REPORTS | ETUNIMI SUKUNIMI | JULKAISUN NIMIKE, PITKÄ NIMIKE JATKUU NÄIN... | N
Reports and Studies in Health Sciences
THE UNIVERSITY OF EASTERN FINLAND
SIRPA HARTIKAINEN (ED.)
Faculty of Health Sciences’
Research Day Symposium 2017
Effectiveness of Health Care
Abstracts
Publications of the University of Eastern Finland Reports and Studies in Health Sciences
Number 23
Series Editors:
Professor Tomi Laitinen, M.D., Ph.D.
Institute of Clinical Medicine, Clinical Physiology and Nuclear Medicine Faculty of Health Sciences
Professor Hannele Turunen, Ph.D.
Department of Nursing Science Faculty of Health Sciences
Professor Kai Kaarniranta, M.D., Ph.D.
Institute of Clinical Medicine, Ophthalmology Faculty of Health Sciences
Associate Professor (Tenure Track) Tarja Malm, Ph.D.
A.I. Virtanen Institute for Molecular Sciences Faculty of Health Sciences
Lecturer Veli-Pekka Ranta, Ph.D. (pharmacy) School of Pharmacy
Faculty of Health Sciences
Distributor:
University of Eastern Finland Kuopio Campus Library
P.O.Box 1627 FI-70211 Kuopio, Finland http://www.uef.fi/kirjasto
ISBN (pdf): 978-952-61-2404-9 ISSN (pdf): 1798-5730
ISSN-L: 1798-5722
Faculty of Health Sciences’ Research Day Symposium 2017. Effectiveness of Health Care. Abstracts.
Publications of the University of Eastern Finland. Reports and Studies in Health Sciences 23. 2017. 22 p.
ISBN (pdf): 978-952-61-2404-9 ISSN (pdf): 1798-5730 ISSN-L: 1798-5722
ABSTRACT
Ineffective treatments are unethical as they are unlikely to benefit the patients but expose them to possible adverse effects. On the other hand, an unsafe treatment cannot be effective as its salutary effects are overridden by adverse ones. Although effectiveness, evaluated with clinical and patient-centered outcomes, should be the primary determinant of resource distribution in health care, it is measured or evaluated too seldom.
Effectiveness in Healthcare and Social Services is one of the emerging research areas in the University of Eastern Finland. In the Faculty of Health Sciences, effectiveness has been approached from different perspectives, including the evaluation of harms and benefits, as well as the cost-effectiveness of treatments and impact of pharmaceutical policy. The research groups have also been active in developing and validating methods and instruments for effectiveness evaluation.
This book compiles the abstracts of the Faculty of Health Sciences’ Research Day
Symposium: Effectiveness of Health Care, held in Kuopio Medistudia MS301, on February
1
st, 2017.
Contents
PROGRAM... 5
LIST OF POSTERS ... 6
ABSTRACT OF ORAL PRESENTATIONS ... 7
ABSTRACT OF POSTERS ... 12
FACULTY OF HEALTH SCIENCES’ RESEARCH DAY SYMPOSIUM 2017 FEBRUARY 1ST, KUOPIO
Program
Wednesday, February 1st
9.159.30 Dean Hilkka Soininen: Opening of the symposium Plenary lectures: Chair: Professor Sirpa Hartikainen
9.3010.30 Helle Kieler: Drugs and pregnancy – a challenging combination 10.3011.30 Teppo Järvinen: Evidence-based and ethically sustainable healthcare 11.3012.30 Lunch break (self-paid) and posters 60’
Session I : Chairs: Professor Riitta Ahonen and adjunct professor Heidi Taipale 12.3013.15 Heidi Taipale: Effectiveness and safety of drug exposure -examples from
studies among real-life users utilizing register-based data
13.1513.30 Marjaana Koponen: Antipsychotic use and the risk of hip fracture among community-dwelling persons with Alzheimer’s disease
13.3013.45 Hanna Kauppinen: The impacts of electronic prescriptions on medication safety in Finnish community pharmacies – a survey of pharmacists
13.4514.30 Coffee break and poster session 45’
Session II : Chairs: Assistant professor Anna-Maija Tolppanen and professor Pekka Mäntyselkä
14.3015.15 Tiina Laatikainen: Quality of chronic disease care and area level differences in primary health care
15.1515.30 Aapo Tahkola: The older the better? Local data mining gives insights to focused interventions in primary care
15.3015.45 Kirubashni Mohan: Under-five mortality trend of the indigenous people of Malaysia over a period of 15 years from 2000 to 2014
15.4516.00 Dean Hilkka Soininen: Closing
FACULTY OF HEALTH SCIENCES’ RESEARCH DAY SYMPOSIUM 2017 FEBRUARY 1ST, KUOPIO
List of Posters
1. Kivimies Kristiina: Comorbid opioid use is undertreated among patients with schizophrenia 2. Metsämuuronen Riikka: Ergonomics and skin and respiratory tract reactions related to antibiotic
reconstitution among nurses and ward pharmacists
3. Torvinen-Kiiskinen Sanna: Antidepressant use and associated risk of hip fractures among community-dwelling older persons with and without Alzheimer’s disease
4. Saarelainen Laura: Risk of death associated with benzodiazepine and related drug use in persons with Alzheimer’s disease
5. Das Indranil:Ongoing study and its effects, on the effectiveness of health care: In context of contraceptive practice among eligible couples in an urban slum of Kolkata, India
6. Heiskanen Jari: Can we improve identification of adverse events by focusing on patients with poor patient-reported outcomes?
7. Junkkari Antti: Health-related quality-of-life outcome in patients with idiopathic normal pressure hydrocephalus – a 1-year follow-up study
8. Semenova Maria: Health and social care services need in the sparsely populated areas of North Karelia and the Republic of Karelia
9. Mohan Kirubashni: Forecasting the incidence of patients with end-stage renal disease in Malaysia up to the year 2040
10. Mohan Kirubashni: Status and the associated factors for quality of life among Diabetes patients
ABSTRACT OF ORAL PRESENTATIONS
ANTIPSYCHOTIC USE AND THE RISK OF HIP FRACTURE AMONG COMMUNITY- DWELLING PERSONS WITH ALZHEIMER’S DISEASE
Marjaana Koponen [1], Heidi Taipale [1,2], Päivi Lavikainen [1], Antti Tanskanen [2,3], Jari Tiihonen [2,3], Anna-Maija Tolppanen [1], Riitta Ahonen [1], Sirpa Hartikainen [1]
[1] School of Pharmacy, University of Eastern Finland; [2] Department of Clinical Neuroscience, Karolinska Institutet; [3] Department of Forensic Psychiatry, Niuvanniemi Hospital
The aim was to study whether antipsychotic use is associated with a risk of hip fracture among individuals with Alzheimer’s disease (AD) and to compare the risk according to the duration of use and between the most frequently used antipsychotics.
Nationwide register-based MEDALZ study included all 70,718 community-dwellers newly diagnosed with AD during 20052011 in Finland. Antipsychotic use was modelled from Prescription register data and hip fractures were identified from the Hospital Discharge register. The incidence of hip fractures in new users of antipsychotics was compared with time without antipsychotics with Cox proportional hazard models.
Compared to nonuse, antipsychotic use was associated with an increased risk of hip fractures (adjusted HR 1.54, 95% CI 1.391.70). The risk was increased from the first days of antipsychotic use and remained increased thereafter. Quetiapine was associated with similar risk of hip fracture as risperidone for the first 2.7 years of use (adjusted HR 0.98, 95% CI 0.791.21).
As the risk of hip fracture was increased from the first days of use, our results confirm the need for setting a high threshold for initiating antipsychotic use among persons with AD to avoid serious adverse events. If antipsychotic use is initiated, the duration of use should be limited as the risk of hip fracture does not attenuate with long-term use.
THE IMPACTS OF ELECTRONIC PRESCRIPTIONS ON MEDICATION SAFETY IN FINNISH COMMUNITY PHARMACIES – A SURVEY OF PHARMACISTS
Hanna Kauppinen [1], Riitta Ahonen [1], Johanna Timonen [1]
[1] School of Pharmacy, University of Eastern Finland
Objectives: To study community pharmacists’ opinions about the impacts of electronic prescriptions (ePrescriptions) on medication safety, and how often and what kinds of ambiguities or errors pharmacists have perceived in ePrescriptions.
Methods: A survey of Finnish pharmacists (n = 1232) in 2014.
Results: In total, 778 (64%) questionnaires were included. Respondents shared the opinion that ePrescriptions lower the number of prescription forgeries (98%), reduce the risk of dispensing errors (86%), promote better management of the patient’s overall medication (83%), facilitate monitoring of duplicate therapy (71%) and drug interactions (67%), and lessen the risk of incorrect interpretation of prescriptions (87%). Many respondents (32%) reported that they had weekly found ambiguities or errors in ePrescriptions that required clarification. Of the respondents, 19% had found those problems daily or almost daily. The three most commonly perceived problems were incorrect total amount of medication (79%), missing notation of exceptional dosage instructions or exceptional purpose of use (69%), and unclear or incorrect dosage instructions (65%). Incorrect strength (15%) and incorrect pharmaceutical form (14%) were also commonly experienced problems.
Conclusions: According to Finnish pharmacists, ePrescriptions have promoted medication safety in many fields. However, ambiguities or errors are common in ePrescriptions. Some of these problems can delay dispensing of medicine, whereas others can jeopardize medication safety.
THE OLDER THE BETTER? LOCAL DATA MINING GIVES INSIGHTS TO FOCUSED INTERVENTIONS IN PRIMARY CARE
Aapo Tahkola [1], Hannu Kautiainen [2], Päivi Korhonen [3], Teemu Niiranen [4], Pekka Mäntyselkä [5]
[1] University of Eastern Finland, Health Centre of Jyväskylä Co-operation Area; [2] Medcare Oy;
[3] University of Turku; [4] National Institute for Health and Welfare; [5] University of Eastern Finland, Institute of Public Health and Clinical Nutrition
Dyslipidemia increases remarkably persons’ individual risk of cardiovascular diseases especially when combined with other risk factors. We investigated the level of plasma LDL-C among hypertensive patients in Finnish primary care setting in Jyväskylä area. The total population of 10 827 hypertensive patients was divided in three groups according to LDL-C target level. Patients in group 1 (N=7622) had a diagnosis of hypertension without diabetes or arterial disease (ischemic heart disease, stroke or peripheral artery disease). Patients in group 2 (N=2116) had hypertension combined with diabetes but with no diagnosis of arterial disease. Patients in group 3 (N=1089) had hypertension combined with arterial disease with or without diabetes. LDL-C target levels for each group were set according to Finnish treatment guidelines. LDL-C target was <3 in group 1, <2,5 in group 2 and <1,8 in group 3. The proportion of statin-treated patients reaching the target was 74% in group 1, 33% in group 2 and 36 % in group 3 and with non-statin-treated patients 38%, 8% and 1% respectively (p
<0.001 in all groups).
Our primary findings suggest that LDL-C control in Finnish primary health care is insufficient but still reflects the ideal of guide lines as the mean level of LDL-C decreases remarkably according to tightening LDL -target level in the groups with multiple risk factors and/or arterial disease (groups 2 and 3). For our surprise the LDL-C control was poorest with the youngest patients who would, however, have the greatest cardiovascular risk decrease to gain in a long run. This may indicate that the focus of risk factor control should be re-directed between different age groups but we still have to re-analyze the data ensure the findings.
UNDER-FIVE MORTALITY TREND OF THE INDIGENOUS PEOPLE OF MALAYSIA OVER A PERIOD OF 15 YEARS FROM 2000 TO 2014
Kirubashni Mohan [1], Shanta Kumar Chandrasekaran [2]
[1] Department of Public Health and Clinical Nutrition, University of Eastern Finland, Finland; [2] National Clinical Research Centre, Malaysia
Under-five mortality rate is the probability per 1,000 that a newborn baby will die before reaching the age of five. Many of the causes of mortality among indigenous children are preventable. This study aims to determine the top five medically certified causes of under-five mortality of the indigenous Orang Asli population in Peninsular Malaysia.
This is a cross-sectional study that determines the mortality rates and top five causes of death of the under-five Orang Asli population using mortality registry data obtained from the National Registration Department (NRD) of Malaysia from the year 2000 to 2014. Data was analysed using Microsoft Excel and Stata version 14.0.
In general, there is a decreasing trend of the under -five mortality rates among the Orang Asli from 2000 to 2014. The top five causes of death using the ICD 10 classification are other symptoms, signs and abnormal clinical and laboratory findings that are not elsewhere classified, certain infectious and parasitic disease, diseases of the respiratory system, congenital malformations, deformations and chromosomal abnormalities, and disorders related to length of gestation and fetal malnutrition. In 2000, other symptoms, signs and abnormal clinical and laboratory findings that are not elsewhere classified, topped the cause of mortality at a rate of 2.4 per 1000 cases, while in 2014, the main cause of mortality replaced by certain infectious and parasitic disease at the same rate. Congenital malformations, deformations and chromosomal abnormalities, and disorders related to length of gestation and fetal malnutrition increased from 0.09 per 1000 cases and 0.18 per 1000 cases in 2000 respectively to 0.47 per 1000 cases and 0.61 per 1000 cases in 2014 respectively.
Studying the mortality trends and patterns among the indigenous population can help to identify their health status and serves as a benchmark to further improve their conditions.
ABSTRACT OF POSTERS
COMORBID OPIOID USE IS UNDERTREATED AMONG PATIENTS WITH SCHIZOPHRENIA Kristiina Kivimies [1], Eila Repo-Tiihonen [1], Hannu H. Kautiainen [2], Jari Tiihonen [1,3]
[1] University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; [2] Helsinki University Central Hospital and University of Helsinki, Helsinki Finland; [3] Karolinska Institutet, Stockholm, Sweden
Objective: To access does falling history predict fractures in postmenopausal Objectives: Opioid replacement therapy is generally considered to be an essential element when treating patients with opioid dependence. However, it is poorly known how it is actualized among persons with schizophrenia and comorbid opioid abuse. In this study, we examined if patients with schizophrenia spectrum disorder have obtained pharmacological treatment for their opioid abuse before they were involuntarily ordered to forensic psychiatric treatment.
Methods: The study population consisted of 148 individuals who were in involuntary psychiatric treatment as forensic patients in 2012 in Finland, and who had a schizophrenia spectrum disorder according to ICD-10, which is the official diagnostic classification used in Finland. The proportion of the study population with comorbid opioid abuse patients having received opioid substitution treatment was compared to that of opioid dependent patients in general. The data was collected from the forensic examination statements, patient files and other medical registers retrospectively.
Results: Of the study population, 15.6% (23/148) had a history of harmful opioid use or dependence, of whom 8.7% (2/23) had received opioid substitution treatment (95%: Cl 1.128.0). The corresponding proportion among all patients with harmful use/dependence was 46.0% (672/1462), (95% Cl: 43.448.6). The fraction of patients receiving substitution treatment was significantly lower among patients with schizophrenia (p< 0.001).
Conclusions: According to our study, opioid substitution therapy is seldom used among schizophrenia patients with comorbid opioid abuse. More attention should be given to the possible use of opioids when planning treatment for patients with schizophrenia.
ERGONOMICS AND SKIN AND RESPIRATORY TRACT REACTIONS RELATED TO ANTIBIOTIC RECONSTITUTION AMONG NURSES AND WARD PHARMACISTS
Riikka Metsämuuronen [1], Meri-Tuuli Vilmunen [1], Hannu Kokki [2], Minna Kurttila [3], Toivo Naaranlahti [3], Susanna Saano [3], Peter Šišovský [1], Reeta Heikkilä [1]
[1] Department of Pharmacy, University of Eastern Finland; [2] Department of Medicine, University of Eastern Finland; [3] Pharmacy of Kuopio University Hospital
Introduction: Reconstituting antibiotics requires static postures and repetitive motions which may contribute to the appearance of musculoskeletal symptoms. Exposure to drugs can cause allergic contact reactions, with antibiotics being the most common cause for occupational contact sensitization among health care workers.
Methodology: We evaluated the prevalence of musculoskeletal symptoms and skin and respiratory tract reactions associated with parenteral antibiotic reconstitution among nurses and ward pharmacists in a tertiary hospital in Kuopio, Finland. A total of 28 ward pharmacists and 296 nurses were sent a link to a questionnaire. All of the 28 pharmacists (100%) and 92 nurses (31%) answered the questionnaire.
Results: Musculoskeletal symptoms associated with antibiotic reconstitution were more commonly experienced by the pharmacists than by the nurses (68% vs. 5%; p < 0.001). Skin and respiratory tract reactions were reported by 33% of the nurses, but only 18% of the pharmacists (p=0.13). The most common musculoskeletal symptoms experienced by the pharmacists were wrist (43%) and neck pain (43%). Nurses´ most common symptoms were sneezing (21%) and itching (14%).
Conclusion: Musculoskeletal symptoms associated with antibiotic reconstitution were very common among pharmacists; reported by two out of every three pharmacists, but rare among nurses.
Reconstitution-related skin and respiratory tract reactions were reported by every third nurse and every sixth pharmacist.
ANTIDEPRESSANT USE AND ASSOCIATED RISK OF HIP FRACTURES AMONG COMMUNITY-DWELLING OLDER PERSONS WITH AND WITHOUT ALZHEIMER’S DISEASE
Sanna Torvinen-Kiiskinen [1,2], Anna-Maija Tolppanen [2,3], Marjaana Koponen [1,2], Antti Tanskanen [4,5,6] Jari Tiihonen [4,5] Sirpa Hartikainen [1,2,7], Heidi Taipale [1,2,4]
[1] Kuopio Research Centre of Geriatric Care, University of Eastern Finland (UEF); [2] School of Pharmacy, UEF; [3] Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), UEF; [4] Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; [5] Department of Forensic Psychiatry, Niuvanniemi Hospital, UEF; [6] National Institute for Health and Welfare, Helsinki, Finland; [7] Department of Psychiatry, Kuopio University Hospital
Aim of this study was to investigate whether antidepressant use is associated with an increased risk of incident hip fracture among community-dwelling persons with and without Alzheimer's disease (AD), and to compare the risk according to duration of use and between antidepressant groups.
This study was a retrospective cohort study, including 50,491 persons with AD (mean age 80) and 100,982 age- and sex-matched comparison persons without AD. We utilized nationwide register- based MEDALZ cohort, which includes all community-dwelling persons newly diagnosed with AD during 2005–2011 in Finland. The follow-up was until December 31, 2012.
Drug use was modelled with PRE2DUP method and incident users were identified with one year washout period from Prescription register data and antidepressant use was compared with nonuse.
Main outcome was hospitalization due to hip fracture. Cox proportional hazard models were used and adjusted for confounders.
During antidepressant use, the age-adjusted rate of hip fractures per 100 person-years was 3.01 (95%
CI 2.753.34) among persons with AD and 2.28 (1.942.61) among persons without AD.
Antidepressant use was associated with an increased risk of hip fracture among persons with and without AD (adjusted HR 1.66, 95% CI 1.491.85; HR 2.76, 2.393.93, respectively) compared with nonuse. The risk was most prominent in the beginning of use and was elevated even up to 4 years.
The risk was increased with all of the most frequently used antidepressants.
As a conclusion, antidepressant use is associated with an increased risk of hip fracture among older persons with and without AD. Thus, if the antidepressant treatment is necessary among this vulnerable patient group, treatment should be regularly monitored.
RISK OF DEATH ASSOCIATED WITH BENZODIAZEPINE AND RELATED DRUG USE IN PERSONS WITH ALZHEIMER’S DISEASE
Laura Saarelainen [1], Anna-Maija Tolppanen [1], Marjaana Koponen [1], Antti Tanskanen [2], Reijo Sund [3,4], Piia Lavikainen [1], Jari Tiihonen [2], Sirpa Hartikainen [1], Heidi Taipale [1]
[1] School of Pharmacy, UEF; [2] Department of Clinical Neuroscience, Karolinska Institutet, Sweden;
[3] Department of Social Research, University of Helsinki; [4] Institute of Clinical Medicine, UEF
Conflicts: LS has received a personal research grant from University Pharmacy outside the submitted work. HT and AT have participated in research projects funded by Janssen with grants paid to the institution where they were employed. MK has received personal research grant from Oy H.
Lundbeck Ab foundation outside the submitted work. JT has received lecture fees from Eli Lilly, Lundbeck, and Otsuka as well as grants from Stanley Foundation, Sigrid Jusélius Foundation, and Swedish Research Council. He has research collaboration with Lilly and Janssen. SH has received lectures fees from MSD and Professio. Other authors declare no conflicts of interest.
Benzodiazepines and related drugs (BZDR) are frequently used by persons with Alzheimer’s disease (AD), although the risks of BZDR use in this population are mostly unknown. Therefore, we investigated the risk of death associated with new BZDR use in community-dwelling persons with AD.
The study was based on the register-based MEDALZ cohort which included all Finnish persons diagnosed with AD during 20052011 (n=70,718). Time-varying BZDR exposure for study participants was modelled from purchase data in the Prescription Register. To study new users, we excluded persons who had any BZDR use during the year preceding the AD diagnosis, leaving 48,429 persons in the study.
For each person initiating BZDR use, two nonusers were matched based on age, gender, and time since AD diagnosis. We analyzed 180-day mortality during BZDR use in comparison to nonuse with Cox regression.
In total, 10,372 persons with AD (21.4%) initiated BZDR use during the study. During the follow-up, 13.4 (12.214.6) and 7.9 (7.48.5) deaths per 100 person-years occurred during BZDR use and nonuse, respectively. BZDR use was associated with an increased risk of mortality (adjusted hazard ratio=1.44, 95% confidence interval=1.251.67). The association was significant during 30-120 days of drug use.
BZDR use seems to increase mortality in persons with AD. Careful consideration of the symptomatic treatment of AD might reduce the mortality associated with BZDR use in this vulnerable population.
ONGOING STUDY AND ITS EFFECTS, ON THE EFFECTIVENESS OF HEALTH CARE: IN CONTEXT OF CONTRACEPTIVE PRACTICE AMONG ELIGIBLE COUPLES IN AN URBAN SLUM OF KOLKATA, INDIA
Das Indranil [1], Dasgupta Aparajita [2]
[1] DIH (AIIH and PH, Kolkata, India), MPH (University of Eastern Finland, Kuopio, Finland); [2] Professor and Head, Department of Preventive and Social Medicine. AIIH and PH, Kolkata, India
Introduction: Slums are densely populated urban informal settlements, usually located in and around big cities. Nearly 65 million of the Indian population lives in urban slums, as per the last census. The health indicators in urban slums of India are lower than the national figures. This can be attributed to various socio-economic and environmental problems. Various complex situations in the slums often prevents reaching eligible couples, this apparently seem to reduce contractive use among eligible couples. This reduces the effectiveness of all maternal and child health care programs.
Aim: The aim of the study was to qualitatively assess the nature of problems faced by school aged children in urban slums of Kolkata. (This study was performed as a part of Family Visit Program of AIIH & PH, Kolkata, India.)
Methodology: Qualitative data was collected, by informal interview, independently and separately (with permission of the people interviewed and supervisor) during field training for Family visit program of AIIH and PH, Kolkata, India. Data was collected regarding contraceptive use, as a part of the program in various phases during 20102012 in urban slum (Chetla area) of Kolkata, India.
Result: Results of the study showed, increase in barrier as well as, hormonal contractive among eligible couples. Before the study 44% of the eligible couples were using contraceptive; which increased to 83% by the time data collection was finished.
Conclusions: Socio-economic and environmental problems are the most important reasons for not using contraceptives, among eligible couples. Health education given during the process of data collection improved the situation. This in turn is also expected to improve the effectiveness of health care programs (specifically, Maternal and child health programs) in the region. Hence, it can be concluded that ongoing study (coupled with health education) helps to improve the effectiveness of health care.
CAN WE IMPROVE IDENTIFICATION OF ADVERSE EVENTS BY FOCUSING ON PATIENTS WITH POOR PATIENT-REPORTED OUTCOMES?
Jari Heiskanen [1,2], Anna-Maija Tolppanen [2], Janne Martikainen [2], Juha Hartikainen [1,3], Heikki Miettinen [1,3], Mikko Hippeläinen [1,3], Risto P Roine [1,4,5]
[1] Kuopio University Hospital; [2] School of Pharmacy, UEF; [3] School of Medicine, UEF; [4] Department of Health and Social Management UEF; [5] Helsinki University Hospital
Aims: Learning from adverse events is important to improve patient safety. Consequently, much effort has been focused on tedious inspection of patient records to identify adverse events. As that is not always productive we evaluated whether focusing the search to patients with poor outcome could target adverse event detection to the right patients.
Methods: Patients admitted for coronary artery bypass grafting or percutaneous coronary intervention in the Kuopio university hospital were asked to fill in the 15D health-related quality of life (HRQoL) questionnaire at baseline and 12 months later. Patients were categorized to those with a clinically significant HRQoL improvement (15D score change≥ 0.015), or deterioration (15D score change≥ - 0.015) over the follow-up. Patient records were reviewed for adverse events.
Results: Eighty-one patients showed clinically significant improvement and 64 deterioration in their 15D scores. Of those with a deteriorated score, a significantly larger proportion had encountered a major complication (27% vs. 9%, p=0.004) or a post-intervention infection (16% vs. 5 %, p=0.030) than patients with an improved score. Patients with a negative treatment outcome also tended to have more cardiovascular complications (19% vs. 9%, p=0.068) and more minor complications (16% vs. 7%, p=0.118).
Conclusion: Poor effectiveness of treatment, as judged by a patient-reported outcome, is often related to adverse events after the index procedure. Patient reported outcomes may target the search for adverse events to the right patients, and reveal a larger number of adverse events than current approaches. This enables more efficient learning from adverse events and consequent improvement of health care processes.
HEALTH-RELATED QUALITY-OF-LIFE OUTCOME IN PATIENTS WITH IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS – A 1-YEAR FOLLOW-UP STUDY
A Junkkari [1], A Häyrinen[1], T Rauramaa [2], H Sintonen [3], O Nerg[4], AM Koivisto [4], RP Roine [5], H Viinamäki [6], H Soininen [7], A Luikku [4], JE Jääskeläinen [1], V Leinonen [1]
[1] Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF); [2] Department of Pathology, KUH and UEF; [3] Department of Public Health, University of Helsinki;
[4] Neurology of NeuroCenter, KUH and UEF; [5] RECEPS, UEF and Group Administration of Helsinki and Uusimaa Hospital District; [6] Department of Psychiatry, KUH and UEF; [7] Department of Neurology, UEF
Introduction: This prospective study explored the factors affecting the health-related quality of life (HRQoL) outcome in patients with idiopathic normal pressure hydrocephalus (iNPH) one year after the installation of the cerebrospinal fluid (CSF) shunt.
Methods: HRQoL outcome was evaluated using 15D instrument, in which the minimum clinically significant change/difference has been estimated to be ± 0.015. The follow-up data (15D, Mini-Mental State Examination, Beck Depression Inventory, iNPH Grading Scale), frontal cortical biopsy, Charlson Age Comorbidity Index and body mass index (BMI) of 145 patients diagnosed with iNPH by clinical and radiological examination were analyzed.
Results: At one year follow-up 63 (43%) patients had experienced a clinically significant improvement in HRQoL. Multivariate binary logistic regression analysis indicated that the absence of Aβ and HPτ pathology in the frontal cortical biopsy (53 vs. 33%, absolute risk difference, 20%; adjusted OR=2.27, 95% CI 1.07–4.84; p < 0.05) and lower BMI (adjusted OR=0.90, 95% CI 0.82–0.98; p < 0.05) predicted favorable HRQoL outcome one year after the shunting.
Conclusions: Less than half of the patients with iNPH experienced clinically significant favorable HRQoL outcome, partly explained by the patient’s characteristics and comorbidities. The HRQoL approach reveals aspects that are important for the patient’s well-being, but may also improve the quality of the outcome assessment of CSF shunting. Study results may help clinicians to estimate which patient will benefit shunt surgery.
HEALTH AND SOCIAL CARE SERVICES NEED IN THE SPARSELY POPULATED AREAS OF NORTH KARELIA AND THE REPUBLIC OF KARELIA
Maria Semenova [1], Tiina Laatikainen [2], Tiina Vlasoff [3]
[1,2] Institute of Public Health and Clinical Nutrition, University of Eastern Finland; [3] North Karelia Centre for Public Health
There are differences between Finland and Russia in risk factors distribution and health outcomes.
The study aim is to find out whether there are also differences in the factors of health and social care services need between populations of rural areas in North Karelia, Finland, and the Republic of Karelia, Russia.
Data on services need were obtained during self-administered questionnaire survey (20132014 ENPI CBC). Random sample of 3000 respondents aged 2085 years from six remote municipalities (postal codes at least 10 km away from the municipal center) was captured from the Population Register in Finland and Health Insurance Register in Russia. The response rates were in Finland 801/1500 (53.4%) and in Russia 1124/1500 (73.9%). An assessment of whether service need is associated with self- reported health and socio-economic status and levels of trust to public health or social services was done by binary logistic regression testing.
Both in Finland and in Russia population’s need in health care is higher, than in social care services.
In the Republic of Karelia females reported higher need in health care services, than males. Self- reported health status and levels of trust to public services determined needs in health and social care services both in North Karelia and the Republic of Karelia, but no association was found for economic status of the respondents.
Self-reported health status is an important predictor for majority of health and social care services need in rural areas, however, each service should be analysed separately to reveal its specific factors.
FORECASTING THE INCIDENCE OF PATIENTS WITH END-STAGE RENAL DISEASE IN MALAYSIA UP TO THE YEAR 2040
Kirubashni Mohan [1], Mohamad Adam Bujang [2], Tassha Hilda Adnan [2], Nadiah Hanis [2], Ang Kim Leong [3], et al
[1] Department of Public Health and Clinical Nutrition, University of Eastern Finland, Finland; [2] National Clinical Research Centre, Malaysia; [3] Clinical Research Centre, Serdang Hospital, Malaysia
The incidence of patients with End Stage Renal Disease (ESRD) requiring dialysis has been growing rapidly in Malaysia from 18 per million population (pmp) in 1993 to 96 pmp in 2002, and to 199 pmp in 2012.
The purpose of this study is to forecast the incidence and prevalence of ESRD patients who will require treatment up until year 2040 using data from the Malaysian Dialysis and Transplant Registry.
Univariate forecasting models using the number of new dialysis patients in Malaysia from 1993 to 2012 were used. Four forecasting models were evaluated. They were the naive with trend model, the double exponential smoothing model, Holt’s model and the autoregressive integrated moving average (ARIMA) model. The model with the smallest Root Mean Squared Error (RMSE) was selected for the prediction. R software was used for analysis.
ARIMA (0,2,1) modelling was selected to predict the number of new dialysis patients since the method yields the lowest RMSE (RMSE=132.96). The estimated incidence of new dialysis patients in Malaysia in 2020 is 10,754 cases; and 21,814 cases in 2040 while the estimated prevalence are 51269 and 106249 in 2020 and 2040 respectively. The incidence rate of new dialysis patients in Malaysia is estimated to increase by more than two-fold from 199pmp in 2012 to 566pmp in 2040.
Effective steps to address and curb further increase in new patients requiring dialysis are urgently needed, in order to mitigate the expected financial and health catastrophes associated with the projected increase of such patients.
STATUS AND THE ASSOCIATED FACTORS FOR QUALITY OF LIFE AMONG DIABETES PATIENTS
Kirubashni Mohan [1], Mohamad Adam Bujang [2], Nurakmal Baharum [2], Nur Khairul Bariyyah [2], Mastura Ismail [3]
[1] Department of Public Health and Clinical Nutrition, University of Eastern Finland, Finland; [2] National Clinical Research Centre, Malaysia; [3] Health Clinic Seremban 2, Negeri Sembilan, Malaysia
Quality of life (QoL) is an important measure of health among type 2 Diabetes Mellitus (T2DM) patients in addition to measuring clinical outcome. This study aims to measure the QoL among T2DM patients and study the associated factors that contribute to their QoL.
This is a cross sectional study where data was collected from December 2014 till March 2015 at the Seremban 2 Health Clinic in Negeri Sembilan, Malaysia. Self-administered questionnaires that consisted of questions with regards to demographic and clinical variables together with the validated Malay version questionnaire of the “Diabetic Quality of Life” questionnaire was distributed to patients with type 2 Diabetes Mellitus.
A total of 529 patients participated in the study. The mean (SD) age of the patients was 56.6 (10.8) years. The majority, 63.8% were within the age group of 30-60 years, female participants accounted for 53.7% and Malay participants accounted for 55.8%. On a Likert scale of 1 to 5, the mean (SD) of the average scores for overall, satisfaction, impact and worry were 2.0 (0.5), 2.5 (0.9), 2.1 (0.5) and 1.2 (0.7) respectively. This study found that age (p=0.002 for worry), gender (p=0.05 for impact), ethnicity (p=0.044 for worry), status of diabetes treatment (p=0.046 for worry) and whether patients had attended a diabetes course (p=0.025 for impact) contributed to QoL.
The patients with Diabetes Mellitus are moderately satisfied with their life. Other factors that could contribute to better QoL also need to be emphasized besides monitoring and controlling the patients’
clinical outcome.
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