Gender Differences in Symptoms and Care Delivery for Chronic Obstructive Pulmonary Disease

Abstract Background: Morbidity and mortality for women with chronic obstructive pulmonary disease (COPD) are increasing, and little is known about gender differences in perception of COPD care. Methods: Surveys were administered to a convenience sample of COPD patients to evaluate perceptions about symptoms, barriers to care, and sources of information about COPD. Results: Data on 295 female and 273 male participants were analyzed. With similar frequencies, women and men reported dyspnea and rated their health as poor/very poor. Although more women than men reported annual household income <$30,000, no significant gender differences in frequency of health insurance, physician visits, or ever having had spirometry were detected. In adjusted models (1) women were more likely to report COPD diagnostic delay (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.13-2.45, p=0.01), although anxiety (OR 1.83, 95% CI 1.10-3.06, p=0.02) and history of exacerbations (OR 1.60, 95% CI 1.08-2.37, p=0.01) were also significant predictors, (2) female gender was associated with difficulty reaching one's physician (OR 2.54, 95% CI 1.33-4.86, p=0.004), as was prior history of exacerbations (OR 2.25, 95% CI 1.21-4.20, p=0.01), and (3) female gender (OR 2.15, 95% CI 1.10-4.21, p=0.02) was the only significant predictor for finding time spent with their physician as insufficient. Conclusions: Significant gender-related differences in the perception of COPD healthcare delivery exist, revealing an opportunity to better understand what influences these attitudes and to improve care for both men and women.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98466/1/jwh%2E2012%2E3650.pd

Review article: the economic impact of the irritable bowel syndrome

Background: Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal system affecting a large number of people worldwide. Whilst it has no attributable mortality, it has substantial impact on patients' quality of life (QoL) and is associated with considerable healthcare resource use. Aim: To review the economic impact of IBS, firstly on the individual, secondly on healthcare systems internationally and thirdly to society. Methods: Appropriate databases were searched for relevant papers using the terms: Irritable Bowel Syndrome; IBS; irritable colon; functional bowel/colonic disease; economics; health care/service costs; health expenditure/resources; health care/service utilisation; productivity. Results: Irritable bowel syndrome impacts most substantially on patients' work and social life. Reduction in QoL is such that on average patients would sacrifice between 10 and 15 years of their remaining life expectancy for an immediate cure. Between 15% and 43% of patients pay for remedies. No studies quantify loss of earnings related to IBS. Direct care costs are substantial; 48% of patients incur some costs in any year with annual international estimates per patient of: USA $742–$7547, UK £90–£316, France €567–€862, Canada $259, Germany €791, Norway NOK 2098 (€262) and Iran$92. Minimising extensive diagnostic investigations could generate savings and has been shown as not detrimental to patients. Cost to industry internationally through absenteeism and presenteeism related to IBS is estimated between £400 and £900 per patient annually. Conclusions: costs to patients, healthcare systems and society. Considerable benefit could be obtained from effective interventions

Relations between Financing and Output in the Not-for-Profit Hospital

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68639/2/10.1177_107755878804500204.pd

Delayed granulomatous reaction to hyaluronic acid gel injection

Injectable hyaluronic acid (HA) derivatives are the most used resorbable dermal fillers used for soft tissue augmentation. While their use is considered safe, there have been reports of cutaneous granulomatous reactions.We describe the clinical, radiological, and cytological findings in a patient who presented a full year after cosmetic treatment with HA injections and discuss the various treatment options. Level of Evidence: Level V, therapeutic study

Effective Utilization of Pharmacoeconomics for Decision Makers

Increased worldwide cost consciousness with regard to healthcare spending has resulted in a greater reliance of health systems on pharmacoeconomics as a tool for obtaining optimal value, attaining better outcomes, and controlling spending. In such capacities, pharmacoeconomics is often used as a basis for pricing, purchasing, and reimbursement decisions. Current barriers to the use of pharmacoeconomic data are related to the international coexistence of various evolutionary states of the theory and implementation of pharmacoeconomics, the fragmentation of healthcare budgets, and the diversity of healthcare systems and clinical settings. One result of these barriers is the decision makers' need for more rigorous, more directly relevant pharmacoeconomic data that are presented in an interactive, customizable manner. Other stakeholders in the healthcare market have been noticeably affected by decision makers' use of pharmacoeconomics and the more stringent data demands. Physicians have experienced decreased autonomy, patients have experienced delayed drug access and possibly compromised care, and manufacturers have endured greater financial burden and risk. This paper identifies ways in which manufacturers can maximize the effectiveness of their pharmacoeconomic activities to efficiently meet decision-maker needs, overcome some of the current barriers to the use of pharmacoeconomics, and minimize deleterious effects on major healthcare stakeholders.Healthcare expenditure, Pharmacoeconomics