Healthcare Professional Visits Research Articles

Gender differences in the association between attitudes toward mental health treatment and mental health outcomes among noninstitutionalized adults with depression

ABSTRACTThis study examined whether the effects of attitudes toward mental health treatment on mental health outcomes are moderated by gender in the U.S. population. We utilized the data (N = 491,773) from the 2013 Behavioral Risk Factor Surveillance System (BRFSS), which is an annual U.S. health survey administered through the Centers for Disease Control and Prevention. The study subsample consisted of 3,857 noninstitutionalized adults who were diagnosed with a depressive disorder and had healthcare professional visits in the past 12 months. Results showed that depressed adults having very positive attitudes toward mental health treatment reported to experience fewer days of poor mental health than those with less positive attitudes. While both men and women with a very positive attitude reported fewer days of experiencing poor mental health, the advantage of having a very positive attitude is only seen for women, not for men after the covariates are accounted for. The study suggests important social work intervention and policy implications.

PMS75 - SEEKING THE STATE OF THE ART IN STANDARDIZED MEASUREMENT OF HEALTH CARE RESOURCE USE AND COSTS IN JUVENILE IDIOPATHIC ARTHRITIS: A SCOPING REVIEW

The aim of this scoping review was to identify current practices in identifying and measuring health care resource use and unit costs in economic evaluation or costing studies of juvenile idiopathic arthritis (JIA). We searched PubMed and EMBASE to August 2017 to identify economic evaluations, costing studies or resource utilization studies focusing on patients with JIA and written in English language. Data from included articles were extracted and analyzed to identify the reported healthcare resource use items and unit costs and the data sources used. Of 1,061 unique citations identified by the search, 20 full-text articles were included. The most commonly reported healthcare resource use items involved medication use (85%), healthcare professional visits (70%) and/or paramedical care (60%), hospitalizations and/or hospital visits (80%), and laboratory tests (75%). Productivity loss of caregivers was considered in the majority studies (65%), but (future) productivity losses of patients were much less commonly considered (35%). Out-of-pocket costs, for example transportation costs, costs of home adaptations, school costs, and the use of complementary and alternative healthcare were only reported in some articles (range 10%-45%). When considering the data sources used, resource use was most frequently obtained from questionnaires. Estimates of unit costs were mostly based on reimbursement claims, administrative data, or the literature. Although there was some consistency in commonly included healthcare resource use items, there remains a gap in reporting items related to productivity losses (lost work and school time) and out-of-pocket costs. However, these are particularly relevant in JIA (and other childhood diseases), because of their strongly debilitating impact and because its consequences may continue into adulthood. Therefore, improved guidance for conducting and reporting (health) economic evaluations for these diseases is required. This can be achieved by developing a standardized list of items for collecting resource use and unit costs in chronic childhood diseases.

Real-life use of onabotulinumtoxinA for symptom relief in patients with chronic migraine: REPOSE study methodology and baseline data

BackgroundMigraine is a debilitating neurological disorder that affects 14.1% of the US and 14.7% of the European populations. Chronic migraine (CM) is broadly defined as headache occurring on ≥15 days per month for ≥3 months, and has an estimated worldwide prevalence of 1.4% to 2.2%. OnabotulinumtoxinA is currently approved for the treatment of CM in most European countries, and is the only preventative treatment approved for adults with CM, based on results from the PREEMPT clinical trial programme. The ongoing prospective, observational REal-life use of botulinum toxin for the symptomatic treatment of adults with chronic migraine, measuring healthcare resource utilisation, and Patient-reported OutcomeS observed in practice (REPOSE) Study aims to describe real-world healthcare resource utilisation and patient-reported outcomes over a 2-year period in Germany, Italy, Norway, Russia, Spain, Sweden, and the United Kingdom, among patients with CM prescribed onabotulinumtoxinA.MethodsHerein, methodology and baseline characteristics of patients who participated for ≥6 months in REPOSE are reported. No outcomes data are presented, although the methods for collecting these data are detailed. In REPOSE, onabotulinumtoxinA is administered at baseline and each follow-up visit (approximately every 3 months) during the 24-month treatment period, according to the treating physician’s best clinical judgment and standard of care, guided by the terms of the marketing authorisation described in the Summary of Product Characteristics. Outcome assessments include Migraine-Specific Quality of Life Questionnaire (MSQ), EuroQol Group Questionnaire (EQ-5D), headache-day frequency, treatment satisfaction, headache-related healthcare resource utilisation (ie, healthcare professional visits, hospital admissions, medication use), onabotulinumtoxinA utilisation (ie, dose, sites), and safety/tolerability.ResultsAs of the interim assessment date for this analysis, the study has enrolled 644 patients from 78 sites throughout Europe, and baseline data are available for 336 patients from 61 sites who participated in the study for ≥6 months. Baseline measures indicate substantial disease burden and healthcare resource utilisation.ConclusionsFinal results from the REPOSE Study will provide the largest real-world, long-term analysis of the clinical use of onabotulinumtoxinA for the treatment of CM and will add important information to existing real-world findings. Future analyses will assess the long-term safety and efficacy of onabotulinumtoxinA in this population.

The Economic Burden of Insulin-Related Hypoglycemia in Spain.

IntroductionAn analysis was conducted to estimate the economic burden of insulin-related hypoglycemia in adults in Spain, derived from a novel concept developed for the UK known as the Local Impact of Hypoglycemia Tool.MethodsCosts per severe and non-severe hypoglycemic episode were calculated for patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM). The costs per episode were applied to the population of adults with T1DM and T2DM using insulin in Spain according to the number of severe and non-severe episodes experienced per year. Costs were calculated using Spanish-specific resource costs and published values for resource utilization, including ambulance, accident and emergency (A&E) department, hospitalization, healthcare professional visits, and extra self-monitoring of blood glucose (SMBG) tests used in the week following the episode. A one-way sensitivity analysis on all model inputs was then performed.ResultsThe cost of insulin-related hypoglycemia in Spain is estimated as €662.0 m per year, €292.6 m of which is due to severe episodes and €369.4 m to non-severe episodes. The cost per episode varies from €1.25 for patients with T1DM and €1.48 for patients with T2DM for a non-severe episode where extra SMBG testing after the episode is the only action taken, to €4378.22 for T1DM and €3005.74 for T2DM for a severe episode that was treated in hospital and requires an ambulance, A&E visit, hospitalization, and a diabetes specialist visit. A reduction in severe and non-severe hypoglycemia rates of just 20% could lead to considerable cost savings of €284,925 per 100,000 general population.ConclusionThis analysis highlights the substantial economic burden of hypoglycemia in Spain, and gives budget holders the ability to assess the costs of new treatments or patient education programs in relation to the potential cost savings due to lower hypoglycemia rates.

Examining the association between pain severity and quality-of-life, work-productivity loss, and healthcare resource use among European adults diagnosed with pain

Objective: The goal of this research was to quantify the association between pain severity and several health outcomes in a large sample of patients diagnosed with some form of pain.Methods: Responses from patients who had been diagnosed with some form of pain (n = 14,459) were drawn from the 2013 EU National Health and Wellness Survey (NHWS; n = 62,000). Respondents reported their subjective pain severity in the past week on a numerical rating scale (0–10) as well as the Medical Outcomes Study Short Form (SF-36), Work Productivity and Activity Impairment Questionnaire (WPAI), and healthcare resource utilization in the past 6 months (healthcare professional (HCP) visits, emergency room (ER) visits, and hospitalizations). Associations between pain severity and health outcomes were examined via a series of regression models controlling for a set of demographic and health-related covariates.Results: After controlling for demographics and comorbidities, pain severity in the past week was shown to be significantly negatively associated with Health Utilities (b = −0.022, p < 0.001) and positively associated with overall WPAI scores (b = 0.18, p < 0.001) and healthcare resource use (Hospitalizations: b = 0.13, p < 0.001; ER Visits: b = 0.14, p < 0.001; HCP Visits: b = 0.08, p < 0.001). The nature of these relationships (linear, curvilinear, etc.) is also explored.Limitations: This study was a self-report cross-sectional study which may have biased the results and does not allow for causal inferences to be made. Finally, the regression models run were limited to available covariates and, hence, some potentially important covariates may not have been included in these models.Conclusions: The findings suggest that reducing pain severity could result in an increase in patients’ quality-of-life and work productivity, and a decrease in healthcare resource use. The equations, linking pain and outcomes, were presented in an accessible format so they could be readily applied in healthcare decision-making.

The Humanistic and Economic Burden of Narcolepsy.

To evaluate the burden of narcolepsy--with respect to psychiatric comorbidities, Health-Related Quality of Life (HRQoL), direct costs for healthcare resource utilization, and indirect costs for reported work loss-through comparison of patients to matched controls. This analysis was conducted on data from the 2011, 2012, and 2013 US National Health and Wellness Survey (NHWS; 2011 NHWS n = 75,000, 2012 NHWS n = 71,157, and 2013 NHWS n = 75,000). Patients who reported a narcolepsy diagnosis (n = 437) were matched 1:2 with controls (n = 874) on age, sex, race/ethnicity, marital status, education, household income, body mass index, smoking status, alcohol use, exercise, and physical comorbidity. Chi-square tests and one-way analyses of variance were used to assess whether the narcolepsy and control groups differed on psychiatric comorbidities, HRQoL, labor force participation, work productivity, and healthcare resource utilization. Patients with narcolepsy, in comparison to matched controls, reported substantially (two to four times) greater psychiatric comorbidity, HRQoL impairment, prevalence of long-term disability, absenteeism, and presenteeism, and greater resource use in the past 6 mo as indicated by higher mean number of hospitalizations, emergency department visits, traditional healthcare professional visits, neurologist visits, and psychiatrist visits (each p < 0.05). These population-based data suggest that a narcolepsy diagnosis is associated with substantial adverse impact on mental health, HRQoL, and key economic burdens that include work impairment, resource use, and both direct and indirect costs. Although this study is cross-sectional, the results highlight the magnitude of the potential opportunity to improve mental health, lower costs, and augment work-related productivity through effective assessment and treatment of narcolepsy.

OC-039 Oral nutritional supplements are cost effective in improving quality adjusted life years in malnourished care home residents

IntroductionMalnutrition has a detrimental effect on quality of life (QOL) but the extent to which nutrition support can improve QOL in a cost effective manner is unclear. This study aimed...

Economic burden and cost determinants of deep vein thrombosis during 2 years following diagnosis: a prospective evaluation

Few studies have evaluated the long-term economic consequences of deep vein thrombosis (DVT). None of them have incorporated prospectively collected clinical data to ensure accurate identification of incident cases of DVT and DVT-related health outcomes of interest, such as post-thrombotic syndrome (PTS). To prospectively quantify medical and non-medical resource use and costs related to DVT during 2 years following diagnosis, and to identify clinical determinants of costs. Three hundred and fifty-five consecutive patients with acute DVT were recruited at seven Canadian hospital centers. Resource use and cost information were retrieved from three sources: weekly patient-completed cost diaries, nurse-completed case report forms, and the Quebec provincial administrative healthcare database (RAMQ). The rate of DVT-related hospitalization was 3.5 per 100 patient-years (95% confidence interval [CI] 2.2-4.9). Patients reported a mean (standard deviation) of 15.0 (14.5) physician visits and 0.7 (1.2) other healthcare professional visits. The average cost of DVT was $5180 (95% CI $4344-6017) in Canadian dollars, with 51.6% of costs being attributable to non-medical resource use. Multivariate analysis identified four independent predictors of costs: concomitant pulmonary embolism (relative increase in cost [RIC] 3.16; 95% CI 2.18-4.58), unprovoked DVT (RIC 1.65; 95% CI 1.28-2.13), development of PTS during follow-up (RIC 1.35; 95% CI 1.05-1.74), and management of DVT in the inpatient setting (RIC 1.79; 95% CI 1.33-2.40). The economic burden of DVT is substantial. The use of measures to prevent the occurrence of PTS and favoring outpatient care of DVT has the potential to diminish costs.

Home blood pressure monitoring among Canadian adults with hypertension: Results from the 2009 Survey on Living with Chronic Diseases in Canada

Canadians with hypertension are recommended to use home blood pressure monitoring (HBPM) on a regular basis. To characterize the use of HBPM among Canadian adults with hypertension. Respondents to the 2009 Survey on Living with Chronic Diseases in Canada who reported diagnosis of hypertension by a health professional (n=6142) were asked about blood pressure monitoring practices, sociodemographic characteristics, management of hypertension and blood pressure control. Among Canadian adults with hypertension, 45.9% (95% CI 43.5% to 48.3%) monitor their own blood pressure at home, 29.7% (95% CI 41.1% to 46.3%) receive health professional instruction and 35.9% (95% CI 33.5% to 38.4%) share the results with their health professional. However, fewer than one in six Canadian adults diagnosed with hypertension monitor their own blood pressure at home regularly, with health professional instruction, and communicate results to a health professional. Regular HBPM was more likely among older adults (45 years of age and older); individuals who believed they had a plan for how to control their blood pressure; and those who had been shown how to perform HBPM by a health professional - with the latter factor most strongly associated with regular HBPM (prevalence rate ratio 2.8; 95% CI 2.4 to 3.4). Although many Canadians with hypertension measure their blood pressure between health care professional visits, a minority do so according to current recommendations. More effective knowledge translation strategies are required to support self-management of hypertension through home measurement of blood pressure.

The Economic Burden of Dry Eye

To develop a conceptual framework for analyzing the economic burden of dry eye and a preliminary assessment of key factors that contribute to that burden. The MEDLINE database was searched from 1966 to May 2003 combining the term "dry eye" with various economic terms. In addition, individual interviews with a panel of clinicians were conducted to provide additional insight on resource use. Direct resource utilization among dry eye sufferers includes healthcare professional visits, nonpharmacological therapies, pharmacological treatments, and surgical procedures, with the latter 2 categories being the major cost drivers. Complementary and alternative medicine (CAM) therapies are a newly recognized component of the dry eye economic burden. There is wide variation in patterns of diagnosis and treatment, but current therapies are not universally effective. Given the prevalence of the condition, indirect costs may be large. Utilization of pharmacological therapies, especially those other than tear replacements, the extent of CAM use, cost of complications of surgical procedures, and indirect costs are unknown. The natural history and probability that patients will transition between therapies, based on underlying disease severity, need to be elucidated. Dry eye is a prevalent condition with the potential for a high economic burden; additional studies are needed to further characterize the economic impact.

Trust and satisfaction with physicians, insurers, and the medical profession.

Conceptual or theoretical analysts of trust in medical settings distinguish among markedly different objects or types of trust. However, little is known about how similar or different these types of trust are in reality and the relationship of trust with satisfaction. This exploratory study conducted a comparison among trust in one's personal physician, health insurer, and in the medical profession, and examined whether the relationship between trust and satisfaction differs according to the type of trust in question. Random national telephone survey using validated multi-item measures of trust and satisfaction. A total of 1117 individuals aged 20 years and older with health insurance and reporting 2 healthcare professional visits in the past 2 years. Rank-order correlation analyses find that both physician and insurer trust are sensitive to the amount of contact the patient has had and their adequacy of choice in selecting the physician or insurer. Trust in the medical profession stands out as being uniquely related to patients' desire to seek care and their preference for how much control physicians should have in making medical decisions. Adding satisfaction to the models reduced the number of significant predictors of insurance trust disproportionately. Consistent with theory, we found both substantial similarities and notable differences in the sets of factors that predict 3 different types of trust. Trust and satisfaction are much less distinct with respect to health insurers than with respect to physicians or the medical profession.

A Randomised Controlled Trial of Medication Liaison Services—Patient Outcomes

Objectives: To evaluate the effects of a Medication Liaison Service (MLS) on quality of medication‐related information associated with hospital admission, risk of drug misadventure and other patient outcomes, and health resource utilisation.Method: Patients were randomly selected from eight acute wards (servicing 12 medical and five surgical units) and an orthopaedic pre‐admission clinic at two major hospitals. Subjects were randomly assigned to an intervention (MLS) or control group. For each patient in the MLS group a clinical pharmacist attached to the MLS contacted the general practitioner and community pharmacist in order to prepare a comprehensive medication history. Prior to discharge, the MLS clinical pharmacist, in consultation with the hospital medical staff, prepared a discharge communication which included a list of medications on admission and discharge, corresponding therapy changes, intended duration of therapy, sources of supply, allergies and adverse drug reactions, new therapeutic devices, medication‐related problems and actions required by the general practitioner. This information was forwarded to the patient's general practitioner and community pharmacist within 24 hours of discharge. Patient outcomes were evaluated 30 days after discharge using a mailed questionnaire and review of medical files.Results: Of 240 patients recruited, 113 were randomised to the MLS group and 127 to the control group. During hospital admission a significantly greater proportion of MLS subjects experienced a clinical pharmacist intervention (MLS 68% vs control 44%) and more subjects had at least one change to their therapy (MLS 97% vs control 90%), with more interventions (mean MLS 1.43 [SD 1.5] vs control 0.77 [SD 1.1]) and more medication changes per subject (mean MLS 3.75 [SD 2.6] vs control 3.10 [SD 2.3]). There was no significant effect on length of stay or mortality. In the 30 days following discharge there were fewer réadmissions per subject in the MLS group (mean 0.12 [SD 0.4] vs 0.46 [SD 1.9]) but this difference did not quite reach statistical significance (p = 0.055). The MLS group had significantly fewer healthcare professional visits per subject (mean MLS 7.54 [SD 7.4] vs control 9.94 [SD 10]). In an assessment of functional health status, MLS subjects improved for 7 of 8 factors (significantly so for two), and tended to improve more than controls in all factors except vitality.Conclusion: MLS was associated with improved patient outcomes and a greater number of inpatient clinical pharmacy interventions and medication changes intended to optimise therapy. There was also a tendency for reduced readmissions, a significant decrease in community healthcare professional visits, and significant improvements in functional health status score.

PCN7: ECONOMIC EVALUATION OF GEMZAR AND BEST SUPPORTIVE CARE (BSC) RELATIVE TO BEST SUPPORTIVE CARE ALONE IN THE TREATMENT OF NON SMALL CELL LUNG (NSCLC) CANCER IN THE UK

OBJECTIVES: Lung cancer is a leading cause of morbidity and mortality. Chemotherapy is one of the main treatment options but its availability in the UK is limited in comparison to other countries, is inconsistent across geographical regions, with many patients receiving only palliative care. The present study reports results of an economic evaluation of Gemzar (one of the newer agents available) and best supportive care (BSC) relative to BSC in the treatment of advanced NSCLC. BSC relates to all forms of care which are non-curative in intent excluding chemotherapy. METHODS: The study is undertaken from the perspective of the UK NHS. Data were extracted from a comparative trial undertaken in the UK (Anderson et al in 1997). Cost estimates are based on: chemotherapy and associated infusion, hospitalisations, health care professional visits, concomitant medications, radiotherapy and terminal palliative care. Resource utilisation data from the clinical trial were combined with unit-cost data from various UK sources. Costs are presented in 2000 price levels and the time horizon for their estimation is one year; hence discounting was unnecessary. Treatment effectiveness is measured by progression-free survival and tumour response. Extensive sensitivity analysis was also performed. RESULTS: Total treatment cost per patient in the Gemzar/BSC arm was estimated at £5,502 and at £3,861 for the BSC arm, the difference attributed mainly to the drug (Gemzar) and its administration costs. The intervention arm had lower radiotherapy/concomitant medication costs, but this did not offset the drug acquisition cost. Progression free life years and overall tumour response rates were 0.789 and 18.5% in the Gemzar/BSC arm and 0.474 and 0% in the BSC arm. The incremental cost-per-progression-free-life-year gained in Gemzar/BSC relative to BSC is £5,228 and the incremental cost-per-tumour-response £8,873. Changes in the key variables varied the above ratios between £3,000 and £23,000. CONCLUSIONS: The economic evaluation presented above shows that Gemzar/BSC is a cost-effective therapy for advanced NSCLC relative to BSC alone.

Objective assessment of spine function following industrial injury. A prospective study with comparison group and one-year follow-up.

Objective functional capacity measurement techniques were used to guide a treatment program for a group of 66 chronic back pain patients. These patients were compared with a group of 38 chronic patients who were not administered the treatment program. Outcome data were collected by telephone survey at an average 1 year follow-up. In addition, functional capacity measures were collected for treatment group patients on admission and follow-up evaluations. Results demonstrated that the functional capacity measures collected for the treatment group improved in approximately 80% of the patients. These changes were also accompanied by positive changes in psychologic measures. In addition, at 1 year follow-up, the treatment group had approximately twice the rate of patients who returned to work, relative to the comparison group. Additional surgery rates were comparable for both groups (6% in the treatment and 7% in the comparison group), but the frequency of additional health-care professional visits was substantially higher in the comparison group. The findings suggest that quantitative functional capacity measures can give objective evidence of patient physical abilities and degree of effort and can significantly guide the clinician in administering an effective treatment program.