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Una C. Lantion-Ang, MD and the Diabcare-Asia Philippines ; Study Group The aim of the DiabcareAsia project was to collect data on diabetes control, management and complication status among patients in 12 Asian countries including the Philippines. A total of 34 diabetes centres from four regions Metro Manila, Luzon, Visayas and Mindanao ; in the Philippines participated in the study between July and September 1998. Information was extracted from the medical records, interviews and laboratory assessment. Of the 3061 patients recruited, 90% constituted the statistical analysis population. The majority 96% ; of patients studied were diagnosed with type 2 diabetes mellitus, with mean age + SD ; of 59.3 + 12.5 years and mean diabetes duration of 9.4 + 7.0 years. Overall mean BMI was 24.7 + 4.9 kg m2 and majority 60% ; had BMI 25 kgVm2. Majority 70% ; of the patients were treated w i t oral antidiabetic drugs OADs.
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Given that each Division has its own set of circumstances and a particular GP population, Facilitators' approaches have varied somewhat from one area to the next. There was considerable delay in getting the Facilitator Program in place, and in many cases Divisions did not employ a Facilitator until a year or more after Item 900 was introduced. The lack of support and information available to GPs and pharmacies during this time was said to be a significant barrier to uptake of the HMR, with some GPs who had early negative experiences being reluctant to make subsequent HMR referrals. The effectiveness of the training and support provided to MMR Facilitators by the Guild and the National Management Group was reported to have a significant bearing on the capacity of Facilitators to undertake their promotional work effectively. Like the Facilitator Program itself, such support was seen to be initially wanting, but more satisfactory over the past couple of years. The MMR Facilitator Program is discussed in more detail in Chapter 7, for instance, zovirax canada.
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Aim: In a budget constrained healthcare system the decision to invest in strategies to improve the implementation of cost-effective technologies must be made alongside decisions regarding investment in the technologies themselves and investment in further research. This paper presents a single, unified framework that simultaneously addresses the problem of allocating funds between these separate but linked activities. Methods: The framework presents a simple 4 state world where both information and implementation can be either at the current level or `perfect'. Through this framework it is possible to determine the maximum return to further research and an upper bound on the value of adopting implementation strategies. The framework is illustrated through case studies of health care technologies selected from those previously considered by the UK National Institute for Health and Clinical Excellence NICE ; . Results: Through the case studies, several key factors that influence the expected values of perfect information and perfect implementation are identified. These factors include the maximum acceptable cost-effectiveness ratio, the level of uncertainty surrounding the adoption decision, the expected net benefits associated with the technologies, the current level of implementation and the size of the eligible population. Conclusions: Previous methods for valuing implementation strategies have confused the value of research and the value of implementation. This framework demonstrates that the value of information and the value of implementation can be examined separately but simultaneously in a single framework. This can usefully inform policy decisions about investment in healthcare services, further research and adopting implementation strategies which are likely to differ between technologies.
Source: Health Protection Agency, UK, 2007 5. September 2007 18.
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