Pharmacoeconomic evaluation in cost of illness in type 2 diabetes mellitus patients in a tertiary care hospital

Background: India is expected to bear the burden of world’s greatest increase of diabetes population. This burden needs to be considered in terms of costs.Methods: Cross-sectional study was done in type 2 diabetes mellitus 100 patients that attended Medicine OPD. Prior to enrollment Institutional Ethics Committee permission was taken. Written Informed consent was taken. Demographic information related to Education, Occupation and Income was taken down. Also Information related to diagnostic tests and medications were documented. Inclusion criterion were 18-70 years of either gender diagnosed by Physicians in OPD as type 2 diabetes, willing to participate and have followed in OPD for at least one year. The Exclusion criterion was Critically ill or unconscious patients and Pregnant women. Direct and indirect costs were calculated.Results: The average age was 56.31±10.50 years. The average fasting blood glucose was 120.65±22.70mg/dl. The average cost per month for investigations was 159.74±128.06. Annual visit to OPD was 13.06±7.35. Time loss per visit was 5.62±1.29 hours and of accompanying person was 6.55±3.87 hours. There were 2 from Lower and 63 from Upper Lower socioeconomic class. There were 41 patients having diabetic complications. The indirect cost was around 5838.51 and direct cost was around 19925. Total cost per annum per patient was around 32361.27 INR.Conclusions: There is need for strategies to reduce the cost burden. There is also needed to design financial systems for diabetes related nationwide health programs

Optimising corticosteroid injection for lateral epicondylalgia with the addition of physiotherapy: A protocol for a randomised control trial with placebo comparison

<p>Abstract</p> <p>Background</p> <p>Corticosteroid injection and physiotherapy are two commonly prescribed interventions for management of lateral epicondylalgia. Corticosteroid injections are the most clinically efficacious in the short term but are associated with high recurrence rates and delayed recovery, while physiotherapy is similar to injections at 6 weeks but with significantly lower recurrence rates. Whilst practitioners frequently recommend combining physiotherapy and injection to overcome harmful effects and improve outcomes, study of the benefits of this combination of treatments is lacking. Clinicians are also faced with the paradox that the powerful anti-inflammatory corticosteroid injections work well, albeit in the short term, for a non-inflammatory condition like lateral epicondylalgia. Surprisingly, these injections have not been rigorously tested against placebo injections. This study primarily addresses both of these issues.</p> <p>Methods</p> <p>A randomised placebo-controlled clinical trial with a 2 × 2 factorial design will evaluate the clinical efficacy, cost-effectiveness and recurrence rates of adding physiotherapy to an injection. In addition, the clinical efficacy and adverse effects of corticosteroid injection beyond that of a placebo saline injection will be studied. 132 participants with a diagnosis of lateral epicondylalgia will be randomly assigned by concealed allocation to one of four treatment groups – corticosteroid injection, saline injection, corticosteroid injection with physiotherapy or saline injection with physiotherapy. Physiotherapy will comprise 8 sessions of elbow manipulation and exercise over an 8 week period. Blinded follow-up assessments will be conducted at baseline, 4, 8, 12, 26 and 52 weeks after randomisation. The primary outcome will be a participant rating of global improvement, from which measures of success and recurrence will be derived. Analyses will be conducted on an intention-to-treat basis using linear mixed and logistic regression models. Healthcare costs will be collected from a societal perspective, and along with willingness-to-pay and quality of life data will facilitate cost-effectiveness and cost-benefit analyses.</p> <p>Conclusion</p> <p>This trial will utilise high quality trial methodologies in accordance with CONSORT guidelines. Findings from this study will assist in the development of evidence based practice recommendations and potentially the optimisation of resource allocation for rehabilitating lateral epicondylalgia.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trials Register ACTRN12609000051246</p

A Policy-into-Practice Intervention to Increase the Uptake of Evidence-Based Management of Low Back Pain in Primary Care: A Prospective Cohort Study

BACKGROUND: Persistent non-specific low back pain (nsLBP) is poorly understood by the general community, by educators, researchers and health professionals, making effective care problematic. This study evaluated the effectiveness of a policy-into-practice intervention developed for primary care physicians (PCPs). METHODS: To encourage PCPs to adopt practical evidence-based approaches and facilitate time-efficient, integrated management of patients with nsLBP, we developed an interdisciplinary evidence-based, practical pain education program (gPEP) based on a contemporary biopsychosocial framework. One hundred and twenty six PCPs from primary care settings in Western Australia were recruited. PCPs participated in a 6.5-hour gPEP. Self-report measures recorded at baseline and at 2 months post-intervention included PCPs' attitudes, beliefs (modified Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS), evidence-based clinical practices (knowledge and skills regarding nsLBP management: 5-point Likert scale with 1  =  nil and 5  =  excellent) and practice behaviours (recommendations based on a patient vignette; 5-point Likert scale). RESULTS: Ninety one PCPs participated (attendance rate of 72%; post-intervention response rate 88%). PCP-responders adopted more positive, guideline-consistent beliefs, evidenced by clinically significant HC-PAIRS score differences (mean change  =  -5.6±8.2, p<0.0001; 95% confidence interval: -7.6 to -3.6) and significant positive shifts on all measures of clinical knowledge and skills (p<0.0001 for all questions). Self management strategies were recommended more frequently post-intervention. The majority of responders who were guideline-inconsistent for work and bed rest recommendations (82% and 62% respectively) at pre-intervention, gave guideline-consistent responses at post-intervention. CONCLUSION: An interprofessional pain education program set within a framework that aligns health policy and practice, encourages PCPs to adopt more self-reported evidence-based attitudes, beliefs and clinical behaviours in their management of patients with nsLBP. However, further research is required to determine cost effectiveness of this approach when compared with other modes of educational delivery and to examine PCP behaviours in actual clinical practice

The establishment of a primary spine care practitioner and its benefits to health care reform in the United States

It is widely recognized that the dramatic increase in health care costs in the United States has not led to a corresponding improvement in the health care experience of patients or the clinical outcomes of medical care. In no area of medicine is this more true than in the area of spine related disorders (SRDs). Costs of medical care for SRDs have skyrocketed in recent years. Despite this, there is no evidence of improvement in the quality of this care. In fact, disability related to SRDs is on the rise. We argue that one of the key solutions to this is for the health care system to have a group of practitioners who are trained to function as primary care practitioners for the spine. We explain the reasons we think a primary spine care practitioner would be beneficial to patients, the health care system and society, some of the obstacles that will need to be overcome in establishing a primary spine care specialty and the ways in which these obstacles can be overcome.https://doi.org/10.1186/2045-709X-19-1

Flour Mill Workers Occupational Noise Exposure in Chandrapur City, Central India

Assessment of occupational noise exposure of flour mill workers in Chandrapur city of central India was carried out during November 2015-January 2016. Total 62 flour mills were selected for this study comprising one, two and three grinding machines operating in the shop floor. The sound level meter was used to measure sound level at 50 cm and 3 meters from grinding machines at receiver’s position during operation. Noise monitoring was also recorded when one, two and three machines were operating individually and simultaneously. The results showed that noise levels when one grinding machine in operation in close proximity (50 cm) was in the range of 80-97 dB(A). Comparison of these observations with that of 3 meters distance; it was observed that noise levels got reduced and in the range of 70-77 dB(A). In the case of two machines in operation, it was in the range of 95-118 dB(A) at 50 cm distance and reduced to 75-95 dB(A) at 3 meters distance. This reduction in noise level was due to the propagation of noise in the ambient environment. Furthermore, daily noise exposure points, exposure points job per task and exposure points per hour were computed by using noise exposure calculator developed by Health and Safety Executive (HSE), United Kingdom. The computation from this calculator revealed that these attributes were directly depended upon noise levels in flour mills and duration of noise exposure. A positive linear Pearson’s correlation (p&lt;0.01) was observed between noise level and exposure points per hour. Of the 65 flour mill workers surveyed, 70.76% reported a hearing problem, 23.07% headache at work and out of which 7.69% workers headache remains after completion of work also. Remedial measures to control noise exposure to flour mill workers such as ear plugs, ear muff, semi-insert are recommended.</p

Stakeholders Behaviour towards Clean India Mission's New Municipal Solid Waste Collection System in Chandrapur City, Central India

The study was carried out to analyze behavioural pattern of stakeholders–inhabitants of Chandrapur city as well as employees of Chandrapur Municipal Corporation (CMC)–towards the "Clean India Mission" scheme as compared with previous scheme of women’s self help group. For behavioural change analysis field survey was carried out in October 2015 in Chandrapur city. Total 41 respondent including inhabitants and employees of CMC were interviewed. The results of the study shows that, previously municipal solid waste (MSW) collection was irregular (41.66%) however, since the implementation of this new scheme it has become regular (100%). Enhanced MSW collection frequency was observed (once a day, 83.33%) with alternative staff arrangement in case of staff is absent. The work was monitored by officials (79%) which were previously not existing. In previous scheme, extra money was charged for collection of MSW, however no such charges are levied in this new scheme. Satisfaction rate of this new scheme was 95.83% among inhabitants. As reported by MSW collection employees, there was awareness among inhabitants about dry and wet waste (41.17%). The employees were satisfied with the scheme (94.11%) as there is improved and timely salary with a job guaranty.INTERNATIONAL JOURNAL OF ENVIRONMENTVolume-5, Issue-4, Sep-Nov 2016, page: 32-43</p