RESUMO
The Salisbury Pressure Ulcer Outreach Service successfully treats patients with chronic pressure ulcers that have not healed during routine community treatment. These patients have grade 4 pressure ulcers, involving extensive destruction, or damage to muscle and bone. A combination of scientific, seating and tissue viability expertise with a holistic approach results in non-surgical healing for 70% of patients. For those who still require surgery, outcomes are more successful with this approach, resulting in low recurrence rates. Prior to creation of the outreach service, patients were referred directly for surgical closure, resulting in high recurrence levels and long waiting lists. The authors compared costs of the Pressure Ulcer Outreach Service with the previous system of surgical closure. The model base case found that the Pressure Ulcer Outreach Service saved £8588 per patient, and that cost savings could be even greater if the outreach service was extended into preventative work.
Assuntos
Serviços de Saúde Comunitária/organização & administração , Úlcera por Pressão/enfermagem , Higiene da Pele/economia , Higiene da Pele/normas , Doença Crônica , Redução de Custos , Análise Custo-Benefício , Inglaterra , Saúde Holística , Humanos , Úlcera por Pressão/cirurgia , Listas de EsperaRESUMO
INTRODUCTION: Pressure ulcer management represents a growing problem for medical and social health care systems all over the world, particularly in European Union countries where the incidence of pressure ulcers in older persons (> 60 years of age) is predicted to rise. OBJECTIVES: The aim of this study was to provide evidence for the lower impact on economic resources of using advanced dressings for the treatment of pressure ulcers with respect to conventional simple dressings. METHODS: Two different models of analysis, derived from Activity Based Costing and Health Technology Assessment, were used to measure, over a 30-day period, the direct costs incurred by pressure ulcer treatment for community-residing patients receiving integrated home care. RESULTS: Although the mean cost per home care visit was higher in the advanced dressings patient group than in the simple dressings patient one (E 22.31 versus E 16.03), analysis of the data revealed that the cost of using advanced dressings was lower due to fewer home care visits (22 versus 11). CONCLUSION: The results underline the fact that decision-makers need to improve their understanding of the advantages of taking a long-term view with regards to the purchase and use of materials. This could produce considerable savings of resources in addition to improving treatment efficacy for the benefit of patients and the health care system.
Assuntos
Visita Domiciliar/economia , Úlcera por Pressão/economia , Úlcera por Pressão/terapia , Atenção Primária à Saúde/economia , Adulto , Idoso , Bandagens/economia , Custos e Análise de Custo , Desbridamento/economia , Gerenciamento Clínico , União Europeia , Feminino , Visita Domiciliar/estatística & dados numéricos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Úlcera por Pressão/epidemiologia , Estudos Prospectivos , Higiene da Pele/economia , Resultado do TratamentoRESUMO
BACKGROUND: Pressure ulcers are common in many care settings, with adverse health outcomes and high treatment costs. We evaluated the cost-effectiveness of evidence-based strategies to improve current prevention practice in long-term care facilities. METHODS: We used a validated Markov model to compare current prevention practice with the following 4 quality improvement strategies: (1) pressure redistribution mattresses for all residents, (2) oral nutritional supplements for high-risk residents with recent weight loss, (3) skin emollients for high-risk residents with dry skin, and (4) foam cleansing for high-risk residents requiring incontinence care. Primary outcomes included lifetime risk of stage 2 to 4 pressure ulcers, quality-adjusted life-years (QALYs), and lifetime costs, calculated according to a single health care payer's perspective and expressed in 2009 Canadian dollars (Can$1 = US$0.84). RESULTS: Strategies cost on average $11.66 per resident per week. They reduced lifetime risk; the associated number needed to treat was 45 (strategy 1), 63 (strategy 4), 158 (strategy 3), and 333 (strategy 2). Strategy 1 and 4 minimally improved QALYs and reduced the mean lifetime cost by $115 and $179 per resident, respectively. The cost per QALY gained was approximately $78 000 for strategy 3 and $7.8 million for strategy 2. If decision makers are willing to pay up to $50 000 for 1 QALY gained, the probability that improving prevention is cost-effective is 94% (strategy 4), 82% (strategy 1), 43% (strategy 3), and 1% (strategy 2). CONCLUSIONS: The clinical and economic evidence supports pressure redistribution mattresses for all long-term care residents. Improving prevention with perineal foam cleansers and dry skin emollients appears to be cost-effective, but firm conclusions are limited by the available clinical evidence.
Assuntos
Leitos , Análise Custo-Benefício , Assistência de Longa Duração , Terapia Nutricional , Úlcera por Pressão , Higiene da Pele , Idoso , Idoso de 80 Anos ou mais , Leitos/economia , Leitos/normas , Canadá , Feminino , Custos de Cuidados de Saúde , Humanos , Imobilização/efeitos adversos , Assistência de Longa Duração/economia , Assistência de Longa Duração/métodos , Masculino , Terapia Nutricional/economia , Terapia Nutricional/normas , Úlcera por Pressão/economia , Úlcera por Pressão/etiologia , Úlcera por Pressão/prevenção & controle , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Índice de Gravidade de Doença , Higiene da Pele/economia , Higiene da Pele/normasRESUMO
PURPOSE: A decision model was developed in a pilot study comparing a regimen using a skin care product line containing active ingredients and nutrients with a commercially available alternative skin care regimen in an elderly convalescent care hospital-based center. METHODS: Using a decision-tree model, skin treatment with a nutrient-based skin care (NBSC) formulation was compared with products without nutrients. The number of skin-tear-free days was the primary outcome measure. A cost-effectiveness ratio was calculated for each skin treatment as the average cost for reaching a particular outcome. Incidence of skin tear data was collected from residents in a convalescent center from 2004 to 2005. An independent t test was used to compare differences in the number of skin tears between periods when NBSC and other formulations were used. All costs in the decision model were adjusted to 2007 dollars. Sensitivity analysis was used to test uncertain data. RESULTS: The NBSC provided more skin-tear-free days and was less costly than the use of non-NBSC products. The expected skin-tear-free days for a patient in the model treated with NBSC were 179.7 days compared with 154.6 days for non-NBSC products, yielding an incremental effect of 25.1 days. The expected cost of preventing skin tears and treatment via skin treatment per patient in the NBSC group was $281.00 versus $324.10 for periods when other products were used. CONCLUSION: The NBSC had a lower projected cost for prevention of skin tears and more skin-tear-free days when compared with non-NBSC products.
Assuntos
Suplementos Nutricionais/economia , Hospitais de Convalescentes , Lacerações/epidemiologia , Lacerações/prevenção & controle , Higiene da Pele/economia , Pele/lesões , Idoso , Estudos de Coortes , Análise Custo-Benefício , Árvores de Decisões , Humanos , Incidência , Fosfolipídeos/economia , Fosfolipídeos/uso terapêutico , Estudos Retrospectivos , Tensoativos/economia , Tensoativos/uso terapêuticoRESUMO
The non-coordinated use of advanced therapies is not clinically or cost effective. A care pathway for the sequential use of these interventions on complex wounds provides a more restructured approach, and helped improve patient outcomes.
Assuntos
Procedimentos Clínicos/organização & administração , Desbridamento/métodos , Pé Diabético/terapia , Tratamento de Ferimentos com Pressão Negativa/métodos , Poliésteres/uso terapêutico , Polietilenos/uso terapêutico , Higiene da Pele/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Amputação Cirúrgica/estatística & dados numéricos , Pesquisa em Enfermagem Clínica , Análise Custo-Benefício , Desbridamento/economia , Árvores de Decisões , Feminino , Humanos , Hidroterapia/economia , Hidroterapia/métodos , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/economia , Projetos Piloto , Poliésteres/economia , Polietilenos/economia , Higiene da Pele/economia , Resultado do Tratamento , CicatrizaçãoRESUMO
OBJECTIVE: Wound pain and tissue trauma are two main considerations of wound management, and appropriate dressing selection plays an important role in both. Traditional dressings may adhere to wounds resulting in significant pain and trauma to new tissue upon removal. The development of primary wound contact materials has provided a unique approach to solving this problem. This article aims to aid clinicians in identifying wound types on which Mepitel, a primary wound contact dressing with Safetac soft silicone adhesive technology, can be used by summarizing the published clinical literature relating to its use. METHOD: Searches of bibliographic databases and internet sites were supplemented with manual searches of journals of relevance to wound management for clinical data relating to the use of Mepitel. RESULTS: The literature search identified a number of articles, presenting data generated from randomized controlled trials, non-randomized controlled trials and case study evaluations of Mepitel on a wide range of wound types and skin injuries. CONCLUSION: The results of the clinical evaluations demonstrate that Mepitel is associated with atraumatic and virtually pain-free dressing changes. The dressing with Safetac can be used cost-effectively in the treatment of a wide range of wound types and skin injuries.
Assuntos
Adesivos/uso terapêutico , Seleção de Pacientes , Silicones/uso terapêutico , Higiene da Pele/métodos , Ferimentos e Lesões/terapia , Adesivos/efeitos adversos , Adesivos/economia , Queimaduras/terapia , Doença Crônica , Pesquisa em Enfermagem Clínica , Análise Custo-Benefício , Humanos , Micose Fungoide/terapia , Avaliação em Enfermagem , Dor/etiologia , Dor/prevenção & controle , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/enfermagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Silicones/efeitos adversos , Silicones/economia , Pele/lesões , Higiene da Pele/economia , Higiene da Pele/enfermagem , Transplante de Pele/enfermagem , Resultado do Tratamento , CicatrizaçãoRESUMO
This article explains the legalities of selling retail products in the medical practice and how to sell effectively and profitably. It additionally explains how this will help retain clients and provides advice on how to encourage those clients to refer their friends with confidence.
Assuntos
Balneologia/economia , Dermatologia/economia , Marketing de Serviços de Saúde/economia , Marketing de Serviços de Saúde/métodos , Higiene da Pele/economia , Humanos , Prática Privada/economia , Estados UnidosRESUMO
The objectives of this survey were to examine the effectiveness of a static magnet device--4UlcerCare--in preventing recurrence of leg ulcers after healing. Two hundred and eighty-nine randomly selected purchasers of 4UlcerCare were telephoned and asked to complete a short questionnaire. Our focus was on the 211 respondents who had ulcers that had already healed. The average age of subjects was 70.6 years and sex distribution was 55% female to 45% male. Mean duration of leg ulcers before using 4UlcerCare was 4.4 years. Sixty-five per cent of those surveyed had had ulcer recurrence before using 4UlcerCare, with a mean of 2.41 episodes of ulceration. This was close to the expected recurrence rate in the population of 67%. Using 4UlcerCare daily, these respondents' ulcers had healed within an average of 3.57 months. The survey took place an average of 19.94 months after healing. The manufacturers advise wearing 4UlcerCare daily post-healing, and of those respondents that had, none had suffered any recurrence. Extrapolating these results across the health economy, an estimate has been made of a potential pound153.7 million per year saving on leg ulcer care to the NHS.
Assuntos
Úlcera da Perna/prevenção & controle , Magnetismo/uso terapêutico , Idoso , Redução de Custos , Efeitos Psicossociais da Doença , Desenho de Equipamento , Medicina Baseada em Evidências , Feminino , Humanos , Úlcera da Perna/economia , Úlcera da Perna/epidemiologia , Magnetismo/instrumentação , Masculino , Recidiva , Distribuição por Sexo , Higiene da Pele/economia , Medicina Estatal/economia , Inquéritos e Questionários , Resultado do Tratamento , Reino Unido/epidemiologia , CicatrizaçãoRESUMO
Venous leg ulcers affect approximately 0.6% of the western population, consuming millions of healthcare dollars every year. To determine whether an alternative venous ulcer treatment using horsechestnut seed extract-- Aesculus hippocastanum-- and conventional therapy involving dressings and compression was more cost-effective than using conventional therapy alone, a 12-week cost-benefit analysis of horsechestnut seed extract therapy was conducted. The study, using data from a 12-week prospective, randomized, placebo-controlled trial conducted in South Australia in 2002-2004, involved 54 patients with venous ulceration who received treatment through a large South Australian district nursing service. Taking into account the cost of horsechestnut seed extract, dressing materials, travel, staff salaries, and infrastructure for each patient, horsechestnut seed extract therapy combined with conventional therapy was found to be more cost-effective than conventional therapy alone with an average savings of AUD 95 in organizational costs and AUD 10 in dressing materials per patient. This study confirms that dressing change frequency has a significant impact on the total cost of wound care and suggests that district nursing service operation efficiency may be enhanced through the use of horsechestnut seed extract as a result of less frequent nursing visits. Further study of this treatment modality is warranted.
Assuntos
Aesculus , Fitoterapia/economia , Higiene da Pele/economia , Úlcera Varicosa/tratamento farmacológico , Bandagens/economia , Pesquisa em Enfermagem Clínica , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Custos Diretos de Serviços/estatística & dados numéricos , Custos de Medicamentos , Humanos , Pesquisa em Administração de Enfermagem , Admissão e Escalonamento de Pessoal/economia , Fitoterapia/métodos , Fitoterapia/enfermagem , Placebos , Extratos Vegetais , Estudos Prospectivos , Enfermagem em Saúde Pública/organização & administração , Sementes , Sensibilidade e Especificidade , Higiene da Pele/métodos , Higiene da Pele/enfermagem , Austrália do Sul , Resultado do Tratamento , Úlcera Varicosa/economia , Úlcera Varicosa/epidemiologiaRESUMO
This study compared clinical outcomes and nursing labor costs associated with (a) balsam Peru, hydrogenated castor oil, and trypsin (BCT) ointment; (b) BCT + Other; and (c) Other treatments in 2014 wound episodes occurring in 861 patients (mean 2.34 wounds/patient). Treatment with BCT ointment or BCT + Other was associated with a higher healing rate (P < .05). No Stage 1 or 2 ulcer treated with BCT ointment progressed, compared with 13.8% treated with BCT + Other and 13.4% treated with Other. The reported mean duration of treatment and time to heal were shorter for ulcers treated with BCT ointment, but differences did not reach significance, possibly because of the variability in reported treatment times. Mean daily nursing labor costs were lower for treatment with BCT than Other ($50.8 vs $61.7, P < .05). These data suggest that treatment of Stage 1 or 2 ulcers with BCT may be associated with shorter treatment time and time to heal and a potential reduction in treatment-related nursing labor costs.