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|Title:||Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial|
|Citation:||British Medical Journal, 2005; 331(7525):1110-1113|
|Publisher:||British Med Journal Publ Group|
|Maria Crotty, Craig H Whitehead, Rachel Wundke, Lynne C Giles, David Ben-Tovim and Paddy A Phillips|
|Abstract:||Objective: To determine the costs and benefits of interventions for maternal and newborn health to assess the appropriateness of current strategies and guide future plans to attain the millennium development goals. Design: Cost effectiveness analysis. Setting: Two regions classified by the World Health Organization according to their epidemiological grouping: Afr-E, those countries in sub-Saharan Africa with very high adult and high child mortality, and Sear-D, comprising countries in South East Asia with high adult and high child mortality. Data: sources Effectiveness data from several sources, including trials, observational studies, and expert opinion. For resource inputs, quantities came from WHO guidelines, literature, and expert opinion, and prices from the WHO choosing interventions that are cost effective database. Main outcome measures: Cost per disability adjusted life year (DALY) averted in year 2000 international dollars. Results: The most cost effective mix of interventions was similar in Afr-E and Sear-D. These were the community based newborn care package, followed by antenatal care (tetanus toxoid, screening for pre-eclampsia, screening and treatment of asymptomatic bacteriuria and syphilis); skilled attendance at birth, offering first level maternal and neonatal care around childbirth; and emergency obstetric and neonatal care around and after birth. Screening and treatment of maternal syphilis, community based management of neonatal pneumonia, and steroids given during the antenatal period were relatively less cost effective in Sear-D. Scaling up all of the included interventions to 95% coverage would halve neonatal and maternal deaths. Conclusion: Preventive interventions at the community level for newborn babies and at the primary care level for mothers and newborn babies are extremely cost effective, but the millennium development goals for maternal and child health will not be achieved without universal access to clinical services as well.|
|Keywords:||Humans; Hospitalization; Patient Transfer; Long-Term Care; Follow-Up Studies; Aged, 80 and over; Hospitals, Public; Homes for the Aged; Nursing Homes; South Australia; Female; Male|
|Appears in Collections:||Obstetrics and Gynaecology publications|
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