RESUMO
Sickle cell disease is a progressively debilitating genetic condition that affects red blood cells and can result in a variety of serious medical complications, reduced life expectancy, and diminished quality of life. Medicaid nationwide covered 66 percent of sickle cell disease hospitalizations in 2004 and 58 percent of emergency department visits for the disease between 1999 and 2007. Using Medicaid data from four states with large populations that account for more than one-third of Medicaid program enrollment, we examined the characteristics of those with sickle cell disease. We found instances of mortality rates more than nine times the age-adjusted population average (in Texas, a mortality rate for Medicaid enrollees with SCD of 1.11 percent compared to 0.12 percent overall); rates of disability-related eligibility-which is associated with long-term Medicaid enrollment-of up to 69 percent; and half or more of affected enrollees having (all-cause) hospital stays, emergency department visits, and opioid prescription fills. With gene therapies on the horizon that will spur discussions of treatment coverage, costs, and outcomes for people with sickle cell disease, it is important for relevant stakeholders to understand the affected populations.
Assuntos
Analgésicos Opioides/uso terapêutico , Anemia Falciforme/epidemiologia , Serviço Hospitalar de Emergência/economia , Medicaid/economia , Adulto , Idoso , Analgésicos Opioides/economia , Anemia Falciforme/economia , Anemia Falciforme/terapia , Pessoas com Deficiência , Feminino , Hospitalização/economia , Humanos , Pacientes Internados , Masculino , Medicare/economia , Pessoa de Meia-Idade , Mortalidade , Pacientes Ambulatoriais , Prescrições/economia , Qualidade de Vida , Texas/epidemiologia , Estados Unidos/epidemiologiaRESUMO
The aim of this study was to evaluate the effectiveness of the addition of manual-based cognitive-behavioral therapy to a medication regimen of clomipramine and fluoxetine and the withdrawal of medication during cognitive-behavioral therapy. The participant was an 11-year-old girl with symptoms of obsessive thoughts about germs and illness and handwashing compulsions. The addition of cognitive-behavioral therapy reduced the participant's daily number of obsessions and avoidance behaviors after three sessions. When medication was tapered during the cognitive-behavioral therapy program, the participant's symptoms continued to decline, and after treatment, she no longer met diagnostic criteria for obsessive-compulsive disorder. Impressively, the participant remained medication free and treatment gains were maintained at 4 months' follow-up.
