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At least 1,333 records · Page 74Linked to original sources
PubMed2005

Low utilization and wide interhospital variation in investigation of patients after acute myocardial infarction: inadequate resources or insufficient evidence?

BACKGROUND: Guidelines for the management of patients with acute myocardial infarction are available, but implementation may be difficult when resources are limited. OBJECTIVE: The aim of this study was to investigate whether resources, manpower or access to specialist facilities affect care following myocardial infarction. PATIENTS AND METHODS: A representative sample of 1595 patients in all 19 district general hospitals in Wales was analysed for differences in use of investigations and prescription of secondary prevention and how these factors were related to provision of cardiologists and coronary care beds and distance from specialist cardiac services. RESULTS: Inpatient investigation rates were low and there were wide interhospital variations for exercise testing [mean 42%; interquartile range (IQR) 27-59%] and echocardiography (mean 46%; IQR 33-66%). In comparison, prescription of secondary prevention was similar to European standards and showed less interhospital variation (beta blockers mean 48%; IQR 44-54%; angiotensin-converting enzyme inhibitors mean 59%; IQR 43-63%). There was little association between investigation or secondary prevention rates and cardiac services, but overall rates and provision were low. CONCLUSION: Delivery of care after acute myocardial infarction for stratifying risk and preventing recurrence was unrelated to relative provision or distance from specialist centres. Low use of investigations and high interhospital variability could imply limited access to resources such as echocardiography. Higher rates of prescription of drugs, with less variation between hospitals, argues against low utilization because of insufficient evidence.

Female↗
PubMed2005

Characteristics and staff resources of child and adolescent psychiatric hospital wards in Finland.

The aim of this study is to describe structural characteristics and staff resources of child psychiatric and adolescent psychiatric hospital wards in Finland. The target group of the survey consisted of 69 child and adolescent psychiatric hospital units in Finland. Information was obtained from 64 units (93%). Most of the wards were based on 24-h-a-day provision. There were only 7-day-treatment programmes including two family wards. When compared internationally, the numbers of units, beds and staff levels were high in Finland, with all members of staff qualified. The nurse-patient ratio and psychiatrist resources were rather satisfactory. However, in many units there was a lack of psychologists, social workers and occupational therapists. General recommendations and guidelines for staff resources in child and adolescent hospital treatment wards are warranted.

Adolescent↗
PubMed1991

Resource allocation in contemporary paediatrics: the case against high technology.

High technology has introduced a new dimension to medical treatment. There are inevitable social costs as well as benefits, and the allocation of resources to high technology, as opposed to other areas of health care, is a contentious issue. The current balance in health service funding between high technology and low technology is not appropriate. It is driven by the technological imperative and only offers solutions to a limited number of problems. There is a scarcity of health resources left to develop intersectoral responses and provide adequate funding for research into person-intensive interventions suitable for many problems. Arguments against allocating too many resources to high technology in paediatrics are examined in this paper.

Australia↗
PubMed1987

Major trauma in an urban New Zealand setting: resource requirements.

Patients with severe injuries, place significant demands on an institution's facilities and staff if these patients are to be treated adequately. In the USA, requirements for institutions managing patients with major injuries have been outlined and 'trauma centres' designated. In New Zealand, the requirements for care of patients with severe injuries have not been documented. One hundred and fourteen patients who presented to the Accident and Emergency Department at Auckland Hospital over a 6 month period were prospectively evaluated. All patients had Injury Severity Scores greater than or equal to 16 and the majority were young males. The greatest number of patients presented at night and during the weekend. Radiographic studies and resuscitation room procedures were commonly required and 54% of patients required surgery within the first 24 h after presentation. Management of patients required involvement by a large variety of specialties with general surgery, intensive care, anaesthetics, neurosurgery and orthopaedics more commonly involved. Sixty per cent of patients required intensive care admission and the overall group had a 30% mortality rate. This study confirms that major trauma in New Zealand patients places similar demands on resources to that experienced in the USA. Although health resources are currently limited, appropriate allocation of these resources must be considered to best treat patients suffering severe injuries.

Adolescent↗
PubMed1990

Health care as a right, fairness and medical resources.

Our intention in the following is to use the WHO declaration as a basis for considering the allocation of resources in health care. We shall first argue that most of the criteria suggested as grounds for fair allocation of scarce medical resources have their difficulties if one tries to apply them one by one to medical practices. We shall then go on to claim that, if we take the right of all human beings to health or health care even moderately seriously, increasing the resources would in most cases be more ethical than attempting to allocate them 'fairly'.

Altruism↗
PubMed2005

Medical resource use and costs of health care after acute stroke in Germany.

The purpose of this study was to determine the 12 months medical resource use following admission to hospital with acute stroke and to calculate costs from a societal perspective. Data of consecutive patients with confirmed stroke were analysed. Acute hospital data were taken from medical records, socio-demographic variables from patients' interviews. A follow-up questionnaire about resource utilization was completed by patients or proxies 12 months after acute hospital admission. Costs were calculated by multiplying medical resource units used with cost factors per unit. Mean age of a total of 383 patients was 65 years and 41% were female. The median length of the initial stay in the acute hospital was 12 days at an average cost of 4650 per patient (49% of direct costs). Rehabilitation (16%), readmission (11%), medication (9%), and nursing costs (6%) were other contributors to the direct costs which amounted to a total of 9452 +/- 7599 per patient during 12 months. Indirect cost amounted to a total of 2014 +/- 5312. Patients' age, severity and type of stroke influenced the total stroke-associated costs. The large economic burden of stroke indicates the need for assessing and improving efficient health care for affected patients.

Aged↗
PubMed1992

Alcohol availability and the formal power and resources of state alcohol beverage control agencies.

The formal powers and resources of state alcohol beverage control agencies place them in a position to regulate access to alcoholic beverages through restrictions on retail distribution and sales. For example, monopoly states restrict access to spirits, and sometimes wine, by allowing retail sales only through state stores. On the other hand, license and monopoly states share in restricting sales through the use of price posting and fixing provisions. The degree to which these powers are realized in restrictions on alcohol outlets (e.g., licenses) and subsequent alcohol consumption (e.g., sales) was investigated in the current study. In a cross-sectional analysis of data available from 44 alcohol beverage control (ABC) jurisdictions in the United States, it was shown that states with greater restrictions on retail sales had greater resources for the conduct of ABC activities and lower densities of spirit outlets. These states, however, had greater densities of wine and beer outlets. States with greater marketplace restrictions had more resources for ABC enforcement activities and lower outlet densities across all beverage types. Further, supporting the suggestion that availability and demand may be simultaneously related, greater outlet densities were related to greater alcohol consumption (for beer) and greater levels of consumption were related to greater outlet densities (for wine).

Alcohol Drinking↗
PubMed2005

The impact of somatization on the use of gastrointestinal health-care resources in patients with irritable bowel syndrome.

BACKGROUND: It is unclear why patients with irritable bowel syndrome (IBS) consume a disproportionate amount of health-care resources versus matched controls. One possibility is the presence of comorbid somatization-a process marked by multiple unexplained somatic complaints that is highly prevalent in IBS. We sought to determine whether higher levels of somatization are associated with higher levels of gastrointestinal (GI) resource utilization in IBS. METHODS: A total of 1,410 patients >18 yr with IBS were evaluated at a university-based clinic. Subjects completed a symptom questionnaire, the SCL-90R psychometric checklist, and the SF-36 Health Survey. We measured two outcomes: (1) a 1-yr direct GI health-care costs and (2) a 1-yr number of GI physician visits. Our primary regressor was somatization as measured by the somatization subscale of the SCL-90R. We performed regression analyses to measure the adjusted influence of somatization on GI resource utilization. RESULTS: In the full sample of patients, there were no differences in the likelihood of expending versus not expending previous GI health-care costs among groups with varying levels of somatization. Similarly, there were no differences in either the likelihood of visiting a GI physician or the number of overall physician visits among patients with varying levels of somatization. However, in the subset of patients expending at least $1.00 in GI costs in the previous year (53% of cohort), there was a significantly higher cost of care for subjects with high versus low levels of somatization. CONCLUSIONS: IBS patients with high levels of somatization are not more likely to seek GI care compared to patients with low levels of somatization. However, once they are evaluated for care, patients with high somatization expend significantly more GI health-care costs. This suggests that somatization is positively associated with health-care costs in IBS, and that the association may be driven more by physicians than patients.

Adolescent↗
PubMed2006

Epidemiology, prescribing patterns and resource use associated with overactive bladder in UK primary care.

This study aimed to estimate the incidence and prevalence of overactive bladder (OAB) symptoms in the UK and analyse the use of anticholinergic/antispasmodic medications and other healthcare resources within UK general practice. Patients with a record of urinary frequency, urgency, nocturia, urge incontinence or irritable/unstable bladder between 1987 and 2004 were identified from the General Practice Research Database. Demographic characteristics, referrals, consultations, investigations and prescriptions for medications licensed for use in OAB were identified. Regression analyses were used to identify the factors determining switches between medications, referrals and use of healthcare resources. The overall prevalence of OAB-related symptoms was 3.87 per 1000 persons, with an incidence of 2.79 per 1000 person-years. Among 68,910 patients with OAB symptoms, 19,444 (28.2%) received anticholinergic medication, of whom 14,454 (74.3%) received one drug and 4055 (20.9%) received two medications sequentially. Overall, 59.1% of patients were referred to relevant secondary care specialities, 2.8% underwent urinary tests/investigations in primary care and 0.2% were seen by a continence nurse. Resource use was higher among patients who tried several different medications. In conclusion, this study suggests that OAB may be under-diagnosed in the UK and that current guidelines recommending use of anticholinergic medication, continence nurse consultations and urinary tests/investigations are inadequately followed.

Cholinergic Antagonists↗
PubMedDate not supplied

A fresh water odyssey: some observations on the global resource.

Appreciable increases in the human population are expected to continue in the next 50 to 100 years. This population will require additional water for nonfungible (nonexchangeable) uses such as irrigated agriculture, livestock watering, domestic supply, and ecosystem support. Because most of the world's easily captured water is already identified and allocated, society must improve efficiency, change the present allocations, and/or develop new sources to meet the expected demands. As the global economy expands, apparently unrelated changes in policy or technology may have large, unexpected consequences for water resources. Foreshadowing these changes in stress on these resources will be the result of nonlinear thinking. Whereas policy cannot create new water, it can provide strategies to promote more efficient use of present water and foster an environment in which important technological improvements can be made. This manuscript provides a brief overview of some of the physical and policy considerations relating to fresh water resources.

Agriculture↗
PubMed1998

Knowledge and opinions about dental human health resources planning in Mexico.

Dental human health resource planning (DHHRP), or manpower planning in Mexico has been plagued by fundamental contradictions. In spite of having trained a great many dentists in the past two decades, the dental health status of the population has not significantly improved. Concurrently, the relative scarcity of patients in relation to the number of practising dentists seems to be more marked, a critical issue since most dental care is delivered under private schemes. In the present investigation, 196 practising dentists in Mexico City were interviewed to establish their knowledge and opinions about DHHRP, and their views about the introduction of innovative alternatives in transforming, evaluating and planning human health resources. Concerns were: a need to examine and re-define the aims, skill content and marketability of professional training in professional practice; a lack of consensus as to how this is to be achieved; and a degree of awareness that professional practice has a limited scope in meeting the challenge of providing adequate care because of maldistribution of dentists and of limited financial resources of patients.

Adult↗
PubMed2003

Social capital and the collective management of resources.

The proposition that natural resources need protection from the destructive actions of people is widely accepted. Yet communities have shown in the past and increasingly today that they can collaborate for long-term resource management. The term social capital captures the idea that social bonds and norms are critical for sustainability. Where social capital is high in formalized groups, people have the confidence to invest in collective activities, knowing that others will do so too. Some 0.4 to 0.5 million groups have been established since the early 1990s for watershed, forest, irrigation, pest, wildlife, fishery, and microfinance management. These offer a route to sustainable management and governance of common resources.

Animals↗
PubMed1990

Extending the use of clinical audit data: a resource planning model.

OBJECTIVE: To create a means by which we can examine and understand the interrelations among the fundamental elements of hospital inpatient care (patients, beds, theatre time, and staff). DESIGN: Predictive study of resource utilisation based on a computerised clinical information system of five years' audit data from a surgical management system. SETTING: One surgical firm (of one consultant, one registrar, and one preregistration houseman) in a district general hospital. PATIENTS: 5267 Patients whose admission records were part of the five years' audit of surgical management. MAIN OUTCOME MEASURES: Mean length of stay; number of occupied beds; turnover interval; throughput (patients/bed); percentage elective theatre occupancy; waiting time for elective admissions; and theatre, hotel, and total costs. RESULTS: Predicted outcome was analysed in the model, taking the actual outcomes in 1988-9 as baseline values, for four clinical scenarios: an increase in accident and emergency admissions, a reduction in beds, a reduced length of stay, and creation of a new firm. Baseline values showed a mean stay of just over five days in 15 beds and with a theatre occupancy of 94%; the total cost was 812,000 pounds (hotel costs 597,000 pounds). Increasing the accident and emergency admissions to 460/year (19%), based on projected trends from 1984 to 1988, resulted in increased hotel costs (55,000 pounds) and reducing bed numbers (by halving admissions) in decreased use of theatres to 71%, decreased throughput, and increased waiting time, from 20 to 92 weeks, at a saving of 99,000 pounds (12%). Reducing stay marginally reduced bed occupancy (8%) and hotel costs (14%), and creating a new surgical team considerably reduced bed occupancy (14%) and waiting time for elective operations (by 20%). The minimum number of beds for referrals, accident and emergency admissions, and planned admissions was 9.0; that for urgent elective admissions was 3.3 and for non-urgent admissions was 2.4. CONCLUSION: A well designed clinical information system with the routine collection of data can provide the necessary output data to enable resource modelling. IMPLICATION: Use of such a model will allow clinicians to participate in resource planning on the basis of what is actually happening within the hospital.

Data Interpretation, Statistical↗
PubMed1995

'These sorts of people don't do very well': race and allocation of health care resources.

Recent literature has highlighted issues of racial discrimination in medicine. In order to explore the sometimes subtle influence of racial determinants in decisions about resource allocation, we present the case of a 53-year-old Australian Aboriginal woman with end-stage renal failure. The epidemiology of renal failure in the Australian Aboriginal population and amongst other indigenous peoples is discussed. We show that the use of utilitarian outcome criteria for resource allocation may embody subtle racial discrimination where consideration is not given to issues of justice, race, culture and gender. It is only where the processes by which resources are allocated are transparent, clearly defined and based upon consultation with individual patients that issues and justice are likely to be adequately addressed.

Americas↗
PubMed2006

UK National COPD Audit 2003: Impact of hospital resources and organisation of care on patient outcome following admission for acute COPD exacerbation.

BACKGROUND: Acute chronic obstructive pulmonary disease (COPD) exacerbations use many hospital bed days and have a high rate of mortality. Previous audits have shown wide variability in the length of stay and mortality between units not explained by patient factors. This study aimed to explore associations between resources and organisation of care and patient outcomes. METHODS: 234 UK acute hospitals each prospectively identified 40 consecutive acute COPD admissions, documenting process of care and outcomes from a retrospective case note audit. Units also completed a resources and organisation of care proforma. RESULTS: Data for 7529 patients were received. Inpatient mortality was 7.4% and mortality at 90 days was 15.3%; the readmission rate was 31.4%. Mean length of stay for discharged patients was 8.7 days (median 6 days). Wide variation was observed in all outcomes between hospitals. Both inpatient mortality (odds ratio (OR) 0.67, CI 0.50 to 0.90) and 90 day mortality (OR 0.75, CI 0.60 to 0.94) were associated with a staff ratio of four or more respiratory consultants per 1000 hospital beds. The length of stay was reduced in units with more respiratory consultants, better organisation of care scores, an early discharge scheme, and local COPD management guidelines. CONCLUSIONS: Units with more respiratory consultants and better quality organised care have lower mortality and reduced length of hospital stay. This may reflect unit resource richness. Dissemination of good organisational practice and recruitment of more respiratory specialists offers the potential for improved outcomes for hospitalised COPD patients.

Acute Disease↗
PubMedDate not supplied

Impact of irritable bowel syndrome on quality of life and resource use in the United States and United Kingdom.

BACKGROUND: Although irritable bowel syndrome (IBS) is not a life-threatening condition, it can have a serious impact on a patient's daily activities and quality of life. This effect on quality of life has not been compared previously across different cultures. METHODS: We compared measures of health-related quality of life and health care resource utilization using a cross-sectional point-in-time postal survey of a random sample of 500 members of the International Foundation for Functional Gastrointestinal Disorders in the US and 500 members of the IBS Network support group in the UK. The analysis was limited to persons who reported that a physician had told them they had IBS. A general health status questionnaire, the SF-36, and a disease-specific questionnaire, the Irritable Bowel Syndrome Quality of Life questionnaire (IBSQOL), were self-administered as part of the survey to measure health-related quality of life. Results on the SF-36 were compared with published normative data for adults in the US and UK with and without chronic diseases. RESULTS: The UK group (n = 343) reported significantly poorer quality of life on the SF-36 and on four parameters of the IBSQOL than did the US group (n = 287). The general health status of persons with IBS in either country was much poorer compared with that of general populations in the respective countries. Health care resource utilization (i.e. emergency room, doctor and hospital outpatient visits) of persons with IBS was similar in the two countries, as was the direct effect of IBS on employment. Nearly one third of those surveyed missed at least 1 day of work due to IBS in the previous 4 weeks, and a greater percentage cut back in their work or activities due to IBS. Taken together, average time lost or cut back amounted to nearly 5 days or 1 work-week. CONCLUSION: IBS has a significant impact on quality of life and resource use in both the US and UK. The effect on quality of life, however, appears to be greater in the UK than in the US.

Absenteeism↗
PubMed2001

Randomized controlled trial of rehabilitation at home after stroke: one-year follow-up of patient outcome, resource use and cost.

BACKGROUND AND PURPOSE: This study sought to evaluate early supported discharge and continued rehabilitation at home after stroke, at a minimum of 6 months after the intervention, in terms of patient outcome, resource use and health care cost. METHODS: Eighty-three patients, moderately impaired 5-7 days after acute stroke, were included in a randomized controlled trial, 42 being allocated to the intervention and 41 to routine rehabilitation. One-year follow-up of patient outcome included mortality, motor capacity, dysphasia, activities of daily living, social activities, perceived dysfunction, and self-reported falls. Resource use over 12 months included inpatient hospital care, outpatient health care, use of health-related services, informal care, and cost of health care. RESULTS: On univariate analysis there was no difference in patient outcome. Multivariate regression analysis showed that intervention had a significant effect on independence in activities of daily living. A significant difference in inpatient hospital care, initial and recurrent, was observed, with a mean of 18 (intervention) versus 33 days (control) (p = 0.002). Further significant differences were that the control group registered more outpatient visits to hospital occupational therapists (p = 0.02), private physical therapists (p = 0.03) and day-hospital attendance (p = <0.001), while the intervention group registered more visits to nurses in primary care (p = 0.03) and home rehabilitation (p = <0.001). Other differences in outcomes or resource utilization were nonsignificant. CONCLUSION: In Sweden, early supported discharge with continued rehabilitation at home proved no less beneficial as a rehabilitation service, and provided care and rehabilitation for 5 moderately disabled stroke patients over 12 months after stroke onset for the cost of 4 in routine rehabilitation.

Aged↗
PubMed2004

Health care resource use after acute stroke in the Glycine Antagonist in Neuroprotection (GAIN) Americas trial.

BACKGROUND AND PURPOSE: To compare 3-month stroke outcomes and stroke-related health care resource use between the US and Canada in the Glycine Antagonist in Neuroprotection (GAIN) Americas study. Delivery of medical care for stroke patients, often driven by efforts to curb costs, varies substantially between countries. Data on the potential impact of these variations on clinical outcomes are sparse. METHODS: The analysis of health care resource included total length of stay (LOS) in hospital, intensive care unit (ICU), and acute-care ward or rehabilitation unit, or both; number of outpatient rehabilitation sessions and visits to a physician; place of residence after discharge; and employment status. Cox proportional hazards models and logistic regression were used to calculate survival hazards and predictors of favorable functional outcome (Barthel Index of 95 to 100). RESULTS: One thousand six hundred four patients who were independent before stroke (mean age: 69.9+/-12.7 years, 53% men, 85% ischemic stroke, 69% in the US) were included. Three-month survival and functional outcome did not differ between the US and Canada. Survival rate was 80% in both countries. Favorable functional outcome was achieved in 43% of Canadian and 47% of US patients. Fewer Canadian patients received treatment in ICU (19% versus 63% in the US), and Canadians had longer stays in hospital or rehabilitation facility (median: 33 days versus 16 days in the US). CONCLUSIONS: Despite similar 3-month survival and functional outcome, patterns of health care resource varied substantially between the US and Canada. US patients had more intensive early care; Canadian patients had longer hospitalizations and rehabilitation care. Further research is required to determine the most cost-effective treatment and rehabilitation plan for people who have a stroke.

Acute Disease↗