The American journal of managed care
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Neurogenic bladder is a disorder of the lower urinary tract created by damage to or diseases of the nervous system. Found in many patients with neurologic disorders, including multiple sclerosis, Parkinson's disease, spinal cord injury, and spina bifida among others, neurogenic bladder can lead to problematic symptoms and complications including urinary incontinence, frequency, and urgency, along with risk for infection and involvement of the upper urinary tract and kidney disease. ⋯ Healthcare utilization may be excessive in patients with neurogenic bladder, including office and emergency department visits and subsequent hospitalizations. Because of its significant effects on quality of life, it is important to reassess the epidemiology and physiology of neurogenic bladder, its diagnosis and assessment, and the impact of the symptoms and complications associated with it to better manage patients with this disorder and improve outcomes.
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The efficacy of first-line therapeutic agents for postherpetic neuralgia (PHN) has been established in randomized, controlled clinical trials. However, pain in PHN is often refractory to treatment. Many of the patients with PHN are elderly, with additional issues of polypharmacy and comorbidity. ⋯ Few patients with PHN and physicians are satisfied with the currently available treatments. Thus, the effective management of postherpetic neuralgia remains an ongoing challenge. New and improved treatment options are therefore needed for the effective management of PHN.
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Despite the benefits of vaccination and guidelines for their use, the rates for influenza and pneumococcal vaccination remain below the 90% goal set by Healthy People 2010 for persons 65 years and older. Standing order programs (SOPs) authorize vaccination administration without physician orders. Here we examine the cost-effectiveness of SOPs to improve both pneumococcal and influenza vaccination rates in outpatient settings for individuals 65 years and older. ⋯ SOPs used to improve PPSV and influenza vaccination rates in outpatient settings is a promising and economically favorable investment, with cost-effectiveness analysis results remaining robust to parameter variation over clinically plausible ranges.
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To identify quality measures that health plans can reliably report during the early years of health insurance exchanges and over time, and to suggest strategies to increase the availability of quality results to use in rating and monitoring plans. ⋯ In 2015 and 2016, all exchanges should require plans to report the 14 measures and if needed, use suggested strategies to build the results for public reporting.
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The control rate for hypertension is unacceptably low worldwide, and poor adherence to medication is a primary reason. ⋯ Low-income rural residents in China receiving free drugs had enhanced medication adherence and reduced total medical costs. Providing hypertension drugs at no charge may be a promising strategy for preventing costly cardiovascular events associated with hypertension in China and other parts of the world with growing rates of cardiovascular disease.