Health outcomes research

In Chapter 8, professor J.L. Pinto Prades of Pompeu Fabra University and X. Badla Llach of the Health Outcomes Research Unit at Santa Creu i Sant Pau Hospital take a look at the potential contribution of economic evaluation to the regulation and control of public spending on pharmaceuticals. The authors focus on observing how economic evaluation can be used in pharmaceutical policy. To this end, they distinguish and analyse the potential this instrument has in six distinct areas the approval of pharmaceuticals by health... 

X. Bad i a Llach Consultant, Clinical Epidemiology and Public Health Department, Health Outcomes Research Unit, Sant Pau Hospital, Barcelona... 

Joshua J. Spooner Manager, Health Outcomes Research Health Core, Inc. 

Foundation for Health Sciences Research. 1993. Health Outcomes Research a Primer. Foundation for Health Services Research Washington, DC. 

Pathak DS. QALYs in health outcomes research Representation of real preferences or another numerical abstraction J Res Pharm Econ 1995 6 3-27. 

Exposure Registries. No exposure registries for methyl parathion were located. This substance is not currently one of the compounds for which a subregistry has been established in the National Exposure Registry. The substance will be considered in the future when chemical selection is made for subregistries to be established. The information that is amassed in the National Exposure Registry facilitates the epidemiological research needed to assess adverse health outcomes that may be related to exposure to methyl parathion. 

In the recently released book on worldwide compliance issues (Adherence to Long-term Therapies, Evidence for Action),7 published by the World Health Organization, researchers indicate that the problem of noncompliance is worse in countries in the developing world than in countries in the industrialized world. Many parts of the United States have similar morbidity and mortality rates as countries in the Third World.8 Specific disease states may have significant additional noncompliance ramifications due to the development of drug-resistant strains of bacteria.9 Many times what is necessary is referral to specific clinicians for individualized treatment and monitoring to enhance compliance. The case histories provided in this text will allow you to follow what others have done in similar situations to optimally help patients succeed in improving compliance rates and subsequent positive health outcomes. 

Larry I. Palmer, LL.B., Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine, Louisville, KY C.E. Reeder, Ph.D., Center for Outcomes Research and Evaluation, College of Pharmacy, University of South Carolina, Columbia, SC John A. Robertson, J.D., School of Law, University of Texas at Austin, Austin, TX Mark A. Rothstein, J.D., Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine, Louisville, KY... 

But assume that those barriers are overcome and a pharmaceutical company markets an important drug based on pharmacogenomics. Assume, for example, that pharmacogenomics research allows the firm to know which 80% of the population will benefit from the drug, which 10% will receive absolutely no benefit, and which 10% will be seriously harmed by it. The short-term consequence would be to improve health outcomes of everyone, not just the 80% who would benefit but the other 20% who should not take the drug. The dynamic consequences are less clear. If such pharmacogenomic... 

The White House and Congress have heralded the fact that the NIH budget was doubled to 27.3 billion in the five-year period ending in fiscal 2003. Nevertheless, the benefits of basic and clinical research supported by the NIH will not be realized if there is little or no grant support for translational research. Neither the pharmaceutical industry nor health care practitioners are well positioned to perform this research. A national commitment to improving health outcomes cannot end at the clinical research phase. Substantial new resources must be committed to translational research. 

In the U.S., race has been used as a proxy for a variety of physical, mental, and social dimensions. The legacy of racism still pervades society, including disparity in access to health care and in health care outcomes (see chapter by Nsiah-Jefferson, this volume). In attempting to eliminate these health disparities there have been efforts to include racial and ethnic minorities in research studies and to generate better data on racial and ethnic variations in health status. Although most policy makers and commentators believe that racial classifications in data collection and outcomes research are needed to eliminate health disparities, others believe that such policies prolong the use of a flawed concept and reify race as a pseudoscientific measure (Lee et al., 2001). 

Polypharmacy is often a consequence of the cascade of problems. A literature review found that polypharmacy continues to increase and is a known risk factor for important morbidity and mortality (Hajjar et al. 2007). The reviewers states that many studies have found that various numbers of medications are associated with negative health outcomes, but more research is needed to further delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks and fully evaluate all medications at each patient visit to prevent polypharmacy from occurring . 

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