Quality of life patient

Urinary incontinence (UI) is defined as the complaint of involuntary leakage of urine.1 It is often associated with other bothersome lower urinary tract symptoms such as urgency, increased daytime frequency, and nocturia. Despite its prevalence across the lifespan and in both sexes, it remains an underdetected and underreported health problem that can have significant negative consequences for the individual s quality of life. Patients with UI may be depressed due to a... 

Axis IV Quality of life (patients own perceptions about the level of their physical and emotional well-being, their functioning, the social support they receive and the fulfillment of their personal and spiritual aspirations)... 

Patients with SAD should be monitored for symptom response, adverse effects, and overall functionality and quality of life. Patients should be seen weekly during dosage titration and monthly once stabilized. Patients should be asked to keep a diary to record symptoms and their severity. The clinician-related Liebowitz Social Anxiety Scale and the patient-rated Social Phobia Inventory can be used to monitor severity of symptoms and symptom change. 

The overall goal of therapy is to optimize the patient s duration and quality of life. Patients who reach CKD stage 4 almost inevitably progress to ESRD, requiring dialysis to sustain life. 

Table 12.1 summarizes five major types of pharmacoeconomic evaluations cost-consequence, cost-benefit, cost-effectiveness, cost-minimization, and cost-utility (Drummond et al., 1997 Kielhorn and Graf von der Schulenburg, 2000). In a cost-consequence analysis, a comprehensive list of relevant costs and outcomes (consequences) of alternative therapeutic approaches are presented in tabular form. Costs and outcomes are typically organized according to their relationship to cost (direct and indirect), quality of life, patient preferences, and clinical outcomes (see taxonomy below). No attempt is made to combine the costs and outcomes into an economic ratio, and the interpretation of the analysis is left in large part to the reader. 

Narcolepsy is a lifelong disorder without a known cure. At present, ideally, the goal is to control the symptoms to enable the affected individual to have a good quality of life. Patients with narcolepsy should be referred to a sleep specialist for evaluation and treatment. Regular retesting is recommended however, the patient needs to be medication free for a minimum of 2 weeks to facilitate repeat testing. 

As health delivery systems move toward total managed care, the need for outcomes studies will increase. Issues to be addressed by outcomes research will include clinical efficacy of interventions, health-related quality of life, patient satisfaction, employee productivity, and resource utilization. Pharmacists can either participate in or direct outcomes research. Outcomes studies may also be used to support a pharmacy position for interventions. 

In recent years pharmacoeconomics has been used as a term to describe the identification, measurement and comparison of the costs and consequences of pharmaceutical products and services (Bootman et al 1996). As such, pharmacoeconomics focuses primarily on pharmaceuticals, and attempts to evaluate the economic and humanistic impact of drug therapy. Pharmacoeconomic tools are derived from a variety of sources, including the fields of economics and outcomes research. Quite often the pharmacoeconomist will bring to the development team skills and experience in quality of life, patient satisfaction and other patient-centered measures. Health economists and a pharmacoeco-nomists differ (while the terms are sometimes used interchangeably), in having stronger backgrounds in the theoretical and applied aspects of health economics, respectively. A researcher with solid... 

Near normal quality of life—Patient can bathe and swim. (Specification—system must be waterproof to a depth of 3 m)... 

The overall effectiveness of Xolair treatment was clearly reflected in measures of the asthma-related quality of life. Patient s self-assessment of asthma-related quality of life, using the validated asthma-related quality-of-life questionnaire (AQLQ) (16), showed a clinically significant change from baseline of 0.5 units improvement in both treatment groups for all domains at the end of both treatment stabilization and steroid-reduction periods. Importantly, a significantly greater improvement over placebo was seen in Xolair-treated patients for each of the individual domains (activities, emotions, symptoms, environmental exposure) and overall scores (p = 0.02). 

It is important to treat melasma because this condition has a severe impact on the quality of life and it is particularly disturbing to patients because of its location on the face. 

The na/ outcomes which are changes over time in the symptoms, welfare and quality of life of patients (and their families if relevant to the context), relative to some baseline position, standard or comparator. Final outcomes are clearly measures of effectiveness. They can equivalently be defined as reductions in need. 

Only two randomized, controlled trials have been completed, and neither provides anything like compelling data (Table 2.6). Chouinard and Albright (1997) conducted a unique evaluation of a subset of patients from a previously conducted clinical trial. Subjects were categorized and profiled at baseline and end point according to clinical severity, and a group of psychiatric nurses were asked to rate various aspects of likely outcome and quality of life to each profile (mild, moderate or severe symptoms). Health state utilities were then calculated risperidone was found to provide more than double the number of quality-adjusted life years compared with haloperidol. Csernansky and Okamoto (1999) conducted a rather more conventional trial, but included no economic analyses. However, they did find that the use of risperidone substantially reduced relapse rates compared with haloperidol—an outcome likely to have a positive impact on cost-effectiveness. 

There is little evidence relating to the pharmacoeconomic aspects of the use of quetiapine. In the UK, a retrospective audit of 20 patients (Lee et al, 1998), published only as a conference abstract, tentatively suggested decreased costs for those patients, largely through a reduction in hospital stay and resource use. Quetiapine may also improve quality of life (Hellewell et al, 1999). A large, randomized, controlled pharmacoeconomic evaluation is apparently under way (Drummond et al, 1998) and results are awaited. 

With few exceptions, models find in favour of newer compounds Qonsson and Bebbington, 1994 Le Pen et al, 1994 McFarland, 1994 Stewart, 1994 Einarson et al, 1995 Lapierre et al, 1995 Nuitjen et al, 1995 Montgomeiy et al, 1996). One study (CCOHTA, 1997) did make allowances for variations in practice and patient behaviour. The results indicated that in the short term treatment was likely to be more successful with an SSRI than with a TCA, but at a higher cost. However, when treatment dropout rates found in naturalistic studies were substituted for drop-out rates found in controlled trials, the cost differences became smaller. When cost-utility analysis was applied, this increased cost was offset by improvements in quality of life for the patients. 

The symptoms of bipolar disorder and the side effects associated with its treatment have implications for the patient s health-related quality of life. The disorder itself has an impact upon mental and emotional wellbeing. Bipolar disorder also affects areas of life such as employment, social partnerships and independence. The side effects of treatment may further impair the quality of life. 

A number of economic studies have been published that assess the economic impact of the introduction of anticholinesterase drugs on the care for people with dementia. Overall, they suggest that the introduction of the new drugs might be cost-neutral, while leading to modest improvements in the health-related quality of life of patients and carers. However, the reliability and robustness of the economic evidence need to be considered before concluding that any additional benefits of the new dmgs for dementia are indeed worth the cost. 

It is cmcial that an economic study includes the health-related consequences of morbidity and mortality. These could be measured as number of years of life lost, reductions in health status, and quality of remaining years of life due to morbidity for both patients and informal carers. These consequences should also be valued to reflect the preferences of individuals and society for changes in the length and quality of life or health. 

One study used quality-adjusted life years to capture the range of health-related dimensions that may affect the quality of life of patients. This measure also provides an estimate of the value or preferences for changes in health status (Neumann et al, 1999). The study used the Health Utility Index Mark II in a sample of patients and carers, which is a generic measure of the value of health-related quality of life. However, it is clear that further research is needed to explore (a) the key determinants or dimensions of quality of life that are important to people with dementia and their carers (b) whether existing instmments to measure and value health-related quality of life are able to detect differences in quality of life that are important to people with cognitive disability and their carers and (c) whether the assessment and... 

---