Treatment for stable HIV patients in England: can we increase efficiency and improve patient care?

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.

authors

Adams E,Ogden D,Ehrlich A,Hay P

doi

10.1177/1355819613508176

subject

Has Abstract

pub_date

2014-07-01 00:00:00

pages

131-137

issue

3

eissn

1355-8196

issn

1758-1060

pii

1355819613508176

journal_volume

19

pub_type

杂志文章
  • Ethnicity, socioeconomic deprivation and consultation rates in New Zealand general practice.

    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

    authors: Health Utilisation Research Alliance (HURA).

    更新日期:2006-07-01 00:00:00

  • Involving interpreters in research studies.

    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

    authors: Plumridge G,Redwood S,Greenfield S,Akhter N,Chowdhury R,Khalade A,Gill P

    更新日期:2012-07-01 00:00:00

  • Do managers pay their way? The impact of management input on hospital productivity in the NHS internal market.

    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

    authors: Söderlund N

    更新日期:1999-01-01 00:00:00

  • Patient preferences in randomised trials: threat or opportunity?

    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

    authors: Torgerson DJ,Klaber-Moffett J,Russell IT

    更新日期:1996-10-01 00:00:00

  • Large-scale organizational and managerial change in health care: a review of the literature.

    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

    authors: Ferlie E

    更新日期:1997-07-01 00:00:00

  • Patient choice in general practice: the implications of patient satisfaction surveys.

    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

    authors: Robertson R,Dixon A,Le Grand J

    更新日期:2008-04-01 00:00:00

  • Case mix measurement in English hospitals: an evaluation of five methods for predicting resource use.

    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

    authors: Söderlund N,Gray A,Milne R,Raftery J

    更新日期:1996-01-01 00:00:00

  • Collectivising the Kulaks? General practitioners and primary care groups in England.

    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

    authors: Clegg K

    更新日期:2000-07-01 00:00:00

  • Challenges and opportunities associated with the introduction of assistant practitioners supporting the work of registered nurses in NHS acute hospital trusts in England.

    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

    authors: Spilsbury K,Adamson J,Atkin K,Bloor K,Carr-Hill R,McCaughan D,McKenna H,Wakefield A

    更新日期:2011-04-01 00:00:00

  • Variations in the persistence of health expenditures and the implications for the design of capitation payments in Taiwan.

    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

    authors: Ku LJ,Chiou MJ,Liu LF

    更新日期:2015-07-01 00:00:00

  • Searching for a threshold, not setting one: the role of the National Institute for Health and Clinical Excellence.

    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

    authors: Culyer A,McCabe C,Briggs A,Claxton K,Buxton M,Akehurst R,Sculpher M,Brazier J

    更新日期:2007-01-01 00:00:00

  • How useful are Cochrane reviews in identifying research needs?

    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

    authors: Clarke L,Clarke M,Clarke T

    更新日期:2007-04-01 00:00:00

  • Understanding phenomena in the real world: the case for real time data collection in health services research.

    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

    authors: Jones M,Johnston D

    更新日期:2011-07-01 00:00:00

  • Investigating Choice Experiments for Preferences of Older People (ICEPOP): evaluative spaces in health economics.

    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

    authors: Coast J,Flynn T,Sutton E,Al-Janabi H,Vosper J,Lavender S,Louviere J,Peters T

    更新日期:2008-10-01 00:00:00

  • Integrating mental health services through reimbursement reform and managed mental health care.

    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

    authors: Mechanic D

    更新日期:1997-04-01 00:00:00

  • Being open about unanticipated problems in health care: the challenges of uncertainties.

    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

    authors: Birks Y,Entwistle V,Harrison R,Bosanquet K,Watt I,Iedema R

    更新日期:2015-01-01 00:00:00

  • Medicaid waivers and negotiated federalism in the US: is there relevance to other federal systems?

    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

    authors: Weissert CS,Weissert WG

    更新日期:2017-10-01 00:00:00

  • Taking data seriously: the value of actor-network theory in rethinking patient experience data.

    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

    authors: Desai A,Zoccatelli G,Adams M,Allen D,Brearley S,Rafferty AM,Robert G,Donetto S

    更新日期:2017-04-01 00:00:00

  • Ethics and economics: does programme budgeting and marginal analysis contribute to fair priority setting?

    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

    authors: Gibson J,Mitton C,Martin D,Donaldson C,Singer P

    更新日期:2006-01-01 00:00:00

  • Patient preferences for treatment for angina: an overview of findings from three studies.

    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

    authors: Bowling A,Reeves B,Rowe G

    更新日期:2008-10-01 00:00:00

  • The art and science of non-evaluation evaluation.

    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

    authors: Jones L

    更新日期:2018-10-01 00:00:00

  • Shifting services from secondary to primary care: stakeholders' views of the barriers.

    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

    authors: O'Cathain A,Musson G,Munro J

    更新日期:1999-07-01 00:00:00

  • Partnership working and improved service delivery: views of staff providing sexual health services.

    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

    authors: Pow J,Elliott L,Raeside R,Themessl-Huber M,Claveirole A

    更新日期:2013-07-01 00:00:00

  • An economic analysis of implementing the SIGN third molar guideline: implications for the design and analysis of implementation studies.

    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

    authors: Tilley C,McIntosh E,Bahrami M,Clarkson J,Deery C,Pitts N

    更新日期:2005-07-01 00:00:00

  • 'Biohoarding': treasures not seen, stories not told.

    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

    authors: Catchpoole D

    更新日期:2016-04-01 00:00:00

  • Primary care utilization and clinical quality performance: a comparison between health centres in Medicaid expansion states and non-expansion states.

    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

    authors: Lee DC,Shi L,Liang H

    更新日期:2019-01-01 00:00:00

  • Toward a general theory of indifference to research-based evidence.

    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

    authors: Lewis S

    更新日期:2007-07-01 00:00:00

  • End-of-life decisions: the policy issue that will not die.

    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

    authors: Shortt S,Lavery J

    更新日期:1999-10-01 00:00:00

  • Using meta ethnography to synthesise qualitative research: a worked example.

    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

    authors: Britten N,Campbell R,Pope C,Donovan J,Morgan M,Pill R

    更新日期:2002-10-01 00:00:00

  • Health services research: building capacity to meet the needs of the health care system.

    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

    authors: Barratt H,Shaw J,Simpson L,Bhatia S,Fulop N

    更新日期:2017-10-01 00:00:00