Improving an outpatient clinic utilization using decision analysis-based patient scheduling

This study presents a predictive model to be used in scheduling patients in an urban outpatient clinic. The model is based upon actual patient characteristics from a physical therapy clinic within an urban health and wellness center situated in a public university. A number of reported patients' characteristics such as age, education level, distance from the clinic, historical attendance records, etc. were examined to determine if they significantly impacted the patients' missing scheduled appointments (no-shows.) Decision tree analysis was used to develop a model that assessed the likelihood of a patient's no-show, using key patient characteristics and attendance records. Such a model can be used to assist with scheduling patients in an outpatient clinic, while attempting to increase the clinic's overall utilization. Four tree growing criteria were examined to develop the model with the strongest predictive power. Predictive power of each method was assessed by using the entire dataset as well as using split sampling. The results were then compared with those of a Bayesian networks model and a neural networks model. In addition, the trade-off between the selected decision tree model's predictive power versus simplicity of the associated classification rules was examined. We also assessed the impact of various levels of overbooking on the clinic's utilization when using patients' schedules based on the predictive model.     

“反讽”与“药”——对庄子与柏拉图语言观中悖论的比较

在庄子与柏拉图的哲学中，语言受到排斥，他们认为道（意）与言之间、理念与语言之间存在等级关系。然而，他们都没有全盘否定语言，而是充分认识到了语言的价值。虽然他们对待语言的态度都存有悖论，但二者的悖论是有很大差别的，在庄子的语言观点中更多地显露出非理性、直觉性和生态自然性等后现代特征。     

门诊西药房药品调剂差错的防范措施

目的保证合理安全用药,提高门诊药学服务质量。方法结合笔者经验,从环境、管理制度、药师自身因素等着手,提出几项具体药品调剂差错防范措施。结果减少了药品调剂差错的发生,提高药学服务质量。结论防止和减少差错发生是一项长期进行的工作,药学人员应坚持不懈地努力,最大限度地减少差错发生。     

Metafrontier efficiency analysis for hospital pharmacy services using dynamic network DEA framework

Medication management is a complex but critical process within the healthcare delivery system. The pharmacy department in healthcare facilities is responsible for acquisition, distribution and dispensing of medication to patients that involves a series of network process. This process can be categorized into two main subprocesses: i) pharmacy store and ii) patient services (i.e., ambulatory and inpatient pharmacy). The objective of this study was to investigate the relative efficiency level of the two subprocesses of pharmacy services in Malaysia's public hospitals. We used a nonconvex metafrontier technology to estimate technical efficiency of hospital pharmacies between specialist and nonspecialist hospital categories under the dynamic network data envelopment analysis (DNDEA) framework. For overall efficiency, both specialist and nonspecialist categories had similar mean efficiency scores. However, when measuring the efficiency level according to pharmacy store and patient services separately, the nonspecialist category had a higher mean efficiency score in pharmacy store, whereas for patient service efficiency, both categories had similar results. The patient service efficiency level was lower consistently over time, suggesting that the overall inefficiency of hospital pharmacy is greatly influenced by the inefficiency of the patient service. This suggests that systematic improvements in patient service efficiency should be a higher priority than pharmacy store efficiency to further increase the overall efficiency level. We believe that our findings will provide valuable information to policymakers towards achieving an efficient public healthcare service.     

关于医药分开问题的新制度经济学思考

本文从制度经济学视角分析“医药分开”的问题,提出了该制度实施的制度环境约束问题。解决的思路是用市场化的办法来过渡,同时将医疗机构补偿制度、医疗保险付费方法、执业药师制度等配套改革措施多管齐下,并逐步影响改变人们的非正式规范,在制度环境上为医药分开的制度变迁创造条件。     

丙泊酚复合芬太尼与咪唑安定静脉麻醉在妇产科门诊手术中的应用

目的探讨丙泊酚复合芬太尼、咪唑安定用于妇产科门诊手术中的麻醉效果及安全性。方法以86例妇科门诊手术患者为研究对象,给予丙泊酚、芬太尼联合咪唑安定,并以同期使用丙泊酚联合芬太尼的86例为对照,观察两组麻醉效果。结果观察组药物在睫毛反射消失节点时对呼吸和循环的影响明显小于对照组（P＜0.05）;起效平均时间（2.2±0.8）min,明显短于对照组（P＜0.05）;丙泊酚用量（82.3±25.5）mg,明显少于对照组（P＜0.01）;术中躁动和不良反应情况少于对照组（P＜0.05或0.01）。结论丙泊酚、芬太尼联合咪唑安定应用于妇科门诊手术起效快、对呼吸和循环的影响小、丙泊酚用量低,麻醉效果优于丙泊酚联合芬太尼,值得临床进一步研究推广。     

Enhancing financial performance by pharmacy innovation

Antecedents and consequences of customer orientation have been the subject of significant empirical investigation. Although several studies have explored employee variables as antecedents to customer orientation, work ethic has received little research attention. Additionally, there have been incongruent findings related to the effect of customer orientation on performance, as some have found it to be direct or indirect via innovation. This study explores overall work ethic as an antecedent to customer orientation and innovativeness as the missing link between customer orientation and performance among Canadian retail pharmacies. The results show support for the influence of work ethic on customer orientation, and the role of innovation as a mediating variable. This study advances the understanding of work ethic, customer orientation, innovation, and performance in Canadian retail pharmacy.     

An assessment of the interruption level of doctors in outpatient appointment scheduling

Interruptions to the server in an outpatient clinic environment have received limited attention in the appointment scheduling literature. However, explicitly modeling interruptions on the part of the doctor may have an impact on the optimal appointment schedule and consequently, on patient waiting times. This is explored with a simulation optimization model that is based on data from time studies and interviews with medical professionals from multiple outpatient clinics. The results show a “plateau-dome” scheduling rule for practical implementation to be robust for low interruption rates and a traditional dome pattern for higher levels of interruptions. In addition, if clinic operations are such that doctors are able to adjust their behavior to complete all work during the session, then the schedule is invariant to changes in the interruption rate.     

Mail-order pharmacy use and medication adherence among Medicare Part D beneficiaries with diabetes

Abstract

Objective:

To examine medication adherence among Medicare Part D beneficiaries initiating oral anti-diabetic medications and explore whether there is any association of using mail-order pharmacy (vs. retail pharmacy) with better adherence in this patient population.

Research design and methods:

Using administrative pharmacy claims data, we conducted a retrospective cohort study on Medicare Part D beneficiaries who newly initiated oral anti-diabetic treatment between July 1, 2008 and December 31, 2008. Mail-order pharmacy users were matched to retail pharmacy users via propensity scoring, controlling for patient demographic and clinical characteristics. Adherence with oral anti-diabetic medications during the benefit year of 2009 was assessed using the proportion of days covered (PDC). Comparison of medication adherence between the mail-order pharmacy group and retail pharmacy group was conducted in the propensity matched sample using the paired t-tests and McNemar’s tests.

Results:

A total of 22,546 patients who initiated oral anti-diabetic medications were identified. The average PDC was 0.60 and only 41.6% of the study population attained good adherence (defined as PDC?≥?0.8) with oral anti-diabetic medications during calendar year 2009. The matched sample included 1361 patients in each of the mail-order and retail pharmacy cohorts. Compared with the retail pharmacy group, mail-order pharmacy users demonstrated a significantly higher PDC (0.68 vs. 0.61; P?<?0.001) throughout the benefit year. More patients in the mail-order pharmacy group (49.7%) attained good adherence with their oral anti-diabetic medications compared to 42.8% in the retail pharmacy group (P?<?0.001).

Limitations:

The study was subject to limitations inherent in retrospective claims database analysis.

Conclusions:

Adherence with oral anti-diabetic medications among Medicare Part D beneficiaries is suboptimal. Patients using mail-order pharmacy had better adherence to oral anti-diabetic medications than those who used retail pharmacies. However, the causal relationship between mail-order pharmacy use and adherence should be further examined in a randomized study setting.