RESUMO
YES. MONTHLY EXTENDED-RELEASE INJECTABLE NALTREXONE (XR-NTX) TREATS OPIOID USE DISORDER AS EFFECTIVELY AS DAILY SUBLINGUAL BUPRENORPHINE-NALOXONE (BUP-NX) WITHOUT CAUSING ANY INCREASE IN SERIOUS ADVERSE EVENTS OR FATAL OVERDOSES. (STRENGTH OF RECOMMENDATION: A, 2 GOOD-QUALITY RCTS).
Assuntos
Administração Sublingual , Combinação Buprenorfina e Naloxona/administração & dosagem , Combinação Buprenorfina e Naloxona/uso terapêutico , Preparações de Ação Retardada/administração & dosagem , Injeções Intramusculares , Antagonistas de Entorpecentes/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Combinação Buprenorfina e Naloxona/economia , Preparações de Ação Retardada/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas de Entorpecentes/uso terapêutico , Noruega , Estados UnidosRESUMO
INTRODUCTION: Opioid use disorder (OUD) affects 2 million Americans, yet many patients do not receive treatment. Lack of team-based care is a common barrier for office-based opioid treatment (OBOT). In 2015, we started OBOT in a family medicine practice. Based on our experiences, we developed a financial model for hiring a team member to provide nonbillable OBOT services through revenue from increased patient volume. METHODS: We completed a retrospective chart review from July 2015 to December 2016 to determine the average difference in medical visits per patient per month pre-OBOT versus post-OBOT. Secondary outcomes were the percentage of visits coded as a Level 3, Level 4, and Level 5, and the percentage of patients with Medicaid, private insurance, or self pay. With this information, we extrapolated to build a financial model to hire a team member to support OBOT. RESULTS: Twenty-three patients received OBOT during the study period. There was a net increase of 1.93 visits per patient per month (P < .001). Fourteen patients were insured by Medicaid, 7 had private insurance, and 2 were self pay. Twenty-three percent of OBOT visits were Level 3, 69% were Level 4, and 8% were Level 5. Assuming all visits were reimbursed by Medicaid and accounting for 20% cost of business, treating 1 existing patient for 1 year would generate $1,439. Treating 1 new patient would generate $1,677. CONCLUSIONS: In a fee-for-service model, the revenue generated from increased medical visits can offset the cost of hiring a team member to support nonbillable OBOT services.
Assuntos
Medicina de Família e Comunidade/economia , Tratamento de Substituição de Opiáceos/economia , Transtornos Relacionados ao Uso de Opioides/terapia , Buprenorfina/uso terapêutico , Medicina de Família e Comunidade/organização & administração , Planos de Pagamento por Serviço Prestado , Humanos , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Estudos RetrospectivosAssuntos
Antiulcerosos/efeitos adversos , Antiulcerosos/uso terapêutico , Hipercolesterolemia/etiologia , Hipertensão/etiologia , Magnésio/sangue , Inibidores da Bomba de Prótons/efeitos adversos , Inibidores da Bomba de Prótons/uso terapêutico , Erros Inatos do Transporte Tubular Renal/etiologia , Relação Dose-Resposta a Droga , Humanos , Fatores de TempoRESUMO
Chronic medical and common behavioral health conditions have been shown to benefit from team-based care approaches that include integrated behavioral health providers. Team-based integrated care can promote the Quadruple Aim, encompassing health care outcomes, patient satisfaction, provider work/life experience, and the cost of care.
Assuntos
Prestação Integrada de Cuidados de Saúde , Implementação de Plano de Saúde , Serviços de Saúde Mental/organização & administração , Assistência Centrada no Paciente , Atenção Primária à Saúde , Humanos , North Carolina , Estados UnidosRESUMO
One nonfatal myocardial infarction (MI) will be avoided for every 126 to 138 adults who take daily aspirin for 10 years (strength of recommendation [SOR]: A, systematic reviews and meta-analyses of multiple randomized controlled trials [RCTs]). Taking low-dose aspirin for primary prevention shows no clear mortality benefit. A benefit for primary prevention of stroke is less certain. Although no evidence establishes increased risk of hemorrhagic stroke from daily low-dose aspirin, one gastrointestinal hemorrhage will occur for every 72 to 357 adults who take aspirin for longer than 10 years (SOR: A, systematic reviews and meta-analyses of multiple RCTs and cohort studies).
Assuntos
Aspirina/efeitos adversos , Aspirina/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Hemorragia Gastrointestinal/induzido quimicamente , Inibidores da Agregação Plaquetária/efeitos adversos , Inibidores da Agregação Plaquetária/uso terapêutico , Prevenção Primária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de RiscoRESUMO
Osteoporosis imposes a significant burden of morbidity, mortality, and cost on patients and the health care system. Compliance with existing screening and treatment recommendations is low. There are multiple barriers to treatment including complexity of medical management, cost of medications, real and perceived side effects of medications, and nonadherence.
Assuntos
Absorciometria de Fóton/métodos , Programas de Rastreamento , Conduta do Tratamento Medicamentoso , Osteoporose , Fraturas por Osteoporose/prevenção & controle , Gerenciamento Clínico , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Osteoporose/complicações , Osteoporose/diagnóstico , Osteoporose/terapiaRESUMO
Three beta-blockers--carvedilol, metoprolol succinate, and bisoprolol--reduce mortality equally (by about 30% over one year) in patients with Class III or IV systolic heart failure. Insufficient evidence exists comparing equipotent doses of these medications head-to-head to recommend any one over the others.