Suchergebnisse

Abstract Background To plan integrated care at end of life for people with either heart failure or lung disease, we used a case conference between the patient's general practitioner (GP), specialist services and a palliative care consultant physician. This intervention significantly reduced hospitalisations and emergency department visits. This paper reports estimates of potential savings of reduced hospitalisation through end of life case conferences in a pilot study. Methods We used Australian Refined Diagnosis Related Group codes to obtain data on hospitalisations and costs. The Australian health system is a federation: the national government is responsible for funding community based care, while state and territory governments fund public hospitals. There were 35 case conferences for patients with end stage heart failure or lung disease, who were patients of the public hospital system, involving 30 GPs in a regional health district. Results The annualised total cost per patient was AUD$90,060 before CC and AUD$11,841 after CC. The mean per person cost saving was AUD$41,023 ($25,274 excluding one service utilisation outlier). For every 100 patients with end of life heart failure and lung disease each year, the case conferencing intervention would save AUD$4.1 million (AUD$2.5 million excluding one service utilisation outlier). Conclusions Multidisciplinary case conferences that promote integrated care among specialists and GPs resulted in substantial cost savings while providing care. Cost shifting between national and state or territory governments may impede implementation of this successful health service intervention. An integrated model such as ours is very relevant to initiatives to reform national health care. Trial registration Australian and New Zealand Controlled Trials Register ACTRN12613001377729 : Registered 16/12/2013.

Jia, K., Fleiter, J., King, M., Sheehan, M., Ma, W., & Zhang, J. (2015). Knowledge and behaviors of drunk-driving offenders in Guangzhou, China. The International Journal Of Alcohol And Drug Research, 4(2), 151-158. doi:http://dx.doi.org/10.7895/ijadr.v4i2.203Aims: To better understand the knowledge and behaviors of drunk-driving offenders relating to alcohol use and driving in thecontext of recently amended Chinese legislation, and to investigate the involvement of alcohol-use disorders.Design: The study was a cross-sectional survey conducted in 2012.Setting and participants: Data were collected at a local jail and 101 participants were recruited while in detention.Measures: Questionnaire items examined demographic characteristics as well as practices and knowledge relating to alcohol useand driving. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess hazardous drinking levels.Findings: Knowledge about the two legal limits for "drink driving" and for "drunk driving" was low, at 28.3% and 41.4%,respectively. AUDIT scores indicated that a substantial proportion of the offenders had high levels of alcohol-use disorders.Higher AUDIT scores were found among the least experienced drivers, those who lacked knowledge about the legal limits, andrecidivist drunk drivers.Conclusions: Limited awareness of legal alcohol limits might contribute to offending; high AUDIT scores suggest thathazardous drinking levels may also contribute. This study provides important information to assist in refining communityeducation and prevention efforts.

OBJECTIVE: To explore factors behind inpatient admissions by high-cost users (HCUs) in pre-end-stage chronic kidney disease (CKD). DESIGN: Retrospective analysis of CKD.QLD Registry and hospital admissions of the Queensland Government Department of Health recorded between 1 July 2011 and 30 June 2016. SETTING: Queensland public and private hospitals. PARTICIPANTS: 5096 individuals with CKD who consented to the CKD.QLD Registry via 1 of 11 participating sites. MAIN OUTCOMES: Associations of HCU status with patient characteristics, pathways and diagnoses behind hospital admissions at 12 months. RESULTS: Age, advanced CKD, primary renal diagnosis, cardiovascular disease and hypertension were predictors of the high-cost outcome. HCUs were more likely than non-HCUs to be admitted by means of episode change (relative risk: 5.21; 95% CI 5.02 to 5.39), 30-day readmission (2.19; 2.13 to 2.25), scheduled readmission (1.29; 1.11 to 1.46) and emergency (1.07; 1.02 to 1.13), for diagnoses of the nervous (1.94; 1.74 to 2.15), circulatory (1.24; 1.14 to 1.34) and respiratory (1.2; 1.03 to 1.37) systems and other factors influencing health status (1.92; 1.74 to 2.09). CONCLUSIONS: The high relevance of episode change and other factors influencing health status revealed that a substantial part of excess demand for inpatient care was associated with discordant conditions often linked to frailty, decline in psychological health and social vulnerability. This suggests that multidisciplinary models of care that aim to manage discordant comorbidities and address psychosocial determinants of health, such as renal supportive care, may play an important role in reducing inpatient admissions in this population.