The cost of oropharyngeal cancer in England: A retrospective hospital data analysis.

OBJECTIVES: To estimate the total costs of treating head and neck cancers, specifically oropharyngeal, laryngeal and oral cavity cancer, in secondary care facilities in England during the period 2006/2007 to 2010/2011. DESIGN: Patient records were extracted from an English hospital database to estimate the number of patients treated for oropharyngeal, laryngeal and oral cavity cancer in England. Identified resource use was linked to published United Kingdom cost estimates to quantify the reimbursement of treatment through the Payment by Results system. SETTING: Retrospective hospital data analysis. PARTICIPANTS: From the hospital data, patient records of patients treated for oropharyngeal, laryngeal and oral cavity cancer were selected. MAIN OUTCOME MEASURES: Annual total costs of treatment, stratified by inpatient and outpatient setting and by male and female patients. RESULTS: From 2006/2007 to 2010/2011, total costs of treatment across the three head and neck cancer sites were estimated to be approximately £309 million, with 90% attributable to inpatient care (bundled costs). Oropharyngeal cancer accounted for 37% of total costs. Costs and patient numbers increased over time, largely due to a rise in oropharyngeal cancer, where total costs increased from £17.21 million to £30.32 million, with over 1400 (52%) more inpatients treated in 2010/11 compared to 2006/07. CONCLUSIONS: In 4 years, the number of patients with oropharyngeal cancer receiving some form of inpatient care increased by more than half, and associated costs increased by three quarters. This reinforces the case for prevention and early detection strategies to help contain this epidemiological and economic burden.

Re-thinking risk communication: information needs of patients, health professionals and the public regarding MRSA--the communicative behaviour of a public health network in Germany responding to the demand for information.

OBJECTIVES: Multidrug resistant organisms (MDRO), including Meticillin-resistant Staphylococcus aureus (MRSA), and health care associated infections (HCAIs) are pressing issues for health care systems across the world. Information and communication are considered key tools for the prevention and management of infectious diseases. Public Health Authorities (PHA) are in a unique position to communicate with health care professionals, patients and the public regarding the health risks. STUDY DESIGN: We used PHA helpdesk interaction data to first ascertain the information requirements of those getting in contact with the service, and secondly to examine the communicative behaviour of the PHA, with a view to improving the quality of communication strategies. METHODS: Data on helpdesk interactions between 2010 and 2012 were obtained from a MDRO network of nine German PHAs. 501 recordings were coded and descriptive statistics generated for further qualitative thematic analysis. RESULTS: Our analysis revealed a similar pattern of questions among different groups. Key areas of need for information were around eradication, cleaning and isolation measures. Reported problems were a lack of expert knowledge and continuity of treatment. The helpdesk response was mainly a conversation offering scientific advice, but also included other communication services that went beyond the provision of scientific facts, such as follow-up calls, referral suggestions and consultations on behalf of the caller. These social communication activities seem to have an important impact on the acceptability of public health recommendations and use of the helpdesk. CONCLUSIONS: Our findings support a broader discussion about the role of information in the communication process and underline the importance of social elements in the communication process, such as relationship and trust building.

Do local enhanced services in primary care improve outcomes? Results from a literature review.

OBJECTIVE: This paper aims to examine the role of local enhanced services (LES) as a financial incentive in improving clinical and process outcomes in primary care with a view to discussing their future in light of the Health and Social Care Act. METHODS: A literature review was conducted to identify LES commissioned in the UK in any disease area and to evaluate common themes relating to their impact on outcomes. The literature review consisted of two stages: an initial reference database search (MEDLINE, MEDLINE IN-PROCESS and EMBASE) and a more general internet search. The internet search used free text augmented by a targeted search of key health organisations' websites. Data were extracted from the LES to provide information on the background and context of the LES before going on to describe the incentive structure, health and economic outcomes and limitations of the LES. RESULTS: Although a number of LES were identified in the online search, only 14 reported any data on outcomes. These LES programmes related to 10 different disease areas, with cancer, alcohol dependence and chronic obstructive pulmonary disease (COPD) being the most common health needs. Three common factors between the selected LES emerged that appear to influence the extent of the impact on local health or economic outcomes: (1) a national framework supporting the LES, (2) existing service provision, and (3) the size of the financial incentives. CONCLUSION: The common themes emerging from the literature review suggest that, following the Health and Social Care Act 2012 and newly established national standards, given sufficient attention to planning service specifications, LES could continue to be important in reducing health inequalities and preparing poorly performing general practices for longer term changes directed at improving outcomes and standards in healthcare.