Abstract

OBJECTIVES: The aim of the study was to investigate the feasibility and effectiveness of searching selected databases to identify information required to populate a decision-analytic model.

METHODS: Methods of searching for information to populate a decision-analytic model were piloted using a case study of prophylactic antibiotics to prevent recurrent urinary tract infections in children. This study explored how the information requirements for a decision-analytic model could be developed into searchable questions and how search strategies could be derived to answer these questions. The study also assessed the usefulness of three published search filters and explored which resources might produce relevant information for the various model parameters.

RESULTS: Based on the data requirements for this case study, 42 questions were developed for searching. These questions related to baseline event rates, health-related quality of life and outcomes, relative treatment effects, resource use and unit costs, and antibiotic resistance. A total of 1,237 records were assessed by the modeler, and of these, 48 were found to be relevant to the model. Search precision ranged from 0 percent to 38 percent, and no single database proved the most useful for all the questions.

CONCLUSIONS: The process of conducting specific searches to address each of the model questions provided information that was useful in populating the case study model. The most appropriate resources to search were dependent on the question, and multiple database searching using focused search strategies may prove more effective in finding relevant data than thorough searches of a single database.

Abstract

No abstract available

Abstract

OBJECTIVES: To assess the effectiveness of the response of NHS hospital trusts to an alert issued by the National Patient Safety Agency designed to limit the availability of concentrated potassium chloride in hospitals in England and Wales, and to determine the nature of any unintended consequences.

DESIGN: Multi-method study involving interviews and a physical inspection of clinical areas.

SETTING: 207 clinical areas in 20 randomly selected acute NHS trusts in England and Wales between 31 October 2002 and 31 January 2003.

PARTICIPANTS: Senior managers and ward based medical and nursing staff.

MAIN OUTCOME MEASURES: Degree of staff awareness of and compliance with the requirements of the national alert, withdrawal of concentrated potassium chloride solutions from non-critical areas, provision of pre-diluted alternatives, storage and recording in accordance with controlled drug legislation.

RESULTS: All trusts required that potassium chloride concentrate be stored in a separate locked cup-board from common injectable diluents (100% compliance). Unauthorized stocks of potassium chloride were found in five clinical areas not authorized by the trust (98% compliance). All trusts required documentation control of potassium chloride concentrate in clinical areas, but errors were recorded in 20 of the 207 clinical areas visited (90% compliance). Of those interviewed, 78% of nurses and 30% of junior doctors were aware of the alert.

CONCLUSIONS: The NPSA alert was effective and resulted in rapid development and implementation of local policies to reduce the availability of concentrated potassium chloride solutions. The success is likely to be partly due to the nature of the proposed changes and it cannot be assumed that future alerts will be equally effective. Continued vigilance will be necessary to help sustain the changes.

Abstract

This study aimed to find out whether General Practitioners (GPs) use quality of life (QOL) information in primary care, to explore their reasoning and to assess any barriers to use. A second purpose was to see whether the Trans-Theoretical Model (TTM) of behaviour change could be applied to doctor's use of QOL information in primary care. A representative, cross-sectional sample of 800 GPs was approached in a national postal survey; 280 (38%) provided qualitative and quantitative information. Most GPs said that QOL was interesting and important. Users had seen more information and scales, and were more aware of its uses; only 8% had ever used formal standardised questionnaires. The main barriers to implementation were a shortage of time and information, and experience with using QOL assessment. A sizable minority wanted to know more. Seventy-one percent would use QOL to monitor treatment effectiveness. The five stages of the TTM were used to identify whether GP's were predisposed to use QOL information from their knowledge levels and values. While there was some support for the model, the TTM did not sensitively and reliably discriminate between users and non-users on all variables, and so has limited value here.

Abstract

Recent research has employed different analytical techniques to estimate the impact of the various long-term complications of type 2 diabetes on health-related utility and health status. However, limited patient numbers or lack of variety of patient experience has limited their power to discriminate between separate complications and grades of severity. In this study alternative statistical model forms were compared to investigate the influence of various factors on self-assessed health status and calculated utility scores, including the presence and severity of complications, and type of diabetes therapy. Responses to the EuroQol EQ-5D questionnaire from 4641 patients with type 2 diabetes in 5 European countries were analysed. Simple multiple regression analysis was used to model both visual analogue scale (VAS) scores and time trade-off index scores (TTO). Also, two complex models were developed for TTO analysis using a structure suggested by the EuroQol calculation algorithm. Both VAS and TTO models achieved greater explanatory power than in earlier studies. Relative weightings for individual complications differed between VAS and TTO scales, reflecting the strong influence of loss of mobility and severe pain in the EuroQol algorithm. Insulin-based therapy was uniformly associated with a detrimental effect equivalent to an additional moderate complication. Evidence was found that TTO values are not responsive in cases where 3 or more multiple complications are present, and therefore may underestimate utility loss for patients most adversely affected by complex chronic diseases like diabetes.

Abstract

No abstract available

Abstract

This paper overviews the EURONHEED (EUROpean Network of Health Economics Evaluation Databases) project. Launched in 2003, this project is funded by the EU. Its aim is to create a network of national and international databases dedicated to health economic evaluation of health services and innovations. Seven centres (France, Germany, Italy, The Netherlands, Spain, Sweden and the UK) are involved covering 17 countries. The network is based on two existing databases, the French CODECS (COnnaissance et Decision en EConomie de la Santé) database, created in 2000 by the French Health Economists Association (Collège des Economistes de la Santé), and the UK NHS-EED (NHS Economic Electronic Database), run by the Centre for Reviews and Dissemination, University of York, York, England.

The network will provide bibliographic records of published full health economic evaluation studies (cost-benefit, cost-utility and cost-effectiveness studies) as well as cost studies, methodological articles and review papers. Moreover, a structured abstract of full evaluation studies will be provided to users, allowing them access to a detailed description of each study and to a commentary stressing the implications and limits, for decision making, of the study. Access will be free of charge. The database features and its ease of access (via the internet: http://www.euronheed.org) should facilitate the diffusion of existing economic evidence on health services and the generalisation of common standards in the field at the European level, thereby improving the quality, generalisability and transferability of results across countries.