Biomedical subjects

Graeme Hawthorne

Publications and source records attributed to Graeme Hawthorne.

25 records · Page 2Linked to original sources

PubMed2003

The effect of different methods of collecting data: mail, telephone and filter data collection issues in utility measurement.

When collecting data researchers can interview participants, conduct telephone interviews, or mailout questionnaires. Often mixed methods are used. Whether these methods produce equivalent data is under-researched in the health-related quality of life (HRQoL) field. In addition, the effect of using filter questions has not been researched among HRQoL multi-attribute utility instruments. This study randomly sampled from Melbourne, Australia, and employed a test-retest design to investigate whether mail or telephone interview made any difference to Assessment of Quality of Life (AQoL) instrument utility scores. A filter question AQoL version investigated the effect of filters on scores. There was no significant difference in standard AQoL scores between mail self-completion and telephone interview, regardless of which was administered first. Inclusion of filter questions encouraged respondents to select the best response category thereby screening out minor health conditions. The effect was to increase utility scores by 0.06 or 7%. This effect has not been previously reported in utility instruments and has profound implications for economic evaluations using cost-utility analysis; there are implications for researchers using filter questions in general. In conclusion, researchers should feel confident that utility scores elicited from the standard AQoL through self-completion mail and telephone interview administrations are directly comparable.

Adult↗

PubMed2003

The excess cost of depression in South Australia: a population-based study.

OBJECTIVE: To establish excess costs associated with depression in South Australia, based on the prevalence of depression (from the Primary Care Evaluation of Mental Disorders (PRIME-MD)) and associated excess burden of depression (BoD) costs. METHOD: Using data from the 1988 South Australian (SA) Health Omnibus Survey, a properly weighted cross-sectional survey of SA adults, we calculated excess costs using two methods. First, we estimated the excess cost based on health service provision and loss of productivity. Second, we estimated it from loss of utility. RESULTS: We found symptoms of major depression in 7% of the SA population, and 11% for other depression. Those with major depression reported worse health status, took more time off work, reported more work performance limitations, made greater use of health services and reported poorer health-related quality-of-life. Using the service provision perspective excess BoD costs were AUD$1921 million per annum. Importantly, this excluded non-health service and other social costs (e.g. family breakdown, legal costs). With the utility approach, using the Assessment of Quality of Life (AQoL) instrument and a very modest life-value (AUD$50 000), the estimate was AUD$2800 million. This reflects a societal perspective of the value of illness, hence there is no particular reason the two different methods should agree as they provide different kinds of information. Both methods suggest estimating the excess BoD from the direct service provision perspective is too restrictive, and that indirect and societal costs ought be taken into account. CONCLUSIONS: Despite the high ranking of depression as a major health problem, it is often unrecognized and undertreated. The findings mandate action to explore ways of reducing the BoD borne by individuals, those affected by their illness, the health system and society generally. Given the limited information on the cost-effectiveness of different treatments, it would seem important that resources be allocated to evaluating alternative depression treatments.

Adult↗

PubMed2003

Comorbidity as a predictor of symptom change after treatment in combat-related posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is a difficult condition to treat, and existing studies show considerable variability in outcome. Investigations of factors that influence outcome have the potential to inform alternate treatment approaches to maximize benefits gained from interventions for the disorder. Because PTSD is commonly associated with comorbidity, it is important to investigate the influence of comorbidity on symptom change after treatment. This article examines pretreatment and 9-month follow-up data for 134 Australian Vietnam veterans who attended a treatment program for combat-related PTSD. A series of analyses were conducted to investigate the influence of the comorbid factors of anxiety, depression, anger, and alcohol use on PTSD symptom change after treatment. Analyses identified anger, alcohol, and depression as significant predictors of symptom change over time, independent of the effect of initial PTSD severity. Further analyses indicated that anger at intake was the most potent predictor of symptom change. Further investigations of anger as an influence on symptom change after treatment of combat-related PTSD is recommended.

Alcohol-Related Disorders↗

PubMed2002

Quality of life assessment in people living with psychosis.

BACKGROUND: The value of measuring health-related quality of life (HRQoL) among people with persisting psychotic disorders is contentious, despite the call for it in treatment outcome and economic evaluation. Our aim was to investigate the validity of psychotic patients' self-report regarding their HRQoL, using the WHOQOL-Brèf, a generic measure, and the Assessment of Quality of Life (AQoL), a utility instrument. METHODS: Community-dwelling patients (N = 173) with a long-standing psychotic disorder who were attending an inner-city mental health service completed the WHOQOL and AQoL, and measures of their symptoms, disability and living conditions. Case managers completed the measures as proxies. RESULTS: Both instruments were acceptable and completed readily. There were significant differences by instrument dimension, with social relationships obtaining the worst scores. Patients' and case managers' scores correlated moderately, with case managers' being lower. When examined by other study instruments, correlations varied according to who completed the instrument, which suggested bias by instrument completer. Patients' scores correlated better with a neutral estimator of health status, suggesting there are areas of patients' lives that clinicians know little about. When examined against population data, patients experienced significantly worse HRQoL. CONCLUSIONS: The WHOQOL-Brèf and AQoL are sensitive to the HRQoL status of those with long-term mental illness. We found no evidence to reject patient self-reports. Given systematic differences between patient and case manager reports, patient perspectives should be preferred in evaluation research. Utility measurement and generic HRQoL assessment are feasible and important in this population.

Adolescent↗

PubMed2002

Measuring disability-specific patient benefit in cochlear implant programs: developing a short form of the Glasgow Health Status Inventory, the Hearing Participation Scale.

As healthcare resources are limited, evidence of program effectiveness is necessary. To demonstrate this, measurement should be conducted at the specific illness level, the generic health status level, and the utility level. Instruments need to be parsimonious to avoid cognitive overload, response burden, or participation refusal. Critical analysis of the Glasgow Hearing Status Inventory (GHSI) suggested that several items were redundant and the instrument could be shortened. We administered the GHSI and Assessment of Quality of Life (AQoL) instruments to 148 deafened adults with cochlear implants (CIs) and to 54 without CIs, as part of a cross-sectional study. We used standard psychometric procedures to examine the GHSI's structure, resulting in the removal of half of the items. The short version of the GHSI we labeled the Hearing Participation Scale (HPS), to avoid confusion with the GHSI. The HPS is an 11-item instrument measuring self-esteem, social handicap, and hearing handicap. Factor analysis suggested that each subscale was unidimensional. All items loaded on the principal component. Correlation with the GHSI was 0.95, suggesting that the two instruments could be used interchangeably. Both the HPS and the GHSI pro-vided evidence of monotonicity when used to predict AQoL scores. They were equally sensitive at differentiating between implantees and non-implantees. Although these findings need to be confirmed, the HPS is ready to be used in studies of interventions for deafness. At a time when evaluators are being asked for evidence of program effect, the parsimonious HPS achieves similar results to the GHS but requires half the items.

Adult↗

PubMedDate not supplied

The relationship between quality of life, Mini-Mental State Examination, and the Instrumental Activities of Daily Living in patients with Alzheimer's disease.

Alzheimer's disease (AD) affects the cognitive function and capacity for independent living of the elderly, however little is known about the measurement of patient's overall health-related quality of life (HRQoL) and its relationship to these effects. We examined the relationship between patient/caregiver-rated HRQoL and cognition (using the Mini-Mental State Examination (MMSE)) or Instrumental Activities of Daily Living (IADL). One hundred AD patients participating in an open-label trial of donepezil were followed for 6 months. Cognition and function were assessed using the MMSE (clinician-rated) and IADL scale (caregiver-rated). Patient QoL, as assessed by the Assessment of Quality of Life (AQoL) scale, was rated separately by patients and their primary caregivers. Mean patient-rated AQoL was 0.60, whilst caregiver-rated AQoL was 0.50. Patient and caregiver AQoL assessments correlated (r = 0.37, P = 0.0038) for all levels of disease severity. Patient-rated AQoL scores ranged from 0.52 for patients with severe AD, to 0.71 for patients with mild AD. Caregiver-rated AQoL scores ranged from 0.40 to 0.59. There were approximately linear relationships between the AQoL and MMSE scores (patient-rated r = 0.30, P < 0.0001; caregiver-rated r = 0.28, P < 0.0001), and AQoL and IADL scores (patient-rated r = 0.36, P < 0.0001; caregiver-rated r = 0.43, P < 0.0001). Patient self-assessment of AQoL is a useful instrument for measuring HRQoL in AD that displays an approximately linear relationship with MMSE, IADL, and caregiver-rated AQoL.

Activities of Daily Living↗

PubMedDate not supplied

Communication skills and undergraduate psychiatry: a description of an innovative approach to prepare Australian medical students for their clinical psychiatry attachment.

OBJECTIVE: To address the increasing diversity in the linguistic and ethnic backgrounds of medical students at the University of Melbourne, a program was developed to prepare students for the particular challenges in cultural literacy and idiomatic English language proficiency, especially when exploring sensitive areas of patients' personal history. The authors outline the University of Melbourne program and present two case studies. RESULTS: Post hoc confidential survey of students' appraisals of the program is presented. CONCLUSION: The survey found a high level of acceptance and approval among most students.

Adult↗