Systematic review on quality control for drug management programs: Is quality reported in the literature?

<p>Abstract</p> <p>Background</p> <p>Maintaining quality of care while managing limited healthcare resources is an ongoing challenge in healthcare. The objective of this study was to evaluate how the impact of drug management programs is reported in the literature and to identify potentially existing quality standards.</p> <p>Methods</p> <p>This analysis relates to the published research on the impact of drug management on economic, clinical, or humanistic outcomes in managed care, indemnity insurance, VA, or Medicaid in the USA published between 1996 and 2007. Included articles were systematically analyzed for study objective, study endpoints, and drug management type. They were further categorized by drug management tool, primary objective, and study endpoints.</p> <p>Results</p> <p>None of the 76 included publications assessed the overall quality of drug management tools. The impact of 9 different drug management tools used alone or in combination was studied in pharmacy claims, medical claims, electronic medical records or survey data from either patient, plan or provider perspective using an average of 2.1 of 11 possible endpoints. A total of 68% of the studies reported the impact on plan focused endpoints, while the clinical, the patient or the provider perspective were studied to a much lower degree (45%, 42% and 12% of the studies). Health outcomes were only accounted for in 9.2% of the studies.</p> <p>Conclusion</p> <p>Comprehensive assessment of quality considering plan, patient and clinical outcomes is not yet applied. There is no defined quality standard. Benchmarks including health outcomes should be determined and used to improve the overall clinical and economic effectiveness of drug management programs.</p

The insulin-glucose tolerance test in pituitary growth retardation.

The differential diagnosis of growth retardation has become of great importance in the past few years, since human growth hormone (HGH) treat-ment has become available to patients with pituitary dwarfism. The diagnosis of low birthweight dwarf-ism (Black, 1961) is usually easy, but before puberty the differentiation ofconstitutionally retarded growth (Wilkins, 1957) from pituitary dwarfism may be very difficult. The insulin tolerance test has proved, in our experience, a useful supplement to other tests in the selection of patients for HGH treatment, despite the contrary conclusions of some other workers (Colombo, Richterich, Rossi, and Feinsmith, 1962). In this paper we give our experience with the insulin-glucose test, comparing its usefulness with that of other tests of endocrine function. Material and Methods During the past two years the insulin tolerance test has been carried out on 22 patients between 6 and 19 years of age who were diagnosed as having pituitary growth retardation. Of these, 13 are now receiving continuous treatment with HGH; 9 have been treated for more than a year with good response, their height increments ranging from 7 to 13 cm. during the first year of treatment. During the same period insulin tolerance tests have also been carried out on 12 patients in whom the diagnosis of constitutional growth retardation has been made, and on 15 control patients without hormonal or metabolic disorders, and of the same age distribution. The insulin tolerance tests were carried out after the patients had been in hospital for at least three days on a moderately high carbohydrate diet. Patients with pituitary failure are known to be hypersensitive to insulin, which often causes a considerable decrease in blood sugar, followed by a very slow return to normal levels. Even when adrenaline or glucagon are injected the blood sugar rises only slowly. The usual insulin tolerance test may, therefore, be hazardous in these patients. For a standardized test without reduction of the insulin dose when insulin hypersensitivity is suspected, we have preferred the less dangerous insulin-glucose tolerance tes