Tuberculosis: a six-month cure.

Today the treatment of tuberculosis can be based on a course of chemotherapy that lasts only 6 months, giving patients the best change of cure and affording the health personnel an exceptional opportunity to improve both their patients' compliance with the treatment and the overall efficiency of their own activities.

Prescribing efficiently in nursing homes.

Giving medications in nursing homes is time consuming and expensive. The orders for medications in a community nursing home were examined to determine if nursing time could be saved by consolidating the administration of medications. Nineteen percent of the medication administration visits could be eliminated by this method according to the independent judgments of two physicians. This could save up to $19,000 in nursing time per year, and the time could be redirected to other nursing activities that could improve the quality of care in nursing homes.

Individualizing gentamicin dosage regimens in burn patients with gram-negative septicemia: a cost--benefit analysis.

Services provided by a clinical pharmacokinetics laboratory were evaluated in terms of an accepted cost--benefit model, and a model to evaluate clinical services provided by the pharmacist is presented. A retrospective study was conducted to evaluate the impact, in terms of patient outcomes, of individualizing gentamicin dosage regimens in severely burned patients. Analysis was conducted using multivariate statistical techniques and appropriate nonparametric and parametric tests to determine significant differences. This analysis provided the necessary data to quantify the impact of the pharmacokinetic service. The findings suggest that significant differences do exist in comparing individually dosed patients against those who were not, based upon discriminant and multiple regression analyses and/or nonparametric tests. Furthermore, the results will be useful for insurance companies, third-party payers, and government agencies in deciding which innovative clinical services should be reimbursed.

Cost of individualizing aminoglycoside dosage regimens.

The estimated annual costs associated with operating a clinical pharmacokinetics service within a 450-bed, metropolitan county hospital were studied. Using three aminoglycoside serum level determinations, a computer program estimates the patient's pharmacokinetic variables and calculates a dosage regimen which will maintain serum concentrations in the desired range. Pharmacists are involved in assessing the patient's initial clinical condition and in recommending doses and dosing intervals. Fixed costs included the costs of the physical facility and office equipment ($778/yr). Operating costs included salaries, equipment leasing fees, journal subscription fees and medical supplies ($73,915/yr). The estimated cost per blood sample analyzed for aminoglycoside content was $17.35/sample (4,305 samples/yr). The study provides a basis for comparing the cost of operating a pharmacokinetics service with the cost of other innovative pharmaceutical services.

A single-bedtime-dose self-medication system.

A medication system in use at the Florida Mental Health Institute is based on the unit-dose procedure and weekly reviews of patients' medications. The program is aimed at reducing the use of polypharmacy and of concentrates and stabilizing patients on a single daily bedtime dose of medication. Once patients are stabilized on a single dose, they are trained by the nurses and through a drug group to manage their medications independently after discharge. The system has produced savings of up to 90 per cent of medication costs per patient and is gaining acceptance in other mental health facilities in the state. The authors believe it has the potential for even greater therapeutic and financial benefits by reducing the recidivism that occurs when discharged patients discontinue their drugs.

Efficacy and acceptability of injectable medroxyprogesterone. A comparison of 3-monthly and 6-monthly regimens.

Five hundred Black Rhodesian women given injections of 150 mg Depo-Provera every 3 months (group A) and 500 women given an injection of 450 mg Depo-Provera every 6 months (group B) were reviewed after 6 months. Group B had a significantly lower rate of defaulters. There was no significant difference between the groups with regard to weight gain, systolic and diastolic blood pressure increase, overall abnormal bleeding patterns and complaints of side-effects. Among those women who reported abnormal bleeding patterns, significantly more in group B had amenorrhoea. There was no significant increase of prolonged bleeding in group B. Among those women who complained of side-effects, significantly more in group B complained of headaches and a bloated abdomen. No pregnancies occurred in either group. The increased annual cost of the 450 mg injections, which was the main reason for women not accepting this regimen, is outweighed by convenience and reduced travel costs. Depo-Provera 450 mg given by 6-monthly injection is well tolerated and effective, and appears to be even more satisfactory as regards continued acceptance than 150 mg given every 3 months.