Objectives: To evaluate the impact in terms of use of health services, clinical outcomes, functional status, and patient´s satisfaction of an integrated care program, the CareWell program, for complex patients with multimorbidity, supported by information and communication technology platforms in six European regions.Data Sources: Primary data were used and the follow-up period ranged between 8 and 12 months.Study design: A quasi-experimental study, targeting chronic patients aged 65 or older, with 2 or more conditions – one of them necessarily being diabetes, congestive heart failure or congestive obstructive pulmonary disease. The intervention group received the integrated care program and the control group received usual care. Generalized mixed regression models were used.Data collection: Data were obtained from individual interviews and electronic clinical records.Principal Findings: Overall, 856 patients were recruited (475 intervention and 381 control). In the intervention group, the number of visits to emergency rooms was significantly lower, and the number of visits to the general practitioners and primary care nurses was higher than in the control group.Conclusion: The CareWell program resulted in improvements in the use of health services, strengthening the role of PC as the cornerstone of care provision for complex patients with multimorbidity.

The aim of this study was to investigate the quality of life in Croatian homeland war veterans who suffer from post-traumatic stress disorder and chronic low back pain (LBP).

Aim To determine Croatian healthcare (HC) professionals' perspectives on HC management and leadership challenges. Methods This cross-sectional study, conducted between May and June 2021, enrolled 1179 respondents from both the public and private sector, including medical doctors, nurses, pharmacists, economists, and other HC professionals. Their perspective on various facets of HC management, namely governance, ownership, accountability, financing, and potential for improvement, were investigated using an anonymous online survey. Results Most respondents agreed that the system may be allocating resources ineffectively and that political mandates unduly influenced management decisions, impeding accountability. Competencies in organizational and financial experience, along with communication and leadership skills, were deemed fundamental for health care managers. Participants overwhelmingly supported data- driven decision-making, improved education, and the development of leadership skills as key avenues for system enhancement. Conclusions The study underscores the need for better financial management and overall governance, in the Croatian HC, offering insights that can inform evidence-based policy decisions and reforms toward a more efficient and accountable HC system.

Background Breast cancer is the most frequently diagnosed and leading cause of death amongst cancers in women. Understanding its burden is important in healthcare management. We assessed direct medical and indirect costs of advanced breast cancer (ABC) in selected countries: Bulgaria, Croatia, Czech Republic, Estonia, Greece, Israel, Latvia, Poland, Romania, and Slovak Republic. Methods The data were collected in individual countries with a unified questionnaire (covering epidemiology, mortality, treatment patterns, and economic aspects) based on databases/registries, published studies, or experts’ opinions in the absence of published data. International scope allowed for consistency checks and missing data imputing. Results The total annual costs of ABC per 100,000 women varied from 1 million EUR in Romania to 3.4 million EUR in Slovak Republic with the differences partially related to data availability. The direct costs resulted mainly from the costs of treatment (covering surgery, breast reconstruction, external breast prosthesis, chemotherapy, radiation, hormonal and targeted therapy). The indirect costs (lost productivity due to premature mortality and reduced employment rate) constitute a large part (>50%) of the total costs. The average (for all countries) total annual costs per 100,000 women amounts to 1.8 million EUR. Conclusion ABC is associated with substantial healthcare costs and imposes a significant societal burden, as indicated by high indirect costs. Early detection, timely intervention, and effective treatment of early stage BC hold potential to decrease burden of ABC. Our findings may be used in informing decisions on resource allocation, improving cancer policies and supporting national cancer plans. Highlights · Advanced breast cancer costs between 1 and 3.4 million euro per 100,000 women in studied countries; lost productivity (from societal perspective) accounts for most of the cost. · The data availability is still limited; comparisons between countries reveal some gaps, but collecting more information, e.g. in registries, is crucial for improved decision making. · The results of our study may be used in cost-effectiveness modelling of diagnostic or treatment technologies.

Background and Aims: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of mortality worldwide, with lipid abnormalities playing a central role in disease development. While the causal role of low-density lipoprotein cholesterol (LDL-C) in ASCVD is well-established, the long-term population impact of combined lipid profiles, particularly the HDL-C/LDL-C ratio, remains less clearly quantified. This study aimed to estimate the lifetime burden of cardiovascular outcomes associated with different lipid risk profiles using a patient-level simulation framework. Methods: The authors analyzed projected lifetime ASCVD events across four HDL-C/LDL-C risk strata, ranging from low (≥0.45) to very high (<0.25), using the National Health Model Database of Projected and Estimated Outcomes (NHM-DPEO)—a digital twin of national healthcare systems built from multiple data sources, including national health and demographic statistics and estimates from the relevant literature. The framework is structured as a patient-level simulation model that projects individual health trajectories over a lifetime horizon. Model outputs were assessed for plausibility by comparison with published epidemiological estimates. Results: The NHM simulation revealed a strong, graded relationship between lipid profiles and cardiovascular survival. Life expectancy declined from 80.2 years in the lowest risk group (HDL-C/LDL-C ≥ 0.45) to 63.0 years in the very-high-risk group (HDL-C/LDL-C < 0.25), a reduction of 17.2 years, with 13.7 fewer QALYs. Similarly, participants with LDL-C > 5.0 mmol/L had a life expectancy 13.4 years shorter than those with LDL-C < 3.1 mmol/L. The burden of ASCVD increased exponentially with worsening lipid ratios: MI events rose from 5000 to 73,090 per 100,000 births, with onset in the highest risk group occurring as early as age 20. Ischaemic heart disease followed a similar pattern, showing up to 92% of events attributable to elevated lipid risk. While ischaemic stroke risk displayed a more complex pattern due to earlier MI mortality in high-risk groups, overall cardiovascular mortality and lifetime event burden were dominated by LDL-driven disease. These findings demonstrate that sustained LDL-C reduction and balanced HDL-C/LDL-C ratios confer substantial survival benefits across both sexes and all age groups. Conclusions: This study shows that lipid balance has a decisive influence on cardiovascular survival. Sustained LDL-C reduction and favourable HDL-C/LDL-C ratios markedly extend life expectancy and delay the onset of MI and IHD. The magnitude of this survival benefit highlights the need for early and continuous lipid control as a cornerstone of ASCVD prevention. The NHM quantifies these lifetime effects, offering valuable insights for targeted strategies that improve both longevity and quality of life.