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Age and closeness of death as determinants of health and social care utilization: a case-control study.

https://arctichealth.org/en/permalink/ahliterature152068
Source
Eur J Public Health. 2009 Jun;19(3):313-8
Publication Type
Article
Date
Jun-2009
Author
Leena Forma
Pekka Rissanen
Mari Aaltonen
Jani Raitanen
Marja Jylhä
Author Affiliation
Tampere School of Public Health, University of Tampere, Finland. leena.forma@uta.fi
Source
Eur J Public Health. 2009 Jun;19(3):313-8
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Case-Control Studies
Female
Finland
Health Services - utilization
Home Care Services - utilization
Hospitalization - statistics & numerical data
Humans
Long-Term Care - utilization
Male
Sex Factors
Social Work - statistics & numerical data
Terminal Care - utilization
Terminally Ill - statistics & numerical data
Time Factors
Abstract
We used case-control design to compare utilization of health and social services between older decedents and survivors, and to identify the respective impact of age and closeness of death on the utilization of services.
Data were derived from multiple national registers. The sample consisted of 56,001 persons, who died during years 1998-2000 at the age of > or = 70, and their pairs matched on age, gender and municipality of residence, who were alive at least 2 years after their counterpart's death. Data include use of hospitals, long-term care and home care. Decedents' utilization within 2 years before death and survivors' utilization in the same period of time was assessed in three age groups (70-79, 80-89 and > or = 90 years) and by gender.
Decedents used hospital and long-term care more than their surviving counterparts, but the time patterns were different. In hospital care the differences between decedents and survivors rose in the last months of the study period, whereas in long-term care there were clear differences during the whole 2-year period. The differences were smaller in the oldest age group than in younger age groups.
Closeness of death is an important predictor of health and social service use in old age, but its influence varies between age groups. Not only the changing age structure, but also the higher average age at death affects the future need for services.
PubMed ID
19286838 View in PubMed
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Burdensome transitions at the end of life among long-term care residents with dementia.

https://arctichealth.org/en/permalink/ahliterature262778
Source
J Am Med Dir Assoc. 2014 Sep;15(9):643-8
Publication Type
Article
Date
Sep-2014
Author
Mari Aaltonen
Jani Raitanen
Leena Forma
Jutta Pulkki
Pekka Rissanen
Marja Jylhä
Source
J Am Med Dir Assoc. 2014 Sep;15(9):643-8
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Continuity of Patient Care
Dementia - mortality
Female
Finland - epidemiology
Hospitalization - statistics & numerical data
Humans
Length of Stay - statistics & numerical data
Long-Term Care
Male
Patient Transfer - statistics & numerical data
Registries
Retrospective Studies
Terminal Care - statistics & numerical data
Abstract
The purpose of the study was to examine the frequency of burdensome care transitions at the end of life, the difference between different types of residential care facilities, and the changes occurring between 2002 and 2008.
A nationwide, register-based retrospective study.
Residential care facilities offering long-term care, including traditional nursing homes, sheltered housing with 24-hour assistance, and long-term care facilities specialized in care for people with dementia.
All people in Finland who died at the age of 70 or older, had dementia, and were in residential care during their last months of life.
Three types of potentially burdensome care transition: (1) any transition to another care facility in the last 3 days of life; (2) a lack of continuity with respect to a residential care facility before and after hospitalization in the last 90 days of life; (3) multiple hospitalizations (more than 2) in the last 90 days of life. The 3 types were studied separately and as a whole.
One-tenth (9.5%) had burdensome care transitions. Multiple hospitalizations in the last 90 days were the most frequent, followed by any transitions in the last 3 days of life. The frequency varied between residents who lived in different baseline care facilities being higher in sheltered housing and long-term specialist care for people with dementia than in traditional nursing homes. During the study years, the number of transitions fluctuated but showed a slight decrease since 2005.
The ongoing change in long-term care from institutional care to housing services causes major challenges to the continuity of end-of-life care. To guarantee good quality during the last days of life for people with dementia, the underlying reasons behind transitions at the end of life should be investigated more thoroughly.
PubMed ID
24913211 View in PubMed
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Changes in older people's care profiles during the last 2 years of life, 1996-1998 and 2011-2013: a retrospective nationwide study in Finland.

https://arctichealth.org/en/permalink/ahliterature293459
Source
BMJ Open. 2017 Dec 01; 7(11):e015130
Publication Type
Journal Article
Date
Dec-01-2017
Author
Mari Aaltonen
Leena Forma
Jutta Pulkki
Jani Raitanen
Pekka Rissanen
Marja Jylha
Author Affiliation
Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, University of Tampere, Tampere, Finland.
Source
BMJ Open. 2017 Dec 01; 7(11):e015130
Date
Dec-01-2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Cross-Sectional Studies
Dementia - epidemiology
Female
Finland - epidemiology
Home Care Services - statistics & numerical data
Homes for the Aged
Hospitalization - statistics & numerical data
Humans
Long-Term Care - statistics & numerical data
Male
Nursing Homes - statistics & numerical data
Patient Transfer - statistics & numerical data
Registries
Retrospective Studies
Terminal Care - statistics & numerical data
Time Factors
Abstract
The time of death is increasingly postponed to a very high age. How this change affects the use of care services at the population level is unknown. This study analyses the care profiles of older people during their last 2?years of life, and investigates how these profiles differ for the study years 1996-1998 and 2011-2013.
Retrospective cross-sectional nationwide data drawn from the Care Register for Health Care, the Care Register for Social Care and the Causes of Death Register. The data included the use of hospital and long-term care services during the last 2?years of life for all those who died in 1998 and in 2013 at the age of =70 years in Finland.
We constructed four care profiles using two criteria: (1) number of days in round-the-clock care (vs at home) in the last 2?years of life and (2) care transitions during the last 6?months of life (ie, end-of-life care transitions).
Between the study periods, the average age at death and the number of diagnoses increased. Most older people (1998: 64.3%, 2013: 59.3%) lived at home until their last months of life (profile 2) after which they moved into hospital or long-term care facilities. This profile became less common and the profiles with a high use of care services became more common (profiles 3 and 4 together in 1998: 25.0%, in 2013: 30.9%). People with dementia, women and the oldest old were over-represented in the latter profiles. In both study periods, fewer than one in ten stayed at home for the whole last 6?months (profile 1).
Postponement of death to a very old age may translate into more severe disability in the last months or years of life. Care systems must be prepared for longer periods of long-term care services needed at the end of life.
Notes
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PubMed ID
29196476 View in PubMed
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Clients' and workers' perceptions on clients' functional ability and need for help: home care in municipalities.

https://arctichealth.org/en/permalink/ahliterature154327
Source
Scand J Caring Sci. 2009 Mar;23(1):21-32
Publication Type
Article
Date
Mar-2009
Author
Teija Hammar
Marja-Leena Perälä
Pekka Rissanen
Author Affiliation
STAKES, National Research and Development Centre for Welfare and Health, Helsinki, Finland. teija.hammar@stakes.fi
Source
Scand J Caring Sci. 2009 Mar;23(1):21-32
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Cities
Disability Evaluation
Female
Finland
Home Care Services
Home Health Aides - psychology
Humans
Interviews as Topic
Male
Needs Assessment
Patients
Questionnaires
Abstract
The aim of the study was to compare clients' and named home care (HC) workers' perceptions of clients' functional ability (FA) and need for help and to analyse which client- and municipality-related factors are associated with perceptions of client's FA. The total of 686 Finnish HC clients was interviewed in 2001. Further, the questionnaire was sent to 686 HC workers. FA was assessed by activities of daily living (ADL), which included both basic/physical (PADL) and instrumental (IADL) activities. The association between client's FA and municipality-related variables was analysed by using hierarchical logistic regression models. The findings indicated that clients' and HC-workers' perceptions about what the clients were able to do were similar in the PADL functions, but perceptions differed when it comes to the IADL functions for mobility and in climbing stairs. A smaller proportion of clients compared with HC workers assessed themselves to be in need of help in all ADL functions. Use of home help and bathing services increased the probability of belonging to the 'poor' FA class while living alone and small size of municipality decreased the probability. The study indicates that although clients and workers assessed client's FA fairly similarly, there were major differences in perceptions concerning clients' needs for help in ADL functions. Clients' and workers' shared view of need for help forms a basis for high-quality care. Therefore, the perception of both the clients and workers must be taken into account when planning care and services. There was also variation in clients' FA between municipalities, although only the size of municipality had some association with the variation. The probability that clients with a lower FA are cared for in HC is higher if the clients live in large- rather than small-sized municipalities. This may reflect a better mix of services and resources in large-sized municipalities.
PubMed ID
19000091 View in PubMed
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Cost-effectiveness analysis of guidelines for antihypertensive care in Finland.

https://arctichealth.org/en/permalink/ahliterature160632
Source
BMC Health Serv Res. 2007;7:172
Publication Type
Article
Date
2007
Author
Neill Booth
Antti Jula
Pasi Aronen
Minna Kaila
Timo Klaukka
Katriina Kukkonen-Harjula
Antti Reunanen
Pekka Rissanen
Harri Sintonen
Marjukka Mäkelä
Author Affiliation
Tampere School of Public Health, University of Tampere, Tampere, Finland. neill.booth@uta.fi
Source
BMC Health Serv Res. 2007;7:172
Date
2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Antihypertensive Agents - economics - therapeutic use
Cost-Benefit Analysis
Decision Making
Drug Administration Schedule
Drug Utilization - economics - standards
Female
Finland - epidemiology
Guideline Adherence - economics
Humans
Hypertension - drug therapy - economics - epidemiology
Male
Middle Aged
Practice Guidelines as Topic
Quality-Adjusted Life Years
Registries
Abstract
Hypertension is one of the major causes of disease burden affecting the Finnish population. Over the last decade, evidence-based care has emerged to complement other approaches to antihypertensive care, often without health economic assessment of its costs and effects. This study looks at the extent to which changes proposed by the 2002 Finnish evidence-based Current Care Guidelines concerning the prevention, diagnosis, and treatment of hypertension (the ACCG scenario) can be considered cost-effective when compared to modelled prior clinical practice (the PCP scenario).
A decision analytic model compares the ACCG and PCP scenarios using information synthesised from a set of national registers covering prescription drug reimbursements, morbidity, and mortality with data from two national surveys concerning health and functional capacity. Statistical methods are used to estimate model parameters from Finnish data. We model the potential impact of the different treatment strategies under the ACCG and PCP scenarios, such as lifestyle counselling and drug therapy, for subgroups stratified by age, gender, and blood pressure. The model provides estimates of the differences in major health-related outcomes in the form of life-years and costs as calculated from a 'public health care system' perspective. Cost-effectiveness analysis results are presented for subgroups and for the target population as a whole.
The impact of the use of the ACCG scenario in subgroups (aged 40-80) without concomitant cardiovascular and related diseases is mainly positive. Generally, costs and life-years decrease in unison in the lowest blood pressure group, while in the highest blood pressure group costs and life-years increase together and in the other groups the ACCG scenario is less expensive and produces more life-years. When the costs and effects for subgroups are combined using standard decision analytic aggregation methods, the ACCG scenario is cost-saving and more effective.
The ACCG scenario is likely to reduce costs and increase life-years compared to the PCP scenario in many subgroups. If the estimated trade-offs between the subgroups in terms of outcomes and costs are acceptable to decision-makers, then widespread implementation of the ACCG scenario is expected to reduce overall costs and be accompanied by positive outcomes overall.
Notes
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PubMed ID
17958883 View in PubMed
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A cost-effectiveness analysis of tension-free vaginal tape versus laparoscopic mesh colposuspension for primary female stress incontinence.

https://arctichealth.org/en/permalink/ahliterature165431
Source
Acta Obstet Gynecol Scand. 2006;85(12):1485-90
Publication Type
Article
Date
2006
Author
Antti Valpas
Pekka Rissanen
Erkki Kujansuu
Carl-Gustaf Nilsson
Author Affiliation
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland. antti.valpas@ekshp.fi
Source
Acta Obstet Gynecol Scand. 2006;85(12):1485-90
Date
2006
Language
English
Publication Type
Article
Keywords
Colposcopy - economics - methods
Cost-Benefit Analysis
Female
Finland
Follow-Up Studies
Health Care Costs
Humans
Length of Stay
Postoperative Complications - economics - epidemiology
Quality of Life
Surgical Mesh - economics
Surgical Tape - economics
Treatment Outcome
Urinary Incontinence, Stress - economics - surgery
Vagina - surgery
Abstract
Evaluation of cost-effectiveness of new surgical techniques is important. As the data on incontinence procedures are scarce, we evaluated the cost-effectiveness of tension-free vaginal tape procedure and laparoscopic mesh colposuspension as a primary surgical treatment for female stress urinary incontinence.
In four university teaching hospitals and two central hospitals 128 stress incontinent women were randomized to tension-free vaginal tape procedure (n=70) or laparoscopic mesh colposuspension (n=51) in order to investigate the clinical performance of these two procedures. Primary objective clinical outcome measures were: stress test and 48-h pad test. Secondary subjective outcome measures were health-related quality of life measured in terms of visual analogue scale and Urinary Incontinence Severity Score. Alongside the clinical trial, a cost-effectiveness analysis for the main outcome measures was performed.
The changes in the 48-h pad test result did not reach statistical significance (p=0.105). When the visual analogue scale or Urinary Incontinence Severity Score are used as the outcome measure, the tension-free vaginal tape is more cost-effective than laparoscopic mesh colposuspension over a follow-up period of one year (p
PubMed ID
17260226 View in PubMed
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The cost-effectiveness of integrated home care and discharge practice for home care patients.

https://arctichealth.org/en/permalink/ahliterature152160
Source
Health Policy. 2009 Sep;92(1):10-20
Publication Type
Article
Date
Sep-2009
Author
Teija Hammar
Pekka Rissanen
Marja-Leena Perälä
Author Affiliation
The National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland. teija.hammar@thl.fi
Source
Health Policy. 2009 Sep;92(1):10-20
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Costs and Cost Analysis
Data Interpretation, Statistical
Female
Finland
Follow-Up Studies
Health Services for the Aged - economics - organization & administration - utilization
Health Status Indicators
Home Care Services - economics - organization & administration - utilization
Humans
Interviews as Topic
Male
Patient Discharge - economics
Quality of Life
Utilization Review
Abstract
To evaluate the effects of integrated home care and discharge practice (IHCaD-practice) on the use of services and cost-effectiveness.
A cluster randomised trial with Finnish municipalities (n=22) as the units of randomisation. At baseline the sample included 668 home care patients aged 65 years or over. Data consisted of interviews (discharge, 3-week, 6-month) and care registers. The intervention was a generic prototype of care/case management-practice that was tailored to each municipality's needs. The effects were evaluated in terms of the use and cost of health and social care services. Unit costs of services were calculated. Cost-effectiveness was calculated for changes in health-related quality of life using the Nottingham Health Profile (NHP) and the EQ-5D instruments. All analyses were based on intention-to-treat.
At 6-month follow-ups, the patients in the trail group used less home care, doctor and laboratory services than patients in the non-trial group. Similar differences between groups were found regarding costs. According to the NHP instrument, the IHCaD-practice showed higher cost-effectiveness compared to the old practice. No evidence for cost-effectiveness was found with the EQ-5D instrument.
The study suggests that the IHCaD-practice may be a cost-effective alternative to usual care.
PubMed ID
19272667 View in PubMed
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[Cost effects of laparoscopic and hysteroscopic female sterilization].

https://arctichealth.org/en/permalink/ahliterature104321
Source
Duodecim. 2014;130(8):823-31
Publication Type
Article
Date
2014
Author
Maria Rajecki
Sanna Blomqvist
Saana Väisänen
Ewa Jokinen
Sirkka-Liisa Kyöstilä
Merja Nord-Saari
Pekka Rissanen
Ritva Hurskainen
Source
Duodecim. 2014;130(8):823-31
Date
2014
Language
Finnish
Publication Type
Article
Keywords
Cost-Benefit Analysis
Female
Finland
Humans
Hysteroscopy - economics
Laparoscopy - economics
Pain, Postoperative - economics
Retrospective Studies
Sterilization, Tubal - adverse effects - economics - methods
Abstract
The aim was to elucidate the costs and clinical results of sterilization.
A retrospective analysis was carried out on sterilizations conducted at the Hyvinkää hospital in 2006 to 2007 by tubal ligation with clips and by microimplants.
Total costs obtained for microimplant sterilization per patient were 1,146 Euros and for clip sterilization 1,712 Euros. Postoperative pain was significantly less in the microimplant group, and adverse effects associated with the procedure were more common in the clip sterilization group.
Microimplant sterilization performed on an outpatient basis is more cost-effective than laparoscopic clip sterilization.
PubMed ID
24822333 View in PubMed
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Costs of screening for prostate cancer: Evidence from the Finnish Randomised Study of Screening for Prostate Cancer after 20-year follow-up using register data.

https://arctichealth.org/en/permalink/ahliterature297514
Source
Eur J Cancer. 2018 04; 93:108-118
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
04-2018
Author
Neill Booth
Pekka Rissanen
Teuvo L J Tammela
Kimmo Taari
Kirsi Talala
Anssi Auvinen
Author Affiliation
Faculty of Social Sciences (Health Sciences), University of Tampere, FI-33014 Tampere, Finland. Electronic address: Neill.Booth@uta.fi.
Source
Eur J Cancer. 2018 04; 93:108-118
Date
04-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Case-Control Studies
Early Detection of Cancer - economics - methods
Finland - epidemiology
Follow-Up Studies
Humans
Male
Middle Aged
Prognosis
Prostatic Neoplasms - diagnosis - economics - epidemiology
Registries - statistics & numerical data
Survival Rate
Abstract
Few empirical analyses of the impact of organised prostate cancer (PCa) screening on healthcare costs exist, despite cost-related information often being considered as a prerequisite to informed screening decisions. Therefore, we estimate the differences in register-based costs of publicly funded healthcare in the two arms of the Finnish Randomised Study of Screening for Prostate Cancer (FinRSPC) after 20 years.
We obtained individual-level register data on prescription medications, as well as inpatient and outpatient care, to estimate healthcare costs for 80,149 men during the first 20 years of the FinRSPC. We compared healthcare costs for the men in each trial arm and performed statistical analysis.
For all men diagnosed with PCa during the 20-year observation period, mean PCa-related costs appeared to be around 10% lower in the screening arm (SA). Mean all-cause healthcare costs for these men were also lower in the SA, but differences were smaller than for PCa-related costs alone, and no longer statistically significant. For men dying from PCa, although the difference was not statistically significant, mean all-cause healthcare costs were around 10% higher. When analysis included all observations, cumulative costs were slightly higher in the CA; however, after excluding extreme values, cumulative costs were slightly higher in the SA.
No major cost impacts due to screening were apparent, but the FinRSPC's 20-year follow-up period is too short to provide definitive evidence at this stage. Longer term follow-up will be required to be better informed about the costs of, or savings from, introducing mass PCa screening.
PubMed ID
29501976 View in PubMed
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Dementia as a determinant of social and health service use in the last two years of life 1996-2003.

https://arctichealth.org/en/permalink/ahliterature135510
Source
BMC Geriatr. 2011;11:14
Publication Type
Article
Date
2011
Author
Leena Forma
Pekka Rissanen
Mari Aaltonen
Jani Raitanen
Marja Jylhä
Author Affiliation
School of Health Sciences, FI-33014 University of Tampere, Finland. leena.forma@uta.fi
Source
BMC Geriatr. 2011;11:14
Date
2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cause of Death - trends
Dementia - mortality - psychology - therapy
Female
Finland - epidemiology
Home Care Services - trends
Hospitalization - trends
Humans
Long-Term Care - psychology - trends
Male
Patient Acceptance of Health Care - psychology
Registries
Social Work - trends
Abstract
Dementia is one of the most common causes of death among old people in Finland and other countries with high life expectancies. Dementing illnesses are the most important disease group behind the need for long-term care and therefore place a considerable burden on the health and social care system. The aim of this study was to assess the effects of dementia and year of death (1998-2003) on health and social service use in the last two years of life among old people.
The data were derived from multiple national registers in Finland and comprise all those who died in 1998, 2002 or 2003 and 40% of those who died in 1999-2001 at the age of 70 or over (n = 145 944). We studied the use of hospitals, long-term care and home care in the last two years of life. Statistics were performed using binary logistic regression analyses and negative binomial regression analyses, adjusting for age, gender and comorbidity.
The proportion of study participants with a dementia diagnosis was 23.5%. People with dementia diagnosis used long-term care more often (OR 9.30, 95% CI 8.60, 10.06) but hospital (OR 0.33, 95% CI 0.31, 0.35) and home care (OR 0.50, 95% CI 0.46, 0.54) less often than people without dementia. The likelihood of using university hospital and long-term care increased during the eight-year study period, while the number of days spent in university and general hospital among the users decreased. Differences in service use between people with and without dementia decreased during the study period.
Old people with dementia used long-term care to a much greater extent and hospital and home care to a lesser extent than those without dementia. This difference persisted even when controlling for age, gender and comorbidity. It is important that greater attention is paid to ensuring that old people with dementia have equitable access to care.
Notes
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PubMed ID
21470395 View in PubMed
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