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Trümmler J, Razum O, Poetter AR, Sauzet O. [Self-help measures as determinants of emergency department utilization among people with and without a migration history in Germany]. DAS GESUNDHEITSWESEN 2024; 86:346-353. [PMID: 37816383 PMCID: PMC11077547 DOI: 10.1055/a-2098-3597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
INTRODUCTION We analyzed whether there were differences between people with and without migration history in their implementation of self-help measures before they accessed the services of an emergency department and if there was an association between self-help measures and an appropriate utilization of emergency departments. METHODS The data basis of this secondary analysis is the EUMaR study, which was conducted from July 2018 to July 2019 and aimed to identify causes contributing to inappropriate and frequent use of emergency departments by migrants. Our study aimed to analyze the differences in self-help measures carried out by the population groups using several multiple logistic regressions. The association between self-help measures implemented and appropriate emergency department utilization was quantified using a multiple logistic regression as well as interactions. RESULTS The odds of first-generation migrants visiting an emergency department on their own initiative (OR=1.28; 95% CI, 1.01-1.61) was high compared to people without migrant history. Furthermore, the odds of their doing something by themselves against their complaints (OR=0.70; 95% CI, 0.56-0.86) were low. The odds of appropriate utilization of emergency services by respondents who self-initiated a visit to an emergency department were lower (OR=0.41; 95% CI, 0.34-0.50). The odds of appropriate utilization of emergency department services by respondents who had previously measured vital signs (e. g., blood pressure) were higher (OR=1.28; 95% CI, 1.02-1.59). CONCLUSION Barriers to the health care system as well as to general practitioners, medicines or medical aids among first-generation migrants could explain the increased odds of their visiting an emergency department on their own and the lower odds of their doing something by themselves about their complaints. A hypothesis of our study is that measuring vital signs may help to better assess individual health status.
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Affiliation(s)
- Jannis Trümmler
- Department of Epidemiology & International Public Health,
School of Public Health, Bielefeld University, Bielefeld, Germany
- Institute of Medical Sociology, Centre for Health and Society, Medical
Faculty, Heinrich Heine University Duesseldorf, Dusseldorf,
Germany
| | - Oliver Razum
- Department of Epidemiology & International Public Health,
School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Anna Rahel Poetter
- Campus Virchow Clinic, Clinic for Gynecology with Center for
Oncological Surgery, Charité University Medicine Berlin, Berlin,
Germany
| | - Odile Sauzet
- Department of Epidemiology & International Public Health,
School of Public Health, Bielefeld University, Bielefeld, Germany
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2
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Tischler L, Beyer A, Moon K, Hoffmann W, van den Berg N. Effects of Closure of the Paediatric Department of a District Hospital on Regional Care: Analysis of Patient Flows. DAS GESUNDHEITSWESEN 2023; 85:S205-S211. [PMID: 37751757 PMCID: PMC10662054 DOI: 10.1055/a-2130-2479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND The consequences of economization and staff shortage in the German health care system strongly affect paediatric care structures, especially in rural regions. It is not known how closures of paediatric departments influence patient flows of surrounding hospitals. Here, we investigate the quantitative effects of closure of the paediatric department of a district hospital and the subsequent opening of an alternative inpatient service on the utilisation of inpatient and outpatient care services of the two neighboring hospitals and the emergency services of the region. METHODOLOGY In the observation period from 2015 to 2019, patient-related data from the three hospitals in the study region as well as data from the rescue service were evaluated. RESULTS In the year after the paediatric department of the district hospital was closed in 2016, the total number of inpatient cases in the region decreased by 33% (2015: n=1,787; 2016: n=1,193) and then decreased by an additional 11% (2019: n=1,005). The number of outpatient cases decreased by further 8% (2015: n=6,250; 2019: n=5,770). In the last observation year, emergency services were used much more frequently than in the year before the closure (2015: n=398; 2019: n=572). This means an increase of 44%. CONCLUSION After the closure of the paediatric department, the total number of inpatient cases in the region fell sharply. However, actual gaps in care apparently did not arise. Before closing, the consequences for the surrounding hospitals should be assessed more precisely. Real gaps in care must be counteracted, e. g. through alternative outpatient services.
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Affiliation(s)
- Luisa Tischler
- Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin
Greifswald Institut für Community Medicine, Greifswald, Germany
| | - Angelika Beyer
- Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin
Greifswald Institut für Community Medicine, Greifswald, Germany
| | - Kilson Moon
- Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin
Greifswald Institut für Community Medicine, Greifswald, Germany
| | - Wolfgang Hoffmann
- Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin
Greifswald Institut für Community Medicine, Greifswald, Germany
| | - Neeltje van den Berg
- Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin
Greifswald Institut für Community Medicine, Greifswald, Germany
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Koh VTJ, Ong RHS, Chow WL, Tiah L, Oh HC, Yow WQ, Sharma S, Huat Yap JC. Understanding patients' health-seeking behaviour for non-emergency conditions: a qualitative study. Singapore Med J 2023:384043. [PMID: 37675670 DOI: 10.4103/singaporemedj.smj-2020-494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
| | | | - Wai Leng Chow
- Epidemiology and Disease Control, Ministry of Health, Singapore
| | - Ling Tiah
- Accident and Emergency Department, Changi General Hospital, Singapore
| | - Hong Choon Oh
- Health Services Research, Changi General Hospital, Singapore
| | - Wei Quin Yow
- Humanities Arts and Social Sciences, Singapore University of Technology and Design, Singapore
| | - Shrutivandana Sharma
- Engineering Systems and Design, Singapore University of Technology and Design, Singapore
| | - Jason Chin Huat Yap
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Oh HC, Sridharan S, Yap MF, Goh PSK, Lee LSH, Venkataraman N, How CH, Lim HC. Impact of a primary care partnership programme on accident and emergency attendances at a regional hospital in Singapore: a pilot study. Singapore Med J 2023; 64:534-537. [PMID: 34628785 PMCID: PMC10476921 DOI: 10.11622/smedj.2021157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Hong Choon Oh
- Health Services Research, Changi General Hospital, Singapore
| | | | - Mei Foon Yap
- Integrated Care, Singapore Health Services, Singapore
| | | | | | | | - Choon How How
- Family Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Hoon Chin Lim
- Accident and Emergency, Changi General Hospital, Singapore
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Kuan WS, Kumar R, Yau YW, Ng WM, Chia DWJ, Ng EY, Lather KS, Chua MT. Headache in the Emergency Department: A Multicenter Observational Study from Singapore. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1340. [PMID: 37512151 PMCID: PMC10384407 DOI: 10.3390/medicina59071340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: There is scarce data about the epidemiology, clinical features, investigations, diagnosis, treatment, and outcome in patients attending Singapore emergency departments (EDs) with nontraumatic headache. We sought to describe these characteristics of adult patients presenting to the ED with a primary complaint of headache. Materials and Methods: We performed a cross-sectional study on adult patients with nontraumatic headache over 4 consecutive weeks from 18 March 2019 to 14 April 2019 across four EDs in Singapore. Exclusion criteria were history of head trauma within 48 h of presentation, missing records, interhospital transfers, representation with the same headache as a recent previous visit and headache as an associated symptom. Results: During the study period, 579 patients (representing 1.8% of the total ED census) comprising 55.3% males and with a median age of 36 years presented to the four Singapore EDs with a primary complaint of nontraumatic headache. Paracetamol (41.5%), non-steroidal anti-inflammatory drugs (34.4%) and tramadol (31.5%) were the three commonest analgesics used either singly or in combination. Prochlorperazine (22.9%) and metoclopramide (17.4%) were frequent anti-emetic adjuncts. One-third of patients had computed tomography of the brain performed, which found abnormalities among 20.9% of them. ED diagnoses of primary headache conditions were made in 73.6% of patients. Conclusions: Primary headaches constituted most ED headache diagnoses. ED imaging of selected patients yielded a relatively high pick-up rate for significant intracranial abnormalities. Opioid use for symptomatic relief of headaches in the ED was found to be high, underscoring the need for improvement in headache analgesia relief practices in the ED.
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Affiliation(s)
- Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Ranjeev Kumar
- Acute & Emergency Care Centre, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore
| | - Ying Wei Yau
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Wei Ming Ng
- Emergency Department, Ng Teng Fong General Hospital, National University Health System, Singapore 609606, Singapore
| | - Dennis Wen Jie Chia
- Emergency Department, Sengkang General Hospital, Singapore Health Services, Singapore 544886, Singapore
| | - Ee Yang Ng
- Acute & Emergency Care Centre, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore
| | - Kanwar Sudhir Lather
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Mui Teng Chua
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
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Hospital crowdedness evaluation and in-hospital resource allocation based on image recognition technology. Sci Rep 2023; 13:299. [PMID: 36609446 PMCID: PMC9822910 DOI: 10.1038/s41598-022-24221-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 11/11/2022] [Indexed: 01/09/2023] Open
Abstract
How to allocate the existing medical resources reasonably, alleviate hospital congestion and improve the patient experience are problems faced by all hospitals. At present, the combination of artificial intelligence and the medical field is mainly in the field of disease diagnosis, but lacks successful application in medical management. We distinguish each area of the emergency department by the division of medical links. In the spatial dimension, in this study, the waitlist number in real-time is got by processing videos using image recognition via a convolutional neural network. The congestion rate based on psychology and architecture is defined for measuring crowdedness. In the time dimension, diagnosis time and time-consuming after diagnosis are calculated from visit records. Factors related to congestion are analyzed. A total of 4717 visit records from the emergency department and 1130 videos from five areas are collected in the study. Of these, the waiting list of the pediatric waiting area is the largest, including 10,436 (person-time) people, and its average congestion rate is 2.75, which is the highest in all areas. The utilization rate of pharmacy is low, with an average of only 3.8 people using it at the one time. Its average congestion rate is only 0.16, and there is obvious space waste. It has been found that the length of diagnosis time and the length of time after diagnosis are related to age, the number of diagnoses and disease type. The most common disease type comes from respiratory problems, accounting for 54.3%. This emergency department has congestion and waste of medical resources. People can use artificial intelligence to investigate the congestion in hospitals effectively. Using artificial intelligence methods and traditional statistics methods can lead to better research on healthcare resource allocation issues in hospitals.
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Pek PP, Lau CY, Sim X, Tan KB, Mao DRH, Liu Z, Ho AF, Liu N, Ong MEH. Nationwide study of the characteristics of frequent attenders with multiple emergency department attendance patterns. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:483-492. [PMID: 36047523 DOI: 10.47102/annals-acadmedsg.2021483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The burden of frequent attenders (FAs) of emergency departments (EDs) on healthcare resources is underestimated when single-centre analyses do not account for utilisation of multiple EDs by FAs. We aimed to quantify the extent of multiple ED use by FAs and to characterise FAs. METHODS We reviewed nationwide ED attendance in Singapore data from 1 January 2006 to 31 December 2018 (13 years). FAs were defined as patients with ≥4 ED visits in any calendar year. Single ED FAs and multiple ED FAs were patients who attended a single ED exclusively and ≥2 distinct EDs within the year, respectively. Mixed ED FAs were patients who attended a mix of a single ED and multiple EDs in different calendar years. We compared the characteristics of FAs using multivariable logistic regression. RESULTS We identified 200,130 (6.3%) FAs who contributed to1,865,704 visits (19.6%) and 2,959,935 (93.7%) non-FAs who contributed to 7,671,097 visits (80.4%). After missing data were excluded, the study population consisted of 199,283 unique FAs. Nationwide-linked data identified an additional 15.5% FAs and 29.7% FA visits, in addition to data from single centres. Multiple ED FAs and mixed ED FAs were associated with male sex, younger age, Malay or Indian ethnicity, multiple comorbidities, median triage class of higher severity, and a higher frequency of ED use. CONCLUSION A nationwide approach is needed to quantify the national FA burden. The multiple comorbidities and higher frequency of ED use associated with FAs who visited multiple EDs and mixed EDs, compared to those who visited a single ED, suggested a higher level of ED burden in these subgroups of patients. The distinct characteristics and needs of each FA subgroup should be considered in future healthcare interventions to reduce FA burden.
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Affiliation(s)
- Pin Pin Pek
- Pre-hospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore
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8
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Dundar C, Yaylaoglu SD. Non-emergent care visits in a turkish tertiary care emergency department after 2008 health policy changes: review and analysis. Arch Public Health 2022; 80:31. [PMID: 35039087 PMCID: PMC8762921 DOI: 10.1186/s13690-022-00787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background The Turkish government liberalized national healthcare policies in 2008 enabling Turkish citizens to seek general care in hospital emergency departments (ED). The number of ED visits has exceeded the total population every year for the last ten years. To explain this phenomenon and to identify trends and risk factors for non-emergent visits, we retrospectively reviewed the ED records of a tertiary hospital and the Turkish Ministry of Health bulletin. Methods This retrospective record-based study was conducted at a tertiary hospital in Samsun province of Turkey. A total of 87,528 records of adult patients who visited the ED between January 1 and December 31, 2017, were included in this study. We evaluated the pattern of ED use for non-emergent patients by age, gender, nationality, time of visit, means of arrival, ICD (International Classification of Diseases) diagnostic codes, triage codes, number of repeated and out-of-hours visits. We used the Turkish Ministry of Health statistics bulletins to compare the number of ED visits across the country by year. Results The non-emergent visit rate in ED was found 9.9%. The rate of non-emergent ED visits was significantly higher in the 18-44 age group, in the female gender, and in those who arrived at the ED without an ambulance. The number of non-emergent visits was very similar between weekends and weekdays but was significantly higher in working hours on weekdays than out-of-hours (p<0.001). The most frequent diagnostic code was “Pain, unspecified” (R52) and the rate of repeat visits was 14.8% of non-emergent ED visits. According to binary logistic analysis, non-emergency visits were associated with 18-44 age group (OR = 2.75), female gender (OR = 1.11) and non-ambulance transportation (OR = 9.86). Conclusions Our results showed that the 18-44 age group and female gender seek care in the ED for non-emergent problems more than the other parts of the population. The numbers of ED visits in the last decade continued to increase regardless of population growth. The health policy changes may have facilitated access to rapid physical and laboratory examination but also an exacerbation of the free-rider problem in ED services.
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Affiliation(s)
- Cihad Dundar
- Department of Public Health, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
| | - Seydanur Dal Yaylaoglu
- Department of Public Health, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Cheng L, Ng WM, Lin Z, Law LSC, Yong L, Liew YST, Yeoh CK, Mathews I, Chor WPD, Kuan WS. Factors reducing inappropriate attendances to emergency departments before and during the COVID-19 pandemic: A multicentre study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:818-826. [PMID: 34877585 DOI: 10.47102/annals-acadmedsg.2021151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Inappropriate attendances (IAs) to emergency departments (ED) create an unnecessary strain on healthcare systems. With decreased ED attendance during the COVID-19 pandemic, this study postulates that there are less IAs compared to before the pandemic and identifies factors associated with IAs. METHODS We performed a retrospective review of 29,267 patient presentations to a healthcare cluster in Singapore from 7 April 2020 to 1 June 2020, and 36,370 patients within a corresponding period in 2019. This time frame coincided with local COVID-19 lockdown measures. IAs were defined as patient presentations with no investigations required, with patients eventually discharged from the ED. IAs in the 2020 period during the pandemic were compared with 2019. Multivariable logistic regression was performed to identify factors associated with IAs. RESULTS There was a decrease in daily IAs in 2020 compared to 2019 (9.91±3.06 versus 24.96±5.92, P<0.001). IAs were more likely with self-referrals (adjusted odds ratio [aOR] 1.58, 95% confidence interval [CI] 1.50-1.66) and walk-ins (aOR 4.96, 95% CI 4.59-5.36), and those diagnosed with non-specific headache (aOR 2.08, 95% CI 1.85-2.34), or non-specific low back pain (aOR 1.28, 95% CI 1.15-1.42). IAs were less likely in 2020 compared to 2019 (aOR 0.67, 95% CI 0.65-0.71) and older patients (aOR 0.79 each 10 years, 95% CI 0.78-0.80). CONCLUSION ED IAs decreased during COVID-19. The pandemic has provided a unique opportunity to examine factors associated with IAs.
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Affiliation(s)
- Lenard Cheng
- Emergency Medicine Department, National University Hospital, Singapore
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10
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Yang Z, Song K, Lin H, Li C, Ding N. Factors Associated with Emergency Department Length of Stay in Critically Ill Patients: A Single-Center Retrospective Study. Med Sci Monit 2021; 27:e931286. [PMID: 34333509 PMCID: PMC8336256 DOI: 10.12659/msm.931286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Length of stay (LOS) in the emergency department (ED) should be measured and evaluated comprehensively as an important indicator of hospital emergency service. In this study, we aimed to analyze clinical characteristics of critically ill patients admitted to the ED and identify the factors associated with LOS. MATERIAL AND METHODS All patients with level 1 and level 2 of the Emergency Severity Index who were admitted to the ED from January 2018 to December 2019 were included in this retrospective study. The patients were divided into 2 groups: LOS ≥4 h and LOS <4 h. Variables were comprehensively analyzed and compared between the 2 groups. RESULTS A total of 19 616 patients, including 7269 patients in the LOS ≥4 h group and 12 347 patients in the LOS <4 group, were included. Advanced age, admission in winter and during the night shift, and diseases excluding nervous system diseases, cardiovascular diseases, and trauma were associated with higher risk of LOS. Nervous system diseases, cardiovascular diseases, trauma, and procedures including tracheal intubation, surgery, percutaneous coronary intervention, and thrombolysis were associated with lower risk of LOS. CONCLUSIONS Prolonged LOS in the ED was associated with increased age and admission in winter and during the night shift, while shortened LOS was associated with nervous system diseases, cardiovascular diseases, and trauma, as well as with procedures including tracheal intubation, surgery, percutaneous coronary intervention, and thrombolysis. Our findings can serve as a guide for ED physicians to individually evaluate patient condition and allocate medical resources more effectively.
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Affiliation(s)
- Zhiwei Yang
- Department of Emergency Medicine, Changsha Central Hospital, University of South China, Changsha, Hunan, China (mainland)
| | - Kun Song
- Department of Emergency Medicine, Changsha Central Hospital, University of South China, Changsha, Hunan, China (mainland)
| | - Hang Lin
- Department of Emergency Medicine, Changsha Central Hospital, University of South China, Changsha, Hunan, China (mainland)
| | - Changluo Li
- Department of Emergency Medicine, Changsha Central Hospital, University of South China, Changsha, Hunan, China (mainland)
| | - Ning Ding
- Department of Emergency Medicine, Changsha Central Hospital, University of South China, Changsha, Hunan, China (mainland)
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Tan LE, Tan WHG, Aziz MIA, Koh MS, Tay TR, Pearce F, Ng K. Assessing the cost-effectiveness of mepolizumab as add-on therapy to standard of care for severe eosinophilic asthma in Singapore. J Asthma 2020; 59:189-199. [PMID: 33058740 DOI: 10.1080/02770903.2020.1837158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of mepolizumab added to standard of care (SOC) compared with SOC alone among patients with severe uncontrolled eosinophilic asthma in the Singapore setting. METHODS A Markov model with three health states (asthma on mepolizumab and SOC, asthma on SOC alone, and death) was developed from a healthcare system perspective over a lifetime horizon. During each 4-week cycle, patients in the non-death health states could experience asthma exacerbations requiring oral corticosteroid burst, emergency department visit, or hospitalization. Asthma-related mortality following an exacerbation or all-cause mortality could also occur at each cycle. The model was populated using local costs while utilities were derived from international literature. Transition probabilities were obtained from a mixture of Singapore-specific and internationally published data. RESULTS The base-case analysis comparing mepolizumab plus SOC with SOC alone resulted in an incremental cost-effectiveness ratio (ICER) of SGD335 486 (USD238 195) per quality-adjusted life-year (QALY) gained. Sensitivity analysis demonstrated that the ICER was most sensitive to the price of mepolizumab, followed by the proportion of exacerbations which required hospital intensive care. Despite restricting mepolizumab use to patients with a higher baseline exacerbation rate (3 in the past year) in a scenario analysis, the ICER remained high at SGD238 876 (USD 169 602) per QALY gained. CONCLUSION At its current price, mepolizumab is not considered a cost-effective use of healthcare resources in Singapore. Substantial price reductions for mepolizumab are required to improve its cost-effectiveness to an acceptable range. These results will be useful to inform national funding decisions.
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Affiliation(s)
- Ling Eng Tan
- Ministry of Health, Agency for Care Effectiveness, Singapore, Singapore
| | | | | | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore.,Office of Clinical, Academic and Faculty Affairs, Duke NUS Medical School, Singapore, Singapore
| | - Tunn Ren Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore
| | - Fiona Pearce
- Ministry of Health, Agency for Care Effectiveness, Singapore, Singapore
| | - Kwong Ng
- Ministry of Health, Agency for Care Effectiveness, Singapore, Singapore
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Lateef F. The Impact of the COVID 19 Pandemic on Emergency Department Attendance: What Seems To Be Keeping the Patients Away? J Emerg Trauma Shock 2020; 13:246-251. [PMID: 33897139 PMCID: PMC8047960 DOI: 10.4103/jets.jets_133_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/22/2020] [Indexed: 01/17/2023] Open
Abstract
During outbreaks such as severe acute respiratory syndrome and COVID 19, many Emergency Departments across the world had a reduction in the general attendance, including the attendance of more serious and critical diagnoses. Here, the author shares the numbers seen at Singapore General Hospital, the largest public hospital in Singapore during the period of February to June 2020. The reduction ranged from 13% to 28% compared to the same period in 2019, before the outbreak. Patient and healthcare system-related factors which may have caused these observations are discussed. The author also puts forth the Behavioral Immune System and Response mechanism as a possible explanation for patients staying away from the hospitals during the outbreak.
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Affiliation(s)
- Fatimah Lateef
- Department of Emergency Medicine, Singapore General Hospital, National University of Singapore, Singapore
- Department of Emergency Medicine, Duke-NUS Graduate Medical School, National University of Singapore, Singapore
- Department of Emergency Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Emergency Medicine, SingHealth Duke NUS Institute of Medical Simulation, Singapore
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13
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Chong SL, Ong MEH. Advancing research in the exciting field of emergency medicine. Singapore Med J 2020; 61:58-59. [PMID: 32152641 DOI: 10.11622/smedj.2020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore
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