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Biomedical subjects

D S Pathak

Publications and source records attributed to D S Pathak.

At least 19 recordsLinked to original sources
PubMed2001

Psychometric evaluation of four HIV disease-specific quality-of-life instruments.

OBJECTIVE: To provide a comparative evaluation of psychometric properties for three or more HIV disease-specific quality-of-life (QoL) instruments. METHODS: Four instruments were selected using the following criteria: multiple publiations of instrument, focus of instrument on QoL, psychometric validation publication or comparison with prevoiusly validated questionnaire, stages of HIV/AIDS used or evaluated in the study, and inclusion of sample items or the instrument in at least one publication. The four HIV-specific QoL instruments were: HIV/AIDS-Targeted Quality of Life Instrument, Medical Outcomes Study HIV questionnaire (MOS-HIV), Functional Assessment of Human Immunodeficiency Virus Infection, and HIV Overview of Problems -- Evaluation System. These instruments were evaluated using combined criteria derived from McHorney and Tarlov and Shumaker et al. The criteria include: administration, content, depth, reliability, validity, and responsiveness. A letter grade scale (A,B,C,D) was used in rating the criteria. RESULTS: No instrument demonstrated ideal psychometric properties. The MOS-HIV questionnaire was the only instrument that published results for seven of the eight categories. Therefore, a decision cannot be made about the best instrument to use for measuring QoL in an HIV-positive patient. CONCLUSIONS: Published data for these questionnaires had common limitations of sample size, study design, and population demograhpics, Hence, further testing of these questionnaires is recommended before use in any study to determine suitability, reliability and validity.

HIV Infections↗
PubMed2000

Validity and reliability of the migraine-specific quality of life questionnaire (MSQ Version 2.1).

OBJECTIVE: To assess the scaling properties, reliability, and validity of the revised Migraine-Specific Quality of Life Questionnaire (MSQ) (Version 2.1) BACKGROUND: The MSQ is a disease-specific, quality-of-life instrument with three hypothesized scales that has been developed, tested, and revised. METHODS: The study used a multicenter, nondrug, prospective, parallel group, quasi-experimental design. Patients with migraine were recruited at outpatient headache specialty practices and were administered the MSQ, the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and migraine symptom questionnaires at baseline, 4 weeks, and 12 weeks. Internal consistency (Cronbach alpha) and 4-week test-retest reproducibility (intraclass correlation coefficients) were estimated to assess reliability. Construct validity was assessed using an adaptation of the Campbell and Fiske multitrait-multimethod approach and by correlating MSQ scores with symptom measures. RESULTS: A total of 267 subjects enrolled in the trial. The criteria for summated rating scales were all met. The internal consistency coefficients ranged from 0.86 to 0.96, and the intraclass correlation coefficients ranged from 0.57 to 0.63 across the three dimensions. As anticipated, the MSQ dimensions had low-to-modest correlations with the two component scores of the SF-36 and were modestly to moderately correlated with migraine symptoms. CONCLUSIONS: The MSQ is a reliable instrument in the assessment of quality of life for patients with migraine with items that can be summed without weights. The MSQ has demonstrated evidence of construct validity.

Evaluation Studies as Topic↗
PubMed2000

A comparison of time-and-motion and self-reporting methods of work measurement.

OBJECTIVE: To compare results obtained from a time-and-motion study with those obtained using self-reporting. SUMMARY BACKGROUND DATA: Nurse executives are often required to provide additional patient care services with limited personnel resources. As a result, nurse executives must evaluate the appropriate allocation of nursing personnel resources. Work measurement may be used to evaluate personnel allocation. Multiple measurement approaches are available, but few studies have compared these methods. METHODS AND SUBJECTS: Eight nurses were observed by a single observer during five shifts (or approximately 40 hours per nurse). After completion of the time-and-motion study, participants were to self-report their work activities during their ensuing five shifts. Mixed-effects analysis of variance was used to determine the significance of the work measurement method on percentage of total time, number of activities, and mean time per activity by activity category. RESULTS: Two hundred ninety hours of time-and-motion study observations and 338 hours of self-report data were available for analysis. Comparable amounts of total time were reported within the various activity categories using time-and-motion and self-reporting methods. In terms of number of activities reported, a significantly higher number of activities were reported using time-and-motion. As a result, mean activity times were significantly longer using the self-reporting method compared with time-and-motion. CONCLUSIONS: Nurse executives should consider continuous self-reporting as a low-cost means of quantifying allocation of time among nursing personnel. Self-reporting, however, is not recommended for estimating the total number of activities or the mean time per activity because of perceptual differences between participants of what constitutes an activity.

Humans↗
PubMed1999

Modelling the EuroQol data: a comparison of discrete choice conjoint and conditional preference modelling.

This article compares two measurement strategies for measuring EuroQol health state preferences: (a) conditional preference modelling, implemented using rating scale and standard gamble scaling methods and (b) discrete choice conjoint modelling. The nature of the model form of the EuroQol health status preference function and the predictive ability of each measurement strategy formed the basis of the comparison. Data were collected via personal interviews with 140 US patients, 139 of whom provided usable responses. Both strategies supported a multiplicative model form as representative of the EuroQol health status preference function and were acceptable in terms of predictive ability. The agreement of the two measurement strategies on the nature of the model form provides evidence of the convergent validity of the multiplicative nature of the EuroQol health status preference function in this patient population. Since both strategies were found to be acceptable in terms of predictive ability, further research comparing preference scores and measuring respondent evaluations of the methodologies is necessary to illustrate the relative strengths and weaknesses of different health state preference measurement methodologies.

Aged↗
PubMed1999

Quality-adjusted life-years and other health indices: a comparative analysis.

This article provides a descriptive overview of both unadjusted and adjusted health indices that are being applied in the current health-services research literature. We describe, give examples, and discuss a variety of the better-known health indices. Summary tables that compare health indices across dimensions, such as level of analysis, weighting methodology, preference measurement, and longevity measurement, are also included. Our goal is to provide information about similarities among and differences between health indices and enhance understanding of comparative health-outcome measurement. An extensive list of references is included to guide the reader toward additional discussions of metrics and methodologies. Given the multitude of health indices reported in the literature, this descriptive and comparative overview provides a framework for understanding these metrics in the context of health-outcomes research.

Epidemiology↗
PubMed1999

Productivity-cost controversies in cost-effectiveness analysis: review and research agenda.

Productivity costs represent true costs to society and should not be ignored in a cost-effectiveness analysis. However, there is dissension among health economists regarding measurement of productivity costs. Certain health economists argue for inclusion of productivity costs in the denominator of the cost-effectiveness ratio, measured in quality-adjusted life-years. Others argue that productivity costs should be included in the numerator of the cost-effectiveness ratio, measured in dollars using the friction-cost method or the human-capital method. This paper reviews the productivity-cost controversies and offers suggestions for future research addressing the debated issues.

Cost of Illness↗
PubMed1999

Economic evaluation of risperidone in an outpatient population.

OBJECTIVE: To study the impact of risperidone use on the cost of services provided to severely mentally disabled outpatients and on hospital avoidance, and to analyze patterns in the use of concomitant medications as a surrogate marker of changes in adverse effects or patient well-being. METHODS: The patients were 31 clients of community mental health centers who had received risperidone for at least three months and for whom there were at least three months of available data on medication use and costs prior to risperidone treatment. The actual average monthly costs of community mental health services obtained from a county mental health board were compared with service costs prior to use of risperidone, using the patients as their own controls, and compared with a control group. RESULTS: Compared with the pre-risperidone period, the average cost per month of providing mental health services increased by 73.7% during the risperidone treatment period. Compared with the pre-risperidone period, the average total cost of treatment (including medications) increased by 113.3% during the risperidone treatment period. The average total cost of medication increased by 422.8% during the risperidone treatment period compared with the pre-risperidone treatment period. CONCLUSIONS: From the perspective of the community mental health board, risperidone treatment did not reduce the cost of services provided to these clients, but substantially and significantly increased total costs, including medication.

Ambulatory Care↗
PubMed1999

Costs of epilepsy in an intermediate care facility for persons with mental retardation.

Epilepsy is a significant comorbid condition in institutionalized persons with developmental disabilities and may contribute significant additional costs. This study was conducted to provide an estimate of the costs of epilepsy from the institutional perspective. Costs were measured retrospectively for 50 persons with epilepsy and 50 persons without epilepsy matched by severity of developmental disability. A time and motion study was employed to assign opportunity costs to documented nursing and physician activities. Two separate methods of attribution were used and incremental costs attributable to epilepsy were found to be approximately $825 and $918 per person over a 6-month period. The following categories accounted for costs: personnel (47.0%), drug (39.6%), hospitalization (9.4%), and laboratories/procedures (4.0%). Results are useful for describing the economic burden of epilepsy.

Adult↗
PubMed1999

Situational factors as predictors of pharmaceutical care in a community setting: an application of the adaptive decision-making model.

Various situational factors are perceived to affect the level of pharmaceutical care (PC) delivery. Despite numerous discussions in the literature stating its importance, a literature search showed a lack of studies evaluating this relationship. The objective of this study was to determine the affect of the presence of situational factors, based on the adaptive decision making (ADM) model, on the level of pharmaceutical care delivered by pharmacists in a community setting. Pharmacists in a community setting with access to hypertensive patients were selected for study participation. An exploratory, cross-sectional study was used to acquire pharmacist self-perception of the level of PC delivered (dependent variable) in the state of Ohio.

Antihypertensive Agents↗
PubMed1999

Pharmaceutical care and health outcomes in community settings: a matched pair analysis of perceptions of hypertensive patients versus pharmacists.

UNLABELLED: This study aimed to: (1) assess the level of pharmaceutical care delivered by pharmacists, and (2) compare patients' and pharmacists' health related quality of life (HRQOL) assessments for patients receiving antihypertensive therapy as an indicator of the delivery of pharmaceutical care. DESIGN: An exploratory, cross-sectional study using matched pair survey instruments. SETTING: Columbus, Ohio. PARTICIPANTS: Patients in a community setting prescribed antihypertensive medication and their pharmacists were selected for study participation. INTERVENTIONS: Parallel surveys distributed to patients and their pharmacists. MAIN OUTCOME MEASURES: Level of pharmaceutical care delivered by pharmacists, and perceived patient viewpoints on: clinical outcomes (blood pressure control, and side effects due to antihypertensive medication) and humanistic outcomes (overall, emotional and physical HRQOL) by patients and pharmacists. RESULTS: Analysis of 52 useable matching surveys of pharmacists and patients indicated that nearly all pharmacists counsel patients and two thirds of pharmacists counsel and monitor drug therapy. This is consistent with providing the minimal OBRA 90 requirements. When comparing patient and pharmacist perceived patient clinical as well as humanistic outcomes, a high level of association was reported between the two groups. CONCLUSIONS: The results of this study suggest that pharmacists are cognizant of patient clinical and humanistic outcomes and hence, they are in an excellent position to improve patient outcomes by making appropriate drug therapy changes.

Antihypertensive Agents↗
PubMed1999

Determining the differences among cost savings, cost avoidance, and cost reduction.

Cost savings, cost avoidance, and cost reduction are important factors to measure when valuing clinical pharmacy services. Currently, there are no universally accepted definitions for these terms. The authors of this study evaluated 44 articles which claimed to measure cost savings, cost avoidance, or cost reduction associated with clinical pharmacy services, and offered recommendations for when it would be appropriate to use these terms. Based on the results of our analysis, it is evident that controversy exists in the literature when determining if services result in cost avoidance or cost reduction. Therefore, there is a need for universally accepted definitions of these terms so that future research may evaluate such factors uniformly.

Cost Savings↗
PubMed1998

Health status utility assessment by standard gamble: a comparison of the probability equivalence and the lottery equivalence approaches.

PURPOSE: Utility values obtained with the standard gamble (SG) method using the probability equivalence approach (PE) have a reported bias due to the "certainty effect." This effect causes individuals to overvalue a positive outcome when it occurs under certainty. Researchers in the decision sciences have proposed an alternative, "lottery equivalence" (LE) approach, using paired gambles, to eliminate this bias. The major objective of the current study was to investigate the certainty effect in health status utility measures and to test our hypothesis that the certainty effect would act in a reverse direction for negatively valued outcomes. METHODS: Fifty-four subjects completed the study by assessing preferences for three health states by rating scale and then by SG using PE as well as LE approaches with assessment lotteries of 0.5 and 0.75. RESULTS: The results from 41 useable responses point towards possible existence of the certainty effect in health in the hypothesized direction: utility values obtained with the PE were significantly lower than with the LEs. There was no significant difference between the LE values indicating elimination of the bias. CONCLUSIONS: The results have important implications since the SG using PE is thought be the "gold standard" in health status utility measurements.

Health Status Indicators↗
PubMed1998

Economic evaluations and diabetes.

Diabetes and its treatment have significant economic implications for society, as evidenced by estimated health expenditures for diabetes and its complications in the range of $85-$105 billion in the United States in 1992. With constrained resources, health care professionals need to understand the burden of any illness, benefits and costs of alternative treatments, and the process of combining benefits and costs for the purpose of comparing alternatives. The economic evaluation approach seems best suited for this task. Full and partial economic evaluation techniques will be reviewed with descriptions that have appeared in the recent diabetes literature.

Cost of Illness↗
PubMed1998

Incorporating individualized quality of life measures in the evaluation of pharmacy services: the IN*COMPASS framework.

Quality of life is a fascinating field to researchers and practitioners alike. To some researchers, quality of life is of interest because it offers untold challenges in constructing instruments and capturing data necessary to answer key questions about health, disease, and treatment. For such researchers, quality of life is about statistical relationships among questions and about using questions to define the physical, social, and emotional domains of health. To other researchers, this field is about finding practical applications in policy and treatment decision making for the information provided by quality of life assessments. To these researchers, the focus of quality of life is on ways to apply knowledge of quality of life differences between groups with and without specific diseases or ways to use knowledge about how treatments affect the quality of life of various patient populations. To practitioners, quality of life is about treatment outcomes that impact individual patients' daily lives. It is the practitioner that Funderburk, Pleil, and Pathak are considering in their paper in this issue of Pharmacy Practice Management Quarterly. These authors give several important messages to practitioners seeking to serve their patients by incorporating quality of life into their practices. The key message in the paper is that to better understand and determine the impact of treatment on a patient's quality of life, it is critical to start with a baseline or reference point relevant to that patient. From that baseline or reference point, treatment decisions can be made and progress, in quality of life terms, can be evaluated. Critical questions in their framework, which is called the IN*COMPASS (Individualized Client Oriented Method for Preferred Alleviation of Sickness States) Approach, are "How are you now?" and "How would you like to be?" The authors do not endorse particular quality of life tools in their approach; rather they prescribe certain critical questions that must be answered if information captured by any quality of life tool is to be useful at the patient level. Readers should not be put off by the fancy acronym used in this paper; nor must readers be keen students of quality of life to appreciate its message. The IN*COMPASS approach is fundamental to good patient care and can be applied by practitioners with any level of understanding of and appreciation for quality of life assessments.

Education, Pharmacy↗
PubMed1996

Health-related quality-of-life claims in prescription drug advertisements.

Health-related quality-of-life (HRQOL) claims in drug advertisements and HRQOL advertisements' compliance with FDA regulations were studied. HRQOL advertisements from three medical journals from the years 1984, 1988, and 1992 were analyzed. Information was collected on the drug products and classes for which HRQOL claims were made and (1) whether the claims were explicit or implied, (2) how the products were claimed to affect HRQOL, and (3) whether claims related to overall well-being, a specific physiological aspect, or functional ability. For 1992 only, the compliance of HRQOL advertisements with FDA regulations was assessed. Ninety-four HRQOL advertisements were identified: 27 for 1984, 41 for 1988, and 26 for 1992. The drug classes for which HRQOL advertisements were most commonly used were diuretics (1984), nonsteroidal anti-inflammatory drugs (all three years), antianginals (1984 and 1988), antihypertensives (1988 and 1992), and anti-depressants (1992). Almost all the advertisements contained a claim (usually implicit) related to a specific physiological aspect of HRQOL, and claims concerning physical functioning outnumbered other function-related claims. In 1992, 42% of the HRQOL advertisements appeared out of compliance with at least one FDA regulation. In 1984, 1988, and 1992, HRQOL claims in prescription drug advertisements in three medical journals were mainly implicit and related mainly to specific physiological aspects of HRQOL. Over 40% of the HRQOL advertisements reviewed for compliance with FDA regulations for prescription drug advertising appeared not to comply.

Advertising↗
PubMed1996

The relationship of service user closeness and belief in departmental values with perceived marketing effectiveness of hospital pharmacy directors.

This study examines the relationships between department values, service user closeness and marketing effectiveness as perceived by hospital pharmacy directors. Data from 171 hospital pharmacy directors, representing a cross-section of hospitals, revealed that departments of pharmacy characterized as having superior perceived marketing effectiveness also have shared department value profiles. However, no significant relationship was found between perceived level of marketing effectiveness and perceived service user closeness. More years of experience as a director and the larger the size of pharmacist staff each positively influence the director's perception of marketing effectiveness. The results of the study indicate that hospital pharmacy directors generally perceive the services offered by their respective departments are marketed effectively.

Attitude of Health Personnel↗