Number Of Physician Consultations Research Articles

Health economic perspective on a community-based intervention for older people at risk of care dependency - results of a prospective quasi-experimental study.

This prospective, quasi-experimental study aims to compare healthcare resource utilization (HCRU) and costs of a multi-component care approach for older people in a community setting (intervention group (IG)) with usual care in a matched control group (CG) during a 21-month observation period. The reablement-oriented intervention included a geriatric assessment, a case and network management and digital supporting tools. Regression models were applied to determine intervention effects regarding hospitalization, total hospital length of stay (LOS), number of physician consultations, and healthcare costs using claims data. 872 subjects were included in the IG and 1,768 in the CG. The analyses showed that the intervention did not affect hospitalization (OR = 1.153; 95% CI: 0.971-1.369, p = .105). However, participating in the IG lead to a small but significant increase of physician contacts by a factor of 1.078 (Exp(ß) = 1.078; 95% CI: 1.011-1.149; p = .022). A non-significant mean difference in costs of €1,183 (95% CI: €-261.6 to €2,627.6, p = .108) per participant was identified. Further research is needed to generate robust evidence on the optimal design of care approaches for older people and the health economic implications of such interventions to improve care and resource allocation decision-making. Trial registration: The study was registered at the German Clinical Trials Register (DRKS00027866).

Development and implementation of a cardiac resynchronisation therapy care pathway: improved process and reduced resource use

BackgroundCardiac resynchronisation therapy (CRT) requires intensive, complex and multidisciplinary care to maximize the clinical benefit. In current practice this is typically a task for highly specialised physicians. We report on...

Utilization of diabetes management health care services and its association with glycemic control among patients participating in a peer educator-based program in Cambodia.

Substantial evidence supports the effectiveness of peer educator programs for diabetes management in low- and middle-income countries. However, little is known about peer educators' impact relative to other treatment components such as medication and physician consultation. In Cambodia, the non-governmental organization MoPoTsyo organizes four services for people with diabetes: self-management training through peer educator visits, lab tests, physician consultations, and low-cost medicines. Our aims were to 1) quantify MoPoTsyo participant utilization of each program service and 2) define the relationship between each program service and glycemic control. We conducted a retrospective cohort study among 4,210 MoPoTsyo participants, using data collected by MoPoTsyo from 2006-2016. Independent variables assessed were medication adherence, number of peer educator visits, number of physician consultations, and number of lab tests. A multiple logistic regression model was used to evaluate the association between these disease management services and glycemic control-fasting plasma glucose ≤130 mg/dl or post-prandial glucose ≤180 mg/dl-based on most recent glucose level. The model was adjusted for baseline demographic and disease characteristics. Participants with 12 or more peer educator visits per year had a 35% higher odds of glycemic control relative to participants with 4 or fewer visits (odds ratio 1.35, 95% CI: 1.08-1.69; p = 0.009), after adjustment for utilization of other treatment components (medication adherence, number of physician visits, number of lab tests), follow-up time, and demographic and disease characteristics. Better adherence to medications and a greater number of lab tests per year were also associated with a higher odds of glycemic control after adjustment. Number of physician consultations was not associated with glycemic control after adjustment. This study demonstrates a positive association between peer educator utilization and glycemic control incremental to other elements of diabetes management. These results suggest that peer educators may be a valuable addition to comprehensive diabetes management programs in low- and middle-income countries even when other health care services are accessible. The associations identified in this research warrant further prospective studies to explore the causal impact of peer educators on glycemic control relative to other disease management components.

Patient Preferences for Anti-Vascular Endothelial Growth Factor Treatment for Wet Age-Related Macular Degeneration in Japan: A Discrete Choice Experiment.

BackgroundIn Japan, intravitreal anti-vascular endothelial growth factor (anti-VEGF) dosing regimens for wet age-related macular degeneration (wAMD) include pro re nata, every 2 months, and treat-and-extend, resulting in different outcomes and patient burden. Although reflecting patient preferences in treatment decision-making is desirable, few studies have examined this in Japan. This study assessed the patients willingness to trade-off between different dosing regimens.Patients and MethodsPatients with wAMD were recruited from four Japanese university hospitals to complete a face-to-face cross-sectional survey. In a discrete choice experiment, patients were asked to choose their preferred option from two anti-VEGF treatment profiles shown side-by-side across a series of choice tasks. The profiles varied on four attributes: number of injections in 12 months, number of physician consultations in 12 months, chance of 1-year visual acuity (VA) improvement, and chance of 2-year VA maintenance. Preference weights were estimated using hierarchical Bayes' models.ResultsOverall, 120 patients (30 treatment naïve and 90 anti-VEGF experienced) completed the survey. Patients were willing to accept an increase from three to approximately eight injections in 12 months to increase the chance of 1-year VA improvement from 25% to 40%. They would be willing to accept 11 injections in 12 months if the chance of 2-year VA maintenance increased from 80% to 96%. The most valued attributes were increasing the chance of 2-year VA maintenance and reducing the number of injections in 12 months, which were each about twice as important as decreasing physician consultations in 12 months and increasing the chance of 1-year VA improvement (p<0.001). Among the dosing regimens, patients most preferred treat-and-extend because of its higher chance of 2-year VA maintenance.ConclusionInforming patients with wAMD about the likelihood of long-term VA maintenance when selecting treatment may increase the acceptance of an optimal treatment regimen and number of injections.

P770 Ascertainment of pediatric inflammatory bowel disease cases from administrative health data in Québec, Canada

Abstract Background Administrative databases are useful for estimating population-level disease occurrence. Our objective was to ascertain cases of pediatric inflammatory bowel disease (IBD) by applying two validated algorithms to administrative health data, evaluate agreement, and compare health services utilisation between concordant and discordant cases. Methods The Quebec Birth Cohort on Immunity Health was established through linkage of administrative databases and includes 400 611 persons born in the province of Québec (Canada) from 1970 to 1974. Physician consultations (PC) and hospitalisations (H) for IBD were documented in health databases until 2014. Two validated algorithms were used to identify pediatric IBD cases. Firstly, a single-step algorithm was applied [5PC or 2H within 4 years]. Secondly, a two-step algorithm was implemented, first considering whether the person had undergone sigmoidoscopy/colonoscopy before age 18 [yes: 4PC or 2H within 3 years; no: 7PC or 3H within 3 years]. We evaluated the agreement between both algorithms using the Kappa statistic, and compared health services utilisation among concordant and discordant cases using a t-test. Results The single-step algorithm generated 527 pediatric IBD cases (0.13%), whereas 480 (0.12%) were identified with the multi-step algorithm. Among the 534 cases identified by either algorithm, 473 (88.6%) were identified by both, 54 (10.1%) only by the single-step, and 7 (1.3%) only by the multi-step algorithm. Kappa was 0.94 (95% confidence interval: 0.92, 0.95), and the proportions of positive and negative agreement were respectively 0.94 and 1.00. The average number of PC and H before age 18 years among concordant and discordant cases was respectively 26.0 and 3.9 (p &amp;lt; 0.0001). Conclusion The prevalence of pediatric IBD was similar when applying two different case identification algorithms, few cases were discordant. In the near future, a survey conducted in a subset of the cohort will allow us to compare self-report with ascertainment from administrative databases.

Reducing complications and overall healthcare costs of hip fracture management: a retrospective study on the application of a Diagnostic Therapeutic Pathway in the Cosenza General Hospital.

Diagnostic Therapeutic Pathways (DTPs) are multidisciplinary plans designed by each healthcare organization for a specific category of patients to reduce the variability of professional behaviors and to ensure greater safety and better overall healthcare outcomes. Hip fractures are a frequent traumatic injury, particularly in the elderly, and DTPs recommend early surgical intervention, often not done due to organizational challenges and bureaucracy. Medical conditions suggesting a delay are not frequent, however long waiting times not only increase the risk of complications and mortality, but also increase the number of diagnostic test and physician consultations. This study tried to understand the benefits of performing surgical intervention within 48 hours in terms of cost savings, reduction of complications and better overall outcomes. We performed statistical analyses on data gathered from 130 patients submitted to DTPs, and we evaluated the benefits obtained by operating within 48 hours in terms of resource saving (number of physician consultations, hospitalization days, etc.), reduction in complications reported in the literature. About 40% of clinical records of femoral fractures from 2015 at the Cosenza General Hospital were used in our statistical analysis taking into account independent variables such as age, sex,surgery waiting times and ASA (e.g. American Society of Anesthesiologists) score. Additionally, dependent variables such as: the type of complications during the hospital stay (e.g. infections, delirium, etc), days of hospitalization, and number of physician consultations were considered. The average waiting time for surgical intervention was 5.48 days (132 hr). Patients with ASA score of 4 had a greater chance of complications (p-value 0.03), whereas patients operated within 48 hours avoided complications, and spent fewer days in the hospital. The ASA score value correlated positively with the number of physician consultation, as the ASA score increased in number, so did the number of physician consultations. Moreover, each additional day of waiting increased the possibility of physician consultation by approximately 13. The lack of available hospital beds and staff shortages are the main reasons for the delay in performing surgery, this situation does not allow an efficient treatment and timely release of patients from the healthcare system. Therefore, there is an important need to implement standardized orthopedic and geriatric pathways (DTPs), inspired by the collaboration between healthcare system management, orthopedic and geriatric specialists, and physical therapists, to drive shorter days of hospitalization and better overall patient health outcome by performing surgery as soon as possible.

The Economic Impact of Hospitalization for Diabetic Foot Infections in a Caribbean Nation

Foot infection is the most common complication of diabetes mellitus in the Caribbean. Diabetic foot infections place a heavy burden on health care resources in the Caribbean. To evaluate the treatment-related costs for diabetic foot infections in a Caribbean nation. We identified all patients with diabetic foot infections in a 730-bed hospital serving a catchment population of approximately 400,000 persons from June 1, 2011 through July 31, 2012. The following data were collected: details of infection, antibiotic usage, investigations performed, number of physician consultations, details of operative treatment, and duration of hospitalization. Total charges were tallied to determine the final cost for inhospital treatment of diabetic foot infections. There were 446 patients hospitalized with diabetic foot infections, yielding approximately 0.75% annual risk for patients with diabetes to develop foot infections. The mean duration of hospitalization was 22.5 days. Sixteen patients (3.6%) were treated conservatively without an operative procedure and 430 (96.4%) required some form of operative intervention. There were 885 debridements, 193 minor amputations and 60 major amputations, 7102 wound dressings, 2763 wound cultures, and 27,015 glucometer measurements. When the hospital charges were tallied, a total of US $13,922,178 (mean, US $31,216) were spent to treat diabetic foot infections in these 446 patients during 1 year at this hospital. Each year, the government of Trinidad and Tobago spends US $85 million, or 0.4% of their gross domestic product, solely to treat patients hospitalized for diabetic foot infections. With this level of national expenditure and the anticipated increase in the prevalence of diabetes, it is necessary to revive the call for investment in preventive public health strategies.

Facts, Facts, Facts: What Is a Physician to Do?

IT IS A CLICHE TO OBSERVE THAT EVERYONE LIVES IN A GLOBAL economy. Anyone who travels internationally can see how rapidly the world is becoming similar in terms of shops, goods, and services. Perhaps it is timely to reengage physicians in thediscussion of international comparativedata about health care and to ask why the United States is so provincial in designing the systems by which care is delivered. Recently the Organisation for Economic Co-operation and Development (OECD) published Health at a Glance 2009, the annual compilation of health statistics from 30 countries. Even though most of the data are from 2007, these statistics provide revealing snapshots of various aspects of health and health systems, especially when comparing several US statistics to comparable statistics from other countries. Seventeen comparisons were selected to be representative of the different concepts (health status, nonmedical determinants of health, health work force, health care activities, quality of care, and health expenditures) that are covered in the OECD report. The comparisons (reported as United States; another country) are as follows. 1. Life expectancy in the United States is 78.1 years; in Switzerland, it is 81.9 years. 2. Years of life lost before age 70 per 100 000 men is 6291; in Italy, it is 3605. 3. The age-standardized ischemic heart mortality rate per 100 000 males is 145; in France, it is 54. 4. The percentage of newborns weighing less than 2500 g is 8.3%; in Ireland, it is 5%. 5. The percentage of children aged 11 to 15 years who are overweight or obese is 29.8%; in Belgium, it is 10.5%. 6. The number of practicing physicians per 1000 population is 2.4; in Belgium, it is 4.0. 7. The percentage of US physicians who are non-US trained is 25.9%; in the Netherlands, the percentage of non-Netherlands−trained physicians is 6.3%. 8. The ratio of the self-employed specialist’s average salary to the average salary of a full-time employee is 5.6:1; in Germany, the ratio is 4.1:1. For a selfemployed general practitioner, the comparable ratio is 3.7:1; in Canada, it is 3.1:1. 9. The number of physician consultations per capita is 3.8; in Germany, it is 7.5, and in Japan, it is 13.6. 10. The number of consultations per physician per year (data are from administrative sources and include visits in physician offices, hospital outpatient clinics, or patient homes) is 1570; in Korea, it is 7251 and in Canada, it is 3335 (fee-for-service visits only). 11. The number of magnetic resonance imaging (MRI) machines per 1 000 000 of population is 25.9; in Japan, it is 40.1; in Canada, it is 6.7. 12. The number of MRI examinations per 1000 population is 91.2; in Canada, the number is 31.2. 13. The hospital discharge rate is 126 per 1000; in France, it is 274. 14. The coronary revascularization rate is 521 per 100 000; in Switzerland, it is 144 and in Ireland, it is 128. 15. The number of patients treated for end-stage renal failureis169per100 000population; intheNetherlands, it is 77. 16. The age-sex standardized in-hospital death rate for acute myocardial infarction is 5.1%; in Sweden, it is 2.9%. 17. Health expenditures are 16.0% of gross domestic product; in France, 11% and in Ireland, 7.6%.

Impact of Fatty Liver Disease on Health Care Utilization and Costs in a General Population: A 5-Year Observation

Fatty liver disease is a common condition in the Western world. Fatty liver may progress to steatohepatitis and cirrhosis. It is not yet known whether fatty liver disease results in higher health care utilization and costs. We used data from the Study of Health in Pomerania (SHIP), Germany, to assess the relation of fatty liver disease to self-reported health care utilization and costs at baseline and 5 years. The SHIP is a general population cohort study of 4310 adults aged 20 to 79 years at baseline in Pomerania. Fatty liver disease was defined as the presence of a hyperechogenic pattern of the liver and elevated serum alanine aminotransferase (ALT) levels. In multivariable analyses, average annual overall health care costs at baseline and follow-up measurement were significantly higher for individuals with sonographic fatty liver and increased serum ALT levels. For example, controlling for comorbid conditions, subjects with sonographic fatty liver disease and increased serum ALT levels had 26% higher overall health care costs at 5-year follow-up. Analyses also suggest that diabetes and cardiovascular disease might mediate the relation of fatty liver disease and health care utilization and costs. Policies seeking to minimize costs associated with fatty liver disease might want to consider addressing behavioral risk factors of fatty liver disease.