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C Donaldson

Publications and source records attributed to C Donaldson.

At least 109 records · Page 6Linked to original sources
PubMed1994

An economic view of high compliance as a screening objective.

Accepted wisdom holds that high compliance is essential for a screening programme to be successful. Indeed, a reason that the national breast screening programme is not routinely offered to women aged 65 or more is on the grounds of predicted poor compliance by older women. Increasing compliance is often associated with increased costs. These costs represent a lost opportunity for screening alternative target populations. We question the need for screening programmes to achieve high compliance, and we argue that a screening programme can be efficient with very low levels of compliance. Adopting compliance as a screening objective and as a measure of the success of screening may be detrimental to the efficiency of a screening programme.

Breast Neoplasms↗
PubMed1994

Population screening for low bone mineral density: do non-attenders have a lower risk of osteoporosis?

Poor compliance may be detrimental to the effectiveness of a screening programme if those at greatest risk of the disease do not attend. Therefore we undertook a study to test whether non-attenders to a screening programme for low bone density, a risk factor for osteoporosis, were at a differential risk of low bone density compared with attenders. Seven hundred and eighty-nine women aged 45-49 years living within 32 km of Aberdeen were selected at random from the Community Health Index and invited to attend for screening for low bone density as a risk of factor for osteoporosis. Attenders and non-attenders were surveyed regarding their risk factors for osteoporosis. Non-attenders were significantly heavier than attenders. In addition, 6 non-attenders who subsequently chose to attend had significantly higher body weight and bone mineral density, at Ward's triangle, than initial attenders. Non-attenders to a screening service for bone density may be at lower risk of developing osteoporosis. Non-attendance, therefore, would not be detrimental to the cost-effectiveness of a screening service for bone density. However, this study indicates there is a potential for response bias in studies of bone density and osteoporosis.

Bias↗
PubMed1994

Using economics to assess the place of screening.

To an economist the place of screening is, in principle, no different from that of any other medical intervention. Any screening activity should be evaluated in terms of the costs it incurs and the benefits it produces. The reasoning for this is based on one fundamental principle of economics: that of opportunity cost. Resources are scarce, requiring choices to be made about what health care to provide and what not to provide. Sacrifices will be made through not taking up some opportunities, and the benefits of these sacrifices are known as opportunity costs. The place of economics is to assist decision making to promote efficiency and equity in the health care sector. To do this it is necessary to relate the benefits of any screening activity to its costs. Of course, the practicalities of applying economics to assessment of screening activities may be different than for other areas of health care. For instance, screening has a broader range of outcomes than most types of health care, including investment in knowledge as well as health gain. This does have implications for the way in which these outcomes are valued in an economic analysis. This means that economics can be applied to a wide range of policy questions about screening. In this paper examples from applications of economics are used to consider the following issues: How should we set out and estimate costs and benefits (using the example of cholesterol screening)? What is benefit and how should it be measured (using an example from cystic fibrosis carrier screening)? How can economics be used to examine equity issues in screening (using an example from bone mineral density screening)? Together, these case studies highlight the range of screening issues to which economics can be usefully applied.

Adult↗
PubMed1993

Absent friends.

Explore the source record for details and available documents.

Appointments and Schedules↗
PubMed1993

Recruitment methods for screening programmes: the price of high compliance.

High population compliance is seen as a prerequisite for an equitable screening service. To achieve high compliance fixed appointments are usually advocated. However, the costs of achieving high compliance have not previously been described. To assess the costs of achieving high compliance we have used a randomised trial of two common appointment methods: 800 women aged 45-49 living within 20 miles of Aberdeen were selected at random from the Community Health Index. They were randomly assigned to receive one of two letters--one offering a fixed appointment, the other inviting them to telephone to make an appointment. For a defined population fixed appointments achieved high compliance but only by reducing the opportunities for screening; for every 100 women screened, 110 additional women were denied the opportunity of a screening test. In contrast the open letters of invitation achieved efficiency by increasing the number of women screened with given resources within a larger population. Thus for screening services with fixed budgets, high compliance is achieved only by screening fewer people.

Appointments and Schedules↗
PubMed1993

The new NHS in a global context: is it taking us where we want to be?

In this paper, the new NHS is put in a global context, comparing the UK internal market arrangements with changes occurring in other health care systems. An assessment is made of whether the new UK NHS will result in more efficient and equitable health care provision than the 'old' NHS. Regarding financing of health care, most countries seem to be moving in the direction of NHS or public-insurance-based systems. New Zealand and The Netherlands are among the few countries attempting to inject competition into health care financing. There is a greater move, globally, towards competition in the provision of services. In terms of allocative efficiency and equity, we believe that, on balance, the new NHS will bring no improvement. Indeed, in terms of equity, it may be detrimental. If there is any improvement, it is likely to be in technical efficiency.

Economic Competition↗
PubMed1993

Needs assessment: developing an economic approach.

Health authorities and health boards in the UK are required under the provisions of the NHS Act, 1990, to assess the needs of their resident populations for health care and, through contracting, to act as purchasers of services informed by those needs. This paper presents an economic approach to informing the purchaser on priority setting for contracting. For illustrative purposes, the technique is applied to services for elderly people with dementia. The paper demonstrates that an economic approach to needs assessment is both desirable and practicable.

Aged↗
PubMed1993

Teaching and research in hospitals: implications for the NHS reforms.

In this paper the implications of the support of undergraduate medical education and research for the new NHS market are examined. Inaccuracies in current methods of distribution of the Service Increment for Teaching and Research (SIFTR) and Additional Cost of Teaching and Research (ACTR) monies will have adverse effects. Receipt of too much money results in providers' care being unfairly subsidised while receipt of too little results in providers bearing an unfair burden of the cost of teaching and research. Results are reported from a study in the north east of Scotland with regard to the feasibility of obtaining more accurate estimates of the costs to the NHS of supporting teaching and research. The choice is between potentially accurate, but cumbersome and costly, systems of data collection or the continuation of the current, more arbitrary, approach of allocating monies. A combination of the two is recommended.

Attitude of Health Personnel↗
PubMed1993

Immune reconstitution after BMT in children.

Serial assessment of peripheral blood T and B cell recovery and serum immunoglobulins was performed in 19 children for the first year following BMT and compared with normal values established from healthy children. Immunophenotypic analysis on bone marrow was performed in selected cases by Southern blotting of the immunoglobulin heavy chain (IgH) gene. We found no significant differences between T cell-replete or depleted allogeneic bone marrow transplants. Lymphocyte numbers were low until 9 months post-BMT. T cell numbers (CD2, CD3, CD5) were also low until 12 months but B cell numbers (CD19) became normal at 3 months. Both CD4+ and CD8+ T cell subsets were low post-BMT with depression of CD4+ greater and more prolonged than that of CD8+. No overshoot of CD8+ was seen. The principal effect of GVHD or its treatment was further depression of CD4+ cells but with no increase in CD8+; recovery of B cells was also delayed. Recovery of IgG was slow with only six of 11 children reaching an age-adjusted normal level by 1 year, whereas there was more rapid recovery of IgM and IgA. Several children had an increase in lymphocytes of immature appearance in their bone marrow at varying times post-BMT with increased cells of phenotype CD19+, CD10+, HLA-DR+ and TdT+. In each case Southern blotting showed a germline pattern of the IgH indicating a polyclonal early B cell regenerative population.

Adolescent↗
PubMed1992

Recruitment methods for screening programmes: trial of a new method within a regional osteoporosis study.

OBJECTIVE: To estimate the response rates and operating costs of three recruitment methods within a regional osteoporosis screening programme. DESIGN: Randomised trial of three types of invitation letter: one offering fixed appointments with option to change time, one offering fixed appointments but requiring telephoned confirmation of intention to attend, and one inviting recipient to telephone to make an appointment. SETTING: Osteoporosis screening unit, Aberdeen. SUBJECTS: 1200 women aged 45-49 years living within 32 km of Aberdeen and randomly selected from the community health index. 400 women were randomised to each appointment method. MAIN OUTCOME MEASURES: Numbers attending for screening; default rate among women who confirmed appointments; social class of attenders; cost per appointment slot and per completed scan. RESULTS: 299 (75%), 277 (69%), and 217 (54%) women were scanned after fixed, confirmable, and open invitations respectively. Women who attended were given a questionnaire, and 694 (87.5%) returned it. No significant differences were found in the social class of attenders among the three methods. Of the 514 women who made or confirmed appointments, 494 attended for a scan. Total costs per scan were 25.00 pounds, 21.40 pounds, and 21.00 pounds for fixed, confirmable, and open invitations respectively. CONCLUSIONS: The offer of a fixed appointment requiring telephoned confirmation has the potential to reduce the costs of scanning without exaggerating any social bias or significantly reducing response rates provided that empty appointments can be rebooked at short notice.

Appointments and Schedules↗
PubMed1992

DRGs: the road to hospital efficiency.

In this paper, the effects of using diagnosis-related groups (DRGs) as the basis of a hospital funding mechanism and within a global budgeting mechanism are reviewed. Most forthcoming is the indeterminate effect of DRGs as a funding mechanism. By controlling only the price of hospital care, such systems remain vulnerable to compensatory increases in patient throughout, cost shifting and patient-shifting. Whether the use of DRGs has substantially reduced hospital cost per case is also not clear cut. Effects on patient outcome have not been adequately assessed. At this stage, use of DRGs within a system of global budgeting will simply focus attention on the current average costs of treating cases without consideration of whether such average costs represent efficient clinical practice. Efficient clinical practice is better established through use of less sophisticated techniques, such as clinical budgeting and cost-effectiveness analysis. The failure of more global budgeting in the past has been that patient outcome has not been monitored. Data on outcome are crucial to determining efficiency. Once efficient clinical practice is established through budgeting, DRGs could be calculated according to efficiency criteria rather than current average cost.

Australia↗
PubMed1992

The cost of cervical cancer screening provided by a women's health nurse.

This study examines the cost of cervical cancer screening provided by a women's health nurse. Methods used to estimate the cost of taking a Pap smear were based on the economic principle of opportunity cost. Techniques for estimating the magnitude of some costs were developed specifically for this study because the cost of taking a Pap smear had to be isolated from the costs of other services provided by the women's health nurse. The cost of taking a Pap smear in 1989 was estimated to be between $17.68 and $17.95. A sensitivity analysis was carried out so that the results of this study could be adapted for practices which differ from the women's health nurse's practice in the Mount Druitt and Hawkesbury area of New South Wales. As a result of this analysis, the cost of taking a Pap smear ranged from $14.16 to $38.88, depending on whether the women's health nurse was a Clinical Nurse Consultant or Clinical Nurse Specialist, the number of Pap smears taken, the proportion of clients who come for postnatal examinations, length of consultations and the distance travelled. It should be noted that the cost of taking a Pap smear would rise considerably above $38.88 for women's health nurses working in remote areas.

Capital Expenditures↗