Socioeconomics of ophthalmic surgical care in the new millennium.
Medically Uninsured; Health; Insurance; Reimbursement; Medicare; Eye Surgery – Economics
Health care in the future will continue to be complex and involve private companies and the government. Decisions regarding medical necessity will need to be made regarding the type and intensity of care for different individuals. Insurance programs will limit care by denial of nonessential procedures, but they will make care available to the workforce and the uninsured. Demographics of patients, providers, and facilities will limit care for some individuals. Technology will continue to evolve rapidly, causing some current procedures to become unnecessary, and will allow for more efficient and cost-efficient care and cures that are unknown today. Copyright © 2000 by W.B. Saunders Company
Weinstock F J; Meltzer G
Ophthalmology Clinics of North America
2000
2000-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0896-1549(05)70164-4" target="_blank" rel="noreferrer noopener">10.1016/s0896-1549(05)70164-4</a>
Should Acute Appendicitis Be Managed Without Appendectomy?
Medically Uninsured; Appendectomy; Office Visits; Treatment Outcomes; Abdominal Abscess; Cecal Neoplasms; Clostridium Infections; Intestinal Obstruction; Readmission; Appendicitis – Therapy
Watkins Richard R
Internal Medicine Alert
2019
2019-01-30
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Over diagnosis of chronic obstructive pulmonary disease in an underserved patient population.
Adult; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Predictive Value of Tests; Prevalence; *Diagnostic Errors; *Medically Underserved Area; Ohio/epidemiology; *Vulnerable Populations; *Spirometry; Bronchodilator Agents/administration & dosage; Cholinergic Antagonists/administration & dosage; chronic obstructive pulmonary disease; COPD; Forced Expiratory Volume; Lung/drug effects/*physiopathology; Medically Uninsured; misdiagnosis; over diagnosis; Smoking/adverse effects/epidemiology; spirometry; underserved; uninsured; Vital Capacity; Administration; Pulmonary Disease; Inhalation; Chronic Obstructive/*diagnosis/drug therapy/epidemiology/physiopathology
INTRODUCTION: While cross-national studies have documented rates of chronic obstructive pulmonary disease (COPD) misdiagnosis among patients in primary care, US studies are scarce. Studies investigating diagnosis among uninsured patients are lacking. OBJECTIVE: The purpose of this study is to identify patients who are over diagnosed and thus, mistreated, for COPD in a federally qualified health center. METHODS: A descriptive study was conducted for a retrospective cohort from February 2011 to June 2012. Spirometry was performed by trained personnel following American Thoracic Society recommendations. Patients were referred for spirometry to confirm previous COPD diagnosis or to assess uncontrolled COPD symptoms. Airway obstruction was defined as a forced expiratory volume in the first second of expiration (FEV1) to forced vital capacity ratio less than 0.7. Reversibility was defined as a postbronchodilator increase in FEV1 greater than 200 mL and greater than 12%. RESULTS: Eighty patients treated for a previous diagnosis of COPD (n = 72) or on anticholinergic inhalers (n = 8) with no COPD diagnosis were evaluated. The average age was 52.9 years; 71% were uninsured. Only 17.5% (14/80) of patients reported previous spirometry. Spirometry revealed that 42.5% had no obstruction, 22.5% had reversible obstruction, and 35% had non-reversible obstruction. CONCLUSION: Symptoms and smoking history are insufficient to diagnose COPD. Prevalence of COPD over diagnosis among uninsured patient populations may be higher than previously reported. Confirming previous COPD diagnosis with spirometry is essential to avoid unnecessary and potentially harmful treatment.
Ghattas Christian; Dai Allen; Gemmel David J; Awad Magdi H
International journal of chronic obstructive pulmonary disease
2013
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2147/COPD.S45693" target="_blank" rel="noreferrer noopener">10.2147/COPD.S45693</a>