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PIH1 |
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COST-BENEFIT ANALYSIS OF THE
SCHOOL-BASED HEALTH CENTER PROGRAM IN GREATER
CINCINNATI
Guo JJ1, Jang R1, Keller KN2, 1University
of Cincinnati, Cincinnati, OH, USA, 2Health
Foundation of Greater Cincinnati, Cincinnati, OH,
USA
OBJECTIVE:
This study was designed to measure the
cost benefit of the School-Based Health Centers(SBHC).
METHODS:
Four SBHCs (3 urban and one rural) plus
four comparison school districts were studied from
1997 to 2003. A total of 5,056 students who
enrolled in six schools and the Ohio Medicaid
program were evaluated to assess the value of
health status change. Parent’s survey was
conducted to assess the potential benefit for
families. SBHC coordinator’s survey was conducted
to document the operational costs and benefits.
Cost-benefit analysis (CBA) was conducted to
estimate the value of resources used by the SBHCs
compared to the value of resources the program
might save or create. RESULTS:
During the first
three years of operation, the total cost for four SBHCs was $1.5 million. The savings from health
improvement included $228,144 from students with
asthma, $594,228 from prescription drug use,
$42,956 form travel expense, and $542,761 from
parent’s productivity. The value of health status
changes involved $771,840 for mental health care,
and $51,672 for dental care. The benefits of four
SBHCs ranged from $2.72 to $5.99 million.
CONLUSIONS:
From a societal perspective, the four SBHCs were cost beneficial with a net social
benefit from $0.71 to $3.98 million over the first
three year of operation. The SBHCs were cost
beneficial in a societal perspective.
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PIH2 |
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A GERIATRIC SCREENING PROGRAM
CONDUCTED AT THE OBSERVATION ROOM OF AN EMERGENCY
DEPARTMENT (GSPOR)
Ho WWS, Dai D, The Chinese University of
Hong Kong, Hong Kong
OBJECTIVE:
Elderly people who have chronic
diseases frequently requires Emergency Department
attendances and hospital admissions. Patients
staying in Observation room are more prone at
risk. We believe many of the geriatric medical and
psychosocial problems could be settled in the
Observation Room obviating the need of
hospitalization. Extended community supportive
services, such as community nursing, community
geriatric out-reach assessment team; geriatric day
hospital can be organized to provide close
monitoring of the medical and social problems of AED attendees.
METHODS:
Geriatric screening
program is provided to all elders aged 65 and
above who are admitted to Observation Room.
Geriatric input includes making diagnosis and
management, assessment of common geriatric
syndromes, detection of social problems and
evaluation of the home care support. In cases of
necessity, direct transferal to convalescence
hospital, referral to appropriate social services
and medical follow up for continuity of care are
made. RESULTS:
A total of 615 elderly patients
were admitted to Observation room during June to
August 2004. The Geriatric screening program was
evaluated with 234 cases received. One hundred and
thirty-five (57.7 %) cases were female. The mean
age was 78.2 (SD 7.49).The average length of stay
was 1.68 days. Most common complaints were
dizziness and vertigo (21.1%), chest pain (14.6%),
gastroenteritis (5.7%) and hypoglycemia (4.8%).
The program was welcomed by AED colleagues and was
helpful in making the diagnosis in 31.3% of
patients. Medication was adjusted in 58.1%, and
underlying social problems were identified in
13.7%. Majority of patients (81.2%) were
discharged back to their original accommodations.
CONLUSIONS:
A geriatric screening program in the
Observation Room is effective in resolving common
geriatric problems and may possibly reduce
unnecessary hospital admissions.
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PIH3 |
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FEASIBILITY OF A
COMPUTER-MEDIATED TAI CHI EXERCISE
Li J, Finkelstein J, University of Maryland
School of Medicine, Baltimore, MD, USA
OBJECTIVE:
To assess the feasibility and patient
acceptance of a Tai Chi Home Automated Telemanagement (HAT) system in patients with
chronic diseases. We will explore the magnitude of
effect of the Tai Chi HAT system on over all
quality of life, psycho-cognitive factors related
to exercise and physical performance. METHODS:
We
used the existing HAT system as a prototype for
development of multi-component support for
patients to practice Tai Chi at home. It consists
of a Home Unit (HU), HAT server, and clinician
unit (CU). The HU, a laptop supporting a
patient-tailored Tai Chi exercise plan, will be
used by the patient at home. The HU sends patient
data to the HAT server. Any web-enabled device can
serve as a CU to review patient results. Patients
report exercise information using an HU. The HAT
system is able to automatically monitor patient
compliance and analyzes self-testing results
according to the practice guidelines in real-time.
Therefore, the system assists patients in carrying
out their individual exercise plans. In instances
of patient non-compliance or failure to follow
their exercise plans, the system gives feedback to
the patient to motivate better compliance, and
notifies a case manager who contacts the patients
when necessary. RESULTS:
The Tai Chi HAT system
may be able to help patients engage in a regular
exercise and manage their symptoms of chronic
disease, therefore, improve their quality of life.
CONLUSIONS:
The advantages of the Tai Chi HAT
system are: 1) the system has the potential to
assess compliance to the exercise program and
support adjustments in the individualized exercise
program that may be needed; 2) patients will be
able to observe the progress being achieved with
the exercise 3) the system is able to provide
patient education, verbal encouragement, and
social support.
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PIH4 |
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TAI CHI FOR IMPROVING BALANCE
AND PREVENTING FALLS - A REVIEW OF EXISTING
OBSERVATIONAL STUDIES
Li J, Lawpoolsri S, Finkelstein J,
University of Maryland School of Medicine,
Baltimore, MD, USA
OBJECTIVE:
To review the epidemiologic literature
on evaluating the effectiveness of Tai Chi, an
aged Chinese exercise regime, for improving
balance and preventing falls and to provide
recommendations for future research design.
METHODS:
Literature on Tai Chi, published after
1966, as identified by Medline, was reviewed.
Studies were selected if they met the following
criteria: 1) the research was related to balance
and fall prevention; and 2) observational study
designs, including: case series, ecologic,
cross-sectional, cohort, case-control and
quasi-experiment. RESULTS:
Thirteen studies were
identified, based on the two criteria above, from
a total of 187 articles. Findings from these
studies are inconsistent because of a number of
inherent limitations and potential biases in the
study design. These limitations include: selection
bias due to non-randomization of study subjects in
quasi-experimental study; no convincing causal
relationship established using cross-sectional
study; selection bias due to poor baseline
demographic data collection and assessment;
failure to identify the difference between people
who are compliant to the study and those who drop
off; lack of external validity due to including
only one gender or one age group in the study;
failure to define intervention assessment in the
study (e.g., the style, intensity, frequency of
the Tai Chi intervention) and no standard
measurement for improving balance across different
studies. CONLUSIONS:
The evidence of the
effectiveness of Tai Chi on improving balance and
preventing falls based on existing observational
studies is inconclusive. In the future, randomized
clinical trial should be used in order to control
confounding and eliminate bias. More systematic
studies are needed to understand the therapeutic
nature of Tai Chi. Based on this, the consensus
about the terms of use and core measures that help
describe and compare participants, characterize
Tai Chi interventions, and describe relevant
outcomes has to be achieved.
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PIH5 |
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MINIMAL CLINICALLY IMPORTANT
DIFFERENCE (MCID) OF THE ERECTION QUALITY SCALE
Huang X1, Harris K1, Song J1, Wincze J2,
Rosen R3, 1Bayer Pharmaceuticals Corporation, West
Haven, CT, USA, 2Brown University, Providence, RI,
USA, 3UMDNJRobert Wood Johnson Medical School,
Piscataway, NJ, USA OBJECTIVE:
The recently
developed Erection Quality Scale (EQS) is a
self-reported measure for assessing the quality of
penile erections. To clinicians, it is important
not only to ascertain validity of the EQS, but
also to comprehend the smallest change in EQS
score that patients consider important. The
objectives are to report the MCID of EQS and the
scientific process within which the MCID was
estimated. METHODS:
A randomized, doubleblind,
placebo-controlled study was conducted to
investigate the responsiveness of the EQS. Men age
>= 18 years with ED for at least 6 months were
eligible. Following a 4- week run-in period,
eligible subjects were randomized to receive 10 mg
vardenafil or matching placebo for 4-weeks.In a
subsequent 4-week period, subjects remained on the
assigned treatment with an option to titrate the
dose to 5 mg or 20 mg. The International Index of
Erectile Function (IIEF), the Global Assessment
Question (GAQ), Sexual Encounter Profile (SEP),
Keep it Simple (KIS) scale, EQS, and anchor
question were administered to study subjects.
Safety was assessed throughout the study period.
Anchor-based methods and distribution based
methods were used to estimate the MCID. RESULTS:
A
total of 219 men were enrolled in this study, of
whom 113 received placebo and 106 received vardenafil. The MCID generated by two distribution
based methods, namely the 1/2 SD and SEM, were
comparable and was 5 points. The estimate
generated by cross-sectional anchor-based analyses
ranged from 4.82 to 16.33 (with ES ranging from
0.66 to 1.16). With longitudinal method, the mean
EQS change scores for subjects with one point of
anchor score change were 8.08 and 8.03 with ES of
1.12 and 1.18, respectively. Applying Cohen’s ES
criteria ranging from 0.2 and 0.8, the estimated
EQS MCID was five points with corresponding ES of
0.5. CONLUSIONS:
The MCID of EQS is five points.
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PIH6 |
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A COST-EFFECTIVENESS ANALYSIS
OF CONTRACEPTIVES IN UKRAINE
Zaliska O, Pushak K, Lviv National Medical
University named Danylo Galitsky, Lviv, Ukraine
OBJECTIVE:
In the Ukraine the authorized National
program «Reproductive health» which provides
rational contraception of women. To carry out the
pharmacoeconomical analysis of hormonal
contraceptives and to validate economical
advantages New-Ring compared to oral
contraceptives in Ukraine. METHODS:
A marketing
analysis, a “cost-effectiveness” analysis. The
marketing analysis of hormonal contraceptives has
shown, that in Ukraine the import preparations
submitted only. It is carried out the pharmacoeconomic analysis of hormonal combined
contraceptives in different medical forms: vaginal
rings (New–ring), scin plaster (Evra) and tablets
for oral reception (Jaryna). Mean cost of
contraceptives was calculated based on the minimal
wholesale price and the limiting state margin - 35
% the April 2005. The costs for contraception
within one year preparation Åvra have made
33396,12 Hryven (1 Euro - 6,35 Hryven.), the
New-ring - 1014,96 Hrn., Jaryna - 784,08 Hrn. By
results of an expert estimation of women
compliance preparations following: Åvra – 88,7 %,
New-ring – 81,0 %, Jaryna – 79,2 %. The maximum
compliance of a plaster and vaginal rings caused
by transdermal receipt of contraceptives provides,
as against tablets, stable concentration of
hormones during a month. RESULTS:
The marketing
analysis having shown necessity of creation of a
domestic production contraceptives in Ukraine.
Taking into account similar level of compliance to
the Åvra and to the New-ring, it is possible to
recommend the New-ring as an optimum contraceptive
behind a CER. The analysis “cost-effectiveness”
has shown, that contraception within one year Evra
will cost to the woman in 4,3 times more
expensive, and a ring the New-ring - in 1,3 times
more expensive, than tablets Jaryna. CONLUSIONS:
The New-ring represents a less expensive
alternative to long-term oral contraceptives.
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PIH7 |
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THE SITUATION OF HEALTH
TECHNOLOGY ASSESSMENT IN HUNGARY
Kincses G, National Institute of Strategic
Health Research, Budapest, Hungary The
situation of health technology assessment in
Hungary Ministry of Health, Budapest, Hungary;
After Hungary’s accession to the European Union (1
May 2004) technology assessment plays a mandatory
role in granting social insurance subsidies. In
every case the process starts with
licensing/registration, then continues with
decisions on social insurance inclusion, and if
judged so after a period of time, it ends with
exclusion from circulation/ subsidy. In all this
cost-efficiency, health policy, social-political
and insurance policy considerations also play a
role. This is the process in which the National
Institute for Strategic Health Research (ESKI)
takes part as it supports decision-making by
preparing background materials, analyses and
studies. Within this the Technology Assessment
Office (TEI) supports decision-makers of the
committee of the National Health Insurance Fund (OEP)
that awards social insurance subsidies with its
work of evaluating pharmaceutical subsidy
applications. The basic criteria of this work
among others are cost-efficiency and
ranking/qualifying of the technology to be
replaced or the problem to be solved. The
inclusion of pharmaceutical products operates in
accordance with the principle of transparency:
Within the framework laid down by law the
appropriate data sheet with its supplements are
passed to the Pharmaceutical Division of the
National Health Insurance Fund (OEP), where in a
simplified case the inclusion of generic drugs, as
well as new potencies and packaging, etc. takes
place directly on the premises. The documentation
of drugs containing new agents are transferred to
ESKI TEI, where evaluation of applications are
prepared for the OEP committee that makes
recommendation for inclusions. After the committee
decisions all final recommendations are made in
OEP’s Pharmaceutical Division that are then
disseminated as law by the minister of health in
agreement with the minister of finance. There is a
possibility for appeal. In that case the director
of OEP makes decisions.
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PIH8 |
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PRIVATE PRACTICE AMONG PUBLIC
MEDICAL DOCTOR IN THAILAND
Prakongsai P1, Tantivess S2,
Tangcharoensathien V2, 1International Health
Policy Program, Amphoe Muang, Thailand,
2International Health Policy Program, Nonthaburi,
Thailand
OBJECTIVE:
To investigate patterns, behavior,
motivation, and impacts of private practice among
public medical doctors in Thailand and search for
appropriate policies to regulate and mitigate
consequences of private practice toward public
health services. METHODS:
Comprehensive literature
review, an anonymous self-administered
questionnaire for 1,808 public medical doctors in
five selected provinces, and in-depth interviews
with key informants at local and national levels.
RESULTS:
Sixty-nine percent of public doctors had
undertaken private practice. The main reason for
having private practice was “income from public
services is not adequate”. A logistic regression
analysis indicated that factors influencing
private practice engagement were being male
medical doctors and being a medical specialist
(e.g. surgeons, obstetricians). The ratio of total
monthly income between fully public and dual
job-holding doctors was 2.2. In-depth interviews
illustrated that implications of private practice
were ranging from public-time corruption,
neglecting public patients, poor performance in
the public sector due to exhaustion from private
work, and differences in the quality of care
providing for public and private patients.
Existing regulations towards private practice in
Thailand tend to be weak with poor enforcement.
Responsible organizations such as Ministry of
Public Health and Thai Medical Council have
neither any policies in this area nor intention to
regulate such practice. CONLUSIONS:
Even though
private practice provides two useful functions:
compensating for the low salary scale of public
medical services and increasing access to health
care for those who are affordable, its negative
impact requires regulations and measures to
minimize those consequences. Strengthening of
regulatory measures and administrative
capabilities with an introduction of new payment
methods reflecting performance and quality of care
are urgently needed. Indirect measures including
changing payment methods for public health care
providers, quality assurance (QA), and hospital
accreditation (HA) are widely accepted as an
effective measure by Thai health care providers. |
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