Abstract:
AIMS:Low molecular weight heparins (LMWH) permit safe and effective treatment of uncomplicated deep venous thrombosis (DVT) at home. The aim of this study was to evaluate the cost minimization, cost shifting and patient satisfaction associated with at-home DVT treatment using the LMWH enoxaparin, compared to standard inpatient care in an Australian health-care setting. METHODS:Subjects presenting with a principal diagnosis of uncomplicated DVT to the Emergency Department at The Queen Elizabeth Hospital, Adelaide, were recruited over 1997-1999. Costs to the hospital, to Federal funding (Medicare) and to patients were tracked prospectively, and satisfaction was also measured. Subjects were matched to historical controls (1994-1997) for age, gender and level of comorbidity (same or lower) by two medical officers who were blinded to costs. Control costs were obtained using the clinical costing system Trendstar, and adjusted for consumer price index. RESULTS:Twenty-eight subjects participated in the at-home programme. Of these, 26 were discharged without any inpatient admission (including one who agreed to self-injection) and two were admitted briefly. Audit demonstrated that only 29% of eligible subjects were managed at home. Mean (SEM) total treatment cost was $756 (76) per patient for at-home, and $2,208 (146) for controls. Minimal cost shifts to patients and to Medicare occurred, and satisfaction was high. CONCLUSIONS:At-home treatment of uncomplicated DVT using enoxaparin in an Australian metropolitan setting provides effective cost minimization, with little cost-shifting. Our cost minimisation estimates are conservative as most at-home subjects received enoxaparin twice daily (now used once per day) and controls had at least as high comorbidity. However, uptake of the at-home programme was limited.
journal_name
Intern Med Jjournal_title
Internal medicine journalauthors
Smith BJ,Weekley JS,Pilotto L,Howe T,Beven Rkeywords:
subject
Has Abstractpub_date
2002-01-01 00:00:00pages
29-34issue
1-2eissn
1444-0903issn
1445-5994journal_volume
32pub_type
杂志文章abstract:BACKGROUND:Timor-Leste is one of the poorest countries in the world. The East Timor Hearts Fund is a charitable organisation involving Australian cardiologists providing outreach screening and access to cardiac interventions. AIMS:To assess ten years of clinical volume, demographics and patient outcomes. Our intention...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/imj.14411
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Tuberculous lymphadenitis is the commonest form of extrapulmonary tuberculosis. However, the optimal approach to diagnosis, employing biopsy by either fine needle aspiration (FNA) or surgical excision, remains uncertain. AIMS:To evaluate the diagnostic value of biopsy using each of the component diagnostic ...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/j.1445-5994.2012.02748.x
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:Ageism among health professionals is increasingly recognized, but few studies investigated hospital doctors' attitudes towards older people. The aims of this study were to investigate hospital doctors' attitudes towards older people and to determine whether factors, which were identified in studies on other ...
journal_title:Internal medicine journal
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1445-5994.2009.02140.x
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:There are several treatment modalities available for diabetes; however, the effects of the different medications on coronary artery disease are less understood. The purpose of this study was to evaluate the correlation of insulin-sensitizing therapy with the outcome of stress myocardial perfusion testing and...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/j.1445-5994.2007.01480.x
更新日期:2008-04-01 00:00:00
abstract::The burden and consequences of skin infections for remote living indigenous people are high. While skin infections are recognised as an antecedent to conditions such as acute rheumatic fever in children, data are limited concerning skin infection complications such as cellulitis, abscesses and osteomyelitis in older c...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/imj.14858
更新日期:2020-06-01 00:00:00
abstract::The adverse fallout following the Royal Australasian College of Physician's (RACP) introduction to computer-based testing that was disrupted in the February 2018 examinations, aroused great sympathy for the candidates and perhaps rekindled worrying memories by the College fellowship. The RACP's entrance procedures hav...
journal_title:Internal medicine journal
pub_type: 历史文章,杂志文章
doi:10.1111/imj.14206
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Glomerular M-type phospholipase A2 receptor (PLA2 R) is important for diagnosing idiopathic membranous nephropathy (IMN). The relation between glomerular PLA2 R expression and response to treatment remains to be explored. AIMS:We conducted the study to explore the positive rate and clinical significance of ...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/imj.13233
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:The thiopurines azathioprine and 6-mercaptopurine are recommended for maintenance of remission in inflammatory bowel disease (IBD). Measurement of concentrations of the metabolites 6-thioguanine nucleotide and 6-methylmercaptopurine helps delineate interindividual variation in metabolism that may underlie va...
journal_title:Internal medicine journal
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1445-5994.2012.02936.x
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:Poor lung function is a predictor of future all-cause mortality. In Australia, respiratory diseases are particularly prevalent among the indigenous population, especially in remote communities. However, there are little published pulmonary function tests' (PFT) data of remote-based adult indigenous patients....
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/imj.14112
更新日期:2019-02-01 00:00:00
abstract::These consensus guidelines provide recommendations for the safe handling of monoclonal antibodies. Definitive recommendations are given for the minimum safe handling requirements to protect healthcare personnel. The seven recommendations cover: (i) appropriate determinants for evaluating occupational exposure risk; (i...
journal_title:Internal medicine journal
pub_type: 杂志文章,实务指引
doi:10.1111/imj.12564
更新日期:2014-10-01 00:00:00
abstract::To improve organ donation processes and outcomes, many Australian hospitals have introduced donation after cardiac death (DCD) following the 2010 publication of the National Protocol for DCD. As emergency clinicians play a significant role in identifying potential DCD donors, it is critical to assess their support and...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/imj.12181
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:Many patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have type 2 respiratory failure (T2RF). Often arterial blood gases are not performed and correlation with venous blood gases (VBG) is controversial. The venous pH and bicarbonate (HCO3 ) are useful, but VBG pCO2 (PvCO2 )...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/imj.14186
更新日期:2019-07-01 00:00:00
abstract::A 75-year-old man of Fijian-Indian extraction complained of a 3-year history of progressive right knee pain and stiffness which were limiting his mobility. On examination, multiple hard nodules were palpable in the popliteal fossa and along the path of the quadriceps tendon. The joint line was not tender, knee flexion...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1046/j.1445-5994.2002.00260.x
更新日期:2002-08-01 00:00:00
abstract::Thrombotic microangiopathy (TMA) is a potentially fatal complication in solid organ and bone marrow transplant patients, with reported incidence of 0.5-3% and mortality of about 75%. To emphasise the importance of early diagnosis and prompt commencement of therapy results in improved clinical outcomes. A retrospective...
journal_title:Internal medicine journal
pub_type: 杂志文章,评审
doi:10.1111/imj.12048
更新日期:2013-03-01 00:00:00
abstract::Decompressive hemicraniectomy (DHC) has been shown to reduce mortality in malignant middle cerebral artery (MCA) infarction. Our primary objective was to compare 1-year mortality between patients receiving DHC for malignant MCA infarction at our institution based on hospital of origin. We retrospectively reviewed the ...
journal_title:Internal medicine journal
pub_type: 杂志文章,meta分析
doi:10.1111/imj.14050
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:The clinical significance of extreme hyperferritinaemia has come under scrutiny with the increasing recognition of haemophagocytic lymphohistiocytosis (HLH) in adults. Most studies of hyperferritinaemia have focused on serum ferritin greater than 1000 μg/L, often in ambulatory patients. The conditions associ...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/imj.12768
更新日期:2015-08-01 00:00:00
abstract::Paradigms for managing acromegaly have undergone major changes in the past two decades. This has been brought about by combining surgical, pharmacological and radiotherapeutic approaches that provide tight biochemical control to reduce mortality to that of the general population. The biochemical targets for treatment ...
journal_title:Internal medicine journal
pub_type: 杂志文章,评审
doi:10.1111/j.1445-5994.2006.01097.x
更新日期:2006-07-01 00:00:00
abstract:BACKGROUND:The international literature advocates for cancer screening in newly diagnosed patients with autoimmune myositis; however, there is no widely accepted consensus or guideline to outline the optimal cancer screening strategy and the evidence is currently insufficient to support any recommendation. AIM:Our stu...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/imj.13556
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Population-based studies of the prevalence of all functional gastrointestinal disorders (FGID) using the Rome II criteria are lacking. It is also not certain whether subjects who meet the Rome II criteria for an FGID are different in terms of demographic and psychological characteristics from those subjects ...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/j.1445-5994.2006.01006.x
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:While medications may prolong life and prevent morbidity in older people, adverse effects of polypharmacy are increasingly recognised. As patients age and become frail, prescribing may be expected to focus more on symptom control and minimise potentially harmful preventive medication use that confer little b...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/imj.13526
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:The rate of hospital admissions for cirrhosis increased 1.3-fold during 2008-2016 in Queensland. Alcohol misuse was a contributing factor for cirrhosis in 55% of admissions and 40% of patients had at least one comorbidity. AIM:This paper examines the temporal change in aetiology of liver disease and presenc...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/imj.14809
更新日期:2020-02-25 00:00:00
abstract:BACKGROUND:Iatrogenic medication errors are a cause of medical morbidity and mortality. They result in significant cost to the Australian healthcare system each year. There is limited Australian evidence describing the iatrogenic errors occurring within the hospital system. AIMS:To examine and describe iatrogenic medi...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/imj.14940
更新日期:2020-06-15 00:00:00
abstract:BACKGROUND:Timely administration of intravenous tissue plasminogen activator (IVtPA) for acute ischaemic stroke is associated with better clinical outcomes. Therefore, a coordinated hospital system of acute clinical assessment and neuroimaging will likely avoid delays in IV-tPA administration. AIM:In July 2007, we imp...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/j.1445-5994.2011.02709.x
更新日期:2012-12-01 00:00:00
abstract::The use of tissue-type plasminogen activator (t-PA) in ischaemic stroke outside of experienced stroke centres remains controversial. The aim of this study was to present the initial experience with t-PA in patients with ischaemic stroke at an institution with no prior experience in i.v. stroke thrombolysis and to comp...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/j.1445-5994.2006.01127.x
更新日期:2006-08-01 00:00:00
abstract:BACKGROUND:Our previous work identified deficiencies in stroke care practices at regional hospitals in comparison to standards suggested by published stroke care guidelines. These deficiencies might be improved by the implementation of clinical pathways. The aim of this study was to assess changes in acute stroke care ...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/j.1445-5994.2006.01147.x
更新日期:2006-10-01 00:00:00
abstract:BACKGROUND:Stroke is an Australian health priority area causing considerable levels of disability. We report 90-day outcomes for a cohort of acute stroke patients in New South Wales (NSW), Australia prior to randomization to a large cluster randomized controlled trial (CRCT), the Quality in Acute Stroke Care (QASC) tri...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/j.1445-5994.2010.02330.x
更新日期:2011-10-01 00:00:00
abstract::More than 177 000 potentially preventable healthcare-associated infections (HAIs) occur per annum in Australia with sizable attributable mortality. Organizational systems to protect against HAI in hospitals in Australia are relatively poorly developed. Awareness and practice of infection control by medical and other h...
journal_title:Internal medicine journal
pub_type: 杂志文章,评审
doi:10.1111/j.1445-5994.2009.02004.x
更新日期:2009-09-01 00:00:00
abstract:BACKGROUND:Neoadjuvant chemoradiation therapy (CRT) is standard of care treatment for locally advanced rectal cancer (LARC). A pathologic complete response (pCR) following CRT is an early indicator of treatment benefit and associated with excellent survival outcomes. As capecitabine replaces infusional 5-fluorouracil (...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/imj.15045
更新日期:2020-09-08 00:00:00
abstract:BACKGROUND:Frailty is common among acute hospital patients and might adversely affect recovery from inpatient cardiac arrest. AIM:To assess the relationship between hospital admission characteristics, including frailty, and discharge outcome after in-hospital cardiac arrest. METHODS:Prospectively collected data were ...
journal_title:Internal medicine journal
pub_type: 杂志文章
doi:10.1111/imj.14159
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND AND AIMS:Cardiac myxoma is a rare but important cause of stroke, which affects young people. More recently the diagnosis has been enhanced by the use of echocardiograms. We aimed to review the neurological presentations, including stroke, of cardiac myxoma in this modern era of diagnosis and management. MET...
journal_title:Internal medicine journal
pub_type: 杂志文章,评审
doi:10.1111/j.1444-0903.2004.00563.x
更新日期:2004-05-01 00:00:00