scholarly journals Estimating the pre- and post-diagnosis costs of tuberculosis care for adults in Karachi, Pakistan: Household economic impact and strategies for meeting the costs

2021 ◽  
Author(s):  
Shama Razzaq ◽  
Aysha Zahidie ◽  
Zafar Fatmi
Keyword(s):  
Public Service ◽  
Point Of Care ◽  
Indirect Costs ◽  
Support Network ◽  
Private Provider ◽  
Patient Treatment ◽  
And Coping ◽  
Tuberculosis Care ◽  
Out Of Pocket Costs ◽  
Critical Investigation

Abstract Background Despite of free TB care in Pakistan, patients still have to bear high costs which push them more into poverty. This study estimated the types of costs households bear for TB care, and coping mechanisms used for bearing TB expenditures among adults ≥ 18 years in Karachi, Pakistan. Methods A total of 516 TB patients with completion of at least one month intensive treatment were recruited from four public sector hospitals in Karachi, Pakistan. A standardized questionnaire to estimate patient's costs was administered. Direct medical and non-medical costs incurred as out-of-pocket and indirect costs (loss of income) during pre-diagnostic, diagnostic, treatment and hospitalization phase were estimated. Results Out of 516 participants, 52.1% were female with a mean age of 32.4 (± 13.7) years. The median costs per patient borne during the pre-diagnostic, diagnostic, treatment and hospitalization was estimated at USD63.8/ PKR7377, USD24/ PKR2755, USD10.5/ PKR1217 and USD349.0/ PKR40300, respectively. The total household median costs was estimated at USD129.2/ PKR14919 per patient. The median indirect costs were estimated at USD52.0/ PKR5950 per patient. First point of care was a private provider by 54.1% of patients, 36% attended public service, 5% and 4.1% went to dispensary and pharmacy, respectively. Conclusion TB patients bear substantial out-of-pocket costs before they are enrolled in publically funded TB program. There should be provision of transport and food vouchers, also health insurance for in-patient treatment. This advocates a critical investigation into an existing financial support network for TB patients in Pakistan with an eye towards easing the burden.

Out-of-Pocket Costs and Importance of Nonmedical and Indirect Costs of Inpatients

2021 ◽  
Vol 24 ◽  
pp. 141-147
Author(s):  
Asma Sabermahani ◽  
Mohammad Jafari Sirizi ◽  
Farzaneh Zolala ◽  
Sonia Nazari
Keyword(s):  
Indirect Costs ◽  
Out Of Pocket Costs

scholarly journals Optical spectroscopic methods for diagnostics of intervertebral disc degeneration

2018 ◽  
Vol 58 (2) ◽  
Author(s):  
Juozas Vidmantis Vaitkus ◽  
Darius Varanius ◽  
Ignas Čiplys ◽  
Vilmantas Gėgžna ◽  
Gunaras Terbetas ◽  
...  
Keyword(s):  
Intervertebral Disc ◽  
Raman Scattering ◽  
Medical Condition ◽  
Point Of Care ◽  
Infrared Light ◽  
Patient Treatment ◽  
Ir Absorption ◽  
And Gender ◽  
Raman Scattering Spectra ◽  
Ft Raman

The level of degeneration (LOD) in the human intervertebral disc (IVD) could determine the choice of patient treatment strategy, thus there is a need for methods applicable at a point of care that enable quick medical decisions. In this paper, infrared light absorption, FT-Raman scattering and fluorescence spectroscopy were used to analyse the same specimens from different groups of IVD samples. Samples from the lumbar part of spine of 37 patients (mean age 48.2 years old) were included in the study. The gender distribution was 27 women and 10 men. The distribution by LOD in the Pfirrmann scale was as follows: grade 3 (40.5%), grade 4 (48.6%) and grade 5 (10.8%) were evaluated in our samples. Spectroscopic signals were measured and analysed. Features such as medical condition (LOD), patient’s age and gender were taken into account. All three methods of spectroscopy revealed age-dependent spectroscopic features related to LOD. For the first time a promissing possibility was found to recognize the LOD by fluorescence spectra in human IVD material taking gender and age into account. The findings create a background for the design of equipment and the design of experiment of more advanced clinical trials. FT-IR absorption and FT-Raman scattering spectra demonstrated the age dependences of a few components. The Raman peak at 2707 cm–1 seems promising for recognition of lumbar IVD LOD, but a higher number of specimens is necessary.

Relationship Between Gender, Stress, and Quality of Social Support

2020 ◽  
pp. 003329412093984 ◽  
Author(s):  
Meredith Kneavel
Keyword(s):  
Social Support ◽  
Perceived Stress ◽  
Internet Survey ◽  
Support Network ◽  
Tend And Befriend ◽  
Gender And Age ◽  
Males And Females ◽  
And Gender ◽  
And Coping

Background Research suggests that gender differences exist in both stress and how social support is utilized and that the relationship between stress and social support may not be linear. Methods An internet survey of n = 1080 participants was conducted evaluating quality and quantity of social support, gender, age, and perceived stress and coping. Results Reported quality of social support, gender, and age significantly predicted perceived stress and that there was a curvilinear interaction between the quality of social support and gender which significantly predicted perceived stress. Conclusion The current findings supported Taylor’s Tend and Befriend theory that females have higher reported stress levels, a larger support network, and report more quality in their social support. Practitioner points:  • Males and females may manifest stress differently in their relationships. • When working with males and females in practice it may be important to understand the depth and breadth of their social networks and how they utilize those networks. • Females indicate higher levels of stress and greater social support quality. • It is important to understand that one’s social network can be an important source of support (a coping mechanism) but that it can also serve as a stressor in some cases.

scholarly journals From Point-of-Care Testing (PoCT) and vaccination to changing the care paradigm: the role of primary care

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Petelos ◽  
C Lionis
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Point Of Care ◽  
Behavioural Change ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Prescribing Patterns ◽  
Patient Treatment ◽  
Therapeutic Decisions

Abstract The speaker will discuss the role of primary care for all patients and cancer patients, elaborating on prescribing patterns vaccinations, recommendations for Over-The-Counter medicines (OTCs) nutritional supplements, and as well as its contribution of behavioural change to raise awareness and change prescription practice. The role of PoCT for reducing the threat of AMR and for improving the differential diagnosis will be discussed, according to the WHO Approach of “diagnostic stewardship” for the appropriate use of microbiological diagnostics to guide therapeutic decisions. In the context of syndromic surveillance and preparedness, as well as in terms of protecting cancer patients at times of epidemics, methods of specimen collection for limited community transmission and for the timely pathogen identification along with accurate, timely reporting of results to guide patient treatment will be discussed. The role of behavioural modification interventions will be discussed, incl. in relation to vaccination and the role it can play in AMR. Improvement of the survivorship experience will be examined in the context of improving health literacy. The case of Greece, currently having the highest antibiotic consumption in Europe and the fourth highest globally, along with an increasing trend on antibiotic use will also be discussed.

scholarly journals Quality of Life and Caregiver Burden in Patients and Their Caregivers Undergoing Outpatient Autologous Stem Cell Transplantation Compared to Inpatient Transplantation

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 62-62
Author(s):  
Vinita Dhir ◽  
Lara Zibdawi ◽  
Harminder K Paul ◽  
Osvaldo Espin-Garcia ◽  
Christine I Chen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Board Of Directors ◽  
Research Funding ◽  
Indirect Costs ◽  
Opportunity Costs ◽  
Advisory Committees ◽  
Significant Difference ◽  
Lost Opportunity ◽  
Out Of Pocket Costs

Introduction Outpatient autologous stem cell transplantation (ASCT) has become standard of care in many centres due to limited inpatient resources and rising financial constraints. Outpatient ASCT involves family members/friends assuming some patient care responsibilities during the acute transplant period. Although this may be associated with reduced direct medical costs, little work has been done to ascertain the "out of pocket costs" and "lost opportunity costs" to patients and their caregivers. Outpatient transplantation is perceived to provide superior quality of life (QOL) for patients, but there is little evidence to support this. In addition to patients' QOL, there is limited data on the impact of these treatments on caregivers' QOL. Thus, our objectives were to compare the QOL of patients and their caregivers undergoing outpatient and inpatient ASCT, and to quantify indirect costs to them. Methods This is a single centre cohort study of consecutive patients with lymphoma and plasma cell disorders undergoing ASCT at Princess Margaret Cancer Centre from April 2016 - July 2019. Patients without a primary caregiver were still eligible to complete the QOL portion of the study. All patients completed four questionnaires: Functional Assessment of Cancer Therapy - Bone Marrow Transplant (FACT-BMT); FACT-Fatigue (FACT-F); EQ-5D-3L; and a distress impact thermometer. Clinically meaningful differences between the groups and serially were defined as ≥ 4 points on the FACT-BMT and FACT-F, and ≥0.08 on the EQ-5D-3L. Caregivers completed three questionnaires: Caregiver Quality of Life Index-Care (C-QOLC), a distress impact thermometer, and a caregiver self-administered financial expenditure survey (C-SAFE). Indirect costs were defined as lost opportunity costs (i.e., wages) and out-of-pocket costs (e.g., parking, accommodations). Questionnaires were completed at 5 time points: D0 (prior to ASCT), D+7, D+14 (discharge from daily visits), D+28 (discharge from ASCT) and D+100 (follow-up). Results In total, 68 patients have been enrolled to date (41 outpatients and 27 inpatients), and 54 caregivers (38 outpatients and 16 inpatients). Median patient age was 57 yrs (range: 18-71), and 66% were male. Of the 68 patients, 69% had a diagnosis of multiple myeloma and 31% lymphoma. Majority of caregivers were spouses (74%). In the overall sample, FACT-F scores (fatigue) increased significantly at D+7, D+14, and D+28, with improvement at D+100 (all p<0.05 and clinically meaningful). Compared to inpatients, outpatients had higher fatigue levels at D+7 and D+14 that were statistically significant (Figure 1), with D+14 being clinically significant as well. For all patients, QOL scores by FACT-BMT declined at D+7, but then improved to above baseline values at D+100 (p<0.05) (Table 1). On the EQ-5D-3L, patients' self-reported overall best imaginable health status decreased at D+7 and D+14 relative to baseline (p<0.05); no significant difference was observed at D+28 and D+100 (Figure 1). Health utility scores were also calculated from the EQ-5D-3L. There were no significant trends in the overall sample, but when comparing the two groups, outpatients had lower measures at D+14 that were statistically and clinically relevant. With respect to caregiver QOL, in the entire sample, QOL was higher at D+100 relative to baseline (p<0.05) (Figure 2). There were no differences between the two groups. In addition, there was no statistically significant difference in lost opportunity costs (wages) between the two groups, however there was a trend towards higher lost opportunity costs in outpatient caregivers in the early ASCT process (D0, D+7, D+14). The mean overall costs (burden) for the primary caregiver in the acute first 100d phase of ASCT was C$4475. The indirect out-of-pocket costs by caregivers varied greatly, with an average of $58 at baseline (range $0-455) and $121 at D+28 (range $0-710). Conclusions There was significant deterioration of various QOL measures in all patients, irrespective of outpatient or inpatient status. Outpatients, however, reported significantly higher fatigue levels at D+7 and D+14. Caregiver QOL appears comparable between the two modalities, and appears to improve significantly by the follow-up period. The financial burden on caregivers, mostly driven by lost opportunity costs (wages), is high, with a trend towards higher burden in outpatient caregivers in the early parts of ASCT. Disclosures Chen: Celgene: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Amgen: Honoraria. Kridel:Gilead Sciences: Research Funding. Kukreti:Celgene: Honoraria; Amgen: Honoraria; Takeda: Honoraria. Kuruvilla:Celgene: Honoraria; Astra Zeneca: Honoraria; Seattle Genetics: Consultancy; Amgen: Honoraria; Roche: Consultancy; Karyopharm: Consultancy; Gilead: Consultancy; Abbvie: Consultancy; BMS: Consultancy; Roche: Research Funding; Janssen: Research Funding; Merck: Consultancy; Gilead: Honoraria; BMS: Honoraria; Karyopharm: Honoraria; Janssen: Honoraria; Roche: Honoraria; Seattle Genetics: Honoraria; Novartis: Honoraria; Merck: Honoraria. Reece:Otsuka: Research Funding; Karyopharm: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Merck: Research Funding; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria, Research Funding; BMS: Research Funding. Tiedemann:Amgen: Honoraria; Novartis: Honoraria; Takeda: Honoraria; Celgene: Honoraria; BMS: Honoraria; Janssen: Honoraria. Trudel:Pfizer: Honoraria; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GlaxoSmithKline: Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Honoraria; Janssen: Honoraria, Research Funding; Astellas: Research Funding; Genentech: Research Funding; Sanofi: Honoraria. Prica:Janssen: Honoraria; Celgene: Honoraria.

scholarly journals Point of Care Diagnostics in Resource-Limited Settings: A Review of the Present and Future of PoC in Its Most Needed Environment

Biosensors ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 133
Author(s):  
Benjamin Heidt ◽  
Williane Siqueira ◽  
Kasper Eersels ◽  
Hanne Diliën ◽  
Bart van Grinsven ◽  
...  
Keyword(s):  
Low Income ◽  
Value Chain ◽  
Point Of Care ◽  
Healthcare Providers ◽  
Low Income Countries ◽  
Patient Treatment ◽  
Resource Limited Settings ◽  
Widespread Application ◽  
Resource Limited ◽  
Fundamental Research

Point of care (PoC) diagnostics are at the focus of government initiatives, NGOs and fundamental research alike. In high-income countries, the hope is to streamline the diagnostic procedure, minimize costs and make healthcare processes more efficient and faster, which, in some cases, can be more a matter of convenience than necessity. However, in resource-limited settings such as low-income countries, PoC-diagnostics might be the only viable route, when the next laboratory is hours away. Therefore, it is especially important to focus research into novel diagnostics for these countries in order to alleviate suffering due to infectious disease. In this review, the current research describing the use of PoC diagnostics in resource-limited settings and the potential bottlenecks along the value chain that prevent their widespread application is summarized. To this end, we will look at literature that investigates different parts of the value chain, such as fundamental research and market economics, as well as actual use at healthcare providers. We aim to create an integrated picture of potential PoC barriers, from the first start of research at universities to patient treatment in the field. Results from the literature will be discussed with the aim to bring all important steps and aspects together in order to illustrate how effectively PoC is being used in low-income countries. In addition, we discuss what is needed to improve the situation further, in order to use this technology to its fullest advantage and avoid “leaks in the pipeline”, when a promising device fails to take the next step of the valorization pathway and is abandoned.

COST OF ILLNESS PADA PASIEN PENYAKIT KANKER PAYUDARA DI RSUD ULIN BANJARMASIN

2020 ◽  
Vol 5 (2) ◽  
pp. 407-415
Author(s):  
Noor Aisyah ◽  
◽  
Shela Puji Dina
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cost Of Illness ◽  
Medical Cost ◽  
Indirect Costs ◽  
Medical Costs ◽  
Patient Treatment ◽  
Breast Cancer Patients ◽  
Economic Burden Of Disease ◽  
Direct Medical Costs

The cost of illness is an important element in disease decision making because it can evaluate the economic burden of disease. One of them is breast cancer because breast cancer is a catastrophic disease. This study aims to determine direct medical costs, direct non-medical costs, indirect costs, and total costs based on a societal perspective in breast cancer patients at Ulin Hospital, Banjarmasin. This study is an observational analytic study with a prevalence-based cost of illness approach. Data was taken retrospectively for direct medical costs collected from patient medical records that met the inclusion and exclusion criteria, patient treatment data, and details of direct medical costs for the period January-July 2020. Direct non-medical costs and indirect costs were taken from the results of filling out a questionnaire to Breast cancer patients who have undergone treatment in the inpatient room of RSUD Ulin Banjarmasin. Data analysis used descriptive statistics to identify patient characteristics and the costs of breast cancer. The results of the study, the average direct medical cost of breast cancer patients at Ulin Banjarmasin Hospital was Rp. 6,281,700. The average direct non-medical cost was Rp. 416,780 and the average indirect cost was Rp. 229,820. Meanwhile, the average overall cost per episode of inpatient was Rp. 6,928,300

Using mobile app technology for patient data capture and implementation.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 317-317
Author(s):  
Steven J. Nurkin ◽  
Stephen B. Edge ◽  
Venkata R. Kakarla ◽  
Nikhil I. Khushalani
Keyword(s):  
Cancer Registry ◽  
Patient Reported Outcomes ◽  
Breast Surgery ◽  
Point Of Care ◽  
Data Entry ◽  
Patient Data ◽  
Care Plan ◽  
Patient Treatment ◽  
Patient Reported ◽  
Treatment Summary

317 Background: Mobile application technology has quickly become an integral part of clinical cancer care. While this technology is most commonly used as a point of care reference or educational tool, it may also be an effective method to capture patient data. The purpose of this project was to create a mobile solution for fast, point-of-care data capture and implementation, patient reported outcomes, to generate a patient treatment summary and provide data for cancer registry and clinical trials. Methods: Using the “MedDB app” (Bitwise Analytics) on an iPad2 (Apple) device, an application was developed to collect patient data following breast surgery for cancer. Collected data included elements required for pathologic staging using the American Joint Committee on Cancer TNM system (7th Edition) with the application deriving pathologic TNM and Stage Group. In addition, the type of breast surgery, lymph node surgery, and the expected next steps in treatment are coded for collection. Data are entered into the App in the clinic and transferred using a blinded code number to a web-based database. This database is then used to generate a patient surgical treatment summary and care plan, and is available for uploading into a research database. We then developed an individual patient App for their own personal mobile device. The purpose was to collect patient reported outcomes through their adjuvant care and surviorship. Results: The initial pilot included data entry on 20 breast cancer patients who had surgery prior to adjuvant therapy. The time to complete data entry was less than 60 seconds per case. Conclusions: Mobile communication devices are increasingly becoming key tools for clinicians. They are primarily used to search for medical resource information and the review of medical records. This pilot demonstrates the potential for use of mobile computer devices for collecting key data for clinical trials, the cancer registry, generating a patient treatment summary and care plan at the point of service as well as patient reported outcomes through personalized patient apps. Future development will include studies of integration with the electronic health record, the cancer registry systems, and expansion to a complete survivorship care plan system.

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