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Kuwornu JP, Maldonado F, Groot G, Cooper EJ, Penz E, Sommer L, Reid A, Marciniuk DD. An economic evaluation of chronic obstructive pulmonary disease clinical pathway in Saskatchewan, Canada: Data-driven techniques to identify cost-effectiveness among patient subgroups. PLoS One 2024; 19:e0301334. [PMID: 38557914 PMCID: PMC10984414 DOI: 10.1371/journal.pone.0301334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Saskatchewan has implemented care pathways for several common health conditions. To date, there has not been any cost-effectiveness evaluation of care pathways in the province. The objective of this study was to evaluate the real-world cost-effectiveness of a chronic obstructive pulmonary disease (COPD) care pathway program in Saskatchewan. METHODS Using patient-level administrative health data, we identified adults (35+ years) with COPD diagnosis recruited into the care pathway program in Regina between April 1, 2018, and March 31, 2019 (N = 759). The control group comprised adults (35+ years) with COPD who lived in Saskatoon during the same period (N = 759). The control group was matched to the intervention group using propensity scores. Costs were calculated at the patient level. The outcome measure was the number of days patients remained without experiencing COPD exacerbation within 1-year follow-up. Both manual and data-driven policy learning approaches were used to assess heterogeneity in the cost-effectiveness by patient demographic and disease characteristics. Bootstrapping was used to quantify uncertainty in the results. RESULTS In the overall sample, the estimates indicate that the COPD care pathway was not cost-effective using the willingness to pay (WTP) threshold values in the range of $1,000 and $5,000/exacerbation day averted. The manual subgroup analyses show the COPD care pathway was dominant among patients with comorbidities and among patients aged 65 years or younger at the WTP threshold of $2000/exacerbation day averted. Although similar profiles as those identified in the manual subgroup analyses were confirmed, the data-driven policy learning approach suggests more nuanced demographic and disease profiles that the care pathway would be most appropriate for. CONCLUSIONS Both manual subgroup analysis and data-driven policy learning approach showed that the COPD care pathway consistently produced cost savings and better health outcomes among patients with comorbidities or among those relatively younger. The care pathway was not cost-effective in the entire sample.
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Affiliation(s)
- John Paul Kuwornu
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Gary Groot
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Elizabeth J. Cooper
- Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Erika Penz
- Respirology, Critical Care & Sleep Medicine, The Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Leland Sommer
- Stewardship and Clinical Appropriateness, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Amy Reid
- Clinical Integration Unit, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Darcy D. Marciniuk
- Respirology, Critical Care & Sleep Medicine, The Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Kuwornu JP, Maldonado F, Groot G, Penz E, Cooper EJ, Reid A, Marciniuk DD. Real-World Cost-Consequence Analysis of an Integrated Chronic Disease Management Program in Saskatchewan, Canada. Health Serv Insights 2024; 17:11786329231224621. [PMID: 38223214 PMCID: PMC10785729 DOI: 10.1177/11786329231224621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/28/2023] [Indexed: 01/16/2024] Open
Abstract
An integrated disease management program otherwise called a clinical pathway was recently implemented in Saskatchewan, Canada for patients living with chronic obstructive pulmonary disease (COPD). This study compared the real-world costs and consequences of the COPD clinical pathway program with 2 control treatment programs. The study comprised adult COPD patients in Regina (clinical pathway group, N = 759) matched on propensity scores to 2 independent control groups of similar adults in (1) Regina (historical controls, N = 759) and (2) Saskatoon (contemporaneous controls, N = 759). The study measures included patient-level healthcare costs and acute COPD exacerbation outcomes, both tracked in population-based administrative health data over a one-year follow-up period. Analyses included Cox proportional hazards models and differences in means between groups. The bias-corrected and accelerated bootstrap method was used to calculate 95% confidence intervals (CI). The COPD pathway patients had lower risks of moderate (hazard ratio [HR] =0.57, 95% CI [0.40-0.83]) and severe (HR = 0.43, 95% CI [0.28-0.66]) exacerbations compared to the historical control group, but similar risks compared with the contemporaneous control group. The COPD pathway patients experienced fewer episodes of exacerbations compared with the historical control group (mean difference = -0.30, 95% CI [-0.40, -0.20]) and the contemporaneous control group (mean difference = -0.12, 95% CI [-0.20, -0.03]). Average annual healthcare costs in Canadian dollars were marginally higher among patients in the COPD clinical pathway (mean = $10 549, standard deviation [SD] =$18 149) than those in the contemporaneous control group ($8841, SD = $17 120), but comparable to the historical control group ($10 677, SD = $21 201). The COPD pathway provides better outcomes at about the same costs when compared to the historical controls, but only slightly better outcomes and at a marginally higher cost when compared to the contemporaneous controls.
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Affiliation(s)
- John Paul Kuwornu
- Research Department, Saskatchewan Health Authority, Regina, SK, Canada
| | | | - Gary Groot
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Erika Penz
- Respirology, Critical Care & Sleep Medicine, The Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Elizabeth J Cooper
- Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | - Amy Reid
- Clinical Integration Unit, Saskatchewan Health Authority, Regina, SK, Canada
| | - Darcy D Marciniuk
- Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
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Bell J, Lim S, Mikami T, Bahk J, Argiro S, Steiger D. The impact on thirty day readmissions for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease admitted to an observation unit versus an inpatient medical unit: A retrospective observational study. Chron Respir Dis 2024; 21:14799731241242490. [PMID: 38545901 PMCID: PMC10981268 DOI: 10.1177/14799731241242490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/01/2023] [Accepted: 02/19/2024] [Indexed: 04/01/2024] Open
Abstract
OBJECTIVES We aimed to evaluate the utility of an Observation Unit (OU) in management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and to identify the clinical characteristics of patients readmitted within 30-days for AECOPD following index admission to the OU or inpatient floor from the OU. METHODS This is a retrospective observational study of patients admitted from January to December 2017 for AECOPD to an OU in an urban-based tertiary care hospital. Primary outcome was rate of 30-day readmission after admission for AECOPD for patients discharged from the OU versus inpatient service after failing OU management. Regression analyses were used to define risk factors. RESULTS 163 OU encounters from 92 unique patients were included. There was a lower readmission rate (33%) for patients converted from OU to inpatient care versus patients readmitted after direct discharge from the OU (44%). Patients with 30-day readmissions were more likely to be undomiciled, with history of congestive heart failure (CHF), pulmonary embolism (PE), or had previous admissions for AECOPD. Patients with >6 annual OU visits for AECOPD had higher rates of substance abuse, psychiatric diagnosis, and prior PE; when these patients were excluded, the 30-day readmission rate decreased to 13.5%. CONCLUSION Patients admitted for AECOPD with a history of PE, CHF, prior AECOPD admissions, and socioeconomic deprivation are at higher risk of readmission and should be prioritized for direct inpatient admission. Further prospective studies should be conducted to determine the clinical impact of this approach on readmission rates.
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Affiliation(s)
- Jacob Bell
- Department of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel Hospital, New York, NY, USA
- Department of Pulmonary and Critical Care Medicine, Mount Sinai West Hospital, New York, NY, USA
| | - Steven Lim
- Department of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel Hospital, New York, NY, USA
- Department of Pulmonary and Critical Care Medicine, Mount Sinai West Hospital, New York, NY, USA
| | - Takahisa Mikami
- Department of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel Hospital, New York, NY, USA
| | - Jeeyune Bahk
- Department of Internal Medicine, Mount Sinai West Hospital, New York, NY, USA
| | - Stephen Argiro
- Department of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel Hospital, New York, NY, USA
| | - David Steiger
- Department of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel Hospital, New York, NY, USA
- Department of Pulmonary and Critical Care Medicine, Mount Sinai West Hospital, New York, NY, USA
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Eekholm S, Samuelson K, Ahlström G, Lindhardt T. Development of an Implementation Strategy Tailored to Deliver Evidence-Based and Person-Centred Nursing Care for Patients with Community-Acquired Pneumonia: An Intervention Mapping Approach. Healthcare (Basel) 2023; 12:32. [PMID: 38200938 PMCID: PMC10779328 DOI: 10.3390/healthcare12010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Community-acquired pneumonia is a serious public health problem, and more so in older patients, leading to high morbidity and mortality. However, this problem can be reduced by optimising in-hospital nursing care. Accordingly, this study describes a systematic process of designing and developing a tailored theory- and research-based implementation strategy that supports registered nurses (RNs) in delivering evidence-based and person-centred care for this patient population in a hospital setting. The implementation strategy was developed by completing the six steps of the Intervention Mapping framework: (1) developing a logic model of the problem and (2) a logic model of change by defining performance and change objectives, (3) designing implementation strategy interventions by selecting theory-based change methods, (4) planning the interventions and producing materials through a co-design approach, (5) developing a structured plan for adoption, maintenance and implementation and (6) developing an evaluation plan. This method can serve as a guide to (1) target behavioural and environmental barriers hindering the delivery of nursing care in local clinical practice, (2) support evidence uptake, (3) support RNs in the delivery of nursing care according to individual patient needs and thereby (4) optimise health-related patient outcomes.
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Affiliation(s)
- Signe Eekholm
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
- Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 4, 2nd. Floor, DK-2900 Hellerup, Denmark;
| | - Karin Samuelson
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
| | - Tove Lindhardt
- Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 4, 2nd. Floor, DK-2900 Hellerup, Denmark;
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Urrutia-Royo B, Garcia-Olivé I, Compte M, Folgado C, Rosell A, Abad Capa J. Impact of Comorbidities in Clinical Outcomes in Patients Admitted for Exacerbation of Bronchiectasis. Arch Bronconeumol 2023; 59:762-764. [PMID: 37532645 DOI: 10.1016/j.arbres.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Blanca Urrutia-Royo
- Respiratory Department, Hospital de Mataró, Mataró, Spain; Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Respiratory Department, Hospital Universitari Germans Trias i Pujol (HUGTiP), Badalona, Spain
| | - Ignasi Garcia-Olivé
- Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Respiratory Department, Hospital Universitari Germans Trias i Pujol (HUGTiP), Badalona, Spain; The Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain.
| | - Marina Compte
- Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Carlos Folgado
- Respiratory Department, Hospital Universitario de Toledo, Toledo, Spain
| | - Antoni Rosell
- Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Respiratory Department, Hospital Universitari Germans Trias i Pujol (HUGTiP), Badalona, Spain; The Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Jorge Abad Capa
- Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Respiratory Department, Hospital Universitari Germans Trias i Pujol (HUGTiP), Badalona, Spain; The Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
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Nygård T, Wright D, Nazar H, Haavik S. Enhancing potential impact of hospital discharge interventions for patients with COPD: a qualitative systematic review. BMC Health Serv Res 2023; 23:684. [PMID: 37349764 DOI: 10.1186/s12913-023-09712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) are frequently readmitted to hospital resulting in avoidable healthcare costs. Many different interventions designed to reduce hospital readmissions are reported with limited evidence for effectiveness. Greater insight into how interventions could be better designed to improve patient outcomes has been recommended. AIM To identify areas for optimisation within previously reported interventions provided to reduce COPD rehospitalisation to improve future intervention development. METHODS A systematic review was conducted by searching Medline, Embase, CINAHL, PsycINFO, and CENTRAL in June 2022. Inclusion criteria were interventions provided to patients with COPD in the transition from hospital to home or community. Exclusion criteria were lack of empirical qualitative results, reviews, drug trials, and protocols. Study quality was assessed using the Critical Appraisal Skills Programme tool and results were synthesised thematically. RESULTS A total of 2,962 studies were screened and nine studies included. Patients with COPD experience difficulties when transitioning from hospital to home. It is therefore important for interventions to facilitate a smooth transition process and give appropriate follow-up post-discharge. Additionally, interventions should be tailored for each patient, especially regarding information provided. CONCLUSION Very few studies specifically consider processes underpinning COPD discharge intervention implementation. There is a need to recognise that the transition itself creates problems, which require addressing, before introducing any new intervention. Patients report a preference for interventions to be individually adapted-in particular the provision of patient information. Whilst many intervention aspects were well received, feasibility testing may have enhanced acceptability. Patient and public involvement may address many of these concerns and greater use of process evaluations should enable researchers to learn from each other's experiences. TRIAL REGISTRATION The review was registered in PROSPERO with registration number CRD42022339523.
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Affiliation(s)
- Torbjørn Nygård
- Department of Clinical Science, University of Bergen, P.O. box 7804, 5020, Bergen, Norway.
| | - David Wright
- School of Healthcare, University of Leicester, Leicester, UK
| | - Hamde Nazar
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK
| | - Svein Haavik
- Department of Clinical Science, University of Bergen, P.O. box 7804, 5020, Bergen, Norway
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General practice management of COPD patients following acute exacerbations: a qualitative study. Br J Gen Pract 2023; 73:e186-e195. [PMID: 36823067 PMCID: PMC9975965 DOI: 10.3399/bjgp.2022.0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/24/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Exacerbations are the strongest risk factor for future exacerbations for patients living with chronic obstructive pulmonary disease (COPD). The period immediately following exacerbation is a high-risk period for recurrence and hospital admission, and is a critical time to intervene. GPs are ideally positioned to deliver this care. AIM To explore perceptions of GPs regarding the care of patients following exacerbations of COPD and to identify factors affecting the provision of evidence-based care. DESIGN AND SETTING A descriptive qualitative study was undertaken involving semi-structured, in-depth interviews with Australian GPs who volunteered to participate following a national survey of general practice care for COPD patients following exacerbations. METHOD Interviews were conducted via the Zoom video conference platform, which were audio-recorded and transcribed verbatim. QSR NVivo was used to support data management, coding, and inductive thematic analysis. RESULTS Eighteen GPs completed interviews. Six key themes were identified: 1) GPs' perceptions and knowledge in the management of COPD patients following exacerbation and admission to hospital; 2) pharmacological management; 3) consultation time; 4) communication between healthcare professionals; 5) access to other health services; and 6) patient compliance. CONCLUSION Delivery of post-exacerbation care to COPD patients is affected by GPs, patients, and health service-related factors. The care of COPD patients may be further improved by supporting GPs to overcome identified barriers.
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Management of routine postoperative pain for children undergoing cardiac surgery: a Paediatric Acute Care Cardiology Collaborative Clinical Practice Guideline. Cardiol Young 2022; 32:1881-1893. [PMID: 36382361 DOI: 10.1017/s1047951122003559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pain following surgery for cardiac disease is ubiquitous, and optimal management is important. Despite this, there is large practice variation. To address this, the Paediatric Acute Care Cardiology Collaborative undertook the effort to create this clinical practice guideline. METHODS A panel of experts consisting of paediatric cardiologists, advanced practice practitioners, pharmacists, a paediatric cardiothoracic surgeon, and a paediatric cardiac anaesthesiologist was convened. The literature was searched for relevant articles and Collaborative sites submitted centre-specific protocols for postoperative pain management. Using the modified Delphi technique, recommendations were generated and put through iterative Delphi rounds to achieve consensus. RESULTS 60 recommendations achieved consensus and are included in this guideline. They address guideline use, pain assessment, general considerations, preoperative considerations, intraoperative considerations, regional anaesthesia, opioids, opioid-sparing, non-opioid medications, non-pharmaceutical pain management, and discharge considerations. CONCLUSIONS Postoperative pain among children following cardiac surgery is currently an area of significant practice variability despite a large body of literature and the presence of centre-specific protocols. Central to the recommendations included in this guideline is the concept that ideal pain management begins with preoperative counselling and continues through to patient discharge. Overall, the quality of evidence supporting recommendations is low. There is ongoing need for research in this area, particularly in paediatric populations.
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van der Feltz-Cornelis CM, Sweetman J, Allsopp G, Attree E, Crooks MG, Cuthbertson DJ, Forshaw D, Gabbay M, Green A, Heightman M, Hillman T, Hishmeh L, Khunti K, Lip GYH, Lorgelly P, Montgomery H, Strain WD, Wall E, Watkins C, Williams N, Wootton DG, Banerjee A. STIMULATE-ICP-Delphi (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways Delphi): Study protocol. PLoS One 2022; 17:e0277936. [PMID: 36449461 PMCID: PMC9710789 DOI: 10.1371/journal.pone.0277936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/17/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION As mortality rates from COVID-19 disease fall, the high prevalence of long-term sequelae (Long COVID) is becoming increasingly widespread, challenging healthcare systems globally. Traditional pathways of care for Long Term Conditions (LTCs) have tended to be managed by disease-specific specialties, an approach that has been ineffective in delivering care for patients with multi-morbidity. The multi-system nature of Long COVID and its impact on physical and psychological health demands a more effective model of holistic, integrated care. The evolution of integrated care systems (ICSs) in the UK presents an important opportunity to explore areas of mutual benefit to LTC, multi-morbidity and Long COVID care. There may be benefits in comparing and contrasting ICPs for Long COVID with ICPs for other LTCs. METHODS AND ANALYSIS This study aims to evaluate health services requirements for ICPs for Long COVID and their applicability to other LTCs including multi-morbidity and the overlap with medically not yet explained symptoms (MNYES). The study will follow a Delphi design and involve an expert panel of stakeholders including people with lived experience, as well as clinicians with expertise in Long COVID and other LTCs. Study processes will include expert panel and moderator panel meetings, surveys, and interviews. The Delphi process is part of the overall STIMULATE-ICP programme, aimed at improving integrated care for people with Long COVID. ETHICS AND DISSEMINATION Ethical approval for this Delphi study has been obtained (Research Governance Board of the University of York) as have approvals for the other STIMULATE-ICP studies. Study outcomes are likely to inform policy for ICPs across LTCs. Results will be disseminated through scientific publication, conference presentation and communications with patients and stakeholders involved in care of other LTCs and Long COVID. REGISTRATION Researchregistry: https://www.researchregistry.com/browse-the-registry#home/registrationdetails/6246bfeeeaaed6001f08dadc/.
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Affiliation(s)
- Christina M. van der Feltz-Cornelis
- Dept of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, (HYMS), University of York, York, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- * E-mail:
| | | | - Gail Allsopp
- Royal College of General Practitioners, London, United Kingdom
- National Institute of Health and Care Excellence, London, United Kingdom
| | | | - Michael G. Crooks
- Hull York Medical School, University of Hull, Hull, United Kingdom
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Daniel J. Cuthbertson
- Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Denise Forshaw
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom
| | - Mark Gabbay
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
- NIHR ARC NWC, Liverpool, United Kingdom
| | - Angela Green
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Melissa Heightman
- Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Toby Hillman
- Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- UCL Respiratory, University College London, London, United Kingdom
| | | | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Paula Lorgelly
- School of Population Health and Department of Economics, University of Auckland, Auckland, New Zealand
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Hugh Montgomery
- Department of Medicine, University College London, London, United Kingdom
| | - W. David Strain
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Emma Wall
- Francis Crick Institute, London, United Kingdom
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre and NIHR UCLH Clinical Research Facility, London, United Kingdom
| | - Caroline Watkins
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom
- Faculty of Health and Care, University of Central Lancashire, Preston, United Kingdom
| | - Nefyn Williams
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Dan G. Wootton
- Institute of Infection Veterinary and Ecological Sciences and NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
- Department of Cardiology, University College London Hospitals NHS Trust, London, United Kingdom
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Gong Y, Chen Q, Zhang Y. The Role of the Clinical Pharmacist on the Health Outcomes of Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD). Int J Chron Obstruct Pulmon Dis 2022; 17:1863-1870. [PMID: 35996393 PMCID: PMC9391938 DOI: 10.2147/copd.s370532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background Clinical pharmacists play a significant role in clinical practice, but their work in the clinical pathway (CP) of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) remains undefined. Methods This prospective study included patients who met the discharge criteria during hospitalization at the department of respiratory medicine of the Second Affiliated Hospital of Fujian Medical University from March to December 2017 (no pharmacists involved) and from March 2018 to January 2019 (pharmacists involved). The adverse drug reaction (ADR) reporting rate, the average DDD number of antibacterial drugs, the per capita cost of pharmaceutical services, and the benefit-cost ratio (B/C) were analyzed. Results and Discussion Eighty participants were enrolled during the traditional period and eighty-five participants during the clinical pharmacist period. The average hospital stays (9.2±0.4 vs 10.7±0.6 days, P=0.032), the total cost of hospitalization expenses (¥ 14,058±826 vs ¥ 18,765±1434, P=0.004), the total cost of drugs (¥ 5717±449 vs ¥ 8002±755, P=0.004), and cost of antimicrobial drugs (¥ 3639±379 vs ¥ 5636±641, P=0.007) were all lower in the clinical pharmacist group than in the traditional group. The B/C was 10.38 and 5.05 in the total cost of hospitalization expenses and the total cost of drugs, respectively. The clinical pharmacists’ participation was independently associated with the total cost of hospitalization expenses (β=−0.201, 95% confidence interval: −0.390, −0.055, P=0.010). What is New and Conclusion The participation of the clinical pharmacist in implementing an AECOPD CP significantly reduces patients’ hospitalization days, the total cost of hospitalization expenses, and antibiotic use and improves the B/C of AECOPD management. The clinical pharmacists’ participation was independently associated with the total hospitalization expenses.
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Affiliation(s)
- Yanqing Gong
- Department of Pharmacy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China.,Department of Pharmacy, Gaoxin Branch of the First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Qiying Chen
- Department of Pharmacy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China
| | - Yin Zhang
- Department of Pharmacy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China
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Vachon B, Giasson G, Gaboury I, Gaid D, Noël De Tilly V, Houle L, Bourbeau J, Pomey MP. Challenges and Strategies for Improving COPD Primary Care Services in Quebec: Results of the Experience of the COMPAS+ Quality Improvement Collaborative. Int J Chron Obstruct Pulmon Dis 2022; 17:259-272. [PMID: 35140460 PMCID: PMC8819163 DOI: 10.2147/copd.s341905] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/17/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Management of chronic obstructive pulmonary disease (COPD) remains a challenge in primary care and multiple barriers can limit implementation of COPD guidelines. Since 2016, a quality improvement (QI) collaborative, called COMPAS+, has been implemented across the province of Quebec (Canada) to support improvement of chronic disease management in primary care. The aim of this study was to describe the main COPD quality problems reported by participating teams and the strategies they proposed and implemented to improve COPD primary care services in Quebec. Methods Sixteen sites in four different regions of Quebec were engaged in the COMPAS+ intervention to improve primary care services delivered to people living with COPD. A total of 14 workshop reports, 31 QI action plans and 4 regional final reports underwent content analysis. Key COPD quality problems were first identified and, for each of them, root causes were classified according to the domains and constructs of the Consolidated Framework for Implementation Research. Proposed strategies were organized according to the intervention function types described in the Behavior Change Wheel. Results Four key COPD quality problems were identified: 1) lack of organization/coordination of COPD services, 2) lack of screening services coordination, 3) lack of interprofessional communication and collaboration and 4) lack of treatment adherence. Main root causes explaining these quality gaps were 1) lack of awareness of COPD, 2) lack of professional knowledge, 3) lack of definition of professional roles, 4) lack of resources and tools for COPD prevention, diagnosis, and follow-up, 5) lack of communication tools, 6) lack of integration of the patient-as-partner approach, and 7) lack of adaptation of patient education to their specific needs. Multiple strategies were proposed to improve healthcare professionals’ education and interprofessional collaboration and communication. Conclusion QI collaborative activities can support achieving understanding of QI challenges healthcare organizations face to improve COPD services.
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Affiliation(s)
- Brigitte Vachon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du CIUSSS de l’Est de Montréal, Montreal, Quebec, Canada
- Correspondence: Brigitte Vachon, School of Rehabilitation, Faculty of Medicine, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, Quebec, H3C 3J7, Canada, Tel +1 514 343-2094, Email
| | | | - Isabelle Gaboury
- Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Dina Gaid
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | | | - Lise Houle
- Institut national d’excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada
| | - Jean Bourbeau
- Center of Innovative Medicine, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marie-Pascale Pomey
- Public Health School, Department of Management, Evaluation and Health Policy, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de Centre hospitalier universitaire de l’Université de Montréal, Montreal, Quebec, Canada
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12
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Wirth IM, Penz ED, Marciniuk DD. Examination of COPD management in patients hospitalized with an acute exacerbation of COPD. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2022. [DOI: 10.1080/24745332.2020.1719941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Ingrid M. Wirth
- Division of Respirology, Critical Care, and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Erika D. Penz
- Division of Respirology, Critical Care, and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Respiratory Research Center, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Darcy D. Marciniuk
- Division of Respirology, Critical Care, and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Respiratory Research Center, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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13
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Brullo J, Rushton S, Brickner C, Madden-Baer R, Peng T. Using Root Cause Analysis to Inform a Falls Practice Change in the Home Care Setting. Home Healthc Now 2022; 40:40-48. [PMID: 34994719 DOI: 10.1097/nhh.0000000000001036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Falls are a significant health problem in community-dwelling older adults, resulting in injuries, deaths, and increased healthcare costs. Falls were a quality concern for a Northeastern home care agency and this project aimed to evaluate the falls prevention process for older adults receiving home care services by determining potential root causes of falls and to identify a practice change. This quality improvement project used a root cause analysis methodology with a retrospective matched case-control design. Records of patients with falls were assessed for falls prevention process fidelity and compared with patients without a fall matched on the Missouri Alliance for Home Care-10 (MAHC-10) assessment, examining plan of care accuracy and patient fall risk factors. Findings indicated fidelity concerns in the fall prevention process, with gaps in care planning aligned with identified risk factors. Interventions to mitigate identified MAHC-10 risk factors on care plans were present less than 50% of the time for four of the six factors. Polypharmacy (7.46%) and pain affecting function (9.21%) were most frequently unaddressed risk factors in the care plan. Recommendations included implementation of a falls prevention pathway, including standardized falls risk assessment, universal falls precautions in the care plan with tailored interventions based on risk factors, and referral initiation when necessary.
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14
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Heightman M, Prashar J, Hillman TE, Marks M, Livingston R, Ridsdale HA, Bell R, Zandi M, McNamara P, Chauhan A, Denneny E, Astin R, Purcell H, Attree E, Hishmeh L, Prescott G, Evans R, Mehta P, Brennan E, Brown JS, Porter J, Logan S, Wall E, Dehbi HM, Cone S, Banerjee A. Post-COVID-19 assessment in a specialist clinical service: a 12-month, single-centre, prospective study in 1325 individuals. BMJ Open Respir Res 2021; 8:8/1/e001041. [PMID: 34764200 PMCID: PMC8587466 DOI: 10.1136/bmjresp-2021-001041] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/29/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Post-COVID-19 complications require simultaneous characterisation and management to plan policy and health system responses. We describe the 12-month experience of the first UK dedicated post-COVID-19 clinical service to include hospitalised and non-hospitalised patients. Methods In a single-centre, observational analysis, we report the demographics, symptoms, comorbidities, investigations, treatments, functional recovery, specialist referral and rehabilitation of 1325 individuals assessed at the University College London Hospitals post-COVID-19 service between April 2020 and April 2021, comparing by referral route: posthospitalised (PH), non-hospitalised (NH) and post emergency department (PED). Symptoms associated with poor recovery or inability to return to work full time were assessed using multivariable logistic regression. Results 1325 individuals were assessed (PH: 547, 41.3%; PED: 212, 16%; NH: 566, 42.7%). Compared with the PH and PED groups, the NH group were younger (median 44.6 (35.6–52.8) years vs 58.3 (47.0–67.7) years and 48.5 (39.4–55.7) years), more likely to be female (68.2%, 43.0% and 59.9%), less likely to be of ethnic minority (30.9%, 52.7% and 41.0%) or seen later after symptom onset (median (IQR): 194 (118–298) days, 69 (51–111) days and 76 (55–128) days; all p<0.0001). All groups had similar rates of onward specialist referral (NH 18.7%, PH 16.1% and PED 18.9%, p=0.452) and were more likely to require support for breathlessness (23.7%, 5.5% and 15.1%, p<0.001) and fatigue (17.8%, 4.8% and 8.0%, p<0.001). Hospitalised patients had higher rates of pulmonary emboli, persistent lung interstitial abnormalities and other organ impairment. 716 (54.0%) individuals reported <75% optimal health (median 70%, IQR 55%–85%). Less than half of employed individuals could return to work full time at first assessment. Conclusion Post-COVID-19 symptoms were significant in PH and NH patients, with significant ongoing healthcare needs and utilisation. Trials of interventions and patient-centred pathways for diagnostic and treatment approaches are urgently required.
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Affiliation(s)
- Melissa Heightman
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Jai Prashar
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Toby E Hillman
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Michael Marks
- University College London Hospitals NHS Foundation Trust, London, UK.,Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Robert Bell
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Michael Zandi
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Patricia McNamara
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Alisha Chauhan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Emma Denneny
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Ronan Astin
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Helen Purcell
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Rebecca Evans
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Puja Mehta
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Ewen Brennan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Jeremy S Brown
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Joanna Porter
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Sarah Logan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Emma Wall
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK.,Francis Crick Institute, London, UK
| | | | - Stephen Cone
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Amitava Banerjee
- University College London Hospitals NHS Foundation Trust, London, UK .,University College London, London, UK.,Barts Health NHS Trust, London, UK
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15
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Nguyen TA, Pham YN, Doan NP, Nguyen TH, Do TT, Van Vu G, Marks GB, McKinn S, Negin J, Bernays S, Fox GJ. Factors affecting healthcare pathways for chronic lung disease management in Vietnam: a qualitative study on patients' perspectives. BMC Public Health 2021; 21:1145. [PMID: 34130687 PMCID: PMC8207672 DOI: 10.1186/s12889-021-11219-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and asthma rank among the leading causes of respiratory morbidity, particularly in low- and middle-income countries. This qualitative study aimed to explore the healthcare pathways of patients with chronic respiratory disease, and factors influencing their ability to access healthcare in Vietnam, where COPD and asthma are prevalent. METHODS We conducted 41 in-depth interviews among patients, including 31 people with COPD, eight with asthma and two with asthma-COPD overlap syndrome. Participants were recruited at provincial- or national-level health facilities in two urban and two rural provinces in Vietnam. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. RESULTS Patients' healthcare pathways were complex and involved visits to multiple health facilities before finally obtaining a definitive diagnosis at a provincial- or national-level hospital. Access to healthcare was affected considerably by participants' limited knowledge of their respiratory conditions, the availability of social support, especially from family members, the costs of healthcare as well as health system factors (including the coverage of public health insurance, the distance to health facilities, and attitude of healthcare providers). CONCLUSION The study demonstrated the need for improved access to timely diagnosis and treatment of chronic lung disease within the lower level of the health system. This can be achieved by enhancing the communication skills and diagnostic capacity of local healthcare workers. Health education programmes for patients and caregivers will contribute to improved control of lung disease.
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Affiliation(s)
- Thu-Anh Nguyen
- Woolcock Institute of Medical Research, 298 Kim Ma, Ba Dinh, Hanoi, Vietnam. .,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Yen Ngoc Pham
- Woolcock Institute of Medical Research, 298 Kim Ma, Ba Dinh, Hanoi, Vietnam
| | - Nhung Phuong Doan
- Woolcock Institute of Medical Research, 298 Kim Ma, Ba Dinh, Hanoi, Vietnam
| | - Thao Huong Nguyen
- Woolcock Institute of Medical Research, 298 Kim Ma, Ba Dinh, Hanoi, Vietnam
| | - Toan Thanh Do
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | | | - Guy B Marks
- Australia South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Shannon McKinn
- School of Public Health, University of Sydney, Sydney, Australia
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
| | - Sarah Bernays
- School of Public Health, University of Sydney, Sydney, Australia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Greg J Fox
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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