Medicinal cannabis may be cost effective for alleviating refractory symptoms associated with chronic conditions

Background: The holistic and multidisciplinary approach of in-home palliative care (IHPC) is known to offer high-quality and cost-effective care for patients at the end of life. However, the financial benefits of upstream IHPC programs to hospitals, patients, and payers have not been fully characterized for patients with comorbid chronic conditions. Aim: To characterize the financial benefits that upstream IHPC offers to patients with multiple chronic conditions. Methods: A structured retrospective patient record review was conducted on the number of emergency department (ED) visits, number of inpatient hospitalizations, hospital length of stay (LOS), and payments made to the hospital for all patients (N = 71) enrolled in an IHPC program between January 1, 2016, and June 30, 2016. Discharge history from each patient’s medical record was also assessed. Comparisons were drawn between patients’ LOS on IHPC and an equivalent time period prior to enrollment in IHPC. Results: After patients enrolled in IHPC, average ED and inpatient utilization declined significantly by 41% ( P = .01) and 71% ( P < .001), respectively. The payers for health-care services realized a significant decline of US$2,201 ( P < .001) in hospital payments per patient per month. Inpatient LOS was also significantly lower than expected once patients enrolled in the program ( P = .01). Conclusions: As the need for chronic disease management continues to grow, managers of health systems, managed care organizations, and home health agencies should be cognizant of the financial value that IHPC has to offer.

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Unleashing Our Potential— Pharmacists' Role in Vaccination and Public Health

The Senior Care Pharmacist ◽

10.4140/tcp.n.2020.372. ◽

2020 ◽

Vol 35 (9) ◽

pp. 372-378

Author(s):

Arjun Poudel ◽

Esther T. L. Lau ◽

Chris Campbell ◽

Lisa M. Nissen

Keyword(s):

Public Health ◽

Health Care ◽

Side Effects ◽

Chronic Conditions ◽

Cost Effective ◽

Vaccine Hesitancy ◽

Noncommunicable Diseases ◽

Easy Access ◽

Immunization Programs ◽

Vaccine Preventable Diseases

One of the greatest innovations in health care has been the development of vaccines and immunization programs that have significantly minimized the morbidity and mortality resulting from vaccine preventable diseases. While vaccines were traditionally used against infectious diseases, recent advances in technology have led to the development of vaccines for noncommunicable diseases and chronic conditions. Vaccinations are considered the most cost-effective intervention in public health that has the potential to save millions of lives every year. Despite the availability and effectiveness of vaccines for many diseases, immunization programs, and service uptake remain underused in many countries. This is mainly because of the lack of easy access to vaccinations, risk-benefit perceptions, false beliefs, and concerns about the side effects. Vaccine hesitancy—the reluctance or refusal to vaccinate, is listed as one of the top 10 threats to global health.

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Specializing Nurses as An Indirect Education Program for Stoma Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16132272 ◽

2019 ◽

Vol 16 (13) ◽

pp. 2272

Author(s):

Manuel García-Goñi

Keyword(s):

Chronic Conditions ◽

Cost Effective ◽

Effectiveness Analysis ◽

Education Strategy ◽

Related Quality ◽

Health Related ◽

Low Incidence ◽

Specialist Nurses ◽

The Impact

Education programs are beneficial for patients with different chronic conditions. Prior studies have examined direct education, where information is transferred directly to patients. In contrast, in this program, information is transferred directly to nurses who become specialists and transfer education individually to patients. Hence, this paper evaluates the impact of having specialist nurses for stoma patients at hospitals, as those nurses provide healthcare to patients but also inform and educate patients about their condition and needs. The analysis uses an observational study with ostomized patients in Spain at hospitals with and without specialist nurses, and measures health service utilization and health-related quality of life (HRQL), besides performing a cost analysis and a cost-effectiveness analysis at both types of hospitals. The results show that patients with access to specialist nurses self-manage better, present lower adverse events and a better evolution of HRQL, and significantly demand more consultations with specialist nurses and less to A&E, primary care or specialists, resulting in important savings for the health system. Consequently, specializing or hiring nurses to provide indirect education to stoma patients is cost-effective and highly beneficial for patients. This type of indirect education strategy might be considered for specific conditions with low incidence or difficulties in identifying target patients or delivering information directly to them.

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Older Adults Engage With Personalized Digital Coaching Programs at Rates That Exceed Those of Younger Adults

Frontiers in Digital Health ◽

10.3389/fdgth.2021.642818 ◽

2021 ◽

Vol 3 ◽

Author(s):

Sarah A. Graham ◽

Natalie Stein ◽

Fjori Shemaj ◽

OraLee H. Branch ◽

Jason Paruthi ◽

...

Keyword(s):

Older Adults ◽

Technology Use ◽

Chronic Conditions ◽

Digital Health ◽

Cost Effective ◽

Health Programs ◽

Care Providers ◽

Younger Adults ◽

Health Technologies ◽

Healthcare Needs

Background: The US population is aging and has an expanding set of healthcare needs for the prevention and management of chronic conditions. Older adults contribute disproportionately to US healthcare costs, accounting for 34% of total healthcare expenditures in 2014 but only 15% of the population. Fully automated, digital health programs offer a scalable and cost-effective option to help manage chronic conditions. However, the literature on technology use suggests that older adults face barriers to the use of digital technologies that could limit their engagement with digital health programs. The objective of this study was to characterize the engagement of adults 65 years and older with a fully automated digital health platform called Lark Health and compare their engagement to that of adults aged 35–64 years.Methods: We analyzed data from 2,169 Lark platform users across four different coaching programs (diabetes prevention, diabetes care, hypertension care, and prevention) over a 12-month period. We characterized user engagement as participation in digital coaching conversations, meals logged, and device measurements. We compared engagement metrics between older and younger adults using nonparametric bivariate analyses.Main Results: Aggregate engagement across all users during the 12-month period included 1,623,178 coaching conversations, 588,436 meals logged, and 203,693 device measurements. We found that older adults were significantly more engaged with the digital platform than younger adults, evidenced by older adults participating in a larger median number of coaching conversations (514 vs. 428) and logging more meals (174 vs. 89) and device measurements (39 vs. 28) all p ≤ 0.01.Conclusions: Older adult users of a commercially available, fully digital health platform exhibited greater engagement than younger adults. These findings suggest that despite potential barriers, older adults readily adopted digital health technologies. Fully digital health programs may present a widely scalable and cost-effective alternative to traditional telehealth models that still require costly touchpoints with human care providers.

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COST-EFFECTIVENESS OF INTERVENTIONS BASED ON PHYSICAL ACTIVITY IN THE TREATMENT OF CHRONIC CONDITIONS: A SYSTEMATIC LITERATURE REVIEW

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462318000533 ◽

2018 ◽

Vol 34 (5) ◽

pp. 481-497 ◽

Cited By ~ 5

Author(s):

Marlène Guillon ◽

Lise Rochaix ◽

Jean-Claude K. Dupont

Keyword(s):

Physical Activity ◽

Cost Effectiveness ◽

Cardiovascular Diseases ◽

Neurological Disorders ◽

Chronic Conditions ◽

Respiratory Diseases ◽

Cost Effective ◽

Mental Illnesses ◽

Economic Evaluations ◽

The Cost

Objectives:The aim of this study is to review evidence on the cost-effectiveness of exercise-based interventions in the treatment of chronic conditions a decade after the publication of Roine et al. in 2009 (Roine E, Roine RP, Räsänen P, et al. Int J Technol Assess Health Care. 2009;25:427–454).Methods:We carried out a review of published articles in PUBMED and JSTOR between January 1, 2008, and December 31, 2016. Full economic evaluations of exercise programs targeting patients with a chronic condition were eligible for inclusion. Data on program, design, and economic characteristics were extracted using a predefined extraction form. The quality of the economic evaluations was appraised using the adjusted Consensus Health Economic Criteria List.Results:A total of 426 articles were identified and thirty-seven studies were selected. Eleven studies dealt with musculoskeletal and rheumatologic disorders, ten with cardiovascular diseases, six with neurological disorders, three with mental illnesses, three with cancers, and four with diabetes, respiratory diseases, or pelvic organ prolapse. In total, 60 percent of exercise programs were dominant or cost-effective. For musculoskeletal and rheumatologic disorders, 72 percent of programs were dominant or cost-effective while this was the case for 57 percent of programs for cardiovascular diseases using a nonsurgical comparator.Conclusions:There is clear evidence in favor of exercise-based programs for the treatment of musculoskeletal and rheumatologic disorders and, to a lesser extent, for the treatment of cardiovascular diseases. More research is needed to evaluate the cost-effectiveness of physical activity in the treatment of neurological disorders, mental illnesses, cancers, respiratory diseases, and diabetes/obesity.

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Self-Efficacy in Researching and Obtaining Medical Cannabis by Patients With Chronic Conditions

Health Education & Behavior ◽

10.1177/1090198120914249 ◽

2020 ◽

Vol 47 (5) ◽

pp. 740-748

Author(s):

John P. Brady ◽

Douglas Bruce ◽

Elissa Foster ◽

Mona Shattell

Keyword(s):

Information Seeking ◽

Self Efficacy ◽

Chronic Conditions ◽

Semistructured Interview ◽

Medical Cannabis ◽

Interview Protocol ◽

Telephone Interviews ◽

Social Landscape ◽

Medicinal Cannabis ◽

Administration Methods

Background. Due to the increasing availability of medical-grade cannabis for treatment of chronic conditions, we examined how prospective users navigate the process of researching, procuring, and using cannabis. Given the barriers prospective users experience, self-efficacy may be a factor for those who incorporate cannabis into treatment. Aims. The purpose of this study was to identify behaviors associated with self-efficacy in the context of researching, procuring, and using cannabis. We analyzed narratives of patients who obtained legal medical cannabis in the currently complex medical, legal, and social landscape. Method. Data were collected through 30 telephone interviews utilizing a semistructured interview protocol, which were analyzed using inductive coding. The protocol emphasized four topics: (a) symptom management/pain reduction, (b) provider communication about chronic conditions/cannabis, (c) perspectives on medicinal cannabis and stigma, and (d) views on recreational cannabis. Results. Participants demonstrated self-efficacy in three contexts: (a) self-directed experimentation with cannabis strains, dosages, and administration methods; (b) managing care by selecting and educating their providers; and (c) information-seeking and research behaviors. Discussion. High self-efficacy may be an important factor in navigating the medical cannabis process. Results suggest that providers who are not prepared to partner with patients as they seek information about medical cannabis may be replaced by dispensaries and websites with expertise in cannabis but without understanding of patients’ medical conditions and individual needs. Conclusion. Patients with higher self-efficacy may engage in various activities to investigate, procure, experiment with, and incorporate medical cannabis into their condition management outside the purview of their providers.

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Ethical challenges in argumentation and dialogue in a healthcare context

Argument & Computation ◽

10.3233/aac-200908 ◽

2020 ◽

pp. 1-16

Author(s):

Mark Snaith ◽

Rasmus Øjvind Nielsen ◽

Sita Ramchandra Kotnis ◽

Alison Pease

Keyword(s):

Health Systems ◽

Chronic Conditions ◽

Cost Effective ◽

Health Data ◽

Chronic Illnesses ◽

Limited Resources ◽

Effective Solution ◽

Ethical Challenges ◽

Health Advice ◽

Future Work

As the average age of the population increases, so too do the number of people living with chronic illnesses. With limited resources available, the development of dialogue-based e-health systems that provide justified general health advice offers a cost-effective solution to the management of chronic conditions. It is however imperative that such systems are responsible in their approach. We present in this paper two main challenges for the deployment of e-health systems, that have a particular relevance to dialogue and argumentation: collecting and handling health data, and trust. For both challenges, we look at specific issues therein, outlining their importance in general, and describing their relevance to dialogue and argumentation. Finally, we go on to propose six recommendations for handling these issues, towards addressing the main challenges themselves, that act both as general advice for dialogue and argumentation research in the e-health domain, and as a foundation for future work on this topic.

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Abstract C-C2-01: Guided Care: The Translation of Research Into Cost-Effective Primary Care for Persons With Chronic Conditions

Clinical Medicine & Research ◽

10.3121/cmr.6.3-4.126 ◽

2008 ◽

Vol 6 (3-4) ◽

pp. 126-126

Author(s):

C. Groves ◽

L. Karm ◽

C. Boult ◽

L. Reider ◽

K. Frey

Keyword(s):

Primary Care ◽

Chronic Conditions ◽

Cost Effective

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Human Factors Assessment of a Pediatric Elliptical Machine With Cost Effective Modifications

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857921101132 ◽

2021 ◽

Vol 10 (1) ◽

pp. 199-203

Author(s):

Rumena Begum ◽

Bernadette McCrory

Keyword(s):

Human Factors ◽

Interaction Design ◽

Chronic Conditions ◽

Stride Length ◽

Cost Effective ◽

Typically Developing ◽

Before And After ◽

Kinematic Analyses ◽

Cardio Vascular ◽

Training Objective

Background: Developing and sustaining cardio vascular fitness for ambulation are common rehabilitation foci for children with disabilities and their families. Properly designed elliptical trainers may help with pediatric rehabilitation training. Objective: This study focused on the investigation of human factors and ergonomics (HFE) associated with a pediatric elliptical machine, its redesign, and proposing further modifications based on user’s feedback to aid usability, comfort, safety, and interaction. Method: Twenty-eight children(11 typically developing and 17 with physical disabilities and/or chronic conditions) who are 3 to 12 years old, their parents and caregivers, and clinicians participated in the evaluation of the machine before and after modification. Temporospatial data of the children were collected, and their interaction with the machine was assessed. Results: Most features, (i.e., chair height, chair depth, console height, stride length, pedalstraps, and steps height etc.) resulted in positive child and adults’ assessments, whereas six other features resulted in divergent user assessments. Clinicia ns were satisfied with the positioningof chair, stationary handles, pedal, and pedalstraps. However, a lack of adjustability of the stride length was significantly associated with less-than-optimal elliptical training (p = 0.044). Clinicians and 94.3% adult caregivers agreed on the less-than-optimal elliptical training for the children while using the redesigned machine. Conclusion: The modified elliptical machine is a cost effective one and comfortable with im proved safety. A continuously adjustable stride length of 40cm to 110cm was recommended based on kinematic analyses. Additional modifications were suggested to improve the elliptical’s interaction design.

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