RESUMO
As provider and managed care organizations continue to look for better ways to control costs and improve patient outcomes, disease management programs are getting an increasing share of their attention. One often-over-looked area with significant potential to improve outcomes, reduce costs, and enhance revenues is pain management. It has been estimated that at least 40 percent of senior citizens suffer from chronic pain, and as the population ages, the number of chronic pain sufferers will only increase. Pain management companies have been forming to meet the current and future demand for comprehensive pain management programs. One such company is ProCare Systems, a single-specialty physician practice management company based in Grand Rapids, Michigan. HFM spoke with Fred N. Davis, MD, president and cofounder of ProCare Systems, and Cyndy Walsh, ProCare System's CEO, about pain management programs and the patient care and financial impact they can effect.
Assuntos
Gerenciamento Clínico , Dor/tratamento farmacológico , Gerenciamento da Prática Profissional/economia , Assistência Ambulatorial/classificação , Capitação , Controle de Acesso , Cuidados Paliativos na Terminalidade da Vida , Humanos , Michigan , Dor/classificação , Cuidados Paliativos , Administração de Linha de Produção , Estados UnidosRESUMO
Many patients with chronic musculoskeletal pain suffer associated functional limitations in work capacity and personal productivity. However, pain differs among patients and is quite difficult to measure. Although some validity lies in an individual's reports of pain, no generally accepted measurements are applicable between individuals. On a scale of 0 to 10, changes in pain that a patient reports are valid only with respect to that person. However, what constitutes one person's rating of 10 may represent only 5 or 6 to another person, so pain rating scales have only a limited role in assessing impairment.
Assuntos
Doenças Musculoesqueléticas/reabilitação , Dor/reabilitação , Reabilitação Vocacional/métodos , Avaliação da Capacidade de Trabalho , Administração de Caso , Doença Crônica , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/psicologia , Dor/diagnóstico , Dor/psicologia , Medição da Dor/métodos , Medição da Dor/normas , Planejamento de Assistência ao Paciente/organização & administração , Modalidades de Fisioterapia , Reprodutibilidade dos TestesRESUMO
Twenty-four individuals with sympathetically maintained pain were treated by posterior paravertebral T2 sympathectomy following transient response to sympathetic nerve blockade. Eight surgical patients (33.4%) had causalgia, and 16 patients (66.4%) suffered with reflex sympathetic dystrophy. Overall, physical evidence of improvement was noted in 87% of surgical patients, with subjective improvement in 71%. Reflex sympathetic dystrophy patients fared better than those with causalgia. Complications were minor. The techniques employed appear safe and effective; a multidisciplinary approach with neurosurgery, physiatry, anesthesiology, psychology, and allied health services is recommended.
Assuntos
Ganglionectomia , Dor/fisiopatologia , Cuidados Paliativos , Sistema Nervoso Simpático/fisiopatologia , Vértebras Torácicas/inervação , Adulto , Causalgia/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/cirurgia , Distrofia Simpática Reflexa/cirurgiaRESUMO
A Yersinia pseudotuberculosis enteritis in four yearling calves is described. This is the first report of this organism causing enteric disease in domestic cattle in North America.
