Managed Care and the Infectious Diseases Specialist

Abstract

There is growing demand to contain health care costs and to reassess the value of medical services. The traditional hospital, academic, and research roles of the infectious disease (ID) specialist are threatened, yet there is an increasing need for expertise because of growing antimicrobial resistance and emerging pathogens. Opportunities exist to develop and expand services for the care of patients infected with human immunodeficiency virus and in infection control, epidemiology, outcomes research, outpatient intravenous therapy, and resource management. It is important for ID physicians to appreciate the principles involved in managed care and the areas in which ID services can be valuable. To be effective, physicians need to know about tools such as practice guidelines, physician profiling, outcomes monitoring, computerized information management, risk sharing, networking, and marketing, as well as related legal issues. With a positive attitude toward learning, application, and leadership, ID physicians can redefine their role and expand their services through managed care.

Standardizing the Care of Bronchiolitis

“…7 Conditions targeted for this type of intervention should have high prevalence, high care burden, high cost, and notable variation in treatment and outcome. 8 While bronchiolitis meets many of these criteria, guidelines from authoritative agencies like the American Academy of Pediatrics, the Agency for Health Care Policy and Research, or the National Institutes of Health Consensus Development Program have not been published. Local guidelines, such as those used in this study, may be developed with less rigor than those is- sued from large national bodies.…”

A Role for an Infectious Diseases Physician

“…for patients with bacteraemia) to in-patients and out-patients in all sectors of the hospital ( e.g. internal medicine, ICU, surgery, oncology, haematology), 10,11 travel advice and immunisation clinics for the community, [12][13][14] in-patient antibiotic review, [15][16][17][18] HIV care, 19 infection guideline and critical care pathway development, dissemination, implementation and audit, [20][21][22] management of needle stick injuries in health care workers (in collaboration with the occupational health service) from proven HIV or 'high-risk' sources requiring commencement of anti-retroviral prophylaxis, 23 out-patient and home parenteral antibiotic therapy programmes (OHPAT), 24 and urgent (within 24 hours) consultation availability.…”

Infectious Diseases Training in Canada: One Size Does Not Fit All

“…Health care reform, driven by continued economic pressures, will undoubtedly provide the incentive for the creation of new career opportunities for highly trained infectious diseases specialists (10). Such career pathways will likely deviate from the traditional, strict academic model.…”