Care Database (care + database)

Distribution by Scientific Domains

Selected Abstracts

Model simulation of the patient flow through a screening centre for diabetic retinopathy

Anja B. Hansen
Abstract. Purpose:,To construct a quantitative, flexible and simplified mathematical model of the patient flow through the Eye Clinic at the Steno Diabetes Centre (SDC) in order to enable rational dimensioning and assess the effects of modifications. Methods:,Patient data were drawn from the Eye Care database at the SDC. A simple patient flow model was constructed, allowing simultaneous adjustments of all variables, and the model was tested. Two scenarios were simulated: (1) adjusting the algorithm that assigns the follow-up intervals, and (2) increasing the population size to include all patients with diabetes in Copenhagen County. Results:,The model can describe the patient flow under steady state conditions, but is less precise in predicting transient changes with the present set-up. Accordingly all simulations were run for a substantial number of iterations. The two scenarios illustrate the usefulness of the model by calculating the required photographic examination capacity for the specific population, thereby allowing better estimations of future dimensioning of the organization. Conclusion:,The study presents a patient flow model that can be used to illustrate the effects of proposed changes prior to their implementation, specifically with respect to the capacity of the system. [source]

Assessing Treatment Effects of Inhaled Corticosteroids on Medical Expenses and Exacerbations among COPD Patients: Longitudinal Analysis of Managed Care Claims

Manabu Akazawa
Objective. To assess costs, effectiveness, and cost-effectiveness of inhaled corticosteroids (ICS) augmenting bronchodilator treatment for chronic obstructive pulmonary disease (COPD). Data Sources. Claims between 1997 and 2005 from a large managed care database. Study Design. Individual-level, fixed-effects regression models estimated the effects of initiating ICS on medical expenses and likelihood of severe exacerbation. Bootstrapping provided estimates of the incremental cost per severe exacerbation avoided. Data Extraction Methods. COPD patients aged 40 or older with ,15 months of continuous eligibility were identified. Monthly observations for 1 year before and up to 2 years following initiation of bronchodilators were constructed. Principal Findings. ICS treatment reduced monthly risk of severe exacerbation by 25 percent. Total costs with ICS increased for 16 months, but declined thereafter. ICS use was cost saving 46 percent of the time, with an incremental cost-effectiveness ratio of $2,973 per exacerbation avoided; for patients ,50 years old, ICS was cost saving 57 percent of time. Conclusions. ICS treatment reduces exacerbations, with an increase in total costs initially for the full sample. Compared with younger patients with COPD, patients aged 50 or older have reduced costs and improved outcomes. The estimated cost per severe exacerbation avoided, however, may be high for either group because of uncertainty as reflected by the large standard errors of the parameter estimates. [source]

Outpatient care and medical treatment of children and adults with atopic eczema

Jochen Schmitt
Summary Background: Despite the high prevalence, morbidity and economic burden of atopic eczema (AE), data on outpatient care of affected patients are missing. Methods: Utilizing a population-based administrative health care database from Saxony, Germany, this study describes outpatient care and medical treatment of AE by different medical disciplines in 2003 and 2004 by means of a representative sample of 11,555 patients with AE. Results: About 60% of all patients with AE seeking outpatient care were adults. Of the adults 66% and among children 51% consulted a dermatologist at least once within the study period. More than 50% of patients in all age groups received potent topical steroids. Of all patients 8% and 3% received topical pimecrolimus and topical tacrolimus, respectively. More than 10% of patients received systemic steroids, while less than 0.1% was given cyclosporine. The mean annual amount of topical anti-inflammatory treatment per patient was about 40 grams. Conclusions: Unexpectedly high proportions of patients with AE received potent topical and systemic steroids. The average total amount of prescribed medications was low. This study suggests insufficient care and medical treatment of patients with AE in routine practice. [source]

Use of Inhaled Corticosteroids and Risk of Fractures

T. P. Van Staa
Abstract Treatment with systemic corticosteroids is known to increase the risk of fractures but little is known of the fracture risks associated with inhaled corticosteroids. A retrospective cohort study was conducted using a large UK primary care database (the General Practice Research Database [GPRD]). Inhaled corticosteroid users aged 18 years or older were compared with matched control patients and to a group of noncorticosteroid bronchodilator users. Patients with concomitant use of systemic corticosteroids were excluded. The study comprised 170,818 inhaled corticosteroid users, 108,786 bronchodilator users, and 170,818 control patients. The average age was 45.1 years in the inhaled corticosteroid, 49.3 years in the bronchodilator, and 45.2 years in the control groups. In the inhaled corticosteroid cohort, 54.5% were female. The relative rates (RRs) of nonvertebral, hip, and vertebral fractures during inhaled corticosteroid treatment compared with control were 1.15 (95% CI, 1.10,1.20), 1.22 (95% CI, 1.04,1.43), and 1.51 (95% CI, 1.22,1.85), respectively. No differences were found between the inhaled corticosteroid and bronchodilator groups (nonvertebral fracture RR = 1.00; 95% CI, 0.94,1.06). The rates of nonvertebral fractures among users of budesonide (RR = 0.95; 95% CI, 0.85,1.07) and fluticasone propionate (RR = 1.03; 95% CI, 0.71,1.49) were similar to the rate determined for users of beclomethasone dipropionate. We conclude that users of inhaled corticosteroids have an increased risk of fracture, particularly at the hip and spine. However, this excess risk may be related more to the underlying respiratory disease than to inhaled corticosteroid. [source]

Intra-Arterial Thrombolysis for Central Retinal Artery Occlusion in United States: Nationwide In-Patient Survey 2001-2003

M. Fareed K. Suri MD
ABSTRACT BACKGROUND Intra-arterial thrombolysis (IAT) has been used as a treatment modality for central retinal artery occlusion (CRAO). However, national estimates of such practice and associated outcomes are not available. We performed this study to determine the frequency and outcomes of thrombolysis among adult patients hospitalized in United States (US) for CRAO. METHODS We determined the rates, hospital outcomes, and hospital charges incurred for patients with CRAO treated with thrombolysis using Nationwide Inpatient Survey (NIS) and compared them with patients treated without thrombolysis. NIS is the largest all-payer inpatient care database in the US approximating a 20-percent stratified sample of US community hospitals. RESULTS There were 1379 admissions for primary diagnosis of CRAO in 2001-2003. IAT was used in 27(1.9%) of the patients with CRAO. There was no in-hospital mortality or intracranial hemorrhage reported among any patient with CRAO treated with thrombolysis. All patients treated with IAT were discharged home. IAT was exclusively used in urbanteaching hospitals. CONCLUSIONS There is potential of benefit from IAT in CRAO, which is only offered in certain centers. Clinical trials are needed to demonstrate this beneficial effect. [source]

Autoimmune cholestatic liver disease in people with coeliac disease: a population-based study of their association

A. Lawson
Summary Background :,Population data supporting an association between the autoimmune cholestatic liver diseases, primary biliary cirrhosis and primary sclerosing cholangitis and coeliac disease, is limited and at times contradictory. Aim :,To explore the relationship between coeliac disease and both primary biliary cirrhosis and primary sclerosing cholangitis within the General Practice Research Database, a UK-based longitudinal primary care database. Methods :,We identified 4732 people with diagnosed coeliac disease and 23 620 age- and sex-matched controls within the General Practice Research Database. We calculated the prevalence of primary biliary cirrhosis and primary sclerosing cholangitis for both the coeliac disease and control group. Results :,There was a higher prevalence of primary biliary cirrhosis in adults with coeliac disease, compared with controls [0.17% vs. 0.05%, odds ratio 3.63 (95% confidence interval: 1.46,9.04)]. Primary sclerosing cholangitis was also more common in the coeliac disease group [0.04% vs. 0%, fishers exact test (P = 0.03)]. Conclusions :,There was a threefold or greater increase in risk of both primary biliary cirrhosis and primary sclerosing cholangitis in people with coeliac disease compared with the general population. The association with primary biliary cirrhosis was weaker than in some reports and it is difficult on the basis of this study to justify screening patients with coeliac disease for either primary biliary cirrhosis or primary sclerosing cholangitis. [source]

Initial management of cerebrovascular disease by general practitioners

R. G. J. Gibbs
Background: The aim of this study was to determine the primary management of patients presenting with a new diagnosis of transient ischaemic attack (TIA) or stroke by general practitioners and to establish whether practice was uniform across the UK, and to determine whether initial management influenced the performance of carotid endarterectomy (CEA) across the health regions of the UK. Methods: Information on regional reporting of new cases of TIA and stroke between 1992 and 1996 was obtained from the General Practice Research Database, a database of six million patients from 450 practices. Analysis of data from the primary care database and routine data sources was undertaken. Main outcome measures were incidence of TIA and stroke, rates of referral for specialist opinion, prescription of antiplatelet agents and rates of CEA. Results: There were twofold differences (P < 000005, ,2 test) in the incidence of cerebrovascular disease between Regional Health Authorities (RHAs) between the years 1992 and 1996 and also for each year. Mean stroke incidence per annum was 143 per 100 000 and TIA incidence 183 per 100 000. Yorkshire had the highest incidence at 170 (stroke) and 206 (TIA) per 100 000 of the population compared with 95 and 98 per 100 000 for Oxford. Some 37 per cent of new patients with stroke and 19 per cent of patients with TIA were referred for specialist opinion following initial diagnosis. These rates did not change over time. There was no positive correlation between disease incidence and referral rate; Yorkshire referred the least (14 per cent) and Oxford the most (26 per cent). The majority of referrals for TIA were made to general medicine (39 per cent); 6 per cent of patients were referred directly for surgical opinion. Mean prescription rate of antiplatelet medication over the time period was 17 per cent for patients with stroke and 35 per cent for those with TIA. Mean CEA rate for English RHAs for the time interval was 155 per 100 000. There was a positive correlation between the incidence of disease and rate of CEA, with the regions with the highest incidence of disease tending to perform the most CEAs. Conclusion: The incidence of cerebrovascular disease varies significantly across health regions in the UK. There was no correlation between the regional incidence of disease and the number of patients referred for specialist opinion, but CEA rates were generally correlated with the regional difference in incidence of disease. The low referral rate may be a factor in the perceived underperformance of CEA in the UK and the low usage of antiplatelet medication is surprising. 2000 British Journal of Surgery Society Ltd [source]