Reported numbers of patients with rare diseases based on ten-year longitudinal national disability registries in Taiwan

Parental Intervention Program for Preschool children with Rare Diseases - a mixed methods evaluation of parents' experiences and utility

BACKGROUND

The purpose of this study was twofold: (i) To assess the parents' experiences and perception of participating in a "Parental Intervention Program for Preschool children with Rare Diseases" (PIPP-RDs). (ii) To evaluate which elements of the PIPP-RDs that the parents emphasized as important for improving their health literacy related to facilitating the transition of their children from kindergarten to school.

METHOD

A mixed methods evaluation study was conducted ten and eleven months post-intervention, integrating an online quantitative survey combined with individual semi-structured interviews. Twenty-two parents participated in individual interviews, of these 18 also responded to the online questionnaire survey.

RESULTS

All parents that participated in this study reported that the information conveyed at the program was of great value and utility, 88% reported significantly alleviated stress associated to their child`s school-start, 84% indicated had improved the school-home collaboration and 84% reported that it had encouraged them to establish contact with the school prior to school commencement. From the qualitative data five main themes emerged: (i) Competence and Knowledge Acquisition, (ii) Becoming more Prepared and Relaxed, (iii) Achieved Realistic Expectations, (iv) Enhanced Communication Skills, (v) Increased Health Literacy and Self-Efficacy. The evaluative findings suggest that this invention program has notably improved the parents' aptitude for school interaction, enhanced the adaptions according to children`s needs for accommodations, and has provided reassurance in the school-home collaboration. Parents also described increased self-confidence and self-efficacy in managing the school start for children with RDs.

CONCLUSION

The highly positive response of participating in PIPP-RDs may not only reflect the merits of the program`s content, but also underscore the significant needs for such support during the transition to school for parents of children with RDs. Comparable initiatives, oriented towards enhancing the health literacy and empowering the parents, are anticipated to yield similarly favourable results. We argue that intervention program amalgamate pertinent information, group discourse, and workshops on school-related issues, alongside opportunities for parents to meet other parents in similar situations.

Survival and Its Correlates in Multiple Sclerosis Patients under a Universal Health Insurance Program in Taiwan: An 18-Year Nationwide Cohort Study

Despite the global decline in the standardized mortality rate of multiple sclerosis (MS), recent research on MS patient survival, especially in Taiwan, remains limited. This study aimed to investigate survival, mortality causes, and associated factors among MS patients in Taiwan. The Taiwan National Health Insurance Research Database was used as the primary data source, and a Cox proportional hazard model was employed to estimate and analyze factors related to survival. We analyzed data from 1444 MS patients diagnosed between 2000 and 2018. Age at diagnosis was positively correlated with the risk of death. Among the 190 patients who died, the leading causes of disease-related deaths were nervous system diseases (n = 83, 43.68%), followed by respiratory system diseases and certain infectious and parasitic diseases. The 8-, 13-, and 18-year survival rates for MS patients were 0.97, 0.91, and 0.81, respectively. This study highlights that the MS patient's socioeconomic status, environmental factors, comorbidity severity, and related medical variables were not significantly associated with survival.

Association Between Visual Impairment and Health Care Use

PURPOSE

To determine the association between visual impairment (VI) and medical care use.

DESIGN

Population-based cohort study.

METHODS

The study cohort included individuals from 2007 to 2017. The Disability Registry was used to identify all patients aged ≥20 years who newly developed visual disability. All patients were observed until they became visually impaired (case group). They were then matched with 2 control groups: (1) people with nonvisual disability and (2) people without any disability. The main outcome measures were (1) ophthalmic outpatient and inpatient use and (2) nonophthalmic outpatient and inpatient use.

RESULTS

Compared with people with nonvisual disability, those with visual disability demonstrated a lower nonophthalmic outpatient costs (-NT$42,841, P < .001) and outpatient visits (-2.8 times). However, the opposite was noted for ophthalmic use, where people with visual disability used more medical care compared with people with other types of disability and people without disability. An age-stratified analysis revealed that visual disabilities had an age-related dose-response effect on the reception of nonophthalmic care and a slight nonlinear effect on the receipt of ophthalmic care.

CONCLUSIONS

Studies investigating the effect of VI on medical use should differentiate aggregate use into different types. Use of ophthalmic and nonophthalmic care for people with VI should be compared with that of people with other types of disability and people without disability.

Healthcare burden of rare diseases in Hong Kong - adopting ORPHAcodes in ICD-10 based healthcare administrative datasets

Background

The burden of rare diseases is important for healthcare planning but difficult to estimate. This has been facilitated by the development of ORPHAcodes, a comprehensive classification and coding system for rare diseases developed by the international consortium Orphanet, with cross-references to the 10th version of the International Classification of Diseases and Related Health Problems (ICD-10). A recent study in Western Australia made use of this cross-referencing to identify rare diseases-related admissions in health administrative datasets. Such methodology was adopted in Hong Kong, which has a population of 7 million comprising of 92% ethnic Chinese, with over 80% of admissions taking place in the public hospitals and available for review from the local public healthcare database.

Main body

Our objective was to identify the inpatient healthcare burden of rare diseases in Hong Kong. We extracted admission records of all patients coded with one or more of the 1084 ICD-10 codes cross referenced with 467 ORPHAcodes during the study period from 1st January 2005 to 31st December 2016. We further analysed rare disease-related inpatient healthcare cost using a subset of patients admitted during 1st April 2015 – 31st March 2016. A total number of 546,673 admissions were identified, representing 3.2% of total admissions during the study period. By the end of the study, 109,535 patients were alive, representing 1.5% of the overall population. Prevalence of rare diseases was found to be 1 in 67 in the Hong Kong population. The most common rare disease category in the paediatric age group was ‘rare developmental defect during embryogenesis’; whereas that amongst adults was ‘rare haematologic disease’. The aforementioned subset of patients accounted for 330,091 inpatient-days, placing the estimated total inpatient cost for rare disease population at HKD$1,594,339,530 i.e. 4.3% of total inpatient cost in 2015–2016.

Conclusion

Cross referencing between ICD-10 and ORPHAcodes may be adopted in different healthcare datasets for international comparison. Despite differences in the prevalence of individual disease, the disparity between rare disease prevalence (1.5%) and associated inpatient cost (4.3%) in Hong Kong reflects the importance of rare diseases in healthcare policies.

Development of genetic counseling services in Taiwan

Taiwan is an emerging industrial country in subtropical Asia with a population of 23 million. There were around 200,000 newborns in 2011. Delayed first marriage, low birth rate, and rapid aging are major demographic issues. Genetic counseling services were established following the rapid introduction of genetic technology and enactment of relevant laws and regulations. Ultrasound was first used in 1968 to examine pregnant women. The first amniotic fluid laboratory was founded in 1981 to identify chromosomal abnormalities. In 1984, the Genetic Health Act was legislated for prevention and control of genetic disorders, and the metabolic disorder screen project was launched. National Health Insurance with overall coverage of prenatal examinations was established in 1995. A master-level genetic counseling program was launched in 2003 and by 2011 has graduated eighty students. Two professional societies have been formed to certify genetic counselors, and 66 professionals have been certified. In summary, genetic counseling services in Taiwan are continuously improving.