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Biomedical subjects

S J Coons

Publications and source records attributed to S J Coons.

At least 37 records · Page 2Linked to original sources
PubMed1998

Comparison of the EQ-5D and SF-12 in an adult US sample.

The purpose of this paper is to discuss the results of a direct comparison of two instruments, the SF-12 health survey and the EuroQol Group's EQ-5D, in a sample drawn from the adult US population. The data were collected via a survey instrument mailed to 1,800 subjects in the USA. The instrument contained the EQ-5D valuation questionnaire and the items of the SF-12. In addition, the subjects were asked to provide demographic information, complete a depression screening item and to indicate if they had any of seven common chronic conditions. The usable response rate was 23.7%. Patients indicating a health problem on the EQ-5D had significantly lower mean SF-12 component scores (i.e. MCS-12 and PCS-12) for all dimensions. As was expected, the relationships were stronger between the EQ-5D functional dimensions and the PCS-12 and between the MCS-12 and the EQ-5D anxiety/depression dimension. The EQ-5D visual analogue scale (VAS) scores were positively correlated with both component scores; r = 0.55 for PCS-12 and r = 0.41 for MCS-12. The results of this investigation provide support for the validity of both the EQ-5D and the SF-12 as descriptive measures of health status. The measurements by both instruments behaved in patterns that were consistent with recognized sociodemographic differences in health status. The limitations of the dimensional structure of the EQ-5D were somewhat overcome by the use of the VAS, which may also be possible with a constructed index score based on explicit values derived from a general population. The SF-12 appeared to be more sensitive to differences associated with less severe morbidity.

Adult↗
PubMed1998

The structure of satisfaction with pharmacy services.

OBJECTIVES: The objectives of this investigation were to evaluate the dimensional structure of satisfaction with pharmacy services, to determine whether satisfaction is best viewed as a unidimensional or multidimensional construct, and to determine the degree of correspondence between a general satisfaction scale and satisfaction with specific aspects of pharmacy services. METHODS: Data was collected via telephone interviews of 509 patrons of traditional retail pharmacies and analyzed using structural equation modeling techniques. RESULTS: The hypothesized, multidimensional measurement model fit the observed data reasonably well. However, correlations between the latent dimensions of satisfaction with pharmacy services indicated that some dimensions were empirically indistinguishable. CONCLUSIONS: Considering item content and theoretical considerations, modifications to the structure of previously used measures of satisfaction with pharmacy services were suggested. The data also support the hypothesis of a hierarchical model in which general satisfaction could be simultaneously represented as both an overall domain and as a set of distinct dimensions tapping unique aspects of satisfaction with pharmacy services. Depending on the purpose of the measurement, either or both levels of analysis may be useful.

Adult↗
PubMed1998

Reliability of an Arabic version of the RAND-36 Health Survey and its equivalence to the US-English version.

OBJECTIVES: The objectives of this research were to: (1) evaluate the reliability and equivalence of the Arabic and English versions of the RAND-36 Health Survey (RAND-36) in a sample of Saudi Arabian citizens; and (2) assess the health status of a sample of Saudi Arabian citizens using both the Arabic and English versions. METHODS: Both the Arabic and English versions of the survey were administered to a convenience sample of bilingual (English and Arabic) Saudi citizens (n = 415) at Saudi ARAMCO Company, Dhahran, Saudi Arabia. Internal consistency, equivalent-forms, and test-retest reliability were estimated for the eight multi-item scales in the Arabic and English versions. Mean scale scores were calculated for each version and compared with the general US populations. RESULTS: The median Cronbach's alphas for the Arabic RAND-36 in multiple subgroups exceeded 0.70 for every scale except one. Two of the English RAND-36 scales had median Cronbach's alphas that exceeded 0.70; the remainder exceeded 0.50. Two-week test-retest correlations were all statistically significant for both versions. Product-moment correlations to test the equivalence of the corresponding Arabic and English versions of the RAND-36 ranged from 0.73 to 0.92. Saudi citizens reported significantly higher vitality scores, but significantly lower physical functioning, social functioning, and general health perception scores than the general US population. CONCLUSIONS: The results provide support for the reliability and equivalence of the Arabic and English versions of the RAND-36. Additional studies need to be conducted in a representative sample of the general Saudi population to further assess the psychometric properties of the Arabic version.

Adult↗
PubMed1998

Valuation of EuroQOL (EQ-5D) health states in an adult US sample.

While the EuroQOL instrument (EQ-5D) is being considered and used in clinical trials in the United States and Canada, and in large international multicentre studies, population weights for the instrument have never been established in North America. The primary purpose of this investigation was to derive a set of US-based population weights for the standard set of health states described in the EQ-5D health questionnaire. Valuations for EQ-5D health states were obtained via a postal survey using the visual analogue scale (VAS) format. A sample of 3,500 adults from the continental US were surveyed. A response rate of 25.8% was obtained. Mean and median valuations for 45 distinct health states, including dead and unconscious, were calculated. An ordinary least squares (OLS) regression-based weighting scheme was constructed to impute scores for states not directly valued in the questionnaire formats. Valuations for the standard EQ-5D health states displayed similar characteristics to VAS valuations obtained in previous investigations in European countries. The OLS model fit the observed data relatively well, achieving an adjusted R2 of 0.42. However, the diagnostic testing indicated that the initial model was misspecified. Subsequent alternative models alleviated some, but not all, of the problems of misspecification. The EQ-5D valuations from adult Americans in this sample appeared to behave in much the same fashion as in previous valuation studies. However, the generalisability of results to the entire adult American population may be limited. Violations of assumptions of the OLS regression model indicate the need for further investigation into the modelling technique used in deriving a single index score.

Adult↗
PubMed1997

Peripheral vascular disorders. A pharmacoeconomic and quality-of-life review.

The purpose of this article is to review the literature on the pharmacoeconomics and quality of life of therapy interventions for patients with peripheral vascular disorders. The paper is in 4 parts. The first presents a framework for the analysis of such drug interventions, which contrasts studies that have a clinical focus with those that take a system or modelling focus and presents a research typology for studies in this area. The second part of the paper reviews pharmacoeconomic studies of selected interventions and assesses their contribution to decision-making within healthcare systems. The particular focus is on the pharmacoeconomics of therapy for atherosclerosis. While there are no studies which have evaluated the overall costs of treatment in this disease area or considered the cost effectiveness of the range of alternative treatment strategies, the issues of good clinical practice and the implicit cost effectiveness of identifying patients for treatment options and prevention strategies has been addressed. The few studies which have considered the cost consequences of particular intervention strategies, specifically pentoxifylline therapy and surgical options, are limited in scope and are difficult to generalise due to their age, their study design or the treating environment from which data are drawn. The third part reviews quality-of-life studies and, once again, assesses their contribution to formulary decision-making. There are no published studies which have compared quality-of-life outcomes associated with alternative treatment approaches or which have reported changes associated with pharmacotherapy in patients with peripheral vascular disorders. Finally, given the dearth of studies in this area, a research agenda is proposed for ongoing investigations.

Cost-Benefit Analysis↗
PubMed1996

The use of two measures of health-related quality of life in HIV-infected individuals: a cross-sectional comparison.

Two measures of health-related quality of life in 65 HIV-infected individuals were compared in a cross-sectional design. The Quality of Well-Being Scale (QWB) results in a single score ranging from death to perfect health. The MOS-HIV Health Survey (MOS-HIV, 34-item version) gives scores in 11 dimensions. The QWB score distinguished subjects with AIDS from those who were asymptomatic (p = 0.027). For the seven multi-item scales of the MOS-HIV, Cronbach's alpha ranged from 0.85-0.95, indicating good internal consistency reliability. Clinical HIV-infection status was significantly associated with the dimensions of Overall Health (p = 0.002), Role Function (p = 0.022), Social Function (p = 0.037), Energy/Fatigue (p = 0.027) and Health Distress (p = 0.025). All eleven dimensions of the MOS-HIV were significantly correlated with the QWB score (Spearman's coefficient = 0.405-0.670; for all, p < 0.01) and the QWB score could be predicted from the MOS-HIV dimension scores using multiple regression. The QWB and the MOS-HIV may be useful in assessing health-related quality of life in patients infected with HIV.

Adult↗
PubMed1996

Health-related quality of life of diabetic Pima Indians.

This study was designed to measure the health-related quality of life of a sample of diabetic Pima Indians. Health status questionnaires were administered to 54 diabetic Pima Indians attending an outpatient pharmacy in southern Arizona. Health-related quality of life was assessed using the SF-36 Health Survey. Internal consistencies of the eight multi-item scales of the SF-36 were estimated. Nonparametric analyses were performed to determine relationships between mean SF-36 scale scores and various clinical and demographic variables. Favorable internal consistencies for the multi-item scales were observed, with alpha coefficients ranging from 0.63 to 0.91. SF-36 scale scores were not influenced by sex or education level. Age was significantly associated with four of the eight dimensions. Indicators of glycemic control were not significantly associated with any SF-36 multi-item scale scores. Subjects with more comorbid chronic conditions had significantly lower SF-36 scores. If the goal of maximizing health status of American Indians is to be reached, health-related quality-of-life assessment should be used as a means to monitor progress toward that goal. Further evaluation of the SF-36 or other health status/quality-of-life instruments in this population should be undertaken.

Adult↗
PubMed1995

Psychoactive medication, alcohol use, and falls among older adults.

The purposes of this study were to determine: (1) the prevalence of psychoactive medication and alcohol use and (2) the relationship among psychoactive medications, alcohol use, and falls in a sample of 1028 independently living women and men, aged 55 and older. Twenty-six percent of the sample reported falling, 28% were taking one or more psychoactive drugs, and 38% drank alcohol during the past year. Analyses with logistic regression indicate that predictors of falls were psychoactive drug use, age, and number of illnesses. Living alone, frequency of alcohol use, and gender were not significant predictors.

Accidental Falls↗
PubMed1994

Development of the kidney disease quality of life (KDQOL) instrument.

This paper describes the Kidney Disease Quality of Life (KDQOL) Instrument (dialysis version), a self-report measure that includes a 36-item health survey as the generic core, supplemented with multi-item scales targeted at particular concerns of individuals with kidney disease and on dialysis (symptom/problems, effects of kidney disease on daily life, burden of kidney disease, cognitive function, work status, sexual function, quality of social interaction, sleep). Also included were multi-item measures of social support, dialysis staff encouragement and patient satisfaction, and a single-item overall rating of health. The KDQOL was administered to 165 individuals with kidney disease (52% female; 48% male; 47% White; 27% African-American; 11% Hispanic; 8% Asian; 4% Native American; and 3% other ethnicities), sampled from nine different outpatient dialysis centres located in Southern California, the Northwest, and the Midwest. The average age of the sample was 53 years (range from 22 to 87), and 10% were 75 years or older. Internal consistency reliability estimates for the 19 multi-item scales exceeded 0.75 for every measure except one. The mean scores for individuals in this sample on the 36-item health scales were lower than the general population by one-quarter (emotional well-being) to a full standard deviation (physical function, role limitations due to physical health, general health), but similar to scores for dialysis patients in other studies. Correlations of the KDQOL scales with number of hospital days in the last 6 months were statistically significant (p < 0.05) for 14 of the 19 scales and number of medications currently being taken for nine of the scales. Results of this study provide support for the reliability and validity of the KDQOL.

Adult↗
PubMed1993

Quality of life assessment: understanding its use as an outcome measure.

The limited available evidence of the effectiveness of many existing and emerging medical practices has led to the realization that health outcome data should be used in the evaluation of health care interventions. Interest in improving health outcome evaluation is increasing as a result of the need to balance the costs and benefits of medical technologies. Measures of health-related quality of life are receiving greater use in clinical studies. Quality of life measurement provides additional data for making clinical and health care policy decisions. In addition, there is growing awareness that in certain diseases, quality of life may be the most important health outcome to consider in assessing treatment efficacy. There are a number of methodological issues that must be considered in conducting or evaluating quality of life research.

Health Services Research↗
PubMed1992

Quality of life and policy analysis in arthritis.

Problems in the American health care system have stimulated interest in cost-effectiveness methodologies. However, there is little consensus on how to define a common unit of health outcome. Many measures used in policy studies consider only mortality and do not fully capture the significant impact of disease-related dysfunction. The impact of conditions, such as osteoarthritis, that have little impact on mortality rates but substantial impact on functioning and well-being may be underestimated in these analyses. In this article, we propose a measurement and policy model that is based on a theoretical conceptualization of health outcome. The model considers the impact of disease and its treatment in terms of both morbidity and mortality. The value of the model for clinical trials, population assessments, and policy analysis is reviewed. A public policy application of the model in Oregon is briefly described.

Arthritis↗
PubMed1990

The use of pregnancy test kits by college students.

The self-testing product market is experiencing tremendous growth. Technical breakthroughs are allowing tests to be conducted in the home that at one time were possible only in a clinical laboratory. One of the more rapidly expanding components of the self-testing market is home pregnancy test kits. We conducted a study to obtain information about the use of home pregnancy test kits by college students. Questionnaires were distributed to 1,000 women entering the student health service between October 1 and November 4, 1987. A total of 761 (76.1%) questionnaires were completed and returned. Results indicated that approximately 1 out of 6 respondents (17.2%) had used a pregnancy test kit at least once. Of those who had used a test kit, the majority did so because of the speed or confidentiality of obtaining results. The magnitude of test kit use by this sample suggests that college women should be encouraged to use self-testing products as a supplement to but not as a substitute for professional medical care.

Adolescent↗
PubMed1990

Home monitoring of theophylline levels: a novel therapeutic approach.

This pilot clinical investigation was conducted to compare a home therapeutic drug-monitoring (TDM) method for theophylline blood levels and a traditional TDM method with respect to various patient outcome factors. Outpatients with chronic obstructive pulmonary diseases (COPD) or asthma who were receiving long-term theophylline therapy were randomized to one of two groups: home TDM or traditional TDM (controls). Patients in the former group monitored their serum theophylline levels at home over 6 months. Patients in both groups completed survey instruments, including questionnaires, visual analog scales, and other psychosocial measures, at designated times throughout the study period. Pulmonary function tests and dyspnea index scores were evaluated at each clinic visit. Results indicated a significantly lower (p less than 0.05) number of changes in concomitant drug therapy in the home TDM group compared with controls. Other indicators that showed a trend toward more favorable outcomes in the home TDM group included symptomology, percentage of levels within the therapeutic range, patient attitudes regarding participation in health care management, and pulmonary function test results. Home monitoring prevented unnecessary clinic visits in several instances when theophylline dosage adjustments were based on telephone reports from patients. The utility of a home TDM method for theophylline has not been reported previously despite potential for broad applications. Findings from this preliminary study may support the use and feasibility of state-of-the-art methodologies in carefully selected subpopulations outside the confines of the hospital or clinic setting.

Ambulatory Care↗