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At least 433 records · Page 24Linked to original sources
PubMed2004

A systematic review evaluating health-related quality of life, work impairment, and healthcare costs and utilization in bipolar disorder.

BACKGROUND: Bipolar disorder greatly impacts health-related quality of life (HRQoL), physical and social functioning, employment, and work productivity, and greatly increases health-care utilization and costs. Our objective was to characterize how bipolar disorder impacts HRQoL, work impairment, and health-care utilization and costs. DATA SOURCES AND STUDY SELECTION: A systematic literature review was conducted to identify bipolar disorder studies of HRQoL, functioning, work impairment, and health-care utilization and costs. We searched Medline, ClinPSYC, and HealthSTAR for English-language articles published between January 1985 and November 2002 using MeSH headings and keywords. Additional articles were identified from references of relevant articles. RESULTS: We identified 65 HRQoL articles, 14 work-impairment articles, and 28 utilization-and-care-cost articles. For all HRQoL instruments used, bipolar disorder patients' HRQoL was rated similarly to that of unipolar depression patients, and equal to or lower compared with patients with other chronic nonmental illnesses. Current treatments have been shown to improve HRQoL and physical and social functioning; some data indicate that management may improve selfreported work impairment and absenteeism. Bipolar disorder patients have been found to utilize health-care services more than do patients with depression or chronic medical conditions. Inpatient costs are the largest cost contributor; treatment to prevent recurrence has been shown to be the most effective way to reduce costs. CONCLUSIONS: Bipolar disorder imposes a tremendous burden on patients and the health-care system, resulting in decreased HRQoL and increased medical and work impairment costs. Limited data suggest that appropriate management can improve HRQoL and functioning while reducing utilization and cost.

Bipolar Disorder↗
PubMed2001

Predictive power of a risk-assessment questionnaire across different disease states: results in an elderly managed care enrolled population.

OBJECTIVE: To examine the predictive power of self-reported assessment questionnaire data to explain changes in healthcare service utilization and expenditures of a population of Medicare health maintenance organization enrollees during a 2-year period. STUDY DESIGN: A prospective cohort study with a 2-year postenrollment follow-up period. Multiple robust regression analyses were conducted to examine associations among self-reported health status variables obtained from responses to the questionnaire. SAMPLE AND METHODS: Participants were administered a voluntary comprehensive questionnaire at enrollment that collected self-reported information on morbidity, health status, perceptions of health, and healthcare service utilization during the preenrollment year. Questionnaire responses were combined with actual 2-year postenrollment claims data. For the complete follow-up period, 4128 patients were available. RESULTS: Participants with such chronic conditions as depression and diabetes were likelier than the average enrollee to have higher healthcare service utilization. Self-reported health status predictors examined in this study explained a larger percentage of the variance (as much as 20%) in such chronic conditions as cancer and depression. Despite evidence of underreporting of preenrollment healthcare service utilization, these variables were highly predictive of actual postenrollment utilization patterns. CONCLUSIONS: Self-reported health status information collected at baseline is as predictive of postenrollment risk as are currently used traditional approaches that require archival healthcare service utilization data. In addition, this approach is sensitive to changes in healthcare service utilization across differing morbidity states in older adults.

Activities of Daily Living↗
PubMed2000

An epidemiological case-control study of migraine and its associated comorbid conditions.

BACKGROUND: The economic impact of migraine to society has been well documented. However, few studies have identified the risk of migraine-specific comorbid conditions to explain the higher healthcare resource utilization by migraineurs. Because comorbidity has the potential to increase treatment costs, estimating its risks and its economc impact becomes imperative.OBJECTIVES: To estimate the risk for migraine by presence of a defined set of comorbidities, and to quantify the association of estimated healthcare costs between the case-control groups with and without comorbidity.METHODS: A matched case-control was designed using data from 1998 Idaho Medicaid claims. Cases were identified by physician-diagnoses and migraine-specific medication use. A 1:1 matching was performed on age, race, gender, and residence. Presence of comorbidity was determined by ICD-9 diagnostic categories. Total healthcare resource utilization was estimaed for all physician, hospital (inpatient and outpatient), and emergency services, including prescription medicines paid by Idaho Medicaid. Multivariate logistic regression was used to compute the odds ratio controlling for the matching variables. Multiple-regression models were used to quantify the association of total healthcare costs.RESULTS: Migraine patients were approximately five times more likely (Odds Ratio = 5.34; Confidence Interval(95%)-4.38 to 6.52) than their controls to be diagnosed with comorbid condition(s). A model with variables of age, gender, presence of comorbidity and migraine, explained approximately 21% of the variance in healthcare utilization (p < 0.05).CONCLUSIONS: Migraine patients are at a higher risk for defined comorbid conditions resulting in significantly higher healthcare costs as compared to non-migraine patients.

Journal Article↗
PubMed1998

Formulary limitations and the elderly: results from the Managed Care Outcomes Project.

OBJECTIVE: To examine whether restrictive formularies are associated with differences in healthcare resource utilization, including number of office visits, prescriptions, and hospitalizations, and whether this association varies by age. STUDY DESIGN: Cross-sectional, longitudinal study. PATIENTS AND METHODS: Patients enrolled in one of six health maintenance organizations in six different states, three in the eastern and three in the western United States, were eligible for the study. Data from between 1309 and 3938 patients were available for analysis for each of the five diseases studied, for a total of 12,997 patients across all study diseases. Healthcare utilization by patients in the study included more than 99,000 office visits, 1000 hospitalizations, and 240,000 prescriptions. We used severity-adjusted prescription counts, prescription costs, office visit counts, and measures of inpatient hospital utilization to assess the effects of formulary limitations. RESULTS: We found positive, significant associations between the independent variable formulary limitations in drug class and the dependent variables measuring resource utilization. These associations were sometimes significantly greater for elderly patients after controlling for severity of illness and other variables. CONCLUSIONS: Common strategies for decreasing drug expenditures may be associated with higher severity-adjusted resource utilization. In specific areas, this association is more pronounced in the elderly.

Aged↗
PubMed2005

Relationship of anxiety, depression and alcohol use disorders to persistent high utilization and potentially problematic under-utilization of primary medical care.

Psychiatric disorders in primary medical care are prevalent, frequently undetected, under-treated, and costly. Studies report that psychiatric disorders are associated with high utilization of healthcare, but the stability of high utilization has not been systematically examined. Medical records data for 500 primary care patients in Connecticut, USA, representing high and modal utilization levels were examined over a 2-year period. In multi-variate analyses, only anxiety disorders were associated with persistent high utilization of primary care, as well as with inconsistent attendance. Alcohol use disorders were inversely associated with persistent high utilization, and positively related to inconsistent attendance and low complexity services (determined by evaluation and management coding). Depression was associated with low complexity primary care services and inconsistent attendance. Anxiety disorders and mixed anxiety-depression disorders warrant attention as potential contributors to persistent high or inconsistent utilization of primary healthcare. Alcohol use disorders may be under-treated in primary care due to inconsistent attendance, few visits, and low complexity services.

Adolescent↗
PubMedDate not supplied

[Characteristics of 107 Spanish healthcare registries and evaluation of the utilization thereof].

BACKGROUND: The information concerning the currently existing healthcare registries in our country is not readily accessible, is scarce and some are not well-known, possibly being underused in comparison to their many potential uses. This study is aimed at evaluating the characteristics of the Spanish Healthcare registries and the utilization thereof, especially in Healthcare technology assessment. METHODS: Descriptive, cross-sectional study of the Spanish Healthcare registries within the 1997-2002 period. These registries were identified by means ofa bibliographic databases search and by way of a survey of Scientific Societies and Central and Autonomic Healthcare Administration. Another bibliographic databases search was conducted of the publications which use data from the healthcare registries included and have been evaluated by applying the scientific evidence quality criteria. RESULTS: A total of 107 healthcare registries were identified, most of which of local or regional coverage (71%), preferably were under Autonomic government authority (64.5%). The areas showing the largest number of registries identified were those related to death statistics (16.8%) and cancer (15.9%). A total of 298 publications were retrieved which analyze data produced by the registries identified, most of which are devoted to the study of the frequency and distribution of the events recorded (58.1%) and less frequently to the conducting of healthcare technology assessment studies (24.4%). CONCLUSIONS: The critical evaluation of the publications made it possible to identify some elements related to the analysis methodology and design which would heighten the quality of the healthcare technology assessment. Healthcare registries in Spain have developed recently and to differing degrees. Important areas without any records and improvement elements related to the use of healthcare registries for healthcare technology assessment were detected. It would be advisable to avail of a register of registries which would provide relevant, up-dated information thereon.

Cross-Sectional Studies↗
PubMed2003

Genetic testing: costs and access to intensive care unit care.

Critically ill patients require significant medical care and use limited healthcare resources. Furthermore, the mortality rate from most forms of critical illness is much higher than for noncritically ill hospitalized patients. Although genetic diseases increase mortality, most are easily identified at birth and have only limited treatments and prognoses. Recently, more subtle single nucleotide polymorphisms at key loci have been demonstrated to result in a profoundly different prevalences of acute illness and subsequent survival rates for subjects with apparently similar insults and otherwise similar phenotypes. With the maturation of the human genome project, this new discovery will allow for the characterization of individual subject's responsiveness and potential for recovery from a number of insults. This realization makes our definition of genetic diseases blurred and begs the questions, "Will these new insights allow for more effective healthcare resource utilization, as defined from patient, healthcare system, and societal perspectives?" and, perhaps more worrisome, "Should intensive care resources be limited to those with the greatest chance of benefit?" Similarly, as with other genetic predispositions such as cystic fibrosis and congenital hypercholesterolemia, to what extent should these data be available outside the patient-doctor relationship?

Critical Care↗
PubMed2005

Drug-related emergency department visits in an elderly veteran population.

BACKGROUND: Given that adverse drug events result in extensive costs and healthcare resource utilization, the goal is to better understand drug-related emergency department (ED) visits so that programs can be implemented to improve the quality of health care. OBJECTIVE: To (1) determine the incidence of drug-related ED visits at a large, tertiary care, Veterans Affairs hospital; (2) identify causes of these drug-related ED visits; (3) determine patient outcomes, healthcare resource utilization, and costs associated with these visits; and (4) determine the proportion of adverse drug reaction (ADR)-related ED visits that were spontaneously reported to the hospital's ADR reporting program. METHODS: We conducted a retrospective electronic chart review of all patients who visited the ED during the second week of each month in 2003. Causes for drug-related visits were identified. ADRs in this study included side effects, drug allergies, and drug-drug interactions (DDIs) and were assessed using the Naranjo probability scale. RESULTS: A total of 2169 patients were included in the study. Drug-related visits accounted for 12.6% of all ED visits. The main causes of drug-related visits were ADRs and nonadherence, which accounted for 33% and 19% of drug-related visits, respectively. Only 11% of these ADRs were spontaneously reported to the hospital's ADR reporting program. Thirty-five percent of drug-related visits led to hospitalizations, which resulted in an average length of stay of 9.3 days. The institution's total cost of drug-related visits was approximately 1.5 million US dollars over 12 weeks. CONCLUSIONS: Many ED visits are drug related and often result in hospitalization and increased healthcare resource utilization. Only a minimal number of the ADRs resulting in ED visits are spontaneously reported to hospital ADR reporting programs.

Adult↗
PubMed2000

Impact of birthweight on healthcare charges within a managed care organization.

OBJECTIVE: To determine the rate of low-birthweight (LBW) births and the association of LBW with utilization and healthcare charges in a managed care organization. DESIGN: Observational study of computerized and medical record data. PATIENTS AND METHODS: We assessed the rate of LBW (weight < 2500 g) for singleton infants born during 1993 and 1995 at 2 hospitals (1993, N = 3212; 1995, N = 3073). For a subset of infants born during 1995 (n = 1273), we examined differences in utilization and medical charges, by birthweight category (moderately LBW [MLBW; 1500 to 2499 g] vs normal birthweight [NBW]), at 1 year postdischarge. RESULTS: In both 1993 and 1995, 3% of singleton infants were LBW infants, and 2% to 3% were macrosomic (> or = 4500 g). Complete data for analyses of utilization and healthcare charges were available on 1273 infants who were enrolled for the entire postdischarge year. The use of outpatient, emergency department (ED), and subspecialty care by MLBW infants and by NBW infants was similar. However, MLBW was associated with an increased rate of rehospitalization during the first year of birth (P < .01). MLBW infants' medical care charges were 46% higher than those of NBW infants (P = .0125). CONCLUSIONS: MLBW infants and NBW infants had similar outpatient and ED service use during the first year after hospital discharge. Excess charges incurred by MLBW infants were primarily due to higher rates of rehospitalization. Of the 38 admissions, 21 were related to infection or fear of infection, and 4 were due to congenital malformations.

Adolescent↗
PubMedDate not supplied

Knowledge transfer and utilization: implications for home healthcare pain management.

Implementation of research evidence into clinical practice is a complex and dynamic process that has become the subject of investigation in the field of "translation science" or "knowledge utilization." Research shows how individuals, units, and organizations all influence the rate and extent of adoption of research evidence. Environmental factors also play an important role in this process. This article summarizes key lessons from translation science and examines the implications for the organization and delivery of home healthcare. The implementation of pain management guidelines is used as an example.

Health Knowledge, Attitudes, Practice↗
PubMed2006

Income-related inequality in utilization of health services in Denmark: evidence from Funen County.

AIMS: To examine income-related inequity in utilization of healthcare services in Denmark. METHODS: A health survey of 2,915 respondents in Funen County interviewed in 2000 and 2001 on health status and socioeconomic and sociodemographic characteristics was merged with various computerized registers including inpatient stays, ambulatory visits, contacts in the primary healthcare sector, and prescription medicine. The index of horizontal inequity was used to estimate the degree of horizontal inequity in utilization of healthcare services across income groups, using the indirect method of standardization to control for age, gender, and self-assessed health as a proxy for need. The standardization method rests on the assumption of equal response behaviour across income groups. RESULTS: The least advantaged with respect to income consume a bigger share of the health services than the most advantaged with the exception of dental treatments where the opposite is true. After standardization for age, gender, and health status there is no significant inequity in use of all healthcare services. However, when it comes to specific healthcare services the least advantaged have a significantly lower share of the medicine consumption and dental treatments than expected. CONCLUSION: The index of horizontal inequity suggests that the Danish healthcare system is in general equitable. In sectors with a high degree of co-payment some horizontal inequity disfavouring the lower income groups appears to be present.

Adult↗
PubMed2006

Glimepiride versus pioglitazone combination therapy in subjects with type 2 diabetes inadequately controlled on metformin monotherapy: results of a randomized clinical trial.

OBJECTIVE: To compare the effect of add-on glimepiride or pioglitazone in subjects with type 2 diabetes inadequately controlled on metformin monotherapy. RESEARCH DESIGN AND METHODS: Multicenter, randomized, parallel-group, open-label, forcedtitration study involving 203 adults with poorly controlled type 2 diabetes (A1C 7.5-10%) on metformin monotherapy. Subjects were randomized to receive glimepiride or pioglitazone, titrated to the maximum dose for 26 weeks. Subjects were evaluated for A1C changes, fasting plasma glucose (FPG), insulin, C-peptide, and lipid levels. Safety outcomes and diabetes-related healthcare resource utilization were also evaluated. RESULTS: Both treatment groups achieved similar and significant mean decreases from baseline to endpoint (week 26) in A1C (p = 0.0001) and FPG (p < 0.05). Glimepiride therapy, however, resulted in a more rapid decline in A1C levels at weeks 6, 12, and 20 vs. pioglitazone (p < 0.05). A mean A1C < or = 7% was reached faster in the glimepiride group (median, 80-90 days vs. 140-150 days [p = 0.024]). Total and LDL cholesterol were significantly higher with pioglitazone treatment than with glimepiride at endpoint (p < 0.05). Glimepiride treatment was associated with an increased risk of hypoglycemia and pioglitazone with higher rate of peripheral edema. Healthcare resource utilization was similar between groups, but total healthcare costs were significantly lower for glimepiride versus pioglitazone over the course of the study, driven largely by drug costs. The use of fasting C-peptide concentration > or = 0.27 nmol/L in the inclusion criteria was a potential limitation as it may have included those patients with an improved probability for glimepiride or pioglitazone response. In addition, a larger patient population would have provided a greater degree of data applicability. CONCLUSIONS: In patients with type 2 diabetes inadequately controlled on metformin monotherapy, add-on glimepiride or pioglitazone results in similar overall improvements in glycemic control. Compared with pioglitazone, glimepiride is associated with faster glycemic control, lower total and LDL cholesterol levels and reduced short-term healthcare costs.

Adolescent↗
PubMed2004

The impact of delayed chemotherapy-induced nausea and vomiting on patients, health resource utilization and costs in German cancer centers.

BACKGROUND: Delayed chemotherapy-induced nausea and vomiting (CINV) remains a major adverse effect of cancer chemotherapy. We assessed, under current practice patterns, the occurrence and impact on healthcare resource utilization of CINV in patients receiving emetogenic chemotherapy. An additional aim of this study was to estimate costs imputable to CINV in the German healthcare environment. MATERIALS AND METHODS: This prospective, multi-center, cross-sectional cost-of-illness study was conducted in three hospitals and in three office-based facilities in Germany. Consecutive patients undergoing emetogenic chemotherapy (levels 4 or 5 according to Hesketh classification of emetogenicity) were enrolled. Data were obtained from preplanned chart reviews and from self-administered patient questionnaires. Analysis of direct costs was performed from the perspectives of third party payer (statutory sick fund), provider (hospital) and patients. Indirect costs were assessed on the basis of paid workdays lost. RESULTS: During the 5-day observation period, 134 of 208 chemotherapy cycles observed (64.4%) were associated with at least one episode of nausea or vomiting. More patients experienced delayed than acute CINV (60.7% versus 32.8%), and more patients reported nausea than vomiting (62.5% versus 26.0%). A total of 68 patients (32.6%) utilized healthcare resources due to CINV. The most frequently used resources were rescue medications and outpatient hospital and office physician visits. Only one patient required hospitalization and only three patients lost workdays due to CINV. Average costs imputable to CINV per patient (with or without CINV) per treatment cycle incurred by third party payers and hospital providers were Euro 49 and Euro 48, respectively. Patient or treatment characteristics that were associated with high costs imputable to CINV were as follows: cisplatin-containing regimen; experience of emesis; and presence of delayed CINV. CONCLUSIONS: A substantial proportion of patients continue to experience CINV. This entails not only clinical but also economic consequences, and highlights a continuing need for improved utilization of existing antiemetic agents and for new, more efficacious treatments. The greatest improvements in patient care and potential for cost offset may be realized by preventing delayed CINV.

Antiemetics↗
PubMed2004

[The role of utilities in economic evaluations of healthcare interventions-an introduction].

Assessment of strength of preference values (utilities) for patients' own health, or disease states from a societal perspective, is an essential element to economic evaluations of healthcare interventions. This review provides an overview of the different methods used to directly elicit strength of preference values: the standard gamble, time trade-off and rating scale methods. Methods used to derive utilities for patients' health states indirectly, and from a societal perspective are described. Three commonly used questionnaires: Health Utilities Index 3, EQ-5D and SF-6D are briefly commented upon. We also discuss the usefulness of utilities and advantages and disadvantages to be considered when choosing direct or indirect utility elicitation methods.

Arthritis, Psoriatic↗
PubMed1997

What are the treatment goals for Helicobacter pylori infection?

The goals of therapy of Helicobacter pylori are commonly viewed as either clinical (e.g., avoid further morbidity, mortality, or prevent disease from occurring) or economic (e.g., save healthcare dollars by avoiding further expenditure of resources). However, when viewed globally, these goals are not incongruent but are inexorably linked. Prevention of disease or avoidance of further morbidity and mortality by curing H. pylori infection is obviously an improved clinical outcome, but it also concurrently avoids further utilization of healthcare resources and is "cost-effective," resulting in improved economic outcome as well. The more clinically effective an H. pylori treatment is, the more economically effective it is as well. When comparing regimens, the cost-effectiveness is determined by efficacy of the regimen, not its cost. Put more simply, "The most expensive therapy is the one that doesn't work!" Therefore, the goals of the therapy are simple: avoid further morbidity, mortality, and prevent disease while minimizing further utilization of healthcare resources, thus saving money. The most clinically effective therapy is also the most cost-effective therapy. Regimens used should have demonstrated greater than 90% efficacy or effectiveness in the population being treated for H. pylori infection. The regimens should be simple and well tolerated. It is clinically and economically inappropriate to use a regimen not meeting these criteria.

Gastroenterology↗
PubMedDate not supplied

Technologies' impact on healthcare facilities.

Technologies common to other industries are gradually being utilized in healthcare. Heavily led by information technology, providers are using technology to increase efficiency, improve customer service and better integrate and streamline business and clinical processes. These changes are gradually making many hospitals' physical facilities obsolete, requiring substantial changes or upgrades. Eight examples are illustrated where technology is changing the requirements in facility utilization, design and construction.

Diagnostic Imaging↗