Methodological issues in assessing changes in costs pre- and post-medication switch: a schizophrenia study example

<p>Abstract</p> <p>Background</p> <p>Schizophrenia is a severe, chronic, and costly illness that adversely impacts patients' lives and health care payer budgets. Cost comparisons of treatment regimens are, therefore, important to health care payers and researchers. Pre-Post analyses ("mirror-image"), where outcomes prior to a medication switch are compared to outcomes post-switch, are commonly used in such research. However, medication changes often occur during a costly crisis event. Patients may relapse, be hospitalized, have a medication change, and then spend a period of time with intense use of costly resources (post-medication switch). While many advantages and disadvantages of Pre-Post methodology have been discussed, issues regarding the attributability of costs incurred around the time of medication switching have not been fully investigated.</p> <p>Methods</p> <p>Medical resource use data, including medications and acute-care services (hospitalizations, partial hospitalizations, emergency department) were collected for patients with schizophrenia who switched antipsychotics (n = 105) during a 1-year randomized, naturalistic, antipsychotic cost-effectiveness schizophrenia trial. Within-patient changes in total costs per day were computed during the pre- and post-medication change periods. In addition to the standard Pre-Post analysis comparing costs pre- and post-medication change, we investigated the sensitivity of results to varying assumptions regarding the attributability of acute care service costs occurring just after a medication switch that were likely due to initial medication failure.</p> <p>Results</p> <p>Fifty-six percent of all costs incurred during the first week on the newly initiated antipsychotic were likely due to treatment failure with the previous antipsychotic. Standard analyses suggested an average increase in cost-per-day for each patient of $2.40 after switching medications. However, sensitivity analyses removing costs incurred post-switch that were potentially due to the failure of the initial medication suggested decreases in costs in the range of$4.77 to $9.69 per day post-switch.</p> <p>Conclusion</p> <p>Pre-Post cost analyses are sensitive to the approach used to handle acute-service costs occurring just after a medication change. Given the importance of quality economic research on the cost of switching treatments, thorough sensitivity analyses should be performed to identify the impact of crisis events around the time of medication change.</p

Pengaruh Pendidikan Kesehatan Bagi Ibu Terhadap Asupan Energi, Aktivitas Fisik Dan Indeks Massa Tubuh Pada Anak Kelebihan Berat Badan

Background : The percentage of overweight children in Bengkulu (16.4%) is higher than the national (11.9%). Factors causing overweight is a high energy intake and low physical activity.Objective : To analyze the impact of health education for mothers in changes of maternal behavior, energy intake, physical activity level and Body Mass Index (BMI) z-score among overweight children 3-6 years old.Methode : Quasi-Experiment with non-randomized pre-post test control group design. Subjects (48 mothers) were selected purposively and divided into 2 groups (treatment and control). Health education in the treatment group was conducted 6 times in 12 weeks. Analyses were conducted by Independent t-test, Mann Whitney, Paired t-test, Wilcoxon and Covariance.Results: There was an increased in attitude score (20.9 ± 3.52), carbohydrate intake percentage (3.7 ± 7.30%) and physical activity level (0.04 ± 0.01) in the treatment group. The energy adequacy level (-3.4 ± 13.26%) and BMI z-score (-0.57 ± 0.26) decreased in the treatment group. There were difference between the treatment and control groups in attitude, energy adequacy level, physical activity level and BMI z-score after intervention (p <0.05).Conclusion: Health education for mothers affect the positive change in mother attitude in terms of the overweight children treatment and increased physical activity level, decreased energy adequacy level and BMI z-score in overweight children

Involvement in the US criminal justice system and cost implications for persons treated for schizophrenia

<p>Abstract</p> <p>Background</p> <p>Individuals with schizophrenia may have a higher risk of encounters with the criminal justice system than the general population, but there are limited data on such encounters and their attendant costs. This study assessed the prevalence of encounters with the criminal justice system, encounter types, and the estimated cost attributable to these encounters in the one-year treatment of persons with schizophrenia.</p> <p>Methods</p> <p>This post-hoc analysis used data from a prospective one-year cost-effectiveness study of persons treated with antipsychotics for schizophrenia and related disorders in the United States. Criminal justice system involvement was assessed using the Schizophrenia Patients Outcome Research Team (PORT) client survey and the victimization subscale of the Lehman Quality of Life Interview (QOLI). Direct cost of criminal justice system involvement was estimated using previously reported costs per type of encounter. Patients with and without involvement were compared on baseline characteristics and direct annual health care and criminal justice system-related costs.</p> <p>Results</p> <p>Overall, 278 (46%) of 609 participants reported at least 1 criminal justice system encounter. They were more likely to be substance users and less adherent to antipsychotics compared to participants without involvement. The 2 most prevalent types of encounters were being a victim of a crime (67%) and being on parole or probation (26%). The mean annual per-patient cost of involvement was $1,429, translating to 6% of total annual direct health care costs for those with involvement (11% when excluding crime victims).</p> <p>Conclusions</p> <p>Criminal justice system involvement appears to be prevalent and costly for persons treated for schizophrenia in the United States. Findings highlight the need to better understand the interface between the mental health and the criminal justice systems and the related costs, in personal, societal, and economic terms.</p

Medication adherence levels and differential use of mental-health services in the treatment of schizophrenia

<p>Abstract</p> <p>Background</p> <p>Adherence to antipsychotics for schizophrenia is associated with favorable clinical outcomes. This study compared annual mental-health service utilization by recent medication adherence levels for patients treated for schizophrenia, and assessed whether adherence levels change from pre- to post-psychiatric hospitalization.</p> <p>Methods</p> <p>We analyzed data from a large prospective, non-interventional study of patients treated for schizophrenia in the United States, conducted between 7/1997 and 9/2003. Detailed mental-health resource utilization was systematically abstracted from medical records and augmented with patients' self report. Medication possession ratio (MPR) with any antipsychotic in the 6 months prior to enrollment was used to categorize patients as: adherent (MPR ≥ 80%, N = 1758), partially adherent (MPR ≥ 60% < 80%, N = 36), or non-adherent (MPR < 60%, N = 216). Group comparisons employed propensity score-adjusted bootstrap re-sampling methods with 1000 iterations, adjusting for baseline patient demographic and clinical characteristics identified a priori.</p> <p>Results</p> <p>Adherent patients had a lower rate of psychiatric hospitalization compared with partially adherent and non-adherent patients (p < 0.001) and were more likely than non-adherent to engage in group therapy, individual therapy, and medication management. Most patients (92.0%) who were adherent in the 6 months prior to hospital admission continued to be adherent 6 months following hospitalization. However, 75.0% of previously partially adherent became adherent, and 38.7% of previously non-adherent became adherent following hospitalization.</p> <p>Conclusion</p> <p>Adherence is associated with lower utilization of acute care services and greater engagement in outpatient mental-health treatment. Adherence is a potentially dynamic phenomenon, which may improve, at least temporarily, following patients' psychiatric hospitalizations.</p

Antecedents of Turnover Intentions: Health Care Staff in Saudi Arabia

This research aims to investigate the antecedents of turnover intentions and the relationship between work stress and job satisfaction among health care staff in Saudi Arabia. Data were collected via an online survey, and the sample consists of 143 health care staff both medical and non-medical staff in Saudi Arabia. Results generated using Statistical Package for Social Science (SPSS). The results show there is a significant positive effect between work stress and turnover intention, and a significant negative effect between job satisfaction and turnover intentions. The results also show that there is significant positive relationship between work stress and job satisfaction. Keywords: Turnover intentions, Work stress, Job satisfaction, Health care staff. DOI: 10.7176/EJBM/13-8-18 Publication date: April 30th 202

Characteristics of patients misdiagnosed with Alzheimer’s disease and their medication use: an analysis of the NACC-UDS database

BACKGROUND: This study compared individuals whose clinical diagnosis of Alzheimer’s disease (AD) matched or did not match neuropathologic results at autopsy on clinical and functional outcomes (cognitive impairment, functional status and neuropsychiatric symptoms). The study also assessed the extent of potentially inappropriate medication use (using potentially unnecessary medications or potentially inappropriate prescribing) among misdiagnosed patients. METHODS: Longitudinal data from the National Alzheimer’s Coordinating Center Uniform Data Set (NACC-UDS, 2005–2010) and corresponding NACC neuropathological data were utilized to compare 88 misdiagnosed and 438 accurately diagnosed patients. RESULTS: Following adjustment of sociodemographic characteristics, the misdiagnosed were found to have less severe cognitive and functional impairment. However, after statistical adjustment for sociodemographics, dementia severity level, time since onset of cognitive decline and probable AD diagnosis at baseline, the groups significantly differed on only one outcome: the misdiagnosed were less likely to be depressed/dysphoric. Among the misdiagnosed, 18.18% were treated with potentially inappropriate medication. An additional analysis noted this rate could be as high as 67.10%. CONCLUSIONS: Findings highlight the importance of making an accurate AD diagnosis to help reduce unnecessary treatment and increase appropriate therapy. Additional research is needed to demonstrate the link between potentially inappropriate treatment and adverse health outcomes in misdiagnosed AD patients

Freezing of hard spheres confined in narrow cylindrical pores

Monte Carlo simulations for the equation of state and phase behavior of hard spheres confined inside very narrow hard tubes are presented. For pores whose radii are greater than 1.1 hard sphere diameters, a sudden change in the density and the microscopic structure of the fluid is neatly observed, indicating the onset of freezing. In the high-density structure the particles rearrange in such a way that groups of three particles fit in sections across the por