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INTRODUCTION: Lung cancer exerts a significant societal and health-care-related economic burden and chemotherapy drugs constitute a major factor of total direct cost. The aim of the present study was to assess the direct health-care cost of lung cancer in Greece by conducting a retrospective analysis on the last 6 months of life. METHODS: The present study was based on both the medical data and costs of treatment of deceased adult patients who suffered from terminal stage IIIB/IV lung cancer (non-small cell lung cancer and small cell lung cancer) during the last 6 months of their life. The study's protocol was approved by the Hospital's Research Ethics Committee. Costs included outpatient (outpatient services) and inpatient (inpatient services) costs. Descriptive statistics were mainly used for statistical analysis. RESULTS: The files of 144 patients were analyzed. The total cost of health-care services for the study population during the last 6 months of life was attributed by 57% to inpatient services, whereas chemotherapy costs (74%) comprised the largest proportion of the total inpatient cost. The highest expenditure for outpatient services was attributed to concomitant medication (59%), followed by the cost of tests (21%) and radiotherapy (20%). CONCLUSIONS: The results of our study indicate that both inpatient and outpatient costs were substantial. The main inpatient and outpatient cost drivers were chemotherapy and concomitant medication, respectively. A more comprehensive nationwide study would be useful to validate our results and to include also indirect costs of cancer care in Greece.
RESUMO
Specialty areas, such as the PACU, are currently characterized by a shortage of qualified nursing personnel along with the pressure for a most cost-conscious function of services. These, in combination with both the increasing acuity of patients and the advances of science and technology, have rendered necessary the investigation of how existing personnel can be better used. The work sampling approach has been widely used in different clinical settings to offer data about the amount of time nurses devote to specific activities. The aim of the current study was to categorize and quantify the activities of nurses employed in the PACU of the General University Hospital of Patras, Greece, and to identify differences with regard to shifts, varying nurse-patient ratios, and nurses' experiences. In the first phase, a classification form, which included all nursing activities, was constructed. This was based on literature review, researchers' experience, and semistructured personnel interviews. In the second phase, the researchers observed all PACU nurses, and activities were recorded on an hourly check sheet. A total of 4,320 observations were collected from 9/1/2004 to 9/30/2004. Nurses spent 35.2% of their time on direct clinical care, 11.6% on patient assessment, 7.0% on communication with patients, 7.2% on communication with other persons, 8.6% on clerical nursing duties, 9.3% on documentation, 2.3% on non-nursing duties, and 18.8% on personal activities. Variations in the use of time were found between shifts, different nurse-patient ratios, and PACU experience. Methods of decreasing time when the nurse-patient ratio is inappropriate and increasing time allocated to direct care activities are proposed.
