introductionparticipants and methodsresults, tables and graphics discussionreferences

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IntroductionParticipants and

MethodsResults, Tables and

GraphicsDiscussion References





The health care should be provided in view of complete welfare of the patient

Definition of “health”, which has been existed till now and basically refers to the preamble of WHO Constitution in 1948, noted that: “Health is a state of complete physical, mental, and social well being, not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” [1]

The individual must be considered in all its extension: physical, psychological and social dimensions:





The health care should be provided in view of complete welfare of the patient

Definition of “health”, which has been existed till now and basically refers to the preamble of WHO Constitution in 1948, noted that: “Health is a state of complete physical, mental, and social well being, not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” [1]

The individual must be considered in all its extension: physical, psychologic and social dimensions:

“Complete welfare” is differently understood by different peolple, according to the importance they assign to the multiple components of health

People should intervene in this conception of health care, being asked about the way they value the referred components constituents of health





The conception of “complete welfare” of a society could offer an indication about what are the areas of health services in wich the investment of resources (economical or human) should be done, in order to obtain the better health level in the population





The conception of “complete welfare” of a society could offer an indication about what are the areas of health services in wich the investment of resources (economical or human) should be done, in order to obtain the better health stage of the population

By changing the health services of medical assistance in order to treat patients according to all the necessities they reveal, it is possible that the generalized health state of the population could improve, making higher the quality of life of the active population





It is necessary to analyse how the elements of a society value different health-states, adjusting the survival years of the treated patients considering their conception of quality of life

In order to ascertain the prospects of the societies about the importance of certain parameters to be achieved the “life

with quality” several questionnaires have been developed, of which, in this study, it will be used EQ-5D





“The EQ-5D provides community-based preference weights (utilities) for calculating quality adjusted life years (QALYs) in cost-utility analisys” [2]

“EQ-5D is a generic measure of health status that provides a simple descriptive profile and a single index value that can be used in the clinical and economic evaluation of health care and in population health surveys” [3]

In this article, EQ-5D is understood as a preference-based measure designed to summarise HR-QOL in a single number ranging from 0 to 1. [4]

“Assessment of strenght of preference values (utilities) for patients’ own health or disease states from a societal perspective, is na essencial element to economic evaluations of healthcare interventions” [5]





AIMS OF THE STUDY:

Compare the differences between the opinions of the three groups interviewed (FMUP, FEUP and outpatient consulting in order:

Analyze who has the more optimistic/pessimistic opinions

Discover which group shows more difficulties in answering the questionnaire

Compare the worst and best health-state chosen by each group

Create separated mathematical models based on the results obtained on each group generalize the conclusions of the study, applying them to the comparison of perpectives about health of different groups in the population: university students, students related with health and ill people





Study ParticipantsStudy DesignData Collection MethodsVariables DescriptionStatistical Analysis





Target Population: FMUP and FEUP students and patients in the outpatient consulting

Sampling Method: non-random method

Inclusion Criteria: being FMUP or FEUP student or a patient in the outpatient consulting in São João Hospital, that is awating the call

Exclusion Criteria: it hasn´t been defined exclusion criteria a priori, although it will not be possible to consider the questionnaires wich were not filled completely, including those of the patients whom presence was solicited for the call

Sample size: 50-100 respondants in each group


Ill peopleUniversity studentsStudents related with health






FMUP / FEUP

Years






FMUP / FEUP

Years

Classes






Outpatient Consulting

Services






Observational

There isn’t a direct application of an intervention to the population; it is observed and its characteristics are recorded

Cross-Sectional

The data collection is done only once time

Unit of analysis

Individual






FMUP FEUP Outpatient Consulting

Individuals50 < N < 100

EQ-5D

Results Analysis Conclusions

PERSONAL

INTERVIEW






JUSTIFICATION FOR THE CHANGES:

Adoption of personal interview advantages: participants can clarify doubts;

it is ensured that the questionnaire is well responded less invalid questionnaires;

provides a good answer rate;

practical barrier for using a random sample different target population:it is adequated to the number of disponible interviewers (12), can show how ill people, medicinestudents and non-medicine students evaluate each health-state

it would imply a larger number of deslocations and a larger number of interviewers to be done in the pretended period of time

PREVIOUS SELECTION OF THE STUDY PARTICIPANTS:

Random method



AIMS OF THE STUDY:

Compare the differences between the opinions of the three groups interviewed in order to:

Analyze who has the more optimistic/pessimistic opinions

Discover which group shows more difficulties in answering the questionnaire

Compare the worst and best health-state chosen by each group

Create separated mathematical models based on the results obtained on each group generalize the conclusions of the study, applying them to the comparison of perpectives about health of different groups in the population: university students, students related with health and ill people




PREVIOUS AIM:Analyse how the Oporto inhabitants value different health-states;

Create a model adapted to Oporto reality;








5 DIMENSIONS OF THE QUESTIONNAIRE:

It is an ordinal variable:

1 parameter 3 answer hipothesis

each hipothese corresponds either to a good health state or to a bad one or even to an intermediate one

“The EQ-5D includes single item measures of: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.Each item is coded using 3-levels (1 = no problems; 2 = some problems; 3 = severe problems). The instrument includes a global rating of current health using a visual analog scale (VAS) ranging from 0 (worst imaginable) to 100 (best imaginable).” [7]







VISUAL SCALE:

It is a continuous variable

Classification that the responder atributes to their own health state at the moment of the questionnaire






VISUAL SCALE:

It is a continuous variable

Classification that the responder atributes to eight different contexts in terms of health;

Classification attributed to death;






Cathegorical variables






SOCIO-DEMOGRAPHIC VARIABLES:

They are cathegorical variables

Integrated in the questionnaire to obtain a profile for the anonymous responder, wich could be useful to interprete the answers according to the context in wich they were given or to better understant some possible discrepancies






EVALUATION OF THE QUESTIONNAIRE:

They are cathegorical variables

They are important to confere more validity to the answers, by serving as an indicator of the degree of understanding them






Cathegorical variables

Tables of frequencies

Continuous variables

MedianInterquartile Range

Analysis of the results of visual scales separating it in classes according to the variables “sexo” and “local de entrevista”

Small N





p was determined using Mann Whitney test

FEUPFMUP





p was determined using Mann Whitney test

MaleFemale





FMUP students show less health problems than FEUP students

Possible explanation: pre-requirements necessary to ingress the medical school, which were not asked in FEUP

Possible explanation: those students have not only final exams, but also intermediate tests

FEUP studends found the questionnaire easier than FMUP students

Possible explanation: as FEUP students do not have such a close contact with ill people it may be easier to them to speculate about the different health states, specially if they do not know anyone in such conditions

FEUP students are more depressed and anxious





FMUP students found limitations in the questionnaire

Possible explanation: the contact and knowlegde about a larger number of health-states makes them more exigent with the classification

FEUP students are mainly male

Possible explanation: the kind of skills acquired in the course

FMUP are more in contact with severe illnesses

Possible explanation: they frequent the medical school, and have contact with the pacients of SJH

FMUP students smoke more

No specific explanation

There were no significant results between sexes, maybe because of the age bracket and similar education.





“EQ-5D indices are less responsive and require larger patient samples to detect meaningful clinical differences compared to other used instruments” [6]

May happen that some people qualify a certain heatlh state as being worst than they would consider if they had lived an experience like that.Similarly, two different health states could look like being the same when, in the end, they have different results [8]

Several questionnaires weren´t filled completely

Questionnaire can be too long Questionnaire can be complicated

Old peoplePeople without specific formation





[1] WHO. Constitution of the World Health Organization, Geneva, 1946. Accessed Page 20 of "NATIONAL MENTAL HEALTH POLICY 2001-2005" on March 2001

[2] Günther OH, Roick C, Angermeyer MC, König HH, 2008 Jan 1, Responsiveness of EQ-5D utility indices in alcohol-dependent patients, Drug Alcohol Depend.;92(1-3):291-5

[3] Rabin R, de Charro F, 2001 Jul, EQ-5D: a measure of health status from the EuroQol Group, Ann Med, 33(5):337-43

[4] Coons SJ, Rao S, Keininger DL, Hays RD, 2000 Jan, A comparative review of generic quality-of-life instruments, Pharmacoeconomics, 17(1):13-35

[5] Maetzel A, 2004 Oct, The role of utilities in economic evaluations of healthcare interventions-na introduction, Z Rheumatol, 63(5):380-4

[6] Günther OH, Roick C, Angermeyer MC, König HH, 2008 Jan 1, Responsiveness of EQ-5D utility indices in alcohol-dependent patients, Drug Alcohol Depend.;92(1-3):291-5

[7] Mathews WC, May S: “EuroQol (EQ-5D) measure of quality of life predicts mortality, emergency department utilization, and hospital discharge rates in HIV-infected adults under care”

[8] Williams C Mathews and Sussane May, “Euroquol(Eq-5D) measure of quality of life predicts mortality, emergency department utilizations, and hospital discharge rates in HIV-infected adults under care”, 2007


introductionparticipants and methodsresults, tables and graphics discussionreferences

Documents

patientdefinition of

conception of health

social dimensions

social condition

state of complete physical

view of complete welfare

political belief

distinction of race