Patient Satisfaction: Key Strategies for Better Health Care Outcomes

Patient satisfaction is the key indicator for evaluation of health care system and measuring quality of care. It affects the quality of care and health outcome. Patient satisfaction is an alternate but an effective indicator to measure the success of nurses and health setting. Patient satisfaction is affected by various factors such as communication skill, interpersonal relationship, quality of care and behaviour of staff. Strategies like effective communication, transparency of health care-related information, empathetic hospital environment and prioritising quality outcome can be used for improving patient satisfaction. Meanwhile, nursing care is major component of healthcare services because nurse spends more time with patient in health care organisation. Therefore, measuring patient satisfaction with nursing care could be effective in improving quality of nursing services.

Progress and implications of value-based medical payment in the United States / 中华医院管理杂志

Value-based medicine is a healthcare delivery mode with the objective of obtaining better medical quality and health outcomes at a certain cost. The authors introduced the concept of value-based medicine, reviewed its background in the United States, described the transformation of payments from fee-for-service to value-based modes of the Centers for Medicare and Medicaid Services in the United States, and analyzed current challenges of value-based payment. Then the authors discussed the implications for China′s medical service providers to carry out value-based medical practice, in order to provide reference for China′s medical workers to participate in the construction of high-value medical system.

Effectiveness of health education in the self-care and adherence of patients with heart failure: a meta-analysis / Efetividade da educação em saúde no autocuidado e adesão de pacientes com insuficiência cardíaca: metanálise / Efectividad de la educación en salud para el autocuidado y la adhesión al tratamiento de pacientes con insuficiencia cardíaca: meta-análisis

Objective: to evaluate in the literature the effectiveness of the health education interventions in self-care and adherence to treatment of patients with Chronic Heart Failure. Method: a systematic review with meta-analysis. Studies were selected that compared health education interventions with the usual care to assess the outcomes of adherence and self-care. The quality of the methodological evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation system. Results: the educational interventions were more effective in relation to the usual care in the outcome of adherence (fixed effect=0-3841; p-value <0.001). There was no statistical difference in the outcome of self-care (fixed effect=0.0063; p-value=0.898). Conclusion: the educational interventions improved the outcome of adherence, though not self-care in the patient with Heart Failure.

Objetivo: avaliar na literatura a efetividade das intervenções de educação em saúde na adesão e autocuidado ao tratamento de pacientes com Insuficiência Cardíaca Crônica. Método: revisão sistemática com metanálise. Foram selecionados estudos que comparavam intervenções de educação em saúde com o cuidado usual para avaliar os desfechos de adesão e autocuidado. A qualidade da evidência metodológica foi avaliada pelo sistema Grading of Recommendations, Assessment, Development and Evaluation. Resultados: as intervenções educativas foram mais efetivas em relação ao cuidado usual no desfecho de adesão (efeito fixo =0,3841; p-valor <0,001). Não houve diferença estatística no desfecho de autocuidado (efeito fixo =0,0063; p-valor =0,898). Conclusão: as intervenções educativas melhoraram o desfecho de adesão, mas não o de autocuidado no paciente com Insuficiência Cardíaca.

Objetivo: evaluar en la literatura la efectividad de las intervenciones de educación en salud para la adhesión al tratamiento y el autocuidado de pacientes con Insuficiencia Cardíaca Crónica. Método: revisión sistemática con meta-análisis. Se seleccionaron estudios que comparaban intervenciones de educación en salud con el cuidado habitual para evaluar los resultados de adhesión al tratamiento y autocuidado. La calidad de la evidencia metodológica se evaluó con el sistema Grading of Recommendations, Assesment, Development and Evaluation. Resultados: las intervenciones educativas fueron más efectivas en relación al cuidado habitual en el resultado de adhesión al tratamiento (efecto fijo=0,3841; valor p <0,001). No se registró diferencia estadística en el resultado de autocuidado (efecto fijo=0,0063; valor p =0,898). Conclusión: las intervenciones educativas mejoraron el resultado de adhesión al tratamiento, aunque no el de autocuidado en el paciente con Insuficiencia Cardíaca.

Scientific research presentations in pharmacoeconomics and health outcomes research: status of India compared to SAARC and BRICS countries

South Asian Association for Regional Cooperation (SAARC) and Brazil, Russia, India, China, and South Africa(BRICS) countries’ contribution in the field of science and engineering has grown immensely over the decade. BRICScountries have accelerated their efforts in healthcare, as well in the pharmaceutical sector through increased efforts inresearch and development, acquisitions, and generic drug manufacturing. Pharmacoeconomics and health outcomesresearch field give an indication about healthcare coverage and access decisions. India being significantly majorplayer among SAARC and BRICS countries in terms of economy and policy making, the present study attemptedto analyze scientific research presentation made by India compared to SAARC and BRICS countries in the area ofpharmacoeconomics and health outcomes research at International Society for Pharmacoeconomics and OutcomesResearch Meetings. The scientific research presentation abstracts published from 2008 to 2017 were included in thestudy. Research in the area of pharmacoeconomics and health outcomes studies has increased in SAARC and BRICScountries over the last 10 years. The collaborative research with foreign/international authors is also increasing, whichis an encouraging trend in this area. The research carried out by SAARC and BRICS countries in the above-said areashould be strengthened further which may be beneficial to the society in the coming years.

Effect Evaluation of PBM Pilots in Wuhu City of Anhui Province from the Perspective of Patients / 中国药房

OBJECTIVE： To evaluate the effects of Pharmacy Benefit Management （PBM） model on drug compliance， health outcomes， economic burden and satisfaction of patients in Wuhu city of Anhui province. METHODS： In cross-sectional study， the questionnaires were designed according to the National Health Service Survey. Through cluster sampling and convenient sampling， the questionnaire survey （including subjective evaluation） was conducted among hypertensive patients who participated in or did not participate in the PBM program in pilot area of Wuhu city. Descriptive analysis was used to analyze the general characteristics of the two groups. The Propensity Score Matching （PSM） was used to approximately randomize the included data to balance the baseline characteristics. Univariate linear regression or Logistic regression analysis were used to evaluate the relationship of whether to join PBM or not with drug compliance，QALY， hospitalization probability，monthly average drug cost for chronic diseases and monthly self-paid drug cost for chronic diseases， etc. RESULTS： A total of 755 valid questionnaires were collected， including 405 in the PBM group and 350 in the non-participating group. There was statistical significance in patient’s gender， age， education degree， nature of household registration， type of medical insurance or usual visited medical institutions （P＜0.05）. About 95％ patients （405 cases） satisfied with PBM program. 281 cases of PBM group and 193 cases of non-participating group were included through PSM. Results of regression analysis showed that lower one level at least of medication compliance in PBM group was 0.49 times as that in the non-participating group； the hospitalization probability in PBM group was 0.56 times as that in the non-participating group （P＜0.05）. There was no statistical significance of difference in control of blood pressure QALY， monthly average drug cost for chronic diseases and monthly self-paid drug cost for chronic diseases between two groups （P＞0.05）. CONCLUSIONS： The implementation of PBM model in pilot areas can improve drug compliance and reduce hospitalization rate of patients. The most patients are highly satisfied. However， the effects of PBM on patients’ control of blood pressure， QALY and medical expense are not obvious， and its long-term effect needs more follow-up studies to verify.

Developing Block Wise Composite Health Index in Yavatmal District, Maharashtra State, India: An Analysis of Available Data

Introduction: Numerous health indicators from different domains and comprehensive systems for describing health of community at state or district level are in vogue. Some sub-district information is also available from Health Management Information System but the numbers of indicators are many. Here composite health index of sub-district level is calculated similar to documented procedure. Objective: To develop block wise composite health index in an average district, Yavatmal district using available data. Methods: We grouped health indicators in following four categories; health outcomes, health system, other determinants and utilization of services. From these categories we selected four, three, two and one indicator respectively. Almost all the information is collected from already available data. There are 16 blocks in Yavatmal district. Block wise information of all indicators was first compiled. The block having best value was given 100 marks and remaining blocks were given proportionately less marks. The block wise total marks were calculated. The total score was converted into index by dividing by 1,000. Results: The composite health index ranged from 0.369 to 0.794. The median was 0.425 and interquartile range was 0.126. Out of ten, nine health indicators had normal distribution. We observed positive correlation between urbanization and composite health index. The Yavatmal block obtained highest composite index 0.794 and was an outlier. Principal component analysis extracted four components which contributed 82.06% to total variance. Conclusion: Using only ten indicators and simple method blocks composite health index can be developed which may be used to compare blocks or even districts.

Relationship analysis between health expenditure and GDP based on health outcomes / 中国卫生政策研究

Objective:To put forward some suggestions for the national health development in the filed of health expenditure indicators .Methods:Two health expenditure indicators and four health outcomes indicators were chosen from WB and WHO official websites , and researches on the relationship between health expenditure and outcomes were conducted .We put forward proposed value of the health cost indicator .Results: With different levels of GDP per capita , the scatter diagram of health expenditure and GDP per capita had different rules .When health outcomes were taken into consideration , the rules were the same .When GDP per capita was at different level , better health outcomes were not related to higher health expenditure .Input-output ratio should be taken into consideration fully . Suggestions:The study should be dynamic as GDP develops .More factors can be added in the research , if the data of the factors is available .In this study , the GDP per capita was divided into 4 sections .The division standard of the GDP per capita can be more delicate .What is more important for the development of health expenditure is not contin-uing input , but better input-output ratio because of diminishing of marginal returns .One set of standards cannot be a-dapted to all countries and districts .We should give full consideration to the improvement of people's health instead of increasing input because the ultimate goal is the former .

Cost Effectiveness of Intermittent Preventive Treatment of Malaria in Infants in Ghana.

Aim: In order to integrate malaria Intermittent Preventive Treatment in infants (IPTi) into the Ghana national immunization programme, there was the need to evaluate the feasibility of IPTi by assessing the intervention operational issues including its implementation costs, and its cost effectiveness. Study Design: Cross-sectional study. Place and Duration of Study: Upper East Region, Ghana, between July 2007 and July 2009 Methods: We calculated the costs of administrating IPTi during vaccination sessions; the costs of programme implementation during the first year of implementation (start-up costs) and in routine years (recurrent costs). For the purposes of cost-effectiveness analysis, all economic costs (including financial and opportunity costs) and the net cost were estimated. To estimate the cost effectiveness ratios of IPTi, the aggregate cost of providing the intervention for a reference target population of 1,000 infants was divided by its health outcome. Sensitivity analyses were carried out to understand the results robustness. Results: IPTi gross costs in start up and in routine years were estimated at 70.66 cents and 29.72 cents per dose, or $2.0 and $0.87 per infant, respectively. The gross cost per DALY saved was estimated at $3.49 and the net cost of IPTi for 1,000 infants was $-3,416.38 in the routine years rending IPTi a highly cost saving intervention. Sensitivity analyses showed that the cost per DALY saved never went up more than $4.50 maintaining the intervention still highly cost effective. Conclusion: IPTi in Ghana is a highly and robust cost effective intervention. The intervention is cost-saving and should be scaled up nationally to save children’s health and economic capital.

Breakfast Consumption Pattern, Diet Quality and Health Outcomes in Adults from 2001 National Health and Nutrition Survey

This study was conducted to investigate breakfast consumption pattern in relation to diet quality and health outcomes of Korean adults. Data are from 2001 National Health and Nutrition Survey. Dietary information of 3406 adults aged 30~49 years and their socio-demographic characteristics, blood lipid profile, fasting blood glucose, blood pressure, anthropometric measurements were analyzed. According to the breakfast consumption of the subjects, they were classified to breakfast skippers and eaters and the eaters' breakfast staple types were defined as RICE, BREAD, NOODLES, MIXED (mixed types including several grain-based dishes), and OTHERS. The proportions of breakfast consumption patterns were 18.4% for skippers, 71.1% for RICE, 2.6% for BREAD, 1.6% for NOODLES, 4.0% for MIXED, and 2.4% for OTHERS. Breakfast skippers had lower daily nutrients intake than breakfast eaters but their health outcomes did not differ from those of eaters. Instead, men with BREAD pattern had higher blood cholesterol and women in NOODLE pattern had higher blood glucose and lower HDL cholesterol. The BREAD pattern breakfast had higher energy contribution from fat and lower nutrient densities and the subjects in BREAD pattern had higher level of household income. Men's BREAD pattern breakfast consisted more animal products than that of women. There was high probability of undernutrition among women in NOODLE pattern and their mean household income was the lowest. From these results, in Korea, breakfast staple types have different food patterns and there was need for developing healthy food patterns appropriate to each staple type. The breakfast consumption pattern had influences on nutrient adequacy of the diet and health outcomes and seemed to represent socio-economic status. These could be used in doing nutrition education in community.

Quality of Life Assessments in Patients Treated with Anticancer Drugs / 薬剤疫学

Health-related quality of life (HR-QOL) has become one of the important endpoints in cancer clinical trials. However, a relatively small proportion of oncologists truly understand the concepts and uses of QOL assessments. In this article, I discuss in detail the psychometric properties that should be verified with QOL instruments, the range of QOL concepts that should be assessed in oncology, how to choose the appropriate QOL instruments, cross-cultural issues and statistical problems. Several examples of QOL assessments in cancer clinical trials are also introduced.