Persistent somatization patients put a serious burden on the health care system with multiple admissions, tests, surgeries, and medications. This study reports on factors relevant to the health-seeking behavior of somatizing patients and aspects of the health care system that facilitate their overutilization of health resources. Individuals (age 17-49 years) from the general population of two Danish municipalities with at least 10 general admissions during an 8-year period were studied comparing persistent somatizers with other high utilizers of medical admissions. Results are reported on geographical mobility, change in family doctors, route and distribution of admissions by time of day or week, discharges against medical advice, physical disease overlooked, and distribution of admissions to specialties. Although the health-seeking behavior of persistent somatizers may in part explain their overutilization of health care resources, such overutilization could be reduced and much suffering avoided if physicians displayed the same enthusiasm in diagnosing somatization as in ruling out organic pathology.
Comment In: Gen Hosp Psychiatry. 1993 Jul;15(4):208-108344509
Medical and social data on 980 consecutive admissions to the Medical Department, Aker Hospital, Oslo, were recorded prospectively with emphasis on patients' requirements and the Department's use of available resources. 73% of the admissions were acute, 4% were considered unnecessary. Half were because of chronic illness. Although 88% of the patients' requirements could have been met at a local hospital, 59% were treated in specialized units. 12% were admitted to the day unit at reduced cost for an average stay of three days. 41% of the patients were over 70 years of age, 37% lived alone and 14% needed rehabilitation. A main reason for admission was the patient's inability to take care of him/herself at home, in nearly all cases the main reason being acute illness or deterioration. Therefore many of the patients seemed to need care in an acute geriatric unit. At any one time the reason for 20-25% of the patients being in the department was delay in providing care at home or in a nursing home.
To determine whether, from a healthcare perspective, a specific occupational health intervention is cost effective in reducing sickness absence when compared with usual care in occupational health in workers with high risk of sickness absence.
Economic evaluation alongside a randomised controlled trial. 418 workers with high risk of sickness absence from one corporation were randomised to intervention (n = 209) or to usual care (n = 209). The subjects in the intervention group were invited to occupational health service for a consultation. The intervention included, if appropriate, a referral to specialist treatment. Register data of sickness absence were available for 384 subjects and questionnaire data on healthcare costs from 272 subjects. Missing direct total cost data were imputed using a two-part regression model. Primary outcome measures were sickness absence days and direct healthcare costs up to 12 months after randomisation. Cost effectiveness (CE) was expressed as an incremental CE ratio, CE plane and CE acceptability curve with both available direct total cost data and missing total cost data imputed.
After one year, the mean of sickness absence was 30 days in the usual care group (n = 192) and 11 days less (95% CI 1 to 20 days) in the intervention group (n = 192). Among the employees with available cost data, the mean days of sickness absence were 22 and 24, and the mean total cost euro974 and euro1049 in the intervention group (n = 134) and in the usual care group (n = 138), respectively. The intervention turned out to be dominant-both cost saving and more effective than usual occupational health care. The saving was euro43 per sickness absence day avoided with available direct total cost data, and euro17 with missing total cost data imputed.
One year follow-up data show that occupational health intervention for workers with high risk of sickness absence is a cost effective use of healthcare resources.
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We assessed the predictive value of intra-operative quality indicators (incidents) with respect to outcome (hospital mortality) and resource utilisation (length of stay in the postanaesthesia care unit and in hospital). Institutional data obtained from reports of a quality system that complies with the ISO 9002 standard were evaluated retrospectively. Incidents occurred in 2009 of 25 091 anaesthetics. Mortality was higher after incidents than after uneventful anaesthetics, but in multivariate analysis the incidents did not contribute to mortality. Length of stay in the postanaesthesia care unit and hospital were longer after incidents (p
Clinical competence is a determinant of the quality of care delivered, and may be associated with use of health care resources by primary care physicians. Clinical competence is assumed to be assessed by licensing examinations, yet there is a paucity of information on whether scores achieved predict subsequent practice.
To determine if licensing examination scores were associated with selected aspects of quality of care and resource use in initial primary care practice.
Prospective cohort study of recently licensed family physicians, followed up for the first 18 months of practice.
The Quebec health care system.
A total of 614 family physicians who passed the licensing examination between 1991 and 1993 and entered fee-for-service practice in Quebec.
All patients seen by physicians were identified by the universal health insurance board and all health services provided to these patients were retrieved for the 18 months prior to (baseline) and after (follow-up) the physicians' entry into practice. Medical service and prescription claims files were used to measure rates of resource use (specialty consultation, symptom-relief prescribing compared with disease-specific prescribing) and quality of care (inappropriate prescribing, mammography screening). Baseline data were used to adjust for differences in practice population.
Study physicians saw a total of 1116389 patients, of whom 113535 (10.2%) were elderly and 83391 (7.5%) were women aged 50 to 69 years. Physicians with higher licensing examination scores referred more of their patients for consultation (3.8/1000 patients per SD increase in score; 95% confidence interval [CI], 1.2-7.0; P = .005), prescribed to elderly patients fewer inappropriate medications (-2.7/1000 patients per SD increase in score; 95% CI, -4.8 to -0.7; P=.009) and more disease-specific medications relative to symptom-relief medications (3.9/1000 patients per SD increase in score; 95% CI, 0.3 to 7.4; P= .03), and referred more women aged 50 to 69 years (6.6/1000 patients per SD increase in score; 95% CI, 1.2-11.9; P = .02) for mammography screening. If patients of physicians with the lowest scores had experienced the same rates of consultation, prescribing, and screening as patients of physicians with the highest scores, an additional 3027 patients would have been referred, 179 fewer elderly patients would have been prescribed symptom-relief medication, 912 more elderly patients would have been prescribed disease-specific medication, 189 fewer patients would have received inappropriate medication, and 121 more women would have received mammography screening.
Licensing examination scores are significant predictors of consultation, prescribing, and mammography screening rates in initial primary care practice.
The aims were to evaluate the profile of newly diagnosed adult asthma cases and the approach adopted to the secondary care management at the launch of the Finnish asthma programme in 1994 and seven years later, in 2001.
A retrospective medical record audit was made of non-acutely referred patients with asthma in 1994 (n=165) and in 2001 (n=133). Clinical profile data, numbers of out-patient visits and periods of in-patient care before and after asthma diagnosis were gathered from referral letters and secondary care records.
The newly diagnosed asthma patients in 2001 were older, more obese and had more co-morbidities. The main asthma symptoms, such as dyspnoea, wheezing and cough, occurred equally in both years but were more often periodic than daily in 2001. Wheezing during auscultation was significantly less common in 2001. The diagnostic process was associated to a history of asthma in first-degree relatives (OR 5.34, 95% CI 1.12-24.49) in 1994 and a visit to a nurse prior to that to a physician (OR 3.13, 95% CI 1.17-8.37) in 2001. Secondary care visits per new case of asthma (7.3 in 1994 vs. 5.4 in 2001) and days in hospital (3.6 in 1994 vs. 0.95 in 2001) decreased significantly.
The profile of asthma diagnosed in secondary care indicates milder disease with more co-morbidities in 2001 than in 1994.Trends towards assigning a more active role on the part of primary care physicians and more rational use of secondary care resources in the management of asthma were found.
The aim of this study was to evaluate the total burden and health care provider costs of prevention, management and treatment of HP-related genital disease outcomes including all organized and opportunistic screening tests. Information about HPV-related disease outcomes in the Finnish female population of 2.7 million was obtained from nationwide population-based registry data. We estimated the incidence, health care resource use, health provider costs and life years lost due to cervical, vaginal and vulvar cancer and intraepithelial neoplasia (CIN, VaIN, VIN), cervical adenocarcinoma in situ, and external genital warts. The average annual disease burden of HPV-related genital disease in the female population of Finland comprises altogether 241 cases of cervical, vaginal and vulvar cancer, 2,898 new cases of CIN, 34,432 cases of minor cytological abnormalities, and almost 4,000 cases of external genital warts. The total annual costs of screening, further diagnostics and treatment of HPV-related genital disease were € 44.7 million of which the annual costs due to cervical cancer screening were € 22.4 million and due to diagnostics, management and treatment of HPV-related genital disease outcomes were € 22.3 million. The latter included € 8.4 million due to minor cervical abnormalities detected by the current cervical screening practice. The extensive opportunistic Pap testing fails to keep the incidence of cervical cancer from increasing among women aged 30-34. In addition opportunistic screening among this and younger age group detects a significant number of cytological abnormalities, most of which are probably treated unnecessarily.
To describe the burden of bilateral neovascular age-related macular degeneration (NV-AMD) on patient-reported functioning and health resource utilization.
A cross-sectional study of 401 patients with bilateral NV-AMD and 471 elderly control subjects without AMD was conducted in 5 countries. Subjects completed a telephone survey, including the National Eye Institute 25-Item Visual Function Questionnaire, the EuroQol instrument, the Hospital Anxiety and Depression Scale, and history of falls, fractures, and health care resource utilization.
The mean age for patients with NV-AMD was 78.1 years, and 65% were women. The patients reported 45% worse vision-related functioning, 13% worse overall well-being, and 30% more anxiety and 42% more depression symptoms than controls after adjusting for covariates (all, P
Age-related macular degeneration (AMD) is a retinal disease affecting more than 2 million Canadians over the age of 50. The neovascular form of AMD is responsible for 90% of severe vision loss associated with the disease. This study was conducted to assess the burden of neovascular AMD in the Canadian population.
A cross-sectional, observational study was conducted of self-reported functional health, well-being, and disease burden among elderly subjects in Canada with (n = 67) and without (n = 99) neovascular AMD. Subjects completed telephone surveys of the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), the EuroQol questionnaire (EQ-5D), and the Hospital Anxiety and Depression Scale (HADS). Subjects also reported their history of falls and fractures and annual health care resource utilization.
Subjects with neovascular AMD reported significantly worse vision-related functioning and overall well-being than controls (adjusted mean scores on the NEI-VFQ-25: 48.0 vs. 87.5; p
In Canada the incidence of Fetal Alcohol Spectrum Disorder (FASD) is estimated to be 1 in 100 live births. FASD is the leading cause of developmental and cognitive disabilities in Canada. Only one study has examined the cost of FASD in Canada. In that study we did not include prospective data for infants under the age of one year, costs for adults beyond 21 years or costs for individuals living in institutions.
To calculate a revised estimate of direct and indirect costs associated with FASD at the patient level.
Cross-sectional study design was used. Two-hundred and fifty (250) participants completed the study tool. Participants included caregivers of children, youth and adults, with FASD, from day of birth to 53 years, living in urban and rural communities throughout Canada participated. Participants completed the Health Services Utilization Inventory (HSUI). Key cost components were elicited: direct costs: medical, education, social services, out-of-pocket costs; and indirect costs: productivity losses. Total average costs per individual with FASD were calculated by summing the costs for each in each cost component, and dividing by the sample size. Costs were extrapolated to one year. A stepwise multiple regression analysis was used to identify significant determinants of costs and to calculate the adjusted annual costs associated with FASD.
Total adjusted annual costs associated with FASD at the individual level was $21,642 (95% CI, $19,842; $24,041), compared to $14,342 (95% CI, $12,986; $15,698) in the first study. Severity of the individual's condition, age, and relationship of the individual to the caregiver (biological, adoptive, foster) were significant determinants of costs (p