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PubMed2006

The economic impact of the introduction of home blood pressure measurement for the diagnosis and treatment of hypertension.

OBJECTIVES: To investigate the economic consequences resulting from introduction of home blood pressure measurement in diagnosis of hypertension instead of casual clinic blood pressure measurement. METHODS: We constructed a decision tree model using data from the Ohasama study and a Japanese national database. The Ohasama study provided the prognostic value of home blood pressure as compared with clinic blood pressure measurement. RESULTS: It is predicted that the use of home blood pressure for hypertension diagnosis results in a saving of 9.30 billion US dollars (1013.6 billion yen) in hypertension-related medical costs in Japan. Most of this was attributable to medical costs saved by avoiding the start of treatment for untreated individuals who were diagnosed as hypertensive by clinic blood pressure but whose blood pressures were in the normal range when based on home blood pressure; that is, the so called white-coat hypertension. Furthermore, it could be expected that adequate blood pressure control mediated by the change in the diagnostic method from clinic to home blood pressure measurement would improve the prognosis for hypertension. We estimated that the prevention of hypertensive complications resulted in a reduction of annual medical costs by 28 million US dollars (3.0 billion yen). In addition, stroke prevention due to adequate blood pressure control based on home blood pressure measurement reduced annual long-term care costs by 39 million US dollars (4.2 billion yen). A per-person break-even cost for introducing home blood pressure monitoring was calculated as 409 US dollars (44,580 yen). CONCLUSIONS: The introduction of home blood pressure measurement for the diagnosis and treatment of hypertension would be very effective to save costs.

Adult↗
PubMedDate not supplied

Health and social care policy for the elderly in Belgium.

Current Belgian health care policy for the elderly can be classified broadly into institutional care, community care, and home care. Economic restrictions, smaller families, increased employment among women, geographic distances between family members, and the preference of the elderly to remain at home are factors challenging Belgian policy makers and health professionals to restructure the current health care system and provide integrated holistic health and social care to the elderly. These challenges are being addressed through initiatives to customize care for the elderly at home, in the community, or in care environments by improving coordination of care, programs of support for geriatric care and dementia, and research into new accommodation and health solutions.

Aged↗
PubMed1996

A pilot study of rehabilitation at home after stroke: a health-economic appraisal.

This study aimed at describing the health-economic implications and organisational issues of rehabilitation at home in south-west Stockholm of 15 acute stroke patients, mean age 68.2, male:female ratio 9:6, independent in feeding and continent one week after their stroke. Average patient satisfaction with different dimensions of care was 92%. Perceived dysfunction, by means of the Sickness Impact Profile, 3 months after stroke was highest for Recreation-and-Pastime, Home Management and Ambulation. Between 3-12 months after stroke, functional improvement was particularly seen in Home Management, Recreation-and-Pastime and Emotional Behaviour. Three fourths of the patients received help with different ADL tasks from a family caregiver and 1/5 from home service assistants. According to the scores for subjective health of the spouses and time used to help the patient, the burden that the programme put on the patient's family was modest, temporary and in accordance with preferences reported by the elderly in Sweden. The mean duration of hospital stay for patients under rehabilitation at home was 14 days and for a selected comparison group with similar ADL-grade, 27 days. The mean number of therapy sessions at home was 11. Each home visit took 3.2 hours, 60% of which were direct patient time. In the selected comparison group, 1/3 was referred to other departments for rehabilitation and care, and 40% had contacts with day-care and paramedical professionals after discharge from the hospital. During the first year after stroke, the average, direct, per capita cost for rehabilitation at home amounted to SEK 127,730 divided between hospital care (50%), followed by contribution by family caregivers (18%), rehabilitation at home (10%), out-patient visits to physicians and nurses (8.8%), home-help service (7%), auxiliary equipment (2%), medication (1.5%), home adaptation (1%) and transportation service (0.3%). This organisational model of home-based rehabilitation of stroke patients constitutes a feasible, possibly less expensive alternative and complement to current rehabilitation in hospital and primary care, which could be further developed and evaluated.

Aged↗
PubMed1998

Cost analysis of transmural home care for terminal cancer patients.

The economic implications of home care service programmes for oncology patients remain unclear. This quasi-experimental study investigated the costs of a transmural home care programme for terminal cancer patients and compared them to those of the standard care available. The programme intended to optimize communication, cooperation and coordination between the intra- and extra- mural health care organizations (transmural care). Complete sets of data could be retrieved for 57 of the 79 patients in the intervention group, and for 29 of the 37 patients in the control group. Comparison of the intervention and control group revealed significantly lower pharmaceutical and rehospitalization costs in the intervention group, whilst community nursing and home help costs were significantly higher. However, no significant difference could be found for total health care costs between the groups. In view of this, and that the programme has proved to have significantly positive effects on both the patient's and direct caregiver's quality of life, the installation of such programmes in every hospital with a multidisciplinary oncology unit is recommended.

Aged↗
PubMed1988

Obstetric care in The Netherlands: regional differentiation in home delivery.

In this paper attention is focused on home delivery in the Netherlands, which still accounts for 36% of the total number of births delivered. Compared to countries with a similar level of socio-economic development, home delivery plays an important role within Dutch obstetric care. To understand this unique situation, one needs to have insight into the organization and structure of Dutch obstetric care which is described in the first part of this paper. In the second part of this paper regional differentiation in the relative importance of home delivery is described. Finally regression analysis is used in order to explain the observed regional pattern. A brief abstract from the vast amount of Dutch literature on the discussion between advocates and adversaries of home delivery is included in an appendix.

Delivery, Obstetric↗
PubMedDate not supplied

Social and psychologic influences on employment of married nurses.

Seven summary factors were obtained from a principal components factor analysis and Varimax rotation of 21 variables, based on 145 pieces of information given by 1,998 nurses in metropolitan Detroit, Michigan, in 1973. Study nurses were under 60 years of age, were married and living with spouse, and had at least one child 18 or younger. The factors were: career desirability, professional attitude, professional behavior, achievement personality, conducive home situation, economic value of work, and satisfaction with nursing. When these factors were compared with employment status-1) current employment activity of all subjects, 2) subjects whose employment status was constant for five years, highest scores were registered in both categories on career desirability, professional behavior, and economic value of work. Both groups of nurses scored lowest on satisfaction with nursing, with the five-year employees scoring lower. When the seven factors were correlated with employment status while controlling financial need and age of youngest child at home, highest correlation scores resulted for professional behavior, career desirability, and, in the case of those with financial need, on the economic value of nursing.

Achievement↗