Monitoring health outcomes

In the recently released book on worldwide compliance issues (Adherence to Long-term Therapies, Evidence for Action),7 published by the World Health Organization, researchers indicate that the problem of noncompliance is worse in countries in the developing world than in countries in the industrialized world. Many parts of the United States have similar morbidity and mortality rates as countries in the Third World.8 Specific disease states may have significant additional noncompliance ramifications due to the development of drug-resistant strains of bacteria.9 Many times what is necessary is referral to specific clinicians for individualized treatment and monitoring to enhance compliance. The case histories provided in this text will allow you to follow what others have done in similar situations to optimally help patients succeed in improving compliance rates and subsequent positive health outcomes. 

To monitor fetal outcomes of pregnant women exposed to bupropion, the manufacturer maintains a bupropion pregnancy registry. Health care providers are encouraged to register patients by calling (800) 336-2176. 

Useful as initial approaches for evaluating human health risks for a particular exposure Useful for population-based monitoring, such as the detection of spatial or temporal trends and patterns Residual confounding may threaten internal validity Not applicable for many health outcomes without available registry data... 

Monitor long-term physical health outcomes of survivors. 

Monitor Health Status to Identify and Solve Community Health Problems. This service includes accurate diagnosis of the community s health status identification of threats to health and assessment of health service needs timely collection, analysis, and publication of information pertaining to access, utilization, costs, and outcomes of personal health services attention to the vital statistics and health status of specific groups that are at higher risk than the total population and the management of integrated information systems in successful collaboration with private providers and health benefit plans. 

Nonadherence to medication regimens remains a major problem in health care. The National Council on Patient Information and Education (NCPIE) has termed noncompliance America s other drug problem.Pharmacists are in an ideal position to assess and treat adherence-related problems that can adversely affect patients health outcomes. Strategies to monitor and improve adherence are key components of pharmaceutical care plans, especially for patients with chronic diseases, such as hypertension, diabetes, and atherosclerotic heart disease. Nonadherence is a behavioral disorder that can be assessed and managed through a carefully devised pharmaceutical care plan. 

Nuclear pharmacy seeks to improve and promote public health through the safe and effective use of radioactive drugs for diagnosis and therapy. A nuclear pharmacist, as a member of the nuclear medicine team, specializes in procurement, compounding, quality assurance, dispensing, distribution, and development of radiopharmaceuti-cals. In addition, the nuclear pharmacist monitors patient outcomes and provides information and consultation regarding health and safety issues. 

The MOS was a 2-year observational study designed to help understand how specific components of the health care system affected the outcomes of care. One of the two original purposes of the MOS was to develop more practical tools for monitoring patient outcomes, and their determinants, in routine practice using state-of-the-art psychometric techniques. The study and its many implications and conclusions are discussed in detail elsewhere and mentioned here for completeness. 

Irrespective of the type of analysis, monitoring and evaluation of equity must compare differences in outcomes by socioeconomic status. Without a consistent summary measure, confusion can arise, because differences or changes over time can be caused by either variation in the socioeconomic status of the populations being compared or by variation in the distribution of health outcomes among them. This issue can be addressed by using appropriate summary measures, such as concentration coefficients or the index of relative inequality (Wagstaff, Pad, and Van Doorslaer 1991). 

Data on health outcomes is required to develop, monitor and evaluate pharmaceutical policy. The types of health outcomes data commonly collected includes mortality and morbidity data, as well as data on health related quality of life (HRQL). Morbidity data can include both measures of actual and perceived disability. 

This chapter has focused on the types of data needed to develop and monitor drug policies. Whether using data on drug expenditure, utilisation, price, health outcomes or on the pharmaceutical industry... 

Table 1 reviews examples of three types of studies (1) multi-city studies, such as the Six Cities and ACS studies (2) multi-county studies and (3) studies of a particular location, in this case the Atlanta area (chosen because of the wealth of studies in this area). Health outcomes examined are restricted to all-cause and cardiopulmonary mortality, and cardiovascular disease hospital or emergency department admissions, in order to retain focus. Although additional studies could be included, these studies were chosen because, in concert, they are among the best to illustrate with the least amount of complexity how epidemiology studies with some similarities can reach different conclusions about which pollutants are harmful. In particular, the multi-county and Atlanta studies were chosen because they monitored for many types of PM2 5. Table 1 generally does not include factor analyses (such as those of Mar et al. [2(X)0, 2006]), because (as discussed in Sect. 1.4) such analyses typically come to inconsistent conclusions, because of varying inputs and methodological factors. 

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