Academic literature on the topic 'Family medicine Australia Cost effectiveness'
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Journal articles on the topic "Family medicine Australia Cost effectiveness"
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Vos, Theo, Michelle M. Haby, Anne Magnus, Cathrine Mihalopoulos, Gavin Andrews, and Rob Carter. "Assessing Cost-Effectiveness in Mental Health: Helping Policy-Makers Prioritize and Plan Health Services." Australian & New Zealand Journal of Psychiatry 39, no. 8 (August 2005): 701–12. http://dx.doi.org/10.1080/j.1440-1614.2005.01654.x.
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Objective: We assessed, from a health sector perspective, options for change that could improve the efficiency of Australia's current mental health services by directing available resources toward ‘best practice’ cost-effective services. Method: We summarize cost-effectiveness results of a range of interventions for depression, schizophrenia, attention deficit hyperactivity disorder and anxiety disorders that have been presented in previous papers in this journal. Recommendations for change are formulated after taking into account ‘second-filter criteria’ of equity, feasibility of implementing change, acceptability to stakeholders and the strength of the evidence. In addition, we estimate the impact on total expenditure if the recommended mental health interventions for depression and schizophrenia are to be implemented in Australia. Results: There are cost-effective treatment options for mental disorders that are currently underutilized (e.g. cognitive–behavioural therapy (CBT) for depression and anxiety, bibliotherapy for depression, family interventions for schizophrenia and clozapine for the worst course of schizophrenia). There are also less cost-effective treatments in current practice (e.g. widespread use of olanzapine and risperidone in the treatment of established schizophrenia and, within those atypicals, a preference for olanzapine over risperidone). Feasibility of funding mechanisms and training of staff are the main second-filter issues for CBT and family interventions. Acceptability to various stakeholders is the main barrier to implementation of more cost-effective drug treatment regimens. More efficient drug intervention options identified for schizophrenia would cost A$68 million less than current practice. These savings would more than cover the estimated A$36M annual cost of delivering family interventions to the 51% of people with schizophrenia whom we estimated to be eligible and this would lead to an estimated 12% improvement in their health status. Implementing recommended strategies for depression would cost A$121M annually for the 24% of people with depression who seek care currently, but do not receive an evidence-based treatment. Conclusions: Despite considerable methodological problems, a range of cost-effective and less cost-effective interventions for major mental disorders can be discerned. The biggest hurdle to implementation of more efficient mental health services is that this change would require reallocation of funds between interventions, between disorders and between service providers with different funding mechanisms.
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Hawthorne, Graeme, Frida Cheok, Robert Goldney, and Laura Fisher. "The Excess Cost of Depression in South Australia: A Population-Based Study." Australian & New Zealand Journal of Psychiatry 37, no. 3 (June 2003): 362–73. http://dx.doi.org/10.1046/j.1440-1614.2003.01189.x.
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Objective: To establish excess costs associated with depression in South Australia, based on the prevalence of depression (from the Primary Care Evaluation of Mental Disorders (PRIME-MD)) and associated excess burden of depression (BoD) costs. Method: Using data from the 1988 South Australian (SA) Health Omnibus Survey, a properly weighted cross-sectional survey of SA adults, we calculated excess costs using two methods. First, we estimated the excess cost based on health service provision and loss of productivity. Second, we estimated it from loss of utility. Results: We found symptoms of major depression in 7% of the SA population, and 11% for other depression. Those with major depression reported worse health status, took more time off work, reported more work performance limitations, made greater use of health services and reported poorer health-related quality-of-life. Using the service provision perspective excess BoD costs were AUD$1921 million per annum. Importantly, this excluded non-health service and other social costs (e.g. family breakdown, legal costs). With the utility approach, using the Assessment of Quality of Life (AQoL) instrument and a very modest life-value (AUD$50 000), the estimate was AUD$2800 million. This reflects a societal perspective of the value of illness, hence there is no particular reason the two different methods should agree as they provide different kinds of information. Both methods suggest estimating the excess BoD from the direct service provision perspective is too restrictive, and that indirect and societal costs ought be taken into account. Conclusions: Despite the high ranking of depression as a major health problem, it is often unrecognized and undertreated. The findings mandate action to explore ways of reducing the BoD borne by individuals, those affected by their illness, the health system and society generally. Given the limited information on the cost-effectiveness of different treatments, it would seem important that resources be allocated to evaluating alternative depression treatments.
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Schofield, Deborah, Michelle M. Cunich, and Lucio Naccarella. "An evaluation of the quality of evidence underpinning diabetes management models: a review of the literature." Australian Health Review 38, no. 5 (2014): 495. http://dx.doi.org/10.1071/ah14018.
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Objective There is a paucity of research on the quality of evidence relating to primary care workforce models. Thus, the aim of the present study was to evaluate the quality of evidence on diabetes primary care workforce models in Australia. Methods The National Health and Medical Research Council of Australia’s (National Health and Medical Reseach Council; 2000, 2001) frameworks for evaluating scientific evidence and economic evaluations were used to assess the quality of studies involving primary care workforce models for diabetes care involving Australian adults. A search of medical databases (MEDLINE, AMED, RURAL, Australian Indigenous HealthInfoNet and The Cochrane Institute), journals for diabetes care (Diabetes Research and Clinical Practice, Diabetes Care, Diabetic Medicine, Population Health Management, Rural and Remote Health, Australian Journal of Primary Health, PLoS Medicine, Medical Journal of Australia, BMC Health Services Research, BMC Public Health, BMC Family Practice) and Commonwealth and state government health websites was undertaken to acquire Australian studies of diabetes workforce models published 2005–13. Various diabetes workforce models were examined, including ‘one-stop shops’, pharmacy care, Aboriginal services and telephone-delivered interventions. The quality of evidence was evaluated against several criteria, including relevance and replication, strength of evidence, effect size, transferability and representativeness, and value for money. Results Of the14 studies found, four were randomised controlled trials and one was a systematic review (i.e. Level II and I (best) evidence). Only three provided a replicable protocol or detailed intervention delivery. Eleven lacked a theoretical framework. Twelve reported significant improvements in clinical (patient) outcomes, commonly HbA1c, cholesterol and blood pressure; only four reported changes in short- and long-term outcomes (e.g. quality of life). Most studies used a small or targeted population. Only two studies assessed both benefits and costs of their intervention compared with usual care and cost effectiveness. Conclusions More rigorous studies of diabetes workforce models are needed to determine whether these interventions improve patient outcomes and, if they do, represent value for money. What is known about the topic? Although health systems with strong primary care orientations have been associated with enhanced access, equity and population health, the primary care workforce is facing several challenges. These include a mal-distribution of resources (supply side) and health outcomes (demand side), inconsistent support for teamwork care models, and a lack of enhanced clinical inter-professional education and/or training opportunities. These challenges are exacerbated by an ageing health workforce and general population, as well as a population that has increased prevalence of chronic conditions and multi-morbidity. Although several policy directions have been advocated to address these challenges, there is a lack of high-quality evidence about which primary care workforce models are best (and which models represent better value for money than current practice) and what the health effects are for patients. What does this paper add? This study demonstrated several strengths and weaknesses of Australian diabetes models of care studies. In particular, only five of the 14 studies assessed were designed in a way that enabled them to achieve a Level II or I rating (and hence the ‘best’ level of evidence), based on the NHMRC’s (2000, 2001) frameworks for assessing scientific evidence. The majority of studies risked the introduction of bias and thus may have incorrect conclusions. Only a few studies described clearly what the intervention and the comparator were and thus could be easily replicated. Only two studies included cost-effectiveness studies of their interventions compared with usual care. What are the implications for practitioners? Although there has been an increase in the number of primary care workforce models implemented in Australia, there is a need for more rigorous research to assess whether these interventions are effective in producing improved health outcomes and represent better value for money than current practice. Researchers and policymakers need to make decisions based on high-quality evidence; it is not obvious what effect the evidence is having on primary care workforce reform.
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Mahmood, Amreen, Anagha Deshmukh, Manikandan Natarajan, Dianne Marsden, Glade Vyslysel, Sebastian Padickaparambil, Shwetha TS, et al. "Development of strategies to support home-based exercise adherence after stroke: a Delphi consensus." BMJ Open 12, no. 1 (January 2022): e055946. http://dx.doi.org/10.1136/bmjopen-2021-055946.
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ObjectiveTo develop a set of strategies to enhance adherence to home-based exercises after stroke, and an overarching framework to classify these strategies.MethodWe conducted a four-round Delphi consensus (two online surveys, followed by a focus group then a consensus round). The Delphi panel consisted of 13 experts from physiotherapy, occupational therapy, clinical psychology, behaviour science and community medicine. The experts were from India, Australia and UK.ResultsIn round 1, a 10-item survey using open-ended questions was emailed to panel members and 75 strategies were generated. Of these, 25 strategies were included in round 2 for further consideration. A total of 64 strategies were finally included in the subsequent rounds. In round 3, the strategies were categorised into nine domains—(1) patient education on stroke and recovery, (2) method of exercise prescription, (3) feedback and supervision, (4) cognitive remediation, (5) involvement of family members, (6) involvement of society, (7) promoting self-efficacy, (8) motivational strategies and (9) reminder strategies. The consensus from 12 experts (93%) led to the development of the framework in round 4.ConclusionWe developed a framework of comprehensive strategies to assist clinicians in supporting exercise adherence among stroke survivors. It provides practical methods that can be deployed in both research and clinical practices. Future studies should explore stakeholders’ experiences and the cost-effectiveness of implementing these strategies.
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Paton, Kate, Lynn Gillam, Hayley Warren, Melissa Mulraney, David Coghill, Daryl Efron, Michael Sawyer, and Harriet Hiscock. "Clinicians’ perceptions of the Australian Paediatric Mental Health Service System: Problems and solutions." Australian & New Zealand Journal of Psychiatry 55, no. 5 (January 18, 2021): 494–505. http://dx.doi.org/10.1177/0004867420984242.
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Objectives: Despite substantial investment by governments, the prevalence of mental health disorders in developed countries remains unchanged over the past 20 years. As 50% of mental health conditions present before 14 years of age, access to high-quality mental health care for children is crucial. Barriers to access identified by parents include high costs and long wait times, difficulty navigating the health system, and a lack of recognition of the existence and/or severity of the child’s mental health disorder. Often neglected, but equally important, are clinician views about the barriers to and enablers of access to high-quality mental health care. We aimed to determine perspectives of Australian clinicians including child and adolescent psychiatrists, paediatricians, psychologists and general practitioners, on barriers and enablers within the current system and components of an optimal system. Methods: A total of 143 clinicians (approximately 35 each of child and adolescent psychiatrists, paediatricians, child psychologists and general practitioners) from Victoria and South Australia participated in semi-structured phone interviews between March 2018 and February 2019. Inductive content analysis was applied to address the broad study aims. Findings: Clinician-identified barriers included multi-dimensional family factors, service fragmentation, long wait times and inadequate training for paediatricians and general practitioners. Rural and regional locations provided additional challenges but a greater sense of collaboration resulting from the proximity of clinicians in rural areas, creating an opportunity to develop support networks. Suggestions for an optimal system included novel ways to improve access to child psychiatry expertise, training for paediatricians and general practitioners, and co-located multidisciplinary services. Conclusion: Within the current mental health system for children, structural, training and workforce barriers prevent optimal access to care. Clinicians identified many practical and systemic ideas to improve the system. Implementation and evaluation of effectiveness and cost effectiveness of these ideas is the next challenge for Australia’s children’s mental health.
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Mumford, Virginia, Mary Ann Kulh, Clifford Hughes, Jeffrey Braithwaite, and Johanna Westbrook. "Controlled pre–post, mixed-methods study to determine the effectiveness of a national delirium clinical care standard to improve the diagnosis and care of patients with delirium in Australian hospitals: a protocol." BMJ Open 8, no. 1 (January 2018): e019423. http://dx.doi.org/10.1136/bmjopen-2017-019423.
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IntroductionDelirium, an acute confusional state, affects up to 29% of acute inpatients aged 65 years and over. The Australian Delirium Clinical Care Standard (the Standard) contains evidence-based, multicomponent interventions, to identify and reduce delirium. This study aims to: (1) conduct a controlled, before-and-after study to assess the clinical effectiveness of the Standard to improve diagnosis and treatment of delirium; (2) conduct a cost-effectiveness study of implementing the Standard and (3) evaluate the implementation process.Methods and analysisThe study will use a controlled, preimplementation and postimplementation mixed-methods study design, including: medical record reviews, activity-based costing analysis and interviews with staff, patients and their family members. The study population will comprise patients 65 years and over, admitted to surgical, medical and intensive care wards in four intervention hospitals and one control hospital. The primary clinical outcome will be the incidence of delirium. Secondary outcomes include: length of stay, severity and duration of delirium, inhospital mortality rates, readmission rates and use of psychotropic drugs. Cost-effectiveness will be evaluated through activity-based costing analysis and outcome data, and the implementation process appraised through the qualitative results.Ethics and disseminationEthics approval has been received for two hospitals. Additional hospitals have been identified and ethics applications will be submitted once the tools in the pilot study have been tested.The results will be submitted for publication in peer-reviewed journals and presented to national and international conferences. Results seminars will provide a quality feedback mechanism for staff and health policy bodies.
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Papadopoulos, Nicole, Emma Sciberras, Harriet Hiscock, Katrina Williams, Jane McGillivray, Cathrine Mihalopoulos, Lidia Engel, et al. "Sleeping sound with autism spectrum disorder (ASD): study protocol for an efficacy randomised controlled trial of a tailored brief behavioural sleep intervention for ASD." BMJ Open 9, no. 11 (November 2019): e029767. http://dx.doi.org/10.1136/bmjopen-2019-029767.
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IntroductionSleep problems are a characteristic feature of children with autism spectrum disorder (ASD) with 40% to 80% of children experiencing sleep difficulties. Sleep problems have been found to have a pervasive impact on a child’s socio-emotional functioning, as well as on parents’ psychological functioning. The Sleeping Sound ASD project aims to evaluate the efficacy of a brief behavioural sleep intervention in reducing ASD children’s sleep problems in a fully powered randomised controlled trial (RCT). Intervention impact on child and family functioning is also assessed.Methods and analysisThe RCT aims to recruit 234 children with a diagnosis of ASD, aged 5–13 years, who experience moderate to severe sleep problems. Participants are recruited from paediatrician clinics in Victoria, Australia, and via social media. Families interested in the study are screened for eligibility via phone, and then asked to complete a baseline survey online, assessing child sleep problems, and child and family functioning. Participants are then randomised to the intervention group or treatment as usual comparator group. Families in the intervention group attend two face-to-face sessions and a follow-up phone call with a trained clinician, where families are provided with individually tailored behavioural sleep strategies to help manage the child’s sleep problems. Teacher reports of sleep, behavioural and social functioning are collected, and cognitive ability assessed to provide measures blind to treatment group. The primary outcome is children’s sleep problems as measured by the Children’s Sleep Habits Questionnaire at 3 months post-randomisation. Secondary outcomes include parent and child quality of life; child social, emotional, behavioural and cognitive functioning; and parenting stress and parent mental health. Cost-effectiveness of the intervention is also evaluated.Ethics and disseminationFindings from this study will be published in peer-reviewed journals and disseminated at national and international conferences, local networks and online.Trial registration numberISRCTN14077107 (ISRCTN registry dated on 3 March 2017).
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Khano, Sonia, Lena Sanci, Susan Woolfenden, Yvonne Zurynski, Kim Dalziel, Siaw-Teng Liaw, Douglas Boyle, et al. "Strengthening Care for Children (SC4C): protocol for a stepped wedge cluster randomised controlled trial of an integrated general practitioner-paediatrician model of primary care." BMJ Open 12, no. 9 (September 2022): e063449. http://dx.doi.org/10.1136/bmjopen-2022-063449.
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IntroductionAustralia’s current healthcare system for children is neither sustainable nor equitable. As children (0–4 years) comprise the largest proportion of all primary care-type emergency department presentations, general practitioners (GPs) report feeling undervalued as an integral member of a child’s care, and lacking in opportunities for support and training in paediatric conditions. This Strengthening Care for Children (SC4C) randomised trial aims to evaluate a novel, integrated GP-paediatrician model of care, that, if effective, will improve GP quality of care, reduce burden to hospital services and ensure children receive the right care, at the right time, closer to home.Methods and analysisSC4C is a stepped wedge cluster randomised controlled trial (RCT) of 22 general practice clinics in Victoria and New South Wales, Australia. General practice clinics will provide control period data before being exposed to the 12-month intervention which will be rolled out sequentially each month (one clinic per state) until all 22 clinics receive the intervention. The intervention comprises weekly GP-paediatrician co-consultation sessions; monthly case discussions; and phone and email paediatrician support, focusing on common paediatric conditions. The primary outcome of the trial is to assess the impact of the intervention as measured by the proportion of children’s (0–<18 years) GP appointments that result in a hospital referral, compared with the control period. Secondary outcomes include GP quality of care; GP experience and confidence in providing paediatric care; family trust in and preference for GP care; and the sustainability of the intervention. An implementation evaluation will assess the model to inform acceptability, adaptability, scalability and sustainability, while a health economic evaluation will measure the cost-effectiveness of the intervention.Ethics and disseminationHuman research ethics committee (HREC) approval was granted by The Royal Children’s Hospital Ethics Committee in August 2020 (Project ID: 65955) and site-specific HRECs. The investigators (including Primary Health Network partners) will communicate trial results to stakeholders and participating GPs and general practice clinics via presentations and publications.Trial registration numberAustralia New Zealand Clinical Trials Registry 12620001299998.
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Quach, Jon L., Ben Deery, Margaret Kern, Janet Clinton, Lisa Gold, Francesca Orsini, and Emma Sciberras. "Can a teacher-led mindfulness intervention for new school entrants improve child outcomes? Protocol for a school cluster randomised controlled trial." BMJ Open 10, no. 5 (May 2020): e036523. http://dx.doi.org/10.1136/bmjopen-2019-036523.
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IntroductionThe first years of school are critical in establishing a foundation for positive long-term academic, social and well-being outcomes. Mindfulness-based interventions may help students transition well into school, but few robust studies have been conducted in this age group. We aim to determine whether compared with controls, children who receive a mindfulness intervention within the first years of primary school have better: (1) immediate attention/short-term memory at 18 months post-randomisation (primary outcome); (2) inhibition, working memory and cognitive flexibility at 18 months post-randomisation; (3) socio-emotional well-being, emotion-regulation and mental health-related behaviours at 6 and 18 months post-randomisation; (4) sustained changes in teacher practice and classroom interactions at 18 months post-randomisation. Furthermore, we aim to determine whether the implementation predicts the efficacy of the intervention, and the cost effectiveness relative to outcomes.Methods and analysisThis cluster randomised controlled trial will be conducted in 22 primary schools in disadvantaged areas of Melbourne, Australia. 826 students in the first year of primary school will be recruited to detect between groups differences of Cohen’s d=0.25 at the 18-month follow-up. Parent, teacher and child-assessment measures of child attention, emotion-regulation, executive functioning, socio-emotional well-being, mental health-related behaviour and learning, parent mental well-being, teacher well-being will be collected 6 and 18 months post-randomisation. Implementation factors will be measured throughout the study. Intention-to-treat analyses, accounting for clustering within schools and classes, will adopt a two-level random effects linear regression model to examine outcomes for the intervention versus control students. Unadjusted and analyses adjusted for baseline scores, baseline age, gender and family socioeconomic status will be conducted.Ethics and disseminationEthics approval has been received by the Human Research Ethics Committee at the University of Melbourne. Findings will be reported in peer-review publications, national and international conference presentations and research snapshots directly provided to participating schools and families.Pre-Results Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12619000326190).
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Byrnes, Joshua M., Linda J. Cobiac, Christopher M. Doran, Theo Vos, and Anthony P. Shakeshaft. "Cost‐effectiveness of volumetric alcohol taxation in Australia." Medical Journal of Australia 192, no. 8 (April 2010): 439–43. http://dx.doi.org/10.5694/j.1326-5377.2010.tb03581.x.
Full textDissertations / Theses on the topic "Family medicine Australia Cost effectiveness"
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Gouge, Natasha B., and Jodi Polaha. "Integration Can Work! Demonstrating Cost Effectiveness and Marketing It in the Real World." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6592.
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"But how do you pay for it?" Sigh no more! The indirect benefits of hiring a Behavioral Health Consultant have been demonstrated in large health care industry but not in small, stand-alone practices. Until now! In this session, we will tell you how we answered this worn-out question with a short study comparing productivity and income in one small rural pediatric practice on days with a BHC and days without. Come find out how we showed the providers and staff how this practice saved over $1,000 per day when the BHC was present. We'll also talk about how we've marketed this data to other practices and third party payers.
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Antioch, Kathryn M. "Improving cost effectiveness, distributional justice and allocative efficiency in hospital funding and service delivery in Australia and internationally." Monash University, Dept. of Epidemiology and Preventive Medicine, 2004. http://arrow.monash.edu.au/hdl/1959.1/5296.
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McCarter, Kayla, Dannel Petgrave, Courtney Lilly, Natasha Gouge, and Jodi Polaha. "The Cost Effectiveness of Behavioral Health Consultant Utilization for Attention-Deficit Hyperactivity Disorder Cases in Rural Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6633.
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Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed behavior disorder in children. With the frequency of ADHD diagnoses, primary care providers (PCP) are challenged with managing this chronic and complex concern in an efficient yet effective way, both in terms of time and money. Research indicates behavioral diagnoses and management take approximately five minutes longer than medical-only concerns. This can result in a revenue loss for primary care practices. However, an on- site behavioral health consultant (BHC) can help PCPs provide a high standard of care for children presenting with behavioral concerns without compromising cost effectiveness. This study’s aim was to assess the cost per minute in a small rural primary care practice that utilizes an on-site BHC by comparing data between ADHD appointments when the BHC was utilized versus ADHD appointments when the BHC was not utilized. This study used extant data consisting of a sample of 53 children with ICD-9-CM codes 314.00 or 314.01, indicating an ADHD diagnosis. Of the 53 children with these codes, 40 (75.5%) were billed using E/M codes 99213 or 99214. The first of these indicates a regular office visit with an established patient not exceeding 15 minutes while the latter is used if the visit lasts longer than 25 minutes. Both codes were combined and evaluated together. The database was then recoded to indicate whether or not a BHC was utilized. Using descriptive statistics, it was found that children with ADHD spent a max of 69 minutes (20.19 minutes on average) with the PCP when a BHC was not utilized and a max of 22 minutes (13.67 minutes on average) when a BHC was utilized. Furthermore, an average of $82.79 in insurance reimbursement was received by the practice for these types of visits, regardless of up-coding for physician time spent. Using these statistics, it was determined that the practice makes $4.10 per minute when a BHC is not utilized versus $6.06 per minute when a BHC is utilized for ADHD appointments, due to the time savings ratio. The results indicate that utilization of a BHC increases revenue with respect to minutes spent with the child, while still providing behavioral health time and attention to the patient. These findings have practical implications for the treatment and management of ADHD and support the use of BHCs in pediatric primary care settings. Given the nature of pediatric primary care, it would be more cost effective for PCPs to utilize an on-site BHC with all ADHD visits.
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Hendriks, Hans Jurgen. "Is CPAP a feasible treatment modality in a rural district hospital for neonates with respiratory distress syndrome?" Thesis, Stellenbosch : Stellenbosch University, 2010. http://hdl.handle.net/10019.1/20453.
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Thesis (MMed) -- Stellenbosch University, 2010.ENGLISH ABSTRACT: Introduction: Limited facilities exist at rural hospitals for the management of newborn infants with respiratory distress syndrome (RDS). Furthermore, the secondary and tertiary hospitals are under severe strain to accept all the referrals from rural hospitals. Many of these infants require intubation and ventilation with a resuscitation bag which must be sustained for hours until the transport team arrives. Not only is lung damage inflicted by the prolonged ventilation, but transferring the infant by helicopter and ambulance is expensive. CPAP (continuous positive airway pressure), a non-invasive form of ventilatory support, has been used successfully at regional (Level 2) and tertiary (Level 3) neonatal units, to manage infants with RDS. It is cost-effective for infants with mild to moderate grades of RDS to be managed at the rural hospital instead of being transferred to the regional secondary or tertiary hospital. CPAP was introduced to Ceres Hospital, a rural Level 1 hospital, in February 2008 for the management of infants with RDS. Aim: To determine the impact of CPAP on the management of infants with RDS in a rural level 1 hospital and whether it can reduce the number of referrals to regional hospitals. Study setting: Nursery at Ceres District Hospital, Cape Winelands District, Western Cape. Study design: Prospective cohort analytical study with an historic control group (HCG). Patients and Methods: The study group (SG) comprised all neonates with respiratory distress born between 27/02/2008 and 26/02/2010. The infants were initially resuscitated with a Neopuff® machine in labour-ward and CPAP was commenced for those with RDS. The survival and referral rates of the SG were compared to an historic control group (HCG) of infants born between 1/2/2006 to 31/01/2008 at Ceres Hospital. Results: During the 2 years of the study, 51 neonates received CPAP (34 <1800g, 17>1800g). Twenty (83%) of the SG infants between 1000g and 1800g and 23 (68%) of the infants between 500g and 1800g survived. Those <1800g that failed CPAP, had either a severe grade of RDS which required intubation and ventilation or were <1000g. Seventeen (33%) of the infants that received CPAP, were in the >1800g group. Thirteen (76%) of these infants were successfully treated with CPAP only. The four infants that failed CPAP suffered from congenital abnormalities and would not have benefited from CPAP. There was no statistically significant difference in the survival between the SG and HCG (80%) (p=0.5490) but the number of referrals decreased significantly from 21% in the HCG to 7% in the SG (p=0.0003). No complications related to CPAP treatment, such as pneumothorax, were noted. The nursing and medical staff quickly became proficient and confident in applying CPAP and were committed to the project. Conclusion: CPAP can be safely and successfully practised in infants with mild to moderate RDS in a rural Level 1 hospital. The survival rate stayed the same as the HCG, even though a higher risk infants were treated in the SG. The transfers were significantly reduced from 21% to 7%. This resulted in significant cost savings for the hospital.
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Books on the topic "Family medicine Australia Cost effectiveness"
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Moore, Kent. Assessing and improving your cost-effectiveness. Kansas City, MO: American Academy of Family Physicians, 1996.
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Pharmaceuticals, Zeneca, ed. Improving health care: A general practitioner's guide to cost-benefit analysis. Wilmslow: Zeneca, 1994.
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Carmo, Leide Silva do, and Nelson Iguimar Valerio. Psicologia & saúde treino de habilidades de vida e saúde mental em universitários. Brazil Publishing, 2021. http://dx.doi.org/10.31012/978-65-87836-06-5.
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Several factors can cause damage to the mental health of university students, e.g. academic adaptation, housing change, distance from family and friends, and dealing with stressors regarding new requirements, which need some resources to cope with such situations. The content of this book, from the Master's Dissertation developed by the authors at the Stricto-Sensu Psychology and Health Post-Graduation Program at the Medical School of São José do Rio Preto - FAMERP, aims at describing the presence of mental disorders and demonstrating the implementation of a life-skills training in university students (Medicine and Nursing), randomly chosen in a teaching institution in a medium-sized city, interior of São Paulo state. The participants expressed high symptoms of anxiety, depression and stress in the initial evaluation, however, after the training of group life skills, they showed significant improvements with maintenance of these rates during the follow-up. This training can be stood out to improve the mental health and life skills of the students. It is likely that the intervention group may have helped these students to cope with negative pressures, avoiding risky behaviors, communicating effectively; moreover, coping with adaptations and changes in such academic process. It is worthwhile to point out that this study may encourage further research in relation to mental health and life-skills in university students, and that it will encourage the insertion of programs with these skills training, due to their effectiveness, low cost, the participants´ acceptance, improvement in mental health, and provide increasing academic performance.
Book chapters on the topic "Family medicine Australia Cost effectiveness"
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Gillick, Muriel R. "Finale." In Old and Sick in America. University of North Carolina Press, 2017. http://dx.doi.org/10.5149/northcarolina/9781469635248.003.0013.
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The evidence suggests that medical care for frail, old people should be interdisciplinary, coordinated, and accessible. Analysis of the current system suggests it should begin with comprehensive assessment of the individual, including physical function, emotional state, degree of social engagement, support system, and medical insurance. Next, the ideal interdisciplinary team should determine the person’s goals of care. Finally, a plan of care should be developed, taking both goals and needs into account. Implementing the plan will require a robust home care program as well as family support. Achievement of such a system will necessitate reforming the complex adaptive system that makes up American health care today. The most promising change agent is the Medicare program itself, which could introduce requirements into medical training programs to assure competence in geriatric medicine and communication skills. With appropriate legislative changes, Medicare could also negotiate with drug companies over price and set reimbursement for medical technology based on cost-effectiveness. Medicare could also develop a new benefit plan for frail elders that offered more intensive home care and other services in exchange for decreased coverage of invasive, expensive, and often non-beneficial hospital-based technology.