Biomedical subjects
Publications and source records attributed to J Roberts.
The costs of an after-hours triage service and potential savings for a medium-sized (90,000 member) division of an HMO are presented. Other benefits are also described, including access to member medical records and coverage information, direct-linked telephone conferencing, and more personalized and continuous care.
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Much of the cultural diversity and racial prejudice that exist in the healthcare industry today is rooted in ignorance more than outright bigotry. The time is ripe for facing the problems and seeking solutions.
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This paper describes the methods used in economic evaluation and illustrates the challenges of assessing the cost-effectiveness of new interventions in Hepatitis C (HCV), where the impact of interventions needs to be assessed over the patient's lifetime. This paper provides an example of an economic evaluation in HCV using a model estimating the cost-effectiveness of combination therapy (CMB) for patients with mild HCV. The preliminary results from the model suggested that for 1000 cases with mild disease CMB lead to 55 fewer deaths from liver disease compared to no treatment, an average gain of 1.2 life years. Although CMB lead to additional costs of 14,882 EURO's, the cost-effectiveness ratio was 8,490 EURO's per Quality Adjusted Life Year (QALY), which suggests the intervention is relatively cost-effective. The sensitivity analysis showed that the cost-effectiveness ratio was sensitive to the effectiveness of the intervention, and the progression rates between mild disease and cirrhosis. A large UK study is collecting data on the effectiveness of CMB for patients with mild disease, and the costs and quality of life for patients at different stages of HCV. These data will be used to improve the projections of the model. In general, economic evaluations can provide information to help decide where priorities lie both in HCV, and other disease areas.
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The reliability and validity of a recently developed Meaning of Illness Questionnaire (MIQ) is described. Questionnaire content was based on the work of Lazarus and Folkman (1984b). Three hundred twenty chronically ill subjects completed the 33-item MIQ and two open-ended questions. Subjects also completed the 45-item Psychosocial Adjustment to Illness--Self-Report Scale (PAIS-SR) described by Derogatis and Lopez (1983). Test-retest reliability for 70 subjects was, on the whole, substantial (kappa = .45 to 1.00) as was the ability of nurse clinicians to reliably categorize the qualitative component of the questionnaire into one of 12 categories (kappa = .64). The factor structure of the questionnaire supported the theoretical assumptions underlying the instrument. Three of the factors of meaning given the illness, R2 = .46, and/or three items, R2 = .60, had more power than coping behavior in explaining a person's adjustment to chronic illness. The questionnaire has accumulated reliability and validity in measuring a variety of concurrent yet divergent meanings that may be given an illness for three chronically ill populations--those with mixed cancer, rheumatological, and gastroenterological disorders.
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