Outpatient Hospital Research Articles

Providers Paid Substantially Less By Marketplace Nongroup Insurers Than By Employer Small-Group Plans, 2021.

Numerous studies show that employer plans pay providers significantly more than Medicare, but less is known about prices in nongroup plans sold both on and off the Marketplaces established by the Affordable Care Act (ACA), where narrow networks and low-cost insurers are more prevalent. We estimated prices for three market segments (Marketplace nongroup, off-Marketplace nongroup, and employer small group) and three types of services (professional, outpatient hospital, and inpatient hospital) relative to a Medicare benchmark. We used 2021 claims data covering virtually all enrollment in ACA risk-adjusted plans. In aggregate, in 2021, Marketplace prices were 152percent of Medicare prices, whereas the prices paid in small-group employer plans were 179percent of Medicare prices. Comparing across market segments, relative to employer small-group plans, Marketplace professional prices were 6.9percent lower, inpatient prices were 13.3percent lower, and outpatient prices were 26.3percent lower. Off-Marketplace prices fell between Marketplace and employer small-group prices. The finding that nongroup prices were significantly lower than prices paid by employer small-group plans-more so than indicated by prior research-is important for understanding federal subsidies and affordability for nongroup coverage and evaluating policies such as a nongroup public option with prices capped at a percentage of Medicare prices.

Planning hospital-focused training in internal medicine at the CHUV

Switzerland already suffers from the long-predicted shortage of physicians. Moreover, the latter often face long and meandering postgraduate training. At the beginning of their career, most doctors work on internal medicine hospital wards, even though their future may just as well lie in an outpatient or inpatient setting, in general internal medicine or in other disciplines. To help these physicians identify and clarify their hospital trajectory at an early stage, thus optimizing training pathways, the Medicine Department of the CHUV set up its Housestaff. Using a mentorship system and clearly defining a training track (outpatient practice, hospital, academic, or transition), it supports candidates, in close partnership with other departments, regional hospitals and networks, in particular ambulatory ones.

Changes in Healthcare Utilization in Japan in the Aftermath of the COVID-19 Pandemic: A Time Series Analysis of Japanese National Data Through November 2023

Introduction: The COVID-19 pandemic precipitated substantial disruptions in healthcare utilization globally. In Japan, reduced healthcare utilization during the pandemic’s early phases had been documented previously. However, few studies have investigated the impact of the pandemic’s later stages (2022–2023) on healthcare utilization rates, particularly in the Japanese context. Methods: We employed a quasi-Poisson regression model, adapted from the FluMOMO framework, to analyze temporal trends in Japanese healthcare utilization throughout the pandemic until November 2023. We estimated inpatient and outpatient volumes and hospital length of stay by bed type (general and psychiatric). Results: In general hospital beds, inpatient volumes remained significantly below pre-pandemic levels for every month until November 2023, with a reduction of 7.8 percent in 2023 compared to pre-pandemic levels. Psychiatric inpatient volumes, which had been declining before the pandemic, continued this downward trend, with the average occupancy rate decreasing by approximately 5.3% to 81.3% in 2023 compared to pre-pandemic levels. Significantly reduced outpatient volumes for both general and psychiatric care, in addition to prolonged lengths of hospital stay for psychiatric beds, were observed sporadically for several months in 2022 and 2023, persisting beyond the cessation of state of emergency and quasi-state of emergency declarations. Conclusion: The COVID-19 pandemic fundamentally altered healthcare utilization patterns in Japan. We observed a sustained reduction in general and psychiatric inpatient volumes relative to pre-pandemic baselines nationwide. The prolonged impact on healthcare utilization patterns, persisting beyond emergency measures, warrants continued monitoring of service delivery.

Opioid Use Following Spine Surgery in Ambulatory Surgical Centers Versus Hospital Outpatient Departments.

Retrospective cohort study. To assess the association between undergoing spine surgery in an ambulatory surgical center (ASC) vs a hospital outpatient department (HOPD) and (a) perioperative opioid prescription patterns and (b) prolonged opioid use. Data from the Merative MarketScan Database included patients aged 18-64 who underwent single-level or multilevel anterior cervical discectomy and fusion (ACDF) or lumbar decompression between January 2017 and June 2021. Primary outcomes included receipt of a perioperative opioid prescription, perioperative oral morphine milligram equivalents (MMEs), and prolonged opioid use (defined as opioid prescription 91-180days post-surgery). Secondary outcomes included the number of perioperative opioid prescriptions filled (single/multiple) and type of initial perioperative opioid filled (potent/weak). Analysis of prolonged opioid use was limited to opioid-naive patients. Propensity score matching (1 ASC to 3 HOPD cases) and logistic regression models were used for analysis. The study included 11,654 ACDF and 26,486 lumbar decompression patients. For ACDF, ASCs had higher odds of an initial potent opioid prescription (OR = 1.18, 95% CI 1.08-1.30, P < .001) and higher total adjusted mean MMEs (+21.14, 95% CI 3.08-39.20, P = .02). For lumbar decompression, ASCs had increased odds of an initial potent opioid (OR = 1.23, 95% CI 1.16-1.30, P < .001) but lower odds of multiple opioid prescriptions (OR = 0.90, 95% CI 0.85-0.96, P < .001). There was no significant association between the surgery setting and prolonged opioid use. Differences in perioperative opioid prescribing were observed between ASCs and HOPDs, but there was no increase in prolonged opioid use in ASCs. Further research is needed to optimize postoperative pain management in different outpatient settings.

Preliminary guidelines for the detection and management of drug-related problems in cancer patients with type 2 diabetes mellitus: a practical resource for oncology pharmacists.

The prevalence of type 2 diabetes mellitus (T2DM) in cancer patients is high. During the medication review process, clinical pharmacists could detect and manage drug-related problems (DRP) to optimize pharmacotherapy but there is a need to standardize pharmacists' interventions (PI) especially for T2DM-related DRP. The present study aims to describe DRP in cancer patients with T2DM undergoing anticancer treatment (AT) and to propose related preliminary guidelines to manage T2DM-related DRP. The study was conducted in one oncology outpatient hospital where a clinical pharmacy team performs medication reviews to detect and manage DRP by performing PI in cancer patients undergoing AT. All the data from November 23rd, 2015 to November 23rd, 2019 were extracted and demographic, clinical, oncological, and biological data were collected and analyzed. Based on these results and a literature review, a working group (2 pharmacists and one diabetologist) was constituted to propose a first set of preliminary guidelines clinical pharmacists that were then reviewed using the Delphi method by an expert panel of oncologists and pharmacists. A total of 161 T2DM cancer patients were included in the study (19.7% of all cancer patients screened). Overall, 152 DRP (mean 1.67/patient) were detected (49.3% drug interaction) and 152 PI were performed by clinical pharmacists, mainly drug monitoring (48.0) and drug discontinuation (25.7%). Specifically, there was 24 T2DM-related DRP (including 29.2% drug interactions). Twenty-four DRPs were directly related to T2DM status. The five proposed guidelines reached a consensus after revisions and a sixth has been added. DRPs were frequent among cancer patients with T2DM and we hypothesize that the preliminary guidelines should improve the detection of DRPs directly related to T2DM. The implementation of the preliminary guidelines should now be assessed in clinical practice.

Commercial insurers' market power and hospital prices in Medicaid managed care.

To examine the relationship between insurers' commercial market power and negotiated prices in Medicaid Managed Care (MMC) plans for hospital care. MMC prices from hospital-disclosed price transparency data as of July 2023 compiled by Turquoise Health, insurance enrollment information from the 2021 Clarivate InterStudy enrollment data. Log-transformed linear regression with hospital and procedure fixed effects estimating the within-hospital MMC price variation as a function of insurers' commercial market share quartile and MMC market share for 15 common outpatient hospital services. A total of 39,049 MMC price samples measured at hospital-procedure-MMC insurer level are merged with county-insurer level market share data. Around 25% of price variation in MMC plans are driven by within-hospital factors. Compared with MMC insurers from the lowest commercial market share quartile (<0.8%), those from the highest commercial market share quartile (>17%) are associated with negotiating 4.6% (95% confidence interval: [2.8%-6.4%], p < 0.001) lower MMC prices for outpatient hospital care, including 3.6% (p < 0.05) for medical/surgical procedures, 3.6% (p < 0.01) for radiology, and 6.7% (p < 0.001) for emergency department visits. MMC insurers with substantial commercial market share negotiate lower MMC prices for multiple outpatient hospital services.

A prospective cost analysis model for financial impact of Connected Care interventions on hospitals’ budget

ObjectivesTo present a prospective cost analysis (PCA) model for estimating the financial impact of Connected Care interventions in hospitals to support managerial decision-making, and describe its application to three different care pathways. MethodsInput of the developed PCA model consisted of standard of care input and intervention-specific input. The output of the model included: capacity benefits, costs, and reimbursements. The model was applied to three types of interventions in a large Dutch teaching hospital: 1) home telemonitoring for chronic patients (case (COPD), 2) remote aftercare for patients with acute illnesses (case: stroke), and 3) parenteral medication administration at home (case: prosthetic hip or knee joint infections). ResultsOutput of the PCA model showed that the cost savings can exceed the intervention costs if an intervention decreases the length of stay of patients. For COPD telemonitoring 10.1 % of the healthcare utilization should be reduced to reach break-even, and for antibiotic treatment at home break-even is reached if 4.6 % of the length of stay is reduced. The cost savings of remote aftercare for stroke patients is focused on reducing outpatient visits, and in the current Dutch reimbursement system this does not completely cover the costs. ConclusionsThe PCA model is an easy to implement and useful tool for assessing the financial impact of CC interventions from a hospital perspective. It supports decision makers to prospectively assess the cost and capacity benefits of interventions and to inform decisions on implementation. Further studies are needed to extend the model across the entire healthcare continuum. Public interest summaryWe present a prospective cost analysis (PCA) model for estimating the financial impact of Connected Care interventions in hospitals to support managerial decision-making. Connected Care interventions are based on an integrated care approach utilizing digital health technologies to enhance patient-centred, collaborative care, where patients receive care at home. Examples are telemonitoring of chronic obstructive pulmonary disease (COPD) patients, remote aftercare for stroke patients and infusion treatment at home for orthopaedic patients with an infection. These interventions have additional costs, but also save part of the costs of the conventional care, and have benefits in terms of a decrease in outpatient visits or hospitalizations. We provide a model where a hospital can calculate the impact in costs and benefits of Connected Care interventions and test this on these three examples. We show that the cost savings are able to exceed the intervention costs if an intervention has impact on the hospitalization.

Analysis of epidemiological and clinical manifestations of foodborne botulism in the Volgograd region

Aim. To analyze the situation regarding manifestations of foodborne botulism in the Volgograd region in the 2005–2023 period.Materials and methods. A retrospective analysis of 158 records of hospital patients with a diagnosis of foodborne botulism was carried out. The epidemiological data under analysis included transmission factors and outcomes. The clinical data under analysis were duration of the incubation period, severity of clinical manifestations at the time of admission and during the course of the disease, severity of changes in laboratory parameters, studies of biological material for the presence of botulinum toxin. Statistical data were processed using the MS Excel and Stastica 10.0 MS Office software packages. Results. Predominant sporadic cases of botulism were identified. The leading factors of infection transmission and the predominant type of botulinum toxin in the Volgograd region in the period from 2005 to 2023 were determined.Conclusion. Physicians and other specialists working in outpatient facilities and hospital emergency departments should maintain updated knowledge about this severe food bacterial poisoning.

A ‘Tuba Drain’ incorporated in sink drains reduces counts of antibiotic-resistant bacterial species at the plughole; A blinded, randomised trial in 36 sinks in a hospital Outpatients with a low prevalence of sink colonisation by antibiotic-resistant species

Multi-resistant Gram-negative bacteria (GNB) survive in hospital drains in traps that contain water and may ascend into the sink because of splashes, or biofilm growth. To investigate whether the 'Tuba Drain' (TD) a long, bent, continually descending copper tube between the sink outlet and the trap prevents the ascent of bacteria. After initial laboratory tests confirmed that the TD prevented bacteria in the U-bend from splashing upwards into the sink outlet, TDs were assessed in a randomised, blinded trial in a hospital out-patients built in 2019. Sinks were paired into those with a similar clinical exposure and each member of each pair was randomised to receive either new, standard plumbing up to and including the trap (18 sinks) or the same new standard plumbing but including the TD inserted between the sink outlet and trap. Bacterial counts in swabs from the sink outlets were determined blindly before and monthly after the plumbing change for a year. GNBs that are associated with clinical infection and carriage of resistance genes, Pseudomonas aeruginosa, Acinetobacter baumanii, Stenotrophomonas maltophilia and all Enterobacteriales spp were the organisms of primary interest and termed target bacteria. The TDs fitted into the required spaces and functioned without problems. The geometric means (over months) of the counts of target bacteria in TD-plumbed sinks was lower than those in their paired controls p= 0.012 (sign test 2 tailed). Prevalence of target bacteria in sinks was low. TDs were effective for reducing target bacteria in sinks.

З когорти «святих лікарів»: Володимир Павлович Бобін

The article highlights the life path of Volodymyr Pavlovich Bobin (1858-1925), one of the leading doctors of Kharkiv at the end of the 19th and the first quarter of the 20th centuries. Various aspects of his ascetic activity are analyzed including his role as medic-manager of the outpatient clinic and hospital of the Kharkiv Medical Society, a doctor of the Kharkiv Third Men's Gymnasium, speaker of the City Duma, etc. The provided testimonies of the contemporaries of «holy doctor» are revealing his influence on colleagues. The innovations of V.P. Bobin in the field of medical care for schoolchildren is also vastly explored as well as the overall significance of Volodymyr Bobin for the history of medicine in Ukraine, as well as the history of Kharkiv. The work is accompanied by the publication of rare photographs and documents.

Intrapartum antibiotic exposure and infectious diseases in childhood – a population-based cohort study

Intrapartum antibiotics are used to prevent group B streptococcus disease in newborn infants. We hypothesised that intrapartum antibiotic exposure is associated with the occurrence of childhood infectious diseases because it influences the development of the gut microbiome. The cohort for this population-based study comprised vaginally delivered children born in Northern Finland in 2007-2018. We used structured electronic medical records linked to comprehensive national registers. Primary outcome was the number of infectious disease episodes leading to an emergency room visit, outpatient hospital visit, or hospitalisation from birth until five years of age. Analyses were performed on 9733 children (48.8% girls) exposed to intrapartum antibiotics and on 35,842 unexposed children (49.9% girls). Exposure to intrapartum antibiotics was associated with increased risk of any infectious disease episode at the ages 7-28 days (adjusted incidence rate ratio [aIRR] 1.30, 95% CI 1.10-1.54) and 1-2 years (aIRR 1.10, 95% CI 1.02-1.18). The occurrence of urinary tract infections was associated with the exposure to intrapartum antibiotics whereas the occurrence of severe infections caused by pathogens susceptible to penicillin was reversely associated with the exposure to intrapartum antibiotics. Maternal intrapartum antibiotics were associated with the occurrence of infectious diseases in the offspring. The observed associations appeared to depend on bacterial pathogens and their antimicrobial susceptibility to penicillin. Pediatric Research Foundation, Alma och K.A. Snellman Foundation, Orion Research Foundation, Päivikki and Sakari Sohlberg Foundation, Finnish Medical Foundation, Academy of Finland, Finland.

Eliciting patient preferences and predicting behaviour using Inverse Reinforcement Learning for telehealth use in outpatient clinics.

Non-attendance (NA) causes additional burden on the outpatient services due to clinician time and other resources being wasted, and it lengthens wait lists for patients. Telehealth, the delivery of health services remotely using digital technologies, is one promising approach to accommodate patient needs while offering more flexibility in outpatient services. However, there is limited evidence about whether offering telehealth consults as an option can change NA rates, or about the preferences of hospital outpatients for telehealth compared to in-person consults. We model patient preferences with a Maximum Entropy Inverse Reinforcement Learning (IRL) behaviour model, allowing for the calculation of general population- and demographic-specific relative preferences for consult modality. The aim of this research is to use real-world data to model patient preferences for consult modality using Maximum Entropy IRL behaviour model. Retrospective data were collected from an immunology outpatient clinic associated with a large metropolitan hospital in Brisbane, Australia. We used IRL with the Maximum Entropy behaviour model to learn outpatient preferences for appointment modality (telehealth or in-person) and to derive demographic predictors of attendance or NA. IRL models patients as decision making agents interacting sequentially over multiple time-steps, allowing for present actions to impact future outcomes, unlike previous models applied in this domain. We found statistically significant (α = 0.05) within-group preferences for telehealth consult modality in privately paying patients, patients who both identify as First Nations individuals and those who do not, patients aged 50-60, who did not require an interpreter, for the general population, and for the female population. We also found significant within-group preferences for in-person consult modality for patients who require an interpreter and for patients younger than 30. Using the Maximum Entropy IRL sequential behaviour model, our results agree with previous evidence that non-attendance can be reduced when telehealth is offered in outpatient clinics. Our results complement previous studies using non-sequential modelling methodologies. Our preference and NA prediction results may be useful to outpatient clinic administrators to tailor services to specific patient groups, such as scheduling text message consult reminders if a given patient is predicted to be more likely to NA.

Valuation of prescription patterns of &lt;i&gt;Helicobacter pylori&lt;/i&gt; drugs in outpatient department, Meru Teaching and Referral Hospital

BACKGROUND Helicobacter pylori infects up to half of the world’s population. Infection with Helicobacter pylori is a major contributing factor for gastric ulcers, gastric carcinoma, and extra gastric disease. The main aim of this study was to observe the prescription patterns of Helicobacter pylori drugs at Meru Teaching and Referral Hospital, Meru. This infection is mostly treated by a triple-drug regimen for successful eradication. The available regimens are a combination of proton pump inhibitors, antibiotics, bismuth sulfate, and histamine blockers. METHODOLOGY A cross-sectional retrospective review of the patient files for Helicobacter pylori was done at Meru Teaching and Referral Hospital (MeTRH). Systematic random sampling was used to select 262 medical records for review. Data was collected using the pre-tested abstraction forms and was coded and analyzed for descriptive statistics. RESULTS Out of the 262 medical records that were reviewed, 147 (56.4%) were males prescribed the Helicobacter pylori drug regimen. Among all the young adults (age: 12-39 years) were more likely to get Helicobacter pylori infection. The medication regimens that were highly preferred at MeTRH were 14-day and 7-day clarithromycin triple-based therapy. The 14-day triple therapy accounted for 74.5% of all patient files. The most administered drug class for Helicobacter pylori were proton pump inhibitors at 45.3% followed by antibiotics at 38.8% and the least prescribed drugs were the H2 blockers with 15.9%. CONCLUSION Regarding the most prescribed drug, the proton pump inhibitors while the most preferred regimen was the 14-day clarithromycin triple-based therapy. This data will certainly be important for the pharmaceutical management chain to manage the stock of analyzed drugs and also can spread awareness regards the appropriate handling of drugs which can improve adherence and reduce the rate of treatment failure and the emergence of antibiotic drug resistance.

Anxiety or depression in heart failure across the ejection fraction spectrum

Abstract Background Anxiety or depression are commonly described in patients with heart failure (HF) but few data exist on characteristics and clinical outcomes associated with anxiety or depression across the different HF phenotypes. Purpose To assess the prevalence of patient characteristics and clinical outcomes associated with anxiety or depression in patients with HF with preserved, mildly reduced and reduced ejection fraction (HFpEF, HFmrEF, and HFrEF). Methods Patients enrolled in the Swedish Heart Failure Registry between 2000-2021 were included. Self-reported anxiety or depression was collected using EuroQoL 5-dimensional questionnaire (EQ-5D) at baseline and follow-up visits. Anxiety or depression was categorized as "not anxious or depressed", "moderately anxious or depressed" or "severe anxious or depressed". The independent associations between baseline characteristics and presence of anxiety or depression were assessed by a multivariable multinominal regression analysis. Cox proportional hazards regressions were performed to model the time to first event according to levels of anxiety or depression. Outcomes included all-cause death and all-cause hospitalizations. Results A total of 45,247 patients were included among whom 58% reported none, 38% moderate and 5% severe anxious or depressed with similar distribution across the HF phenotypes (Figure). Several characteristics were associated with anxiety or depression with the strongest ones for severe versus none being higher NYHA class (OR 3.10 (2.77-3.47)), liver disease (OR 1.99 (1.56-2.55)), in-patient setting (OR 1.62 (1.43-1.84)), smoking (OR 1.75 (1.52-2.00)) while others were inversely related including male sex (OR 0.51 (0.46-0.56)), higher age (OR 0.60 (0.53-0.67)), referral to HF nurse clinic (OR 0.82 (0.72-0.94)) and higher income level (OR 0.68 (0.62-0.76)). The risk of all-cause death and all-cause hospitalizations increased with increasing levels of anxiety or depression across all HF phenotypes during 12 months of follow up. Severe anxiety or depression had a stronger association with all-cause death in hospitalized patients and all-cause hospitalizations in out-patients. Conclusion In this large contemporary cohort of patients with HF in a real-world setting, anxiety or depression was frequently and similarly distributed across all HF phenotypes. Higher NYHA class, liver disease and in-patient setting were strongly associated with the anxiety or depression while male sex, higher age, and higher income were inversely related with anxiety or depression. Anxiety or depression was significantly associated with worse outcomes at 12 months follow up.Proportion anxiety or depression

Parental leave benefit levels and postpartum maternal mental health: a Swedish cohort study

Abstract Background While generous parental leave benefits are protective for postpartum maternal mental health, not all mothers qualify for these benefits due to strong work requirements. Sweden offers paid parental leave to all residents, but the benefit level depends on their salary and labour market attachment. Objectives To evaluate the association between parental leave benefit levels and maternal mental health in the postpartum period. Methods Using total population register data, we studied 210 800 first-time mothers, aged 18-52 years, who gave birth to a live singleton offspring in Sweden between January 1, 2007 and December 31, 2011. We performed multivariable logistic regression to compare odds of mental health outcomes from different levels of severity (prescribed anti-depressants or anxiolytics, specialist outpatient care and hospitalisation) between mothers receiving higher-level benefits (i.e., qualified for earnings-related benefits) and those with basic benefits (i.e., a low flat-rate level). We also performed decomposition analyses using the Karlson-Holm-Breen method, and subgroup analyses by region of birth. Results Mothers receiving basic benefits had increased odds of prescribed antidepressants or anxiolytics (OR 1.44 95% CI 1.37-1.51), specialist outpatient care (OR 2.27 95% CI 2.13-2.44), and hospitalisations (OR 2.47 95% CI 2.97) compared with mothers receiving higher-level benefits. Increased odds remained after adjustment for pre-existing mental health. After further adjustment for income and employment status, the odds remained elevated for specialist outpatient care (OR 1.13, 95%CI 1.02-1.24) and hospitalisation (OR 1.34, 95%CI 1.03-1.76). Conclusions Mothers with basic benefits are more likely to experience moderate-to-severe mental disorders compared to mothers with higher-level benefits, independent of pre-existing mental health, income and employment status. Key messages • Labour market attachment prior to childbirth affects parental leave benefit levels and plays an important role in determining mental health outcomes in the postpartum period. • The work requirements for more generous parental leave benefits may prevent mothers from benefiting from the protective mental health advantages of parental leave.

Healthcare resource utilisation and cost of care of systemic inflammation in individuals with atherosclerotic cardiovascular disease and chronic kidney disease

Abstract Background Atherosclerotic cardiovascular disease (ASCVD) is a chronic disease, progressed by localised or systemic inflammation (SI). Chronic kidney disease (CKD) facilitates the presence of SI and is associated with an increased risk of ASCVD. Previous studies have estimated that 1–2% of the population in Western countries suffer from both conditions. Purpose To investigates the healthcare costs and resource utilisation for individuals diagnosed with ASCVD and CKD, with or without SI. Method The study applied data from the Danish national health and administrative registries from 1994-2022. Patients with ASCVD were identified by ICD-10 codes. CKD was identified by eGFR [15-59mL/min/1.73m2], in the Register of Laboratory Results for Research (RLRR). The latter date of diagnosis of the two diseases were used as index date. CRP-test results were extracted from RLRR. Individuals with conditions associated with CRP-levels and tests observed in association with CVD events or antibiotic/antiviral drug use were excluded. Individuals with at least two valid CRP tests were included. If two CRP-test results ≥2mg/L to &amp;lt;20mg/L were observed less than six month apart, and within two years of index, the individuals were classified to have SI. Individuals diagnosed in the first year of available eGFR were excluded to ensure only incident individuals in the study. Outcomes included costs and use of inpatient (duration ≥12h) and outpatient (&amp;lt;12h) hospital care, cost of primary care and prescription drugs (adjusted to 2022 currency). Results were derived using linear regression models. Results A total of 19,162 individuals’ incident between 2012-2022 were identified – 68% had SI. SI individuals had higher healthcare costs from five years before to three years after index. Individuals generated a total healthcare cost of EUR 69,554 (SI) and EUR 39,540 (no SI) in the study period (difference EUR 30,014, p&amp;lt;0.001). In adjusted analysis, the attributable cost in the three years following index was 1.4 times higher for individuals with SI, compared to individuals with no SI (difference EUR 12,922, p&amp;lt;0.001). Inpatient care accounted for 85% of the cost. SI individuals had significantly more inpatient hospital contacts from four years before to five years after index (7 attributable contacts total, 4.7 attributable contacts after index, 1.2 times more, p&amp;lt;0.001), and more outpatient contacts from five years before to three years after index (6.2 attributable contacts total, 2.3 attributable contacts after index, 1.3 times more, p&amp;lt;0.001). The largest difference was found in the year following index, where the difference was EUR 7,666 (1.5 times higher, p&amp;lt;0.001) cost, 1.5 (1.3 times higher, p&amp;lt;0.001) inpatient hospital contacts, and 1.1 (1.3 times higher, p&amp;lt;0.001) outpatient hospital contacts (adjusted estimates). Conclusion Individuals with SI represent a significant burden to the healthcare system, both in terms of healthcare cost and healthcare resource utilisation.Total healthcare costsAttributable hospital contacts

Guideline-directed medical therapy patterns in heart failure with reduced ejection fraction: the OPTIMA-HF registry

Abstract Background/Introduction European guidelines strongly recommend an optimized pharmacological treatment in patients with heart failure with reduced ejection fraction (HFrEF) with a fast introduction of the four-pillars. Purpose Aim of the Optimization of Therapy in the Italian Management of Heart Failure [OpTIMa-HF] Registry was to collect data on HF patients to describe the current Italian population of HF patients with a specific focus on HFrEF treatment adherence and prescription rates, according to the most recent European Guidelines. Methods OPTIMA-HF is an observational, cross-sectional, multicenter, real-life study conducted in two different clinical settings: HF outpatients’ clinics of Italian University Hospitals and territorial Italian Cardiology outpatients’ services, that enrolled patients with chronic HFrEF receiving at least 1 oral medication for management of HF. Patients were characterized by baseline use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, mineralocorticoid receptor antagonist (MRA) and sodium glucose co-transporter II inhibitor (SGLT2i). Patient-level factors associated with medication use were examined. Results Overall, 1390 patients from 29 ambulatory cardiology practices and university hospitals were included. Mean age was 69.5 ± 11.9 years, 24% were female, and median EF was 33 (28-37). Among enrolled patients, 72.2% were prescribed ARNI, 17.1% ACEI/ARB, 95% beta-blocker, 75.5% MRA and 63% SGLT2i therapy (Figure 1). Despite high prescription rates for each single class, a still not sufficient number of patients was on treatment with all four pillars, in particular 40.4% considering the presence ARNI and 6.2%. When medications were prescribed, few patients were receiving target doses of ACEI/ARB (31.7%), ARNI (16%), and beta-blocker (33.3%), whereas a higher proportion were receiving target doses of MRA therapy (38%), and all were receiving target dose for SGLT2i. Among patients eligible for all classes of medication, only 1.1% were simultaneously receiving target doses of ACE/ARB/ARNI, beta-blocker, MRA and SGLT2i. Prescription rates did not significantly differ between the type of center (University Hospital vs. territorial Cardiology outpatients’ services). As regards patients not on treatment with any of the four pillars, a small but still present amount of patients had no contraindications to these drugs (Figure 1). Conclusions In this contemporary outpatient HFrEF Italian registry, significant high prescription rates of the four-pillars were observed, however therapy combination rate is still not sufficient and drugs' titration need to be implemented to receive the greatest benefits from an optimized treatment. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy.

Pattern of Musculoskeletal Manifestation in Patient with Diabetes Mellitus

Background: Diabetic mellitus (DM) both type 1 and type 2 increasing dramatically throughout worldwide. DM involved all the vital organs including musculoskeletal system. Objective: The purpose of study was to find out patterns of musculoskeletal manifestation (MSM) in diabetic patients &amp; to find out a strategy to improve the outcome of the MS complications in patients with Diabetes Mellitus. Material and Methods: This was hospital based observational study conducted on 143 diabetics patients with musculoskeletal manifestations, both men and women (aged e”15- 70 years) visited in outpatient department and hospital admitted patient in a tertiary care of teaching hospital. Patterns were defined by a meticulous history, relevant general and systemic examination &amp; with the aid of musculoskeletal (MS) Function Assessment semi structured Questionnaire. Results: MSM are common among patients with type 2 diabetes Out of 143 patients in our study 103(72.03%) were Male and 40(27.97%) were female, and male –female ratio 2.57:1. The age distribution of study patients was 15 to 70 years. Overall, 72.03.% of patients were among the 40-59 years old and about 20.28% were 60 years and mean age of the patients was 55±5. Above which is statistically significant (P= 0.048). The shoulder involvement as adhesive capsulitis (frozen shoulder) was found among 69(48.25%) on the diabetic cohort and statistically significant (P= &lt;.05) and mostly among the housewife (27.99%) and manual worker like cultivator (13.99%). Degenerative osteoarthritis was commonly associated with MSM with DM than inflammatory arthritis. Conclusion: In our study shows degenerative, non-inflammatory MSM are common among the diabetic patients that leads to significant pain and disability that directly related with poor glycemic control and co-morbidities like stroke and obesity. Early recognition of these complications, and multidisciplinary management between diabetes and rheumatology specialists is necessary to reduce morbidity. EWMCJ Vol. 12, No. 1&amp;2, January-July 2024: 66-69

Assessing the impact of implantable loop recorder placement on anxiety level

Abstract Background Anxiety is a prolonged state of apprehension or worry that can be an independent predictor of cardiovascular events, associated with a 48% increased risk of cardiac death. About one-third of patients with arrhythmias present with high anxiety levels, and subsequently worse quality of life. In our experience of patient care, many patients feel anxious about the possibility of an arrhythmia that could lead to their demise, especially if their symptoms are undiagnosed. Purpose Our project aims to explore the change in patients’ anxiety levels following implantable loop recorder (ILR) placement. Methods This is a survey-based observational study that was performed in an outpatient clinic and hospital using validated General Anxiety Disorder-7 (GAD-7) questionnaires. Individuals who met indications to undergo ILR implantation including palpitations, syncope, subclinical atrial fibrillation, and cryptogenic stroke underwent baseline assessment of anxiety prior to implantation. Individuals had repeat assessments at 6 weeks and 12 weeks post-implantation to evaluate the effect of ILR placement. Results Our study included 50 individuals. Out of the initial subjects, 10/25 females and 11/25 males were lost to follow-up. The average initial GAD-7 score was 3.3 (Range 0, 15), average 6-week score was 1.6 (Range 0, 14), and average 12-week score was 0.9 (Range 0, 10). Total decrease in GAD-7 score after 6 weeks of having ILR was 50%. Total decrease in GAD-7 score after 12 weeks of ILR was statistically significant at 73% (P=0.03). Females showed greater improvement of GAD-7 scores in comparison to males at 6 weeks (67% vs 36%) and 12 weeks (81% vs 66%). Conclusion Studies have suggested an overall decreased level of anxiety in patients receiving implantable devices that have the potential to treat arrhythmias such as implantable cardiac defibrillators and pacemakers. Our results suggest that the benefit may extend to implantable devices that seek to provide further diagnostic information and aid in the prognostication of disease burden. As seen in our study population, GAD-7 scores showed dramatic improvement with greater percentage in female than male population. After the placement of loop recorders, many patients experience a sense of security with having a device that monitors them. Our study is the first to address the association between ILR and anxiety. Future studies evaluating this association would help increase the power of the study.Figure 1:Bar graph of GAD-7 Scores

Workplace health promotion measures and use of medical services in the German Federal Armed Forces

Abstract Introduction Workplace health promotion measures (WHPM) are among recommended options for maintaining employees health, important for the German Federal Armed Forces as an employer. In order to detect associations between WHPM and health care utilization, we recorded the number of outpatient visits and hospital stays, differentiated according to gender, military or civilian activity. Methods Prospective longitudinal observational substudy with cross sectional analysis of items regarding use of medical services at T0 (6-9/2022). Analysis for T1 (2023) and T2 (2024) follow. Data were obtained with a web-based employee survey to record self-reported endpoints. A total of about 224.000 employees by the German Armed Forces were addressed. Results Survey participation rate was 10.5% (n = 23.568) of all employees in T0, 29.1% were women and 0.3% reported being diverse, 43.2% of the participants were &amp;lt;40 years of age. Independently of taking part in WHPM, we did not detect differences in the proportion of male soldiers receiving treatment in hospitals of the German Federal Armed Forces. Among female soldiers without WHPM, 37.5% stayed in hospitals and with WHPM 30.5%. Higher % of women (84%) than men (78%) presented to the military - or family physician (w: 81%, m: 73%), independent of participation in WHPM and assignment for civil or military. In last 4 weeks, more women (81.3%) than men (65.6%) were prescribed medication. Female employees in civilian w.p.(84.8%) took more medications than those in military w.p (77.7%). Oral contraception was used by 20% of women in both civilian and military w.p. Conclusions There are no gender differences nor difference for civilian or military employees concerning the number of days staying in hospital. More women than men recieved regular outpatient medical care and more women than men take medication regularly. *Ludwig S and Roy R share last authorship Key messages • There are no gender differences nor difference for civilian or military employees concerning the number of days staying in hospital. • More women than men recieved regular outpatient medical care and more women than men take medication regularly.