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Aceituno D, Pennington M, Iruretagoyena B, Prina AM, McCrone P. Health State Utility Values in Schizophrenia: A Systematic Review and Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1256-1267. [PMID: 32940244 DOI: 10.1016/j.jval.2020.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/03/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Patient preferences are increasingly important in informing clinical and policy decisions. Health-state utility values (HSUVs) are quantitative measures of people's preferences over different health states. In schizophrenia, there is no clarity about HSUVs across the symptoms' severity spectrum. This meta-analysis aims to synthesize the literature on HSUVs in people with schizophrenia. METHODS We searched Medline, PsycInfo, Embase, EconLit, The Cochrane Library, and specialized databases. The studies reporting HSUVs in people with schizophrenia were selected and pooled in a random-effects meta-analysis. The primary outcome was the mean HSUV obtained from participants. RESULTS A total of 54 studies involving 87 335 participants were included. The pooled estimate using direct elicitation was a mean HSUV of 0.79 (95% CI: 0.70-0.88) for mild symptomatic states, 0.69 (95% CI: 0.54-0.85) in moderate states, and 0.34 (95% CI: 0.13-0.56) in severe states. Studies using indirect techniques resulted in a pooled mean HSUV of 0.73 (95% CI: 0.67-0.78) applying the EuroQol 5-dimension, 0.66 (95% CI: 0.62-0.71) in the Short-Form 6-dimension, and 0.59 (95% CI: 0.57-0.61) using the Quality of Well-Being scale. All the estimates resulted in considerable heterogeneity, partially reduced by meta-regression. CONCLUSION Our findings suggest that the severity of psychotic symptoms has an important effect on HSUVs in schizophrenia, with values mirroring patients with disabling physical conditions such as cancer and stroke. Decision makers should be aware of these results when including people's preferences in trials, models, and policy decisions.
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Affiliation(s)
- David Aceituno
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience. King's College London, London, United Kingdom; Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Mark Pennington
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience. King's College London, London, United Kingdom
| | - Barbara Iruretagoyena
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Early Intervention Program, J. Horwitz Psychiatric Institute, Santiago, Chile
| | - A Matthew Prina
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience. King's College London, London, United Kingdom
| | - Paul McCrone
- Healthcare Economics, Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
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de Waal A, Dixon L, Humensky J. Association of participant preferences on work and school participation after a first episode of psychosis. Early Interv Psychiatry 2018; 12:959-963. [PMID: 29052948 PMCID: PMC5910294 DOI: 10.1111/eip.12513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/06/2017] [Accepted: 09/13/2017] [Indexed: 01/30/2023]
Abstract
AIM To explore baseline ratings of importance (ROI) across life domains for participants in the Recovery After an Initial Schizophrenia Episode Connection Program (RAISE CP), and investigate whether ratings were correlated with intervention outcomes over time. METHODS At baseline, 63 participants rated the importance of reducing symptoms, side-effects, confusion, increasing energy and school/work functioning and improving social relations. ROIs were examined in relation to work/school participation (n = 41) and occupational functioning (n = 37) after 12 months. Participants' mean age was 22.3 (±4.2). RESULTS The ROI domain rated as most important was school/work functioning, and higher school/work ROI at baseline predicted work/school participation after 12 months of participation. CONCLUSIONS It is particularly important to assess participant preferences and priorities when treating psychotic disorders because most areas of life are affected. Understanding the impact of participant goals on outcomes is essential as programs design patient-centred treatment plans.
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Affiliation(s)
| | - Lisa Dixon
- Columbia University Department of Psychiatry
- New York State Psychiatric Institute, Division of Behavioral Health Services and Policy Research
| | - Jennifer Humensky
- Columbia University Department of Psychiatry
- New York State Psychiatric Institute, Division of Behavioral Health Services and Policy Research
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Abstract
OBJECTIVE Most of the existing studies investigating the impact of schizophrenia on utility have focused on the different stages of the disease. The objective of this study was to describe and quantify the impact of treatment-related side-effects on utility in patients with schizophrenia, using data from an observational study. METHODS This study used data from the European Schizophrenia Cohort (EuroSC), a multi-center 2-year cohort study conducted in France, England, and Germany. The EQ-5D questionnaire was completed every 6 months, as well as the Subjective Side Effect Rating Scale, assessing patient distress over extrapyramidal symptoms (EPS), weight gain, sedation, and sexual dysfunction, used to assess whether or not the patient experienced the side-effect. At first a bivariate analysis was conducted to describe utility values with and without side-effects. Then, a random effects regression analysis was performed on utility, where random effects were controlled for repeated measures on the same subjects, with potential confounding factors. Finally, findings were compared with those of previous publications. RESULTS This sample consisted of 1208 patients with schizophrenia. At the baseline visit, the most reported side-effect was EPS (almost 60% of patients), followed by sedation and weight gain (∼50% of patients for each), and sexual dysfunction (almost 30% of patients). Significant association with severity of symptoms, functioning abilities, and utility were found. Patients reporting none of the studied side-effects had an average EQ-5D index score of 0.81, found to be higher than scores of patients reporting EPS (0.70), sexual dysfunction (0.67), sedation (0.70), or weight gain (0.72). The random effects model reported a utility decrement of 0.042 for EPS, 0.022 for weight gain, 0.022 for sexual dysfunction, and 0.019 for sedation. Although the external validation was difficult due to the different methods or definitions of the side-effects, as well as the paucity of data for weight gain, sedation and sexual dysfunction, the results were generally consistent with previous studies. CONCLUSION This study aimed at quantifying the direct impact of main side-effects associated with antipsychotics on patients' utility. RESULTS suggested a significant direct impact of side-effects, with EPS being the most impactful.
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Green CA, Estroff SE, Yarborough BJH, Spofford M, Solloway MR, Kitson RS, Perrin NA. Directions for future patient-centered and comparative effectiveness research for people with serious mental illness in a learning mental health care system. Schizophr Bull 2014; 40 Suppl 1:S1-S94. [PMID: 24489078 PMCID: PMC3911266 DOI: 10.1093/schbul/sbt170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Stalmeier PFM, Verheijen AL. Maximal endurable time states and the standard gamble: more preference reversals. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:971-977. [PMID: 23224226 DOI: 10.1007/s10198-012-0445-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 11/19/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND The time trade off (TTO) method is not sensitive to maximal endurable time preferences, as preference reversals occur. The standard gamble (SG) method has not been tested regarding its sensitivity to maximal endurable time preferences. OBJECTIVE This study investigates whether preference reversals occur for the SG method as well. METHODS Fifty-nine respondents stated for several migraine health states their preference for living 10 or 20 years in that state. A migraine state was selected for which a respondent preferred 10-20 years, a maximal endurable time preference. Two probability equivalent gambles were obtained for the migraine states lasting 10 and 20 years, respectively. Preference reversals occurred when the gamble, equivalent to the longer duration, was preferred to the gamble equivalent to the shorter duration. RESULTS Out of 59 respondents, 48 had maximal endurable time preferences. Of these 48 respondents, 34 (71%) showed a preference reversal. This percentage differed significantly from chance, that is 50% (P = 0.004), indicating that preference reversals occurred reliably. CONCLUSION The observed reversal rate for the standard gamble is similar to rates observed previously with the TTO method. Utility measurement of poor health states is problematic, both with the TTO and standard gamble methods.
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Affiliation(s)
- P F M Stalmeier
- Department for Health Evidence, Radboud University Medical Centre, HEV 133, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands,
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Kay EJ, Nassani MZ, Aswad M, Abdelkader RS, Tarakji B. The disutility of tooth loss: a comparison of patient and professional values. J Public Health Dent 2013; 74:89-92. [PMID: 24171838 DOI: 10.1111/jphd.12042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 09/01/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The objectives of this study are to study how tooth loss affects the utility of the dentition from both patient and professional perspectives and to compare patient and professional utility values. METHODS One hundred six patients and 118 dentists were asked to read 19 different written scenarios accompanied by visual images and models, describing mouths with missing teeth, and to indicate on a visual analog scale the value of that oral health state. RESULTS Both groups of participants attached the greatest utility to missing incisor teeth and disutility of tooth loss decreased as the tooth in question became nearer the back of the mouth. When dentist and patient utility values for the loss of different tooth types were compared, using independent t-tests, differences were statistically significant for only one tooth loss scenario - the loss of upper canines. CONCLUSIONS The patient and professional groups valued tooth loss scenarios in a similar way. This finding is contrary to the majority of previous studies comparing patient and professional utilities.
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Abstract
To make a difference to patients who increasingly suffer multiple chronic conditions, in a healthcare system that is capable of providing excellent care but is often ineffective and at cross-purposes in its application, means being prepared to take a different approach not only to the delivery of patient care, but to the education of physicians and other healthcare professionals. The model we must now practice and teach is one that emphasizes collaboration and prevention, quality and efficiency. Changes in practice recommended by the 2001 US Institute of Medicine report are being implemented system-wide, following the enactment of the US Patient Protection and Affordable Care Act. This paper discusses the evolving needs of patients with chronic psychiatric illness, and the psychiatrist's role in a rapidly changing healthcare landscape as a care provider, an interdisciplinary role model, and educator. In an aging population in which multi-morbidity is the norm, episodic, crisis-driven care is prohibitively expensive and does not serve patients well. Yet we still teach that model of care. The medications we prescribe for psychiatric illness, particularly antipsychotics, can cause and/or aggravate some of the commonest chronic medical illnesses; psychiatric educators must address the management of these complications. The management of chronic psychiatric illness in multi-morbid patients demands that we practice and teach a 'whole patient' approach to care, preferably delivered as part of a patient-centred team. The Affordable Care Act has mandated and created opportunities for new models designed to facilitate this, and a paradigm shift is needed in medical education. Clinicians must become adept at identifying underlying and contributing factors and collaborating with the patient, other providers, and the patient's family and significant others. Psychiatric formulation and patient care rely on these principles; we must now teach their application to other specialties, disciplines and professions.
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Affiliation(s)
- Deirdre Johnston
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Valuation and attainment of treatment goals in schizophrenia: perspectives of patients, relatives, physicians, and payers. J Psychiatr Pract 2012; 18:321-8. [PMID: 22995959 DOI: 10.1097/01.pra.0000419816.75752.65] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study investigated and compared the valuation and perceived attainment of multiple treatment goals in schizophrenia from the perspectives of four different groups of stakeholders. METHOD Twenty treatment goals (identified in a qualitative patient-based pre-study) were ranked and rated according to their relevance in standardized interviews. Goal attainment was also rated. A rank correlation was computed to identify congruencies among the stakeholder groups. A hierarchical cluster analysis of the data from the stakeholders groups was also conducted. RESULTS In this study, 105 outpatients, 160 physicians, 50 relatives, and 30 payers were interviewed. All goals were considered very relevant by all stakeholder groups. "Improved cognitive abilities" was ranked among the top three goals by patients, physicians, and relatives, while "reduced disease-related symptoms" was ranked first by relatives and second by physicians. Payers gave the highest priority to goals that were more likely to affect costs (i.e., ability to resume work, reduced disease-related symptoms, less hospitalization/ need for outpatient visits). Pairwise agreement rates ranged from 38.9% to 63.3%. Rank correlations were found between relatives and patients (r=0.51; P=0.002), relatives and physicians (r=0.43; P=0.008), and payers and patients (r=0.43; P=0.008). The cluster analysis revealed a relevant congruency among patients, relatives, and physicians. Goal attainment was rated lower than goal relevance by all groups, with patients judging attainment the best on average, followed by relatives, physicians, and payers. Reduction in disease-related symptoms was rated as the goal that was best achieved. CONCLUSION Discordances among the groups with respect to their valuation of treatment goals should encourage stakeholders to better understand others' preferences as a prerequisite for improved shared decision making and potentially improved treatment outcomes.
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Chan KK, Mak WW. Shared decision making in the recovery of people with schizophrenia: The role of metacognitive capacities in insight and pragmatic language use. Clin Psychol Rev 2012; 32:535-44. [DOI: 10.1016/j.cpr.2012.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 04/29/2012] [Accepted: 06/11/2012] [Indexed: 11/16/2022]
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Mauriño J, Cordero L, Ballesteros J. The subjective well-being under neuroleptic scale - short version (SWN-K) and the SF-36 health survey as quality of life measures in patients with schizophrenia. Patient Prefer Adherence 2012; 6:83-5. [PMID: 22298947 PMCID: PMC3269321 DOI: 10.2147/ppa.s28354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The desired outcome in schizophrenia treatment has evolved from symptom management to maximization of quality of life and functional recovery. The aim of this study was to assess the relationship between a specific well-being measure, the Subjective Well-being under Neuroleptic Scale - short version (SWN-K), and the SF-36 Health Survey as a generic quality of life measure. PATIENTS AND METHODS A multicenter, cross-sectional study was conducted with clinically stable outpatients diagnosed with schizophrenia. Spearman's rank correlation was used to assess the associations between the SWN-K total score, its five subscales, and the SF-36 domains. RESULTS Ninety-seven patients were included in the study. The mean age was 35 years (standard deviation = 10) and 72% were male. All correlations among domains were positive and most were statistically significant. The bodily pain domain of the SF-36 presented the lower correlations with the SWN-K (rho range 0.10-0.25), whereas the other seven domains correlated significantly (rho range 0.49-0.60, all P < 0.001). The largest correlations were obtained between the SWN-K and the SF-36 domains of general health (rho = 0.53), mental health (rho = 0.60), and vitality (rho = 0.54). CONCLUSION The positive but nevertheless moderate correlations observed between a specific well-being instrument and a generic quality of life scale supports the inclusion of diagnosis-specific tools for outcome assessment of patients with schizophrenia.
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Affiliation(s)
- Jorge Mauriño
- AstraZeneca Medical Department, Madrid, Spain
- Correspondence: J Mauriño, Serrano Galvache, 56, Parque Norte, Edificio Roble, (28033) Madrid, Spain, Tel +34 9130 19738, Fax +34 9130 19606, Email
| | | | - Javier Ballesteros
- Department of Neuroscience-Psychiatry, University of the Basque Country, UPV/EHU, CIBERSAM, Leioa, Spain
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Nicolino PS, Vedana KGG, Miasso AI, Cardoso L, Galera SAF. [Schizophrenia: adherence to treatment and beliefs about the disorder and the drug treatment]. Rev Esc Enferm USP 2011; 45:708-15. [PMID: 21710079 DOI: 10.1590/s0080-62342011000300023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 10/03/2010] [Indexed: 11/21/2022] Open
Abstract
This study verified the adherence of people with schizophrenia to the medication, identified and compared their beliefs about the disorder and the drug among patients who adhered and those who did not. Participants were 14 patients of a psychiatric outpatient clinic. Semi-structured interviews and the Morisky-Green test were performed. The data was analyzed using a quali-quantitative approach. Results showed that 64.3% of patients do not adhere to treatment. Most participants considered the drug capable of reducing the seriousness and severity of the disorder. However, the drawbacks for patients that did not adhere to the treatment were more expressive. Side effects were the cause for interrupting the treatment for 80% of patients who intentionally did not adhere to treatment. It was observed there is insufficient knowledge about schizophrenia and the drug treatment. Patients referred to faith as a strategy to cope with the process they were experiencing. This study points at the need for strategies directed towards the promotion of drug treatment adherence among people with schizophrenia.
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Affiliation(s)
- Paula Silva Nicolino
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Røsvik AH, Movik E, Nylenna M. [Do patients participate in the development of clinical guidelines in Norway?]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:2236-8. [PMID: 21109844 DOI: 10.4045/tidsskr.09.1511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The National Health Plan (2007-2010) establishes that users should participate in development of all parts of the health services. We have investigated whether and how patients participate in development of guidelines in Norway. MATERIAL AND METHODS Nine doctors and one nurse, trained in the AGREE instrument (an international tool for evaluation of clinical guidelines), evaluated patient involvement in development of key guidelines in Norway, on a scale from 1 (patient views not mentioned) to 4 (patients participate). RESULTS 127 guidelines (published in the period 2000-2009) were assessed. The average score for extent of patient involvement was 1.8. Guidelines from public institutions scored higher than those developed by professional medical organizations; mean 2.4 (95 % CI 2.2-2.7) versus 1.5 (1.2-1.7). Guidelines on cancer, mental health, musculoskeletal disorders and pediatrics had the highest scores. There were no differences between older (2000-05) and more recent (2006-09) guidelines. INTERPRETATION Norwegian guidelines developers seldom involve patients in guideline development. Patient views are mainly not taken into account in literature searches or systematic collection of information.
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Affiliation(s)
- Anne Hilde Røsvik
- Helsebiblioteket, Nasjonalt kunnskapssenter for helsetjenesten, Postboks 7004 St. Olavs plass, 0130 Oslo, Norway.
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Mavranezouli I. A review and critique of studies reporting utility values for schizophrenia-related health states. PHARMACOECONOMICS 2010; 28:1109-1121. [PMID: 21080736 DOI: 10.2165/11537300-000000000-00000] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Economic evaluation of health technologies in the form of cost-utility analysis is increasingly advocated. The most common outcome measure in this type of analysis is the QALY. In order to estimate QALYs, appropriate utility values are required. The objective of this review was to identify and critique utility values for schizophrenia-related health states. A critical appraisal was performed on utility values for schizophrenia identified in the systematic literature review that informed the economic analysis of the updated edition of the National Institute for Health and Clinical Excellence (NICE) clinical guideline on schizophrenia for England and Wales. Seven studies reporting utility values for schizophrenia were identified. The studies employed a variety of methods for generating utility values. None of the reported sets of utility values for schizophrenia were generated using the EQ-5D, which is a measure widely used in cost-utility analysis and preferred by NICE. Nevertheless, the EQ-5D may be less sensitive in capturing aspects of health-related quality of life in patients with schizophrenia. A condition-specific preference-based instrument may be more appropriate than a generic measure to inform cost-utility analyses of interventions for schizophrenia.
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Affiliation(s)
- Ifigeneia Mavranezouli
- National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
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Schwarzinger M, Carrat F, Luchini S. "If you have the flu symptoms, your asymptomatic spouse may better answer the willingness-to-pay question". Evidence from a double-bounded dichotomous choice model with heterogeneous anchoring. JOURNAL OF HEALTH ECONOMICS 2009; 28:873-884. [PMID: 19362383 DOI: 10.1016/j.jhealeco.2009.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 02/22/2009] [Accepted: 03/04/2009] [Indexed: 05/27/2023]
Abstract
The small sample size of contingent valuation (CV) surveys conducted in patients may have limited the use of the single-bounded (SB) dichotomous choice format which is recommended in environmental economics. In this paper, we explore two ways to increase the statistical efficiency of the SB format: (1) by the inclusion of proxies in addition to patients; (2) by the addition of a follow-up dichotomous question, i.e. the double-bounded (DB) dichotomous choice format. We found that patients (n=223) and spouses (n=64) answering on behalf of the patient had on average a similar willingness-to-pay for earlier alleviation of flu symptoms. However, a patient was significantly more likely to anchor his/her answer on the first bid as compared to a spouse. Finally, our original DB model with shift effect and heterogeneous anchoring reconciled the discrepancies found in willingness-to-pay statistics between SB and DB models in keeping with increased statistical efficiency.
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Affiliation(s)
- Michaël Schwarzinger
- Center for Health Policy, Freeman Spogli Institute for International Studies/Center for Primary Care & Outcomes Research, School of Medicine, Stanford University, CA 94305-6019, USA.
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van Os J, Triffaux JM. Evidence that the Two-Way Communication Checklist identifies patient-doctor needs discordance resulting in better 6-month outcome. Acta Psychiatr Scand 2008; 118:322-6. [PMID: 18644005 DOI: 10.1111/j.1600-0447.2008.01228.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess an intervention aimed at reducing patient-professional carer needs discordance. METHOD In a group of 460 patients with schizophrenia, the Two-Way Communication Checklist (2-COM), an instrument to rate needs, was completed at baseline, 2 months and 6 months by both the patient and the professional carer, allowing for the quantification of patient-carer needs discordance. RESULTS Reduction in patient-reported 2-COM needs in the group with low baseline needs discordance was much greater at 2 and 6 months (2 months: beta = -0.65, P < 0.001; 6 months: beta = -1.00, P < 0.001) than in the group with high baseline discordance (2 months: beta = -0.35, P < 0.001; 6 months: beta = -0.49, P < 0.001). Reduction in needs discordance between baseline and 2 months (beta = -0.07, P = 0.004) as well between 2 and 6 months (beta = -0.05, P = 0.020) was associated with greater levels of CGI clinical improvement. CONCLUSION The fact that patient-carer needs discordance impacts negatively, and its reduction positively, on 6-month outcome suggests that systematic inventory of patient-carer views on needs is necessary.
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Affiliation(s)
- J van Os
- Department of Psychiatry and Neuropsychology, European Graduate School of Neuroscience, Maastricht University, Maastricht, the Netherlands.
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Doctor JN, Bleichrodt H, Lin HJ. Health Utility Bias: A Systematic Review and Meta-Analytic Evaluation. Med Decis Making 2008; 30:58-67. [DOI: 10.1177/0272989x07312478] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. A common assertion is that rating scale (RS) values are lower than both standard gamble (SG) and time tradeoff (TTO) values. However, differences among these methods may be due to method specific bias. Although SG and TTOs suffer systematic bias, RS responses are known to depend on the range and frequency of other health states being evaluated. Over many diverse studies this effect is predicted to diminish. Thus, a systematic review and data synthesis of RS-TTO and RS-SG difference scores may better reveal persistent dissimilarities. Purpose. The purpose of this study was to establish through systematic review and meta-analysis the net effect of biases that endure over many studies of utilities. Methods. A total of 2206 RS and TTO and 1318 RS and SG respondents in 27 studies of utilities participated. MEDLINE was searched for data from 1976 to 2004, complemented by a hand search of full-length articles and conference abstracts for 9 journals known to publish utility studies, as well as review of results and additional recommendations by 5 outside experts in the field. Two investigators abstracted the articles. We contacted the investigators of the original if required information was not available. Results. No significant effect for RS and TTO difference scores was observed: effect size (95% confidence interval [CI]) = 0.04 (−0.02, 0.09). In contrast, RS scores were significantly lower than SG scores: effect size (95% CI ) =−0.23 (−0.28, −0.19). Correcting SG scores for 3 known biases (loss aversion, framing, and probability weighting) eliminated differences between RS and SG scores: effect size (95% CI ) = 0.01 (−0.03, 0.05). Systematic bias in the RS method may exist but be heretofore unknown. Bias correction formulas were applied to mean not individual utilities. Conclusions. The results of this study do not support the common view that RS values are lower than TTO values, may suggest that TTO biases largely cancel, and support the validity of formulas for correcting SG bias.
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Affiliation(s)
- Jason N. Doctor
- Department of Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA,
| | - Han Bleichrodt
- Department of Economics and iMTA/iBMG, Erasmus University, Rotterdam, The Netherlands
| | - H. Jill Lin
- Department of Radiology, School of Medicine, Stanford University, Menlo Park, CA
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Schackman BR, Teixeira PA, Weitzman G, Mushlin AI, Jacobson IM. Quality-of-life tradeoffs for hepatitis C treatment: do patients and providers agree? Med Decis Making 2008; 28:233-42. [PMID: 18349430 DOI: 10.1177/0272989x07311753] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The authors investigated differences between how patients and providers evaluate the quality-of-life tradeoffs associated with HCV treatment in computer-assisted interviews. They interviewed 92 treatment-naive HCV patients at gastroenterology, methadone maintenance, and HIV clinics at 3 hospitals in New York City and 23 physicians or nurses experienced in treating HCV at other hospitals in New York City. Subjects completed rating scale and standard gamble evaluations of current health and hypothetical descriptions of HCV symptoms and treatment side effects on a scale from 0 (death or worse than death) to 1 (best possible health). RESULTS . Treatment side effects were rated worse by patients than providers using the rating scale (moderate side effects 0.42 v. 0.62; severe side effects 0.24 v. 0.40) and standard gamble (moderate side effects 0.61 v. 0.91; severe side effects 0.52 v. 0.75) (all P < or = 0.01). A year of severe side effects was equivalent to 4.1 years of mild HCV symptoms avoided for patients if they returned to their current health after treatment compared with 2.0 years avoided if they achieved average population health. For patients with depression symptoms, HCV treatment with severe side effects had lower value unless it would also improve their current health. CONCLUSIONS . Patients have more concerns about treatment side effects than providers. Further research is warranted to develop HCV decision aids that elicit patient preferences and to evaluate how improved communication of the risks and benefits of HCV treatment and more effective treatment of depression may alter these preferences.
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Affiliation(s)
- Bruce R Schackman
- Department of Public Health, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Dawson NV, Singer ME, Lenert L, Patterson MB, Sami SA, Gonsenhouser I, Lindstrom HA, Smyth KA, Barber MJ, Whitehouse PJ. Health state valuation in mild to moderate cognitive impairment: feasibility of computer-based, direct patient utility assessment. Med Decis Making 2008; 28:220-32. [PMID: 18349434 DOI: 10.1177/0272989x07311750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most patients with dementia will, at some point, need a proxy health care decision maker. It is unknown whether persons with various degrees of cognitive impairment can reliably report their health-related preferences. METHODS The authors performed health state valuations (HSVs) of current and hypothetical future health states on 47 pairs of patients with mild to moderate cognitive impairment and their caregivers using computer-based standard gamble, time tradeoff, and rating scale techniques. RESULTS Patients' mean (SD) age was 74.6 (9.3) years. About half of the patients were women (48%), as were most caregivers (73%), who were on average younger (mean age= 66.2 years, SD= 12.2). Most participants were white (83%); 17% were African American. The mean (SD) Mini-Mental State Examination (MMSE) score of patients was 24.2 (4.6) of 30. All caregivers and 77% of patients (36/47) completed all 18 components of the HSV exercise. Patients who completed the HSV exercise were slightly younger (mean age [SD]= 74.1 [8.5] v. 75.9 [11.8]; P = 0.569) and had significantly higher MMSE scores (mean score [SD] = 25.0 [4.3] v. 21.4 [4.4]; P = 0.018). Although MMSE scores below 20 did not preclude the completion of all 18 HSV ratings, being classified as having moderate cognitive impairment was associated with a lower likelihood of completing all scenario ratings (44% v. 82%). Patient and caregiver responses showed good consistency across time and across techniques and were logically consistent. CONCLUSION Obtaining HSVs for current and hypothetical health states was feasible for most patients with mild cognitive impairment and many with moderate cognitive impairment. HSV assessments were consistent and reasonable.
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Affiliation(s)
- Neal V Dawson
- Department of Medicine, University Memory and Aging Center, Case Western University, Cleveland, Ohio, USA.
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Honer WG, Thornton AE, Sherwood M, MacEwan GW, Ehmann TS, Williams R, Kopala LC, Procyshyn R, Barr AM. Conceptual and methodological issues in the design of clinical trials of antipsychotics for the treatment of schizophrenia. CNS Drugs 2007; 21:699-714. [PMID: 17696571 DOI: 10.2165/00023210-200721090-00001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Schizophrenia is one of the most severe and disabling psychiatric disorders. Antipsychotic drugs offer considerable benefits in controlling symptoms and preventing relapse. The strategy for the present review of clinical trials was to ask 'What are the features of schizophrenia and the existing treatments of the illness that have implications for future clinical trials'? Six key facts were identified.First, schizophrenia is genetically 'complex'. Trials may benefit from designs including genetically related illnesses, by focussing on cross-cutting aspects of the phenotype such as psychosis or cognitive dysfunction, and by collecting information on possible moderators and mediators of treatment response.Second, schizophrenia affects multiple neurotransmitter systems. Multiple signalling pathways may need to be considered, with different time courses of response. Outcome measures from clinical trials could be collected at more frequent intervals, particularly in the early phase of response.Third, the clinical features used to define the illness are a mix of symptoms and social-occupational dysfunction, yet treatment response is often defined only by changes in symptoms. Multiple measures of functioning need to be collected at baseline and at the endpoint of trials. Consensus definitions for response, remission, relapse, recovery and recurrence need to be developed.Fourth, schizophrenia is often highly disabling. Linking treatment response in clinical trials to measures of quality-adjusted life-years will allow comparison with other medical illnesses using common metrics.Fifth, the general health and care of individuals with schizophrenia is often poor. 'Complex' interventions, which include, but are not limited to, antipsychotic medications, need to be designed and tested for the problems facing these patients.Finally, large gaps exist between clinical trials, practice guidelines and patterns of practice. Trials need to be designed to investigate widely used approaches such as antipsychotic polypharmacy, where actual practice diverges from evidence-based guidelines.
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Affiliation(s)
- William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
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21
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Robert PH, Michel E, Van Os J, Altamura AC, Bobes J, Gerlach J, Hellewell JSE, Kasper S, Nabel D. 2-COM : présentation d’un instrument permettant de faciliter la communication entre médecin et soignants en pratique quotidienne. Encephale 2007; 33:60-4. [PMID: 17457295 DOI: 10.1016/s0013-7006(07)91559-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Communication between the patient and the professional carer lies at the heart of all decisions regarding diagnosis and treatment. However, patients and doctors often have divergent views on care needs; 2-COM (for 2-communication) is a simple patient-completed self-report instrument designed in order to facilitate patient-professional carer communication. Aims - To present 2-COM and to examine whether providing patients with an opportunity to identify and discuss their needs would improve communication and induce changes in care. Methods - The 2-COM is a simple list of 20 common problems, or areas of perceived need, that might be experienced by patients with severe mental illness. The list includes problems with housing, relationships, money, lack of activities, psychological distress, sexuality, symptoms and treatment side effects; 2-COM has shown adequate test-retest reliability and is well accepted by patients as a valued aid to communication with their doctor; 134 patients in a clinical diagnosis of schizophrenia or schizoaffective disorder were recruited at seven European centres: Maastricht, Oviedo, Gijon, Hamburg, Copenhagen, Milan and Nice. The assessment took place over 3 out patient clinic visits; at visit 1, the clinician recorded a list of all current interventions, including medication and non-medical treatments, together with demographic information and an assessment of current level of functioning, using the Global Assessment of Functioning scale. Prior to the second visit, patients were randomised to receive either 2-COM or "standard care" - a routine appointment without 2-COM. Immediately after the interview, all patients, whether they had completed 2-COM or not, completed a confidential questionnaire in which they could indicate the perceived quality of communication. Similarly, clinicians completed a repeat of the list of all current interventions, together with an assessment of any changes to the treatment plan implemented after the interview with the patient. Four to six weeks after clinic visit 2, patients attended the clinic for a third, "routine" clinical interview. Both patients and clinicians then completed the same set of post-interview assessments as at visit 2. The 2-COM induced a stable improvement of patient-reported quality of patient-doctor communication (B=0.33, P=0.031), and induced changes in management immediately after the intervention. Treatment change was more likely in patients with more reported needs at the 2-COM and needs most likely to induce treatment changes. In conclusion, the study showed that 2-COM is a useful instrument to expose and subsequently bridge, patient-professional carer discordance on patient needs.
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Affiliation(s)
- P H Robert
- Centre Mémoire de Ressources et de Recherche, CHU Pasteur, Nice, France
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Bramlett RE, Bothe AK, Franic DM. Using preference-based measures to assess quality of life in stuttering. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2006; 49:381-94. [PMID: 16671851 DOI: 10.1044/1092-4388(2006/030)] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 08/05/2005] [Indexed: 05/09/2023]
Abstract
PURPOSE The purpose of this study was to determine whether standard pharmaco-economic preference methods can be used to assess perceived quality of life in stuttering. METHOD Seventy-five nonstuttering adults completed a standardized face-to-face interview that included a rating scale, standard gamble, and time trade-off preference measures for 4 health states (your health and mild, moderate, and severe stuttering) in the context of 2 anchor states (perfect health and death). RESULTS Results showed mean utility values between .443 for severe stuttering estimated using the rating scale technique and .982 for respondents' own current health estimated using a standard gamble technique. A two-way repeated measures analysis of variance and post hoc tests showed significant effects for method, health state, and the interaction. CONCLUSIONS These results confirm that utility estimates can differentiate between stuttering severity levels and that utility scores for stuttering conform to the known properties of data obtained using these standard measurement techniques. These techniques, therefore, can and should be further investigated as potential contributors to complete measurement protocols for the study and treatment of stuttering.
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Affiliation(s)
- Robin E Bramlett
- Department of Communication Sciences and Disorders, University of Georgia, Athens 30602-7153, USA.
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Gasquet I, Tcherny-Lessenot S, Lépine JP, Falissard B. Patient satisfaction with psychotropic drugs: sensitivity to change and relationship to clinical status, quality-of-life, compliance and effectiveness of treatment. Results from a nation-wide 6-month prospective study. Eur Psychiatry 2006; 21:531-8. [PMID: 16388932 DOI: 10.1016/j.eurpsy.2005.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2005] [Accepted: 09/19/2005] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To see if patient satisfaction with psychotropics (PSP) could be used as a patient-oriented outcome variable in the evaluation of PSP drugs in clinical epidemiological studies, relationships between PSP, clinical status, QoL, compliance and the type of antipsychotic were analyzed. Elements of validation of PSP were also assessed. METHOD In a 6-month prospective study, 933 schizophrenic outpatients with initiation or change to their antipsychotic treatment were enrolled. Psychiatrists completed five CGI-SCH scales (positive, negative, cognitive, depressive and global), hospitalization, compliance, and prescription variables. Patients completed PSP, EuroQoL scales, sexual function and compliance variables. RESULTS A satisfactory structural equation model was obtained showing significant relationships PSP/compliance (coef.=0.16), QoL/PSP (coef.=0.37), clinical status/QoL (coef.=0.61), clinical status/compliance (coef.=0.09). Patients receiving olanzapine were more satisfied than patients receiving other atypicals (coef.=012) and had better clinical status than patients treated with typicals (coef.=0.08). Evolution of PSP was related to clinical status, QoL, and continuation of treatment (all P<001). Sensitivity to change of PSP was moderate (effect size=0.2). CONCLUSION PSP produced consistent results in relation to validated outcome variables. However, a single-item measure was not sufficiently sensitive to change. Multi-item questionnaires evaluating different dimensions are needed.
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Affiliation(s)
- Isabelle Gasquet
- National Institute of Health and Medical Research-U669 (Paris-Sud Innovation Group in Adolescent Mental Health Methodology), Maison des Adolescents, Cochin Hospital, Paris, France.
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Rosenheck R, Stroup S, Keefe RSE, McEvoy J, Swartz M, Perkins D, Hsiao J, Shumway M, Lieberman J. Measuring outcome priorities and preferences in people with schizophrenia. Br J Psychiatry 2005; 187:529-36. [PMID: 16319405 DOI: 10.1192/bjp.187.6.529] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Measures have not taken account of the relative importance patients place on various outcomes. AIMS To construct and evaluate a multidimensional, preference-weighted mental health index. METHOD Each of over 1200 patients identified the relative importance of improvement in six domains: social life, energy, work, symptoms, confusion and side-effects. A mental health index was created in which measures of well-being in these six domains were weighted for their personal importance. RESULTS The strongest preference was placed on reducing confusion and the least on reducing side-effects. There was no significant difference between the unweighted and preference-weighted mental health status measures and they had similar correlations with global health status measures. Patients with greater preference for functional activities such as work had less preference for medical model goals such as reducing symptoms and had less symptoms. CONCLUSIONS A preference-weighted mental health index demonstrated no advantage over an unweighted index.
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Affiliation(s)
- Robert Rosenheck
- Northeast Program Evaluation Center (182), VA Connecticut Health Care System, 950 Campbell Avenue, West Haven, CT 06516, USA.
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Bravata DM, Nelson LM, Garber AM, Goldstein MK. Invariance and inconsistency in utility ratings. Med Decis Making 2005; 25:158-67. [PMID: 15800300 DOI: 10.1177/0272989x05275399] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess utilities of composite health states for dependence in activities of daily living (ADLs) for invariance (i.e., when subjects provide a utility of 1 for all health states) and order inconsistency (i.e., when subjects order their utilities such that their utility for a combination of ADL dependencies is greater than their utility for any subset of the combination). METHODS Each of the 400 subjects, age 65 y and older, enrolled in one of several regional medical centers of the Kaiser Permanente Medical Care Program of Northern California and provided standard-gamble utilities for single ADL dependencies (e.g., bathing, dressing, continence) and for dependence in 8 other combinations of ADL dependencies. For order-inconsistent responses, the authors calculated the maximum magnitude of inconsistency as the maximum difference between the utility for the combined ADL dependence health state and that of its inconsistent subset. RESULTS A total of 76 subjects (19%) gave a utility of 1.0 for all health states presented to them; 19 (5%) gave the same utility other than 1.0 for all health states; 130 (33%) gave at least 1 utility < 1.0 and had no order inconsistencies; and 175 (44%) had at least 1 order inconsistency. Invariance was associated with a Mini-Mental Status Examination score < 28.6 (P = 0.01), with education < 12 y (P = 0.004), with race/ethnicity other than non-Hispanic White/Caucasian (P = 0.001), and with shorter time spent on the utility elicitation task (P < 0.0001). Among the inconsistent subjects, 69% had a maximal magnitude of inconsistency that was within 1 standard deviation of the mean utilities. The maximal magnitude of inconsistency was associated with longer time spent on the elicitation task (P < 0.0001) and race/ethnicity other than non-Hispanic White/Caucasian (P = 0.005). The mean (s) utility for dependence in continence among consistent subjects who were not invariant (0.88 [0.24]) was higher than among inconsistent subjects (0.80 [0.27]; P = 0.01). CONCLUSIONS Invariance and order inconsistencies in utility ratings for complex health states occur frequently. Utilities of consistent subjects may differ from those of inconsistent subjects. Utility assessments should attempt to measure and report these patterns.
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Affiliation(s)
- Dena M Bravata
- Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305-6019, USA.
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Revicki DA, Hanlon J, Martin S, Gyulai L, Nassir Ghaemi S, Lynch F, Mannix S, Kleinman L. Patient-based utilities for bipolar disorder-related health states. J Affect Disord 2005; 87:203-10. [PMID: 16005983 DOI: 10.1016/j.jad.2005.03.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Accepted: 03/29/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bipolar disorder is a psychiatric disorder which impacts patient functioning and well-being. With increasing interest in cost-effectiveness of treatments, it is necessary to provide estimates of patient's perspectives on treatment outcomes. This study estimated health state utilities for hypothetical bipolar-related health states and patient's current health from bipolar I patients. METHODS Clinicians completed Young Mania Rating Scale, Montgomery-Asberg Depression Rating Scale, and Global Assessment Score. Patients completed structured standard gamble (SG) utility assessment interviews, and the other patient-based measures. Interviews obtained utilities for hypothetical bipolar-related health states describing symptom severity, functioning and well-being, and treatment-related side effects. RESULTS Ninety-six patients were recruited from psychiatry outpatient practices. Mean utilities for inpatient states ranged from 0.12 to 0.33; outpatient mania states ranged from 0.29 to 0.64; outpatient stable states ranged from 0.53 to 0.85. Mean utility for current health was 0.80 (S.D.=0.22). Patients preferred monotherapy compared with combination therapy health states. Ordinary least squares regression indicated weight gain was associated with a 0.066 decrease in health state utilities (P=0.013). LIMITATIONS Study sample consisted of selected stable and educated patients and small sample sizes may limit generalizability for some utilities. CONCLUSIONS Bipolar disorder patients are capable of participating in utility assessment and providing ratings for hypothetical health states associated with different mood stabilizer treatments.
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Affiliation(s)
- Dennis A Revicki
- Center for Health Outcomes Research, The MEDTAP Institute at United BioSource Corporation, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA.
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Van Os J, Altamura AC, Bobes J, Gerlach J, Hellewell JSE, Kasper S, Naber D, Robert P. Evaluation of the Two-Way Communication Checklist as a clinical intervention. Results of a multinational, randomised controlled trial. Br J Psychiatry 2004; 184:79-83. [PMID: 14702232 DOI: 10.1192/bjp.184.1.79] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients and doctors often have divergent views on care needs. AIMS To examine whether providing patients with an opportunity to identify and discuss their needs would improve communication and induce changes in care. METHOD Patients with schizophrenia (n=134) were randomly allocated to either standard care or use of the Two-Way Communication Checklist (2-COM). Before seeing their clinician for a routine follow-up, participants in the active intervention group were given 2-COM, a list of 20 common needs, and told to indicate those areas they wanted to discuss with their doctor. Outcomes were assessed immediately and again after 6 weeks. RESULTS Using 2-COM induced a stable improvement of patient-reported quality of patient-doctor communication (B=0.33, P=0.031), and induced changes in management immediately after the intervention (OR=3.7, P=0.009; number needed to treat, 6). Treatment change was more likely inpatients with more reported needs, and needs most likely to induce treatment change displayed stronger associations with non-medication than with medication changes. CONCLUSIONS A simple intervention to aid people in discussion of their needs results in improved communication and changes in management.
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Affiliation(s)
- Jim Van Os
- Department of Psychiatry and Neuropsychology, European Graduate School of Neuroscience, Maastricht University, The Netherlands.
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Lenert LA, Sturley A, Rupnow M. Toward improved methods for measurement of utility: automated repair of errors in elicitations. Med Decis Making 2003; 23:67-75. [PMID: 12583456 DOI: 10.1177/0272989x02239649] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines the effects of use of an automated computer protocol to correct a common error in utility elicitations--namely, scoring of a health state with a greater impairment as being more desirable than one with lesser impairment. The authors studied the protocol in a sample of 563 members of the Internet-using public. Results revealed that errors were common (17% of ratings) but were typically successfully repaired (individuals who made only 1 or 2 errors had a 75% chance of repairing them). The values of individuals who repaired errors were similar to those without apparent error. In contrast, individuals who refused to repair errors had lower scores for the best health state in the series and higher ones for the worst health state. Results suggest that the repair procedures were successful and that inclusion of utility scores from individuals who fail to repair illogically ordered ratings may bias estimates of mean utilities.
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Affiliation(s)
- Leslie A Lenert
- Department of Medicine, University of California at San Diego, La Jolla, California, USA.
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van Os J, Altamura AC, Bobes J, Owens DC, Gerlach J, Hellewell JSE, Kasper S, Naber D, Tarrier N, Robert P. 2-COM: an instrument to facilitate patient-professional communication in routine clinical practice. Acta Psychiatr Scand 2002; 106:446-52. [PMID: 12392488 DOI: 10.1034/j.1600-0447.2002.01454.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A simple patient-completed self-report instrument may facilitate patient-professional carer communication. METHOD A 19-item self-report needs schedule was used in a sample of 243 out-patients with non-affective psychosis. Patients and professional carers commented on the usefulness of the instrument. In a subgroup of 95 patient-carer dyads, the professional carer was asked to rate the needs in addition to the patient. RESULTS Patients scored their needs reliably and lower than the professionals (OR = 0.9, 95% CI: 0.9, 0.97). Concordance between patients and professional carers on individual needs was very low. More than 50% of the professional carers and more than 80% of the patients found 2-COM useful. The higher the number of needs indicated by the patient, the greater the discrepancy between patients and professional carers with regard to the usefulness of the schedule. CONCLUSION 2-COM is a useful instrument to expose, and subsequently bridge, patient-professional carer discordance on patient needs.
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Affiliation(s)
- J van Os
- Department of Psychiatry and Neuropsychology, European Graduate School of Neuroscience, Maastricht University, The Netherlands.
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Lenert LA, Sturley A, Watson ME. iMPACT3: Internet-based development and administration of utility elicitation protocols. Med Decis Making 2002; 22:464-74. [PMID: 12458976 DOI: 10.1177/0272989x02238296] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
iMPACT3 (Internet Multimedia Preference Assessment Instrument Construction Tool, version 3) is a software development environment that helps researchers build Internet-capable multimedia utility elicitation software programs. The program is a free, openly accessible Web site (http.// preferences.ucsd.edu/impact3/asp). To develop a utility elicitation software program using iMPACT3, a researcher selects modular protocol components from a library and custom tailors the components to the details of his or her research protocol. iMPACT3 builds a Web site implementing the protocol and downloads it to the researcher's computer. In a study of 75 HIV-infected patients, an iMPACT3-generated protocol showed substantial evidence of construct validity and good internal consistency (logic error rates of 4% to 10% and procedural invariance error rates of 10% to 28%, depending on the elicitation method) but only fair 3- to 6-week test-retest reliability (intraclass correlation coefficient= 0.42 to 0.55). Further work may be needed on specific utility assessment procedures, but this study's results confirm iMPACT3's feasibility in facilitating the collection of health state utility data.
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Affiliation(s)
- L A Lenert
- Veterans Administration Healthcare System, San Diego, CA 92161, USA.
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Abstract
The subjective experience of patients with schizophrenia who are receiving antipsychotic medication has been a neglected research area, as has the satisfaction of patients with their drug treatments. This is unfortunate, as satisfaction with treatment appears to be related strongly to the readiness of patients to take their medication as prescribed, and thereby to outcome. Patients' perceptions of their treatment do not appear to be related strongly to severity of illness or symptom ratings, although there are associations between perceptions of treatment and adverse effects. Surveys of patient experience with typical antipsychotics have tended to indicate high levels of dissatisfaction and perceived adverse effects. There have been a number of surveys of patients' perceptions of treatment with the atypical antipsychotics. These tend to accord with the expectation that a relative freedom from adverse effects with the atypical antipsychotics will be reflected in enhanced levels of satisfaction and perceived well-being. In general, these studies share a number of weaknesses, including small sample sizes, bias in selection of respondents, open treatment and lack of suitable comparator groups. In addition, many have adopted a cross-sectional, rather than longitudinal, approach and have relied on nonvalidated and perhaps idiosyncratic rating measures. Recently, there have been studies of better methodological quality. These, too, have indicated that patients regard the newer treatments more positively than the older regimens. In addition, there is now evidence that the various new-generation antipsychotics may be evaluated differently by patients.
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Schaffer A, Levitt AJ, Hershkop SK, Oh P, MacDonald C, Lanctot K. Utility scores of symptom profiles in major depression. Psychiatry Res 2002; 110:189-97. [PMID: 12057830 DOI: 10.1016/s0165-1781(02)00097-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Utility is a measure of undesirability for a specific health state. This study determines the utility scores for the individual symptoms of depression, and examines the impact that personal experience with depression has on these scores. Seventy-five subjects (19 with current depression, 21 with past depression, and 35 healthy controls) assigned utility scores to each of 10 individual symptoms of depression, and three depression severity profiles. Utility scores were measured using the standard gamble technique. Mean utility scores were used to list the symptoms of depression from most to least undesirable. The three diagnostic groups were compared with respect to the magnitude of undesirability of the depressive symptoms. The results of this study found that individuals assigned different utility scores to different symptoms of depression. The psychological symptoms of depression such as suicidal ideation, guilt and depressed mood were ranked as more undesirable than the somatic symptoms of depression. Each diagnostic group ranked the symptoms of depression in a similar manner. Patients with a current depression were willing to accept a greater risk of death to avoid suffering from lifelong depressive symptoms as compared to patients with a past depression or healthy controls.
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Affiliation(s)
- Ayal Schaffer
- Mood & Anxiety Disorders Program, Department of Psychiatry, Sunnybrook & Women's College Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada.
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Abstract
BACKGROUND Nurse prescribing initiatives have potential to impact on medication management for long-term conditions. Over time, the adverse effects of medications become increasingly onerous. This 'side-effect burden' is particularly heavy for users of antipsychotic medication. Although consensus exists that strategies are needed to alleviate these problems, currently, they are not clearly the responsibility of any one professional group. AIM This paper explores the introduction of nurse-administered evaluation checklists, in relation to nurse prescribing initiatives and division of professional responsibilities for medication management. METHODS This was an observation study, with a quasi-experimental comparator group design, undertaken with clients receiving long-term antipsychotic medication. In both intervention and comparator groups, before and after introduction of evaluation checklists in the intervention group, 20 nurse-client interactions were observed. Problems actioned by the nurses, with and without the checklists, were compared. Stakeholders' views were sought concurrently. FINDINGS Implementation of evaluation checklists increased the numbers of adverse effects detected and actioned by nurses. They also served to apportion aspects of medication management between nurses and medical prescribers. Most actions taken by nurses to alleviate adverse effects concerned clients' physical health and advice on health-promotion. However, the nurses' interventions would have been more effective had they been able to supply clients with certain medicines either by prescribing from the Nurse Prescribers' Formulary or issuing under Patient Group Directions. For some clients, ameliorating the adverse effects of medication would have involved changes to prescribed antipsychotic medication; here decisions were more equivocal. IMPLICATIONS The identification of previously unattended problems, together with the views of service users, suggests that empowering nurses to address the 'care gaps' in medication management may benefit service users. The 'checklist evaluation' approach warrants further investigation, ideally in conjunction with nurse prescribing initiatives.
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Affiliation(s)
- Sue Jordan
- School of Health Science, University of Wales, Swansea, UK.
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Morrow-Howell N, Proctor E, Rozario P. How much is enough? Perspectives of care recipients and professionals on the sufficiency of in-home care. THE GERONTOLOGIST 2001; 41:723-32. [PMID: 11723340 DOI: 10.1093/geront/41.6.723] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE STUDY This study sought to increase knowledge about the impact of rater role on the assessment of in-home supportive care. The authors compared the perspectives of care recipients and professionals on one aspect of the broad concept of quality of care in home care-the sufficiency of the amount of care provided by informal and formal caregivers. DESIGN AND METHOD Sufficiency of home care was assessed through concurrent elderly persons' self-report through telephone interview and nurse clinical report based on in-home interviews with the elder. Care was assessed in terms of the sufficiency of the amount of informal and formal assistance received to meet functional dependency needs. Statistical analyses compared the ratings of elder and professional. RESULTS Professional ratings of the sufficiency of care were significantly lower than those of the elderly care recipients. From the perspective of both care recipients and professionals, sufficiency of care was significantly related to coresidence of elder and caregiver, and to caregiver health. IMPLICATIONS Consistent with previous literature, rater role was found to influence the assessment of the sufficiency of in-home care. Researchers and providers should recognize that care recipient and professional ratings are not interchangeable.
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Affiliation(s)
- N Morrow-Howell
- George Warren Brown School of Social Work, Washington University, St. Louis, MO 63130, USA.
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