What happens to quality in integrated homecare? A 15-year follow-up study

<p><strong>Objectives:</strong> To explore the impact of structural integration on homecare quality.</p><p><strong>Methods:</strong> A case study in an organisation comprising a before-after comparison with baseline and four follow-up measurements during 1994-2009, using interviews with clients (n=66-84) and postal inquiries to relatives (n=73-78) and staff (n=68-136).</p><p><strong>Results</strong>: Despite the organisational reform involving extensive mergers of health and social care organisations and cuts in staff and service provision, homecare quality remained at almost the same level throughout the 15-year follow-up. According to the clients, it even slightly improved in some homecare areas.</p><p><strong>Conclusions:</strong> The results show that despite the structural integration and cuts in staff and service provision, the quality of homecare remained at a good level. Assuming that the potential confounders did have inhibiting effects, the results suggest that structural integration had a positive impact on homecare quality. To obtain firmer evidence to support this tentative conclusion, further research with a randomised comparison design is needed.<strong> </strong></p

Subjective measures of binge drinking and adverse health outcomes : Self-reported intoxications, hangovers, and alcohol-induced pass-outs as indicators of at-risk drinking patterns in the Finnish adult population

The purpose of this study is to validate three subjective measures of binge drinking, i.e. subjectively defined intoxications/drunkenness, hangovers, and alcohol-induced pass-outs as indicators of at-risk drinking patterns. There are no previous prospective studies which would have assessed the relative performance of these three separate indicators. This study used data from the Health and Social Support Study (HeSSup), which consists of a baseline measurement in 1998 (n=25 901), and a repeated measurement after five years in 2003 (n=19 629). The baseline sample was stratified by gender and four age groups (aged 20–24, 30–34, 40–44, 50–54 years at baseline). Measures of alcohol use included beverage-specific average total intake, frequency of intoxications/drunkenness, frequency of hangovers, and frequency of alcohol-induced pass-outs. The baseline postal survey data was linked with follow-up information from national registers on hospitalizations and deaths. The results showed that subjects at higher frequency levels of a given binge drinking measure drank on average more than subjects at lower frequency levels. Hangover frequency levels were associated with slightly higher average intake than the corresponding frequency levels of intoxication, suggesting that hangovers, on average, reflected somewhat heavier drinking than intoxications. All three binge drinking measures were markedly more frequently reported by persons who were diagnosed with an alcohol-specific diagnosis than by persons who were not. The relative differences were largest in high-frequency binge drinking, and in binge drinking measures potentially capturing higher intensity binge drinking, i.e. in hangovers and pass-outs. The results on the ability of each binge drinking measure to predict adverse health outcomes showed positive graded relations (dose response relation). The results of this study, thus, support the feasibility and utility of using these three measures as indicators of at-risk drinking patterns in epidemiological research. The results demonstrated that in terms of methodological performance, the three indicators were complementary to each other, meaning that each measure contained additional information of the risk of adverse health outcomes that was not captured by the other two indicators, or by total intake. Self-reported intoxications, alcohol-induced hangovers, and alcohol-induced pass-outs had both diagnostic and prognostic utility in identifying harmful alcohol drinking patterns at the population level. Because asking about the number of drinking occasions leading to intoxication, experiencing a hangover, or passing out as a consequence of drinking is much simpler and quicker than asking about quantities of intake of various different beverage types and beverage ethanol strengths, these results have important implications to clinical and public health practice as well. Public health messages aimed to reduce alcohol-related harm should be formulated to encourage avoiding/cutting-down drinking until intoxication in general, but highlighting the prognostic role of experiencing alcohol-induced hangovers and alcohol-induced pass-outs could potentially enhance that message further as these indicators could serve as face valid self-screening instruments.Tämän tutkimuksen tarkoituksena on validoida kolme humalajuomisen mittaria: humaltumistiheys, krapulatiheys ja sammumistiheys. Tämä on ensimmäinen seurantatutkimus, jossa on voitu selvittää näiden kolmen mittarin toimivuutta ja keskinäistä paremmuutta haitallisen juomatavan indikaattoreina. Tutkimuksessa käytettiin Sosiaalisen tuen terveysvaikutukset (HeSSup) aineistoa, joka käsittää lähtötason mittauksen vuonna 1998 (n=25 901) ja toistomittauksen viiden vuoden jälkeen vuonna 2003 (n=19 629). Vastaajat olivat vuonna 1998 iältään 20–54 -vuotiaita. Alkoholin kulutuksen mittarit olivat keskimääräinen kokonaiskulutus juomalajeittain, humaltumistiheys, krapulatiheys, ja sammumistiheys. Postikyselyyn vastanneiden tiedot liitettiin rekisteritietoihin sairaalahoidoista ja kuolemansyistä. Tulokset osoittivat, että kunkin humalamuuttujan ylemmillä tiheystasoilla olevat vastaajat joivat keskimäärin enemmän kuin vastaajat alemmilla tiheystasoilla. Krapulatiheystasot olivat yhteydessä hieman korkeampiin kulutusmääriin kuin vastaavat humalatiheystasot, mikä antoi viitteitä siitä, että krapulajuomiskerroilla kulutettiin keskimäärin enemmän alkoholia kuin humalajuomiskerroilla. Tulokset osoittivat, että vastaajat jotka saivat seurannan aikana alkoholiin liittyvän diagnoosin, raportoivat selvästi enemmän kaikkia kolmea humalajuomistyyppiä, kuin vastaajat, jotka eivät saaneet vastaavaa diagnoosia. Suhteelliset erot kolmen humalajuomistyypin yleisyydessä olivat suurimmillaan ylemmillä humalajuomistiheystasoilla, ja mittareissa jotka potentiaalisesti kuvasivat korkeampaa humalajuomisintensiteettiä (krapulat ja sammumiset). Kaikki kolme humalajuomisen mittaria ennusti terveyshaittoja annos vaste -suhteella. Tämän tutkimuksen tulokset tukevat itseilmoitetun humalatiheyden, krapulatiheyden ja sammumistiheyden soveltuvuutta ja käyttökelpoisuutta haitallisen juomatavan osoittimina epidemiologisissa tutkimuksissa. Tulokset osoittivat, että menetelmällisestä näkökulmasta käsin nämä kolme humalajuomisen mittaria täydensivät toisiaan, eli kukin mittari sisälsi lisäinformaatiota alkoholihaittojen riskistä, jota toiset mittarit eivät kyenneet selittämään. Koska humaltumiseen, krapulan kokemiseen ja sammumiseen johtavien juomiskertojen lukumäärän kysyminen on huomattavasti yksinkertaisempaa ja nopeampaa kuin vaihteleviin juomalajeihin ja etanolipitoisuuksiin perustuvan kokonaiskulutuksen kysyminen, näillä tuloksilla on myös käytännön merkitystä kliiniselle ja kansanterveydelliselle työlle. Alkoholihaittojen ehkäisyyn pyrkivän kansanterveydellisen viestin tulisi kannustaa välttämään ja vähentämään humalajuomista yleensä, mutta krapulan kokemisen ja sammumisten haittoja ennustavan roolin esille tuominen voisi vahvistaa tätä viestiä entisestään, koska nämä juomatapaindikaattorit voisivat toimia ymmärrettävinä ja hyväksyttävinä itse toteutetun haitallisen juomatavan tunnistamisen keinoina

Purchases of prescription drugs before an alcohol-related death : A ten-year follow-up study using linked routine data

Background: Physician's intention to prescribe drugs could potentially be used to improve targeting of alcohol interventions and enhanced disease management to patients with a high risk of severe alcohol-related harm within outpatient settings. Methods: Comparison of ten-year incidence trajectories of 13.8 million reimbursed purchases of prescription drugs among 303,057 Finnish men and women of whom 7490 ultimately died due to alcohol-related causes (Ale+), 14,954 died without alcohol involvement (Alc-), and 280,613 survived until the end of 2007. Results: 5-10 years before death, 88% of the persons with an Alc+ death had received prescription medication, and over two-thirds (69%) had at least one reimbursed purchase of drugs for the alimentary tract and metabolism, the cardiovascular system, or the nervous system. Among persons with an Alc+ death, the incidence rate (IR) for purchases of hypnotics, and sedatives was L38 times higher (95% confidence interval (C1):1.32,1.44) compared to those with an Alc death, and 4.07 times higher (95%C1:3.92,4.22) compared to survivors; and the IR for purchases of anxiolytics was 1.40 times higher (95%Ck1.34,1.47) compared to those with an Ale death, and 3.61 times higher (95%C1:3.48,3.78) compared to survivors. Conclusions: Using physician's intention to prescribe drugs affecting the alimentary tract and metabolism, cardiovascular system and nervous system could potentially be used to flag patients who might benefit from screening, targeted interventions or enhanced disease management. In particular, patients who are to be prescribed anxiolytics, hypnotics, and sedatives, and antidepressants may benefit from enhanced interventions targeted to problem drinking.Peer reviewe

Non-Employment Histories of Middle-Aged Men and Women Who Died from Alcohol-Related Causes: A Longitudinal Retrospective Study

Peer reviewe

Peri-Conceptual and Mid-Pregnancy Alcohol Consumption:A Comparison between Areas of High and Low Deprivation in Scotland

© 2016 Wiley Periodicals, Inc. Background: Alcohol-related mortality and morbidity among women has increased over recent decades, especially in areas of higher deprivation. Pre-pregnancy alcohol use is associated with continued consumption in pregnancy. We assessed whether general population alcohol consumption patterns were reflected among pregnant women in two Scottish areas with different deprivation levels. Methods: Cross-sectional study in two health boards (HB1, lower deprivation levels, n = 274; HB2, higher deprivation levels, n = 236), using face-to-face 7-day Retrospective Diary estimation of peri-conceptual and mid-pregnancy alcohol consumption. Results: A greater proportion of women in HB2 (higher deprivation area) sometimes drank peri-conceptually, but women in HB1 (lower deprivation area) were more likely to drink every week (49.6 vs 29.7%; p < 0.001) and to exceed daily limits (6 units) at least once each week (32.1 vs 14.8%; p < 0.001). After pregnancy recognition, consumption levels fell sharply, but women in HB2 were more likely to drink above recommended daily limits (2 units) each week (2.5 vs 0.0%; p < 0.05). However, women in HB1 were more likely to drink frequently. Women with the highest deprivation scores in each area drank on average less than women with the lowest deprivation scores. Conclusions: Heavy episodic and frequent consumption was more common in the lower deprivation area, in contrast with general population data. Eliciting a detailed alcohol history at the antenatal booking visit, and not simply establishing whether the woman is currently drinking, is essential. Inconsistent messages about the effects of alcohol in pregnancy may have contributed to the mixed picture we found concerning peri-conceptual and mid-pregnancy alcohol consumption