ABSTRACT
In 1992 a project was started in which home care technology was made available to patients with cancer or serious infections. Primary care providers were trained and supported to administer parenteral drugs and fluids in the home setting. Between 1992 and 1995 we applied the Rotterdam Symptom Checklist (RSCL) and the Sickness Impact Profile (SIP) as questionnaires for quality of life (QoL) assessment in a group of 112 hospitalized patients who were prepared to receive further treatment at home. Scores on the RSCL revealed a high level of symptomatology in both the physical and the psychological dimension. Factor analysis showed a five-factor rather than a two-factor structure. The SIP showed considerable restrictions in daily living, particularly in the physical dimension. Whereas the RSCL and the SIP correlated well in the psychological and physical dimensions in advanced cancer patients, this correlation disappeared in the group of endstage cancer patients. The data indicate that the health-related QoL of end-stage cancer patients cannot be reliably be assessed with a symptom-based instrument alone; it needs to be supplemented by other instruments, such as the SIP.
Subject(s)
HIV Infections/psychology , Neoplasms/psychology , Quality of Life , Activities of Daily Living , Adult , Attitude to Health , Female , Fluid Therapy , HIV Infections/drug therapy , HIV Infections/physiopathology , Health Status , Home Care Services , Home Infusion Therapy , Humans , Infusions, Parenteral , Life Expectancy , Male , Middle Aged , Neoplasms/drug therapy , Neoplasms/physiopathology , Palliative Care , Reproducibility of Results , Sickness Impact Profile , Surveys and QuestionnairesABSTRACT
BACKGROUND: In 1992 a home care technology project was started in which infusion therapy in the home setting was made available for patients with end-stage cancer. Beside aspects of feasibility and quality of life the resource utilization and costs of this transition was studied. PATIENTS AND METHODS: We conducted a cost evaluation study, to determine the actual cost of managing patients with endstage cancer who require parenteral administration of fluid or analgesics in the home setting. A total of 128 patients were prospectively followed, with a detailed analysis of some aspects in a sample of 24 patients. RESULTS: The cost for each patient was found to be between $250.00 and $300.00 per day, half of which are for hospital charges, even with this active home care technology program. One-third of the costs can be attributed to primary health care activities, in particular those of the district nurses. A hypothetical control group (n = 25) was constructed based on current practice and chart review. Patients in this group would have cost around $750.00 per day. With a median treatment period of 16 days this means a saving of $8000.00 per patient. CONCLUSION: Our data suggest that significant savings can be obtained by implementing programs transferring palliative care technology to the home setting.
Subject(s)
Analgesics/therapeutic use , Fluid Therapy , Health Care Costs , Home Care Services/economics , Neoplasms/therapy , Palliative Care/economics , Terminal Care/economics , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle AgedSubject(s)
Attitude , Dental Health Services , Dentist-Patient Relations , Adolescent , Adult , Aged , Female , Humans , Insurance, Dental , Male , Middle Aged , Netherlands , Professional Competence , Socioeconomic FactorsSubject(s)
Attitude , Dental Health Services , Dentist-Patient Relations , Adolescent , Adult , Aged , Dental Care/psychology , Health Services Research , Humans , Middle Aged , Netherlands , Socioeconomic FactorsSubject(s)
Attitude to Health , Dental Care , Oral Health , Adolescent , Adult , Behavior , Female , Humans , MaleSubject(s)
Attitude , Consumer Behavior , Dental Care , Adult , Dental Clinics , Dental Prophylaxis , Dentist-Patient Relations , Female , Health Education, Dental , Humans , Male , State Dentistry , United KingdomABSTRACT
A series of examiner variability studies were carried out in the assessment of restorations in adults made by extended duty ancillaries (E.D.A.s). While there were some differences between the two supervising team dentists these were smaller than those found when dentists who did not work in the project were examined. The use of indirect evaluation by examining bitewing radiographs for the presence of overhangs was no improvement over the clinical examination in terms of examiner agreement, and moreover only identified half of the restorations scheduled for replacement clinically. Using the results of these experiments, it is suggested that quality control should take into account examiner variability and consequently a 3-4% sample would be sufficient to maintain standards.
Subject(s)
Dental Restoration, Permanent/standards , Adult , Clinical Competence , Dental Assistants/statistics & numerical data , Evaluation Studies as Topic , Humans , Time FactorsABSTRACT
A survey of a representative adult population of a district in Amsterdam (the Jordaan) revealed an overall edentulousness rate of 23%. Proportionally more females than males wore complete dentures, and the lower socioeconomic group was proportionally better represented in edentate group than were the middle and the higher classes. No significant differences were found in comparisons of the edentulousness rate in the Study group and other investigations in Holland and England and Wales. It is suggested that there might be a relationship between the rate of edentulousness and changes in the amount of freely disposable income.
