Lotte Groth Jensen

National use of thrombolysis with alteplase for acute ischaemic stroke via telemedicine in Denmark: a model of budgetary impact and cost effectiveness.

AbstractAim: The purpose of this analysis was to assess the budgetary impact and cost effectiveness of the national use of thrombolysis with alteplase (recombinant tissue plasminogen activator; rt-PA) for acute ischaemic stroke via telemedicine in Denmark. Methods: Computations were based on a Danish health economic model of thrombolysis treatment of acute ischaemic stroke via telemedicine. Cost data for stroke units and satellite clinics were taken from the first practical experiences in Denmark with implementing thrombolysis via telemedical linkage to the Stroke Department at Aarhus University Hospital. Effectiveness data were taken from a published pooled analysis of results from randomized controlled trials of alteplase. Results: The calculations showed that the additional total costs to the hospitals of implementing thrombolysis with alteplase for acute ischaemic stroke via telemedicine were approximately

Organisational barriers to thrombolysis treatment of acute ischaemic stroke

US3.0 (range 2.0–5.8) million per year in the case of five centres and five satellite clinics, or

Community families: A qualitative study of families who volunteer to support persons with severe mental illness

US3.6 (range 2.4–7.0) million per year based on seven centres and seven satellite clinics. The incremental cost-effectiveness ratio was calculated to be approximately

Psychiatric service users’ experiences of emergency departments: a CERQual review of qualitative studies

US50 000 when taking a short time perspective (1 year), but thrombolysis was dominant (both cheaper and more effective) after as little as 2 years and cost effectiveness improved over longer time scales. Conclusion: The budgetary impact of using thrombolysis with alteplase for acute ischaemic stroke via telemedicine depends on the existing capacity and organizational conditions at the local hospitals. The health economic model computations suggest that the macroeconomic costs may balance with savings in care and rehabilitation after as little as 2 years, and that potentially large long-term savings are associated with thrombolysis with alteplase delivered by telemedicine, although the long-term calculations are uncertain.

EUnetHTA: Patients’ Perspectives in the HTA Core Model ®

ABSTRACT Background: Intravenous thrombolysis with fibrinolytic drugs such as alteplase is not implemented widely in any country although the treatment is both effective and cost-effective in selected patients within a 3-h window after acute ischaemic stroke. The purpose of the present study was to describe the organisational barriers to delivery of thrombolysis for acute ischaemic stroke with special regard to the Danish healthcare system. Method: Systematic and unsystematic searches of medical, economic and grey literature on organisational barriers to thrombolysis treatment were performed in Cochrane, PubMed, EMBASE, Cinahl, Econlit, NHS EED, SvedMed+ and the Health Technology Assessment (HTA) database. The search periods were 1996-2006. Findings: Three main types of literature on organisational barriers were found: medical literature including HTA reports on barriers related to the 3-h window, economic literature on barriers related to the lack of capacity to provide the treatment on a 24-h basis, and grey literature/policy papers on standards and demands to the hospitals and healthcare systems who implements the treatment. Conclusion: Information on organisational barriers can be extracted from different types of literature (medical, economic and grey literature/policy papers), but organisational barriers are most often not the primary study objective in the relevant literature. This review showed a broad spectrum of possible organisational barriers to the delivery of thrombolysis treatment of acute ischaemic stroke.

Evaluation of a comprehensive EHR based on the DeLone and McLean model for IS success: Approach, results, and success factors

Background: Social interventions targeted at people with severe mental illness (SMI) often include volunteers. Volunteers’ perspectives are important for these interventions to work. This article investigates the experiences of volunteer families who befriend a person with SMI. Material: Qualitative interviews with members of volunteer families. Discussion: The families were motivated by helping a vulnerable person and by engaging in a rewarding relationship. However, the families often doubted their personal judgement and relied on mental health workers to act as safety net. Conclusion: The volunteer involvement is meaningful but also challenging. The families value professional support.

How physicians 'achieve overview': a case-based study in a hospital ward

Abstract Background: There is increased clinical and political attention towards integrating general and psychiatric emergency departments (ED). However, research into psychiatric service users’ experiences regarding general EDs is limited. Aim: To identify and summarize current, qualitative evidence regarding service users’ experiences attending EDs. A secondary aim is to apply and test the newly developed CERQual approach to summarizing qualitative review findings. Methods: A systematic literature review of five databases based on PRISMA guidelines yielded 3334 unique entries. Screening by title/abstract identified 57 studies and, after full text assessment, nine studies were included. The included studies were critically appraised using CASP. Thematic synthesis was applied for data extraction and identification of findings. The CERQual approach was utilized to assess the confidence of the findings. Results: The results of the review showed moderate confidence in the findings that service users experience meeting caring and judgmental ED staff, and that waiting times and a stressful environment are integral to their ED experiences. In contrast, low-to-very low confidence was seen in the findings that service users experience having their symptoms ignored and that EDs are used due to a lack of alternatives. A companion may improve service users experience and outcome of ED visits. Conclusion: Service users experience stress and discomfort in the ED. Service users highly appreciate knowing staff who can ease the discomfort. Overall, the results of this review speak in favour of integrated EDs where service users’ needs are more likely to be recognized and accommodated.

Is population screening for abdominal aortic aneurysm cost-effective?

EUnetHTA has developed the HTA Core Model® as a methodological framework for collaborative production and sharing of HTA information (Lampe et al. 2009; Pasternack et al. 2009). In this chapter, the construct of the HTA Core Model® version 3.0 is described. The HTA Core Model® provides a construction for HTA that gives a comprehensive assessment of nine domains, each of which represents an aspect of the use of a given health technology (Pasternack et al. 2009). The processes and inputs that shaped the creation of the Patients’ and Social Aspects domain are explored. A description of the final content and scope of the Patients’ and Social Aspects domain and its relation to other HTA Core Model® domains is provided, and ways to strengthen research on patients’ perspectives in HTA are discussed. The HTA Core Model® stresses the importance of a multidisciplinary design when conducting HTAs to provide a sufficient and solid political decision aid. However, challenges remain in using the Patients’ and Social Aspects domain. This is discussed in the concluding section in suggestions on how patients’ perspectives may be integrated into future EUnetHTA collaboration.