Biomedical subjects

J Beecham

Publications and source records attributed to J Beecham.

At least 37 records · Page 2Linked to original sources

PubMed1997

The cost-effectiveness of community care for adults with learning disabilities leaving long-stay hospital in Northern Ireland.

Among the many questions concerning the replacement of long-stay hospital services with community-based care are those of cost and cost-effectiveness. Is community care more expensive than hospital care? Are levels of expenditure associated with clients' needs and changes in their well-being? By following a cohort of people discharged from seven long-stay hospitals in Northern Ireland, this wide-ranging evaluation was able to address such cost-related questions. Although nearly three-quarters of the sample were living in private sector residential or nursing homes, a six-fold variation in the total costs of support was found. However, at the mean, community care was less expensive than hospital care. For only ten people in our sample of 192 clients did the costs of community care exceed the average cost of long-stay inpatient care. Multivariate analysis revealed that the costs of community care 'packages' were linked to some client needs, but higher spending was not unequivocally associated with better client outcomes. Care in the community is reasonably cost-effective in Northern Ireland when compared with long-term hospital care. However, there is a case for increasing expenditure on community care for people with learning difficulties, to increase use of services provided outside the accommodation and enhance staffing arrangements within the accommodation facilities. Distributing resources appropriately and targeting resources on priority needs through coordination will hep to continue to improve clients' quality of life.

Community Health Services↗

PubMed1997

The use of a case register to evaluate the costs of psychiatric care.

The aim of this study was to show the usefulness of adding cost information to a routine data collection provided by a case register for analysing the association between patients' characteristics and the direct costs of the psychiatric care actually provided. All patients (n = 706) who in 1992 had at least one contact with services which report to the South Verona psychiatric case register and who received an ICD-10 diagnosis were included in the study. The costs of specialist psychiatric care provided during the 365 days following the first contact in 1992 were calculated using a unit cost list. A bespoke software, linked to the case register, was designed to produce the individual information on costs directly. For each patient, costs were categorized as in-patient costs, sheltered accommodation costs, day-care costs, out-patient costs and community costs. All costs, grouped by service type, were found to differ significantly (P < 0.01) between diagnostic groups (affective disorders, neurotic and somatoform disorders, schizophrenia and related disorders, and other diagnoses). The multivariate analyses showed that costs are significantly higher for patients with a diagnosis of schizophrenia and related disorders than for patients belonging to the other diagnostic groups. However, only 6% of the variation could be explained by diagnostic group alone. On the other hand, between 40 and 50% of the costs of mental health care was predicted by patients' personal characteristics and other measures recorded on the case register. The results of the present study show that, where service use is monitored regularly, the base from which decisions on community provision and placement are made can be informed by careful analysis of routinely or easily available data on direct costs.

Adolescent↗

PubMed1997

[Lessons in transferring resources: the system of fees per patient].

Dowries can be defined as lump sum payments or continuing grants which health authorities make between themselves and to local authorities or voluntary organisations in respect of people with severe mental disorders to be cared for in the community instead of in hospital. This paper has three aims. First to describe how dowries and other processes were set up to encourage the closure of two psychiatric hospitals in England. The broader financing context for mental health care (prior to the reforms in England engendered by the NHS and Community Care Act, 1990) is also described and shows some similarities to the current arrangements in Québec. Second, we abstract some information from a long-running evaluation of the reprovision programme to look at the type of services used in the community by former long-stay patients of these two hospitals and the comparative costs of hospital and community-based care. After leaving hospital, former patients require considerable inputs from other health and social care services; any development of community care for these patients should at the least mirror the facilities provided on the hospital campus. The final aim of this paper is to examine the extent to which this English system of budget reallocation ("dowries") can be employed in Québec to further reduce long-stay hospital provision. There are many similarities between the health and social care systems of the two countries but there are also organisational and political differences. It is not sensible, therefore, to transfer the English budget reallocation to Québec wholesale, but we suggest that there are important process and implementation issues which can guide the development of financing mechanisms in Québec.

Fee-for-Service Plans↗

PubMed1996

One and two year outcomes for adults with learning disabilities discharged to the community.

BACKGROUND: Long-stay patients with learning disabilities (n = 214) were assessed in hospital and 12 and 24 months after discharge in order to examine the effects of relocation. METHOD: Each resident acted as his/her own control in a prospective repeated-measures design. Skills and behavioural problems were assessed by keyworkers. Self-perceived quality of life was obtained during interviews with researchers who also completed an environmental checklist of the residents' accommodation. RESULTS: There was little or no change in people's low pre-discharge skill levels. Certain aspects of problem behaviour improved after 12 months, although socially unacceptable behaviour increased slightly. People were less depressed (P < or = 0.01) 12 months after discharge (N = 119) and were more satisfied (P < or = 0.05) with their new 'homes' (n = 108). There were few changes in the pattern of activities or the social networks of people 12 months later. Little or no further change in outcomes was reported 24 months after discharge. CONCLUSIONS: The implementation of the deinstitutionalisation policy in Northern Ireland has been limited by the predominance of residential and nursing homes and the lack of 'ordinary' accommodation. There is a need for purchasers and providers to give more attention to ways in which the principles of normalisation could be incorporated in the process of contracting and delivering services.

Activities of Daily Living↗

PubMed1996

A review of problems of universal access to prenatal care.

Despite the preponderance of evidence that points to the advantages of prenatal care, the number of women who receive adequate prenatal care has remained at a plateau or actually decreased since 1980. Over the past decades, many demographic and structural barriers to receiving prenatal care have been identified; financial obstacles have been cited as the major barrier. The assumption has generally been made that if financial barriers to prenatal care were removed, problems with access to prenatal care would be solved. Recent appreciation of the significance of nonfinancial barriers to prenatal care has resulted in recognition that even if all financial barriers were removed, there would still be access problems.

Attitude to Health↗

PubMed1995

Schizophrenia: shifting the balance of care.

Schizophrenia poses a major challenge to policy makers in health and social care in England. As deinstitutionalisation has progressed, public concern about people with the condition has increased owing to a small number of public incidents. This paper describes the overall balance of care or support for people with schizophrenia, particularly between different settings and the services received. Using these data we are able to provide a basic estimate of the current resource implications of schizophrenia care in England with respect to different public sector agencies, the voluntary sector and service users and their families. The targeting of public sector resources between different care settings is also considered. The discussion suggests that resources are still targeted at existing care facilities rather than on individuals, and examines the roles of individual care agencies and the relationships between them. Four broad resource guidelines are suggested that could improve the effective use of resources for schizophrenia care.

Health Care Costs↗

PubMed1995

Community mental health care for former hospital in-patients. Predicting costs from needs and diagnoses.

BACKGROUND: In the UK the replacement of long-term in-patient care with community-based support has been part of central government health policy for many years. One of the challenges of implementing such a policy is the prediction of support and service needs in the community and the associated costs. METHOD: Using research data from north London analyses were undertaken to examine the associations between service use and costs in the community and the characteristics of hospital in-patients. RESULTS: Although clinical diagnosis was not a useful predictor of either service utilisation or costs, more than a third of the variation in community care costs could be explained by symptoms, behaviour and personal characteristics at least one year earlier.

Adult↗

PubMed1994

The costs of accommodation and care. Community provision for former long-stay psychiatric hospital patients.

The development of community services to replace two long-stay psychiatric hospitals in the North East Thames Health Authority region of the UK has been the subject of a research programme since 1985. The economic evaluation is conducted by the Personal Social Services Research Unit; research results relating to the first five cohorts of hospital leavers are reported in this paper. When followed up 1 year after discharge, almost half of the sample were living in highly supported residential care units, most of which were managed by district health authorities. More than 40 services provided outside the accommodation facility were used by clients and, although contact with certain professionals remained constant, some changes in service use over time were marked. The average total cost of community care for this group was 493 pounds per week (1992-93 prices), accommodation facility costs comprising approximately 85% of the total. In the new service configuration, district health authorities fund half of the costs of supporting the hospital leavers, 50% less than when they funded long-stay hospital placements. The rest of the funding burden is borne by a range of agencies, resulting in pressure on budgets and staff case loads.

Adult↗

PubMed1994

Dietary advice based on the glycaemic index improves dietary profile and metabolic control in type 2 diabetic patients.

The effect of dietary education incorporating information about the glycaemic index of carbohydrate was tested against standard dietary advice in a randomized controlled study in 51 newly diagnosed patients with Type 2 diabetes treated as out-patients with diet only over a 12-week study period. Outcome was assessed by dietary analysis of 3-day diet diaries, fasting blood glucose, fructosamine, total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides. Dietary analysis indicated that the group who received low glycaemic advice not only had a significantly lower calculated mean diet glycaemic index intake (77 +/- 1.1 (SEM) vs 82 +/- 1%, p < 0.01) but also had a lower fat intake (25 +/- 1 vs 32 +/- 2% of total energy day-1, p < 0.001), a higher carbohydrate intake (49 +/- 2% vs 44 +/- 1% of total energy day-1, p < 0.05) and non-starch polysaccharide intake (21 +/- 1.5 vs 14 +/- 1 g, p < 0.01). There was a significantly greater within-group fall in fructosamine (3.8 +/- 0.2 to 3.2 +/- 0.2 mmol-1 vs 3.6 +/- 0.2 to 3.6 +/- 0.3 mmol-1, p < 0.05) and cholesterol (6.1 +/- 0.3 to 5.4 +/- 0.3 mmol-1 vs. 5.6 +/- 0.2 to 5.3 +/- 0.1 mmol-1, p < 0.05) in the low glycaemic index group.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗

PubMed1994

Service use and costs of home-based versus hospital-based care for people with serious mental illness.

BACKGROUND: The Daily Living Programme (DLP) offered problem-oriented, home-based care for people aged 17-64 with severe mental illness facing emergency admission to the Bethlem-Maudsley Hospital. The multidisciplinary DLP team acted as direct provider and link with other services. Each patient had a key worker. Cost-effectiveness was assessed. METHOD: The comprehensive costs of DLP and standard in-patient care were compared within a randomised controlled trial. Cost measures ranged over all service inputs and living expenses. The costs of informal care and lost employment were also considered. Assessments of service use, costs and outcomes were conducted at referral, 4, 11 and 20 months. RESULTS: The DLP was significantly less costly than standard treatment in both short and medium term (P = 0.000). Cost savings accrued almost exclusively to the NHS, with no other agency's costs being higher. CONCLUSIONS: Coupled with mildly encouraging outcome results over the 20 month period, the DLP was clearly cost-effective in this medium term.

Absenteeism↗

PubMed1994

Community psychiatric nurse teams: cost-effectiveness of intensive support versus generic care.

BACKGROUND: Part of the community psychiatric nurse (CPN) service was reorganised into a community support team (CST), with staff acting as case managers. An economic evaluation ran parallel to the comparison with generic CPN care. METHOD: Eighty-two clients were randomly allocated to experimental and control groups. Costs were comprehensively measured over a pre-referral period (three months), and then at 6, 12, and 18 months. RESULTS: The economic evaluation found a cost difference between the groups. Generic group costs averaged 89 pounds per patient per week more than CST group costs. The difference was only significant for the first six months. Changes in the burden of cost across agencies were observed. CONCLUSIONS: Although CPN inputs and costs were higher for the CST group, there was a significant short-term reduction in total cost. Beyond the short term, the CST did not confer cost or cost-effectiveness advantages.

Adult↗

PubMed1993

Reduced list costings: examination of an informed short cut in mental health research.

The demands for cost information in health services are many and various but the supply of such information is less than might be expected and is compounded by the expense of undertaking costs research. This paper examines a short cut to mental health research which, if certain rules and conventions are obeyed, can still produce valid costs data. By distilling evidence from previous research a reduced list of services is identified which accounts for the greater part of the total costs of care packages. By concentrating on these key services, 94 per cent of the total costs of care were predicted for discharged long-stay patients and no less than 91 per cent for people supported by community psychiatric nurses. The results suggest that this reduced list method can work well where the aim is to obtain broad orders of magnitude for the costs of care. By reducing the resources required for research, the approach could expand the current costs information base and move towards meeting the pressing practice demands for costs data.

Combined Modality Therapy↗

PubMed1991

Costs, needs, and outcomes.

There is a tendency in discussions of mental health policy and psychiatric practice to talk of the cost of a treatment, facility, or policy and to ignore variations. These variations can be considerable, which alone suggests they should not be overlooked, and they can be explored and perhaps exploited to improve the delivery of services. This article describes a theoretical framework for the examination of cost differences, applies it to a particularly rich data base on people with long-term mental health problems moving from hospital to the community, and uses the empirical evidence to address four key policy questions. The study finds encouragingly strong positive associations between costs, needs, and outcomes. It also uncovers significant cost-effectiveness differences between the public and private sectors and between community accommodation types.

Adult↗

PubMed1991

Phase II trial of cisplatin as first-line chemotherapy in patients with advanced or recurrent uterine sarcomas: a Gynecologic Oncology Group study.

Ninety-six assessable patients with advanced or recurrent uterine sarcomas, who were no longer controllable with surgery and radiotherapy, and who had not received prior chemotherapy were treated with cisplatin 50 mg/m2 intravenously every 3 weeks. Of 63 cases with mixed mesodermal tumors, five complete responses (CRs; 8%) and seven partial responses (PRs; 11%) were observed (95% confidence interval [CI], 10.3% to 30.9%). Of 33 patients with leiomyosarcoma, one PR (3%) was observed (95% CI, .1% to 15.8%). Adverse effects included leukopenia (23%), nausea and vomiting (73%), and mild azotemia (42%). No patients experienced life-threatening toxicity. Cisplatin has definite activity when given at the dose and schedule that we tested for patients with mixed mesodermal sarcomas who have not received prior chemotherapy, but has little activity in patients with leiomyosarcoma.

Adult↗

PubMed1990

A randomized trial of cyclophosphamide, doxorubicin, and cisplatin with or without bacillus Calmette-Guerin in patients with suboptimal stage III and IV ovarian cancer: a Gynecologic Oncology Group study.

Four hundred and eleven evaluable patients with suboptimal (greater than 1 cm residual) stage III and IV and recurrent ovarian cancer after surgical exploration and tumor debulking were prospectively randomized to receive cyclophosphamide, doxorubicin, and cisplatin (CAP) with or without bacillus Calmette-Guerin (BCG). Therapy was planned for eight courses with the BCG to be given by the sacrification technique on Days 8 and 15 of each course. The addition of BCG did not improve response rate, progression-free interval (PFI), or survival. In a multivariate analysis prognostic factors significantly favorable for survival include nonmeasurable disease and young age. Those patients having tumor with a mucinous histology had poorer survival and PFI than patients with tumors composed of other cell types.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1990

Costing mental health services.

In this paper four principal topics are addressed: (a) the policy and political contexts in which demands arise for cost information; (b) the nature and phasing of those demands; (c) the basic rules of empirical costs research for meeting those demands; and (d) concomitant implications for the design, execution and interpretation of their research. Mental health care policy or practice changes which ignore costs, or which embody cost information without obeying or recognizing the four basic rules, can only be of dubious validity, or can only be used to answer a limited range of questions. But, as the illustrative studies show, it need not be an horrendous, or ideologically compromising or scientifically complex task to add a cost dimension to the evaluation of mental health services. There are enough examples in the literature of bad costs research to demonstrate that it is not as simple as some people think, but there are also enough examples of good research to encourage further attempts.

Community Mental Health Services↗

PubMed1990

Mitoxantrone in the treatment of advanced uterine sarcoma. A phase II trial of the Gynecologic Oncology Group.

Twenty-nine evaluable patients with metastatic or recurrent leiomyosarcoma or malignant mixed mesodermal tumors of the uterus were treated with mitoxantrone 12 mg/m2 every 3 weeks. All patients had good performance status and measurable disease. Nineteen had prior chemotherapy but only five had prior doxorubicin. No complete or partial responses were seen in 12 patients with leiomyosarcoma (95% confidence interval for a response of 0-22%) or 17 patients with mixed mesodermal tumors (95% confidence interval for a response of 0-16%). The median progression-free interval for patients with leiomyosarcoma was 1.4 months and the median survival 4.1 months. The median progression-free interval for patients with mixed mesodermal was 1.4 months and median survival 4.0 months. Mitoxantrone does not appear to be very active against leiomyosarcoma or mixed mesodermal tumors as second-line therapy.

Adult↗

PubMed1990

The TAPS project. 3: Predicting the community costs of closing psychiatric hospitals.

The planning of long-term care in the community as an alternative to in-patient care requires accurate information on the likely expense of altering the balance of provision. Unfortunately, as very few long-stay psychiatric hospitals have yet closed, the planning of these resource requirements has had to proceed in a vacuum. By examining the costs of community reprovision for the first 136 people to leave Claybury and Friern Hospitals, a prediction equation has been estimated from existing data which links the hospital-assessed characteristics (including psychiatric symptoms and behavioural problems) of these people to the subsequent cost of community care. About a third of the observed variation in these costs can be explained statistically by these 'baseline' characteristics. However, the first cohorts exhibit fewer behavioural problems and other symptoms of mental illness, they have been in hospital for shorter lengths of time, and they are younger. The prediction equation for the leavers is thus used to extrapolate community costs for those hospital residents yet to leave. It is found that community costs are lower than hospital costs, not just for the first cohorts of leavers, but for the full populations of the two hospitals scheduled to close.

Adult↗