Cost-effective Care Research Articles

A novel way to integrate economic information into clinical practice guidelines.

Clinical guidelines are widely used to support clinical decision making, so they could also provide economic information about medical interventions to promote cost-conscious health care. We developed a new way to integrate economic information into the Finnish Current Care Guidelines. Our development team consisted of clinical guideline specialists and health economists. We first looked at integration of economic information in clinical guidelines of other countries. Our key principle was that economic information should be integrated only to mutually exclusive medical interventions where the extensive choice of one the options will yield a significant cost differences on the national level. For the comparative effectiveness information of the interventions, we primarily looked for network meta-analyses. We then combined the effectiveness information presented as number needed to treat with prices or costs for the interventions and present the result as a cost per responder, which reflects both effectiveness and price or costs. We introduce a process to integrate and present the economic information of the selected interventions in tables in the Current Care Guidelines. Our novel way to integrate economic information into the Current Care Guidelines is an effort to support cost-conscious clinical decision making to promote cost-effective health care in Finland. This process is general and could be used in clinical guidelines in other countries as well.

A comparative study of efficacy of platelet rich fibrin and conventional saline dressing in chronic non-healing ulcers: A randomized controlled trial in a tertiary care centre, Chengalpattu, Tamil Nadu

Non-healing ulcers pose a significant risk for deformities and platelet-rich fibrin (PRF) emerges as a promising treatment modality with feasible, easy, cost-effective day care therapy for chronic non-healing ulcers, exhibiting notable improvement in these chronic conditions. This study aims at demonstrating the efficacy of PRF (platelet rich fibrin) dressing in chronic non- healing ulcers.A prospective study with Forty patients of chronic non-healing ulcer aged more than 18 years are recruited, treated with PRF dressing and normal saline dressing. PRF dressing is repeated every week for 4 weeks and for normal saline dressing it is done every alternate days for the same period. Photographs were taken before treatment and at every subsequent session and sizes are measured in baseline (1) and 2,3,4 weeks. Each patient was followed up after four weeks from the last visit.In this study, excellent improvement was seen in 57% of total ulcers, 15% have showed moderate improvement. PRF dressing have shown significant improvement with >75% improvement in the size of the ulcer in visit 3 where as normal saline have shown only 34% improvement in 3 visit. Depth of the ulcer improved to 100% and 35% in visit 3 for PRF and normal saline dressing respectively.This study have found that PRF dressing has shown significant reduction in the overall size of the ulcer and quality of life with minimal visits and without any adverse events.

The perspectives of people living with dementia and their carers on the role of the general practice nurse in dementia care provision: a qualitative study.

Background Models that optimise the role of the general practice nurse have the potential to deliver cost-effective best-practice dementia care in the primary care setting. Patient experience is recognised as a vital contribution to the design, provision and evaluation of healthcare services. The aim of this study was to gain insights into the healthcare needs and experiences of people living with dementia and carers as relevant to the provision of dementia care by general practice nurses. Methods A qualitative design with semi-structured interviews was employed. Data were transcribed verbatim and thematically analysed. Six carers and five people living with dementia who received care from a general practice nurse in the previous 12months took part in the study. Results Five overarching themes were identified: (1) the general practice nurse and dementia care: a golden opportunity, (2) respectful communication: talk to me and hear what I am saying, (3) person-centred information: tell me what I want to know, (4) provide support: more than just information provision, and (5) include the carer: we are a team. Conclusion This study describes the experiences and healthcare needs of people living with dementia and their carer(s) with regard to the general practice nurse role. These findings can inform strategies to support the general practice nurse provision of dementia care that meet the healthcare needs of people living with dementia and carers.

Envisioning the Future of Burnout Support: Understanding Frontline Workers' Experiences in Nonprofit Gender-Based Violence Organizations

Frontline workers (FLWs) provide essential services necessary for a functioning society, but the nature of their work contributes to their high rates of burnout. This burnout impacts not only their own health, but also has dire consequences for the people most in need of their services. Digital interventions for burnout may provide scalable, accessible, and cost-effective care. However, such interventions have been designed to intervene at the individual-level and have been inadequate in sustainably alleviating burnout. In addition, these interventions have not considered how we might integrate more effective organizational-level strategies or reflect FLWs' own experiences and the unique contexts of frontline work in their design. One important, yet understudied, domain of frontline work that experiences high rates of burnout is gender-based violence (GBV) service provision in nonprofit organizations. Using a community-based participatory research approach, we ran 8 co-design workshops with FLWs and supervisors from various nonprofit GBV organizations in a large metropolitan city in the United States to understand their experiences, hopes, and perceptions of technology for burnout support within their organizations. We found that participants greatly valued their support systems and supervisory relationships at work. And while there was a desire to use technology as support tools for burnout, participants were wary of how it could conflict with these support systems and important organizational values. We contribute a multilevel framework for digital burnout interventions and argue for a methodological shift to an assets-based approach, reframing the future of research and design of burnout interventions to center and reflect the needs, values, and lived experiences of FLWs.

Cost-effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-COVID-19 condition after hospitalisation for COVID-19: the REGAIN RCT

BackgroundFollowing the COVID-19 pandemic, millions of people continue to experience ongoing physical and mental health sequelae after recovery from acute infection. There is currently no specific treatment for the diverse symptoms associated with post-COVID-19 condition. Physical and mental health rehabilitation may help improve quality of life in such patients. This study reports the cost-effectiveness of a programme of physical and mental health rehabilitation compared to best practice usual care in people with post-COVID-19 condition who were previously hospitalised.MethodsWe conducted an economic evaluation within a randomised controlled trial from the perspective of the UK national health service (NHS) and personnel social services perspective (PSS). Resource used and health-related quality of life were collected using bespoke questionnaire and the EQ-5D-5 L questionnaire at three, six, and 12 months. Incremental costs and quality adjusted life years accrued over the follow-up period were estimated and reported as the incremental cost-effectiveness ratio. Estimate uncertainty was managed by multiple imputation and bootstrapping cost-effectiveness estimates; and displayed graphically on the cost-effectiveness plane.ResultsOver a 12-month time horizon, incremental costs and QALYs were £305 (95% CI: -123 to 732) and 0.026 (95% CI: -0.005 to 0.052) respectively. The ICER was £11,941 per QALY indicating cost-effective care. Sensitivity analyses supported the base case findings. The probability of the intervention being cost-effective at a £30,000 per QALY willingness-to-pay threshold was 84%.ConclusionThe within-trial economic evaluation suggested that people with post-COVID-19 condition after hospitalisation should be offered a programme of physical and mental health rehabilitation as it likely reflects a cost-effective use of NHS resources. Hospitalisation for COVID-19 has become less commonplace: further evaluation in non-hospitalised patients may be worthwhile.Trial registrationISRCTN registry ISRCTN11466448 23rd November 2020.

The Role of Communities in Nurse-Led Clinics, 1965-2000: Lessons From History.

Since the 1960s, nurses have worked to improve access to health care services among underserved communities through the establishment of community-based nurse-led clinics (NLCs). Evidence demonstrates NLCs' effectiveness in delivering high quality and cost-effective primary care services to underserved communities. However, few studies have analyzed the role and meaning of community within NLCs. This article uses historical research to analyze and evaluate the roles played by communities in three community-based NLCs established between the 1960s and 1990s. This research shows that how nurses entered the communities they intended to provide care, the degree to which they collaborated with community members to conceptualize, operationalize, and maintain NLCs, and how they balanced community needs with academic imperatives are critical to understanding and addressing the difficulties NLCs have encountered delivering sustained, community-centered care. This research also addresses the impact on communities when NLCs fail, making clear the need for policy interventions that address the financial and political factors undermining NLCs' sustainability, particularly limitations on nurse practitioners' practice authority and credentialing as Medicaid providers, and reduced reimbursement rates for nurse practitioners. Ultimately, it argues that NLCs' engagement with underserved communities should be historically informed and integrate community expertise, robust community engagement, and community-centered definitions of quality care.

Return to work after hip and knee arthroplasty: qualitative outcome from the Netherlands

Abstract Background Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are performed daily worldwide. More younger working-age patients are receiving a THA and/or TKA. Outcomes, including Quality-of-Life (QOL), patient satisfaction and Return-to-Work (RTW) are becoming more important and have implications for healthcare budget and health workforce. Clinical recovery pathways should improve patient outcomes and cost-effective care. Insight in patient experiences and expectations regarding RTW remains behind. This study aims to gain insight into influenceable factors in the recovery pathway after THA or TKA that could lead to improved care and enhanced patient participation. Methods In this single-center qualitative study, performed at Zuyderland Medical Center (Sittard-Geleen, the Netherlands), 12 patients (n = 6 THA; n = 6 TKA) aged under 65 years were approached to participate. During interviews 6-weeks after arthroplasty, this research explored their RTW experiences in both pre-, and postoperative, in- and outpatient settings. Results In total, 12 employed patients who received a THA (n = 6, mean age 56 ± 7.4 years; female: n = 4, 66%) or a TKA (n = 6, mean age 61 ± 2.6 years; female n = 3, 50%) participated. Own control regarding RTW and a minimal recovery time after the operation was necessary for all patients. During this time, focus on physical therapy and strengthening was most important. RTW was not expected to be the primary goal during the clinical recovery pathway. The RTW topic was said to belong to the occupational physician (OP) and employer. Patients however knowledge that the type of work should gain importance in the consultation room. Patients missed accessible communication between the orthopedic surgeon and OP. Conclusions Overall, patients are satisfied with the current clinical recovery pathway. Intercollegiate communication should be made more accessible. Own control and strengthening self-management in the RTW remain important for all patients. Key messages • Own control and strengthening self-management should have importance in the guidance of working-age patients after THA or TKA. • Intercollegiate communication should be made more accessible.

Why the NHS needs adult generalists: A call for single certification in general internal medicine

As the UK NHS faces growing challenges of the ageing population and escalating healthcare costs, we examine the role of the general internal medicine (GIM) consultant in inpatient medicine. We argue that the reintroduction of GIM could provide a sustainable and valuable contribution to high-quality, cost-effective inpatient care drawing on parallels from the GIM hospitalist model in the USA. Additionally, GIM expansion could contribute to improved outcomes for complex medical patients and surgical patients, as well as safety and quality initiatives.

Homoeopathy vs. conventional primary care in children during the first 24 months of life—a pragmatic randomised controlled trial

To compare the difference between primary homoeopathic and conventional paediatric care in treating acute illnesses in children in their first 24 months of life. One hundred eight Indian singleton newborns delivered at 37 to 42 weeks gestation were randomised at birth (1:1) to receive either homoeopathic or conventional primary care for any acute illness over the study period. In the homoeopathic group, conventional medical treatment was added when medically indicated. Clinicians and parents were unblinded. Children in the homoeopathic group experienced significantly fewer sick days than those in the conventional group (RR: 0.37, 95% CI: 0.24–0.58; p < 0.001), with correspondingly fewer sickness episodes (RR: 0.53, 95% CI: 0.32–0.87; p = .013), as well as fewer respiratory illnesses over the 24-month period. They were taller (F (1, 97) = 8.92, p = .004, partial eta squared = 0.84) but not heavier than their conventionally treated counterparts. They required fewer antibiotics, and their treatment cost was lower.Conclusion: Homoeopathy, using conventional medicine as a safety backdrop, was more effective than conventional treatment in preventing sick days, sickness episodes, and respiratory illnesses in the first 24 months of life. It necessitated fewer antibiotics and its overall cost was lower. This study supports homoeopathy, using conventional medicine as a safety backdrop, as a safe and cost-effective primary care modality during the first 2 years of life.Trial registration: Clinical Trial Registry-India (2018/09/015641). https://ctri.nic.in/Clinicaltrials/login.phpWhat is Known:• Due to their holistic nature, many Complementary and Alternative Medical (CAM) modalities are not readily amenable to assessment by head-to-head RCT for a given Indication.• We propose a pragmatic, RCT comparing homoeopathic with conventional medicine as a system.What is New:• Homoeopathic was apparently superior to conventional primary care in preventing sick days, sickness episodes, and respiratory illness episodes and was significantly associated with growth in height but not weight and required fewer antibiotics in children from birth to 24 months of age.

Integrated care for children and young people with special health and care needs: a systematic review

ContextThere is a dearth of high-quality evidence on integrated, coordinated and cost-effective care for children with special health and care needs (CSHCN).ObjectiveTo assess the effectiveness of integrated/coordinated care models for...

Integrated Care in a Large Public System Improves Simple Kidney Stone Management.

In the Los Angeles County Department of Health Services-the second largest public health care system in the United States-clinical integration allows specialists and primary care providers to collaboratively provide specialty care. We used time-driven activity-based costing to compare patient burden and cost of kidney stone diagnosis, workup, and management with and without clinical integration. We interviewed and observed teams of physicians and staff to understand workflow practices and personnel, space, material, and device requirements for stone care in the 2 models. We created process maps that outline the entire arc of care and used time-driven activity-based costing to calculate the all-inclusive costs of kidney stone diagnosis, workup, and scheduling for surgical treatment. The total cost of kidney stone treatment per stone episode in the integrated pathway was $499.04, compared with $699.81 in the traditional, nonintegrated pathway, a difference of 29%. The number of steps needed to arrive at operating room scheduling was 11 with integration and 14 without it. Clinical integration resulted in more efficient and cost-effective care from patient, provider, and health system perspectives. Integrated care may improve access to specialty care and increase the value of care and reduce treatment burden on patients.

SPINE20 Recommendations 2024 -Spinal Disability: Social Inclusion as a Key to Prevention and Management.

Spine disorders are the leading cause of disability worldwide. To promote social inclusion, it is essential to ensure that people can participate in their societies by improving their ability, opportunities, and dignity, through access to high-quality, evidence-based, and affordable spine services for all.To achieve this goal, SPINE20 recommends six actions.- SPINE20 recommends that G20 countries deliver evidence-based education to the community health workers and primary care clinicians to promote best practice for spine health, especially in underserved communities.- SPINE20 recommends that G20 countries deliver evidence-based, high-quality, cost-effective spine care interventions that are accessible, affordable and beneficial to patients.- SPINE20 recommends that G20 countries invest in Health Policy and System Research (HPSR) to generate evidence to develop and implement policies aimed at integrating rehabilitation in primary care to improve spine health.- SPINE20 recommends that G20 countries support ongoing research initiatives on digital technologies including artificial intelligence, regulate digital technologies, and promote evidence-based, ethical digital solutions in all aspects of spine care, to enrich patient care with high value and quality.- SPINE20 recommends that G20 countries prioritize social inclusion by promoting equitable access to comprehensive spine care through collaborations with healthcare providers, policymakers, and community organizations.- SPINE20 recommends that G20 countries prioritize spine health to improve the well-being and productivity of their populations. Government health systems are expected to create a healthier, more productive, and equitable society for all through collaborative efforts and sustained investment in evidence-based care and promotion of spine health.

The “flipped visit”: an innovative method to improve medical student self-efficacy through a structured approach in clinic

BackgroundSpecialty clinics can be challenging for students on the internal medicine clerkship. They often lack the specialized knowledge necessary to fully engage in the clinic and may be pushed into an observational role, rather than being afforded meaningful opportunities. These peripheral roles undermine self-efficacy, and, therefore, education and interest. We sought to improve self-efficacy of students attending non-malignant hematology clinic, as well as to enhance interest in hematology and internal medicine.MethodsWe developed a flipped visit model analogous to the flipped classroom. Students each received pre-readings accompanied and pre-assigned cases with delineated reasons for referral and learning objectives. This model allowed students to prepare the hematology content for visits prior to arrival and then focus their time in clinic on executing visits. Participating students completed pre- and post-clinic surveys. These surveys covered core concepts in self-efficacy and interest in hematology and internal medicine on a five-point Likert scale.ResultsOf 103 students attending hematology clinic, 38 students (37%) opted to participate. Two of the 38 did not complete the post-clinic survey. Students had a statistically significant increase in four of six measures of self-efficacy: evaluation of research relevant to patient care and practicing cost-effective care (p = 0.008 and 0.001, respectively); and creation of a differential diagnosis and treatment plan specific to hematology (both p < 0.001). While pre-clinic student responses expressed interest in more exposure to hematology or a possible career in hematology or internal medicine, this was not changed post-clinic. When comparing their experience to other clinics, 75% and 71% students rated hematology clinic slightly or much better than other medicine clinics and non-medicine clinics, respectively. The flipped visit improved self-efficacy both specific to hematology and more generally. While students rated the experience more highly than other clinics, there was no impact on career interest in hematology or internal medicine.ConclusionA flipped visit approach to incorporating medical students into hematology clinic that included pre-assigned cases and readings improved self-efficacy and was preferred by students. They may be adopted easily in other ambulatory education settings.

Artificial Intelligence (AI) In Dental Clinical Practice

Artificial intelligence (AI) characterized as the ability of a machine to mimic human intelligence, has been a breakthrough in technological advancements during the last few decades and has made a huge impact on our everyday life. In current scenario, it has become necessary for the dental professionals too to get oriented with clinical as well as technological advancement to provide easy, rapid, relatively cost-effective and excellent patient care. In dentistry, artificial intelligence has been playing a significant role in improving diagnosis, treatment planning and quality of patient care. But dental practice involves more than just disease diagnosis and includes evaluating correlation between clinical and radiographic findings and administering customized definitive treatment to the patients. Hence, AI cannot replace dentists but can definitely help reducing his efforts and assisting him in decision making. This review provides information about the existence of this new technology, its current applications and its influence on dental practice

Physiotherapy-led care versus physician-led care for persons with low back pain: A systematic review

Objective To summarise the evidence on the effect of physiotherapy-led versus physician-led care on clinical outcomes, healthcare use, and costs in persons with low back pain. Data sources PubMed, Web of Science, CINAHL, Embase, and PEDro were systematically searched with the latest search performed in July 2024. Reference lists of articles were hand-searched. Review methods Studies comparing clinical outcomes, healthcare use, or costs between adults with low back pain first consulting a physiotherapist and those first consulting a physician were included. Methodological quality was assessed with the Newcastle-Ottawa Scale. Study design, clinical setting, patient characteristics, and group effects were extracted. Findings on outcomes assessed in two or more studies were synthesised narratively. Certainty of evidence was determined using the GRADE approach. Results Eighteen studies comprising 1,481,980 persons with low back pain were included. Most studies were non-randomised retrospective or prospective cohort studies. In primary care (15 studies), consistent evidence, though of mostly very low certainty, indicated that physiotherapy-led care leads to higher patient satisfaction, less use of medication, injections and imaging, fewer physician's visits, lower total healthcare costs, and less sick leave compared to physician-led care, without increased harm. In emergency care (three studies), evidence of very low certainty showed that physiotherapy-led care leads to shorter waiting and treatment times, and fewer hospital admissions. Conclusion Physiotherapy-led care is a clinically, time- and cost-effective care pathway for low back pain, although the certainty of evidence was overall very low. Further high-quality research with a greater focus on clinical outcomes is warranted.

The Interconnections between Obesity, Diabetes, Breast Cancer, and Hospital Costs

Obesity and diabetes are prominent public health concerns, closely linked to an increased risk of chronic diseases, including breast cancer. The interconnections between these conditions contribute to significant financial burdens on healthcare systems, encompassing both direct and indirect hospital costs. This review explores the complex relationships between obesity, diabetes, and breast cancer, emphasizing their collective impact on hospital costs. By examining the mechanisms that connect these conditions and their economic implications, the review highlights the need for comprehensive and integrated strategies that address prevention, early intervention, and cost-effective care. The findings underscore the importance of public health initiatives, innovative treatment approaches, and collaborative efforts among stakeholders to mitigate the growing healthcare costs associated with these interconnected conditions. The review concludes by identifying research gaps and future directions aimed at improving patient outcomes and reducing the economic burden on healthcare systems. Keywords: Obesity, Diabetes, Breast Cancer, Hospital Costs, Chronic Diseases, Public Health, Economic Burden.

Diversity, equity, and inclusion in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy Position Statement.

1: The European Society of Gastrointestinal Endoscopy (ESGE) adheres to the overarching principles of equality of opportunity, fair treatment, nondiscrimination, and diversity of health care professionals. 2: ESGE strongly supports the creation of collaborations within and between national and international endoscopy societies to disseminate the principles of diversity, equality, and inclusion (DEI) in the field of gastrointestinal (GI) endoscopy. 3: ESGE aims to reflect the diversity of its membership in all its scientific and educational activities. 4: ESGE supports the fostering of collaborative work settings that empower all members of the endoscopy team to reach their full potential. 5: ESGE supports international and national endoscopy societies in promoting equitable access to high quality endoscopy training. 6: ESGE recommends the implementation of ergonomic principles in endoscopy units to prevent injuries and to provide adapted workplace conditions for personnel with disabilities and/or special needs. 7: ESGE recommends comprehensive mentorship, that includes diverse backgrounds, and equitable sponsorship for professional development, training, and academic excellence. 8: ESGE recommends that endoscopists actively identify, discuss, and attempt to accommodate reasonable patient preferences and expectations regarding endoscopy procedures. 9: ESGE advocates for educational and awareness campaigns targeting both health care professionals and patients, as well as the adoption of cost-effective health care strategies to address disparities and enhance equity in endoscopy care. 10: ESGE is committed to increasing support for underrepresented scholars and minorities pursuing research in endoscopy. 11: ESGE identifies mentorship and sponsorship as factors that may mitigate the barriers to academic careers for underrepresented endoscopy scholars. 12: ESGE recognizes the need to increase awareness of diversity, equity, and inclusion (DEI) in the field of endoscopy and supports publications on these topics.

Health of refugees settled in Australia over time and generations: a transformative mixed methods study protocol

BackgroundRefugees resettled in Australia may experience significant physical, mental and emotional health issues on arrival and difficulty accessing mainstream healthcare that often demands specialised services. It is not known if...

A community health-coaching referral program following discharge from treatment for chronic low back pain – a qualitative study of the patient’s perspective

BackgroundGlobal policy and guidelines for low back pain (LBP) management promote physical activity and self-management yet adherence is poor and a decline in outcomes is common following discharge from treatment. Health coaching is effective at improving exercise adherence, self-efficacy, and social support in individuals with chronic conditions, and may be an acceptable, cost-effective way to support people in the community following discharge from treatment for LBP.AimThis qualitative study aimed to understand which aspects of a community over-the-phone health-coaching program, were liked and disliked by patients as well as their perceived outcomes of the service after being discharged from LBP treatment.MethodsA purposive sampling approach was used to recruit 12 participants with chronic LBP, from a large randomised controlled trial, who were randomly allocated to receive a health coaching program from the Get Healthy Service® in Australia. Semi-structured interviews were conducted, and a general inductive thematic analysis approach was taken.ResultsThe main themes uncovered regarding the intervention included the positive and negative aspects of the health coaching service and the relationship between the participant and health coach. Specifically, the participants spoke of the importance of the health coach, the value of goal setting, the quality of the advice received, the benefits of feeling supported, the format of the coaching service, and LBP-specific knowledge. They also reported the health coach and the coaching relationship to be the primary factors influencing the program outcomes and the qualities of the coaching relationship they valued most were connection, communication, care, and competence. The sub-themes uncovered regarding the outcomes of the intervention included positive impacts (a greater capacity to cope, increased confidence, increased motivation and increased satisfaction) and negative impacts (receiving no personal benefit).Clinical implicationsIn an environment where self-management and self-care are becoming increasingly important, understanding the patient’s experience as part of a coaching program is likely to lead to improved quality of health coaching care, more tailored service delivery and potentially more effective and cost-effective community-based care for individuals with chronic LBP in the community after being discharged from treatment.Trial RegistrationThe GBTH trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000889954) on 10/9/2020. Ethical approval was prospectively granted by the Western Sydney Local Health District Human Research and Ethics Committee (2020/ETH00115). Written informed consent was obtained from all participants. The relevant sponsor has reviewed the study protocol and consent form.

Dr. Thanjavur Santhanakrishna Kanaka: Asia's First Female Neurosurgeon and a Pioneer of Functional Neurosurgery.

Dr. Thanjavur Santhanakrishna Kanaka significantly advanced Indian healthcare through her pioneering contributions to modern surgical techniques and advocacy for gender equity in medical education. Her research in stereotactic surgery and electrode implantation, coupled with her focus on cost-effective care for low-income patients, has had a profound impact on neurosurgery. Dr. Kanaka's enduring legacy continues to inspire and shape the field, reflecting her substantial influence on both medical practice and community service.