Video Counselling in Rehabilitation Management

Background Telemedicine can provide great benefits for patients, their physicians and other professionals in the health care system. We have asked ourselves whether a similar service could make a sensible contribution to the rehabilitation management of Germanyʼs statutory accident insurance? Patients/Materials and Methods In the present study, consultations of insured persons with their physicians and rehabilitation managers were transmitted via video conference. Patient satisfaction was determined by survey and potential benefits were analysed. Results The participants of the study were generally very satisfied with the telecounselling. In particular, 96% of their questions to the rehabilitation manager could be cleared up during the sessions. However, roughly a third of those surveyed prefer personal contact with the rehabilitation manager. Conclusion Telecounselling is well received by the insured in the rehabilitation management of occupational insurance associations and offers a useful alternative when, due to lack of resources – such as lack of time or great distance – the rehabilitation plan cannot be prepared locally together with the insured patient. Under the special circumstances of the coronavirus pandemic, it can also contribute to protecting the health of all involved.

Dementia, Subtype of Seizures, and the Risk of New Onset Seizures: A Cohort Study of a National U.S. Managed Care Database

Background: Seizure disorders have been identified in patients suffering from different types of dementia. However, the risks associated with the seizure subtypes have not been characterized. Objective: To compare the occurrence and risk of various seizure subtypes (focal and generalized) between patients with and without a dementia diagnosis. Methods: Data from 40.7 million private insured patient individual electronic health records from the U.S., were utilized. Patients 60 years of age or more from the Optum Insight Clinformatics-data Mart database were included in this study. Using ICD-9 diagnoses, the occurrence of generalized or focal seizure disorders was identified. The risk of new-onset seizures and the types of seizures associated with a dementia diagnosis were estimated in a cohort of 2,885,336 patients followed from 2005 to 2014. Group differences were analyzed using continuity-adjusted chi-square and hazard ratios with 95%confidence intervals calculated after a logistic regression analysis Results: A total of 79,561 patient records had a dementia diagnosis, and 56.38%of them were females. Patients with dementia when compared to those without dementia had higher risk for seizure disorders [Hazard ratio (HR) = 6.5 95%CI = 4.4–9.5]; grand mal status (HR = 6.5, 95%CI = 5.7–7.3); focal seizures (HR = 6.0, 95%CI = 5.5–6.6); motor simple focal status (HR = 5.6, 95%CI = 3.5–9.0); epilepsy (HR = 5.0, 95%CI = 4.8–5.2); generalized convulsive epilepsy (HR = 4.8, 95%CI = 4.5–5.0); localization-related epilepsy (HR = 4.5, 95%CI = 4.1–4.9); focal status (HR = 4.2, 95%CI = 2.9–6.1); and fits convulsions (HR = 3.5, 95%CI = 3.4–3.6). Conclusion: The study confirms that patients with dementia have higher risks of generalized or focal seizure than patients without dementia.

Diagnostics of Financing the System of Public Health in the Kyrgyzstan Republic and its Modernization

Despite the multi-channel resources, the financial sources of state health programs do not cover the needs of their implementation in the Kyrgyz Republic. The residual principle of health financing keeps unchanged and the amount of financing does not match the real health needs. The variety of problems in financing, the ambiguity of their positive practical solutions and controversy of theoretical aspects makes the research topic particularly relevant. No funds are allocated for prevention, and this type of medical service remains formally, just on paper. The main drawback of compulsory health insurance is the lack of forms for the insured patient to participate in the economic system of insurance relations. In this connection, it is relevant to develop a mechanism for attracting additional sources of financing. To increase the interest of commercial structure to this structure, it is proposed to introduce personalized accounting of compulsory medical insurance. Informal payments in medicine shouldn’t be considered as a “bribe”, since this type of payment for medical services acts as an addition to the market price in the absence of an adequate regulatory mechanism by the state, and it is impossible to cancel such a mechanism. The only way to formalize them is legalization. Revenues from paid services should be the source of the own fund of health organizations and used primarily to increase the salaries of medical workers.

Opioid Consumption after Foot and Ankle Surgery: The Influence of Payer Status

Category: Ankle, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Opioid utilization after foot and ankle surgery has received more attention recently with several papers publishing guidelines on the number of opioids to prescribe following surgery. To our knowledge the patient populations that have been studied in all of these papers are all private payer mixes, with a low amount of indigent patients. Social factors often have a large influence over surgical outcomes and therefore we aimed to see if this held true for post-operative opioid utilization as well. In this study we investigated differences in opioid utilization among patients with either Medicaid, Medicare or commercial insurance. Methods: All bony foot and ankle procedures performed by a single foot and ankle surgeon were reviewed between the dates of 7/1/2017 - 6/30/2018. Inclusion criteria were age over 18, did not have a history of chronic pain, and not incarcerated. Bony procedures included any osteotomy, fracture fixation, or arthrodesis. The number of narcotic prescriptions filled by the patient within 6 months following surgery was retrieved via the Texas Prescription Monitoring Program Database. Patients were also called and surveyed about their post-operative pain. The patients were then divided into 3 groups by payer status: commercial insurance including workman’s compensation, Medicaid including county insurance and self pay patients, and Medicare. Results: 92 patients met inclusion criteria, 22 Medicare, 26 Medicaid, and 44 commercial. Medicaid patients filled more narcotic prescriptions than commercial and medicare patients (870 mg morphine equivalent vs 781 mg morphine equivalent for commercial and 649 mg morphine equivalent for medicare) however this difference was not statistically significant (Medicaid vs Medicare p = 0.07). Medicaid patients also needed a greater number of refills per patient (0.27 for Medicaid vs 0.20 and 0.09 for commercial and Medicare, p = 0.22) and had a larger number of telephone encounters for pain (p = 0.02) than the other payer types. Conclusion: Although not statistically significant, there was a trend toward greater opioid utilization within the Medicaid and county insured patient population.