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Alternative Interventions (alternative + intervention)

Distribution by Scientific Domains
Medical Sciences66%

Selected Abstracts

Impact of Alternative Interventions on Changes in Generic Dispensing Rates

HEALTH SERVICES RESEARCH, Issue 5 2006
A. James O'Malley
Objectives. To evaluate the effectiveness of four alternative interventions (member mailings, advertising campaigns, free generic drug samples to physicians, and physician financial incentives) used by a major health insurer to encourage its members to switch to generic drugs. Methods. Using claim-level data from Blue Cross Blue Shield of Michigan, we evaluated the success of four interventions implemented during 2000,2003 designed to increase the use of generic drugs among its members. Around 13 million claims involving seven important classes of drugs were used to assess the effectiveness of the interventions. For each intervention a control group was developed that most closely resembled the corresponding intervention group. Logistic regression models with interaction effects between the treatment group (intervention versus control) and the status of the intervention (active versus not active) were used to evaluate if the interventions had an effect on the generic dispensing rate (GDR). Because the mail order pharmacy was considered more aggressive at converting prescriptions to generics, separate generic purchasing models were fitted to retail and mail order claims. In secondary analyses separate models were also fitted to claims involving a new condition and claims refilled for preexisting conditions. Results. The interventions did not appear to increase the market penetration of generic drugs for either retail or mail order claims, or for claims involving new or preexisting conditions. In addition, we found that the ratio of copayments for brand name to generic drugs had a large positive effect on the GDR. Conclusions. The interventions did not appear to directly influence the GDR. Financial incentives expressed to consumers through benefit designs have a large influence on their switching to generic drugs and on the less-costly mail-order mode of purchase. [source]

Effects of therapist gender and type of attention on assessment and treatment of attention-maintained destructive behavior

BEHAVIORAL INTERVENTIONS, Issue 1 2001
Linda A. LeBlanc
Adult attention frequently serves as a maintaining variable for problem behavior (Iwata et al., 1994). In addition, different aspects of attention such as the content of a statement or the person delivering the attention may moderate the rate of problem behavior and potentially affect treatment outcome (Fisher, Ninness, Piazza, & Owen-DeSchryver, 1996). In the current study, we examined the effects of two variables hypothesized to affect the rate of attention-maintained aggression in an adolescent female with profound mental retardation: gender of therapist and type of attention (physical versus verbal). The initial study examined the results of functional analyses conducted with therapists of different genders. An analysis was then conducted to determine the main and interaction effects of therapist gender and type of attention on the effectiveness of noncontingent reinforcement. The results indicate that each variable affected the rate of problem behavior (i.e., main effects) and that the two variables combined to produce an even greater effect (i.e., interaction effect) for males than for females. Next, we examined the impact of therapist gender on the effectiveness of an alternative intervention (functional communication training with extinction). The results support the initial hypotheses that therapist gender impacted both assessment and intervention results for this adolescent female. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Whither trial-based economic evaluation for health care decision making?

HEALTH ECONOMICS, Issue 7 2006
Mark J. Sculpher
Abstract The randomised controlled trial (RCT) has developed a central role in applied cost-effectiveness studies in health care as the vehicle for analysis. This paper considers the role of trial-based economic evaluation in this era of explicit decision making. It is argued that any framework for economic analysis can only be judged insofar as it can inform two key decisions and be consistent with the objectives of a health care system subject to its resource constraints. The two decisions are, firstly, whether to adopt a health technology given existing evidence and, secondly, an assessment of whether more evidence is required to support this decision in the future. It is argued that a framework of economic analysis is needed which can estimate costs and effects, based on all the available evidence, relating to the full range of possible alternative interventions and clinical strategies, over an appropriate time horizon and for specific patient groups. It must also enable the accumulated evidence to be synthesised in an explicit and transparent way in order to fully represent the decision uncertainty. These requirements suggest that, in most circumstances, the use of a single RCT as a vehicle for economic analysis will be an inadequate and partial basis for decision making. It is argued that RCT evidence, with or without economic content, should be viewed as simply one of the sources of evidence, which must be placed in a broader framework of evidence synthesis and decision analysis. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Impact of Alternative Interventions on Changes in Generic Dispensing Rates

HEALTH SERVICES RESEARCH, Issue 5 2006
A. James O'Malley
Objectives. To evaluate the effectiveness of four alternative interventions (member mailings, advertising campaigns, free generic drug samples to physicians, and physician financial incentives) used by a major health insurer to encourage its members to switch to generic drugs. Methods. Using claim-level data from Blue Cross Blue Shield of Michigan, we evaluated the success of four interventions implemented during 2000,2003 designed to increase the use of generic drugs among its members. Around 13 million claims involving seven important classes of drugs were used to assess the effectiveness of the interventions. For each intervention a control group was developed that most closely resembled the corresponding intervention group. Logistic regression models with interaction effects between the treatment group (intervention versus control) and the status of the intervention (active versus not active) were used to evaluate if the interventions had an effect on the generic dispensing rate (GDR). Because the mail order pharmacy was considered more aggressive at converting prescriptions to generics, separate generic purchasing models were fitted to retail and mail order claims. In secondary analyses separate models were also fitted to claims involving a new condition and claims refilled for preexisting conditions. Results. The interventions did not appear to increase the market penetration of generic drugs for either retail or mail order claims, or for claims involving new or preexisting conditions. In addition, we found that the ratio of copayments for brand name to generic drugs had a large positive effect on the GDR. Conclusions. The interventions did not appear to directly influence the GDR. Financial incentives expressed to consumers through benefit designs have a large influence on their switching to generic drugs and on the less-costly mail-order mode of purchase. [source]

The practice characterization model: the importance of organizational life cycles and targeted interventions in general medical practice

INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2001
E. M. Atkins
Abstract In response to a climate of constant change and increasing demand for services, general practice in the UK has undergone significant modification over the last 10 years. It has become a multi-disciplinary organisation encouraged by funding bodies to plan for service delivery using a more structured team based approach. In Tayside in 1996, practices were charged with producing formal Practice Development Plans (PDPs) which would focus on priority areas aligned with the Health Boards own strategic plan,those were teamwork, information management and technology, and clinical service delivery. The University of Dundee's Department of General Practice successfully applied for funding to develop ways of facilitating practices so that they could a) identify their own development priorities, and b) plan and implement action and learning to see these priorities through. Using action research methodology, the project attempted to create a climate for change, provide support and training to see the changes implemented, and ensure commitment to the changes from all members of the practice team. The Facilitator adopted a flexible style varying her role between expert, guide and support. Analysis of progress made by different practices, coupled with the Facilitator's in depth knowledge of them, suggested the importance of certain key aspects of practice organisation and culture. A practice characterisation model identified practices which were stable, currently coping, proactive and ready to face the challenge of change as best placed to engage in a full scale development programme. Other profiles suggested a range of alternative interventions as more likely to be acceptable and productive. [source]

Considerations of scale in biodiversity conservation

ANIMAL CONSERVATION, Issue 3 2010
J. T. Du Toit
Abstract The dilemma of conservation practice lies in weighing the urgency for action against the need for sustainable long-term solutions, with urgent responses incurring the risk of failure and long-term solutions incurring the cost of time. Wisdom of hindsight reveals that sustainable solutions are not achieved when conservation action is initiated at an inappropriate scale. Here, I review recent studies that have included considerations of scale to illustrate how conservation problems and solutions might be unapparent, or even counterintuitive, to conservation practitioners responding to issues at the scales at which they were first perceived. Case studies cover the conservation of ecosystems, ecosystem services, species and populations. These studies collectively illustrate how most biodiversity conservation efforts can be improved by considering the problem at a broader spatiotemporal scale than that at which local natural resource management has traditionally operated. Globalization is increasingly challenging conservation practitioners to search for solutions across an ever-wider range of spatiotemporal scales and institutional levels. Identifying real problems and threats at relevant scales is part of conservation triage, when opportunity costs and cost efficiencies of alternative interventions are evaluated and ranked, before action is implemented through the appropriate institutional levels. [source]