Resource use and costs of exenatide bid or insulin in clinical practice: the European CHOICE study

Introduction: Acute aortic syndrome (AAS) is an uncommon, life-threatening emergency that is frequently misdiagnosed. The Canadian clinical practice guidelines for the diagnosis of AAS were developed in order to reduce the frequency of misdiagnoses and number of diagnostic tests. As part of the guidelines, a clinical decision aid was developed in order to facilitate clinician decision-making based on practice recommendations. The objective of this study was to identify barriers and facilitators among physicians to implementation of the decision aid. Methods: We conducted semi-structured interviews with emergency room physicians working at 5 sites distributed between urban academic and rural settings. We used purposive sampling, contacting ED physicians until data saturation was reached. Interview questions were designed to understand potential barriers and facilitators affecting the probability of decision aid uptake and accurate application of the tool. Two independent raters coded interview transcripts using an integrative approach to theme identification, combining an inductive approach to identification of themes within an organizing framework (Theoretical Domains Framework), discrepancies in coding were resolved through discussion until consensus was reached. Results: A majority of interviewees anticipated that the decision aid would support clinical decision making and risk stratification while reducing resource use and missed diagnoses. Facilitators identified included validation and publication of the guidelines as well as adoption by peers. Barriers to implementation and application of the tool included the fact that the use of D-dimer and knowledge of the rationale for its use in the investigation of AAS were not widespread. Furthermore, scoring components were, at times, out of alignment with clinician practices and understanding of risk factors. The complexity of the decision aid was also identified as a potential barrier to accurate use. Conclusion: Physicians were amenable to using the AAS decision aid to support clinical decision-making and to reduce resource use, particularly within rural contexts. Key barriers identified included the complexity of scoring and inclusion criteria, and the variable acceptance of D-dimer among clinicians. These barriers should be addressed prior to implementation of the decision aid during validation studies of the clinical practice guidelines.

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FIMA, the questionnaire for health-related resource use in the elderly population: validity, reliability, and usage of the Polish version in clinical practice

Clinical Interventions in Aging ◽

10.2147/cia.s158951 ◽

2018 ◽

Vol Volume 13 ◽

pp. 787-795 ◽

Cited By ~ 1

Author(s):

Justyna Mazurek ◽

Edyta Sutkowska ◽

Dorota Szcześniak ◽

Katarzyna Małgorzata Urbańska ◽

Joanna Rymaszewska

Keyword(s):

Clinical Practice ◽

Resource Use ◽

Elderly Population ◽

The Elderly ◽

Polish Version ◽

Health Related

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Febrile Neutropenia in Lymphoma Patients Is Associated with Substantial Resource Use and Healthcare Costs in Clinical Practice in Spain.

Blood ◽

10.1182/blood.v108.11.5512.5512 ◽

2006 ◽

Vol 108 (11) ◽

pp. 5512-5512 ◽

Cited By ~ 1

Author(s):

A. López ◽

J.D. Alonso ◽

J. Gómez-Codina ◽

A. Novo ◽

C. Herrera ◽

...

Keyword(s):

Clinical Practice ◽

Febrile Neutropenia ◽

Resource Use ◽

Healthcare Costs ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Substantial Impact ◽

Ct Dose ◽

Common Clinical Practice ◽

The Impact

Abstract Background Despite the significant impact of chemotherapy-induced febrile neutropenia (FN) on patients (pts) with cancer and its consequences for health care costs, there have been no studies in common clinical practice in Spain assessing the burden and economic impact of this complication. Methods This is a sub-analysis of lymphoma pts included in a multicentre, retrospective, chart review of adult pts from 16 Spanish hospitals who suffered from at least one FN episode related to cytotoxic chemotherapy (CT). Resource use and subsequent costs including days of hospitalization, number of transfusions, number and type of complementary tests, use of colony-stimulating factors (CSFs), and use of antibiotics and other drugs to manage FN were assessed for each episode. The impact of FN on planned CT was also analysed in terms of dose delays (DD) and/or reductions (DR). Results Medical charts from 194 pts were reviewed, 67 (34.5%) of whom had lymphoma, which accounted for 87 documented FN episodes included in this analysis. The median (range) age of patients was 62 (19–85) years, 31.7% had aggressive NHL, and 58.2% were treated with CHOP-like CT. FN appeared during first CT cycle in 61.2% of the pts. Hospitalization was required in 100% of the pts and the median length of hospital stay due to FN was 8 days (p25:6–p75:11). During an FN episode, 42% of pts required ≥1 transfusion, 100% needed a blood test and 98.9% a blood culture. Microbiologically documented infection appeared in 33% of FN episodes. All pts were treated with antibiotics (69.3% with cephalosporins) and CSFs were used in 64.8% of pts. In 40.9% of episodes, FN impacted on planned CT dose and/or schedule: DR was observed in 16.7% of pts, DD in 24.0% and CT withdrawal in 15.2%. Conclusions FN has a substantial impact on resource use and associated costs in pts with lymphoma. Hospitalization and antibiotic treatment were the main drivers of the cost associated with the management of FN in current clinical practice. Furthermore, FN has a meaningful effect on planned CT dose and/or schedule, with potential consequences for treatment outcome. Mean (SD) healthcare costs per FN episode (All cost data expressed as €) Hospitalization Transfusions Complementary Tests CSFs Antibiotics and Other Drugs Total 3,557.17 (3,050.44) 43.24 (58.59) 162.77 (135.36) 223.39(231.40) 527.67 (448.56) 4,514.24 (3,392.20)

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