Butler, John Spencer (1995) Health care resource utilization in Newfoundland. Masters thesis, Memorial University of Newfoundland.
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Health care delivery is not subject to the economic forces which achieve productive and allocative efficiencies in competitive markets. Allocative efficiency is addressed in the context of a methods review for measuring hospital bed utilization. Productive efficiency is addressed by examining the utilization of ciprofloxacin, an expensive antibiotic. -- The reliability and validity of several methods of measuring hospital bed utilization were assessed. Nurse (A) prospectively collected data on the clinical condition and care plans of 80 patients at an acute care hospital, and identified and classified inappropriate days using her clinical judgement. In the same way, a second nurse (B), experienced in appropriateness evaluation, independently rated the same cases as did a third nurse (C), using a modified version of the Appropriateness Evaluation Protocol (AEP). Nurse A's data was also independently rated by a panel (P). Agreement for the number of inappropriate hospital days per case as measured using the Intraclass Correlation Coefficient (Rx) was excellent: Nurse A v P = 0.95, Nurse A v C = 0.87, P vs C = 0.88, B v A = 0.87, B v P = 0.79, B v C = 0.72. Reliable and valid judgements of inappropriateness can thus be made by any of these methods. -- In the second study, an academic panel and an industry panel used guidelines to assess the appropriateness of 278 ciprofloxacin prescriptions which were generated through chart review and interview of 72 physicians. Ciprofloxacin was considered to be appropriately prescribed in 42% of cases by the academic panel, and in 62% by the industry panel. The only diagnoses where the two panels differed significantly were nursing home-acquired pneumonia (p < 0.0005) and acute exacerbation of chronic bronchitis (AECB) (p < 0.0001). Agreement between the two panels was fair (K = 0.36), but agreement increased to moderate when cases of nursing home-acquired pneumonia and AECB were removed (K = 0.58). -- Inappropriate prescription of ciprofloxacin inhibits productive efficiency in the health care system and stems from a combination of lack of knowledge of pharmacotherapy for common infections, as well as a lack of knowledge or concern for the cost differential among antibiotic alternatives. Physician education through academic detailing is needed to disseminate price information and appropriate guidelines with the intent of improving physician prescribing behaviour.
|Item Type:||Thesis (Masters)|
|Additional Information:||Bibliography: leaves 88-101.|
|Department(s):||Medicine, Faculty of|
|Geographic Location:||Canada--Newfoundland and Labrador|
|Library of Congress Subject Heading:||Medical care--Utilization review--Newfoundland and Labrador; Drugs--Prescribing--Newfoundland and Labrador; Drugs--Effectiveness; Ciprofloxacin|
|Medical Subject Heading:||Delivery of Health Care--Newfoundland and Labrador; Health Services--utilization--Newfoundland and Labrador; Drug Prescriptions; Ciprofloxacin|
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