Cost Minimalisation Analysis of the Screening of Tuberculosis Contacts in the Czech Republic (the current situation and proposed modifications)
The study presents a cost minimalisation analysis of examination models for persons in contact with tuberculosis in the Czech Republic. The study draws on available cost data from the Czech Republic and clinical data from international studies. It calculates the costs of the MI model, which constitutes the current examination method for people in contact with TBC, with the use of the tuberculin skin test (TST) and X-ray examination, the MII model, which uses the in vitro release of interferon-gamma from blood cells (IGRA) and X-ray examination, and the MIII model, which is a two-step model using the confirmation of positive TST results by means of the IGRA test and X-ray examination. From the standpoint of the social cost (direct and indirect), the MIII model (two-step with the use of TST and IGRA – CZK 21,186 / 10 examinations) is the least expensive. This cost is, however, almost identical to the cost necessary for the MII model (only IGRA – CZK 22,551 / 10 examinations), which is simpler from the examination technique standpoint. The most costly is the MI model (TST – CZK 27,958 / 10 examinations), which has been used in the Czech Republic since 1986 and which is, furthermore, burdened with low TST specificity. The direct cost (CZK 16,175 / 10 examinations) is the lowest for the MIII model; the MII model has the lowest indirect costs (CZK 2,194 / 10 examinations). One of the most important findings of the study was that, despite its high price, the IGRA test does not present a significant increase in costs in comparison with the MII model, compared to the current type of contact examination. Vyšetřování kontaktů TBC v ČR - současný stav a navrhované úpravy (nákladově-minimalizační analýza) [Cost Minimalisation Analysis of the Screening of Tuberculosis Contacts in the Czech Republic (the current situation and proposed modifications)]. Zdravotnictví v ČR, 2008, roč. 11, č. 2. Praha.
Use of addictive substances in the Czech Republic – current situation
Attention is paid to the use of illegal drugs worldwide and, in particular, to infectious diseases spreading in the population, which can be a threat to health and the quality of life not only for individual drug users but also for their close relatives and society. The prevalence of dependency in the EU (by DSM-IV) on alcohol is 0.1-6.6% and on illegal substances 0.1- 0.2%, the highest being in the 18-49-year-old age group (Wittchen and Jacobi, 2005). The estimated number of dependent individuals in the adult population (18-65 years old) in the EU in the last 12 months is: a) 7.2 million people dependent on alcohol and b) 2 million on illegal drugs.
Harm Reduction in Prison
Introducing harm reduction into the prison environment is a controversial issue. However, as evidenced by foreign research, harm reduction in the prison environment may significantly reduce the spread of infectious diseases, such as HIV/AIDS and hepatitis C. Public health protection, on one hand, and equal access to HIV and hepatitis C protection devices for inmates, on the other, are the two main arguments for considering the consistent implementation of harm reduction in prisons.
Pre-Treatment Counselling
Pre-treatment counselling for substance users may be briefly characterised as working with the client’s motivation. Miller and Rollnick (2002) see motivation as something that could be described as a state of readiness or eagerness to change. This approach enables them to handle motivation as something that is dynamic, changing and, accordingly, subject to influence.
Specific Aspects of Working with a Client Held on Remand
Counselling for drug users whose substance use has brought them into conflict with the law and who are being held on remand seeks to use the client’s detention in pre-trial custody as a strong motivational element. This external factor (restriction of liberty) breaks the routine which the client has been following for some time and which he or she is unable to escape from. The confrontation with the consequences of substance use may become an impulse for such a person to consider a change. In working with a remanded client, the principles of motivational training may be applied. To a certain extent, the counselling services for clients on remand copy similar services provided by low-threshold agencies. The prison environment entails certain specific aspects of the actual work with a client which need to be taken into account.
Low-Threshold Drug Services
Low-threshold drug services operate in the field of the secondary and tertiary prevention of addictive substance use. They are also referred to as “clients’ first contact services”. The nature and course of the first contact are essential, as they may have a significant impact on the development of the client’s attitude to other agencies within the system of services for drug users. Practically speaking, if, during his/her first visit to a low-threshold service, a client meets with a lack of respect or understanding on the part of the staff, he/she may not come back to an agency of that type for a long time. This increases the risk of the client not being in contact with any drug service, which may result in his/her risky drug-using behaviour posing a danger to himself/herself, as well as to other people. Therefore, it is desirable that low-threshold services hire experienced professionals who possess both expertise and good communication skills.
Telephone Counselling in Low-Threshold Drug Services
Telephone intervention carried out as part of the operation of low-threshold agencies (LTAs) – contact centres – may be an additional item in the range of services offered by these types of agencies. For the caller, telephone communication is a safe form of contact, as opposed to a personal visit, which the person may find endangering at that moment, depending on his or her problem. It gives the caller sufficient space to talk about his or her problems while also enabling the caller to influence the length of the phone call. The principles behind the provision of telephone counselling are similar to those applied to hotlines. Nevertheless, certain differences may be identified as a result of the specific nature of counselling lines.
Qualitative needs analysis of the clients of low-threshold services in the Central Bohemian region
Background: The three-year project "Evaluation of drug precautions and programmes realised in the Central Bohemian region", which started in 2003, was initiated by the local authority of the Central Bohemian region. The first phase of the project was concluded in the first three months of 2004, and the outcome of this phase consisted of three substudies. The third one is the needs analysis of the clients of low-threshold services in the region. Methods: the design of the study was based on the Rapid Assessment and Response qualitative methodology. During a contact with a client a question sheet aimed at ascertaining socio-economic data and drug experience was filled in. The chief method used for data collection was a semi-structured interview. The focus group was created to obtain data from social workers.
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