RESUMO
Anti-coagulated patients are monitored at regular intervals to ensure that their warfarin dosage is appropriate for their target International Normalized Ratio. The traditional setting for this monitoring has been the hospital clinic. Technological advances allow-- and with growing numbers of anti-coagulated patients, are leading to-- greater provision of monitoring clinics outside the hospital, at a more convenient location nearer patients' homes. This paper discusses the differences in organization between a hospital clinic and one set in the community (although provided by the hospital), and compares their costs. The comparison demonstrates the greater average cost per appointment in outreach of pound sterling 13.12 under current arrangements. Estimates are presented of incremental cost per appointment of pound sterling 3.93 and pound sterling 15.88 for a 10% increase in weekly patient numbers put through hospital and outreach clinics, respectively. Cost estimates are also presented for suggested alterations to hospital clinics that may reduce patient inconvenience, and the conditions under which outreach provision might be expanded at comparable cost to hospital provision are also examined.
Assuntos
Monitoramento de Medicamentos/economia , Varfarina/sangue , Varfarina/economia , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/sangue , Anticoagulantes/economia , Serviços de Saúde Comunitária/economia , Relações Comunidade-Instituição/economia , Custos e Análise de Custo , Monitoramento de Medicamentos/métodos , Inglaterra , Feminino , Hospitalização/economia , Humanos , Coeficiente Internacional Normatizado/economia , Coeficiente Internacional Normatizado/normas , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Inquéritos e Questionários , Fatores de Tempo , Viagem/economia , Varfarina/administração & dosagemRESUMO
The increased incidence of violence in our society has led to a concern for personal safety. For self-protection, many individuals are turning to personal aerosol protection devices (PAPDs), which are readily accessible to the general public. The greater use and misuse of these noxious chemicals has led to an increase in injuries associated with exposure. Health care providers need to be aware of the modes of action of PAPDs, the presenting exposure symptoms, first aid measures, and decontamination procedures of the environment and the victim's belongings. This article provides a thorough discussion of PAPDs and will assist the clinician in delivering primary care and health education to victims of PAPD exposures.