Stratification of chronic and complex wounds according to healing characteristics: a retrospective study.

OBJECTIVE: Wound risk-stratified analyses are clinically relevant as they can assist in identifying hard-to-heal wounds. The aim of the study is to develop risk categories for wound healing based on a limited number of reliably recordable clinical data. METHOD: This retrospective study used observational data. The primary outcome measure was wound healing at the end of treatment and the secondary outcome measure was the time to wound healing. A stratification model using regression analyses was developed to assign the patients to risk categories for wound healing and the time-to-heal. RESULTS: The study cohort comprised of 540 patients. The most common wound diagnoses were diabetic ulcers, wounds in irradiated areas and wound dehiscence after surgery. Average wound duration before starting treatment at the wound centre was 11.7 months. Healing was achieved in 382 (71%) wounds, after an average treatment time of 4.4 months. A total of four risk categories for wound healing were developed by combining wound diagnosis (favourable versus unfavourable) and duration (<3 months versus >3 months). These risk categories demonstrated healing percentages ranging from 69-97% (p=0.0004) and mean time-to-healing varying from 2.7-5.9 months (p=0.01). CONCLUSION: Using two clinical wound variables, diagnosis and duration, stratification categories were identified with significant associations with wound healing outcomes. Longer wound duration and unfavourable diagnoses, when combined into unfavourable risk categories, were associated with a lower percentage of wound healing and a longer treatment time until healing.

Healthcare utilization and costs of multiple sclerosis patients in the Netherlands: a healthcare claims database study.

AIM: To investigate the incidence and prevalence and healthcare costs of multiple sclerosis (MS) in the Netherlands by using healthcare claims data. MATERIALS & METHODS: A claims database was analyzed including 26% of the Dutch population. RESULTS: Average prevalence of MS in the Netherlands was 88 per 100,000 inhabitants (males 48, 127 females) and incidence nine per 100,000. Yearly per patient medication costs were highest in the year after the first MS claim and then decreased. Hospital costs were 30% higher in the first year of MS claims than after 3 years of MS claims. The patients often used co-medication, such as antidepressants and antibiotics. CONCLUSION: Dutch incidence and cost estimates based on claims were consistent with previous estimates. Prevalence estimates were somewhat higher. Drug and hospital costs were highest shortly after the diagnosis. Healthcare consumption related to comorbidities was in-line with the previously reported comorbidity estimates.

Observational evidence that urbanisation and neighbourhood deprivation are associated with escalation in chronic pharmacological pain treatment: a longitudinal population-based study in the Netherlands.

OBJECTIVE: To examine, in the light of the association between urban environment and poor mental health, whether urbanisation and neighbourhood deprivation are associated with analgesic escalation in chronic pharmacological pain treatment and whether escalation is associated with prescriptions of psychotropic medication. DESIGN: Longitudinal analysis of a population-based routine dispensing database in the Netherlands. SETTING: Representative sample of pharmacies, covering 73% of the Dutch nationwide medication consumption in the primary care and hospital outpatient settings. PARTICIPANTS: 449 410 patients aged 15-85 years were included, of whom 166 374 were in the Starter group and 283 036 in the Continuation group of chronic analgesic treatment. MAIN OUTCOME MEASURE: Escalation of analgesics (ie, change to a higher level of analgesic potency, classified across five levels) in association with urbanisation (five levels) and dichotomous neighbourhood deprivation was analysed over a 6-month observation period. METHODS: Ordered logistic multivariate model evaluating analgesic treatment. RESULTS: In both Starter and Continuation groups, escalation was positively associated with urbanisation in a dose-response fashion (Starter group: OR (urbanisation level 1 compared with level 5): 1.24, 95% CI 1.18 to 1.30; Continuation group: OR 1.18, 95% CI 1.14 to 1.23). An additional association was apparent with neighbourhood deprivation (Starter group: OR 1.07, 95% CI 1.02 to 1.11; Continuation group: OR 1.04, 95% CI 1.01 to 1.08). Use of somatic and particularly psychotropic co-medication was associated with escalation in both groups. CONCLUSIONS: Escalation of chronic analgesic treatment is associated with urban and deprived environments and occurs in a context of adding psychotropic medication prescriptions. These findings suggest that pain outcomes and mental health outcomes share factors that increase risk and remedy suffering.