Intravenous drug abuse and Type 1 diabetes: financial and healthcare implications.

AIMS: To determine the morbidity, mortality and healthcare costs of intravenous drug-abusing patients with Type 1 diabetes (IVDA-DM), who are admitted to hospital. METHODS: Retrospective case note analysis of admissions, complications and cost estimation over a 6-year period. Each drug-abusing patient (IVDA-DM) (n = 9) was compared with two controls (n = 18) with Type 1 diabetes but without a history of intravenous drug abuse (DM-controls). Admissions were also analysed for patients with intravenous drug abuse, but without Type 1 diabetes (IVDA-controls) (n = 198). Admissions were at a University teaching hospital in Liverpool, UK. DM-controls were drawn from a population attending diabetes outpatient clinics between 1997 and 2002 at the same hospital. The main outcome measures were: the duration and healthcare costs of hospital admissions per year, outpatient attendances per year, glycated haemoglobin (HbA(1c)), weight, micro- and macrovascular complications and mortality. RESULTS: Multiple admissions, mainly related to ketoacidosis, led to marked differences in mean (95% CI) inpatient days per year per patient [IVDA-DM 28.1 (13.6-42.7) vs. DM-control 1.1 (0.2-1.9); P < 0.0001], mean inpatient days per year per patient in critical care bed (IVDA-DM 1.7 (-0.7-4.2) vs. DM-control 0; P < 0.02) and mean costs of admission, per patient per year (pound sterling 7320 vs. pound sterling 230). The IVDA-DM group frequently omitted insulin, were underweight, failed to attend as outpatients and five had died by the end of 2002. The IVDA-controls spent considerably less time in hospital [3.4 (2.8-3.9) days per patient per year]. CONCLUSION: IVDA-DM patients have higher rates of diabetes complications, are admitted more frequently and have a high mortality compared with DM and IVDA-controls. The cost of inpatient care of this small group of patients was considerable.     

我院平均住院日状况的调查分析

目的：通过对医院平均住院日情况的简要分析，以探索缩短平均住院日的有效途径。方法：从统计室提取数据，与病案核对，计算相对指标。结果：我院的平均住院日呈下降趋势，但与卫生部颁布的标准还有差距，中医各科和康复科科别的平均住院日更长一些。结论：我院的平均住院日还有潜力可挖，术前住院日多数病种都较长，应在医疗质量和护理质量上狠下功夫，加强科室间的协作，降低平均住院日，减少无效住院日。     

基于Logistics模型与随机森林的患者流向及影响因素研究--以安徽省太湖县为例

目的:研究分级诊疗制度下患者就医流向的态势和影响因素。方法;利用安徽太湖县2015~2018年新农合数据,采用Logistics模型和随机森林分析患者流向及影响因素。结果:县域内就医比例增加,县域外就医费用明显增加。年龄、患者所在地,政策实施等对就医流向影响显著。结论:太湖县分级诊疗有效促进患者合理分流,新农合支付手段对患者县内就医起到一定作用。     

住院精神病患者滥用镇静催眠药物倾向

目的:调查我院住院精神病患者镇静催眠药物使用情况.并对相关因素进行分析.方法:通过对591例住院精神病患者的病历进行回顾性调查,获取相关资料并进行分析.结果:住院精神病患者应用镇静催眠药物主要集中在40～49岁,住院时间≤5年,且女性相对用药率明显高于男性.结论:镇静催眠药物在住院精神病患者中的滥用倾向与患者的性别、年龄、住院时间及医师的工作情况有关.     

老年住院患者口服药使用情况调查

目的：了解某医院老年住院患者口服药使用情况，并调查不良药物相互作用发生情况。方法：随机抽取2002年9月2日、9月11日及9月27日住院者中＞60岁老年患者摆药单452份，统计患者的基本情况及口服药应用种类，使用《合理用药软件系统》2002版检查每份摆药单中存在的药物相互作用。结果：超过40％的老年患者口服6种以上的药物；117份病例存在中度的不良药物相互作用，26份存在严重的相互作用。结论：该院老年住院患者口服药使用种类过多，产生不良药物相互作用情况较多，部分病例中存在可能危及生命的药物联合应用。     

社会因素对城镇医保患者住院医疗费用支付方式的影响

目的探讨影响城镇职工基本医疗费用支付方式的社会因素。方法选择某县2004年度所有在县、镇级12个医院住院治疗的城镇参保职工1145例，从社会因素的7个方面对医疗费用支付方式进行分析，组间比较采用t检验及单因素方差分析（one way ANOVA）。用多元逐步回归分析方法对住院费用不同支付方式的社会影响因素进行多因素分析。结果影响个人账户和统筹金支付费用的主要因素为医院级别、年龄、性别，影响现金支付费用的因素主要为医院级别、年龄两个因素。结沦医院级别、性别、年龄是影响医保患者3种支付方式医疗费用的主要社会因素。     

城镇女性医保患者住院医疗费用的影响因素分析

目的:探讨城镇女性医保患者住院医疗费用的影响因素,为建立合理的费用控制机制提供理论基础。方法:选择某县2004年度在县、镇级12个医院所有住院治疗的城镇参保女职工499例,从社会因素与非社会因素9个因素方面对其住院医疗费用进行分析,组间比较采用t检验及单因素方差分析,用多元逐步回归方法进行多因素分析。结果:女性医保患者住院医疗费用的主要影响因素依次为住院日、医院级别、收入水平,二甲医院住院总费高于一甲医院,随收入水平的提高和住院日的延长,住院费用增加。结论:缩短平均住院日,是有效控制医疗费用重要措施。     

Behavioral Self-Management

While behavioral treatments have been increasingly utilized with older patients, they have almost entirely involved operant, rather than self-management, approaches. In the present paper, differences between operant and self-control behavioral approaches are discussed. A case example is presented of the successful use of a behavioral self-management treatment with an elderly patient with severe agitation. The potential utility of the self-management approach with older patients is discussed.