Dear all,
Apart from answers provided, there were also a lot of requests to share any
information I received concerning my questions to the 3 lists. I have
therefore compiled a lengthy reply for those interested- attachments to
lists may cause great trouble. I have meant to credit the contributors by
providing their names as best I could manage. Also, I reflected a bit on
the process of using mail bases.
Thanks for the responses!
Dr. Atle Klovning, MD, Specialist in general practice
Finding answers to health economy questions- the power of mail base
communities, or, when electronic searching fails: try knowledgeable colleagues!
Background
Searching for medical information for therapy questions, either based on
randomised controlled trials or systematic reviews and meta-analyses seem
to be a lot easier than retrieving information on health economy. I have
developed a strategy for searching therapy documentation, published in a
newsletter for evidence-based health (1) and on the Internet at the
University of Bergen WebPages at www.uib.no/isf/people/atle/ebm.htm (2).
Interested colleagues have translated these pages to German, amongst other
languages, and I have learnt that they have been included in the CASP CD-ROM.
Having a new type of problem to work on, the health economy of
non-compliance, I consulted the mail base communities.
The questions
I used my regular approach (1, 2) and searched The Cochrane Library, Best
Evidence, Medline, WHO, Yahoo, AltaVista, finding only descriptive
data/efficacy/effectiveness for different conditions, but nothing helpful
on the health economy aspects I needed for my two questions:
1. Demographic data on incidence and prevalence of major diseases and
ailments in Europe, like diabetes, overweight, cardiovascular diseases,
asthma, and others
2. The health economic consequences of non-compliance/non-adherence to
standard therapy/prevention of these entities
Method
I posted the request to 3 academic discussion lists:
* Eyr (550 Norwegian GPs) http://www.uib.no/isf/eyr/
* Evidence-based-health list (1637 members)
http://www.mailbase.ac.uk/lists/evidence-based-health/
* Healthecon-discuss list (593 members)
http://www.mailbase.ac.uk/lists/healthecon-discuss/
Results
A total of 14 respondents from 8 countries kindly wrote me 22 helpful
mails. The total number of list members was 2780, some of them
participating on several lists.
1. John Platt, Sheffield, UK suggested posting a question at:
http://www.mailbase.ac.uk/lists/healthecon-discuss/, which was very rewarding.
2. Signe Flottorp, GP researcher consulted Erik Nord, Health economist, Norway
and suggested Journal of Health Economics. Contents at
www.elsevier.nl/locate/estoc.
“Non-adherence” or “Non-compliance”, but this search yielded zero references.
3. Roland Andersson, MD PhD, Department of Surgery, Sweden:
On the EPIDEMIO-L list there were just today some lists about useful
epidemiological sites with information that may be useful, thus saving me a
lot of effort.
http://www.who.int/whr/1999/en/disease.htm
http://www.ons.gov.uk/ons_f.htm
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/
http://wwow.who.int/whosis/#topics
http://www-dccps.ims.nci.nih.gov/ARB/Prevalence/index.html
http://www.cdc.gov/nchs/about/major/dvs/mortdata.htm
http://www.cdc.gov/nchs/fastats/ce94t58.htm
http://www.gao.gov/
4. Trish Greenhalgh, Senior lecturer in primary health care, Unit for
Evidence-Based Practice and Policy, UK, and organiser of the EBM workshop
in London, kindly provided:
NEW definition, diagnosis etc of diabetes http://www.idi.org.au/whoreport.htm
NHS economic evaluation database
http://nhscrd.york.ac.uk/cgi-bin/v1.engine?*ID=0&*DB=EECT
SIGN guidelines (these are generally very good - may have something)
http://www.show.scot.nhs.uk/sign/home.htm
She is now on the recently-formed UK National Service Framework Expert
Reference Group for diabetes, and wrote: “I will have quite a bit of
descriptive stuff on that topic in a few weeks' time, but I already know
that economic evaluation of compliance strategies is not well developed on
diabetes. Hope this helps!” She also set me in contact with a statistician
working in the problem.
5. Albert J. Kirshen, MD, MSc, FRCPC, Canada
asked if I had tried the paper library and the WHO annual reports? This
reminds us all that there is lots of offline information. I could not
access this material, and found WHO’s web pages to be very amateurish, with
many broken links etc.
6. Bob Woodward, USA.
Kindly provided a presentation he held for the American Association of
Nephrologists in Miami in December of 1999.
7. Thomas Roy,
suggested I took a look at the database called EconBase, in which you will
find the major health economics journals, like Health Economics or Journal
of Health Economics, etc... The link is
http://www.elsevier.nl:80/homepage/sae/econbase/menu.sht. The lack of
results while searching on the medical database is not very surprising,
since medical journals are not very good for economic evaluations, apart
from cost-effectiveness analysis.
8. Nina Hakak, Information Specialist ICTAHC, The Israeli Centre for
Technology; Israel. Assessment in Health Care, The Gertner Institute
NH faxed demographic information from an Israeli report, also providing
comparative data for many of the European countries I was looking for. The
comparative data were very helpful.
NH also pointed to a number of conferences:
17th to 19th Jan 2000
Diabetes in Primary Care 2000 Hospital Medicine; Practice Nursing
This conference aims to provide up-to-date information on the key
areas in diabetes, and to highlight the practical issues involved in the
area of this increasingly common condition. Tel: 0181 671 7521
19th Jan 2000:The NHS Performance Assessment FrameworkAimed at
health service managers, health care professionals and health information
professionals, this study day will provide a greater
understanding on the use and implementation of the Performance Assessment
Framework from a range of perspectives.Tel: 0161 295 0447
19th Jan 2000: Information for Health 2000 : The EPR and Clinical
Governance - A British
Medical Informatics Society Conference hosted by Winchester & Eastleigh
Healthcare NHS TrustThis event will give a view inside one of the leading
NHS beacon sites for the Electronic Patient Record, together with briefings
on several key New NHS / Information for
Health programmes. Tel: 0171 351 8706
28th Jan 2000: Research: Who's Learning NHS Executive. This conference will
look at how and why researchers and consumers are collaborating within
health research, and who is involved in these collaborations.Tel: 01962 849100
1st Feb 2000:Institute of Child Health; Institute of Education;
International Health ExchangeAn opportunity for visitors to become familiar
with the wide range of organisations concerned with different aspects of
international health and education. This event is free to attend. Tel: 0171
242 9789 http://www.cich.ich.ucl.ac.uk
4th Feb 2000: British Hyperlipidaemia Association & Primary Care Cardiovascular
Society. Community Cardiology at the Birmingham International Conference
Centre. Tel: 01628 628638
9. Andrea Donatini, MSc, at the Agency for Regional Health Care Services,
Rome, Italy.
The OECD Health Data 1999 (CD Rom) should provide you with all the data on
disease incidence. It seems that this resource was just what I was looking
for.
http://electrade.gfi.fr/cgi-bin/OECDBookShop.storefront/EN/product/811999053C1
OECD Health Data 1999: A Comparative Analysis of 29 Countries
Eco-Santé OCDE 1999: Analyse comparative de 29 pays
OECD HEALTH DATA is a unique software package consisting of an interactive
database and query modules to provide a tool for the comparative analysis
of health systems within and between the 29 OECD countries. It includes
statistical data and indicators covering the period 1960-1997 as well as a
selection of expenditure projections for 1998. OECD HEALTH DATA uses fast,
user-friendly WindowsTM-based software which enables you to carry out data
extractions, and build graphs and tables. It is in English, French, German
and Spanish, and provides free technical assistance and access to updates
via the Internet. Main fields covered are: Health Status Health Care
Resources Health Care Utilisation Expenditure on Health Financing and
Remuneration Social Protection Pharmaceutical Market Non-medical
Determinants of Health Demographic References Economic References OECD
HEALTH DATA is a quadrilingual product: English, French, German, Spanish
www.oecd.org/els/health.htm
10. Martin Brown, Senior Health Economist, Outcomes Research, Central
Research, Pfizer Ltd., UK. Le Pen, C et al. The cost of treatment dropout
in depression.A cost-benefit analysis of fluoxetine vs. tricyclics. J
Affect Disorders, 31: 1-18. 1994.
It's quite a few years since I read this paper and so I can't guarantee
good quality, relevance etc.
11. Bjarte Reve, Manager, MSD, Norway
BR provided a lot of useful information I could use straightaway.
"Adherence to Treatment in Medical conditions" edited by Lynn B.Meyers &
Kenny Midence
Harwood academic publishers, ISBN 90-5702-265-6. He pointed out that there
were quite a number of American studies, the best known apparently being:
Task Force for Compliance: (1993) Non-compliance with medications: an
economic tragedy with important implications for health care reform.
Baltimore, MD: Task Force for compliance.
This group estimated the cost of non-compliance in the US would amount to
100 billion USD. The Norwegian pharmaceutical association (Norges
Apotekerforening) extrapolated these figures to Norway (4.5 mill
inhabitants), finding that the cost of non-compliance amounted to NOK 10
billion/year. A French study estimated that 5-10 percent of all hospital
admissions might be due to wrong use of medication. The Norwegian Ministry
of Health uses these figures.
1. From Compliance to Concordance: Achieving Shared Goals in Medicine
Taking. Royal Pharmaceutical Society of Great Britain and Merck Sharp &
Dohme. 1997
2. "Much quoted USA figures suggest that non-compliance in cardio-vascular
disease resulted in 125 000 deaths and several thousand hospitalisations a
year, which represented 20 million lost work days, costing over 1.5 billion
USD in lost earnings. (Smith 1985) The costs of non-compliance and the
capacity of improved compliance to reduce health care expenditures. In
improving Medication Compliance: proceedings of a symposium. DC, November
1983, pp35-44. National Pharmaceutical Council Reston, Virginia
3. Prescription Medicine Compliance: A review of the Baseline of Knowledge.
A report of the National Council on Patient Information and Education, Aug
1995, Washington DC.
12. David LB Schwappach, MSc Econ; MPH, Germany
He also pointed to the OECD CD ROM: For the first part of your question
(epidemiological data) I recommend the OECD health database
(http://www.oecd.fr/els/health/). Maybe your library has it? A German,
officialweb site is at http://www.gbe-bund.de/. But I'm not sure which
information is available in English. If you are looking for something
special there let me know, maybe I could help you out.
13. Antonio Giuffrida, National Primary Care Research and Development
Centre, Centre for Health Economics, The University of York, UK.
I thought that you may find useful the following two papers that I have
co-authored, addressing the issue of patient non compliance and possibility
to use financial incentive to increase patient's compliance with medical
treatment.
TI: Paying patients to comply: An economic analysis
AU: Giuffrida_A, Gravelle_H JN: HEALTH ECONOMICS, 1998, Vol.7, No.7,
pp.569-579 AB: A significant proportion of patients do not complete
prescribed treatment or do not follow medical advice. There is evidence
that financial incentives can increase compliance. We present a model of
patient compliance and use it to examine the circumstances in which
patients should be paid to comply with treatment and discuss the factors
determining the optimal level of payment to patients.
TI: Should we pay the patient? Review of financial incentives to enhance
patient compliance AU: Giuffrida_A, Torgerson_DJ JN: BRITISH MEDICAL
JOURNAL, 1997, Vol.315, No.7110, pp.703-707
AB: Objective: To determine whether financial incentives increase patients'
compliance with healthcare treatments. Data sources: Systematic literature
review of computer databases- Medline Embase, PsyckLit, EconLit, and the
Cochrane Database of Clinical Trials. in addition, the reference list of
each retrieved article was reviewed and relevant citations retrieved. Study
selection: Only randomised trials with quantitative data concerning the
effect of financial incentives (cash, vouchers, lottery tickets, or gifts)
on compliance with medication, medical advice, or medical appointments were
included in the review. Eleven papers were identified as meeting the
selection criteria. Data extraction: Data on study populations,
interventions, and outcomes were extracted and analysed using odds ratios
and the number of patients needed to be treated to improve compliance by
one patient Results: 10 of the 11 studies showed improvements in patient
compliance with tile use of financial incentives. Conclusions: Financial
incentives can improve patient compliance.
14. Giuseppe Giocoli, (Desenzano d/G), Italy.
For Italy, try http://www.iss.it/ (Istituto Superiore di Sanita') or
http://www.istat.it/ (Istituto Nazionale di Statistica) they can be read in
English, also. For Italian figures, these sites gave very detailed
demographics.
Conclusion
It seems that if the main outcome of my questions were only finding the
health demographics, the OECD database would be the right thing. The next
step of finding the health economy consequences of non-compliance for major
ailments is a task of much greater dimensions, requiring further analysis.
Still, proper demographics would have to be the basis for further analysis.
Using mail bases when my electronic searching seemed to fail seems to be a
very useful process. I was directed to a lot of useful links, paper
documents, faxes were sent, and presentations attached. Also, many offered
personal assistance, like preparing faxes, or searching the OECD database
for me, if I could be more specific first. It seems that this database
provided the comparative information I needed, and I personally think that
this resource should have been online accessible through the Internet, and
probably for free.
A few of the mails were very specific, providing the exact and digested
information, while other mails pointed to resources I would have to search,
extract and synthesize myself.
Mail bases make it possible for researchers to communicate with others
interested, even never having met before. Help was offered for complex
issues, where the strategy I had used previously (1, 2) did not lead to the
answer.
Structured feedback should be posted back to the list, sharing information
with all, especially if one has to systematise a lot of the information given.
Acknowledgements
Thanks to everybody who kindly helped!
References
1. Klovning A. Finding answers to questions in EBHC. Nordic Newsletter
1999;3:19.
2. Klovning A. Finding answers to questions in evidence-based medicine
(WWW). 1998.
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