Date post: | 31-Dec-2015 |
Category: |
Documents |
Upload: | edward-simmons |
View: | 225 times |
Download: | 1 times |
1
Patient values or values from the general public
2
The clinical perspective
Quality of life is subjective….. “Given its inherently subjective nature, consensus was quickly
reached that quality of life ratings should, whenever possible, be elicited directly from patients themselves. “
• (Neil Aaronson, in B. Spilker: Quality of life and Pharmacoeconomics in Clinical Trails, 1996, page 180)
…therefore ask the patient!
3
A problem in the patient perspective….
Stensman Scan J Rehab Med
1985;17:87-99.
Scores on a visual analogue scale 36 subjects in a
wheelchair
36 normal matched controls
Mean score Wheelchair: 8.0
Health controls: 8.3
Healthy
Death
4
The economic perspective
In a normal market: the consumer values count
The patient seems to be the consumer Thus the values of the patients….
If indeed health care is a normal market… But is it….?
5
Health care is not a normal market
Supply induced demands Government control
Financial support (egalitarian structure)
Patient Consumer The patient does not pay
Consumer = General public Potential patients are paying
Health care is an insurance market A compulsory insurance market
6
Health care is an insurance market
Values of benefit in health care have to be judged from a insurance perspective
Who values should be used the insurance perspective?
7
Who determines the payments of unemployment insurance?
Civil servant Knowledge: professional
But suspected for strategical answers
• more money, less problems
• identify with unemployed persons
The unemployed persons themselves Knowledge: specific
But suspected for strategical answers
General public (politicians) Knowledge: experience
Payers
8
Who’s values (of quality of life) should count in the health insurance?
Doctors Knowledge: professional
But suspected for strategical answers
• See only selection of patient
• Identification with own patient
Patients Knowledge: disease specific
But suspected for strategical answers
But coping
General public Knowledge: experience
Payers
Like costs: the societal perspective
9
The general public should be informed…
Valuing without knowledge makes no sense Thyroid Eye Disease
Give description of the disease
A patient with bilateral thyroid eye disease with upper lid retraction and exophthalmos.
10
…or use validated questionnaires
MOBILITY I have no problems in walking about I have some problems in walking about I am confined to bed
SELF-CARE I have no problems with self-care I have some problems washing or dressing myself I am unable to wash or dress myself
USUAL ACTIVITIES (e.g. work, study, housework family or leisure activities)
I have no problems with performing my usual activities I have some problems with performing my usual activities I am unable to perform my usual activities
PAIN/DISCOMFORT I have no pain or discomfort I have moderate pain or discomfort I have extreme pain or discomfort
ANXIETY/DEPRESSION I am not anxious or depressed I am moderately anxious or depressed I am extremely anxious or depressed
11
Validated Questionnaires
Describe health states Have values from the general public
Rosser Matrix
QWB
15D
HUI Mark 2
HUI Mark 3
EuroQol EQ-5D
12
Different perspective belong to different research questions
Health economics Societal perspective
• General public
Medical decision making Patients perspective
Epidemiology Doctors perspective
• Global Burden of Disease