1,721,584 research outputs found
Resource use associated with type 2 diabetes in Africa, the Middle East, South Asia, Eurasia and Turkey: results from the International Diabetes Management Practice Study (IDMPS)
Full text linkType 2 diabetes (T2D) and its complications form a global healthcare burden but the exact impact in some geographical regions is still not well documented. We describe the healthcare resource usage (HRU) associated with T2D in Africa, the Middle East, South Asia, Eurasia and Turkey.Fil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Cs.médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Atanasov, Petar K.. Amaris; Reino UnidoFil: Chan, Juliana C. N.. The Chinese University of Hong Kong; ChinaFil: Mbanya, Jean C.. University Of Yaounde; CamerúnFil: Shestakova, Marina V. Sechenov First Moscow State Medical University; Rusia. Endocrinology Research Centre; RusiaFil: Leguet Dinville, Prisca. Sanofi; FranciaFil: Annemans, Lieven. Ghent University; Bélgic
Facilitating more efficient negotiations for innovative therapies: a value-based negotiation framework
Full text linkObjectives: An increasing number of innovative therapies (e.g., gene- and cell-based treatments) have been developed in the past 20 years. Despite the significant clinical potential of these therapies, access delays may arise because of differing perspectives of manufacturers and payers regarding issues such as the value of the product, clinical and financial uncertainties, and sustainability. Managed entry agreements (MEAs) can enable access to treatments that would not be reimbursed by conventional methods because of such concerns. However, although MEA typologies exist, there is currently no structured process to come to agreements on MEAs, which can be
difficult to decide upon and implement. To facilitate more structured MEA negotiations, we propose a conceptual “value-based negotiation
framework” with corresponding application tools.
Methods: The framework was developed based on an iterative process of scientific literature review and expert input.
Results: The framework aims to (i) systematically identify and prioritize manufacturer and payer concerns about a new treatment, and (ii) select a mutually acceptable combination of MEA terms that can best address priority concerns, with the lowest possible implementation burden.
Conclusions: The proposed framework will be tested in practice, and is a step toward supporting payers and manufacturers to engage in more structured, transparent negotiations to balance the needs of both sides, and enabling quicker, more transparent MEA negotiations and patient access to innovative products
Physician-hospital alignment : economic, administrative and professional aspects
Full text linkHospitals face challenging times. Currently many Western countries are seeking ways to increase the efficiency of care delivery and improve the quality care. Physicians have a major impact on hospital performance. This doctoral dissertation focuses on alignment of self-employed physicians. Economic, administrative and professional aspects are considered. The first chapter discusses the context and main characteristics of hospital-physician relationships in Belgium. The following chapters present five academic studies. We conclude with the general discussion of our findings. In a first study we developed an integrative conceptual framework of physician-hospital alignment including economic and noneconomic exchange. Building on the available literature and the theoretical insights of agency theory and social exchange theory, risk and trust were identified as two key antecedents. Since the payment framework cannot be neglected when studying physician-hospital alignment we continued with a second study focusing on the relationship between provider financial risk bearing and physician-hospital integration. These first two studies were followed by three empirical studies. In the third study two comparative case-studies were performed to investigate the contractual mechanisms in physician-hospital exchanges. Besides the contract, the relationship established on the basis of the transactions taking place was studied. The fourth study comprises a qualitative study of administrative and professional aspects of the noneconomic relationship between physician and hospital. Drawing on the concepts of the psychological contract we developed a rich understanding how mutual obligations and areas of ambiguity are perceived. In the fifth study we quantitatively investigated the impact of noneconomic exchange (administrative and professional psychological contract breach) and economic exchange (distributive and procedural organizational justice) on physicians’ organizational attitudes and organizational citizenship behaviours. In addition we focus on the moderating role of the Chief Medical Officer and organizational trust in these relationships. The final chapter summarises the theoretical, methodological and practical implications of this dissertation
Effectiveness and cost-effectiveness of a health promotion intervention targeting physical activity and healthy eating in individuals with mental disorders
Full text linkPreventive landscape of skin cancer in Belgium : a clinical and health economical analysis
Full text linkPsychological, perinatal, lifestyle and health-economic aspects of the polycystic ovary syndrome : what really matters for the patient, her family and the society
Full text linkStudy question: How are objective characteristics of the polycystic ovary syndrome (PCOS) and PCOS-related concerns associated with the sexual and relational satisfaction of PCOS women and their partners?
Summary answer: Both objective PCOS characteristics (parity, women’s body mass index (BMI) and current unfulfilled wish to conceive) and PCOS-related concerns (women’s infertility-related and acne-related concerns) were associated with sexual and/or relational satisfaction, although some associations differed for PCOS women and their partners.
What is known already: There is some evidence indicating an association between objective PCOS characteristics and sexual satisfaction of PCOS women, but this evidence is conflicting, scarce, and often no validated questionnaires are used to evaluate sexual satisfaction. No evidence is available about the association of (i) PCOS with relational satisfaction; (ii) PCOS-related concerns with sexual and relational satisfaction; and (iii) PCOS with sexual and relational satisfaction as experienced by partners of PCOS women.
Study design, size, duration: We set up a cross sectional study from April 2007 till April 2009 including 31 overweight (BMI ≥ 25 kg/m²) women with PCOS at reproductive age as well as their partners with who they had a committed intimate relationship at the time of recruitment.
Participants/materials, setting, methods: The study was performed at the fertility center of the Ghent University Hospital. Objective PCOS characteristics were registered and PCOS-related concerns were evaluated by the PCOS Questionnaire. Sexual (SS) and relational (RS) satisfaction were measured by the Maudsley Marital Questionnaire (MMQ). Dyadic statistical analyses were performed using linear mixed models (α < 0.05).
Main results and the role of chance: A lower parity tended to be associated with higher levels of sexual and relational satisfaction, with a significantly stronger association in PCOS women than their partners (p(SS) = .015 and p(RS) = .009). A higher BMI tended to be associated with lower and higher satisfaction levels (sexual and relational) in PCOS women and their partners, respectively, with a significantly stronger association in the partners (p(SS) = .029 and p(RS) = .021). The presence of a current unfulfilled wish to conceive and a higher level of infertility-related concerns was significantly stronger associated with a higher level of PCOS women’s relational satisfaction than their partners’ (p(RS) = .021 and p(RS) = .011, respectively). And higher levels of acne-related concern were significantly associated with lower levels of sexual satisfaction in PCOS women (p(SS) = .025) and their partners (p(SS) = .002).
Limitations, reasons for caution: The fact that this study was performed in a sample of PCOS women who were all overweight and the small sample size are important limitations. Data were partially missing in some couples but this limitation was dealt with by using linear mixed models.
Wider implications of the findings: Our results suggest a differential association of PCOS with sexual and relational satisfaction between PCOS women and their partners. This should be kept in mind during the psychological guidance of couples dealing with PCOS
Clinical and economic value of in-hospital clinical pharmacy activities form a health care perspective
No full textEconomic evaluations have become increasingly important in health care systems. Scarce resources necessitate to consider both outcomes and costs to guide decision-making. This dissertation explores the return on investment of pharmaceutical recommendations in a hospital setting ('a clinical pharmacy service'). Subsequently the clinical added value of clinical pharmacy, the methodology to evaluate a clinical pharmacy program and the studied cost benefit are presented. In a last part this work explores the role of information technology in reducing the pharmacist workload
Pressure ulcers : predicting factors, prevention and costs
Full text linkThe research outline pursued with this thesis can be divided in three parts. In the first part, studies to compare the effectiveness of several interventions for the prevention of pressure ulcers were conducted. Pressure ulcer prevention focusses on the reduction of the amount and duration of pressure and shear. An alternating device intermittently removes pressure and shear from vulnerable areas. It provides pressure relief via cyclic inflating and deflating air cells. Systematic reviews and (inter)national guidelines demonstrate inconclusive results as to the superiority of one specific alternating pressure device. An example of an active support surface is an alternating pressure air mattress (APAM), available as overlays or replacement mattress, and ALPAMs (Alternating Low Pressure Air Mattresses). Differences between several types of active support surfaces can be related to differences in surface characteristics, such as cycle time, air cell inflation sequence, and pressure amplitude. The inflation and deflation of the air cells of an APAM and ALPAMs are characterized by a steep, one-stage inflation or deflation.
ALPAMs were designed by the medical technology industry to generate lower pressures compared to APAMs. More recently these ALPAMs have been modified so that the transition from deflated air cell to inflated air cell is more gradual or multi-staged. As more complex technology does not necessarily lead to more effective devices, the aim of the first trial was to examine the influence of a multi-stage inflation and deflation cycle versus a one-stage inflation and deflation cycle. The multi-stage ALPAM did not result in a significantly lower pressure ulcer incidence compared to the one-stage ALPAM. Both mattresses were equally effective to prevent pressure ulcers. The time to develop a pressure ulcer was comparable in both groups.
Secondly, the effectiveness of an APAM overlay was compared with the effectiveness of a one-stage and a multi-stage ALPAM. A reduced incidence of pressure ulcers was found in the multi-stage ALPAM group compared to the APAM overlay group. No significant differences in pressure ulcer development were found between a one-stage ALPAM and an APAM overlay. The median time to develop a pressure ulcer was similar among groups.
Despite preventive measures provided in the effectiveness studies, a proportion of the patients developed a pressure ulcer. The identification of these ‘high risk’ patients is examined in the second part of this dissertation and is crucial to further improve the quality of care. The aim of a subsequent study was to identify factors that independently predicted the development of a pressure ulcer in an at risk population who received standardised preventive care. The presence of non-blanchable erythema, having a urogenital disorder, and higher body temperature were found to be predictive factors associated with the development of a pressure ulcer.
In the third part of this thesis the cost of pressure ulcer prevention and treatment was addressed. International literature found a cost of pressure ulcer prevention per patient at risk varying between €2.65 and €87.57 per day. The cost of pressure ulcer treatment ranged from €1.73 to €812.92 per patient per day. These studies encompassed a considerable methodological heterogeneity in terms of the type of health economic design, health economic perspective, the cost components, and the health outcomes. In a subsequent study insight was provided into the cost of pressure ulcer prevention and treatment in hospitals and nursing homes in Flanders using a mixed perspective. In hospitals, a cost for pressure ulcer prevention of €7.88 per patient at risk per day was found. In nursing homes, a cost of €2.15 per resident at risk per day was calculated. The cost of pressure ulcer prevention for patients and residents perceived not at risk for pressure ulcer development was €1.44 per day in hospitals and €0.50 per day in nursing homes. The main cost driver was found to be the cost of labour, rather than the cost of devices. The average cost of treatment per patient per day varied from €2.34 (category I) to €77.36 (category IV) in hospitals, and from €2.42 (category I) to €16.18€ (category IV pressure ulcer) in nursing homes
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