共查询到20条相似文献，搜索用时 484 毫秒
1.
2.
Marita R. Zimmermann Elisabeth Vodicka Joseph B. Babigumira Timothy Okech Nelly Mugo Samah Sakr Louis P. Garrison Michael H. Chung 《Cost effectiveness and resource allocation : C/E》2017,15(1):13
Objective
This study evaluated the potential cost-effectiveness of cervical cancer screening in HIV treatment clinics in Nairobi, Kenya.Methods
A Markov model was used to project health outcomes and costs of cervical cancer screening and cryotherapy at an HIV clinic in Kenya using cryotherapy without screening, visual inspection with acetic acid (VIA), Papanicolaou smear (Pap), and testing for human papillomavirus (HPV). Direct and indirect medical and non-medical costs were examined from societal and clinic perspectives.Results
Costs of cryotherapy, VIA, Pap, and HPV for women with CD4 200–500 cells/mL were $99, $196, $219, and $223 from a societal perspective and $19, $94, $124, and $113 from a clinic perspective, with 17.3, 17.1, 17.1, and 17.1 years of life expectancy, respectively. Women at higher CD4 counts (>500 cells/mL) given cryotherapy VIA, Pap, and HPV resulted in better life expectancies (19.9+ years) and lower cost (societal: $49, $99, $115, and $102; clinic: $13, $51, $71, and $56). VIA was less expensive than HPV unless HPV screening could be reduced to a single visit.Conclusions
Preventative cryotherapy was the least expensive strategy and resulted in highest projected life expectancy, while VIA was most cost-effective unless HPV could be reduced to a single visit.3.
Hannah K. Knudsen Jennifer Cook Michelle R. Lofwall Sharon L. Walsh Jamie L. Studts Jennifer R. Havens 《Substance abuse treatment, prevention, and policy》2017,12(1):37
Background
Opioid use disorder (OUD) is a major risk factor in the acquisition and transmission of HIV. Clinical practice guidelines call for the integration of HIV services in OUD treatment. This mixed methods study describes the integration of HIV services in buprenorphine treatment and examines whether HIV services vary by prescribers’ medical specialty and across practice settings.Methods
Data were obtained via qualitative interviews with buprenorphine experts (n = 21) and mailed surveys from US buprenorphine prescribers (n = 1174). Survey measures asked about screening for HIV risk behaviors at intake, offering HIV education, recommending all new patients receive HIV testing, and availability of on-site HIV testing. Prescribers’ medical specialty, practice settings, caseload demographics, and physician demographics were measured. Multivariate models of HIV services were estimated, while accounting for the nesting of physicians within states.Results
Qualitative interviews revealed that physicians often use injection behaviors as the primary indicator for whether a patient should be tested for HIV. Interviews revealed that HIV-related services were often viewed as beyond the scope of practice among general psychiatrists. Surveys indicated that prescribers screened for an average of 3.2 of 5 HIV risk behaviors (SD = 1.6) at intake. About 62.0% of prescribers delivered HIV education to patients and 53.2% recommended HIV testing to all new patients, but only 32.3% offered on-site HIV testing. Addiction specialists and psychiatrists screened for significantly more HIV risk behaviors than physicians in other specialties. Addiction specialists and psychiatrists were significantly less likely than other physicians to offer on-site testing. Physicians in individual medical practice were significantly less likely to recommend HIV testing and to offer onsite testing than physicians in other settings.Conclusions
Buprenorphine treatment providers have not uniformly integrated HIV-related screening, education, and testing services for patients. Differences by medical specialty and practice setting suggest an opportunity for targeting efforts to increase implementation.4.
Background
A voluntary-based pay-for-performance (P4P) program (the CAPI) aimed at general practitioners (GPs) was implemented in France in 2009. The program targeted prevention practices, including breast cancer screening, by offering a maximal amount of €245 for achieving a target screening rate among eligible women enrolled with the GP.Objective
Our objective was to evaluate the impact of the French P4P program (CAPI) on the early detection of breast cancer among women between 50 and 74 years old.Methods
Based on an administrative database of 50,752 women aged 50–74 years followed between 2007 and 2011, we estimated a difference-in-difference model of breast cancer screening uptake as a function of visit to a CAPI signatory referral GP, while controlling for both supply-side and demand-side determinants (e.g., sociodemographics, health and healthcare use).Results
Breast cancer screening rates have not changed significantly since the P4P program implementation. Overall, visiting a CAPI signatory referral GP at least once in the pre-CAPI period increased the probability of undergoing breast cancer screening by 1.38 % [95 % CI (0.41–2.35 %)], but the effect was not significantly different following the implementation of the contract.Conclusion
The French P4P program had a nonsignificant impact on breast cancer screening uptake. This result may reflect the fact that the low-powered incentives implemented in France through the CAPI might not provide sufficient leverage to generate better practices, thus inviting regulators to seek additional tools beyond P4P in the field of prevention and screening.5.
Shuang Sui Mayineur Niyazi Lin Wang Ping Lu Kaichun Zhu Zhen Jiao 《Zeitschrift fur Gesundheitswissenschaften》2016,24(3):245-251
Aim
To investigate the features of type-specific persistent HPV infection and the associated risk factors in Uyghur women.Subjects and methods
From September 2012 to August 2013, Uyghur women who underwent opportunistic screening for cervical cancer at the People’s Hospital of Xinjiang Uygur Autonomous Region were recruited during the baseline investigation. After testing for HPV infection and genotyping, 300 women with chronic cervicitis and 300 women negative for HPV were enrolled in the nested case-control study. Information came from the sample subjects interviewed using questionnaires and follow-up study.Results
The type-specific persistent HPV infection rate was 25.50 % (65/255). The top five most common HPV types were HPV16 (48.00 %), HPV18 (31.03 %), HPV58 (28.30 %), HPV52 (23.40 %) and HPV45 (21.43 %). The risk of type-specific persistent HPV infection was increased 4.81-fold for HPV16 compared with non-HPV16. Compared with transient HPV infection, menopause and not using condoms were risk factors for persistent infection.Conclusion
The risk factors for persistent HPV infection for Uyghur women included having HPV16 infection, having menopause and not using condoms. Regular screening and close follow-up should be carried out in this high-risk population.6.
E. S. Koster A. Schmidt D. Philbert E. M. W. van de Garde M. L. Bouvy 《Zeitschrift fur Gesundheitswissenschaften》2017,25(2):181-186
Aim
Patients with limited health literacy have poorer surgical outcomes. However, current studies assessing the prevalence of limited health literacy in patients expecting surgery are small scale. We aimed to provide insight into the health literacy level of patients undergoing planned surgery.Subject and Methods
Patients aged ≥18 years visiting the preoperative screening department were approached in the waiting area and invited to participate in a brief interview including the Functional Communicative Critical Health Literacy (FCCHL).Results
In total, 225 patients (84.9% response) were studied. Based on the FCCHL, 37.3% of the patients were classified as having limited health literacy. The mean score in the critical domain (2.7?±?0.9) was lower than scores in the functional (3.3?±?0.6) and communicative (3.3?±?0.6) domains.Conclusion
More than one third of the patients admitted to the hospital for surgery had limited health literacy. Healthcare professionals should be aware of the different health literacy levels and tailor their information provision strategies accordingly.7.
8.
Background
Patient experience and clinical quality, which are represented by preventive care measures such as cancer screening, are both widely used for the evaluation of primary care quality. The aim of this study was to examine the association between patient experience and cancer screening uptake among women in a Japanese population.Methods
We conducted a cross-sectional mail survey. The questionnaire was sent to 1000 adult female residents randomly selected from a basic resident register in Yugawara town, Kanagawa, Japan. We assessed patient experience of primary care using a Japanese version of Primary Care Assessment Tool (JPCAT) and uptake of breast and cervical cancer screening.Results
The overall response rate was 46.5%. Data were analyzed for 190 female participants aged 21–74 years who had a usual source of primary care. Multivariate logistic regression analyses revealed that the JPCAT total score was significantly associated with uptake of breast cancer screening [odds ratio (OR) per 1 standard deviation increase = 1.63; 95% CI 1.11–2.41], but not with uptake of cervical cancer screening (OR per 1 standard deviation increase = 1.47; 95% CI 0.97–2.24).Conclusions
Patient experience of primary care was associated with uptake of breast cancer screening among Japanese women. The results of our study might support the argument that patient experience of primary care and the clinical process of preventive care, such as breast cancer screening, are linked.9.
Mirjam Philippi Petra Melchert Dagmar Renaud 《Pr?vention und Gesundheitsf?rderung》2018,13(3):203-210
Background
The inclusion of refugees into the German health system is fraught with challenges. Besides need-based health services, refugees need information that enables them to appropriately use the German health care system and to increase their health literacy.Objectives
The aim of the study was to analyze the demands and needs for further health information for refugees from the views of medical experts and refugees.Materials and methods
In a mixed-methods design, 10 experts (medical staff) were interviewed. Based on the results of this qualitative research, a standardized questionnaire was developed. A total of 100 refugees (76.3% men; mean age 30.5 years; 84.7% came from Syria) answered the questionnaire.Results
The medical experts identified information needs for refugees about structures, access, and characteristics of the German health system. Concerning health knowledge, the experts miss appropriate information about prevention, health behavior, medication management as well as psyche and somatization. For the refugees, information about expenses, contact points in case of emergency and diagnostic screening seemed to be remarkably relevant.Conclusions
The results of this study illustrate health-related information needs of refugees. The results serve as a basis for target health information and health promotion. They can alert health care staff to the health information needs of refugees. Important topics for more understandable information seem to be the access to health system and additional costs for health services.10.
Darren K. Burns Edward C. F. Wilson Paula Browne Sandra Olive Allan Clark Penny Galey Emma Dix Helene Woodhouse Sue Robinson Andrew Wilson 《Applied health economics and health policy》2016,14(1):105-115
Background
Chronic obstructive pulmonary disease (COPD) affects approximately 3 million people in the UK. An 8-week pulmonary rehabilitation (PR) course is recommended under current guidelines. However, studies show that initial benefits diminish over time.Objective
We present here an economic evaluation conducted alongside a randomised controlled trial (RCT) of a low-intensity maintenance programme over a time horizon of 1 year delivered in UK primary and secondary care settings.Methods
Patients with COPD who completed at least 60 % of a standard 8-week PR programme were randomised to a 2-h maintenance session at 3, 6 and 9 months (n = 73) or treatment as usual (n = 75). Outcomes were change in Chronic Respiratory Questionnaire (CRQ) score, EQ-5D-based QALYs, cost (price year 2014) to the UK NHS and social services over the 12 months following initial PR, and incremental cost-effectiveness ratios (ICERs).Results
At 12 months, incremental cost to the NHS and social services was ?£204.04 (95 % CI ?£1522 to £1114). Incremental CRQ and QALY gains were ?0.007 (?0.461 to 0.447) and +0.015 (?0.050 to 0.079), respectively. Based on point estimates, PR maintenance therefore dominates treatment as usual from the perspective of the NHS and social services in terms of cost per QALY gained. Whether it is cost effective in terms of CRQ depends on whether the £204 per patient could be reinvested elsewhere to a CRQ gain of greater than 0.007. However, there is much decision uncertainty: 95 % CIs around increments did not exclude zero, and there is a 72.9 % (72.5 %) probability that the ICER is below £20,000 (£30,000) per QALY.Conclusion
Future research should explore whether more intensive maintenance regimens offer benefit to patients at reasonable cost.11.
Background
Migration from Thailand to Sweden has increased threefold over the last 10 years. Today Thailand is one of the most common countries of origin among immigrants in Sweden. Since the year 2000, new HIV cases are also more prevalent among Thai immigrants compared to other immigrant nationalities in Sweden. The purpose of this study was to investigate the association between knowledge and utilization of sexual and reproductive healthcare services, contraceptive knowledge and socio-demographic characteristics and social capital among Thai immigrant women in Sweden.Methods
This is a cross-sectional study using a postal questionnaire to all Thai women (18–64) in two Swedish regions, who immigrated to the country between 2006 and 2011. The questionnaire was answered by 804 women (response rate 62.3 %). Bivariate and multivariate logistic regression analyses were used.Results
The majority (52.1 %) of Thai women had poor knowledge of where they should turn when they need sexual and reproductive healthcare services. After controlling for potential confounders, living without a partner (OR?=?2.02, CI: 1.16–3.54), having low trust in others (OR?=?1.61, CI: 1.10–2.35), having predominantly bonding social capital (OR?=?1.50, CI: 1.02–2.23) and belonging to the oldest age group (OR?=?2.65, CI: 1.32–5.29) were identified as risk factors for having poor knowledge. The majority (56.7 %) had never been in contact with healthcare services to get advice on contraception, and about 75 % had never been HIV/STI tested in Sweden. Low utilization of healthcare was associated with poor knowledge about healthcare services (OR?=?6.07, CI: 3.94–9.34) and living without a partner (OR?=?2.53, CI: 1.30–4.90). Most Thai women had knowledge of how to prevent an unwanted pregnancy (91.6 %) and infection with HIV/STI (91.1 %).Conclusions
The findings indicate that social capital factors such as high trust in others and predominantly bridging social capital promote access to knowledge about healthcare services.However, only one-fourth of the women had been HIV/STI tested, and due to the HIV prevalence among Thai immigrants in Sweden, policy makers and health professionals need to include Thai immigrants in planning health promotion efforts and healthcare interventions.12.
13.
Maria Liljeroos Susanna Ågren Tiny Jaarsma Kristofer Årestedt Anna Strömberg 《Quality of life research》2017,26(2):367-379
Background
Partners of patients with heart failure provide both practical and emotional support. Many partners assume caregiving responsibilities without being aware of the burden related with this role.Objective
Our work has established that a psycho-educational intervention has benefits at 3, but not at 12 months for patients with heart failure. Further we had not described the long-term effects in caregivers. This study aimed to determine the 24-months effects of a dyadic psycho-educational intervention on caregiver burden and morbidity in partners of patients with heart failure and study factors associated with a change in caregiver burden.Design
A randomized controlled study design, with a follow-up assessment after 24 months.Setting and participants
Partners to patients with heart failure were recruited from two hospitals in the southeast of Sweden.Intervention
A three session nurse-led psycho-educational program was tested and included psychosocial support to maintain the partners’ physical and mental functions, and perceived control. Several instrument were used to measure caregiver burden, perceived control, physical and mental health, depression and morbidity.Results
One hundred fifty-five partners were included. There were no significant differences in any index of caregiver burden or morbidity among the partners in the intervention and control groups after 24 months. Overall, the mean total caregiver burden was found to be significantly increased compared to baseline (36 ± 12 vs 38 ± 14, p < 0.05). A younger partner, less comorbidity, higher levels of perceived control, better physical health and less symptoms of depression in patients, and better mental health in the partners were factors associated with absence of increased caregiver burden over time.Discussion and conclusion
Our intervention did not significantly decrease caregiver burden or morbidity. Over time, several aspects of burden increased in both groups. To improve outcomes, individualized and targeted interventions might be beneficial.Registered on ClinicalTrials.gov Identifier
NCT02398799.14.
L. Standfield T. Comans M. Raymer S. O’Leary N. Moretto P. Scuffham 《Applied health economics and health policy》2016,14(4):479-491
Background
Hospital outpatient orthopaedic services traditionally rely on medical specialists to assess all new patients to determine appropriate care. This has resulted in significant delays in service provision. In response, Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services (OPSC) have been introduced to assess and co-ordinate care for semi- and non-urgent patients.Objectives
To compare the efficiency of delivering increased semi- and non-urgent orthopaedic outpatient services through: (1) additional OPSC services; (2) additional traditional orthopaedic medical services with added surgical resources (TOMS + Surg); or (3) additional TOMS without added surgical resources (TOMS ? Surg).Methods
A cost-utility analysis using discrete event simulation (DES) with dynamic queuing (DQ) was used to predict the cost effectiveness, throughput, queuing times, and resource utilisation, associated with introducing additional OPSC or TOMS ± Surg versus usual care.Results
The introduction of additional OPSC or TOMS (±surgery) would be considered cost effective in Australia. However, OPSC was the most cost-effective option. Increasing the capacity of current OPSC services is an efficient way to improve patient throughput and waiting times without exceeding current surgical resources. An OPSC capacity increase of ~100 patients per month appears cost effective (A$8546 per quality-adjusted life-year) and results in a high level of OPSC utilisation (98 %).Conclusion
Increasing OPSC capacity to manage semi- and non-urgent patients would be cost effective, improve throughput, and reduce waiting times without exceeding current surgical resources. Unlike Markov cohort modelling, microsimulation, or DES without DQ, employing DES-DQ in situations where capacity constraints predominate provides valuable additional information beyond cost effectiveness to guide resource allocation decisions.15.
Background
Nursing care insurance funds are supposed to deliver preventive services in nursing homes. The strengthening of cognitive resources is considered as one field of action.Aim
The preventive effectiveness of physical activity on cognitive performance in nursing home residents shall be evaluated.Methods
A systematic search was carried out in the databases MEDLINE, the Cochrane Library, EMBASE, CINAHL, PsycINFO and PEDro. Results were combined in random-effects meta-analyses.Results
Taking into account 13 primary studies, it was shown that those participating in physical activity showed statistically significant greater cognitive performance compared to controls (SMD = 0.43, 95% CI 0.20–0.66, p = 00002). Subgroup analyses suggest that nursing home residents with different cognitive impairments might benefit from long-lasting physical activity interventions. Due to the high risk of bias in included studies, the results must be interpreted with caution.Conclusion
Physical activity might be effective in the inpatient care setting. Further studies with longer intervention periods are required.16.
Katja Makowsky 《Pr?vention und Gesundheitsf?rderung》2017,12(1):68-72
Background
During the last 10 years, family midwives have become increasingly integrated into the Early Intervention System in Germany. As representatives of the health care professions and based on a trusting relationship with vulnerable families, they use several strategies to promote positive health behavior and health conditions.Objectives
The aim of the study was to obtain insight into subjective theories of family midwives, which influence their dealings with families and taking a guiding role for the families.Methods
Following a qualitative research approach, 13 family midwives were interviewed. The interviews were interpreted according to methods recommendations by Witzel.Results
Structural circumstances influence family midwives’ subjective theories of good quality. In spite of disclaiming controlling function, family midwives who work directly with representatives of child welfare services, by trend follow the aims of child welfare services. Family midwives working in conjunction with a private agency emphasize their strategies of health promotion.Conclusion
Family midwives can be supported in their strategies of health promotion. Association with a private agency seems to be helpful for maintaining the salutogenetic perspective of midwives.17.
Background
Suicide is a leading cause of death among youth. Suicide screening programs aim to identify mental health issues and prevent death by suicide.Objective
The present study evaluated outcomes of a multi-stage screening program implemented over 3 school years in a moderately-sized Midwestern high school.Methods
One hundred ninety-three 9th-grade students were screened in the program. Students who screened positive were referred to mental health services and followed. Suicide-related thoughts and behaviors among 9th-grade students in the school with screening were compared to those of students in a similar school without screening.Results
There was a significant increase in utilization of mental health services among students who screened positive and a decrease in rates of suicidal ideation and attempts among 9th-grade students at the school with screening.Conclusions
This multi-stage screening program shows promise in addressing suicide-related behaviors in schools. Randomized trials are needed to confirm program efficacy.18.
Bolaji Samson Aregbeshola Samina Mohsin Khan 《The European journal of health economics》2018,19(4):521-532
Background
Catastrophic health expenditure is a measure of financial risk protection and it is often incurred by households who have to pay out of pocket for health care services that are not affordable. The study assessed the determinants of catastrophic health expenditure among households in Nigeria.Methods
Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/10 was utilized to assess factors associated with catastrophic health expenditure in Nigeria. Household and individual characteristics associated with catastrophic health expenditure were determined using bivariate analysis and multivariate logistic regression.Results
Results showed that irrespective of the threshold for the two concepts of total household expenditure and non-food expenditure, having household members aged between 6 and 14 years, having household members aged between 15 and 24 years, having household members aged between 25 and 54 years, having no education, having primary education, having secondary education, lack of health insurance coverage, visiting a private health facility, households living in north central zone, households living in north east zone and having household members with non-chronic illnesses were factors that increase the risk of incurring catastrophic health expenditure among households.Conclusions
Policy-makers and political actors need to design equitable health financing policies that will increase financial risk protection for people in both the formal and informal sectors of the economy.19.
Noreen Islam Yvonne N. Flores Paula Ramirez Roshan Bastani Jorge Salmerón 《International journal of public health》2014,59(2):381-394
Objectives
To assess the knowledge and preventive practices regarding hepatitis and liver disease among a sample of participants in the Mexican Health Worker Cohort Study.Methods
The study population consisted of 892 participants from Cuernavaca, Mexico. Demographic characteristics, knowledge about hepatitis B, hepatitis C, and liver disease in general, as well as information about prevention practices were obtained from self-reported questionnaires. Participants were grouped into categories that were created using information about their professional background and patient contact status. Knowledge and prevention practices were compared within these categories.Results
Inadequate levels of knowledge and preventive practices were found, even within the more highly educated group. Nearly 57 % of the participants had inadequate knowledge about liver disease in general, while 76 and 79 % had inadequate knowledge about Hepatitis B virus (HBV) and Hepatitis C virus (HCV), respectively. For general liver disease, the mean knowledge score increased significantly with education, history of HCV screening, and low alcohol consumption.Conclusions
Health workers should be better educated about hepatitis and liver disease so they can reduce their own risk and share their knowledge of how to prevent liver disease with patients.20.
Edward C. F. Wilson George Stanley Zulfiquar Mirza 《Applied health economics and health policy》2016,14(2):205-215