This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ http://www.biomedcentral.com/bmchealthservres/ The latest articles from BMC Health Services Research (ISSN 1472-6963) published by BioMed Central Background: Patients face increasing insurance restrictions on prescription drugs, including generic-only coverage. There are no generic inhaled corticosteroids (ICS), which are a mainstay of asthma therapy, and patients pay the full price for these drugs under generic-only policies. We examined changes in ICS use following the introduction of generic-only coverage in a Medicare Advantage population from 2003-2004. Methods: Subjects were age 65+, with asthma, prior ICS use, and no chronic obstructive pulmonary disorder (n=1,802). In 2004, 74.0% switched from having a $30 brand-copayment plan to a generic-only coverage plan (restricted coverage); 26% had $15-25 brand copayments in 2003-2004 (unrestricted coverage). Using linear difference-in-difference models, we examined annual changes in ICS use (measured by days-of-supply dispensed). There was a lower-cost ICS available within the study setting and we also examined changes in drug choice (higher- vs. lower-cost ICS). In multivariable models we adjusted for socio-demographic, clinical, and asthma characteristics. Results: In 2003 subjects had an average of 188 days of ICS supply. Restricted compared with unrestricted coverage was associated with reductions in ICS use from 2003-2004 (-15.5 days-of-supply, 95% confidence interval (CI): -25.0 to -6.0). Among patients using higher-cost ICS drugs in 2003 (n=662), more restricted versus unrestricted coverage subjects switched to the lower-cost ICS in 2004 (39.8% vs. 10.3%). Restricted coverage was not associated with decreased ICS use (2003-2004) among patients who switched to the lower-cost ICS (18.7 days-of-supply, CI: -27.5 to 65.0), but was among patients who did not switch (-38.6 days-of-supply, CI: -57.0 to -20.3). In addition, restricted coverage was associated with decreases in ICS use among patients with both higher- and lower-risk asthma (-15.0 days-of-supply, CI: -41.4 to 11.44; and -15.6 days-of-supply, CI: -25.8 to 5.3, respectively). Conclusions: In this elderly population, patients reduced their already low ICS use in response to losing drug coverage. Switching to the lower-cost ICS mitigated reductions in use among patients who previously used higher-cost drugs. Additional work is needed to assess barriers to switching ICS drugs and the clinical effects of these drug use changes. http://www.biomedcentral.com/1472-6963/8/151 Vicki Fung, Ira B Tager, Richard Brand, Joseph P Newhouse and John Hsu BMC Health Services Research 2008, 8:151 2008-07-18 doi:10.1186/1472-6963-8-151 BMC Health Services Research 1472-6963 8 151 2008-07-18 Background: Although abortion or termination of pregnancy (TOP) has become an increasingly normalized component of womens' health care over the past forty years, insufficient attention has been paid to womens' experiences of surgical or medical methods of TOP. ObjectiveTo undertake a narrative review of qualitative studies of womens' experiences of TOP and their perspectives on surgical or medical methods. Methods: Keyword searches of Medline, CINAHL, ISI, and IBSS databases. Manual searches of other relevant journals and reference lists of primary articles. Results: Qualitative studies (n=18) on womens' experiences of abortion were identified. Analysis of the results of studies reviewed revealed three main themes: experiential factors that promote or inhibit the choice to seek TOP; experiences of TOP; and experiential aspects of the environment in which TOP takes place. Conclusion: Womens' choices about TOP are mainly pragmatic ones that are related to negotiating finite personal and family and emotional resources. Women who are well informed and supported in their choices experience good psychosocial outcomes from TOP. Home TOP using mifepristone appears attractive to women who are concerned about professionals' negative attitudes and lack of privacy in formal healthcare settings but also leads to concerns about management and safety. http://www.biomedcentral.com/1472-6963/8/150 Mabel LS Lie, Stephen C Robson and Carl R May BMC Health Services Research 2008, 8:150 2008-07-17 doi:10.1186/1472-6963-8-150 BMC Health Services Research 1472-6963 8 150 2008-07-17 Background: Data linkage is a technique that has long been used to connect information across several disparate data sources - most commonly for medical and population health research. Often the purpose is to connect data for individuals over extended time periods or across different service settings, and so person-based linkage using detailed personal information is preferred. Linkage which aims to link connected events, on the other hand, requires information about the time and place of the event as well as the person or persons involved in that event in order to make high quality linkages. This paper describes the detailed process of event linkage and compares directly an event-based linkage method for identifying transition events between two care sectors in Australia with a well-established high quality longitudinal person-based linkage which facilitates identification of event data for individuals. Methods: Direct comparisons are made between transition events identified using an event-based linkage and an existing person-based linkage for people moving from hospital into aged care in Western Australia. Several aspects of event-based linkage are examined: refinement of the strategy to reduce false positives, causes of false positives and false negatives, quality of the linked event dataset, and utility of the linked event dataset for transition analysis. Results: Over 97% of the event-based links were among those selected using the person-based linkage and over 90% of the latter were identified by the event-based method, with the remainder missed mostly due to differences in reported event date or residential region. Consequently the two linked datasets were sufficiently similar to give very similar results for analyses, but the actual volume of movement from hospital to RAC was underestimated by about 10% by the event-based method. Conclusions: This project has allowed a 'preferred event' event-based linkage strategy to be selected and deployed across Australia to study movements from hospital to residential aged care facilities using databases in which only limited personal information is available, but event dates and details can be readily accessed. The utility of this approach in other transition situations depends on the volume of movement and the accuracy of recording information in each setting. http://www.biomedcentral.com/1472-6963/8/149 Rosemary Karmel and Diana L Rosman BMC Health Services Research 2008, 8:149 2008-07-17 doi:10.1186/1472-6963-8-149 BMC Health Services Research 1472-6963 8 149 2008-07-17 Background: Recent guidelines recommend assessment and treatment of the overall risk for cardiovascular disease (CVD) through management of multiple risk factors in patients at high absolute risk. The aim of our study was to assess the level of cardiovascular risk in patients with known risk factors for CVD by applying the SCORE risk function and to study the implications of European guidelines on the use of treatment and goal attainment for blood pressure (BP) and lipids in the primary care of Cyprus. Methods: Retrospective chart review of 1101 randomly selected patients with type 2 diabetes mellitus (DM2), or hypertension or hyperlipidemia in four primary care health centres. The SCORE risk function for high- risk regions was used to calculate 10-year risk of cardiovascular fatal event. Most recent values of BP and lipids were used to assess goal attainment to international standards. Most updated medications lists were used to compare proportions of current with recommended antihypertensive and lipid-lowering drug (LLD) users according to European guidelines. Results: Implementation of the SCORE risk model labelled overall 39.7% (53.6% of men, 31.3% of women) of the study population as high risk individuals (CVD, DM2 or SCORE [greater than or equal to] 5%). The SCORE risk chart was not applicable in 563 patients (51.1%) due to missing data in the patient records, mostly on smoking habits. The LDL-C goal was achieved in 28.6%, 19.5% and 20.9% of patients with established CVD, DM2 (no CVD) and SCORE [greater than or equal to] 5%, respectively. BP targets were achieved in 55.4%, 5.6% and 41.9% respectively for the above groups. There was under prescription of antihypertensive drugs, LLD and aspirin for all three high risk groups. Conclusion: This study demonstrated suboptimal control and under-treatment of patients with cardiovascular risk factors in the primary care in Cyprus. Improvement of documentation of clinical information in the medical records as well as GPs training for implementation and adherence to clinical practice guidelines are potential areas for further discussion and research. http://www.biomedcentral.com/1472-6963/8/148 Theodora Zachariadou, Henri EJH Stoffers, Costas A Christophi, Anastasios Philalithis and Christos Lionis BMC Health Services Research 2008, 8:148 2008-07-16 doi:10.1186/1472-6963-8-148 BMC Health Services Research 1472-6963 8 148 2008-07-16 Background: The burden of arthritis is increasing in the face of diminishing health human resources to deliver care. In response, innovative models of care delivery are developing to facilitate access to quality care. Most models have developed in response to local needs with limited evaluation. The primary objective of this study is to a) examine the range of models of care that deliver specialist services using a medical/surgical specialist and at least one other health care provider and b) document the strengths and challenges of the identified models. A secondary objective is to identify key elements of best practice models of care for arthritis. Methods: Semi-structured interviews were conducted with a sample of key informants with expertise in arthritis from jurisdictions with primarily publicly-funded health care systems. Qualitative data were analyzed using a constant comparative approach to identify common types of models of care, strengths and challenges of models, and key components of arthritis care. Results: Seventy-four key informants were interviewed from six countries. Five main types of models of care emerged. 1) Specialized arthritis programs deliver comprehensive, multidisciplinary team care for arthritis. Two models were identified using health care providers (e.g. nurses or physiotherapists) in expanded clinical roles: 2) triage of patients with musculoskeletal conditions to the appropriate services including specialists; and 3) ongoing management in collaboration with a specialist. Two models promoting rural access were 4) rural consultation support and 5) telemedicine. Key informants described important components of models of care including knowledgeable health professionals and patients. Conclusions: A range of models of care for arthritis have been developed. This classification can be used as a framework for discussing care delivery. Areas for development include integration of care across the continuum, including primary care. http://www.biomedcentral.com/1472-6963/8/147 Crystal MacKay, Paula Veinot and Elizabeth M Badley BMC Health Services Research 2008, 8:147 2008-07-14 doi:10.1186/1472-6963-8-147 BMC Health Services Research 1472-6963 8 147 2008-07-14 Background: Use of gonadotropin-releasing hormone (GnRH) agonists has become popular for virtually all stages of prostate cancer. We hypothesized that some men receive these agents after only a limited work-up for their cancer. Such cases may be missed by tumor registries, leading to underestimates of the total extent of GnRH agonist use. Methods: We used linked Surveillance, Epidemiology and End-Results (SEER)-Medicare data from 1993 through 2001 to identify GnRH agonist use in men with either a diagnosis of prostate cancer registered in SEER, or with a diagnosis of prostate cancer based only on Medicare claims (from the 5% control sample of Medicare beneficiaries residing in SEER areas without a registered diagnosis of cancer). The proportion of incident GnRH agonist users without a registry diagnosis of prostate cancer was calculated. Factors associated with lack of a registry diagnosis were examined in multivariable analyses. Results: Of incident GnRH agonist users, 8.9% had no diagnosis of prostate cancer registered in SEER. In a multivariable logistic regression model, lack of a registry diagnosis of prostate cancer in GnRH agonist users was significantly more likely with increasing comorbidity, whereas it was less likely in men who had undergone either inpatient admission or procedures such as radical prostatectomy, prostate biopsy, or transurethral resection of the prostate. Conclusion: Reliance solely on tumor registry data may underestimate the rate of GnRH agonist use in men with prostate cancer. http://www.biomedcentral.com/1472-6963/8/146 Yong-Fang Kuo, James S Goodwin and Vahakn B Shahinian BMC Health Services Research 2008, 8:146 2008-07-14 doi:10.1186/1472-6963-8-146 BMC Health Services Research 1472-6963 8 146 2008-07-14 Background: Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews. Methods: We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. Results: A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching. Conclusion: Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated. http://www.biomedcentral.com/1472-6963/8/145 Gro Jamtvedt, Kristin Thuve Dahm, Inger Holm and Signe Flottorp BMC Health Services Research 2008, 8:145 2008-07-08 doi:10.1186/1472-6963-8-145 BMC Health Services Research 1472-6963 8 145 2008-07-08 Background: The purpose of this study was to describe the prevalence of respiratory diseases in older adults and compare the demographic, health and smoking characteristics of those with and without these diseases. Furthermore, we evaluate the association between smoking status and patterns in health care and how concordant this care is with guidelines. Methods: Using a nationally representative sample of 29,902 older adults who participated in the Medicare Current Beneficiary Survey (1992-2002), we compared guideline recommendations on the treatment and prevention of chronic obstructive pulmonary disease and asthma with survey utilization data, including the use of bronchodilators, spirometry and influenza vaccine. Results: 26% to 30% of older adults were diagnosed with or self-reported chronic respiratory diseases; however 69% received no pharmacological treatment and 30% of patients reporting use of pharmacological treatments did not receive short-acting bronchodilator inhalers. Current smokers appeared to receive significantly less care for respiratory diseases than non-smokers or former smokers. Conclusions: Disparities between recommended and actual care for older adults with chronic lung disease require further research. The needs of older adults with comorbidities and nicotine addiction deserve special attention in care as well as guideline development and implementation. http://www.biomedcentral.com/1472-6963/8/144 Benjamin M Craig, Connie K Kraus, Betty A Chewning and James E Davis BMC Health Services Research 2008, 8:144 2008-07-08 doi:10.1186/1472-6963-8-144 BMC Health Services Research 1472-6963 8 144 2008-07-08 Background: The objective of this article is to describe the design of a study to evaluate the clinical and economic effects of a Disease Management model on functional health, quality of care and quality of life of persons living in homes for the elderly. Methods: This study concerns a cluster randomized controlled clinical trial among five intervention homes and five usual care homes in the North-West of the Netherlands with a total of over 500 residents. All persons who are not terminally ill, are able to be interviewed and sign informed consent are included. For cognitively impaired persons family proxies will be approached to provide outcome information. The Disease Management Model consists of several elements: (1) Trained staff carries out a multidimensional assessment of the patients functional health and care needs with the interRAI Long Term Care Facilities instrument (LTCF). Computerization of the LTCF produces immediate identification of problem areas and thereby guides individualized care planning. (2) The assessment outcomes are discussed in a Multidisciplinary Meeting (MM) with the nurse, primary care physician, nursing home physician and Psychotherapist and if necessary other members of the care team. The MM presents individualized care plans to manage or treat modifiable disabilities and risk factors. (3) Consultation by an nursing home physician and psychotherapist is offered to the frailest residents at risk for nursing home admission (according to the interRAI LTCF). Outcome measures are Quality of Care indicators (LTCF based), Quality Adjusted Life Years (Euroqol), Functional health (SF12, COOP-WONCA), Disability (GARS), Patients care satisfaction (QUOTE), hospital and nursing home days and mortality, health care utilization and costs.DiscussionThis design is unique because no earlier studies were performed to evaluate the effects and costs of this Disease Management Model for disabled persons in homes for the elderly on functional health and quality of care. Trail registration number: ISRCTN11076857 http://www.biomedcentral.com/1472-6963/8/143 Marijke Boorsma, Hein PJ van Hout, Dinnus H Frijters, Miel W Ribbe and Giel Nijpels BMC Health Services Research 2008, 8:143 2008-07-07 doi:10.1186/1472-6963-8-143 BMC Health Services Research 1472-6963 8 143 2008-07-07 Background: The purposes of this cohort study were to establish how frequently people with physician-diagnosed diabetes self-reported the disease, to determine factors associated with self-reporting of diabetes, and to evaluate subsequent differences in self-management behaviour, health care utilisation and clinical outcomes between people who do and do not report their disease. Methods: We used a registry of physician-diagnosed diabetes as a reference standard. We studied respondents to a 2000/01 population-based health survey who were in the registry (n = 1,812), and we determined the proportion who reported having diabetes during the survey. Baseline factors associated with self-report and subsequent behavioural, utilisation and clinical differences between those who did and did not self-report were defined from the survey responses and from linkage with administrative data sources. Results: Only 75% of people with physician-diagnosed diabetes reported having the disease. People who did self-report were more likely to be male, to live in rural areas, to have longer disease duration and to have received specialist physician care. People who did not report having diabetes in the survey were markedly less likely to perform capillary blood glucose monitoring in the subsequent two years (OR 0.05, 95% CI 0.02 to 0.08). They were also less likely to receive specialist physician care (OR 0.55, 95% CI 0.37 to 0.86), and were less likely to require hospital care for hypo- or hyperglycaemia (OR 0.09, 95% CI 0.01 to 0.28). Conclusion: Many people with physician-diagnosed diabetes do not report having the disease, but most demographic and clinical features do not distinguish these individuals. These individuals are much less likely to perform capillary glucose monitoring, suggesting that their diabetes self-management is inadequate. Clinicians may be able to use the absence of glucose monitoring as a screening tool to identify people needing a detailed evaluation of their disease knowledge. http://www.biomedcentral.com/1472-6963/8/142 Baiju R Shah and Douglas G Manuel BMC Health Services Research 2008, 8:142 2008-07-07 doi:10.1186/1472-6963-8-142 BMC Health Services Research 1472-6963 8 142 2008-07-07 Background: Encouraging men to make more effective use of (preventive) health services is considered one way of improving their health. The aim of this study was to appraise the available evidence of effective interventions aimed at improving menas health. Methods: Systematic review of relevant studies identified through 14 electronic databases and other information resources. Results were pooled within health topic and described qualitatively. Results: Of 11,749 citations screened, 338 articles were assessed and 27 met our inclusion criteria. Most studies were male sex-specific, i.e. prostate cancer screening and testicular self-examination. Other topics included alcohol, cardiovascular disease, diet and physical activity, skin cancer and smoking cessation. 23 interventions were effective or partially effective and 18 studies satisfied all quality criteria. Conclusions: Most of the existing evidence relates to male sex-specific health problems as opposed to general health concerns relevant to both men and women. There is little published evidence on how to improve menas uptake of services. We cannot conclude from this review that targeting men works better than providing services for all people. Large-scale studies are required to help produce evidence that is sufficiently robust to add to the small evidence base that currently exists in this field. http://www.biomedcentral.com/1472-6963/8/141 Lynn M Robertson, Flora Douglas, Anne Ludbrook, Garth Reid and Edwin R van Teijlingen BMC Health Services Research 2008, 8:141 2008-07-03 doi:10.1186/1472-6963-8-141 BMC Health Services Research 1472-6963 8 141 2008-07-03