Effective health care最新文献

{"title":"A clinician's view on palliative care, terminal care and quality of life.","authors":"T D Bates","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>No more than 20-25% of cancer patients are cured and 55% need palliative treatment from the time of diagnosis. Medical and nurse training in palliative care, and pain control in particular, is poor and there is a great shortage of doctors trained in terminal care. Palliative care is detailed, complex care and includes many services both in the hospital and in the community. It should be available to all patients wherever they live. We need a network of Home Care and Hospital Support Teams throughout the country, and a limited number of specialist hospice inpatient units to deal with the difficult problems, research and training in terminal care. These services need to be co-ordinated and monitored and will require funding by governmental bodies.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 5","pages":"211-17"},"PeriodicalIF":0.0,"publicationDate":"1985-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21182809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cimetidine and the cost of peptic ulcer in the Netherlands.","authors":"R Bulthuis","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the autumn of 1977 the first histamine H2 receptor antagonist, cimetidine, was introduced into the Netherlands. Histamine H2 receptor antagonists are powerful suppressors of the stomach's production of hydrochloric acid, which is believed to play a major role in the development of peptic ulcers. Controlled clinical trials and interview with medical experts prior to the introduction suggested that the new drug might make treatment of peptic ulcer less costly. In particular, savings in hospital treatment, the major component of medical care cost (i.e., direct cost) seemed possible. The manufacturer of cimetidine, Smith, Kline and French Laboratories SA, commissioned the Netherlands Economic Institute to estimate the impact of cimetidine on the direct (medical care) cost of peptic ulcer in the Netherlands in 1980, with special reference to hospital costs. In this study the term 'cost' refers to aggregate expenditure by sick funds, insurance companies and private individuals. It was found that hospital treatment cost at constant (1980) prices declined by 61.6 million Dutch guilders, or 49%, over the chosen reference period, 1972-1980. Multiple regression analysis showed that a linear trend factor and other factors appearing to operate from the mid-seventies (possibly including the introduction of diagnostic endoscopy and government cost containment policies) together accounted for about three quarters of the reduction of costs. The remaining one quarter, Dfl. 15.7 million, was specifically attributable, with acceptable confidence, to the availability of cimetidine. In particular, the number of vagotomy and partial gastrectomy operations significantly dropped in the three years following its introduction. The saving more than compensated for a substantial increase in the drug bill, leaving a net benefit of Dfl. 3.2 million in 1980. This is likely to be an underestimate of net benefit since the cost of cimetidine prescribed for those not at risk of hospital admission was included while any benefits from cimetidine use in general practice had to be excluded for lack of data. The decline of hospital costs, the increase of drug costs and the growth of diagnosis/consultation costs, the latter largely attributable to the introduction of endoscopy, led to a dramatic change in the cost structure of peptic ulcer treatment between 1972 and 1980.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"1 6","pages":"297-311"},"PeriodicalIF":0.0,"publicationDate":"1984-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21180393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measurement and definition of the link between unemployment and health.","authors":"I D McAvinchey","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Some of the statistical difficulties inherent in any measure of the interaction between employment and health are considered. Unemployment and health are seen to be difficult terms to define and both are seen to contain subjective elements. Micro and macro models are discussed as both have strengths and weaknesses. Most micro models trace the experience of small groups of individuals usually selected either because they are unemployed and/or are ill. Thus the results cannot be acceptably generalized to the population at large. Macro time series are concerned with a measure of the interaction of unemployment and health at the aggregate national level. In macro models the precise link between the unemployment experience of an individual and the health experience of the same individual is lost in favour of the association of a measure of aggregate unemployment with a measure of aggregate health status. Both model types are liable to error in describing what is happening at the national level. Panel data macro models are likely to be most accurate as they answer most of the criticisms mentioned above, but such data are scarce and expensive to collect. However, it is argued that macro time series models applied to data for subgroups of individuals may provide a low cost way to obtain a useful measure of possible interaction.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"1 6","pages":"287-95"},"PeriodicalIF":0.0,"publicationDate":"1984-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21139940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing guidelines into clinical practice.","authors":"F G Fowkes,&nbsp;C J Roberts","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The impetus for guidelines of practice has been accelerated by a worldwide trend towards insurance based systems of health care. In the past it has been the tradition for the clinician to order all the diagnostic procedures that conceivably might help to clarify what is wrong with a patient, or what course of treatment should be followed. This traditional view ignores the stubborn economic reality that resources are finite and that it is no longer possible to be both endlessly generous and continually fair. Making judgements about the need for, and value of, services now forms an important part of coping with this problem. Clinical practice has to strive to be as safe as possible and to produce a given benefit at a socially acceptable cost. Guidelines are recommendations, preferably developed by clinicians themselves, which describe how and when individual clinical activities should be offered in order to achieve these objectives. Utilisation review of current practice is a valuable source of information for the development of guidelines. In the United Kingdom the Royal College of Radiologists attempted to do this in connection with the use of pre-operative chest X-rays. In 1979 they published the findings of a multicentre review of 10,619 consecutive cases of elective non-cardiopulmonary surgery undertaken in 8 centres throughout the United Kingdom. Substantial variations were found in national practice. Use of pre-operative chest X-rays varied from 11.5% of patients in one centre to 54.2% of patients in another centre. The study also found that the chest X-ray report did not seem to have much influence on the decision to operate nor on the decision to use inhalation anaesthesia. The College study failed to find \"any evidence at all for the effectiveness of pre-operative chest X-ray when used routinely\" and it was estimated that even if the procedure was 10% effective the costs of avoiding one death would be approximately 1 million pounds. These findings provided the impetus for the College to develop guidelines for the use of pre-operative chest X-rays in hospitals in the United Kingdom. Creating a change in clinical practice through the introduction of guidelines is a three stage process: Stage I: introducing the idea of a change in practice. Stage II: introduction of guidelines into clinical practice. Stage III: sustained implementation of guidelines in clinical practice.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"1 6","pages":"313-23"},"PeriodicalIF":0.0,"publicationDate":"1984-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21188806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility and equity: attributable risk or relative risk as tools for planning health care with limited resources.","authors":"F Sturmans","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"1 5","pages":"233-4"},"PeriodicalIF":0.0,"publicationDate":"1984-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21134094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Will our health system fall apart? The need for a new paradigm.","authors":"F Gremy","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>It is a truism that medicine is in a crisis but the truism is right. This paper sets out the symptoms of the crisis. The effectiveness of modern medicine has been questioned by many. Doctors use too many tests and do not always understand the results. This is the practice of 'decerebrate medicine'. The alleged triumphs of modern medicine have made only a modest impact on mortality rates and death from iatrogenic causes is real. Modern medicine is allied to the industrial society with its hierarchies and division of work. This leads to tensions between doctors and between doctors and their patients. Administrators fear the progressive rise in health costs and ask whether more really means better. Economists demand evaluation of medical procedures and there is a growing demand for real preventive medicine. Health is a problem for the whole of society. This paper then sets out the epistemological aspects of the crisis in medicine. It suggests that a new paradigm must be constructed in the light of the scientific revolution. The concept of medicine based on analytical science with its reductionism and disjunctivism is not enough to cover the complexity of man. The new paradigm needs to embrace all the sciences, both of nature and of man. A view is given of how this process of comprehending an exceedingly complex problem should be tackled and the role to be played by information sciences.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"1 5","pages":"239-47"},"PeriodicalIF":0.0,"publicationDate":"1984-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21136165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selecting a health indicator for comparative health surveys among different social categories using employment as example.","authors":"H Verkleij,&nbsp;I P Spruit","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the last decade a number of subjective health indicators have been developed and validated. In view of the investment involved in developing a new one, a researcher designing a health survey will preferably choose one of the existing indicators. To facilitate such a choice, a set of criteria is developed. Six existing indicators are valued according to the stipulated criteria. Unemployment is taken as the example because there is a demand for comparative health surveys between unemployed and employed in order to validate findings in the unemployment literature. The comparison of the health of unemployed and employed is used as an example on the basis of which more general statements can be made about the comparison of the health of people in other polar social roles like divorced versus married, immigrants versus residents, that involve a transition from one social role to another.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"1 5","pages":"251-6"},"PeriodicalIF":0.0,"publicationDate":"1984-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21136166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of clinical epidemiology in medical practice.","authors":"F G Fowkes,&nbsp;A J Dobson,&nbsp;M J Hensley,&nbsp;S R Leeder","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Epidemiological research has been carried out traditionally in the field on non-clinical populations and has sought to reveal the aetiology of disease. But in the 1960's a possible role for epidemiology in the study of clinical practice emerged. A series of articles on scientific methodology and clinical medicine argued that much of the reasoning underpinning clinical practice might be expressed in numerical terms. This numerical expression would require the counting of diseases and events in groups of patients and would thus employ similar methods to traditional epidemiology where diseases are counted in populations. Although the term 'clinical epidemiology' was introduced as early as 1938, Sackett was instrumental in promoting the concept in 1969 as the 'application by a physician... of epidemiologic and biometric methods to the study of the diagnostic and therapeutic process in order to effect an improvement in health'. The management of individual patients involves the clinician in a multitude of decisions, concerned with making a diagnosis, ordering tests, prescribing treatment and estimating prognosis. Decisions are often made in a state of uncertainty because no reasonably objective information is available to indicate the best decision in the given circumstances, or because the most appropriate sequence of decisions for an individual patient is not apparent. Although the state of the art does not allow us to do this completely, the role of clinical epidemiology is, by way of clinical research, to provide clinicians with the information to make decisions that are most appropriate for the welfare of their patients, and in combination with information derived from decision theory to make these decisions rapidly and logically.(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"1 5","pages":"259-65"},"PeriodicalIF":0.0,"publicationDate":"1984-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21136167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technology assessment in the U.S.A.","authors":"H D Banta","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"1 5","pages":"271"},"PeriodicalIF":0.0,"publicationDate":"1984-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21136168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a general theory for health care budgeting?","authors":"I Wickings","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This article suggests that a broad theoretical framework is needed within which the empirical evidence about the results of the many different health care funding systems can be analysed. A possible framework is described. The article also proposes that when policy makers select the budgetary system most likely to produce the patterns of health care that are required they should also install output and quality controls designed to avoid any predictable and undesirable side effects. Reimbursement under the budget could be made conditional upon an adequate performance as measured by the controls.</p>","PeriodicalId":79874,"journal":{"name":"Effective health care","volume":"2 2","pages":"51-6"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21138951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}