[Show abstract][Hide abstract] ABSTRACT: IntroductionThe health impact of acquired brain injury (ABI) is not only apparent in the patient, but also in the loss of health related quality of life (HRQol) of their carers. The objectives of this study were to measure the loss of HRQol as well as the burden of the carers of patients with ABI.
Revista Española de Geriatría y Gerontología 07/2011; 46(4):200-205. DOI:10.1016/j.regg.2011.01.010
[Show abstract][Hide abstract] ABSTRACT: The health impact of acquired brain injury (ABI) is not only apparent in the patient, but also in the loss of health related quality of life (HRQol) of their carers. The objectives of this study were to measure the loss of HRQol as well as the burden of the carers of patients with ABI.
A retrospective study was conducted with 76 carers of patients with ABI. A questionnaire was used to collect information on the sociodemographic aspects, carer burden (Zarit Scale) and the HRQol (EuroQol Questionnaire) of the carers. A multiple linear regression model was constructed to analyse the effect of the different variables.
The carers were predominantly women over 50 years, retired or dedicated to domestic tasks and who cared for their husband or one of their parents. One third showed a high risk of claudication. The mean HRQol obtained with the EuroQol went from a similar score to that of the general population (0.9) in the group without burden, to 0.67 in the group with risk of claudication. The regression models explained the burden better than the loss in quality of life.
Carers of patients with brain injury suffer a significant loss in HRQol compared to the general population. The deterioration arises from the mental dimensions and depends on the level of burden.
Revista Española de Geriatría y Gerontología 05/2011; 46(4):200-5.
[Show abstract][Hide abstract] ABSTRACT: Patients with acquired brain damage (ABD) have suffered a brain lesion that interrupts vital development in the physical, psychological and social spheres. Stroke and traumatic brain injury (TBI) are the two main causes. The objectives of this study were to estimate the incidence and prevalence of ABD in the population of the Basque Country and Navarre in 2008, to calculate the associated cost of the care required and finally to assess the loss in health-related quality of life.
On the one hand, a cross-sectional survey was carried out, in order to estimate the incidence of ABD and its consequences in terms of costs and loss in quality of life from the evolution of a sample of patients diagnosed with stroke and TBI. On the other hand, a discrete event simulation model was built that enabled the prevalence of ABD to be estimated. Finally, a calculation was made of the formal and informal costs of ABD in the population of the Basque Country and Navarre (2,750,000 people).
The cross-sectional study showed that the incidences of ABD caused by stroke and TBI were 61.8 and 12.5 cases per 100,000 per year respectively, while the overall prevalence was 657 cases per 100,000 people. The SF-36 physical and mental component scores were 28.9 and 44.5 respectively. The total economic burden was calculated to be 382.14 million euro per year, distributed between 215.27 and 166.87 of formal and informal burden respectively. The average cost per individual was 21,040 € per year.
The main conclusion of this study is that ABD has a high impact in both epidemiological and economic terms as well as loss in quality of life. The overall prevalence obtained is equivalent to 0.7% of the total population. The substantial economic burden is distributed nearly evenly between formal and informal costs. Specifically, it was found that the physical dimensions of quality of life are the most severely affected. The prevalence-based approach showed adequate to estimate the population impact of ABD and the resources needed to compensate the disability.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to analyse the inter-hospital variation in the appropriateness of cataract phacoemulsification in Spain.
This observational, multicentre, prospective study involved patients aged 18-90 years. Each phacoemulsification intervention was classified as 'necessary', 'appropriate', 'uncertain' or 'inappropriate' according to explicit appropriateness criteria previously established using the RAND/UCLA methodology. A descriptive statistical analysis was performed, followed by univariate and multivariate logistic regression analysis, in order to examine the differences between hospitals.
In total, 5063 patients from 15 hospitals were enrolled. The percentage of patients in each hospital who inappropriately underwent phacoemulsification varied from 1.2% to 24.0% (P < 0.0001). The most common inappropriate scenario was that of patients with a simple, unilateral cataract with no limitation of their visual function, with a pre-surgery visual acuity of ≥ 0.5 in both eyes, and for whom surgical correction would involve low technical complexity.
The variation in appropriateness of phacoemulsification cannot be attributed solely to the clinical differences between the hospitals' patients. There is room for improvement in the appropriate indication of phacoemulsification. Measures based on the dissemination of appropriateness criteria might improve quality of care.
Journal of Evaluation in Clinical Practice 02/2011; 17(1):188-95. DOI:10.1111/j.1365-2753.2010.01421.x · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To identify variables related to time spent on a waiting list for cataract extraction and the effect of waiting time on some outcomes.
Twelve ophthalmology units throughout Spain.
This study included consecutive patients scheduled to have cataract removal by phacoemulsification. Sociodemographic and clinical data, including visual acuity, and Visual Function Index 14 (VF-14) results were collected before and after cataract extraction. Univariate and multivariate linear regression was performed to identify variables related to time on the waiting list for cataract extraction and the influence of waiting time on postoperative visual acuity, visual function, and complications.
The study comprised 3787 patients. Patients with social support spent significantly more time (1.04 times) on the waiting list (P = .0188), while those with contralateral visual acuity better than 0.5 and those with vision-related daily living difficulties spent less time on the waiting list. Patients who waited longer than 5 months for cataract extraction had smaller gains in visual acuity than those who waited fewer than 3 months (P = .0348). Time on the waiting list did not significantly influence changes in the VF-14 results or complications from surgery.
The finding that some contradictory sociodemographic factors influence time spent on a waiting list for cataract extraction suggests that rational, explicit, and homogeneous appropriateness and priority criteria are not being applied to these patients. Use of such criteria could improve waiting times and order waiting lists so patients who need cataract extraction the most would receive it soonest.
No author has a financial or proprietary interest in any material or method mentioned.
Journal of Cataract and Refractive Surgery 11/2010; 37(1):19-26. DOI:10.1016/j.jcrs.2010.07.020 · 2.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the contribution of hospital-to-hospital variability in changes in clinical and health-related quality of life outcomes among patients undergoing cataract extraction by phacoemulsification.
Prospective observational study of 14 public hospitals. We recruited consecutive patients on waiting lists for cataract extraction. Clinical data were collected prior to the intervention and 6 weeks afterward. Subjects completed the visual function index (VF-14) prior to the procedure and 3 months afterward. Univariate and multivariate analysis were performed for visual acuity and VF-14 scores.
Substantial differences were observed across the 14 hospitals. At baseline, mean visual acuity ranged from 0.16 to 0.34, and mean VF-14 scores ranged from 48.06 to 75.89. Following cataract extraction, the mean improvement in visual acuity ranged from 0.35 to 0.57 and in VF-14 scores from 10.94 to 41.70. The ranges were even more pronounced among patients with low visual acuity or low VF-14 scores prior to the intervention. Significant differences remained in multivariate analysis. Within the multivariate analysis, the variable 'hospitals' had an R(2) of 0.069 for the visual acuity model and of 0.073 for the VF-14 model, 20% and 13%, respectively, of the total variability explained. Variation was also observed within geographic regions.
Outcomes of patients undergoing cataract extractions vary widely from hospital to hospital, even within the same geographic region, explaining an important part of the results. Quality improvement efforts should concentrate on patients with low pre-intervention visual acuity or vision-related disability to reduce this variability in outcomes.
Journal of Evaluation in Clinical Practice 08/2010; 16(4):665-72. DOI:10.1111/j.1365-2753.2009.01157.x · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The relationship between disability and health related quality of life (HRQL) is complex because of the role that function plays in the measurement, and certain points need to be dealt with in greater detail when the analysis is applied to the different dimensions of HRQL. The purpose of this study was to assess the impact of disability on different domains of quality of life. Variables were drawn from the 2002 Basque Country Health Survey. Logistic regression models were constructed to measure the adjusted effect of disability on quality of life as determined by the SF-36 questionnaire. The models were adjusted for sociodemographic variables and the presence of comorbidity. The greatest difference between disabled and nondisabled subjects was found in the physical components of the questionnaire. Odds Ratios (ORs) for a suboptimal level of quality of life as determined by functional status were much higher for the physical than for the mental dimensions. Adjustment for different variables showed a decrease in ORs in the physical, mental, and social dimensions. This study establishes a significant relationship between disability and the loss of quality of life in both physical and mental dimensions of SF-36, irrespective of the associated disease.
ClinicoEconomics and Outcomes Research 07/2010; 2(1):97-103.
[Show abstract][Hide abstract] ABSTRACT: El aumento de la esperanza de vida en nuestra población ha incrementado la importancia del cuidado de las personas mayores dependientes. Esta labor se lleva a cabo principalmente por mujeres, las cuales viven a su vez los efectos de los cambios sociales ocurridos a nivel familiar y laboral. Objetivo: Profundizar en el conocimiento de las diferentes estrategias que las mujeres y hombres adoptan en su rol de cuidadores a través de la interpretación y análisis de sus propias percepciones. Metodología: para comprender mejor el significado de dichas repercusiones se llevó a cabo una investigación cualitativa mediante cinco grupos de discusión con hombres y mujeres cuidadores de personas mayores dependientes. Resultados: la interiorización del rol de cuidadora en las mujeres conlleva mayor carga física y emotiva y mayor vulnerabilidad a sus efectos. La asunción de estas nuevas tareas por los hombres refleja significados, estrategias de afrontamiento y efectos diferentes. Diferencias que han de ser tenidas en cuenta en el diseño de estrategias dirigidas a conseguir una mayor equidad de género y una mejora del trabajo de cuidado.
[Show abstract][Hide abstract] ABSTRACT: The introduction of phacoemulsification in the early 1990s significantly changed the treatment of cataract. It is possible that appropriateness criteria for cataract extraction developed before the widespread adoption of phacoemulsification no longer is as accurate or valid as possible. The objective of this study was to validate newly developed explicit appropriateness criteria.
Prospective, observational cohort study.
Consecutive patients with a diagnosis of cataract who were on waiting lists to undergo cataract extraction by phacoemulsification were recruited.
Newly developed explicit appropriateness criteria for cataract extraction, following Research and Development methodology, were applied in this study conducted in 17 public teaching hospitals. Data necessary to classify the appropriateness of the intervention, including demographic and clinical data and that related to the surgery and complications, were recorded by previously trained ophthalmologists in all centers before the intervention and at the 6-week visit afterward.
Subjects completed 2 questionnaires that measure health-related quality of life--the Short Form 36 and the Visual Function Index 14 (VF-14)--before the procedure and 3 months afterward. Also, visual acuity was recorded by ophthalmologists previous to the intervention and at 6 weeks after.
Five thousand two hundred fifty-seven cases were included in the study. At 3 months after cataract extraction, 4335 (82.5%) patients had responded to the questionnaires. Patients whose procedures were classified as necessary or appropriate by the new appropriateness criteria had greater improvements in visual acuity and VF-14 scores than those undergoing procedures classified as inappropriate. These differences seemed to be clinically relevant by measures such as the minimal clinically important difference and minimal detectable change. Complications rates were similar among all appropriateness categories, except for complications occurring in the peri-intervention period.
These results suggest a direct relationship between the newly developed explicit appropriateness criteria for cataract extraction and outcomes, as measured by clinical evaluation and health-related quality-of-life instruments. The results support the use of these criteria for clinical evaluation or the development of clinical guidelines.
[Show abstract][Hide abstract] ABSTRACT: Objetivos: Caracterizar a los cuidadores y cuidadoras informales, cuantificar el efecto que la actividad de cuidar tiene sobre su salud y determinar si éste es diferente según el sexo. Métodos: Estudio descriptivo basado en la Encuesta de Salud del País Vasco 2002. Se compararon la salud física y mental, la utilización de servicios, la salud social y la calidad de vida relacionada con la salud (CVRS) en personas cuidadoras (n = 836) y no cuidadoras (n = 5.706). Se calcularon los modelos de regresión logística para estimar la asociación entre el cuidado y los resultados en salud por sexos, ajustados por edad, nivel socioeconómico y situación laboral. Resultados: Las cuidadoras puntuaron peor que las no cuidadoras en 6 de los 10 indicadores, y los cuidadores en 4. Las asociaciones entre el cuidado (cuidar frente a no cuidar) y los resultados en salud fueron más notorias en las mujeres, excepto en la salud social. Al considerar la intensidad de la carga del cuidado, los hombres cuidadores con carga elevada presentaron riesgos iguales o superiores de mala CVRS (física hombres: odds ratio [OR] = 3,0, intervalo de confianza del 95% [IC95%]: 1,4-6,3; física mujeres: OR = 2,3, IC95%: 1,5-3,5; mental hombres: OR = 2,5, IC95%: 1,4-4,3; mental mujeres: OR = 2,5, IC95%: 1,7-3,7) y poco apoyo social (apoyo afectivo hombres: OR = 2,6, IC95%: 1,5-4,6; apoyo afectivo mujeres: OR = 1,5, IC95%: 1,0-2,3). Sin embargo, las cuidadoras mostraron mayor riesgo de sedentarismo, falta de sueño, número de consultas y peor salud mental. Conclusiones: Cuidar afecta negativamente a la salud de quienes cuidan, pero entraña mayores riesgos para las mujeres por la mayor carga de trabajo que deben asumir. Cuando los hombres aumentan la carga de cuidados, las desigualdades de género se reducen o invierten
[Show abstract][Hide abstract] ABSTRACT: To describe informal caregivers' characteristics, quantify the effect of caregiving activities on caregivers' health, and determine whether this effect differs by sex.
A descriptive study was carried out based on the Basque Health Survey 2002. Physical and mental health, use of health services, social health and health related quality of life (HRQL) indicators were compared in caregivers (n=836) and non-caregivers (n=5,706). Age-adjusted logistic regression models were calculated to assess the association between the caregiver and effects on health by sex, socioeconomic position and occupational status.
Female caregivers showed worse results in 6 out of 10 indicators compared with non-caregiver women, whereas male caregivers showed worse results in only four indicators compared with non-caregiving men. The associations between caregiving (caregiving vs. non-caregiving) and health results were stronger in women than in men, except in social health. When caregiving burden intensity was considered, greatly burdened men showed a similar or higher risk of poor HRQL (physical in men: OR=3.0, CI95%: 1.4-6.3; women: OR=2.3, CI95%: 1.5-3.5; mental in men: OR=2.5, CI95%: 1.4-4.3; women: OR=2.5, CI95%: 1.7-3.7) and low social support (affective support in men: OR=2.6, CI95%: 1.5-4.6; women: OR=1.5, CI95%: 1.0-2.3). However, the risk of sedentariness, lack of sleep, greater use of health services and mental ill-health remained higher for women caregivers.
Caregiving damages the health of informal caregivers but the risks for female caregivers are higher due to greater intensity of caregiver burden. As men's caregiving burden increases, gender inequalities decrease or invert.
[Show abstract][Hide abstract] ABSTRACT: Thrombolysis is used to treat stroke patients based on the National Institute of Neurological Disorders and Stroke study and meta-analysis results. We present a cost-effectiveness analysis based on a probabilistic model of the use of thrombolytic therapy in stroke treatment.
We surveyed patients who had had a stroke during their hospital stay and examined them again 1 year after release from the hospital to obtain data on costs and natural history. We then calculated utility weights using the European Quality of Life Questionnaire. When the model runs, 4,000 Monte Carlo simulations are undertaken in which each parameter value changes depending on its probability distribution. The results are expressed in terms of the cost-effectiveness plane and the cost-effectiveness acceptability curve.
We studied 435 patients, of whom 304 had had an ischemic stroke. One year later, 216 were still alive. The mean utility values were 0.22 for disabled patients and 0.77 for autonomous patients. The incremental cost-effectiveness ratio (ICER) obtained by means of the parameters was -19,000 EUR/quality-adjusted life year, reflecting a saving of 6,000 EUR and a health benefit for patients. The cost-effectiveness plane showed that thrombolysis was a dominant variable in 96.1% of simulations. In the acceptability curves, only 0.4 of simulations obtained an ICER higher than the societal threshold.
Thrombolytic therapy seems to be a useful intervention because it is inexpensive and cost-effective. The key factor is the decreased rate of disability, which results in a better quality of life of the patient and lower costs.