Cost-Effectiveness Analysis of Integrated Care in Management of Advanced Chronic Obstructive Pulmonary Disease (COPD).

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common disease that occurs all over the world. Models of care, initially accessed from the clinical point of view, must also be evaluated in terms of their economic effectiveness, as health care systems are limited. The Integrated Care Model (ICM) is a procedure dedicated to patients suffering from advanced COPD that offers home-oriented support from a multidisciplinary team. The main aim of the present study was to evaluate the cost-effectiveness of the ICM. MATERIAL AND METHODS We included 44 patients in the study (31 males, 13 females) with an average age 72 years (Me=71). Costs of care were estimated based on data received from public payer records and included general costs, COPD-related costs, and exacerbation-related costs. To evaluate cost-effectiveness, cost-effectiveness analysis (CEA) was used. The incremental cost-effectiveness ratio (ICER) was calculated based on changes in health care resources utilization and the value of costs observed in 2 consecutive 6-month periods before and after introducing ICM. RESULTS Costs of care of all types decreased after introducing ICM. Demand for ambulatory visits changed significantly (p=0.037) together with a substantial decrease in the number of emergency department appointments and hospitalizations (p=0.033). ICER was more profitable for integrated care than for standard care when assessing costs of avoiding negative parameters such as hospitalizations (-227 EUR), exacerbations-related hospitalizations (-312 EUR), or emergency procedures (-119 EUR). CONCLUSIONS ICM is a procedure that meets the criteria of cost-effectiveness. It allows for avoiding negative parameters such as unplanned hospitalizations with higher economic effectiveness than the standard type of care used in managing COPD.

Lung cancer survival and comorbidities in lung cancer screening participants of the Gdansk screening cohort.

BACKGROUND: In 2010, the World Health Organisation recommended implementation of screening programmes in four groups of diseases-neoplasms, cardiovascular diseases (CVD), diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD). It is due to the fact that they share the same, modifiable risk factors. METHODS: Between 2009 and 2011, 8637 heavy smokers (aged 50-75, smoking history >20 pack-years) were screened in the Pomeranian Pilot Lung Cancer Screening Programme (PPP) in Gdansk, Poland. We looked at 5-year follow-up and analysed the medical events and comorbidities of all participants. One health care provider in the Polish health care system provides a unique opportunity to gather most reliable data on all medical events in each person. RESULTS: In 52.0% of lung cancer screening participants CVD (33.5%), DM (26.0%) and COPD (21.0%) were diagnosed. Prevalence of these diseases is higher in lung cancer patients than in the non-cancer screening group (P < 0.0001). One hundred and seven (1.2%) lung cancers were diagnosed during PPP programme performance and another 382 cases (4.4%) in the 5-year follow-up, so the potential mean annual lung cancer detection rate is 0.77%. CONCLUSIONS: Lung cancer screening programme offers a great potential for joint screening of lung cancer, CVD, diabetes and COPD.

Factors Associated With Quitting Among Smoking Pregnant Women From Small Town and Rural Areas in Poland.

INTRODUCTION: Smoking rates among women in Poland are high, and access to specialized smoking cessation services in rural areas are limited. The aim of this study was to assess factors related to quitting among pregnant women who smoke in rural areas of Poland. METHODS: Data were collected during interviews conducted by midwives among 4512 women at various stages of their pregnancy. The interviews took place in small towns with populations having less than 8000 residents, located within 12 out of 16 voivodships (provinces). We used exhaled carbon monoxide to verify self-reported smoking status. RESULTS: Overall, 38% of women interviewed (n = 1578) smoked before they found out they were pregnant. Among these women, 33% quit just after they had become aware of their pregnancy. The main predictors of early quitting were: higher educational attainment among pregnant women (adjusted odds ratio [AOR] 3.21; 95% confidence interval [CI] = 1.81-5.68), secondary educational attainment among their partners (AOR 1.63; 95% CI = 1.06-2.48), and not having children (AOR 1.71; 95% CI = 1.31-2.24). The main barriers to early quitting were: living with at least one current smoker (AOR 0.55, 95% CI = 0.39-0.76), being single (AOR 0.45; 95% CI = 0.29-0.71), and having both parents smoke cigarettes (AOR 0.67; 95% CI = 0.46-0.97). CONCLUSIONS: A modest proportion of women included in this study quit after they became aware of their pregnancy. However, women faced multiple barriers to quitting, including the smoking status of their family members. The factors identified in the study can inform the design of tailored interventions for pregnant women in rural areas. IMPLICATIONS: Smoking rates among women in Poland are high, and access to specialized smoking cessation services in rural areas are limited. This study found that women were motivated to quit smoking, and many quit after they had become aware of their pregnancy. However, women faced multiple barriers to quitting, including the smoking status of their family members. The factors identified in the study can inform the design of tailored interventions for pregnant women in rural areas.

Impact of Integrated Care Model (ICM) on Direct Medical Costs in Management of Advanced Chronic Obstructive Pulmonary Disease (COPD).

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a commonly diagnosed condition in people older than 50 years of age. In advanced stage of this disease, integrated care (IC) is recommended as an optimal approach. IC allows for holistic and patient-focused care carried out at the patient's home. The aim of this study was to analyze the impact of IC on costs of care and on demand for medical services among patients included in IC. MATERIAL AND METHODS The study included 154 patients diagnosed with advanced COPD. Costs of care (general, COPD, and exacerbations-related) were evaluated for 1 year, including 6-months before and after implementing IC. The analysis included assessment of the number of medical procedures of various types before and after entering IC and changes in medical services providers. RESULTS Direct medical costs of standard care in advanced COPD were 886.78 EUR per 6 months. Costs of care of all types decreased after introducing IC. Changes in COPD and exacerbation-related costs were statistically significant (p=0.012492 and p=0.017023, respectively). Patients less frequently used medical services for respiratory system and cardiovascular diseases. Similarly, the number of hospitalizations and visits to emergency medicine departments decreased (by 40.24% and 8.5%, respectively). The number of GP visits increased after introducing IC (by 7.14%). CONCLUSIONS The high costs of care in advanced COPD indicate the need for new forms of effective care. IC caused a decrease in costs and in the number of hospitalization, with a simultaneous increase in the number of GP visits.

[Efficacy and costs of ovarian cancer therapy in Poland--regional approach]. / Skutecznosc i koszty leczenia raka jajnika w PoIsce--ujecie regionalne.

UNLABELLED: Ovarian cancer (OC) affects over 3 000 women in Poland annually The efficacy of the therapy remains relatively low due to challenges of systematic improvement in the early detection OC rates. International comparisons indicate a positive correlation between health expenditures and 5-year survival rates of cancer patients. To the best of our knowledge, our study has been the first to present a correlation between the 5-year survival rates (SRs) and the cost of ovarian cancer therapy in particular regions of Poland. MATERIAL AND METHODS: The study was based on the National Health Fund (NHF) data, available in the Disease Treatment Registry The analysis included approximately 13,000 OC patients who started their treatment between 2005 and 2008 to allow for the evaluation of long-term therapy results. The 5-year survival rates were analyzed in relation to average NHF expenditures in various regions of Poland, distinguishing the population of patients aged 45-64 years. RESULTS: The 5-year survival rate in the cohorts diagnosed in 2005 and 2008 changed marginally from 42% to 43%, maintaining relatively large differences between the regions (from 35% to 53% in patients diagnosed in 2008). The NHF expenditures in particular regions differed significantly: mean cost for the entire treatment cycle ranged from 31.600 PLN do 58.000 PLNperperson among patients diagnosed in 2008. No significant correlation between the survival and the cost was found. CONCLUSIONS: SRs of OC patients in particular regions of Poland are not correlated with average treatment cost. Thus, the differences in SRs between various regions of Poland have their source in other factors, e.g., clinical stage at diagnosis, or prevailing treatment patterns in the given region. Further studies may decrease regional discrepancies in patient care and SRs in OC subjects.

Epidemiology of asthma in Poland in urban and rural areas, based on provided health care services.

INTRODUCTION: Asthma is a serious health and social problem, also in Poland. The epidemiological data indicate that the problem of asthma concerns approximately 4 million people in Poland, whereas almost approximately 70% of them have no diagnosis and are not aware of their illness, and on the other hand in 39% of persons who declared the diagnosis of asthma in a survey the diagnosis was negatively verified (overdiagnosis of asthma). So far, no detailed comparative studies for asthma incidence rate in urban and rural areas were conducted in Poland. The aim of the study was to analyze patients with asthma in Poland in the years 2008-2012, with regard to province and type of commune (rural/urban). MATERIAL AND METHODS: The study used data from National Health Fund (NFZ) - reported by health care providers regarding the patients diagnosed with asthma. Using structured query language (SQL) a set of patients was selected and created, for whom at the same time ICD-10 code: J45.X-bronchial asthma was reported. In order to estimate the number of patients with asthma we used the PESEL social security number as a unique identifier of the patient. Code of the patient's commune of residence in conjunction with the Central Statistical Office data formed the basis for the division of municipalities into urban and rural areas. The analysis of asthma incidence trends in Poland was performed on the basis of health services provided to patients. The analysis was performed by using the Statistica 10 software using a negative binomial regression model. RESULTS: In 2009 a significant increase in the number of patients with asthma was observed compared with the previous year, whereas after 2009 the number of patients diagnosed with asthma remained relatively constant. A significant increase of predominance of women among asthma patients in recent years can be noticed: from 107% in 2008 to almost 115% in 2012 (F:M ratio). Regardless of the analyzed year and the diagnosis the incidence rate remained constant: approximately 55-57% for urban areas and about 43-45% in rural areas. CONCLUSIONS: The average prevalence rate for rural areas is significantly lower than for urban areas. The use of adjusted incidence rate leads to the conclusion that the number of sufferers in urban areas is higher (about 10%) of the number of sufferers in the rural areas. The results of the analysis are consistent with information from previous studies in Poland and in the world.

Evaluation of the Organisation of the COVID-19 Vaccination Process by the Teachers in a Region of Poland.

The aim of this study was to assess the organisational process of vaccination within the National Vaccination Programme against COVID-19 (NVP) in the professional group of teachers in Pomeranian Province, Poland. The main goal of the survey was to assess the quality of planning and executing of the NVP and to find a correlation between social and employment placements with the level of perception of chosen quality indicators of the NVP. The presented cross-sectional survey was conducted among 4622 teachers from all levels of education in public and non-public institutions who received the SARS-CoV-2 virus vaccination campaign with the vaccine from AstraZeneca as part of the NVP. The survey was conducted using an original, self-designed questionnaire prepared for this study and distributed to teachers in the form of an online survey via email. Bayesian logistic and linear regression were used to estimate the relationship between predictors and dependent variables. Age was the main factor associated with the performance assessment of the vaccination centre (log[BF] = 0.86-16.88), while gender was the main factor associated with the assessment of NVP (log[BF] = 3.15-10,6). The evaluation of the vaccination registration process (log[BF] = -7.01-50.26) and the evaluation of the information received on the management of post-vaccination reactions (log[BF] = -2.22-65.26) were significant parts of the NVP. It is crucial to tailor information messages to the age and gender of the recipients and to ensure the quality of the information provided by medical personnel, in particular the possible occurrence of vaccination reactions and how to deal with them.

Socioeconomic correlates and biochemical profiles of smokers in Poland: a cross-sectional study.

INTRODUCTION: Epidemiological studies have shown a fairly constant association between the socioeconomic status and smoking. However, associations between smoking and the biological indicators of health status have not been well described yet. OBJECTIVES: This study aimed to determine the relationship among smoking, biochemical risk factors, and sociodemographic characteristics in the Polish population. PATIENTS AND METHODS: A survey was carried out in a representative sample of Polish residents aged 18 to 79 years. A total of 2413 randomly selected subjects participated in the survey. Logistic regression analysis as well as parametrical and nonparametrical tests were performed. RESULTS: Significantly higher cholesterol, apolipoprotein B, and potassium levels were observed in smoking women and men compared with the nonsmoking population. Significantly lower bilirubin levels were noted in smoking individuals. Higher C­reactive protein and lower creatinine levels were reported only in the smoking male population compared with nonsmokers. There was a significant inverse gradient in the relationship between income and smoking. Single women and men were at greater risk of being smokers (odds ratio [OR], 1.9 and 2.39, respectively). Individuals from small towns (less than 50 000 inhabitants) were at significantly greater risk of smoking compared with those living in rural areas (OR, 1.45 and 1.64 in women and men, respectively). CONCLUSIONS: We found differences regarding socioeconomic characteristics and major biochemical parameters between smokers and nonsmokers in Poland. However, it is difficult to establish which associations are causal for cardiovascular risk owing to the cross­sectional design of this study.

Acute Ischemic Stroke Hospital Admissions, Treatment, and Outcomes in Poland in 2009-2013.

INTRODUCTION: Ischemic stroke (IS) still constitutes a serious problem for public health worldwide. The data on its burden in Poland before 2009 is limited and came only from a few metropolitan areas. THE AIMS OF THE STUDY WERE: To assess temporal trends in the hospital admissions, treatment, and outcomes of IS in Poland in 2009-2013, to identify risk factors for IS mortality and to compare the results with other countries. METHODS: The data from the Polish Stroke Registry were analyzed. The data concerned all subjects hospitalized due to IS (classified according to the ICD10 classification as I63.0-I63.9) as primary diagnosis in Poland in 2009-2013. Temporal trends in treatment and outcome were analyzed. Hospital admissions rates as well as case fatality and 12-month mortality rates were calculated. RESULTS: Altogether, 360,556 patients (47.5% of males) were hospitalized due to IS in Poland in 2009-2013. The median of age was 75 years, IQR 18 (Women 78, IQR 14 vs. Men 70, IQR 17; p < 0.001). The hospital admissions age-standardized annual rate for IS in Poland in 2013 was 8% lower than in 2009 (169 vs. 157/100,000; p for trend < 0.001). In-hospital case fatality has slightly decreased (from 13.6% in 2009 to 12.9% in 2013; p for trend < 0.001). One-year posthospital mortality rate has not changed (19.3% in 2009 and 2013). The percentage of IS subjects treated with intravenous thrombolysis was low but increased from 1.7% in 2009 to 6.3% in 2013 (p for trend <0.001). CONCLUSION: Since 2009, Poland has had national epidemiological data on the hospital admissions, treatment, and outcomes in IS. The data indicate a slow improvement of in-hospital survival and suggest the need for better stroke prevention and further dissemination of reperfusion therapy.

Consensus statement on a screening programme for the detection of early lung cancer in Poland.

INTRODUCTION: Lung cancer is the most common cancer in Poland and worldwide, and the leading cause of cancer-related deaths. Compared to the present day, the annual number of new cases of lung cancer will have increased by approximately 50%, by 2030. The overall ratio of mortality to incidence totals 0.87 and is among the highest. The five-year survival rate in Poland has recently achieved 13.4%. In 2015, lung cancer screening using low-dose computed tomography (LDCT) was introduced to routine clinical practice in the United States following the publication of the largest randomised study, The National Lung Screening Trial. The implementation of screening programmes in Poland and the rest of Europe also seems unavoidable. Due to the differences, both in the socioeconomic considerations and healthcare funding, compared to that in the United States, the current approach comes down to the awaited results of the European randomised study, NELSON. MATERIAL AND METHODS: During the meeting of an expert panel at the "Torakoneptunalia 2016" conference in Jastarnia, Poland, a decision was made to summarise and publish the current data on LDCT lung cancer screening in the form of recommendations, or a position statement. The document was prepared by a team composed of a radiologist, thoracic surgeons, pulmonologists, clinical oncologists, epidemiologists, internists, health prevention specialists and pathologists. It reflects the current body of knowledge about lung cancer, its diagnosis and treatment, and provides recommendations on early detection of lung cancer using LDCT. The recommendations address the screening procedure, the requirements for the teams conducting the screening, and the requirements for radiologists, pathologists and surgeons involved in the diagnosis and treatment of patients. RESULTS: While awaiting the results of the NELSON study and the European position statement on lung cancer screening methodology, the multidisciplinary group of experts presents their position, laying grounds for the development of an action plan for early detection of lung cancer in the upcoming future in Poland. CONCLUSIONS: Primary and secondary prophylaxis are the principal ways to reduce lung cancer mortality. While smoking cessation is a task of utmost importance, it must be accompanied by an effective screening programme if the outcome of the disease is to be improved.

[Evaluation of human resources management in selected health care organizations in Pomerania voivodeship as far as workers motivation is concerned]. / Ocena zarzadzania zasobami ludzkimi w zakresie motywacji pracowników w wybranych zakladach opieki zdrowotnej województwa Pomorskiego.

The success of management in any organization in market-oriented environment is impossible without the proper management of human resource. The statement is true also in health care, where the internal market was imposed as a result of reforms. W scanned 44 medical organization of few different types, i.e. hospitals, clinics, nurses homes etc. In most of the organization there were no financial motivational bonus (38% of health care organizations) or only the basic bonus (40%). The system of personnel activities evaluation does not exist in 58% of scanned hospitals and clinics, and in 20% of the evaluation was conducted only occasionally. The system of employees evaluation existed only in one of each five of studied units. To improve the quality of personnel management it is necessary to improve communication inside the organizations. Only one in three of scanned facilities was marked as good or very good.

[Health services provided for victims of traumas and accidents in the Gdansk metropolitan area]. / Swiadczenia medyczne udzielane ofiarom urazów i wypadków w aglomeracji Gdanskiej.

Traumas and accidents are one of three main treats of public health. There are many research works on the topic, but only some of them concentrate on the issue of organization of the services and cost of hospitalisation. In our research we have analysed individual patients' documentation in the clinic of traumatic surgery of the main regional hospital. We were searching for the reason of hospitalisations and delivered services during the stay in hospital ward. There are three main reason of hospitalisation: transportation accidents (25%), acts of violence (20% of the man and 7% of the women) and home accidents (7% of treated man and 28 of treated women). The background of diagnoses were classic radiograms. In addition to this ultrasonography was carried out in 16% of patients and computer topography in 12% of patients.

[Evaluation of the quality of primary health care in Sopot after privatization]. / Ocena jakosci swiadczen podstawowej opieki zdrowotnej w Sopocie po prywatyzacji.

One of the main aims of health system reform was to increase the quality of service and patients' satisfaction. The deepest changes were in the primary care sector. Besides the changes in financing the services, we can observe here the process of privatisation of primary care clinics. We have evaluated the quality of services of four private primary care clinics in the town of Sopot. We received 571 questionnaires from the patients. The average patient was 50 years old, finished high school and complained of mild health problems. Most of patients were satisfied of given services by physicians and nurses. In most categories they gave 85 to 95% good and very good marks for specific quality aspects. One of the main complains was information received, both in the registration board and from the physician. Most of patients were also delighted by medical outcome of treatment, because only 18% gave their mark as satisfactory and worse.

[Spatial differentiation in financing medical services under universal health insurance selected segments of services]. / Przestrzenne zróznicowanie finansowania swiadczen zdrowotnych w systemie powszechnego ubezpieczenia zdrowotnego. Wybrane segmenty uslug.

After the universal health insurance has been started in Poland, patients believed that access to the health care system financed by the sick fund could be improved. It is generally known that there is a kind of relationship between both the access to the health care system and quality of medical system, and amount of money to be paid for that. There are 17 separate and independent sick funds in Poland. In this work the authors try to find how sick funds spend their financial resources in selected segments of medical services. The strongest influence of sick fund is in the region where its headquarter is located. If each sick fund has different amount of money to spend for a single patient and the right to divide funds according to its policy, the authors expect regional differentiation in financing medical services (according to the district). The data used in the work came from Urzad Nadzoru nad Ubezpieczeniami Zdrowotnymi (UNUZ) and Glówny Urzad Statystyczny (GUS). As a result their is no doubt that public money from the medical insurance is regionally significantly differentiated and each sick fund, spending money resources, creates its own medical policy in the examined segments of services.

Prevalence and control of cardiovascular risk factors in Poland. Assumptions and objectives of the NATPOL 2011 Survey.

BACKGROUND: Cardiovascular diseases (CVD) have been the main cause of death in Poland for the last five decades. In 2010, CVD caused 46.0% of all deaths in Poland. An analysis performed using the IMPACT model, have shown that the reduction in mortality due to ischaemic heart disease, which took place in Poland, was primarily a result of lifestyle changes and of changes affecting risk factors in the population of adults. From the perspective of health policy planning it is very important to know the prevalence of CVD risk factors and to be aware of trends in the population. AIM: The NATPOL 2011 Survey was a cross-sectional observational study aimed to assess the prevalence and control of CVD risk factors in Poland. The aim of this paper is to describe the objectives and methodology of the NATPOL 2011 project. METHODS: The survey was designed as a representative observational study and was carried out on a representative sample of Polish residents aged 18-79 years. The planned size of the research sample was 2,400 subjects. Participants were randomly selected in bundles, in a stratified, proportional draw performed in three stages. The study was composed of a questionnaire interview, blood pressure and anthropometric measurements as well as a blood and urine sample collection. The examination consisted of two visits at subjects' homes and was performed by well-trained nurses. RESULTS AND CONCLUSIONS: Letters of invitation were sent to 4,420 potential participants. Of those, 786 persons could not be contacted because the addresses were wrong, the respondents resided at an address other than their registered place of residence or, in some cases, the respondents died prior to the survey. Among 3,634 addresses of the persons sampled for the study there were 661 (M: 328, F: 333) "closed doors" (the nurse was unable to contact the respondent during three consecutive attempts) and 560 (M: 295, F: 265) direct refusals. Finally, 2,413 subjects participated in the study and 2,401 of them completed all the procedures in the survey. The data mentioned above give the response rate of 66.4%.The structure of the study sample, including age groups and gender is almost identical to the structure of the adult population of Poland in 2010, according to the Central Statistical Office data. The sample reflected the structure of the adult population quite well, therefore the weights' adjustments calculated for epidemiological analyses were in range from 0.36 to 4.11.

[Prevention and health promotion programmes on websites of the Polish health insurance funds]. / Programy profilaktyki i promocji zdrowia prezentowane w serwisach internetowych kas chorych.

OBJECTIVE: The aim of our study was to evaluate the content and presentation of prevention and health promotion programmes on websites of the Polish health insurance funds. DESIGN: A systematic review of the content of official websites of all 17 national health insurance funds was done. RESULTS: Information on health care programmes was given on 12 websites, In four cases information can be described as sufficient and in only one case the programme was described in detail. Health insurance funds in Poland make extensive use of the Internet to communicate with contractual service providers. However, there is much to be done concerning communication with the patients.