Evaluation of a personal protective equipment support programme for staff during the COVID-19 pandemic in London

BACKGROUND

The coronavirus disease 2019 pandemic has presented an enormous challenge to healthcare providers worldwide. The appropriate use of personal protective equipment (PPE) has been essential to ensure staff and patient safety. The 'PPE Helper Programme' was developed at a large London hospital group to counteract suboptimal PPE practice. Based on a behaviour change model of capability, opportunity and motivation (COM-B), the programme provided PPE support, advice and education to ward staff.

AIM

Evaluation of the PPE Helper Programme.

METHODS

Clinical and non-clinical ward staff completed a questionnaire informed by the Theoretical Domains Framework and COM-B model. The questionnaire was available in paper and electronic versions. Quantitative responses were analysed using descriptive and non-parametric statistics, and free-text responses were analysed thematically.

FINDINGS

Over a 6-week period, PPE helpers made 268 ward visits. Overall, 261 questionnaires were available for analysis. Across the Trust, 68% of respondents reported having had contact with a PPE helper. Staff who had encountered a PPE helper responded significantly more positively to a range of statements about using PPE than staff who had not encountered a PPE helper. Black and minority ethnic staff were significantly more anxious regarding the adequacy of PPE. Non-clinical and redeployed staff (e.g. domestic staff) were most positive about the impact of PPE helpers. Free-text comments showed that staff found the PPE Helper Programme supportive and would have liked it earlier in the pandemic.

CONCLUSION

The PPE Helper Programme is a feasible and beneficial intervention for providing support, advice and education to ward staff during infectious disease outbreaks.

Investigating an outbreak of Clostridium perfringens gastroenteritis in a school using smartphone technology, London, March 2013

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P4-11-19: Healthcare Resource Utilization among Breast Cancer Patients with Bone Metastases and Skeletal-Related Events: A Population-Based Cohort Study in Denmark (1997 - 2009)

Background

The healthcare resource utilization (HRU) of breast cancer patients who develop bone metastases and skeletal-related events (SREs) has not been well-characterized. Our objective was to describe the HRU associated with SREs in a large population-based cohort of Danish breast cancer patients with bone metastases and one or more SRE.

Methods: We identified women diagnosed with incident breast cancer from January 1, 1997 through December 31, 2006 using the Danish Cancer Registry. We followed this cohort of patients for development of subsequent bone metastases and SREs identified through the Danish National Registry of Patients through December 31, 2009. SREs were defined as pathologic fracture, spinal cord compression, and radiation or surgery to bone. Among patients with only one SRE, the HRU period, composed of all HRU occurring within a 90-day period after the SRE and within a two-week diagnostic period prior to the SRE, was assessed. For patients with multiple SREs (each one separated by less than 90 days), the HRU period, composed of all HRU occurring within a two-week diagnostic period prior to the first SRE up until 90 days after the last SRE, was described. Patients may have had multiple HRU periods if SREs were separated by more than 90 days. The HRU summarized included number of inpatient hospitalizations, length of hospitalization stay, outpatient physician visits, emergency room visits, and procedures.

Results: We identified 1,148 patients with bone metastases and SREs among 38,485 breast cancer patients. The mean age at breast cancer diagnosis for those who developed bone metastases and SREs was 59 years (SD, 13 years) and the majority (72%) of patients had multiple SREs during the first HRU period. Approximately 20% to 30% of patients with single and multiple SREs, respectively, died within the first HRU period. Overall, length of hospitalization was longest for patients with spinal cord compression followed by patients with pathologic fracture. In general, patients with multiple SREs had higher HRU compared to those with a single SRE in the first HRU period, particularly in length of hospitalization stay.

Conclusion: SREs secondary to bone metastases are serious events. In Denmark, high HRU was observed in all patients with SREs, but especially in those with multiple SREs, where increased lengths of hospitalization were observed.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-19.

Abstract P1-13-06: Health Resource Utilization Associated with Skeletal-Related Events in Patients with Bone Metastases: Interim Analysis Results from the US Breast Cancer Cohort of a Multinational Observational Study

Background: Bone metastases are common in women with advanced breast cancer and are frequently associated with skeletal-related events (SREs). The burden of individual SRE types on health resource utilization (HRU) indicators in breast cancer has been only minimally described. Methods: The aim of this ongoing observational, prospective, multinational study is to assess, by tumor type, the amount of HRU associated with different SRE types including pathologic fracture, surgery or radiation to bone, and spinal cord compression. Patients with breast, prostate, or lung cancer and bone metastases or multiple myeloma were enrolled after experiencing a SRE. Inpatient hospitalizations, length of stay, outpatient visits, emergency room visits, nursing home/long-term care facility stays, home health visits, procedures, and medications were collected for the period 90 days prior to enrollment and prospectively to a maximum of 18 months. Each patient could contribute multiple SREs. The investigator determined which HRU were attributed to each SRE. This abstract describes interim analysis data from the US breast cancer cohort; final analysis data will be available 9/2010.

Results: As of 12/1/2009, 67 patients contributed 119 SREs for the HRU analyses across 25 US sites. Patient mean [SD] age was 61 [12] years, all patients were female, and 27% discontinued the study (most due to death). Mean duration of follow-up was 9.9 months. HRU for each of the SRE types are shown in the table.

Table. Mean and median number of HRU per SRE during the study period by SRE type in patients with breast cancer

Conclusion: In this interim analysis of advanced breast cancer patients in the US, SREs are associated with considerable HRU, with the nature and extent of HRU varying depending on the SRE type.

The quest for an accurate accounting of public health expenditures

This article describes one effort to develop management tools that will help public health administrators and policy makers implement comprehensive public health strategies. It recounts the ongoing development of a methodology through which the Essential Public Health Services can be related to public health budgets, appropriations, and expenditures. Through three pilot projects involving: (1) nine state health agencies, (2) three local health agencies, and (3) all local jurisdictions and the state health agency in one state, a workable methodology for identifying public expenditures for comprehensive public health programming has been identified.