Assessing the efficiency of hospital pharmacy services in Thai public district hospitals.

The purpose of this study was to assess the efficiency of hospital pharmacy services and to determine the environmental factors affecting pharmacy service efficiency. The technical efficiency of a hospital pharmacy was assessed to evaluate the hospital's ability to use pharmacy manpower in order to produce the maximum output of the pharmacy service. Data Envelopment Analysis (DEA) was used as an efficiency measurement. The two labor inputs were pharmacists and support personnel and the ten outputs were from four pharmacy activities: drug dispensing, drug purchasing and inventory control, patient-oriented activities, and health consumer protection services. This was used to estimate technical efficiency. A Tobit regression model was used to determine the effect of the hospital size, location, input mix of pharmacy staff, working experience of pharmacists at the study hospitals, and use of technology on the pharmacy service efficiency. Data for pharmacy service input and output quantities were obtained from 155 respondents. Nineteen percent were found to have full efficiency with a technical efficiency score of 1.00. Thirty-six percent had a technical efficiency score of 0.80 or above and 27% had a low technical efficiency score (< 0.60). The average TE score increased in respect to the hospital size (0.60, 0.71, 0.75, and 0.83 in 10, 30, 60, and 90-120 bed hospitals, respectively). Hospital size and geographic location were significantly associated with pharmacy service efficiency.

Handling uncertainty of the economic evaluation result: sensitivity analysis.

An economic evaluation of health technology and interventions often comes with uncertainty in the parameters that were used in the model. To determine sensitivity of the result obtained from a reference case analysis, researchers can employ deterministic and probabilistic approaches. This methodological guideline summarizes the principles underlying the sensitivity analysis and recommends that the probabilistic sensitivity analysis is the best method to handle the parameter uncertainty.

The validity of A new practical quality of life measure in patients on renal replacement therapy.

OBJECTIVE: A new quality of life measure, apart of the National Health and Welfare 2003 survey, is a promising tool for outcome evaluation of clinical practice due to its brevity, validity, reliability, and providing easy interpretation against general population norm-based scores. The measure consisting of 9-items, and so called 9-item Thai Health status Assessment Instrument (9-THAI) was used to assess its validity and reliability in patients on renal replacement therapy (RRT). MATERIAL AND METHOD: Three hundred and two patients on RRT who visited Srinagarind Hospital from March to May 2005 were studied Convergent and divergent validity were assessed using SF-36 as the concurrent measure. Concurrent validity was also assessed using hematocrit level and hospitalization history in the last year as concurrent clinical measures. Test-retest reliability was studied by repeated measure within one 1 month. Responsiveness of 9-THAI was studied in patients who reported health improvement. RESULTS: Results of correlations between 9-THAI and SF-36 domains were as hypothesized 9-THAI scores were significantly correlated with hematocrit level and hospitalization history. The results confirmed the validity of 9-THAI for use as a quality of life measure. Intraclass correlation coefficients of 9-THAI scores in stable patients were satisfactory. Among patients on RRT who reported overall health improvement, 9-THAI scores significantly increased, thus adding further evidence of the responsiveness of 9-THAI. CONCLUSION: The 9-THAI is a valid and reliable generic health status measure that can be used as an ideal core in a battery of quality of life measures in clinical practice for patients on RRT.

Effect of changes in diagnosis and management of active infective endocarditis on the clinical outcome at Srinagarind Hospital.

BACKGROUND: In recent years, diagnostic methods and treatment of infective endocarditis (IE) have been improved. It is not known whether the clinical outcome is any better. OBJECTIVE: To assess the effect of changes on the clinical outcomes of IE patients. MATERIAL AND METHOD: The authors performed a retrospective study comparing IE patients hospitalized at Srinagarind hospital during the period from 1/1/1990 to 31/12/2002. The authors classified the patients according to the period of diagnosed from 1990 to 1993 (n=57), 1994 to1997 (n=71), and 1998 to 2002 (n=72) cohorts. RESULTS: There were two hundred IE patients in the present study. Mean age and degenerative heart disease were increasing. Operative and in-hospital mortality were decreasing. Overall survival rate was 81% at the first year 60% at 5 years, 55% at 12 years in surgically treated patients, with 30-day mortality in 27.1% mostly from the 1990 to 1993 cohort. In medically treated IE, overall the survival rate was 37% in the first year, 32% at 5 years, 20% at 12 years, with 30-day mortality in 72.86% mostly in the 1990 to 1993 cohort. Early surgical intervention, improved long-term survival rates (hazard ratio 0.23; 95% CI 0.14-0.37), severe congestive heart failure (hazard ratio 1.87; 95% CI 1.17-2.99) and renal failure (hazard ratio 4.10; 95% CI 2.05-7.84) are the predictors of mortality by multivariate analysis. Survival rate from 1998 to 2002 cohort was 85%, 1994 to 1997 cohort was 54% and 1993 to 1990 cohort was 27% at 1-year (p < 0.001). CONCLUSION: The data indicated that the changing clinical outcome of this disease, reflected improvements in diagnostic method and treatment. Although IE remains a serious condition characterized by significant morbidity and mortality, the overall survival rate has significantly improved over time. The authors therefore, believe that early diagnosis and prompt treatment both medical or surgical interventions will improve the outcome of IE patients.

Clinical outcome of native valve infective endocarditis in Khon Kaen: 1990-1999.

OBJECTIVE: To compare the survival of infective endocarditis (IE) patients following different treatment strategies and to determine the predictors of patient survival. BACKGROUND: IE is a life-threatening infectious disease that is often difficult to manage. Studies on long-term outcome are limited. METHOD: Data on 152 patients with IE from 1990 to 1999 were collected from two hospitals. The main outcome is death after definite diagnosis of native valve IE. RESULTS: The overall case fatality rate was 38 per 100 patient-years. Survival curves showed better survival for patients treated with surgery compared with patients treated medically (p <0.0001). Survival rate at year 1 was 72 per cent for surgically treated patients and 33 per cent for medically treated patients. Five-year survival rates were 66 per cent and 27 per cent in the two groups, respectively. Based on Cox proportional hazards regression analysis, surgery to be an independent predictor of survival (relative risk [RR] = 0.23; 95% confidence interval [CI] 0.14 to 0.39, p < 0.0001), while the presence of congestive heart failure (RR = 2.55; 95% CI 1.61 to 4.02, p < 0.0001), and being male (RR = 1.76; 95% CI 1.04 to 2.82, p <0.05) were independent predictors of mortality. CONCLUSION: Patients with native valve endocarditis have a high long-term mortality rate. The most common types of cardiac death are post-operative and sudden death. Surgical treatment was the preventive factor of mortality.