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Boven A, Simin J, Andersson FL, Vlieghe E, Callens S, Zeebari Z, Engstrand L, Brusselaers N. Clostridioides difficile infection, recurrence and the associated healthcare consumption in Sweden between 2006 and 2019: a population-based cohort study. BMC Infect Dis 2024; 24:468. [PMID: 38702635 PMCID: PMC11067081 DOI: 10.1186/s12879-024-09364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Clostridioides difficile infection (CDI) causes a major burden to individuals and society, yet the impact may vary depending on age, sex, underlying comorbidities and where CDI was acquired (hospital or community). METHODS This Swedish nationwide population-based cohort study (2006-2019) compared all 43,150 individuals with CDI to their 355,172 matched controls (first year and entire follow-up). Negative binomial regression models compared the cumulated length of stay, number of in-hospital admissions, outpatient visits and prescriptions after the first CDI episode expressed as incidence rate ratios (IRR) and 95% confidence intervals for the entire follow-up. RESULTS Overall, 91.6% of CDI cases were hospital acquired, and 16.8% presented with recurrence(s); 74.8%of cases were ≥ 65 years and 54.2% were women. Compared to individuals without CDI, in-hospital stay rates were 18.01 times higher after CDI (95% CI 17.40-18.63, first-year: 27.4 versus 1.6 days), 9.45 times higher in-hospital admission (95% CI 9.16-9.76, first-year: 2.6 versus 1.3 hospitalisations), 3.94 times higher outpatient visit (95% CI 3.84-4.05, first-year: 4.0 versus 1.9 visits) and 3.39 times higher dispensed prescriptions rates (95% CI 3.31-3.48, first-year: 25.5 versus 13.7 prescriptions). For all outcomes, relative risks were higher among the younger (< 65 years) than the older (≥ 65 years), and in those with fewer comorbidities, but similar between sexes. Compared to those without recurrence, individuals with recurrence particularly showed a higher rate of hospital admissions (IRR = 1.18, 95% 1.12-1.24). Compared to community-acquired CDI, those with hospital-acquired CDI presented with a higher rate of hospital admissions (IRR = 7.29, 95% CI 6.68-7.96) and a longer length of stay (IRR = 7.64, 95% CI 7.07-8.26). CONCLUSION CDI was associated with increased health consumption in all affected patient groups. The majority of the CDI burden could be contributed to hospital-acquired CDI (~ 9/10), older patients (~ 3/4) and those with multiple comorbidities (~ 6/10 Charlson score ≥ 3), with 1/5 of the total CDI burden contributed to individuals with recurrence. Yet, relatively speaking the burden was higher among the younger and those with fewer comorbidities, compared to their peers without CDI.
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Affiliation(s)
- Annelies Boven
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Solnavägen 9, 171 65, Stockholm, Sweden
- Department of Family Medicine and Population Health, Antwerp University, Antwerp, Belgium
| | - Johanna Simin
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Solnavägen 9, 171 65, Stockholm, Sweden
- Department of Family Medicine and Population Health, Antwerp University, Antwerp, Belgium
| | - Fredrik L Andersson
- Global Health Economics & Outcomes Research at Ferring Pharmaceuticals, Copenhagen, Denmark
| | - Erika Vlieghe
- Department of Family Medicine and Population Health, Antwerp University, Antwerp, Belgium
- General Internal Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Steven Callens
- General Internal Medicine, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Zangin Zeebari
- Department of Economics, Finance, Statistics and Informatics, Jönköping University, Jönköping, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Lars Engstrand
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Solnavägen 9, 171 65, Stockholm, Sweden
| | - Nele Brusselaers
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Solnavägen 9, 171 65, Stockholm, Sweden.
- Department of Family Medicine and Population Health, Antwerp University, Antwerp, Belgium.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
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Dahlgren C, Spånberg E, Sveréus S, Dackehag M, Wändell P, Rehnberg C. Short- and intermediate-term impact of DTC telemedicine consultations on subsequent healthcare consumption. Eur J Health Econ 2024; 25:157-176. [PMID: 36823408 PMCID: PMC9950019 DOI: 10.1007/s10198-023-01572-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
AIM The use of direct-to-consumer (DTC) telemedicine consultations in primary healthcare has increased rapidly, in Sweden and internationally. Such consultations may be a low-cost alternative to face-to-face visits, but there is limited evidence on their effects on overall healthcare consumption. The aim of this study was to assess the short- and intermediate-term impact of DTC telemedicine consultations on subsequent primary healthcare consumption, by comparing DTC telemedicine users to matched controls in a Swedish setting. METHODS We constructed a database with individual-level data on healthcare consumption, for all residents of Region Stockholm in 2018, by linking national and regional registries. The study population included all individuals who had ≥ 1 physician consultation (telemedicine or face-to-face) during the first half of 2018. DTC telemedicine users were matched 1:2 to controls who were non-users of DTC telemedicine but who had a traditional face-to-face consultation during the study period. The matching criteria were diagnosis and demographic and socioeconomic variables. An interrupted time series analysis was performed to compare the healthcare consumption of DTC telemedicine users to that of the control group. RESULTS DTC telemedicine users increased their healthcare consumption more than controls. The effect seemed to be mostly short term (within a month), but was also present at the intermediate term (2-6 months after the initial consultation). The results were robust across age and disease groups. CONCLUSION The results indicate that DTC telemedicine consultations increase the total number of physician consultations in primary healthcare. From a policy perspective, it is therefore important to further investigate for which diagnoses and treatments DTC telemedicine is suitable so that its use can be encouraged when it is most cost-efficient and limited when it is not. Given the fundamentally different models for reimbursement, there are reasons to review and possibly harmonise the incentive structures for DTC telemedicine and traditional primary healthcare.
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Affiliation(s)
- Cecilia Dahlgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, LIME, 171 77, Stockholm, Sweden.
- Region Stockholm, Center for Health Economics, Informatics and Healthcare Research, Stockholm, Sweden.
| | - Emma Spånberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, LIME, 171 77, Stockholm, Sweden
- Region Dalarna, Department of Analysis, Falun, Sweden
| | - Sofia Sveréus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, LIME, 171 77, Stockholm, Sweden
- Region Stockholm, Center for Health Economics, Informatics and Healthcare Research, Stockholm, Sweden
| | | | - Per Wändell
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Clas Rehnberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, LIME, 171 77, Stockholm, Sweden
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Bonnet JB, Nicolet G, Papinaud L, Avignon A, Duflos C, Sultan A. Global healthcare pathway of people living with diabetes prior to wounding is associated with a decreased risk of amputation. Diabetes Res Clin Pract 2023; 206:111007. [PMID: 37952599 DOI: 10.1016/j.diabres.2023.111007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
AIMS Diabetic foot ulcer (DFU) has a poor prognosis and high amputation rate. We previously used the French National Health Data System (Système National des Données de Santé: SNDS) to analyze the impact of deprivation and healthcare access on DFU prognosis. The purpose of this ancillary study was to explore the relationship between the global care pathway (care consumption) the year before and after DFU and the risk of amputation. METHODS We conducted a study based on a cohort from the SNDS. The data came from a region of France and subjects living with a complication of DFU. We looked at care consumption one year before and one year after wound onset. Risk of amputation was calculated one year after DFU onset. RESULTS Data were extracted for 6,642 patients. Subjects with DFU had a better prognosis regarding amputation risk when they are taking cardiovascular, antibiotic, neurological, drugs. A consultation with an ophthalmologist was also linked to a better prognosis: HR = 0.71 IC95 (0.499-0.995) (p = 0.04). CONCLUSION People with the best diabetes follow-up, even with several comorbidities, appear to have a better prognosis for their DFU. This highlights the importance of global healthcare and the care pathway in this chronic disease.
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Affiliation(s)
- Jean-Baptiste Bonnet
- UMR 1302, Institute Desbrest of Epidemiology and Public Health, Univ Montpellier, INSERM, CHU, Montpellier, France; Nutrition-Diabetes Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Guillaume Nicolet
- Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Laurence Papinaud
- Information Systems Unit at the Regional Medical Office of the Assurance Maladie, Montpellier, France
| | - Antoine Avignon
- UMR 1302, Institute Desbrest of Epidemiology and Public Health, Univ Montpellier, INSERM, CHU, Montpellier, France; Nutrition-Diabetes Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Claire Duflos
- UMR 1302, Institute Desbrest of Epidemiology and Public Health, Univ Montpellier, INSERM, CHU, Montpellier, France; Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Ariane Sultan
- Nutrition-Diabetes Department, CHU Montpellier, Univ Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.
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Norström F, Järvholm LS, Eskilsson T. Healthcare utilisation among patients with stress-induced exhaustion disorder treated with a multimodal rehabilitation programme - a longitudinal observational study. BMC Psychiatry 2022; 22:642. [PMID: 36229810 PMCID: PMC9563845 DOI: 10.1186/s12888-022-04300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/10/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Stress-induced exhaustion disorder is a major challenge in Swedish working life. Despite its increase in prevalence, there is still limited knowledge about the effectiveness of different rehabilitation methods. In this study, we aim to describe the healthcare utilisation for patients with stress-induced exhaustion disorder before, during and after a multi-modal rehabilitation (MMR) programme, as well as the health-related quality of life, work ability, sick leave level and psychological measures, and their possible relations. METHODS In this longitudinal observational study, 53 patients who were part of an MMR programme at the Stress Rehabilitation Clinic participated with survey data, and among them 43 also contributed with healthcare data. Data were collected from one year before start of MMR to one year after the end of it. The patients also answered a questionnaire at the start of, end of and at a one-year follow-up of the MMR, which included questions about health-related quality of life, work ability, clinical burnout, sick leave level, anxiety and depression. RESULTS There was a statistically significant increase in healthcare consumption during MMR, if including visits to the Stress Rehabilitation Clinic, while it decreased if excluding such visits, when comparing with before and after MMR. During the follow-up period there was a non-statistically significant (p=0.11), but still rather large difference (15.4 compared with 12.0 visits per patient), in healthcare consumption in comparison with the period before MMR, when excluding follow-up visits at the Stress Rehabilitation Clinic. Health-related quality of life was rated as poor before MMR (mean 0.59). There was a statistically significant improvement, but values were still below normal at the end of follow-up (mean 0.70). In addition, the level of sick leave, the work ability and signs of clinical burnout improved statistically significantly after MMR, but were not fully normalised at the end of follow-up. Individual healthcare consumption was related to residual health problems. CONCLUSIONS Patients with stress-induced exhaustion disorder have not reduced their healthcare consumption notably after MMR, and residual health problems remain for some patients. More studies are needed for a deeper understanding of the individual effectiveness of MMR, and also of its cost-effectiveness.
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Affiliation(s)
- Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden.
| | - Lisbeth Slunga Järvholm
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden ,grid.12650.300000 0001 1034 3451Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
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Heller HM, de Vries AVR, Hoogendoorn AW, Scheele F, Kop WJ, de Groot CJM, Honig A, Broekman BFP. Complications and Healthcare Consumption of Pregnant Women with a Migrant Background: Could There be an Association with Psychological Distress? Matern Child Health J 2022; 26:1613-1621. [PMID: 35653053 PMCID: PMC9329408 DOI: 10.1007/s10995-022-03451-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/27/2022]
Abstract
Objective Previous studies reported less prenatal healthcare consumption and more perinatal complications in women with a migrant background. Hence, we investigated in a country with free healthcare access whether women with a migrant background differed with respect to pregnancy complications, healthcare consumption and in terms of associations with psychological distress in comparison to native Dutch. Methods We included 324 native Dutch and 303 women with a migrant background, who visited two hospitals in Amsterdam for antenatal care between 2014 and 2015. Participants completed the Edinburgh Postnatal Depression Scale, the Hospital Depression and Anxiety Scale, and sociodemographic questions. Complications and healthcare consumption during pregnancy were extracted from medical records. Regression analyses were used with adjustment for covariates. Results Except for gestational diabetes [adjusted OR = 3.09; 95% CI = (1.51, 6.32)], no differences were found between groups in perinatal complications [OR = 1.15; 95% CI = (0.80, 1.64)], nor in healthcare consumption [OR = 0.87; 95% CI = (0.63, 1.19)]. Women with a migrant background reported more depressive symptoms [Cohen’s d = 0.25; 95% CI = (0.10, 0.41)], even after adjustment for socio-economic factors. Psychological distress was associated with more hospital admissions during pregnancy. When experiencing depressive symptoms, women with a migrant background had an increased risk to be admitted [OR = 1.11; 95% CI = (1.01, 1.21)]. Conclusions for Practice This cohort study found no differences in pregnancy-related complications, except for diabetes, nor different healthcare consumption, in women with a migrant background versus native Dutch, in a country with free health care access. However, women with a migrant background experienced more depressive symptoms, and when depressed their risk for hospital admission increased. Additional research is warranted to improve healthcare for this population.
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Affiliation(s)
- Hanna M. Heller
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Annemijn V. R. de Vries
- Department of Psychology and Psychiatry, Spaarne Gasthuis, POB 417, 2000 AK Haarlem, The Netherlands
| | - Adriaan W. Hoogendoorn
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- GGZ inGeest Mental Health Care, 1081 HJ Amsterdam, The Netherlands
| | - Fedde Scheele
- Department of Obstetrics and Gynaecology, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Willem J. Kop
- Department of Medical and Clinical Psychology, Tilburg University, De Warandelaan 2, 5037 AB Tilburg, The Netherlands
| | - Christianne J. M. de Groot
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Psychiatry, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands
| | - Birit F. P. Broekman
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Psychiatry, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands
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Ludwig L, Scheyer N, Remen T, Guerci B. The Impact of COVID-19 Lockdown on Metabolic Control and Access to Healthcare in People with Diabetes: the CONFI-DIAB Cross-Sectional Study. Diabetes Ther 2021; 12:2207-2221. [PMID: 34241812 PMCID: PMC8267505 DOI: 10.1007/s13300-021-01105-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/22/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic led to an international health crisis and restrictions. While the phenotype associated with COVID-19 severity in people with diabetes has rapidly been explored, the impact of restrictive measures, including lockdown, and tertiary care disruption on metabolic control and access to healthcare remained unknown. The aim of our study was to provide a comprehensive assessment on the overall management of diabetes during lockdown, including glucose control, weight changes, health care consumption and use of alternative forms of care such as telemedicine services, in a large sample of patients with type 1 (T1DM) or type 2 diabetes mellitus (T2DM). METHODS A prioritization of a care self-administered questionnaire was sent at the end of the first COVID-19 lockdown to all patients with diabetes routinely followed by diabetologists from the University Hospital of Nancy (France). This observational cross-sectional single-center study focused on data from patients with diabetes who returned the questionnaire along with medical records. The primary outcome was the change in HbA1c levels between the 6 months preceding and the 6 weeks following the lockdown. Data are expressed as numbers (%) or medians (quartiles). This study is registered with ClinicalTrials.gov (NCT04485351). RESULTS We analyzed data from 870 patients with diabetes: 549 T2DM (63.1%), 520 males (59.8%), age 65.0 (57.0, 72.0), body mass index 28.6 (25.1, 32.9) and diabetes duration 20.0 (10.0, 30.0) years. HbA1c levels pre- and post-lockdown were respectively 7.7% (7.1, 8.4) and 7.4% (6.8, 8.2), translating into a significant reduction of - 0.1% (- 0.6, 0.15) (p < 0.0001). Stratified analyses suggested a consistent significant reduction of HbA1c independently of diabetes type. HbA1c reduction was significantly different according to weight changes: - 0.3% (- 0.8, 0.0), - 0.1% (- 0.5, 0.1) and - 0.1% (- 0.5, 0.3) for patients who lost, had stable or gained weight, respectively (p = 0.0029). Respectively, 423 (49.4%) and 790 (92.3%) patients did not consult their general practitioner and diabetologist. Blood tests were undergone by 379 (44.8%) patients, 673 (78.3%) did refill their prescriptions, and 269 (32.1%) used teleconsultation services. CONCLUSIONS Despite the implementation of a lockdown and disruption in healthcare, no deterioration, rather an improvement, in metabolic control was observed in a large sample of patients with T1DM and T2DM.
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Affiliation(s)
- Lisa Ludwig
- Endocrinology, Diabetology and Nutrition, CHRU of Nancy, Brabois Hospital, ILCV Lorraine University, 54500, Vandoeuvre-lès-Nancy, France.
| | - Nicolas Scheyer
- Endocrinology, Diabetology and Nutrition, CHRU of Nancy, Brabois Hospital, ILCV Lorraine University, 54500, Vandoeuvre-lès-Nancy, France
| | - Thomas Remen
- Methodology, Data Management and Statistics Unit, University Hospital of Nancy, 54000, Nancy, France
| | - Bruno Guerci
- Endocrinology, Diabetology and Nutrition, CHRU of Nancy, Brabois Hospital, ILCV Lorraine University, 54500, Vandoeuvre-lès-Nancy, France
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Wijana MB, Feldman I, Ssegonja R, Enebrink P, Ghaderi A. A pilot study of the impact of an integrated individual- and family therapy model for self-harming adolescents on overall healthcare consumption. BMC Psychiatry 2021; 21:374. [PMID: 34311711 PMCID: PMC8311924 DOI: 10.1186/s12888-021-03375-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 07/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-harming behaviors in adolescents cause great suffering and can lead to considerable costs to the healthcare system. The aim of the current study was to investigate the cost of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) and to compare the adolescent's healthcare consumption 1 year before and 1 year after treatment. METHOD The study had a within group design with repeated measures. The clinical outcomes and the cost of ICT treatment are based on a sample of 49 participants who were previously enrolled in an intervention trial. Participants with significantly improved clinical outcomes (self-harm behavior, or general mental health symptoms) were defined as treatment responders. Calculation of changes in healthcare consumption is based on 25 participants who gave their consent to participate in a retrospective collection of healthcare data from medical records, including inpatient and outpatient care, and prescribed medication. RESULTS The average estimated cost of ICT per person was €5293. There were no significant differences between the cost of healthcare consumption 1 year before and after ICT, but the results suggested that the adolescents consumed less inpatient and specialized care after treatment. There was a significantly higher cost of psychotropic medication after treatment explained by a higher consumption of central stimulants. Treatment responders (general mental health problems) reduced their consumption of healthcare resources significantly more than non-responders, especially regarding hospital visits and total health care costs. CONCLUSIONS Good response to the ICT in terms of improved general mental health symptoms seems to be associated with reduced healthcare consumption during the post-treatment period. However, controlled studies with larger sample sizes are needed to draw causal conclusions. The results of this study should be interpreted with caution as it is based on a small sample and attrition rate was high. TRIAL REGISTRATION This study has been registered with the ISRCTN: 15885573 .
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Affiliation(s)
- Moa Bråthén Wijana
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. .,Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala, Sweden.
| | - Inna Feldman
- grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden ,grid.12650.300000 0001 1034 3451Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Richard Ssegonja
- grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
| | - Pia Enebrink
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ata Ghaderi
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Vidarsson B, Löfling Skogar M, Sundbom M. Impact of a severe complication two years after laparoscopic Roux-en-Y gastric bypass: a cohort study from the Scandinavian Obesity Surgery Registry. Surg Obes Relat Dis 2021; 17:1874-1882. [PMID: 34373144 DOI: 10.1016/j.soard.2021.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/09/2021] [Accepted: 06/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although severe complications (SCs) after laparoscopic Roux-en-Y gastric bypass (LRYGB) are rare, they can be devastating for the affected patient. OBJECTIVE To access the impact of SCs (Clavien-Dindo ≥3b) 2 years after LRYGB by using a nationwide Swedish cohort of 48,201 primary cases between 2007 and June 2016. SETTING University hospital, Sweden. METHODS Patients with SC were matched 1:1 on age, sex, diabetic status, body mass index (BMI), and year of operation to patients without an SC. Weight loss, patient-scored quality of life (QoL), antidepressant use, proton pump inhibitors (PPI) and opioids, and in-hospital care were gathered from 3 national registers. RESULTS A total of 1411 (2.9%) patients suffered an SC and 16 (.03%) died. In total, 1403 patients with SC (mean age, 42 yr; female, 75%; with diabetes, 15.7%; mean BMI, 41.9 kg/m2) could be matched. Both groups had a total body weight loss of 32% at 2 years. A lower physical QoL was observed in SCs throughout the study period. Antidepressant, PPI and opioid use was higher among patients with SC, even 2 years after surgery. At this time point, a doubling of oral morphine equivalents (7.3 to 17.0 mg/d) was found in patients with SC compared with prior to surgery. The SC group required more in-hospital care after the initial 30 days (3.8 versus .9 d in the remaining part of the first year). CONCLUSION An SC resulted in higher antidepressant, PPI and opioid use as well as higher need for in-hospital care during the first 2 postoperative years. Affected patients should therefore receive special attention during follow up.
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Affiliation(s)
- Bjarni Vidarsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | | | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Johansen CB, Egeberg A, Jimenez Solem E, Vittrup I, Skov L, Francis Thomsen S. Comorbidities, socioeconomic status, drug use, and health care consumption in Danish women with psoriasis: A nationwide cross-sectional study. Int J Womens Dermatol 2021; 7:246-258. [PMID: 34222579 PMCID: PMC8243156 DOI: 10.1016/j.ijwd.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psoriasis is a disease that extends beyond the skin, with profound medical, social, and mental health implications. To our knowledge, no previous studies have specifically investigated the medical and socioeconomic characteristics of women with versus without psoriasis. OBJECTIVE We investigated whether women with psoriasis differed from women without psoriasis with respect to comorbidities, socioeconomic status, healthcare consumption, and drug use, as well as how these characteristics differed according to psoriasis severity. METHODS In this nationwide, register-based, cross-sectional study, data were collected from Danish registries from 1977 to 2017, linked at the individual level, and identified by International Classification of Diseases codes, prescription data, income and educational information, and contact with public health care services. Psoriasis was defined by either a hospital International Classification of Diseases code for psoriasis or calcipotriol prescription data. Psoriasis severity was stratified based on psoriasis treatment. Age-adjusted logistic regression models were used to estimate the odds ratios (ORs) of outcomes compared with those of women without psoriasis. RESULTS A total of 77,143 women (3%) met the criteria for psoriasis. Psoriasis was significantly associated with all investigated outcomes. Women with psoriasis were less likely to have a high income (OR: 0.89; 95% confidence interval [CI], 0.87-0.91), more likely to visit their general practitioner more often (OR: 3.82; 95% CI, 3.70-3.95), and received pain medication more often (OR: 1.57; 95% CI, 1.52-1.62) compared with women without psoriasis. CONCLUSION Psoriasis was significantly associated with all investigated adverse medical and socioeconomic outcomes. Risk of outcomes increased with psoriasis severity. Our study highlights the need for a multidisciplinary collaboration to optimize medical care for women with (especially moderate and severe) psoriasis.
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Affiliation(s)
- Cæcilie Bachdal Johansen
- Department of Dermatology and Venereology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Espen Jimenez Solem
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ida Vittrup
- Department of Dermatology and Allergy, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology and Venereology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
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Sevilla-Dedieu C, Billaudeau N, Paraponaris A. Healthcare consumption after a change in health insurance coverage: a French quasi-natural experiment. Health Econ Rev 2020; 10:17. [PMID: 32529529 PMCID: PMC7291705 DOI: 10.1186/s13561-020-00275-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Compared with the number of studies performed in the United States, few studies have been conducted on the link between health insurance and healthcare consumption in Europe, likely because most European countries have compulsory national health insurance (NHI) or a national health service (NHS). Recently, a major French private insurer, offering voluntary complementary coverage in addition to the compulsory NHI, replaced its single standard package with a range of offers from basic coverage (BC) to extended coverage (EC), providing a quasi-natural experiment to test theoretical assumptions about consumption patterns. METHODS Reimbursement claim data from 85,541 insurees were analysed from 2009 to 2018. Insurees who opted for EC were matched to those still covered by BC with similar characteristics. Difference-in-differences (DiD) models were used to compare both the monetary value and physical quantities of healthcare consumption before and after the change in coverage. RESULTS As expected, the DiD models revealed a strongly significant, though transitory (mainly during the first year), increase after the change in coverage for EC insurees, particularly for costly care such as dental prostheses and spectacles. Surprisingly, consumption seemed to precede the change in coverage, suggesting that one possible determinant of opting for more coverage may be previous unplanned expenses. CONCLUSION Both catching-up behaviour and moral hazard are likely to play a role in the observed increase in healthcare consumption.
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Affiliation(s)
| | | | - Alain Paraponaris
- Aix-Marseille Univ, CNRS, EHESS, Centrale Marseille, AMSE, Marseille, France
- ORS PACA, South-Eastern Health Observatory, Marseille, France
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11
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Grundström H, Hammar Spagnoli G, Lövqvist L, Olovsson M. Healthcare Consumption and Cost Estimates Concerning Swedish Women with Endometriosis. Gynecol Obstet Invest 2020; 85:237-244. [PMID: 32248191 DOI: 10.1159/000507326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/09/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Endometriosis is known for its substantial effect on women's wellbeing and quality of life. In order to evaluate disease burden, treatments and health services, assessments of healthcare consumption and cost estimates are necessary. OBJECTIVES The aim of this study was to estimate healthcare consumption and annual cost per woman with endometriosis in Sweden and to examine healthcare consumption and costs in different age groups. METHODS A questionnaire was distributed to 400 members of the Endometriosis Association and to 400 randomly selected women with surgically confirmed endometriosis. Official statistics were obtained via correspondence, publications, and database searches. RESULTS Analysis of the 431 returned questionnaires showed that women under 30 years utilized more inpatient and outpatient care than older women. The mean annual cost among all women was EUR 8,768/woman. The direct healthcare cost of managing the disease was EUR 4,282, while the indirect cost was EUR 4,486. Absence from work was reported by 32% of the women, while 36% reported reduced time at work because of endometriosis. CONCLUSION Our results confirm the substantial negative effect of endometriosis upon women's lives and their relatively high healthcare consumption.
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Affiliation(s)
- Hanna Grundström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden, .,Department of Obstetrics and Gynecology in Norrköping, Linköping, Sweden,
| | | | - Lena Lövqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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12
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van Eeden M, van Mastrigt GAPG, Evers SMAA, van Raak EPM, Driessen GAM, van Heugten CM. The economic impact of mental healthcare consumption before and after stroke in a cohort of stroke patients in the Netherlands: a record linkage study. BMC Health Serv Res 2016; 16:688. [PMID: 27964721 PMCID: PMC5155378 DOI: 10.1186/s12913-016-1915-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 11/09/2016] [Indexed: 11/20/2022] Open
Abstract
Background Post-stroke healthcare consumption is strongly associated with a mental health diagnosis. This study aimed to identify stroke patients who utilised mental healthcare facilities, explored their mental healthcare consumption pre-stroke and post-stroke, and examined possible predictors of costs incurred by mental healthcare consumption post-stroke. Methods Three databases were integrated, namely the Maastricht University Medical Centre (MUMC) Medical Administration, the Stroke Registry from the Department of Neurology at MUMC, and the Psychiatric Case Registry South-Limburg. Patients from the MUMC who suffered their first-ever stroke between January 1 2000 and December 31 2004 were included and their records were analysed for mental healthcare consumption from 5 years preceding to 5 years following their stroke (1995–2009). Regression analysis was conducted to identify possible predictors of mental healthcare consumption costs. Results A total of 1385 patients were included and 357 (25.8%) received services from a mental healthcare facility during the 10-year reference period around their stroke. The costs of mental healthcare usage increased over time and peaked 1 year post-stroke (€7057; 22% of total mental healthcare costs). The number of hospitalisation days and mental healthcare consumption pre-stroke were significant predictors of mental healthcare costs. Explained variances of these models (costs during the 5 years post-stroke: R2 = 15.5%, costs across a 10 year reference period: R2 = 4.6%,) were low. Conclusion Stroke patients have a significant level of mental healthcare comorbidity leading to relatively high mental healthcare costs. There is a relationship between stroke and mental healthcare consumption costs, but results concerning the underlying factors responsible for these costs are inconclusive.
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Affiliation(s)
- M van Eeden
- Department of Health Services Research, CAPHRI, Research School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - G A P G van Mastrigt
- Department of Health Services Research, CAPHRI, Research School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, CAPHRI, Research School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - E P M van Raak
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G A M Driessen
- MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - C M van Heugten
- MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands
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Villoro R, Merino M, Hidalgo-Vega A, Jiménez M, Martínez L, Aracil J. Women with urinary incontinence in Spain: Health-related quality of life and the use of healthcare resources. Maturitas 2016; 94:52-57. [PMID: 27823745 DOI: 10.1016/j.maturitas.2016.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/03/2016] [Accepted: 08/18/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To describe Health-Related Quality of Life (HRQOL) and healthcare resource utilization in women aged 60 and over in Spain. DESIGN Descriptive analysis of primary data from the Spanish National Health Survey, 2012. MAIN OUTCOME MEASURES Utility indices were obtained through the EQ5D5L questionnaire included in the survey, and utilization rates of consultations, hospitalizations, emergency services, and medication intake. HRQOL and utilization rates were systematically compared between women diagnosed with UI, women diagnosed with other chronic conditions (OCC) and healthy women of the same age. RESULTS Utility indices were 0.47 in UI women versus 0.78 and 0.96 in women diagnosed with OCC and healthy women, respectively. Each year 351,675 Quality Adjusted Life Years are lost in Spain due to UI in the population of women aged 60 and over. Resource utilization of these women was significantly higher than that of other women. CONCLUSIONS UI has a larger impact on both HRQOL and healthcare consumption in women who are aged 60 and over, than OCC. Appropriate treatment of UI might entail an important gain in terms of HRQOL and a significant reduction in healthcare consumption in Spain.
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Affiliation(s)
- Renata Villoro
- Instituto Max Weber, Calle Las Norias, 123, Majadahonda, 28221 Madrid, Spain.
| | - María Merino
- Instituto Max Weber, Calle Las Norias, 123, Majadahonda, 28221 Madrid, Spain
| | - Alvaro Hidalgo-Vega
- Department of Economics, Universidad de Castilla-La Mancha, Facultad de Ciencias Jurídicas y Sociales de Toledo, Cobertizo de San Pedro Mártir s/n., Toledo, 45071, Spain
| | - Margarita Jiménez
- Instituto Max Weber, Calle Las Norias, 123, Majadahonda, 28221 Madrid, Spain
| | - Lucía Martínez
- Instituto Max Weber, Calle Las Norias, 123, Majadahonda, 28221 Madrid, Spain
| | - Javier Aracil
- Allergan, International Market Access Area, 1st floor Marlow International Parkway, Marlow, Bucks SL7 1YL, United Kingdom
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Amoura Z, Deligny C, Pennaforte JL, Hamidou M, Blanco P, Hachulla E, Pourrat J, Queyrel V, Garofano A, Maurel F, Levy-Bachelot L, Boucot I. [Cost of systemic lupus erythematosus for adult patients with active and treated disease in France (LUCIE study)]. Rev Med Interne 2014; 35:700-8. [PMID: 24630588 DOI: 10.1016/j.revmed.2014.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 01/23/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate in France the annual direct medical cost of adult patients with active systemic lupus erythematosus (SLE) on medication and estimate the cost of a flare. METHODS A two-year, observational, retrospective, multicenter study, carried out between December 2010 and February 2011. Patients' characteristics, SLE disease activity and severity, rate of flares, healthcare consumption (medications, hospitalisations, etc.) were evaluated. Medical costs were assessed from the national Health Insurance perspective. Cost predictors were estimated using multivariate regression models. RESULTS Eight centres specialized in SLE management included 93 eligible patients (including 50.5% severe). The mean age was 39.9 (11.9) years and 93.5% were women. At baseline, the mean SLE duration was 9.8 (6.6) years. The mean scores of the SELENA-SLEDAI instrument and the SLICC/ACR index were higher in severe patients (9.8 vs 5.6, and 1.2 vs 0.4 respectively; P<0.001). Over the study period, 51% of patients received the combination containing at least corticosteroids or immunosuppressants. The mean annual direct medical cost of severe patients was €4660 versus €3560 for non-severe patients (non-significant difference). The cost of medications (61.8% of the annual cost) was higher in severe patients (€3214 vs €1856; P<0.05). Immunosuppressants and biologics represented 26.5% and 4.6% of the annual total cost respectively. Patients experienced on average 1.10 (0.59) flares/year, of which 0.50 were severe flare. The occurrence of a new severe flare incremented the annual cost of €1330 (P<0.05). CONCLUSION Medications represented the major component of the annual direct medical cost. Severe flares increase significantly the cost of SLE care management.
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Affiliation(s)
- Z Amoura
- Service de médecine interne 2, Centre national de référence lupus, hôpital La Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - C Deligny
- Service de médecine interne et rhumatologie, CHU de Fort-de-France, BP 63297261, Fort-de-France cedex, Martinique
| | - J-L Pennaforte
- Service de médecine interne, hôpital Robert-Debré, rue du Général-Koenig, 51090 Reims, France
| | - M Hamidou
- Service de médecine interne, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - P Blanco
- Service de médecine interne, hôpital Pèllegrin, place Amélie-Rabat-léon, 33076 Bordeaux cedex, France
| | - E Hachulla
- Service de médecine interne, hôpital Huriez, 1, place de Verdun, 59037 Lille cedex, France
| | - J Pourrat
- Service de néphrologie et immunologie clinique, hôpital Rangueil, 1, avenue du Professeur-Jean-Pouhlès TSA 50032, 31059 Toulouse cedex 9, France
| | - V Queyrel
- Service de médecine interne, hôpital l'Archet, 151, route Saint-Antoine-Ginestière BP 79, 06202 Nice cedex 3, France
| | - A Garofano
- IMS Real-World Evidence Solutions, Health Economics & Outcomes Research, Tour Ariane, 5-7, place de la Pyramide, 92088 La Défense cedex, France
| | - F Maurel
- IMS Real-World Evidence Solutions, Health Economics & Outcomes Research, Tour Ariane, 5-7, place de la Pyramide, 92088 La Défense cedex, France
| | - L Levy-Bachelot
- GlaxoSmithKline, 100, route de Versailles, 78163 Marly-le-Roi cedex, France
| | - I Boucot
- GlaxoSmithKline, 100, route de Versailles, 78163 Marly-le-Roi cedex, France
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