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  • 1
    Electronic Resource
    Electronic Resource
    Influence of an Infectious Disease Service on Antibiotic Prescription Behavior and Selection of Multiresistant Pathogens (2000)
    Springer
    Infection 28 (2000), S. 384-387 
    Details
    ISSN: 1439-0973
    Keywords: Key Words Infectious disease service ; Cost control ; Multiresistant pathogens ; Intensive care ; Antibiotics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Background: A routine infectious disease service was established in January 1998 in order to optimize the antibiotic usage and prescription pattern of a neurologic intensive care unit (NICU). Methods: Treatment guidelines for the most prevalent infections wer implemented and individual antibiotic regimes were discussed at the bedside with infectious disease experts. Results: This interdisciplinary cooperation reduced the total number of antibiotics prescribed by 38.1%, from 7,789 in 1997 to 4,822 in 1998, without comprimising patient outcomes (mortality rate: 22/313 patients in 1997 vs 32/328 patients in 1998). Total patient days (2,254 days vs 2,296 days) and average length of stay in the NICU (7.2 days vs 7.0 days) were comparable. Antimicrobial expenditure decreased by 44.8% (71,680 Euros in 1997 vs 39,567 Euros in 1998). Taking into account the costs for the infectious disease service (approximately 8,000 Euros in 1998), a total saving of 24,113 Euros was made. The dramatic reduction in antibiotic usage (mainly of carbapenems) resulted in a statistically significant decreased isolation of Stenotrophomonas maltophilia (p 〈 0.05), Enterobacter cloacae (p 〈 0.05), multiresistant Pseudomonas aeruginosa (p 〈 0.05) and Candida spp. (p 〈 0.05), without any change in the infection control guidelines. Conclusion: These data show that an infectious disease service can optimize and reduce antibiotic usage. This results in a decrease in the occurrence of multiresistant gram-negative pathogens and Candida spp. in intensive care units, and, at the same time, saves costs.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s150100070010
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  • 2
    Electronic Resource
    Electronic Resource
    Evaluation of care for the disabled mentally ill: Theoretical issues (1989)
    Springer
    European archives of psychiatry and clinical neuroscience 238 (1989), S. 179-184 
    Details
    ISSN: 1433-8491
    Keywords: Care ; Evaluation ; Disabled ; Mentally ill
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A precondition for the discharge from an institution of the chronically disabled mentally ill is the availability of adequate alternative facilities and services, optimally meeting their social and mental health needs and allowing as much quality of life as possible at the lowest possible cost. Only a few studies have found alternative care to lead to better outcomes than treatment in good-quality hospitals with respect to illness course and social disablement. Therefore, it is an important question whether extramural care and of what type is better and possibly less expensive than traditional inpatient treatment and for which patients. Health data collected at the national and regional levels provide a basis for continuous monitoring of utilization of services. Such data, however, usually have the limitation of being aggregate in nature and not including contacts with social services. These deficits can be avoided by using cumulative case registers, recording if possible all contacts of the socially disabled mentally ill with intramural and extramural mental health and social services and covering a defined catchment area. Because the disabled mentally ill, depending on their own resources and those of their family and the community at large, have basic needs differing in each individual case, as well as various specific needs determined by the illness which they cannot meet on their own, it is necessary to provide a variety of facilities and services and to coordinate their work. Evaluation and cost-effectiveness investigations of complex packages of care yield generalizable results only if the forms of care under study are defined precisely enough. A precondition of a satisfactory causal analysis of the effectiveness of care programmes and services is sufficient external and internal validity and the use of a design allowing all relevant intervening variables to be controlled for. Because of the problems posed by quasiexperimental designs and controlled case studies in the evaluation of the care of the chronically mentally ill, an observation design will be discussed that allows a more or less reliable analysis of cause and effect, thanks to the inclusion of relevant intervening variables and the partialling out of their effects on outcome. In the evaluation of community services for the disabled mentally ill, it must be taken into account that outcome and costs depend on the system aspect in as much as during the transition from intramural to extramural care severely disabled patients with a greater need of care, consequently producing higher costs, are discharged from hospital to community care in increasing numbers.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00381461
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    Paper (German National Licenses)
    Fulltext
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