Cost-effectiveness of hospice-based palliative care in Kazakhstan

Background

According to the Quality of Death Index, Kazakhstan ranks 50th out of 80 countries assessed. Currently, some form of inpatient end-of life care in Kazakhstan is provided by only 9 hospices, palliative care units and mobile teams. In 2020, the total number of palliative care beds did not exceed 980 across the country, while around 135,000 patients need palliative care at any given time.

Objective: To assess the effectiveness and cost-effectiveness of hospice-based palliative care for cancer patients compared to usual hospital care in cancer centers across Kazakhstan from societal perspective.

Methods

A total of 182 family caregivers were recruited, 104 in a hospice group and 78 in a control (palliative units). Patients’ state of health and family caregivers’ burden been measured using Palliative Outcome Scale (POS) and Zarit Burden Inventory (ZBI) on 14th day of the inpatient palliative care. Direct and indirect medical costs as well as family caregivers’ out-of-pocket expenses associated with the care has been collected. The cost-effectiveness analysis was conducted by calculating the difference between mean cost of treatment, including OOPs, over 14 days of treatment. Uncertainty around the cost-effectiveness estimates was explored by generating 10,000 resamples using bootstrapping.

Results

At 14 days, patients’ mean quality of life was 2,4 points better (95% CI: 0,06 - 4,9) in the hospice group compared to the control. Family caregiver burden was 4,6 points better in the hospice group (95% CI: -0,26 - 9.3). Mean treatment costs, including direct medical costs and out-of-pocket expenditures over 14 days were $31 lower for the hospice group (95% CI: $29 - $32). There was a significant correlation between the total cost of treatment and patients’ quality of life (rxy = 0,58; p < 0,01). The cost-effectiveness plane graphically represents 10,000 replications, 85% of them showed that hospice care has better outcomes and lower costs than the control group.

Key messages

• Hospice-based palliative care is cost-effective compared to the care provided in palliative units of cancer centers.

• There is a significant correlation between patients’ quality of life and family caregivers’ burden.

The impact of depression on satisfaction with prenatal care in Kazakhstan during COVID-19 pandemic

Background

Depression and anxiety are common during perinatal periods, representing a considerable public health concern during global pandemic. Only few studies have examined the influence of emotional disturbances on satisfaction with maternity care. This study aimed to assess the prevalence of satisfaction with prenatal care and to examine its association with depression and anxiety among pregnant women in Kazakhstan.

Methods

Participants were recruited to this online cross-sectional survey in the outpatient clinic in Novoshamalgan, Almaty region (n = 174) in December-January, 2022. A single-item measure of satisfaction was used by asking a question “How satisfied are you with health services?”, scored on a 5-point Likert scale. A simplified 2-item Edinburgh Postpartum Depression Scale and 2-item Generalized Anxiety Disorder scale were used to measure depressive and anxiety symptoms.

Results

Majority of women were very satisfied or satisfied (n = 128; 74%), while less than a third of the sample (n = 46; 26%) were dissatisfied with the received care. The prevalence of depression in the total sample was higher, compared to the prevalence of anxiety (34% versus 18%). Multivariable logistic regression showed that dissatisfaction with prenatal care was associated with older age, not attending check-ups regularly, and being employee of private company or student. Depression increased the odds of being dissatisfied by 2.6 times (95% CI 1.19∼5.79); while obstetric issues and anxiety were not associated with satisfaction. Perception of women about inadequate solution of the problem of antenatal depression was a significant predictor of dissatisfaction (AOR 6.87; 95% CI 1.81∼26.12).

Conclusions

Depressed women in our study were less satisfied with prenatal care. Further investigation of the perception of women about specific aspects of perinatal health services is suggested. Providing a quality, patient-centered care is needed to support pregnant women during the current pandemic.

Key messages

Assessment of unmet needs and barriers to end-of-life care provision in Kazakhstan

Introduction

Palliative care, a holistic multidisciplinary approach for those persons with terminal diseases, providing relief for physical, emotional, psychosocial and spiritual suffering of both the patients and their families and to support the dignity of all involved in the process of dying. The purpose of this qualitative research project is to identify the barriers for end-of-life care provision in Kazakhstan and to provide recommendations on how to integrate and assure high quality palliative care for patients within the cultural context of Kazakhstan.

Methods

Our proposed research project employed qualitative research methods, including semi-structured in-depth interviews using grounded theory. We conducted purposive recruiting with content analysis and semi-structured interviews until saturation was achieved. The interviews have been conducted at the University Medical Center (UMC) teaching hospitals, including National Research Center for Maternal and Child Health and the National Children’s Rehabilitation Center. The total number of participants were 65 individuals, of whom 26 were medical doctors, 20 nurses, 7 speech therapists, 6 psychologists, 4 educators and 2 social workers. All participants had experience working with terminally ill patients, family members, and caregivers. The data was then translated into English. Analysis of the interview data have been performed by using the computer assisted software analysis package - NVivo. Institutional review board (IRB) approval of the Nazarbayev University has been received, assuring informed consent and confidentiality safeguards in the research.

Results

The study findings indicate the evidence of growing demand in training of healthcare professionals, inadequate provision of pain relief and lack of public awareness about palliation as primary obstacles for palliative care development in Kazakhstan.

Key messages

The findings of the study are very important to help stakeholders to focus on the development of training opportunities for palliative care specialists. The results of the study help to develop milestones and concrete strategy for integration of palliative care services into the national healthcare system of Kazakhstan.

Trends in crime and the introduction of a needle exchange program

OBJECTIVES

This study sought to determine whether introduction of a needle exchange program would be associated with increased crime rates.

METHODS

Trends in arrests were compared in program and nonprogram areas before and after introduction of a needle exchange program in Baltimore. Trends were modeled and compared via Poisson regression.

RESULTS

No significant differences in arrest trends emerged. Over the study period, increases in category-specific arrests in program and nonprogram areas, respectively, were as follows: drug possession, 17.7% and 13.4%; economically motivated offenses, 0.0% and 20.7%; resistance to police authority, 0.0% and 5.3%; and violent offenses, 7.2% and 8.0%.

CONCLUSIONS

The lack of association of overall and type-specific arrest data with program implementation argues against the role of needle exchange programs in increasing crime rates.