The impact of primary care organization on avoidable hospital admissions for diabetes in 23 countries

Objective: Diabetes is a so-called ambulatory care sensitive condition. It is assumed that by appropriate and timely primary care, hospital admissions for complications of such conditions can be avoided. This study examines whether differences between countries in diabetes-related hospitalization rates can be attributed to differences in the organization of primary care in these countries. Design: Data on characteristics of primary care systems were obtained from the QUALICOPC study that includes surveys held among general practitioners and their patients in 34 countries. Data on avoidable hospitalizations were obtained from the OECD Health Care Quality Indicator project. Negative binomial regressions were carried out to investigate the association between characteristics of primary care and diabetes-related hospitalizations. Setting: A total of 23 countries. Subjects: General practitioners and patients. Main outcome measures: Diabetes-related avoidable hospitalizations. Results: Continuity of care was associated with lower rates of diabetes-related hospitalization. Broader task profiles for general practitioners and more medical equipment in general practice were associated with higher rates of admissions for uncontrolled diabetes. Countries where patients perceive better access to care had higher rates of hospital admissions for long-term diabetes complications. There was no association between disease management programmes and rates of diabetes-related hospitalization. Hospital bed supply was strongly associated with admission rates for uncontrolled diabetes and long-term complications. Conclusions: Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related hospitalizations. Hospital bed supply appeared to be a very important factor in this relationship. Apparently, it takes more than strong primary care to avoid hospitalizations.

• Key points

• Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related avoidable hospitalization.

• Hospital bed supply is strongly associated with admission rates for uncontrolled diabetes and long-term complications.

• Continuity of care was associated with lower rates of diabetes-related hospitalization.

• Better access to care, broader task profiles for general practitioners, and more medical equipment in general practice was associated with higher rates of admissions for diabetes.

     

Post-neonatal hospitalization and health care costs among IVF children: a 7-year follow-up study

BACKGROUND: The objective of this study was to evaluate whether the post-neonatal hospitalization and resulting health care costs are increased among in vitro fertilization (IVF) children up to 7 years of age. METHODS: We conducted a population-based cohort study with linkage to a national hospital discharge register including 303 IVF children, born from 1990 to 1995, and 567 control children (1:2) randomly chosen from the Finnish Medical Birth Register and matched for sex, year of birth, area of residence, parity, maternal age and socioeconomic status. The cost calculations were stratified for singleton (n = 152 vs. n = 285) and twin (n = 103 vs. n = 103) status. Main outcome measures were hospitalizations and societal health care costs. RESULTS: The full-sample and singleton analyses showed that IVF children were significantly more frequently admitted to hospital (mean 1.76 vs. 1.07, P < 0.0001; 1.61 vs. 1.07, P = 0.0004, respectively) and spent significantly more days in the hospital (mean 4.31 vs. 2.61, P < 0.0001; 3.47 vs. 2.56, P = 0.0014, respectively) than control children. No differences were detected between IVF and control twins. The costs of post-neonatal hospital care per child were 2.6-fold for IVF singletons, but 0.7-fold for IVF twins when compared with controls. Cost estimation showed 2.6-fold costs for total IVF population in comparison to general population based controls. CONCLUSIONS: The incidence of multiple births increases the utilization of post-neonatal health care services and costs among IVF children in comparison to naturally conceived children. Increased hospitalization and costs were also seen among IVF singletons.     

Predisposing factors of complicated deep neck infection: an analysis of 158 cases

Both the introduction of antibiotics and improvements in oral hygiene have made deep neck infections occur less frequently today than in the past. Nevertheless, the complications from these infections are often life-threatening. The purpose of this article was to review the clinical findings of deep neck infections and identify the predisposing factors of these complications. The present study reviewed 158 cases of deep neck infections between the years of 1995 to 2004, 23 of which had life-threatening complications. Cases were excluded if they had peritonsillar abscesses, superficial infections, infections related to external neck wounds, or head and neck tumors. The authors used multiple linear regression and the logistic regression analysis in order to determine the clinical parameters that are associated with longer hospitalizations and complicated deep neck infections, respectively. The multiple linear regression showed that patients with a large number of involved spaces, diabetes mellitus, and complications required longer hospitalizations (p < 0.05). The logistic regression showed that patients with more than two involved spaces were more likely to have complicated deep neck infections (p < 0.05). Patients with odontogenic causes had negative correlation (p < 0.05). We recommend that high-risk groups, such as diabetic patients and/or patients with more than two involved spaces, should be more closely monitored throughout their hospitalization.     

The burden of severe hypoglycemia in type 1 diabetes

Aims: Approximately 1.25 million people in the US have type 1 diabetes mellitus (T1DM), a chronic metabolic disease that develops from the body’s inability to produce insulin, and requires life-long insulin therapy. Poor insulin adherence may cause severe hypoglycemia (SHO), leading to hospitalization and long-term complications; these, in turn, drive up costs of SHO and T1DM overall. This study’s objective was to estimate the prevalence and costs of SHO-related hospitalizations and their additional longer-term impacts on patients with T1DM using basal-bolus insulin.

Methods: Using Truven MarketScan claims, we identified adult T1DM patients using basal-bolus insulin regimens who were hospitalized for SHO (inpatient SHO patients) during 2010–2015. Two comparison groups were defined: those with outpatient SHO-related encounters only, including emergency department (ED) visits without hospitalization (outpatient SHO patients), and those with no SHO- or acute hyperglycemia-related events (comparison patients). Lengths of stay and SHO-related hospitalization costs were estimated and propensity score and inverse probability weighting methods were used to adjust for baseline differences across the groups to evaluate longer-term impacts.

Results: We identified 8,734 patients, of which 4.2% experienced at least one SHO-related hospitalization. Among those who experienced SHO (i.e. of those in the inpatient and outpatient SHO groups), 31% experienced at least one SHO-related hospitalization, while 9% were treated in the ED without subsequent hospitalization. Approximately 79% of patients were admitted directly to the hospital; the remainder were first assessed or treated in the ED. The inpatient SHO patients stayed in the hospital, including time in the ED, for 1.7 days and incurred $3551 in costs. About one-third of patients were hospitalized again for SHO. Inpatient SHO patients incurred significantly higher monthly costs after their initial SHO-related hospitalization than patients in the two other groups ($2084 vs $1313 and $1372), corresponding to 59% or 52% higher monthly costs for inpatient SHO patients.

Limitations: These analyses excluded patients who did not seek ED or hospital care when faced with SHO; events may have been miscoded; and we were not able to account for clinical characteristics associated with SHO, such as insulin dose and duration of diabetes, or unmeasured confounders.

Conclusions: The burden associated with SHO is not negligible. About 4% of T1DM patients using basal-bolus insulin regimens are hospitalized at least once due to SHO. Not only did those patients incur the costs of their SHO hospitalization, but they also incur red at least $712 (52%) more in costs per month after their hospitalization than outpatient SHO or comparison patients. Reducing SHO events can help decrease the burden associated with SHO among patients with T1DM.     

抗肿瘤药物不良反应信息评价与分析

目的:评价药物不良反应(ADR)报告质量,分析抗肿瘤药物使用中发生ADR患者临床资料,为指导临床合理用药提供参考。方法:收集某院2015年1月1日-12月31日上报的住院患者ADR报告,收集2014年、2015年住院患者使用抗肿瘤药发生ADR肿瘤患者病历资料。符合纳入标准的ADR报告,按患者性别、药品种类、给药途径、ADR类型进行回顾性分析。对2014年、2015年住院患者使用抗肿瘤药发生ADR病历资料进行危险因素分析。结果:2015年合格ADR报告共1 053份,男487例(46.25%)、女566例(53.75%);药品种类涉及20类,排名前5位的分别是心血管系统药、抗微生物药、电解质酸碱平衡及营养药、抗肿瘤用药、诊断用药;静脉滴注给药引发ADR例数最多,共529例(50.24%);新的ADR有30例(2.80%),严重ADR有90例(8.39%)。2014年和2015年抗肿瘤药合格ADR报告186例,严重ADR有25例(13.44%)。ADR主要临床表现为恶心呕吐、骨髓抑制等。抗肿瘤药致ADR发生的单因素分析影响因素共有3个指标,分别是:中性粒细胞数、血小板数、谷草转氨酶量;抗肿瘤药致ADR发生的多因素分析危险因素共有2个指标,分别是:中性粒细胞数的降低和血小板数的减少。结论:医疗机构需重视ADR监测、加强上报ADR报告质量管理;临床观察用药过程中患者的临床表现、临床指标、抗肿瘤药检测危险因素,以便及时得到预警信息,为合理指导用药,保障用药安全服务。     

玉屏风颗粒联合多索茶碱治疗儿童喘息性支气管炎的临床研究

目的探讨玉屏风颗粒联合多索茶碱治疗儿童喘息性支气管炎的临床效果。方法选择竹山县人民医院2016年1月—2017年3月收治的喘息性支气管炎患儿108例,随机分成对照组(54例)与治疗组(54例)。对照组患儿静脉滴注注射用多索茶碱,4 mg/kg加入5%葡萄糖注射液50 m L,1次/d。治疗组在对照组的基础上口服玉屏风颗粒,1袋/次,3次/d。两组患儿均连续治疗14 d。观察两组患儿临床疗效,比较治疗前后两组患儿症状体征消失时间和住院时间及免疫功能和治疗后3、6个月复发率。结果治疗后,对照组临床总有效率为77.78%,显著低于治疗组的96.30%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组症状体征消失时间和住院时间均比对照组明显缩短,两组比较差异具有统计学意义(P0.05)。治疗后,两组Ig E明显降低,CD~(4+)、CD~(4+)/CD~(8+)明显升高,治疗组CD~(8+)明显下降,同组比较差异具有统计学意义(P0.05),且治疗组免疫功能均明显优于对照组(P0.05)。治疗3、6个月后,治疗组复发率分别为1.85%、3.70%,均明显低于同期对照组的20.37%、25.93%,两组比较差异具有统计学意义(P0.05)。结论玉屏风颗粒联合多索茶碱治疗儿童喘息性支气管炎能有效促进症状体征的缓解,提高患儿的免疫功能,具有一定的临床推广应用价值。