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Biomedical subjects

S M McGhee

Publications and source records attributed to S M McGhee.

At least 19 recordsLinked to original sources
PubMed2001

Cost-effectiveness study on influenza prevention in Hong Kong.

INTRODUCTION: Recent studies confirm that influenza vaccination confers health benefits and reduces direct and indirect costs associated with the illness. However, these studies did not examine the situation in southern China, a hypothetical influenza epicentre for the emergence of pandemic influenza viruses. METHODS: Surveillance data were collected in Hong Kong in 1993/94 and used economic model was used to estimate the medical and social costs associated with influenza-like illness (ILI) and to predict the cost-effectiveness of implementing an influenza prevention programme. FINDINGS: The estimated ILI incidence was 110/1000. It was highest in those between 1 and 25 years of age while the rate of hospitalization was highest in the elderly. Influenza occurred throughout the study period, which was a mild influenza year. The model predicted more than 660000 ILI cases in a non-epidemic year, in which influenza B virus predominated, with an average ILI-associated cost of HK$283/case (US$36) and vaccination-associated costs of HK$74 (US$9.50) per vaccinated individual. CONCLUSION: The medical, social and monetary costs of ILI in Hong Kong were not observed to be large when compared with those in more developed countries where there is a clearly defined influenza season and recognized disease burden. From the perspective of a susceptible individual, the vaccine was cost-effective but from the perspective of society it was not, even with the most cost-effective strategy of targeting the elderly. However, if the vaccine were effective in controlling newly emerging and highly virulent strains, targeted vaccination programmes might be highly cost-effective.

Adolescent↗
PubMed2001

An evaluation of the use of hand-held computers for bedside nursing care.

Both keyboard-based and pen-based devices for data input have advantages and disadvantages. The suitability of the two input devices for entering different types of clinical data into computers remains unclear. This study aimed to determine the usefulness of different types of technology for nurses' data entry by comparing the utility and efficiency of keyboard and pen-based data input for clinical tasks. The study was conducted in the six largest specialties of an acute care hospital. In each specialty, several wards were randomly selected, and all nurses working in these wards were invited to participate. The input prototype was designed according to the type of text that was to be entered into the system. Task 1 mainly consisted of structured data, Task 2 contained equal amount of structured and textual data, and Task 3 was mainly in textual form. Each nurse was asked to complete the three simulations of nursing records (Tasks 1, 2 and 3). Preliminary findings showed that nurses found the pen-based interface easier to use than the keyboard for completing Tasks 1 and 2, but not Task 3. In terms of accuracy, the nurses preferred the keyboard to the pen when the data were more structured. The pen-based device is not a panacea for all kinds of user interface, and more importantly, the choice of input device should depend on the amount of structured and textual data.

Data Collection↗
PubMed2001

Health risks during travel: a population-based study amongst the Hong Kong Chinese.

Between June 1998 and October 1998, a cross-sectional survey was carried out in Hong Kong on 369 Chinese residents who had travelled to mainland China or elsewhere overseas in the previous 12 months. The aim was to collect data on which intervention strategies to minimise travel-related illness among the public might be based. In interviews by telephone, information on travel-related health problems, factors related to such problems, and barriers in the acquisition of travel-health advice was gathered using a structured, pre-tested questionnaire. Most of the subjects had travelled to countries in the Asia-Pacific region, with mainland China as the most popular destination (44%), followed by Thailand (14%). Overall, 16% of the respondents had developed health (mainly alimentary and respiratory) problems during or after their travel, 8% had received pre-travel health advice but 59% reported taking some form of precaution against travel-related illness. Although only 12% had lost at least a day of work or travel because of their travel-related health problems, 40% perceived themselves at risk of future travel-related illness, and 68% said they were willing to pay for the prevention of travel-health problems. Younger travellers and those who perceived relatively few health risks in future travel were relatively more likely to have developed health problems. There appears to be a clear need to develop appropriate health-promotion strategies to reduce travel-health risks among the residents of Hong Kong and the rest of the Asia-Pacific region.

Adolescent↗
PubMed2001

Efficiency is dependent on the control of supply.

At a time when health care systems are undergoing reform, it is useful to review the causes of inefficiency in health care, along with potential solutions. Such solutions can affect suppliers (supply-side measures) or users of care (demand-side measures). This paper argues that to have an efficient health care system, supply-side measures must be implemented. Some examples of supply-side measures, with particular relevance to the Hong Kong situation, are discussed. By their nature, supply-side measures require government intervention. Only then, can allocative efficiency, as well as technical efficiency, be achieved. Once a health care system is operating efficiently, it is an easier task to determine whether the system requires more resources, either currently, or in the future.

Delivery of Health Care↗
PubMed2001

Cost-effectiveness analysis of applying the Cholesterol and Recurrent Events (CARE) study protocol in Hong Kong.

OBJECTIVE: To determine the cost-effectiveness of secondary prevention with pravastatin in Hong Kong patients with coronary heart disease and average cholesterol levels. DESIGN: Cost-effectiveness analysis based on published results of the CARE study. PATIENTS: Men and women post-myocardial infarction with average cholesterol levels. MAIN OUTCOME MEASURES: Cost-effectiveness analysis: cost per life saved, cost per fatal or non-fatal coronary event prevented, cost per procedure prevented, and cost per fatal or non-fatal stroke prevented. Cost-utility analysis: gross cost and net cost per quality-adjusted life year gained calculated using two alternative models. RESULTS: Cost per life saved or death prevented was HK$4,442,350 (non-discounted); cost per fatal or non-fatal cardiac event prevented HK$1,146,413; cost per procedure prevented HK$732,759; and cost per fatal or non-fatal stroke prevented HK$2,961,566. Net cost per quality adjusted life year gained was HK$73,218 and HK$65,280 non-discounted, respectively using the two alternative models. CONCLUSIONS: The results of this study can assist in prioritising the use of health care resources in Hong Kong but should be considered alongside the benefits and costs of alternative interventions for coronary heart disease.

Adult↗
PubMed2000

Environmental tobacco smoke exposure among police officers in Hong Kong.

CONTEXT: Few epidemiological studies have examined the relationship between chronic respiratory symptoms and exposure to environmental tobacco smoke (ETS) at work in adults, and none have shown clear dose-response relationships. OBJECTIVE: To examine the respiratory effects of ETS exposure at home and at work among never-smoking adults. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, self-administered questionnaire survey conducted in December 1995 and January 1996 among 4468 male and 728 female police officers in Hong Kong who were never-smokers. MAIN OUTCOME MEASURES: Respiratory symptoms and physician consultation in the previous 14 days for such symptoms by presence and amount of ETS exposure at work. RESULTS: Eighty percent of both men and women reported ETS exposure at work. Significant odds ratios (ORs) for respiratory symptoms were found among men with ETS exposure at work (for any respiratory symptoms, difference in absolute rate, 20.4%; OR, 2.33; 95% confidence interval [CI], 1.97-2.75; attributable risk, 57%) and physician consultation (difference in absolute rate, 4.5%; OR, 1.30; 95% CI, 1. 05-1.61; attributable risk, 23%). Trends were similar among women for any respiratory symptoms (difference in absolute rate, 15.4%; OR, 1.63; 95% CI, 1.04-2.56; attributable risk, 39%) and for physician consultation (difference in absolute rates, 2.8%; OR, 1.45; 95% CI, 0.87-2.41; attributable risk, 31%). Positive dose-response relationships with number of coworkers smoking nearby and amount of ETS exposure in the work place were found. CONCLUSIONS: This study provides further evidence of the serious health hazards associated with ETS exposure at work. The findings support a ban on smoking in the workplace to protect all workers in both developed and developing countries. JAMA. 2000;284:756-763

Adult↗
PubMed2000

Contract medicine arrangements in Hong Kong: an example of risk-bearing provider networks in an unregulated environment.

It is increasingly common in Hong Kong and elsewhere for employers to contract directly with physician networks to provide medical services to employees. These contracts are known in Hong Kong as contract medicine arrangements. In other countries and areas, managed care organizations are generally required by regulation or legislation to ensure that services of adequate quality are provided to patients who are locked in to network providers. There are no such requirements in Hong Kong and concerns have been raised about potential quality and cost trade-offs in contract medicine arrangements. Satisfaction surveys were sent to contract medicine enrollees in one large company in Hong Kong. The response rate was 30% and analysis of non-respondent data shows that respondents were representative of their group. Comparison of satisfaction using logistic regression showed that risk-bearing networks paid by capitation had consistently lower satisfaction ratings across all major dimensions including access, interpersonal care, communication with the doctor, choice of doctor, and outcomes. These findings suggest that quality, at least as perceived by the patient, may be lower in these networks. The issue is of concern in Asia where infrastructures and data systems are not well developed to adequately monitor quality of care or protect patient interests. This study highlights the need to structure pre-paid provider networks and managed care organizations so that quality of care is not compromised. At a time when managed care concepts are being applied throughout Asia, we believe attention needs to be drawn to this problem.

Community Networks↗
PubMed2000

Passive smoking at work: the short-term cost.

STUDY OBJECTIVE: To estimate the impact of passive smoking at work on use of health care services and absenteeism. DESIGN: Cross sectional survey. SETTING: A workforce in Hong Kong. PARTICIPANTS: 5142 never-smoking police officers in a total sample of 9926. MAIN RESULTS: A consistently strong association was found among men between length of time exposed to passive smoking at work and self reported consultations with a doctor, use of medicines and time off work. Results for women were similar but most were not statistically significant. CONCLUSIONS: The exposure of healthy adults to passive smoking at work is related to utilisation of health care services and extra time off work. This results in costs to the health services, to employers and to those exposed.

Absenteeism↗
PubMed1999

The application of a computerized problem-oriented medical record system and its impact on patient care.

The present computer system is the first of its kind based on problem-oriented medical record (POMR) design developed and operated in a hospital in Hong Kong. It went live in May 1996 with two workstations installed in the medical record office (MRO). Doctors have no direct access to it. They dictate medical notes on tape using either structured or free dictation format, and the tape is brought to the MRO for processing. The principal aim of this study is to study the impact of the computer system on patient care. Retrospective review of medical records and in-depth interviews were conducted to study the quality of medical records and doctor's opinions. A total of 400 manual and 398 computerized patient records were randomly selected for review. The completeness of the manual notes and computerized notes using free dictation format were about the same. The computerized records using structured dictation format may be more complete than those using free dictation format. The in-depth interview shows that most doctors preferred structured medical records but some disagreed with too detailed a level of structuring. They were not familiar with POMR, and some even thought that breaking down the record by problem was not possible. All felt that the present system would not directly affect patient care, but some said that it would facilitate research. In conclusion, since the utility of the information mainly depends on the doctors' efforts, commitment to the agreed structure and subsequent routine audit of computerized medical records are essential to make sure that diagnoses are accurately coded and information is correctly structured.

Attitude of Health Personnel↗
PubMed1999

Influenza surveillance in Hong Kong: results of a trial Physician Sentinel Programme.

The H5N1 influenza outbreak in Hong Kong at the end of 1997 emphasised the need for viral surveillance so that new influenza epidemics can be foreseen. Although South China is regarded as the regional epicentre of influenza epidemics, there has been little epidemiological documentation of the disease there. A sentinel physician network was established in Hong Kong in 1993 to estimate the incidence, severity, and seasonality of influenza-like illnesses and to provide data on the demand for health care that is related to this illness. Influenza-like illness occurred throughout the year of the survey, peaking from March through May and accounting for 15% of doctor visits. The incidence was approximately 117 in 1000 patients and was greatest among children aged 1 to 4 years. Ongoing physician surveillance with appropriate coverage of the general population supported by a laboratory virus isolation capability may help control future influenza outbreaks.

Journal Article↗
PubMed1995

Shared care.

Explore the source record for details and available documents.

Ambulatory Care↗
PubMed1995

Delivery of care for hypertension.

To overcome shortcomings in the delivery of care for hypertension various approaches have been developed including a system whereby care of hypertension is shared in a formal manner between general practitioners and hospital specialists. The feasibility, acceptability and cost-effectiveness of a computerised model of shared care were investigated in three matched groups of patients attending hypertension clinics in Glasgow. Glasgow Blood Pressure Clinic attenders considered suitable for shared care by their consultants were randomised to shared care (n = 277) or continued clinic follow-up; a further control group (n = 277) was identified from an independent nurse-practitioner clinic. After 2 years of follow-up, feasibility was estimated by the proportion of patients who had undergone an adequate review (blood pressure, serum creatinine and electrocardiograph); acceptability to general practitioners and patients was assessed by questionnaires; cost-effectiveness was calculated as the cost (to National Health Service and patient) per adequate review. The drop-out rate for shared care over 2 years was 3% compared with 14% for the outpatient clinic and 9% for the nurse-practitioner clinic. In year 2, rates of adequate reviews were 82%, 52% and 75%, respectively. Blood pressure control was similar in the groups. Of 297 general practitioners invited to participate, 85% agreed and 68% wished to continue participation after 2 years. About 50% of shared care patients preferred this method of follow-up compared with their earlier experience of clinic attendance. Shared care was more cost-effective than either conventional or nurse-practitioner clinic follow-up, especially with respect to cost to the patient; costs per adequate review (pound sterling) were 28.96, 50.55 and 30.95, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Delivery of Health Care↗
PubMed1994

Coordinating and standardizing long-term care: evaluation of the west of Scotland shared-care scheme for hypertension.

BACKGROUND: The long-term management of patients with chronic conditions such as hypertension presents problems for the health services. Shared care addresses these by coordinating care and defining responsibilities. AIM: This study set out to investigate the feasibility, acceptability and cost effectiveness of shared general practitioner-hospital care for well-controlled hypertensive patients in an urban area by comparing three matched groups of patients. METHOD: A total of 554 outpatient clinic attenders, considered suitable for shared care by their consultant, were randomly allocated to shared care or follow up in the outpatient clinic; a third group of 277 patients was selected from a nurse practitioner clinic. Main outcome measures were the proportion of patients in the second year of follow up who had undergone a complete review (blood pressure measurement, serum creatinine level result and electrocardiograph report), acceptability to patients and general practitioners as assessed by questionnaire, and cost per complete review in year two (National Health Service and patient costs). RESULTS: After two years 220 (82%) shared care patients had had a complete review compared with 146 (54%) outpatient clinic attenders and 202 (75%) nurse practitioner clinic attenders. Blood pressure control was similar in each group. Of 297 general practitioners invited, 85% wished to participate in the study; 61% of questionnaire respondents subsequently wanted shared care to continue while 25% were unsure. Half of the patients receiving shared care preferred this method of follow up. The rank order of cost-effectiveness ratios was shared care, nurse practitioner care and conventional outpatient care, relative differences being most marked when only patient costs were considered. CONCLUSION: Shared care for hypertension is feasible in an urban setting, acceptable to the majority of participants and is a cost-effective method of long-term follow up.

Chronic Disease↗
PubMed1993

Incidence of and mortality from cancer in hypertensive patients.

OBJECTIVES: To assess incidence of and mortality from cancer in hypertensive patients taking atenolol, comparing the findings with two control populations and with hypertensive patients taking other drugs. DESIGN: Retrospective analysis of patients first seen in the Glasgow Blood Pressure Clinic between 1972 and 1990. Patients' records were linked with the registrar general's data for information on mortality and with the West of Scotland Cancer Registry for information on incident and fatal cancers. Cancers were compared in patients and controls and in patients taking atenolol, beta blockers other than atenolol, and hypotensive drugs other than beta blockers. SUBJECTS: 6528 male and female patients providing 54,355 years of follow up. SETTING: Hypertension clinic in Glasgow. MAIN OUTCOME MEASURES: Observed numbers of cancers in clinic patients were compared with expected numbers derived from cancer rates in two control populations adjusted for age, sex, and time period of data collection. RESULTS: Cancer mortality was not significantly different in clinic patients as a whole and controls. Incident and fatal cancers were not significantly increased in male or female patients taking atenolol. Cancer incidence did not rise in the clinic after a large increase in prescriptions for atenolol after 1976. CONCLUSION: This analysis does not suggest a link between atenolol and cancer.

Age Factors↗
PubMed1993

Patient knowledge about diuretic prescription.

1. In order to assess the prevalence and knowledge of diuretic prescription, 203 consecutive admissions to three general medical wards were interviewed. Additional information was collected on forms sent to general practitioners and hospital doctors responsible for each patient. 2. Prevalence of diuretic use was 31% (63 patients); other drugs only, 60% (121 patients); no drugs, 9% (19 patients). Patients gave an incorrect indication for 31% of diuretics prescribed, but for only 16% of other drugs (P < 0.005). 3. Compared with patients not taking diuretics, diuretic-users were older (mean +/- s.d., 70 years +/- 14 vs 54 +/- 20, P < 0.001), had lower abbreviated mental test scores (AMT scores seven or less, 21% vs 9%, chi 2 = 3.48, P = 0.06) and were prescribed more drugs (5.0 +/- 2.4 vs 3.2 +/- 2.0, P < 0.001). Increasing age and decreasing AMT score were associated with poorer knowledge of drug indication, but these factors could not explain fully the poor understanding of diuretic prescription. 4. Accurate recall of dose was the same for diuretics and for other agents. Knowledge about medication was not different if the general practitioner or hospital initiated treatment.

Adolescent↗