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Admission patterns of persistent somatization patients.

https://arctichealth.org/en/permalink/ahliterature73318
Source
Gen Hosp Psychiatry. 1993 Jul;15(4):211-8
Publication Type
Article
Date
Jul-1993
Author
P. Fink
Author Affiliation
Institute of Psychiatric Demography, Aarhus Psychiatric Hospital, Risskov, Denmark.
Source
Gen Hosp Psychiatry. 1993 Jul;15(4):211-8
Date
Jul-1993
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cross-Sectional Studies
Denmark - epidemiology
Diagnosis, Differential
Female
Health Resources - utilization
Health Services Misuse - statistics & numerical data
Humans
Incidence
Male
Middle Aged
Patient Admission - statistics & numerical data
Patient Discharge - statistics & numerical data
Primary Health Care - utilization
Referral and Consultation - utilization
Research Support, Non-U.S. Gov't
Somatoform Disorders - diagnosis - epidemiology - psychology
Specialties, Medical - statistics & numerical data
Abstract
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.
Notes
Comment In: Gen Hosp Psychiatry. 1993 Jul;15(4):208-108344509
PubMed ID
8344510 View in PubMed
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[Admissions to the medical wards. Are resources used in accordance to patients' needs?]

https://arctichealth.org/en/permalink/ahliterature73721
Source
Tidsskr Nor Laegeforen. 1990 Oct 30;110(26):3362-5
Publication Type
Article
Date
Oct-30-1990
Author
E. Bjørnstad
O. Bergesen
B. Nordhaug
U. Abildgaard
G. Stene-Larsen
Author Affiliation
Medisinsk avdeling, Aker sykehus, Oslo.
Source
Tidsskr Nor Laegeforen. 1990 Oct 30;110(26):3362-5
Date
Oct-30-1990
Language
Norwegian
Publication Type
Article
Keywords
Adult
Aged
English Abstract
Female
Health Resources - utilization
Health services needs and demand
Hospital Departments - utilization
Humans
Internal Medicine - statistics & numerical data
Male
Middle Aged
Norway
Patient Admission - statistics & numerical data
Abstract
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.
PubMed ID
2256059 View in PubMed
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An occupational health intervention programme for workers at high risk for sickness absence. Cost effectiveness analysis based on a randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature160853
Source
Occup Environ Med. 2008 Apr;65(4):242-8
Publication Type
Article
Date
Apr-2008
Author
S. Taimela
S. Justén
P. Aronen
H. Sintonen
E. Läärä
A. Malmivaara
J. Tiekso
T. Aro
Author Affiliation
Evalua International, PO Box 35, FIN-01531 Vantaa, Finland. simo.taimela@evalua.fi
Source
Occup Environ Med. 2008 Apr;65(4):242-8
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Absenteeism
Adolescent
Adult
Cost-Benefit Analysis
Female
Finland
Health Care Costs - statistics & numerical data
Health Resources - utilization
Humans
Male
Middle Aged
Occupational Health - statistics & numerical data
Occupational Health Services - economics - methods
Outcome and Process Assessment (Health Care) - methods
Risk assessment
Sick Leave - economics - statistics & numerical data
Abstract
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.
Notes
Cites: Stat Med. 2003 Sep 15;22(17):2799-81512939787
Cites: J Occup Environ Med. 2003 May;45(5):499-50612762074
Cites: Annu Rev Public Health. 2002;23:151-6911910059
Cites: Occup Environ Med. 2004 Nov;61(11):924-915477286
Cites: Occup Environ Med. 2007 Nov;64(11):739-4617303674
Cites: Eur Spine J. 2007 Jul;16(7):919-2417186282
Cites: J Occup Rehabil. 2006 Dec;16(4):557-7817086503
Cites: Occup Environ Med. 2006 Oct;63(10):676-8216644897
Cites: Spine (Phila Pa 1976). 2006 May 1;31(10):1075-8216648740
Cites: Med Care. 2006 Apr;44(4):352-816565636
Cites: J Occup Rehabil. 2005 Dec;15(4):569-8016254756
Cites: Occup Environ Med. 2005 Feb;62(2):74-915657187
Comment In: Occup Environ Med. 2008 Apr;65(4):219-2018349154
PubMed ID
17933885 View in PubMed
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Association between intra-operative incidents and postoperative outcome and resource utilisation.

https://arctichealth.org/en/permalink/ahliterature188051
Source
Anaesthesia. 2002 Nov;57(11):1052-9
Publication Type
Article
Date
Nov-2002
Author
M M Niskanen
E T Ruokonen
Author Affiliation
Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland.
Source
Anaesthesia. 2002 Nov;57(11):1052-9
Date
Nov-2002
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anesthesia Recovery Period
Anesthesia, Conduction - adverse effects
Female
Finland - epidemiology
Health Resources - utilization
Hospital Mortality
Humans
Intraoperative Complications - mortality
Length of Stay - statistics & numerical data
Male
Middle Aged
Multivariate Analysis
Prognosis
Proportional Hazards Models
Quality Indicators, Health Care
Recovery Room - standards - utilization
Retrospective Studies
Risk factors
Abstract
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
PubMed ID
12392452 View in PubMed
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Association between licensing examination scores and resource use and quality of care in primary care practice.

https://arctichealth.org/en/permalink/ahliterature204494
Source
JAMA. 1998 Sep 16;280(11):989-96
Publication Type
Article
Date
Sep-16-1998
Author
R. Tamblyn
M. Abrahamowicz
C. Brailovsky
P. Grand'Maison
J. Lescop
J. Norcini
N. Girard
J. Haggerty
Author Affiliation
Department of Medicine, McGill University, Montreal, Québec, Canada. mi64@musica.mcgill.ca
Source
JAMA. 1998 Sep 16;280(11):989-96
Date
Sep-16-1998
Language
English
Publication Type
Article
Keywords
Adult
Aged
Clinical Competence
Drug Utilization - statistics & numerical data
Educational Measurement
Family Practice - standards - statistics & numerical data
Female
Health Policy
Health Resources - utilization
Humans
Licensure, Medical
Linear Models
Male
Mammography - utilization
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Primary Health Care - standards
Prospective Studies
Quality of Health Care
Quebec
Referral and Consultation - utilization
United States
Abstract
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.
PubMed ID
9749481 View in PubMed
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Asthma Programme in Finland: Did the use of secondary care resources become more rational?

https://arctichealth.org/en/permalink/ahliterature145037
Source
Respir Med. 2010 Jul;104(7):957-65
Publication Type
Article
Date
Jul-2010
Author
L E Tuomisto
M. Erhola
T. Luukkaala
H. Puolijoki
M M Nieminen
M. Kaila
Author Affiliation
Seinäjoki Central Hospital, Huhtalantie 53, FI 60220 Seinäjoki, Finland. leena.tuomisto@epshp.fi
Source
Respir Med. 2010 Jul;104(7):957-65
Date
Jul-2010
Language
English
Publication Type
Article
Keywords
Adult
Asthma - epidemiology - therapy
Female
Finland - epidemiology
Health Resources - utilization
Humans
Male
Medical Audit
Middle Aged
Quality Assurance, Health Care - standards
Referral and Consultation - utilization
Retrospective Studies
Abstract
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.
PubMed ID
20207125 View in PubMed
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The burden and costs of prevention and management of genital disease caused by HPV in women: a population-based registry study in Finland.

https://arctichealth.org/en/permalink/ahliterature115805
Source
Int J Cancer. 2013 Sep 15;133(6):1459-69
Publication Type
Article
Date
Sep-15-2013
Author
Heini Salo
Tuija Leino
Terhi Kilpi
Kari Auranen
Petri Tiihonen
Matti Lehtinen
Simopekka Vänskä
Miika Linna
Pekka Nieminen
Author Affiliation
Department of Vaccination and Immune Protection/Vaccination Programme Unit, National Institute for Health and Welfare (THL), FI-00271, Helsinki, Finland. heini.salo@thl.fi
Source
Int J Cancer. 2013 Sep 15;133(6):1459-69
Date
Sep-15-2013
Language
English
Publication Type
Article
Keywords
Cervical Intraepithelial Neoplasia - prevention & control
Child
Female
Finland - epidemiology
Genital Neoplasms, Female - economics - epidemiology - prevention & control - therapy
Health Care Costs
Health Resources - utilization
Humans
Incidence
Papillomavirus Infections - complications
Registries
Uterine Cervical Neoplasms - prevention & control
Vaginal Smears - economics
Abstract
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.
PubMed ID
23463194 View in PubMed
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Burden and health care resource utilization in neovascular age-related macular degeneration: findings of a multicountry study.

https://arctichealth.org/en/permalink/ahliterature161462
Source
Arch Ophthalmol. 2007 Sep;125(9):1249-54
Publication Type
Article
Date
Sep-2007
Author
Gisèle Soubrane
Alan Cruess
Andrew Lotery
Daniel Pauleikhoff
Jordi Monès
Xiao Xu
Gergana Zlateva
Ronald Buggage
John Conlon
Thomas F Goss
Author Affiliation
Department of Ophthalmology, University Paris XII, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, Créteil, France. gisele.soubrane@chicreteil.fr
Source
Arch Ophthalmol. 2007 Sep;125(9):1249-54
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada
Choroidal Neovascularization - economics - physiopathology
Comorbidity
Cost of Illness
Cross-Sectional Studies
Europe
Female
Health Resources - utilization
Health Services Research
Humans
Macular Degeneration - economics - physiopathology
Male
Middle Aged
Quality of Life
Questionnaires
Sickness Impact Profile
Visual Acuity - physiology
Abstract
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
Notes
Comment In: Arch Ophthalmol. 2007 Sep;125(9):1266-817846369
PubMed ID
17846366 View in PubMed
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Burden of illness of neovascular age-related macular degeneration in Canada.

https://arctichealth.org/en/permalink/ahliterature160243
Source
Can J Ophthalmol. 2007 Dec;42(6):836-43
Publication Type
Article
Date
Dec-2007
Author
Alan Cruess
Gergana Zlateva
Xiao Xu
Sophie Rochon
Author Affiliation
Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS.
Source
Can J Ophthalmol. 2007 Dec;42(6):836-43
Date
Dec-2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada
Choroidal Neovascularization - economics - etiology - physiopathology
Cost of Illness
Cross-Sectional Studies
Female
Health Care Costs
Health Resources - utilization
Health Services Research
Humans
Macular Degeneration - complications - economics - physiopathology
Male
Middle Aged
Ophthalmology - economics
Quality of Life
Questionnaires
Sickness Impact Profile
Visual Acuity - physiology
Abstract
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
PubMed ID
18026200 View in PubMed
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The burden of prenatal exposure to alcohol: revised measurement of cost.

https://arctichealth.org/en/permalink/ahliterature152976
Source
Can J Clin Pharmacol. 2009;16(1):e91-102
Publication Type
Article
Date
2009
Author
Brenda Stade
Alaa Ali
Dainel Bennett
Douglas Campbell
Mary Johnston
Cynthia Lens
Sofia Tran
Gideon Koren
Author Affiliation
Department of Paediatrics, St Michael's Hospital, Toronto, Canada. stadeb@smh.toronto.on.ca
Source
Can J Clin Pharmacol. 2009;16(1):e91-102
Date
2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Canada - epidemiology
Child
Child, Preschool
Costs and Cost Analysis
Cross-Sectional Studies
Female
Fetal Alcohol Spectrum Disorders - economics - epidemiology
Health Care Costs - statistics & numerical data
Health Resources - utilization
Health Services Needs and Demand - economics
Humans
Incidence
Infant
Infant, Newborn
Male
Middle Aged
Pregnancy
Prospective Studies
Sickness Impact Profile
Young Adult
Abstract
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
PubMed ID
19168935 View in PubMed
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170 records – page 1 of 17.