Challenges for economic evaluation when doing research with people with learning disabilities - Claire Hulme, Professor of Health Economics, University of Leeds
Comprehensive geriatric assessment (CGA) is a multidisciplinary process to assess medical, psychological, and functional limitations in frail older adults to develop a coordinated care plan. It involves a 3-step process of targeting appropriate patients, assessing patients across domains, and implementing recommendations from the multidisciplinary team. Meta-analyses have found CGA to be effective in reducing functional decline, mortality, and nursing home admissions. Key domains assessed include cognition, mood, functional status, nutrition, vision, hearing, continence, social support, medications, and advance care planning.
A geriatric assessment is a comprehensive evaluation of an older person's physical, mental, social, and functional abilities designed to optimize their health and quality of life. It involves examining these domains, identifying any problems, developing a care plan to address problems, and coordinating services. It is performed by an interdisciplinary team and results in a care plan listing the person's needs and recommendations for support services. Geriatric assessments can improve outcomes for older adults and are most beneficial for those at risk of functional decline or institutionalization.
This document discusses the long-term health impacts of sexual violence on women and calls for improved healthcare responses. It notes that sexual violence has serious physical and psychological effects over a lifetime but that survivors often do not disclose to doctors and doctors do not routinely ask. It recommends national frameworks to educate all medical students and doctors about the impacts of trauma, and government support for holistic, long-term healthcare including access to long-term psychotherapy for survivors. The goal is for healthcare providers to be able to identify, respectfully listen to, and address both the physical and psychological needs of survivors over their lifetime.
Comprehensive geriatric assessment (CGA) involves a multidisciplinary evaluation of an older person's medical conditions, mental health, functional ability, and social circumstances. The goal is to create a holistic care plan addressing treatment, rehabilitation, support, and long-term follow-up. A CGA benefits the patient through a coordinated care plan, benefits caregivers by addressing social needs, and benefits healthcare systems by reducing hospital readmissions.
This document discusses mental health and provides information on several related topics:
1. It defines mental health as a state of well-being where one can cope with stress and realize their abilities.
2. Several factors are discussed that affect mental health prevalence including treatment gaps, stigma, and epidemiological transitions.
3. Statistics on the prevalence of various mental disorders globally and in India are provided, showing a large proportion of populations affected. However, treatment gaps remain high.
The document discusses geriatric health maintenance and comprehensive geriatric assessments. It outlines the components of primary, secondary, and tertiary prevention for older adults, including screening tests, immunizations, and identifying/managing common conditions like falls, incontinence, and medication management. Comprehensive geriatric assessments evaluate multiple domains like function, cognition, mood, social support and goals of care to develop care plans for older patients.
The roles and responsibilities of a geriatric nurse include providing specialized care to older adults that addresses their complex physical and mental health needs. Geriatric nurses work in various settings like hospitals, nursing homes, and patients' homes. Their responsibilities involve assessing patients' health status, understanding health issues, educating patients and families, and linking patients to community resources to help older adults stay independent for as long as possible. Geriatric nurses play an important advocacy role in the care of older patients.
Better Healthcare Through Community and Stakeholder Engagement, 2015 Webinar ...Paul Gallant
"An enjoyable presentation, well-delivered with excellent insight into community and stakeholder engagement strategies. Terry Dyni - July 23, 2015" on the webinar version. This version is my complete slide deck from a live webinar presentation requested by the Conference Board of Canada. April, 2015. Thanks for your interest in Better Healthcare Through Community and Stakeholder Engagement.
Compliments of Paul W. Gallant, CHE, GALLANT HEALTHWORKS & Associates (GHWA), Vancouver, BC, Canada. PS See the last slide for contact details or to arrange customized training/facilitation or advice on your organizational needs.
Comprehensive geriatric assessment (CGA) is a multidisciplinary process to assess medical, psychological, and functional limitations in frail older adults to develop a coordinated care plan. It involves a 3-step process of targeting appropriate patients, assessing patients across domains, and implementing recommendations from the multidisciplinary team. Meta-analyses have found CGA to be effective in reducing functional decline, mortality, and nursing home admissions. Key domains assessed include cognition, mood, functional status, nutrition, vision, hearing, continence, social support, medications, and advance care planning.
A geriatric assessment is a comprehensive evaluation of an older person's physical, mental, social, and functional abilities designed to optimize their health and quality of life. It involves examining these domains, identifying any problems, developing a care plan to address problems, and coordinating services. It is performed by an interdisciplinary team and results in a care plan listing the person's needs and recommendations for support services. Geriatric assessments can improve outcomes for older adults and are most beneficial for those at risk of functional decline or institutionalization.
This document discusses the long-term health impacts of sexual violence on women and calls for improved healthcare responses. It notes that sexual violence has serious physical and psychological effects over a lifetime but that survivors often do not disclose to doctors and doctors do not routinely ask. It recommends national frameworks to educate all medical students and doctors about the impacts of trauma, and government support for holistic, long-term healthcare including access to long-term psychotherapy for survivors. The goal is for healthcare providers to be able to identify, respectfully listen to, and address both the physical and psychological needs of survivors over their lifetime.
Comprehensive geriatric assessment (CGA) involves a multidisciplinary evaluation of an older person's medical conditions, mental health, functional ability, and social circumstances. The goal is to create a holistic care plan addressing treatment, rehabilitation, support, and long-term follow-up. A CGA benefits the patient through a coordinated care plan, benefits caregivers by addressing social needs, and benefits healthcare systems by reducing hospital readmissions.
This document discusses mental health and provides information on several related topics:
1. It defines mental health as a state of well-being where one can cope with stress and realize their abilities.
2. Several factors are discussed that affect mental health prevalence including treatment gaps, stigma, and epidemiological transitions.
3. Statistics on the prevalence of various mental disorders globally and in India are provided, showing a large proportion of populations affected. However, treatment gaps remain high.
The document discusses geriatric health maintenance and comprehensive geriatric assessments. It outlines the components of primary, secondary, and tertiary prevention for older adults, including screening tests, immunizations, and identifying/managing common conditions like falls, incontinence, and medication management. Comprehensive geriatric assessments evaluate multiple domains like function, cognition, mood, social support and goals of care to develop care plans for older patients.
The roles and responsibilities of a geriatric nurse include providing specialized care to older adults that addresses their complex physical and mental health needs. Geriatric nurses work in various settings like hospitals, nursing homes, and patients' homes. Their responsibilities involve assessing patients' health status, understanding health issues, educating patients and families, and linking patients to community resources to help older adults stay independent for as long as possible. Geriatric nurses play an important advocacy role in the care of older patients.
Better Healthcare Through Community and Stakeholder Engagement, 2015 Webinar ...Paul Gallant
"An enjoyable presentation, well-delivered with excellent insight into community and stakeholder engagement strategies. Terry Dyni - July 23, 2015" on the webinar version. This version is my complete slide deck from a live webinar presentation requested by the Conference Board of Canada. April, 2015. Thanks for your interest in Better Healthcare Through Community and Stakeholder Engagement.
Compliments of Paul W. Gallant, CHE, GALLANT HEALTHWORKS & Associates (GHWA), Vancouver, BC, Canada. PS See the last slide for contact details or to arrange customized training/facilitation or advice on your organizational needs.
This document discusses ethical issues surrounding disclosure of diagnoses, specifically Alzheimer's disease, to patients and their families. It provides guidance on assessing a patient's understanding and desire to know their diagnosis before disclosure. When disclosing Alzheimer's, it is important to arrange a joint meeting with family, allow time for questions, discuss disease progression and care plans, and involve caregivers going forward. The case study describes one family's experience where the husband decided to disclose the wife's Alzheimer's diagnosis to her in the doctor's office, but she initially reacted with disbelief and later developed aggressive behaviors towards her husband caregiver.
A geriatrician takes a comprehensive approach to caring for seniors, coordinating care across various specialists and services. They work with a team that may include nurses, psychiatrists, surgeons, pharmacists, social workers, therapists and others to develop personalized care plans. Seniors often see multiple doctors for different issues, but a geriatrician acts as a central point of contact to ensure all care is coordinated. The document outlines several types of specialists seniors may see, such as cardiologists for heart issues, endocrinologists for diabetes, and audiologists for hearing problems. It stresses the importance of managing multiple chronic conditions that often affect seniors.
'If we lose our friends, we're done': mental health and psychosocial wellbein...Ruth Evans
Presentation by Fiona Samuels, Research Fellow, ODI, at workshop "Putting the 'social' back into young people's psychosocial wellbeing, care and support", hosted by ODI and the University of Reading, London 22 November 2016.
This presentation about ‘Valuing Mental Health’ by Dr Geraldine Strathdee, National Clinical Director of Mental Health, NHS England, was delivered to the Foundation Trust Network on 16 October 2013.
Geraldine covers:
- Why does the NHS need to value mental health: The impact of mental health on outcomes and costs
- Parity between mental health and physical health: What would it mean in practice
- Fast tracking Value in the NHS: What role can the Foundation Trust Network have in delivering it?
Presentation at PHABC Public Health Reducing Health Inequities Conference, Vancouver, British Columbia, Canada.
Also see several additional slideshares of mine about males and eating disorders and an excerpt from Global National TV 16x9 news documentary, Canadian national television.
Brief excerpt (2.5 minutes) here: https://www.youtube.com/watch?v=ctlGqM0ekOY
Full 23 mins show here: https://www.youtube.com/watch?v=OwhyB8mR-U8
This document discusses mental health issues among women of reproductive age. It notes that depression is common, affecting around 8% of pregnant women and 11% of non-pregnant women. Poor mental health can negatively impact physical health, pregnancy outcomes, and child development. The document reviews risk factors for depression like stress, low social support, pregnancy complications, and chronic illness. It also discusses treatments like antidepressants and therapy.
Major mental illnesses like depression, anxiety, and personality disorders are highly prevalent among prison populations worldwide. Prisons can exacerbate existing mental health issues due to overcrowding, violence, isolation, and lack of treatment services. Juvenile offenders also experience high rates of mental disorders, and screening and treatment are important but often inadequate. Reform is needed to establish better mental healthcare in correctional facilities and address the factors contributing to mental illness among inmates.
This document provides an overview of the Balanced Living with Diabetes (BLD) program, a community-based lifestyle intervention for improving blood glucose control among people with diabetes. BLD is based on social cognitive theory and community-based participatory research principles. It involves weekly 2-hour classes over 4 weeks that teach diabetes self-management skills like healthy eating, physical activity, and goal setting using interactive lessons and activities. Pilot programs of BLD found improvements in A1c, diet, and physical activity. A large randomized controlled trial of BLD found it effective at lowering A1c levels among African Americans with diabetes in medically underserved areas when delivered in faith-based community settings.
This document discusses health-related behavior and its determinants. It defines behavior and provides examples. It discusses the role of behavior in health and disease and approaches to diagnosing health behavior. It covers the behavior change process and models like the Health Belief Model. It discusses factors that influence human behavior like predisposing factors (knowledge, attitudes, beliefs), enabling factors (availability of resources), and reinforcing factors (social pressures). Finally, it compares concepts like knowledge, attitudes, beliefs, values and discusses the difficulty of changing each.
Men with Eating Disorders: Deepening Our Understanding to Improve CaringPaul Gallant
This document provides an overview of a presentation on deepening our understanding of eating disorders in males to improve care. The presentation covers background information, statistics showing eating disorders are underdiagnosed and undertreated in males, stories from caring for males with eating disorders, and ways to improve care. A poll asks participants about their interests and backgrounds. The presentation discusses the need for more research focused on males, training for medical professionals, and improving access to counseling, psychiatry, and treatment programs for males with eating disorders.
This document discusses adolescent mental health issues globally and in sub-Saharan Africa. It notes that common mental disorders in adolescents include conduct disorder, attention-deficit/hyperactivity disorder, autism spectrum disorders, depression, anxiety, and eating disorders. Risk factors include infectious diseases, injuries, pregnancy complications, self-harm, and lack of access to healthcare. Interventions should enhance social skills, provide early detection and treatment like counseling and medication, and address challenges like stigma and human rights violations.
Improving the Patient's Experience, Mental Health, Collaborative Stakeholder ...Paul Gallant
The document discusses improving mental health services through collaborative stakeholder approaches. It provides an overview of mental health services and experiences, and examples of collaborations including assessing a city's population needs and a project focusing on youth mental health. The document advocates for meaningfully engaging patients, providers, and other stakeholders to improve services and ensure priorities address patient experiences and outcomes. It also provides lessons learned around engagement, flexibility, participation support, and empowering stakeholders.
Paul Gill: The value of psychiatric liaison servicesThe King's Fund
Dr Paul Gill, Consultant Psychiatrist at Sheffield Liaison Psychiatry Service, explains what liaison psychiatry is and how it can help provide better outcomes across secondary and acute points of care.
2 mental health and disorders mental health and dismile790243
This document discusses a rising trend of mental health disorders among individuals on Chicago's south side. It notes that African Americans have higher rates of mental health disorders like post-traumatic stress disorder and schizophrenia. The document proposes a research study called Project IMPACT that would survey adults in south side Chicago neighborhoods about their mental health using questionnaires. The expected result is an increased risk of mental health disorders among African Americans in those areas. It concludes that decreasing this risk is important for improving the overall health of the African American population.
The document provides an agenda and background information for a stakeholder scoping workshop on long term conditions. The workshop aims to define the scope of a joint strategic needs assessment on long term conditions by gaining consensus on key conditions and cross-cutting themes to focus on. Presentations will cover the changing landscape of long term conditions, definitions and prevalence locally, and identifying priority conditions and common issues. Breakout groups will discuss potential conditions and themes to prioritize. Understanding local data availability and stakeholder priorities will help shape the needs assessment.
This document outlines goals for transforming the mental health system in the United States. It discusses the large burden of mental illness through lost productivity, high economic costs, and prevalence of disorders. The document proposes 6 goals: 1) increasing understanding of mental health, 2) making the system consumer-driven, 3) eliminating disparities, 4) promoting early screening and treatment, 5) delivering evidence-based care, and 6) using technology to improve access and information. The transformation aims to make mental health services equally accessible and effective as physical health care.
Better health, better lives conference tuesday 20 june 2017 - presentationsNHS England
1. Health, wellbeing and people with learning disabilities – Professor Jane Cummings
2. What the numbers are telling us – Professor Chris Hatton
3. What the numbers are telling us – Professor Chris Hatton (accessible)
4. The Learning Disability Mortality Review – and what it is telling us – Dr Richard Jeffrey
5. The Learning Disability Mortality Review – and what it is telling us – Dr Richard Jeffrey (accessible)
6. Health inequalities – Dr Angela Donkin
7. Health Checks – Dr Kirsten Lamb
HSC PDHPE Core 1 – Health Priorities in AustraliaVas Ratusau
The document discusses how priority health issues in Australia are identified. It notes that epidemiology plays a key role by measuring health status indicators like life expectancy, mortality rates, and prevalence of diseases and conditions. This data is collected by organizations like the Australian Bureau of Statistics and Australian Institute of Health and Welfare. The data shows trends like increasing life expectancy but also rising rates of obesity, diabetes, and mental health issues. Priority issues are identified based on factors like the social and economic burden of diseases.
This poster was presented to highlight the following mental health conditions in adolescent patients: attention deficit/hyperactivity disorder (ADD/ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD).
Mental Health is a very important aspect of public health. Although mental health assessment is vital within all populations, it is especially vital to assess mental health within our vulnerable populations (e.g. adolescents)
This document summarizes the key points of a presentation on mechanism-based pharmacoeconomic modelling. It discusses two main types of economic modelling: empirical modelling which uses statistical techniques to find parameter values that maximize correlation with observed data, and mechanism-based modelling which uses fundamental knowledge to define model structure and experiments to determine parameter values. It then provides examples of applying mechanism-based pharmacokinetic-pharmacodynamic models integrated with economic evaluations for rituximab and novel oral anticoagulants for atrial fibrillation. The results suggest genotype-guided warfarin dosing and newer anticoagulants like apixaban provide better outcomes and may be cost-effective alternatives to clinically dosed warfar
‘In with the old, out with the new’ – In search of ways to help health economists break their addiction to technology adoption. CHE Seminar presented by Professor Stirling Bryan, Director, Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Professor, School of Population & Public Health, University of British Columbia. 17th October 2014
This document discusses ethical issues surrounding disclosure of diagnoses, specifically Alzheimer's disease, to patients and their families. It provides guidance on assessing a patient's understanding and desire to know their diagnosis before disclosure. When disclosing Alzheimer's, it is important to arrange a joint meeting with family, allow time for questions, discuss disease progression and care plans, and involve caregivers going forward. The case study describes one family's experience where the husband decided to disclose the wife's Alzheimer's diagnosis to her in the doctor's office, but she initially reacted with disbelief and later developed aggressive behaviors towards her husband caregiver.
A geriatrician takes a comprehensive approach to caring for seniors, coordinating care across various specialists and services. They work with a team that may include nurses, psychiatrists, surgeons, pharmacists, social workers, therapists and others to develop personalized care plans. Seniors often see multiple doctors for different issues, but a geriatrician acts as a central point of contact to ensure all care is coordinated. The document outlines several types of specialists seniors may see, such as cardiologists for heart issues, endocrinologists for diabetes, and audiologists for hearing problems. It stresses the importance of managing multiple chronic conditions that often affect seniors.
'If we lose our friends, we're done': mental health and psychosocial wellbein...Ruth Evans
Presentation by Fiona Samuels, Research Fellow, ODI, at workshop "Putting the 'social' back into young people's psychosocial wellbeing, care and support", hosted by ODI and the University of Reading, London 22 November 2016.
This presentation about ‘Valuing Mental Health’ by Dr Geraldine Strathdee, National Clinical Director of Mental Health, NHS England, was delivered to the Foundation Trust Network on 16 October 2013.
Geraldine covers:
- Why does the NHS need to value mental health: The impact of mental health on outcomes and costs
- Parity between mental health and physical health: What would it mean in practice
- Fast tracking Value in the NHS: What role can the Foundation Trust Network have in delivering it?
Presentation at PHABC Public Health Reducing Health Inequities Conference, Vancouver, British Columbia, Canada.
Also see several additional slideshares of mine about males and eating disorders and an excerpt from Global National TV 16x9 news documentary, Canadian national television.
Brief excerpt (2.5 minutes) here: https://www.youtube.com/watch?v=ctlGqM0ekOY
Full 23 mins show here: https://www.youtube.com/watch?v=OwhyB8mR-U8
This document discusses mental health issues among women of reproductive age. It notes that depression is common, affecting around 8% of pregnant women and 11% of non-pregnant women. Poor mental health can negatively impact physical health, pregnancy outcomes, and child development. The document reviews risk factors for depression like stress, low social support, pregnancy complications, and chronic illness. It also discusses treatments like antidepressants and therapy.
Major mental illnesses like depression, anxiety, and personality disorders are highly prevalent among prison populations worldwide. Prisons can exacerbate existing mental health issues due to overcrowding, violence, isolation, and lack of treatment services. Juvenile offenders also experience high rates of mental disorders, and screening and treatment are important but often inadequate. Reform is needed to establish better mental healthcare in correctional facilities and address the factors contributing to mental illness among inmates.
This document provides an overview of the Balanced Living with Diabetes (BLD) program, a community-based lifestyle intervention for improving blood glucose control among people with diabetes. BLD is based on social cognitive theory and community-based participatory research principles. It involves weekly 2-hour classes over 4 weeks that teach diabetes self-management skills like healthy eating, physical activity, and goal setting using interactive lessons and activities. Pilot programs of BLD found improvements in A1c, diet, and physical activity. A large randomized controlled trial of BLD found it effective at lowering A1c levels among African Americans with diabetes in medically underserved areas when delivered in faith-based community settings.
This document discusses health-related behavior and its determinants. It defines behavior and provides examples. It discusses the role of behavior in health and disease and approaches to diagnosing health behavior. It covers the behavior change process and models like the Health Belief Model. It discusses factors that influence human behavior like predisposing factors (knowledge, attitudes, beliefs), enabling factors (availability of resources), and reinforcing factors (social pressures). Finally, it compares concepts like knowledge, attitudes, beliefs, values and discusses the difficulty of changing each.
Men with Eating Disorders: Deepening Our Understanding to Improve CaringPaul Gallant
This document provides an overview of a presentation on deepening our understanding of eating disorders in males to improve care. The presentation covers background information, statistics showing eating disorders are underdiagnosed and undertreated in males, stories from caring for males with eating disorders, and ways to improve care. A poll asks participants about their interests and backgrounds. The presentation discusses the need for more research focused on males, training for medical professionals, and improving access to counseling, psychiatry, and treatment programs for males with eating disorders.
This document discusses adolescent mental health issues globally and in sub-Saharan Africa. It notes that common mental disorders in adolescents include conduct disorder, attention-deficit/hyperactivity disorder, autism spectrum disorders, depression, anxiety, and eating disorders. Risk factors include infectious diseases, injuries, pregnancy complications, self-harm, and lack of access to healthcare. Interventions should enhance social skills, provide early detection and treatment like counseling and medication, and address challenges like stigma and human rights violations.
Improving the Patient's Experience, Mental Health, Collaborative Stakeholder ...Paul Gallant
The document discusses improving mental health services through collaborative stakeholder approaches. It provides an overview of mental health services and experiences, and examples of collaborations including assessing a city's population needs and a project focusing on youth mental health. The document advocates for meaningfully engaging patients, providers, and other stakeholders to improve services and ensure priorities address patient experiences and outcomes. It also provides lessons learned around engagement, flexibility, participation support, and empowering stakeholders.
Paul Gill: The value of psychiatric liaison servicesThe King's Fund
Dr Paul Gill, Consultant Psychiatrist at Sheffield Liaison Psychiatry Service, explains what liaison psychiatry is and how it can help provide better outcomes across secondary and acute points of care.
2 mental health and disorders mental health and dismile790243
This document discusses a rising trend of mental health disorders among individuals on Chicago's south side. It notes that African Americans have higher rates of mental health disorders like post-traumatic stress disorder and schizophrenia. The document proposes a research study called Project IMPACT that would survey adults in south side Chicago neighborhoods about their mental health using questionnaires. The expected result is an increased risk of mental health disorders among African Americans in those areas. It concludes that decreasing this risk is important for improving the overall health of the African American population.
The document provides an agenda and background information for a stakeholder scoping workshop on long term conditions. The workshop aims to define the scope of a joint strategic needs assessment on long term conditions by gaining consensus on key conditions and cross-cutting themes to focus on. Presentations will cover the changing landscape of long term conditions, definitions and prevalence locally, and identifying priority conditions and common issues. Breakout groups will discuss potential conditions and themes to prioritize. Understanding local data availability and stakeholder priorities will help shape the needs assessment.
This document outlines goals for transforming the mental health system in the United States. It discusses the large burden of mental illness through lost productivity, high economic costs, and prevalence of disorders. The document proposes 6 goals: 1) increasing understanding of mental health, 2) making the system consumer-driven, 3) eliminating disparities, 4) promoting early screening and treatment, 5) delivering evidence-based care, and 6) using technology to improve access and information. The transformation aims to make mental health services equally accessible and effective as physical health care.
Better health, better lives conference tuesday 20 june 2017 - presentationsNHS England
1. Health, wellbeing and people with learning disabilities – Professor Jane Cummings
2. What the numbers are telling us – Professor Chris Hatton
3. What the numbers are telling us – Professor Chris Hatton (accessible)
4. The Learning Disability Mortality Review – and what it is telling us – Dr Richard Jeffrey
5. The Learning Disability Mortality Review – and what it is telling us – Dr Richard Jeffrey (accessible)
6. Health inequalities – Dr Angela Donkin
7. Health Checks – Dr Kirsten Lamb
HSC PDHPE Core 1 – Health Priorities in AustraliaVas Ratusau
The document discusses how priority health issues in Australia are identified. It notes that epidemiology plays a key role by measuring health status indicators like life expectancy, mortality rates, and prevalence of diseases and conditions. This data is collected by organizations like the Australian Bureau of Statistics and Australian Institute of Health and Welfare. The data shows trends like increasing life expectancy but also rising rates of obesity, diabetes, and mental health issues. Priority issues are identified based on factors like the social and economic burden of diseases.
This poster was presented to highlight the following mental health conditions in adolescent patients: attention deficit/hyperactivity disorder (ADD/ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD).
Mental Health is a very important aspect of public health. Although mental health assessment is vital within all populations, it is especially vital to assess mental health within our vulnerable populations (e.g. adolescents)
This document summarizes the key points of a presentation on mechanism-based pharmacoeconomic modelling. It discusses two main types of economic modelling: empirical modelling which uses statistical techniques to find parameter values that maximize correlation with observed data, and mechanism-based modelling which uses fundamental knowledge to define model structure and experiments to determine parameter values. It then provides examples of applying mechanism-based pharmacokinetic-pharmacodynamic models integrated with economic evaluations for rituximab and novel oral anticoagulants for atrial fibrillation. The results suggest genotype-guided warfarin dosing and newer anticoagulants like apixaban provide better outcomes and may be cost-effective alternatives to clinically dosed warfar
‘In with the old, out with the new’ – In search of ways to help health economists break their addiction to technology adoption. CHE Seminar presented by Professor Stirling Bryan, Director, Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Professor, School of Population & Public Health, University of British Columbia. 17th October 2014
Comparative hospital performance: new data, borrowed methods, more targeted a...cheweb1
Comparative hospital performance data can be used for two main purposes: 1) to identify general poor performance among hospitals, and 2) to inform quality improvement initiatives for specific conditions. This document analyzes data on chest pain presentations across four hospitals. It finds variations in costs, outcomes, and processes of care across the hospitals. Specifically, one hospital had higher costs, readmission rates, and length of stay compared to the benchmark hospital. Analyzing the data by patient subgroups found some of the variations were driven by differences in patients seen after hours with existing conditions. The document discusses potential strategies for using this type of comparative data to incentivize hospitals to reduce unwarranted variations in performance.
Methods for incorporating health equity impacts in economic evaluation with a...cheweb1
This document describes four approaches to incorporating equity into economic evaluation of health interventions:
1. Equity evidence review examines existing evidence on equity issues and stakeholder perspectives
2. Equity constraint analysis assesses health benefits foregone if more equitable but less cost-effective options are chosen
3. Equity distribution analysis quantifies how health impacts are distributed across groups
4. Equity trade-off analysis enables analysis of trade-offs between health and equity impacts by estimating both, allowing evaluation of interventions based on improving outcomes and reducing inequality.
The document reviews previous literature on these approaches and provides examples of studies that have implemented each type.
HIV in men-who-have-sex-with-men(MSM)in the UK:predicted effectiveness and co...cheweb1
1) The document discusses using a simulation model to study the potential impact of increased HIV testing rates and changes to when antiretroviral therapy (ART) is initiated on HIV incidence in men who have sex with men (MSM) in the UK.
2) The model results suggest that increasing testing rates and initiating ART at diagnosis could reduce annual new HIV infections by up to 64% by 2030, but ongoing high levels of condomless sex and poorer adherence to ART treatment may limit these prevention benefits.
3) For HIV incidence to fall below 1 per 1000 people per year, the analysis finds that the proportion of all MSM with suppressed viral loads would need to increase from the current approximately 60%
Getting evidence from economic evaluation into healthcare practicecheweb1
Seminar:Understanding the underutilisation of evidence from economic evaluations in healthcare: a mixed methods design. Speaker: Gregory Merlo, Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Australia.
Projecting ‘time to event’ outcomes in technology assessment: an alternative ...cheweb1
This document discusses alternative methods for projecting survival outcomes in technology assessments beyond what is observed in clinical trials.
The standard method of fitting parametric survival functions to trial data and extrapolating is problematic as it assumes a single mechanism and does not account for trial design or changes in risk over time. LRiG proposes examining trial data to understand risk trajectories and formulating hypotheses based on clinical context rather than selecting a model solely on fit. A case study demonstrates modeling progression-free survival, post-progression survival, and overall survival as separate phases using exponential convolution functions. LRiG advocates understanding empirical data and developing more informative multi-phase models rather than relying on standard projections.
Using Value-of-Information methodology to inform the design of clinical trial...cheweb1
This document summarizes research from the InSPiRe project on using value of information analysis for clinical trials of treatments for rare diseases. It discusses challenges with rare diseases like small patient populations and high drug costs. It also reviews literature on decision-theoretic trial designs and using a Bayesian framework to optimize decisions between alternatives. Finally, it provides an example of modeling strategic interaction between a drug sponsor and regulator to identify optimal trial size and drug price that maximize objectives for all parties.
An illustration of the usefulness of the multi-state model survival analysis ...cheweb1
This seminar will demonstrate the potential of multi-state survival modeling (MSM) as a tool for decision analytic modelling and compare it to the usual Markov transition modelling approach. After briefly reviewing examples of MSM in the health economics literature, a technology appraisal submitted to NICE evaluating the cost effectiveness of Rituximab for first line treatment of chronic lymphocytic leukaemia will be used for illustration purposes. Finally, areas of future research will be outlined.
CHE Economic Evaluation Seminar presentation 17th September 2015, Edit Remak,...cheweb1
This document introduces real options analysis (ROA) and real options games (ROG) as approaches to health technology assessment that explicitly consider multiple decision points and uncertainty over time. It discusses how ROA allows flexibility in timing, scope, and abandonment of investments under uncertainty. A ROG combines ROA and game theory to model strategic interactions between decision makers like coverage, pricing, and research actors. The document uses drug-eluting stents versus bare metal stents as a case study, modeling it as a two-player sequential game between manufacturer and payer to demonstrate how ROG can assess health technologies.
The document discusses activities of daily living (ADLs), which are essential tasks required for independent living such as eating, bathing, and mobility. It describes the six basic ADLs and instrumental ADLs. ADLs are used to assess a patient's functional status and ability to live independently. Declines in ADLs can result from aging, illness, injury or other factors. Several assessment tools are used to measure patients' abilities related to ADLs. Healthcare professionals play an important role in routinely assessing patients' ADLs to plan care, ensure safety, and determine needs for rehabilitation or assisted living.
This document discusses the management of developmentally disabled children. It begins with an introduction to developmental disabilities, including causes and prevalence. It then discusses societal attitudes towards disabilities over time, from primitive periods of neglect to modern integration. Common developmental disabilities like autism, intellectual disabilities, cerebral palsy, and Down syndrome are explained. The document outlines approaches to monitoring development, screening, diagnosis and adaptive testing. It provides guidance on managing specific disabilities during dental treatment, including allowing choices, relaxation, positive reinforcement and shorter appointments tailored to needs.
The document discusses the principles of health education, including educational diagnosis, participation, using multiple methods, planning and organizing, basing education on facts, segmenting audiences, assessing needs, and respecting local culture. It also describes the targets of health education as individuals, groups, and communities. There are three levels of health education for disease prevention: primary aims to prevent disease onset, secondary aims to prevent disability, and tertiary aims to avoid major disability for chronic conditions. Finally, it lists schools, workplaces, healthcare settings, and homes as common locations for delivering health education.
Ethical, moral and legal issues in oncologyManali Solanki
The document discusses end of life care and ethics in oncology nursing. It defines end of life care as treating, comforting, and supporting those living with or dying from chronic life-threatening illnesses. It also discusses the importance of communication, education, and addressing spiritual-psychosocial needs of dying patients and their families. The document outlines several ethical issues that may arise in end of life care, such as medical futility, terminal sedation, euthanasia, physician assisted suicide and advocates respecting patient autonomy.
Key note presentation at Global Health Disparity Conference, North Carolina Central University, United States
5/4/2019
By;
Amara Frances Chizoba MPH, AAHIVS, PhD
Director, Mission to Elderlies Project
Renewal Health Foundation Nigeria
www.renewalhealthfoundation.org
missiontoelderlies@gmail.com
+2347088698103
This document provides an overview of mental illness, including common myths and facts, accommodating people's needs, recovery, and the Centre for Addiction and Mental Health (CAMH). It defines mental illness and lists common categories. It discusses myths such as the predictability of those with mental illness and their employment potential. It also outlines principles of accommodation and recovery. Finally, it provides details about CAMH, including its approach and statistics.
The document discusses mental illness, including common types and myths and facts about mental illness. It also covers accommodating people with mental illness, including examples of accommodations, as well as recovery and the recovery framework. Finally, it provides an overview of the Centre for Addiction and Mental Health (CAMH), including its services and referral process.
Unit 7 providing young people with the health services they needDeus Lupenga
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Challenges for economic evaluation when doing research with people with learning disabilities
1. Challenges for economic evaluation when doing research
with people with learning disabilities
Claire Hulme, John O’Dwyer, Louise
Bryant, Amy Russell, Allan House on
behalf of the OK Diabetes Research
Team
Academic Unit of Health Economics,
University of Leeds
c.t.hulme@leeds.ac.uk
0113 343 0875
Funded by National Institute of Health Research, Health Technology Assessment Research Programme 10/102/03: Managing with Learning Disability and Diabetes.
OK Diabetes. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health
2. Introduction
• Research with hard to reach vulnerable
groups presents myriad challenges
• This is particularly pertinent for people
with learning difficulties
• People with learning difficulties were
not involved in research that was about
them even as interviewees until the
1980s
• Methodological difficulties include a
tendency to acquiesce because so
much of their lives are controlled by
others
• How do we know if the person really
understands what we are asking them?
• Economic evaluations rely on health
care or health insurance records or
forms such as the CSRI completed by
the service provider rather than by
people with learning disabilities
themselves
• This presentation reports on the
development and testing of data
collection methods for use in an
economic evaluation within a RCT for a
manualised supported diabetes self-
management programme for people
with mild/moderate learning
disabilities: the OK Diabetes study
3. • Background: Learning difficulties and diabetes
• A little about the research and overall study ‘challenges’
• The Challenges for economic evaluation so far
• Discussion
4. Background: Diabetes
• Prevalence of diabetes rising nationally
• Leeds (Pop ~725k) there are >27000 on
the QOF diabetes register and in
Bradford (Pop ~520k) there are 26500
on the QOF diabetes register
• This gives population prevalence that
are typical of published figures from
elsewhere of 4% and 5%
• There are 3.2 million people diagnosed
with diabetes in the UK
• An estimated 630,000 people have the
condition, but don’t know it
• Diabetes develops when glucose can’t
enter the body’s cells to be used as
fuel. This happens when either:
• There is no insulin to unlock the cells
(Type 1)
• There is not enough insulin or the
insulin is there but not working
properly (Type 2)
5. Background: Learning disabilities
• People with a learning disability have
poorer health
• More likely to have additional health
problems e.g. weight, mental health
and respiration
• Have poorer health outcomes
• CIPOLD (Confidential Inquiry into
Premature deaths Of people with
Learning Disabilities)
• Men with learning disabilities die on
average 13 years earlier than those
without ; women on average 20 years
earlier; 22% under age of 50 when they
died
• Most common underlying problem was
heart /circulatory disorders and cancer
• Most common immediate problem was
a respiratory
• More likely to have multiple long term
conditions
• Delays in diagnosis and treatment
• Lack of communication between
professionals; co-ordination of care
across different disease pathways and
service providers
6. Learning disabilities and diabetes
• Type 2 diabetes disproportionately
affects people with a learning disability
• Studies of GP data (NHS MiQuest
system) in the UK shown higher
prevalence of diabetes in people with
LD (Glover et al, 2012)
• This higher rate has also been found in
USA, Netherlands and Canada
• People with LD are more likely to be
admitted to hospital as an emergency
with complications of diabetes
• Admission to hospital for Ambulatory
Care Sensitive Conditions (ACSCs)
indicates potential weaknesses in
primary care that need addressing
• ACSCs are chronic conditions for which
it is possible to prevent acute
exacerbations and reduce the need for
hospital admission through active
management. Examples include
congestive heart failure, diabetes,
asthma, angina, epilepsy and
hypertension.
7. Supported self-management
• Self-management is a standard part of
the NHS response to long-term
conditions
• It is unclear whether supported self-
management, which is widely
promoted in other areas, would be of
benefit in improving the health of
people with mild/moderate learning
disability and type 2 diabetes
• Supported self-management
programmes have an educational
component
• Problem-solving strategies;
• Goal setting and planning behaviour
change
• Self-monitoring
• Effective use of resources – including
healthcare
• Work with supporters
• Managing emotions
8. Research question
• Is it possible to develop a practicable
programme of supported self-
management for people with
mild/moderate learning disability and
type 2 diabetes?
• And evaluate it in an RCT?
• Type 2 as it has lifestyle management
aspects
• Insulin use needs very specific advice to
calculate doses
Phase 1:
• identify people with learning disability
and type 2 diabetes and characterize
their diabetes management and control
• Develop a supported self-management
programme
Phase 2:
• Undertake a feasibility RCT
9. Learning disabilities or difficulties?
• Phase 1: Identifying people with a
learning disability and type 2 diabetes
• We have asked:
– GPs
– Charities like Tenfold and People in
Action
– Secondary Care e.g. LGI diabetes
clinic
– Community LD Team
– LD Housing providers
• Learning difficulty is difficult to define
and identify, especially at the milder
end of the spectrum
• It can be defined statistically based on
test scores, which typically show a
negatively-skewed distribution, and in
those terms, it is often said that 2% of
the general population will have some
degree of learning difficulty
• However, the picture becomes more
complex when functional impairment in
real-world activities is built into the
definition
10. Learning disabilities or difficulties?
• Functional deficit may not be entirely
attributable to intellectual impairment
but to (for example) emotional or social
problems or missed schooling
• Conversely, an adult with intellectual
impairment may not come to the
attention of statutory or non-statutory
agencies if he or she is functioning
independently or is well supported by
family or some other informal carer
• The functional approach to definition is
now widespread
• Learning disability (referring to an
intellectual impairment) and learning
difficulty (referring to a functional
state)
• Learning disability often refers to
specific deficits such as dyslexia, even
when it is not associated with more
general intellectual impairment or
functional deficit
• We use the term learning difficulties to
encompass all types of intellectual and
educational deficit that lead to
problems with self-management,
11. Case definition
• Not a diagnostic checklist but a guide to
help identify possible participants
• Activities
• Can/do they:
• Read, write, manage money, look after
their personal care, tell the time, cook,
have difficulty in communicating with
other people?
• Remembering
• Can they remember:
• Significant things about themselves
(e.g. birthday), significant things about
their environment (e.g. where they
live), when to do things (get up, what
time dinner is), what you have said?
• Life experience
• Have/do they:
• Attended a special school, or statement
of special educational need; attend a
day centre; live outside a hospital or a
LD residential service; have people who
support them e.g. care manager,
advocate, or informal supporter?
12. Learning disability in Leeds
• Estimated 14,000 people in Leeds with
a learning disability
• Only 2128 on LD register
• 3300 in receipt of paid support
• QOF Diabetes register in Leeds has
27,000 people
• Only 98 of these are also on LD register
• Assuming 2% of adults have LD, should
be 540 (approx.)
13. Recruitment from primary care:
• Read-code based searches
• Advice to GPs re: alternative
approaches
• Regular mailings & newsletters
• Face to face meetings (GPs & Practice
Managers)
• Attendance at events
• Engagement with and support from
WSY&B CSU
• WYCLRN support
• But... recruitment slow
Recruitment from primary care:
• Non-response from GPs
• Uncomfortable referring vulnerable
population
• Reluctance to discuss with those
without formal diagnosis of LD
• Primary Care LD registers limited
• Lack of support from PCRN
• Higher proportions using insulin -
reduced ‘pool’
• Difficulty contacting potential
participants
• More cases than expected come from
outside healthcare
14. Recruitment Beyond Healthcare
Local
Authority
LD
Charities
Further
Education
Advocacy Employment
Citizens
Advice
Bureau
Disability
Employment
Advisors
(Job Centre)
MENCAP
employability
service
Foundation
Skills
Advisors FE
colleges
Fulfilling
Lives Day
Centres
Advocacy
Charities in
all 3 areas
Carers
Community
Volunteering
e.g. The
Conservation
Volunteers
Supported
housing
providers
Carers orgs. In
all 3 areas:
events and
newsletters
Health
Charities
HALE Bradford,
Zest Health for
Life, Feelgood
Factor
MENCAP,
Thru the
Maze, People
1st Bradford/
Keighley,
Tenfold
1:1 Support
Services
e.g. St
Anne’s
15. Where we are now.....
• We have produced all the necessary
materials for a trial:
– information; consent;
– Protocol; CRFs; outcome measures
– Intervention + adherence measure
• We have learned a great deal about
recruitment from the target population
• We on target to recruit 200 participants
of whom at least 75% will be eligible to
participate and have already expressed
an interest in being re-contacted
16. What about the economic evaluation?
• Resource use
• HES – but need for community
resources
• GP records – completed by the GP or
GP surgeries
• TPP Systmone
• Client questionnaires – interviewer
administered
• Outcomes
• EQ-5D interview administered
• Client questionnaires
• 4 week recall except diet, previous day
• Interview administered by researcher
• Often there will be a supporter present
at the interview
• Form designed to ask about health and
social care, employment, travel, and
diet (change in diet important part of
the self-management intervention)
• Each question on the EQ-5D printed on
an A4 sheet as interview aid
17. Obtaining data from GPs
• Forms were simplified and contained
only 10 questions for brevity
• Tick box plus number of
visits/appointments
• Researcher regularly sent reminders
and visited to talk through completion
Challenges:
• Skip sections
• Refuse to complete
• Incomplete forms
• Use tick box but not number
• This was even from GPs who are very
research ‘savvy’
• Why?
• Many of the contracts are recorded as
free text in the records – e.g. phone
contact with the GP; referral letters
from psychiatrist – not coded
• Time intensive to go through
• Dependent on the knowledge of the
practice manager or whoever is tasked
with completing the form
• Some admin staff reluctant to hand
over data – don’t feel they have the
authority
18. Possible solutions…
• Find out who the client sees most often
in the GP surgery – send the form to
them?
• But… if this is the GP this will be likely
delegated to the practice manager
• Often practice nurses do health checks?
• Lack of coded data – free text is a worry
in data returns to Systmone
19. Client questionnaire
• Supporter can be formal or informal
• Informal supporters often also have LD
• Formal supporters have incomplete
knowledge
• Concept of time: poor recall of GP visits
etc
• Recall big events such as hospital, A&E
– but often these are actually years ago
• Confusion over hospital and clinic visits
• Little understanding of
medication/prescriptions as these tend
to be sent by the pharmacy or collected
by a supporter
• No recall of some GP consultations as
they are not involved e.g. their
supporter may phone the GP on their
behalf
• In terms of domestic help needed
(social care) most in our cohort live in
shared homes so the paid supporter
does these things – although there are
different levels of help
• Means of travel to health care
appointment is always remembered;
given bus numbers and for some there
is a staff driver
20. Client questionnaire
• Employment status is an emotive
question: Found the question upsetting
• Defensive about never working
• Almost all at home on disability benefit
• Felt employers wouldn’t give them a
job
• Recall of food was also challenging
• Most recalled evening meal but there
was confusion over earlier meals
• Reluctance to admit to snacks or drinks
during the day
• Asked if what they ate the previous day
was usual or unusual – no difficulties
answering this
• Found ‘more or less’ very difficult as
the food eaten might be different
21. EQ-5D
• This was perceived by the researcher to
be the most difficult part of the
questionnaire
• Respondents had a lot of difficulty with
the terminology
• In particular the change in terminology
within the domains:
• From no problems and some problems
to confined (to bed) or unable (to wash
or dress)
• The change from self care (no
problems) to some problems washing
and dressing
• In self care often the supporter helps
washing and dressing and as such no
problems
• Didn’t understand what ‘performing’
meant
• In the pain/discomfort and
anxiety/depression domains found the
terms moderate and extreme baffling
• In the anxiety/depression domain
didn’t understand the term anxious
22. Discussion
• Four primary impressions from this
preliminary data: acquiescence, time,
terminology, control
• Previous research that highlights
acquiescence – telling the person the
person what they want to hear might
be at play here - particularly within the
food section
• There appears to be a real challenge in
the conception of time apparent in the
4 week and previous day recall
• The terminology – especially in the EQ-
5D was a clear problem. Input in the
phrasing of the resource use questions
was received from the advisory group
and more widely from the third sector
but the EQ-5D is validated and can’t be
changed
• The level of control over activities of
daily living is also clear in everything
from transport, to household chores, to
cooking (and therefore to an extent
food intake?)
• If we include only those with
supporters do we exclude those with
mild/very mild LDs?
23. What now?
• These are preliminary results we are
still collecting data
• Immediately after each interview the
researcher complete a questionnaire
that records level of difficulty
answering each question, whether the
supporter helped, and free text with
their perceptions – this should provide
a rich dataset
• Overall…
• Unlikely GPs will provide robust data on
community health use but we will
explore better targeting who completes
the form
• The amount of free text rather than
coded items. Need to explore how
Systmone address this
• Challenges in acquiescence, time,
terminology, control
• More input from supporter? – but only
includes those with supporters? And
assumes the supporter has that
knowledge (formal/informal/advocate)
• How to measure HRQoL?
CIPOLD cohort of 247 people with LD who died between 2010-12
Glover G, Emerson E, Eccles R. Using local data to monitor the Health Needs of People with Learning Disabilities. Durham: Improving Health & Lives: Learning Disabilities Public Health Observatory, 2012.
Ambulatory Care Sensitive Condition (ACSC) a condition which can normally be treated effectively in primary care.
Flags that change is needed in Primary care treatment of diabetes in this group