Maria Michela Gianino

Critical issues in current comparative and cost analyses between retropubic and robotic radical prostatectomy

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Torino 2006 Winter Olympic Games: Highlight on Health Services Organization

BACKGROUND Mass gatherings require attention toward planning and execution of dedicated medical care. OBJECTIVES The aims were to describe the organization and provision of medical care in the Torino 2006 Winter Olympic Games in light of the epidemiology of illnesses and injuries among athletes during this event. METHODS The organization integrated 18 medical centers operating at Olympic venues, three polyclinics inside the Olympic Villages, and 13 pre-existing Olympic Hospitals. The design was a retrospective study, with review of medical records at Olympic medical facilities. All the athletes who attended any medical center or polyclinic were eligible. The main outcomes included type of injuries and illnesses affecting athletes, incidence of injuries and illnesses by provenance and discipline, and rate of hospital admissions. RESULTS A total of 330 athletes received medical care and 676 medical encounter forms were documented, with an overall medical utilization rate of 12.66%. Skeleton, snowboard, bobsleigh, and alpine and freestyle skiing had the highest medical attendance rate relative to other disciplines (p < 0.001). The majority of injuries and illnesses were of a minor nature. A total of 23 visits required hospital admissions (3.40%). CONCLUSION The described model of medical coverage for such events seemed to be practical and efficient for the athletes, without depleting services to the general population. The risk of severe injury and illness seemed to be low. These data could be useful for planning medical services in future mass gatherings.

A comparative costs analysis of brachytherapy and radical retropubic prostatectomy therapies for clinically localized prostate cancer.

OBJECTIVES The aim of this study is to perform a comparative costs analysis of brachytherapy (BT) and radical retropubic prostatectomy (RRP) for clinically localized prostate cancer and to shed light on the difficulties of comparing their relative economic effectiveness. METHODS A systematic literature review of costing studies available in the Medline, Embase, DARE, and INAHTA databases. RESULTS There is a lack of homogeneity among published studies in this field. Differences in the reported costs are related to different environments in which the two techniques (BT and RRP) are applied, and in particular due to the use of different methodology, cost items included, time frames, and different price levels in different settings. CONCLUSION Published studies of costing data of BT and RRP do not provide clear-cut evidence for a conclusion about which treatment may be more effective from an economic point of view.

Visibility, accessibility and quality of Italian public health institutional websites

Background : Since the large volume of health information available on the Web has the potential to improve health, Public Health institutions must represent a strong Internet presence with accessible and scientific information. The aims of the study were to verify the presence and visibility of Italian Institutions on the Web and to evaluate the accessibility and quality of the information provided. Methods : In a focus group setting, 21 keywords were generated, and launched in search-engines Google and MSN. Researchers noted the first 30 results found and determined the position of institutional websites. The accessibility of 303 Public Health websites was assessed in relation to the logo presence and web validation of XHTML, CSS and WAI indicators. Regarding the quality of information, the presence of the HONcode logo in the websites’ homepage was checked. Results : A high percentage of the keywords selected did not lead to any institutional website in the first three pages of Google (19.0%) and MSN (42.8%). Few institutional websites presented the logo indicator and a full web validation. Considering the XHTML indicator, only for 34.0% of the websites there was concordance between the logo presence/absence and results of direct validation, 50.2% for CSS. The quality level seemed to be extremely low. Conclusions :In order to achieve a larger visibility and guarantee accessibility, Public Health websites have to be correctly designed, edited and maintained. Common and strict European laws about health information on the Web have to be arranged, deeply monitored and carefully adjourned in order to guarantee and support the positive role of institutional websites.

Temporal changes in the current practice of primary angioplasty: a real life experience of a single high-volume center ☆,☆☆

BACKGROUND In the last years, new techniques, drugs and devices have been introduced in the current practice of primary angioplasty (PPCI) and validated by pivotal studies The objective of our study was to evaluate if these studies have led to significant changes on the current practice of primary PCI in our center. METHODS From March 2003 to December 2013 1980 patients with ST-segment elevation myocardial infarction underwent PPCI within 12-hours of onset of symptoms. We considered 2 periods of our activity: from 2003 to 2009 (P1) with 1078 patients and from 2010 to 2013 (P2) with 902 patients, and compared them in terms of pharmacological and arterial access strategies and of devices utilization. RESULTS In P2 there was a significant increase of radial access (34.1% vs. 1.5, p<0.001), as well as of the use of bivalirudin (22.7% vs. 0.5%, p<0.001) and of new antiplatelet drugs (prasugrel or ticagrelor) (18.3% vs. 0%, p<0.001) whereas the use of GP IIb-IIIa and of intraaortic balloon pump significantly decreased (from 82.3% to 52%, p<0.001 and from 17% to 7.5%, p<0.001 respectively). In the P2 there was a significant increase of the procedural efficacy (97.2% vs. 95.1%, p=0.01) that persisted after the logistic regression adjustment (OR 2.09, CI 95%, 1.04-4.21). CONCLUSIONS Our study shows that in the last years, in a high-PCI center, after the publication of pivotal randomized trial and nationwide registries, there were significant changes in the PPCI current practice that could have had an impact on procedural efficacy.

Tobacco smoke in Piedmont: attributable morbidity and impact on hospital costs

Background : Tobacco smoke is the main cause of mortality and morbidity in most industrialized countries. The aim of this research is to estimate the smoke attributable morbidity for Piedmont residents in the years 1997-2002 and the related costs for the regional health service, using as an indicator the number of hospital admissions caused by smoke and as an instrument the DRG rates. Methods : extraction of hospital admissions for smoking-related diseases; estimate of the proportion of hospital admittances attributable to smoking; estimate of the overall cost and the smoke attributable cost for each year. Results : The attributable proportion in men is clearly higher than in women. In men it decreases from 10.6% in 1997 to 8.2% in 2002, while values among women seem to have reached a plateau. The economic value of the attributable admissions, at current prices, shows a downward trend for men from 1997 to 2001 and an upward one in the year 2002, while for women the trend is fluctuating. Conclusions : This method demonstrates the following original features: we used metanalytic relative risks real prevalence data, considering a fifteen-year latency period between exposure and effect on health.The model that we developed adheres more adherent to the natural history of the disease and to the local health problem, giving us a useful tool for planning purposes.Furthermore, the economic estimate is made for each single DRG instead of applying medium rates for MDC, which happens more frequently at the national level.

Estimation of sickness absenteeism among Italian healthcare workers during seasonal influenza epidemics

Objectives To analyze absenteeism among healthcare workers (HCWs) at a large Italian hospital and to estimate the increase in absenteeism that occurred during seasonal flu periods. Design Retrospective observational study. Methods The absenteeism data were divided into three “epidemic periods,” starting at week 42 of one year and terminating at week 17 of the following year (2010–2011, 2011–2012, 2012–2013), and three “non-epidemic periods,” defined as week 18 to week 41 and used as baseline data. The excess of the absenteeism occurring among HCWs during periods of epidemic influenza in comparison with baseline was estimated. All data, obtained from Hospital’s databases, were collected for each of the following six job categories: medical doctors, technical executives (i.e., pharmacists), nurses and allied health professionals (i.e., radiographers), other executives (i.e., engineers), nonmedical support staff, and administrative staff. The HCWs were classified by: in and no-contact; vaccinated and unvaccinated. Results 5,544, 5,369, and 5,291 workers in three years were studied. The average duration of absenteeism during the epidemic periods increased among all employees by +2.07 days/person (from 2.99 to 5.06), and the relative increase ranged from 64–94% among the different job categories. Workers not in contact with patients experienced a slightly greater increase in absenteeism (+2.28 days/person, from 2.73 to 5.01) than did employees in contact with patients (+2.04, from 3.04 to 5.08). The vaccination rate among HCWs was below 3%, however the higher excess of absenteeism rate among unvaccinated in comparison with vaccinated workers was observed during the epidemic periods (2.09 vs 1.45 days/person). Conclusion The influenza-related absenteeism during epidemic periods was quantified as totaling more than 11,000 days/year at the Italian hospital studied. This result confirms the economic impact of sick leave on healthcare systems and stresses on the necessity of encouraging HCWs to be immunized against influenza.

Trajectories of long-term care in 28 EU countries: evidence from a time series analysis.

Background This study aims to confirm whether an increase in the number of elderly people and a worsening in the auto-evaluation of the general health state and in the limitation of daily activities result in increases in the offered services (beds in residential LTC facilities), in the social and healthcare expenditure and, consequently, in the percentage of LTC users. Methods This study used a pooled, cross-sectional, time series design focusing on 28 European countries from 2004 to 2015. The indicators considered are: population aged 65 years and older; self-perceived health (bad and very bad) and long-standing limitations in usual activities; social protection benefits (cash and kind); LTC beds in institutions; LTC recipients at home and in institutions; healthcare expenditures and were obtained from the Organization for Economic Co-operation and Development and Eurostat. Results The proportion of elderly people increased, and conversely, the percentage of subjects who had a self-perceived bad or very bad health decreased. Moreover, there was an orientation to reduce the share of elderly people who received LTC services and to focus on the most serious cases. Finally, the combination of formal care at home and in institutions resulted in most Member States shifting from institutional care to home care services. Conclusions Demographic, societal, health changes could considerably affect LTC needs and services, resulting in higher LTC related costs. Thus, knowledge of LTC expenditures and the demand for services could be useful for healthcare decision makers.

Availability of emergency contraception: A survey of hospital emergency department gynaecologists and emergency physicians in Piedmont, Italy

ABSTRACT Objectives To compare the knowledge and the willingness of emergency physicians and gynaecologists caring for women in Italian emergency departments (EDs) to prescribe levonorgestrel-only emergency contraceptive pills (LNG-EC pills). Methods A cross-sectional survey was conducted in 2009; anonymous postal questionnaires were mailed to the medical staff working at the 30 EDs located in Piedmont (Italy). Results Emergency physicians and gynaecologists have similar knowledge of the pharmacokinetics and pharmacodynamics of LNG-EC pills, but do not feel at ease in prescribing these and consider the prescription of LNG-EC pills an inappropriate activity for ED staff. Conclusions In Italy, unlike in most other European countries, LNG-EC pills are still prescription drugs. Thus it may be useful to further investigate the reasons why Italian ED medical staff do not feel the prescription of LNG-EC pills should be within their remit and whether women can successfully obtain the prescription from physicians working in other services that can be accessed around the clock.

Public and private in italian health care: trends and market quotas

Background : The Italian healthcare system has two components: public and private healthcare providers. Both deliver services on behalf of and payable by the national health care service. This study explores therelationships between public and private healthcare providers. Methods : The number of hospital admissions and length of stay or number of times the service was accessed stratified by year 2000, 2001, 2002; DRG; type of hospital admission (ordinary or day hospital/surgery); health provider category: public institutions without a specific reference territory, public institutions with a specific reference territory and accredited private institutions and medical or surgery DRGs. A distinction is made between those DRGs defined as belonging to the private sector and those falling within the public sector, assuming there is a majority market portion for services primarily supplied by the private sector. Case-mix index was utelised as the indicator for the complexity of the cases treated and the comparative performance index was used as the indicator for efficiency. Lastly in order to evaluate the services delivered with an inappropriate organizational profile reference is made the rulings defining Essential Level of assistance. Results : The results showed a shift in the reallocation of service volumes for ordinary admissions towards the private sector; the reallocation relates to the volumes but not to the types of cases treated, since the DRG mix remained substantially unchanged over the 3-year period and those DRG that absorb 51% of services were essentially constant. The private sector never achieved a market majority quota but rather controlled market niches with minority quotas. The private institutions treated less complex cases and worked with lower efficiency levels than the public sector. There was also a shift in the distribution of admissions from ordinary admissions to day hospital/day surgery regimes with a growth in the proportion of the latter. Conclusions : The study confirmed the predominance of public healthcare providers in the Italian healthcare system as well as their higher complexity and efficiency levels.