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עמוד בית
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December 2010
M. Ojeniran, R. Shouval, I.N. Miskin,A.E. Moses and A. Shmueli

Background: Appropriate antibiotic use is of both clinical and economic significance to any health system and should be given adequate attention. Prior to this study, no in-depth information was available on antibiotic use patterns in the emergency department of Hadassah Medical Center.

Objectives: To describe the use and misuse of antibiotics and their associated costs in the emergency department of Hadassah Medical Center.

Methods: We analyzed the charts of 657 discharged patients and 45 admitted patients who received antibiotics in Hadassah Medical Center’s emergency department during a 6 week period (29 April – 11 June 2007). A prescription was considered appropriate or inappropriate if the choice of antibiotic, dose and duration by the prescribing physician after diagnosis was considered suitable or wrong by the infectious diseases consultant evaluating the prescriptions according to Kunin’s criteria.

Results: The overall prescribing rate of antibiotics was 14.5% (702/4830) of which 42% were broad- spectrum antibiotics. The evaluated antibiotic prescriptions numbered 1105 (96 prescriptions containing 2 antibiotics, 2 prescriptions containing 3 antibiotics), and 54% of them were considered appropriate. The total inappropriate cost was 3583 NIS[1] (1109 USD PPP[2]) out of the total antibiotic costs of 27,300 NIS (8452 USD PPP). The annual total antibiotic cost was 237,510 NIS (73,532 USD PPP) and the annual total inappropriate cost was 31,172 NIS (9648 USD PPP). The mean costs of inappropriate prescriptions were highest for respiratory (112 NIS, 35 USD PPP) and urinary tract infection (93 NIS, 29 USD PPP). There were more cases when the optimal cost was lower than the actual cost (N=171) than when optimal cost was higher than the actual cost (N=9). In the first case, the total inappropriate costs were 3805 NIS (1,178 USD PPP), and in the second case, -222 NIS (68.7 USD PPP).

Conclusions: The use of antibiotics in emergency departments should be monitored, especially in severely ill patients who require broad-spectrum antibiotics and for antibiotics otherwise restricted in the hospital wards. Our findings indicate that 12% of the total antibiotic costs could have been avoided if all prescriptions were optimal.

[1] NIS = New Israeli Shekel

[2] USD PPP = US dollar purchasing power parity

October 2007
A. Shmueli and D. Tamir

Research findings have shown the protective effect of religiosity – among both Christians and Israeli Jews – in terms of morbidity and mortality. To explore the relationship between religiosity and health behavior as a possible explanation for these findings we conducted 3056 telephone interviews, representing the Israeli adult urban Jewish population. Health status, health behavior, frequency of medical checkups, and eating habits were measured. Logistic regressions were used to estimate the religiosity gradient on health behavior, controlling for other personal characteristics. We found a lower prevalence of stress and smoking among religious persons; we also found that religious women exercise less than secular women and that religious people – both men and women – are more obese than their secular counterparts. While no religiosity gradient was found with relation to the frequency of blood pressure, cholesterol and dental checkups, religious women are less likely to undergo breast examinations and mammography. Finally, religious people generally follow a healthier dietary regime, consuming less meat, dairy products and coffee, and much more fish. The lower smoking rates, lower levels of stress, and the healthier dietary regime are consistent with the previously shown longer life expectancy of religious people; however, obesity might become a risk factor in this community.

January 2004
A. Shmueli and J. Shuval

Background: Complementary and alternative medical care has gained increasing popularity in western societies in recent years.

Objectives: To provide a cross-sectional and temporal (2000 vs. 1993) analysis of the use of complementary and alternative medicine in Israel.

Methods: The subjects studied represented the Israeli Jewish urban population aged 45–75 years. Full sit-down interviews were conducted with 2,003 respondents in 1993 and 2,505 respondents in 2000.

Results: For 1993, 6% of the population reported on consultations with CAM[1] providers during the previous year. For 2000, that proportion increased to 10%. Being a woman, having higher education, enjoying better economic status, being younger, living in a big city, and being dissatisfied with specialists’ care were all positively related to the use of non-conventional medicine, particularly in 2000. In both years, more than 50% of the consultations were with acupuncturists and homeopaths. However, chiropractors have doubled their market shares, and lower back pain became the leading problem for which care was sought. The main reason for consulting CAM was a reluctance to use too many drugs or to undergo an invasive procedure. However, a significant proportion of the users continue to use conventional medicine concurrently. Seventy-five percent in 2000 and 60% in 1993 reported that the treatment helped.

Conclusions: Between 1993 and 2000, CAM in Israel changed from an infant industry into a mainstream medical commodity, reflected in both prevalence and different patterns of consumption.

[1] CAM = complementary and alternative medicine

October 2000
Amir Shmueli, PhD

Background: With market failures characterizing the health care sector, societies are continuously searching for ways to achieve an efficient and fair allocation of resources. A natural source of opinion on the desired allocation of health resources is the public. In fact, several governments have recently involved the general public in decisions about resource allocation in their health systems.

Objectives: To investigate the views of the Israeli Jewish public aged 45-75 on horizontal equity in medical care; specifically, the characteristics (including a lottery) for determining which of two individuals with similar medical need should be treated first, against a background of limited resources.

Methods: A sample of 2,030 individuals was chosen to represent a population of about 800,000 urban Jewish Israelis aged 45–75. Data were collected in face-to-face full sit-down interviews by trained interviewers between October 1993 and February 1994.

Results: The three most preferred prioritizers were chances of recovery, number of dependants, and young age. Random prioritization was preferred by only 8% of the population. Age, level of education and religiosity were the main characteristics associated with the choice.

Conclusions: The Israeli adult public does not favor strict horizontal equity in health care. As in other social programs, “equals” were defined in a multi-criteria manner, based on both medical need and other personal characteristics. The preferred prioritizers seem to reflect universal tastes and cast doubt on the traditional distinction between efficiency and equity and between horizontal and vertical equity when applied to health care.

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