The routine use of scans in patients with lower back pain does not improve their outcomes, US scientists say.
They looked at six trials including more than 1,800 patients and found no benefit from the scans when patients were followed for up to a year.
Previous studies in the UK have shown similar results.
The National Institute for Clinical Excellence (NICE) is expected to publish guidelines on the treatment of lower back pain in May.
The researchers said the results were most applicable to the type of acute lower back pain assessed by a GP.
They looked at pain, function, quality of life, mental health, overall patient-reported improvement and patient satisfaction in the care they received for up to a year after their initial treatment.
All the patients were randomised to receive either immediate scans or standard clinical care.
Some of the standard care group were offered scans if they had not improved within three weeks.
They did not find significant differences between immediate imaging with X-ray or MRI scans and usual clinical care either in the short-term - up to three months later, or the long-term - six to 12 months.
Existing guidelines
Imaging in the first month of low back pain is not recommended in the US or in draft guidelines from NICE that were published in October.
DRAFT NICE GUIDELINES ON BACK PAIN
Consider course of manual therapy
Consider course of acupuncture
Consider structured exercise programme
Do not offer an X-ray
MRI only for suspected spinal fusion or other serious underlying conditionBut
Dr Roger Chou, lead researcher from the Oregon Health and Science University said some doctors still do it routinely, "possibly because they aim to reassure their patients and themselves, to meet patient expectations about tests or because reimbursement structures provide financial incentives to image".
He added: "Clinicians should refrain from routine, immediate lumbar imaging in patients with acute or sub-acute low back pain and without features suggesting a serious underlying condition."
In the paper published in the Lancet, the researchers say rates of MRI scans for back pain are rising according to figures from US medical programme Medicare.
They think patient expectations and preferences for imaging should be addressed, because in one trial 80% of patients with low back pain would undergo radiography if given the choice.
"Educational interventions could be effective for reducing the proportion of patients with low back pain who believe that routine imaging should be done."
UK experience
It is estimated that 40% to 50% of the population in the UK experience back pain in any given year.
With normal clinical care 80% of them will recover within six weeks.
The remaining five million go on to have back pain that needs some sort of help and investigation.
Dr Dries Hettinga, head of research at the UK charity Backcare, said: "While back pain is very common, we still have a very poor understanding of this condition and its causes.
"Health professionals play a vital role in reassuring patients.
"While it may seem that sending patients for an X-ray or MRI can provide this reassurance, the scans often reveal very little.
"With the right information and support, most people are able to manage their pain and find that it gets better within days or weeks."
The draft guidelines from NICE say X-ray and MRI investigations of the spine should be limited to when tumours, breaks, fusions or serious inflammation and infection is suspected.
It advises all people with lower back pain to exercise, if necessary in supervised groups, and that doctors should be able to offer a course of manual therapy or acupuncture.
Sunday, February 8, 2009
Friday, January 30, 2009
Wednesday, January 14, 2009
Surgical checklist 'saves lives'
Using a simple surgical checklist during major operations can cut deaths by more than 40% and complications by more than a third, research has shown.
The National Patient Safety Agency (NPSA) has ordered all hospitals in England and Wales to use it across the board by February 2010.
The checklist, devised by the World Health Organization (WHO), was tested in eight cities around the globe.
The year-long study features online in the New England Journal of Medicine.
Dr Atul Gawande, of Harvard School of Public Health, explains the checks
The checklist is made up of a single page that requires only a few minutes to complete.
It focuses on basic good practice before anaesthesia is administered, before a patient is cut open, and before a patient is removed from the operating theatre, and is designed to promote effective teamwork and prevent problems such as infection and unnecessary blood loss.
It was tested in hospitals in Seattle, Toronto, London, Auckland, Amman, New Delhi, Manila and Ifakara, Tanzania.
In total data was collected from 7,688 patients, 3,733 before the checklist was implemented, and 3,955 afterwards.
The rate of major complications fell from 11% to 7%, and the rate of inpatient deaths following surgery fell more than 40% from 1.5% to 0.8%.
The National Patient Safety Agency (NPSA) has ordered all hospitals in England and Wales to use it across the board by February 2010.
The checklist, devised by the World Health Organization (WHO), was tested in eight cities around the globe.
The year-long study features online in the New England Journal of Medicine.
Dr Atul Gawande, of Harvard School of Public Health, explains the checks
The checklist is made up of a single page that requires only a few minutes to complete.
It focuses on basic good practice before anaesthesia is administered, before a patient is cut open, and before a patient is removed from the operating theatre, and is designed to promote effective teamwork and prevent problems such as infection and unnecessary blood loss.
It was tested in hospitals in Seattle, Toronto, London, Auckland, Amman, New Delhi, Manila and Ifakara, Tanzania.
In total data was collected from 7,688 patients, 3,733 before the checklist was implemented, and 3,955 afterwards.
The rate of major complications fell from 11% to 7%, and the rate of inpatient deaths following surgery fell more than 40% from 1.5% to 0.8%.
Saturday, December 6, 2008
Group Health Insurance
The Group Medical/Health Insurance is a one of the methods of paynig the healthcare financing. Others are
Out of pocket (where the patient pays from his/her own to the service provider)
Individual Health insurance
Govt. Financing
In most of the devloped countries, group healht insurance is considered to be the best way of healthcare financing for the employees and their families.
Coverage of Alfalah Group Health Insurance is Explained as.....
HOSPITALIZATION COVER
Medical Expenses will be covered/ reimbursed as per policy terms & conditions incurred up to the specified limit as in the Table of Benefits on account of the following.
1. Daily Room Charges (inclusive of meal charges wherever applicable)
2. Operation Theatre Charges
3. Surgeons/ Consultant’s fee
4. Anesthetist fee
5. Medicines and drugs
6. Diagnostic tests
7. Endoscopies, Angiography, Thallium Scan (on out-patient setting when advised by the relevant physician/surgeon).
8. Day Care Surgeries (without the condition of 24 hours in hospital) eg cataract etc.
9. Pre-admission and Post-hospitalization Benefits (expenses incurred outside the hospital provided they lead to hospitalisation, up to a limit specified (mentioned in the Table of Benefits). These expenses are payable if the hospitalization limit if not fully consumed during hospitalization. MRI and CT Scan can also be covered as pre and post hospitalization benefit.
MATERNITY COVER
Medical Expenses will be covered/ reimbursed as per policy terms & conditions incurred up to the specified limit as in the Table of Benefits on account of the following.
1. Gynaecologist’s fee
2. Labor Room/Operation theatre charges
3. Anaesthetist fee
4. Miscarriage, D&C and D&E
5. Medicines
6. Diagnostic tests
7. Baby’s Nursing Care
Maternity expense benefit limit also covers and is inclusive of:
1. Charges of baby nursing care
2. Daily Room Rent Charges set in the basic hospitalisation policy.
3. Circumcision of baby boys (Limit as mentioned in the Benefits Table)
HOW DOES THE SCHEME WORK?
1) Procedure For Admission in a Panel Hospital
1. If a qualified doctor advises hospitalisation due to a valid reason, then any of our panel hospital can be approached for treatment on credit basis against Health Card/Letter of Authority.
2. The attending hospital will retain the attested photocopy of the Health Card/Letter & National ID Card of the employee/dependent) and will extend the required hospitalisation services to the insured patient as advised by the attending doctor.
An employee can visit any of our Network Hospital according to his plan/category of benefits. The list of these hospitals changes from time to time and is available at the website (www.alfalahinsurance.com). These hospitals besides meeting our stringent quality criteria are accredited upon the credentialing of their physicians/surgeons and favourable assessment of their facilities.
2) What if an employee visits a hospital not on our panel?
We strongly urge the use of panel hospitals especially in non emergency cases. The hospitals on our panel are selected based on scientific methods and their facilities and general level of care are regularly monitored to ensure quality. Reasonable discounts have also been taken from these hospitals that are passed to the patients in the billing. If an insured wishes to utilize the services of a hospital not on our panel, then he is required to take our prior approval by sending us the history, findings & procedure to be done on the prescription paper of the attending doctor and its complete detail of charges about 3 days before the scheduled procedure. This can be faxed /emailed to Health Insurance Department. In emergency situations, an insured can go to a non-panel, but he has to inform us within 24 hours of such hospitalization. Then these claims can be submitted after filling & signing the Claim Form and a deductible will be applicable according to the policy terms & conditions and payment will be made according to the charges of our nearest panel hospital/hospital of the same standard whatever decided by the insurance company. The company reserves the right to decline the claim and to exclude the employee from the policy if a false claim is launched.
IMPORTANT NOTE:
Please ensure that before submission, your in-patient claim must be supported by documents according to the checklist provided below. Please submit your claim within 15 days of the expenses incurred along with the attested claim form.
CHECK LIST FOR REIMBURSEMENT OF CLAIM
1. Final Hospital Bill with Receipt (Original)
2. Discharge certificate / card from the Hospital indicating final diagnosis
3. Original cash memos of medicines from the Hospital / Chemist(s) supported with proper prescription
4. Receipt (Original) and Pathological / Radiogical test reports with proper prescription of the attending
Medical Practitioner / Consultant / Surgeon
5. Surgeon’s certificate stating nature of operation performed and Surgeon’s bill and receipt
6. Attending Doctor’s / Consultant’s / Specialist’s / Anesthetist’s bill and receipt (Original)
7. Medical Certificate from the attending Medical Practitioner / Consultant / Surgeon
8. Copy of Birth Certificate (In Case of Maternity)
9. Copy of Company’s Reference Letter / Health Card
10. Copy of CNIC of patient (if patient is adult)
MAIN EXCLUSIONS
Some (and not all) of the main exclusions are –
1. Mental illnesses, and any sickness or condition arising from and including drug abuse, alcoholism or a criminal act.
2. Treatment or investigation of fertility, infertility, sterilization, contraception and any complication relating thereto or hormone treatment and investigations.
3. General check-ups or rest cures or hospitalization only for evaluation and diagnostic purposes.
4. Supply or fitting of eye glasses, contact lenses or hearing aids.
5. Cost of limbs or supporting equipment for revival or correction of the function of body.
6. Dental examinations, extraction or filling unless necessitated due to an accidental injury occurring during the insured period.
7. Cost of radial keratotomy and excimer and lasik laser procedures.
8. Cosmetic surgery, unless necessitated by an accidental injury occurring during the insured period.
9. Personal comfort items such as, charges for telephone, meals for other than the patient or other non-medical items.
10. Any outpatient treatment, except that arises out of an accident.
11. In few hospitals, charges of certain treatment vary in different type of rooms i.e. private, semi private, general ward etc. individuals staying in higher than their entitlement will be responsible for payment of additional expenses for room rate plus any increase in other expenses as well.
Out of pocket (where the patient pays from his/her own to the service provider)
Individual Health insurance
Govt. Financing
In most of the devloped countries, group healht insurance is considered to be the best way of healthcare financing for the employees and their families.
Coverage of Alfalah Group Health Insurance is Explained as.....
HOSPITALIZATION COVER
Medical Expenses will be covered/ reimbursed as per policy terms & conditions incurred up to the specified limit as in the Table of Benefits on account of the following.
1. Daily Room Charges (inclusive of meal charges wherever applicable)
2. Operation Theatre Charges
3. Surgeons/ Consultant’s fee
4. Anesthetist fee
5. Medicines and drugs
6. Diagnostic tests
7. Endoscopies, Angiography, Thallium Scan (on out-patient setting when advised by the relevant physician/surgeon).
8. Day Care Surgeries (without the condition of 24 hours in hospital) eg cataract etc.
9. Pre-admission and Post-hospitalization Benefits (expenses incurred outside the hospital provided they lead to hospitalisation, up to a limit specified (mentioned in the Table of Benefits). These expenses are payable if the hospitalization limit if not fully consumed during hospitalization. MRI and CT Scan can also be covered as pre and post hospitalization benefit.
MATERNITY COVER
Medical Expenses will be covered/ reimbursed as per policy terms & conditions incurred up to the specified limit as in the Table of Benefits on account of the following.
1. Gynaecologist’s fee
2. Labor Room/Operation theatre charges
3. Anaesthetist fee
4. Miscarriage, D&C and D&E
5. Medicines
6. Diagnostic tests
7. Baby’s Nursing Care
Maternity expense benefit limit also covers and is inclusive of:
1. Charges of baby nursing care
2. Daily Room Rent Charges set in the basic hospitalisation policy.
3. Circumcision of baby boys (Limit as mentioned in the Benefits Table)
HOW DOES THE SCHEME WORK?
1) Procedure For Admission in a Panel Hospital
1. If a qualified doctor advises hospitalisation due to a valid reason, then any of our panel hospital can be approached for treatment on credit basis against Health Card/Letter of Authority.
2. The attending hospital will retain the attested photocopy of the Health Card/Letter & National ID Card of the employee/dependent) and will extend the required hospitalisation services to the insured patient as advised by the attending doctor.
An employee can visit any of our Network Hospital according to his plan/category of benefits. The list of these hospitals changes from time to time and is available at the website (www.alfalahinsurance.com). These hospitals besides meeting our stringent quality criteria are accredited upon the credentialing of their physicians/surgeons and favourable assessment of their facilities.
2) What if an employee visits a hospital not on our panel?
We strongly urge the use of panel hospitals especially in non emergency cases. The hospitals on our panel are selected based on scientific methods and their facilities and general level of care are regularly monitored to ensure quality. Reasonable discounts have also been taken from these hospitals that are passed to the patients in the billing. If an insured wishes to utilize the services of a hospital not on our panel, then he is required to take our prior approval by sending us the history, findings & procedure to be done on the prescription paper of the attending doctor and its complete detail of charges about 3 days before the scheduled procedure. This can be faxed /emailed to Health Insurance Department. In emergency situations, an insured can go to a non-panel, but he has to inform us within 24 hours of such hospitalization. Then these claims can be submitted after filling & signing the Claim Form and a deductible will be applicable according to the policy terms & conditions and payment will be made according to the charges of our nearest panel hospital/hospital of the same standard whatever decided by the insurance company. The company reserves the right to decline the claim and to exclude the employee from the policy if a false claim is launched.
IMPORTANT NOTE:
Please ensure that before submission, your in-patient claim must be supported by documents according to the checklist provided below. Please submit your claim within 15 days of the expenses incurred along with the attested claim form.
CHECK LIST FOR REIMBURSEMENT OF CLAIM
1. Final Hospital Bill with Receipt (Original)
2. Discharge certificate / card from the Hospital indicating final diagnosis
3. Original cash memos of medicines from the Hospital / Chemist(s) supported with proper prescription
4. Receipt (Original) and Pathological / Radiogical test reports with proper prescription of the attending
Medical Practitioner / Consultant / Surgeon
5. Surgeon’s certificate stating nature of operation performed and Surgeon’s bill and receipt
6. Attending Doctor’s / Consultant’s / Specialist’s / Anesthetist’s bill and receipt (Original)
7. Medical Certificate from the attending Medical Practitioner / Consultant / Surgeon
8. Copy of Birth Certificate (In Case of Maternity)
9. Copy of Company’s Reference Letter / Health Card
10. Copy of CNIC of patient (if patient is adult)
MAIN EXCLUSIONS
Some (and not all) of the main exclusions are –
1. Mental illnesses, and any sickness or condition arising from and including drug abuse, alcoholism or a criminal act.
2. Treatment or investigation of fertility, infertility, sterilization, contraception and any complication relating thereto or hormone treatment and investigations.
3. General check-ups or rest cures or hospitalization only for evaluation and diagnostic purposes.
4. Supply or fitting of eye glasses, contact lenses or hearing aids.
5. Cost of limbs or supporting equipment for revival or correction of the function of body.
6. Dental examinations, extraction or filling unless necessitated due to an accidental injury occurring during the insured period.
7. Cost of radial keratotomy and excimer and lasik laser procedures.
8. Cosmetic surgery, unless necessitated by an accidental injury occurring during the insured period.
9. Personal comfort items such as, charges for telephone, meals for other than the patient or other non-medical items.
10. Any outpatient treatment, except that arises out of an accident.
11. In few hospitals, charges of certain treatment vary in different type of rooms i.e. private, semi private, general ward etc. individuals staying in higher than their entitlement will be responsible for payment of additional expenses for room rate plus any increase in other expenses as well.
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