Vladimír Mucha, Patrícia Ďuďák Teplanová, Ján Gogola
et al.
The aim of this paper is to analyse the cancellation of life insurance contracts on death using an accelerated failure time (AFT) model. The study focuses on identifying risk factors that influence the time to cancellation, with the objective of determining which to identify those insureds who cancel their policies the fastest. The analysis revealed several notable findings regarding the impact of premium payment frequency on contract cancellation. Specifically, yearly premium payments were found to extend the time to cancellation by 27% compared with monthly payments, holding all other factors constant. For contracts with monthly premiums, 10% of clients cancel within approximately 376 days, whereas for yearly premiums, the corresponding period is 476 days. Additionally, the results indicate that clients who did not conclude their contracts through the tied agent distribution channel tend to cancel their policies sooner. The AFT model was constructed using established R packages for survival analysis.
Robin Whittemore, Sangchoon Jeon, Samuel Akyirem
et al.
BackgroundDiabetes self-management education and support (DSMS) delivered via patient portals significantly improves glycemic control. Yet, disparities in patient portal use persist. Community health centers (CHCs) deliver care to anyone who needs it, regardless of income or insurance status.
ObjectiveThis study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a multilevel intervention to increase access and use of portals (MAP) among people with type 2 diabetes (T2D) receiving health care at CHCs.
MethodsA within-subjects, pre-post design was used. Adults with T2D who were portal naive were recruited from 2 CHCs. After informed consent, participants met with a community health worker for referrals for social determinants of health, provision of a tablet with cell service, and individualized training on use of the tablet and portal. Next, a nurse met individually with participants to develop a DSMS plan and then communicated with patients via the portal at least twice weekly during the first 3 months and weekly for the latter 3 months. Data were collected at baseline, 3 months and 6 months. The primary outcome was patient activation and engagement with the portal. Secondary outcomes included technology attitudes, digital health literacy, health-related outcomes and psychosocial function.
ResultsIn total, 26 patients were eligible, 23 received the intervention, and one was lost to follow up. The sample was predominately Latino or Hispanic (17/22, 77%) and reported low income (19/22, 86%< US $40,000/year), low education (13/22, 59% <high school), and no health insurance (12/22, 55%). All participants had access to a Smartphone, but 91% (20/22) had never accessed a health app. The baseline hemoglobin A1c level was 8.31%. Portal activation was high; 100% (22/22) of participants created a portal account and logged in within the first month. Mean participant logins per week over the first 3 months was 3.16 (SD 1.55) and 1.45 (SD 0.93) over the final 3 months; mean logins per month over the first 3 months was 12.65 (SD 6.21) and 5.79 (SD 3.74) over last 3 months. Engagement was high; 96% (20/21) logged in at least twice per month in the first 3 months and 76% (16/21) between 3 and 6 months. At 6 months, improvements were seen in technology confidence, digital health literacy, diabetes self-efficacy, and diabetes distress. Participant satisfaction with MAP was high as was intention to continue portal use. Barriers to clinical integration and recommendations for portal development were identified.
ConclusionsMAP shows promise for improving health equity in portal use for T2D. Larger, controlled studies are needed to determine how best to implement MAP in complex clinical settings and to evaluate efficacy over time.
Trial RegistrationClinicalTrials.gov NCT05180721; https://clinicaltrials.gov/study/NCT05180721
Melda Emilya, Misnaniarti Misnaniarti, Rizma Adlia Syakurah
et al.
Fraud poses a major threat to the integrity of Indonesia’s National Health Insurance–Healthy Indonesia Card (JKN-KIS) program, affecting health financing, hospital quality, and institutional reputation. Despite continuous efforts to combat fraud, allegations persist, particularly in hospitals in Palembang. This study aimed to identify potential fraud in hospitals in Palembang and analyze management countermeasures. Using a descriptive qualitative design with a phenomenological approach, the study was conducted from March to July 2022 and involved three hospitals in Palembang, the City Health Office, and the local branch of the Social Security Administrative Body for Health (BPJS Kesehatan). Data were collected through in-depth interviews with 16 informants representing hospitals, BPJS Kesehatan, and anti-fraud teams, supported by observations and document reviews. Thematic analysis revealed several fraud risks, including diagnosis manipulation, unnecessary treatment, and overcharging. Weak internal and external monitoring mechanisms fostered opportunities for fraud, often driven by financial pressure, revenue targets, and personal motives, and influenced by tenure and position within the organization. Fraud countermeasures remain suboptimal, although BPJS Kesehatan’s management shows potential that requires further improvement. Applying the Hexagon Vousina theory, this study emphasizes the need for a more comprehensive and integrated approach to fraud risk management. Strengthening oversight, professional ethics, inter-agency coordination, and policy enforcement is crucial to maintain the sustainability and effectiveness of the JKN-KIS program.
Acromegaly is a rare endocrine disorder caused by excessive growth hormone secretion. Its low prevalence poses challenges in studying its long-term prognosis and systemic effects. To address this research gap, we conducted five studies using nationwide cohort data from the Korean National Health Insurance Database (NHID). This review consolidates the findings of these studies, which examined various long-term effects of acromegaly. The results demonstrated significant associations between acromegaly and increased mortality, a higher prevalence of mortality, cardiovascular outcomes, neurodegenerative diseases, depression, end-stage kidney disease, respiratory complications, specifically bronchiectasis, spine & hip fracture, and malignancy. These findings highlight the critical need for early diagnosis, comprehensive care, and long-term monitoring, and underscore the importance of a multidisciplinary approach in managing acromegaly.
Diseases of the endocrine glands. Clinical endocrinology
Nicole P. Jenkins, Gregory W. Vurture, Amber Wai-San Chan
et al.
COVID-19 introduced widespread challenges in healthcare access and was demonstrated to be a significant stressor for patients with pelvic floor dysfunction (PFD). Pelvic Floor Physical Therapy (PFPT) is a first line behavioral modification to address PFD. The impact of COVID-19 on PFPT adherence rates in a urogynecologic population is unknown; therefore, a retrospective chart review was conducted looking at “pre-pandemic” (referring to before 1 March 2020) and “pandemic” (referring to after 1 March 2020) cohorts. A total of 173 women met the inclusion criteria (93 pre-pandemic vs. 80 pandemic). The PFPT adherence rates were similar between the pre-pandemic and pandemic groups (20.0% vs. 18.8%, <i>p</i> = 0.85). Patient-reported barriers to initiation included insurance coverage, transportation, and time commitment. When looking for clinical correlates associated with non-adherence, patients who utilized an internal referral to a hospital-associated PFPT facility were 4.9-fold more likely to adhere to PFPT for PFD (95% confidence interval: 1.31–18.23, <i>p</i> = 0.018). While COVID-19 was not identified as a barrier to PFPT adherence, identifying barriers preventing patients from attending PFPT remains an area for improvement. Increasing the utilization of an internal referral system to a hospital-associated PFPT facility may be an effective solution for increasing patient adherence.
Tati Rahmawati, Hui-Min Hsieh, Hui-Min Hsieh
et al.
IntroductionThe Indonesian government introduced universal health insurance through the National Social Security System (JKN) in 2014 to enhance overall healthcare. This study compares maternal health care (MHC) service utilization before and after JKN implementation in Indonesia.MethodUsing 2012 and 2017 data from Indonesia Demographic and Health Surveys (DHS), we conducted a two-period cross-sectional design study following the Anderson model. We assessed how the JKN policy and population characteristics influenced healthcare utilization for women aged 15–49 who had given birth in the last 5 years. Multivariable logistic regression models were used to assess the impact of the JKN policy and related factors.ResultIn two waves of Indonesia DHS with 14,782 and 15,021 subjects, this study observed a significant increase in maternal healthcare service utilization post-JKN implementation. Women were more likely to have at least four antenatal care visits (adjusted odds ratio, AOR = 1.17), receive skilled antenatal care (AOR = 1.49), obtain skilled birth assistance (AOR = 1.96), and access facility-based delivery (AOR = 2.45) compared with pre-JKN implementation.ConclusionThis study revealed a significant positive impact of JKN on enhancing MHS utilization. The introduction of universal health insurance coverage likely reduced financial barriers for specific demographics, resulting in increased service utilization. Our study may offer valuable insights for Asian countries with similar demographics and health insurance implementations.
Abrham Demis, Birhanetensay Masresha Altaye, Mulugeta Emiru
et al.
Background. Self-medication practice is the use of medicine without consulting health professionals to treat self-recognized illness by the general population including pregnant women. Inappropriate self-medication practice during pregnancy may pose harmful consequences for the fetus as well as the mother. There is not given much attention on the practice of self-medication among pregnant women in our setting. Therefore, this study aimed to assess the prevalence of self-medication practice and associated factors among pregnant women who attended antenatal care at North Shewa Zone public hospitals. Methods. An institution-based cross-sectional study was conducted from June 01, 2022 to July 30, 2022, among 650 pregnant women who attended antenatal care at North Shewa Zone public hospitals. A multistage sampling technique was employed. The questionnaires were pretested. A structured interviewer-administered questionnaire and reviewed medical records were used for data collection. Epi-data version 4.6.2 and SPSS version 20 were utilized for data entry and analysis, respectively. Bivariate and multivariable logistic regression was done to identify associated factors, and P values less than 0.05 were considered statistically significant. Results. The prevalence of self-medication practice among pregnant women was 65.38%. Housewives (AOR = 0.097 95% CI 0.030, 0.310), farmers (AOR = 0.117, 95% CI 0.028, 0.493), people with health insurance (AOR = 0.507, 95% CI 0.300, 0.858), and people in preconception care (AOR = 0.038, 95% CI 0.011–0.135) were less likely to practice self-medication, while people with primary education (AOR = 3.00, 95% CI 1.217, 7.435), income less than 3,000 birr (AOR = 5.46, 95% CI 1.41, 21.1), participants in the first (AOR = 4.183, 95% CI 2.12, 8.24) and second trimesters (AOR = 2.05, 95% CI 1.18, 3.56), pregnant women who lived in rural areas (AOR = 1.579, 95% CI 1.103–2.260), and people who previously practiced self-medication (AOR = 8.2, 95% CI 5.04, 13.3) were more likely to practice self-medication. Conclusion. From the present finding, it can be concluded that self-medication among pregnant women is high. Previous self-medication practice, gestation period, educational status, monthly income, no preconception care, no health insurance, being a housewife, farmer, and place of residence were significantly associated with self-medication practice. Therefore, preventive measures such as proper counseling during dispensing, awareness creation programs on preconception care, and enrolling in health insurance programs to minimize the practice of self-medication are necessary.
Gholamali Karimi, Kourosh Kabir, Babak Farrokhi
et al.
Abstract Purpose Irrational prescription of antibiotics is an ongoing global public health concern, leading to antibiotic resistance. Understanding the prescribing pattern of antibiotics is important to tackling mal-prescription and antibiotic resistance. We aimed to investigate the pattern and factors affecting outpatients’ antibiotic prescribing by family physicians in Primary Health Care (PHC). Methods A cross-sectional study was conducted in 19 PHC facilities in Alborz province. Prescribing pattern of antibiotics was evaluated among 1068 prescriptions by family physicians. Prescribing pattern of antibiotics included prescriptions containing antibiotics, the number of antibiotics per prescription, type, name of antibiotic, and mal-prescription. Multiple logistic regression analysis was used to estimate the adjusted odds ratios and 95% confidence intervals. Results Overall, 57% of the prescriptions had ≥ 1 antibiotic and the average number of antibiotics per prescription was 1.27. Amoxicillin was the commonly prescribed antibiotic. There was a significant relationship between age, sex, type of health insurance, work experience of the physician, and seasons with antibiotic prescribing (P < 0.05). In 59.31% of antibiotic prescriptions at least one of the scientific criteria was not fulfilled. In the final analysis, after adjusting for the potential confounders, field experts of physicians (OR = 1.59; 95% CI: 1.08–6.17), female sex (OR = 2.23; 95% CI: 1.18–4.21), and winter season (OR = 3.34; 95% CI: 1.26–8.15) were found associated factors with antibiotic prescribing. Conclusion The average number of antibiotics per prescription and the percentage of irrational prescriptions were relatively high in this study. There is need to improve antibiotic prescribing patterns among family physicians working in primary health care.
Therapeutics. Pharmacology, Pharmacy and materia medica
BackgroundLoss to follow-up (LTFU) is a significant barrier to the completion of anti-tuberculosis (TB) treatment and a major predictor of TB-associated deaths. Currently, research on LTFU-related factors in China is both scarce and inconsistent.MethodsWe collected information from the TB observation database of the National Clinical Research Center for Infectious Diseases. The data of all patients who were documented as LTFU were assessed retrospectively and compared with those of patients who were not LTFU. Descriptive epidemiology and multivariable logistic regression analyses were conducted to identify the factors associated with LTFU.ResultsA total of 24,265 TB patients were included in the analysis. Of them, 3,046 were categorized as LTFU, including 678 who were lost before treatment initiation and 2,368 who were lost afterwards. The previous history of TB was independently associated with LTFU before treatment initiation. Having medical insurance, chronic hepatitis or cirrhosis, and providing an alternative contact were independent predictive factors for LTFU after treatment initiation.ConclusionLoss to follow-up is frequent in the management of patients with TB and can be predicted using patients’ treatment history, clinical characteristics, and socioeconomic factors. Our research illustrates the importance of early assessment and intervention after diagnosis. Targeted measures can improve patient engagement and ultimately treatment adherence, leading to better health outcomes and disease control.
Bibinur Sydykova, Dariga Smailova, Zaituna Khismetova
et al.
Background and aimThis article stresses the importance of comprehensive nursing documentation in scientific medicine and discusses the adoption of standardized terminologies in Europe. The study also presents findings from a cross-sectional study conducted in Kazakhstan, assessing the utilization of standard operating procedures and nursing documentation in various clinical scenarios. The aim was evaluate the level of use of the form of nursing documentation and Standard Operating Procedure within the framework of reforming the Republic of Kazakhstan.Materials and methodsDuring the period from December 2021 to February 2022, a cross-sectional study was conducted in Kazakhstan, involving a randomly selected sample of nurses with technical and vocational education as well as those with applied/academic baccalaureate degrees in nursing.ResultsIn this cross-sectional study of 2,263 female nurses, 75.3% were nurse practitioners, and 44% held the highest qualification category. Awareness levels varied, with around 64.7% aware of the pilot program for care services, 65.8% aware of the deputy head position, and 73.8% familiar with the “extended practice nurse” role. Only 55.2% knew about the International Clinical Nursing Classification, and 54.5% observed changes in their nursing approach due to education. The limb edema measurement checklist was not used by the majority (88.4%) of respondents, and 68% did not utilize the antibiotic susceptibility testing checklist. Various other checklists and algorithms had limited utilization, with percentages ranging from 9.1 to 69.3%, indicating varying levels of adoption among participants. For assisting children with cerebral palsy, the “Assessment of hand use capacity according to the MACS classification system” was utilized by 9.1%, while 90.9% did not employ it. In the context of communication, 30.7% of the respondents utilized the “Algorithm of actions of a medical registrar when communicating with a patient,” while 69.3% did not use it. These findings highlight variable adoption rates among participants for these medical procedures and protocols.ConclusionIn Kazakhstan, nursing documentation forms and Standard Operating Procedures face challenges and limited utilization, but their implementation has shown positive impacts on patient care and healthcare outcomes. Overcoming resistance to change, increasing awareness, and addressing resource constraints are essential for further improvement.
Sigortacılık, genel anlamda kişilerin mal ve canlarının maruz kalma ihtimali olan risklerin gerçekleşmesi halinde ortaya çıkacak zararın tazmin edilmesini hedefleyen bir sistemdir. Geleneksel sigortacılık sistemi faiz ve garar gibi unsurlar barındırdığından İslam hukuku açısından birtakım tereddütlere yol açmaktadır. Bu nedenle İslami finans sisteminin de gelişmesiyle birlikte İslami bir sigorta modeli olan tekâfül sistemi gündeme gelmiştir. Katılım sigortacılığı (tekâfül), yardımlaşma usulüyle yapılan karşılıklı bir sigorta türüdür ve belirli rizikolara maruz şahısların bu rizikoların gerçekleşmesiyle ortaya çıkacak zararların telafisi üzerine anlaşmaları olarak tanımlanmaktadır (AAOIFI). Bu çalışma, Türkiye’de İslam hukuku alanında yapılan İslami sigortacılık, tekâfül ve/veya katılım sigortacılığıyla ilgili yapılan çalışmaları tespit etmeyi ve kısmen değerlendirmeyi amaçlamaktadır. Bu amaçla bugüne kadar konuyla ilgili literatürün tespiti ve tasnifi yapılarak özellikle İslam hukuku alanında yapılmış çalışmalar, değerlendirmeye tabi tutulmuştur. Ancak ihtiyaç duyulan yerlerde fıkıh ilminin kaynaklık ettiği İslam iktisadı ve finansı alanında yapılan bazı çalışmalar da bu anlamda incelenmiştir. Değerlendirmede kronoloji ve çalışmanın türü olmak üzere iki kıstas göz önünde bulundurulmuştur. Çalışmada sempozyum ve çalıştay gibi ilmi toplantıların yanı sıra kitap, tez, makale, tebliğ türü çalışmalar üzerinde durulmuş ve bugüne kadar çokça tekrar eden ve ihmal edilen hususların tespitine çalışılmıştır. Böylece bundan sonraki süreçte bu alanda yapılacak çalışmalara yön verecek bazı öneriler sunulması hedeflenmiştir. Çalışmada sayısal verilere ve diğer alanlarda yapılmış çalışmaların listesine yer verilmiştir. Bu yönüyle çalışma, bir bibliyografya denemesi niteliği taşıdığından önem arz etmektedir. Çünkü bugüne kadar katılım sigortacılığı literatürüne dair bir çalışma yapılmamıştır. Bu anlamda çalışma benzerlerine ilk adım olacak ve bundan sonra konuyla ilgili mevcut çalışmalara tek elden ulaşma imkânı sunacaktır.
BACKGROUND:Although the high disease burden that results from cardiovascular complications of hypertension, factors related to the progression to hypertension in the normotensive population are not actively reported. The purpose of this study was to estimate the rate of the progression to hypertension and to reveal the associated risk factors. METHODS:The study included normotensive participants from the National Health Insurance Service-National Health Screening Cohort, and contained a 10% sample of all adults who received a national health screening test in either 2002 or 2003. At the end of the study in 2015, the patients were divided into two groups based on whether or not they progressed to hypertension. Cox proportional hazard modeling was performed to identify risk factors for progression. Subgroup analysis using logistic regression was employed to reveal factors influencing the different natural history of the progression. RESULTS:Among the 75,335 included participants, the progression rate to hypertension was 66.39% (50,013), with an adjusted incidence rate of 8.62 per 100 person-year in the aged 40-64 group and 12.68 in the aged 65 or above group. Age, BMI, hemoglobin, and family history of hypertension and other diseases were related to the progression. Among the progression group, 78.21% (39,116) participants skipped a pre-hypertensive status; this group consisted of older females with lower pulse pressure and more alcohol consumption compared to people who had pre-hypertensive status before the progression. CONCLUSION:Substantial risk factors for the progression to hypertension should be carefully managed even in normotensive participants who receive health screening tests.
Abstract Background Ethnicity and insurance status have been shown to impact odds of presenting with metastatic cancer, however, the interaction of these two predictors is not well understood. We evaluate the difference in odds of presenting with metastatic disease in minorities compared to white patients despite access to the same insurance across three common cancer types. Methods Using the National Cancer Database, a multilevel logistic regression model that estimated the odds of metastatic disease was fit, adjusting for covariates including year of diagnosis, ethnicity, insurance, income, and region. We included adults diagnosed with metastatic prostate, non–small cell lung cancer (NSCLC), and breast cancer from 2004 to 2015. Results The study cohort consisted of 1 191 241 prostate cancer (PCa), 1 310 986 breast cancer (BCa), and 1 183 029 NSCLC patients. Private insurance was the most protective factor against metastatic presentation. Odds of presenting with metastatic disease were 0.190 [95% CI, 0.182‐0.198], 0.616 [95% CI, 0.602‐0.630], and 0.270 [95% CI, 0.260‐0.279] for PCa, NSCLC, and BCa compared to uninsured patients, respectively. Private insurance provided the most significant benefit to non‐Hispanic White PCa patients with 81% reduction in odds of metastatic presentation and conferred the least benefit to African‐American NSCLC patients at 30.4% reduction in odds of metastatic presentation. Conclusions Insurance status provided the single most protective effect against metastatic presentation. This benefit varied for minorities despite similar insurance. Reducing metastatic disease presentation rates requires addressing social barriers to care independent of insurance.
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Gerhard Müller, Manuela Pfinder, Christian Schmahl
et al.
Abstract Background Mental health promotion programs have been shown to reduce the burden associated with mental distress and prevent the onset of mental disorders, but evidence of cost-effectiveness is scarce. Objective To evaluate the cost-effectiveness of a mindfulness-based mental health prevention program provided by health coaches in a multi-site field setting in Germany. Methods The single-study based economic evaluation was conducted as part of a nonrandomized controlled trial, comparing the effects of a group-based prevention program to usual care based on propensity score matching. Participants (N = 1166) were recruited via a large statutory health insurance fund. Health outcome was assessed with the Hospital Anxiety and Depression Scale (HADS). Cost outcomes were actually incurred costs compiled from the health insurance’ records. Incremental cost-effectiveness ratios (ICER) were analyzed from a societal and a health care perspective for a 12-month time horizon with sampling uncertainty being handled using nonparametric bootstrapping. A cost-effectiveness acceptability curve was graphed to determine the probability of cost-effectiveness at different willingness-to-pay ceiling ratios. Results From a societal perspective, prevention was cost-effective compared to usual-care by providing larger effects of 1.97 units on the HADS (95% CI [1.14, 2.81], p < 0.001) at lower mean incremental total costs of €-57 (95% CI [− 634, 480], p = 0.84), yielding an ICER of €-29 (savings) per unit improvement. From a health care perspective, the incremental health benefits were achieved at additional direct costs of €181 for prevention participants (95% CI [40, 318], p = 0.01) with an ICER of €91 per unit improvement on the HADS. Willingness-to-pay for the prevention program to achieve a 95% probability of being cost-effective compared to usual-care, was estimated at €225 per unit improvement on the HADS score from a societal, and €191 from a health care perspective respectively. Sensitivity analyses suggested differential cost-effect-ratios depending on the initial distress of participants. Limitations Due to the complexity of the field trial, it was not feasible to randomize participants and offer an active control condition. This limitation was met by applying a rigorous matching procedure. Conclusions Our results indicate that universal mental health promotion programs in community settings might be a cost-effective strategy to enhance well-being. Differences between the societal and health care perspective underline the call for joint funding in the dissemination of preventive services. Trial registration German Clinical Trials Registration ID: DRKS00006216 (2014/06/11, retrospective registration).
Thomas D Szucs,1 Kevin P Szillat,2 Eva Blozik3 1University of Basel, Institute of Pharmaceutical Medicine (ECPM), Basel, Switzerland; 2Department of Biology, Institute of Molecular Health Sciences, ETH Zurich, Zürich, Switzerland; 3Department of Health Sciences, Helsana Group, Zürich, Switzerland Abstract: Single-nucleotide polymorphisms (SNPs) can severely impact individual drug response and health outcomes in cancer patients. Genetic tests to screen for marker SNPs are available to adjust the drug dose of oncologicals to the patient’s needs. However, it is unclear whether the positive effects outbalance the increased costs or even lead to an overall cost reduction. This very pragmatic analysis used three frequently used oncologicals for the treatment of breast cancer to evaluate whether preemptive pharmacogenetic testing may have a cost-reducing impact on health care spending in the Swiss health care system. Our results indicate that oncopharmacogenetics might help to reduce health care costs (ie, by avoiding adverse drug effects) and to increase efficiency of drugs in oncologic patients. Keywords: pharmacogenetics, oncology, budget impact model, Switzerland, health insurance
Farimah Rahimi, Hamid Reza Rasekh, Ezatollah Abbasian
et al.
Multiple sclerosis is a chronic, progressive, and common disease affecting the central nervous system in young adults. Interferon-beta is one of the most widely used medicines to reduce the disease progression. Given the variety of drugs in this category, we aimed to identify the preferences of patients for IFN-β that play an important role in policymaking in this area. Discrete choice experiment method was used in the present study to identify and prioritize those attributes that are of interest to MS patients and increases the utility of the use of IFN-β in their treatment. Questionnaires were given to 358 patients in Isfahan-Iran, who were asked to choose between the two treatment choices in each scenario. The results of the logit model showed that the changes in the efficacy lead to the most changes in the patient utility. Changes in side effects and ease of injection have been placed in the next rankings. Considering the drug attributes considered more desirable by patients can lead to greater medication adherence and possibly better treatment outcomes. Also, pharmaceutical companies, the health ministry, the Food and Drug Administration, insurance organizations, and neurologists can benefit from this information in production and importation, policymaking, and prescription.
Sandra Belalcazar Rey, Shirley Rosenstiehl, Willy Carpio Rosso
et al.
Purpose: To obtain feedback on the behavior of glaucoma patients with their treatment and identify factors that may be related to the adherence to treatment in a reference ophthalmological center in Bogotá - Colombia.
Method: A cross-sectional study was conducted, including 105 patients who attended the glaucoma consultation at the Fundación Oftalmológica Nacional, between April 2010 and June 2011.
Results: The distribution with respect to gender was similar, 53.3% were men. The average age was 64.8 years (range 25-88 years). The level of education was similar in the different groups: primary 34.3%, high school 35%, professional 29.9%
67.7% of the patients documented adherence to treatment; of these, 91.4% have a stable provider of the drops, in 53.3% drops were provided by their health insurance, in 37.1% drops were purchased by the patient, in 5.7% were supplied as a medical sample by the ophthalmologist and 3.8% responded that they not have a stable provider for the drops. Gender was not associated with adherence to treatment (p=0,53). No statistically significant association was found between adherence to treatment and educational level (p=0,56), whether or not the information provided by the treating physician is understood (p=0,314) or the number of bottles required for the treatment (p=0,75).
Patients who had a stable provider of the drops had greater adherence to treatment (p <0.001). The stable provider of the drops is a protective factor for adherence to glaucoma treatment (OR 0.26 CI 0.186-0.365).
Conclusion: We can conclude that the main cause of non-adherence to topical treatment of glaucoma or intraocular hypertension in our country is not having access to medication. It will be interesting to analyze the impact of the new medication delivery system introduced by our health authority on the adherence to chronic treatments in ophthalmology.
Resumen
Propósito: Obtener retroalimentación de la conducta del paciente de glaucoma con su tratamiento e identificar qué factores puedan estar relacionados con la adherencia al tratamiento en pacientes de un centro oftalmológico de referencia en Bogotá - Colombia.
Métodos: Se realizó un estudio transversal, que incluyó a 105 pacientes que acudieron a la consulta de glaucoma en la Fundación Oftalmológica Nacional, entre abril de 2010 y junio de 2011.
Resultados: La distribución con respecto al género fue similar, el 53.3% fueron hombres. La edad promedio fue 64,8 años (rango 25-88 años). El nivel de escolaridad fue similar en los diferentes grupos: primaria 34,3%, bachillerato 35%, profesional 29,9%.
El 67,7% de los pacientes documentaron adherencia al tratamiento; de estos, el 91.4% tiene un proveedor estable de las gotas, en el 53,3% las gotas fueron suministradas por su seguro médico, en el 37,1% fueron compradas por el paciente, en el 5,7% fueron suministradas como una muestra médica por el oftalmólogo tratante y el 3,8% respondió que no tienen un proveedor estable para su medicamento. El género no se asoció con la adherencia al tratamiento (p=0,53). No se encontró asociación estadísticamente significativa entre la adherencia al tratamiento y el nivel educativo (p=0,56), si se comprende o no la información proporcionada por el médico tratante (p=0,314) o el número de frascos requeridos para el tratamiento (p= 0,75).
Los pacientes que tenían un proveedor estable de las gotas tenían una mayor adherencia al tratamiento (p <0.001). El proveedor estable de las gotas es un factor protector para la adherencia al tratamiento del glaucoma (OR 0.26 CI 0.186-0.365).
Conclusión: Podemos concluir que la causa principal de la no adherencia al tratamiento tópico del glaucoma al de la hipertensión intraocular en nuestro país es no tener acceso a la medicación. Será interesante analizar el impacto del nuevo sistema de dispensación de medicamento implementado por nuestra autoridad de salud sobre la adherencia a los tratamientos crónicos en oftalmología.
In the context of the stochastic models for the management of life insurance portfolio, the authors explore, with simulation approach, the effects induced by the application of a particular method of calculation of the surrender value. In the life insurance, the policyholder position is, at any moment, quantified by the mathematical reserve. In case the reserve amount results are positive, the insurance company can allow the contract surrender, consisting in an amount payment, called surrender value, commensurate with the mathematical reserve. Generally, the insurance company enforces some restrictions in the surrender value determination, in order to avoid, first of all, that an amount is disbursed to the policyholder while, on the contrary, he results to be indebted to the Company. In this paper the authors will consider a surrender value calculation method based precisely on the profit recovery concept which shall be supplied by the contract in case it remains in the portfolio. Additionally, the authors shall analyze, by simulation approach, the effects caused by the enforcement of the surrender value calculation concept on a life portfolio profitability, and on the penalties extent enforced to the policyholders which cancel from the contract. Keywords: surrender value, life insurance, internal risk model, stochastic simulation