The use of administrative health care databases to identify patients with Rheumatoid Arthritis

Objective: To validate and compare the decision rules to identify rheumatoid arthritis (RA) in administrative databases. Methods: A study was performed using administrative health care data from a population of 1 million people who had access to universal health care. Information was available on hospital discharge abstracts and physician billings. RA cases in health administrative databases were matched 1:4 by age and sex to randomly selected controls without inflammatory arthritis. Seven case definitions were applied to identify RA cases in the health administrative data, and their performance was compared with the diagnosis by a rheumatologist. The validation study was conducted on a sample of individuals with administrative data who received a rheumatologist consultation at the Arthritis Center of Nova Scotia. Results: We identified 535 RA cases and 2,140 non-RA, noninflammatory arthritis controls. Using the rheumatologist's diagnosis as the gold standard, the overall accuracy of the case definitions for RA cases varied between 68.9% and 82.9% with a kappa statistic between 0.26 and 0.53. The sensitivity and specificity varied from 20.7% to 94.8% and 62.5% to 98.5%, respectively. In a reference population of 1 million, the estimated annual number of incident cases of RA was between 176 and 1,610 and the annual number of prevalent cases was between 1,384 and 5,722. Conclusion: The accuracy of case definitions for the identification of RA cases from rheumatology clinics using administrative health care databases is variable when compared to a rheumatologist's assessment. This should be considered when comparing results across studies. This variability may also be used as an advantage in different study designs, depending on the relative importance of sensitivity and specificity for identifying the population of interest to the research question

A Longitudinal Study of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Patients with Rheumatoid Arthritis: A 13-year Population Health Study

Objective. To determine total physician encounters, emergency room (ER) visits, and hospitalizations in an incident cohort of rheumatoid arthritis (RA) cases and matched control patients over 13 years. Methods. A retrospective cohort study was performed using administrative healthcare data from about 1 million people with access to universal healthcare. Using the International Classification of Diseases, 9th ed (ICD-9) and ICD-10 diagnostic codes, 7 RA case definitions were used. Each case was matched by age and sex to 4 randomly selected controls. Data included physician billings, ER visits, and hospital discharges over 13 years. Results. The number of incident RA cases varied from 3497 to 27,694, depending on the case definition. The mean age varied from 54.3 to 65.0 years, and the proportion of women from 67.8% to 71.3%. The number of physician encounters by patients with RA was significantly higher than by controls. It was highest in the index year and declined promptly thereafter for all case definitions and by 12.2%–46.8% after 10 years. Encounters with subspecialty physicians fell by 61% (rheumatologists) and 34% (internal medicine). In contrast, clinical encounters with family physicians and other physicians fell by only 9%. Visits to the ER and hospital admissions were also significantly higher in RA cases, particularly early in the disease, and fell significantly over the followup. Conclusion. In patients with RA, healthcare use is highest in the first year following the diagnosis, which is also the time of maximal involvement by rheumatologists. Use declines over time, and encounters with patients’ family physicians predominate over other physician groups

Broadening Responsibilities: Consideration Of The Potential To Broaden The Role Of Uniformed Fire Service Employees

What is this report about? This report, commissioned by the National Joint Council for Local Authority Fire and Rescue Services (NJC), aims to identify what impact, if any, firefighters can have on the delivery of emergency medical response and wider community health interventions in the UK. What are the overall conclusions? Appropriately trained and equipped firefighters co-responding1 to targeted, specific time critical medical events, such as cardiac arrest, can improve patient survival rates. The data also indicate that there is support from fire service staff – and a potential need from members of the public, particularly the elderly, isolated or vulnerable – to expand ‘wider work’. This includes winter warmth assessments, Safe and Well checks, community defibrillator training and client referrals when staff believe someone may have dementia, are vulnerable or even, for example, have substance dependencies such as an alcohol addiction. However, there is currently insufficient data to estimate the net benefit of this work

Adjuvant Statin Therapy for Esophageal Adenocarcinoma: a cost-effectiveness analysis

Background: Emerging preclinical evidence indicates statins, medications commonly used in the prevention of cardiovascular disease, inhibit proliferation, promote apoptosis and limit invasiveness of esophageal adenocarcinoma (EAC). Population-based observational data demonstrates statin treatment after diagnosis of EAC is associated with significant reductions in all-cause and cancer-specific mortality. A feasibility study of adjuvant statin therapy following potentially curative resection for EAC has completed, with planned progression to a full phase III randomised controlled trial Aim: To estimate the cost-utility of statin therapy following surgical resection for EAC from an NHS perspective. Methods: A Markov model was developed to estimate the costs and outcomes (quality adjusted life years, QALYs) for hypothetical cohorts of patients with EAC exposed or not exposed to statins following potentially curative surgical resection. Model parameters were based on estimates from published observational and trial data. Costs, utilities and transition probabilities were modelled to reflect clinical practice from a payer’s perspective. Probabilistic and one-way sensitivity analyses were performed to account for uncertainty in key parameters. Results: Overall, a cost-saving of £6,781 per patient was realised with statin treatment compared to no statins. In probabilistic sensitivity analysis, 99% of all iterations were cost-saving and 99% of all iterations were less than £20,000 per QALY gained. These results were robust to changes in the price and effectiveness of statins. Conclusions: The cohort exposed to statins had lower costs and better QALY outcomes than the no statin cohort. Assuming a causal relationship between statin exposure and outcomes suggests that statins following resection of EAC is a cost-saving treatment

Is the public supportive and willing to pay for a national assistive reproductive therapies programme? Results from a multicountry survey

Objectives: To understand attitudes towards infertility and willingness to pay (WTP) towards a publicly funded national assistive reproductive therapies (ART) programme. Design: Attitudes survey with dichotomous and open-ended WTP questions. Setting: Online survey administered in the USA, UK, Norway, Sweden, Finland, Denmark and China. Participants: 7945 respondents, analysed by country. Nordic respondents were pooled into a regionally representative sample. Primary and secondary outcome measures: Primary outcome measures were proportion of sample agreeing with different infertility-related and ART-related value statements and supporting a monthly contribution to fund a national ART programme, expressed in local currency. Secondary outcome measure was maximum WTP. Results: Across the nationally representative samples, 75.5% of all respondents agreed with infertility as a medical condition and 82.3% and 83.7% with ART eligibility for anyone who has difficulty having a baby or a medical problem preventing them from having a baby, respectively. 56.4% of respondents supported a defined monthly contribution and 73.9% supported at least some additional contribution to fund a national ART programme. Overall, converting to euros, median maximum WTP was €3.00 and mean was €15.47 (95% CI 14.23 to 16.72) per month. Maximum WTP was highest in China and the USA and lowest in the European samples. Conclusions: This large, multicountry survey extends our understanding of public attitudes towards infertility and fertility treatment beyond Europe. It finds evidence that a majority of the public in all sampled countries/regions views infertility as a treatable medical condition and supports the idea that all infertile individuals should have access to treatments that improve the chance of conception. There was also strong agreement with the idea that the desire for children is a basic human need. WTP questions showed that a majority of respondents supported a monthly contribution to fund a national ART programme, although there is some evidence of an acquiescence bias that may overstate support among specific samples

Adherence to guidelines and the Screening Tool of Older Persons' potentially inappropriate Prescriptions criteria for colchicine dosing for gout treatment in beneficiaries of the Nova Scotia Seniors' Pharmacare Program Clinical Therapeutics

Purpose: Colchicine is commonly used in the management of gout; however, older persons have higher risks of toxicity. Accordingly, the Screening Tool of Older Person’s potentially inappropriate Prescriptions (STOPP) criteria for colchicine consider 43 months of treatment as potentially inappropriate in older persons. Recent evidence also suggests lower dosing of colchicine is as effective and results in fewer toxicities than high-dose colchicine. The objectives of this study were to determine the dose, duration, and prescribers of colchicine and to evaluate adherence to the STOPP criteria and international guidelines for colchicine in older persons. Methods: A retrospective, observational study was conducted from April 1, 2006 to March 31, 2011 to evaluate colchicine use. Nova Scotia Seniors’ Pharmacare Program beneficiaries who met inclusion criteria for an incident case of gout and who filled at least 1prescription for colchicine during the study period were included. Colchicine dose and duration were reported descriptively. Multivariate logistic regression was used to identify predictors of the study population in making a claim for colchicine 490 and 4180 days. Findings: A total of 518 persons were dispensed 1327 courses of colchicine during the study period. The mean daily dose of colchicine ranged from 1.39 to 1.50 mg. Colchicine doses 41.2 mg were prescribed in approximately one-third of the study population. Colchicine was prescribed for 490 days in 14.2% of treatment courses and for 4180 days in 8.1% of treatment courses. Female sex was the only predictor of treatment duration 490 days. Implications: This study is the first to report on colchicine dose and duration using STOPP criteria in a specific cohort of older persons with incident gout. Strategies to improve colchicine prescribing in older persons are needed

How do people with experience of infertility value different aspects of assistive reproductive therapy? Results from a multi-country discrete choice experiment

Objectives: Assistive reproductive therapies can help those who have difficulty conceiving but different forms of assistive reproductive therapies are associated with different treatment characteristics. We undertook a large, multinational discrete choice experiment to understand patient preferences for assistive reproductive therapies. Methods: We administered an online discrete choice experiment with persons who had experience with subfertility or assistive reproductive therapies in the USA, UK, the Nordic region (Denmark, Norway, Sweden, Finland), Spain, and China. Attributes encouraged trade-offs between effectiveness, risk of adverse effects, treatment (dis)comfort, (in)convenience, cost per cycle and shared decision making. We used multinomial logit and mixed-logit models to estimate preferences and attribute importance by country/region, and estimated willingness to pay for changes in attribute levels. Results: A total of 7565 respondents participated. Mixed logit had a better fit than multinomial logit across all samples. Preferences moved in expected directions across all samples, but the relative importance of attributes differed between countries. Willingness to pay was greatest for improvements in effectiveness and a greater degree of shared decision making, and we observe a substantial ‘option value’ independent of treatment characteristics. Unexpectedly, preferences over cost were insignificant in the Chinese sample, limiting the use of willingness to pay in this sample. Conclusions: Respondents balanced concerns for effectiveness with other considerations, including the cost and (dis)comfort of treatment, and the degree of shared decision making, but there is also substantial option value independent of treatment characteristics, demonstrating value of assistive reproductive therapies to individuals with experience of subfertility. We hypothesise that price insensitivity in the Chinese sample may reflect a degree of social desirability bias

National Institute for Health Research Policy Research Programme Project Dementia Friendly Communities: The DEMCOM evaluation (PR-R15-0116- 21003)

Final Report: National Institute for Health Research Policy Research Programme Project Dementia Friendly Communities: The DEMCOM evaluation (PR-R15-0116- 21003) As the number of people living with dementia is increasing globally, Dementia Friendly Communities (DFCs) offer one way of providing the infrastructure and support that can enable people affected by dementia to live well. There is no universally agreed definition of a DFC, and DFCs need not be geographical entities. This study adopted a broad definition, recognising that becoming a DFC is an ongoing process only fully achieved when living with dementia is normalised into a community’s culture, language, infrastructure and activities. A DFC can involve a wide range of people, organisations and geographical areas. A DFC recognises that a person with dementia is more than their diagnosis and that everyone has a role in supporting their independence and inclusion. DFCs in England can apply for official recognition by Alzheimer’s Society as working towards dementia friendly status. A growing number of national and international frameworks and guidance is available to communities seeking to become dementia friendly. Evaluations of DFCs are largely descriptive. While work exists on identifying core outcomes of DFC initiatives, there are very few studies that have tested DFC effectiveness or compared current practice with known need. Evidence on cost effectiveness, cost benefit, social value and social return on investment (SRoI) of DFCs is also missing. This study addresses key gaps in the evidence