Medical care
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Comparative Study
Reliability of clinical guideline development using mail-only versus in-person expert panels.
Clinical practice guidelines quickly become outdated. One reason they might not be updated as often as needed is the expense of collecting expert judgment regarding the evidence. The RAND-UCLA Appropriateness Method is one commonly used method for collecting expert opinion. We tested whether a less expensive, mail-only process could substitute for the standard in-person process normally used. ⋯ The reproducibility of the overuse and underuse assessments from the mail-only compared with the conventional in-person conduct of expert panels in this application was similar to the underlying reproducibility of the process. This suggests a potential role for updating guidelines using an expert judgment process conducted entirely through the mail.
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Comparative Study
Assessing the effect of Taiwan's outpatient prescription drug copayment policy in the elderly.
This study uses variance cost analysis and regression analysis as tools for investigating the initial effects of Taiwan's outpatient prescription drug copayment program in the elderly. Under its new National Health Insurance program, Taiwan implemented a prescription drug cost-sharing program August 1, 1999. We compare an elderly population's prescription drug use after the policy was implemented with an elderly population's prescription drug use before the policy change to describe initial and general consequences of the drug cost-sharing program. ⋯ The significant increase in average drug price per prescription indicates that many prescriptions could move above the upper bound of the cost-sharing schedule. The results suggest that the Bureau of National Health Insurance should increase the upper bound. We do not think these effects are unique to Taiwan. Rather, these effects should be considered as countries change their outpatient drug benefit programs. We also found a decrease in utilization of essential drugs with an increase in utilization of nonessential drugs for patients subject to copayments. The results suggest potential adverse effects on patients' health outcome.
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Comparative Study
The association of race/ethnicity with the receipt of traditional and alternative arthritis-specific health care.
The role of race/ethnicity in the receipt of arthritis-specific health care has not been well defined. ⋯ In this population of community-dwelling older adults, white race was significantly associated with CAM use and visits to primary care physicians for arthritis care. In contrast, the use of specialists and prescription arthritis medications was better explained by factors other than race/ethnicity, which included female gender, urban residence, higher educational level, and other arthritis-specific variables.
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Little research has been conducted that examined the intended effects of nursing care on clinical outcomes. ⋯ The results of this study suggest that a higher proportion of RNs/RPNs on inpatient units in Ontario teaching hospitals is associated with better clinical outcomes at the time of hospital discharge.