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PubMed1997

Asthma treatment costs using inhaled corticosteroids.

Asthma is a chronic inflammatory disorder of the airways that affects 10 to 17.5 million people and leads to more than $5 billion in treatment costs in the Unites States annually. This retrospective study is an initial step in understanding the beneficial economic outcomes of inhaled corticosteroid therapy by determining whether differences exist in healthcare utilization expenditures for three inhaled corticosteroids available for use in the United States: (1) beclomethasone dipropionate (Vanceril/Schering and Beclovent/Allan & Hanburys); (2) flunisolide (Aerobid/Forest); and (3) and triamcinolone acetonide (Azmacort/Rhône-Poulenc Rorer). This study was based on an analysis of 4,441 patients with at least one pharmaceutical claim for one of the study drugs, using inpatient, outpatient, and prescription drug claims data obtained from The MEDSTAT Group's MarketScan database for calendar years 1990 through 1993. We tested a null hypothesis for no differences in total asthma treatment costs, when drugs were excluded, using multivariate linear regression modeling controlling for patient demographic and clinical characteristics that might affect the study outcome. We found that, after excluding study drug payments and controlling for other contributing factors, total asthma healthcare expenditures to triamcinolone acetonide (Azmacort) users were higher than those for beclomethasone dipropionate (Vanceril and Beclovent) and flunisolide (Aerobid) users. When study drug costs were included in the expenditure measure, both triamcinolone acetonide (Azmacort) and flunisolide (Aerobid) users had higher expenditures than did beclomethasone dipropionate (Vanceril and Beclovent) users. No significant differences in expenditures were detected between Vanceril and Beclovent patients, a finding consistent with the fact that these drugs are the same type of inhaled corticosteroid. Other factors contributing to differences in total asthma healthcare costs included patient age, patterns of switching among and continuing with study drugs, prestudy asthma utilization or drug proxy severity, and comorbidities of precipitating illnesses.

Administration, Inhalation↗
PubMedDate not supplied

Helpseeking for self-discovered breast symptoms. Implications for early detection.

PURPOSE: Most breast cancer symptoms are discovered by women themselves, and at least one third of these women will be aware of their symptoms for 3 months or more before seeking an initial provider evaluation. The authors identify personal, social, and environmental influences on women's intention to seek an immediate provider evaluation (helpseek) versus to delay evaluation of a breast symptom that worried them. DESCRIPTION OF STUDY: Black women (N = 352) from the San Francisco Bay are women's organizations, community settings, and churches formed this convenience sample. Participants ranged across age, income, and educational levels. The survey contained 10 scales that measured health behavior variables, including new and existing scales augmented by items derived from prior interview and focus group investigations. RESULTS: Women of younger age and lower income were significantly less likely to intend to seek an evaluation for self-discovered breast symptoms. Single and partnered women were less likely to seek a provider evaluation than married or widowed women. Perceiving negative consequences of delaying, having previous habits of healthcare utilization, perceiving access to services, and feeling fearful were positively related to the intention to seek evaluation of breast symptoms. Holding fatalistic beliefs about getting breast cancer or dying and perceiving constraints to seeing a provider negatively influenced helpseeking intention. Racism in the healthcare delivery system was perceived, but was not a significant influence on helpseeking intention. A multiple linear regression model containing these variables explained 46% of the variance in helpseeking intention. CLINICAL IMPLICATIONS: This study shows that the intent to helpseek is not merely a matter of education and economics, but is dependent on a complex picture of personal, social, and economic factors. Gynecologic and primary care providers should consider this and the potential influences on helpseeking in the women for whom they provide cancer screening and early detection services. History taking should be expanded to assess women's ideas about the consequences of delaying evaluation of self-discovered breast symptoms, their sense of vulnerability to breast cancer, the constraints on cancer early detection they may be feeling related to role obligations, their economic or strategic limitations to accessing services, the pressures they may feel to hide a breast cancer symptom, or their own tendency to interpret the breast symptom as not threatening. Healthcare providers should not assume that helpseeking for breast symptoms is an automatic behavior for all women. Rather, providers should assess whether a women is the one in three who will delay the evaluation of a breast cancer symptom she discovers herself for months or years.

Adult↗
PubMed2000

Issues in families of children with brain tumors.

PURPOSE/OBJECTIVES: To determine the needs of children with brain tumors and their parents/guardians and siblings during the six stages of illness: diagnosis, hospitalization, posthospitalization, adjuvant treatment, recurrence, and terminal or reported cured. DESIGN: A cross-sectional, qualitative study of families using focus group methodology. SETTING/SAMPLE: Families with a child diagnosed with a brain tumor recruited from the practices and clinics of several major teaching hospitals in the New York metropolitan area. Families traveled as far as 70 miles for the group meeting. Varying ethnic groups and family structures were represented. METHODS: Groups were separated into parents/guardians, siblings, and affected children. The children's groups were divided further into age 10 and older and younger than age 10. During the focus group, moderators followed an outline of topics identified from family interviews, the literature, and content experts that were important to families in similar situations. An assistant moderator took detailed notes, and the entire group meeting was audiotaped. Information was transcribed and analyzed using qualitative analysis techniques. FINDINGS: 11 focus groups met involving 7 affected children, 24 adults, and 19 siblings. Issues identified as important by the group members fell into four categories: Interaction With Healthcare Providers, Medical Information/Education, Healthcare Utilization and Treatment, and Psychosocial Issues. The needs of family members differed at various stages of the illness. CONCLUSIONS: The particular impact of the four major areas of concern differed by family role and stage of illness. IMPLICATIONS FOR NURSING PRACTICE: To provide optimal care, healthcare professionals must be aware of the family's composition and support systems and the impact that the illness has on individual family members at each stage of illness.

Adaptation, Psychological↗
PubMed2004

Race and sexual identity: perceptions about medical culture and healthcare among Black men who have sex with men.

Black men who have sex with men (BMSM) in the United States are disproportionately affected by HIV. Using a qualitative approach, the authors describe the healthcare experiences of BMSM in New York State and Atlanta, GA, exploring the social issues that influence barriers to care, communication, and adherence in medical settings. Racial and sexual discrimination socially displace BMSM, and are often compounded by negative encounters within medical institutions. The internalization of these experiences influences healthcare utilization, HIV testing, communication, and adherence behaviors among members of this population. Increasing the number of ethnic and sexual minority providers, expanding current definitions of cultural competency curricula at academic institutions, targeting future research efforts on BMSM, and improving the structural and communication barriers within healthcare settings should be incorporated into our HIV prevention and routine healthcare interventions for BMSM.

Adult↗
PubMed1997

Cost-effectiveness of sumatriptan in a managed care population.

We conducted an open-labeled study to determine whether sumatriptan is more cost-effective than other therapies used to treat migraine headache. We contacted by phone 220 sumatriptan users enrolled in QualMed, a health maintenance organization (HMO) in Spokane, Washington. Of these, 203 met the inclusion criteria and 164 (81%) completed our telephone survey. The main outcome measures were healthcare costs to the HMO and number of days free of migraine-related disability before and after sumatriptan treatment. Before sumatriptan treatment, 89% of patients reported severe migraine, compared with 63% after sumatriptan treatment. The number of monthly migraine disability days decreased from 6.5 days per month before sumatriptan to 3.9 days per month after sumatriptan. Healthcare utilization rates (ie, number of hospitalizations, emergency department visits) and costs were lower after the patients began taking sumatriptan. The number of different over-the-counter medicines and prescription medications (other than sumatriptan) taken for migraine disabilities decreased. Although total drug expenditures per month increased, the total migraine healthcare expenditure was 41% lower after sumatriptan was initiated. The cost-effectiveness ratio was 47% more favorable after patients started taking sumatriptan. Overall, patients reported fewer migraine-related disabilities, had lower migraine severity scores, and used fewer healthcare resources when taking sumatriptan. These changes resulted in a better cost-effectiveness ratio for migraine treatment.

Cost of Illness↗
PubMed2005

Asthma control in Latin America: the Asthma Insights and Reality in Latin America (AIRLA) survey.

OBJECTIVES: The aims of this survey were (1) to assess the quality of asthma treatment and control in Latin America, (2) to determine how closely asthma management guidelines are being followed, and (3) to assess perception, knowledge and attitudes related to asthma in Latin America. METHODS: We surveyed a household sample of 2,184 adults or parents of children with asthma in 2003 in 11 countries in Latin America. Respondents were asked about healthcare utilization, symptom severity, activity limitations and medication use. RESULTS: Daytime asthma symptoms were reported by 56% of the respondents, and 51% reported being awakened by their asthma at night. More than half of those surveyed had been hospitalized, attended a hospital emergency service or made unscheduled emergency visits to other healthcare facilities for asthma during the previous year. Patient perception of asthma control did not match symptom severity, even in patients with severe persistent asthma, 44.7% of whom regarded their disease as being well or completely controlled. Only 2.4% (2.3% adults and 2.6% children) met all criteria for asthma control. Although 37% reported treatment with prescription medications, only 6% were using inhaled corticosteroids. Most adults (79%) and children (68%) in this survey reported that asthma symptoms limited their activities. Absence from school and work was reported by 58% of the children and 31% of adults, respectively. CONCLUSIONS: Asthma control in Latin America falls short of goals in international guidelines, and in many aspects asthma care and control in Latin America suffer from the same shortcomings as in other areas of the world.

Adolescent↗
PubMed2004

Burden of allergic disease in the UK: secondary analyses of national databases.

BACKGROUND: Although allergy represents an important source of patient morbidity and healthcare utilization, there is little reliable information on the overall disease burden posed by allergic conditions in the UK. OBJECTIVES: Focusing on the following conditions: allergic rhinitis, anaphylaxis, asthma, conjunctivitis, eczema/dermatitis, food allergy and urticaria/angioedema, we sought to (i) describe the prevalence, incidence and outcomes of allergic disorders; (ii) describe the NHS healthcare burden posed by allergic disorders; (iii) estimate the costs of allergic disorders from a healthcare perspective. METHODS: Secondary analyses of data from the Health Survey for England, Scottish Health Survey, International Study of Allergies and Asthma in Childhood, European Community Respiratory Health Survey, Morbidity Statistics from General Practice 1991/1992, Royal College of General Practitioners Weekly Returns Service, Prescribing Analysis and Cost data, Hospital Episodes Statistics and national mortality data. RESULTS: Thirty-nine percent of children and 30% of adults have been diagnosed with one or more atopic conditions. Six percent of general practice consultations and 0.8% of hospital admissions are for allergic diseases. Treatments for asthma and other allergic disorders currently account for 10% of primary care prescribing costs. Direct NHS costs for managing allergic problems are estimated at over one billion UK pounds per annum. CONCLUSIONS: Allergic disorders are common throughout the UK, affecting males and females of all ages and peoples from all social classes and ethnic groups. They currently represent a substantial burden of morbidity and health service cost.

Adolescent↗
PubMed2002

Long-term consequences of type 2 diabetes mellitus: economic impact on society and managed care.

Type 2 diabetes is the most common form of diabetes in the United States and is associated with significant long-term morbidity and increased mortality. Patients with diabetes are at much higher risk for development of both microvascular and macrovascular complications, including peripheral neuropathy, nephropathy, ophthalmic abnormalities, and cardiovascular disease. Not surprisingly, direct and indirect healthcare costs associated with diabetes totaled $98 billion in 1997. Studies have shown that improving glycemic control leads to reductions in healthcare utilization and a decrease in overall costs. Notably, early and aggressive treatment may delay or even prevent many of the complications associated with diabetes, leading to improved quality of life and reduced expenditures in patients with type 2 diabetes. This article will provide a review of recent findings on the impact of diabetes on healthcare costs.

Cost of Illness↗
PubMedDate not supplied

Relationship between symptoms of depression, functional health status, and chronic disease among a residential sample of African Americans.

Depression and psychological distress often go unrecognized and untreated in primary care settings. The association between depression, socioeconomic status, and chronic disease underscore the importance of incorporating mental health education and screening into community-based health initiatives. This is particularly critical for African Americans who bear a disproportionate burden of poverty and chronic disease. This descriptive study assessed associations between symptoms of depression, socioeconomic status, healthcare utilization, physical and mental health functioning, and reactions to race among a sample of low-income African Americans. Consistent with the findings of previous research, respondents with symptoms of depression reported lower levels of physical and mental health functioning, and perceived that they had been treated worse by others at work, and had worse healthcare experiences than those of other races. Community-based programs for reducing disparities in physical illness may need to address the burden of undiagnosed and untreated depression in order to become optimally effective.

Adult↗
PubMed2006

A Cross-Sectional Comparison of Direct Medical Care Costs among COPD and Asthma Patients Living in the Community in Northern Ireland.

INTRODUCTION: Asthma and COPD are known to have significant health and economic consequences. Little is known about the costs of the latter in the UK. In this study we report the results of a comparison of the direct medical costs associated with COPD and asthma, where diagnoses are based on a robust prevalence study of a random sample of the Northern Ireland population. METHODS: A two-stage survey was used to identify individuals with COPD and asthma. The diagnoses of asthma and COPD were based on patient history and lung function. Patients completed a detailed questionnaire covering healthcare utilization over the past 12 months, socioeconomic characteristics, impact of the disease on quality of life, and activities of daily living. RESULTS: Forty-nine patients were diagnosed with COPD and 57 with asthma. Three asthma patients were excluded from the main analysis because they were thought to have atypical inpatient stays or other resource use. The mean direct healthcare cost for each COPD patient was estimated at pound171.69 ($US309; year 2000 value) per annum, significantly less than the average cost of asthma among the 54 analyzed of pound544.54 ($US980) [p < 0.05]. A correlation analysis revealed that among COPD patients, disease severity, defined by lung function, was a significant predictor of costs. CONCLUSION: Community-based costs for asthma are greater than those for COPD; this may relate in part to a relative under-diagnosis of COPD (73.5% COPD vs 15.8% asthma). As anticipated, the cost of COPD increases as FEV(1) decreases. Further analysis will enable modeling of the cost consequences of both increased diagnosis and better management of COPD.

Activities of Daily Living↗
PubMedDate not supplied

Effect of practitioner education on adherence to asthma treatment guidelines.

OBJECTIVE: To determine whether a letter-based intervention program submitted to prescribers and pharmacists would improve drug therapy in users of high-dose beta(2)-agonists (HDBs). STUDY DESIGN: Retrospective drug utilization review. PATIENTS AND METHODS: The intervention group consisted of 135 asthmatic patients (identified through ICD-9-CM codes) in the Connecticut Medicaid Program who submitted >1 claim per month for short-acting beta(2)-agonists (over a 6-mo period). Patient-specific intervention packets were mailed to the patients' prescribers and pharmacists, and their use of long-term control agents and healthcare utilization was evaluated over 6 months. These variables were compared with a comparison group (n = 510) of asthmatics drawn from the same Medicaid program who were not considered to be high-dose users of short-acting beta(2)-agonists at baseline. RESULTS: Prior to the intervention, the intervention group used fewer long-term asthma control agents as compared with the comparison group (58% vs. 96%; p < 0.001); there was no significant difference after the intervention program (65% vs. 71%; p = 0.169). The acquisition of spacers was greater in the intervention group than in the control group after the intervention (7% vs. 2%; p = 0.007). At the end of the 6-month intervention period, 46% of patients in the intervention group were no longer HDB users (p < 0.001). The higher frequency of prescriber office visits in the intervention group than the comparison group before the intervention (0.46 +/- 0.82 vs. 0.25 +/- 0.66; p < 0.001) was not evident after the intervention program (0.24 +/- 0.63 vs. 0.18 +/- 0.60; p = 0.283). CONCLUSIONS: This intervention program had modest impact on improving the use of long-term control agents and reducing prescriber office visits.

Adrenergic beta-2 Receptor Agonists↗
PubMed2005

Impact of medication adherence on hospitalization risk and healthcare cost.

OBJECTIVE: The objective of this study was to evaluate the impact of medication adherence on healthcare utilization and cost for 4 chronic conditions that are major drivers of drug spending: diabetes, hypertension, hypercholesterolemia, and congestive heart failure. RESEARCH DESIGN: The authors conducted a retrospective cohort observation of patients who were continuously enrolled in medical and prescription benefit plans from June 1997 through May 1999. Patients were identified for disease-specific analysis based on claims for outpatient, emergency room, or inpatient services during the first 12 months of the study. Using an integrated analysis of administrative claims data, medical and drug utilization were measured during the 12-month period after patient identification. Medication adherence was defined by days' supply of maintenance medications for each condition. PATIENTS: The study consisted of a population-based sample of 137,277 patients under age 65. MEASURES: Disease-related and all-cause medical costs, drug costs, and hospitalization risk were measured. Using regression analysis, these measures were modeled at varying levels of medication adherence. RESULTS: For diabetes and hypercholesterolemia, a high level of medication adherence was associated with lower disease-related medical costs. For these conditions, higher medication costs were more than offset by medical cost reductions, producing a net reduction in overall healthcare costs. For diabetes, hypercholesterolemia, and hypertension, cost offsets were observed for all-cause medical costs at high levels of medication adherence. For all 4 conditions, hospitalization rates were significantly lower for patients with high medication adherence. CONCLUSIONS: For some chronic conditions, increased drug utilization can provide a net economic return when it is driven by improved adherence with guidelines-based therapy.

Adolescent↗
PubMed1999

One-year follow-up of newly diagnosed irritable bowel syndrome patients.

BACKGROUND: Irritable bowel syndrome is the most common functional gastrointestinal disorder seen by general physicians. METHODS: We followed up a population-based cohort of newly diagnosed irritable bowel syndrome patients aged 20-79 years, to examine patterns of treatment, comorbidity and healthcare utilization. We used the UK General Practice Research Database as the source population. Individuals with other gastrointestinal diseases, cancer and pregnant women were not included. There were 2956 patients in our final cohort. RESULTS: Irritable bowel syndrome patients were mainly young and middle-aged; only 12% were 60 years or older. The majority of patients were women (74%). There were no marked differences in terms of use of healthcare services or comorbidity status in the year before irritable bowel syndrome diagnosis as compared to the year after. Fourteen per cent of irritable bowel syndrome patients received no drug treatment at all. Among those treated, the first choice was an antispasmodic. Elderly patients (>60 years old) were more likely to receive drug treatment. Females had a slightly higher probability of being treated than men, except for the category of anti-diarrhoeal drugs. CONCLUSION: This study has shown that irritable bowel syndrome patients are mainly young and female. We also found that treatment pattern varied according to age and gender. Elderly patients and females were at a higher risk of receiving drug treatment.

Adult↗
PubMed2005

Positive factors associated with promoting health in low-risk and high-risk populations of 15- and 16-year-old pupils in Oslo, Norway.

AIM: To explore possible risk-reducing factors associated with the incidence of common illnesses and use of healthcare services among adolescents. METHODS: Cross-sectional questionnaire study conducted in all Oslo schools among all 15- and 16-y-olds in 2000 and 2001. The adolescent population was divided into a low-risk (LR) and a high-risk (HR) group, and into quartiles, based on a sum score of different negative life experiences. The groups were compared with respect to potential risk-reducing factors. RESULTS: 88% of the 8316 pupils filled in the questionnaires. The difference between the LR and HR groups was largest for the possible risk-reducing factor "my family values my opinion" (LR group = 92%; HR group = 82%), and "I manage to solve serious problems myself" (LR = 91%; HR = 86%). The family valuing the adolescents' opinions was the risk-reducing factor most often associated with lower incidences of illness and healthcare utilization. Among the adolescents at highest risk, less depression was strongly related to positive relationships with friends, boys: odds ratio = 0.1 (CI 95%: 0.0-0.7); and girls: 0.2 (0.1-0.5). Adolescents reporting that they managed their own problems had about half the risk of depression. CONCLUSION: Good relations with family and friends, and a feeling of managing one's own life, are significantly related to lower rates of illness, in particular depression, and less healthcare-seeking behaviour. The risk-reducing effects increase with increasing risk. Healthcare workers therefore need to pay more attention to HR patients.

Adolescent↗
PubMed2001

Diagnosis and care of irritable bowel syndrome in a community-based population.

OBJECTIVE: To identify the healthcare utilization and evaluation in a community-based population with an incident diagnosis of irritable bowel syndrome (IBS). STUDY DESIGN: Retrospective cohort. PATIENTS: A randomly selected cohort of 149 Olmsted County, MN, adults with an incident diagnosis of IBS between June 1, 1992, and December 31, 1994. METHODS: Retrospective medical record review of each medical encounter for the 10 years before and the 3 years after the incident IBS diagnosis. Specific attention was given to healthcare visits, tests, and treatment associated with documented gastrointestinal (GI) tract symptoms and diagnosis of IBS. RESULTS: Of 149 patients, 98 (66%) were women, and the mean patient age was 46.6 years. Patients averaged 4.7 healthcare visits annually, including 0.5 related to GI tract symptoms. Two thirds of patients had GI tract symptom-related visits at least 2 years before IBS diagnosis. Only 5% of IBS diagnoses were made by a gastroenterologist. Colon examinations (colonoscopy or barium enema) were performed on 47% of patients and were more common in those aged > or = 55 years (58% vs 36%; P = .02). One third of patients had no GI tract testing proximal to the IBS diagnosis. Following the IBS diagnosis, only about half the patients made any IBS or GI tract symptom-related visits per year. CONCLUSION: The path to diagnosis of IBS is through the primary care physician and includes minimal testing and limited follow-up care.

Adolescent↗
PubMedDate not supplied

Self-reported cost of illness and health-related quality of life.

PURPOSE: To evaluate how well a rapid, self-report of the costs of illness correlates with health-related quality of life. METHODS: A total of 211 patients, participating in a clinical trial of an arthritis medication, completed a Quality of Well-being scale interview and an 18-item self-assessment of healthcare utilization. Subjects completed both these instruments at each of three time points during the trial. RESULTS: Correlations between the measures and across time suggest that patient-reported costs are associated with quality of life and function. CONCLUSIONS: A self-reported cost of illness measure may provide valuable information. With the increase move to assess cost as well as health outcomes, such rapid self-report techniques may prove useful to health services researchers, healthcare system managers, and clinicians.

Activities of Daily Living↗
PubMed2003

Posttraumatic stress disorder following medical illness and treatment.

Studies describing posttraumatic stress disorder (PTSD) as a result of physical illness and its treatment were reviewed. PTSD was described in studies investigating myocardial infarction (MI), cardiac surgery, haemorrhage and stroke, childbirth, miscarriage, abortion and gynaecological procedures, intensive care treatment, human immunodeficiency virus (HIV) infection, awareness under anaesthesia, and in a group of miscellaneous conditions. Cancer medicine was not included as it had been the subject of a recent review in this journal. Studies were reviewed in terms of the prevalence rates for PTSD, intrusive and avoidance symptoms, predictive and associated factors and the consequences of PTSD on healthcare utilization and outcome. There was considerable variability both in the study methodology and design and in the results. The highest prevalence rates were identified in patients treated in intensive care units (ICUs) and those with HIV infection. Irrespective of the physical illness, posttraumatic symptomatology is more common than PTSD caseness. Existing characteristics of the patient may well predispose individuals to the development of PTSD as do other factors such as poor social support and negative interactions with healthcare staff. Generally, the severity of the illness itself is not predictive of PTSD. Issues relating to sampling, attrition, diagnosis, the course of symptoms, aetiological pathways, and the consequences of the disorder are discussed. The presence of PTSD most probably influences the patient's use of healthcare resources and may affect their clinical outcome.

Acute Disease↗
PubMed1999

Compliance with sulfonylureas in a health maintenance organization: a pharmacy record-based study.

OBJECTIVE: To determine which factors affect compliance with sulfonylureas in a population served by a health maintenance organization in Southern California. METHODS: Retrospective analysis of pharmacy records and healthcare utilization data for two years (April 1993-March 1995), and a survey mailed to patients. Patients treated with sulfonylureas were selected for analysis on the basis of their prescription profile. Compliance was measured from the pharmacy records as the proportion of days the patient was in possession of the prescribed medications. Patient compliance with sulfonylureas was modeled as a function of four clusters of determinants: patient-related attributes, drug regimen characteristics and complexity, health status and disease-related variables, and characteristics of the interaction with healthcare providers. RESULTS: 786 patients were identified for analysis (49.1% women, mean age 59 y). The mean compliance rate was 83% +/- 22% SD. Compliance was significantly positively related with age and self-reported level of medication-taking compliance at baseline. Factors shown to have an inverse relationship with compliance were treatment complexity, perception of general health, and being a newly treated patient (adjusted R2 for the final model = 0.148). CONCLUSIONS: Our results suggest that factors found to be associated with noncompliant behavior (e.g., being a newly treated patient, self-reported compliance, regimen complexity) can be assessed by physicians and pharmacists as a routine practice.

Aged↗