The meagre outcomes of HoNOS

Objective: To ask the Leginski question of an outcome measurement process. Method: Articles elicited by a literature search of ‘HoNOS’ are analysed for evidence of its value or cost effectiveness to consumers, clinicians or administrators. Results: None of the 260 studies elicited by the search attempted to assess the cost of the use of Health of the Nation Outcome Scale (HoNOS). One study investigated the effect of routine outcome measurement, finding that it failed to result in the provision of evidence-based care. One study reported positive outcomes. Conclusions: The ability of HoNOS to improve the health and social functioning of mentally ill people has not been demonstrated. The widespread use of HoNOS as a routine outcome measure is not justified by the evidence.

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Modelling the population cost-effectiveness of current and evidence-based optimal treatment for anxiety disorders

Psychological Medicine ◽

10.1017/s003329170300881x ◽

2004 ◽

Vol 34 (1) ◽

pp. 19-35 ◽

Cited By ~ 65

Author(s):

C. ISSAKIDIS ◽

K. SANDERSON ◽

J. CORRY ◽

G. ANDREWS ◽

H. LAPSLEY

Keyword(s):

Cost Effectiveness ◽

Anxiety Disorders ◽

Social Phobia ◽

Evidence Based ◽

Post Traumatic Stress ◽

Optimal Care ◽

Post Traumatic ◽

The Cost ◽

Evidence Based Care ◽

Care Costs

Background. The present paper describes a component of a large population cost-effectiveness study that aimed to identify the averted burden and economic efficiency of current and optimal treatment for the major mental disorders. This paper reports on the findings for the anxiety disorders (panic disorder/agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder and obsessive–compulsive disorder).Method. Outcome was calculated as averted ‘years lived with disability’ (YLD), a population summary measure of disability burden. Costs were the direct health care costs in 1997–8 Australian dollars. The cost per YLD averted (efficiency) was calculated for those already in contact with the health system for a mental health problem (current care) and for a hypothetical optimal care package of evidence-based treatment for this same group. Data sources included the Australian National Survey of Mental Health and Well-being and published treatment effects and unit costs.Results. Current coverage was around 40% for most disorders with the exception of social phobia at 21%. Receipt of interventions consistent with evidence-based care ranged from 32% of those in contact with services for social phobia to 64% for post-traumatic stress disorder. The cost of this care was estimated at $400 million, resulting in a cost per YLD averted ranging from $7761 for generalized anxiety disorder to $34 389 for panic/agoraphobia. Under optimal care, costs remained similar but health gains were increased substantially, reducing the cost per YLD to <$20 000 for all disorders.Conclusions. Evidence-based care for anxiety disorders would produce greater population health gain at a similar cost to that of current care, resulting in a substantial increase in the cost-effectiveness of treatment.

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A review of techniques for difficult catheterisation and their costs

Journal of Clinical Urology ◽

10.1177/20514158211039149 ◽

2021 ◽

pp. 205141582110391

Author(s):

Rion Healy ◽

James Edward Dyer

Keyword(s):

Supply Chain ◽

Cost Analysis ◽

Literature Search ◽

Cost Effective ◽

Evidence Based ◽

Level Of Evidence ◽

Flexible Cystoscopy ◽

Cost Implications ◽

The Cost

Objective: Awareness of departmental expenditure gives surgeons the ability to make cost-effective decisions. We reviewed the available techniques for difficult catheterisation and assessed the cost of each method. Methods: A literature search was undertaken using EMBASE and Medline databases. Seven techniques for difficult catheterisation were identified, and a cost analysis was performed. All items required for a technique were costed per unit, including VAT, and can be referenced to the NHS supply chain. Results: Techniques were divided into three broad categories: simple urethral techniques – increased lubrication with different catheter sizes (£5.05) or types (£8.83 Tiemann tip, £10.65 Coude tip); complex urethral techniques – blind hydrophilic guidewire (£27.31), S-dilators (£244.62) and flexible cystoscopy (£38.78); and percutaneous techniques – suprapubic catheterisation (£117.38). Conclusion: This paper demonstrates a progression in cost and specialist input required when moving from simple urethral techniques to complex and percutaneous techniques. It is clear that clinicians should consider these cost implications and exhaust all simple techniques before moving to the more complex options. We would advocate the use of a national evidence-based difficult catheter algorithm to guide management based on both effectiveness and cost. Level of evidence: Not applicable.

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Leg Ulcers: A Cross-Sectional Survey of Management Practices and Treatment Costs in Ireland

Phlebology The Journal of Venous Disease ◽

10.1177/026835550201700304 ◽

2002 ◽

Vol 17 (3-4) ◽

pp. 98-102

Author(s):

J. F. O'Brien ◽

M. Clarke-Moloney ◽

P. A. Grace ◽

I. J. Perry ◽

P. E. Burk

Keyword(s):

Management Practices ◽

Health Board ◽

Evidence Based ◽

Leg Ulcers ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Routine Work ◽

Median Period ◽

The Cost ◽

Evidence Based Care

Objective: To review the management and the cost of leg ulcers. Design: Cross-sectional survey based on a questionnaire completed by healthcare workers caring for patients with leg ulcers in a defined population. Setting: The Mid-Western Health Board area in Ireland with a population of 317069. Patients: All patients receiving healthcare for active leg ulceration. Results: Leg ulcers were recorded for 389 individuals and public health nurses primarily provided care (n = 283). Patients had open ulcers for a median period of 8 months (interquartile range: 3 months — 2 years) with almost half (n = 181) reporting previous episodes of ulceration. Fifty different dressing products were used to treat leg ulcers in the region. Only 52.2% (203/389) of patients had the aetiology of their leg ulcers properly investigated and evidence-based care was generally apparent in this group. Otherwise, care appeared haphazard and at times inappropriate. The estimated annual direct cost of dressing leg ulcers was £585 660. Conclusion: A regional strategy for managing leg ulcers needs to be clarified and implemented if practitioners are to incorporate evidence-based care into routine work.

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Use of a routine, self-report outcome measure (HoNOSCA–SR) in two adolescent mental health services

The British Journal of Psychiatry ◽

10.1192/bjp.180.3.266 ◽

2002 ◽

Vol 180 (3) ◽

pp. 266-269 ◽

Cited By ~ 44

Author(s):

Simon Gowers ◽

Warren Levine ◽

Sarah Bailey-Rogers ◽

Alison Shore ◽

Emma Burhouse

Keyword(s):

Mental Health ◽

Outcome Measure ◽

Outcome Measurement ◽

Reliability And Validity ◽

Adolescent Mental Health ◽

Self Report ◽

Routine Outcome Measurement ◽

Health Measures ◽

Length Of Treatment ◽

Report Outcome Measure

BackgroundThe Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) is an established outcome measure for child and adolescent mental health. Little is known of adolescent views on outcome.AimsTo develop and test the properties of an adolescent, self-rated version of the scale (HoNOSCA–SR) against the established clinician-rated version.MethodA comparison was made of 6-weekly clinician-rated and self-rated assessments of adolescents attending two services, using HoNOSCA and other mental health measures.ResultsAdolescents found HoNOSCA–SR acceptable and easy to rate. They rated fewer difficulties than the clinicians and these difficulties were felt to improve less during treatment, although this varied with diagnosis and length of treatment. Although HoNOSCA–SR showed satisfactory reliability and validity, agreement between clinicians and users in individual cases was poor.ConclusionsRoutine outcome measurement can include adolescent self-rating with modest additional resources. The discrepancy between staff and adolescent views requires further evaluation.

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Routine outcome measurement in public mental health: results of a clinician survey

Australian Health Review ◽

10.1071/ah060164 ◽

2006 ◽

Vol 30 (2) ◽

pp. 164 ◽

Cited By ~ 30

Author(s):

Tom Callaly ◽

Mary Hyland ◽

Tim Coombs ◽

Tom Trauer

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Outcome Measures ◽

Outcome Measure ◽

Health Workers ◽

Outcome Measurement ◽

Public Mental Health ◽

Mental Health Workers ◽

Clinical Value ◽

Routine Outcome Measurement

This paper explores the attitudes of mental health workers in one public mental health service towards the implementation and use of routine outcome measurement. Two years after their introduction into routine clinical practice, there were equal numbers of positive and negative observations from clinicians about the clinical value of the clinician-rated outcome measures, while more positive observations were made about value of the consumer-rated outcome measure. The most frequent observation from clinicians in relation to making outcome measures more useful to them in clinical practice was that more training, particularly refresher training, is needed. In addition, clinicians indicated that more sophisticated support which assists them to understand the meaning and possible use of outcome measure ratings is required.

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The Cost-Effectiveness of Postal and Telephone Methodologies in Increasing Routine Outcome Measurement Response Rates in CAMHS

Child and Adolescent Mental Health ◽

10.1111/j.1475-3588.2009.00544.x ◽

2010 ◽

Vol 15 (1) ◽

pp. 60-63

Author(s):

Rachel Horn ◽

Steve Jones ◽

Kate Warren

Keyword(s):

Cost Effectiveness ◽

Outcome Measurement ◽

Response Rates ◽

Routine Outcome Measurement ◽

The Cost

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Investing in Evidence-Based Care for the Severely Mentally Ill

JAMA ◽

10.1001/jama.2013.278065 ◽

2013 ◽

Vol 310 (13) ◽

pp. 1345 ◽

Cited By ~ 5

Author(s):

Mark Olfson ◽

Harold A. Pincus ◽

Herbert Pardes

Keyword(s):

Mentally Ill ◽

Evidence Based ◽

Severely Mentally Ill ◽

Evidence Based Care

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Goal Attainment and Treatment Compliance in a Cognitive-Behavioral Telephone Intervention for Family Caregivers of Persons with Dementia

GeroPsych ◽

10.1024/1662-9647/a000043 ◽

2011 ◽

Vol 24 (3) ◽

pp. 115-125 ◽

Cited By ~ 18

Author(s):

Gabriele Wilz ◽

Denise Schinköthe ◽

Renate Soellner

Keyword(s):

Family Caregivers ◽

Mentally Ill ◽

Goal Attainment ◽

Outcome Measurement ◽

Controlled Trial ◽

Treatment Success ◽

Treatment Compliance ◽

Control Group ◽

Telephone Intervention ◽

Effective Interventions

Introduction: The evaluation of effective interventions is still needed to prevent family caregivers of persons with dementia from becoming physically or mentally ill. However, in most existing intervention studies, primary outcomes are not well matched to the treatment goals. Method: A randomized controlled trial (N = 229) was conducted to compare a treatment group (CBT), a treated control group, and an untreated control group. In theses analyses we focused on the primary outcome measurement (GAS) as a perceived treatment success as well as treatment compliance and participants’ evaluation. Results: Results showed that 30.1% achieved complete goal attainment, 39.8% partial goal attainment, and 24.1% declared no change (overachievement 2.4%; deterioration 3.6%). Discussion: The intervention can be considered to have been successful.

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