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In Finland diabetologists have long been concerned about the level of diabetes care as the incidence of type 1 diabetes and complicated type 2 diabetes is exceeding the capacity of specialist clinics. We compared the outcome of diabetes care in two middle-sized Finnish municipalities with different models of diabetes care organisation in public pri...
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Background:
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Background and objectives
Depression and anxiety are common mental health disorders among the elderly worldwide. In this study, we estimated the prevalence of depression and anxiety and related risk factor among elderly attending Primary Health care (PHC) centers in Palestine.
Methods
A cross-sectional study was conducted from February to July 202...
Citations
... Several methods have been used to evaluate the quality of diabetes care [1,[10][11][12]. However, these evaluations exhibit three significant shortcomings. ...
Background
Diabetes is the most prevalent metabolic disease globally. Correct and effective healthcare management requires up-to-date and accurate information at the local level. This level of information allows managers to determine whether the health system has achieved its desired goals in this area. This study aimed to evaluate the adequacy and quality of care for Type 2 diabetes mellitus (T2DM) patients using the Lot quality assurance sampling (LQAS) technique to provide evidence for decision-making at the local level, prioritizing and allocating resources.
Methods
A descriptive-analytical study was conducted in 12 supervision areas (SAs)/health facilities in northwestern Iran involving 240 patients with T2DM in primary health care. The selection of patients and determination of SAs were done randomly using the LQAS technique. Glycated Hemoglobin (HbA1c) was used to evaluate patients’ blood sugar control in each SA. Multiple linear regression analysis was used to estimate predictors of HbA1c in T2DM.
Results
The overall average of HbA1c value was 7.84%. The HbA1c level was > 7% in 148 (61.6%) of the patients. Among the 12 SAs, the LQAS identified unacceptable quality of care in 5 SAs. In the final analysis, each unit increase in fasting blood sugar (FBS), High-density lipoprotein (HDL), Low-density lipoprotein (LDL), and Thyroglobulin (TG) values resulted in an increased in HbA1c levels by 0.43, 0.183, 0.124, and 0.182 times, respectively. However, with a one-unit increase in the care of a family physician and nutritionist, along with regular physical activity, HbA1c levels decreased by − 0.162, -0.74, and − 0.11 times, respectively.
Conclusions
The quality of care for diabetic patients needs improvement in some SAs. Findings indicated that the LQAS technique effectively identifies centers/areas with substandard diabetes care quality and efficiently allocates resources to those in need. It is recommended to implement corrective measures in areas with inadequate care quality.
... [11] Honkasalo et al. concluded that the follow-up of most DM patients can be organized in primary care with the same quality of secondary care. [17] Huang et al. did not find a definitive positive impact of specialized DM clinics over a 4-year period. [18] Chou et al. suggest that family physicians may provide better care at a lower cost to DM patients. ...
... If we consider breath testing as a complete service, where the testing, results and any referrals to secondary care were managed as a streamlined pathway, we could draw comparisons to other centralised services such as diabetes care, which lowers costs. 27 The hub-and-spoke model evaluated in phase 2 of this study explored the concept of testing patients in a central location, in this instance a GP practice. Finding may be applicable to other centralised testing centres such as diagnostic centres and hospitals. ...
Objectives
To examine the feasibility and acceptability of breath research in primary care.
Design
Non-randomised, prospective, mixed-methods cross-sectional observational study.
Setting
Twenty-six urban primary care practices.
Participants
1002 patients aged 18–90 years with gastrointestinal symptoms.
Main outcome measures
During the first 6 months of the study (phase 1), feasibility of patient enrolment using face-to-face, telephone or SMS-messaging (Short Message Service) enrolment strategies, as well as processes for breath testing at local primary care practices, were evaluated. A mixed-method iterative study design was adopted and outcomes evaluated using weekly Plan-Do-Study-Act cycles, focus groups and general practitioner (GP) questionnaires.
During the second 6 months of the study (phase 2), patient and GP acceptability of the breath test and testing process was assessed using questionnaires. In addition a ‘single practice’ recruitment model was compared with a ‘hub and spoke’ centralised recruitment model with regards to enrolment ability and patient acceptability.
Throughout the study feasibility of the collection of a large number of breath samples by clinical staff over multiple study sites was evaluated and quantified by the analysis of these samples using mass spectrometry.
Results
1002 patients were recruited within 192 sampling days. Both ‘single practice’ and ‘hub and spoke’ recruitment models were effective with an average of 5.3 and 4.3 patients accrued per day, respectively. The ‘hub and spoke’ model with SMS messaging was the most efficient combined method of patient accrual. Acceptability of the test was high among both patients and GPs. The methodology for collection, handling and analysis of breath samples was effective, with 95% of samples meeting quality criteria.
Conclusions
Large-scale breath testing in primary care was feasible and acceptable. This study provides a practical framework to guide the design of Phase III trials examining the performance of breath testing in primary care.
... High costs were caused by hospitalisations and prescriptions, which are firmly correlated to diabetes complications and comorbidities [14]. As asserted by several authors [13,76], the prevention of complications represents the primary policy measure to decrease expenditure for diabetes. Besides, the cost of hospitalisation may be decreased by a gradual shift from the hospital setting to ambulatory care in the management of diabetes [77]. ...
Background
Type 2 diabetes represents an increasingly critical challenge for health policy worldwide. It absorbs massive resources from both patients and national economies to sustain direct costs of the treatment of type 2 diabetes and its complications and indirect costs related to work loss and wages. More recently, there are innovations based on remote control and personalised programs that promise a more cost-effective diabetes management while reducing diabetes-related complications. In such a context, this work attempts to update cost analysis reviews on type 2 diabetes, focusing on France and Germany, in order to explore most significant cost drivers and cost-saving opportunities through innovations in diabetes care. Although both countries approach care delivery differently, France and Germany represent the primary European markets for diabetes technologies.
Methods
A systematic review of the literature listed in MEDLINE, Embase and EconLit has been carried out. It covered interventional, observational and modelling studies on expenditures for type 2 diabetes management in France or Germany published since 2012. Included articles were analysed for annual direct, associated and indirect costs of type 2 diabetes patients. An appraisal of study quality was performed. Results were summarised narratively.
Results
From 1260 records, the final sample was composed of 24 papers selected according to predefined inclusion/exclusion criteria. Both France and Germany revealed a predominant focus on direct costs. Comparability was limited due to different study populations and cost categories used. Indirect costs were only available in Germany. According to prior literature, reported cost drivers are hospitalisation, prescriptions, higher HbA1c and BMI, treatment with insulin and complications, all indicators of disease severity. The diversity of available data and included costs limits the results and may explain the differences found.
Conclusions
Complication prevention and glycaemic control are widely recognized as the most effective ways to control diabetes treatment costs. The value propositions of self-based supports, such as hybrid closed-loop metabolic systems, already implemented in type 1 diabetes management, are the key points for further debates and policymaking, which should involve the perspectives of caregivers, patients and payers.
... Most costs were caused by hospitalisations and prescriptions, which are rmly correlated to diabetes-related complications and comorbidities (13). As asserted by several authors (12,66), the prevention of complications represents the primary policy measure to decrease expenditure for diabetes. ...
Background
Type 2 diabetes represents an increasingly critical challenge for health policy worldwide. It absorbs massive resources for both patients and national economies to sustain direct and associated costs of treatment and indirect costs related to loss of work and wages. Last years are fuelling of innovations grounded on the remote control and personalised programs which are significantly improving the management of diabetes and the reduction of its related complications. In this view, this work attempts to update cost analysis reviews on type 2 diabetes, focusing on France and Germany, in order to explore most significant cost drivers and rooms for cost savings by technology advancement. Although characterized by different approaches in delivering care, France and Germany represent the primary European markets for diabetes technologies.
Methods
A systematic review of the literature was carried out in MEDLINE, Embase and EconLit for interventional, observational, and modelling studies on expenditures for type 2 diabetes management in France or Germany published since 2012. Included articles were analysed for annual direct, associated, and indirect costs of type 2 diabetes patients. An appraisal of study quality was performed. Results are summarised narratively.
Results
From 1.260 records, the final sample was composed of 24 papers selected according to predefined inclusion/exclusion criteria. Both France and Germany revealed a predominant focus on direct cost. Comparability was limited due to different study populations and cost categories used. Nevertheless, France seems to reimburse higher direct costs than Germany. Indirect costs were only available for Germany. According to prior literature, reported cost drivers are hospitalisation and prescriptions as well as higher HbA1c and BMI, treatment with insulin and complications all indicating the severity of the disease. Diversity in available data and in included costs limit the results and may explain differences found.
Conclusions
Preventing complications and glycaemic control are widely recognized as the most effective ways to govern the expenditure for the treatment of diabetes. The implementation of self-based supports, such as hybrid closed-loop metabolic, already implemented for type 1 diabetes management, are the key pillars for further debates and policymaking, involving the perspectives of both caregivers and patients.
... High costs were caused by hospitalisations and prescriptions, which are rmly correlated to diabetes complications and comorbidities (14). As asserted by several authors (13,76), the prevention of complications represents the primary policy measure to decrease expenditure for diabetes. Besides, the cost of hospitalisation may be decreased by a gradual shift from the hospital setting to ambulatory care in the management of diabetes (77). ...
Background: Type 2 diabetes represents an increasingly critical challenge for health policy worldwide. It absorbs massive resources from both patients and national economies to sustain direct costs of the treatment of type 2 diabetes and its complications and indirect costs related to work loss and wages. More recently, there are innovations based on remote control and personalised programs that promise a more cost-effective diabetes management while reducing diabetes-related complications. In this context, this work attempts to update cost analysis reviews on type 2 diabetes, focusing on France and Germany, in order to explore most significant cost drivers and cost-saving opportunities through innovations in diabetes care. Although both countries approach care delivery differently, France and Germany represent the primary European markets for diabetes technologies.
Methods: A systematic review of the literature listed in MEDLINE, Embase and EconLit has been carried out. It covered interventional, observational and modelling studies on expenditures for type 2 diabetes management in France or Germany published since 2012. Included articles were analysed for annual direct, associated and indirect costs of type 2 diabetes patients. An appraisal of study quality was performed.
Results: were summarised narratively. Results From 1.260 records, the final sample was composed of 24 papers selected according to predefined inclusion/exclusion criteria. Both France and Germany revealed a predominant focus on direct costs. Comparability was limited due to different study populations and cost categories used. Indirect costs were only available in Germany. According to prior literature, reported cost drivers are hospitalisation, prescriptions, higher HbA1c and BMI, treatment with insulin and complications, all indicators of disease severity. The diversity of available data and included costs limits the results and may explain the differences found.
Conclusions: Complication prevention and glycaemic control are widely recognized as the most effective ways to control diabetes treatment costs. The value propositions of self-based supports, such as hybrid closed-loop metabolic systems, already implemented in type 1 diabetes management, are the key points for further debates and policymaking, which should involve the perspectives of caregivers, patients and payers.
... Honkasalo et al estimated that the average annual cost of treating patients with type 1 diabetes in a tertiary-level clinic was €344 (fixed in 2016 price level). 21 They included the costs of visits and treatment periods related to type 1 diabetes or diabetes-related diseases. Non-diabetes-related treatment episodes were excluded. ...
... Non-diabetes-related treatment episodes were excluded. 21 Mustonen et al estimated the average annual healthcare cost of treating patients with psoriasis or psoriatic arthritis to be €1550 (fixed in 2016 price level). These costs included all medications, medical equipment, time used by doctors and other medical staff members, as well as other expenses of the tertiary-level clinic, such as outpatient visits, phototherapy or hospitalisation. ...
Background
Inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) are chronic diseases associated with a high and continuous economic burden. The introduction of biologics has changed the distribution of costs over the past two decades, and there are no recent studies on direct costs in Finland. This study aimed to estimate the direct healthcare costs of these diseases in a tertiary-level clinic.
Methods
The data were collected during a 1-year period of patients with IBD visiting Turku University Hospital. Patients were included if they lived in the hospital district area and were over 18 years old. This comprised an IBD group of 2208 patients, including 794 cases of CD and 1414 cases of UC. A sex-matched and age-matched control group was collected for comparison. Direct costs were collected during a 1-year study period from the hospital records.
Results
Total direct costs per patient with IBD in a tertiary-level clinic were €4223 annually. IBD-generated direct costs were estimated to total €3981 per patient annually. Patients with IBD who were given infliximab had €9157 higher direct healthcare costs per patient annually than patients with IBD with no infliximab medication. Direct healthcare costs generated in a tertiary-level gastroenterological clinic averaged €1652 per patient with IBD annually. On average, patients with CD had €1111 higher direct healthcare costs annually than patients with UC.
Conclusions
The direct healthcare costs of IBD were significant, almost 17-fold higher compared with a control group. Patients with IBD administered with biologics had significantly higher costs. Patients with CD had higher annual infliximab costs than patients with UC.
... 4 Additionally, in T1D, the cornerstone of treatment is insulin, and patients are mostly under the care of endocrinologists or other specialists, whereas uncomplicated T2D patients are managed by general practitioners primarily using oral antihyperglycemic drugs (OADs), with insulin therapy usually reserved for patients who are uncontrolled on OADs. 5,6 Therefore, it is important from both public health surveillance and planning perspectives to monitor the individual prevalence of T1D and associated health care resource utilization (HCRU) and costs. The number of patients with diabetes is projected to reach 39.7 million in the United States (13.9% of the population) by 2030 and 60.6 million (17.9% of the population) by 2060. ...
Background:
Diabetes health care resource utilization (HCRU) studies tend to focus on patients with type 2 diabetes (T2D) or pool patients with T2D and type 1 diabetes (T1D). There is a paucity of recent data on the cost of treating patients with T1D in the United States.
Objectives:
To (a) estimate the per-patient per-year (PPPY) HCRU and costs, from a payer perspective, associated with treating U.S. adults with T1D and (b) compare these with the HCRU and costs for patients with T2D.
Methods:
This retrospective cohort study used claims data from the Optum Clinformatics database between January 2015 and December 2017. Adults (aged ≥ 18 years) with a diagnosis of T1D were propensity score-matched to adults with T2D. Overall and nondiabetes-related HCRU and costs were assessed for T1D and T2D and compared between the 2 groups.
Results:
Propensity scores were used to match 10,103 patient pairs from T1D and T2D cohorts (mean ages 54.4 and 56.9 years, respectively). In the T1D cohort, inpatient, emergency department (ED), outpatient, and prescription claims occurred in 14.0%, 17.3%, 85.5%, and 100% of patients, respectively, resulting in a mean total cost of U.S. 11,002; nondiabetes-related = 18,817 vs. 103.4 million.
Conclusions:
This study showed that the total annual cost of managing an adult with T1D is significantly higher than that of an adult with T2D. Nondiabetes costs accounted for 40% of the total per-patient cost, similar to patients with T2D, confirming that as patients with T1D live longer lives, they may also be at greater risk for cardiometabolic complications.
Disclosures:
This study was funded by Sanofi U.S. and Lexicon Pharmaceuticals as part of a business partnership in a diabetes program at the time this study was conducted. Joish and Davies are employees and stockholders of Lexicon Pharmaceuticals. Zhou, Preblick, and Paranjape are employees and stockholders of Sanofi. Lin was a postdoctoral fellow at Sanofi through Rutgers University during this project. Deshpande provided consulting services through Communication Symmetry. Verma is an employee of Evidera, which was contracted by Sanofi for work on this study. Pettus is a consultant for Diasome, Insulet, Lexicon, Lilly, Mannkind, Novo Nordisk, Sanofi, and Senseonics.
... Extracting the patient-level data from the patient administration systems (with diagnosis and contact information) made it possible to group each individual encounter type by the Ambulatory and Primary Care Related Patient Groups (APR) grouper, a grouping system equivalent to the DRG used in hospital care. 22 The APR groups were supplemented with cost weights indicating the rela- ...
Objective:
To evaluate the long-term effect of telephone health coaching on health care and long-term care (LTC) costs in type 2 diabetes (T2D) and coronary artery disease (CAD) patients.
Data sources/study setting:
Randomized controlled trial (RCT) data were linked to Finnish national health and social care registries and electronic health records (EHR). Post-trial eight-year economic evaluation was conducted.
Study design:
A total of 1,535 patients (≥45 years) were randomized to the intervention (n = 1034) and control groups (n = 501). The intervention group received monthly telephone health coaching for 12 months. Usual health care and LTC were provided for both groups.
Principal findings:
Intention-to-treat analysis showed no significant change in total health and long-term care costs (intervention effect €1248 [3 percent relative reduction], CI -6347 to 2217) in the intervention compared to the control group. There were also no significant changes among subgroups of patients with T2D or CAD.
Conclusions:
Health coaching had a nonsignificant effect on health care and long-term care costs in the 8-year follow-up among patients with T2D or CAD. More research is needed to study, which patient groups, at which state of the disease trajectory of T2D and cardiovascular disease, would best benefit from health coaching.
... The costs per diagnosis related groups (DRG) were based on the Finnish version of the Nordic Classification of Surgical Procedures (NCSP) codes for diagnostic and treatment procedures and the respective nordic diagnosis related groups (nordDRG) patient classifications. For primary-level care costs, patient-level data from the patient information systems (with diagnoses and activity information) were grouped using the Ambulatory and Primary Care Related Patient Groups individual encounter type grouper, a grouping system equivalent to DRG. 26 After grouping, a cost weight indicating the relative consumption of resources was assigned to each contact. These cost weights were based on the national standard price lists for primarylevel care contacts. ...
After a care episode in a hospital, elderly patients often face delays in transitions to permanent residence. Poor care coordination burdens both the patients and the healthcare system. Whereas different models for coordinating geriatric patients’ care and discharge planning have been developed, evidence on their cost-effectiveness remains scant. In this study, we evaluated the associations of an integrated care model on health and social care costs and service utilization among geriatric patients admitted to a hospital in a Finnish city with c. 68,000 citizens. Elderly patient cohorts admitted before (N = 709) and after (N = 364) the implementation of the integrated care model were compared restrospectively. The new model consisted of changes in regional care criteria, discharge planning, coordination between inpatient facilities, and the daily work of nursing staff. Patients treated in the new model spent, on average, 7.4 days less in institutionalized care during one year, and the total annual cost of care decreased by 967€ per patient. A regionally coordinated care pathway from hospital admission to permanent residence may improve the cost-effectiveness of elderly care. Coordination and monitoring of outcomes at regional level is essential to avoid fragmentation of care and suboptimization among different care providers serving the elderly.