scholarly journals PCV52 ECONOMIC ANALYSIS OF THE USE OF CLOPIDOGREL IN PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT STSEGMENT ELEVATION (ACS) FROM THE RUSSIAN HEALTH CARE SYSTEM PERSPECTIVE

2003 ◽  
Vol 6 (6) ◽  
pp. 663 ◽  
Author(s):  
YB Belousov ◽  
LB Lazebnik ◽  
AV Bykov ◽  
T Nguyen ◽  
J Spiesser
Keyword(s):  
Health Care ◽  
Acute Coronary Syndrome ◽  
Economic Analysis ◽  
Health Care System ◽  
System Perspective ◽  
Coronary Syndrome ◽  
Care System

From Bodily Sensations to Symptoms: Health Care–Seeking Practices Among People Affected by Acute Coronary Syndrome

2019 ◽  
Vol 29 (11) ◽  
pp. 1651-1660
Author(s):  
Kirsten Beedholm ◽  
Lene Søndergaard Andersen ◽  
Vibeke Lorentzen
Keyword(s):  
Health Care ◽  
Acute Coronary Syndrome ◽  
Health Care System ◽  
Medical Anthropology ◽  
Care Seeking ◽  
Coronary Syndrome ◽  
Starting Point ◽  
Depth Analysis ◽  
Bodily Sensations ◽  
Care System

The reduction of prehospital delay for patients with acute coronary syndrome (ACS) is widely discussed within cardiac research. Medically informed literature generally considers patient hesitancy in seeking treatment a significant barrier to accessing timely treatment. With this starting point, we conducted an interview study with people previously hospitalized for ACS and with the bystanders involved in their decision to contact the health care system. The analysis was conducted in two stages: first, a systematic extraction of key information; second, an in-depth analysis informed by medical anthropology. This led us to understand the prehospital period as an interpretation process where bodily sensations appeared as symptoms. Informants vacillated between sensations, knowledge, interpretations, and emotions as they struggled to preserve everyday ordinariness. They were led to contact the health care system by bodily discomfort rather than a rational decision to reduce risk. The paradigmatic implications from medical anthropology proved an important alternative to the medical paradigm.

P5497The gender paradox in non-ST-segment elevation acute coronary syndrome: an outdated paradigm or a persistent reality-an analysis of contemporary practice from an integrate health care system

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Elkoustaf ◽  
M Patel ◽  
R Rao ◽  
C Batiste ◽  
S Quon ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Coronary Syndrome ◽  
Health Care System ◽  
Medical Therapy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Gender Paradox ◽  
Contemporary Practice ◽  
Care System

Abstract Introduction Although sex related differences in Non-ST-Segment elevation (NSTEMI) acute coronary syndrome (ACS) have been well delineated in the past, there is a paucity of data from contemporary practice on the evolutions of this paradox and its clinical practice implications. Purpose We hypothesized that in the era of guideline driven contemporary practice, and in the setting of an integrated heath care model, gender related differences in care and outcomes would be marginal at best if no altogether absent. Methods We utilized data from an integrated health care system to identify 4099 patients with NSTEMI-ACS (1531 women; 2561 men). The patients were stratified by gender and a comparative analysis was performed on guideline directed medical therapy, revascularization strategy and major adverse cardiac events between the two groups. Results There were significant difference in pharmacologic treatment, catheter based interventions and surgical revascularizations strategies. Underutilization of guideline directed medical therapy was demonstrated in women specifically vis a vis angiotensin converting enzyme inhibitor (ACE-I) (p=0.0014), statins (p=0.0001), and antiplatelet therapy: clopodigrel (p=0.0004), prasugrel (p=0.0012), and ticagrelor (p=0.03). Additionally, clear differences emerged in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) options despite similarities in high risk status at index presentation by well validated risk algorithms. Specifically, men were more likely to undergo PCI (p=0.021) and CABG (p<0.001) than women. Finally, women had a greater incidence of bleeding complications (p=0.0003) and stroke (p=0,038). Conclusions There were treatment disparities in pharmacologic interventions, catheter based interventions, surgical revascularization access and clinical outcomes among patients with NSTEMI-ACS. The persistence of this gender paradox in contemporary practice and despite increasing education and awareness should potentiate further public policy initiatves as well as reinforce the need for geneder specific guidelines

scholarly journals Micro Economic Analysis Of The COPD Exacerbations And Hospitalizations Burden On The Health Care System In Bulgaria

2017 ◽  
Vol 20 (9) ◽  
pp. A580-A581
Author(s):  
K Tachkov ◽  
M Dimitrova ◽  
K Mitov ◽  
A Savova ◽  
M Kamusheva ◽  
...  
Keyword(s):  
Health Care ◽  
Economic Analysis ◽  
Health Care System ◽  
Copd Exacerbations ◽  
Care System

Cost-effectiveness of continuous positive airway pressure therapy for obstructive sleep apnea: health care system and societal perspectives

SLEEP ◽  
2019 ◽  
Vol 42 (12) ◽  
Author(s):  
Jared Streatfeild ◽  
David Hillman ◽  
Robert Adams ◽  
Scott Mitchell ◽  
Lynne Pezzullo
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Health System ◽  
Health Care System ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Cpap Therapy ◽  
System Perspective ◽  
Obstructive Sleep ◽  
Care System

Abstract Study Objectives To determine cost-effectiveness of continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) in Australia for 2017–2018 to facilitate public health decision-making. Methods Analysis was undertaken of direct per-person costs of CPAP therapy (according to 5-year care pathways), health system and other costs of OSA and its comorbidities averted by CPAP treatment (5-year adherence rate 56.7%) and incremental benefit of therapy (in terms of disability-adjusted life years [DALYs] averted) to determine cost-effectiveness of CPAP. This was expressed as the incremental cost-effectiveness ratio (= dollars per DALY averted). Direct costs of CPAP were estimated from government reimbursements for services and advertised equipment costs. Costs averted were calculated from both the health care system perspective (health system costs only) and societal perspective (health system plus other financial costs including informal care, productivity losses, nonmedical accident costs, deadweight taxation and welfare losses). These estimates of costs (expressed in US dollars) and DALYs averted were based on our recent analyses of costs of untreated OSA. Results From the health care system perspective, estimated cost of CPAP therapy to treat OSA was $12 495 per DALY averted while from a societal perspective the effect was dominant (−$10 688 per DALY averted) meaning it costs more not to treat the problem than to treat it. Conclusions These estimates suggest substantial community investment in measures to more systematically identify and treat OSA is justified. Apart from potential health and well-being benefits, it is financially prudent to do so.

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