scholarly journals Healthcare trajectories and costs in the last year of life: a retrospective primary care and hospital analysis

2020 ◽  
pp. bmjspcare-2020-002630
Author(s):  
Xhyljeta Luta ◽  
Katharina Diernberger ◽  
Joanna Bowden ◽  
Joanne Droney ◽  
Daniel Howdon ◽  
...  
Keyword(s):  
Primary Care ◽  
Retrospective Cohort ◽  
Inpatient Care ◽  
Healthcare Utilisation ◽  
Age Group ◽  
Specialist Palliative Care ◽  
Age At Death ◽  
Reference Category ◽  
The Mean ◽  
Proximity To Death

ObjectivesTo analyse healthcare utilisation and costs in the last year of life in England, and to study variation by cause of death, region of patient residence and socioeconomic status.MethodsThis is a retrospective cohort study. Individuals aged 60 years and over (N=108 510) who died in England between 2010 and 2017 were included in the study.ResultsHealthcare utilisation and costs in the last year of life increased with proximity to death, particularly in the last month of life. The mean total costs were higher among males (£8089) compared with females (£6898) and declined with age at death (£9164 at age 60–69 to £5228 at age 90+) with inpatient care accounting for over 60% of total costs. Costs decline with age at death (0.92, 95% CI 0.88 to 0.95, p<0.0001 for age group 90+ compared with to the reference category age group 60–69) and were lower among females (0.91, 95% CI 0.90 to 0.92, p<0.0001 compared with males). Costs were higher (1.09, 95% CI 1.01 to 1.14, p<0.0001) in London compared with other regions.ConclusionsHealthcare utilisation and costs in the last year of life increase with proximity to death, particularly in the last month of life. Finer geographical data and information on healthcare supply would allow further investigating whether people receiving more planned care by primary care and or specialist palliative care towards the end of life require less acute care.

scholarly journals Socioeconomic inequalities in healthcare utilisation in Indonesia: a comprehensive survey-based overview

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e026164 ◽  
Author(s):  
Joko Mulyanto ◽  
Dionne S Kringos ◽  
Anton E Kunst
Keyword(s):  
Primary Care ◽  
Preventive Care ◽  
Secondary Care ◽  
Inpatient Care ◽  
Healthcare Utilisation ◽  
Cross Sectional Study ◽  
Socioeconomic Inequalities ◽  
Educational Inequalities ◽  
Cross Sectional ◽  
Relative Index

ObjectiveMonitoring inequality in healthcare utilisation is essential to reduce persistent inequalities in health in lower-middle income countries. This study aimed to assess socioeconomic inequalities in the utilisation of primary care, secondary care and preventive care in Indonesia.MethodsA cross-sectional study was conducted using data from the 2014 Indonesia Family Life Survey with a total of 42 083 adult participants. Socioeconomic status (SES) was measured by educational level and income. Healthcare utilisation was measured in: (1) primary care, (2) outpatient in secondary care, (3) inpatient care and (4) cardiovascular-related preventive care. The magnitude of inequalities was measured using the relative index of inequality (RII).ResultsSmall educational inequalities were found for primary care utilisation (RII 1.13, 95% CI 1.01 to 1.26). Larger educational inequalities were found for outpatient secondary care (RII 10.35, 95% CI 8.11 to 13.22) and inpatient care (RII 2.78, 95% CI 2.32 to 3.32). The largest educational inequalities were found for preventive care, particularly regarding blood glucose tests (RII 30.31, 95% CI 26.13 to 35.15) and electrocardiography tests (RII 30.90, 95% CI 24.97 to 38.23). Compared with educational inequalities, income inequalities were larger for primary care (RII 1.68, 95% CI 1.52 to 1.85) and inpatient care (RII 3.11, 95% CI 2.63 to 3.66), but not for outpatient secondary care and preventive care.ConclusionsSocioeconomic inequalities in healthcare utilisation in Indonesia are particularly large in secondary and preventive care. Therefore, it is recommended to prioritise policies focused on improving timely, geographical and financial access to secondary and preventive care for lower SES groups.

A telemedicine strategy to reduce waiting lists and time to specialist care: A retrospective cohort study

2020 ◽  
pp. 1357633X2096393
Author(s):  
Juliana N Pfeil ◽  
Dimitris V Rados ◽  
Rudi Roman ◽  
Natan Katz ◽  
Luciana N Nunes ◽  
...  
Keyword(s):  
Primary Care ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Intervention Group ◽  
Care Physician ◽  
Control Group ◽  
Specialist Care ◽  
Medical Specialties ◽  
The Mean ◽  
Consultation Time

Introduction The demand for specialty care is rising worldwide. In the state of Rio Grande do Sul, Brazil, more than 150,000 people were waiting for specialist consultations in 2013. A telemedicine programme (RegulaSUS) developed referral protocols, audited waitlisted cases, authorised/prioritised referrals by risk and discuss deferred cases primary-care physician. This study assesses the effectiveness of RegulaSUS. Methods A retrospective cohort analysis with contemporaneous controls was performed from June 2014 to June 2016. Six medical specialties included in RegulaSUS (50,185 patients) were compared to 50,124 control patients waitlisted according to the usual routine (scheduled for specialty consultation at the next available date). The groups were matched (1:1) by semester and year of waitlisting and by the specialty demand-to-supply ratio. Primary outcomes were referral-to-consultation time and number of waitlisted patients. Results The mean referral-to-consultation time was 584.8 days in the intervention group and 607.0 days in controls ( p<0.001). For specialties regulated by RegulaSUS, the mean referral-to-consultation time was 237.6 days for higher-risk patients. At the end of the observation, 26,708 control patients had been unlisted compared to 31,050 patients in the intervention group (reduction of 53.5% vs. 61.9%, respectively; p<0.001). The number of cancelled referrals was lower in the control group ( n=14,403; 28.7%) than in the intervention group ( n=16,387; 32.7%; p<0.001). Discussion Telemedicine support for primary care effectively decreased the time to specialty consultation, reduced the number of waitlisted patients and allowed sicker patients to reach a specialist faster.

scholarly journals Mortality Rate and Years of Life Lost Due to COVID-19 in Iran, Fars Province.

2021 ◽  
Author(s):  
Habibollah Azarbakhsh ◽  
Alireza Mirahmadizadeh ◽  
Haleh Ghaem ◽  
Sanaz Amiri ◽  
Ali Mohammad Mokhtari ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Decision Makers ◽  
Lower Airway ◽  
Years Of Life Lost ◽  
Fars Province ◽  
Age Group ◽  
Age At Death ◽  
Specific Mortality ◽  
The Mean ◽  
Standard Life

Abstract Introduction: Corona became a public health threat worldwide in late 2019, in which its main target is lower airway. The aim of this study was to calculate the mortality rate and years of life lost due to COVID-19 in Iran.Method: All definite deaths due to COVID-19 from February 20, 2020 to the February 12, 2021 have been used. Descriptive analyzes included mean and standard deviation of age at death, the number and sex ratio of deaths. Then the age and sex-specific mortality rate were calculated. YLL were calculated using the standard life expectancy based on the 2015 WHO life-table.Results: During the study period, 3169 (58.78% men and 41.22% women) definite coronary deaths occurred. The mean age at death was higher in women than men. The fatality rate of the disease was 1.83%. The highest number of years of life lost, according to both methods of YLL calculation, was in the age group of 69-60 years and the lowest was in the age group of 10-19 years.Conclusion: This study showed that due to the high mortality of this disease, decision makers should focus on reducing mortality in the start of the next waves of COVID-19.

A STUDY OF SERUM URIC ACID LEVELS IN PREECLAMPSIA

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Sushma Goad ◽  
Anita Verma ◽  
Subhash Chandra
Keyword(s):  
Uric Acid ◽  
Serum Uric Acid ◽  
Uric Acid Level ◽  
Acid Level ◽  
Serum Uric Acid Level ◽  
Control Group ◽  
Age Group ◽  
Hypertensive Disorders Of Pregnancy ◽  
Level Elevation ◽  
The Mean

Background: To Study Serum Uric Acid level elevation in Hypertensive Disorders of Pregnancy. Methods: 50 Patients diagnosed as having Pre-eclampsia with age between 18-37 years and 50 controls with similar age group. Results: The mean serum uric acid level in control group was 3.41 ± 0.62 and in patient 7.01 ± 0.58 which was statistically significant (p =0.001). Conclusion: Serum uric acid levels were significantly higher in preeclampsia could be a useful indicator of fetal complication in preeclampsia patients. Keywords: serum uric acid, preeclampsia, laboratory.

A Retrospective Cohort Study of SARS-CoV-2 Infection in Hypertenses Patients in a Primary Care Center

2020 ◽  
Author(s):  
Esther Hernandez Castilla ◽  
Lucia Vallejo Serrano ◽  
Monica Saenz Ausejo ◽  
Beatriz Pax Sanchez ◽  
Katharina Ramrath ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Care Center ◽  
Primary Care Center

Vitamin D Level Stability in Dystrophinopathy Patients on Vitamin D Supplementation

2021 ◽  
pp. 1-7
Author(s):  
Naomi Vather-Wu ◽  
Matthew D. Krasowski ◽  
Katherine D. Mathews ◽  
Amal Shibli-Rahhal
Keyword(s):  
Vitamin D ◽  
Retrospective Cohort ◽  
Vitamin D Supplementation ◽  
Hydroxyvitamin D ◽  
Frequent Monitoring ◽  
25 Hydroxyvitamin D ◽  
The Mean ◽  
Stable Maintenance ◽  
Mean Time

Background: Expert guidelines recommend annual monitoring of 25-hydroxyvitamin D (25-OHD) and maintaining 25-OHD ≥30 ng/ml in patients with dystrophinopathies. Objective: We hypothesized that 25-OHD remains stable and requires less frequent monitoring in patients taking stable maintenance doses of vitamin D. Methods: We performed a retrospective cohort study, using the electronic health record to identify 26 patients with dystrophinopathies with a baseline 25-OHD ≥30 ng/mL and at least one additional 25-OHD measurement. These patients had received a stable dose of vitamin D for ≥3 months prior to their baseline 25-OHD measurement and throughout follow-up. The main outcome measured was the mean duration time the subjects spent with a 25-OHD ≥30 ng/mL. Results: Only 19% of patients dropped their 25-OHD to <  30 ng/ml, with a mean time to drop of 33 months and a median nadir 25-OHD of 28 ng/mL. Conclusions: These results suggest that measurement of 25-OHD every 2–2.5 years may be sufficient in patients with a baseline 25-OHD ≥30 ng/mL and who are on a stable maintenance dose of vitamin D. Other patients may require more frequent assessments.

scholarly journals Exercise Intensity during Olympic-Distance Triathlon in Well-Trained Age-Group Athletes: An Observational Study

Sports ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 18
Author(s):  
Atsushi Aoyagi ◽  
Keisuke Ishikura ◽  
Yoshiharu Nabekura
Keyword(s):  
Heart Rate ◽  
Observational Study ◽  
Exercise Intensity ◽  
Time Range ◽  
Age Group ◽  
Slow Group ◽  
H 41 ◽  
The Mean ◽  
Aerobic And Anaerobic ◽  
Very High

The aim of this study was to examine the exercise intensity during the swimming, cycling, and running legs of nondraft legal, Olympic-distance triathlons in well-trained, age-group triathletes. Seventeen male triathletes completed incremental swimming, cycling, and running tests to exhaustion. Heart rate (HR) and workload corresponding to aerobic and anaerobic thresholds, maximal workloads, and maximal HR (HRmax) in each exercise mode were analyzed. HR and workload were monitored throughout the race. The intensity distributions in three HR zones for each discipline and five workload zones in cycling and running were quantified. The subjects were then assigned to a fast or slow group based on the total race time (range, 2 h 07 min–2 h 41 min). The mean percentages of HRmax in the swimming, cycling, and running legs were 89.8% ± 3.7%, 91.1% ± 4.4%, and 90.7% ± 5.1%, respectively, for all participants. The mean percentage of HRmax and intensity distributions during the swimming and cycling legs were similar between groups. In the running leg, the faster group spent relatively more time above HR at anaerobic threshold (AnT) and between workload at AnT and maximal workload. In conclusion, well-trained male triathletes performed at very high intensity throughout a nondraft legal, Olympic-distance triathlon race, and sustaining higher intensity during running might play a role in the success of these athletes.

scholarly journals 996. The Potential for Reducing Opioid and Analgesic Prescriptions Via Herpes Zoster Vaccination

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S527-S527
Author(s):  
Jean-Etienne Poirrier ◽  
Justin Carrico ◽  
Jessica K DeMartino ◽  
Katherine A Hicks ◽  
Jeffrey J Stoddard ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Age Group ◽  
Opioid Prescription ◽  
Varicella Zoster ◽  
Effectiveness Model ◽  
Prescription Rates ◽  
Medication Exposure ◽  
The Mean ◽  
The Impact ◽  
Analgesic Use

Abstract Background Herpes zoster (HZ), or shingles, is a common neurocutaneous disease caused by the reactivation of latent varicella zoster virus that often includes rash and neuropathic pain that may last for months. Opioids and other analgesics may be prescribed. Recombinant zoster vaccine (RZV) is preferentially recommended for the prevention of HZ in adults aged 50 years and older. This study aimed to assess the impact of RZV vaccination on opioid and other analgesic prescription-related outcomes. Methods Estimates of analgesic prescription rates (opioids, benzodiazepines, and other analgesics) among HZ cases were established using Truven claims data from 2012-2018 for adults aged 50 years and older. HZ case avoidance with RZV vaccination was calculated using a previously published cost-effectiveness model. This data was included in a calculator assessing the impact of RZV vaccination on analgesic prescription-related outcomes (compared to no vaccination). Results Between 24.4% and 28.0% of HZ cases in the observed claims had at least one opioid prescription, dependent on age group (4.5%-6.5% and 8.6%-19.6% for benzodiazepines and other analgesics, respectively). The mean number of opioid prescriptions per person in each age group with at least one opioid prescription was between 1.7 and 1.9 (1.7-2.3 and 1.7-2.0 prescriptions for benzodiazepines and other analgesics, respectively). Assuming a 1-million-person population and 65% RZV coverage, the calculator predicts RZV vaccination will prevent 75,002 cases of HZ and will prevent 19,311 people from being prescribed at least 1 HZ-related opioid, 4,502 people from being prescribed benzodiazepines, and 12,201 people from being prescribed other analgesics. Additionally, 34,520 HZ-related opioid prescriptions will be avoided (9,413 benzodiazepine prescriptions; 22,406 other analgesic prescriptions). Conclusion HZ is associated with high levels of opioid, benzodiazepine, and other analgesic use. Primary prevention of HZ by vaccination could potentially reduce opioid and other medication exposure. Disclosures Jean-Etienne Poirrier, PhD, MBA, The GSK group of companies (Employee, Shareholder) Justin Carrico, BS, GlaxoSmithKline (Consultant) Jessica K. DeMartino, PhD, The GlaxoSmithKline group of companies (Employee, Shareholder) Katherine A. Hicks, MS, BSPH, GlaxoSmithKline (Scientific Research Study Investigator, GSK pays my company for my contractual services.) Saurabh P. Nagar, MS, RTI Health Solutions (Employee) Juliana Meyers, MA, GlaxoSmithKline (Other Financial or Material Support, This study was funded by GlaxoSmithKline.)

scholarly journals Nutrition Study People over 80 Years

2012 ◽  
Vol 2 (3) ◽  
pp. 77-89
Author(s):  
Javier Benítez ◽  
Nieves Perejón ◽  
Marcelino Arriaza ◽  
Pilar Bellanco
Keyword(s):  
Quality Of Life ◽  
The Elderly ◽  
Blood Chemistry ◽  
Living Alone ◽  
Age Group ◽  
Nutrition Study ◽  
Geriatric Evaluation ◽  
The Mean ◽  
Elderly Living

Loneliness has always been associated and reported as a risk factor of malnutrition in the elderly. People over 80 who live alone have deserved this study to detect their situation and potential for action to improve their quality of life. Objectives: To determinate the nutritional status of people over 80 living alone in the area of “La Laguna”, Cádiz. Material and method: In PIAMLA`80 program analyse those parameters and their possible correlations in a group of 342 elderly living alone over 80 years old. Different parameters were measured: Integral Geriatric Evaluation, Barthel, Lawton-Brody, Lobo, Gijon, specific analytical blood chemistry and MNA. Results: In a population of 984 people, were selected 342 initially, but finally the group decreases to 247 people. The mean Barthel was 80.42 points, 5.76 Lawton and Gijon from 11.3 Lobo 26.48. The MNA for the whole population was 24.25/30 detecting only a risk age group in women of 85-95. Correlation between nutrition and the biochemical test values showed positive for haemoglobin (0.19), total protein (0.26), Fe (0.32) and albumin (0.46). Conclusions: In our research we have not detected malnutrition in any age group or gender. The use of nutrition test MNA and its MINI version must be generalized as an accurate, clear, quick and easy tool to use.

scholarly journals Acute coronary syndrome: which age group tends to delay call for help?

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Ahmed Ayuna ◽  
Ayyaz Sultan
Keyword(s):  
Acute Coronary Syndrome ◽  
Time Delay ◽  
Local Population ◽  
Age Groups ◽  
Age Group ◽  
Teaching Programme ◽  
The Road ◽  
Coronary Syndrome ◽  
The Mean ◽  
Mean Time

Abstract Background Early diagnosis and treatment of ACS can reduce the risk of complications and death. Delay calling for help can increase morbidity and mortality. It is unclear which age group among patients with acute coronary syndrome tend to delay their call for help. Results Our observational retrospective study showed that men and women in their 50s and 40s respectively tend to delay their call for help from symptoms onset. For the former, the mean time delays (590 ± 71.1 min), whereas for the latter it was (1084 ± 120.1 min). Moreover, these groups tend to have a longer time delay between symptoms onset and arrival at the hospital. Among deaths, we observed that the death rate was proportional to the time delay, which is not unexpected. Next step, we plan to perform a qualitative study in the form of questionnaires to target the individuals with a high risk of CVD within these age groups. Conclusion Middle age group of both genders tend to delay their call for help when they experience symptoms of ACS; moreover, regardless of the age, the longer the delay, the higher the mortality rate. The results of this study gave us a better understanding of our local population and will pave the road for a well-structured teaching programme for them to minimise the time delay for calling for help.

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