- Email: [email protected]
A Comparative Analysis on Health Security System Between China and Developed Countries
A830
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
patients (n= 282, 63.9%) patients were having acute disease. The mean SF score was 40.38 however mean PCS score was found to be 36.14 and MCS overall mean score is 44.30. Conclusions: The findings showed that hospital admitted patients were having poor quality of life, the physical health status is lower than the psychological health status. PHP94 Developing a Comprehensive, Culturally Sensitive Conceptual Framework of Health Domains in Singapore Uy EJ1, Ow MY2, Xin X1, Sung SC2, Cheung YB2, Bautista D2, Thumboo J1 1Singapore General Hospital, Singapore, Singapore, 2Duke-NUS Medical School, Singapore, Singapore
Objectives: The emerging focus of Singapore’s healthcare system on long-term care highlights the need for culturally sensitive Health-Related Quality of Life (HRQOL) instruments to accurately capture the health needs of Singaporeans. Such instruments require a contextualized conceptual framework of health domains. In this study, we developed a comprehensive and culturally sensitive conceptual framework of health domains relevant to the Singaporean population. Methods: We recruited Singaporeans/permanent residents, English or Chinese-speaking, with and without chronic illnesses to participate in focus group discussions (FGDs) and in-depth interviews. We elicited what areas of health participants perceived to be important for them to be happy and satisfied with life. To encourage a spontaneous emergence of themes, the standardized moderator guides did not specify any aspect of health as a focus of discussion. We also recruited healthcare workers, viewed as patient-proxies, to participate in separate FGDs. Themes from the transcripts were first distilled through open coding (2 independent coders) then classified into more abstract domains (each transcript coded independently by 2 coders from a pool of 5 coders) using Nvivo10 software. Results: 121 members of the general public participated in 18 FGDs and 13 in-depth interviews from October 2013 to August 2014 (Male: 44.6%, mean age: 53.3 years (SD: 55, Range: 22 to 85), 77% Chinese, 9% Malay, 12% Indian, 63% with chronic illness). Thirteen healthcare workers participated in 3 focus groups. Thematic analysis identified 27 domains of health: 15 physical, 9 mental, and 3 social domains. Conclusions: The conceptual framework developed from the ground-up in Singapore reflected physical, mental, and social dimensions of well-being, suggesting that the Singapore population’s views on health are similar to the World Health Organization’s framework and definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.
PHP95 How Much are Chinese Willing to Pay for the Health Improvement? Sun J, Sun L Shenyang Pharmaceutical University, Shenyang, China
Objectives: Estimate the willingness to pay value for the health improvement of the general Chinese using contingent valuation method. And comparing the difference of results between on-line and face-to-face survey. Methods: Two widely used preference-based health-related quality of life instruments were used to elicit utility. Firstly, the respondents were requested to evaluate their own health states with the instruments of VAS and EQ-5D. Secondly, collected the respondents’ WTP for obtaining an improvement in health from their own health state to the perfect health state, using an open ended method. Finally, we collected the social-demographic characteristics of the respondents. Results: We randomly sampled 97 respondents in total. Among them, 61 were from an on-line panel and 36 were from face-to-face survey in July 2015. The average utility of subject’s own health were 0.96 and 0.87, based VAS and EQ-5D respectively. With the EQ-5D instrument, more than 70% (68/97) of the respondents thought the utility of their own health were 1, namely the perfect health state. For those respondents, the health improvement were zero, so the willingness to pay for health improvement cannot be estimated. On the other hand, the social-demographic characteristics in on-line and face-to-face survey showed no difference except the age characteristic. Conclusions: It is not a good idea in China to estimate the respondents’ willingness to pay for the health improvement that from their own health states to the perfect health state. We should try to explore other methods to express the health improvement, for example, assume that the respondents in a not perfect health state. We also conclude that the respondents in on-line survey were younger than the face-to-face survey. So we suggest that on-line and face-to-face survey can be used in the same time to ensure the respondents were representative.
PHP96 My Opinions Matter! How Perspectives, Knowledge And Expectations Matter in Moderating the Success of New Pharmaceutical Services Implementation in Malaysia Tan
CL1, Gan VB2
1Ministry
of Health Malaysia, Seremban, Malaysia, 2Universiti Putra Malaysia, Serdang, Malaysia
Objectives: The Malaysian Government through the National Health Policy aims to improve health outcomes through public pharmaceutical healthcare services. Pharmacy Value Added Services (PVAS) was introduced as a matter of public pharmaceutical health policy by the Ministry of Health. PVAS is seen as an important service to improve clinical outcomes by improving compliance, monitoring and even information dissemination. However, adoption rates are low and therefore hampering the achievement of national health policy goals. Our objective is to explore the key determinants and moderators of successful implementation of new public pharmaceutical services by investigating the cognitive perspectives of
patients’ intentions to adopt with the Theory of Planned Behavior as the theoretical framework. Methods: A two phase mixed methodology involving first a qualitative exploration and the second a quantitative phase was conducted in public health facilities in Negeri Sembilan, Malaysia. A cross-sectional survey (N = 410) was conducted using the Pharmacy Value Added Services Questionnaire (PVASQ). Multiple regression and robust moderation analysis were performed. Results: Overall, perspectives were found to be significant predictors of intentions. In greater detail, subjective norms, perceived behavioural control, knowledge, expectations and ethnicity were found to be significant predictors of intentions to adopt PVAS. Perspectives and expectations are found to exert significant partial effects on intentions. We find that a significant self-reinforcing feedback loop exists between Expectations-Perspectives-Intentions. Conclusions: Overall, we suggest that patient perspectives and knowledge be enhanced through appropriate channels and expectations of service quality be met to increase intentions. Positive perspectives and meeting the high expectations of the public can greatly improve the uptake of the new service. Ethnicity plays a crucial role in determining uptake of the new service and should be given greater focus. Our results are robust and suggests that a bottom-up approach should be key to successful implementation of health policies and services. PHP98 Health State Valuation in Sri Lanka Using the EQ-5D-3l; Precursor to Qaly Estimation in South Asia Kularatna S1, Scuffham P2 University, Meadowbrook, Australia, 2Griffith University, Gold Coast, Australia
1Griffith
Objectives: Quality adjusted life years (QALYs) are used commonly as an outcome measure in health economic evaluations. Health state valuations are used to determine the country specific utility values which are necessary to derive QALYs. The objective of this study is to derive an algorithm to estimate utility values for the EQ-5D-3L health states using preferences of Sri Lankan general population. Methods: The time trade off preference elicitation was used to directly value 198 EQ-5D-3L health states in a general population sample (n= 780) from Sri Lanka. Four district were used to data collect. The sample was selected by stratified cluster sampling with random selection within clusters. Each participant valued 15 health states via face-to-face interviews. Direct valuation was modelled to find values for the 243 health states. The best fit model was selected based on consistency, parsimony and goodness of fit. Based on logical inconsistency numerous sub samples were also used for model specification. For each model, the numbers of illogical orderings in the resulting value set were also examined. Results: The best model specific action was generalized least squares with random effects. The sub sample consisting of participants with less than seven logical inconsistent observations and producing no illogical ordering in the final value set and was considered the preferred model. Compared to value sets in other countries, a high disutility is associated with level 3 deficits in the mobility dimension. More than 50% of health states in the Sri Lankan value set are deemed worse than death health states. Conclusions: This study derived first EQ-5D-3L utility value set for the South Asian region. The Sri Lankan values deviate markedly from existing values for upper middle and high income countries. PHP99 Bilirubin and Neurodegenerative Disease Prevention Muhsain SN1, Farooqui M1, Lang M2, Abu Bakar A2 MARA, Kepala Batas, Malaysia, 2University of Queensland, Coopers Plains, Australia
1Universiti Teknologi
Objectives: Bilirubin (BR), a protective endogenous antioxidant is cytotoxic at high concentrations. Its intracellular levels are regulated by a system comprising haem oxygenase, biliverdin reductase and CYP2A5 enzymes, and considered to be a molecule that promote health in adults. This paper will highlight the association between bilirubin and pathological conditions such as CVD, cancer, diabetes and neurodegenerative diseases. Furthermore, the mechanism by which bilirubin and its metabolism may influence disease prevention, will also be discussed. Methods: Studies on serum bilirubin levels and association with prevalence and incidence of oxidative stress related chronic disease, as well as experimental studies were collated and reviewed. Results: Mildly elevated serum bilirubin levels are strongly associated with reduced prevalence of chronic disease especially CVD, cancer and metabolic diseases.It has been suggested as a biomarker and predictor of these diseases. Experimental studies indicate that it is a strong endogenous antioxidant and tumour suppressor agent, which would confer this protective properties. Conclusions: BR is promising molecule which importance should be considered in clinical practice. However, greater molecular work is needed to strengthen this conclusion. PHP100 A Comparative Analysis on Health Security System Between China and Developed Countries Wu J1, Liu J2, Zhu B2, Mao Y2 University of Hong Kong, Kowloon, Hong Kong, 2Xi’an Jiaotong University, Xi’an, China
1City
Objectives: In order to achieve the goal of Healthy China 2020, it is critical to establish and perfect a universal coverage health security system for all. This paper takes German, England, America, and Singapore and other developed countries as examples to conduct a comparative analysis on their health security systems from the aspects of financing methods, mode of medical organization, service supply, payment mode, expenditure control, equity of health system, and operation mechanism, thus putting forward some useful practice to improve health system in China. Methods: Comparative analysis from the international perspective has
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
been mainly adopted in this paper. Results: Through comparison and contrast, it is suggested that the health security system in China be of Chinese characteristics, of multi-levels and multi-formats, of a balance between equity and efficiency, and of an organic combination of government supervision and market mechanism. Conclusions: Based on the comparison and experiences, related policy suggestions have been put forward to improve the health security system in China, which go as follows: deal with the relationship between government and market; promote the press forward with legislation focusing on specialized law of health security; set up a stable and multiple financing mechanism; and enhance the supervision on health service institutions. PHP101 Evaluation of Antibacterial and Cytotoxic Effects of Gymnema Sylvestre R.BR. Species Cultivated in Pakistan Against Common Resistant Pathogens Tahir M1, Anjum MS2, Zahid Tanveer M1, Iqbal MZ3 1University of Veterinary and Animal Sciences, Lahore, Pakistan; Lahore, Pakistan, 2PMAS- Arid Agriculture University, Rawalpindi, Pakistan, Rawalpindi, Pakistan, 3AIMST University, Sungai Petani, Malaysia
Objectives: The purpose of this experiment was to evaluate the antibacterial efficacy and safety profile of sequential extracts of an indigenous plant Gymnema sylvestre R.Br. (Gurmar) leaves. Methods: This study was conducted against 4 bacteria including Staphylococcus aureus, Salmonella enterica, Clostridium perfringens type-A, Haemophillus paragallinarum which are common causatives of various infections. In order to assess antibacterial potential of Chloroform, Hexane, Ethanolic and Aqueous extracts of Gymnema sylvestre R.Br. leaves, agar well diffusion method was used. Results: The results exhibited that ethanolic and chloroformic extracts have more antibacterial activity against all four microorganisms under study. Hexane, chloroform and ethanolic extracts of G. sylvestre R. Br. showed antibacterial activity against all isolates of selected 4 microorganisms (Salmonella enterica, Staphylococcus aureus, Haemophillus paragallinarum and Clostridium perfringens type-A) under study. On the other hand aqueous extract showed antibacterial activity only against Clostridium perfringens type-A while no antibacterial activity was observed against remaining three bacteria under study. MTT Assay was performed using vero cell lines. The results showed that 2900µg/ml, 3612.50µg/ml, 4075µg/ml and 1562.50µg/ml concentrations of Hexane, Chloroform, Ethanol and Aqueous extracts respectively were found safe as Cell Survival Percentage (CSP) at these concentrations was above 50%. Conclusions: The antibacterial and MTT Assay results suggest that sequential extracts of dried leaves of Gymnema sylvestre R. Br. can be used as a safer antibacterial against tested resistant bacteria. All results were compared statistically using DMR (Duncan’s Multiple Range) Post hoc test at P ≤ 0.05. PHP102 What is Government’s Responsibility for China’s Universal Health Security? An Outlook for a National Health Security System Wu J, Liu J, Zhu B, Mao Y Xi’an Jiaotong University, Xi’an, China
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improving the patient education at an outpatient department of a tertiary care hospital in India Methods: A multidisciplinary team trained on HFMEA methodology analyzed various processes involved in patient education at outpatient department. The team identified potential failure modes in each process, assigned hazard scoring for each of them, followed it with the various causes leading to these failure modes and actions or outcome measures to overcome them. Results: We identified 8 processes and 32 failure modes with average hazard scoring of 6. The high risk potential failure is identified as, “healthcare worker doesn’t identify the need for patient education in specific cases” and the least potential failure is identified as, “absence of translator for language barrier”. The actions or outcome measures and the persons responsible for implementing them are detailed for further improvement. Conclusions: Patient Safety and care reliability issues are a major concern in healthcare. This study suggests that tools such as HFMEA can enable a detailed analysis of the patient education process and guiding improvement efforts PHP104 Trends of Including Pharmacoeconomics Course in the Undergraduate Pharmacy Curriculum Thomas D, Sundararaj KG, Shirwaikar A Gulf Medical University, Ajman, United Arab Emirates
Objectives: Although pharmacoeconomics was recognized as a sub-discipline of health economics for over 25 years, its diffusion into pharmacy education has been gradual. The purpose of this global review was to describe the global trend of inclusion of pharmacoeconomics course in undergraduate pharmacy education. Methods: Published literatures were searched and information on the inclusion of pharmacoeconomics course in the undergraduate pharmacy curriculum was collected and collated. PubMed, Google Scholar, and Google databases were used for the search in October and December 2015. Both compulsory and elective pharmacoeconomic courses in the undergraduate pharmacy curriculum (BS, B.Pharm, PharmD) were considered. We have organized and summarized the information by countries and time period. Results: Four surveys from the US have provided the key baseline for documenting trends in inclusion of pharmacoeconomics course in the pharmacy curriculum. As per 2011 survey, pharmacoeconomics course was included in almost all colleges/schools of pharmacy in the US. Other than surveys from the US, 6 out of 9 were conducted or published in the last 3 years. Many of the surveys identified that the contents in pharmacoeconomic course vary to different extent. Information from many countries was not available, especially in Africa and Asia. Conclusions: The pharmacoeconomics course was very much part of the undergraduate pharmacy programs in the US. Even though the diffusion of pharmacoeconomics course to the rest of the world was slow; it has picked up the pace in this decade. Standardization of pharmacoeconomics education shall be necessary. PHP105 The Impact of Surgical Professional Education: A Review of Clinical and Economic Outcomes Bourcet A1, Lim S2, Metz L1 1Johnson & Johnson Medical Asia Pacific, Singapore, Singapore, 2Costello Medical Singapore Pte Ltd, Singapore, Singapore
Objectives: Chinese Government has announced the Healthy China 2020 initiative to reform disease prevention and health promotion, healthcare services, pharmaceutical policies and health insurance system. As pointed out in report of 3rd Plenum of the 18th Communist Party of China, the transformation of government functions will be sped up, leaving market to play the decisive role in allocation of resources. In this view, government’s responsibility in setting up universal health security system and protecting universal health is due to be defined clearly. Methods: Based on China’s social reality and international experience, we put forward the development strategy for National Health Security and clarify the government’s responsibility in the area of medical resources from both health services supply-side and demand-side. Results: Firstly, it is the government’s responsibility to deliver universal basic health coverage and eliminate urban-rural, regional and population disparities, thus achieving the goal of Health for all on schedule. Secondly, government is supposed to take the leading role in the establishment of a Uniform and Multi-standard Universal Primary Health System and, meanwhile, introduce the market mechanism. Not only the access to basic medical service of low-income groups should be ensured by the government, commercial health insurance and long-term care service, in the area of which socialist market mechanism domains, should also be vigorously supported by the government. Relevant policies should be introduced to meet different health needs of different groups. Finally, health service industry’s development in the future ought to be government-led and market-driven. Conclusions: It is suggested not only strengthen the government’s responsibility in policy decision, supervision and administration and the cultivation of a decent policy environment suitable for the development of health industry but also give greater play to the fundamental role of the market in resource allocation and inspire social energy on the improving of quality and efficiency of health service.
Objectives: Patient safety concerns have led to the emergence of alternative training models (eg. workshops, simulator training) that allow surgeons to develop surgical proficiency outside the operating theatre. In Moore’s educational outcomes measurement framework, the ultimate goal of surgical education is improved patient and community health.1 This literature review aimed to qualitatively assess published evidence on the impact of surgical education on clinical and economic outcomes. Methods: A pragmatic literature search of PubMed and Chinese Knowledge Infrastructure was performed (August 2015-November 2015) using search terms developed from “surgical”, “training”, “education”, “clinical” and “economic”. Primary studies, economic studies and reviews reporting clinical or economic outcomes associated with surgical education interventions were included. Results: A total of 47 studies were identified (5 systematic literature reviews, 4 RCTs, 34 cohort studies, 3 review papers, 1 case study). Surgical education reduced technical error rates and operative times when assessed under simulation. Several studies reported favourable clinical outcomes (reduced blood loss, complication rates, mortality). ~50% studies reported outcomes that could indirectly contribute to improved patient safety: procedural/anatomical knowledge acquisition, improved technical skills (instrument/tissue handling, speed, accuracy), improved non-technical skills (decision-making, teamwork, stress management). Economic data primarily comprised direct training costs (simulator costs, cost of faculty time); few studies reported cost-comparative analyses between surgical education models. While evidence for the clinical benefit of surgical education exists, conclusive interpretation was limited due to the pragmatic method of review, heterogeneity of studies and inherent limitations of studies identified (before-after studies, surveys). Conclusions: There is a need to critically evaluate how the impact of surgical education is assessed. Current studies focus on surgical learning outcomes; further research is needed to strengthen the evidence base for the impact of surgical education on not only surgeons, but also patients and hospitals. 1Moore D et al. J Contin Educ Health Prof. 2009;29(1):1-15
PHP103 Application of Healthcare Failure Mode & Effect Analysis in Improving Patient Education at an Outpatient Department Of a Tertiary Care Hospital
Health Care Use & Policy Studies – Health Technology Assessment Programs
Devarakonda S Armed Forces Medical College, pune, India
Objectives: Patient Education has become one of the important standards for many accreditation bodies. This paper describes how the HFMEA can be applied in
PHP106 Health Technology Assessment Supports Evidence-Based DecisionMaking in The Changi General Hospital Marketplace Exercise Pwee KH, Tong SC, Chow WL
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
patients (n= 282, 63.9%) patients were having acute disease. The mean SF score was 40.38 however mean PCS score was found to be 36.14 and MCS overall mean score is 44.30. Conclusions: The findings showed that hospital admitted patients were having poor quality of life, the physical health status is lower than the psychological health status. PHP94 Developing a Comprehensive, Culturally Sensitive Conceptual Framework of Health Domains in Singapore Uy EJ1, Ow MY2, Xin X1, Sung SC2, Cheung YB2, Bautista D2, Thumboo J1 1Singapore General Hospital, Singapore, Singapore, 2Duke-NUS Medical School, Singapore, Singapore
Objectives: The emerging focus of Singapore’s healthcare system on long-term care highlights the need for culturally sensitive Health-Related Quality of Life (HRQOL) instruments to accurately capture the health needs of Singaporeans. Such instruments require a contextualized conceptual framework of health domains. In this study, we developed a comprehensive and culturally sensitive conceptual framework of health domains relevant to the Singaporean population. Methods: We recruited Singaporeans/permanent residents, English or Chinese-speaking, with and without chronic illnesses to participate in focus group discussions (FGDs) and in-depth interviews. We elicited what areas of health participants perceived to be important for them to be happy and satisfied with life. To encourage a spontaneous emergence of themes, the standardized moderator guides did not specify any aspect of health as a focus of discussion. We also recruited healthcare workers, viewed as patient-proxies, to participate in separate FGDs. Themes from the transcripts were first distilled through open coding (2 independent coders) then classified into more abstract domains (each transcript coded independently by 2 coders from a pool of 5 coders) using Nvivo10 software. Results: 121 members of the general public participated in 18 FGDs and 13 in-depth interviews from October 2013 to August 2014 (Male: 44.6%, mean age: 53.3 years (SD: 55, Range: 22 to 85), 77% Chinese, 9% Malay, 12% Indian, 63% with chronic illness). Thirteen healthcare workers participated in 3 focus groups. Thematic analysis identified 27 domains of health: 15 physical, 9 mental, and 3 social domains. Conclusions: The conceptual framework developed from the ground-up in Singapore reflected physical, mental, and social dimensions of well-being, suggesting that the Singapore population’s views on health are similar to the World Health Organization’s framework and definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.
PHP95 How Much are Chinese Willing to Pay for the Health Improvement? Sun J, Sun L Shenyang Pharmaceutical University, Shenyang, China
Objectives: Estimate the willingness to pay value for the health improvement of the general Chinese using contingent valuation method. And comparing the difference of results between on-line and face-to-face survey. Methods: Two widely used preference-based health-related quality of life instruments were used to elicit utility. Firstly, the respondents were requested to evaluate their own health states with the instruments of VAS and EQ-5D. Secondly, collected the respondents’ WTP for obtaining an improvement in health from their own health state to the perfect health state, using an open ended method. Finally, we collected the social-demographic characteristics of the respondents. Results: We randomly sampled 97 respondents in total. Among them, 61 were from an on-line panel and 36 were from face-to-face survey in July 2015. The average utility of subject’s own health were 0.96 and 0.87, based VAS and EQ-5D respectively. With the EQ-5D instrument, more than 70% (68/97) of the respondents thought the utility of their own health were 1, namely the perfect health state. For those respondents, the health improvement were zero, so the willingness to pay for health improvement cannot be estimated. On the other hand, the social-demographic characteristics in on-line and face-to-face survey showed no difference except the age characteristic. Conclusions: It is not a good idea in China to estimate the respondents’ willingness to pay for the health improvement that from their own health states to the perfect health state. We should try to explore other methods to express the health improvement, for example, assume that the respondents in a not perfect health state. We also conclude that the respondents in on-line survey were younger than the face-to-face survey. So we suggest that on-line and face-to-face survey can be used in the same time to ensure the respondents were representative.
PHP96 My Opinions Matter! How Perspectives, Knowledge And Expectations Matter in Moderating the Success of New Pharmaceutical Services Implementation in Malaysia Tan
CL1, Gan VB2
1Ministry
of Health Malaysia, Seremban, Malaysia, 2Universiti Putra Malaysia, Serdang, Malaysia
Objectives: The Malaysian Government through the National Health Policy aims to improve health outcomes through public pharmaceutical healthcare services. Pharmacy Value Added Services (PVAS) was introduced as a matter of public pharmaceutical health policy by the Ministry of Health. PVAS is seen as an important service to improve clinical outcomes by improving compliance, monitoring and even information dissemination. However, adoption rates are low and therefore hampering the achievement of national health policy goals. Our objective is to explore the key determinants and moderators of successful implementation of new public pharmaceutical services by investigating the cognitive perspectives of
patients’ intentions to adopt with the Theory of Planned Behavior as the theoretical framework. Methods: A two phase mixed methodology involving first a qualitative exploration and the second a quantitative phase was conducted in public health facilities in Negeri Sembilan, Malaysia. A cross-sectional survey (N = 410) was conducted using the Pharmacy Value Added Services Questionnaire (PVASQ). Multiple regression and robust moderation analysis were performed. Results: Overall, perspectives were found to be significant predictors of intentions. In greater detail, subjective norms, perceived behavioural control, knowledge, expectations and ethnicity were found to be significant predictors of intentions to adopt PVAS. Perspectives and expectations are found to exert significant partial effects on intentions. We find that a significant self-reinforcing feedback loop exists between Expectations-Perspectives-Intentions. Conclusions: Overall, we suggest that patient perspectives and knowledge be enhanced through appropriate channels and expectations of service quality be met to increase intentions. Positive perspectives and meeting the high expectations of the public can greatly improve the uptake of the new service. Ethnicity plays a crucial role in determining uptake of the new service and should be given greater focus. Our results are robust and suggests that a bottom-up approach should be key to successful implementation of health policies and services. PHP98 Health State Valuation in Sri Lanka Using the EQ-5D-3l; Precursor to Qaly Estimation in South Asia Kularatna S1, Scuffham P2 University, Meadowbrook, Australia, 2Griffith University, Gold Coast, Australia
1Griffith
Objectives: Quality adjusted life years (QALYs) are used commonly as an outcome measure in health economic evaluations. Health state valuations are used to determine the country specific utility values which are necessary to derive QALYs. The objective of this study is to derive an algorithm to estimate utility values for the EQ-5D-3L health states using preferences of Sri Lankan general population. Methods: The time trade off preference elicitation was used to directly value 198 EQ-5D-3L health states in a general population sample (n= 780) from Sri Lanka. Four district were used to data collect. The sample was selected by stratified cluster sampling with random selection within clusters. Each participant valued 15 health states via face-to-face interviews. Direct valuation was modelled to find values for the 243 health states. The best fit model was selected based on consistency, parsimony and goodness of fit. Based on logical inconsistency numerous sub samples were also used for model specification. For each model, the numbers of illogical orderings in the resulting value set were also examined. Results: The best model specific action was generalized least squares with random effects. The sub sample consisting of participants with less than seven logical inconsistent observations and producing no illogical ordering in the final value set and was considered the preferred model. Compared to value sets in other countries, a high disutility is associated with level 3 deficits in the mobility dimension. More than 50% of health states in the Sri Lankan value set are deemed worse than death health states. Conclusions: This study derived first EQ-5D-3L utility value set for the South Asian region. The Sri Lankan values deviate markedly from existing values for upper middle and high income countries. PHP99 Bilirubin and Neurodegenerative Disease Prevention Muhsain SN1, Farooqui M1, Lang M2, Abu Bakar A2 MARA, Kepala Batas, Malaysia, 2University of Queensland, Coopers Plains, Australia
1Universiti Teknologi
Objectives: Bilirubin (BR), a protective endogenous antioxidant is cytotoxic at high concentrations. Its intracellular levels are regulated by a system comprising haem oxygenase, biliverdin reductase and CYP2A5 enzymes, and considered to be a molecule that promote health in adults. This paper will highlight the association between bilirubin and pathological conditions such as CVD, cancer, diabetes and neurodegenerative diseases. Furthermore, the mechanism by which bilirubin and its metabolism may influence disease prevention, will also be discussed. Methods: Studies on serum bilirubin levels and association with prevalence and incidence of oxidative stress related chronic disease, as well as experimental studies were collated and reviewed. Results: Mildly elevated serum bilirubin levels are strongly associated with reduced prevalence of chronic disease especially CVD, cancer and metabolic diseases.It has been suggested as a biomarker and predictor of these diseases. Experimental studies indicate that it is a strong endogenous antioxidant and tumour suppressor agent, which would confer this protective properties. Conclusions: BR is promising molecule which importance should be considered in clinical practice. However, greater molecular work is needed to strengthen this conclusion. PHP100 A Comparative Analysis on Health Security System Between China and Developed Countries Wu J1, Liu J2, Zhu B2, Mao Y2 University of Hong Kong, Kowloon, Hong Kong, 2Xi’an Jiaotong University, Xi’an, China
1City
Objectives: In order to achieve the goal of Healthy China 2020, it is critical to establish and perfect a universal coverage health security system for all. This paper takes German, England, America, and Singapore and other developed countries as examples to conduct a comparative analysis on their health security systems from the aspects of financing methods, mode of medical organization, service supply, payment mode, expenditure control, equity of health system, and operation mechanism, thus putting forward some useful practice to improve health system in China. Methods: Comparative analysis from the international perspective has
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
been mainly adopted in this paper. Results: Through comparison and contrast, it is suggested that the health security system in China be of Chinese characteristics, of multi-levels and multi-formats, of a balance between equity and efficiency, and of an organic combination of government supervision and market mechanism. Conclusions: Based on the comparison and experiences, related policy suggestions have been put forward to improve the health security system in China, which go as follows: deal with the relationship between government and market; promote the press forward with legislation focusing on specialized law of health security; set up a stable and multiple financing mechanism; and enhance the supervision on health service institutions. PHP101 Evaluation of Antibacterial and Cytotoxic Effects of Gymnema Sylvestre R.BR. Species Cultivated in Pakistan Against Common Resistant Pathogens Tahir M1, Anjum MS2, Zahid Tanveer M1, Iqbal MZ3 1University of Veterinary and Animal Sciences, Lahore, Pakistan; Lahore, Pakistan, 2PMAS- Arid Agriculture University, Rawalpindi, Pakistan, Rawalpindi, Pakistan, 3AIMST University, Sungai Petani, Malaysia
Objectives: The purpose of this experiment was to evaluate the antibacterial efficacy and safety profile of sequential extracts of an indigenous plant Gymnema sylvestre R.Br. (Gurmar) leaves. Methods: This study was conducted against 4 bacteria including Staphylococcus aureus, Salmonella enterica, Clostridium perfringens type-A, Haemophillus paragallinarum which are common causatives of various infections. In order to assess antibacterial potential of Chloroform, Hexane, Ethanolic and Aqueous extracts of Gymnema sylvestre R.Br. leaves, agar well diffusion method was used. Results: The results exhibited that ethanolic and chloroformic extracts have more antibacterial activity against all four microorganisms under study. Hexane, chloroform and ethanolic extracts of G. sylvestre R. Br. showed antibacterial activity against all isolates of selected 4 microorganisms (Salmonella enterica, Staphylococcus aureus, Haemophillus paragallinarum and Clostridium perfringens type-A) under study. On the other hand aqueous extract showed antibacterial activity only against Clostridium perfringens type-A while no antibacterial activity was observed against remaining three bacteria under study. MTT Assay was performed using vero cell lines. The results showed that 2900µg/ml, 3612.50µg/ml, 4075µg/ml and 1562.50µg/ml concentrations of Hexane, Chloroform, Ethanol and Aqueous extracts respectively were found safe as Cell Survival Percentage (CSP) at these concentrations was above 50%. Conclusions: The antibacterial and MTT Assay results suggest that sequential extracts of dried leaves of Gymnema sylvestre R. Br. can be used as a safer antibacterial against tested resistant bacteria. All results were compared statistically using DMR (Duncan’s Multiple Range) Post hoc test at P ≤ 0.05. PHP102 What is Government’s Responsibility for China’s Universal Health Security? An Outlook for a National Health Security System Wu J, Liu J, Zhu B, Mao Y Xi’an Jiaotong University, Xi’an, China
A831
improving the patient education at an outpatient department of a tertiary care hospital in India Methods: A multidisciplinary team trained on HFMEA methodology analyzed various processes involved in patient education at outpatient department. The team identified potential failure modes in each process, assigned hazard scoring for each of them, followed it with the various causes leading to these failure modes and actions or outcome measures to overcome them. Results: We identified 8 processes and 32 failure modes with average hazard scoring of 6. The high risk potential failure is identified as, “healthcare worker doesn’t identify the need for patient education in specific cases” and the least potential failure is identified as, “absence of translator for language barrier”. The actions or outcome measures and the persons responsible for implementing them are detailed for further improvement. Conclusions: Patient Safety and care reliability issues are a major concern in healthcare. This study suggests that tools such as HFMEA can enable a detailed analysis of the patient education process and guiding improvement efforts PHP104 Trends of Including Pharmacoeconomics Course in the Undergraduate Pharmacy Curriculum Thomas D, Sundararaj KG, Shirwaikar A Gulf Medical University, Ajman, United Arab Emirates
Objectives: Although pharmacoeconomics was recognized as a sub-discipline of health economics for over 25 years, its diffusion into pharmacy education has been gradual. The purpose of this global review was to describe the global trend of inclusion of pharmacoeconomics course in undergraduate pharmacy education. Methods: Published literatures were searched and information on the inclusion of pharmacoeconomics course in the undergraduate pharmacy curriculum was collected and collated. PubMed, Google Scholar, and Google databases were used for the search in October and December 2015. Both compulsory and elective pharmacoeconomic courses in the undergraduate pharmacy curriculum (BS, B.Pharm, PharmD) were considered. We have organized and summarized the information by countries and time period. Results: Four surveys from the US have provided the key baseline for documenting trends in inclusion of pharmacoeconomics course in the pharmacy curriculum. As per 2011 survey, pharmacoeconomics course was included in almost all colleges/schools of pharmacy in the US. Other than surveys from the US, 6 out of 9 were conducted or published in the last 3 years. Many of the surveys identified that the contents in pharmacoeconomic course vary to different extent. Information from many countries was not available, especially in Africa and Asia. Conclusions: The pharmacoeconomics course was very much part of the undergraduate pharmacy programs in the US. Even though the diffusion of pharmacoeconomics course to the rest of the world was slow; it has picked up the pace in this decade. Standardization of pharmacoeconomics education shall be necessary. PHP105 The Impact of Surgical Professional Education: A Review of Clinical and Economic Outcomes Bourcet A1, Lim S2, Metz L1 1Johnson & Johnson Medical Asia Pacific, Singapore, Singapore, 2Costello Medical Singapore Pte Ltd, Singapore, Singapore
Objectives: Chinese Government has announced the Healthy China 2020 initiative to reform disease prevention and health promotion, healthcare services, pharmaceutical policies and health insurance system. As pointed out in report of 3rd Plenum of the 18th Communist Party of China, the transformation of government functions will be sped up, leaving market to play the decisive role in allocation of resources. In this view, government’s responsibility in setting up universal health security system and protecting universal health is due to be defined clearly. Methods: Based on China’s social reality and international experience, we put forward the development strategy for National Health Security and clarify the government’s responsibility in the area of medical resources from both health services supply-side and demand-side. Results: Firstly, it is the government’s responsibility to deliver universal basic health coverage and eliminate urban-rural, regional and population disparities, thus achieving the goal of Health for all on schedule. Secondly, government is supposed to take the leading role in the establishment of a Uniform and Multi-standard Universal Primary Health System and, meanwhile, introduce the market mechanism. Not only the access to basic medical service of low-income groups should be ensured by the government, commercial health insurance and long-term care service, in the area of which socialist market mechanism domains, should also be vigorously supported by the government. Relevant policies should be introduced to meet different health needs of different groups. Finally, health service industry’s development in the future ought to be government-led and market-driven. Conclusions: It is suggested not only strengthen the government’s responsibility in policy decision, supervision and administration and the cultivation of a decent policy environment suitable for the development of health industry but also give greater play to the fundamental role of the market in resource allocation and inspire social energy on the improving of quality and efficiency of health service.
Objectives: Patient safety concerns have led to the emergence of alternative training models (eg. workshops, simulator training) that allow surgeons to develop surgical proficiency outside the operating theatre. In Moore’s educational outcomes measurement framework, the ultimate goal of surgical education is improved patient and community health.1 This literature review aimed to qualitatively assess published evidence on the impact of surgical education on clinical and economic outcomes. Methods: A pragmatic literature search of PubMed and Chinese Knowledge Infrastructure was performed (August 2015-November 2015) using search terms developed from “surgical”, “training”, “education”, “clinical” and “economic”. Primary studies, economic studies and reviews reporting clinical or economic outcomes associated with surgical education interventions were included. Results: A total of 47 studies were identified (5 systematic literature reviews, 4 RCTs, 34 cohort studies, 3 review papers, 1 case study). Surgical education reduced technical error rates and operative times when assessed under simulation. Several studies reported favourable clinical outcomes (reduced blood loss, complication rates, mortality). ~50% studies reported outcomes that could indirectly contribute to improved patient safety: procedural/anatomical knowledge acquisition, improved technical skills (instrument/tissue handling, speed, accuracy), improved non-technical skills (decision-making, teamwork, stress management). Economic data primarily comprised direct training costs (simulator costs, cost of faculty time); few studies reported cost-comparative analyses between surgical education models. While evidence for the clinical benefit of surgical education exists, conclusive interpretation was limited due to the pragmatic method of review, heterogeneity of studies and inherent limitations of studies identified (before-after studies, surveys). Conclusions: There is a need to critically evaluate how the impact of surgical education is assessed. Current studies focus on surgical learning outcomes; further research is needed to strengthen the evidence base for the impact of surgical education on not only surgeons, but also patients and hospitals. 1Moore D et al. J Contin Educ Health Prof. 2009;29(1):1-15
PHP103 Application of Healthcare Failure Mode & Effect Analysis in Improving Patient Education at an Outpatient Department Of a Tertiary Care Hospital
Health Care Use & Policy Studies – Health Technology Assessment Programs
Devarakonda S Armed Forces Medical College, pune, India
Objectives: Patient Education has become one of the important standards for many accreditation bodies. This paper describes how the HFMEA can be applied in
PHP106 Health Technology Assessment Supports Evidence-Based DecisionMaking in The Changi General Hospital Marketplace Exercise Pwee KH, Tong SC, Chow WL