- Email: [email protected]
Developing a strategy for reducing hospital expenditures
142 counseling. As a geneticist’s view, the pathogenetic concept of diabetes presented here is mostly confuted to genetic mechanisms, leaving aside other influences on the development of diabetes such as hormones, viruses, nutrition, and drugs. Mendelian-inherited diabetic disorders are related to different pathogenetic principles where possible. These are speculative in some cases. 4) Genetic counseling clinical chromosome analysis in 522 cases LI, L., XIA, J., DAI, H., et al. Med. Genet. Lab., Hunan Med. Coll., Changsha, China Chin. Med. J. (Peking) 95(11), 793-804, 1982 Chromosome analysis in 522 cases at a genetic counseling clinic from April 1973 to December 1980 revealed 60 cases (11.5%) with numerical or structural abnormalities. The structural aberrations include 12 types involving chromosomes nos. 1, 2, 4, 5, 7, 9, 12, 13, X and Y. None of the karyotypes had been reported previously in China and nine types in 12 cases had not been reported in the world. These nine karyotypes include 46, XY, t(1; 4) (q43; q25); 46, XY, -13, +der (13), t(4; 13) (q25; q34); 46, XY, t(1; 17) (~36; q21’); 46, XX or XY, t(5; 7) (q22; ~13); 46, XY, or XX, inv(5) (p15.1; q33.1); 46, XX, 39, -9, +del (9), +del (9) (pteralphacen- > qll::q13> qter); 46, XX, inv(l2) (~1110; q1310); 46, XY/45, XY, t(13; 13) (~12; ~12) and 45, X/46, Xx/47, XX, +t(Y; Y) (Yqter> Ypl::Yql 1 - > Yqter). Typical cases with the new chromosome aberrations am described and the origin of chromosomal aberrations and their prevention are discussed. HEALTH
BELIEFS
AND PRACTICES
The outcome of efforts to influence patient behaviors depends ultimately upon the beliefs of the patients themselves. Research has linked selected health beliefs and practices of patients with nearly every health condition known. When health-care providers begin to “diagnose” their clients’ underlying health beliefs, they will begin to understand better the inner reasons affecting patient behaviors. 5) Beliefs and practices concerning measles in Gazankulu IJSSELMUIDEN, C.B. Elim Hosp., Gazankulu, Transvaal, South Africa S. Afr. Med. J. 63(10), 360-363, 1983 A survey was undertaken to isolate social factors that might be influencing the coverage of a measlesvaccination program which, after several years, showed no decrease in the measles admission rate at the area hospital. It was found not only that measles is still a
common disease, but also that it is considered essential for the normal development of a child. In the home treatment of measles, moreover, a variety of indigenous medications ate used, some of which ate potentially dangerous. Almost 80% of mothers will visit a clinic if their children have measles, but 64% combine this with traditional therapy. The majority, however, were in favor of a vaccination program. The content of any health-education program, therefore, must be carefully considered, to prevent adverse effects in the population. 6) Factors influencing initiation of breast-feeding EKWO, E.E., DUSDIEKER, L.B . , and BOOTH, B.M. Dept. Ped., Univ. Iowa Hosp., Iowa City, IA, U.S.A. Am. J. Dis. Child. 137(4), 375-377, 1983 The critical incidence method was used to study factors motivating 33 primigravidas and 39 multigravidas to initiate breast-feeding of their infants. The women studied chose breast-feeding because they believed it would protect the infant against infection, establish matemalinfant bonding, and provide better nutrition than cow ‘s-milk formula. They also viewed it as the natural way to feed infants and felt that it would be both convenient and emotionally satisfying. The decision to breast-feed was made well in advance of pregnancy by primigravidas and shortly before pregnancy by multigravidas. Friends who had successfully nursed infants were as influential as immediate family members in influencing our study subjects in their decision to breastfeed. Prenatal counseling, though important, may not be the optimal period for motivating women to breast-feed. HOSPITAL ROLES IN HEALTH EDUCATION/PATIENT EDUCATION The rising costs of health care have encouraged many hospitals to diversify into the broader fields of health promotion and health education. However, the new requirements of diagnostic related groups will increasingly force hospitals to examine their entire range of educational services and determine first and foremost how to provide the most effective patient education at the lowest cost. 7) Developing a strategy for reducing hospital expenditures BRINES, D.S. Vermont Hosp. Assoc., Blanchard Court, Montpelier, VT, U.S.A. Hosp. Health Serv. Adm. 27(5), 284, 1982 A number of courses of action are suggested to reduce increases in hospitals’ expenditures. They are: utilization of group-purchasing practices; reduction of staff;
PATlENT EDUCATION AND COUNSELING
143 energy conservation; appropriate materials management; initiation of health-education programs; continuation of utilization review; and increasing practitioner availability. Of these, increasing practitioner availability and initiation of health-education programs are relatively new and untried courses of action for hospitals.
maceutical industry and physicians, rates will rapidly decline.
PATIENT
Chemotherapy (Basel) 28(Suppl.
COMPLIANCE
Although many health-care providers dislike the term ‘‘compliance ’‘- as, indeed, do many patients-most research concerning how patients follow prescribed regimens is in fact indexed under this term. Although hundreds of studies are published each year, health-care providers are encouraged to look at whole groups of studies and not to rely on the findings of any single study. It is in the “larger picture, ” obtained from a wide range of studies with multiple variables, that we find clues to more effective ways of stimulating cooperative behavior. 8) Compliance KATZ, W.A. Div. Rheumatol . , Med. Co11. Pennsylvania, Philadelphia, PA, U.S.A. Semin. Arthritis Rheum. 12(2), Suppl. 1, 132-136, 1982
Patient education may be the key to compliance. Overall improvement in a patient’s knowledge of the characteristics of his or her disease and the nature of the treatment program is often reflected in a much higher incidence of cooperation. Particularly in the case of the elderly, a patient advocate-whether a fellow patient, a family member, or a friend-may be of great help if he or she accompanies the patient on office visits. It is also important that a patient with a chronic disease meet other patients with similar conditions who are complying with a treatment program and are experiencing improvement. With regard to the pharmaceutical industry itself, a primary objective should be to minimize the frequency with which drugs have to be administered. Once-daily dosage ensures better compliance than a more complex schedule, particularly for those patients who have to take many drugs. Indomethacin, for example, inspires a high degree of physician confidence because of its long-established use and widely recognized efficacy in the treatment of many patients with acute gouty arthritis, acute painful shoulder and moderate to severe rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis. The new sustained-release formulation will simplify the dosage regimen and no doubt further improve compliance for many patients. Compliance is becoming an increasingly important issue, and it is to be hoped that through the combined efforts of the phar-
VOLUME 5/NUMBER3
noncompliance
9) Patient compliance and the short-term treatment regimen ROBERTSON, W.H. Suite 725, St. Vincent’s Prof. Building, 2660 Tenth Ave., South Birmingham, AL, U.S.A. I), 80-86,
1982
Patient compliance is necessary for the delivery of adequate health care. As such, it is a problem that must be addressed by the medical profession. Good communication between the physician and the patient is essential. Those known to be poor compliers should be identified and special techniques used to overcome particular obstacles. Methods designed to improve patient cooperation are discussed. Emphasis is placed upon the shortterm therapeutic regimen and its role in improving compliance. 10) Once-a-day treatment of hypertension with pindolol FRITHZ, G. Dept. Med., Cent. Hosp., Univ. Uppsala, Uppsala, Sweden Am. Heart J. 104(2, II), 413-416,
1982
Administration of a once-daily dosage of pindolol seems to be a simple and effective way to treat mild to moderate hypertension and one that produces relatively few side effects. In most cases, gradual titration of the drug seems unnecessary and the optimum dose can be given initially without increasing the risk of side effects. Thus a simpler regimen can be instituted that may encourage patient compliance-a factor of great importance in view of the long duration of the therapy. 11) Patient compliance and plasma potassium level in patients VAN KALMTHOUT, P.M., VREE, T.B., and THIEN, T. Alg. Poliklin., Klin. Inwendige Ziekten, St. Radboudziekenh . , Nijmegen , The Netherlands Ned. Tijdschr. Geneeskd.
127(j),
192-195,
1983
During protracted drug treatment of hypertension, patient compliance is less than optimal. In patients for whom chlorthalidone had been prescribed, concentrations of this substance in the blood were determined while at the same time the plasma potassium level was measured. In nine patients with a chlorthalidone concentration below the detection level of 0.4 pg/ml whole blood, the plasma potassium level was found not to have decreased. In a matched group of 18 patients with chlorthalidone levels in the therapeutic range (4 to
BELIEFS
AND PRACTICES
The outcome of efforts to influence patient behaviors depends ultimately upon the beliefs of the patients themselves. Research has linked selected health beliefs and practices of patients with nearly every health condition known. When health-care providers begin to “diagnose” their clients’ underlying health beliefs, they will begin to understand better the inner reasons affecting patient behaviors. 5) Beliefs and practices concerning measles in Gazankulu IJSSELMUIDEN, C.B. Elim Hosp., Gazankulu, Transvaal, South Africa S. Afr. Med. J. 63(10), 360-363, 1983 A survey was undertaken to isolate social factors that might be influencing the coverage of a measlesvaccination program which, after several years, showed no decrease in the measles admission rate at the area hospital. It was found not only that measles is still a
common disease, but also that it is considered essential for the normal development of a child. In the home treatment of measles, moreover, a variety of indigenous medications ate used, some of which ate potentially dangerous. Almost 80% of mothers will visit a clinic if their children have measles, but 64% combine this with traditional therapy. The majority, however, were in favor of a vaccination program. The content of any health-education program, therefore, must be carefully considered, to prevent adverse effects in the population. 6) Factors influencing initiation of breast-feeding EKWO, E.E., DUSDIEKER, L.B . , and BOOTH, B.M. Dept. Ped., Univ. Iowa Hosp., Iowa City, IA, U.S.A. Am. J. Dis. Child. 137(4), 375-377, 1983 The critical incidence method was used to study factors motivating 33 primigravidas and 39 multigravidas to initiate breast-feeding of their infants. The women studied chose breast-feeding because they believed it would protect the infant against infection, establish matemalinfant bonding, and provide better nutrition than cow ‘s-milk formula. They also viewed it as the natural way to feed infants and felt that it would be both convenient and emotionally satisfying. The decision to breast-feed was made well in advance of pregnancy by primigravidas and shortly before pregnancy by multigravidas. Friends who had successfully nursed infants were as influential as immediate family members in influencing our study subjects in their decision to breastfeed. Prenatal counseling, though important, may not be the optimal period for motivating women to breast-feed. HOSPITAL ROLES IN HEALTH EDUCATION/PATIENT EDUCATION The rising costs of health care have encouraged many hospitals to diversify into the broader fields of health promotion and health education. However, the new requirements of diagnostic related groups will increasingly force hospitals to examine their entire range of educational services and determine first and foremost how to provide the most effective patient education at the lowest cost. 7) Developing a strategy for reducing hospital expenditures BRINES, D.S. Vermont Hosp. Assoc., Blanchard Court, Montpelier, VT, U.S.A. Hosp. Health Serv. Adm. 27(5), 284, 1982 A number of courses of action are suggested to reduce increases in hospitals’ expenditures. They are: utilization of group-purchasing practices; reduction of staff;
PATlENT EDUCATION AND COUNSELING
143 energy conservation; appropriate materials management; initiation of health-education programs; continuation of utilization review; and increasing practitioner availability. Of these, increasing practitioner availability and initiation of health-education programs are relatively new and untried courses of action for hospitals.
maceutical industry and physicians, rates will rapidly decline.
PATIENT
Chemotherapy (Basel) 28(Suppl.
COMPLIANCE
Although many health-care providers dislike the term ‘‘compliance ’‘- as, indeed, do many patients-most research concerning how patients follow prescribed regimens is in fact indexed under this term. Although hundreds of studies are published each year, health-care providers are encouraged to look at whole groups of studies and not to rely on the findings of any single study. It is in the “larger picture, ” obtained from a wide range of studies with multiple variables, that we find clues to more effective ways of stimulating cooperative behavior. 8) Compliance KATZ, W.A. Div. Rheumatol . , Med. Co11. Pennsylvania, Philadelphia, PA, U.S.A. Semin. Arthritis Rheum. 12(2), Suppl. 1, 132-136, 1982
Patient education may be the key to compliance. Overall improvement in a patient’s knowledge of the characteristics of his or her disease and the nature of the treatment program is often reflected in a much higher incidence of cooperation. Particularly in the case of the elderly, a patient advocate-whether a fellow patient, a family member, or a friend-may be of great help if he or she accompanies the patient on office visits. It is also important that a patient with a chronic disease meet other patients with similar conditions who are complying with a treatment program and are experiencing improvement. With regard to the pharmaceutical industry itself, a primary objective should be to minimize the frequency with which drugs have to be administered. Once-daily dosage ensures better compliance than a more complex schedule, particularly for those patients who have to take many drugs. Indomethacin, for example, inspires a high degree of physician confidence because of its long-established use and widely recognized efficacy in the treatment of many patients with acute gouty arthritis, acute painful shoulder and moderate to severe rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis. The new sustained-release formulation will simplify the dosage regimen and no doubt further improve compliance for many patients. Compliance is becoming an increasingly important issue, and it is to be hoped that through the combined efforts of the phar-
VOLUME 5/NUMBER3
noncompliance
9) Patient compliance and the short-term treatment regimen ROBERTSON, W.H. Suite 725, St. Vincent’s Prof. Building, 2660 Tenth Ave., South Birmingham, AL, U.S.A. I), 80-86,
1982
Patient compliance is necessary for the delivery of adequate health care. As such, it is a problem that must be addressed by the medical profession. Good communication between the physician and the patient is essential. Those known to be poor compliers should be identified and special techniques used to overcome particular obstacles. Methods designed to improve patient cooperation are discussed. Emphasis is placed upon the shortterm therapeutic regimen and its role in improving compliance. 10) Once-a-day treatment of hypertension with pindolol FRITHZ, G. Dept. Med., Cent. Hosp., Univ. Uppsala, Uppsala, Sweden Am. Heart J. 104(2, II), 413-416,
1982
Administration of a once-daily dosage of pindolol seems to be a simple and effective way to treat mild to moderate hypertension and one that produces relatively few side effects. In most cases, gradual titration of the drug seems unnecessary and the optimum dose can be given initially without increasing the risk of side effects. Thus a simpler regimen can be instituted that may encourage patient compliance-a factor of great importance in view of the long duration of the therapy. 11) Patient compliance and plasma potassium level in patients VAN KALMTHOUT, P.M., VREE, T.B., and THIEN, T. Alg. Poliklin., Klin. Inwendige Ziekten, St. Radboudziekenh . , Nijmegen , The Netherlands Ned. Tijdschr. Geneeskd.
127(j),
192-195,
1983
During protracted drug treatment of hypertension, patient compliance is less than optimal. In patients for whom chlorthalidone had been prescribed, concentrations of this substance in the blood were determined while at the same time the plasma potassium level was measured. In nine patients with a chlorthalidone concentration below the detection level of 0.4 pg/ml whole blood, the plasma potassium level was found not to have decreased. In a matched group of 18 patients with chlorthalidone levels in the therapeutic range (4 to