Ethics and resource allocation: can health care outcomes be QALYfied?

This paper discusses the theoretical foundation of QALY and examines the assumptions which underlie these theories. It argues that there are methodological flaws in the construction of QALY and that there are inherent risks in its possible application to psychiatry. It also draws attention to fundamental ethical problems with the concept of QALY as a tool for valuing the quality of life or well-being of persons.

Download Full-text

Thriving in the 21st Century: Outcome Assessment, Practice Parameters, and Accountability

PEDIATRICS ◽

10.1542/peds.96.4.831 ◽

1995 ◽

Vol 96 (4) ◽

pp. 831-835 ◽

Cited By ~ 2

Author(s):

David A. Bergman

Keyword(s):

Quality Of Life ◽

Health Care ◽

Health Outcomes ◽

Practice Guidelines ◽

Scientific Evidence ◽

Care Practice ◽

Health Care Outcomes ◽

Effective Manner ◽

Care Outcomes

The past two decades have brought about major health care changes that have been driven by an ever-increasing cost of health care, practice variability, and medical malpractice litigation. These changes pose a challenge to pediatricians to contain costs, to reduce inappropriate use of health care services, and to demonstrate improved health care outcomes. To meet this challenge, a new "clinical tool kit" is required, one that will allow the pediatrician to analyze current practices and to document effective interventions. Two of the major tools in this kit are practice guidelines and outcomes assessment instruments. Practice guidelines are optimal care specifications that provide an analytic framework for defining high-quality care and measuring health care outcomes. Ideally, these guidelines should be developed from scientific evidence. In practice, however, scientific evidence to support the majority of recommendations made in guidelines is insufficient. Consequently, these recommendations are instead developed by expert consensus. Measurement of health outcomes includes clinical outcomes, patient satisfaction, cost and use, and quality of life. Health care organizations have become very sophisticated in measuring cost and use, but considerably less work has been done in the patient-centered areas of satisfaction and quality of life. This is particularly true for children, because measures are dependent on the viewpoint chosen (parent, child, or teacher), the age of the child, and the adjustment for severity of illness. Analyzing practice patterns and improving health outcomes will not be easy tasks to accomplish. For the pediatrician to use these tools in an efficient and effective manner, a new research agenda and new skills will be required.

Download Full-text

Quality of life and adherence to mediterranean diet among type 2 diabetes mellitus patients of a primary health care clinic in Hebron city, Palestine

Mediterranean Journal of Nutrition and Metabolism ◽

10.3233/mnm-200515 ◽

2021 ◽

pp. 1-10

Author(s):

Manal Badrasawi ◽

May Hamdan ◽

Mohammad Al Tamimi

Keyword(s):

Quality Of Life ◽

Diabetes Mellitus ◽

Health Care ◽

Primary Health Care ◽

Mediterranean Diet ◽

Well Being ◽

Care Clinic ◽

Primary Health Care Clinic ◽

Primary Health

BACKGROUND: Diabetes mellitus (DM) is a lifelong metabolic disease with a high rate of mortality and morbidity. Uncontrolled and untreated diabetes results in serious complications that subsequently cause patients’ quality of life (QoL) to deteriorate. Adherence to Mediterranean diet (MD) may relieve the complications of diabetes, thereby improving the quality of life for these patients. OBJECTIVE: The aim of this study was to assess the QoL of DM patients who adhered to MD. METHODS: In this cross-sectional study, we examined the QoL and MD data of 106 DM II patients being treated at a primary health care clinic in Hebron. We used the SF-36 questionnaire to measure the patients’ QoL and the MEDAS tool to assess their MD adherence. We also recorded their anthropometric measurements, abdominal obesity, lifestyle habits and blood biochemical results. RESULTS: The sample comprised male and female DM II patients between the ages of 35 and 72, with their mean age being 55.8±10.24. Patients’ QoL scores showed a significant relationship with three BMI categories, i.e., total QoL score, physical function, and pain domains (p < 0.05). In terms of diet, high adherence to MD had a positive impact on all domains and on patients’ total QoL with significant differences in physical functioning, emotional well-being, social functioning and pain domains. CONCLUSION: Patients’ QoL domains were relatively low and highly affected by DM II. Patients with greater MD adherence reported higher scores in all QoL domains. Significantly higher scores were noted for the physical, social and pain domains. Hence, MD is a recommended dietary pattern for DM II patients to achieve a better QoL.

Download Full-text

Komunitas Masyarakat Dan Perawatan Kesehatan Dalam Peningkatan Kualitas Hidup

DINAMIKA KESEHATAN JURNAL KEBIDANAN DAN KEPERAWATAN ◽

10.33859/dksm.v10i1.437 ◽

2020 ◽

Vol 10 (1) ◽

pp. 11-24

Author(s):

Agustinus Hermino

Keyword(s):

Quality Of Life ◽

Health Care ◽

Health Care Quality ◽

Health Sector ◽

Well Being ◽

Individual Variability ◽

Care Quality ◽

Global Era ◽

The Impact

Latar belakang: Seiring dengan perkembangan jaman, dalam beberapa tahun terakhir ini banyak perhatian yang difokuskan pada eksplorasi dampak penyakit fisik dan mental pada kualitas hidup seseorang baik secara individu maupun masyarakat secara keseluruhan. Sifat subyektif dari 'kualitas hidup' individu, merupakan konsep yang dinamis untuk diukur dan didefinisikan, tetapi bahwa secara umum dapat dipandang sebagai konsep multidimensi yang menekankan pada persepsi diri dari keadaan pikiran seseorang saat iniTujuan: penulisan ini bertujuan untuk memberikan pemahaman tentang peran masyarakat dalam memahani pentingnya kesehatan di era global ditinjau dari perspektif akademis. Pada sektor kesehatan pemahaman kesehatan menjadi sangat pentingnya karena akan menunjukkan pada kualitas hidup seseorang, tetapi hal ini tidak cukup secara individu karena diperlukan pemahaman secara menyeluruh terhadap masyarakat tentang makna kesehatan dan perawatan kesehatan.Metode: penulisan ilmiah ini adalah dengan melakukan analisa akademis dari dari berbagai sumber rujukan relevan sehingga menemukan makna teoritis baru dalam rangka menjawab tantangan yang terjadi di masyarakat.Hasil: Berdasarkan berbagai sumber rujukan yang ada, dapat disimpulkan bahwa kesehatan merupakan gaya hidup yang bertujuan untuk mencapai kesejahteraan fisik, emosional, intelektual, spiritual, dan lingkungan. Penggunaan langkah-langkah kesehatan dapat meningkatkan stamina, energi, dan harga diri, kemudian meningkatkan kualitas hidup. Dengan demikian maka konsep kesehatan memungkinkan adanya variabilitas individu. Kesehatan dapat dianggap sebagai keseimbangan aspek fisik, emosional, psikologis, sosial dan spiritual dari kehidupan seseorang. Kata kunci: masyarakat, perawatan kesehatan, kualitas hidup Society Community and Health Care in Improving Quality of LifeAbstract Background: Along with the development of the era, in recent years there has been a lot of attention focused on exploring the impact of physical and mental illness on the quality of life of a person both individually and as a whole. The subjective nature of an individual's 'quality of life' is a dynamic concept to measure and define, but that in general can be seen as a multidimensional concept that emphasizes self-perception of one's current state of mindAim: purpose of this study is to provide an understanding the role of community in understanding the importance of health in the global era from an academic perspective. In the health sector understanding of health is very important because it will show the quality of life of a person, but this is not enough individually because a comprehensive understanding of the meaning of health and health care is needed. Method: The method of scientific writing is to carry out academic analysis from various relevant reference sources, and find new theoretical meanings in order to answer the challenges that occur in society. Keyword: Community, Society,Health Care, Quality oflife Resullt : Based on various academic reference, it can be concluded that health is a lifestyle that aims to achieve physical, emotional, intellectual, spiritual, and environmental well-being. The use of health measures can increase stamina, energy, and self-esteem, then improve the quality of life. Thus the concept of health allows for individual variability. Health can be considered as a balance of physical, emotional, psychological, social and spiritual aspects of one's life. Keywords: community, health care, quality of life

Download Full-text

Consequences of anxiety in older persons: its effect on disability, well-being and use of health services

Psychological Medicine ◽

10.1017/s0033291799008351 ◽

1999 ◽

Vol 29 (3) ◽

pp. 583-593 ◽

Cited By ~ 217

Author(s):

E. de BEURS ◽

A. T. F. BEEKMAN ◽

A. J. L. M. van BALKOM ◽

D. J. H. DEEG ◽

R. van DYCK ◽

...

Keyword(s):

Quality Of Life ◽

Health Care ◽

Anxiety Disorder ◽

Older Persons ◽

Well Being ◽

Anxiety Symptoms ◽

Appropriate Care ◽

Older Subjects ◽

Use Of Health Services

Background. Although anxiety is quite prevalent in late life, its impact on disability, well-being, and health care utilization of older persons has not been studied. Older persons are a highly relevant age group for studying the consequences of anxiety, since their increasing numbers put an extra strain on already limited health care resources.Methods. Data of a large community-based random probability sample (N=659) of older subjects (55–85 year) in the Netherlands were used to select three groups: subjects with a diagnosed anxiety disorder, subjects with merely anxiety symptoms and a reference group without anxiety. These groups were compared with regard to their functioning, subjective well-being, and use of health care services, while controlling for potentially confounding variables.Results. Anxiety was associated with increased disability and diminished well-being. Older persons with a diagnosed anxiety disorder were equally affected in their functioning as those with merely anxiety symptoms. Although use of health services was increased in anxiety sufferers, their use of appropriate care was generally low.Conclusions. Anxiety has a clear negative impact on the functioning and well-being of older subjects. The similarity of participants with an anxiety disorder and those having merely anxiety symptoms regarding quality of life variables and health care use was quite striking. Finally, in spite of its grave consequences for the quality of life, appropriate care for anxiety is seldom received. Efforts to improve recognition, disseminate effective treatments in primary care, and referring to specialized care may have positive effects on the management of anxiety in late life.

Download Full-text

Quality of Life as the Basis of Health Care Resource Allocation: A Philosopher's Perspective on QALYs

The AMA Journal of Ethic ◽

10.1001/virtualmentor.2005.7.2.pfor4-0502 ◽

2005 ◽

Vol 7 (2) ◽

Keyword(s):

Quality Of Life ◽

Health Care ◽

Resource Allocation ◽

Health Care Resource

Download Full-text

Health status and health policy: quality of life in health care evaluation and resource allocation

Choice Reviews Online ◽

10.5860/choice.31-1551 ◽

1993 ◽

Vol 31 (03) ◽

pp. 31-1551-31-1551

Keyword(s):

Quality Of Life ◽

Health Care ◽

Resource Allocation ◽

Health Policy ◽

Health Status ◽

Health Care Evaluation ◽

Care Evaluation

Download Full-text

Discussion: Drummond's “resource allocation decisions in health care: A role for quality of life assessment?”

Journal of Chronic Diseases ◽

10.1016/0021-9681(87)90022-1 ◽

1987 ◽

Vol 40 (6) ◽

pp. 617-619 ◽

Cited By ~ 4

Author(s):

Jane E. Sisk

Keyword(s):

Quality Of Life ◽

Health Care ◽

Resource Allocation ◽

Life Assessment ◽

Quality Of Life Assessment ◽

Allocation Decisions ◽

Resource Allocation Decisions

Download Full-text

More Than Just a Mammogram: Breast Cancer Screening Perspectives of Relatives of Women With Intellectual Disability

Intellectual and Developmental Disabilities ◽

10.1352/1934-9556-52.6.444 ◽

2014 ◽

Vol 52 (6) ◽

pp. 444-455 ◽

Cited By ~ 8

Author(s):

Nechama W. Greenwood ◽

Deborah Dreyfus ◽

Joanne Wilkinson

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Health Care ◽

Intellectual Disability ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Breast Cancer Mortality ◽

Family Members ◽

Well Being

Abstract Women with intellectual disability (ID) have similar rates of breast cancer as the general public, but higher breast cancer mortality and lower rates of regular screening mammography. Screening rates are lowest among women who live with their families. Though women with ID often make decisions in partnership with their relatives, we lack research related to family member perspectives on mammography. We conducted a qualitative study of family members of women with ID, with an interview guide focused on health care decision making and experiences, and breast cancer screening barriers, facilitators, and beliefs as related to their loved ones. Sixteen family members underwent semistructured interviews. Important themes included mammography as a reference point for other social and cultural concerns, such as their loved one's sexuality or what it means to be an adult woman; fear of having to make hard decisions were cancer to be diagnosed acting as a barrier to screening; a focus on quality of life; and desire for quality health care for their loved one, though quality care did not always equate to regular cancer screening. Adults with ID are valued members of their families, and their relatives are invested in their well-being. However, families fear the potentially complicated decisions associated with a cancer diagnosis and may choose to forgo screening due to misinformation and a focus on quality of life. Effective interventions to address disparities in mammography should focus on adults with ID and their families together, and incorporate the family context.

Download Full-text