Abstract:
OBJECTIVES:To estimate the costs and potential efficiency gains of changing the frequency of clinic appointments and drug dispensing arrangements for stable HIV patients compared to the costs of hospital pharmacy dispensing and home delivery. METHODS:We estimated the annual costs per patient (HIV clinic visits and either first-line treatment or a common second-line regimen, with some patients switching to a second-line regimen during the year). The cost of three-, four- and six-monthly clinic appointments and drug supply was estimated assuming hospital dispensing (incurring value-added tax) and home delivery. Three-monthly appointments and hospital drug dispensing (baseline) were compared to other strategies. RESULTS:The baseline was the most costly option (£10,587 if first-line treatment and no switch to second-line regimen). Moving to six-monthly appointments and home delivery yielded savings of £1883 per patient annually. Assuming patients start on different regimens and may switch to second-line therapies, six-monthly appointments and three-monthly home delivery of drugs is the least expensive option and could result in nearly £2000 savings per patient. This translates to annual cost reduction of about £8 million for the estimated 4000 eligible patients not currently on home delivery in London, England. CONCLUSIONS:Different appointment schedules and drug supply options should be considered for stable HIV patients based on efficiency gains. However, this should be assessed for individual patients to meet their needs, especially around adherence and patient support.
journal_name
J Health Serv Res Policyjournal_title
Journal of health services research & policyauthors
Adams E,Ogden D,Ehrlich A,Hay Pdoi
10.1177/1355819613508176subject
Has Abstractpub_date
2014-07-01 00:00:00pages
131-137issue
3eissn
1355-8196issn
1758-1060pii
1355819613508176journal_volume
19pub_type
杂志文章abstract:OBJECTIVES:To explore the relationship between ethnicity, socioeconomic deprivation and utilization of general practice. METHODS:Data routinely collected by New Zealand general practices in 2001 were analysed using generalized linear regression. RESULTS:The mean number of doctor consultations for registered individua...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581906777641721
更新日期:2006-07-01 00:00:00
abstract::It is important to include non English speakers in health services research to ensure not only the generalisability of findings but also to address health inequalities and promote social justice. One approach is to use interpreters but there is little guidance for working with an interpreter in interviews. Involving a...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/JHSRP.2012.012003
更新日期:2012-07-01 00:00:00
abstract:INTRODUCTION:Levels of management staffing in the UK National Health Service (NHS) have received considerable political and media attention in the last four years or so. Both the previous and current governments committed themselves to reducing management expenditure in the health service, and significant cuts appear t...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969900400104
更新日期:1999-01-01 00:00:00
abstract:OBJECTIVES:To assess whether it is feasible to elicit patients' preferences for treatments and then to proceed with randomisation which may allocate those with preferences to their less preferred treatment; and to describe which prognostic variables were associated with such preferences within the context of a randomis...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969600100403
更新日期:1996-10-01 00:00:00
abstract::This paper takes an overview of the organizational and managerial literature on recent large-scale change efforts within health care organizations. Such literature refers to issues of enhanced policy significance, as a succession of such changes has swept through health care, at an international level. Interpretive an...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1177/135581969700200310
更新日期:1997-07-01 00:00:00
abstract:OBJECTIVES:To identify factors that explain patient satisfaction with general practice physicians and hence that may drive patients' choice of practice. METHODS:Logistic regression analysis of English National Health Service national patient survey data is used to identify the aspects of general practice care that are...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2007.007055
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVES:The introduction of an internal market in the British National Health Service (NHS) has highlighted the importance of developing appropriate, valid and timely measures of hospital activity, both for the purposes of specifying and monitoring contracts and for evaluating the success of the NHS reforms in gener...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969600100104
更新日期:1996-01-01 00:00:00
abstract::It has previously been suggested that the English Department of Health seems, wittingly or not, to have drawn on the experiences of Stalinist Russia in devising policies for the National Health Service. The development of general practitioner fundholding during the 1990s could be compared to the Soviet support for the...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581960000500311
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVES:To understand the challenges and opportunities associated with the introduction of assistant practitioner (AP) roles supporting the work of ward-based registered nurses (RNs) in National Health Service (NHS) acute hospital trusts in England. METHODS:Three case studies of NHS acute hospital trusts. This pape...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2011.010106
更新日期:2011-04-01 00:00:00
abstract:OBJECTIVES:The National Health Insurance (NHI) system in Taiwan launched a trial capitation provider payment programme in 2011, with the capitation formula based on patients' average NHI expenditure in the previous year. This study seeks to examine the concentration and persistence of health care expenditure among the ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819615577711
更新日期:2015-07-01 00:00:00
abstract::There has been much speculation about whether the National Institute for Health and Clinical Excellence (NICE) has, or ought to have, a 'threshold' figure for the cost of an additional quality-adjusted life-year above which a technology will not be recommended for use. We argue that it is not constitutionally appropri...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581907779497567
更新日期:2007-01-01 00:00:00
abstract:OBJECTIVES:To determine the extent to which reports of Cochrane reviews recommend the need for further research and, if so, the extent to which they make suggestions regarding that research. METHODS:We examined all 2535 reviews in Issue 4, 2005 of The Cochrane Library. Each review was categorized on the basis of wheth...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581907780279648
更新日期:2007-04-01 00:00:00
abstract::Understanding the environmental and behavioural predictors of wellbeing is a key driver of health and social care research. Research set in the social world examines the relationships between behavioural, cognitive, emotional and environmental factors, linking these to disease or social ills with the aim of providing ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2010.010016
更新日期:2011-07-01 00:00:00
abstract::This paper deals with three concerns about the evaluative framework that is currently dominant within health economics. These concerns are: that the evaluative framework is concerned entirely with health; that the evaluative framework has an individualistic focus on patients alone; and that the methods used to estimat...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2008.008024
更新日期:2008-10-01 00:00:00
abstract::People with serious and persistent mental illness require a range of community services typically provided by different specialized agencies. At the clinical level, assertive team case management is the strategy commonly used to achieve integration of services across specialized sectors. The USA also has used various ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969700200206
更新日期:1997-04-01 00:00:00
abstract::Discussion of unanticipated problems in care with patients and their families ('open disclosure') is now widely advocated. Despite international efforts and the introduction of a range of policies and guidance to promote such discussions, the expectations of policy makers and patients are often not matched in practice...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819614558100
更新日期:2015-01-01 00:00:00
abstract::Medicaid waivers have been a principal tool of innovation in health policy in the US since at least the mid 1970s. As Republicans seek to give the states more flexibility in their implementation and management of both Medicaid and the Affordable Care Act or its replacement, waiver authority is likely to be one of the ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819617702175
更新日期:2017-10-01 00:00:00
abstract::Hospitals are awash with patient experience data, much of it collected with the ostensible purpose of improving the quality of patient care. However, there has been comparatively little consideration of the nature and capacities of data itself. Using insights from actor-network theory, we propose that paying attention...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819616685349
更新日期:2017-04-01 00:00:00
abstract:OBJECTIVE:Limited resources mean that decision-makers must set priorities among competing opportunities. Programme budgeting and marginal analysis (PBMA) is an economic approach that focuses on optimizing benefits with available resources. Accountability for reasonableness (A4R) is an ethics approach that focuses on en...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581906775094280
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Access to cardiac treatments has been documented to vary with patients' age. It is unknown whether these variations reflect patients' treatment preferences. We aimed to investigate patients' preferences for cardiology treatments and develop a Patients' Preferences Questionnaire. METHODS:Semi-structured inte...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2008.008012
更新日期:2008-10-01 00:00:00
abstract::This essay considers some limitations of programme theory evaluation in relation to healthcare policies. This approach, which seeks to surface 'programme theories' or construct 'logic models', is often unable to account for empirical observations of policy implementation in real-world contexts. I argue that this failu...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819618779614
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVES:To identify the barriers to shifting services from secondary to primary care perceived by the involved stakeholders. METHODS:Forty-five semi-structured interviews with stakeholders from primary care, acute and community hospitals, purchasers (health authorities) and other agencies involved in two contrastin...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969900400306
更新日期:1999-07-01 00:00:00
abstract:OBJECTIVES:Successful partnership working has theoretically been linked to improvements in service delivery and is dependent on the strength of the partnership, trust, communication, professional roles and resource sharing. Empirical evidence to confirm the relationships between these factors and improved service provi...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819612473584
更新日期:2013-07-01 00:00:00
abstract:OBJECTIVES:To compare the cost-effectiveness of four third molar guideline implementation strategies. METHODS:Fifty-one dental practices in Scotland were randomized to one of four implementation strategies. The effectiveness of the strategies was measured by general dental practitioners' compliance with the guideline....
journal_title:Journal of health services research & policy
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1258/1355819054339031
更新日期:2005-07-01 00:00:00
abstract::This article raises the concern that biobanks are failing to realize the expected research and health service outcomes. Rather than biobanking, we have been engaging in 'biohoarding', where building a quantifiable collection of tissue samples is the primary basis of the bio-resource. The root cause of 'biohoarding' is...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819615599014
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVES:The United States Government's Medicaid expansion policy has important implications for health centres, since a large proportion of health centre patients are Medicaid enrollees. The objective of this study was to compare primary care utilization and clinical quality performance between health centres in Med...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819618788592
更新日期:2019-01-01 00:00:00
abstract::Evidence-based medicine (EBM) and evidence-based decision-making (EBDM) were intended to revolutionize health care and health policy. Thus far they have not. A great deal of research has demonstrated the persistent ubiquity of error in health care, wide and unjustifiable variations in practice and the minimal impact o...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581907781543094
更新日期:2007-07-01 00:00:00
abstract::In most jurisdictions, public policy regarding assisted death has not advanced beyond simple prohibition. However, this issue is increasingly likely to reach the policy agenda. Policy-makers may be tempted to turn for guidance to the three places in the world with developed policy or legislation: the Netherlands; the ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969900400409
更新日期:1999-10-01 00:00:00
abstract:OBJECTIVES:To demonstrate the benefits of applying meta ethnography to the synthesis of qualitative research, by means of a worked example. METHODS:Four papers about lay meanings of medicines were arbitrarily chosen. Noblit and Hare's seven-step process for conducting a meta ethnography was employed: getting started; ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581902320432732
更新日期:2002-10-01 00:00:00
abstract::Health services researchers have an important role to play in helping health care systems around the world provide high quality, affordable services. However, gaps between the best evidence and current practice suggest that researchers need to work in new ways. The production of research that meets the needs and prior...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819617714815
更新日期:2017-10-01 00:00:00