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Health Care rationing

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https://www.readbyqxmd.com/read/28337039/rationing-of-hip-and-knee-referrals-in-the-public-hospital-the-true-unmet-need
#1
Tom Inglis, Paul Armour, Grahame Inglis, Gary Hooper
AIM: The aim of this paper is to outline the development of a triage system for elective hip and knee referrals to the Orthopaedic Department of the Canterbury District Health Board (CDHB), and to determine the unmet need within this population for accessing first specialist assessment (FSA). METHODS: Between 1 August 2015 and 31 March 2016 data was collected from all elective hip and knee referrals that underwent triage for a FSA. The number of outpatient appointments available according to the government four-month waiting time is set by the CDHB...
March 24, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28334033/a-qualitative-study-mothers-of-late-preterm-infants-relate-their-experiences-of-community-based-care
#2
Shahirose S Premji, Genevieve Currie, Sandra Reilly, Aliyah Dosani, Lynnette May Oliver, Abhay K Lodha, Marilyn Young
PURPOSE: In Alberta, the high occurrence of late preterm infants and early hospital discharge of mother-infant dyads has implications for postpartum care in the community. Shortened hospital stay and complexities surrounding the care of biologically and developmentally immature late preterm infants heighten anxiety and fears. Our descriptive phenomenological study explores mothers' experience of caring for their late preterm infants in the community. METHODS: Eleven mothers were interviewed using a semi-structured interview guide...
2017: PloS One
https://www.readbyqxmd.com/read/28332206/contract-care-in-dentistry-sense-making-of-the-concept-and-in-practice-when-multiple-institutional-logics-are-at-play
#3
Ylva Ulfsdotter Eriksson, Karin Berg, Ulla Wide Boman, Magnus Hakeberg
In 2009 contract dental care was introduced into Sweden's Public Dental Service under a programme called Dental Care for Health (DCH). Previous research has revealed a possible dilemma whereby dental care professionals had the role of insurance agent foisted upon them, as they were assigned the task of 'selling contracts'. Using qualitative interviews, this study explores how these professionals make sense of contract dental care today. Drawing on the concepts of occupational and organisational professionalism, in combination with the institutional logics perspective, we discern that dental care professionals are entangled in multiple rationalities when reasoning about and dealing with DCH...
March 23, 2017: Sociology of Health & Illness
https://www.readbyqxmd.com/read/28331865/growth-hormone-utilization-review-in-a-pediatric-primary-care-setting
#4
Fatemeh Sayarifard, Fereshteh Bakhshi Imcheh, Shirinsadat Badri, Toktam Faghihi, Mostafa Qorbani, Mania Radfar
OBJECTIVE: One of the main problems facing public health providers and administrators in many countries is ensuring the rational use of high-cost drugs. In this regard, on-going process of medication use evaluation can be considered as a useful tool. In this study, we evaluated certain usage aspects of a highly-cost medication, that is, recombinant growth hormone (GH). METHODS: This cross-sectional study conducted from August 2012 to August 2014. Children receiving GH ± gonadotropin releasing hormone (GnRH) analogs were included in the study...
January 2017: Journal of Research in Pharmacy Practice
https://www.readbyqxmd.com/read/28301695/justifying-clinical-nudges
#5
Moti Gorin, Steven Joffe, Neal Dickert, Scott Halpern
The shift away from paternalistic decision-making and toward patient-centered, shared decision-making has stemmed from the recognition that in order to practice medicine ethically, health care professionals must take seriously the values and preferences of their patients. At the same time, there is growing recognition that minor and seemingly irrelevant features of how choices are presented can substantially influence the decisions people make. Behavioral economists have identified striking ways in which trivial differences in the presentation of options can powerfully and predictably affect people's choices...
March 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28289013/prescription-rates-of-adrenaline-auto-injectors-for-children-in-uk-general-practice-a-retrospective-cohort-study
#6
Lavanya Diwakar, Carole Cummins, Ronan Ryan, Tom Marshall, Tracy Roberts
BACKGROUND: Adrenaline auto-injectors (AAI) should be provided to individuals considered to be at high risk of anaphylaxis. There is some evidence that the rate of AAI prescription is increasing, but the true extent has not been previously quantified. AIM: To estimate the trends in annual GP-issued prescriptions for AAI among UK children between 2000 and 2012. DESIGN AND SETTING: Retrospective cohort study using data from primary care practices that contributed to The Health Improvement Network (THIN) database...
March 13, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/28274905/a-learning-health-care-system-using-computer-aided-diagnosis
#7
Amos Cahan, James J Cimino
Physicians intuitively apply pattern recognition when evaluating a patient. Rational diagnosis making requires that clinical patterns be put in the context of disease prior probability, yet physicians often exhibit flawed probabilistic reasoning. Difficulties in making a diagnosis are reflected in the high rates of deadly and costly diagnostic errors. Introduced 6 decades ago, computerized diagnosis support systems are still not widely used by internists. These systems cannot efficiently recognize patterns and are unable to consider the base rate of potential diagnoses...
March 8, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28242411/treatment-acceptability-and-preferences-for-managing-severe-health-anxiety-perceptions-of-internet-delivered-cognitive-behaviour-therapy-among-primary-care-patients
#8
Joelle N Soucy, Heather D Hadjistavropoulos
BACKGROUND & OBJECTIVES: While cognitive behaviour therapy (CBT) is an established treatment for health anxiety, there are barriers to service access. Internet-delivered cognitive behaviour therapy (ICBT) has demonstrated effectiveness and has the potential to improve access to treatment. Nevertheless, it is unknown how patients perceive ICBT relative to other interventions for health anxiety and what factors predict ICBT acceptability. This study investigated these questions. METHODS: Primary care patients (N = 116) who reported elevated levels of health anxiety were presented three treatment vignettes that each described a different protocol for health anxiety (i...
February 20, 2017: Journal of Behavior Therapy and Experimental Psychiatry
https://www.readbyqxmd.com/read/28241771/use-of-theory-to-plan-or-evaluate-guideline-implementation-among-physicians-a-scoping-review
#9
REVIEW
Laurel Liang, Susanne Bernhardsson, Robin W M Vernooij, Melissa J Armstrong, André Bussières, Melissa C Brouwers, Anna R Gagliardi
BACKGROUND: Guidelines support health care decision-making and high quality care and outcomes. However, their implementation is sub-optimal. Theory-informed, tailored implementation is associated with guideline use. Few guideline implementation studies published up to 1998 employed theory. This study aimed to describe if and how theory is now used to plan or evaluate guideline implementation among physicians. METHODS: A scoping review was conducted. MEDLINE, EMBASE, and The Cochrane Library were searched from 2006 to April 2016...
February 27, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28237205/value-assessment-frameworks-for-hta-agencies-the-organization-of-evidence-informed-deliberative-processes
#10
Rob Baltussen, Maarten Paul Maria Jansen, Leon Bijlmakers, Janneke Grutters, Anouck Kluytmans, Rob P Reuzel, Marcia Tummers, Gert Jan van der Wilt
Priority setting in health care has been long recognized as an intrinsically complex and value-laden process. Yet, health technology assessment agencies (HTAs) presently employ value assessment frameworks that are ill fitted to capture the range and diversity of stakeholder values and thereby risk compromising the legitimacy of their recommendations. We propose "evidence-informed deliberative processes" as an alternative framework with the aim to enhance this legitimacy. This framework integrates two increasingly popular and complementary frameworks for priority setting: multicriteria decision analysis and accountability for reasonableness...
February 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28225697/who-should-ration
#11
Philip M Rosoff
A principal component of physician decision making is judging what interventions are clinically appropriate. Due to the inexorable and steady increase of health care costs in the US, physicians are constantly being urged to exercise judicious financial stewardship with due regard for the financial implications of what they prescribe. When applied on a case-by-case basis, this otherwise reasonable approach can lead to either inadvertent or overt and arbitrary restriction of interventions for some patients rather than others on the basis of clinically irrelevant characteristics such as ethnicity, gender, age, or skin color...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28224422/satisfaction-of-village-doctors-with-the-township-and-village-health-services-integration-policy-in-the-western-minority-inhabited-areas-of-china
#12
Da Feng, Liang Zhang, Yuan-Xi Xiang, Dong-Lan Zhang, Ruo-Xi Wang, Shang-Feng Tang, Hang Fu, Bo-Yang Li
Township and Village Health Services Integration Management (TVHSIM) is an essential form of China's two-tiered health service integration plan at the township and village level. Its main purpose, also one of the target goals in China's new healthcare reform, is to gradually integrate rural health services and appropriately allocate rural health resources. This study aims to assess the village doctors' satisfaction with the TVHSIM and provide scientific base to further improve TVHSIM. A cross-sectional study was carried out in which 162 village doctors from Qinghai, Inner Mongolia and Xinjiang in western China were interviewed...
February 2017: Journal of Huazhong University of Science and Technology. Medical Sciences
https://www.readbyqxmd.com/read/28217580/how-to-strengthen-primary-health-care
#13
Pratyush Kumar
Realization of health care as primary objective is necessary to strengthen primary health care (PHC). There is a need to build financial viable and sustainable PHC based on rational principles to fulfill the goals of providing quality health services on an affordable and equitable basis and also ensuring fiscal prudence. Health-care leadership, innovations in primary care, family medicine specialists, and effective and accountable health governance are the key steps toward our goal.
July 2016: Journal of Family Medicine and Primary Care
https://www.readbyqxmd.com/read/28208098/-don-t-think-i-m-going-to-leave-you-over-it-accounts-of-changing-hepatitis-c-status-among-couples-who-inject-drugs
#14
Jake Rance, Carla Treloar, Suzanne Fraser, Joanne Bryant, Tim Rhodes
BACKGROUND: While the health-related benefits of intimate partnership are well documented, little attention has been paid to couples exposed to high levels of social stigma and exclusion. In this project we investigated an important site of stigma for partnerships by collecting accounts of changing hepatitis C (HCV) status ("sero-change") among couples that inject drugs. We explored what these accounts reveal about the meaning of HCV for these couples, and how this understanding contributes to our collective efforts at prevention and care...
April 1, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/28192746/changing-the-navigator-s-course-how-the-increasing-rationalization-of-healthcare-influences-access-for-undocumented-immigrants-under-the-affordable-care-act
#15
Laura López-Sanders
A number of researchers have shown that brokers (e.g., navigators and street-level bureaucrats) bridge access to healthcare services and information for immigrant patients through rich personal relationships and a mission of ethical care. An open question remains concerning how the increasing rationalization of healthcare over the past few decades influences brokerage for undocumented immigrant patients. Drawing from fieldwork and interviews conducted in California, as the Affordable Care Act (ACA) was implemented, I develop the concept of the "double-embedded-liaison...
February 2, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28185714/choosing-wisely-the-top-5-recommendations-from-the-italian-panel-of-the-national-guidelines-for-the-management-of-acute-pharyngitis-in-children
#16
Elena Chiappini, Barbara Bortone, Giuseppe Di Mauro, Susanna Esposito, Luisa Galli, Massimo Landi, Andrea Novelli, Paola Marchisio, Gian Luigi Marseglia, Nicola Principi, Maurizio de Martino
PURPOSE: With the aim to reduce waste in the health care system and avoid risks associated with unnecessary treatment, the Italian Panel of the National Guidelines for the Management of Acute Pharyngitis in Children joined the Choosing Wisely initiative. METHODS: An ad hoc Choosing Wisely task force was selected to develop a candidate list of items for the top-5 list on pharyngitis medicine. Through a process of literature review and consensus, the final list of 5 items was chosen...
February 6, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28169041/treatment-of-postmenopausal-osteoporosis-a-literature-based-algorithm-for-use-in-the-public-health-care-system
#17
Ellen Luz Pereira Caires, Mailze Campos Bezerra, Ana Flávia Torquato de Araújo Junqueira, Sheila Márcia de Araújo Fontenele, Silvana Cristina de Albuquerque Andrade, Catarina Brasil d'Alva
Bisphosphonates are considered first-line agents in the treatment of postmenopausal osteoporosis based on extensive experience of use, safety, and proven efficacy in reducing vertebral, non-vertebral and femur fractures. However, post-marketing reports based on the treatment of millions of patients/year over lengthy periods of time have revealed the occurrence of initially unexpected adverse effects, such as osteonecrosis of the jaw and atypical femoral fracture, leading to the restriction of treatment duration with bisphosphonates by global regulatory agencies...
December 27, 2016: Revista Brasileira de Reumatologia
https://www.readbyqxmd.com/read/28157723/integrated-care-pathway-for-rectal-cancer-treatment-health-care-resource-utilization-costs-and-outcomes
#18
Silvia T Kobayashi, Maria D P E Diz, Alessandro G Campolina, Patricia C De Soárez, Ulysses Ribeiro, Sergio C Nahas, Karina G M C Vasconcelos, Fernanda Capareli, Ivan Cecconello, Paulo M Hoff
AIM: Managed Flow C20 (MFC20) is an integrated care pathway (ICP) for rectal cancer implemented at a public teaching hospital. This study aims to quantify resource utilization and estimate direct costs and outcomes associated with the use of this ICP. METHODS: We evaluated consecutive rectal cancer patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery, comparing the period before the ICP implementation (Pre-MFC20 group) and after (MFC20 group)...
February 2, 2017: International Journal of Evidence-based Healthcare
https://www.readbyqxmd.com/read/28139511/evaluation-of-outpatient-antibiotic-use-in-beijing-general-hospitals-in-2015
#19
Chuan Yang, Wen-Qiang Cai, Zi-Jun Zhou
BACKGROUND: Medical misuse of antibiotics is associated with the acquisition and spread of antibiotic resistance, resulting in a lack of effective drugs and increased health-care cost. Nevertheless, inappropriate antibiotic use in China remains common and the situation requires urgent improvement. Here, we analyzed the prescriptions of antibiotics and evaluated the rationality of antibiotic use among outpatients in Beijing general hospitals during 2015. METHODS: We collected basic medical insurance claim data from January 1, 2015 to December 31, 2015 in 507 general hospitals of Beijing...
February 5, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28133598/health-care-as-a-universal-right
#20
Rui Nunes, Sofia B Nunes, Guilhermina Rego
PURPOSE: Most developed societies recognise the existence of a basic right of access to health care of appropriate quality, considering it a positive welfare right. It can even be one of the most important achievements of pluralistic and secular societies. The main objective of this study is to suggest the foundations for a universal right to health care, meaning the right of access to health care of appropriate quality. A second objective is to propose the necessary tools so that access to health care is viable in a specific commonwealth in accordance with available resources...
2017: Zeitschrift Für Gesundheitswissenschaften, Journal of Public Health
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