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B J O'Brien

Publications and source records attributed to B J O'Brien.

77 records · Page 5Linked to original sources
PubMedDate not supplied

A Canadian physician survey of dyspepsia management.

OBJECTIVE: To determine the management of patients with new onset dyspepsia by Canadian family physicians. METHODS: A survey was mailed to 195 family physicians in August 1995 to identify how they manage dyspepsia in patients according to four scenarios: based on presenting symptoms alone; assuming Helicobacter pylori-positive; known to be H pylori-negative; and endoscopically confirmed nonulcer dyspepsia. RESULTS: A total of 170 of 195 physicians (87.2%) completed the survey. Physicians reported that 7.3% of their practice is devoted to dyspepsia and 23% of these dyspeptic patients present for the first time. Ninety-three per cent of family physicians find a symptom classification of ulcer-, reflux- and dysmotility-like dyspepsia helpful. The majority of patients are advised to make life-style changes and are treated with antacids or empiric drug therapy. A H2 receptor antagonist was the drug of choice for ulcer and reflux-like dyspepsia, while prokinetics were often used for reflux and dysmotility-like dyspepsia. After failure of initial treatment, patients were given another course of empiric treatment, commonly with cisapride or omeprazole. Family physicians estimated that the mean time to obtain a gastrointestinal consult was five weeks, and 70% indicated that this time to consult adversely influenced their decision to refer. If this time was reduced to less than two weeks, responding physicians would consider referring all eligible patients. On average, two to 2.5 courses of empiric therapy were given before referral. If H pylori status was known, fewer empiric treatments (mean 1.8) were given before gastroenterological referral compared with the other scenarios. If the patient had nonulcer dyspepsia, 30% of family physicians provided reassurance only and did not prescribe empiric drug treatment. CONCLUSIONS: Most newly dyspeptic patients in Canada are treated with empiric therapy according to symptom classification and referred for endoscopy after an average two to 2.5 treatment courses.

Adult↗
PubMedDate not supplied

Income effects of reduced health and health effects of reduced income: implications for health-state valuation.

There is increasing use of multiattribute health-state utility systems, such as the Health Utilities Index and the EuroQol (now EQ-5D), to estimate quality-adjusted life years (QALYs) for cost-utility analysis. Whereas the preferences elicited from individuals using willingness-to-pay techniques for cost-benefit analysis would be expected to reflect those individuals' income levels, it is often suggested that cost-utility analysis can avoid this income effect by not valuing health in monetary terms. Contrary to this view, the authors argue that income can influence the measurement of utilities used to estimate QALYs. In the context of multiattribute utility instruments, two income effects can take place: 1) when individuals are asked to value health states to generate the set of utilities to apply in subsequent evaluation studies; 2) when those multiattribute systems are used to categorize individuals' (usually patients') health status in the field in applied evaluation studies. The authors review the most popular utility systems regarding how these income effects are handled and assess the implications for the measurement of utilities using these systems.

Canada↗
PubMedDate not supplied

Holistic versus composite preferences for lifetime treatment sequences for type 2 diabetes.

This study of patient preferences for lifetime treatment sequences for type 2 diabetes had three objectives: to assess the feasibility of obtaining holistic preference assessments using the time-tradeoff (TTO) technique; to compare composite and holistic preference scores for the same lifetime treatment paths; and to assess the validity of composite and holistic preference measures in terms of their congruence with an individual's rank-order preferences. 101 persons with type 2 diabetes provided preference ratings for hyperglycemic treatments lasting 30 years, including eight discrete treatment states and four treatment paths. Scenarios described drug and glucose-testing regimens, efficacy of glucose control, and side effects. After ranking and rating scenarios on a thermometer scale, subjects provided TTO preferences for each treatment state or path scenario. Holistic assessment of treatment paths was feasible with the TTO technique, in terms of useable data (88% of interviews) and effect on coefficients of variation. Holistic and composite preference scores were not statistically different. Agreement was poor between rankings implied by holistic and composite scores and direct rankings. The authors conclude that lifetime treatment paths with minor differences in health effects can be assessed using either composite (QALY) or holistic (HYE) measures. The validity of these TTO-based preference measures remains unknown.

Adult↗