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Healthcare Resources (healthcare + resource)
Terms modified by Healthcare Resources Selected AbstractsPerceptions of a service redesign by adults living with type 2 diabetesJOURNAL OF ADVANCED NURSING, Issue 7 2009Joan R.S. McDowell Abstract Title.,Perceptions of a service redesign by adults living with type 2 diabetes. Aim., This article is a report of a study conducted to explore the perceptions of adults with type 2 diabetes towards the service redesign. Background., Diabetes is reaching epidemic proportions and the management of this chronic illness is changing in response to this challenge. In the United Kingdom, there is ongoing restructuring of healthcare services for people with chronic illnesses to ensure that their general health and clinical needs are met predominantly in primary care. Method., An explorative qualitative approach was used. Eight focus groups were conducted with 35 people with type 2 diabetes in one urban location between 2003 and 2004. Five focus groups were conducted with people who had recently experienced the restructured service and three groups with people who had up to 2 years' experience of the new service. Concurrent data collection and thematic analysis were conducted by three researchers and credibility and verification sought by feedback to participants. Findings., Five main themes were identified: impact of living with diabetes; understanding diabetes; drivers for organizational change; care in context and individual concerns. Participants identified issues for ongoing development of the service. Conclusion., People with type 2 diabetes appreciate their care management within the primary care setting where there has been investment in staff to deliver this care. Healthcare resources are required to support the development of staff and the necessary infrastructure to undertake management in primary care. Policy makers need to address the balance of resources between primary and secondary care. [source] POPULATION AGING AND INTERNATIONAL DEVELOPMENT: ADDRESSING COMPETING CLAIMS OF DISTRIBUTIVE JUSTICEDEVELOPING WORLD BIOETHICS, Issue 1 2007MICHAL ENGELMAN ABSTRACT To date, bioethics and health policy scholarship has given little consideration to questions of aging and intergenerational justice in the developing world. Demographic changes are precipitating rapid population aging in developing nations, however, and ethical issues regarding older people's claim to scarce healthcare resources must be addressed. This paper posits that the traditional arguments about generational justice and age-based rationing of healthcare resources, which were developed primarily in more industrialized nations, fail to adequately address the unique challenges facing older persons in developing nations. Existing philosophical approaches to age-based resource allocation underemphasize the importance of older persons for developing countries and fail to adequately consider the rights and interests of older persons in these settings. Ultimately, the paper concludes that the most appropriate framework for thinking about generational justice in developing nations is a rights-based approach that allows for the interests of all age groups, including the oldest, to be considered in the determination of health resource allocation. [source] Cost-utility analysis of proton pump inhibitors and other gastro-protective agents for prevention of gastrointestinal complications in elderly patients taking nonselective nonsteroidal anti-inflammatory agentsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2010C. CAMERON Aliment Pharmacol Ther,31, 1354,1364 Summary Background The use of proton pump inhibitors (PPIs) among elderly patients using nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs) has increased; the price of PPIs is higher than that of majority of alternative treatment strategies. Aim To evaluate the cost-effectiveness of nsNSAIDS + PPIs relative to alternative gastroprotective regimens in the prevention of GI complications among elderly patients (aged ,65 years). Methods An incremental cost-utility analysis, comparing PPIs with alternative gastroprotective regimens was conducted using a decision analytical model. Clinical outcomes, costs and utilities were derived from recently published studies. Probabilistic and deterministic sensitivity analyses were performed to test the robustness of the results to variation in model inputs and assumptions. Results The incremental cost-utility ratio (ICUR) of PPIs, relative to nsNSAID alone, was $206 315 per QALY gained or were more costly and less effective. Other co-prescribed treatment options had higher costs per QALY gained. In patients with a history of a complicated or uncomplicated ulcer, PPIs had ICURs of $24 277 and $40 876, respectively. Conclusions Use of PPIs in all elderly patients taking nsNSAIDs is unlikely to represent an efficient use of finite healthcare resources. Co-prescribing PPIs, however, to elderly patients taking nsNSAIDs who have a history of complicated or uncomplicated ulcers appears to be economically attractive. [source] Factor VIII requirement to maintain a target plasma level in the prophylactic treatment of severe hemophilia A: influences of variance in pharmacokinetics and treatment regimensJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2 2010P. W. COLLINS Summary.,Background:,Prophylactic factor (F)VIII has been shown to reduce bleeds and arthropathy in patients with severe hemophilia A. Objectives:,Assuming that the trough FVIII level is an important determinant of the efficacy of prophylaxis, this paper addresses the effect of the inter-patient variability in pharmacokinetics and different dosing regimens on trough levels. Methods:,Simulations used FVIII half-lives and in vivo recoveries (IVR), observed during clinical trials with Advate [Antihemophilic Factor (Recombinant), Plasma/Albumin-Free Method], and commonly used prophylactic regimens to calculate their effect on FVIII levels during prophylaxis. Results and conclusions:,Half-life and dose frequency had a larger effect on trough FVIII and time per week with FVIII < 1 IU dL,1 than IVR and infused dose per kg. The combined effect of these parameters resulted in substantial inter-patient variability in the amount of FVIII required to sustain a desired trough level. Prophylactic regimens based on Monday, Wednesday, Friday dosing were less cost effective in maintaining a desired trough level throughout the week. Dose escalation on Friday to cover the weekend would require potentially harmful doses of FVIII in many patients, especially in young children where more than 50% would require a Friday dose of over 100 IU kg,1 and some would require more than 400 IU kg,1. Knowledge of individual patients' half-lives and alteration of frequency of infusions may allow the more cost-effective use of FVIII and potentially expand access to prophylaxis to a greater number of patients, especially in regions where healthcare resources are scarce. [source] Healthcare seeking for constipation: a population-based survey in the Mediterranean area of SpainALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2006C. GÁLVEZ Summary Background The use of healthcare resources for the management of constipation is not well-known. Aim To analyse healthcare seeking for constipation, defined by three different criteria, and its related factors and to assess the frequency of use of laxatives, suppositories and enemas for the treatment of constipation. Methods A cross-sectional study in the general community. A questionnaire comprising 21-items was developed and delivered by mail to a random sample of 506 subjects aged 18,65 years, and belonging to a Spanish population. Results Seeking of health care was high in the sample (16%) and was similar for all definitions of constipation (over 40% of constipated subjects). It was associated with female gender, a higher educational level and two symptoms, such as prolonged defecation and abdominal pain. A 14% of the sample used laxatives, and about a 25% of constipated subjects used laxatives at least once a week. Utilization was more frequent in women, with no differences by age group. Conclusions Chronic constipation is a problem that causes an important consumption of resources in our setting, derived from laxative use and the seeking of medical help to combat the problem. The use of these resources is higher in women. [source] Exploring the healthcare journey of patients with rheumatoid arthritis: A mapping project , implications for practiceMUSCULOSKELETAL CARE, Issue 4 2008Susan Oliver RN Abstract Objective:,Consumers of healthcare can reveal important insights into the personal challenges they experience when negotiating their health needs. The National Rheumatoid Arthritis Society (NRAS) wanted to explore the experiences of those with rheumatoid arthritis (RA) in order to understand the impact on the individual and on healthcare resources and benchmark care against published standards and guidelines. Methods:,A project was designed to explore the experiences of individuals with sero-positive RA who had been diagnosed for three years or less. Qualitative semi-structured interviews were used and combined with process mapping to explore the experiences of a purposeful sample of individuals with RA. The information generated was mapped and variances explored. Ethical approval was not required as the data were collected outside the National Health Service. Results:,Twenty-two participants' stories were mapped. Fifty per cent of participants sought a medical opinion within three weeks of symptom onset and the majority received a disease-modifying anti-rheumatic drug within six months from first presenting symptoms. Work-related issues were highlighted by 13 participants, and seven of these experienced job losses directly attributed to their diagnosis. Conclusions:,This unique mapping approach used qualitative research and process mapping to compare patient experiences against recognized standards and guidelines. These twenty-two stories reveal important insights into the challenges experienced in negotiating these healthcare journeys and the impact upon the individual as a result of variances in standards of care received. The participants in this study were chiefly self-motivated, informed and articulate, and did not reflect the broad ethnic, social or cultural diversity in the UK. Limitations must also be considered in relation to perceptions and recall of participants over a three-year period, as these may have altered over time and illness experience. Copyright © 2008 John Wiley & Sons, Ltd. [source] Design and Analysis of Clinical Trials in Transplantation: Principles and PitfallsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2008J. D. Schold The contributions of prospective randomized controlled trials (RCTs) to the advancement of solid organ transplantation are well appreciated. However, some misconception exists that results deriving from RCTs uniformly provide clinically relevant, definitive and generalized evidence. While there is little doubt that RCTs are the gold standard to test cause-and-effect relationships, the quality and subsequent utility of trials carried out in this field vary substantially. As with all other disciplines, our ability to interpret and implement the findings of RCTs into practice is strongly dependent on the study design and statistical rigor of the analysis. Failure to conduct trials with appropriate standards or interpret trials with the appropriate limitations may place patients at risk or waste valuable healthcare resources. The purpose of this review is to delineate important principles of study design and analysis of RCTs that are commonly overlooked. This review will discuss possible limitations of trials with specific applications in the field of transplantation. Progress in the field of transplantation is highly dependent on critical examination of existing clinical trials and vigilance regarding the optimal development of future trials. [source] Inpatient management of psoriasis: a multicentre service review to establish national admission standardsBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2008A.L. Woods Summary Background, Some patients with psoriasis may require hospital admission to stabilize their condition, although the role of inpatient management is changing given recent advances in therapeutic options, emphasis on community-based care for chronic conditions and limited healthcare resources. There is a need for evidence-based national standards for inpatient management of psoriasis taking account of factors that predict length of stay. Objectives, To determine which factors predict length of stay for patients with psoriasis requiring inpatient hospital care with a view to setting evidence-based standards for inpatient psoriasis management. Methods, A multicentre service review was conducted on all psoriasis admissions over a 9-month period in four dermatology centres in the U.K. We collected data on admission, at discharge and, where possible, at 3 months following discharge. Psoriasis severity was assessed using four validated scoring systems, including Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index. We also recorded length of stay and treatment details. Results, Length of stay varied widely between the four centres, but was similar in the two centres which received a high proportion of tertiary referrals for severe psoriasis (mean 19·7 days, range 1,78, analysis of variance P = 0·002). Disease severity, measured by PASI, on admission (mean 15·7, interquartile range 8·3,20·8) was significantly higher in the tertiary centres (P < 0·0001). However, there was no significant difference in PASI between centres on discharge. The admission PASI was significantly associated with length of stay (r = 0·2, P = 0·02). There was no significant correlation between other measures of disease severity and length of stay. Conclusions, Disease severity on admission for patients with psoriasis is greater in tertiary referral centres for psoriasis and is directly associated with length of stay. Length of stay should be used in conjunction with clinical measures such as PASI improvement to set national standards for quality in secondary care. [source] | ||||||||||