Biomedical subjects

I S Kristiansen

Publications and source records attributed to I S Kristiansen.

At least 19 recordsLinked to original sources

PubMed2006

Young patients with hip fracture: a population-based study of bone mass and risk factors for osteoporosis.

INTRODUCTION: Hip fracture in young patients is rare. The present study was aimed to clarify the comorbidity pattern and reveal relevant risk factors for osteoporosis and fracture in this patient group. MATERIALS AND METHODS: Using electronic diagnosis registers and lists of the operating theatres for the Oslo hospitals, patients with new hip fracture during two 1-year periods from May 1994 through April 1995 and from May 1996 through April 1997 were identified. All patients age 20-49 years at the time of fracture were included (n=49), and a detailed medical history was recorded. Thirty-two of the patients volunteered for examination and completed a questionnaire and interview to reveal risk factors for osteoporosis. Data from the Oslo Health Study served as reference material. Bone mineral density (BMD) was measured using dual x-ray absorptiometry, and Z-scores were calculated using healthy subjects from Oslo as reference. RESULTS: Of the patients identified, the median age was 40 years (range 25-49), and 63% were men. In 65% of the patients, the fracture occurred after a fall at the same level, in 16% it occurred after a fall from a higher level, and in 18% it occurred in a traffic accident. Twenty percent of the patients had a history of alcohol or drug abuse, 39% had neuromuscular diseases, and 12% had endocrine diseases. The patients examined had significantly more risk factors for osteoporosis than the reference population. The BMD expressed as Z-score for L2-4 was -1.0+/-0.9 (mean +/- SD; p<0.001), for femoral neck was -1.5+/-1.0 (p<0.001), and for total body was -1.3+/-1.1 (p<0.001). BMD was significantly lower than in controls for patients sustaining low-energy and high-energy trauma. There was a negative correlation between the total number of risk factors and BMD for lumbar spine (r=-0.35, p<0.05), femoral neck (r=-0.37, p=0.04), and total body (r=-0.55, p=0.001), respectively. CONCLUSIONS: The majority of the young patients with hip fracture have a history of low-energy trauma, comorbidity predisposing for falls or decreased bone strength, as well as several risk factors for osteoporosis. The BMD was significantly lower than in the reference population regardless of the trauma mechanism.

Absorptiometry, Photon↗

PubMed2005

Influence of number needed to treat, costs and outcome on preferences for a preventive drug.

BACKGROUND: The number needed to treat (NNT) has been widely recommended for communicating benefits from risk reductions. It has been claimed that NNT is easily understood and that it has intuitive meaning. There are, however, only few studies of lay people's understanding of NNT. OBJECTIVE: The objective of this study was to explore whether lay people are sensitive to the magnitude of treatment effectiveness as expressed in terms of NNT, and whether the sensitivity is influenced by variation in the type of health outcome, variation in patients' payment for the treatment or variation in the type of side effects. METHODS: In total, 2326 non-institutionalized Danes aged 18-91 years were interviewed face to face and asked whether they would consent to a treatment against a somewhat increased risk of death or heart attack. The respondents were allocated to different levels of effectiveness of treatment expressed as NNT of 10, 100, 200 or 400, different costs and different descriptions of adverse effects. RESULTS: The odds for consenting to therapy were little influenced by the magnitude of NNT, but were greater among married respondents and among those who had side effects presented in terms of headache and constipation. CONCLUSION: In this study, the respondents' choice of treatment was largely insensitive to the magnitude of NNT independently of variations in type of health outcome and costs. NNT may not be easily understood by lay people.

Adult↗

PubMed2005

Local and national electronic databases in Norway demonstrate a varying degree of validity.

OBJECTIVE: The aim of the present study was to examine the validity of local and national electronic databases using medical records as gold Standard. STUDY DESIGN AND SETTING: All hospital admissions with ICD 9-code 820.X (hip fracture) in a 1-year period were identified in the electronic discharge registers of the hospitals in Oslo and in the national electronic database (The Norwegian Patient Register). Medical records for all patients identified by the discharge registers and the logbooks of the operating theater of the hospitals were retrieved, and the diagnosis was verified. RESULTS: Compared with the total number of fractures confirmed in medical records, the electronic discharge register of one of the hospitals underestimated the number of fractures by 46%, whereas the two other overestimated the number by 17% and 19%. For the national electronic database, an overall overestimation of 19% was found. CONCLUSION: The present findings question the validity of electronic databases and thus have implications for epidemiologic studies.

Aged↗

PubMed2004

Consequences of hip fracture on activities of daily life and residential needs.

The aim of this study was to describe the consequences of hip fracture with respect to changes in residential needs and the ability to perform activities of daily life. Patients 50 years and older admitted to the two largest hospitals of Oslo with a hip fracture during the period May 1996 through April 1997 were identified. In November 1997 a questionnaire on residential needs, activities of daily life, hip pain and health status was sent to the patients still alive (n = 767). After reminders, the questionnaires of 593 patients (77%) were included. Logistic regression analysis was applied to assess items associated with functional limitation and need for residential care. The proportion of patients living in nursing homes increased from 15% before to 30% after the hip fracture, and men were twice as likely to move into a nursing home than women. Of the patients living in their own homes before the hip fracture, 6% of those < 75 years compared with 33% of those > 85 years had to move to nursing home after hip fracture. The proportion of patients walking without any aid decreased from 76 to 36%, and 43% of the patients lost their prefracture ability to move outside on their own. More than a fourth of the patients (28%) lost their ability to cook their own dinner after sustaining hip fracture. The probability of these events increased with increasing age. The probability of reporting inferior health status and for having hip pain that affected sleep after the fracture was unrelated to age. Many patients sustaining a hip fracture, and in particular the oldest patients, have reduced ability to perform activities of daily life.

Activities of Daily Living↗

PubMed2001

Threats from patients and their effects on medical decision making: a cross-sectional, randomised trial.

BACKGROUND: Negative experiences are not uncommon among doctors in Norway. Our aim was to find out about the various types of negative reactions (eg, complaints, negative exposure to the media, financial claims, and notification to the police) received by physicians from patients or relatives in response to treatment, to identify their cause, and to study their effects on subsequent clinical decisions. METHODS: We posted questionnaires about negative reactions of patients to a random sample (n=1260) of Norwegian doctors. Each doctor was additionally sent five written case simulations and asked to choose one of several proposed clinical strategies. Half (630) the physicians received cases containing threats from the patient or their relatives. FINDINGS: 988 (78%) physicians returned the questionnaire, 463 (47%) of whom reported negative experiences. Such experiences were reported more frequently by men (357 [51%]) and family physicians (157 [58%]) than by other participants. Negative experiences did not affect choice of strategy for case simulations. For the first case, chest pain, 217 (44%) physicians presented with a threat chose a defensive strategy compared with 145 (30%) of those who were not (difference 14%; 95% CI 8-20). For the second case, a headache case, the corresponding numbers were 278 (57%) and 118 (25%) (32%; 26-38). Physician age, sex, specialty, or experience of negative reactions of patients did not alter the effect of threats received during our study. INTERPRETATION: Negative experiences do not affect subsequent decision making. However, doctors do comply with wishes from patients or relatives when presented with direct threats.

Adult↗

PubMed2001

[Should the society give priority to costly diseases?].

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Cost of Illness↗

PubMed2001

Epidemiology of hip fractures in Oslo, Norway.

The incidence of hip fractures in Oslo has shown a secular increase during the past decades. The main aims of the present study were to report the current incidence of hip fractures in Oslo and to determine whether there is a seasonal variation in the occurrence of fractures. Using the electronic diagnosis registers and the lists of the operating theater for the hospitals in Oslo with somatic care, all patients with ICD-9 code 820.X (hip fracture) from May 1, 1996 to April 30, 1997 were identified. Medical records for all identified patients were obtained and diagnosis was verified. Using the population of Oslo on January 1, 1997 as the population at risk, the age- and gender-specific annual incidence rates were calculated. These rates were compared with those for 1988/89 and 1978/79. Outdoor temperature data for Oslo were obtained to study the relation between temperature and number of hip fractures. A total number of 1316 hip fractures was included, of which 78% occurred in women. An exponential increase in incidence with age was observed in both genders. The age-adjusted fracture rates per 10,000 for the age group > or =50 years were 118.0 and 44.0 in 1996/97, 124.3 and 44.9 in 1988/89, and 104.5 and 35.8 in 1978/79 for women and men, respectively. There was no significant seasonal variation in the incidence of hip fractures and no correlation between mean outdoor temperature and number of fractures for each month in 1996/97. The data show that the incidence of hip fractures in Oslo has not changed significantly during the last decade, and it is still the highest reported. The cold climate of Oslo does not seem to contribute to the high incidence.

Age Distribution↗

PubMed2001

Prediction of five-year survival for patients admitted to a department of internal medicine.

OBJECTIVE: The effect of many common forms of therapy, as medication for mild hypertension or hypercholesterolaemia, only reaches clinical significance after years of treatment. The meaningful application of such therapy presupposes that physicians can, at least to some extent, predict the remaining lifetime of patients. We investigated whether clinicians from different disciplines were able to predict the 5-year survival of patients admitted to a department of internal medicine. DESIGN: The members of two groups, each consisting of an internist, a surgeon and a general practitioner, made individual predictions of the expected remaining lifetime of discharged patients from written summaries of clinical information. Each patient was randomized to be assessed by the members of either of the two groups. The predictions were compared with actual 5-year survival. SETTING: Department of internal medicine at a university hospital. SUBJECTS: Patients admitted consecutively during a 6-week period. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values and areas under the receiver operating characteristic (ROC) curves for predictions of 5-year survival for each of the six experts. RESULTS: A total of 402 patients were included. Five-year survival was 0.63. The sensitivity of the predictions ranged from 0.81 to 0.95, the specificity from 0.61 to 0.77, the positive predictive value from 0.78 to 0.87 and the negative predictive value from 0.68 to 0.87. The areas under the ROC curves ranged from 0.84 to 0.91. CONCLUSION: The quality of predictions of 5-year survival made by experienced clinicians should permit the rational use of treatments with long-term effects.

Adult↗

PubMed2001

Impact of payment method on behaviour of primary care physicians: a systematic review.

OBJECTIVE: To review the impact of payment systems on the behaviour of primary care physicians. METHODS: All randomised trials, controlled before and after studies, and interrupted time series studies that compared capitation, salary, fee-for-service or target payments (mixed or separately) that were identified by computerised searches of the literature. Methodological quality assessment and data extraction were undertaken independently by two reviewers using a data checklist. Study results were qualitatively analysed. RESULTS: Six studies met the inclusion criteria. There was considerable variation in the quality of reporting, study setting and the range of outcomes measured. Fee-for-service resulted in a higher quantity of primary care services provided compared with capitation but the evidence of the impact on the quantity of secondary care services was mixed. Fee-for-service resulted in more patient visits, greater continuity of care, higher compliance with a recommended number of visits, but lower patient satisfaction with access to a physician compared with salary payment. The evidence of the impact of target payment on immunisation rates was inconclusive. CONCLUSIONS: There is some evidence to suggest that how a primary care physician is paid does affect his/her behaviour but the generalisability of these studies is unknown. Most policy changes in the area of payment systems are inadequately informed by research. Future changes to doctor payment systems need to be rigorously evaluated.

Capitation Fee↗

PubMed2001

Criteria for TNF-targeted therapy in rheumatoid arthritis: estimates of the number of patients potentially eligible.

Tumour necrosis factor (TNF) antagonists or blocking agents represent a major advance in the treatment of rheumatoid arthritis (RA), but their use raises economic concerns because of the high drug cost. Population-based patient registers with clinical data allow the estimation of the proportion of patients with RA who are eligible for TNF antagonist therapy according to recent consensus statements on TNF-targeted therapy. Data were derived from a representative county-based (500,000 population) register of patients with RA. Of 894 patients aged between 18 and 70 years, 636 (71%) [females 80%, mean (SD) age 53.6 (12.2) years and mean (SD) disease duration 12.2 (9.3) years] had a clinical and radiographic examination. The eligibility for TNF-targeted therapy was estimated from the following criteria: (i) previous or current therapy with at least one disease-modifying antirheumatic agent (DMARD); and (ii) active disease. Disease activity criteria were set to 28-swollen joint count (28-SJC) > or = 6, 28-tender joint count > or = 6, and erythrocyte sedimentation rate (ESR) > or = 28 mm/hour or C-reactive protein (CRP) > or = 20 mg/L. Sensitivity analyses were performed varying some of these disease activity parameters. Of the 636 patients, as many as 526 (83%) had previously or were currently using DMARDs and 98 (15%) fulfilled both the DMARD and activity criteria, thus being the maximum number of patients considered for TNF-targeted therapy. If the most stringent criteria were used (ever DMARD, 28-SJC > or = 12 and ESR > or = 50 mm/hour or CRP > or = 40 mg/L) only 15 of the 626 (2%) would be candidates for TNF-targeted therapy. In a population of 1 million, assuming a prevalence of 2000 patients with RA under the age of 70 years, the number of candidates for TNF-targeted therapy would be 40 to 300, depending on the disease activity criteria. Stringent ESR and CRP criteria would lead to a major reduction in the number of eligible patients. These utilisation data imply annual drug costs in the range of $US 480,000 to $US 3,600,000 for TNF antagonists for RA per 1 million population. Further economic evaluations are needed to determine for which groups such treatment is warranted from a health economics perspective.

Adolescent↗

PubMed2000

[Should medical errors be avoided at any price?].

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Cost-Benefit Analysis↗

PubMed2000

[Meta-analyses--statistical alchemy of the 21st century?].

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Data Interpretation, Statistical↗

PubMed2000

[Saving billions with telemedicine--fact or fiction?].

BACKGROUND: Some claim that telemedicine technologies can save "billions" in health care expenditure. This study is a review of economic studies of telemedicine applications. MATERIAL AND METHODS: In economic evaluation resource use (costs) is compared to the health benefits generated. If telemedicine technologies have lower costs and equal or greater benefits than traditional methods, the former should be chosen. If telemedicine is more costly, but generates greater health benefits, society have to judge whether the benefits justify the costs. These issues are explored in cost-effectiveness and cost-utility analyses. We started off with a review published by the International Network of Agencies for Health Technology Assessment (INAHTA). We updated this review to December 1999 by searches in various databases. RESULTS: The INAHTA report included 19 economic analyses of telemedicine applications; in addition we identified 11 studies from last year. Three of the studies had been undertaken in Norway while the majority stemmed from North America. Only three studies made an assessment of health outcome while the others were various types of cost analyses. The majority of the studies were of low to moderate quality. Sixteen studies concluded that telemedicine was a cost-saver, three concluded opposite while the others had more "neutral" conclusions. INTERPRETATION: Telemedicine technologies can save costs, but their impact on health outcome is largely unknown. Whether a specific technology is a cost-saver will depend on its type, the cost structure of the health care system, patient volume, and geographic factors. Taking into account the limitations of the studies, we conclude that the cost-effectiveness of telemedicine methods is not established. The claim that telemedicine can save "billions" is not backed by research.

Cost Savings↗

PubMed2000

[Evaluation by public health physicians of collaboration and workload within municipal health services].

BACKGROUND: We wanted to explore the quality and importance of the collaboration between public health physicians and selected groups of professionals and politicians. MATERIAL AND METHODS: The study was a cross-sectional survey based on self-administered questionnaires with closed questions. Response came from 218 public health doctors who worked in the municipalities throughout the study period (1988-91), and from 98 doctors who left public health during the same period (81% and 86% of the study populations respectively). RESULTS: The doctors reported good and important collaboration with other health professionals, but less good and less important collaboration with other professionals and with politicians. With increased administrative distance between the doctor and other municipality staff, the perceived quality of the collaboration decreased. INTERPRETATION: Closer collaboration between public health doctors and important decision makers in the municipality promotes job satisfaction among doctors and may reduce turn-over.

Cooperative Behavior↗

PubMed2000

[Health care systems in the Nordic countries--more similarities than differences?].

The aim of this paper is to explore similarities and differences of the Nordic health care systems. The analysis is based on a three-part model involving patients, providers and the financing third party. In all Nordic countries, about 80% of the funding come from public sources. In Iceland, central government is providing most of the health care services, while the county councils are central in Denmark, Norway and Sweden. In Finland, the municipalities are providing most of the health care. Salary is the only payment system for general practitioners in Iceland, while it is used for some GPs in Finland, Norway and Sweden. Capitation in combination with service fees is used for all Danish GPs and the majority of the Finnish, while various fee-for-service systems are used for the others. All Nordic countries had global hospital budgeting in the 1980s; since then, Finland, Norway and Sweden have implemented others systems, predominantly combinations of diagnosis-related group financing and global budgets. The amounts of resources devoted to health care are about the same in all five countries whether measured by the proportion of GDP devoted to health care, or by hospital beds or doctor/patient ratios. In monetary terms, Denmark, Iceland and Norway spend more than Finland and Sweden. Despite similar amounts of resources, they are quite differently used across the countries. Differences of a factor of two or more are observed for hip operations, gal bladder operations and pharmaceuticals. Danes and Finns are very satisfied with their health care system; the Swedes are not. All the Nordic countries have increased patient co-payments during the 1990s. Finnish patients may pay an extra free to get a one-bed room. Finland also has the greatest number of private hospitals. Despite all these differences, the Nordic health care systems are quite similar when seen in a global perspective.

Capitation Fee↗

PubMed2000

Target payments in primary care: effects on professional practice and health care outcomes.

BACKGROUND: The method by which physicians are paid may affect their professional practice. Although payment systems may be used to achieve policy objectives (e.g. improving quality of care, cost containment and recruitment to under-served areas), little is known about the effects of different payment systems in achieving these objectives. Target payments are a payment system which remunerate professionals only if they provide a minimum level of care. OBJECTIVES: To evaluate the impact of target payments on the professional practice of primary care physicians (PCPs) and health care outcomes. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register; the Cochrane Controlled Trials Register; MEDLINE (1966 to October 1997); BIDS EMBASE (1980 to October 1997); BIDS ISI (1981 to October 1997); EconLit (1969 to October 1997); HealthStar (1975 to October 1997) Helmis (1984 to October 1997); health economics discussion paper series of the Universities of York, Aberdeen, Sheffield, Bristol, Brunel, and McMaster; Swedish Institute of Health Economics; RAND corporation; and reference lists of articles. SELECTION CRITERIA: Randomised trials, controlled before and after studies and interrupted time series analyses of interventions comparing the impact of target payments to primary care professionals with alternative methods of payment, on patient outcomes, health services utilisation, health care costs, equity of care, and PCP satisfaction with working environment. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Two studies were included involving 149 practices. The use of target payments in the remuneration of PCPs was associated with improvements in immunisation rates, but the increase was statistically significant in only one of the two studies. REVIEWER'S CONCLUSIONS: The evidence from the studies identified in this review is not of sufficient quality or power to obtain a clear answer to the question as to whether target payment remuneration provides a method of improving primary health care. Additional efforts should be directed in evaluating changes in physicians' remuneration systems. Although it would not be difficult to design a randomised controlled trial to evaluate the impact of such payment systems, it would be difficult politically to conduct such trials.

Humans↗

PubMed2000

Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians.

BACKGROUND: It is widely believed that the method of payment of physicians may affect their clinical behaviour. Although payment systems may be used to achieve policy objectives (e.g. cost containment or improved quality of care), little is known about the effects of different payment systems in achieving these objectives. OBJECTIVES: To evaluate the impact of different methods of payment (capitation, salary, fee for service and mixed systems of payment) on the clinical behaviour of primary care physicians (PCPs). SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register; the Cochrane Controlled Trials Register; MEDLINE (1966 to October 1997); BIDS EMBASE (1980 to October 1997); BIDS ISI (1981 to October 1997); EconLit (1969 to October 1997); HealthStar (1975 to October 1997) Helmis (1984 to October 1997); health economics discussion paper series of the Universities of York, Aberdeen, Sheffield, Bristol, Brunel, and McMaster; Swedish Institute of Health Economics; RAND corporation; and reference lists of articles. SELECTION CRITERIA: Randomised trials, controlled before and after studies and interrupted time series analyses of interventions comparing the impact of capitation, salary, fee for service (FFS) and mixed systems of payment on primary care physician satisfaction with working environment; cost and quantity of care; type and pattern of care; equity of care; and patient health status and satisfaction. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Four studies were included involving 640 primary care physicians and more than 6400 patients. There was considerable variation in study setting and the range of outcomes measured. FFS resulted in more primary care visits/contacts, visits to specialists and diagnostic and curative services but fewer hospital referrals and repeat prescriptions compared with capitation. Compliance with a recommended number of visits was higher under FFS compared with capitation payment. FFS resulted in more patient visits, greater continuity of care, higher compliance with a recommended number of visits, but patients were less satisfied with access to their physician compared with salaried payment. REVIEWER'S CONCLUSIONS: It is noteworthy that so few studies met the inclusion criteria. There is some evidence to suggest that the method of payment of primary care physicians affects their behaviour, but the findings' generalisability is unknown. More evaluations of the effect of payment systems on PCP behaviour are needed, especially in terms of the relative impact of salary versus capitation payments.

Capitation Fee↗