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Ullman AJ, Larsen E, Gibson V, Binnewies S, Ohira R, Marsh N, Mcbride C, Winterbourn K, Boyte F, Cunninghame J, Dufficy M, Plummer K, Roberts N, Takashima M, Cooke M, Byrnes J, Rickard CM, Kleidon TM. An mHealth application for chronic vascular access: A multi-method evaluation. J Clin Nurs 2024; 33:1762-1776. [PMID: 38413831 DOI: 10.1111/jocn.17034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 12/13/2023] [Accepted: 01/07/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Healthcare consumers require diverse resources to assist their navigation of complex healthcare interactions, however, these resources need to be fit for purpose. AIM In this study, we evaluated the utility, usability and feasibility of children, families and adults requiring long-term intravenous therapy using a recently developed mobile health application (App), intravenous (IV) Passport. DESIGN Multi-site, parallel, multi-method, prospective cohort study. METHODS A multi-site, multi-method study was carried out in 2020-2021, with 46 participants (20 adults, 26 children/family) reporting on their experiences surrounding the use of the IV Passport for up to 6 months. RESULTS Overall, utility rates were acceptable, with 78.3% (N = 36) using the IV Passport over the follow-up period, with high rates of planned future use for those still active in the project (N = 21; 73%), especially in the child/family cohort (N = 13; 100%). Acceptability rates were high (9/10; IQR 6.5-10), with the IV Passport primarily used for documenting new devices and complications. Thematic analysis revealed three main themes (and multiple subthemes) in the qualitative data: Advocacy for healthcare needs, Complexity of healthcare and App design and functionality. CONCLUSION Several recommendations were made to improve the end-user experience including 'how to' instructions; and scheduling functionality for routine care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The IV Passport can be safely and appropriately integrated into healthcare, to support consumers. IMPACT Patient-/parent-reported feedback suggests the Intravenous Passport is a useful tool for record-keeping, and positive communication between patients/parents, and clinicians. REPORTING METHOD Not applicable. PATIENT CONTRIBUTION Consumers reported their experiences surrounding the use of the IV Passport for up to 6 months.
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Affiliation(s)
- Amanda J Ullman
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Emily Larsen
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Sebastian Binnewies
- School of Information and Communication Technology, Griffith University, Gold Coast, Queensland, Australia
| | - Ryoma Ohira
- School of Information and Communication Technology, Griffith University, Gold Coast, Queensland, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Craig Mcbride
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Karen Winterbourn
- Parenteral Nutrition Down Under, Randwick, New South Wales, Australia
| | - Francesca Boyte
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jacqueline Cunninghame
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Mitchell Dufficy
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Karin Plummer
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Natasha Roberts
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Metro North Health Service, Herston, Queensland, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Metro North Health Service, Herston, Queensland, Australia
| | - Tricia M Kleidon
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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Brandenburg C, Thomas SD, Lincoln C, Somerville A, Heffernan E, Kinner SA, Byrnes J, Gardiner P, Davidson P, Daley N, Green D, Crilly J. Supporting equitable care of patients transferred from police watch-houses to the emergency department: A qualitative study of the perspectives of emergency doctors. Emerg Med Australas 2024. [PMID: 38650377 DOI: 10.1111/1742-6723.14408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/05/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE People detained in short-term police custody often have complex health conditions that may necessitate emergency care, yet little is known about their management in EDs. The present study aimed to understand ED doctors' experiences and perceptions regarding the appropriateness and management of detainee transfers from police watch-houses to the EDs. METHODS A qualitative descriptive study, using semi-structured interviews undertaken with ED doctors working in five purposively sampled EDs across Queensland, Australia. Data were analysed using inductive content analysis. RESULTS Fifteen ED specialists and trainees participated. Participants reported that their overarching approach was to provide equitable care for watch-house detainees, as they would for any patient. This equitable approach needed to be responsive to complicating factors common to this population, including presence of police guards; restraints; complexity (physical/mental/social) of presentation; reliance on police to transport; ED doctors' often limited understanding of the watch-house environment; justice processes and uncertain legal disposition; communication with the watch-house; and detainees misreporting symptoms. Thresholds for assessment and treatment of detainees were contextualised to the needs of the patient, ED environment, and imperatives of other relevant agencies (e.g. police). Participants often relied on existing strategies to deliver quality care despite challenges, but also identified a need for additional strategies, including education for ED staff; improved communication with watch-houses; standardised paperwork; extended models of watch-house healthcare; and integrated medical records. CONCLUSIONS Providing equitable healthcare to patients transported from watch-houses to the EDs is challenging but essential. Numerous opportunities exist to enhance the delivery of optimal care for this underserved population.
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Affiliation(s)
- Caitlin Brandenburg
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Stuart Dm Thomas
- Social and Global Studies Centre, RMIT University, Melbourne, Victoria, Australia
| | - Cathy Lincoln
- Forensic Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Annabel Somerville
- Forensic Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Department of Emergency Medicine, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Ed Heffernan
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Forensic Mental Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Stuart A Kinner
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Justice Health Group, Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Justice Health Group, Curtin University, Perth, Western Australia, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Paul Gardiner
- Cairns Watch-House, Far North District, Queensland Police Service, Cairns, Queensland, Australia
| | - Peter Davidson
- Division of Infectious Disease & Global Public Health, Department of Medicine, University of California, San Diego, California, USA
| | - Nathan Daley
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - David Green
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Centre for Mental Health, Griffith University, Gold Coast, Queensland, Australia
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Roberts S, Marshall AP, Bromiley L, Hopper Z, Byrnes J, Ball L, Collins PF, Kelly J. Patient-Led, Technology-Assisted Malnutrition Risk Screening in Hospital: A Feasibility Study. Nutrients 2024; 16:1139. [PMID: 38674830 DOI: 10.3390/nu16081139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Malnutrition risk screening is crucial to identify at-risk patients in hospitals; however, screening rates can be suboptimal. This study evaluated the feasibility, acceptability, and potential cost-effectiveness of patient-led, technology-assisted malnutrition risk screening. A prospective multi-methods study was conducted in a 750-bed public hospital in Australia. Patients were recruited from seven wards and asked to complete an electronic version of the Malnutrition Screening Tool (e-MST) on bedside computer screens. Data were collected on feasibility, acceptability, and cost. Feasibility data were compared to pre-determined criteria on recruitment (≥50% recruitment rate) and e-MST completion (≥75% completion rate). Quantitative acceptability (survey) data were analyzed descriptively. Patient interview data were analyzed thematically. The economic evaluation was from the perspective of the health service using a decision tree analytic model. Both feasibility criteria were met; the recruitment rate was 78% and all 121 participants (52% male, median age 59 [IQR 48-69] years) completed the e-MST. Patient acceptability was high. Patient-led e-MST was modeled to save $3.23 AUD per patient and yield 6.5 more true malnutrition cases (per 121 patients) with an incremental cost saving per additional malnutrition case of 0.50 AUD. Patient-led, technology-assisted malnutrition risk screening was found to be feasible, acceptable to patients, and cost-effective (higher malnutrition yield and less costly) compared to current practice at this hospital.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Southport, QLD 4222, Australia
- Allied Health Research, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Southport, QLD 4222, Australia
- Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Leisa Bromiley
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Zane Hopper
- School of Health Sciences and Social Work, Griffith University, Southport, QLD 4222, Australia
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD 4222, Australia
| | - Lauren Ball
- Centre for Community Health and Wellbeing, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Peter F Collins
- Faculty of Medicine and Health, Sydney Nursing School/Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Jaimon Kelly
- Centre for Online Health, The University of Queensland, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Woolloongabba, QLD 4102, Australia
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Charters B, Foster K, Lawton B, Lee L, Byrnes J, Mihala G, Cassidy C, Schults J, Kleidon TM, McCaffery R, Van K, Funk V, Ullman A. Novel Peripheral Intravenous Catheter Securement for Children and Catheter Failure Reduction: A Randomized Clinical Trial. JAMA Pediatr 2024:2817131. [PMID: 38558161 PMCID: PMC10985620 DOI: 10.1001/jamapediatrics.2024.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/28/2023] [Indexed: 04/04/2024]
Abstract
Importance Peripheral intravenous catheters (PIVCs) facilitate essential treatment. Failure of these essential devices is frequent and new securement strategies may reduce failure and improve patient outcomes. Objective To evaluate clinical effectiveness of novel PIVC securement technologies for children to reduce catheter failure. Design, Setting, and Participants A 3-arm, parallel group, superiority randomized clinical trial was conducted at 2 regional Australian hospitals from February 5, 2020, to January 14, 2022. Children aged 6 months to 8 years who were anticipated to require admission with a PIVC for at least 24 hours of in hospital treatment were eligible. Data were analyzed from May 25, 2022, to February 20, 2024. Interventions Participants were randomly allocated in a 1:1:1 ratio to standard care, bordered polyurethane (Tegaderm [3M]), integrated securement dressing (SorbaView SHIELD [Medline]), and integrated securement dressing with tissue adhesive (Secureport IV). One catheter was studied per patient. Main Outcomes and Measures Primary outcome was PIVC failure, defined as premature cessation of PIVC function for any reason prior to completion of planned treatment. Secondary outcomes were PIVC complications (any time dislodgement, occlusion, infiltration, partial dislodgement, extravasation, device leaking, phlebitis, pain), PIVC longevity, intervention acceptability (clinicians, participants, caregivers; 0-10 scale), and pain on removal (participants and caregivers; 0-10 scale relevant to age), adverse events, and health care costs. Results A total of 383 patients (51% female; median age 36 [25th-75th percentiles, 22-72] months) were randomized 134 to standard care, 118 to integrated securement dressing, and 131 to integrated securement dressing with tissue adhesive. PIVC failure was lowest in integrated securement dressing with tissue adhesive (15 [12%]; adjusted hazard ratio [aHR], 0.47; 95% CI, 0.26-0.84) compared with integrated securement dressing (24 [21%]; aHR, 0.78; 95% CI, 0.47-1.28) and standard care (43 [34%]). Direct costs were significantly lower for integrated securement dressing with tissue adhesive (median, Australian dollars [A$], 312 [A$1 is equal to $0.65 US dollars]; IQR, A$302-A$380) and integrated securement dressing (median, A$303; IQR, A$294-A$465) compared with standard care (median, A$341; IQR, A$297-A$592; P ≤ .002) when considering the economic burden related to failure of devices. PIVC longevity and intervention acceptability were similar across all groups. Conclusions and Relevance In this study, PIVCs secured with integrated securement dressings and tissue adhesive, in comparison with standard care, bordered polyurethane dressings, were associated with significantly reduced PIVC failure, for children admitted to hospital via the emergency department. Further research should focus on implementation in inpatient units where prolonged dwell and reliable intravenous access is most needed. Trial Registration Australian New Zealand Clinical Trials Registry Identifier: ACTRN12619001026112.
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Affiliation(s)
- Brooke Charters
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
- Gold Coast Health, Gold Coast University Hospital, Southport, Queensland, Australia
- University of Southern Queensland, School of Nursing and Midwifery, Ipswich, Queensland, Australia
| | - Kelly Foster
- University of Southern Queensland, School of Nursing and Midwifery, Ipswich, Queensland, Australia
| | - Benjamin Lawton
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
| | - Leonard Lee
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Gabor Mihala
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Corey Cassidy
- West Moreton Hospital and Health Service, Ipswich Hospital, Ipswich, Queensland, Australia
- North West Regional Hospital, Cooee, Tasmania, Australia
| | - Jessica Schults
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Metro North Hospital and Health Service, Herston Infectious Disease Institute, Brisbane, Queensland, Australia
| | - Tricia M. Kleidon
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Ruth McCaffery
- West Moreton Hospital and Health Service, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Kristy Van
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
| | - Vanessa Funk
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
- Central West Hospital and Health Service, Glasson House, Longreach, Queensland, Australia
| | - Amanda Ullman
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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Brandenburg C, Ward EC, Schwarz M, Palmer M, Hartley C, Byrnes J, Coccetti A, Phillips R, Wishart LR. 'The big value of it is getting the patient seen by the right person at the right time': clinician perceptions of the value of allied health primary contact models of care. Int J Qual Health Care 2024; 36:mzae021. [PMID: 38442741 DOI: 10.1093/intqhc/mzae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/18/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Allied health primary contact clinic models of care have increasingly been used as a strategy to increase public health service capacity. A recent systematic review found little consistency or agreement on how primary contact clinics are evaluated. The concept of value of primary contact clinics, which has important implications for evaluation, has not yet been explored in-depth. To explore allied health clinicians' perceptions of the value of allied health primary contact clinics, with the goal of informing an evaluation framework, a descriptive qualitative approach utilizing semi-structured interviews was employed. Participants included allied health staff embedded in clinical lead roles within primary contact clinics across four acute care hospitals in a metropolitan health service located in South-East Queensland, Australia. Lead staff from 30 identified primary contact clinic models in the health service were approached to take part via email. All eligible participants who provided consent were included. An inductive thematic analysis approach was used. A total of 23 clinicians (n = 23) representing 22 diverse models of primary contact clinics participated. Most participants were physiotherapists, dietitians, or occupational therapists, although speech pathology, audiology, and podiatry were also represented. Participant perceptions of the 'value' of PCCs were a highly complex phenomenon, comprising five intersecting domains: (i) patient satisfaction; (ii) clinical outcomes; (iii) care pathway and resource use; (iv) health service performance; and (v) staff satisfaction and professional standing. These five core value domains were positively or negatively influenced by 12 perceived benefits and 8 perceived drawbacks, respectively. Value domains were also highly interrelated and impacted upon each other. The concept of 'value' relating to primary contact clinics involves multiple intersecting domains encompassing different perspectives. This study highlighted potential benefits and drawbacks of primary contact clinics that have not yet been measured or explored in the literature, and as such may be useful for healthcare administrators to consider. The findings of this study will inform an evaluation framework including health economics calculator for primary contact clinics.
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Affiliation(s)
- Caitlin Brandenburg
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Fred Schonell Drive, Brisbane, Queensland 4072 Australia
| | - Maria Schwarz
- Allied Health, Metro South Health, Cnr Armstrong and Loganlea Roads Brisbane, Queensland 4131 Australia
| | - Michelle Palmer
- Nutrition and Dietetics, Logan Hospital, Metro South Health, Cnr Armstrong and Loganlea Roads, Brisbane, Queensland 4131, Australia
| | - Carina Hartley
- Occupational Therapy, Logan Hospital, Metro South Health, Cnr Armstrong and Loganlea Roads, Brisbane, Queensland 4131, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, 1 Parklands Dr, Gold Coast, Queensland 4215, Australia
| | - Anne Coccetti
- Metro South Health, QEII Jubilee Hospital, Cnr Kessels and Troughton Roads, Brisbane, Queensland 4108, Australia
| | - Rachel Phillips
- Metro South Health, Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Laurelie R Wishart
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Fred Schonell Drive, Brisbane, Queensland 4072 Australia
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Ullman AJ, Gibson V, Kleidon TM, Binnewies S, Ohira R, Marsh N, McBride C, Winterbourn K, Boyte F, Cunninghame J, Roberts N, Xu GH, Takashima M, Cooke M, Rickard CM, Byrnes J, Larsen E. An mHealth application for chronic vascular access: Consumer led co-creation. J Pediatr Nurs 2024; 76:68-75. [PMID: 38364591 DOI: 10.1016/j.pedn.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Children with chronic and complex health conditions frequently need intravenous devices. The current approach to intravenous device selection, insertion, and monitoring is inconsistent, and healthcare consumers are often negatively affected by siloed health information, and poor future planning. Despite child- and family-centred care being recognised as a pillar of paediatric nursing care, limited implementation for vascular access device planning and management is evident. DESIGN AND METHODS To address this, we conducted a multi-phased approach to co-create, then evaluate, a mobile health (mHealth) application: IV Passport. Co-creation involved a prioritisation survey, followed by a Passport advisory panel consensus meeting. Following confirmation of the required content and features of the Passport, the mHealth application was designed and content validation achieved via survey. RESULTS The prioritisation survey yielded recommendations for seven features (e.g., graphical presentations of current/past devices). Content for nine device types (e.g., totally implanted ports) was suggested, each with 10 related items (e.g., insertion site). Content items for device-associated complications, future vascular access plans, and educational resources were also suggested. Following design, the application was released through Apple and Android platforms; and adapted to a paper version. Content validation was established; 100% strongly agreed the application was easy to use; 80% agreed/strongly agreed that they would recommend the Passport to others. CONCLUSION IV Passport embodies effective child- and family-centred care through consumer co-creation to empower patients and families manage vascular access devices. PRACTICE IMPLICATIONS IV Passport remains active; and can be utilised across many healthcare settings and patient populations.
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Affiliation(s)
- Amanda J Ullman
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia.
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Tricia M Kleidon
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Sebastian Binnewies
- School of Information and Communication Technology, Griffith University, Gold Coast, QLD, Australia
| | - Ryoma Ohira
- School of Information and Communication Technology, Griffith University, Gold Coast, QLD, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - Craig McBride
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | | | - Francesca Boyte
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Jacqueline Cunninghame
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Natasha Roberts
- Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Grace Hui Xu
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Herston Infectious Disease Institute, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
| | - Emily Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
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Pu L, Coppieters MW, Smalbrugge M, Jones C, Byrnes J, Todorovic M, Moyle W. Associations between facial expressions and observational pain in residents with dementia and chronic pain. J Adv Nurs 2024. [PMID: 38334268 DOI: 10.1111/jan.16063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 12/13/2023] [Accepted: 01/07/2024] [Indexed: 02/10/2024]
Abstract
AIM To identify specific facial expressions associated with pain behaviors using the PainChek application in residents with dementia. DESIGN This is a secondary analysis from a study exploring the feasibility of PainChek to evaluate the effectiveness of a social robot (PARO) intervention on pain for residents with dementia from June to November 2021. METHODS Participants experienced PARO individually five days per week for 15 min (once or twice) per day for three consecutive weeks. The PainChek app assessed each resident's pain levels before and after each session. The association between nine facial expressions and the adjusted PainChek scores was analyzed using a linear mixed model. RESULTS A total of 1820 assessments were completed with 46 residents. Six facial expressions were significantly associated with a higher adjusted PainChek score. Horizontal mouth stretch showed the strongest association with the score, followed by brow lowering parting lips, wrinkling of the nose, raising of the upper lip and closing eyes. However, the presence of cheek raising, tightening of eyelids and pulling at the corner lip were not significantly associated with the score. Limitations of using the PainChek app were identified. CONCLUSION Six specific facial expressions were associated with observational pain scores in residents with dementia. Results indicate that automated real-time facial analysis is a promising approach to assessing pain in people with dementia. However, it requires further validation by human observers before it can be used for decision-making in clinical practice. IMPACT Pain is common in people with dementia, while assessing pain is challenging in this group. This study generated new evidence of facial expressions of pain in residents with dementia. Results will inform the development of valid artificial intelligence-based algorithms that will support healthcare professionals in identifying pain in people with dementia in clinical situations. REPORTING METHOD The study adheres to the CONSORT reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION One resident with dementia and two family members of people with dementia were consulted and involved in the study design, where they provided advice on the protocol, information sheets and consent forms, and offered valuable insights to ensure research quality and relevance. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry number (ACTRN12621000837820).
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Affiliation(s)
- Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Queensland, Australia
- Amsterdam Movement Sciences - Program Musculoskeletal Health, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Michael Todorovic
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Larsen EN, Marsh N, Rickard CM, Mihala G, Walker RM, Byrnes J. Health-related quality of life and experience measures, to assess patients' experiences of peripheral intravenous catheters: a secondary data analysis. Health Qual Life Outcomes 2024; 22:1. [PMID: 38167165 PMCID: PMC10762939 DOI: 10.1186/s12955-023-02217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are essential for successful administration of intravenous treatments. However, insertion failure and PIVC complications are common and negatively impact patients' health-outcomes and experiences. We aimed to assess whether generic (not condition-specific) quality of life and experience measures were suitable for assessing outcomes and experiences of patients with PIVCs. METHODS We undertook a secondary analysis of data collected on three existing instruments within a large randomised controlled trial, conducted at two adult tertiary hospitals in Queensland, Australia. Instruments included the EuroQol Five Dimension - Five Level (EQ5D-5L), the Functional Assessment of Chronic Illness Therapy - Treatment Satisfaction - General measure (FACIT-TS-G, eight items), and the Australian Hospital Patient Experience Question Set (AHPEQS, 12 items). Responses were compared against two clinical PIVC outcomes of interest: all-cause failure and multiple insertion attempts. Classic descriptives were reported for ceiling and floor effects. Regression analyses examined validity (discrimination). Standardised response mean and effect size (ES) assessed responsiveness (EQ5D-5L, only). RESULTS In total, 685 participants completed the EQ5D-5L at insertion and 526 at removal. The FACIT-TS-G was completed by 264 and the AHPEQS by 262 participants. Two FACIT-TS-G items and one AHPEQS item demonstrated ceiling effect. Instruments overall demonstrated poor discrimination, however, all-cause PIVC failure was significantly associated with several individual items in the instruments (e.g., AHPEQS, 'unexpected physical and emotional harm'). EQ5D-5L demonstrated trivial (ES < 0.20) responsiveness. CONCLUSIONS Initial investigation of an existing health-related quality of life measure (EQ5D-5L) and two patient-reported experience measures (FACIT-TS-G; AHPEQS) suggest they are inadequate (as a summary measure) to assess outcomes and experiences for patients with PIVCs. Reliable instruments are urgently needed to inform quality improvement and benchmark standards of care.
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Affiliation(s)
- Emily N Larsen
- School of Nursing and Midwifery, Griffith University, Nathan, Australia.
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Building 34, Corner Bowen Bridge Rd and Butterfield St, Herston, QLD, 4029, Australia.
- Patient-Centred Health Services, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Nathan, Australia.
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Australia.
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, QLD, Australia.
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Nathan, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Building 34, Corner Bowen Bridge Rd and Butterfield St, Herston, QLD, 4029, Australia
- Patient-Centred Health Services, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Nathan, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, QLD, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Nathan, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Building 34, Corner Bowen Bridge Rd and Butterfield St, Herston, QLD, 4029, Australia
- Patient-Centred Health Services, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Nathan, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, QLD, Australia
- Herston Infectious Diseases Institute, Metro North Health, Herston, QLD, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia
| | - Rachel M Walker
- School of Nursing and Midwifery, Griffith University, Nathan, Australia
- Patient-Centred Health Services, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Nathan, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Australia
- Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia
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Byrnes J, Ward L, Jensen S, Sagoo M, Charles D, Mann R, Nghiem S, Finch J, Gavaghan B, McBride LJ, Lazzarini PA. Health-related quality of life in people with different diabetes-related foot ulcer health states: A cross-sectional study of healed, non-infected, infected, hospitalised and amputated ulcer states. Diabetes Res Clin Pract 2024; 207:111061. [PMID: 38104903 DOI: 10.1016/j.diabres.2023.111061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 12/19/2023]
Abstract
AIMS Diabetes-related foot ulcers (DFU) are a leading cause of infection, hospitalisation and amputation. However, to our knowledge no studies have compared the health-related quality of life (HRQoL) of people with DFU that were infected, hospitalised or amputated. This study aimed to investigate and compare the HRQoL of different groups of people with healed, non-infected, infected, hospitalised, or amputated DFU. METHODS This was a multi-centre cross-sectional study measuring the HRQoL of patients, attending one of 18 Diabetic Foot Services across Queensland, Australia, with one of five DFU health states: healed, non-infected, infected, hospitalised, amputated. HRQoL was measured using the EQ-5D-5L to estimate age-sex adjusted utility values. RESULTS Of 376 included patients (mean age 63 (12) years, 75% male), age-sex adjusted HRQoL utility estimates (95% CIs) were: healed DFU 0.57 (0.51-0.64), non-infected DFU 0.55 (0.49-0.62), infected DFU 0.45 (0.36-0.55), hospitalised DFU 0.53 (0.42-0.64), and amputated DFU 0.55 (0.46-0.63). CONCLUSION People in any DFU health state have considerably reduced HRQoL, with greatest reductions in those with infected DFU. These findings provide valuable HRQoL estimates and comparisons for several different important DFU health states, adding to our understanding of the impact of DFU on HRQoL and facilitating future economic evaluations.
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Affiliation(s)
- Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia.
| | - Lauren Ward
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Sarah Jensen
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Manjeet Sagoo
- Diabetes Resource Centre, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Danielle Charles
- Cairns Diabetes Centre, Cairns and Hinterland Hospital and Health Service, and Metro North Hospital and Health Service, Queensland, Australia
| | - Rebecca Mann
- Chronic Disease Brisbane South, Community and Oral Health, Inala Community Health Centre, Metro South Health, Queensland, Australia
| | - Son Nghiem
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Jennifer Finch
- Office of the Chief Allied Health Officer, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Belinda Gavaghan
- Office of the Chief Allied Health Officer, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Liza-Jane McBride
- Office of the Chief Allied Health Officer, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Peter A Lazzarini
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Pu L, Coppieters MW, Smalbrugge M, Jones C, Byrnes J, Todorovic M, Moyle W. Implementing PainChek and PARO to Support Pain Assessment and Management in Residents with Dementia: A Qualitative Study. Pain Manag Nurs 2023; 24:587-594. [PMID: 37105837 DOI: 10.1016/j.pmn.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/27/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Pain is a common problem but often undiagnosed and untreated in people with dementia. AIMS This study explored the experiences of residents with dementia, family, andformal carers with (1) pain assessment and management for residents with dementia; (2) the use of the PainChek app for pain assessment, and (3) the use of a social robot PARO for pain management in residents with dementia. DESIGN A qualitative study. SETTINGS/PARTICIPANTS Interviews were conducted with 13 residents withdementia, three family members, and 18 formal carers from a residential aged carefacility. METHOD Residents with dementia interacted with PARO for 15 mins, five days perweek for three weeks. The PainChek app assessed pain levels before and after eachsession. After three-week intervention, individual interviews were conducted withresidents, family, and formal carers who experienced or observed the use of PainChekapp and PARO for residents. Interviews were audio-recorded, transcribed, andanalyzed using thematic analysis. RESULTS Four themes were identified regarding pain in residents with dementia: (1) the impact, challenges and strategies of pain assessment and management; (2) benefits and barriers of using PainChek app to assess pain; (3) benefits of interacting with PARO to manage pain and behavioral symptoms; and (4) implementing PainChek app and PARO to support pain assessment and management in dementia care. CONCLUSIONS Technology, such as PainChek and PARO, is promising to improve painassessment and reduce pain for people with dementia. Barriers to using technologyinclude limited staff training and the implementation of person-centered care.
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Affiliation(s)
- Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia.
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Amsterdam Movement Sciences - Program Musculoskeletal Health, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Martin Smalbrugge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Michael Todorovic
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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Liddle J, Gustafsson L, Scott T, Byrnes J, Salmon A, Pachana NA. Still in first gear: Exploration of barriers for implementing driving cessation support. Australas J Ageing 2023; 42:796-800. [PMID: 37236918 DOI: 10.1111/ajag.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/14/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Driving cessation is a major life transition; lack of support in this process may lead to deleterious outcomes in terms of physical, mental and social well-being. Despite approaches to driving cessation being developed, their integration into ongoing geriatric clinical practice has been slow. METHODS Health-care providers were surveyed about their impressions of the barriers and facilitators to implementing a driving cessation intervention as part of regular clinical services. Methods of funding the intervention were queried. Surveys were sent via professional listserves and a snowballing strategy employed. Twenty-nine completed surveys were analysed by content analysis. RESULTS Participants identified that an understanding of driving cessation and optimal driving cessation supports was required. They identified four key approaches to support the implementation of driving cessation support: the need to consider complexity and emotional support needs in clinical contexts; knowing and showing the outcomes by clearly communicating the benefits and values to different stakeholders; managing systemic barriers included workforce issues, funding models and efforts required for initiating and sustaining an intervention; and not doing it alone, but instead developing processes supports to collaboratively provide access to programs. CONCLUSIONS The current study reveals a recognition of unmet needs of older persons and families regarding driving cessation as well as signalling service delivery, costing and workforce needs which act as barriers.
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Affiliation(s)
- Jacki Liddle
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Brisbane, Queensland, Australia
| | - Theresa Scott
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Amanda Salmon
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
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Kleidon TM, Gibson V, Cattanach P, Schults J, Royle RH, Ware RS, Marsh N, Pitt C, Dean A, Byrnes J, Rickard CM, Ullman AJ. Midline Compared With Peripheral Intravenous Catheters for Therapy of 4 Days or Longer in Pediatric Patients: A Randomized Clinical Trial. JAMA Pediatr 2023; 177:1132-1140. [PMID: 37695594 PMCID: PMC10495929 DOI: 10.1001/jamapediatrics.2023.3526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023]
Abstract
Importance Peripheral intravenous catheters (PIVCs) frequently fail during treatment causing therapy interruption, pain, recatheterization, and additional health care costs. Midline catheters (MCs) may improve functional dwell time and reduce failure compared with traditional PIVCs. Objective To compare device failure of MCs with PIVCs. Design, Setting, and Participants This was a pragmatic, randomized clinical superiority trial with an embedded internal pilot study conducted from July 2020 to May 2022. The study took place in a quaternary pediatric hospital in Brisbane, Queensland, Australia. Inclusion criteria were patients aged 1 to 18 years requiring peripherally compatible intravenous therapy for 4 days or longer. Interventions Patients were randomly assigned 1:1 to receive a PIVC or MC, stratified by age (≤5 years, >5 years). One catheter was studied per patient. Main Outcomes and Measures The primary outcome was all-cause device failure, defined as premature cessation of device function. Secondary outcomes included number of insertion attempts, insertion failure, pain (on insertion), procedural time, patient/parent satisfaction (with insertion), device dwell time, device complications during dwell time, additional vascular access devices required to complete treatment, clinician satisfaction (at removal), and health care costs. Results Of the 128 patients randomly assigned to study groups, 127 patients (median [IQR] age, 7 [2-13] years; 71 male [56%]) had a device inserted, with 65 (51.2%) in the PIVC group and 62 (48.8%) in the MC group. All patients were included in the intention-to-treat analysis. Device failure was lower in patients in the MC group (10 [16.1%]) compared with those in the PIVC group (30 [46.2%]; odds ratio [OR], 0.22; 95% CI, 0.10-0.52; P <.001). MCs were associated with fewer insertion attempts (mean difference [MD], -0.3; 95% CI, -0.5 to 0; P = .04), increased dwell time (MD, 66.9 hours; 95% CI, 36.2-97.5 hours; P <.001), and fewer patients required additional vascular access devices to complete treatment in the MC group (4 [6.5%]) and PIVC group (19 [29.2%]; OR, 0.17; 95% CI, 0.05-0.52; P = .002). Compared with PIVCs, use of MCs was associated with greater patient (9.0 vs 7.1 of 10; P = .002) and parent (9.1 vs 8.2 of 10; P = .02) satisfaction and lower health care costs (AUS -$151.67 [US -$101.13] per person; 95% credible interval, AUS -$171.45 to -$131.90 [US -$114.20 to -$87.95]). Conclusions and Relevance Findings suggest that MC insertion for patients requiring peripherally compatible intravenous therapy for 4 days or longer should be prioritized to reduce the resource intensive, expensive, and burdensome sequelae of device failure. Trial Registration Australia New Zealand Clinical Trials Registry, ACTRN12620000724976.
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Affiliation(s)
- Tricia M. Kleidon
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Victoria Gibson
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Paula Cattanach
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Jessica Schults
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Ruth H. Royle
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Robert S. Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Colleen Pitt
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Anna Dean
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Claire M. Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Amanda J. Ullman
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
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Wright C, Kelly JT, Byrnes J, Campbell KL, Healy R, Musial J, Hamilton K. A non-randomised feasibility study of a mHealth follow-up program in bariatric surgery. Pilot Feasibility Stud 2023; 9:176. [PMID: 37848959 PMCID: PMC10580544 DOI: 10.1186/s40814-023-01401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/25/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Behavioural support via mobile health (mHealth) is emerging. This study aimed to assess the feasibility, acceptability, cost, and potential effect on weight of a mHealth follow-up program in bariatric surgery. METHODS This was a non-randomised feasibility study describing intervention development and proof in the concept of a mHealth follow-up program in bariatric surgery. The study compares a prospective cohort with a historical control group and was conducted in a tertiary bariatric surgery service in Australia. The intervention group included individuals who had bariatric surgery (2019-2021) and owned a smart device, and the historical control group received usual postoperative care (2018). The intervention involved usual care plus codesigned biweekly text messages, monthly email newsletters, and online resources/videos over a 6-month period. The primary outcome measures included feasibility (via recruitment and retention rate), acceptability (via mixed methods), marginal costs, and weight 12 months postoperatively. Quantitative analysis was performed, including descriptive statistics and inferential and regression analysis. Multivariate linear regression and mixed-effects models were undertaken to test the potential intervention effect. Qualitative analysis was performed using inductive content analysis. RESULTS The study included 176 participants (n = 129 historical control, n = 47 intervention group; mean age 56 years). Of the 50 eligible patients, 48 consented to participate (96% recruitment rate). One participant opted out of the mHealth program entirely without disclosing their reason (98% retention rate). The survey response rate was low (n = 16/47, 34%). Participants agreed/strongly agreed that text messages supported new behaviours (n = 13/15, 87%); however, few agreed/strongly agreed that the messages motivated goal setting and self-monitoring (n = 8/15, 53%), dietary change (n = 6/15, 40%), or physical activity (n = 5/15, 33%). Interviews generated four main themes (n = 12): 'motivators and expectations', 'preferences and relevance', 'reinforced information", and 'wanting social support'. The intervention reinforced information, email newsletters were lengthy/challenging to read, and text messages were favoured, yet tailoring was recommended. The intervention cost AUD 11.04 per person. The mean 12-month weight was 86 ± 16 kg and 90 ± 16 kg (intervention and historical control) with no statistically significant difference. Intervention recipients enrolled at 3 months postoperatively demonstrated a statistically significant difference in 12-month weight (p = 0.014). CONCLUSION Although this study observed high rates of recruitment and retention, findings should be considered with caution as mHealth may have been embraced more by the intervention cohort as a result of the 2019 coronavirus pandemic. Of the various digital strategies developed and tested, the text message approach was the most acceptable; however, future intervention iterations could be strengthened through tailoring information when possible. The use of email newsletters and online resources/videos requires further testing of effectiveness to determine their value for continued use in bariatric surgery services.
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Affiliation(s)
- Charlene Wright
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD, Australia.
- Menzies Health Institute Queensland, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia.
| | - Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Road, Nathan, QLD, Australia
| | - Katrina L Campbell
- Menzies Health Institute Queensland, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Road, Nathan, QLD, Australia
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Butterfield St, Herston, QLD, Australia
| | - Rebecca Healy
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, Australia
| | - Jane Musial
- Nutrition and Dietetics Department, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Australia
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia
- Health Sciences Research Institute, University of California, 5200 Lake Road, Merced, CA, 95343, USA
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Spinks J, Violette R, Boyle DI, Petrie D, Fanning L, Hall KK, Kelly F, Wheeler AJ, Ware RS, Byrnes J, Chen E, Donald A, Ellis N, DelDot M, Nissen L. Activating pharmacists to reduce the frequency of medication-related problems (ACTMed): a stepped wedge cluster randomised trial. Med J Aust 2023; 219:325-331. [PMID: 37586750 DOI: 10.5694/mja2.52073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Medicines are the most frequent health care intervention type; their safe use provides significant benefits, but inappropriate use can cause harm. Systemic primary care approaches can manage serious medication-related problems in a timely manner. OBJECTIVES ACTMed (ACTivating primary care for MEDicine safety) uses information technology and financial incentives to encourage pharmacists to work more closely with general practitioners to reduce the risk of harm, improve patients' experience of care, streamline workflows, and increase the efficiency of medical care. METHODS AND ANALYSIS The stepped wedge cluster randomised trial in 42 Queensland primary care practices will assess the effectiveness of the ACTMed intervention. The primary outcome will be the proportion of people at risk of serious medication-related problems - patients with atrial fibrillation, heart failure, cardiovascular disease, type 2 diabetes, or asthma or chronic obstructive pulmonary disease - who experience such problems. We will also estimate the cost per averted serious medication-related problem and the cost per averted potentially preventable medication-related hospitalisation. ETHICS APPROVAL The University of Queensland Human Research Ethics Committee approved the pilot (2021/HE002189) and trial phases of the ACTMed study (2022/HE002136). Access to Patron data was granted by the Patron Data Governance Committee (PAT052ACTMed). Access to linked hospitalisations and deaths data are subject to Public Health Act approval (pending). DISSEMINATION OF FINDINGS A comprehensive dissemination plan will be co-developed by the researchers, the ACTMed steering committee and consumer advisory group, project partners, and trial site representatives. Aboriginal and Torres Strait Islander communities will be supported in leading community-level dissemination. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (pilot: ACTRN12622000595718; 21 April 2022; full trial: ACTRN12622000574741; 14 April 2022).
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Affiliation(s)
- Jean Spinks
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
| | - Richard Violette
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
- Griffith University, Gold Coast, QLD
| | - Douglas Ir Boyle
- HaBIC Research Information Technology Unit, the University of Melbourne, Melbourne, VIC
| | - Dennis Petrie
- Centre for Health Economics, Monash University, Melbourne, VIC
| | - Laura Fanning
- Centre for Health Economics, Monash University, Melbourne, VIC
- Box Hill Hospital, Melbourne, VIC
| | | | | | - Amanda J Wheeler
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD
- The University of Auckland, Auckland, New Zealand
| | - Robert S Ware
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD
| | - Esa Chen
- Centre for Health Economics, Monash University, Melbourne, VIC
| | | | | | - Megan DelDot
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
| | - Lisa Nissen
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
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Ward EC, Caird E, Khanal S, Kularatna S, Byrnes J, Penman A, Mcallister S, Baldac S, Cardell E, Davenport R, Davidson B, Hewat S, Howells S, Mccabe P, Purcell A, Walters J, Hill AE. A cost analysis of a 5-day simulation-based learning program for speech-language pathology student training. International Journal of Speech-Language Pathology 2023; 25:688-696. [PMID: 36062806 DOI: 10.1080/17549507.2022.2115138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: There is poor reporting of the cost of simulation and greater transparency is needed. The primary study aim was to conduct a financial analysis of the university/training institution costs associated with a 5-day simulation-based learning program for speech-language pathology students. The secondary aim was to consider the economic costs of the model.Method: Costs associated with the delivery of a 5-day simulation-based learning program for speech-language pathology students from six Australian universities were collected regarding: (a) pre-program training, (b) personnel, (c) room hire, (d) equipment, and (e) consumables. Both financial costs and economic costs (Australian dollar, at June 2017) were calculated per university site, and per student.Result: The simulation program was run 21 times involving 176 students. Average total financial cost per program ranged from $4717 to $11 425, with cost variation primarily attributed to local labour costs and various use of in-kind support. Average financial cost per student was $859 (range $683-$1087), however this was almost double ($1461 per student, range $857-$2019) in the economic cost calculation. Personnel was the largest contributing cost component accounting for 76.6% of financial costs. Personnel was also the highest contributing cost in the economic analysis, followed by room hire.Conclusion: This study provides clarity regarding financial and economic costing for a 5-day simulation-based learning program. These data can help universities consider potential up-front financial costs, and well as strategies for financial cost minimisation, when implementing simulation-based learning within the university context.
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Affiliation(s)
- Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Emma Caird
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Saval Khanal
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Sanjeewa Kularatna
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Adriana Penman
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sue Mcallister
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | - Elizabeth Cardell
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Rachel Davenport
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Bronwyn Davidson
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Sally Hewat
- School of Health Science, The University of Newcastle, Callaghan, Australia, and
| | - Simone Howells
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Patricia Mccabe
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alison Purcell
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Joanne Walters
- School of Health Science, The University of Newcastle, Callaghan, Australia, and
| | - Anne E Hill
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Wang T, Scuffham P, Byrnes J, Delatycki MB, Downes M. An overview of reproductive carrier screening panels for autosomal recessive and/or X-linked conditions: How much do we know? Prenat Diagn 2023; 43:1416-1424. [PMID: 37698492 DOI: 10.1002/pd.6434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/14/2023] [Accepted: 08/24/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND & AIM Reproductive carrier screening seeks to identify couples at a high risk of having offspring affected by autosomal recessive and X-linked (XL) conditions. The aim of this paper is to provide a comprehensive overview of existing carrier screening panels by examining their gene content and characteristics, identifying the most common genes/conditions included in these panels, and analyzing their listed prices. METHODS A comprehensive evaluation of existing carrier screening panels was conducted by searching for web-based content, reviewing information brochures, and establishing direct contact with the providers via email or phone. RESULTS Twenty-two panels and their providers were identified with a cumulative total of 2205 unique genes. The number of genes included in these panels varied from 44 to 2054. Only 15 genes (0.7%) were included in all the panels. The carrier frequency of these 15 common genes and their associated conditions varied greatly, but the conditions associated with the genes are "severe". The price of these 22 panels ranged from $349 to $4320 per couple (USD in 2023). The correlation between the listed price and the number of selected genes among these panels was small and not statistically significant (r = 0.1023, p = 0.6959). CONCLUSION Considerable discrepancies exist among carrier screening panels. Ongoing research and monitoring are necessary to capture the dynamic nature of the carrier screening landscape, providing up-to-date information for clinical practice and informed decision-making.
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Affiliation(s)
- Tianjiao Wang
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Paul Scuffham
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Martin B Delatycki
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Victorian Clinical Genetics Services, Parkville, Victoria, Australia
| | - Martin Downes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Hettiarachchi RM, Kularatna S, Byrnes J, Mulhern B, Chen G, Scuffham PA. Valuing the Dental Caries Utility Index in Australia. Med Decis Making 2023; 43:901-913. [PMID: 37724663 PMCID: PMC10625724 DOI: 10.1177/0272989x231197149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 07/06/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION The Dental Caries Utility Index (DCUI) is a new oral health-specific health state classification system for adolescents, consisting of 5 domains: pain/discomfort, difficulty eating food/drinking, worried, ability to participate in activities, and appearance. Each domain has 4 response levels. This study aims to generate an Australian-specific utility algorithm for the DCUI. METHODS An online survey was conducted using a representative sample of the adult Australian general population. The discrete choice experiment (DCE) was used to elicit the preferences on 5 domains. Then, the latent utilities were anchored onto the full health-dead scale using the visual analogue scale (VAS). DCE data were modeled using conditional logit, and 2 anchoring procedures were considered: anchor based on the worst health state and a mapping approach. The optimal anchoring procedure was selected based on the model parsimony and the mean absolute error (MAE). RESULTS A total of 995 adults from the Australian general population completed the survey. The conditional logit estimates on 5 dimensions and levels were monotonic and statistically significant, except for the second level of the "worried" and "appearance" domains. The mapping approach was selected based on a smaller MAE between the 2 anchoring procedures. The Australian-specific tariff of DCUI ranges from 0.1681 to 1. CONCLUSION This study developed a utility algorithm for the DCUI. This value set will facilitate utility value calculations from the participants' responses for DCUI in economic evaluations of dental caries interventions targeted for adolescents. HIGHLIGHTS Preference-based quality-of-life measures (PBMs), which consist of a health state classification system and a set of utility values (a scoring algorithm), are used to generate utility weights for economic evaluations.This study is the first to develop an Australian utility value set for the Dental Caries Utility Index (DCUI), a new oral health-specific classification system for adolescents.The availability of a utility value set will enable using DCUI in economic evaluations of oral health interventions targeted for adolescents and may ultimately lead to more effective and efficient planning of oral health care services.
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Affiliation(s)
- Ruvini M. Hettiarachchi
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, QLD, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovacions and Centre for Healthcare Transformation, The Queensland University of Technology, QLD, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Clayton, VIC, Australia
| | - Paul A. Scuffham
- Centre for Applied Health Economics, School of Medicine, Griffith University, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, QLD, Australia
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18
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Wallis KA, Donald M, Horowitz M, Moncrieff J, Ware RS, Byrnes J, Thrift K, Cleetus M, Panahi I, Zwar N, Morgan M, Freeman C, Scott I. RELEASE (REdressing Long-tErm Antidepressant uSE): protocol for a 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1 in general practice. Trials 2023; 24:615. [PMID: 37770893 PMCID: PMC10537226 DOI: 10.1186/s13063-023-07646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Many people experience withdrawal symptoms when they attempt to stop antidepressants. Withdrawal symptoms are readily misconstrued for relapse or ongoing need for medication, contributing to long-term use (> 12 months). Long-term antidepressant use is increasing internationally yet is not recommended for most people. Long-term use is associated with adverse effects including weight gain, sexual dysfunction, lethargy, emotional numbing and increased risk of falls and fractures. This study aims to determine the effectiveness of two multi-strategy interventions (RELEASE and RELEASE+) in supporting the safe cessation of long-term antidepressants, estimate cost-effectiveness, and evaluate implementation strategies. METHODS DESIGN: 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1. SETTING primary care general practices in southeast Queensland, Australia. POPULATION adults 18 years or older taking antidepressants for longer than 1 year. Practices will be randomised on a 1.5:1:1 ratio of Usual care:RELEASE:RELEASE+. INTERVENTION RELEASE for patients includes evidence-based information and resources and an invitation to medication review; RELEASE for GPs includes education, training and printable resources via practice management software. RELEASE+ includes additional internet support for patients and prescribing support including audit and feedback for GPs. OUTCOME MEASURES the primary outcome is antidepressant use at 12 months self-reported by patients. Cessation is defined as 0 mg antidepressant maintained for at least 2 weeks. SECONDARY OUTCOMES at 6 and 12 months are health-related quality of life, antidepressant side effects, well-being, withdrawal symptoms, emotional numbing, beliefs about antidepressants, depressive symptoms, and anxiety symptoms; and at 12 months 75% reduction in antidepressant dose; aggregated practice level antidepressant prescribing, and health service utilisation for costs. SAMPLE SIZE 653 patients from 28 practices. A concurrent evaluation of implementation will be through mixed methods including interviews with up to 40 patients and primary care general practitioners, brief e-surveys, and study administrative data to assess implementation outcomes (adoption and fidelity). DISCUSSION The RELEASE study will develop new knowledge applicable internationally on the effectiveness, cost-effectiveness, and implementation of two multi-strategy interventions in supporting the safe cessation of long-term antidepressants to improve primary health care and outcomes for patients. TRIAL REGISTRATION ANZCTR, ACTRN12622001379707p. Registered on 27 October 2022.
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Affiliation(s)
- Katharine A Wallis
- General Practice Clinical Unit, Medical School, The University of Queensland, Herston, Brisbane, QLD, 4072, Australia.
| | - Maria Donald
- General Practice Clinical Unit, Medical School, The University of Queensland, Herston, Brisbane, QLD, 4072, Australia
| | - Mark Horowitz
- NHS Foundation Trust, Research and Development Department, London, Northeast London, UK
| | | | - Robert S Ware
- Griffith University, Nathan, Brisbane, QLD, Australia
| | - Joshua Byrnes
- Griffith University, Nathan, Brisbane, QLD, Australia
| | - Karen Thrift
- General Practice Clinical Unit, Medical School, The University of Queensland, Herston, Brisbane, QLD, 4072, Australia
| | - MaryAnne Cleetus
- General Practice Clinical Unit, Medical School, The University of Queensland, Herston, Brisbane, QLD, 4072, Australia
| | - Idin Panahi
- General Practice Clinical Unit, Medical School, The University of Queensland, Herston, Brisbane, QLD, 4072, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, QLD, Australia
| | - Mark Morgan
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, QLD, Australia
| | - Chris Freeman
- The University of Queensland, Herston, Brisbane, QLD, 4072, Australia
| | - Ian Scott
- The University of Queensland, Herston, Brisbane, QLD, 4072, Australia
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Brandenburg C, Crilly J, Thomas S, Gardiner P, Kinner SA, Heffernan E, Lincoln C, Somerville A, Davidson P, Wilson D, Green D, Byrnes J. Police perspectives on the economic considerations of providing healthcare in short-term custodial settings in Australia. Med Sci Law 2023:258024231198915. [PMID: 37691343 DOI: 10.1177/00258024231198915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Providing appropriate healthcare to people in short-term police custody settings (i.e. watch-houses) is challenging due to the complexity of detainee health needs and the limitations of the custodial environment. However, little is known about how detainee healthcare is managed in Australia, including economic considerations. This study had two aims: (1) to understand police perspectives on the costs associated with the delivery of healthcare to watch-house detainees in Queensland, Australia and (2) to scope the applicability of the Prison Healthcare Expenditure Reporting Checklist (PHERC) tool for the Australian watch-house context. The study employed an exploratory qualitative descriptive approach. A purposive sample comprised 16 watch-house staff from six regions in Queensland, Australia, interviewed between April and November 2021. A key finding was that police viewed healthcare expenditure as a major, but largely unavoidable cost for Australian watch-houses. Participants reported that direct expenditure comprised mostly of in-house healthcare services (of which there were a variety of models), but also costs of medication and health-related consumables. Indirect costs included costs of escorting and guarding detainees requiring transfer to hospital for health assessment and treatment. Participants reported that the PHERC was not applicable to the Australian watch-house context. Future research should explore the cost-effectiveness of different watch-house healthcare delivery models and how best to measure this.
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Affiliation(s)
- Caitlin Brandenburg
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
| | - Stuart Thomas
- Social and Global Studies Centre, RMIT University, Melbourne, Victoria, Australia
| | - Paul Gardiner
- Cairns Watch-house, Far North District, Queensland Police Service, Cairns, Queensland, Australia
| | - Stuart A Kinner
- Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
| | - Ed Heffernan
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Forensic Mental Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Cathy Lincoln
- Forensic Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Annabel Somerville
- Department of Emergency Medicine, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Peter Davidson
- Department of Medicine, Division Global Public Health, University of California, San Diego, CA, USA
| | - Daniel Wilson
- Office of the Medical Director, Queensland Ambulance Service, Kedron, Queensland, Australia
| | - David Green
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Queensland, Australia
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20
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Okafor CE, Nghiem S, Byrnes J. One-stage revision versus debridement, antibiotics, and implant retention (DAIR) for acute prosthetic knee infection: an exploratory cohort study. Arch Orthop Trauma Surg 2023; 143:5787-5792. [PMID: 37101087 PMCID: PMC10449712 DOI: 10.1007/s00402-023-04891-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Studies have shown that debridement, antibiotics, and implant retention (DAIR) is an effective procedure for acute infection of total knee arthroplasty (TKA). This study aimed to explore DAIR and one-stage revision for homogenous cohorts with acute postoperative and acute hematogenous infection of TKA, without compelling indications to perform a staged revision. MATERIALS AND METHODS This study was an exploratory analysis that used retrospective data from Queensland Health, Australia, for DAIR and one-stage revision of TKA between June 2010 and May 2017 (3-year average follow-up). The re-revision burden, mortality rate, and the cost of the interventions were explored. Costs were expressed in 2020 Australian dollars. RESULTS There were 15 (DAIR) and 142 (one-stage) patients with homogenous characteristics in the sample. The re-revision burden for DAIR was 20%, while for one-stage revision it was 12.68%. Two deaths were associated with a one-stage revision and no death was associated with DAIR. The total cost since the index revision of DAIR, $162,939, was higher than for one-stage revision $130,924 (p value = 0.501), due to higher re-revision burden. CONCLUSIONS This study would suggest the use of one-stage revision over DAIR for acute postoperative and acute hematogenous infection of TKA. It suggests that there could be other potential criteria which have not been ascertained that need to be considered for optimal DAIR selection. The study indicates the need for more research and, of note, high-quality randomized controlled trials to provide a well-defined treatment protocol with high level of evidence to guide patient selection for DAIR.
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Affiliation(s)
- Charles Ebuka Okafor
- Centre for Applied Health Economics, School of Medicine, and Dentistry, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia.
- Menzies Health Institute, Griffith University, Queensland, Australia.
| | - Son Nghiem
- Department of Health Services, Research and Policy, Australian National University, Canberra, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, and Dentistry, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia
- Menzies Health Institute, Griffith University, Queensland, Australia
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21
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Raatz M, Ward EC, Marshall J, Burns CL, Afoakwah C, Byrnes J. A time and cost analysis of speech pathology paediatric feeding services delivered in-person versus via telepractice. J Telemed Telecare 2023; 29:613-620. [PMID: 33966525 DOI: 10.1177/1357633x211012883] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Telepractice models of care have the potential to reduce the time and financial burdens that consumers may experience accessing healthcare services. The current study aimed to conduct a time and financial cost analysis of paediatric feeding appointments accessed via telepractice (using videoconferencing) compared to an in-person model. METHODS Parents of 44 children with paediatric feeding disorders (PFDs) residing in a metropolitan area completed three questionnaires relating to (a) demographics, (b) time and cost for in-person care and (c) time and cost for telepractice. Both cost questionnaires collected data required for direct and indirect costs comparisons (e.g. out-of-pocket costs associated with the appointment (direct), time away from usual duties (indirect)). Average number of services accessed by each participant, and PFD appointments conducted annually by the service, were collected from service statistics. Analysis involved cost minimisation and cost modelling from a societal perspective. RESULTS The telepractice appointment resulted in significant time (p = 0.007) and cost (AUD$95.09 per appointment, SD = AUD$64.47, p = < 0.0001) savings per family. The health service cost was equivalent for both models (AUD$58.25). Cost modelling identified cost savings of up to AUD$475.45 per family if 50% of appointments in a 10-session block were converted to telepractice. Potential cost savings of AUD$68,750.07 per annum to society could be realised if 50% of feeding appointments within the service were provided via telepractice. DISCUSSION The telepractice model offered both time and cost benefits. Future service re-design incorporating hybrid services (in-person and telepractice) will help optimise benefits and minimise burden for families accessing services for PFDs.
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Affiliation(s)
- Madeline Raatz
- Speech Pathology Department, Queensland Children's Hospital, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Australia
| | - Jeanne Marshall
- Speech Pathology Department, Queensland Children's Hospital, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
- Speech Pathology and Audiology Department, Royal Brisbane and Women's Hospital, Australia
| | | | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Australia
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22
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Shanley DC, Zimmer-Gembeck M, Wheeler AJ, Byrnes J, Ware RS, Liu W, Simcock G, White C, Horton S, Page M, Shelton D, Till H, Mills I, Hislop C, Harris K, Crichton A, Reid N, Reilly S, Moritz K, Walsh K, Rundle-Thiele S, Hawkins E. Diagnostic Accuracy and economic value of a Tiered Assessment for Fetal Alcohol Spectrum Disorder (DATAforFASD): Protocol. BMJ Open 2023; 13:e071004. [PMID: 37586864 PMCID: PMC10432646 DOI: 10.1136/bmjopen-2022-071004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Australian practices for diagnosing fetal alcohol spectrum disorder (FASD) are lengthy and require specialist expertise. Specialist teams are based in urban locations; they are expensive and have prolonged waitlists. Innovative, flexible solutions are needed to ensure First Nations children living in rural/remote communities have culturally appropriate and equitable access to timely diagnosis and support. This study compares the accuracy of rapid assessments (index tests) that can be administered by a range of primary healthcare practitioners to specialist standardised FASD assessments (reference tests). The cost-efficiency of index tests will be compared with reference tests. METHODS AND ANALYSIS At least 200 children aged 6-16 years at-risk of FASD will be recruited across at least seven study sites. Following standards for reporting diagnostic accuracy study (STARD) guidelines, all children will complete index and reference tests. Diagnostic accuracy statistics (including receiver operating curves, sensitivity, specificity, positive and negative predictive values and likelihood ratios) will identify whether rapid assessments can accurately identify: (1) the presence of an FASD diagnosis and (2) impairment in each neurodevelopmental domain, compared to comprehensive assessments. Direct and indirect healthcare costs for index tests compared to reference tests will be collected in primary healthcare and specialist settings. ETHICS AND DISSEMINATION OF RESULTS Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/20/QCHQ/63173); Griffith University Human Research Ethics Committee (2020/743). Results will assist in validating the use of index tests as part of a tiered neurodevelopmental assessment process that was co-designed with First Nations community and primary healthcare practitioners. Outcomes will be summarised and provided to participating practitioners and sites, and disseminated to community health services and consumers. Findings will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12622000498796.
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Affiliation(s)
- Dianne C Shanley
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Melanie Zimmer-Gembeck
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Amanda J Wheeler
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Medical & Health Sciences, The University of Auckland, Auckland, Auckland, New Zealand
| | - Joshua Byrnes
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Wei Liu
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Gabrielle Simcock
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Codi White
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Sarah Horton
- Family Health, Gidgee Healing, Mt Isa, Queensland, Australia
| | - Marjad Page
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- Primary Health Care, Kambu Aboriginal and Torres Strait Islander Corporation for Health, Ipswich, Queensland, Australia
| | - Doug Shelton
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Community Child Health, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Haydn Till
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Community Child Health, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Ianthe Mills
- Child and Adolescent Unit, Sunshine Coast Hospital and Health Service, Nambour, Queensland, Australia
| | - Carly Hislop
- Child Development Service, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Katrina Harris
- Victorian Fetal Alcohol Service, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Alison Crichton
- Victorian Fetal Alcohol Service, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sheena Reilly
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Karen Moritz
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kerryann Walsh
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Erinn Hawkins
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
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Okafor C, Byrnes J, Stewart S, Scuffham P, Afoakwah C. Cost Effectiveness of Strategies to Manage Atrial Fibrillation in Middle- and High-Income Countries: A Systematic Review. Pharmacoeconomics 2023; 41:913-943. [PMID: 37204698 PMCID: PMC10322963 DOI: 10.1007/s40273-023-01276-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) remains the most common form of cardiac arrhythmia. Management of AF aims to reduce the risk of stroke, heart failure and premature mortality via rate or rhythm control. This study aimed to review the literature on the cost effectiveness of treatment strategies to manage AF among adults living in low-, middle- and high-income countries. METHODS We searched MEDLINE (OvidSp), Embase, Web of Science, Cochrane Library, EconLit and Google Scholar for relevant studies between September 2022 and November 2022. The search strategy involved medical subject headings or related text words. Data management and selection was performed using EndNote library. The titles and abstracts were screened followed by eligibility assessment of full texts. Selection, assessment of the risk of bias within the studies, and data extraction were conducted by two independent reviewers. The cost-effectiveness results were synthesised narratively. The analysis was performed using Microsoft Excel 365. The incremental cost effectiveness ratio for each study was adjusted to 2021 USD values. RESULTS Fifty studies were included in the analysis after selection and risk of bias assessment. In high-income countries, apixaban was predominantly cost effective for stroke prevention in patients at low and moderate risk of stroke, while left atrial appendage closure (LAAC) was cost effective in patients at high risk of stroke. Propranolol was the cost-effective choice for rate control, while catheter ablation and the convergent procedure were cost-effective strategies in patients with paroxysmal and persistent AF, respectively. Among the anti-arrhythmic drugs, sotalol was the cost-effective strategy for rhythm control. In middle-income countries, apixaban was the cost-effective choice for stroke prevention in patients at low and moderate risk of stroke while high-dose edoxaban was cost effective in patients at high risk of stroke. Radiofrequency catheter ablation was the cost-effective option in rhythm control. No data were available for low-income countries. CONCLUSION This systematic review has shown that there are several cost-effective strategies to manage AF in different resource settings. However, the decision to use any strategy should be guided by objective clinical and economic evidence supported by sound clinical judgement. REGISTRATION CRD42022360590.
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Affiliation(s)
- Charles Okafor
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Simon Stewart
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Institute for Health Research, University of Notre Dame Australia, Freemantle, WA, Australia
| | - Paul Scuffham
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Clifford Afoakwah
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia.
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.
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Schults JA, Marsh N, Ullman AJ, Kleidon TM, Ware RS, Byrnes J, Young E, Hall L, Keijzers G, Cullen L, Calleja P, McTaggart S, Peters N, Watkins S, Corley A, Brown C, Lin Z, Williamson F, Burgess L, Macfarlane F, Cooke M, Battley C, Rickard CM. Improving difficult peripheral intravenous access requires thought, training and technology (DART 3): a stepped-wedge, cluster randomised controlled trial protocol. BMC Health Serv Res 2023; 23:587. [PMID: 37286977 DOI: 10.1186/s12913-023-09499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are the most used invasive medical device in healthcare. Yet around half of insertion attempts are unsuccessful leading to delayed medical treatments and patient discomfort of harm. Ultrasound-guided PIVC (USGPIVC) insertion is an evidence-based intervention shown to improve insertion success especially in patients with Difficult IntraVenous Access (BMC Health Serv Res 22:220, 2022), however the implementation in some healthcare settings remains suboptimal. This study aims to co-design interventions that optimise ultrasound guided PIVC insertion in patients with DIVA, implement and evaluate these initiatives and develop scale up activities. METHODS A stepped-wedge cluster randomized controlled trial will be conducted in three hospitals (two adult, one paediatric) in Queensland, Australia. The intervention will be rolled out across 12 distinct clusters (four per hospital). Intervention development will be guided by Michie's Behavior Change Wheel with the aim to increase local staff capability, opportunity, and motivation for appropriate, sustainable adoption of USGPIVC insertion. Eligible clusters include all wards or departments where > 10 PIVCs/week are typically inserted. All clusters will commence in the control (baseline) phase, then, one cluster per hospital will step up every two months, as feasible, to the implementation phase, where the intervention will be rolled out. Implementation strategies are tailored for each hospital by local investigators and advisory groups, through context assessments, staff surveys, and stakeholder interviews and informed by extensive consumer interviews and consultation. Outcome measures align with the RE-AIM framework including clinical-effectiveness outcomes (e.g., first-time PIVC insertion success for DIVA patients [primary outcome], number of insertion attempts); implementation outcomes (e.g., intervention fidelity, readiness assessment) and cost effectiveness outcomes. The Consolidated Framework for Implementation Research framework will be used to report the intervention as it was implemented; how people participated in and responded to the intervention; contextual influences and how the theory underpinning the intervention was realised and delivered at each site. A sustainability assessment will be undertaken at three- and six-months post intervention. DISCUSSION Study findings will help define systematic solutions to implement DIVA identification and escalation tools aiming to address consumer dissatisfaction with current PIVC insertion practices. Such actionable knowledge is critical for implementation of scale-up activities. TRIAL REGISTRATION Prospectively registered (Australian and New Zealand Clinical Trials Registry; ACTRN12621001497897).
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Affiliation(s)
- Jessica A Schults
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia.
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia.
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia.
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
| | - Nicole Marsh
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Amanda J Ullman
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Tricia M Kleidon
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Joshua Byrnes
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - Emily Young
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Lisa Hall
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Gerben Keijzers
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Department of Emergency Medicine, Gold Coast University Hospital Southport, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Pauline Calleja
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- School of Nursing, Midwifery & Social Science, Central Queensland University, Queensland, Australia
| | - Steven McTaggart
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Nathan Peters
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Stuart Watkins
- Department of Emergency Medicine, Gold Coast University Hospital Southport, Queensland, Australia
| | - Amanda Corley
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Christine Brown
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Zhen Lin
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Frances Williamson
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Jamieson Trauma Institute, Herston, QLD, Australia
| | - Luke Burgess
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Fiona Macfarlane
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Callan Battley
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Claire M Rickard
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
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Snelling PJ, Jones P, Bade D, Bindra R, Byrnes J, Davison M, George S, Moore M, Keijzers G, Ware RS. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures. N Engl J Med 2023; 388:2049-2057. [PMID: 37256975 DOI: 10.1056/nejmoa2213883] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Data on whether ultrasonography for the initial diagnostic imaging of forearm fractures in children and adolescents is noninferior to radiography for subsequent physical function of the arm are limited. METHODS In this open-label, multicenter, noninferiority, randomized trial in Australia, we recruited participants 5 to 15 years of age who presented to the emergency department with an isolated distal forearm injury, without a clinically visible deformity, in whom further evaluation with imaging was indicated. Participants were randomly assigned to initially undergo point-of-care ultrasonography or radiography, and were then followed for 8 weeks. The primary outcome was physical function of the affected arm at 4 weeks as assessed with the use of the validated Pediatric Upper Extremity Short Patient-Reported Outcomes Measurement Information System (PROMIS) score (range, 8 to 40, with higher scores indicating better function); the noninferiority margin was 5 points. RESULTS A total of 270 participants were enrolled, with outcomes for 262 participants (97%) available at 4 weeks (with a window of ±3 days) as prespecified. PROMIS scores at 4 weeks in the ultrasonography group were noninferior to those in the radiography group (mean, 36.4 and 36.3 points, respectively; mean difference, 0.1 point; 95% confidence interval [CI], -1.3 to 1.4). Intention-to-treat analyses (in 266 participants with primary outcome data recorded at any time) produced similar results (mean difference, 0.1 point; 95% CI, -1.3 to 1.4). No clinically important fractures were missed, and there were no between-group differences in the occurrence of adverse events. CONCLUSIONS In children and adolescents with a distal forearm injury, the use of ultrasonography as the initial diagnostic imaging method was noninferior to radiography with regard to the outcome of physical function of the arm at 4 weeks. (Funded by the Emergency Medicine Foundation and others; BUCKLED Australian New Zealand Clinical Trials Registry number, ACTRN12620000637943).
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Affiliation(s)
- Peter J Snelling
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Philip Jones
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - David Bade
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Randy Bindra
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Joshua Byrnes
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Michelle Davison
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Shane George
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Mark Moore
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Gerben Keijzers
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
| | - Robert S Ware
- From the School of Medicine and Dentistry and Menzies Health Institute Queensland (P.J.S., P.J., R.B., M.D., S.G., G.K., R.S.W.) and the Centre for Applied Health Economics, School of Medicine and Dentistry (J.B.), Griffith University, the Departments of Emergency Medicine (P.J.S., S.G., G.K.) and Orthopaedics (R.B.) and the Children's Critical Care Unit (S.G.), Gold Coast University Hospital, and the Sonography Innovation and Research (Sonar) Group (P.J.S.), Southport, the Child Health Research Centre, University of Queensland, Brisbane (P.J.S., S.G.), the Departments of Orthopaedics (D.B.) and Emergency Medicine (M.M.), Queensland Children's Hospital, South Brisbane, the Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya (M.D.), and the Faculty of Health Sciences and Medicine, Bond University, Gold Coast (G.K.) - all in Queensland, Australia
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Job J, Nicholson C, Donald M, Jackson C, Byrnes J. An eConsultant versus a hospital-based outpatient consultation for general (internal) medicine: a costing analysis. BMC Health Serv Res 2023; 23:478. [PMID: 37170265 PMCID: PMC10174616 DOI: 10.1186/s12913-023-09436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The eConsultant model of care is an outpatient substitution approach which has been evaluated and implemented extensively internationally. It provides an asynchronous, digital, clinician-to-clinician advice service, giving primary care physicians remote access to specialist support for patient care within 3 business days. Results from initial trials of the eConsultant model in Australia support international evidence of reduced wait times and improved access to specialist input, avoidance of face-to-face hospital outpatient visits, and better integrated care. This study compared the cost of delivery of an eConsultant episode of care with that of a hospital-based outpatient appointment. METHODS A cost-minimisation analysis, using a decision analytic model, was used to compare the two approaches. eConsultant costs were calculated from specialist reported data (minutes spent preparing the response; the number of patients referred subsequently for a hospital-based outpatient appointment) and administration staff data (time spent recording the occasion-of-service). Outpatient costs were calculated using finance data and information from outpatient clinic managers at the hospital-based outpatient clinic. The primary outcome was incremental cost saving per patient from a hospital system perspective. Uncertainty was explored using one-way sensitivity analyses and characterised with probabilistic sensitivity analysis using 10,000 Monte Carlo simulations. RESULTS The traditional referral pathway cost estimate was $587.20/consult compared to $226.13/consult for an eConsultant episode: an efficiency saving of $361.07 per patient. The incremental difference between eConsultant and traditional care was most sensitive to the cost estimate of an outpatient attendance, the time for a specialist to complete an eConsult, and the probability of a patient requiring a face-to-face hospital-based attendance following an eConsult. However, at the upper bounds of each of these estimates, an eConsult remained the most cost-efficient model. In 96.5% of the Monte Carlo simulations eConsult was found to be more cost efficient than the traditional approach. CONCLUSIONS The eConsultant model of care was associated with a 61.5% efficiency gain, allowing diversion of support to hospital-based outpatient appointments.
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Affiliation(s)
- Jenny Job
- UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, 4029, Australia.
| | - Caroline Nicholson
- UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, 4029, Australia
| | - Maria Donald
- UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, 4029, Australia
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Claire Jackson
- UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, 4029, Australia
- General Practice and Primary Care Research, The University of Queensland, Brisbane, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Health Economics School of Medicine and Dentistry, Griffith University, Brisbane, Australia
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Wang T, Kiss D, McFadden K, Byrnes J, Scuffham P, Delatycki MB, Downes M. Clinical utility of reproductive carrier screening for preconception and pregnant couples for multiple genetic conditions: a systematic review and meta-analysis. Expert Rev Mol Diagn 2023; 23:419-429. [PMID: 37086152 DOI: 10.1080/14737159.2023.2206519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Many scientific societies have emphasized the importance of evaluating the clinical utility of reproductive carrier screening (RCS). This systematic review aims to assess the clinical utility of RCS and synthesize the outcomes in a meta-analysis. AREAS COVERED A total of eleven studies were included. The number of conditions screened in the studies varied from three to 176 and led to the identification of one to 24 high-risk couples (HRCs) per 1,000 screened individuals. Pooled estimations were as follows: the prenatal diagnosis (PND) rate among pregnant HRCs 0.644 (95% CI=0.364, 0.923), the termination rate among affected pregnancies 0.714 (95% CI=0.524, 0.904), and the rate of in-vitro fertilization (IVF) with preimplantation genetic testing (PGT) 0.631 (95% CI=0.538, 0.725). There is a statistically significant decrease in the rates of undertaking PND and termination as the number of screened conditions increases. Carriers of conditions classified as having a more severe impact were found to be more likely to choose termination or IVF with PGT. EXPERT OPINION Our review suggests that the number and the severity of screened conditions can significantly impact HRCs' reproductive decisions. Future work needs to investigate the definition of clinical utility and the design of screening panels.
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Affiliation(s)
- Tianjiao Wang
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Debra Kiss
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Kathleen McFadden
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Paul Scuffham
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Martin B Delatycki
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Victorian Clinical Genetics Services, Parkville, VIC, Australia
| | - Martin Downes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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Saxby K, Byrnes J, de New SC, Nghiem S, Petrie D. Does affirmative action reduce disparities in healthcare use by Indigenous peoples? Evidence from Australia's Indigenous Practice Incentives Program. Health Econ 2023; 32:853-872. [PMID: 36609870 DOI: 10.1002/hec.4645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Globally, Indigenous populations experience poorer health but use less primary healthcare than their non-Indigenous counterparts. In 2010, the Australian government introduced a targeted reform aimed at reducing these disparities. The reform reduced, or abolished prescription medicine co-payments and provided financial incentives for GPs to better manage chronic disease care for Indigenous peoples. Exploiting the framework of a natural experiment, we investigate how the reform affected these health disparities in primary and specialist healthcare utilization using longitudinal administrative data from 75,826 Australians, including 1896 Indigenous peoples, with cardiovascular disease. The differences-in-differences estimates indicate that the reform increased primary healthcare use among Indigenous peoples, including 12.9% more prescription medicines, 6.6% more GP services, and 34.0% more chronic disease services, but also reduced specialist attendances by 11.8%. Increases in primary care were larger for those who received the largest co-payment relief and lived in metropolitan regions, whereas the reduction in specialist attendances was concentrated among lower income Indigenous patients. Affirmative action can reduce inequalities in Indigenous use of primary healthcare, albeit careful design is required to ensure that benefits are equitable and do not lead to substitution away from valuable, or necessary, care.
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Affiliation(s)
- Karinna Saxby
- Centre for Health Economics, Monash Business School, Monash University, Victoria, Caulfield East, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Queensland, Nathan, Australia
| | - Sonja C de New
- Centre for Health Economics, Monash Business School, Monash University, Victoria, Caulfield East, Australia
- Institute for the Study of Labor (IZA Bonn), RWI Research Network, Essen, Germany
| | - Son Nghiem
- College of Health & Medicine, Australian National University, Australian Capital Territory, Canberra, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Victoria, Caulfield East, Australia
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Royle R, Gillespie BM, Chaboyer W, Byrnes J, Nghiem S. The burden of surgical site infections in Australia: A cost-of-illness study. J Infect Public Health 2023; 16:792-798. [PMID: 36963144 DOI: 10.1016/j.jiph.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/04/2023] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE To estimate the cost of surgical site infections in Australian public hospitals in 2018-19, to demonstrate the economic burden of hospital-associated infection in a well-resourced health system. METHODS A cost-of-illness analysis was conducted over a 1-year time horizon based on data from published literature extrapolated using simulation techniques. The direct and indirect costs of SSI were estimated for Australia and each of its states and territories. RESULTS An estimated 16,541 cases of SSI occurred in Australian public hospitals in 2018-19, resulting in a total direct cost of A$323.5 million. The average cost per case was A$18,814, which was 2.5 times the average per capita spending on health. The indirect costs of absenteeism and premature death were valued at A$23.0 million and A$2 948.1 million per annum, respectively. CONCLUSION SSI is a significant but preventable cost with most of the financial burden coming from premature deaths but underreporting means our costs are likely underestimated.
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Affiliation(s)
- Ruth Royle
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Brigid M Gillespie
- NHMRC CRE in Wiser Wounds, MHIQ, Griffith University, Southport, Queensland, Australia.
| | - Wendy Chaboyer
- NHMRC CRE in Wiser Wounds, MHIQ, Griffith University, Southport, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Son Nghiem
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia; Department of Health Economics, Wellbeing and Society, University Drive, Australian National University, ACT 0200, Australia
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Okafor CE, Nghiem S, Byrnes J. Is 2-Stage Septic Revision Worth the Money? A Cost-Utility Analysis of a 1-Stage Versus 2-Stage Septic Revision of Total Knee Arthroplasty. J Arthroplasty 2023; 38:347-354. [PMID: 36154866 DOI: 10.1016/j.arth.2022.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/23/2022] [Accepted: 09/05/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Two-stage exchange arthroplasty remains the gold standard for the management of prosthetic joint infection (PJI) of the knee, but several studies have demonstrated that 1-stage exchange is as effective as 2-stage exchange. This study aimed to support decision-making via an economic evaluation of 1-stage compared to 2-stage exchange for total knee arthroplasty septic revision in patients who did not have compelling indication PJI (ie, Methicillin-resistant Staphylococcus aureus, multiorganism, systemic sepsis, comorbidities, culture negative, resistant organism, and immunocompromised) to undergo a 2-stage exchange. METHODS A cost-utility analysis was performed using a Markov cohort model from the health care provider perspective using Australia data. One-stage septic knee revisions were compared with 2-stage exchange procedures for chronic PJI using a patient-lifetime horizon. Health outcomes were expressed as quality-adjusted life-years (QALY), whereas costs were presented in 2020 Australian dollars. Sensitivity analyses, population expected values of perfect information, and the perfect information for parameters (EVPPI) were assessed to estimate the opportunity costs surrounding the decision made at a willingness-to-pay threshold of $50,000 per QALY. RESULTS The incremental cost-effectiveness ratio of 2-stage exchange compared with 1-stage exchange was $231,000 per QALY, with 98.5% of the probabilistic sensitivity simulations above the willingness-to-pay threshold. The population expected value of perfect information was $882,000, whereas the expected value of perfect information for parameters for the "cost parameters" was $207,000. CONCLUSION The adoption of 1-stage septic knee revision is the optimal choice for patients who have a PJI and who do not have a compelling need for a 2-stage exchange arthroplasty. One-stage exchange for PJI should be advocated in patients who meet the eligibility criteria.
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Affiliation(s)
- Charles E Okafor
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Queensland, Australia; Menzies Health Institute, Griffith University, Queensland, Australia
| | - Son Nghiem
- Department of Health Services, Research and Policy, Australian National University, Canberra, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Queensland, Australia; Menzies Health Institute, Griffith University, Queensland, Australia
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Okafor CE, Nghiem S, Byrnes J. Are joint replacement registries associated with burden of revision changes? A real-world panel data regression analysis. BMJ Open 2023; 13:e063472. [PMID: 36639213 PMCID: PMC9843180 DOI: 10.1136/bmjopen-2022-063472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The association of joint replacement registries with outcomes such as revision burden is uncertain. This study aimed to evaluate whether joint replacement registries are associated with the burden of revision changes while controlling for confounders that could affect the association. DESIGN A longitudinal study involving a combination of cross-sectional and time series data from 1980 to 2018. The study was a panel regression analysis using the difference-in-difference method. SETTING Data from countries with joint replacement registries and countries without joint replacement registries were used. Registry data were obtained from joint replacement registries' annual reports, while non-registry data were obtained from each included country's pooled hospitals' annual revision burden reported in the literature. OUTCOME MEASURES Changes in revision burden from 1980 to 2018 was the outcome measure. The revision burden in the registry periods of registry countries was compared with the non-registry periods of registry and non-registry countries. RESULTS Data were obtained from 12 registry periods and 8 non-registry periods. The average difference in revision burden in the registry periods of registry countries relative to the non-registry periods of registry and non-registry countries was statistically significant for hip, -3.80 (95% CI (-2.50 to -5.10); p<0.001) percentage points and knee, -1.63 (95% CI (-1.00 to -2.30); p<0.001) percentage points. This translates to a 19.30%, and 21.85% reduction in revision burden for hip and knee registries, for the whole sampling period. CONCLUSION Joint replacement registries are associated with a significant reduction in the burden of revision. Although revision burden reduces over time even without the registries, the establishment of joint replacement registries is associated with an increased reduction. The establishment of joint replacement registries in non-registry countries would be a worthwhile decision as it will further improve the outcomes of arthroplasty surgeries.
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Affiliation(s)
- Charles Ebuka Okafor
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Son Nghiem
- Department of Health Services, Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
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Hawks C, Al-Zubaidi M, Viswambaram P, Gonsalves J, Brown M, Byrnes J, Hayne D. Analysis of the financial impact and efficiency of the One Stop Prostate Clinic: A same day prostate cancer diagnostic clinic in the Australian public health system. J Public Health Res 2023; 12:22799036221146882. [PMID: 36643606 PMCID: PMC9834939 DOI: 10.1177/22799036221146882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023] Open
Abstract
Background Access to prostate cancer diagnostic clinics are challenging for rural men in Western Australia due to remoteness and long travel distances. The One Stop Prostate Clinic (OSPC) provided same day assessment and diagnosis for prostate cancer in a public tertiary hospital to reduce access barriers for rural men. The objective of this study was to determine the financial and resource utilisation impact of the OSPC compared to a usual care pathway (UCP). Design and methods Study design: Cost minimisation analysis of the OSPC model (assuming 100% new referrals) compared with a UCP, including impact on the Patient Assisted Transport Scheme (PATS) for rural men. An estimate of total cost comparison of OSPC and UCP pathways of outpatient and diagnostic costs was calculated based on journey mapping of attendance and follow up. Methods Prospective data collection between August 2011 and November 2017 of referral, attendance and follow up outcomes. Journey mapping to identify time from referral to diagnosis, number of outpatient appointment (OPA) and travel savings. Results A total of 1000 men attended - 466 (47%) rural and 534 (53%) metro. Mean time from referral to diagnosis was 57 days (rural) versus 63 (metro; p = 0.034)). The OSPC saved 543 travel episodes (distance of 1.5M km) and 658 OPA's. Total episode of care costs for the OSPC (100% new) pathway estimated as $2237.34, compared to $2847.00 for a UCP, generating savings of $609.66 per attendance ($609,658.22 overall). Conclusion The OSPC was more cost effective and efficient in comparison to a UCP.
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Affiliation(s)
| | - Mohammed Al-Zubaidi
- Fiona Stanley Hospital, Murdoch, WA,
Australia,Mohammed AM Ali Al-Zubaidi, Fiona Stanley
Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia.
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Rickard CM, Larsen E, Walker RM, Mihala G, Byrnes J, Saiyed M, Cooke M, Finucane J, Carr PJ, Marsh N. Integrated versus nonintegrated peripheral intravenous catheter in hospitalized adults (OPTIMUM): A randomized controlled trial. J Hosp Med 2023; 18:21-32. [PMID: 36372995 PMCID: PMC10099685 DOI: 10.1002/jhm.12995] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND One-third of peripheral intravenous catheters (PIVCs) fail from inflammatory or infectious complications, causing substantial treatment interruption and replacement procedures. OBJECTIVES We aimed to compare complications between integrated PIVCs (inbuilt extension sets, wings, and flattened bases) and traditional nonintegrated PIVCs. DESIGNS, SETTINGS AND PARTICIPANTS A centrally randomized, controlled, superiority trial (with allocation concealment until study entry) was conducted in three Australian hospitals. Medical-surgical patients (one PIVC each) requiring intravenous therapy for >24 h were studied. MAIN OUTCOME MEASURES The primary outcome was device failure (composite: occlusion, infiltration, phlebitis, dislodgement, local, or bloodstream infection). Infection endpoints were assessor-masked. The secondary outcomes were: failure type, first-time insertion success, tip colonization, insertion pain, dwell time, mortality, costs, health-related quality of life, clinician, and patient satisfaction. RESULTS Out of 1759 patients randomized (integrated PIVC, n = 881; nonintegrated PIVC, n = 878), 1710 (97%) received a PIVC and were in the modified intention-to-treat analysis (2269 PIVC-days integrated; 2073 PIVC-days nonintegrated). Device failure incidence was 35% (145 per 1000 device-days) nonintegrated, and 33% (124 per 1000 device-days) integrated PIVCs. INTERVENTION Integrated PIVCs had a significantly lower failure risk (adjusted [sex, infection, setting, site, gauge] hazard ratio [HR]: 0.82 [95% confidence interval, CI: 0.69-0.96], p = .015). The per-protocol analysis was consistent (adjusted HR: 0.80 [95% CI: 0.68-0.95], p = .010). Integrated PIVCs had significantly longer dwell (top quartile ≥ 95 vs. ≥84 h). Mean per-patient costs were not statistically different. CONCLUSIONS PIVC failure is common and complex. Significant risk factors include sex, infection at baseline, care setting, insertion site, catheter gauge, and catheter type. Integrated PIVCs can significantly reduce the burden of PIVC failure on patients and the health system.
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Affiliation(s)
- Claire M Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing Professional Development Unit, Division of Surgery, Princess Alexandra Hospital, Buranda, Queensland, Australia
| | - Emily Larsen
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Rachel M Walker
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing Professional Development Unit, Division of Surgery, Princess Alexandra Hospital, Buranda, Queensland, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Masnoon Saiyed
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Julie Finucane
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Metro South Hospitals and Health Service, Queen Elizabeth II Hospital, Nathan, Queensland, Australia
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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Afoakwah C, Byrnes J, Scuffham P, Nghiem S. Testing for selection bias and moral hazard in private health insurance: Evidence from a mixed public-private health system. Health Econ 2023; 32:3-24. [PMID: 36100982 PMCID: PMC10087718 DOI: 10.1002/hec.4605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 08/15/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
Separating selection bias from moral hazard in private health insurance (PHI) markets has been a challenging task. We estimate selection bias and moral hazard in Australia's mixed public-private health system, where PHI premiums are community-rated rather than risk-rated. Using longitudinal cohort data, with fine-grained measures for medical services predominantly funded by PHI providers, we find consistent and robust estimates of advantageous selection among hospitalized cardiovascular disease (CVD) patients. Specifically, we show that in addition to their risk-averse attributes, CVD patients who purchase PHI use fewer services that are not covered by PHI providers (e.g., general practitioners and emergency departments) and have fewer comorbidities. Finally, unlike previous studies, we show that ex-post moral hazard exists in the use of specific "in-hospital" medical services such as specialist and physician services, miscellaneous diagnostic procedures, and therapeutic treatments. From the perspective of PHI providers, the annual cost of moral hazard translates to a lower bound estimate of $707 per patient, equivalent to a 3.03% reduction in their annual profits.
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Affiliation(s)
- Clifford Afoakwah
- Centre for Applied Health EconomicsGriffith UniversityQueenslandNathanAustralia
- Menzies Health Institute QueenslandGriffith UniversityQueenslandSouthportAustralia
| | - Joshua Byrnes
- Centre for Applied Health EconomicsGriffith UniversityQueenslandNathanAustralia
- Menzies Health Institute QueenslandGriffith UniversityQueenslandSouthportAustralia
| | - Paul Scuffham
- Centre for Applied Health EconomicsGriffith UniversityQueenslandNathanAustralia
- Menzies Health Institute QueenslandGriffith UniversityQueenslandSouthportAustralia
| | - Son Nghiem
- College of Health & MedicineAustralian National UniversityCanberraAustralia
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Rickard C, Larsen E, Marsh N, McGrail M, Ullman A, Kleidon T, Chan R, Byrnes J, Mollee P, Paterson D, Chopra V, Stone L, Tapsall D, Keogh S, Gavin N, McCarthy S, Alexandrou E, Choudhury M, Corley A, Schults J, Ray-Barruel G, Geoffrey Playford E. 76. “Gadgets and gizmos aplenty!” Dressing and securing peripherally inserted central catheters to prevent infection and failure. Infect Dis Health 2022. [DOI: 10.1016/j.idh.2022.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Crilly JL, Brandenburg C, Kinner SA, Heffernan E, Byrnes J, Lincoln C, Gardiner P, Davidson P, Somerville A, Wilson D, Green D, Thomas S. Health care in police watch-houses: a challenge and an opportunity. Med J Aust 2022; 217:287-289. [PMID: 36030509 PMCID: PMC9804427 DOI: 10.5694/mja2.51688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Julia L Crilly
- Gold Coast Hospital and Health ServiceGold CoastQLD
- Griffith UniversityGold CoastQLD
| | | | | | | | | | | | | | | | | | | | - David Green
- Gold Coast Hospital and Health ServiceGold CoastQLD
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Bade D, Malayko G, Johnson L, Bradford K, Reddan T, Stockton C, Frawley K, Phillips T, Saxby D, Ware RS, Byrnes J, Carty CP. Single versus double hamstring tendon graft in anterior cruciate ligament reconstruction in the paediatric patient: a single-blind randomised controlled trial study protocol. BMJ Open 2022; 12:e057465. [PMID: 35985784 PMCID: PMC9396117 DOI: 10.1136/bmjopen-2021-057465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION There is currently no clear indication in the literature regarding a single or double hamstring tendon (single bundle) autograft for anterior cruciate ligament (ACL) reconstruction in the paediatric patient. The primary aim of this single blind randomised controlled trial is to determine whether a single or double hamstring tendon graft ACLR leads to superior clinical outcomes postsurgery in paediatric patients with ACL injury. METHODS AND ANALYSIS Single site, prospective, single blind, randomised controlled trial with two parallel treatment arms. 100 patients aged 10-18 years who present with an isolated ACL tear±meniscal injury, verified on MRI, will be randomly allocated to one of the two surgical groups. The primary outcomes will be side-to-side difference in anterior tibial translation and graft failure incidence 12 months postsurgery. Primary and secondary outcomes will also be assessed at 2-year and 5-year postsurgery. ETHICS AND DISSEMINATION Results will be presented in peer-reviewed journals and at international conferences and disseminated to participants and healthcare professionals via newsletters and hospital presentations. This study is approved by the Children's Health Queensland Hospital and Health Service Human Research Ethics committee. TRIAL REGISTRATION NUMBER ACTRN12620001170910p; Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- David Bade
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Garrett Malayko
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Liam Johnson
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Kylie Bradford
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Tristan Reddan
- Department of Medical Imaging and Nuclear Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Chris Stockton
- Department of Medical Imaging and Nuclear Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Kieran Frawley
- Department of Medical Imaging and Nuclear Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Teresa Phillips
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - David Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Christopher P Carty
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Huynh QL, Nghiem S, Byrnes J, Scuffham PA, Marwick T. Application of a risk-guided strategy to secondary prevention of coronary heart disease: analysis from a state-wide data linkage in Queensland, Australia. BMJ Open 2022; 12:e057856. [PMID: 35508342 PMCID: PMC9073398 DOI: 10.1136/bmjopen-2021-057856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study sought whether higher risk patients with coronary heart disease (CHD) benefit more from intensive disease management. DESIGN Longitudinal cohort study. SETTING State-wide public hospitals (Queensland, Australia). PARTICIPANTS This longitudinal study included 20 426 patients hospitalised in 2010 with CHD as the principal diagnosis. Patients were followed-up for 5 years. PRIMARY AND SECONDARY OUTCOMES AND MEASURES The primary outcome was days alive and out of hospital (DAOH) within 5 years of hospital discharge. Secondary outcomes included all-cause readmission and all-cause mortality. A previously developed and validated risk score (PEGASUS-TIMI54) was used to estimate the risk of secondary events. Data on sociodemography, comorbidity, interventions and medications were also collected. RESULTS High-risk patients (n=6573, risk score ≥6) had fewer DAOH (∆=-142 days (95% CI: -152 to -131)), and were more likely to readmit or die (all p<0.001) than their low-risk counterparts (n=13 367, risk score <6). Compared with patients who were never prescribed a medication, those who consumed maximal dose of betablockers (∆=39 days (95% CI: 11 to 67)), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (∆=74 days (95% CI: 49 to 99)) or statins (∆=109 days (95% CI: 90 to 128)) had significantly greater DAOH. Patients who received percutaneous coronary intervention (∆=99 days (95% CI: 81 to 116)) or coronary artery bypass grafting (∆=120 days (95% CI: 92 to 148)) also had significantly greater DAOH than those who did not. The effect sizes of these therapies were significantly greater in high-risk patients, compared with low-risk patients (interaction p<0.001). Analysis of secondary outcomes also found significant interaction between both medical and interventional therapies with readmission and death, implicating greater benefits for high-risk patients. CONCLUSIONS CHD patients can be effectively risk-stratified, and use of this information for a risk-guided strategy to prioritise high-risk patients may maximise benefits from additional resources spent on intensive disease management.
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Affiliation(s)
- Quan L Huynh
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Son Nghiem
- Griffith University, Nathan, Queensland, Australia
| | | | - Paul A Scuffham
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Thomas Marwick
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
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Evison H, Carrington M, Keijzers G, Marsh NM, Sweeny AL, Byrnes J, Rickard CM, Carr PJ, Ranse J. Peripheral intravenous cannulation decision-making in emergency settings: a qualitative descriptive study. BMJ Open 2022; 12:e054927. [PMID: 35273050 PMCID: PMC8915296 DOI: 10.1136/bmjopen-2021-054927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Rates of unused ('idle') peripheral intravenous catheters (PIVCs) are high but can vary per setting. Understanding factors that influence the decision-making of doctors, nurses and paramedics in the emergency setting regarding PIVC insertion, and what factors may modify their decision is essential to identify opportunities to reduce unnecessary cannulations and improve patient-centred outcomes. This study aimed to understand factors associated with clinicians' decision-making on whether to insert or use a PIVC in the emergency care setting. DESIGN A qualitative descriptive study using in-depth semistructured interviews and thematic analysis. SETTING Gold Coast, Queensland, Australia, in a large tertiary level emergency department (ED) and local government ambulance service. PARTICIPANTS Participants recruited were ED clinicians (doctors, nurses) and paramedics who regularly insert PIVCs. RESULTS From the 15 clinicians interviewed 4 key themes: knowledge and experience, complicated and multifactorial, convenience, anticipated patient clinical course, and several subthemes emerged relating to clinician decision-making across all disciplines. The first two themes focused on decision-making to gather data and evidence, such as knowledge and experience, and decisions being complicated and multifactorial. The remaining two themes related to the actions clinicians took such as convenience and anticipated patient clinical course. CONCLUSION The decision to insert a PIVC is more complicated than clinicians, administrators and policy-makers may realise. When explored, clinician decisions were multifaceted with many factors influencing the decision to insert a PIVC. In actual practice, clinicians routinely insert PIVCs in most patients as a learnt reflex with little cognitive input. When considering PIVC insertion, more time needs to be devoted to the awareness of: (1) decision-making in the context of the clinician's own experience, (2) cognitive biases and (3) patient-centred factors. Such awareness will support an appropriate risk assessment which will benefit the patient, clinician and healthcare system.
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Affiliation(s)
- Hugo Evison
- Gold Coast Region, Queensland Ambulance Service, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery/School of Pharmacy and Medical Science, Griffith University, Nathan, Queensland, Australia
| | - Mercedes Carrington
- Department of Emergency Medicine, Robina Hospital, Robina, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Nicole M Marsh
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery/School of Pharmacy and Medical Science, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Centre Research Centre, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Menzies Health Institute, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Amy Lynn Sweeny
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Joshua Byrnes
- School of Medicine, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery/School of Pharmacy and Medical Science, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Centre Research Centre, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Herston Infectious Disease Institute, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery/School of Pharmacy and Medical Science, Griffith University, Nathan, Queensland, Australia
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Jamie Ranse
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Menzies Health Institute, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
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Nghiem S, Afoakwah C, Scuffham P, Byrnes J. Benchmarking hospital safety and identifying determinants of hospital-acquired complication: the case of Queensland cardiac linkage longitudinal cohort. Infect Prev Pract 2022; 4:100198. [PMID: 35005603 PMCID: PMC8717596 DOI: 10.1016/j.infpip.2021.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hospital-acquired complications (HACs) are costly and associated with adverse health outcomes, although they can be avoided. Administrative linkage health data have become more accessible and can be used to monitor and reduce HAC. AIMS This study aims to use linkage administrative data to benchmark the safety performance of hospitals and estimate the feasible magnitude that HAC can be reduced. We also identify risk factors associated with HACs, and estimate the effects of HACs on adverse health outcomes and hospital costs. METHODS This is a retrospective linkage cohort study. The cohort includes 371,040 inpatient multiple-day admissions of 83,025 cardiovascular disease patients admitted to public hospitals in 2010 with follow-ups until 2015.Data envelopment analysis was applied to benchmark the patient safety performance of hospitals. Logistic regression was used to examine the odds of HAC and its effects on in-hospital mortality and 30-day readmission. Generalised linear models were used to identify the impacts of HACs on hospital costs and the length of hospital stay. FINDINGS On average, 9.3% of multiple-day hospital admissions were associated with HACs. The average HAC rate can be reduced by two percentage points if all hospitals achieve the safety record of best-practice hospitals. Old age and multiple comorbidities were major driving factors of HACs. CONCLUSIONS Cardiovascular disease patients with HAC have a higher risk of death, stay longer in hospitals and incur higher health care costs. The average HAC rates can be reduced by two percentage points by learning from best-practice hospitals operating in the same region.
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Affiliation(s)
- Son Nghiem
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Rd, Nathan, QLD 4111, Australia
| | - Clifford Afoakwah
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Rd, Nathan, QLD 4111, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, G40, Gold Coast Campus, Griffith University QLD 4222, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Rd, Nathan, QLD 4111, Australia
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Truong AP, Pérez-Prieto D, Byrnes J, Monllau JC, Vertullo CJ. Vancomycin Soaking Is Highly Cost-Effective in Primary ACLR Infection Prevention: A Cost-Effectiveness Study. Am J Sports Med 2022; 50:922-931. [PMID: 35180008 DOI: 10.1177/03635465211073338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although presoaking grafts in vancomycin has been demonstrated to be effective in observational studies for anterior cruciate ligament reconstruction (ACLR) infection prevention, the economic benefit of the technique is uncertain. PURPOSE To 1) determine the cost-effectiveness of vancomycin presoaking during primary ACLR to prevent postoperative joint infections and 2) to establish the break-even cost-effectiveness threshold of the technique and determine its cost-effectiveness across various international health care settings. STUDY DESIGN Economic and decision analysis; Level of evidence, 2. METHODS A Markov model was used to determine cost-effectiveness and the incremental cost-effectiveness ratio of additional vancomycin presoaking compared with intravenous antibiotic prophylaxis alone. A repeated search of the PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials databases, using the same criteria as a recent meta-analysis, was completed. A repeated meta-analysis of 9 cohort studies (level 3 evidence) was completed to determine the odds ratio of infection with vancomycin presoaking compared with intravenous antibiotics alone. Estimated costs of the vancomycin technique, treatment of infection, and further surgery were sourced from local hospitals and literature. Transitional probabilities for further surgery, including revision reconstruction and primary arthroplasty, were obtained from the literature. Probabilistic sensitivity analyses and a 1-way sensitivity analysis were performed to evaluate the ACLR infection rate break-even threshold for which the vancomycin technique would be no longer cost-effective. RESULTS The vancomycin soaking technique provides expected cost savings of $660 (USA), A$581 (Australia), and €226 (Spain) per patient. There was an improvement in the quality-adjusted life-years of 0.007 compared with intravenous antibiotic prophylaxis alone (4.297 vs 4.290). If the infection rate is below 0.014% with intravenous antibiotics alone, the vancomycin wrap would no longer be cost-effective. CONCLUSION The vancomycin presoaking technique is a highly cost-effective method to prevent postoperative septic arthritis after primary ACLR.
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Affiliation(s)
- Anthony P Truong
- Department of Orthopaedics, Toowoomba Base Hospital & Gold Coast University Hospital, Toowoomba, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Daniel Pérez-Prieto
- ICATKNEE, Hospital Universitari Dexeus, Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Joan C Monllau
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Department of Orthopaedic Surgery and Traumatology, Hospital del Mar ICATKNEE, Hospital Universitari Dexeus, Barcelona, Spain
| | - Christopher J Vertullo
- Orthopaedic Surgery & Sports Medicine Centre, Gold Coast, Queensland, Australia.,Knee Research Australia, Gold Coast, Queensland, Australia.,Menzies Health, Griffith University, Brisbane, Queensland, Australia.,Australian Knee Society.,Australian Orthopaedic Association.,AOA Continuing Orthopaedic Education
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McBride CA, Rahiman S, Schlapbach LJ, Schults JA, Kleidon TM, Kennedy M, Paterson RS, Byrnes J, Ware RS, Ullman AJ. Comparing ivWatch biosensor to standard care to identify extravasation injuries in the paediatric intensive care: a protocol for a randomised controlled trial. BMJ Open 2022; 12:e047765. [PMID: 35190407 PMCID: PMC8862432 DOI: 10.1136/bmjopen-2020-047765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Peripheral intravenous catheters (PIVCs) frequently fail during therapy administration, resulting in infusates pooling in the surrounding tissue. These extravasation injuries can cause significant pain, tissue destruction and scarring. ivWatch is a biosensor that uses visible and near-infrared light to measure tissue changes surrounding the PIVC and alert clinicians when extravasation may occur. The effectiveness of ivWatch, in comparison to clinical observation, in decreasing injury severity is unknown. The present study aims to investigate whether using ivWatch may potentially detect injury earlier and decrease the severity of PIVC extravasation injuries. METHODS AND ANALYSIS A single centre, parallel group, open-label superiority randomised controlled trial comparing (a) standard care (clinical observation) to (b) ivWatch monitoring in addition to standard care, to decrease the severity of extravasation injuries. 200 children with PIVCs inserted in the distal half of the limb, receiving intermediate-risk to high-risk infusates for ≥24 hours, will be consecutively recruited at a paediatric intensive care unit in Queensland, Australia. The primary outcome is extravasation severity, measured by the Cincinnati Children's Extravasation Harm Scale. Secondary outcomes include severity assessed with three-dimensional camera imaging, extravasation volume, treatment sequelae, the number of PIVCs used and dwell time, quality of life and healthcare costs. The between treatment difference in extravasation severity will be compared using ordinal logistic regression, with the treatment group included as the main effect, and reported with corresponding 95% CIs. Estimates of value will be presented as net monetary benefits and cost per reduction in extravasation injury severity, both presented with corresponding 95% credible intervals. ETHICS AND DISSEMINATION This study received approval from the Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC) (reference number: HREC/20/QCHQ/60867) and the Griffith University HREC (reference number: 2020/310) and will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12620000317998.
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Affiliation(s)
- Craig Antony McBride
- Surgical Team: Infants, Toddlers, Children (STITCh), Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland, South Brisbane, Queensland, Australia
| | - Sarfaraz Rahiman
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Luregn J Schlapbach
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Department of Intensive Care Medicine and Neonatology, Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Jessica A Schults
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Herston Infectious Disease Institute, Metro North Health, Herston, Queensland, Australia
| | - Tricia M Kleidon
- Surgical Team: Infants, Toddlers, Children (STITCh), Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | - Melanie Kennedy
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Rebecca S Paterson
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Robert S Ware
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Amanda Judith Ullman
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
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Nghiem S, Afoakwah C, Scuffham P, Byrnes J. A baseline profile of the Queensland Cardiac Record Linkage Cohort (QCard) study. BMC Cardiovasc Disord 2022; 22:35. [PMID: 35120447 PMCID: PMC8817516 DOI: 10.1186/s12872-022-02478-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Cardiovascular disease (CVD) is one of the leading causes of death in Australia. Longitudinal record linkage studies have the potency to influence clinical decision making to improve cardiac health. This paper describes the baseline characteristics of the Queensland Cardiac Record Linkage Cohort study (QCard).
Methods International Classification of Disease, 10th Revision Australian Modification (ICD-10-AM) diagnosis codes were used to identify CVD and comorbidities. Cost and adverse health outcomes (e.g., comorbidities, hospital-acquired complications) were compared between first-time and recurrent admissions. Descriptive statistics and standard tests were used to analyse the baseline data. Results There were 132,343 patients with hospitalisations in 2010, of which 47% were recurrent admissions, and 53% were males. There were systematic differences between characteristics of recurrent and first-time hospitalisations. Patients with recurrent episodes were nine years older (70 vs. 61; p < 0.001) and experienced a twice higher risk of multiple comorbidities (3.17 vs. 1.59; p < 0.001). CVD index hospitalisations were concentrated in large metropolitan hospitals. Conclusions Our study demonstrates that linked administrative health data provide an effective tool to investigate factors determining the progress of heart disease. Our main finding suggests that recurrent admissions were associated with higher hospital costs and a higher risk of having adverse outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02478-z.
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Affiliation(s)
- Son Nghiem
- Centre for Applied Health Economics, Griffith University, 117 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia.
| | - Clifford Afoakwah
- Centre for Applied Health Economics, Griffith University, 117 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia
| | - Paul Scuffham
- Centre for Applied Health Economics, Griffith University, 117 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia.,Menzies Health Institute Queensland, Griffith University, Level 8.86, G40-Griffith Health Centre, Gold Coast, QLD, 4222, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, 117 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia
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Hettiarachchi RM, Kularatna S, Byrnes J, Chen G, Mulhern B, Scuffham PA. Development of a classification (descriptive) system for a preference-based quality of life measure for dental caries (dental caries utility index) among adolescents. J Public Health Dent 2021; 82:253-261. [PMID: 34859442 DOI: 10.1111/jphd.12490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/16/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Preference-based quality-of-life measures (PBMs) have been developed in many clinical areas to aid estimation of more accurate utility values for economic evaluations. Existing oral health-related quality-of-life (OHRQoL) instruments are non-PBM and hence, cannot be used to generate utility values. The objective of this study was to develop a classification system for a new PBM (dental caries utility index-DCUI) for the most prevalent childhood oral health condition: dental caries. METHODS Possible domains and items to be included in the classification system were identified based on the reviewing available pediatric non-PBM OHRQoL instruments, studies eliciting utility values for oral health outcomes and clinical dentistry textbooks and based on the findings, a draft classification system was developed. To refine the draft classification system, semi-structured interviews were conducted among a convenience sample of 15 12-17-year-old adolescents who had experience with dental caries. The classification system was further refined and validated by a group of dental experts, using a modified Delphi technique. RESULTS The classification system comprised five items (pain/discomfort, difficulty in eating food/drinking, worried, ability to participate in activities, and appearance) and each item had a four-level response scale. CONCLUSION The classification system developed herein is considered an amenable tool for the subsequent development of a new PBM for dental caries. Once the scoring algorithm is completed, the classification system can be used to incorporate economic evaluations of dental caries health interventions.
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Affiliation(s)
- Ruvini M Hettiarachchi
- Centre for Applied Health Economics, School of Medicine and Menzies Health Institute Queensland, Griffith University, Griffith, Queensland, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Menzies Health Institute Queensland, Griffith University, Griffith, Queensland, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, School of Medicine and Menzies Health Institute Queensland, Griffith University, Griffith, Queensland, Australia
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Pu L, Coppieters MW, Byrnes J, Jones C, Smalbrugge M, Todorovic M, Moyle W. Feasibility study protocol of the PainChek app to assess the efficacy of a social robot intervention for people with dementia. J Adv Nurs 2021; 78:587-594. [PMID: 34825740 DOI: 10.1111/jan.15106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/05/2021] [Indexed: 01/21/2023]
Abstract
AIM This study aims to test the feasibility of the PainChek app to assess pain for people with dementia living in residential aged care facilities (RACFs). It will also identify the optimal dosage and efficacy of a social robot (personal assistant robot [PARO]) intervention on chronic pain for people with dementia. DESIGN This is a feasibility randomized controlled trial with three groups. METHODS Forty-five residents living with dementia and chronic pain will be recruited from one RACF. The intervention consists of an individual 15-min non-facilitated session with a PARO robot twice a day (Group 1), a PARO robot once a day (Group 2), or a Plush-Toy (non-robotic PARO) once a day (Group 3) from Monday to Friday for 4 weeks. Participants will be followed at 4 and 8 weeks after baseline assessments. The primary outcome will be the feasibility of using the PainChek app to measure changes in pain levels before and after each session. Secondary outcomes include staff-rated pain levels, neuropsychiatric symptoms, quality of life and changes in psychotropic and analgesic medication use. Participants, staff and family perceptions of using PARO and the PainChek app will be collected after the 4-week intervention. DISCUSSION This study will test the use of the PainChek app and PARO to improve pain management for people with dementia. Results from this study will help determine its usefulness, feasibility and acceptability for pain management in people with dementia living in RACFs. IMPACT As pain is a significant problem for people with dementia, this project will generate evidence on the use of the PainChek to measure the efficacy of a social robot intervention that has the potential to improve the quality of pain care in people with dementia. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry number (ACTRN12621000837820) date registered 30/06/2021.
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Affiliation(s)
- Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Centre for Applied Health Economics, Griffith University, Brisbane, Queensland, Australia
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Faculty of Health Sciences & Medicine, Bond University, Brisbane, Queensland, Australia
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michael Todorovic
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Larsen EN, Byrnes J, Marsh N, Rickard CM. Patient-reported outcome and experience measures for peripheral venous catheters: a scoping review protocol. Br J Nurs 2021; 30:S30-S35. [PMID: 34723667 DOI: 10.12968/bjon.2021.30.19.s30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this scoping review is to conduct a systematic search and establish the current state of evidence for tools and instruments used to measure self-reported outcomes and experiences, including satisfaction scores, specifically for peripheral venous access devices (PVADs). METHODS A systematic search of the literature will be conducted using medical databases including: MEDLINE (Ovid); CINAHL (EbscoHost); PubMed (NCBI); and Scopus (Elsevier); Google (Scholar); and the Cochrane Central Register of Controlled Trials. Experimental, and observational studies, published in English, after 1990 will be eligible for inclusion if they: consist of (i) a survey, instrument or tool that is designed to (ii) collect outcome, experience and/or satisfaction data, relating to PVAD insertion, care, maintenance and/or removal, among (iii) adult and paediatric participants. CONCLUSIONS PVAD-specific patient-reported outcome and experience measures are necessary for researchers, clinicians and policy decision makers to explore more thoroughly the quality of PVAD care provided, and further inform health economic analyses in the context of quality improvement interventions for vascular access devices. This scoping review will establish the existence-or paucity-of instruments to measure these selfreported outcomes and experiences of PVADs, in order to guide value-based healthcare delivery into the future.
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Wang T, Bahrampour M, Byrnes J, Scuffham P, Kirk E, Downes M. Economic evaluation of reproductive carrier screening for recessive genetic conditions: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2021; 22:197-206. [PMID: 34643123 DOI: 10.1080/14737167.2022.1993063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Autosomal recessive (AR) and x-linked (XL) conditions are rare but collectively common which impact millions of people globally on morbidity, mortality and costs. Advanced medical technologies allow prospective parents to make informed reproductive decisions to avoid having affected children. Economic evaluations targeting on reproductive carrier screening (RCS) for AR and/or XL conditions have been conducted, but there has not been a systematic review in this area. AREAS COVERED A systematic search of economic evaluations for RCS was undertaken using the following databases - EMBASE, MEDLINE and SCOPUS. The search strategy was designed to capture full economic evaluations related to RCS since 1990. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) strategy. The included 23 studies adopted various types of methodologies to conduct economic evaluations. The majority of studies examined a single condition. The various clinical strategies and screened conditions caused the different cost-effectiveness conclusions in the published studies. EXPERT OPINION Establishing a validated and practical clinical strategy of RCS and investigating the cost-effectiveness of multiple conditions in one economic evaluation are critical for implementing RCS in the future. Further economic evaluations are essential to provide evidence-based practice for decision-makers.
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Affiliation(s)
- Tianjiao Wang
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Mina Bahrampour
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Paul Scuffham
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Edwin Kirk
- Centre for Clinical Genetics, Sydney Children's Hospital Randwick, Randwick, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, Australia.,New South Wales Health Pathology Randwick Genomics Laboratory, Randwick, Australia
| | - Martin Downes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Nghiem S, Afoakwah C, Scuffham P, Byrnes J. Hospital frailty risk score and adverse health outcomes: evidence from longitudinal record linkage cardiac data. Age Ageing 2021; 50:1778-1784. [PMID: 33989395 DOI: 10.1093/ageing/afab073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite recent evidence on the effect of frailty on health outcomes among those with heart failure, there is a dearth of knowledge on measuring frailty using administrative health data on a wide range of cardiovascular diseases (CVD). METHODS We conducted a retrospective record-linkage cohort study of patients with diverse CVD in Queensland, Australia. We investigated the relationship between the risk of frailty, defined using the hospital frailty risk score (HFRS), and 30-day mortality, 30-day unplanned readmission, non-home discharge, length of hospital stay (LOS) at an emergency department and inpatient units and costs of hospitalisation. Descriptive analysis, bivariate logistic regression and generalised linear models were used to estimate the association between HFRS and CVD outcomes. Smear adjustment was applied to hospital costs and the LOS for each frailty risk groups. RESULTS The proportion of low, medium and high risk of frailty was 24.6%, 34.5% and 40.9%, respectively. The odds of frail patients dying or being readmitted within 30 days of discharge was 1.73 and 1.18, respectively. Frail patients also faced higher odds of LOS, and non-home discharge at 3.1 and 2.25, respectively. Frail patients incurred higher hospital costs (by 42.7-55.3%) and stayed in the hospital longer (by 49%). CONCLUSION Using the HFRS on a large CVD cohort, this study confirms that frailty was associated with worse health outcomes and higher healthcare costs. Administrative data should be more accessible to research such that the HFRS can be applied to healthcare planning and patient care.
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Affiliation(s)
- Son Nghiem
- Centre for Applied Health Economics, Griffith University, Level 1-2, N78, 170 Kessels Rd. Nathan QLD 4111, Australia
| | - Clifford Afoakwah
- Centre for Applied Health Economics, Griffith University, Level 1-2, N78, 170 Kessels Rd. Nathan QLD 4111, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Level 8 G40, Griffith Health Centre, Gold Coast Campus, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Level 1-2, N78, 170 Kessels Rd. Nathan QLD 4111, Australia
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Kleidon TM, Schults JA, Wainwright C, Mihala G, Gibson V, Saiyed M, Byrnes J, Cattanach P, Macfarlane F, Graham N, Shevill E, Ullman AJ. Comparison of midline catheters and peripherally inserted central catheters to reduce the need for general anesthesia in children with respiratory disease: A feasibility randomized controlled trial. Paediatr Anaesth 2021; 31:985-995. [PMID: 34053159 DOI: 10.1111/pan.14229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The optimal intravenous device for antibiotic administration for children with respiratory disease is uncertain. We assessed the feasibility of a randomized controlled trial comparing midline catheters with peripherally inserted central catheters. METHODS Prospective, two-arm, feasibility randomized controlled trial in an Australian tertiary, pediatric hospital. Random assignment of 110 children (<18 years) to receive (i) midline catheter and (ii) peripherally inserted central catheters. Primary outcome was feasibility (eligibility, recruitment, retention, protocol adherence, and acceptability), and the primary clinical outcome was general anesthesia requirement for intravenous catheter insertion. SECONDARY OUTCOMES insertion time, treatment delays, infusion efficiency, device failure, complications, and cost. RESULTS There was 80% recruitment, 100% retention, no missing data, and high patient/staff acceptability. Mean patient experience assessed on a 0-10 numeric rating scale was 8.0 peripherally inserted central catheters and 9.0 (midline catheters), respectively. Participant eligibility was not achieved (49% of screened patients) and moderate protocol-adherence across groups (89% peripherally inserted central catheters vs. 76% midline catheter). Insertion of midline catheter for pulmonary optimization reduced the requirement for general anesthesia compared to peripherally inserted central catheters (10% vs. 69%; odds ratio = 0.01, 95% confidence interval: 0.00-0.09). Midline catheters failed more frequently (18.1 vs. 5.5 peripherally inserted central catheters per 1000 catheter-days); however, this reduced over trial duration. Midline catheter insertion compared to peripherally inserted central catheters saved AUD$1451 per pulmonary optimization episode. CONCLUSIONS An efficacy trial is feasible with expanded eligibility criteria and intensive staff training when introducing a new device. Midline catheter for peripherally compatible infusions is acceptable to patients and staff, might negate the need for general anesthesia and results in significant cost savings.
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Affiliation(s)
- Tricia M Kleidon
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Qld, Australia
| | - Jessica A Schults
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Qld, Australia
| | - Claire Wainwright
- Child Health Research Centre, Queensland Children's Hospital, The University of Queensland and Respiratory Medicine, South Brisbane, Qld, Australia
| | - Gabor Mihala
- Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia.,School of Medicine, Griffith University, Nathan, Qld, Australia.,Menzies Health Institute Group, Centre for Applied Health Economics, Nathan, Qld, Australia
| | - Victoria Gibson
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia
| | - Masnoon Saiyed
- School of Medicine, Griffith University, Nathan, Qld, Australia.,Menzies Health Institute Group, Centre for Applied Health Economics, Nathan, Qld, Australia
| | - Joshua Byrnes
- School of Medicine, Griffith University, Nathan, Qld, Australia.,Menzies Health Institute Group, Centre for Applied Health Economics, Nathan, Qld, Australia
| | - Paula Cattanach
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia
| | - Fiona Macfarlane
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia
| | - Nicolette Graham
- Department of Pharmacy, Queensland Children's Hospital, South Brisbane, Qld, Australia
| | - Elizabeth Shevill
- Child Health Research Centre, Queensland Children's Hospital, The University of Queensland and Respiratory Medicine, South Brisbane, Qld, Australia
| | - Amanda J Ullman
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Qld, Australia.,Child Health Research Centre, Queensland Children's Hospital, The University of Queensland and Respiratory Medicine, South Brisbane, Qld, Australia
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50
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Evison H, Sweeny A, Ranse J, Carrington M, Marsh N, Byrnes J, Rickard CM, Carr PJ, Keijzers G. Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices. Scand J Trauma Resusc Emerg Med 2021; 29:126. [PMID: 34454555 PMCID: PMC8403444 DOI: 10.1186/s13049-021-00941-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment. METHODS This was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February-18 March 2017 and 5 January-4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression. RESULTS A total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%-31.9%) remained idle at 24 hours. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs. 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs. 7.4%). Nursing staff inserted idle PIVCs at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC inserted in the ED was the only factor significantly (p ≤ .001) predicting an idle outcome (Odds Ratio: 2.4; 95% CI 1.7-3.3). CONCLUSION One-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of antecubital insertion. Reasons for these differences are not well understood and requires more targeted research.
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Affiliation(s)
- Hugo Evison
- Queensland Ambulance Service, GPO Box 1425, Brisbane, QLD, 4000, Australia.
| | - Amy Sweeny
- Department of Emergency Medicine, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia.,School of Medicine, Griffith University, Teaching Griffith Health Centre - G40 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia.,Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4226, Australia
| | - Jamie Ranse
- Department of Emergency Medicine, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia
| | - Mercedes Carrington
- Department of Emergency Medicine, Robina Hospital, 2 Bayberry Lane, Robina, QLD, 4226, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia.,School of Nursing and Midwifery, Griffith University, N48 Health Sciences Building, Level 2.06, 170 Kessels Road, Southport, QLD, 4111, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Level 2 Building 34 Royal Brisbane and Women's Hospital, Herston, QLD, 4209, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, N78 Sir Samuel Griffith Building, Level 2.11, 170 Kessels Road, Southport, QLD, 4111, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia.,School of Nursing and Midwifery, Griffith University, N48 Health Sciences Building, Level 2.06, 170 Kessels Road, Southport, QLD, 4111, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Level 2 Building 34 Royal Brisbane and Women's Hospital, Herston, QLD, 4209, Australia.,Herston Infectious Diseases Institute, Metro North Hospitals and Health Service, Herston, QLD, 4006, Australia.,School of Nursing Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, QLD, 4006, Australia
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia.,School of Nursing and Midwifery, National University of Ireland Galway, 26 Upper Newcastle, Galway, H91 E3YV, Ireland
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.,Department of Emergency Medicine, Robina Hospital, 2 Bayberry Lane, Robina, QLD, 4226, Australia.,School of Medicine, Griffith University, Teaching Griffith Health Centre - G40 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia.,Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4226, Australia
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