Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.357
Filtrar
2.
BMC Health Serv Res ; 19(1): 645, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492134

RESUMO

BACKGROUND: Maternal and perinatal mortality is a major public health concern across the globe and more so in low and middle-income countries. In Kenya, more than 6000 maternal deaths, and 35,000 stillbirths occur each year. The Government of Kenya abolished user fee for maternity care under the Free Maternity Service policy, in June of 2013 in all public health facilities, a move to make maternity services accessible and affordable, and to reduce maternal and perinatal mortality. METHOD: An observational retrospective study was carried out in 3 counties in Kenya. Six maternal health output indicators were observed monthly, 2 years pre and 2 years post- policy implementation. Data was collected from daily maternity registers in 90 public health facilities across the 3 counties all serving an estimated population of 3 million people. Interrupted Time Series Analysis (ITSA) with a single group was used to assess the effects of the policy. Standard linear regression using generalized least squares (gls) model, was used to run the results for each of the six variables of interest. Absolute and relative changes were calculated using the gls model coefficients. RESULTS: Significant sustained increase of 89, 97, and 98% was observed in the antenatal care visits, health facility deliveries, and live births respectively, after the policy implementation. An immediate and significant increase of 27% was also noted for those women who received Emergency Obstetric Care (EmONC) services in either the level 5, 4 and 3 health facilities. No significant changes were observed in the stillbirth rate and caesarean section rate following policy implementation. CONCLUSION: After 2 years of implementing the Free Maternity Service policy in Kenya, immediate and sustained increase in the use of skilled care during pregnancy and childbirth was observed. The study suggest that hospital cost is a major expense incurred by most women and their families whilst seeking maternity care services and a barrier to maternity care utilization. Overall, Free Maternity Service policy, as a health financing strategy, has exhibited the potential of realizing the full beneficial effects of maternal morbidity and mortality reduction by increasing access to skilled care.


Assuntos
Serviços de Saúde Materna/economia , Cesárea/economia , Cesárea/estatística & dados numéricos , Parto Obstétrico/economia , Parto Obstétrico/estatística & dados numéricos , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Instalações de Saúde/economia , Instalações de Saúde/estatística & dados numéricos , Humanos , Análise de Séries Temporais Interrompida , Quênia/epidemiologia , Saúde Materna/economia , Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Mortalidade Perinatal , Gravidez , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Natimorto/epidemiologia
3.
N Z Med J ; 132(1499): 18-22, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31352470

RESUMO

AIMS: To examine idarucizumab use via the emergency department (ED), Christchurch Hospital; adherence to Hospital Medicines List (HML) criteria, licensed dosing and local coagulation monitoring guidelines. METHODS: All patients given idarucizumab were recorded over three months. Data collected included demographics, coagulation tests, dabigatran dosing and timing of idarucizumab administration. RESULTS: Twelve patients received idarucizumab. The median age (range) was 73 (56-83) years and male:female was 4:8. HML criteria were met in 11 patients. Eleven patents had idarucizumab administered within licence. Coagulation tests were taken pre-idarucizumab in all patients and post-idarucizumab in eight patients. The median thrombin clotting times pre- and post-idarucizumab were 153 and 16 seconds respectively. CONCLUSION: The indications for idarucizumab use were within HML criteria and administration was as per licensed dosing regimen in 11 of 12 patients. Appropriate monitoring of coagulation parameters was carried out in all patients as per local guidelines prior to idarucizumab administration, and thrombin clotting times pre and post were as expected for all but one patient.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/economia , Anticorpos Monoclonais Humanizados/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Testes de Coagulação Sanguínea , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Guias de Prática Clínica como Assunto , Trombose Venosa/tratamento farmacológico
4.
Prehosp Disaster Med ; 34(4): 415-421, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31298202

RESUMO

When a disaster exceeds the capacity of the affected country to cope with its own resources, the provision of external rescue and health services is required, and the deployment of relief units requested. Recently, the cost of international relief and the belief that such deployment is cost-effective has been questioned by the international community; unfortunately, there is still little informed debate and few detailed data are available. This paper presents the results of a comparative review on the cost-effectiveness analysis (CEA) of search and rescue (SAR) and Emergency Medical Team (EMT) deployment. The aim of this work is to provide an overview of the topic, highlight the criteria used to assess the effectiveness, and identify gaps in existing literature. The results show that both deployments are highly expensive, and their success is strongly related to the time they need to be operational; SAR deployments are characterized by limited outcomes in terms of lives saved, and EMTs by insufficient data and lack of detailed assessment. This research highlights that the criteria used to assess the effectiveness need to be explored further, considering different purposes, lengths of stay, and different activities performed, especially for any comparison. This study concludes that data reporting should be mandatory for humanitarian response agencies.


Assuntos
Análise Custo-Benefício , Desastres/economia , Serviços Médicos de Emergência/economia , Trabalho de Resgate/economia , Altruísmo , Socorristas/estatística & dados numéricos , Feminino , Humanos , Internacionalidade , Masculino
5.
Medicine (Baltimore) ; 98(25): e15993, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232932

RESUMO

Organizing interfacility transfers is an essential component of regionalized care to improve patient outcomes. This study examines transfer characteristics after establishing a transfer center in a tertiary care center in Beirut Lebanon, and identifies predictors of success in patient transfers.This retrospective observational chart review examined all transfer center requests to and from the tertiary care center over a 4-year period (2013-2017). Descriptive analysis was done, followed by a bivariate analysis comparing transfers based on final decision (accepted yes/no) and by a multivariate logistic regression to identify predictors of successful transfers.A total of 4100 transfer requests were analyzed. Incoming transfer requests were more common than outgoing requests (56.5% vs 43.4%) and were mainly for adult patients (71.0% incoming and 78.7% outgoing). Reasons of transfers were mostly medical (99.4%) for incoming transfers and financial (73.1%) and medical (17.9%) for outgoing transfers. Requested level of care was most commonly intensive care unit for incoming transfers (61.6%) and regular floor for outgoing transfers (48.6%). Outgoing transfers were more successful than incoming transfers (59.9% vs 39.6%). Predictors of success in patient transfers within the healthcare system were identified: These included specific types of financial coverage, diagnoses, levels of care, and medical services for incoming transfers in addition to age groups and receiving hospital location for outgoing transfers.Transfer centers can be implemented successfully in any healthcare system to improve patient care and safety. Identifying facilitators and barriers to successful transfers can help healthcare administrators and policymakers address gaps in the system and improve access to care.


Assuntos
Serviços Médicos de Emergência/normas , Segurança do Paciente , Transferência de Pacientes/normas , Centros de Atenção Terciária , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Transferência de Pacientes/economia , Transferência de Pacientes/estatística & dados numéricos , Melhoria de Qualidade , Estudos Retrospectivos , Adulto Jovem
7.
Wilderness Environ Med ; 30(2): 113-120, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30846401

RESUMO

INTRODUCTION: The summit of Yosemite's Half Dome is reached using cable handrails for the final 146 m (480 ft). Access to these cables was restricted to users with permits in 2010. The authors aim to describe the impact of permitting on search and rescue (SAR) in the region of the park most affected by permitting. METHODS: An observational study from 2005 to 2009 and 2011 to 2015 comparing the number of incidents, major incidents (exceeding $500), victims, and fatalities before and after permitting the use of cable handrails on Half Dome in the area above Little Yosemite Valley (LYV) and parkwide. Each year was analyzed separately with t tests and Mann-Whitney U tests. Data are presented as mean±SD. RESULT: The number of hikers in the study area was reduced by up to 66% by permitting. Above LYV from 2005 to 2009, there were 85 SAR incidents, 134 victims, 8 fatalities, 38 major incidents, and annual SAR costs of $44,582±28,972. From 2011 to 2015, the same area saw 54 SAR incidents, 156 victims, 4 fatalities, 35 major incidents, and annual SAR costs of $27,027±19,586. No parameter showed statistical significance. Parkwide SAR incidents decreased from 232 to 198 annual incidents (P=0.013) during the same time period, with parkwide mortality increasing from 8 to 12 deaths annually (P=0.045). CONCLUSIONS: SAR incidents, victims, fatalities, or costs above LYV did not decrease after cable handrail permitting. Parkwide SAR activity decreased during the same intervals. This strongly suggests that overcrowding is not the key factor influencing safety on Half Dome. This discordant trend warrants close observation over 5 to 10 y.


Assuntos
Traumatismos em Atletas/epidemiologia , Parques Recreativos/legislação & jurisprudência , Trabalho de Resgate/estatística & dados numéricos , Traumatismos em Atletas/mortalidade , California , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos , Parques Recreativos/estatística & dados numéricos
8.
PLoS One ; 14(2): e0212314, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30759147

RESUMO

In 2010, the UK embarked on a self-imposed programme of contractionary measures signalling the beginning of a so-called "age of austerity" for the country. It was argued that budgetary cuts were the most appropriate means of eliminating deficits and decreasing national debt as percentage of General Domestic Product (GDP). Although the budget for the National Health Service (NHS) was not reduced, a below-the-average increase in funding, and cuts in other areas of public spending, particularly in social care and welfare spending, impacted significantly on the NHS. One of the areas where the impact of austerity was most dramatically felt was in Accidents and Emergency Departments (A&E). A number of economic and statistical reports and quantitative studies have explored and documented the effects of austerity in healthcare in the UK, but there is a paucity of research looking at the effects of austerity from the standpoint of the healthcare professionals. In this paper, we report findings from a qualitative study with healthcare professionals working in A&E departments in England. The study findings are presented thematically in three sections. The main theme that runs through all three sections is the perceptions of austerity as shaping the functioning of A&E departments, of healthcare professions and of professionals themselves. The first section discusses the rising demand for services and resources, and the changed demographic of A&E patients-altering the meaning of A&E from 'Accidents and Emergencies' to the Department for 'Anything and Everything'. The second section in this study's findings, explores how austerity policies are perceived to affect the character of healthcare in A&E. It discusses how an increased focus on the procedures, time-keeping and the operationalisation of healthcare is considered to detract from values such as empathy in interactions with patients. In the third section, the effects of austerity on the morale and motivations of healthcare professionals themselves are presented. Here, the concepts of moral distress and burnout are used in the analysis of the experiences and feelings of being devalued. From these accounts and insights, we analyse austerity as a catalyst or mechanism for a significant shift in the practice and function of the NHS-in particular, a shift in what is counted, measured and valued at departmental, professional and personal levels in A&E.


Assuntos
Acidentes de Trânsito , Assistência à Saúde/economia , Recessão Econômica/estatística & dados numéricos , Serviços Médicos de Emergência/economia , Pessoal de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/economia , Inglaterra , Financiamento da Assistência à Saúde/ética , Humanos
9.
J Endod ; 45(3): 250-256, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30803531

RESUMO

INTRODUCTION: The impact of the Affordable Care Act (ACA) on the utilization of the emergency department (ED) for periapical abscess (PA) is unknown. The objectives of this study were to provide nationwide estimates of hospital-based ED visits with PA and to examine the effect of the ACA on the use of EDs for PAs. METHODS: We performed a retrospective analysis of the Nationwide Emergency Department Sample (NEDS) for 2008 to 2014. All ED visits with a diagnosis of PA were selected. The International Classification of Diseases, Ninth Revision-Clinical Modification code was used to identify PA. Patient- and hospital-level characteristics were examined. Descriptive statistics were used to summarize the data. RESULTS: From 2008 to 2014, a total of 3,505,633 ED visits for PA occurred. The proportion of ED visits with PA significantly increased over the study period (from 460,260 in 2008 to 545,693 in 2014). Medicaid was the primary payer (30.3%) and more than 40% were uninsured. Mean charge per PA-related ED visit was $1080.50 and total PA-related ED charge across the United States was $3.4 billion. Among those hospitalized following PA-related ED visits, mean hospitalization charges were $34,245 and total hospitalization charges were $5.7 billion. CONCLUSION: Oral health continues to be overlooked in health care. A large proportion of ED visits with PA were made by those covered by Medicaid and uninsured. The passing of the ACA has not reduced the number of ED visits with PA.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Assistência Odontológica/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Abscesso Periapical/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/economia , Assistência Odontológica/economia , Serviços Médicos de Emergência/economia , Serviço Hospitalar de Emergência/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Abscesso Periapical/economia , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
10.
Prehosp Emerg Care ; 23(4): 453-464, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30259772

RESUMO

Objectives: The objectives of this study were to evaluate demographic/clinical characteristics and treatment/transportation decisions by emergency medical services (EMS) for patients with hypoglycemia and link EMS activations to patient disposition, outcomes, and costs to the emergency medical system. This evaluation was to identify potential areas where improvements in prehospital healthcare could be made. Methods: This was a retrospective analysis of the National Emergency Medical Services Information System (NEMSIS) registry and three national surveys: Nationwide Emergency Department Sample (NEDS), National Hospital Ambulatory Medical Care Survey (NHAMCS), and Medical Expenditure Panel Survey (MEPS) from 2013, to examine care of hypoglycemia from the prehospital and the emergency department (ED) perspectives. Results: The study estimated 270,945 hypoglycemia EMS incidents from the NEMSIS registry. Treatments were consistent with national guidelines (i.e., oral glucose, intravenous [IV] dextrose, or glucagon), and patients were more likely to be transported to the ED if the incident was in a rural setting or they had other chief concerns related to the pulmonary or cardiovascular system. Use of IV dextrose decreased the likelihood of transportation. Approximately 43% of patients were not transported from the scene. Data from the NEDS survey estimated 258,831 ED admissions for hypoglycemia, and 41% arrived by ambulance. The median ambulance expenditure was $664 ± 98. From the ED, 74% were released. The average ED charge that did not lead to hospital admission was $3106 ± 86. Increased odds of overnight admission included infection and acute renal failure. Conclusions: EMS activations for hypoglycemia are sizeable and yet a considerable proportion of patients are not transported to or are discharged from the ED. Seemingly, these events resolved and were not medically complex. It is possible that implementation and appropriate use of EMS treat-and-release protocols along with utilizing programs to educate patients on hypoglycemia risk factors and emergency preparedness could partially reduce the burden of hypoglycemia to the healthcare system.


Assuntos
Serviços Médicos de Emergência/economia , Serviço Hospitalar de Emergência/economia , Hipoglicemia/terapia , Idoso , Ambulâncias , Tomada de Decisões , Emergências , Feminino , Glucagon/uso terapêutico , Glucose/uso terapêutico , Hospitalização , Humanos , Hipoglicemia/economia , Sistemas de Informação , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Inquéritos e Questionários
11.
Ann Allergy Asthma Immunol ; 122(1): 79-85, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30025910

RESUMO

BACKGROUND: Layperson food allergy management plans commonly stipulate that if epinephrine is used to immediately call 911 and seek care in the nearest medical facility for observation. OBJECTIVE: To evaluate the cost-effectiveness of this strategy, vs a watchful waiting approach before activating emergency medical services (EMS). METHODS: We performed a cost-effectiveness analysis using Markov modeling simulated over a 20-year horizon comparing activating EMS immediately after epinephrine use for allergic reactions to peanut vs a "wait and see" approach in which EMS was only activated if symptoms of the reaction did not promptly resolve after treatment. The base-case model assumed a 10-fold increased fatality risk with delayed EMS activation. RESULTS: The fatality risk associated with early EMS use was minimal, with a per-patient fatality rate over a 20-year horizon of 1.2 × 10-6, vs 1.9 × 10-6 for a wait and see approach. The incremental cost per life-year saved was $142,943,447 for early EMS vs wait and see, with the cost per death prevented reaching $1,349,335,651 as the simulation concluded. Cost of early EMS activation rose to $321,625,534 per life-year saved ($3,035,454,848 per death prevented) if a 5-fold increase in fatality risk was assumed, and was $12,997,173 per life-year saved ($122,689,936 per death prevented) if a 100-fold increase in fatality risk was assumed. CONCLUSION: Medical observation of a treated and promptly resolved peanut allergic reaction has minimal benefit and excessive costs. Immediately activating EMS after using epinephrine for a peanut allergic reaction in this context is not cost-effective.


Assuntos
Anafilaxia/economia , Análise Custo-Benefício/estatística & dados numéricos , Serviços Médicos de Emergência/economia , Epinefrina/uso terapêutico , Hipersensibilidade a Amendoim/tratamento farmacológico , Hipersensibilidade a Amendoim/economia , Conduta Expectante/economia , Antígenos de Plantas/imunologia , Arachis/imunologia , Humanos , Hipersensibilidade a Amendoim/mortalidade
12.
Telemed J E Health ; 25(5): 380-390, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30036152

RESUMO

Introduction: Nonavailability of emergency healthcare services in mountainous, isolated, and sparsely populated regions is a universal problem. In a first of its kind initiative, Tele-emergency services (TES) was provided in Keylong and Kaza in Himachal Pradesh in Northern India, at an altitude of 3,353 meters with temperatures of -30°C during winter months. Methods: Existing rooms in regional hospital (Keylong) and community health center (Kaza) were converted into tele-emergency centers by connecting them, to a state-of-the-art emergency department at the Joint Commission International-accredited Apollo Main Hospital at Chennai, 2,925 km away. Training was carried out at both ends. Average turnaround time for an emergency teleconsult was less than 12 minutes. Tele-ECG, Spirometry, and Point-of-Care Diagnostics for blood biochemistry were made available. Results: In the first 35 months, 753 teleconsults were given in the 24/7 TES, out of a total of 10,213 teleconsults constituting 7.4%. Out of a total of 6,442 telelaboratory tests, 431 tests were done in an emergency setting constituting 6.7%. Of the 16 cases of myocardial infarction remotely diagnosed, 4 were thrombolysed through telementoring. Of seven patients with Supra Ventricular Tachycardia, six patients were stabilized through electrical cardioversion and one through chemical cardioversion through telementoring. Ten deaths were documented, of which one occurred at the site. One hundred ninety-six were stabilized and transferred to higher centers. Thirteen required helicopter evacuations. Detailed analysis revealed that the total average cost for a single emergency teleconsult during this period was US$208. Conclusions: Preliminary analysis confirms that delivering TES in inhospitable terrains in a Public Private Partnership mode is doable and is welcomed by the community.


Assuntos
Serviços Médicos de Emergência/organização & administração , Serviços de Saúde Rural/organização & administração , Telemedicina/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Resgate Aéreo/estatística & dados numéricos , Altitude , Criança , Pré-Escolar , Temperatura Baixa , Redes de Comunicação de Computadores/organização & administração , Análise Custo-Benefício , Eletrocardiografia , Serviços Médicos de Emergência/economia , Feminino , Humanos , Índia , Lactente , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Serviços de Saúde Rural/economia , Espirometria , Telemedicina/economia , Fatores de Tempo , Adulto Jovem
13.
PLoS One ; 13(12): e0209197, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30571732

RESUMO

BACKGROUND: Whether inpatient services can be successfully substituted by office-based services has been debated for many decades, but the evidence is still inconclusive. This study aims to investigate the effect of office-based care on use and the expenditure for other healthcare services in patients with type II diabetes (T2D). METHODS: A generalized propensity score matching approach was used on pooled Medical Expenditure Panel Survey (MEPS) data for 2000-2012 to explore a dose-response effect. Patients were matched by using a comprehensive set of variables selected following a standard model on access to care. FINDINGS: Office-based care (up to 5 visits/year) acts as a substitute for other healthcare services and is associated with lower use and expenditure for inpatient, outpatient and emergency care. After five visits, office-based care becomes a complement to other services and is associated with increases in expenditure for T2D. Above 20 to 26 visits per year, depending on the healthcare service under consideration, the marginal effect of an additional office-based visit becomes non-statistically significant. CONCLUSIONS: Office-based visits appear to be an effective instrument to reduce use of inpatient care and other services, including outpatient and emergency-care, in patients with T2D without any increase in total healthcare expenditure.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/economia , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/economia , Visita a Consultório Médico/estatística & dados numéricos , Pontuação de Propensão , Inquéritos e Questionários , Estados Unidos
14.
J Safety Res ; 67: 57-63, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30553430

RESUMO

BACKGROUND: Aquatic activities provide physical and social benefits, while the risk of drowning generates countervailing social costs. Drawing on estimates of fatal drowning gathered by Royal Life Saving Society - Australia, this paper outlines a method for estimating the economic burden attributable to fatal drowning. METHODS: This study estimated the burden of fatal drowning by combining Value of a Statistical Life Year (VSLY), hospitalization, productivity and emergency services costs. All unintentional fatal drowning cases in Australia between 1-July-2002 and 30-June-2017 were included. Foregone life years from each drowning were estimated based on Australian life expectancies for the year of death. The societal value of these Years of Life Lost was calculated using the VSLY for Australia, adjusted to reflect income elasticity. Corrections to discounting of VSLY were applied. Estimates of productivity losses not captured in VSLY were produced using net national capital growth. Time spent in hospital was found using coronial data and existing estimates of search, ambulance and coronial costs were adapted and incorporated. RESULTS: The study covers 4285 cases of unintentional fatal drowning over 15 years. Based on this sample and estimates for the VSLY ($203,000), the economic burden of fatal drowning for Australia over this 14 year period was $18.63 billion in 2017 Australian dollars, averaging $1.24 billion annually. CONCLUSIONS: Fatal drowning represents a significant source of health burden in Australia, underlining the need for further preventative measures. PRACTICAL APPLICATIONS: We provide an easily-understood estimate of the scale of Australia's fatal drowning problem, permitting comparison with other social problems. They can also be used in determining net benefits of proposed drowning prevention policies and to identify situations where burden of fatal drowning is disproportionate. Suggestions for improving the calculation of societal burden of illness can be incorporated in cost-benefit analyses in related fields of study.


Assuntos
Efeitos Psicossociais da Doença , Análise Custo-Benefício , Afogamento/economia , Serviços de Saúde/economia , Valor da Vida/economia , Austrália , Afogamento/prevenção & controle , Serviços Médicos de Emergência/economia , Hospitalização/economia , Humanos
15.
BMC Geriatr ; 18(1): 297, 2018 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-30509204

RESUMO

BACKGROUND: To evaluate a Geriatric Emergency Department Intervention (GEDI) model of service delivery for adults aged 70 years and older. METHODS: A pragmatic trial of the GEDI model using a pre-post design. GEDI is a nurse-led, physician-championed, Emergency Department (ED) intervention; developed to improve the care of frail older adults in the ED. The nurses had gerontology experience and education and provided targeted geriatric assessment and streamlining of care. The final format included 2.4 full time equivalent nurses working 7 days from 0700 h to 1730 h (1530 h at weekends). There were three implementations periods: pre-implementation (2012); a developmental phase from January 2013 to August 2015; and full implementation from September 2015 to August 2016. The outcomes measured were disposition (discharged home, admitted or died); ED length of stay; hospital length of stay; all cause in-hospital mortality within 28 days; time to ED re-presentation up to 28 days post-discharge; in-hospital costs. The setting was a tertiary hospital ED, with 385 beds, in Queensland, Australia. Approximately 53,000 patients presented to the ED annually with 20% aged 70 years and older. All patients over the age 70 who presented to the ED between January 2012 and August 2016 (n = 44,983) were included in the trial. RESULTS: Older persons who presented to the ED when the GEDI team were working had increased likelihoods of discharge (Hazard ratio (HR) = 1.19; 95% CI: 1.13-1.24) and reduced ED length of stay (HR = 1.42; 95% CI: 1.33-1.52) compared with those who presented when GEDI were not working. There was no increase in the risk of mortality (HR = 1.01; 95% CI = 0.23-4.43) or risk of same cause re-presentation to 28 days (HR = 1.21; 95% CI: 0.99-1.49). The GEDI service resulted in average cost savings per ED presentation of $35 [95% CI, $21, $49] and savings of $1469 [95% CI, $1105, $1834] per hospital admission. CONCLUSIONS: Implementation of a nurse-led physician-championed model of ED care, focused on frail older adults, reduced ED length of stay, hospital admission and if admitted, hospital length of stay and cost, without increasing mortality or same cause re-presentation. These increases were sustained over time and after the initial implementation team had changed roles. TRIAL REGISTRATION: Australian Clinical Trials Registration Number ACTRN12615001157561 - retrospectively registered on 29/10/2015. Data were retrieved via retrospective access to clinical information systems. First data access was on 1/7/2015.


Assuntos
Serviços Médicos de Emergência/tendências , Serviço Hospitalar de Emergência/tendências , Avaliação Geriátrica , Tempo de Internação/tendências , Idoso , Idoso de 80 Anos ou mais , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/métodos , Serviço Hospitalar de Emergência/economia , Feminino , Idoso Fragilizado , Avaliação Geriátrica/métodos , Mortalidade Hospitalar/tendências , Hospitalização/economia , Hospitalização/tendências , Humanos , Tempo de Internação/economia , Masculino , Alta do Paciente/economia , Alta do Paciente/tendências , Queensland/epidemiologia , Estudos Retrospectivos
16.
Swiss Med Wkly ; 148: w14686, 2018 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-30378091

RESUMO

INTRODUCTION: In Switzerland, mandatory health insurance plans (standard) offer free access to secondary and emergency care. However, in return for a lower premium, individuals can choose alternative healthcare plans (HCPs), with either a general practitioner (GP) or a medical call centre (Telmed) acting as gatekeeper. AIM: To examine the impact of alternative HCPs on patients' intended help-seeking behaviour out-of-hours (OOH) in Switzerland. METHODS: A secondary analysis of the Swiss data collected for the EurOOHnet survey on help-seeking behaviour in Denmark, the Netherlands and Switzerland was made. The survey used hypothetical scenarios for measuring two outcome measures: intended help-seeking for (1) OOH care and (2) OOH face-to-face care. Binomial regression analyses were used to test the influence of HCPs on intended OOH help-seeking, adjusted for other (population) characteristics. RESULTS: Telmed-insured persons were more inclined to OOH help-seeking than persons with a standard HCP (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.91-2.72; controlled for other population factors), mainly driven by contact with the medical call centre (31 vs 5%), and were less inclined to have an OOH face-to-face contact (OR 0.69, 95% CI 0.55-0.87). Persons with a GP HCP had a lower intended use of face-to-face OOH care contacts than persons with a standard plan (OR 0.74, 95% CI 0.63-0.86). CONCLUSION: Alternative HCPs on a voluntary basis seem to influence the use of OOH care. These results could be relevant for policy makers, especially from non-gatekeeping countries, to reduce irrelevant use and subsequent costs of emergency and OOH care services.


Assuntos
Plantão Médico , Clínicos Gerais/estatística & dados numéricos , Comportamento de Busca de Ajuda , Seguro Saúde/economia , Telemedicina/normas , Adulto , Serviços Médicos de Emergência/economia , Feminino , Clínicos Gerais/economia , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Inquéritos e Questionários , Suíça , Telemedicina/economia
17.
J Am Coll Cardiol ; 72(15): 1817-1825, 2018 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-30286926

RESUMO

BACKGROUND: Data related to the epidemiology and resource utilization of congenital heart disease (CHD)-related emergency department (ED) visits in the pediatric population is limited. OBJECTIVES: The purpose of this analysis was to describe national estimates of pediatric CHD-related ED visits and evaluate medical complexity, admissions, resource utilization, and mortality. METHODS: This was an epidemiological analysis of ED visit-level data from the 2006 to 2014 Nationwide Emergency Department Sample. Patients age <18 years with CHD were identified using International Classification of Diseases-9th Revision-Clinical Modification codes. We evaluated time trends using weighted regression and tested the hypothesis that medical complexity, resource utilization, and mortality are higher in CHD patients. RESULTS: A total of 420,452 CHD-related ED visits (95% confidence interval [CI]: 416,897 to 422,443 visits) were identified, accounting for 0.17% of all pediatric ED visits. Those with CHD were more likely to be <1 year of age (43% vs. 13%), and to have ≥1 complex chronic condition (35% vs. 2%). CHD-related ED visits had higher rates of inpatient admission (46% vs. 4%; adjusted odds ratio: 1.89; 95% CI: 1.85 to 1.93), higher median ED charges ($1,266 [interquartile range (IQR): $701 to $2,093] vs. $741 [IQR: $401 to $1,332]), and a higher mortality rate (1% vs. 0.04%; adjusted odds ratio: 1.25; 95% CI: 1.07 to 1.45). Adjusted median charges for CHD-related ED visits increased from $1,219 (IQR: $673 to $2,138) to $1,630 (IQR: $901 to $2,799), while the mortality rate decreased from 1.13% (95% CI: 0.71% to 1.52%) to 0.75% (95% CI: 0.41% to 1.09%) over the 9 years studied. CONCLUSIONS: Children with CHD presenting to the ED represent a medically complex population at increased risk for morbidity, mortality, and resource utilization compared with those without CHD. Over 9 years, charges increased, but the mortality rate improved.


Assuntos
Serviços de Saúde da Criança , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Cardiopatias Congênitas , Adolescente , Criança , Serviços de Saúde da Criança/economia , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Comorbidade , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/tendências , Feminino , Recursos em Saúde/estatística & dados numéricos , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/terapia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Estados Unidos/epidemiologia , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricos
19.
Wilderness Environ Med ; 29(4): 463-470, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30293698

RESUMO

INTRODUCTION: Apostle Islands National Lakeshore (APIS) lies at the northern tip of Wisconsin and is home to a network of 21 islands along Lake Superior. The goal of this report is to investigate search and rescue (SAR) and emergency medical services (EMS) trends at APIS in an effort to improve visitor safety and resource allocation. METHODS: This study is a retrospective analysis reviewing APIS SAR reports and annual EMS summary reports from January 1, 2006, to December 31, 2015. Information related to incident type, incident date, individual demographic characteristics and activities, injury/illness type, cost, and contributing factors were recorded and analyzed in frequency tables. RESULTS: From 2006 to 2015, APIS SAR conducted 133 total missions assisting 261 individuals-200 not injured/ill, 57 injured/ill, and 4 fatalities. Median cost per SAR incident involving aircraft totaled $21,695 (range: $2,993-141,849), whereas incidents not involving aircraft had a median cost of $363 (range: $35-8,830). Nonmotorized boating was the most common activity resulting in SAR incidents. All 4 fatalities were attributed to drowning while kayaking or swimming. Cold-related injury/illness accounted for nearly half of all injuries/illnesses (45%) with the most commonly reported contributing factor being high winds. EMS responded to a total of 134 incidents. Trauma and first aid accounted for 43% and 34% of EMS workload, respectively. CONCLUSIONS: Overall, this study highlights the hazards associated with the frigid and rough conditions of Lake Superior. The reported results aim to help APIS personnel more saliently convey risks to visitors and plan appropriately in an effort to decrease the need for future rescues.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Parques Recreativos/estatística & dados numéricos , Trabalho de Resgate/estatística & dados numéricos , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/tendências , Tratamento de Emergência/economia , Tratamento de Emergência/tendências , Feminino , Humanos , Incidência , Masculino , Trabalho de Resgate/economia , Estudos Retrospectivos , Wisconsin/epidemiologia , Carga de Trabalho , Ferimentos e Lesões/economia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/mortalidade
20.
Br J Hosp Med (Lond) ; 79(9): 520-523, 2018 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-30188207

RESUMO

The use of ambulatory emergency care services in the NHS has been shown to reduce the emergency inpatient burden and enhance the overall patient experience, while demonstrating a cost saving to the NHS. At the James Paget University Hospital point-of-care testing was used as an enabler within an evidence-based lean service redesign to successfully set up a novel unit. A 3-month pilot period, with limited operational times, showed a dramatic improvement in patient flow through the acute medicine pathway, with an equivalent of 59 bed days saved during the pilot period. Further expansion of the unit to a dedicated area with full 7-day opening allowed a continued improvement in performance. This resulted in a mean length of stay of 115 minutes (a 54% reduction from pre-baseline), and just 6.1% of an average of 18.1 daily attendances were converted to full admission. This demonstrated a clinical, operational and financial benefit, allowing improved clinical outcomes.


Assuntos
Assistência Ambulatorial/organização & administração , Testes Imediatos , Assistência Ambulatorial/economia , Redução de Custos , Serviços Médicos de Emergência/economia , Inglaterra , Humanos , Tempo de Internação , Admissão do Paciente , Projetos Piloto , Medicina Estatal
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA