A valid method for classifying chronic pain patients into more homogenous groups could be useful for treatment planning, that is, which treatment is effective for which patient, and as a marker when evaluating treatment outcome. One instrument that has been used to derive subgroups of patients is the Multidimensional Pain Inventory (MPI). The primary aim of this study was to evaluate a classification method based on the Swedish version of the MPI, the MPI-S, to predict sick leave among chronic neck and back pain patients for a period of 7 years after vocational rehabilitation. As hypothesized, dysfunctional patients (DYS), according to the MPI-S, showed a higher amount of sickness absence and disability pension expressed in days than adaptive copers (AC) during the 7-years follow-up period, even when adjusting for sickness absence prior to rehabilitation (355.8days, 95% confidence interval, 71.7; 639.9). Forty percent of DYS patients and 26.7% of AC patients received disability pension during the follow-up period. However, this difference was not statistically significant. Further analyses showed that the difference between patient groups was most pronounced among patients with more than 60days of sickness absence prior to rehabilitation. Cost-effectiveness calculations indicated that the DYS patients showed an increase in production loss compared to AC patients. The present study yields support for the prognostic value of this subgroup classification method concerning long-term outcome on sick leave following this type of vocational rehabilitation.
Patient care classification in Canada in the past has been largely dictated by insurance coverage and the fiscal policies of the individual provinces. In recent years, however, the Canadian Department of Health and Welfare has been promoting the development of a standard patient care classification based on assessment of client or patient needs in regard to the category, type, and level of care. Experimentation with the proposed classification system in several provinces confirms the need in long-term care to include assessment of nursing requirements, physical functioning, and psychosocial assets and liabilities, and points to the importance of using such a classification for planning and evaluating patient care as well as for administrative purposes.
The present system of service provision to people with disability is very complex, fragmented, and costly. The large number of disabilities receiving separate consideration contributes to the complexity and cost. Major costs to society associated with disability are institutional care and income support programs. An action plan is proposed based upon two national goals--reduction in the need for institutional care by 30% and reduction in the level of unemployment among employable disabled people to the national average by 1990. Basic considerations for implementing an action plan are outlined, including the need for morbidity indices to measure progress towards goal attainment.
The aim of the present investigation was to compare the costs for the use of patellar tendon versus hamstring tendons as grafts for anterior cruciate ligament (ACL) reconstruction including the different fixation methods. The background is that during recent years there has been a dramatic shift from patellar tendon to hamstring tendons in ACL reconstructions in Sweden. All our patients with ACL reconstructions performed during 1 year (2004) were included. Knee joints numbering 440 in 439 patients were primary ACL reconstructions. A hamstring graft was used in 345 knee joints (78.4%) and a patellar tendon graft in 95 (21.6%) of the patients (Table 2). On average 34 (SD 12.9; range 14-63) ACL reconstructions per surgeon were performed by a total of 14 surgeons. The average cost for patellar tendon procedure was 197 euros compared to 436 euros for the hamstring procedure. Mean time for surgery in primary reconstructions was 11.5 min shorter (P
The authors describe part of the results of a comparative clinico-economic analysis of the functioning of two models of organizational forms of psychiatric services with special reference to Moscow and Kaluga. The purpose of the given research fragment was to make a comparative analysis of expenditures on schizophrenic patients depending on the system of psychiatric services organization on the whole and between different types of services; to specify approaches to optimization of their functioning with the use of a clinico-economic approach. Based on a comparative investigation of the representative groups of schizophrenic patients (386 patients of a mental health center in Moscow and 531 patients of the Kaluga regional psychiatric hospital No. 1), it has been established that as a result of the proper organization and financing of psychiatric services in Kaluga, the "direct" expenditures on one schizophrenic patient per year could be 20% as reduced and the losses of the national income could be lowered more than 2-fold. It should necessarily be mentioned that the financing of extra hospital services in Kaluga exceeded that in Moscow more than 3-fold, reaching about 20.3% of all the expenditures on schizophrenic patients. Apparently, the organizational and financial experience gained in Kaluga with the design of the common complex and many-staged system of psychiatric services may turn fairly instrumental in elaborating approaches to optimization of the functioning of psychiatric services.
To analyse the acquisition cost of dispensed prescription drugs for individuals with multiple medications in a national population.
We collected and analysed individual based data regarding the acquisition cost of dispensed prescription drugs for all individuals with five or more dispensed drugs (DP=5) in Sweden 2006 (2.2 million).
Individuals with DP=5 (24.5% of the population) accounted for 78.8% of the total acquisition cost, and individuals with DP=10 (8.6% of the population) and DP=15 (3.0% of the population) accounted for 46.3% and 23.2%, respectively. The average acquisition cost per defined daily doses (DDD) generally decreased with increasing age. The highest average cost per DDD was observed for individuals with DP=10. The acquisition cost for women with DP=5 represented 56.0% of the total acquisition cost. Men with DP=5 represented 44.0% of the total acquisition cost.
In an entire national population, individuals with multiple medication accounted for four fifths of the total acquisition cost of dispensed drugs. Actions to reduce the number of prescription drugs for the group of patients with a number of different drugs may also result in a substantial reduction of the total acquisition cost.