Sosioekonomisen aseman yhteys muistisairauslääkkeiden käytön aloitukseen kotona-asuvilla 65 vuotta täyttäneillä: väestöpohjainen kohorttitutkimus

Varhaisella diagnoosilla ja lääkehoidolla pystytään hidastamaan muistisairauksien etenemistä ja parantamaan sairastuneiden toimintakykyä sekä elämänlaatua. Tämän tutkimuksen tavoitteena on selvittää, toteutuuko yhdenvertaisuus uuden muistisairauslääkkeen käytön aloituksessa sosioekonomisten ryhmien välillä. Tutkimuksen paneeliaineisto on 10 prosentin satunnaisotos vuonna 2000 65 vuotta täyttäneistä kotona asuvista suomalaisista (n=64 250), joita on seurattu vuosien 2000–2013 ajan. Tässä kansallisiin rekisteritietoihin perustuvassa kohorttitutkimuksessa tarkasteltiin ensiksi AKE-estäjien uusien käyttäjien (n=6 977) uuden muistisairauslääkkeen (memantiini) käytön aloitusta vuosien 2002–2013 aikana. Toisessa analyysissä tarkasteltiin osa-aineistossa sairaalahoitodiagnoosin saaneita muistisairauslääkkeiden uusia käyttäjiä (n=3 475) vuosien 2003–2013 aikana. Coxin suhteellisten riskitiheyksien mallin avulla tarkasteltiin sosioekonomisen aseman yhteyttä 1) memantiinin käytön aloitukseen AKE-estäjän käytön aloittaneilla, ja 2) muistisairauslääkkeen käytön aloitukseen ensimmäisestä kognitiivisiin oireisiin liittyvästä sairaalahoitodiagnoosista. AKE-estäjien käyttäjillä ylempi sosioekonominen asema lisäsi memantiinin käytön aloitusta (suhteellinen riskitiheys (hazard ratio (HR)) 1,43, 95% luottamusväli (LV) 1,23-1,68, p< 0,001). Sairaalahoitodiagnoosin saaneilla sosioekonominen asema ei ollut yhteydessä muistisairauslääkkeen käytön aloitukseen. Lääkehoidon innovaatioiden käyttöönottoon liittyy tämän tutkimuksen mukaan eriarvoisuutta sosioekonomisten ryhmien välillä. Tulevaisuudessa tulisi tutkia, mitkä taustalla olevat tekijät johtavat terveydenhuollon innovaatioihin liittyvään eriarvoisuuteen

Cost-effectiveness of an educational intervention to reduce potentially inappropriate medication

Background Educational interventions can reduce potentially inappropriate medication (PIM) use in older people. Their effectiveness has been measured mainly as changes in PIM use. In this economic evaluation, we analyse the impact of an educational intervention in terms of costs and quality-adjusted life years (QALYs). Methods The educational intervention consisted of activating and interactive training sessions for nursing staff and consulting physicians, and was compared with treatment as usual (TAU). Participants (n = 227) in a cluster randomised trial (cRCT) were residents living permanently in assisted living facilities (n = 20 wards). For economic evaluation, participants' healthcare service use costs and costs for the intervention were estimated for a 12 month period. Incremental cost-effectiveness ratios (ICERs) were estimated for QALYs per participant. Cost-effectiveness analysis was conducted from a healthcare perspective. A bootstrapped cost-effectiveness plane and one-way sensitivity analysis were undertaken to analyse the uncertainty surrounding the estimates. Results The educational intervention was estimated to be less costly and less effective in terms of QALYs than TAU at the 12 month follow-up [incremental costs -euro1,629, confidence interval (CI) -euro5,489 to euro2,240; incremental effect -0.02, CI -0.06 to 0.02]. The base case ICER was >euro80,000/QALY. Conclusion The educational intervention was estimated to be less costly and less effective in terms of QALYs compared with TAU, but the results are subject to some uncertainties. Reduction in PIM use or benefits in quality of life did not seem to translate into improvements in QALYs. Our findings emphasise the need for better understanding of the impact of decreasing PIM use on health outcomes.Peer reviewe

The effect of educational intervention on use of psychotropics in defined daily doses and related costs - a randomized controlled trial

Objective To investigate the effect of an educational intervention of nursing staff on change in psychotropic use and related costs among older long-term care residents. Design A secondary analysis of a randomized controlled intervention study with 12 months of follow-up. Setting Assisted living facilities in Helsinki, Finland. Subjects Older (>= 65 years) residents (N = 227) living in assisted living facility wards (N = 20) in Helsinki in 2011. Intervention The wards were randomized into two groups. In one group, the nursing staff received training on appropriate medication therapy and guidance to recognize potentially harmful medications and adverse effects (intervention group); in the other group, the nursing staff did not receive any additional training (control group). Main outcome measures Change of psychotropic use counted as relative proportions of WHO ATC-defined daily doses (rDDDs) among older long-term care residents. In addition, the change in drug costs was considered. Comparable assessments were performed at 0, 6, and 12 months. Results A significant decrease in both rDDDs and the cost of psychotropics was observed in the intervention group at 6 months follow-up. However, at 12 months, the difference between the intervention and control group had diminished. Conclusions Educational training can be effective in reducing the doses and costs of psychotropics. Further studies are warranted to investigate whether long-term effects can also be achieved by various educational interventions. Registration number ACTRN 12611001078943Peer reviewe

Emättimen mikrobiomi terveyden ylläpitäjänä

English summaryPeer reviewe

Review: Economic evidence of preventive interventions for anxiety disorders in children and adolescents - a systematic review

BackgroundAnxiety disorders are common in children and youth. Also, in prevention, be it universal, selective or indicated, economic evaluation supports decision-making in the allocation of scarce resources. This review identified and summarised the existing evidence of economic evaluations for the prevention of anxiety disorders in children and adolescents.MethodsA systematic search was conducted on the EBSCO, Scopus, Web of Science, ProQuest, Cochrane and PubMed databases. We included studies that focused on children and adolescents under 18 years of age, aimed to prevent anxiety disorders and presented an incremental analysis of costs and effectiveness. A registered checklist was used that assessed the quality of the included articles.ResultsThe search yielded 1697 articles. Five articles were included in this review. Three were RCT-based, and two were model-based studies. Out of five included interventions, one was a universal school-based intervention, two selective interventions and two indicated interventions. Universal school-based prevention of anxiety was not cost-effective compared with usual teaching. Selective parent training and indicative child- and parent-focused CBT prevention were likely cost-effective compared with usual care or doing nothing.ConclusionParent education and cognitive behaviour therapy interventions can be cautiously interpreted as being a cost-effective way of preventing anxiety in children and adolescents. However, the evidence is weakly related to cost-effectiveness as there are only a few studies, with relatively small sample sizes and short follow-ups.</p

Perehdyttämiskansio Esperi Care Oy Kuopion kotihoito- ja turvapuhelinpalveluille

Opinnäytetyön tarkoituksena oli tuottaa Esperi Care Oy Kuopion kotihoito- turvapuhelinpalveluille perehdyttämiskansio perehdyttämisen kehittämisen apuvälineeksi. Perehdyttämiskansiosta haluttiin helposti muokattava ja mahdollisimman hyvin työntekijöitä palveleva. Kansiosta tehtiin kaksiosainen. Toinen koko Esperi Care Oy:tä koskeva osio ja toinen käytännönläheisempi yksikkökohtainen osio. Lähtötilanne Esperi Care Oy Kuopion kotihoito- ja turvapuhelinpalveluissa oli, että perehdyttämiskansio ei ollut ajantasainen, jonka vuoksi sitä ei ole voitu hyödyntää. Perehdyttäminen oli muistinvaraista ja siten hajanaista. Perehdyttämisen suunnittelua ja kehittämistä helpottamaan haluttiin aineistoa, johon tukeutua. Toimiminen sosiaali- ja terveydenhuollossa luo erilaisia haasteita myös perehdyttämiselle. Tieto perehdyttämiskansioon kerättiin havaintojen ja kokemuksien perusteella sekä työntekijöiden ja toimeksiantajan toiveiden pohjalta. Perehdyttämiskansion yksikkökohtaista osiota varten kysyttiin Kuopion kotihoito- ja turvapuhelinpalveluiden työntekijöiltä, mitä heidän mielestään uuden perehdyttämiskansion tulisi sisältää. Tätä varten yksikön seinällä oli kesän 2008 ajan juliste, johon työntekijät saivat kirjoittaa kommentteja. Perehdyttämiskansiosta on hyötyä perehdytyksen laadun takaamiselle, sen avulla perehdytys on johdonmukaisempaa ja tehokkaampaa. Perehdyttämiskansion muokkaaminen on tehty helpoksi, joten sitä voidaan hyödyntää myös tulevaisuudessa. Perehdyttämiskansion päivitysvastuu jää toimeksiantajalle.The aim of the thesis was to develop the orientation in Esperi Care Oy, Home care and safety telephone services in Kuopio, by creating an orientation guide. The goal was to make an orientation guide that is easy to modify and serves the employees’ needs. The guide consists of two parts; first part includes information on the whole company and latter part consists of information on the home care and safety telephone unit in Kuopio. The earlier orientation guide in Esperi Care Oy, home care and safety telephone services in Kuopio was not up-to-date; therefore it was impracticable. The content of orientation was discursive because it was relying on the memory of the employee giving the orientation. The guide would also make the planning and developing of orientation easier. Working in social- and healthcare services creates challenges also for orientation. The information for the orientation guide was collected by using observation, experience and the wishes from employees and executive organisation. The employees in Kuopios unit were asked what they thought the orientation guide should include. There was a poster on the wall of the unit during summer 2008 where all the employees could write their oppinion. The orientation guide is going to guarantee the quality of orientation by making it more effective and logical. The guide can be used in the future because its modification has been made easy. The executive organisation is responsible for updating the orientation guide

Kuntien kokonaisulkoistusten kustannusvaikutukset: rekisteriaineistoon perustuva analyysi

Outsourcing of health services has increased in municipalities over the past few years, but there is little research on the cost effects of such reforms. The aim of this study was to find out whether the standard and net operating costs of the health services in fully outsourced municipalities differ from the costs of municipalities which produce health services in-house. Total outsourcing refers to a situation where the municipality uses a private service provider to deliver healthcare services and often also some segments of the social services.   The research is based on the registry data collected in the STN IMPRO research project of the Academy of Finland. The data contains information on the use of health services by municipalities, supplemented with the data from the Sotkanet database of the Institute of Health and Welfare on the net operating costs. Using the difference-in-differences with multiple time periods analysis, we compared the standard and net operating costs of the health services of the municipalities performing total outsourcing in 2016–2018 (n= 14) with the corresponding costs of the control municipalities (n=218).   The outsourcing had no effect on the standard costs in primary care (59,0 €/inhabitant, p=0,296), but the net operating costs of primary care decreased (-154,9 €/inhabitant p=0,001) compared to the control group. The standard costs of specialized care decreased (-96,4 € /inhabitant, p=0,027), but the net operating costs did not change (38,7 € /inhabitant, p=0,373). In the overall health services statistically significant effect was observed neither in standard costs (37,4 € /inhabitant, p= 0,621) nor in net operating costs (-116,1 € /inhabitant, p=0,108).   The total use of specialized medical care, i.e., the standard costs, in the outsourcing municipalities decreased, but this was not reflected in the net costs of specialized medical care. On the other hand, the net operating costs of primary healthcare decreased even though the use of primary care services did not change. Elucidating the factors behind the deviations in the amount of service use and the corresponding net costs observed in our study requires further research.Terveyspalvelujen ulkoistaminen on lisääntynyt viime vuosina, mutta ulkoistamisen kustannusvaikutuksista on vähän tutkimustietoa. Tämän tutkimuksen tavoitteena oli selvittää eroavatko kokonaisulkoistaneiden kuntien terveyspalvelujen standardi- tai nettokäyttökustannukset palvelut omana tuotantona tuottavien kuntien kustannuksista.   Tutkimus perustuu Suomen akatemian STN IMPRO-tutkimusprojektin rekisteriaineistoon, joka sisältää tiedot kuntien terveyspalvelujen käytöstä, sekä Terveyden ja hyvinvoinnin laitoksen Sotkanet-tietokannan tietoihin kuntien nettokäyttökustannuksista. Tutkimuksessa verrattiin useiden aikajaksojen difference-in-differences -menetelmän avulla kokonaisulkoistuksen vuosina 2016–2018 tehneiden kuntien (n=14) terveyspalvelujen standardi- ja nettokäyttökustannuksia verrokkikuntien (n=218) vastaaviin kustannuksiin. Valitun menetelmän avulla voitiin arvioida ulkoistuksen vaikutuksia kunnissa, joissa ulkoistaminen on alkanut eri vuosina.    Kokonaisulkoistuksella ei ollut vaikutusta perusterveydenhuollon standardikustannuksiin (59,0 €/asukas, p=0,296), mutta perusterveydenhuollon nettokäyttökustannukset laskivat (-154,9 €/asukas, p=0,001) verrattuna oman tuotannon kuntiin. Erikoissairaanhoidon standardikustannukset laskivat (-96,4 €/asukas, p=0,027), mutta nettokäyttökustannukset eivät muuttuneet (38,7 €/asukas, p=0,373). Terveystoimen standardikustannuksissa (37,4 €/asukas, p= 0,621) tai nettokäyttökustannuksissa (-116,1 €/asukas, p=0,108) ei havaittu tilastollisesti merkitsevää vaikutusta.   Kokonaisulkoistuksen tehneiden kuntien erikoissairaanhoidon käytön kokonaismäärä standardikustannuksina mitattuna laski, mutta tämä ei näkynyt nettokäyttökustannuksissa. Kokonaisulkoistuksen tehneiden kuntien perusterveydenhuollon nettokäyttökustannukset asukasta kohden puolestaan laskivat vaikka käytön määrä ei muuttunut. Tutkimuksessa havaittujen palvelujen käytön määrän ja niitä vastaavien nettokustannusten poikkeamien taustalla olevien tekijöiden selvittäminen edellyttää jatkotutkimuksia

The effect of educational intervention on use of psychotropics in defined daily doses and related costs – a randomized controlled trial

AbstractObjective To investigate the effect of an educational intervention of nursing staff on change in psychotropic use and related costs among older long-term care residents.Design A secondary analysis of a randomized controlled intervention study with 12 months of follow-up.Setting Assisted living facilities in Helsinki, Finland.Subjects Older (≥65 years) residents (N = 227) living in assisted living facility wards (N = 20) in Helsinki in 2011.Intervention The wards were randomized into two groups. In one group, the nursing staff received training on appropriate medication therapy and guidance to recognize potentially harmful medications and adverse effects (intervention group); in the other group, the nursing staff did not receive any additional training (control group).Main outcome measures Change of psychotropic use counted as relative proportions of WHO ATC-defined daily doses (rDDDs) among older long-term care residents. In addition, the change in drug costs was considered. Comparable assessments were performed at 0, 6, and 12 months.Results A significant decrease in both rDDDs and the cost of psychotropics was observed in the intervention group at 6 months follow-up. However, at 12 months, the difference between the intervention and control group had diminished.Conclusions Educational training can be effective in reducing the doses and costs of psychotropics. Further studies are warranted to investigate whether long-term effects can also be achieved by various educational interventions.Registration number ACTRN 12611001078943 KEY POINTSWe explored the effect of staff training on psychotropic use and associated costs among older long-term care residents.Educational training of nursing staff was beneficial as regards the actual drug doses of psychotropics, and cost savings in psychotropic medication were achieved.Educational training was efficient in the short-term, but further research is warranted to achieve long-term effects