RESUMO
Health spillovers arise when an individual's serious illness affects those close to them emotionally, psychologically, and/or physically. As a result, healthcare interventions that improve the lives of patients may also confer wider health benefits. However, contrary to widespread calls for health spillovers to be included in health economic evaluation, others have argued this could have adverse distributional consequences and equity implications. This paper presents a novel approach to spillover inclusion in health economic evaluation using a 'prioritarian transformation' of health gains that allows these equity concerns to be addressed. Affording greater weight to the incremental change in patient outcomes when incorporating carer/family health spillovers into resource allocation decisions, the method provides a feasible means of moderating the distributional impact of spillover inclusion. It also introduces a normative, theoretical perspective to a largely empirical extant literature and, as such, its axiomatic basis is examined. Finally, an illustrative example of the approach is presented to demonstrate its application.
Assuntos
Economia Médica , Alocação de Recursos , Humanos , Análise Custo-BenefícioRESUMO
OBJECTIVE: Despite the policy relevance of carer burden, limited research focuses on family carers' experience of carer burden among different disease groups. This study aimed to examine differences in carer burden among family carers of people with and without dementia. DESIGN: Secondary data analysis was conducted on a national cross-sectional dataset. Multivariable ordered logistic regression was used to analyze four levels of carer burden (low, mild, moderate, high). The main independent variable was dementia diagnosis, and controls included variables relating to the care recipient, family carer, and context of care. SETTING: The original survey was funded by Irish Health Service Executive and undertaken by the National Centre for the Protection of Older People in Ireland. PARTICIPANTS: The original dataset consisted of 2,311 family carers of older people in Ireland. Approximately, one-fifth of this sample had a diagnosis of dementia. MEASUREMENTS: Carer burden was measured using the standardized 22-item Zarit Burden Interview. Care-recipient dependency was measured using the Activities for Daily Living Scale. Sociodemographic details and information about the context of caring were collected using self-report scales. RESULTS: In our model, dementia diagnosis and dependency level were significantly associated with carer burden. Family carer and context of care variables including gender, marital status, education, residence, co-residence, and perceived support showed significant relationships with carer burden. Our results highlighted significant differences in carer burden distribution; in particular, family carers of people with dementia were less likely to report low or mild carer burden (-6.95 ppts and -3.64 ppts, respectively) and more likely to report moderate or high carer burden (8.46 ppts and 2.13 ppts, respectively). CONCLUSION: Our findings suggest that family carers of people with dementia may experience additional challenges associated with caring. Therefore, family carers of people with dementia may require tailored social supports to maintain good health and well-being.
Assuntos
Sobrecarga do Cuidador , Cuidadores/psicologia , Demência , Família/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Apoio SocialRESUMO
This report addresses the extent to which there may be scope for preventive programmes for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and, if so, what economic benefits may accrue from the implementation of such programmes. We consider the economic case for prevention programmes, whether there is scope for preventive programmes for ME/CFS, and what are the health and economic benefits to be derived from the implementation of such programmes. We conclude that there is little scope for primary prevention programmes, given that ME/CFS is attributable to a combination of host and environmental risk factors, with host factors appearing to be most prominent, and that there are few identified modifiable risk factors that could be the focus of such programmes. The exception is in the use of agricultural chemicals, particularly organophosphates, where there is scope for intervention, and where Europe-wide programmes of health education to encourage safe use would be beneficial. There is a need for more research on risk factors for ME/CFS to establish a basis for the development of primary prevention programmes, particularly in respect of occupational risk factors. Secondary prevention offers the greatest scope for intervention, to minimise diagnostic delays associated with prolonged illness, increased severity, and increased costs.
Assuntos
Síndrome de Fadiga Crônica , Europa (Continente) , Humanos , Fatores SocioeconômicosRESUMO
Background and Objectives: We have conducted a survey of academic and clinical experts who are participants in the European ME/CFS Research Network (EUROMENE) to elicit perceptions of general practitioner (GP) knowledge and understanding of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and suggestions as to how this could be improved. Materials and Methods: A questionnaire was sent to all national representatives and members of the EUROMENE Core Group and Management Committee. Survey responses were collated and then summarized based on the numbers and percentages of respondents selecting each response option, while weighted average responses were calculated for questions with numerical value response options. Free text responses were analysed using thematic analysis. Results: Overall there were 23 responses to the survey from participants across 19 different European countries, with a 95% country-level response rate. Serious concerns were expressed about GPs' knowledge and understanding of ME/CFS, and, it was felt, about 60% of patients with ME/CFS went undiagnosed as a result. The vast majority of GPs were perceived to lack confidence in either diagnosing or managing the condition. Disbelief, and misleading illness attributions, were perceived to be widespread, and the unavailability of specialist centres to which GPs could refer patients and seek advice and support was frequently commented upon. There was widespread support for more training on ME/CFS at both undergraduate and postgraduate levels. Conclusion: The results of this survey are consistent with the existing scientific literature. ME/CFS experts report that lack of knowledge and understanding of ME/CFS among GPs is a major cause of missed and delayed diagnoses, which renders problematic attempts to determine the incidence and prevalence of the disease, and to measure its economic impact. It also contributes to the burden of disease through mismanagement in its early stages.
Assuntos
Síndrome de Fadiga Crônica , Médicos de Atenção Primária , Europa (Continente) , Síndrome de Fadiga Crônica/epidemiologia , Humanos , Percepção , Inquéritos e QuestionáriosRESUMO
Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation in Science and Technology (COST)-COST action 15111-from 2016 to 2020. The main goal of the Cost Action was to assess the existing knowledge and experience on health care delivery for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in European countries, and to enhance coordinated research and health care provision in this field. We report our findings and make recommendations for clinical diagnosis, health services and care for people with ME/CFS in Europe, as prepared by the group of clinicians and researchers from 22 countries and 55 European health professionals and researchers, who have been informed by people with ME/CFS.
Assuntos
Síndrome de Fadiga Crônica , Consenso , Atenção à Saúde , Europa (Continente) , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/epidemiologia , Síndrome de Fadiga Crônica/terapia , HumanosRESUMO
BACKGROUND: Day care is an important service for many people with dementia and their carers. In Ireland, day care services for people with dementia are delivered by a mix of dementia-specific day care centres as well as generic day care centres that cater for people with dementia to various degrees. In this paper we examine the geographic distribution of day care services for people with dementia relative to potential need. METHODS: Using a national survey of day care centres, we estimate the current availability of day care services for people with dementia in the country. We use geographic information systems (GIS) to map day care provision at regional and sub-regional levels and compare this to the estimated number of people with dementia in local areas. RESULTS: There is significant variation across the country in the existing capacity of day care centres to cater for people with dementia. The number of places per 100 persons with dementia in the community varies from 14.2 to 21.3 across Community Health Organisation areas. We also show that 18% of people with dementia do not live within 15kms of their nearest day care centre. CONCLUSION: Currently, day care centres, in many parts of the country, have limited capacity to provide a service for people with dementia who live in their catchment area. As the number of people with dementia increases, investment in day care centres should be targeted to areas where need is greatest. Our GIS approach provides valuable evidence that can help inform decisions on future resource allocation and service provision in relation to day care.
Assuntos
Hospital Dia , Demência , Acessibilidade aos Serviços de Saúde , Área de Atuação Profissional , Área Programática de Saúde , Sistemas de Informação Geográfica , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Irlanda , Alocação de Recursos , Inquéritos e QuestionáriosRESUMO
Background and Objectives: The socioeconomic working group of the European myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) Research Network (EUROMENE) has conducted a review of the literature pertaining to GPs' knowledge and understanding of ME/CFS; Materials and Methods: A MEDLINE search was carried out. The papers identified were reviewed following the synthesis without meta-analysis (SWiM) methodology, and were classified according to the focus of the enquiry (patients, GPs, database and medical record studies, evaluation of a training programme, and overview papers), and whether they were quantitative or qualitative in nature; Results: Thirty-three papers were identified in the MEDLINE search. The quantitative surveys of GPs demonstrated that a third to a half of all GPs did not accept ME/CFS as a genuine clinical entity and, even when they did, they lacked confidence in diagnosing or managing it. It should be noted, though, that these papers were mostly from the United Kingdom. Patient surveys indicated that a similar proportion of patients was dissatisfied with the primary medical care they had received. These findings were consistent with the findings of the qualitative studies that were examined, and have changed little over several decades; Conclusions: Disbelief and lack of knowledge and understanding of ME/CFS among GPs is widespread, and the resultant diagnostic delays constitute a risk factor for severe and prolonged disease. Failure to diagnose ME/CFS renders problematic attempts to determine its prevalence, and hence its economic impact.
Assuntos
Síndrome de Fadiga Crônica , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/epidemiologia , Humanos , Atenção Primária à Saúde , Pesquisa Qualitativa , Fatores Socioeconômicos , Reino UnidoRESUMO
BACKGROUND: Haemolytic Uraemic Syndrome (HUS) is a serious complication of Shiga toxin-producing Escherichia coli (STEC) infection and the key reason why intensive health protection against STEC is required. However, although many potential risk factors have been identified, accurate estimation of risk of HUS from STEC remains challenging. Therefore, we aimed to develop a practical composite score to promptly estimate the risk of developing HUS from STEC. METHODS: This was a retrospective cohort study where data for all confirmed STEC infections in Ireland during 2013-15 were subjected to statistical analysis with respect to predicting HUS. Multivariable logistic regression was used to develop a composite risk score, segregating risk of HUS into 'very low risk' (0-0.4%), 'low risk' (0.5-0.9%), 'medium risk' (1.0-4.4%), 'high risk' (4.5-9.9%) and 'very high risk' (10.0% and over). RESULTS: There were 1397 STEC notifications with complete information regarding HUS, of whom 5.1% developed HUS. Young age, vomiting, bloody diarrhoea, Shiga toxin 2, infection during April to November, and infection in Eastern and North-Eastern regions of Ireland, were all statistically significant independent predictors of HUS. Demonstration of a risk gradient provided internal validity to the risk score: 0.2% in the cohort with 'very low risk' (1/430), 1.1% with 'low risk' (2/182), 2.3% with 'medium risk' (8/345), 3.1% with 'high risk' (3/98) and 22.2% with 'very high risk' (43/194) scores, respectively, developed HUS. CONCLUSION: We have developed a composite risk score which may be of practical value, once externally validated, in prompt estimation of risk of HUS from STEC infection.
Assuntos
Infecções por Escherichia coli/complicações , Síndrome Hemolítico-Urêmica/etiologia , Escherichia coli Shiga Toxigênica , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Feminino , Síndrome Hemolítico-Urêmica/epidemiologia , Humanos , Lactente , Recém-Nascido , Irlanda/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estações do Ano , Adulto JovemRESUMO
BACKGROUND: Maternal recognition of overweight/obesity during early childhood is a key determinant in achieving healthy weight status in children. The aim of this study is to 1) investigate maternal perceptions of their child weight, focusing on whether or not mothers accurately identify if their child is overweight or obese at three years old and five years old; 2) identify the factors influencing maternal misperceptions regarding their child's weight at three years old and five years old, 3) ascertain if a failure to recognize overweight/obesity at three years old is associated with the likelihood of doing so at five years old. METHODS: Using two waves of the longitudinal Growing Up in Ireland study data regarding child, maternal, and household characteristics as well as healthcare access and utilization variables were obtained for mothers when their children are three and five years old respectively. Multivariate logistic analysis was used to examine the factors associated with mothers inaccurately perceiving their child to be of normal weight status when the child is in fact either clinically overweight or obese. RESULTS: In wave 2, 22% of mothers failed to accurately identify their child to be overweight or obese. This inaccuracy decreased to 18% in wave 3. A failure of mothers to identify their child's overweight/obesity was more likely to occur if the child was a girl (OR: 1.25) (OR: 1.37), had a higher birth weight (OR:1.00), if the mother was obese (OR: 1.50), (OR: 1.72) or working (OR:1.25) (OR:1.16) in wave 2 and wave 3, respectively. Other factors affecting the odds of misperceiving child's weight include gestation age, income and urban living. CONCLUSION: These findings suggest that mothers of overweight or obese three and five year olds show poor awareness of their child's weight status. Both child and mother characteristics play a role in influencing this awareness. Mothers unable to accurately identify their child's overweight or obesity status at three years old are likely to do again when the child is five years old. This study highlights the need for increased support to help improve mothers' understanding of healthy body size in preschool aged children.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Mães , Obesidade Infantil/diagnóstico , Adulto , Índice de Massa Corporal , Pré-Escolar , Estudos de Coortes , Feminino , Nível de Saúde , Humanos , Irlanda , Estudos Longitudinais , Masculino , Sobrepeso/diagnósticoRESUMO
BACKGROUND: Internationally, the majority of out-of-hospital cardiac arrests where resuscitation is attempted (OHCAs) occur in private residential locations i.e. at home. The prospect of survival for this patient group is universally dismal. Understanding of the area-level factors that affect the incidence of OHCA at home may help national health planners when implementing community resuscitation training and services. METHODS: We performed spatial smoothing using Bayesian conditional autoregression on case data from the Irish OHCA register. We further corrected for correlated findings using area level variables extracted and constructed for national census data. RESULTS: We found that increasing deprivation was associated with increased case incidence. The methodology used also enabled us to identify specific areas with higher than expected case incidence. CONCLUSIONS: Our study demonstrates novel use of Bayesian conditional autoregression in quantifying area level risk of a health event with high mortality across an entire country with a diverse settlement pattern. It adds to the evidence that the likelihood of OHCA resuscitation events is associated with greater deprivation and suggests that area deprivation should be considered when planning resuscitation services. Finally, our study demonstrates the utility of Bayesian conditional autoregression as a methodological approach that could be applied in any country using registry data and area level census data.
Assuntos
Serviços Médicos de Emergência/métodos , Mapeamento Geográfico , Acessibilidade aos Serviços de Saúde , Vida Independente , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Teorema de Bayes , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Vida Independente/estatística & dados numéricos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/diagnóstico , Fatores de RiscoRESUMO
This paper, for the first time, presents estimates of the causal impact of overweight and obesity on self-rated health (SRH) using instrumental variables (IV) econometric methods. While a number of previous studies have sought to better understand the determinants of SRH, there is no consensus in relation to the impact of overweight and obesity. Using data from a large nationally representative sample of Irish parents and their children, we estimate a range of ordered probit models to isolate the causal effect of overweight and obesity on SRH. Our data includes independently and objectively recorded weight and height measures for parents and their children and we instrument for parental body mass index (BMI) status using the BMI of a biological child. After controlling for a range of individual, socioeconomic, health and lifestyle related variables, we find that being overweight has a negligible impact on SRH, while being obese has a practically and statistically significant negative impact on SRH, with these effects most pronounced for those who are most obese. We find only minor differences in these effects across gender. Copyright © 2015 John Wiley & Sons, Ltd.
Assuntos
Autoavaliação Diagnóstica , Modelos Estatísticos , Obesidade/epidemiologia , Obesidade/psicologia , Adulto , Índice de Massa Corporal , Criança , Feminino , Humanos , Irlanda , Estilo de Vida , Masculino , Inquéritos e QuestionáriosRESUMO
BACKGROUND: National data collection provides information on out-of-hospital cardiac arrest (OHCA) incidence, management and outcomes that may not be generalisable from smaller studies. This retrospective cohort study describes the first 2â years' results from the Irish National Out-of-Hospital Cardiac Arrest Register (OHCAR). METHODS: Data on OHCAs attended by emergency medical services (EMS) where resuscitation was attempted (EMS-treated) were collected from ambulance services and entered onto OHCAR. Descriptive analysis of the study population was performed, and regression analysis was performed on the subgroup of adult patients with a bystander-witnessed event of presumed cardiac aetiology and an initial shockable rhythm (Utstein group). RESULTS: 3701 EMS-treated OHCAs were recorded for the study period (1 January 2012-31 December 2013). Incidence was 39/100â 000 population/year. In the Utstein group (n=577), compared with the overall group, there was a higher proportion of male patients, public event location, bystander cardiopulmonary resuscitation (CPR) and early defibrillation. Median EMS call-response interval was similar in both groups. A higher proportion of patients in the Utstein group achieved return of spontaneous circulation (35% vs 17%) and survival to hospital discharge (22% vs 6%). After multivariate adjustment for the Utstein group, the following variables were found to be independent predictors of the outcome survival to hospital discharge: public event location (OR 3.1 (95% CI 1.9 to 5.0)); bystander CPR (2.4 (95% CI 1.2 to 4.9)); EMS response of 8â min or less (2.2 (95% CI 1.3 to 3.6)). CONCLUSIONS: This study highlights the role of nationwide registries in quantifying, monitoring and benchmarking OHCA incidence and outcome, providing baseline data upon which service improvement effects can be measured.
Assuntos
Reanimação Cardiopulmonar/normas , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/mortalidade , Avaliação de Resultados da Assistência ao Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/estatística & dados numéricos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Incidência , Lactente , Irlanda , Masculino , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Análise de Regressão , Estudos Retrospectivos , Análise de SobrevidaRESUMO
BACKGROUND: There has been an increasing interest in the relationship between severity of disease and costs in the care of people with dementia. Much of the current evidence is based on cross-sectional data, suggesting the need to examine trends over time for this important and growing cohort of the population. METHODS: This paper estimates resource use and costs of care based on longitudinal data for 72 people with dementia in Ireland. Data were collected from the Enhancing Care in Alzheimer's Disease (ECAD) study at two time points: baseline and follow-up, two years later. Patients' dependence on others was measured using the Dependence Scale (DS), while patient function was measured using the Disability Assessment for Dementia (DAD) scale. Univariate and multivariate analysis were used to explore the effects of a range of variables on formal and informal care costs. RESULTS: Total costs of formal and informal care over six months rose from 9,266 (Standard Deviation (SD): 12,947) per patient at baseline to 21,266 (SD: 26,883) at follow-up, two years later. This constituted a statistically significant (p = 0.0014) increase in costs over time, driven primarily by an increase in estimated informal care costs. In the multivariate analysis, a one-point increase in the DS score, that is a one-unit increase in patient's dependence on others, was associated with a 19% increase in total costs (p = 0.0610). CONCLUSIONS: Higher levels of dependence in people with Alzheimer's disease are significantly associated with increased costs of informal care as the disease progresses. Formal care services did not respond to increased dependence in people with dementia, leaving it to families to fill the caring gap, mainly through increased supervision with the progress of disease.
Assuntos
Doença de Alzheimer/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Idoso , Feminino , Humanos , Irlanda , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Early intervention in psychosis is an accepted policy internationally. When 'A Vision for Change', the national blueprint for mental health policy in Ireland, was published in 2007 there was one Irish pilot service for early intervention in psychosis. The National Clinical Mental Health Programme Plan (2011) identified early intervention in psychosis as one of three areas for roll out nationally. There is limited economic evaluation in the field of mental health in Ireland to guide service development. This is in part due to lack of robust patient level data. AIMS OF THE STUDY: The aim of the study was to investigate whether the introduction of an early intervention service in psychosis resulted in any change to the number and duration of admissions in people with first-episode psychosis. METHODS: We examined two prospective epidemiological cohorts of individuals presenting with first-episode psychosis to an urban community mental health service (population 172,000). The historical cohort comprised of individuals presenting from 1995 to 1998 and received treatment as usual (n=132). The early intervention cohort presented to the same catchment area between 2008 and 2011 (n=97) following the introduction of an early intervention service in 2005. RESULTS: We found significant reductions in the rates admitted for treatment across the two time periods. Reduction in the rate of admission was larger in this catchment than the reduction in the rate of admission in the country as a whole. There were significant reductions in the duration of untreated psychosis arising from the early intervention programme. Significant reductions in length of stay were accounted for by differences in baseline age and marital status. The average cost of admission declined from 15,821 to 9,398 in the early intervention cohort. DISCUSSION AND LIMITATIONS: The comparison pre and post early intervention service showed cost savings consistent with other studies internationally. Key issues are whether changes in the admission pattern were due to the implementation of early intervention or were explained by other factors. Examination of local and national factors showed that the dominant effect was from the implementation of early intervention. Limitations are that this is a comparison with a historical cohort and analysis is limited to in-patient costs only. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: While there are cost savings, these represent opportunity cost savings, as the majority of costs associated with in-patient care are fixed. Studies such as this provide evidence that it is feasible to consider disinvestment strategies such as home care in the community. IMPLICATIONS FOR HEALTH POLICIES: It is difficult to generalize interventions shown to work in one country to other countries, as health service structures differ and there are both local and national variations in service structure and delivery. It remains important to evaluate whether a policy is applicable within its local context. IMPLICATIONS FOR FURTHER RESEARCH: Further research in this area is required to evaluate contemporaneous services and to examine whether increased costs in the community incurred through implementation of early intervention negate the savings made through reduction of admissions.
Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Transtornos Psicóticos/economia , Transtornos Psicóticos/terapia , Adulto , Estudos de Coortes , Serviços Comunitários de Saúde Mental/economia , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento , População Urbana/estatística & dados numéricosRESUMO
BACKGROUND: Omission of family and caregiver health spillovers from the economic evaluation of healthcare interventions remains common practice. When reported, a high degree of methodological inconsistency in incorporating spillovers has been observed. AIM: To promote emerging good practice, this paper from the Spillovers in Health Economic Evaluation and Research (SHEER) task force aims to provide guidance on the incorporation of family and caregiver health spillovers in cost-effectiveness and cost-utility analysis. SHEER also seeks to inform the basis for a spillover research agenda and future practice. METHODS: A modified nominal group technique was used to reach consensus on a set of recommendations, representative of the views of participating subject-matter experts. Through the structured discussions of the group, as well as on the basis of evidence identified during a review process, recommendations were proposed and voted upon, with voting being held over two rounds. RESULTS: This report describes 11 consensus recommendations for emerging good practice. SHEER advocates for the incorporation of health spillovers into analyses conducted from a healthcare/health payer perspective, and more generally inclusive perspectives such as a societal perspective. Where possible, spillovers related to displaced/foregone activities should be considered, as should the distributional consequences of inclusion. Time horizons ought to be sufficient to capture all relevant impacts. Currently, the collection of primary spillover data is preferred and clear justification should be provided when using secondary data. Transparency and consistency when reporting on the incorporation of health spillovers are crucial. In addition, given that the evidence base relating to health spillovers remains limited and requires much development, 12 avenues for future research are proposed. CONCLUSIONS: Consideration of health spillovers in economic evaluations has been called for by researchers and policymakers alike. Accordingly, it is hoped that the consensus recommendations of SHEER will motivate more widespread incorporation of health spillovers into analyses. The developing nature of spillover research necessitates that this guidance be viewed as an initial roadmap, rather than a strict checklist. Moreover, there is a need for balance between consistency in approach, where valuable in a decision making context, and variation in application, to reflect differing decision maker perspectives and to support innovation.
Assuntos
Cuidadores , Economia Médica , Humanos , Análise Custo-Benefício , Comitês Consultivos , Atenção à SaúdeRESUMO
Population-based breast screening programmes aim to improve clinical outcomes, alleviate health inequalities, and reduce healthcare costs. However, while screening can bring about immediate changes in mode of presentation and stage at diagnosis of breast cancer cases, the benefits and harms of these programmes can only be observed at a population level, and only over a long enough timeframe for the cascade of events triggered by screening to culminate in disease-specific mortality reductions. In this paper we exploit a natural experiment resulting from the phased geographic rollout of a national mammography screening programme to examine the impact of screening on breast cancer outcomes from both a patient cohort and a population perspective. Using data on 33,722 breast cancer cases over the period 1994-2011, we employ a difference-in-differences research design using ten-year follow-up data for cases diagnosed before and after the introduction of the programme in screened and unscreened regions. We conclude that although the programme produced the intended intermediate effects on breast cancer presentation and incidence, these failed to translate into significant decreases in overall population-level mortality, though screening may have helped to reduce socioeconomic disparities in late stage breast cancer incidence.
Assuntos
Neoplasias da Mama , Saúde Pública , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Mamografia , Programas de RastreamentoRESUMO
Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Without appropriate early resuscitation interventions, the prospect of survival is limited. This means that an effective community response is a critical enabler of increasing the number of people who survive. However, while OHCA incidence is higher in more deprived areas, propensity to volunteer is, in general, associated with higher socioeconomic status. In this context, we consider whether there are socioeconomic disparities in geographic accessibility to volunteer community first responders (CFRs) in Ireland, where CFR groups have developed organically and communities self-select to participate. We use geographic information systems and propensity score matching to generate a set of control areas with which to compare established CFR catchment areas. Differences between CFRs and controls in terms of the distribution of catchment deprivation and social fragmentation scores are assessed using two-sided Kolmogorov-Smirnov tests. Overall we find that while CFR schemes are centred in more deprived and socially fragmented areas, beyond a catchment of 4 min there is no evidence of differences in area-level deprivation or social fragmentation. Our findings show that self-selection as a model of CFR recruitment does not lead to more deprived areas being disadvantaged in terms of access to CFR schemes. This means that community-led health interventions can develop to the benefit of community members across the socioeconomic spectrum and may be relevant for other countries and jurisdictions looking to support similar models within communities.
RESUMO
People are interconnected and ill-health is rarely experienced in isolation. However, while there has been extensive research on health spillovers related to informal caregiving, there is comparatively little evidence on how ill-health may impact upon non-caregiving family members. This paper analyses EQ-5D-5L normative data from a nationally representative sample of adult residents of Ireland to estimate the independent relationship between serious family illness and five distinct dimensions of health. The empirical strategy combines inverse probability weighting and multivariate ordered probit regression in a doubly robust estimation. We find that experience of serious family illness is associated with large mental health decrements that are independent of caring responsibilities, while similar results are not evident for the four other health dimensions. Furthermore, stratified sub-sample analyses indicate considerable heterogeneity by sex and by income. In particular, we find evidence consistent with larger mental health spillovers for females than for males, as well as for low- and medium-income households relative to high-income households. The latter suggests that such spillovers may be substantially worse for those with fewer resources. Overall, the findings have a range of potential implications, including for the provision of mental health supports and services, for equity of health outcomes, as well as for health economic evaluation. For example, we calculate that our estimates of health spillovers are consistent with a 1.3% reduction in health utility for non-caregiving family members.
Assuntos
Saúde Mental , Adulto , Análise Custo-Benefício , Feminino , Humanos , Irlanda/epidemiologia , Masculino , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
The COVID-19 pandemic forced many higher education institutions (HEIs) across the world to cancel face-to-face teaching, close campus facilities, and displace staff and students to work and learn from home. Given the persistent nature of the pandemic, many HEIs have continued to deliver courses online and/or use a blended learning approach. However, there are concerns around differences in student access to digital learning resources while at home, including high quality broadband connectivity. This is important, since variation in connectivity may impact the type of online/blended model that faculty can deliver or constrain student engagement with online content. In this context, this paper combines national data on the domiciles of students enrolled in Irish HEIs with detailed spatial data on broadband coverage to estimate the number of higher education students 'at risk' of poor access to high quality internet connectivity. Overall it finds that one-in-six students come from areas with poor broadband coverage, with large disparities by geography and by HEI. It also finds that students from the poorest broadband coverage areas are more likely to be socioeconomically disadvantaged. As a result, this paper recommends that HEIs use their detailed registration data to help identify and support at-risk students. In particular, the results suggest that some HEIs may need to prioritise access to campus facilities and services to less well-off students living in poor broadband coverage areas. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s41239-021-00262-1.
RESUMO
There has been a notable increase in the use of statins in people without cardiovascular disease but who may be at risk in the future. The majority of statin users now fall into this category but little research has focused exclusively on this group. Debate has ensued regarding medicating asymptomatic people, and processes described variously as medicalisation, biomedicalisation and pharmaceuticalisation are used to explain how this happens. These overlapping and interrelated processes require issues to be 'problemised' as medical problems requiring medical solutions given the prevailing understandings of health, risk and disease. However, current understandings of risk and disease are not simply the result of technological and scientific advances, they are also socially constructed. We interviewed members of the public, GPs and others, and found that rather than high cholesterol being seen as one of several risk factors that contributes to heart disease, it tended to be promoted simplistically to the status of a disease needing treatment of itself. Statins were justified by those taking them as different to 'unnecessary medicines'. However, some participants demonstrated resistance to statins, worried about over-medicalisation and deviated from accepted practices, indicating a complex 'muddling through' in the face of uncertainty.