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Hjalte F, Norlin JM, Alverbäck-Labberton L, Johansson K, Wikström G, Eldhagen P. Health care resource use, diagnostic delay and disease burden in transthyretin amyloid cardiomyopathy in Sweden. Ann Med 2023; 55:2292686. [PMID: 38096896 PMCID: PMC10732175 DOI: 10.1080/07853890.2023.2292686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
AIMS To estimate healthcare resource use and direct healthcare costs of Transthyretin Amyloid Cardiomyopathy (ATTR-CM) in Sweden over 12 months across severity stages as defined by the New York Heart Association (NYHA). Secondary to investigate the current diagnostic trajectory for patients with ATTR-CM in Sweden. METHODS A stratified inclusion of patients with a confirmed diagnosis of ATTR-CM in different NYHA classes. Data was extracted from medical records in two cardiology clinics in Sweden. Healthcare resource use data were retrospectively collected for 12 months. RESULTS 38 patients were included, of whom 7 were in NYHA class II, 20 in class III and 4 in class IV. The total cost of health care per patient increased from SEK 69,000 (€6800) in NYHA stage II, SEK 219,000 (€21,500) in NYHA stage III, to SEK 638,000 (€62,900) in stage IV, mainly due to an increase in inpatient stays. Mean time (standard deviation, SD) from any cardiac related diagnosis prior to ATTR-CM diagnosis was 3.5 (3.1) years. CONCLUSIONS Advanced ATTR-CM stages are associated with significant healthcare costs, as patients more often require resource-intensive inpatient care. The current diagnostic trajectory of ATTR-CM in this study was characterized by a diagnostic delay of several years.
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Affiliation(s)
- Frida Hjalte
- The Swedish Institute for Health Economics, Lund, Sweden
| | | | | | | | - Gerhard Wikström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Per Eldhagen
- Department of Medicine Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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Alvarado RN, Alle G, Tobar-Jaramillo MA, Palomino LC, Cáceres AG, Rosa JE, Machnicki G, Zazzetti F, Soriano E, Scolnik M. Burden of lupus activity on health care resources utilization in Buenos Aires, Argentina. Lupus 2023; 32:1656-1665. [PMID: 37955177 DOI: 10.1177/09612033231215386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
OBJECTIVE The aim is to analyze health care resource utilization (HCRU) of patients with lupus (SLE) from a health management organization (HMO) in Buenos Aires, Argentina, compared with matched controls and comparing periods of flare, low disease activity, and remission. METHODS This is a retrospective observational study including all SLE incident cases (ACR 1997/SLICC 2012 criteria) between 2000 and 2020 and 5 matched controls. Clinical data and HCRU (medical and nonmedical consultations, lab and imaging tests performed, emergency room visits, hospitalizations, and drugs prescribed) were obtained from administrative databases and electronic medical records. For each patient with SLE, an activity state was determined in every month of follow-up: flare (BILAG A or 2 BILAG B); low disease activity (LLDAS); remission (DORIS definition); or intermediate activity (not fulfilling any of previous). Incidence rates for each HCRU item and incidence rate ratios between SLE and control patients were and between remission and flare periods were calculated. Multivariate negative binomial logistic regression analyses were performed for identification of variables associated with major resource use. RESULTS A total of 62 SLE and 310 control patients were included, 88.7% were women, the median age at diagnosis was 46 years, and were followed for more than 8 years. Patients with SLE contributed with 537.2 patient-years (CI 95% 461.1-613.3) and controls with 2761.9 patient-years (CI 95% 2600.9-2922.8). HCRU in patients with SLE was significantly higher than in controls in all items, even in remission periods. Patients with SLE remained 74.4% of the time in remission, 12.1% in LLDAS, 12.2% in intermediate activity, and 1.3% in flare (there were 64 flares in 36 patients). HCRU was significantly higher during flare periods compared with remission periods. Number of flares was independently associated with emergency department consultations, lab tests and X-ray performed, number of drugs prescribed, and hospitalizations. CONCLUSION Significantly more HCRU was observed in patients with SLE in flare compared to remission periods.
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Affiliation(s)
| | - Gelsomina Alle
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Luis Carlos Palomino
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Javier Eduardo Rosa
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Federico Zazzetti
- Janssen Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, Titusville, NJ, USA
| | - Enrique Soriano
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marina Scolnik
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Platen M, Flessa S, Teipel S, Rädke A, Scharf A, Mohr W, Buchholz M, Hoffmann W, Michalowsky B. Impact of low-value medications on quality of life, hospitalization and costs - A longitudinal analysis of patients living with dementia. Alzheimers Dement 2023; 19:4520-4531. [PMID: 36905286 DOI: 10.1002/alz.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION This study aimed to analyze the impact of low-value medications (Lvm), that is, medications unlikely to benefit patients but to cause harm, on patient-centered outcomes over 24 months. METHODS This longitudinal analysis was based on baseline, 12 and 24 months follow-up data of 352 patients with dementia. The impact of Lvm on health-related quality of life (HRQoL), hospitalizations, and health care costs were assessed using multiple panel-specific regression models. RESULTS Over 24 months, 182 patients (52%) received Lvm at least once and 56 (16%) continuously. Lvm significantly increased the risk of hospitalization by 49% (odds ratio, confidence interval [CI] 95% 1.06-2.09; p = 0.022), increased health care costs by €6810 (CI 95% -707€-14,27€; p = 0.076), and reduced patients' HRQoL (b = -1.55; CI 95% -2.76 to -0.35; p = 0.011). DISCUSSION More than every second patient received Lvm, negatively impacting patient-reported HRQoL, hospitalizations, and costs. Innovative approaches are needed to encourage prescribers to avoid and replace Lvm in dementia care. HIGHLIGHTS Over 24 months, more than every second patient received low-value medications (Lvm). Lvm negatively impact physical, psychological, and financial outcomes. Appropriate measures are needed to change prescription behaviors.
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Affiliation(s)
- Moritz Platen
- German Center for Neurodegenerative Diseases (DZNE), site Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
| | - Steffen Flessa
- Department of General Business Administration and Health Care Management, University of Greifswald, Friedrich-Loeffler-Straße 70, Greifswald, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), site Rostock, Gehlsheimer Str. 20, Rostock, Germany
- Department of Psychosomatic Medicine, University Hospital Rostock, Gehlsheimer Str. 20, Rostock, Germany
| | - Anika Rädke
- German Center for Neurodegenerative Diseases (DZNE), site Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
| | - Annelie Scharf
- German Center for Neurodegenerative Diseases (DZNE), site Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
| | - Wiebke Mohr
- German Center for Neurodegenerative Diseases (DZNE), site Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
| | - Maresa Buchholz
- German Center for Neurodegenerative Diseases (DZNE), site Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald (UMG), Ellernholzstrasse 1-2, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
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Aguiar de Sousa D, Wilkie A, Norrving B, Macey C, Bassetti C, Tiu C, Roth G, Lunde G, Christensen H, Fiehler J, Pezzella FR, Dichgans M, Roaldsen MB, Kelly P, Mikulik R, Sacco S, Caso V, Fischer U. Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020. Eur Stroke J 2023; 8:618-628. [PMID: 37431768 PMCID: PMC10472963 DOI: 10.1177/23969873231186042] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/18/2023] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION We assessed best available data on access and delivery of acute stroke unit (SU) care, intravenous thrombolysis (IVT) and endovascular treatment (EVT) in the European region in 2019 and 2020. PATIENTS AND METHODS We compared national data per number of inhabitants and per 100 annual incident first-ever ischaemic strokes (AIIS) in 46 countries. Population estimates and ischaemic stroke incidence were based on United Nations data and the Global Burden of Disease Report 2019, respectively. RESULTS The estimated mean number of acute SUs in 2019 was 3.68 (95% CI: 2.90-4.45) per one million inhabitants (MIH) with 7/44 countries having less than one SU per one MIH. The estimated mean annual number of IVTs was 21.03 (95% CI: 15.63-26.43) per 100,000 and 17.14% (95% CI: 12.98-21.30) of the AIIS in 2019, with highest country rates at 79.19 and 52.66%, respectively, and 15 countries delivering less than 10 IVT per 100,000. The estimated mean annual number of EVTs in 2019 was 7.87 (95% CI: 5.96-9.77) per 100,000 and 6.91% (95% CI: 5.15-8.67) of AIIS, with 11 countries delivering less than 1.5 EVT per 100,000. Rates of SUs, IVT and EVT were stable in 2020. There was an increase in mean rates of SUs, IVT and EVT compared to similar data from 2016. CONCLUSION Although there was an increase in reperfusion treatment rates in many countries between 2016 and 2019, this was halted in 2020. There are persistent major inequalities in acute stroke treatment in the European region. Tailored strategies directed to the most vulnerable regions should be prioritised.
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Affiliation(s)
- Diana Aguiar de Sousa
- Stroke Center, Lisbon Central University Hospital and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Claudio Bassetti
- Department of Neurology, Inselspital Bern and Medical Faculty, University of Bern, Bern, Switzerland
| | - Cristina Tiu
- Department of Clinical Neurosciences, University of Medicine and Pharmacy ‘Carol Davila’ Bucharest, and Department of Neurology, University Hospital Bucharest, Romania
| | - Greg Roth
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilian University, Munich and German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Melinda B Roaldsen
- Center for Research and Education, University Hospital of North Norway and Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Peter Kelly
- Stroke and Neurology Department, Mater University Hospital and Stroke Clinical Trials Network Ireland, University College Dublin, Dublin, Ireland
| | - Robert Mikulik
- International Clinical Research Center and Department of Neurology, St. Anne’s University Hospital in Brno and Faculty of Medicine at Masaryk University, Brno, Czech Republic
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences University of L’Aquila, L’Aquila, Italy
| | - Valeria Caso
- Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Urs Fischer
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
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Gauthier S, Ismail Z, Goodarzi Z, Ng KP, Rosa-Neto P. Viewpoint: Clinicians' Perspectives on How Disease Modifying Drugs for Alzheimer's Disease Impact Specialty Care. J Prev Alzheimers Dis 2023; 10:339-341. [PMID: 37357267 DOI: 10.14283/jpad.2023.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Clinicians specialized in the diagnosis and management of persons living with early-stage Alzheimer's disease need to enable access, for those meeting criteria, to the new class of disease modifying drugs (DMDs). These drugs act on amyloid β42 and delay progression of symptoms. Thus, there will be interest from patients and families. Over the short term, the use of antibodies administered intravenously with serial MRIs to detect amyloid-related imaging abnormalities (ARIA) may require participation in structured phase 4 studies or in registries with third party funding for support staff and MRI scans. In the mid term, the availability of oral anti-amyloid therapy, likely with lower risk of ARIA, may transform clinical practice to a model of screening suitable patients using plasma biomarkers, with a subsequent rapid referral to a specialized memory clinic. Eventually, the biological profile of patients for amyloid, tau, and inflammation will determine which type of DMD to use. We are optimistic that clinicians will gain confidence with the use DMDs and answer the increasing needs of our aging population.
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Affiliation(s)
- S Gauthier
- Serge Gauthier, Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, 6875 La Salle Blvd - FBC room 3149, Montreal, QC, Canada H4H 1R3,
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Arístegui J, Alfayate-Miguelez S, Carazo-Gallego B, Garrote E, Díaz-Munilla L, Mendizabal M, Méndez-Hernández M, Doménech E, Ferrer-Lorente B, Unsaín-Mancisidor M, Ramos-Amador JT, Illán-Ramos M, Croche-Santander B, Centeno Malfaz F, Rodríguez-Suárez J, Cotarelo Suárez M, San-Martín M, Ruiz-Contreras J. Clinical characteristics, health care resource utilization and direct medical costs of Rotavirus hospitalizations in Spain (2013-2018). Hum Vaccin Immunother 2022; 18:2046961. [PMID: 35435807 PMCID: PMC9196715 DOI: 10.1080/21645515.2022.2046961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rotavirus (RV) is the most common cause of severe gastroenteritis (GE) in infants and young children worldwide and is associated with a significant clinical and economic burden. The objective of this study was to analyze the characteristics, healthcare resource utilization and the direct medical costs related to RVGE hospitalizations in Spain. An observational, multicenter, cross-sectional study was conducted from June 2013 to May 2018 at the pediatric departments of 12 hospitals from different Spanish regions. Children under 5 years of age admitted to the hospital with a confirmed diagnosis of RVGE were selected. Data on clinical characteristics, healthcare resource use and costs were collected from patient records and hospital databases. Most children hospitalized for RVGE did not have any previous medical condition or chronic disease. Forty-seven percent had previously visited the Emergency Room (ER), 27% had visited a primary care pediatrician, and 15% had received pharmacological treatment prior to hospital admission due to an RVGE episode. The average length of a hospital stay for RVGE was 5.6 days, and the mean medical costs of RVGE hospitalizations per episode ranged from 3,940€ to 4,100€. The highest direct medical cost was due to the hospital stay. This study showed a high burden of health resource utilization and costs related to the management of cases of RVGE requiring hospitalization. RV vaccination with high coverage rates should be considered to minimize the clinical and economic impacts of this disease on the health-care system.
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Affiliation(s)
| | | | | | - Elisa Garrote
- Pediatrics, Hospital Universitario de Basurto, Bilbao, Spain
| | | | | | | | - Elia Doménech
- Paediatrics, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Belén Ferrer-Lorente
- Paediatrics, Hospital Germans Trias i Pujol, Badalona, Spain.,Paediatrics, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María Unsaín-Mancisidor
- Paediatrics, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Paediatrics, Hospital Universitario de Donostia, San Sebastián, Spain
| | - José Tomás Ramos-Amador
- Paediatrics, Hospital Universitario de Donostia, San Sebastián, Spain.,Paediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Marta Illán-Ramos
- Paediatrics, Hospital Universitario de Donostia, San Sebastián, Spain.,Paediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Borja Croche-Santander
- Paediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain.,Paediatrics, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Fernando Centeno Malfaz
- Paediatrics, Hospital Juan Ramón Jiménez, Huelva, Spain.,Paediatrics, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Julián Rodríguez-Suárez
- Paediatrics, Hospital Universitario Río Hortega, Valladolid, Spain.,Paediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Manuel Cotarelo Suárez
- Paediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain.,Medical Affairs Department, MSD, Madrid, Spain
| | - María San-Martín
- Paediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain.,Medical Affairs Department, MSD, Madrid, Spain
| | - Jesús Ruiz-Contreras
- Medical Affairs Department, MSD, Madrid, Spain.,Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
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7
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Muacevic A, Adler JR, Hussain A, Raddy KG, Divekar AB, Shrivastava R, Relwani J. Arthroscopic Debridement and Lavage for Osteoarthritis of the Knee: Results From a Low-Resource Setting. Cureus 2022; 14:e31750. [PMID: 36569725 PMCID: PMC9771083 DOI: 10.7759/cureus.31750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Osteoarthritis of the knee is a highly prevalent disease globally, causing strain on healthcare resources and leading to a reduced quality of life. There are many treatments proposed for this condition, from conservative measures like analgesics and physiotherapy to surgical options like arthroscopy and total knee arthroplasty (TKA). Arthroscopic debridement and lavage provide significant improvement in a cohort of patients with particular features and can be a temporizing measure before TKA. This study aimed to investigate the results of this procedure, in a case series in the short-term and mid-term, in a low-resource setting. Methods This was a case series of 20 patients, who presented with clinical and radiographic features of mild to moderate (Kellgren-Lawrence grades I-III) primary osteoarthritis of the knee. Arthroscopic debridement and lavage were performed and the Knee Society Score (KSS) was recorded pre-operatively and post-operatively in the short and mid-term at one month, three months, and twelve months. Statistical analyses was done for correlation, with different variables such as the presence of meniscal pathology, loose bodies, grade of osteoarthritis, malalignment, and body mass index (BMI). Results The KSS improved at one month, three months, and twelve months for all the patients. The improvement in the KSS scores was associated with varus malalignment of less than 10 degrees, a BMI of less than 25, and the presence of loose bodies. There were no adverse events or complications from this study. Conclusions There was a significant improvement in a patient cohort with malalignment of less than 10 degrees, BMI of less than 25, meniscal pathology, and loose bodies. We can therefore recommend arthroscopic debridement and lavage as a temporizing measure before TKA in this particular cohort.
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Khurana A, Patel B, Sharpe R. Geographic Variations in Growth of Radiologists and Medicare Enrollees From 2012 to 2019. J Am Coll Radiol 2022; 19:1006-1014. [PMID: 35961410 DOI: 10.1016/j.jacr.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Analyze changes in the number of Medicare-serving radiologists and Medicare enrollees nationwide and by geographic region and state from 2012 to 2019 to understand variations in allocation of imaging health care services over the past decade. METHODS The number of radiologists submitting claims to Medicare was extracted from the CMS Physician and Other Supplier Public Use File Database. The number of Medicare enrollees by state was obtained from the Kaiser Family Foundation. National-, regional-, and state-level changes in rates of growth of radiologists, Medicare enrollees, and radiologists per 100,000 Medicare enrollees from 2012 to 2019 were tabulated. RESULTS The overall number of radiologists per 100,000 Medicare enrollees was 79.7 in 2012, increasing to 79.9 in 2019. In 2012, the number of radiologists per 100,000 enrollees was lower than the national average in the South (66.9; 16% lower) and Midwest (79.1; 0.7% lower) and higher in the Northeast (98.3; 23% higher) and West (88.8; 11% higher). In 2019, the number of radiologists per 100,000 enrollees was lower than the national average in the South (69.8; 12% lower) only and was higher in the Midwest (81.4; 1.9% higher), Northeast (99.3; 24% higher), and West (80.2; 0.4% higher). By state, there was a 4.2-fold variation in the number of radiologists per 100,000 Medicare enrollees, ranging from 38.8 in Wyoming to 161.4 in Minnesota (200.5 in Washington, DC). DISCUSSION The growth of Medicare-serving radiologists and Medicare enrollees was stable nationally and demonstrated tremendous variations by US region and state. These variations bring to light potential implications for patient access to care and distribution of health care resources.
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Affiliation(s)
- Aditya Khurana
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota.
| | - Bhavika Patel
- Associate Chair of Research, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Richard Sharpe
- Division Chair of Breast Imaging, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
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9
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Breneol S, Curran JA, Macdonald M, Montelpare W, Stewart SA, Martin-Misener R, Vine J. Children With Medical Complexity in the Canadian Maritimes: Protocol for a Mixed Methods Study. JMIR Res Protoc 2022; 11:e33426. [PMID: 35383571 PMCID: PMC9021950 DOI: 10.2196/33426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ongoing developments in the medical field have improved survival rates and long-term management of children with complex chronic health conditions. While the number of children with medical complexity is small, they use a significant amount of health resources across various health settings and sectors. Research to date exploring this pediatric population has relied primarily on quantitative or qualitative data alone, leaving significant gaps in our understanding of this population. OBJECTIVE The objective of this research is to use health administrative and family-reported data to gain an in-depth understanding of patterns of health resource use and health care needs of children with medical complexity and their families in the Canadian Maritimes. METHODS An explanatory sequential mixed methods design will be used to achieve our research objective. Phase 1 of this research will leverage the use of health administrative data to examine the prevalence and health service use of children with medical complexity. Phase 2 will use case study methods to collect multiple sources of family-reported data to generate a greater understanding of their experiences, health resource use, and health care needs. Two cases will be developed in each of the 3 provinces. Cases will be developed through semistructured interviews with families and their health care providers and health resource journaling. Findings will be triangulated from phase 1 and 2 using a joint display table to visually depict the convergence and divergence between the quantitative and qualitative findings. This triangulation will result in a comprehensive and in-depth understanding into the population of children with medical complexity. RESULTS This study will be completed in May 2022. Findings from each phase of the research and integration of the two will be reported in full in 2022. CONCLUSIONS There is a current disconnect between the Canadian health care system and the needs of children with medical complexity and their families. By combining health administrative and family-reported data, this study will unveil critical information about children with medical complexity and their families to more efficiently and effectively meet their health care needs. Results from this research will be the first step in designing patient-oriented health policies and programs to improve the health care experiences, health system use, and health outcomes of children with medical complexity and their families. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33426.
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Affiliation(s)
- Sydney Breneol
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Strengthening Transitions in Care, Izaac Walton Killam Health Centre, Halifax, NS, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Strengthening Transitions in Care, Izaac Walton Killam Health Centre, Halifax, NS, Canada
| | - Marilyn Macdonald
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - William Montelpare
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Samuel A Stewart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Ruth Martin-Misener
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Jocelyn Vine
- Strengthening Transitions in Care, Izaac Walton Killam Health Centre, Halifax, NS, Canada
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Mateos-Nozal J, Pérez-Panizo N, Zárate-Sáez CM, Vaquero-Pinto MN, Roldán-Plaza C, Mejía Ramírez-Arellano MV, Sánchez García E, Garza-Martínez AJ, Cruz-Jentoft AJ. Proactive Geriatric Comanagement of Nursing Home Patients by a New Hospital-Based Liaison Geriatric Unit: A New Model for the Future. J Am Med Dir Assoc 2021; 23:308-310. [PMID: 34958745 PMCID: PMC8709437 DOI: 10.1016/j.jamda.2021.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
During the SARS-CoV-2 pandemic, hospital-based liaison geriatric units (LGUs) were created in Spanish hospitals with the aim to improve health care coordination between nursing homes (NHs) and hospitals. Our university hospital created a comprehensive, proactive LGU serving 31 public and private NHs of different sizes and characteristics to offer support to more than 2500 residents. In the first 3 months of 2021, this LGU performed 1252 assessments (81% as outpatients, 12% at the emergency department, and 7% during hospitalization), avoiding an estimated 49 hospital transfers and 29 hospitalizations. Other activities included giving NHs support and advice during COVID-19 outbreaks, comanagement of selected residents with other hospital-based specialists (implementing telemedicine), and implementation of a protocol that allowed using drugs only approved for hospital use in selected NHs. This model of LGU has been shown to be feasible, to improve residents' health care, and avoid hospital referrals. Long-term care needs to be re-imagined, and hospital geriatric departments need to prove that they are able to offer expertise to support NH health care professionals.
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Affiliation(s)
- Jesús Mateos-Nozal
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
| | - Nuria Pérez-Panizo
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
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11
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Butler CR, Wightman AG. Scarce Health Care Resources and Equity during COVID-19: Lessons from the History of Kidney Failure Treatment. Kidney360 2021; 2:2024-2026. [PMID: 35419528 PMCID: PMC8986052 DOI: 10.34067/kid.0005292021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/22/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Catherine R. Butler
- Division of Nephrology, University of Washington, Seattle, Washington,Veterans Affairs Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | - Aaron G. Wightman
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington,Treuman Katz Center for Pediatric Bioethics, Seattle, Washington
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Adu MK, Shalaby R, Eboreime E, Sapara A, Nkire N, Chawla R, Chima C, Achor M, Osiogo F, Chue P, Greenshaw AJ, Agyapong VI. Text Messaging Versus Email Messaging to Support Patients With Major Depressive Disorder: Protocol for a Randomized Hybrid Type II Effectiveness-Implementation Trial. JMIR Res Protoc 2021; 10:e29495. [PMID: 34643541 PMCID: PMC8552095 DOI: 10.2196/29495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) accounts for 40.5% of disability-adjusted life years caused by mental and substance use disorders. Barriers such as stigma and financial and physical access to care have been reported, highlighting the need for innovative, accessible, and cost-effective psychological interventions. The effectiveness of supportive SMS text messaging in alleviating depression symptoms has been proven in clinical trials, but this approach can only help those with mobile phones. OBJECTIVE This paper presents the protocol for a study that will aim to evaluate the feasibility, comparative effectiveness, and user satisfaction of daily supportive email messaging as an effective strategy compared to daily supportive text messaging as part of the treatment of patients with MDD. METHODS This trial will be carried out using a hybrid type II implementation-effectiveness design. This design evaluates the effectiveness of an implementation strategy or intervention, while also evaluating the implementation context associated with the intervention. Patients with MDD receiving usual care will be randomized to receive either daily supportive email messaging or daily supportive text messaging of the same content for 6 months. The Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the 5-item World Health Organization Well-Being Index will be used to evaluate the effectiveness of both strategies. The implementation evaluation will be guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, as well as the Consolidated Framework for Implementation Research. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. RESULTS Data collection for this trial began in April 2021. We expect the study results to be available within 18 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated emails as a strategy for delivering supportive messages to patients with MDD in comparison to text messaging. CONCLUSIONS The outcome of this trial will have translational impact on routine patient care and access to mental health, as well as potentially support mental health policy decision-making for health care resource allocation. TRIAL REGISTRATION ClinicalTrials.gov NCT04638231; https://clinicaltrials.gov/ct2/show/NCT04638231. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/29495.
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Affiliation(s)
- Medard Kofi Adu
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Adegboyega Sapara
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nnamdi Nkire
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rajan Chawla
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Chidi Chima
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michael Achor
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Felix Osiogo
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Pierre Chue
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vincent Israel Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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13
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Tishutin AA. [The financial mechanisms in health care system and medical services]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2021; 29:1179-1185. [PMID: 34665556 DOI: 10.32687/0869-866x-2021-29-5-1179-1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/26/2021] [Indexed: 06/13/2023]
Abstract
The article considers financial mechanisms applied in provision of medical services in the Russian health care system. The data concerning the structure of state financing and personal expenses of Russian citizens in health care system is presented. The financial resources in the Russian health care system are formed on the basis of mixed model consisting of personal funds of citizens (private sources of financing) and public funds allocated by budget system to implement the program of state guarantees of free medical care to citizens. Nowadays, the citizens have an opportunity to pay the cost of medical services directly when applying to medical organizations and through medical insurance organization, purchasing voluntary medical insurance policy and visiting medical organizations when insurance case occurred. The key goal of financial policy in concerning health care is the implementation of directions contributing to increase of financial sources in the system of medical services provision, population health support and improving efficiency of financial mechanisms application. The effectiveness of use of financial resources in health care determines the efficiency of impact of financial policy on national economy.
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Affiliation(s)
- A A Tishutin
- The Federal State Budget Educational Institution of Higher Education "The A. N. Kosygin Russian State University (Technologies. Design. Art)" 117997 Moscow, Russia,
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Alcázar-Navarrete B, García-Rio F, Sánchez G, Mariscal E, García A, Cuesta M, Uría E, Miravitlles M. Burden of Disease Among Exacerbating Patients with COPD Treated with Triple Therapy in Spain. Int J Chron Obstruct Pulmon Dis 2021; 16:2149-2161. [PMID: 34321874 PMCID: PMC8312318 DOI: 10.2147/copd.s310319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/19/2021] [Indexed: 12/28/2022] Open
Abstract
Background The cost of chronic obstructive pulmonary disease (COPD) in Spain has been studied from different perspectives, but parameters such as the patient's phenotype have seldom been considered. Our aim was to describe the disease burden of COPD patients with frequent exacerbator phenotype, treated with triple therapy. Methods An observational, multicenter study was carried out from December 2017 to November 2018 in pulmonology services among patients ≥40 years with COPD confirmed diagnosis receiving triple therapy (ICS/LAMA/LABA) and history of ≥2 moderate or ≥1 severe exacerbation in the 12 months prior to the inclusion visit. COPD-related healthcare resources were collected over a 12-months period prior to the inclusion visit: pharmacological and non-pharmacological treatments, medical and ER visits, hospitalizations, tests and productivity loss. Costs were updated to €2019. Patients were classified according to blood eosinophil levels: <150 cells/µL and ≥150 cells/µL. Results A total of 306 patients were included (77.1% men), with mean age of 69.9 years. Mean COPD exacerbation rate was 2.5/patient/year and 51.3% of patients had ≥150 cells/µL eosinophil level. On average, for the total population, COPD-related visits/patients/year were 6.2. Resource use in moderate exacerbation was higher in patients with eosinophils ≥150 cells/µL, whereas in severe exacerbation was higher in patients with eosinophils <150cells/µL. According to eosinophil levels, total annual mean (SD) costs/patient accounted for €8382 (9863) and €5144 (5444) for patients with eosinophils <150 cells/µL and ≥150 cells/µL, respectively. Conclusion The impact of exacerbating COPD patients treated with triple therapy in Spain is large, especially among those with eosinophils <150 cells/µL.
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Affiliation(s)
- Bernardino Alcázar-Navarrete
- Respiratory Department. Hospital Universitario Virgen de las Nieves, Granada, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Francisco García-Rio
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | | | | | | | | | - Marc Miravitlles
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Pneumology Department, Hospital Universitari Vall d’Hebron, Vall D’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
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15
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Contal O, Poncin W, Vaudan S, De Lys A, Takahashi H, Bochet S, Grandin S, Kehrer P, Charbonnier F. One-Year Adherence to Continuous Positive Airway Pressure With Telemonitoring in Sleep Apnea Hypopnea Syndrome: A Randomized Controlled Trial. Front Med (Lausanne) 2021; 8:626361. [PMID: 33959620 PMCID: PMC8093813 DOI: 10.3389/fmed.2021.626361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/18/2021] [Indexed: 12/30/2022] Open
Abstract
Study Objective: Telemedicine (TM) for continuous positive airway pressure (CPAP) treated patients may save health-care resources without compromising treatment effectiveness. We assessed the effect of TM (AirView Online System, ResMed) during the CPAP habituation phase on 3-month and 1-year treatment adherence and efficacy in patients with moderate-to-severe obstructive sleep apnea (OSA). Methods: At CPAP initiation, 120 patients diagnosed with OSA were randomized to either usual care (UC) or TM during the habituation phase (clinical registration: ISRCTN12865936). Both groups received a first face-to-face appointment with a sleep care giver at CPAP initiation. Within the following month, 2 other physical visits were scheduled in the UC group whereas two phone consultations were planned in the TM group, in which CPAP parameters were remotely adapted. Additional physical visits were programmed at the patient's request. Face-to-face consultations were scheduled at 3 and 12 months after CPAP initiation. The primary outcome was the mean CPAP daily use over the course of 12 months. Results: Twenty of 60 patients stopped CPAP therapy in the UC group vs. 14 of 60 in the TM group (p = 0.24). In per protocol analysis, mean [95% CI] daily CPAP use among 86 patients still using CPAP at 12 months was 279 [237; 321] min in the 38 patients on UC and 279 [247; 311] min in the 43 patients on TM, mean difference [95% CI]: 0 [−52; 52] min, P = 0.99. Total consultation time per patient was not different between groups, TM: 163 [147; 178] min, UC: 178 [159; 197] min, difference: −15 [−39; 9] min, p = 0.22. Conclusions: Telemedicine during the CPAP habituation phase did not alter daily CPAP use or treatment adherence and did not require more healthcare time. Telemedicine may support clinic attendance for CPAP titration. Clinical Trial Registration: [ISRCTN], identifier [ISRCTN12865936].
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Affiliation(s)
- Olivier Contal
- School of Health Sciences Haute Ecole de Santé Vaud (HESAV), Haute école spécialisée de Suisse occidentale (HES-SO) University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland
| | - William Poncin
- School of Health Sciences Haute Ecole de Santé Vaud (HESAV), Haute école spécialisée de Suisse occidentale (HES-SO) University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland.,Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, oto-rhino-laryngologie (ORL) et Dermatologie, Université Catholique de Louvain, Brussels, Belgium
| | - Stéphanie Vaudan
- Geneva Pulmonary League, Geneva, Switzerland.,Hôpital du Valais, Service de Physiothérapie, Martigny, Switzerland
| | | | | | | | | | - Philippe Kehrer
- Centre de Médecine du Sommeil et de L'éveil, Geneva, Switzerland
| | - Florian Charbonnier
- Service de Pneumologie, Département des Spécialités de Médecine, Hôpitaux Universitaires Genevois (HUG), Geneva, Switzerland
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16
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Sommersguter-Reichmann M, Reichmann G. Distribution of Health Care Resources in Austria - Inequality Assessment of Different Health Care Resources at Different Points in Time. Int J Health Serv 2019; 50:418-430. [PMID: 31821771 DOI: 10.1177/0020731419893058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A major objective of health policy in many countries is to avoid inequality in the distribution of health care resources. Our goal is to provide initial insight into the inequality in the regional distribution of different health care resources per capita and the variation of the inequality over time in Austria to provide starting points for policy recommendations and international comparisons. We also aim to examine whether the type of inequality measure and need-adjustment has an impact on the results. The findings reveal that inequality in the distribution of GPs with contracts with social health insurance is comparably small, but we observe an increase in inequality from 2002 to 2014. In general, there is a clear trend toward private physicians, of whom private specialists preferably open their practices in densely populated areas. Despite considerable reductions in public hospital beds between 2002 and 2014, the distribution across regions remains almost constant. The use of different inequality measures and need-adjustment provides additional insights so that custom-made policies to reduce inequalities can be developed.
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Affiliation(s)
| | - Gerhard Reichmann
- Department of Information Science and Information Systems, Karl-Franzens-University Graz, Graz, Austria
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17
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Kaczynski A, Michalowsky B, Eichler T, Thyrian JR, Wucherer D, Zwingmann I, Hoffmann W. Comorbidity in Dementia Diseases and Associated Health Care Resources Utilization and Cost. J Alzheimers Dis 2019; 68:635-646. [PMID: 30856111 DOI: 10.3233/jad-180896] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND People with dementia (PwD) suffer from coexisting medical conditions, creating complex clinical challenges and increasing the risk of poor outcomes, which could be associated with high healthcare cost. OBJECTIVE To describe the prevalence of comorbidity in PwD and to analyze the association between comorbidity in dementia diseases and healthcare costs from a payer's perspective. METHODS This cross-sectional analysis was based on n = 362 PwD of the DelpHi-MV trial (Dementia: Life-and person-centered help in Mecklenburg-Western Pomerania). Comorbidity was assessed using the Charlson comorbidity index (CCI) and was categorized into low, high, and very high comorbidity. Healthcare resource utilization and unit costs were used to calculate costs. Multivariable regression models were applied to analyze the association between comorbidity and costs. RESULTS Comorbidity was highly prevalent in the sample. 47% of PwD had a very high, 37% a high, and 16% a low comorbidity in addition to dementia. The most prevalent co-existing comorbidity were diabetes mellitus (42%), peripheral vascular disease (28%) and cerebrovascular disease (25%). Total costs significantly increased by 528€ (SE = 214, CI95 = 109-947, p = 0.014) with each further comorbidity, especially due to higher cost for medication and medical aids. Compared with a low comorbidity, a very high comorbidity was significantly associated with 818€ (SE = 168, CI95 = 489-1147, p < 0.001) higher medication costs and 336€ (SE = 161, CI95 = 20-652, p = 0.037) higher cost for medical aids. There were no significant association between a higher comorbidity and cost for formal care services. CONCLUSIONS Comorbidity in PwD represents a substantial financial burden on healthcare payers and is a challenge for patients, healthcare providers, and the health systems. Innovative approaches are needed to achieve a patient-oriented management of treatment and care in comorbid PwD to reduce long-term costs.
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Affiliation(s)
- Anika Kaczynski
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany
| | - Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE) site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald (UMG), Greifswald, Germany
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18
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Aguiar de Sousa D, von Martial R, Abilleira S, Gattringer T, Kobayashi A, Gallofré M, Fazekas F, Szikora I, Feigin V, Caso V, Fischer U. Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries. Eur Stroke J 2018; 4:13-28. [PMID: 31165091 PMCID: PMC6533860 DOI: 10.1177/2396987318786023] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/24/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction Acute stroke unit care, intravenous thrombolysis and endovascular treatment significantly improve the outcome for patients with ischaemic stroke, but data on access and delivery throughout Europe are lacking. We assessed best available data on access and delivery of acute stroke unit care, intravenous thrombolysis and endovascular treatment throughout Europe. Methods A survey, drafted by stroke professionals (ESO, ESMINT, EAN) and a patient organisation (SAFE), was sent to national stroke societies and experts in 51 European countries (World Health Organization definition) requesting experts to provide national data on stroke unit, intravenous thrombolysis and endovascular treatment rates. We compared both pooled and individual national data per one million inhabitants and per 1000 annual incident ischaemic strokes with highest country rates. Population estimates were based on United Nations data, stroke incidences on the Global Burden of Disease Report. Results We obtained data from 44 European countries. The estimated mean number of stroke units was 2.9 per million inhabitants (95% CI 2.3-3.6) and 1.5 per 1000 annual incident strokes (95% CI 1.1-1.9), highest country rates were 9.2 and 5.8. Intravenous thrombolysis was provided in 42/44 countries. The estimated mean annual number of intravenous thrombolysis was 142.0 per million inhabitants (95% CI 107.4-176.7) and 72.7 per 1000 annual incident strokes (95% CI 54.2-91.2), highest country rates were 412.2 and 205.5. Endovascular treatment was provided in 40/44 countries. The estimated mean annual number of endovascular treatments was 37.1 per million inhabitants (95% CI 26.7-47.5) and 19.3 per 1000 annual incident strokes (95% CI 13.5-25.1), highest country rates were 111.5 and 55.9. Overall, 7.3% of incident ischaemic stroke patients received intravenous thrombolysis (95% CI 5.4-9.1) and 1.9% received endovascular treatment (95% CI 1.3-2.5), highest country rates were 20.6% and 5.6%. Conclusion We observed major inequalities in acute stroke treatment between and within 44 European countries. Our data will assist decision makers implementing tailored stroke care programmes for reducing stroke-related morbidity and mortality in Europe.
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Affiliation(s)
- Diana Aguiar de Sousa
- Department of Neurology, University of Lisbon, Hospital de Santa Maria, Lisbon, Portugal
| | - Rascha von Martial
- Department of Neurology, University of Bern, Inselspital, Bern, Switzerland
| | - Sònia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Adam Kobayashi
- Interventional Stroke and Cerebrovascular Disease Treatment Centre, Department of Neuroradiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Istvan Szikora
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Valery Feigin
- National Institute for Stroke & Applied Neurosciences, Auckland, New Zealand
| | - Valeria Caso
- Stroke Unit, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Urs Fischer
- Department of Neurology, University of Bern, Inselspital, Bern, Switzerland
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Chan HS, Ko FWS, Chan JWM, So LKY, Lam DCL, Chan VL, Tam CY, Yu WC. Comorbidities, mortality, and management of chronic obstructive pulmonary disease patients who required admissions to public hospitals in Hong Kong - computerized data collection and analysis. Int J Chron Obstruct Pulmon Dis 2018; 13:1913-1925. [PMID: 29942124 PMCID: PMC6005303 DOI: 10.2147/copd.s163659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background COPD is a common cause for hospital admission. Conventional studies of the epidemiology of COPD involved large patient number and immense resources and were difficult to be repeated. The present study aimed at assessing the utilization of a computerized data management system in the collection and analysis of the epidemiological and clinical data of a large COPD cohort in Hong Kong (HK). Patients and methods It was a computerized, multicenter, retrospective review of the characteristics of patients discharged from medical departments of the 16 participating hospitals with the primary discharge diagnosis of COPD in 1 year (2012). Comparison was made between the different subgroups in the use of medications, ventilatory support, and other health care resources. The mortality of the subjects in different subgroups was traced up to December 31, 2014. The top 10 causes of death were analyzed. Results In total, 9,776 subjects (82.6% men, mean age = 78 years) were identified. Of the 1,918 subjects with lung function coding, 85 (4.4%), 488 (25.5%), 808 (42.1%), and 537 (28.0%) subjects had the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1, 2, 3, and 4 classes, respectively. Patients with higher GOLD classes had higher number of hospital admissions, longer hospital stay, increased usage of noninvasive mechanical ventilation (NIV), combinations of long-acting bronchodilators, and higher mortality. Of the 9,776 subjects, 2,278 (23.3%) received NIV, but invasive mechanical ventilation was uncommon (134 of 9,776 subjects [1.4%]); 4,427 (45.3%) subjects had died by the end of 2014. The top causes of death were COPD, pneumonia, lung cancer, and other malignancies. Conclusion Patients admitted to hospitals for COPD in HK had significant comorbidities, mortality, and imposed heavy burden on health care resources. It is possible to collect and analyze data of a large COPD cohort through a computerized system. Suboptimal coding of lung function results was observed, and underutilization of long-acting bronchodilators was common.
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Affiliation(s)
- Hok Sum Chan
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
| | - Fanny Wai San Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | | | | | | | | | - Cheuk Yin Tam
- Department of Medicine and Geriatrics, Tuen Mun Hospital
| | - Wai Cho Yu
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
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Zienkiewicz E, Zienkiewicz T, Dziaduch S. Regional differences in access to health care in Poland from the perspective of health care resources. Ann Agric Environ Med 2018; 25:77-81. [PMID: 29575871 DOI: 10.5604/12321966.1235169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine disparities in access to the public in Poland, in association of the resources of health care, socio-economic development of Provinces and their level of urbanization. MATERIAL AND METHODS The Provinces were divided into four groups, using the quartile method, according to the urbanization and level of socio-economic development. The socio-economic development level was identified by the Human Development Index (HDI) for each Province. The urbanization level of each Province was determined by the Index of Urbanization (URBI). Disparities level to access to public health care was identified by taxonomic measure of accessibility (TMA), calculated using resources of health care data. TMA index was compared in the different regions, depending on the level of HDI and URBI. RESULTS There was no linear relationship between accessibility to public healthcare and socio-economic development of each tested region, nor between accessibility to public health care in the Provinces and their urbanization level. During the study, the correlation between the TMA and HDI and URBI alsdo produced a negative result. CONCLUSIONS An insufficient number of physicians and the limited value of contracts within the public health service may cause a drop in the availability of the public medical service sector, regardless of regional level of urbanization and socio-economic development.
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Affiliation(s)
- Ewa Zienkiewicz
- Clinic of Paediatric Neurology, Faculty of Paediatrics, Medical University, Lublin, Poland
| | - Tadeusz Zienkiewicz
- Faculty of Earth Sciences and Spatial Planning, Maria Curie-Skłodowska University, Lublin, Poland.
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Abstract
INTRODUCTION AND OBJECTIVE This study examines the geographical variation of amenable mortality in Poland, focusing primarily on the role of health care resources at the level of administrative districts and regions, and selected area socioeconomic characteristics as explanatory factors. The concept was used of amenable mortality, based on the assumption that deaths from certain causes should not occur in the presence of timely and effective health care. MATERIAL AND METHODS Standardized death rates (SDR) from causes considered amenable to health care and, separately, for ischaemic heart disease (IHD), were calculated for each of 379 districts (NUTS 4 level) in Poland in 1991-1995 and 2006-2010, using unit mortality data from the National Causes of Death Register. The analytical procedure involved spatial analysis of the distribution of amenable mortality rates, selection of explanatory variables and fitting multilevel regression models using area-level and regional-level characteristics. RESULTS The results indicate that mortality from conditions which have become amenable to medical intervention has generally decreased in all districts of Poland in the past two decades. Considerable territorial variation in mortality can be observed. Since the 1990s, these differences have been reduced for IHD-related mortality and have increased for amenable mortality. CONCLUSIONS The presented analysis only partly confirms the correlation between variables reflecting the infrastructure of health care resources and the territorial variation in mortality from these two categories of causes of death. Significant correlations with variation in mortality are revealed for the number of primary care physicians (at district level) and the number of specialist practitioners (at regional level). However, after controlling for socioeconomic variables, such as education and low income, the effect of the health care infrastructure-related variables was considerably reduced. The multi-level models also revealed a substantial variation at the regional level, which implies that there are other unobserved contextual influences on amenable mortality at this level.
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Villoro R, Merino M, Hidalgo-Vega A. Quality of life and use of health care resources among patients with chronic depression. Patient Relat Outcome Meas 2016; 7:145-155. [PMID: 27713651 PMCID: PMC5045235 DOI: 10.2147/prom.s101595] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE This study estimates the health-related quality of life and the health care resource utilization of patients diagnosed with chronic depression (CD) in Spain. PATIENTS AND METHODS We used the Spanish National Health Survey 2011-2012, a cross-sectional survey representative at the national level, that selects people aged between 18 and 64 years (n=14,691). We estimated utility indices through the EuroQol five-dimensional descriptive system questionnaire included in the survey. We calculated percentage use of health care resources (medical visits, hospitalizations, emergency services, and drug consumption) and average number of resources used when available. A systematic comparison was made between people diagnosed with CD and other chronic conditions (OCCs). The chi-square test, Mann-Whitney U-test, and Kruskal-Wallis test were used to determine the statistical significance of differences between comparison groups. Multivariate analyses (Poisson regression, logistic regression, and linear regression) were also carried out to assess the relationship between quality of life and consumption of health care resources. RESULTS Approximately, 6.1% of the subjects aged between 18 and 64 years were diagnosed with CD (average age 48.3±11 years, 71.7% females). After controlling for age, sex, and total number of comorbidities, a diagnosis of CD reduced utility scores by 0.09 (P<0.05) vs OCCs, and increased the average number of hospitalizations by 15%, the average number of days at hospital by 51%, and the average number of visits to emergency services by 15% (P<0.05). CD also increased the average number of visits to secondary care by 14% and visits to general practitioners by 4%. People with CD had a higher probability of consuming drugs than people with OCCs (odds ratio [OR]: 1.24, P<0.05), but only 38.6% took antidepressants. CONCLUSION People with CD had significantly lower health-related quality of life than people with OCCs. CD was associated with increased hospital length of stay and involved a higher consumption of emergency services and drugs than OCCs.
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Affiliation(s)
- Renata Villoro
- Department of Health Economics, Instituto Max Weber, Madrid
| | - María Merino
- Department of Health Economics, Instituto Max Weber, Madrid
| | - Alvaro Hidalgo-Vega
- Department of Economics and Finance, University of Castilla-La Mancha, Toledo, Spain
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Ye H, Lee S, Kim H. Effects of Neighborhood Characteristics on Length of Inpatient Stay: Findings from the U.S. National Data. Soc Work Res 2016; 40:117-126. [PMID: 27257365 PMCID: PMC4886271 DOI: 10.1093/swr/svw004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/02/2015] [Accepted: 09/14/2015] [Indexed: 06/05/2023]
Abstract
Using a nationally representative U.S. sample, this study examined the extent to which neighborhood characteristics affected length of inpatient stay (LOS) in the United States. Data were obtained from the 2012 Area Health Resource Files. A total of 3,148 U.S. counties were included in the study. Generalized linear models and the geographically weighted regression model were used to examine the extent to which neighborhood characteristics affected LOS and its spatial variation. Exploratory spatial data analysis was also conducted to examine the geographic patterns in LOS. Hospital bed capacity was found to be the strongest predictor of LOS. Counties with a lower poverty rate, a lower uninsured rate, a higher proportion of female residents, a higher proportion of residents living in urban areas, and more diverse racial groups had a longer LOS. Significant spatial clustering pattern of LOS was also found. Findings suggest that social work professionals should be aware of spatial disparity in health care resources and develop ways of providing equitable health care for vulnerable populations in socioeconomically disadvantaged neighborhoods.
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Affiliation(s)
- Huairen Ye
- is a doctoral student, Department of Geography, College of Arts and Sciences, University of Tennessee, Knoxville. is assistant professor, School of Social Welfare, Soongsil University, Seoul, South Korea. is assistant professor, Department of Geography, College of Arts and Sciences, University of Tennessee, Knoxville. Address correspondence to Sungkyu Lee, School of Social Welfare, Soongsil University, 369 Sangdo-Ro, Dong-gu, Seoul, 156-743, South Korea
| | - Sungkyu Lee
- is a doctoral student, Department of Geography, College of Arts and Sciences, University of Tennessee, Knoxville. is assistant professor, School of Social Welfare, Soongsil University, Seoul, South Korea. is assistant professor, Department of Geography, College of Arts and Sciences, University of Tennessee, Knoxville. Address correspondence to Sungkyu Lee, School of Social Welfare, Soongsil University, 369 Sangdo-Ro, Dong-gu, Seoul, 156-743, South Korea
| | - Hyun Kim
- is a doctoral student, Department of Geography, College of Arts and Sciences, University of Tennessee, Knoxville. is assistant professor, School of Social Welfare, Soongsil University, Seoul, South Korea. is assistant professor, Department of Geography, College of Arts and Sciences, University of Tennessee, Knoxville. Address correspondence to Sungkyu Lee, School of Social Welfare, Soongsil University, 369 Sangdo-Ro, Dong-gu, Seoul, 156-743, South Korea
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Hochman MJ, Wolf S, Zafar SY, Portman D, Bull J, Kamal AH. Comparing Unmet Needs to Optimize Quality: Characterizing Inpatient and Outpatient Palliative Care Populations. J Pain Symptom Manage 2016; 51:1033-1039.e3. [PMID: 27046299 DOI: 10.1016/j.jpainsymman.2015.12.338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/11/2015] [Accepted: 12/22/2015] [Indexed: 11/26/2022]
Abstract
CONTEXT Palliative care (PC) consultation services are available in most hospitals; outpatient services are rapidly growing to meet the needs of patients at earlier stages of the disease trajectory. OBJECTIVES We aimed to compare the unmet needs of PC patients by location of care to better characterize these populations. METHODS This cross-sectional secondary analysis examined patients receiving hospital and outpatient-based PC across 10 community and academic organizations in the Global Palliative Care Quality Alliance. We identified unmet symptom, advance care planning, and functional needs within our database from October 23, 2012 to January 22, 2015. Kruskal-Wallis, chi-square, and Fisher exact tests were performed. RESULTS We evaluated 633 unique patients. Inpatients (n = 216) were older than outpatients (n = 417; 73 vs. 64 years, P < 0.0001). Seventy-six inpatients (38%) had a Palliative Performance Scale score ≤30%; no outpatients did (P < 0.0001). More inpatients rated their quality of life as poor compared with outpatients (39% vs. 21%, P = 0.0001). We found that outpatients presented with more unresolved pain than inpatients (58.5% vs. 4.1%, P < 0.0001). Conversely, more inpatients presented with unresolved anorexia (52.3% vs. 35.8%, P = 0.002) and dysphagia (28.1% vs. 5.4%, P < 0.0001) than outpatients. We found that inpatient setting was independently associated with lower performance status (odds ratio = 0.068, 95% confidence interval = 0.038-0.120, P < 0.0001). CONCLUSION Compared with inpatients, outpatients are more burdened by pain at first PC encounter yet experience higher quality of life and better performance status. These findings suggest different clinician skillsets, and assessments are needed depending on the setting of PC consultation.
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Affiliation(s)
| | - Steven Wolf
- Duke Biostatistics Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Syed Yousuf Zafar
- Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Diane Portman
- Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Janet Bull
- Four Seasons Compassion for Life, Hendersonville, North Carolina, USA
| | - Arif H Kamal
- Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA; Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
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Saw Chien G, Chee-Khoon C, Wai VHC, Ng CW. Equitable Distribution of Public Hospitals According to Health Needs in Malaysia: Does It Exist or Not? Asia Pac J Public Health 2015; 27:79S-85S. [PMID: 26116582 DOI: 10.1177/1010539515591847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of ensuring geographic equity of health care can be achieved if the geographic distribution of health care services is according to the health needs. This study aims to examine whether acute Ministry of Health hospital beds are distributed according to population health needs in various states within Peninsular Malaysia. The health needs of each state are indicated by the crude death rate. Comparisons of the share of hospital beds to that of population with differential health needs were assessed using concentration curve and index. In most years between 1995 and 2010, the distribution of hospital beds in Peninsular Malaysia were concentrated among states with higher health needs. This is in line with the principle of vertical equity and could be one advantage of a central federal government that can allocate health care resources to prioritize states with higher health care needs.
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Affiliation(s)
| | | | | | - Chiu Wan Ng
- University of Malaya, Kuala Lumpur, Malaysia
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Davis SA, Huang KE, Feldman SR, Fleischer AB, Huang WW. Trends in Ambulatory Health Care Usage for Adult Acne. J Cutan Med Surg 2015; 19:377-9. [PMID: 25775611 DOI: 10.1177/1203475415573775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence of acne is increasing among young children but not well characterized in older patients. OBJECTIVE To determine whether ambulatory health care for adult acne is increasing and whether the average age of adult acne patients seeking care has been increasing over time. METHODS We performed a retrospective analysis of data from the 1993-2010 National Ambulatory Medical Care Survey for acne visits in ages 25 and older. RESULTS Average age of adult acne patients increased by 0.13 years per year over the study period. Visits per 100,000 population declined in the 25 to 34 age group (P=.05) and did not change significantly in the 35 to 44 and 45 and older age groups. CONCLUSIONS The hypothesis that adult acne visits are increasing was not supported, but the average age of adult acne patients seeking care has been rising.
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Affiliation(s)
- Scott A Davis
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Karen E Huang
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alan B Fleischer
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - William W Huang
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Vuorinen AL, Leppänen J, Kaijanranta H, Kulju M, Heliö T, van Gils M, Lähteenmäki J. Use of home telemonitoring to support multidisciplinary care of heart failure patients in Finland: randomized controlled trial. J Med Internet Res 2014; 16:e282. [PMID: 25498992 PMCID: PMC4275484 DOI: 10.2196/jmir.3651] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/10/2014] [Accepted: 11/05/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Heart failure (HF) patients suffer from frequent and repeated hospitalizations, causing a substantial economic burden on society. Hospitalizations can be reduced considerably by better compliance with self-care. Home telemonitoring has the potential to boost patients' compliance with self-care, although the results are still contradictory. OBJECTIVE A randomized controlled trial was conducted in order to study whether the multidisciplinary care of heart failure patients promoted with telemonitoring leads to decreased HF-related hospitalization. METHODS HF patients were eligible whose left ventricular ejection fraction was lower than 35%, NYHA functional class ≥2, and who needed regular follow-up. Patients in the telemonitoring group (n=47) measured their body weight, blood pressure, and pulse and answered symptom-related questions on a weekly basis, reporting their values to the heart failure nurse using a mobile phone app. The heart failure nurse followed the status of patients weekly and if necessary contacted the patient. The primary outcome was the number of HF-related hospital days. Control patients (n=47) received multidisciplinary treatment according to standard practices. Patients' clinical status, use of health care resources, adherence, and user experience from the patients' and the health care professionals' perspective were studied. RESULTS Adherence, calculated as a proportion of weekly submitted self-measurements, was close to 90%. No difference was found in the number of HF-related hospital days (incidence rate ratio [IRR]=0.812, P=.351), which was the primary outcome. The intervention group used more health care resources: they paid an increased number of visits to the nurse (IRR=1.73, P<.001), spent more time at the nurse reception (mean difference of 48.7 minutes, P<.001), and there was a greater number of telephone contacts between the nurse and intervention patients (IRR=3.82, P<.001 for nurse-induced contacts and IRR=1.63, P=.049 for patient-induced contacts). There were no statistically significant differences in patients' clinical health status or in their self-care behavior. The technology received excellent feedback from the patient and professional side with a high adherence rate throughout the study. CONCLUSIONS Home telemonitoring did not reduce the number of patients' HF-related hospital days and did not improve the patients' clinical condition. Patients in the telemonitoring group contacted the Cardiology Outpatient Clinic more frequently, and on this way increased the use of health care resources. TRIAL REGISTRATION Clinicaltrials.gov NCT01759368; http://clinicaltrials.gov/show/NCT01759368 (Archived by WebCite at http://www.webcitation.org/6UFxiCk8Z).
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Stein ML, Rudge JW, Coker R, van der Weijden C, Krumkamp R, Hanvoravongchai P, Chavez I, Putthasri W, Phommasack B, Adisasmito W, Touch S, Sat LM, Hsu YC, Kretzschmar M, Timen A. Development of a resource modelling tool to support decision makers in pandemic influenza preparedness: The AsiaFluCap Simulator. BMC Public Health 2012; 12:870. [PMID: 23061807 PMCID: PMC3509032 DOI: 10.1186/1471-2458-12-870] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 10/10/2012] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Health care planning for pandemic influenza is a challenging task which requires predictive models by which the impact of different response strategies can be evaluated. However, current preparedness plans and simulations exercises, as well as freely available simulation models previously made for policy makers, do not explicitly address the availability of health care resources or determine the impact of shortages on public health. Nevertheless, the feasibility of health systems to implement response measures or interventions described in plans and trained in exercises depends on the available resource capacity. As part of the AsiaFluCap project, we developed a comprehensive and flexible resource modelling tool to support public health officials in understanding and preparing for surges in resource demand during future pandemics. RESULTS The AsiaFluCap Simulator is a combination of a resource model containing 28 health care resources and an epidemiological model. The tool was built in MS Excel© and contains a user-friendly interface which allows users to select mild or severe pandemic scenarios, change resource parameters and run simulations for one or multiple regions. Besides epidemiological estimations, the simulator provides indications on resource gaps or surpluses, and the impact of shortages on public health for each selected region. It allows for a comparative analysis of the effects of resource availability and consequences of different strategies of resource use, which can provide guidance on resource prioritising and/or mobilisation. Simulation results are displayed in various tables and graphs, and can also be easily exported to GIS software to create maps for geographical analysis of the distribution of resources. CONCLUSIONS The AsiaFluCap Simulator is freely available software (http://www.cdprg.org) which can be used by policy makers, policy advisors, donors and other stakeholders involved in preparedness for providing evidence based and illustrative information on health care resource capacities during future pandemics. The tool can inform both preparedness plans and simulation exercises and can help increase the general understanding of dynamics in resource capacities during a pandemic. The combination of a mathematical model with multiple resources and the linkage to GIS for creating maps makes the tool unique compared to other available software.
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Affiliation(s)
- Mart Lambertus Stein
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, 3720, BA, The Netherlands
- Utrecht Centre for Infection Dynamics, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584, CX, Netherlands
| | - James W Rudge
- Communicable Disease Policy Research Group, London School of Hygiene and Tropical Medicine, Mahidol University, Satharanasukwisit Building, 420/1 Rajvithi Road, Bangkok, 10400, Thailand
| | - Richard Coker
- Communicable Disease Policy Research Group, London School of Hygiene and Tropical Medicine, Mahidol University, Satharanasukwisit Building, 420/1 Rajvithi Road, Bangkok, 10400, Thailand
| | - Charlie van der Weijden
- Municipal Health Service (GGD), Flevoland, Post box 1120, Lelystad, 8200 BC, The Netherlands
| | - Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, Hamburg, 20359, Germany
- Hamburg University of Applied Sciences, Lohbrügger Kirchstrasse 65, Hamburg, 21033, Germany
| | - Piya Hanvoravongchai
- Department of Preventive and Social Medicine, Faculty of Medicine Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Irwin Chavez
- Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Weerasak Putthasri
- International Health Policy Program - Thailand, Ministry of Public Health, Tiwanond Road, Amphur Muang, Nonthaburi, 11000, Thailand
| | - Bounlay Phommasack
- National Emerging Infectious Diseases Coordination Office, Ministry of Health, Simoung, Sisatanak District, Vientiane, Lao PDR
| | - Wiku Adisasmito
- Faculty of Public Health, University of Indonesia, UI Campus, Depok, 16424, Indonesia
| | - Sok Touch
- Department of Communicable Disease Control, Ministry of Health, No. 151-153 Kampuchea Krom Blvd, Phnom Penh, Cambodia
| | - Le Minh Sat
- Ministry of Science and Technology of the Socialist Republic of Vietnam, 113 Tran Duy Hung street, Ha Noi, Vietnam
| | - Yu-Chen Hsu
- Centers for Disease Control, R.O.C. (Taiwan), Taipei City, 10050, Taiwan R.O.C
| | - Mirjam Kretzschmar
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, 3720, BA, The Netherlands
- Utrecht Centre for Infection Dynamics, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584, CX, Netherlands
| | - Aura Timen
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, 3720, BA, The Netherlands
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