An economic evaluation of teledermatology care delivery for chronic skin diseases

Aim: Analyze the impact of nationwide implementation of teledermatological care for psoriasis. Methods: Develop a Markov model that estimates the impact of telehealth technology for treatment of moderate-to-severe psoriasis on health and healthcare expenditures compared with in-person clinical care. Results: Lower medical costs by US$1.5 billion and total social costs of US$4.3 billion over 5 years. Patients save more than 67 million hours in work absenteeism and travel time, valued at US$598 million. Employers save US$1.2 billion over 5 years due to decreased employee absenteeism. Conclusion: National implementation of telehealth for psoriasis care has the potential to substantially reduce both formal healthcare costs and informal costs for families and patients, while maintaining equivalent clinical outcomes as traditional in-person care.

The Consult Station® innovation for primary care: a proof of concept study for generalisation of teleconsultation devices (Preprint)

BACKGROUND Telemedicine technology is a growing field, especially in the context of the Covid-19 pandemic. Consult Station® is the first telemedicine device enabling a complete remote medical consultation including clinical parameter collection in a single space-time. OBJECTIVE Here, we report the multisite urban and suburban implantation of Consult Station® for primary care and its contribution to healthcare pathways in medical low-density areas. METHODS In a proof-of-concept multisite prospective cohort study, 2034 consecutive patients having a teleconsultation were included. Consultation characteristics were analysed from the patient and the practitioner perspectives. RESULTS In this study, the main users of Consult Station® were young patients consulting for seasonal infections of low severity. Interestingly, hypertension, diabetes and preventive medical consultations were almost absent, while they represent almost 50% of consultations with a GP. We showed that in the whole territory where the Consult Station® was implanted, the number of consultations increased when GP density decreased. The study of practitioner characteristics showed their motivation to work with this device, while continuing to live in metropolitan areas with a high level of technical acceptability. CONCLUSIONS Multisite implantation of Consult Station® booths is relevant for primary cares but it also could meet the challenge of medical deserts. In addition, further studies should be addressed to evaluate its possible contribution to limit work absenteeism.

Work absenteeism and disability associated with psoriasis and psoriatic arthritis in the USA—a retrospective study of claims data from 2009 TO 2020

Objectives To compare work absenteeism and short-term disability among adults with psoriasis or psoriatic arthritis (PsA), versus controls in the USA. Methods Adults eligible for work absenteeism and/or short-term disability benefits between 1/1/2009 and 4/30/2020 were screened in the IBM® MarketScan® Commercial and Health and Productivity Management Databases. The following groups were defined: (1) psoriasis: ≥ 2 psoriasis diagnoses ≥ 30 days apart and no PsA diagnoses; (2) PsA: ≥ 2 PsA diagnoses ≥ 30 days apart; (3) control: absence of psoriasis and PsA diagnoses. Controls were matched to psoriasis and PsA patients based on age, gender, index year, and comorbidities. Non-recreational work absences and sick leaves were evaluated in absentee-eligible patients, and short-term disability was evaluated in short-term disability-eligible patients. Costs (in 2019 USD) associated with each type of work absence were evaluated. Results 4261 psoriasis and 616 PsA absentee-eligible and 25,213 psoriasis and 3480 PsA short-term disability-eligible patients were matched to controls. Average non-recreational work absence costs were $1681, $1657, and $1217 for the PsA, psoriasis, and control group, respectively. Compared with psoriasis patients and controls, more PsA patients had sick leaves after 1 year (56.2% versus 55.6% and 41.5%, p < 0.0001). Similarly, short-term disability was more frequent in PsA patients than psoriasis patients and controls at year one (8.8% versus 5.6% and 4.7%, p < 0.0001) and corresponding costs were higher ($605, $406, and $335 on average, p < 0.0001). Conclusion Annual work absenteeism and short-term disability were consistently greater among patients with PsA and psoriasis than controls, highlighting the substantial economic burden of psoriatic disease. Key points• Patients with PsA had greater short-term disability compared with patients with psoriasis and patients with neither psoriasis nor PsA.• Patients with PsA and patients with psoriasis incurred greater non-recreational work absences and sick leaves than patients with neither psoriasis nor PsA.

The Influence of Principal's Leadership Style and Work Motivation on Teacher Performance at SMK Negeri 2 Tebing Tinggi

This research uses a quantitative approach, where the symptoms will be measured using numbers. The results of this study, the multiple linear regression equation Y = 15,676 + 0.681X1 - 0.080X2. This means that the principal's leadership style variables and motivation have a significant relationship with teacher performance at SMK Negeri 2 Tebing Tinggi. The coefficient determinant of R² is 0.502 or 50.2%. This means that the Principal leadership style variable (X1) and motivation (X2) can explain the teacher performance variable (Y) by 50.2%, the remaining 49.8% (100% - 50.2%) is explained by other variables that not included in this study such as reward, punishment, communication, education level, years of service, work absenteeism rates, etc., which were not thorough in this study. After testing the hypothesis that the calculated value of 5.529 was obtained. With α = 5%, dk = 46-3 = 43 obtained a table value of 1.681. From these figures it can be seen that tcount (5.529) > ttable (1.681), as well as the significance value of 0.00 <0.05, it can be concluded if the hypothesis is accepted. After testing the hypothesis that the t-value is -0.925. With α = 5%, dk = 46-3 = 43 obtained a table value of 1.681. From these figures it can be seen that tcount (-0.925) < ttable (1.681), as well as the significance value of 0.360 > 0.05, it can be concluded if the hypothesis is rejected. The third hypothesis proposed states that there is an influence of the Principal's leadership style and motivation on teacher performance at SMK Negeri 2 Tebing Tinggi. After being tested the Fcount value was 23.703. With α = 5%, df1 = 3, df2 = 46-3 = 43 the Ftable value of 2.82 is obtained. From these figures it can be seen that Fcount (23.703) > Ftable (3.26), as well as the significance value of 0.000b < 0.05, it can be concluded that the hypothesis is accepted

Estimating Endogenous Treatment Effects Using Latent Factor Models with and without Instrumental Variables

We provide evidence on the least biased ways to identify causal effects in situations where there are multiple outcomes that all depend on the same endogenous regressor and a reasonable but potentially contaminated instrumental variable that is available. Simulations provide suggestive evidence on the complementarity of instrumental variable (IV) and latent factor methods and how this complementarity depends on the number of outcome variables and the degree of contamination in the IV. We apply the causal inference methods to assess the impact of mental illness on work absenteeism and disability, using the National Comorbidity Survey Replication.

The Search for Biomarkers in Fibromyalgia

Fibromyalgia is the most common of the central sensitivity syndromes affecting 2–5% of the adult population in the United States. This pain amplification syndrome has enormous societal impact as measured by work absenteeism, decreased work productivity, disability and injury compensation and over-utilization of healthcare resources. Multiple studies have shown that early diagnosis of this condition can improve patient outlook and redirect valuable healthcare resources towards more appropriate targeted therapy. Efforts have been made towards improving diagnostic accuracy through updated criteria. The search for biomarkers for diagnosis and verification of Fibromyalgia is an ongoing process. Inadequacies with current diagnostic criteria for this condition have fueled these efforts for identification of a reproducible marker that can verify this disease in a highly sensitive, specific and reproducible manner. This review focuses on areas of research for biomarkers in fibromyalgia and suggests that future efforts might benefit from approaches that utilize arrays of biomarkers to identify this disorder that presents with a diverse clinical phenotype.