Physician Resources

In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience. 

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Medical surveillance programs range from support contracts with local hospitals or physicians to full-scale on-site occupational health organizations that include physicians, nurses, and technicians who are employed by prime contractors. The option selected depends on the size of the project, the nature of the hazards involved, the capabilities of local facilities, and the resources available. 

Yazdanpanah et al. (2002) calculated the resource use and cost for different stages of HIV infection in France based on a clinical database of HIV-infected patients between 1994 and 1998. The total costs attributable to bed-day and day-care inpatient care included the mean cost of each inpatient day times the length of stay, as well as total number of laboratory tests, dosage and quantity of medications, and total number of procedures. The total cost attributable to outpatient care included the mean physician and nurse fees per visit, as well as total number of laboratory tests and total number of procedures. In the absence of an AIDS-deflning event, the average total cost of care ranged from US 797 per person-month in the highest CD4 stratum to US 1,261 per person-month in the lowest CD4 stratum. 

Expert opinion is a source, frequently elicited by survey, that is used to obtain information where no or few data are available. For example, in our experience with a multicountry evaluation of health care resource utilization in atrial fibrillation, very few country-specific published data were available on this subject. Thus the decision-analytic model was supplemented with data from a physician expert panel survey to determine initial management approach (rate control vs. cardioversion) first-, second-, and third-line agents doses and durations of therapy type and frequency of studies that would be performed to initiate and monitor therapy type and frequency of adverse events, by body system and the resources used to manage them place of treatment and adverse consequences of lack of atrial fibrillation control and cost of these consequences, for example, stroke, congestive heart failure. This method may also be used in testing the robustness of the analysis [30]. 

The consistent finding across different systems for delivering health care is that the costs for patients beginning treatment with an SSRI are equal to or lower than costs for patients who begin therapy with a TCA (Rosenbaum and Hylan, 1999). The higher acquisition costs of SSRIs tend to be offset by reduced consumption of other resources, including lower expenditures for hospitalizations and physician consultations. 

Several resources are helpful in determining whether or not a compound is under investigation in a current study or if there are funding opportunities available for a compound. From a patient s point of view, these same resources are also useful to identify clinical studies that may be of interest to them and their physicians. 

Physicians are frequently found to rank colleagues as their most used resource [108], Within... 

SP Curley, DP Connelly, EC Rich. Physicians use of medical knowledge resources preliminary theoretical framework and findings. Med Decision Making 10 231-241, 1990. 

Hierarchical factors occur under the commonest assumption, namely that of physicians in contracted employment the insurer sets a series of targets (not all of them explicit) for the health care organization. It should not be taken for granted that these targets pursue efficiency. In turn, the health care organizations - the providers - attempt to transfer the targets (and incentives) received from the insurer or insurers to the clinics, who in the case of prescription allocate the totality of the resources. 

Direct costs include both medical and nonmedical expenditures for the detection, treatment, and prevention of disease. Direct medical costs reflect resources consumed in the "production" of health care, such as pharmaceutical products and services, physician visits, and hospital care. Direct nonmedical costs reflect expenditures for products and services that are not directly related to disease treatment but are still related to patient care. Examples of direct nonmedical costs include transportation to a pharmacy or physician s office and housekeeping during the illness period. Indirect costs account for changes in productivity of an individual because of illness. The monetary value of lost or altered productivity is typically used as a measure of indirect costs. Intangible costs and consequences are nonmonetary in nature and reflect the impact of disease and its treatment on the individual s social and emotional functioning and quality of life. Table 12.2 provides examples of these types of costs and consequences. 

Formal and informal MCS support networks exist across the country. The following resources are intended to be starting points that will lead you to additional resources and help you to locate MCS-aware physicians, support groups or individuals with MCS in your area who can offer local information and referrals. These are just a few of the many organizations and groups serving people with MCS. Most of them are run by volunteers who have the illness. It is recommended that you contact at least several groups for information. Each offers a different perspective. Comparisons can be helpful. 

An MCS treatment center that will provide physician referrals in U.S., Canada and other countries. A health educator on staff will answer questions by telephone or via the center s Web site. They have published a book, Less Toxic Alternatives, as a resource guide for all sorts of MCS-aware organizations and products avail-... 

Leapfrog Group (2004) New guide for hospitals on computerised physician order entery (CPOE) gives hospitals much needed resource http //www.leapfroggroup.org/news/leapfrog news/ 97902.Cited 30 Dec 2008... 

In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.9 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations,... 

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