Treatment use patterns in a large extended-treatment tobacco cessation program: predictors and cost implications

2021 ◽  
pp. tobaccocontrol-2020-056203
Author(s):  
Scott Veldhuizen ◽  
Laurie Zawertailo ◽  
Aliya Noormohamed ◽  
Sarwar Hussain ◽  
Peter Selby
Keyword(s):  
Multinomial Logistic Regression ◽  
Nicotine Patch ◽  
Retention In Care ◽  
Term Care ◽  
Marginal Costs ◽  
Use Patterns ◽  
Extended Care ◽  
Resource Requirements ◽  
Time In Treatment ◽  
Treatment Use

BackgroundTobacco dependence follows a chronic and relapsing course, but most treatment programmes are short. Extended care has been shown to improve outcomes. Examining use patterns for longer term programmes can quantify resource requirements and identify opportunities for improving retention.MethodsWe analyse 38 094 primary care treatment episodes from a multisite smoking cessation programme in Ontario, Canada that provides free nicotine replacement therapy (NRT) and counselling. We calculate distributional measures of weeks of NRT used, clinical visits attended and total length of care. We then divide treatment courses into four exclusive categories and fit a multinomial logistic regression model to measure associations with participant characteristics, using multiple imputation to address missing data.ResultsTime in treatment (median=50 days), visits (median=3) and weeks NRT used (median=8) were well below the maximum available. Of all programme enrolments, 28.8% (95% CI=28.3% to 29.3%) were single contacts, 31.3% (30.8% to 31.8%) lasted <12 weeks, 19.2% (18.8% to 19.6%) were ≥12 weeks with an 8-week interruption and 20.7% (20.3%–21.1%) were ≥12 weeks without interruptions. Care use was most strongly associated with participant age and whether the nicotine patch was dispensed at the first visit.ConclusionTreatment use results imply that the marginal costs of extending treatment programmes are relatively low. The prevalence of single contacts supports additional engagement efforts at the initial visit, while interruptions in care highlight the ability of longer term care to address relapse. Results show that use of the nicotine patch is associated with retention in care, and that improving engagement of younger patients should be a priority.

“Music First”

GeroPsych ◽  
2018 ◽  
Vol 31 (1) ◽  
pp. 17-30 ◽  
Author(s):  
Dane L. Shiltz ◽  
Tara T. Lineweaver ◽  
Tim Brimmer ◽  
Alex C. Cairns ◽  
Danielle S. Halcomb ◽  
...  
Keyword(s):  
Usual Care ◽  
Psychological Symptoms ◽  
Care Facility ◽  
Care Group ◽  
Music Listening ◽  
Term Care ◽  
Antipsychotic Medications ◽  
Risk Of Death ◽  
Extended Care ◽  
Individualized Music

Abstract. Existing research has primarily evaluated music therapy (MT) as a means of reducing the negative affect, behavioral, and/or cognitive symptoms of dementia. Music listening (ML), on the other hand, offers a less-explored, potentially equivalent alternative to MT and may further reduce exposure to potentially harmful psychotropic medications traditionally used to manage negative behavioral and psychological symptoms of dementia (BPSD). This 5-month prospective, naturalistic, interprofessional, single-center extended care facility study compared usual care (45 residents) and usual care combined with at least thrice weekly personalized ML sessions (47 residents) to determine the influence of ML. Agitation decreased for all participants (p < .001), and the ML residents receiving antipsychotic medications at baseline experienced agitation levels similar to both the usual care group and the ML patients who were not prescribed antipsychotics (p < .05 for medication × ML interaction). No significant changes in psychotropic medication exposure occurred. This experimental study supports ML as an adjunct to pharmacological approaches to treating agitation in older adults with dementia living in long-term care facilities. It also highlights the need for additional research focused on how individualized music programs affect doses and frequencies of antipsychotic medications and their associated risk of death and cerebrovascular events in this population.

The TAPS Project. 3: Predicting the Community Costs of Closing Psychiatric Hospitals

1990 ◽  
Vol 157 (5) ◽  
pp. 661-670 ◽  
Author(s):  
Martin Knapp ◽  
Jeni Beecham ◽  
Jeremy Anderson ◽  
David Dayson ◽  
Julian Leff ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Hospital Costs ◽  
Psychiatric Hospitals ◽  
Prediction Equation ◽  
Behavioural Problems ◽  
Accurate Information ◽  
Term Care ◽  
Resource Requirements ◽  
Baseline Characteristics

The planning of long-term care in the community as an alternative to in-patient care requires accurate information on the likely expense of altering the balance of provision. Unfortunately, as very few long-stay psychiatric hospitals have yet closed, the planning of these resource requirements has had to proceed in a vacuum. By examining the costs of community reprovision for the first 136 people to leave Claybury and Friern Hospitals, a prediction equation has been estimated from existing data which links the hospital-assessed characteristics (including psychiatric symptoms and behavioural problems) of these people to the subsequent cost of community care. About a third of the observed variation in these costs can be explained statistically by these ‘baseline’ characteristics. However, the first cohorts exhibit fewer behavioural problems and other symptoms of mental illness, they have been in hospital for shorter lengths of time, and they are younger. The prediction equation for the leavers is thus used to extrapolate community costs for those hospital residents yet to leave. It is found that community costs are lower than hospital costs, not just for the first cohorts of leavers, but for the full populations of the two hospitals scheduled to close.

Kelly, James R., Jr.

2021 ◽  
Author(s):  
Sadye L. M. Logan
Keyword(s):  
United States ◽  
Long Term Care ◽  
The United States ◽  
Veterans Administration ◽  
Term Care ◽  
Extended Care

James R. Kelly, Jr. (1934–2002) undertook pioneering work in the development and administration of the Veterans Administration (VA) Extended Care programs that has basically shaped the modalities of long-term care now available to veterans across the United States.

End-of-life (EOL) trajectories among older adults dying with lung cancer (LC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24008-e24008
Author(s):  
Amy J. Davidoff ◽  
Maureen Canavan ◽  
Shi-Yi Wang ◽  
Elizabeth Horn Prsic ◽  
Maureen Saphire ◽  
...  
Keyword(s):  
Hospice Care ◽  
Multinomial Logistic Regression ◽  
Use Patterns ◽  
Care Services ◽  
Hospital Referral Region ◽  
Hospital Referral ◽  
Palliative Care Services ◽  
Hospice Use ◽  
Therapy And Diagnosis ◽  
Hispanic White

e24008 Background: Medicare decedents often receive intensive care during the last month (mth) of life. There is little information on longer (6-mth) EOL trajectories of care intensity. Area hospice use rates may reflect supply and/or patient and physician preferences, and may influence patterns for individual decedents. Methods: Using SEER-Medicare linked registry and claims data, we selected decedents diagnosed with LC between 2008-2013 who survived ≥6-mths and died between 2008-2014. We linked Dartmouth Atlas data on hospital referral region (HRR) % cancer decedents with hospice use. Each mth we assessed claims to identify cancer-directed (CD) care (chemotherapy or radiation) and pharmacologic or other palliative care services (PCS) and assigned decedents to either CD only, PCS only, concurrent CD & PCS, full-mth inpatient (IP) or full-mth hospice. We ordered monthly care intensity from high to low (IP > CD only > concurrent CD & PCS > PCS only > hospice). Using the indicators arrayed by calendar mth, we assigned each decedent to 1 of 6 trajectories: stable (6-mth continuous) hospice, stable PCS only, stable CD only or concurrent CD & PCS, decreasing intensity, increasing intensity, and mixed (multiple directional shifts). Multinomial logistic regression estimated associations between area hospice rates, socio-demographics, and comorbidity with EOL trajectory, controlling for 1st line therapy, and diagnosis stage. Results: Our sample (N = 24,342) was predominantly male (53.7%), age ≥75 years (59.4%), and non-Hispanic white (80.5%); 19.1% lived in HRRs where ≤50% of cancer decedents received any hospice care. Trajectories were 7% stable hospice, 26% stable PCS only, 4% stable CD; 29% decreasing intensity, 9% increasing intensity, and 26% mixed. Relative to stable hospice, higher HRR-level hospice rates were associated with decreasing EOL intensity; higher age, female, and married were associated with increased probability of stable hospice enrollment); Black, non-Hispanic decedents had higher risk of increasing intensity (aRRR: 1.39, 95% confidence interval: 1.09-1.76, p < .01) and mixed patterns. Conclusions: Among older decedents with LC, only 62% had 6-mth EOL trajectories indicating low- (stable hospice or PCS only) or decreasing intensity, but few received persistent CD care. Area hospice use patterns, demographic characteristics and health status were associated with EOL trajectory. Additional research is needed to identify subgroups at risk of high or increasing intensity trajectories, and interventions that may shift trajectories towards lower intensity at EOL.

Resource Utilization Groups (RUGs): Defining Chronic Care, Rehabilitation and Nursing Home Case Mix in Canada

1993 ◽  
Vol 6 (4) ◽  
pp. 5-11 ◽  
Author(s):  
Chas. K. Botz ◽  
Susan Bestard ◽  
Mary Demaray ◽  
Gail Molloy
Keyword(s):  
Resource Utilization ◽  
Chronic Care ◽  
Long Term Care ◽  
Health Centre ◽  
Classification Systems ◽  
Term Care ◽  
Extended Care ◽  
Rehabilitation Hospitals ◽  
Unified Method

The two major purposes of this study were: (1) to evaluate Resource Utilization Groups (RUGs III) as a unified method for classifying all residential, chronic care and rehabilitation patients at the St. Joseph's Health Centre, London, and (2) to compare the potential funding implications of RUGs and other patient/resident classification systems. RUGs were used to classify a total of 336 patients/residents in residential, extended care, chronic care and rehabilitation beds at the Health Centre. Patients were also concurrently classified according to the Alberta Long Term Care Classification System and the Medicus Long Term Care System. Results show that RUGs provide relatively more credit for higher acuity patients than do the Alberta or Medicus systems. If used as a basis for funding, chronic care and rehabilitation hospitals would be entitled to more funding (relative to residential/nursing homes) under RUGs than under the other two patient classification mechanisms.

scholarly journals Health-care Resource Requirements and Potential Financial Consequences of an Environmentally Driven Switch in Respiratory Inhaler Use in England

2021 ◽  
Vol 8 (2) ◽  
pp. 46-54
Author(s):  
Darsuh Attar-Zadeh ◽  
Harriet Lewis ◽  
Martina Orlovic
Keyword(s):  
Epidemiological Data ◽  
Patient Acceptance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Use Patterns ◽  
Resource Requirements ◽  
Metered Dose ◽  
Financial Consequences ◽  
Organisational Factors

Background: To reduce greenhouse gas emissions, national initiatives advocate the phasing down of respiratory inhalers that use a fluorinated gas as a propellant (pressurised metered-dose inhalers [pMDI]). Nevertheless, pMDIs continue to be an effective and common choice. Objective: To assess the potential financial impact of patients with asthma or chronic obstructive pulmonary disease (COPD) switching from pMDIs to dry powder inhalers (DPIs) in a representative primary care network (PCN) population of 50 000 and the English National Health Service (NHS). Methods: Epidemiological data were combined with current inhaler use patterns to estimate the resources and costs associated with this transition, varying patient acceptance scenarios. Results: Depending on the approach, resource requirements ranged from £18 000 – £53 000 for a PCN, and from £21 – £60 million for the English NHS. Discussion: Significant funds are needed to successfully manage targeted inhaler transitions, together with counselling and follow-up appointment with an appropriately skilled clinician to assess the patient’s inhaler technique and ensure disease control. Conclusions: Targeted transition of inhalers must achieve a balance between environmental impacts, organisational factors, and patient requirements. The resources for managing a switch can be substantial but are necessary to appropriately counsel and support patients, whilst protecting the environment.

scholarly journals Changes in Tobacco Use Patterns among Veterans in San Diego during the Recent Peak of the COVID-19 Pandemic

2021 ◽  
Vol 18 (22) ◽  
pp. 11923
Author(s):  
Javad J. Fatollahi ◽  
Sean Bentley ◽  
Neal Doran ◽  
Arthur L. Brody
Keyword(s):  
Tobacco Use ◽  
San Diego ◽  
Multinomial Logistic Regression ◽  
Psychiatric Diagnoses ◽  
Peak Period ◽  
Health Crisis ◽  
Use Patterns ◽  
Public Health Crisis ◽  
Initial Stage ◽  
Over Time

The prevalence of tobacco use increases in times of stress; however, during the initial stage of the COVID-19 pandemic, tobacco use rates stayed the same in most populations. Previous work focused on the initial months of the pandemic, while this study examined the changes in tobacco use during a later peak period of the pandemic. We used data from 61,852 visits to the VA San Diego Healthcare System from November 2019 to February 2021, divided into pre-, early, and peak pandemic periods. Multinomial logistic regression was used to test whether the odds of being a daily or non-daily tobacco user varied over time, by demographic group, or with the presence of specific psychiatric diagnoses. Younger Veterans had a greater reduction in the prevalence of non-daily tobacco use between the early and peak periods, while older Veterans had a rise in daily use from pre- to the early pandemic, which returned to baseline during the peak. Individuals with substance use disorder and serious mental illness diagnoses were more likely to report tobacco use, but psychiatric diagnoses did not predict change over time. These findings demonstrate factors that potentially contribute to changes in tobacco use during a public health crisis and may help guide future targeted cessation efforts.

scholarly journals Treatment compliance and retention in care among out-patient clients in a tertiary health institution in plateau state North Central Nigeria

2018 ◽  
Vol 6 (6) ◽  
pp. 1902
Author(s):  
Tolulope O. Afolaranmi ◽  
Zuwaira I. Hassan ◽  
Joy L. Mbak ◽  
Davou W. Luka ◽  
Takzhir N. Audu ◽  
...  
Keyword(s):  
Treatment Compliance ◽  
Retention In Care ◽  
Cross Sectional Study ◽  
University Teaching ◽  
P Value ◽  
Cross Sectional ◽  
Term Care ◽  
Plateau State ◽  
Structured Interventions

Background: Compliance with prescribed treatment and retention in care are key components in the management of chronic diseases which is vital in averting the long term complications that could arise from such conditions. Failure to comply with treatment recommendations is often associated with poor retention in care. In view of this, this study was conducted to determine the level of treatment compliance and retention in care among patients with hypertension and diabetes in Jos University Teaching Hospital.Methods: This was a cross sectional study conducted among 290 eligible respondents between September and November 2017 using quantitative method of data collection. SPSS version 20 was used for data analysis with adjusted odds ratio and 95% confidence interval used as point and interval estimates while p-value of ≤0.05 was considered statistically significant.Results: The mean age of the respondents was 54.5±13.1 years with 43.8% of the respondents found to have satisfactorily complied with prescribed treatment while 117 (40.3%) were uninterruptedly retained in care within the last 6 months' clinic appointments  prior to the study.Conclusions: This study has demonstrated the levels of compliance with treatment and retention in care bringing to bear the need to provide structured interventions targeted at attaining improvement in compliance with treatment and retention in care among individuals on long term care.

scholarly journals Helminthiasis among Elderly with Long Term Care Setting, Sisaket Province, Thailand

2021 ◽  
Keyword(s):  
Public Health ◽  
Long Term Care ◽  
Multinomial Logistic Regression ◽  
The Elderly ◽  
Stepwise Multiple Regression ◽  
Parasitic Diseases ◽  
Preventive Behavior ◽  
Term Care ◽  
Factors Associated

Beyond the COVID-19 pandemics, from the Era of New normal along with advancement in technology is a concurrent advancement in public health. Prevention and control programs dealing with tropical and parasitic diseases have been developed and implemented. However, even with these advances, tropical and parasitic diseases remain a serious concern for the public health system in Thailand. The first cross-sectional analytical study identified risk factors associated with helminthiasis among the elderly in Srisaket Province. The investigators already visited and collected from 293 subjects during Year 2020. The data were analyzed descriptive statistics include number, percentage, mean, standard deviation, minimum, and maximum values. Inferential statistics investigated the association of factors affecting the prevention behavior of helminthiasis infection among the elderly by Pearson's correlation coefficient statistics. Analysis equation was also used to predict the relationship between two groups of variables by using Stepwise Multinomial logistic regression statistics. The study revealed a higher prevalence of helminthiasis in the population age group of over 60 to 90 years old compared to other age groups. It also indicated that males (37.9%) were more significant than females (62.1%). The results of fecal eggs or larvae counts of elderly in the overview showed that they were hookworm infection 6.80%, Taenia infection 4.40% and Opisthorchis’s 2.40% respectively. The results revealed 4 factors associated with preventive behavior of helminthiasis knowledge, perceived benefit, social support, and self-efficacy respectively. The stepwise multiple regression analysis used to predict the preventive behavior of helminthiasis among elderly in Sisaket Province could jointly explain 16.20% of the variance (R2 = 0.162, R2adj = 0.150, SEest = 7.39094, F = 13.383, p = 0.03) of preventive behavior of helminthiasis among elderly with significant at level 0.05. Therefore, establishing the long-term care preventive model of helminthiasis should focus on these factors.

scholarly journals Maintaining Resident Social Connections During COVID-19: Considerations for Long-Term Care

2020 ◽  
Vol 6 ◽  
pp. 233372142096266
Author(s):  
Carla Ickert ◽  
Heather Rozak ◽  
Jennifer Masek ◽  
Keeley Eigner ◽  
Sherry Schaefer
Keyword(s):  
Long Term Care ◽  
Significant Risk ◽  
Physical Space ◽  
Infection Prevention And Control ◽  
Social Connections ◽  
Continuing Care ◽  
Term Care ◽  
Resource Requirements ◽  
And Control

Worldwide, long-term care (LTC) homes have been heavily impacted by the coronavirus disease 2019 (COVID-19) pandemic. The significant risk of COVID-19 to LTC residents has resulted in major public health restrictions placed on LTC visitation. This article describes the important considerations for the facilitation of social connections between LTC residents and their loved ones during the COVID-19 pandemic, based on the experiences of 10 continuing care homes in Alberta, Canada. Important considerations include: technology, physical space, human resource requirements, scheduling and organization, and infection prevention and control. We describe some of the challenges encountered when implementing alternative visit approaches such as video and phone visits, window visits and outdoor in-person visits, and share several strategies and approaches to managing this new process within LTC.

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