalence rates for calcium channel blockers and angiotensin-converting enzyme inhibitors increased sharply between the third and fourth survey cycles. Significant age- and sex-related differences in antihypertensive use were detected.
