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Yang Y, Shao Y, Chen H, Guo X, Liang Y, Wang Y, Zhao Y. Characteristics and treatment for severe postpartum haemorrhage in different midwifery hospitals in one district of Beijing in China: an institution-based, retrospective cohort study. BMJ Open 2024; 14:e077709. [PMID: 38569676 DOI: 10.1136/bmjopen-2023-077709] [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] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To identify the characteristics and treatment approaches for patients with severe postpartum haemorrhage (SPPH) in various midwifery institutions in one district in Beijing, especially those without identifiable antenatal PPH high-risk factors, to improve regional SPPH rescue capacity. DESIGN Retrospective cohort study. SETTING This study was conducted at 9 tertiary-level hospitals and 10 secondary-level hospitals in Haidian district of Beijing from January 2019 to December 2022. PARTICIPANTS The major inclusion criterion was SPPH with blood loss ≥1500 mL or needing a packed blood product transfusion ≥1000 mL within 24 hours after birth. A total of 324 mothers with SPPH were reported to the Regional Obstetric Quality Control Office from 19 midwifery hospitals. OUTCOME MEASURES The pregnancy characteristics collected included age at delivery, gestational weeks at delivery, height, parity, delivery mode, antenatal PPH high-risk factors, aetiology of PPH, bleeding amount, PPH complications, transfusion volume and PPH management. SPPH characteristics were compared between two levels of midwifery hospitals and their association with antenatal PPH high-risk factors was determined. RESULTS SPPH was observed in 324 mothers out of 106 697 mothers in the 4 years. There were 74.4% and 23.9% cases of SPPH without detectable antenatal PPH high-risk factors in secondary and tertiary midwifery hospitals, respectively. Primary uterine atony was the leading cause of SPPH in secondary midwifery hospitals, whereas placental-associated disorders were the leading causes in tertiary institutions. Rates of red blood cell transfusion over 10 units, unscheduled returns to the operating room and adverse PPH complications were higher in patients without antenatal PPH high-risk factors. Secondary hospitals had significantly higher rates of trauma compared with tertiary institutions. CONCLUSION Examining SPPH cases at various institutional levels offers a more comprehensive view of regional SPPH management and enhances targeted training in this area.
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Affiliation(s)
- Yike Yang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
| | - Yu Shao
- Haidian Maternal and Child Health Hospital, Beijing, Beijing, China
| | - Huan Chen
- Peking University Health Science Center, Beijing, Beijing, China
| | - Xiaoyue Guo
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yingzhi Liang
- Haidian Maternal and Child Health Hospital, Beijing, Beijing, China
| | - Yan Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
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Thompson M, Jefferson O, James T, Waller B, Reed R, Slade H, Swift K, Pynn HJ. Defining capabilities in deployed UK military prehospital emergency care. BMJ Mil Health 2024; 170:150-154. [PMID: 38508774 DOI: 10.1136/military-2022-002159] [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: 05/16/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
The UK military prehospital emergency care (PHEC) operational clinical capability framework must be updated in order that it retains its use as a valid operational planning tool. Specific requirements include accurately defining the PHEC levels and the 'Medical Emergency Response Team' (MERT), while reinforcing PHEC as a specialist area of clinical practice that requires an assured set of competencies at all levels and mandatory clinical currency for vocational providers.A military PHEC review panel was convened by the Defence Consultant Advisor (DCA) for PHEC. Each PHEC level was reviewed and all issues which had, or could have arisen from the existing framework were discussed until agreement between the six members of this panel was established.An updated military PHEC framework has been produced by DCA PHEC, which defines the minimum requirements for each operational PHEC level. These definitions cover all PHEC providers, irrespective of professional background. The mandatory requirement for appropriate clinical exposure for vocational and specialist providers is emphasised. An updated definition of MERT has been agreed.This update provides clarity to the continually evolving domain of UK military PHEC. It sets out the PHEC provider requirements in order to be considered operationally deployable in a PHEC role. There are implications for training, manning and recruitment to meet these requirements, but the processes required to address these are already underway and well described elsewhere.
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Affiliation(s)
- Michael Thompson
- Royal Air Force Medical Services, RAF High Wycombe, UK
- Emergency Department, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - O Jefferson
- Royal Air Force Medical Services, RAF High Wycombe, UK
- Emergency Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T James
- Royal Air Force Medical Services, RAF High Wycombe, UK
- Emergency Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - B Waller
- Navy Command Headquarters, Navy Healthcare, Portsmouth, UK
- Shackleton Department of Anaesthetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Reed
- Joint Hospital Group South West, Defence Medical Services, Plymouth, UK
- Anaesthetic Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - H Slade
- Royal Air Force Medical Services, RAF High Wycombe, UK
- Emergency Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - K Swift
- Tactical Medical Wing, Royal Air Force Medical Services, RAF Brize Norton, UK
| | - H J Pynn
- Department of Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
- Emergency Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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3
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Gaudette É, Rizzardo S, Zhang Y, Pothier KR, Tadrous M. Cost-effectiveness of the top 100 drugs by public spending in Canada, 2015-2021: a repeated cross-sectional study. BMJ Open 2024; 14:e082568. [PMID: 38485176 PMCID: PMC10941152 DOI: 10.1136/bmjopen-2023-082568] [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: 11/27/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES To assess the distribution and spending by cost-effectiveness category among those drugs with the highest public spending levels in Canada. DESIGN Repeated cross-sectional study. SETTING The Canadian provinces of Manitoba, Ontario, New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland. MAIN OUTCOMES AND MEASURES Cost-effectiveness assessments by the Canadian Agency for Drugs and Technologies in Health (CADTH) for top-100 brand-name outpatient drugs by gross public plan spending in any year between 2015 and 2021 in Canada Institute for Health Information's National Prescription Drug Utilization Information System data. Gross public plan spending by cost-effectiveness category. RESULTS From 2015 to 2021, 152 brand-name drugs occupied a top-100 rank and were included in the analysis. Of those, 117 had been assessed by CADTH. During the 7-year period, there was an increase in both top-100 drugs with cost-effective (from 18 to 24) and cost-ineffective (from 29 to 41) assessments, while drugs not assessed or with an unclear assessment declined (from 31 to 19 and from 22 to 16, respectively). As a share of spending on top-100 drugs with an assessment, spending on cost-effective drugs was mostly stable at 40%-46% from 2015 to 2021, while spending on cost-ineffective drugs increased from 30% to 45%. CONCLUSION A large and growing share of public drug spending has been allocated to cost-ineffective drugs in Canada. Dedicating large budgets to such treatments prevents spending with greater health impact elsewhere in the healthcare system and could restrain the capacity to pay for groundbreaking pharmaceutical innovation in the future.
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Affiliation(s)
- Étienne Gaudette
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Policy and Economics Analysis Branch, Patented Medicine Prices Review Board, Ottawa, Ontario, Canada
| | - Shirin Rizzardo
- Policy and Economics Analysis Branch, Patented Medicine Prices Review Board, Ottawa, Ontario, Canada
| | - Yvonne Zhang
- Policy and Economics Analysis Branch, Patented Medicine Prices Review Board, Ottawa, Ontario, Canada
| | - Kevin R Pothier
- Policy and Economics Analysis Branch, Patented Medicine Prices Review Board, Ottawa, Ontario, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto - St George Campus, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
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4
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Kousoulis AA, Soni A, Cheung BMY, Ferro A. Addressing inequalities in cardiovascular health remains an urgent priority. Postgrad Med J 2024; 100:133-134. [PMID: 37982199 DOI: 10.1093/postmj/qgad108] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 11/21/2023]
Affiliation(s)
| | - Anisha Soni
- The Healthy Heart Trust, London, United Kingdom
| | - Bernard M Y Cheung
- The Healthy Heart Trust, London, United Kingdom
- School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Albert Ferro
- The Healthy Heart Trust, London, United Kingdom
- Faculty of Life Sciences and Medicine, School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, United Kingdom
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5
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Malek N, Nihat A, Mattoscio M, Simioni V, Deeb J, Chawda S, Cifelli A, Krommyda M. A recent surge of nitrous oxide misuse around London which merits a public health warning. Postgrad Med J 2024; 100:174-178. [PMID: 38079632 DOI: 10.1093/postmj/qgad121] [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: 10/03/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Use of nitrous oxide (N2O) gas for recreational purposes by young people is increasingly recognized as a public health hazard in the UK. METHODS We looked at the hospital records of patients admitted over the last 4 years to a single neurological centre in Essex to determine the demographics, presentation, and management of patients presenting with symptoms of N2O toxicity from its recreational use. RESULTS Of the 17 patients (mean age = 22.9 ± 3 years) admitted between September 2018 and October 2022, 70% were admitted between January and October 2022. All patients reported limb paraesthesiae and 16/17 reported (95%) imbalance; 11/17 (65%) showed objective limb weakness. Serum B12 concentration was low in 9/17 (53%). Plasma methylmalonic acid (n = 7) and homocysteine (n = 8) levels were elevated in all patients tested. Spinal cord Magnetic Resonance Imaging (MRI) imaging was abnormal in 10/17 (59%) patients. Nerve conduction studies were abnormal in 10/13 (77%) patients, with evidence of a symmetric, length-dependent, large fibre neuropathy. CONCLUSIONS There has been a recent surge of cases with neurological complications of recreational N2O abuse in the UK, with a relatively greater rate in 2022. Greater awareness of this condition amongst clinicians and health regulators is urgently required to prevent harm from N2O misuse in young people.
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Affiliation(s)
- Naveed Malek
- Department of Neurology, Queen's Hospital, Romford RM7 0AG, United Kingdom
| | - Akın Nihat
- Department of Neurology, Queen's Hospital, Romford RM7 0AG, United Kingdom
| | - Miriam Mattoscio
- Department of Neurology, Queen's Hospital, Romford RM7 0AG, United Kingdom
| | - Valentina Simioni
- Department of Neurophysiology, Queen's Hospital, Romford RM7 0AG, United Kingdom
| | - Jacquie Deeb
- Department of Neurophysiology, Queen's Hospital, Romford RM7 0AG, United Kingdom
| | - Sanjiv Chawda
- Department of Neuroradiology, Queen's Hospital, Romford RM7 0AG, United Kingdom
| | - Alberto Cifelli
- Department of Neurology, Queen's Hospital, Romford RM7 0AG, United Kingdom
| | - Magdalini Krommyda
- Department of Neurology, Queen's Hospital, Romford RM7 0AG, United Kingdom
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Miron M, Bricknell M. Innovation in education: the military medical ethics 'playing cards' and smartphone application. BMJ Mil Health 2024; 170:47-50. [PMID: 34711675 DOI: 10.1136/bmjmilitary-2021-001959] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/11/2021] [Indexed: 11/04/2022]
Abstract
Military medical personnel need to understand military medical ethics to comply with international humanitarian law, national health practice and professional norms. Teaching this subject is constrained by a lack of educational resources, being further exacerbated by the limits imposed by the COVID-19 pandemic. This paper describes an innovative approach to deliver military medical ethics education using 52 scenarios published as a set of playing cards and a smartphone app. The rationale for the methodology and the development of these scenarios is summarised. This package forms a part of a 'd(igital)-learning' educational suite that includes physical cards, the app and a website for teaching both military and military medical ethics. The paper describes the experience of delivering this d-learning package in military medical ethics to UK and international audiences. The final sections offer a look ahead to the next stages for refinement to the current suite and the wider d-learning resources.
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Affiliation(s)
- Marina Miron
- Department of Defence Studies, King's College London, Watchfield, UK
| | - M Bricknell
- Department of War Studies, Conflict and Health Research Group, King's College London - Strand Campus, London, UK
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7
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Ferreira T. Doctors' pay in the United Kingdom: evaluating the broader impacts of change. Postgrad Med J 2024; 100:65-67. [PMID: 37940137 DOI: 10.1093/postmj/qgad099] [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: 08/26/2023] [Accepted: 09/22/2023] [Indexed: 11/10/2023]
Abstract
The United Kingdom's National Health Service (NHS) faces a mounting workforce crisis, with compensation being a focal point of discontent. This editorial explores the real-term erosion of doctors' salaries in the UK, using the Retail Price Index as a more comprehensive measure of inflation. Comparisons with international standards reveal significant disparities, contributing to the emigration of medical talent. The NHS's increased reliance on agency locum doctors poses financial strain and affects continuity of patient care. Economic considerations debunk common counterarguments against pay restoration, emphasising the broader implications for healthcare delivery and societal well-being. The editorial concludes by advocating for policy measures to address this pay disparity as both an economic imperative and a strategic necessity to sustain the NHS.
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Affiliation(s)
- Tomas Ferreira
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0PY, United Kingdom
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Norris SA, Zarowsky C, Murphy K, Ware LJ, Lombard C, Matjila M, Chivese T, Muhwava LS, Mutabazi JC, Harbron J, Fairall LR, Lambert E, Levitt N. Integrated health system intervention aimed at reducing type 2 diabetes risk in women after gestational diabetes in South Africa (IINDIAGO): a randomised controlled trial protocol. BMJ Open 2024; 14:e073316. [PMID: 38195169 PMCID: PMC10806811 DOI: 10.1136/bmjopen-2023-073316] [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: 03/02/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION South Africa has a high prevalence of gestational diabetes mellitus (GDM; 15%) and many of these women (48%) progress to type 2 diabetes mellitus (T2DM) within 5 years post partum. A significant proportion (47%) of the women are not aware of their diabetes status after the index pregnancy, which may be in part to low postnatal diabetes screening rates. Therefore, we aim to evaluate a intervention that reduces the subsequent risk of developing T2DM among women with recent GDM. Our objectives are fourfold: (1) compare the completion of the nationally recommended 6-week postpartum oral glucose tolerance test (OGTT) between intervention and control groups; (2) compare the diabetes risk reduction between control and intervention groups at 12 months' post partum; (3) assess the process of implementation; and (4) assess the cost-effectiveness of the proposed intervention package. METHODS AND ANALYSES Convergent parallel mixed-methods study with the main component being a pragmatic, 2-arm individually randomised controlled trial, which will be carried out at five major referral centres and up to 26 well-baby clinics in the Western Cape and Gauteng provinces of South Africa. Participants (n=370) with GDM (with no prior history of either type 1 or type 2 diabetes) will be recruited into the study at 24-36 weeks' gestational age, at which stage first data collection will take place. Subsequent data collection will take place at 6-8 weeks after delivery and again at 12 months. The primary outcome for the trial is twofold: first, the completion of the recommended 2-hour OGTT at the well-baby clinics 6-8 weeks post partum, and second, a composite diabetes risk reduction indicator at 12 months. Process evaluation will assess fidelity, acceptability, and dose of the intervention. ETHICS AND DISSEMINATION Ethics approval has been granted from University of Cape Town (829/2016), University of the Witwatersrand, Johannesburg (M170228), University of Stellenbosch (N17/04/032) and the University of Montreal (2019-794). The results of the trial will be disseminated through publication in peer-reviewed journals and presentations to key South African Government stakeholders and health service providers. PROTOCOL VERSION 1 December 2022 (version #2). Any protocol amendments will be communicated to investigators, Human Ethics Research Committees, trial participants, and trial registries. TRIAL REGISTRATION NUMBER PAN African Clinical Trials Registry (https://pactr.samrc.ac.za) on 11 June 2018 (identifier PACTR201805003336174).
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Affiliation(s)
- Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Christina Zarowsky
- School of Public Health, University of Montreal, Montreal, Québec, Canada
| | - Katherine Murphy
- Faculty of Health Science, Department of Medicine, University of Cape Town, Rondebosch, South Africa
| | - Lisa Jayne Ware
- SAMRC Developmental Pathways for Health Research Unit, Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Mushi Matjila
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Jean Claude Mutabazi
- Médecine sociale et préventive-Option: Santé Mondiale, University of Montreal, Montreal, Québec, Canada
| | | | | | | | - Naomi Levitt
- Department of Medicine, University of Cape Town, Rondebosch, South Africa
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9
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Srivarathan A, Kristiansen M, Jensen AN. Opportunities and challenges in public-private partnerships to reduce social inequality in health in upper-middle-income and high-income countries: a systematic review and meta-synthesis. BMJ Open 2024; 14:e076209. [PMID: 38184305 PMCID: PMC10773340 DOI: 10.1136/bmjopen-2023-076209] [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: 05/31/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVES There is a need for novel approaches to address the complexity of social inequality in health. Public-private partnerships (PPPs) have been proposed as a promising approach; however, knowledge on lessons learnt from such partnerships remain unclear. This study synthesises evidence on opportunities and challenges of PPPs focusing on social inequality in health in upper-middle-income and high-income countries. DESIGN A systematic literature review and meta-synthesis was conducted using the Mixed Methods Appraisal Tool for quality appraisal. DATA SOURCES PubMed, PsychInfo, Embase, Sociological Abstracts and SocIndex were searched for studies published between January 2013 and January 2023. ELIGIBILITY CRITERIA Studies were eligible if they applied a quantitative, qualitative, or mixed methods design and reported on lessons learnt from PPPs focusing on social inequality in health in upper-middle-income and high-income countries. Studies had to be published in either English, Danish, German, Norwegian or Swedish. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and appraised the quality of the included studies. A meta-synthesis with a descriptive intent was conducted and data were grouped into opportunities and challenges. RESULTS A total of 16 studies of varying methodological quality were included. Opportunities covered three themes: (1) creating synergies, (2) clear communication and coordination, and (3) trust to sustain partnerships. Challenges were identified as reflected in the following three themes: (1) scarce resources, (2) inadequate communication and coordination, and (3) concerns on distrust and conflicting interest. CONCLUSIONS Partnerships across public, private and academic institutions hold the potential to address social inequality in health. Nevertheless, a variety of important lessons learnt are identified in the scientific literature. For future PPPs to be successful, partners should be aware of the availability of resources, provide clear communication and coordination, and address concerns on distrust and conflicting interests among partners. PROSPERO REGISTRATION NUMBER CRD42023384608.
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Affiliation(s)
- Abirami Srivarathan
- Houston Center for Innovations in Quality, Effectiveness and Safety, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Nedergaard Jensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
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Shih P, Ding P, Carter SM, Stanaway F, Horvath AR, Langguth D, Saad M, St John A, Bell K. Direct-to-consumer tests advertised online in Australia and their implications for medical overuse: systematic online review and a typology of clinical utility. BMJ Open 2023; 13:e074205. [PMID: 38151277 PMCID: PMC10759116 DOI: 10.1136/bmjopen-2023-074205] [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: 04/04/2023] [Accepted: 10/30/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES The objective of this study is to map the range and variety of direct-to-consumer (DTC) tests advertised online in Australia and analyse their potential clinical utility and implications for medical overuse. DESIGN Systematic online search of DTC test products in Google and Google Shopping. DTC test advertisements data were collected and analysed to develop a typology of potential clinical utility of the tests at population level, assessing their potential benefits and harms using available evidence, informed by concepts of medical overuse. RESULTS We identified 484 DTC tests (103 unique products), ranging from $A12.99 to $A1947 in cost (mean $A197.83; median $A148.50). Using our typology, we assigned the tests into one of four categories: tests with potential clinical utility (10.7%); tests with limited clinical utility (30.6%); non-evidence-based commercial 'health checks' (41.9%); and tests whose methods and/or target conditions are not recognised by the general medical community (16.7%). Of the products identified, 56% did not state that they offered pretest or post-test consultation, and 51% did not report analytical performance of the test or laboratory accreditation. CONCLUSIONS This first-in-Australia study shows most DTC tests sold online have low potential clinical utility, with healthy consumers constituting the main target market. Harms may be caused by overdiagnosis, high rates of false positives and treatment decisions led by non-evidence-based tests, as well as financial costs of unnecessary and inappropriate testing. Regulatory mechanisms should demand a higher standard of evidence of clinical utility and efficacy for DTC tests. Better transparency and reporting of health outcomes, and the development of decision-support resources for consumers are needed.
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Affiliation(s)
- Patti Shih
- School of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Pauline Ding
- School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Stacy M Carter
- School of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Fiona Stanaway
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrea R Horvath
- NSW Health Pathology, Sydney, New South Wales, Australia
- University of New South Wales, Kensington, New South Wales, Australia
| | - Daman Langguth
- Sullivan Nicolaides Pathology, Wesley Hospital, Brisbane, Queensland, Australia
| | - Mirette Saad
- Australian Clinical Labs, Victorian Central Laboratory Headquarters, Clayton, Victoria, Australia
| | | | - Katy Bell
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Al-Yateem N, Hijazi H, Saifan AR, Ahmad A, Masa'Deh R, Alrimawi I, Rahman SA, Subu MA, Ahmed FR. Quality and safety issue: language barriers in healthcare, a qualitative study of non-Arab healthcare practitioners caring for Arabic patients in the UAE. BMJ Open 2023; 13:e076326. [PMID: 38135338 DOI: 10.1136/bmjopen-2023-076326] [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] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES To identify language-related communication barriers that expatriate (non-Arabic) healthcare practitioners in the UAE encounter in their daily practice. DESIGN Qualitative study utilising semi-structured in-depth interviews. The interviews were conducted in English language. SETTING Different healthcare facilities across the UAE. These facilities were accessed for data collection over a period of 3 months from January 2023 to March 2023. PARTICIPANTS 14 purposively selected healthcare practitioners. INTERVENTION No specific intervention was implemented; this study primarily aimed at gaining insights through interviews. PRIMARY AND SECONDARY OUTCOMES To understand the implications of language barriers on service quality, patient safety, and healthcare providers' well-being. RESULTS Three main themes emerged from our analysis of participants' narratives: Feeling left alone, Trying to come closer to their patients and Feeling guilty, scared and dissatisfied. CONCLUSIONS Based on the perspectives and experiences of participating healthcare professionals, language barriers have notably influenced the delivery of healthcare services, patient safety and the well-being of both patients and practitioners in the UAE. There is a pressing need, as highlighted by these professionals, for the inclusion of professional interpreters and the provision of training to healthcare providers to enhance effective collaboration with these interpreters.
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Affiliation(s)
| | - Heba Hijazi
- College of Health Sciences, University of Sharjah, Sharjah, UAE
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Alaa Ahmad
- Sheikh Shakhbout Medical City, Abu Dabi, UAE
- School of management, Universiti Sains Malaysia, Penang, Malaysia
| | - Rami Masa'Deh
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Intima Alrimawi
- Georgetown University, Washington, District of Columbia, USA
| | | | | | - Fatma Refaat Ahmed
- College of Health Sciences, University of Sharjah, Sharjah, UAE
- Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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12
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Becker J, Kurland L, Höglund E, Hugelius K. Dynamic ambulance relocation: a scoping review. BMJ Open 2023; 13:e073394. [PMID: 38101827 PMCID: PMC10729233 DOI: 10.1136/bmjopen-2023-073394] [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: 03/06/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES Dynamic ambulance relocation means that the operators at a dispatch centre place an ambulance in a temporary location, with the goal of optimising coverage and response times in future medical emergencies. This study aimed to scope the current research on dynamic ambulance relocation. DESIGN A scoping review was conducted using a structured search in PubMed, Scopus and Web of Science. In total, 21 papers were included. RESULTS Most papers described research with experimental designs involving the use of mathematical models to calculate the optimal use and temporary relocations of ambulances. The models relied on several variables, including distances, locations of hospitals, demographic-geological data, estimation of new emergencies, emergency medical services (EMSs) working hours and other data. Some studies used historic ambulance dispatching data to develop models. Only one study reported a prospective, real-time evaluation of the models and the development of technical systems. No study reported on either positive or negative patient outcomes or real-life chain effects from the dynamic relocation of ambulances. CONCLUSIONS Current knowledge on dynamic relocation of ambulances is dominated by mathematical and technical support data that have calculated optimal locations of ambulance services based on response times and not patient outcomes. Conversely, knowledge of how patient outcomes and the working environment are affected by dynamic ambulance dispatching is lacking. This review has highlighted several gaps in the scientific coverage of the topic. The primary concern is the lack of studies reporting on patient outcomes, and the limited knowledge regarding several key factors, including the optimal use of ambulances in rural areas, turnaround times, domino effects and aspects of working environment for EMS personnel. Therefore, addressing these knowledge gaps is important in future studies.
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Affiliation(s)
- Julia Becker
- Institute for Disaster and Emergency Management, Berlin, Germany
| | - Lisa Kurland
- Örebro Univeristy, Faculty of Medicine and Health, Orebro, Sweden
- Örebro University Hospital, Orebro, Sweden
| | - Erik Höglund
- Örebro Univeristy, Faculty of Medicine and Health, Orebro, Sweden
- Ambulance Department, Örebro Country Council, Örebro, Sweden
| | - Karin Hugelius
- Örebro Univeristy, Faculty of Medicine and Health, Orebro, Sweden
- Ambulance Department, Örebro Country Council, Örebro, Sweden
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Diaz CM, Egide A, Berry A, Rafferty M, Amro A, Tesorero K, Shapiro M, Ko B, Jones W, Slocum JD, Johnson J, Stey AM. Defining conditions for effective interdisciplinary care team communication in an open surgical intensive care unit: a qualitative study. BMJ Open 2023; 13:e075470. [PMID: 38097232 PMCID: PMC10729088 DOI: 10.1136/bmjopen-2023-075470] [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: 05/09/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Poor interdisciplinary care team communication has been associated with increased mortality. The study aimed to define conditions for effective interdisciplinary care team communication. DESIGN An observational cross-sectional qualitative study. SETTING A surgical intensive care unit in a large, urban, academic referral medical centre. PARTICIPANTS A total 6 interviews and 10 focus groups from February to June 2021 (N=33) were performed. Interdisciplinary clinicians who cared for critically ill patients were interviewed. Participants included intensivist, transplant, colorectal, vascular, surgical oncology, trauma faculty surgeons (n=10); emergency medicine, surgery, gynaecology, radiology physicians-in-training (n=6), advanced practice providers (n=5), nurses (n=7), fellows (n=1) and subspecialist clinicians such as respiratory therapists, pharmacists and dieticians (n=4). Audiorecorded content of interviews and focus groups were deidentified and transcribed verbatim. The study team iteratively generated the codebook. All transcripts were independently coded by two team members. PRIMARY OUTCOME Conditions for effective interdisciplinary care team communication. RESULTS We identified five themes relating to conditions for effective interdisciplinary care team communication in our surgical intensive care unit setting: role definition, formal processes, informal communication pathways, hierarchical influences and psychological safety. Participants reported that clear role definition and standardised formal communication processes empowered clinicians to engage in discussions that mitigated hierarchy and facilitated psychological safety. CONCLUSIONS Standardising communication and creating defined roles in formal processes can promote effective interdisciplinary care team communication by fostering psychological safety.
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Affiliation(s)
| | - Abahuje Egide
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | - Andrew Berry
- Department of Medical Social Sciences, Northwestern University, Evanston, Illinois, USA
| | - Miriam Rafferty
- 19th floor Strength+Endurance AbilityLab, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation & Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ali Amro
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | | | - Michael Shapiro
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | - Bona Ko
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | - Whitney Jones
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | - John D Slocum
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | - Julie Johnson
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
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14
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Lavergne MR, Moravac C, Bergin F, Buote R, Easley J, Grudniewicz A, Hedden L, Leslie M, McKay M, Marshall EG, Martin-Misener R, Mooney M, Palmer E, Tracey J. Understanding and addressing changing administrative workload in primary care in Canada: protocol for a mixed-method study. BMJ Open 2023; 13:e076917. [PMID: 38086593 PMCID: PMC10729089 DOI: 10.1136/bmjopen-2023-076917] [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: 06/22/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Many Canadians struggle to access the primary care they need while at the same time primary care providers report record levels of stress and overwork. There is an urgent need to understand factors contributing to the gap between a growing per-capita supply of primary care providers and declines in the availability of primary care services. The assumption of responsibility by primary care teams for services previously delivered on an in-patient basis, along with a rise in administrative responsibilities may be factors influencing reduced access to care. METHODS AND ANALYSIS In this mixed-methods study, our first objective is to determine how the volume of services requiring primary care coordination has changed over time in the Canadian provinces of Nova Scotia and New Brunswick. We will collect quantitative administrative data to investigate how services have shifted in ways that may impact administrative workload in primary care. Our second objective is to use qualitative interviews with family physicians, nurse practitioners and administrative team members providing primary care to understand how administrative workload has changed over time. We will then identify priority issues and practical response strategies using two deliberative dialogue events convened with primary care providers, clinical and system leaders, and policy-makers.We will analyse changes in service use data between 2001/2002 and 2021/2022 using annual total counts, rates per capita, rates per primary care provider and per primary care service. We will conduct reflexive thematic analysis to develop themes and to compare and contrast participant responses reflecting differences across disciplines, payment and practice models, and practice settings. Areas of concern and potential solutions raised during interviews will inform deliberative dialogue events. ETHICS AND DISSEMINATION We received research ethics approval from Nova Scotia Health (#1028815). Knowledge translation will occur through dialogue events, academic papers and presentations at national and international conferences.
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Affiliation(s)
- M Ruth Lavergne
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Catherine Moravac
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Fiona Bergin
- Practice Ready Assessment Program, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Richard Buote
- College of Family Physicians of Canada, Mississauga, Ontario, Canada
| | - Julie Easley
- Family Medicine, Horizon Health Network, Fredericton, New Brunswick, Canada
| | - Agnes Grudniewicz
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Lindsay Hedden
- Simon Fraser University, Burnaby, British Columbia, Canada
| | | | | | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Ruth Martin-Misener
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melanie Mooney
- Primary Health Care and Chronic Disease Management, Nova Scotia Health Authority, Yarmoth, Nova Scotia, Canada
| | - Erin Palmer
- Dalhousie University Faculty of Medicine, Saint John, New Brunswick, Canada
| | - Joshua Tracey
- Dalhousie University Faculty of Medicine, Saint John, New Brunswick, Canada
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Penno E, Atmore C, Maclennan B, Richard L, Wyeth E, Richards R, Doolan-Noble F, Gray AR, Sullivan T, Gauld R, Stokes T. How did New Zealand's regional District Health Board groupings work to improve service integration and health outcomes: a realist evaluation. BMJ Open 2023; 13:e079268. [PMID: 38081663 PMCID: PMC10729044 DOI: 10.1136/bmjopen-2023-079268] [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: 08/29/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES In Aotearoa New Zealand (NZ), integration across the healthcare continuum has been a key approach to strengthening the health system and improving health outcomes. A key example has been four regional District Health Board (DHB) groupings, which, from 2011 to 2022, required the country's 20 DHBs to work together regionally. This research explores how this initiative functioned, examining how, for whom and in what circumstances regional DHB groupings worked to deliver improvements in system integration and health outcomes and equity. DESIGN We used a realist-informed evaluation study design. We used documentary analysis to develop programme logic models to describe the context, structure, capabilities, implementation activities and impact of each of the four regional groupings and then conducted interviews with stakeholders. We developed a generalised context-mechanisms-outcomes model, identifying key commonalities explaining how regional work 'worked' across NZ while noting important regional differences. SETTING NZ's four regional DHB groupings. PARTICIPANTS Forty-nine stakeholders from across the four regional groupings. These included regional DHB governance groups and coordinating regional agencies, DHB senior leadership, Māori and Pasifika leadership and lead clinicians for regional work streams. RESULTS Regional DHB working was layered on top of an already complex DHB environment. Organisational heterogeneity and tensions between local and regional priorities were key contextual factors. In response, regional DHB groupings leveraged a combination of 'hard' policy and planning processes, as well as 'soft', relationship-based mechanisms, aiming to improve system integration, population health outcomes and health equity. CONCLUSION The complexity of DHB regional working meant that success hinged on building relationships, leadership and trust, alongside robust planning and process mechanisms. As NZ reorients its health system towards a more centralised model underpinned by collaborations between local providers, our findings point to a need to align policy expectations and foster environments that support connection and collegiality across the health system.
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Affiliation(s)
- Erin Penno
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Carol Atmore
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Brett Maclennan
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Lauralie Richard
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Emma Wyeth
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Rosalina Richards
- Centre for Pacific Health, Va'a o Tautai, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Fiona Doolan-Noble
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew R Gray
- Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Trudy Sullivan
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Otago Business School, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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16
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Fox D, Hall M, Thibodeau C, Coldwell K, Lauder L, Dewell S, Davidson S. Impact of the COVID-19 pandemic on Canadian transplant journeys: a mixed methods study. BMJ Open 2023; 13:e068347. [PMID: 38040429 PMCID: PMC10693860 DOI: 10.1136/bmjopen-2022-068347] [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: 09/15/2022] [Accepted: 11/20/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Navigating the organ donation and transplantation system in Canada can be challenging for individuals on transplant journeys. Although it is likely that the COVID-19 pandemic has further contributed to these challenges, the experiences of individuals during the pandemic in Canada have not been well elicited. OBJECTIVE To illuminate how the COVID-19 pandemic has impacted individuals on transplant journeys in Canada. DESIGN Convergent parallel mixed-methods study. SETTING Canada. PARTICIPANTS Adult patients, caregivers, and donors on transplant journeys across Canada. DATA COLLECTION Eight focus groups and an online survey between May and November 2021. Focus group transcripts were analysed using an inductive conventional content analysis approach. Survey data were analysed using descriptive statistics. The study was guided by individuals with lived experience of organ donation and transplantation. RESULTS A total of 830 participants completed three COVID-19 related survey questions, with 21 participating in the focus groups. Survey results: over 50% of patients and caregivers reported that the pandemic impacted their access to their healthcare team, their mental health (60% and 65%, respectively) and their comfort going out in public (80% and 75%, respectively). Although many donors reported several factors that impacted their transplant journey, the impact appeared to be greater for patients and caregivers. Qualitative results: three themes emerged from the qualitative data that contextualise participant's experiences: compounding isolation, disruption amid uncertainty and unforeseen benefits. CONCLUSION The COVID-19 pandemic has exacerbated many of the challenges that individuals on transplant journeys experience. It will be critical for transplant programmes to consider these factors in future care provision.
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Affiliation(s)
- Danielle Fox
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Marc Hall
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | | | - Kristi Coldwell
- Transplant Research Foundation of British Columbia, Vancouver, British Columbia, Canada
| | - Lydia Lauder
- Kidney Foundation of Canada, Montreal, Québec, Canada
| | - Sarah Dewell
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Sandra Davidson
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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17
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Mordaunt DA, Stark Z, Santos Gonzalez F, Dalziel K, Goranitis I. Development of a microcosting protocol to determine the economic cost of diagnostic genomic testing for rare diseases in Australia. BMJ Open 2023; 13:e069441. [PMID: 38030253 PMCID: PMC10689401 DOI: 10.1136/bmjopen-2022-069441] [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: 10/21/2022] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Genomic testing is a relatively new, disruptive and complex health technology with multiple clinical applications in rare diseases, cancer and infection control. Genomic testing is increasingly being implemented into clinical practice, following regulatory approval, funding and adoption in models of care, particularly in the area of rare disease diagnosis. A significant barrier to the adoption and implementation of genomic testing is funding. What remains unclear is what the cost of genomic testing is, what the underlying drivers of cost are and whether policy differences contribute to cost variance in different jurisdictions, such as the requirement to have staff with a medical license involved in testing. This costing study will be useful in future economic evaluations and health technology assessments to inform optimal levels of reimbursement and to support comprehensive and comparable assessment of healthcare resource utilisation in the delivery of genomic testing globally. METHODS A framework is presented that focuses on uncovering the process of genomic testing for any given laboratory, evaluating its utilisation and unit costs, and modelling the cost drivers and overall expenses associated with delivering genomic testing. The goal is to aid in refining and implementing policies regarding both the regulation and funding of genomic testing. A process-focused (activity-based) methodology is outlined, which encompasses resources, assesses individual cost components through a combination of bottom-up and top-down microcosting techniques and allows disaggregation of resource type and process step. ETHICS AND DISSEMINATION The outputs of the study will be reported at relevant regional genetics and health economics conferences, as well as submitted to a peer-reviewed journal focusing on genomics. Human research ethics committee approval is not required for this microcosting study. This study does not involve research on human subjects, and all data used in the analysis are either publicly available.
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Affiliation(s)
- Dylan A Mordaunt
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Women's and Children's Division, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Zornitza Stark
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Australian Genomics Health Alliance, Australian Genomics Health Alliance, Australia, UK
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Francisco Santos Gonzalez
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ilias Goranitis
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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18
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Whitaker J, Rickard R, Leather A, Davies J. Exploring the global health and defence engagement interface. BMJ Mil Health 2023:e002497. [PMID: 38053261 DOI: 10.1136/military-2023-002497] [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: 07/13/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023]
Abstract
Militaries have an important and inevitable role in global health and will interface with existing health systems on deployments. While the primary concern of militaries is not global health, there are clear, and increasingly frequent, circumstances when global health activities align with the interests of defence. Recognising this link between global health and security warrants thoughtful consideration and action where concerns affecting both intersect. In addition to providing medical support to military personnel on operations, advantageous effects can be achieved directly from military medical activities as part of Defence Engagement. While there are limitations and ethical boundaries to the role of militaries in global health, further training, research and conceptual development are warranted to optimise military medical activity at the intersection of security and global health to deliver advantageous effects. This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement.
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Affiliation(s)
- John Whitaker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - R Rickard
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - A Leather
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Surgery, Stellenbosch University, Stellenbosch, South Africa
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Fystro JR, Feiring E. Policy-makers' conception of patient non-attendance fees in specialist healthcare: a qualitative document analysis. BMJ Open 2023; 13:e077660. [PMID: 38000825 PMCID: PMC10679985 DOI: 10.1136/bmjopen-2023-077660] [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: 07/11/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES Patients missing their scheduled appointments in specialist healthcare without giving notice can undermine efficient care delivery. To reduce patient non-attendance and possibly compensate healthcare providers, policy-makers have noted the viability of implementing patient non-attendance fees. However, these fees may be controversial and generate public resistance. Identifying the concepts attributed to non-attendance fees is important to better understand the controversies surrounding the introduction and use of these fees. Patient non-attendance fees in specialist healthcare have been extensively debated in Norway and Denmark, two countries that are fairly similar regarding political culture, population size and healthcare system. However, although Norway has implemented a patient non-attendance fee scheme, Denmark has not. This study aimed to identify and compare how policy-makers in Norway and Denmark have conceptualised patient non-attendance fees over three decades. DESIGN A qualitative document study with a multiple-case design. METHODS A theory-driven qualitative analysis of policy documents (n=55) was performed. RESULTS Although patient non-attendance fees were seen as a measure to reduce non-attendance rates in both countries, the specific conceptualisation of the fees differed. The fees were understood as a monetary disincentive in Norwegian policy documents. In the Danish documents, the fees were framed as an educative measure to foster a sense of social responsibility, as well as serving as a monetary disincentive. The data suggest, however, a recent change in the Danish debate emphasising fees as a disincentive. In both countries, fees were partly justified as a means of compensating providers for the loss of income. CONCLUSIONS The results demonstrate how, as a regulative policy tool, patient non-attendance fees have been conceptualised and framed differently, even in apparently similar contexts. This suggests that a more nuanced and complex understanding of why such fees are debated is needed.
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Affiliation(s)
- Joar Røkke Fystro
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Eli Feiring
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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20
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Lowe J, Potter D, Warner M, Horne S. Fellowships and defence engagement: from clinical niches to strategic impact. BMJ Mil Health 2023; 169:570-572. [PMID: 35131886 DOI: 10.1136/bmjmilitary-2021-002009] [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: 09/23/2021] [Accepted: 01/24/2022] [Indexed: 11/04/2022]
Abstract
Medical fellowships have traditionally developed the individual rather than furthering military or national strategic objectives. This paper describes a medical fellowship with the British Antarctic Survey to illustrate the benefits to the individual, to the military and to wider international defence engagement efforts.By rebranding such fellowships as Defence Healthcare Engagement and by treating international organisations on a par with partner nations, the humble fellowship can facilitate enduring, mutually beneficial healthcare engagement at low cost and with minimal additional resources.
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Affiliation(s)
- Jonathon Lowe
- Emergency Department, Derriford Hospital, Plymouth, UK
- Emergency Department, British Antarctic Survey Medical Unit, Plymouth, UK
| | - D Potter
- Emergency Department, Derriford Hospital, Plymouth, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - M Warner
- Emergency Department, British Antarctic Survey Medical Unit, Plymouth, UK
| | - S Horne
- Emergency Department, Derriford Hospital, Plymouth, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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21
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Augestad KM, Skyrud KD, Lindahl AK, Helgeland J. Hospital variations in failure to rescue after abdominal surgery: a nationwide, retrospective observational study. BMJ Open 2023; 13:e075018. [PMID: 37977874 PMCID: PMC10661059 DOI: 10.1136/bmjopen-2023-075018] [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: 04/24/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aims to determine hospital variation and intensive care unit characteristics associated with failure to rescue after abdominal surgery in Norway. DESIGN A nationwide retrospective observational study. SETTING All 52 hospitals in Norway performing elective and acute abdominal surgery. PARTICIPANTS All 598 736 patients undergoing emergency and elective abdominal surgery from 2011 to 2021. PRIMARY OUTCOME MEASURE Primary outcome was failure to rescue within 30 days (FTR30), defined as in-hospital or out-of-hospital death within 30 days of a surgical patient who developed at least one complication within 30 days of the surgery (FTR30). Other outcome variables were surgical complications and hospital FTR30 variation. Statistical analysis was conducted separately for general surgery and abdominal surgery. RESULTS The 30-day postoperative complication rate was 30.7 (183 560 of 598 736 surgeries). Of general surgical complications (n=25 775), circulatory collapse (n=6127, 23%), cardiac arrhythmia (n=5646, 21%) and surgical infections (n=4334, 16 %) were most common and 1507 (5.8 %) patients were reoperated within 30 days. One thousand seven hundred and forty patients had FTR30 (6.7 %). The severity of complications was strongly associated with FTR30. In multivariate analysis of general surgery, adjusted for patient characteristics, only the year of surgery was associated with FTR30, with an estimated linear trend of -0.31 percentage units per year (95% CI (-0.48 to -0.15)). The driving distance from local hospitals to the nearest referral intensive care unit was not associated with FTR30. Over the last decade, FTR30 rates have varied significantly among similar hospitals. CONCLUSIONS Hospital factors cannot explain Norwegian hospitals' significant FTR variance when adjusting for patient characteristics. The national FTR30 measure has dropped around 30% without a corresponding fall in surgical complications. No association was seen between rural hospital location and FTR30. Policy-makers must address microsystem issues causing high FTR30 in hospitals.
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Affiliation(s)
- Knut Magne Augestad
- Division of Surgery Campus Ahus, University of Oslo, Oslo, Norway
- Department of Quality and Research, University Hospital North Norway, Oslo, Norway
- Division of Surgery, Akershus Hospital Trust, Oslo, Norway
| | | | | | - Jon Helgeland
- Cluster for Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
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22
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Li X, Xing X, Yao N. Critical quality appraisal and algorithm development of clinical practice guidelines for management of poststroke sensory loss: a systematic review. BMJ Open 2023; 13:e074082. [PMID: 37977862 PMCID: PMC10660658 DOI: 10.1136/bmjopen-2023-074082] [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: 03/27/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aimed to assess the methodological quality of clinical practice guidelines (CPGs) associated with the management of poststroke sensory loss and develop an algorithm for health professionals. METHODS We conducted a systematic review for relevant CPGs published between 2017 and 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist. Appraisal of Guidelines for Research and Evaluation II instrument was used to assess methodological quality. Recommendations for managing poststroke sensory loss from high and average-quality CPGs were summarised and developed into an algorithm. RESULTS First, 1458 records were identified from the database searches and other sources. Finally, four CPGs were included: three were rated as high quality and one as average quality. Twenty-two recommendations were summarised from these CPGs and used to develop a draft algorithm. Then, we revised the draft algorithm developed by the authors based on expert feedback to form the final version. CONCLUSIONS The four CPGs included in this study had good quality. Based on these CPGs, we developed an algorithm to facilitate health professionals' adherence to CPGs and contribute to evidence-based medicine. In the future, more high-quality CPGs are required to give further scientific and convincing evidence to manage poststroke sensory loss.
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Affiliation(s)
- Xiao Li
- Intensive Care Unit, Nanjing Drum Tower Hospital, Nanjing, China
| | - Xingmin Xing
- Intensive Care Unit, Nanjing Drum Tower Hospital, Nanjing, China
| | - Nannan Yao
- Operating Theatre, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
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23
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Villalobos Dintrans P, Roder-DeWan S, Wang H. Financing networks of care: a cross-case analysis from six countries. BMJ Open 2023; 13:e072304. [PMID: 37923350 PMCID: PMC10626858 DOI: 10.1136/bmjopen-2023-072304] [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: 01/30/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES Describe experiences of countries with networks of care's (NOCs') financial arrangements, identifying elements, strategies and patterns. DESIGN Descriptive using a modified cross-case analysis, focusing on each network's financing functions (collecting resources, pooling and purchasing). SETTING Health systems in six countries: Argentina, Australia, Canada, Singapore, the United Kingdom and the USA. PARTICIPANTS Large-scale NOCs. RESULTS Countries differ in their strategies to implement and finance NOCs. Two broad models were identified in the six cases: top-down (funding centrally designed networks) and bottom-up (financing individual projects) networks. Despite their differences, NOCs share the goal of improving health outcomes, mainly through the coordination of providers in the system; these results are achieved by devoting extra resources to the system, including incentives for network formation and sustainability, providing extra services and setting incentive systems for improving the providers' performance. CONCLUSIONS Results highlight the need to better understand the financial implications and alternatives for designing and implementing NOCs, particularly as a strategy to promote better health in low- and middle-income settings.
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Affiliation(s)
| | - Sanam Roder-DeWan
- World Bank, Washington, DC, USA
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
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24
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Alturkistani A, Greenfield G, Beaney T, Norton J, Costelloe CE. Cross-sectional analyses of online appointment booking and repeat prescription ordering user characteristics in general practices of England in the years 2018-2020. BMJ Open 2023; 13:e068627. [PMID: 37827735 PMCID: PMC10583059 DOI: 10.1136/bmjopen-2022-068627] [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: 10/11/2022] [Accepted: 08/24/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES To explore the characteristics of the General Practice Patient Survey (GPPS) respondents using the different functionalities of the online services in the context of England's National Health Service General Practices. We hypothesised that respondents who are older, with lower socioeconomic status and non-white ethnicity would be less likely to use online services, while long-term conditions might increase their usage. DESIGN Cross-sectional study using respondent-level data from the GPPS in England of the years 2018, 2019 and 2020. We assessed the association between online services use and respondent characteristics using two-level mixed-effects logistic regression. PARTICIPANTS Survey respondents of the GPPS 2018-2020. PRIMARY OUTCOME MEASURES Online appointment booking and online repeat prescription ordering. RESULTS 1 807 049 survey respondents were included in this study. 15% (n=263 938) used online appointment booking in the previous 12 months, and 19% (n=339 449) had ordered a repeat prescription in the previous 12 months. Respondents with a long-term condition, on regular multiple medications, who have deafness or hearing loss and who are from the lowest deprivation quintile were more likely to have used online services. Male respondents (compared with females) and respondents with black and other ethnicity compared with white ethnicity were less likely to use online services. Respondents over 85 years old were less likely to use online appointment booking and online repeat prescription ordering compared with the younger age groups. CONCLUSIONS Specific groups of respondents were more likely to use online services such as patients with long-term conditions or those with deafness or hearing loss. While online services could provide efficiency to patients and practices it is essential that alternatives continue to be provided to those that cannot use or choose not to use online services. Understanding the different patients' needs could inform solutions to increase the uptake and use of the services.
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Affiliation(s)
- Abrar Alturkistani
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Geva Greenfield
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - John Norton
- Applied Research Collaboration Northwest London, National Institute for Health Research, London, UK
| | - Ceire E Costelloe
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Division of Clinical Studies, Institute of Cancer Research, London, UK
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25
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Middleton J, Colthart G, Dem F, Elkins A, Fairhead J, Hazell RJ, Head MG, Inacio J, Jimbudo M, Jones CI, Laman M, MacGregor H, Novotny V, Peck M, Philip J, Paliau J, Pomat W, Stockdale JA, Sui S, Stewart AJ, Umari R, Walker SL, Cassell JA. Health service needs and perspectives of a rainforest conserving community in Papua New Guinea's Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases. BMJ Open 2023; 13:e075946. [PMID: 37802618 PMCID: PMC10565268 DOI: 10.1136/bmjopen-2023-075946] [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: 05/23/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Determine community needs and perspectives as part of planning health service incorporation into Wanang Conservation Area, in support of locally driven sustainable development. DESIGN Clinical and rapid anthropological assessment (individual primary care assessments, key informant (KI) interviews, focus groups (FGs), ethnography) with treatment of urgent cases. SETTING Wanang (pop. c189), a rainforest community in Madang province, Papua New Guinea. PARTICIPANTS 129 villagers provided medical histories (54 females (f), 75 males (m); median 19 years, range 1 month to 73 years), 113 had clinical assessments (51f, 62m; median 18 years, range 1 month to 73 years). 26 ≥18 years participated in sex-stratified and age-stratified FGs (f<40 years; m<40 years; f>40 years; m>40 years). Five KIs were interviewed (1f, 4m). Daily ethnographic fieldnotes were recorded. RESULTS Of 113 examined, 11 were 'well' (a clinical impression based on declarations of no current illness, medical histories, conversation, no observed disease signs), 62 (30f, 32m) were treated urgently, 31 referred (15f, 16m), indicating considerable unmet need. FGs top-4 ranked health issues concorded with KI views, medical histories and clinical examinations. For example, ethnoclassifications of three ((A) 'malaria', (B) 'sotwin', (C) 'grile') translated to the five biomedical conditions diagnosed most ((A) malaria, 9 villagers; (B) upper respiratory infection, 25; lower respiratory infection, 10; tuberculosis, 9; (C) tinea imbricata, 15) and were highly represented in declared medical histories ((A) 75 participants, (B) 23, (C) 35). However, 29.2% of diagnoses (49/168) were limited to one or two people. Treatment approaches included plant medicines, stored pharmaceuticals, occasionally rituals. Travel to hospital/pharmacy was sometimes undertaken for severe/refractory disease. Service barriers included: no health patrols/accessible aid post, remote hospital, unfamiliarity with institutions and medicine costs. Service introduction priorities were: aid post, vaccinations, transport, perinatal/birth care and family planning. CONCLUSIONS This study enabled service planning and demonstrated a need sufficient to acquire funding to establish primary care. In doing so, it aided Wanang's community to develop sustainably, without sacrificing their forest home.
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Affiliation(s)
- Jo Middleton
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Watson Building, University of Brighton, Falmer, UK
| | - Gavin Colthart
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Watson Building, University of Brighton, Falmer, UK
| | - Francesca Dem
- New Guinea Binatang Research Centre, Madang, Papua New Guinea
| | - Alice Elkins
- Department of Ecology and Evolution, University of Sussex, Falmer, UK
| | - James Fairhead
- Department of Anthropology, University of Sussex, Falmer, UK
| | - Richard J Hazell
- Department of Ecology and Evolution, University of Sussex, Falmer, UK
| | - Michael G Head
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Joao Inacio
- School of Applied Sciences, Cockcroft Building, University of Brighton, Brighton, UK
| | - Mavis Jimbudo
- New Guinea Binatang Research Centre, Madang, Papua New Guinea
| | - Christopher Iain Jones
- Medical Statistics, Brighton and Sussex Medical School, Watson Building, University of Brighton, Falmer, UK
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Port Moresby, Papua New Guinea
| | - Hayley MacGregor
- Health and Nutrition Research Cluster, Institute of Development Studies, Falmer, UK
| | - Vojtech Novotny
- Department of Zoology, Faculty of Science, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
- Institute of Entomology, Biology Centre, Czech Academy of Sciences, Ceske Budejovice, Czech Republic
| | - Mika Peck
- Department of Ecology and Evolution, University of Sussex, Falmer, UK
| | - Jonah Philip
- New Guinea Binatang Research Centre, Madang, Papua New Guinea
- Wanang Conservation Area, Wanang, Papua New Guinea
| | - Jason Paliau
- New Guinea Binatang Research Centre, Madang, Papua New Guinea
- Department of Environmental Engineering & Renewable Energy, School of Environment and Climate Change, Papua New Guinea University of Natural Resources and Environment, Kokopo, Papua New Guinea
| | - William Pomat
- PNG Institute of Medical Research, Goroka, Papua New Guinea
| | - Jessica A Stockdale
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Watson Building, University of Brighton, Falmer, UK
| | - Shen Sui
- New Guinea Binatang Research Centre, Madang, Papua New Guinea
| | - Alan J Stewart
- Department of Ecology and Evolution, University of Sussex, Falmer, UK
| | - Ruma Umari
- New Guinea Binatang Research Centre, Madang, Papua New Guinea
- Wanang Conservation Area, Wanang, Papua New Guinea
| | - Stephen L Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases, and Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jackie A Cassell
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Watson Building, University of Brighton, Falmer, UK
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26
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St Cyr K, Aiken AB, Cramm H, Whitehead M, Kurdyak P, Mahar AL. Sex-specific differences in physical health and health services use among Canadian Veterans: a retrospective cohort study using healthcare administrative data. BMJ Mil Health 2023; 169:430-435. [PMID: 34635494 PMCID: PMC10579508 DOI: 10.1136/bmjmilitary-2021-001915] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/23/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Military occupations have historically been, and continue to be, male dominated. As such, female military Veteran populations tend to be understudied, and comparisons of the physical health status and patterns of health services use between male and female Veterans are limited outside of US samples. This study aimed to compare the physical health and health services use between male and female Veterans residing in Ontario, Canada. METHODS A retrospective cohort of 27 058 male and 4701 female Veterans residing in Ontario whose military service ended between 1990 and 2019 was identified using routinely collected administrative healthcare data. Logistic and Poisson regression models were used to assess sex-specific differences in the prevalence of select physical health conditions and rates of health services use, after multivariable adjustment for age, region of residence, rurality, neighbourhood median income quintile, length of service in years and number of comorbidities. RESULTS The risk of rheumatoid arthritis and asthma was higher for female Veterans compared with male Veterans. Female Veterans had a lower risk of myocardial infarction, hypertension and diabetes. No sex-specific differences were noted for chronic obstructive pulmonary disease. Female Veterans were also more likely to access all types of health services than male Veterans. Further, female Veterans accessed primary, specialist and emergency department care at greater rates than male Veterans. No significant differences were found in the sex-specific rates of hospitalisations or home care use. CONCLUSIONS Female Veterans residing in Ontario, Canada have different chronic health risks and engage in health services use more frequently than their male counterparts. These findings have important healthcare policy and programme planning implications, in order to ensure female Veterans have access to appropriate health services.
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Affiliation(s)
- Kate St Cyr
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - A B Aiken
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - H Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | | | - P Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - A L Mahar
- ICES, Toronto, Ontario, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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27
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Beňová L, Semaan A, Afolabi BB, Amongin D, Babah OA, Dioubate N, Harissatou N, Kikula AI, Nakubulwa S, Ogein O, Adroma M, Anzo Adiga W, Diallo A, Diallo IS, Diallo L, Cellou Diallo M, Maomou C, Mtinangi N, Sy T, Delvaux T, Delamou A, Nakimuli A, Pembe AB, Banke-Thomas AO. Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania. BMJ Open 2023; 13:e076364. [PMID: 37730410 PMCID: PMC10514648 DOI: 10.1136/bmjopen-2023-076364] [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: 06/06/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes. DESIGN Prospective observational mixed-methods study, combining monthly routine data (March 2019-February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave. SETTING Six referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda. PARTICIPANTS 22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels. RESULTS Percentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and increased at various times in other hospitals. SHP reported unpredictability in the number of referrals due to changing referral networks. All six hospitals registered a slight increase in stillbirths during the study period, the highest increase (by 30%-40%) was observed in Uganda. Four hospitals registered increases in facility maternal mortality ratio; the highest increase was in Guinea (by 158%), which had a relatively mild COVID-19 epidemic. These increases were not due to mortality among women with COVID-19. The main pathways leading to these trends were delayed care utilisation and disruptions in accessing care, including sub-optimal referral linkages and health service closures. CONCLUSIONS Maternal and perinatal survival was negatively affected in referral hospitals in sub-Saharan Africa during COVID-19. Routine data systems in referral hospitals must be fully used as they hold potential in informing adaptations of maternal care services. If combined with information on women's and care providers' needs, this can contribute to ensuring continuation of essential care provision during emergency.
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Affiliation(s)
- Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynaecology, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Dinah Amongin
- Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ochuwa Adiketu Babah
- Department of Obstetrics and Gynaecology, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Nafissatou Dioubate
- Département de santé publique, Centre National de Formation et de Recherche en Santé Rurale, Maférinyah, Forécariah, Guinea
| | | | - Amani Idris Kikula
- Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Sarah Nakubulwa
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, Uganda
| | - Olubunmi Ogein
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Moses Adroma
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - William Anzo Adiga
- Department of Obstetrics and Gynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | | | | | - Lamine Diallo
- Service de la maternité, Hôpital Régional de Mamou, Mamou, Guinea
| | | | - Cécé Maomou
- Service de la maternité, Hôpital Régional de Mamou, Mamou, Guinea
| | - Nathanael Mtinangi
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Telly Sy
- Service de la maternité, Hôpital National Ignace Deen, Conakry, Guinea
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Alexandre Delamou
- Département de santé publique, Centre National de Formation et de Recherche en Santé Rurale, Maférinyah, Forécariah, Guinea
| | - Annettee Nakimuli
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrea Barnabas Pembe
- Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
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Graves N, Ganesan G, Tan KB, Goh OQ, Ho J, Chong TT, Bishnoi P, Carmody D, Yuh AS, Ng YZ, Lo Z, Enming Y, Abu Bakar Aloweni F, Zifei W, Harding K. Chronic wounds in a multiethnic Asian population: a cost of illness study. BMJ Open 2023; 13:e065692. [PMID: 37723106 PMCID: PMC10510887 DOI: 10.1136/bmjopen-2022-065692] [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: 06/17/2022] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE To estimate the 'cost of illness' arising from chronic wounds in Singapore. DESIGN Incidence-based cost of illness study using evidence from a range of sources. SETTING Singapore health services. PARTICIPANTS We consider 3.49 million Singapore citizens and permanent residents. There are 16 752 new individuals with a chronic wound in 2017, with 598 venous ulcers, 2206 arterial insufficiency ulcers, 6680 diabetic ulcers and 7268 pressure injuries.Primary outcome measures expressed in monetary terms are the value of all hospital bed days lost for the population; monetary value of quality-adjusted life years (QALYs) lost in the population; costs of all outpatient visits; and costs of all poly clinic, use of Community Health Assist Scheme (CHAS) and emergency departments (EDs) visits. Intermediate outcomes that inform the primary outcomes are also estimated. RESULTS Total annual cost of illness was $350 million (range $72-$1779 million). With 168 503 acute bed days taken up annually (range 141 966-196 032) that incurred costs of $139 million (range 117-161 million). Total costs to health services were $184 million (range $120-$1179 million). Total annual costs of lost health outcomes were 2077 QALYs (range -2657 to 29 029) valued at $166 million (range -212 to 2399 million). CONCLUSIONS The costs of chronic wounds are large to Singapore. Costs can be reduced by making positive investments for comprehensive wound prevention and treatment programmes.
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Affiliation(s)
- Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ganga Ganesan
- Health Services Research, Ministry of Health, Singapore
| | - Kelvin Bryan Tan
- SingHealth Duke-NUSGlobal Health Institute, Duke-NUS Medical School, Singapore
| | - Orlanda Qm Goh
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Jackie Ho
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Priya Bishnoi
- A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - David Carmody
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Ang Shin Yuh
- Nursing Division, Singapore General Hospital, Singapore
| | - Yi Zhen Ng
- A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Zhiwen Lo
- Department of Surgery, Vascular Surgery Woodlands Health, Singapore
| | - Yong Enming
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Wang Zifei
- Skin Research Institute of Singapore (SRIS), Singapore
| | - Keith Harding
- Skin Research Institute of Singapore (SRIS), Singapore
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Hosar R, Steinsbekk A. Association between Johns Hopkins Adjusted Clinical Groups risk scores and self-reported outcome measures: an observational study among individuals with complex or long-term conditions in Norway. BMJ Open 2023; 13:e071071. [PMID: 37723104 PMCID: PMC10510856 DOI: 10.1136/bmjopen-2022-071071] [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: 12/14/2022] [Accepted: 08/31/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE Investigate the association between Johns Hopkins Adjusted Clinical Groups (ACG) risk scores and low scores in self-reported outcome measures (SROMs) among individuals with complex or long-term conditions. DESIGN Longitudinal study using five ACG risk scores based on diagnoses from general practitioner (GP) visits in 1 year and responses to a survey including three SROMs 4 months later. SETTING Four adjacent municipalities in Central Norway. PARTICIPANTS Non-institutionalised individuals ≥18 years with ≥1 diagnosis code indicating a complex or long-term condition, ≥1 visit to a GP, and who participated in the survey (n=2944). MEASURES Dependent variables were low scores in the three SROMs (threshold for being defined as a low score in parentheses): Patient Activation Measure (level 1-2), EQ-5D (<0.4) or self-rated health ('Poor'). Independent variables were five ACG variables. RESULTS The individuals with the lowest scores in the three SROMs were mostly three separate groups. The lowest Patient Activation Measure scores were associated with high scores in the ACG variables unscaled total cost predicted risk (adjusted odds ratio (adjOR) 1.80) and positive frailty flag (adjOR 1.76). The lowest EQ-5D scores were associated with high scores in the ACG variables unscaled concurrent risk (adjOR 1.60) and probability persistent high user scores (adjOR 2.83). The lowest self-rated health scores were associated with high scores in the ACG variable unscaled concurrent risk scores (adjOR 1.77), unscaled total cost predicted risk scores (adjOR 2.14) and receiving a positive frailty flag (adjOR 1.82). CONCLUSIONS There were associations between ACG risk scores and subsequent low SROM scores. This suggests a potential to use diagnosis-based risk stratification systems as a proxy for SROMs to identify individuals with complex or long-term conditions for person-centred healthcare intervention.
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Affiliation(s)
- Rannei Hosar
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Weyman A, O'Hara R, Nolan P, Glendinning R, Roy D, Coster J. Determining the relative salience of recognised push variables on health professional decisions to leave the UK National Health Service (NHS) using the method of paired comparisons. BMJ Open 2023; 13:e070016. [PMID: 37699606 PMCID: PMC10514647 DOI: 10.1136/bmjopen-2022-070016] [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: 11/17/2022] [Accepted: 07/10/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVE The primary and secondary impacts from the COVID-19 pandemic are claimed to have had a detrimental impact on health professional retention within the UK National Health Service (NHS). This study set out to identify priorities for intervention by scaling the relative importance of widely cited push (leave) influences. DESIGN During Summer/Autumn 2021, a UK-wide opportunity sample (n=1958) of NHS health professionals completed an online paired-comparisons exercise to determine the relative salience of work-related stress, workload intensity, time pressure, staffing levels, working hours, work-homelife balance, recognition of effort and pay as reasons why health professionals leave NHS employment. SETTING The study is believed to be the first large-scale systematic assessment of factors driving staff exits from the NHS since the COVID-19 pandemic. RESULTS All professions gave primacy to work-related stress, workload intensity and staffing levels. Pay was typically located around the midpoint of the respective scales; recognition of effort and working hours were ranked lowest. However, differences were apparent in the rank order and relative weighting of push variables between health professions and care delivery functions. Ambulance paramedics present as an outlier, notably with respect to staffing level (F-stat 4.47, p=0.004) and the primacy of work-homelife balance. Relative to staffing level, other push variables exert a stronger influence on paramedics than nurses or doctors (f 4.29, p=0.006). CONCLUSION Findings are relevant to future NHS health professional retention intervention strategy. Excepting paramedics/ambulance services, rankings of leave variables across the different health professional families and organisation types exhibit strong alignment at the ordinal level. However, demographic differences in the weightings and rankings, ascribed to push factors by professional family and organisation type, suggests that, in addition to signposting universal (all-staff) priorities for intervention, bespoke solutions for different professions and functions may be needed.
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Affiliation(s)
- Andrew Weyman
- Department of Psychology, University of Bath, Bath, UK
| | - Rachel O'Hara
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Peter Nolan
- School of Management, University of Leicester, Leicester, UK
| | | | - Deborah Roy
- Department of Psychology, University of Bath, Bath, UK
| | - Joanne Coster
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Gofine M, Laynor G, Schoenthaler A. Characteristics of programmes designed to link community-dwelling older adults in high-income countries from community to clinical sectors: a scoping review protocol. BMJ Open 2023; 13:e072617. [PMID: 37699628 PMCID: PMC10503318 DOI: 10.1136/bmjopen-2023-072617] [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: 02/07/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Research on effectively navigating older adults into primary care is urgently needed. Community-clinic linkage models (CCLMs) aim to improve population health by linking the health and community sectors in order to improve patients' access to healthcare and, ultimately, population health. However, research on community-based points of entry linking adults with untreated medical needs into the healthcare sector is nascent. CCLMs implemented for the general adult population are not necessarily accessible to older adults. Given the recency of the CCLM literature and the seeming rarity of CCLM interventions designed for older adults, it is appropriate to employ scoping review methodology in order to generate a comprehensive review of the available information on this topic. This protocol will inform a scoping review that reviews characteristics of community-based programmes that link older adults with the healthcare sector. METHODS AND ANALYSIS The present protocol was developed as per JBI Evidence Synthesis best practice guidance and reporting items for the development of scoping review protocols. The proposed scoping review will follow Levac and colleagues' update to Arksey and O'Malley's scoping review methodology. Healthcare access at the system and individual levels will be operationalised in data extraction and analysis in accordance with Levesque and colleagues' Conceptual Framework of Access to Health. The protocol complies with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Beginning in August 2023 or later, citation databases (AgeLine (Ebsco); CINAHL Complete; MEDLINE (PubMed); Scopus Advanced (Elsevier); Social Services Abstracts (ProQuest); Web of Science Core Collection (Clarivate)) and grey literature (Google; American Public Health Association Annual Meeting Conference Proceedings; SIREN Evidence & Resource Library) will be searched. ETHICS AND DISSEMINATION The authors plan to disseminate their findings in conference proceedings and publication in a peer-reviewed journal and deposit extracted data in the Figshare depository. The study does not require Institutional Review Board approval. REGISTRATION DETAILS Protocol registered in Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/2EF9D).
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Affiliation(s)
- Miriam Gofine
- Department of Population Health, NYU Langone Health, New York City, New York, USA
- Vilcek Institute of Graduate Biomedical Sciences, NYU Langone Health, New York City, New York, USA
| | - Gregory Laynor
- Health Sciences Library, New York University Grossman School of Medicine, New York City, New York, USA
| | - Antoinette Schoenthaler
- Department of Population Health, NYU Langone Health, New York City, New York, USA
- Institute for Excellence in Health Equity, NYU Langone Health, New York City, New York, USA
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Haapatalo E, Reponen E, Torkki P. Sustainability of performance improvements after 26 Kaizen events in a large academic hospital system: a mixed methods study. BMJ Open 2023; 13:e071743. [PMID: 37640468 PMCID: PMC10462939 DOI: 10.1136/bmjopen-2023-071743] [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: 01/19/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Implementing Kaizen can improve productivity in healthcare but maintaining long-term results has proven challenging. This study aimed to assess improved performance achieved and sustained by Kaizen events and find explanatory factors for the persistence or decline of long-term results. METHODS Kaizen events were conducted in 26 specialised healthcare units in a large academic hospital system in southern Finland. Primary data for mixed methods analysis was collected from each unit with 21 semi-structured interviews, Kaizen report files and performance metrics. RESULTS Fifteen explanatory factors were found in this study. Work culture and motivation for continuous improvement stood out as the most important explanatory factor for the persistence of long-term results-lack of time for improvement activities and high workload for the decline. Success in preparation and follow-up was associated with sustained long-term results. Thirteen units achieved long-term results, three units could not sustain the performance improvements and five units struggled to make any improvements. CONCLUSIONS This study explains the long-term sustainability of performance improvements, bringing new insights to Kaizen research. Our findings can guide organising successful Kaizen events. The events can be worth organising even though long-term performance improvements are not guaranteed. Units with supportive working culture and motivation for the Kaizen event will likely succeed. A unit should aim to create a supportive foundation for Kaizen before organising a Kaizen event. Units that lack the foundation can be identified, trained and guided to increase their chances of success. Pitfalls like high workload and insufficient follow-up should be proactively identified and appropriately managed by allocating the required time and resources for the development work.
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Affiliation(s)
- Erik Haapatalo
- Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Elina Reponen
- HUS Shared Group Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paulus Torkki
- Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
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Shashar S, Ellen M, Codish S, Davidson E, Novack V. Unravelling the determinants of medical practice variation in referrals among primary care physicians: insights from a retrospective cohort study in Southern Israel. BMJ Open 2023; 13:e072837. [PMID: 37586857 PMCID: PMC10432653 DOI: 10.1136/bmjopen-2023-072837] [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: 02/23/2023] [Accepted: 07/04/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES Reducing medical practice variation (MPV) is a central theme of system improvement because it is associated with poor health outcomes, increased costs and disparities in care. This study aimed to estimate the extent to which each determinant (patient, physician, clinic) explains MPV among primary care physicians and to identify the characteristics of health services with a greater explained variance. METHODS A retrospective cohort study of primary care physicians practising in non-private clinics of Clalit Health Services in Southern Israel, for longer than a year between 2011 and 2017 and with more than 100 adult patients per practice. We assessed the variation in referral rates among 17 health services and the proportion explained by each domain (patient, physician and clinic). We used generalised linear negative binomial mixed models and the Nakagawa's R2, computing the marginal r2. RESULTS The study included 243 physicians working in 295 practices and 139 clinics. The mean-explained variance was 28.5%±10.0%, where physician characteristics explained 4.5% of the variation. The intrapractice variation (within a single physician between the years) was explained better than the interphysician (between physicians). Health services with high explained variation were blood tests characterised by both low intrapractice variation (Rs=-0.65, p value=0.005) and high referral rates (Rs=0.46, p value=0.06). CONCLUSION Over 70% of MPV is not explained by the patient, clinic and physician demographic and professional characteristics. Future research should focus on the fraction of MPV that is explained by the physicians' psychological characteristics, and thus potentially identify psychological targets for behavioural modifications aimed at reducing MPV.
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Affiliation(s)
- Sagi Shashar
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Moriah Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shlomi Codish
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ehud Davidson
- General Management, Clalit Health Services, Tel Aviv, Israel
| | - Victor Novack
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Välimäki MA, Kirsi H, Yang M, Lantta T, Varpula J, Liu G, Tang Y, Chen W, Hu S, Chen J, Löyttyniemi E, Li X. Online training to improve evidence-based leadership competencies among nurse leaders in Finland and China: study protocols for two randomised feasibility trials. BMJ Open 2023; 13:e067306. [PMID: 37580090 PMCID: PMC10432629 DOI: 10.1136/bmjopen-2022-067306] [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: 08/09/2022] [Accepted: 07/31/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION This study protocol describes two randomised feasibility trials that will evaluate the feasibility and preliminary effectiveness of an online training course to improve evidence-based leadership competences among nurse leaders working in hospitals in Finland and China. METHODS AND ANALYSIS Two randomised, parallel-group studies will be conducted separately: one in Finland (n=140) and one in China (n=160). Nurse leaders who fulfil the eligibility criteria will be randomly allocated (1:1) to participate in either the online evidence-based leadership training or conventional online training (reading material only). The primary outcomes will be acceptance of the online course (logging into the platform) and adherence in the online course (returned course tasks and drop-out rate of the participants). The secondary outcomes will be acceptance of the study regarding recruitment, feasibility of the eligibility criteria and outcome measures and potential effectiveness of the online course on leadership skills, evidence-based knowledge, attitudes, practice, self-efficacy, self-esteem and intention to leave. In addition, the feedback will be asked after the course. ETHICS AND DISSEMINATION Two separate trials have received ethical clearance from local ethics committees (12/2022 in Finland, E2021167 in China). Permission to conduct the study will be granted by hospital authorities. All participants will provide electronic informed consent before baseline data are collected. The trial results will be published locally, nationally and internationally in professional and peer-reviewed journals, and shared at national and international meetings and conferences. TRIAL REGISTRATION NUMBERS NCT05244512; NCT05244499.
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Affiliation(s)
- Maritta Anneli Välimäki
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Xiangya Research Center of Evidence-Based Healthcare, Xiangya School of Nursing, Central South University, Changsha, China
| | - Hipp Kirsi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Min Yang
- West China School of Public Health and the 4th West China Hospital, Sichuan University, Chengdu, China
- Faculty of Health, Art and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Tella Lantta
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Jaakko Varpula
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Gaoming Liu
- Department of Nursing, Hunan Cancer Hospital, Changsha, China
| | - Yao Tang
- Xiangya Nursing School, Central South University, Changsha, China
| | - Wenjun Chen
- Xiangya Nursing School, Central South University, Changsha, China
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Shuang Hu
- Xiangya Nursing School, Central South University, Changsha, China
| | - Jiarui Chen
- Xiangya Nursing School, Central South University, Changsha, China
| | - Eliisa Löyttyniemi
- Department of Biostatistics, Faculty of Medicine, University of Turku, Turku, Finland
| | - Xianhong Li
- Xiangya Nursing School, Central South University, Changsha, China
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Bosongo S, Belrhiti Z, Ekofo J, Kabanga C, Chenge F, Criel B, Marchal B. How capacity building of district health managers has been designed, delivered and evaluated in sub-Saharan Africa: a scoping review and best fit framework analysis. BMJ Open 2023; 13:e071344. [PMID: 37532484 PMCID: PMC10401232 DOI: 10.1136/bmjopen-2022-071344] [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] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES We aimed to understand how capacity building programmes (CBPs) of district health managers (DHMs) have been designed, delivered and evaluated in sub-Saharan Africa. We focused on identifying the underlying assumptions behind leadership and management CBPs at the district level. DESIGN Scoping review. DATA SOURCES We searched five electronic databases (MEDLINE, Health Systems Evidence, Wiley Online Library, Cochrane Library and Google Scholar) on 6 April 2021 and 13 October 2022. We also searched for grey literature and used citation tracking. ELIGIBILITY CRITERIA We included all primary studies (1) reporting leadership or management capacity building of DHMs, (2) in sub-Saharan Africa, (3) written in English or French and (4) published between 1 January 1987 and 13 October 2022. DATA EXTRACTION AND SYNTHESIS Three independent reviewers extracted data from included articles. We used the best fit framework synthesis approach to identify an a priori framework that guided data coding, analysis and synthesis. We also conducted an inductive analysis of data that could not be coded against the a priori framework. RESULTS We identified 2523 papers and ultimately included 44 papers after screening and assessment for eligibility. Key findings included (1) a scarcity of explicit theories underlying CBPs, (2) a diversity of learning approaches with increasing use of the action learning approach, (3) a diversity of content with a focus on management rather than leadership functions and (4) a diversity of evaluation methods with limited use of theory-driven designs to evaluate leadership and management capacity building interventions. CONCLUSION This review highlights the need for explicit and well-articulated programme theories for leadership and management development interventions and the need for strengthening their evaluation using theory-driven designs that fit the complexity of health systems.
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Affiliation(s)
- Samuel Bosongo
- Faculté de Médecine et Pharmacie, Département de Santé Publique, Université de Kisangani, Kisangani, Congo (the Democratic Republic of the)
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Zakaria Belrhiti
- Département santé publique and management, Ecole Internationale de Santé Publique, Université Mohammed VI des Sciences de la Santé, Casablanca, Morocco
- Centre Mohammed VI de la recherche et Innovation (CM6), Rabat, Morocco
| | - Joël Ekofo
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Chrispin Kabanga
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Faustin Chenge
- Faculté de Médecine et Pharmacie, Département de Santé Publique, Université de Kisangani, Kisangani, Congo (the Democratic Republic of the)
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
- Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Congo (the Democratic Republic of the)
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Brera AS, Arrigoni C, Magon A, Conte G, Belloni S, Bonavina L, Caruso R, Pasek M. Mapping the literature on decision regret in patients with non-communicable diseases (NCDs): a scoping review protocol. BMJ Open 2023; 13:e072703. [PMID: 37463821 PMCID: PMC10357754 DOI: 10.1136/bmjopen-2023-072703] [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] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Decision regret refers to feelings of remorse or dissatisfaction with a decision made regarding the treatment. Mapping the meaningful aspects of decision regret in patients with non-communicable diseases (NCDs) is necessary to provide a comprehensive understanding of the phenomenon and inform the development of effective interventions to address it. For this reason, this protocol aimed to describe the methodological aspects of a scoping review focused on mapping all the meaningful aspects of decision regret in patients with NCDs and provide a conceptual and comprehensive framework of the phenomenon. METHODS AND ANALYSIS The study described in this protocol will be performed following the Joanna Briggs Institute (JBI) methodology for scoping reviews. The anticipated starting time is July/August 2023 and the anticipated end of the review is June 2024. This scoping review will include quantitative, qualitative, primary and secondary literature, as well as grey literature on decision regret in patients with NCDs. The systematic search will be performed by consulting PubMed, Embase, Scopus, CINAHL, the Cochrane Library and Google Scholar. English-language articles from any context will be eligible for inclusion. Two independent reviewers will take part in an iterative process of evaluating literature, choosing papers and extracting data. Disagreements among reviewers will be solved through consensus meetings. Results will be presented in relation to the review question by employing tables, figures and narrative summaries. ETHICS AND DISSEMINATION This scoping review did not require ethical approval since it involves a literature review and does not include new data collection from human participants. The results of the review will provide a summary of the available literature on decision regret experienced by patients with NCDs, which is crucial for developing preventive educational interventions in situations where multiple therapeutic options are available.
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Affiliation(s)
- Alice Silvia Brera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Silvia Belloni
- Educational and Research Unit, Humanitas Research Hospital IRCCS, Rozzano, Lombardia, Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy
| | - Małgorzata Pasek
- Department of Nursing, Faculty of Health, University of Applied Sciences in Tarnow, Tarnow, Poland
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Healey SJR, Fakes K, Nair BR. Inequitable treatment as perceived by international medical graduates (IMGs): a scoping review. BMJ Open 2023; 13:e071992. [PMID: 37438072 DOI: 10.1136/bmjopen-2023-071992] [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] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES This scoping review seeks to detail experiences of inequitable treatment, as self-reported by international medical graduates (IMGs), across time and location. DESIGN Scoping review. SEARCH STRATEGY Three academic medical databases (MEDLINE, SCOPUS and PSYCINFO) and grey literature (GOOGLE SCHOLAR) were systematically searched for studies reporting first-hand IMG experiences of perceived inequitable treatment in the workplace: discrimination, prejudice or bias. Original (in English) qualitative, quantitative, mixed studies or inquiry-based reports from inception until 31 December 2022, which documented direct involvement of IMGs in the data were eligible for inclusion in the review. Systematic reviews, scoping reviews, letters, editorials, news items and commentaries were excluded. Study characteristics and common themes were identified and analysed through an iterative process. RESULTS We found 33 publications representing 31 studies from USA, Australia, UK, Canada, Germany, Finland, South Africa, Austria, Ireland and Saudi Arabia, published between 1982 and 2022. Common themes identified by extraction were: (1) inadequate professional recognition, including unmatched assigned work or pay; (2) perceived lack of choice and opportunities such as limited freedoms and perceived control over own future; (3) marginalisation-subtle interpersonal exclusions, stereotypes and stigma; (4) favouring of local graduates; (5) verbal insults, culturally or racially insensitive or offensive comments; and (6) harsher sanctions. Other themes identified were effects on well-being and proposed solutions to inequity. CONCLUSIONS This study found evidence that IMGs believe they are subject to numerous common inequitable workplace experiences and that these experiences have self-reported repercussions on well-being and career trajectory. Further research is needed to substantiate correlations and causality in relation to outcomes of well-being and differential career attainment. Furthermore, research into support for IMGs and the creation of more equitable workforce environments is also recommended.
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Affiliation(s)
- Sunita Joann Rebecca Healey
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Health, New Lambton Heights, New South Wales, Australia
| | - Kristy Fakes
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Balakrishnan R Nair
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Health, New Lambton Heights, New South Wales, Australia
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Kidanemariam M, Pieterse AH, van Staalduinen DJ, Bos WJW, Stiggelbout AM. Does value-based healthcare support patient-centred care? A scoping review of the evidence. BMJ Open 2023; 13:e070193. [PMID: 37429675 DOI: 10.1136/bmjopen-2022-070193] [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] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Standardisation of outcome measures is integral to value-based healthcare (VBHC), which may conflict with patient-centred care, focusing on personalisation. OBJECTIVES We aimed to provide an overview of measures used to assess the effect of VBHC implementation and to examine to what extent the evidence indicates that VBHC supports patient-centred care. DESIGN A scoping review guided by the Joanna Briggs Institute methodology. SOURCES OF EVIDENCE We searched the following databases on 18 February 2021: Cochrane Library, EMBASE, MEDLINE and Web of Science. ELIGIBILITY CRITERIA We included empirical papers assessing the effect of the implementation of VBHC, published after introduction of VBHC in 2006. DATA EXTRACTION AND SYNTHESIS Two independent reviewers double-screened papers and data were extracted by one reviewer and checked by the other. We classified the study measures used in included papers into six categories: process indicator, cost measure, clinical outcome, patient-reported outcome, patient-reported experience or clinician-reported experience. We then assessed the patient-centredness of the study measures used. RESULTS We included 39 studies using 94 unique study measures. The most frequently used study measures (n=72) were process indicators, cost measures and clinical outcomes, which rarely were patient-centred. The less frequently used (n=20) patient-reported outcome and experience measures often measured a dimension of patient-centred care. CONCLUSION Our study shows that the evidence on VBHC supporting patient-centred care is limited, exposing a knowledge gap in VBHC research. The most frequently used study measures in VBHC research are not patient-centred. The major focus seems to be on measures of quality of care defined from a provider, institution or payer perspective.
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Affiliation(s)
- Martha Kidanemariam
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Arwen H Pieterse
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorine J van Staalduinen
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
- Institute of Public Administration, Leiden University, The Hague, The Netherlands
| | - Willem Jan W Bos
- Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Anne M Stiggelbout
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
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Colquhoun H, Ellen M, Brehaut J, Weinreich NK, Morvinski C, Zarshenas S, Nguyen T, Presseau J, McCleary N, Proctor E. Potential social marketing applications for knowledge translation in healthcare: a scoping review protocol. BMJ Open 2023; 13:e071901. [PMID: 37399439 DOI: 10.1136/bmjopen-2023-071901] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION Knowledge translation has emerged as a practice and a science to bridge the gap between evidence and practice in healthcare. While the field has appropriately borrowed from other related fields to advance its science, there remain fields less mined. One such field with potential relevance to knowledge translation, but limited application to date, is social marketing. This review aims to determine elements of social marketing interventions that could be applied to knowledge translation science. Our objectives are to: (1) summarise the types of studies that have tested social marketing interventions in controlled intervention study designs; (2) describe the social marketing interventions and their effects; and (3) propose strategies for the integration of social marketing interventions into knowledge translation science. METHODS AND ANALYSIS This scoping review will be conducted using the Joanna Briggs Institute Methodological Guidance. For the first and second objectives, all English-language studies published from 1971 onwards will be included if they (1) used a randomised or non-randomised controlled intervention design, and (2) tested a social marketing intervention as defined by five essential social marketing criteria. The research team will address the third objective through discussion and consensus. All screening and extraction will be performed independently by two reviewers. Variables extracted will include intervention details using essential and desirable social marketing criteria and the context, mechanism and outcomes of the interventions. ETHICS AND DISSEMINATION This project is a secondary analysis of published papers and does not require ethics approval. We will disseminate our review outputs in knowledge translation journals and present at relevant conferences across the spectrum of the field. We will produce a short and long version of a plain language summary that will be tailored to various groups including implementation scientists and quality improvement researchers. REGISTRATION DETAILS Open Science Framework Registration link: osf.io/6q834.
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Affiliation(s)
- Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Moriah Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Coby Morvinski
- Department of Management; Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sareh Zarshenas
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Tram Nguyen
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Enola Proctor
- Brown School, Washington University in St Louis, St Louis, Missouri, USA
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Hoogendijk EO, Onder G, Smalbil L, Vetrano DL, Hirdes JP, Howard EP, Morris JN, Fialová D, Szczerbińska K, Kooijmans EC, Hoogendoorn M, Declercq A, De Almeida Mello J, Leskelä RL, Häsä J, Edgren J, Ruppe G, Liperoti R, Joling KJ, van Hout HP. Optimising the care for older persons with complex chronic conditions in home care and nursing homes: design and protocol of I-CARE4OLD, an observational study using real-world data. BMJ Open 2023; 13:e072399. [PMID: 37385750 PMCID: PMC10314651 DOI: 10.1136/bmjopen-2023-072399] [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: 01/31/2023] [Accepted: 06/08/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION In ageing societies, the number of older adults with complex chronic conditions (CCCs) is rapidly increasing. Care for older persons with CCCs is challenging, due to interactions between multiple conditions and their treatments. In home care and nursing homes, where most older persons with CCCs receive care, professionals often lack appropriate decision support suitable and sufficient to address the medical and functional complexity of persons with CCCs. This EU-funded project aims to develop decision support systems using high-quality, internationally standardised, routine care data to support better prognostication of health trajectories and treatment impact among older persons with CCCs. METHODS AND ANALYSIS Real-world data from older persons aged ≥60 years in home care and nursing homes, based on routinely performed comprehensive geriatric assessments using interRAI systems collected in the past 20 years, will be linked with administrative repositories on mortality and care use. These include potentially up to 51 million care recipients from eight countries: Italy, the Netherlands, Finland, Belgium, Canada, USA, Hong Kong and New Zealand. Prognostic algorithms will be developed and validated to better predict various health outcomes. In addition, the modifying impact of pharmacological and non-pharmacological interventions will be examined. A variety of analytical methods will be used, including techniques from the field of artificial intelligence such as machine learning. Based on the results, decision support tools will be developed and pilot tested among health professionals working in home care and nursing homes. ETHICS AND DISSEMINATION The study was approved by authorised medical ethical committees in each of the participating countries, and will comply with both local and EU legislation. Study findings will be shared with relevant stakeholders, including publications in peer-reviewed journals and presentations at national and international meetings.
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Affiliation(s)
- Emiel O Hoogendijk
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of General Practice, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Ageing and later life research program, Amsterdam, The Netherlands
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Louk Smalbil
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Elizabeth P Howard
- Connell School of Nursing, Boston College, Chestnut Hill, Boston, MA, USA
- The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - John N Morris
- The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, Hradec Králové, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katarzyna Szczerbińska
- Laboratory for Research on Aging Society, Chair of Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University Medical College, Kraków, Poland
| | - Eline Cm Kooijmans
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of General Practice, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Ageing and later life research program, Amsterdam, The Netherlands
| | - Mark Hoogendoorn
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anja Declercq
- LUCAS, Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- Center for Sociological Research, KU Leuven, Leuven, Belgium
| | | | | | - Jokke Häsä
- Data and Analytics Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Johanna Edgren
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Georg Ruppe
- European Geriatric Medicine Society (EUGMS), Vienna, Austria
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Karlijn J Joling
- Amsterdam Public Health research institute, Ageing and later life research program, Amsterdam, The Netherlands
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Medicine for Older People, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Hein Pj van Hout
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of General Practice, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Ageing and later life research program, Amsterdam, The Netherlands
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Lv Y, Qin J, Feng X, Li S, Tang C, Wang H. Preferences of patients with diabetes mellitus for primary healthcare institutions: a discrete choice experiment in China. BMJ Open 2023; 13:e072495. [PMID: 37369417 PMCID: PMC10410837 DOI: 10.1136/bmjopen-2023-072495] [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: 02/06/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES To quantify the preference of patients with diabetes mellitus (DM) for primary healthcare (PHC) institutions in China to redirect the patient flow and improve health outcomes. DESIGN Cross-sectional study. Discrete choice experiment (DCE) surveys asked patients with DM to choose between hypothetical institutions that differed in the medical service capacity, out-of-pocket (OOP) medical costs per month, travel time, the attitude of medical staff and the availability of diabetes drugs. SETTING Shandong province, China. PARTICIPANTS The participants were 887 patients with DM from 36 urban communities and 36 rural villages in Shandong province. One participant did not provide any DCE answers and a further 57 patients failed the internal consistency test. 829 fully completed surveys were included in the final data analysis. MAIN OUTCOMES AND MEASURES A mixed logit model was used to calculate the willingness to pay and predict choice probabilities for PHC institution attributes. Preference heterogeneity was also investigated. RESULTS All five attributes were associated with the preferences of patients with DM. The OOP medical costs and the medical service capacity were the most influential attributes. Improvements simultaneously in the attitude of medical staff, drug availability and travel time increased the likelihood of a patient's PHC institution choice. Preferences differed by region, annual household income and duration of diabetes. CONCLUSIONS Our patient preference data may help policymakers improve health services and increase acceptance of choosing PHC institutions. The OOP medical costs and medical service capacity should be regarded as a priority in decision-making.
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Affiliation(s)
- Yuyu Lv
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
| | - Jingzhu Qin
- Hospital Office, Qingdao Municipal Hospital, Qingdao, China
| | - Xia Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - ShunPing Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
| | - Chengxiang Tang
- Macquarie University Centre for the Health Economy, Macquarie Business 14 School & Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Haipeng Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
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Kaneko M, Ikeda T, Inoue M, Sugiyama K, Saito M, Ohta R, Cooray U, Vingilis E, Freeman TR, Mathews M. Development and validation of a rurality index for healthcare research in Japan: a modified Delphi study. BMJ Open 2023; 13:e068800. [PMID: 37336534 DOI: 10.1136/bmjopen-2022-068800] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES Rural-urban healthcare disparities exist globally. Various countries have used a rurality index for evaluating the disparities. Although Japan has many remote islands and rural areas, no rurality index exists. This study aimed to develop and validate a Rurality Index for Japan (RIJ) for healthcare research. DESIGN We employed a modified Delphi method to determine the factors of the RIJ and assessed the validity. The study developed an Expert Panel including healthcare professionals and a patient who had expertise in rural healthcare. SETTING The panel members were recruited from across Japan including remote islands, mountain areas and heavy snow areas. The panel recruited survey participants whom the panel considered to have expertise. PARTICIPANTS The initial survey recruited 100 people, including rural healthcare providers, local government staff and residents. PRIMARY OUTCOME MEASURES Factors to include in the RIJ were identified by the Expert Panel and survey participants. We also conducted an exploratory factor analysis on the selected factors to determine the factor structure. Convergent validity was examined by calculating the correlation between the index for physician distribution and the RIJ. Criterion-related validity was assessed by calculating the correlation with average life expectancy. RESULTS The response rate of the final survey round was 84.8%. From the Delphi surveys, four factors were selected for the RIJ: population density, direct distance to the nearest hospital, remote islands and whether weather influences access to the nearest hospital. We employed the factor loadings as the weight of each factor. The average RIJ of every zip code was 50.5. The correlation coefficient with the index for physician distribution was -0.45 (p<0.001), and the correlation coefficients with the life expectancies of men and women were -0.35 (p<0.001) and -0.12 (p<0.001), respectively. CONCLUSION This study developed the RIJ using a modified Delphi method. The index showed good validity.
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Affiliation(s)
- Makoto Kaneko
- Department of Health Data Science, Yokohama City University, Yokohama, Japan
| | - Takaaki Ikeda
- Department of Health Policy Science, Yamagata University, Yamagata, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Machiko Inoue
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kemmyo Sugiyama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | | | - Ryuichi Ohta
- Department of Community Care, Unnan City Hospital, Unnan, Shimane, Japan
| | - Upul Cooray
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Evelyn Vingilis
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Maria Mathews
- Department of Family Medicine, Western University, London, Ontario, Canada
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Groothuizen JE, Aroyewun E, Zasada M, Harris J, Hewish M, Taylor C. Virtually the same? Examining the impact of the COVID-19 related shift to virtual lung cancer multidisciplinary team meetings in the UK National Health Service: a mixed methods study. BMJ Open 2023; 13:e065494. [PMID: 37328174 PMCID: PMC10276952 DOI: 10.1136/bmjopen-2022-065494] [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: 06/10/2022] [Accepted: 02/02/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVES To evaluate the impact of the shift to virtual lung cancer multidisciplinary team meetings (MDTMs) in response to the COVID-19 pandemic, specifically in relation to the magnitude of information technology (IT) issues and distractions and MDT members'/managers' perceptions and experiences of this shift. DESIGN A mixed methods study comprising real-time observations of IT issues/distractions within virtual MDTM case discussions held between April and July 2021 and qualitative data from interviews/surveys. SETTING Eight hospital organisations in Southern England. PARTICIPANTS Team members (respiratory physicians, surgeons, oncologists, radiologists, pathologists, palliative care professionals, nurses and MDT coordinators) and managers (n=190) across 8 local MDTs. RESULTS MDTM observations (n=1664) highlighted significant variation between teams regarding IT functionality. IT issues and other distractions relating to the virtual MDTM format were observed 465 times affecting 20.6% of case discussions, most of which were audio issues (18.1%). Case discussions that had audio issues were, on average, 26 s longer (t(1652)=-2.77, p<0.01). A total of 73 MDT members and managers participated in the survey and 41 participated in interviews, with all 8 teams being represented. Increased flexibility, reduced travel time and easier real-time access to patient information were seen as the main advantages of virtual MDTMs. Views regarding the impact on relational aspects and communication differed. In line with observational findings, concerns were raised in relation to IT, including having inappropriate equipment, insufficient bandwidth (impairing image sharing and video communication) and an overarching theme that virtual meeting platforms provided were not fit for purpose. CONCLUSIONS Despite the potential benefits of virtual MDTMs, IT issues can waste valuable MDTM time. If hospital organisations plan to continue virtual MDTMs, a functioning infrastructure is required, necessitating appropriate resource and investment.
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Affiliation(s)
| | - Eunice Aroyewun
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Magdalena Zasada
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Jenny Harris
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Madeleine Hewish
- Oncology Division, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
| | - Cath Taylor
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Kumluang S, Wu O, Langhorne P, Geue C. Stroke resource utilisation and all-cause mortality in Thailand 2017-2020: A retrospective, cross-sectional study. BMJ Open 2023; 13:e072259. [PMID: 37280024 DOI: 10.1136/bmjopen-2023-072259] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE To determine resource utilisation, costs and all-cause mortality related to stroke in Thailand. DESIGN Retrospective, cross-sectional study. SETTING AND PARTICIPANTS Patients with first-ever stroke in the Thai national claims database between 2017 and 2020 were included for analysis. No individuals were involved. METHODS We estimated annual treatment costs using two-part models. Survival analysis for all-cause mortality was performed. RESULTS We identified 386 484 patients with incident stroke of which 56% were men. Mean age was 65 years and ischaemic stroke was the most common subtype. Mean annual cost per patient was 37 179 Thai Baht (95% CI: 36 988 to 37 370). Haemorrhagic stroke was predominantly observed in the youngest age groups with the highest estimated mean annual cost. Patients with haemorrhagic stroke also had a longer length of stay (LOS) in hospital and an increased risk of mortality. Key cost drivers were identified to be age, LOS, comorbidity and thrombolysis. Costs were lower in patients who received rehabilitation; however, only 32% of patients received rehabilitation services. The 4-year survival rate of all stroke types was 66.5% (95% CI: 64.3% to 66.7%). Older age, high comorbidity score, long LOS and being treated outside the Bangkok area were factors associated with significantly increased mortality risk, while receiving thrombolysis or rehabilitation was associated with a decreased risk of death. CONCLUSION The highest mean cost per patient was found in patients with haemorrhagic stroke. Receiving rehabilitation was associated with lower cost and mortality risk. Rehabilitation and disability outcomes should be improved to ensure an enhancement of health outcomes and efficient use of resources.
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Affiliation(s)
- Suthasinee Kumluang
- Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Olivia Wu
- Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter Langhorne
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Whitaker J, Amoah AS, Dube A, Chirwa L, Munthali B, Rickard RF, Leather AJM, Davies J. Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern Malawi. BMJ Open 2023; 13:e070900. [PMID: 37263691 DOI: 10.1136/bmjopen-2022-070900] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES We used the process mapping method and Three Delays framework, to identify and visually represent the relationship between critical actions, decisions and barriers to access to care following injury in the Karonga health system, Northern Malawi. DESIGN Facilitated group process mapping workshops with summary process mapping synthesis. SETTING Process mapping workshops took place in 11 identified health system facilities (one per facility) providing injury care for a population in Karonga, Northern Malawi. PARTICIPANTS Fifty-four healthcare workers from various cadres took part. RESULTS An overall injury health system summary map was created using those categories of action, decision and barrier that were sometimes or frequently reported. This provided a visual summary of the process following injury within the health system. For Delay 1 (seeking care) four barriers were most commonly described (by 8 of 11 facilities) these were 'cultural norms', 'healthcare literacy', 'traditional healers' and 'police processes'. For Delay 2 (reaching care) the barrier most frequently described was 'transport'-a lack of timely affordable emergency transport (formal or informal) described by all 11 facilities. For Delay 3 (receiving quality care) the most commonly reported barrier was that of 'physical resources' (9 of 11 facilities). CONCLUSIONS We found our novel approach combining several process mapping exercises to produce a summary map to be highly suited to rapid health system assessment identifying barriers to injury care, within a Three Delays framework. We commend the approach to others wishing to conduct rapid health system assessments in similar contexts.
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Affiliation(s)
- John Whitaker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Abena S Amoah
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Malawi Epidemiological and Intervention Research Unit, Chilumba, Malawi
- Department of Parasitology, Leiden University Center for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert Dube
- Malawi Epidemiological and Intervention Research Unit, Chilumba, Malawi
| | - Lindani Chirwa
- Karonga District Health Office, Karonga, Malawi
- Department of Pathology, School of Medicine & Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Boston Munthali
- Lilongwe Institute of Orthopaedic and Neurosurgery, Lilongwe, Malawi
- Department of Orthopaedic Surgery, Mzuzu Central Hospital, Mzuzu, Malawi
| | - Rory F Rickard
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Andrew J M Leather
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
- Department of Global Surgery, Stellenbosch University, Stellenbosch, South Africa
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Tan PJ, Ginting ML, Lim ZZB, Balachandar N, Sultana R, Kadir MM, Xu T, Ismail NH, Yap JKY, Wong SF, Yoong J, Matchar DB, Hill K, Wong CH. Pragmatic multicentre stepped-wedge cluster randomised trial to investigate the effectiveness of community-based falls prevention programme for older adults with falls risk in Singapore: a protocol paper. BMJ Open 2023; 13:e072029. [PMID: 37263684 DOI: 10.1136/bmjopen-2023-072029] [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] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Falls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among community-dwelling older adults. However, the evaluation for effectiveness was usually done in a controlled setting with homogeneous population, and thus may not be generalisable to a wider population. This study aims to evaluate the impact of community falls prevention programmes with group-based strength and balance exercises, on falls risk and health outcomes for older adults with falls risk in Singapore. METHODS AND ANALYSIS This is a pragmatic closed cohort stepped-wedge cluster randomised trial design study, which involves sequential crossover of clusters from the waitlist control condition to the intervention condition, with the sequence of crossover randomly determined. The intervention will be sequentially rolled out to 12 clusters (a minimum of 5 participants/cluster), over 6 time periods with 8-week intervals in Central and North regions of Singapore. The primary analysis will be conducted under the intention-to-treat principle. A general linear mixed model or generalised estimating equation analysis appropriate for a multilevel longitudinal study incorporating an appropriate error distribution and link function will be used. Markov model will be developed to estimate the incremental cost per quality-adjusted life years and incremental cost per fall prevented from the implementation of falls prevention strategies from a societal perspective. Conditional on there being clinically relevant differences in short-term outcomes, we will implement simulation modelling to project the long-term divergence in trajectories for outcomes and costs using the Markov model. ETHICS AND DISSEMINATION Ethics approval has been obtained. Results will be disseminated in publications and other relevant platforms. TRIAL REGISTRATION NUMBER NCT04788251.
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Affiliation(s)
- Pey June Tan
- Geriatric Education and Research Institute, Singapore
| | | | | | | | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | | | - Tianma Xu
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Noor Hafizah Ismail
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore
| | - Joyce Kwee Yong Yap
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore
| | - Sweet Fun Wong
- Population Health & Community Transformation, Khoo Teck Puat Hospital, Singapore
| | - Joanne Yoong
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
- Research for Impact, Singapore
| | | | - Keith Hill
- Rehabilitation Aging and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Zhang Z, Zhang R, Peng Y, Zhai S, Zhang J, Jin Q, Zhou J, Li H, Chen J. Barriers and facilitators of family doctor contract services in caring for disabled older adults in Beijing, China: a mixed methods study. BMJ Open 2023; 13:e070130. [PMID: 37263682 DOI: 10.1136/bmjopen-2022-070130] [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] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To evaluate the current state of family doctor contract services (FDCS) in Beijing, identify the roles of family doctors who have worked with disabled older adults and investigate the barriers and facilitators faced by family doctors in providing care for them. DESIGN A convergent mixed methods study was carried out from October 2020 to January 2021 to collect and analyse both quantitative and qualitative data. The integration strategies in this study were connecting the results of the quantitative phase to data collection of the qualitative phase. SETTING A multi-stage sampling strategy was used to select 15 community health centres (CHCs) in four districts of Beijing. Of the four districts, two were from urban areas and two were from rural areas. PARTICIPANTS The inclusion criteria for participants were (1) family doctors, (2) contracted with disabled older adults, (3) engaged in related work for disabled older adults more than 6 months. METHODS A cluster sampling of 283 family doctors was used in the questionnaire. A purposive sample of 30 family doctors from the same CHCs was selected during the same period. Frequency and rank, rank-sum test, Kruskal-Wallis test were conducted in qualitative data analysis, the views of the interviewees were analysed through the thematic framework method. RESULTS Currently, family doctors provided various services to satisfy the health needs of disabled older adults, while the usage of FDCS for disabled older adults is affected by many factors. The differences of the importance of family doctors' role (p<0.001) and service satisfaction (p=0.004) were significant among four districts. Compared with contracted health senior citizens, this study has identified five unique roles of family doctors, including 'psychological consultant', 'rehabilitation physiotherapist', 'health educator', 'health manager' and 'family health guardian'. Moreover, family doctors are confronted with a myriad of barriers (including high risks in the process of home visits, a lack of supervisory and incentive mechanisms, insufficiency of time and energy, etc) and facilitators (including establishing a doctor-patient trust relationship, developing humanistic care services, etc) in the FDCS for disabled older adults. CONCLUSIONS Family doctors play a pivotal role in the FDCS for disabled older adults, while the effect and quality of FDCS in China needs to be improved. It is suggested that further research needs to focus on solving existing barriers of FDCS to optimise the health of disabled older adults and improve the quality of their lives.
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Affiliation(s)
- Zhiying Zhang
- School of Medical Humanities, Capital Medical University, Beijing, China
| | - Ruyi Zhang
- Ethics Committee Office, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yingchun Peng
- School of Medical Humanities, Capital Medical University, Beijing, China
| | - Shaoqi Zhai
- School of Medical Humanities, Capital Medical University, Beijing, China
| | - Jiaying Zhang
- School of Medical Humanities, Capital Medical University, Beijing, China
| | - Qilin Jin
- Cardiac Surgery Department, People's Hospital of Beijing Daxing District, Beijing, China
| | - Jiaojiao Zhou
- Medical Department, Fengtai District Xiluoyuan Community Health Service Center, Beijing, China
| | - Hanlin Li
- School of Basic Medical Science, Capital Medical University, Beijing, China
| | - Jingjing Chen
- Administrative Office, Huairou District Liulimiao Community Health Service Center, Beijing, China
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Saia M, Salmaso L, Bellio S, Miatton A, Cocchio S, Baldovin T, Baldo V, Buja A. Hospital readmissions and mortality following discharge against medical advice: a five-year retrospective, population-based cohort study in Veneto region, Northeast Italy. BMJ Open 2023; 13:e069775. [PMID: 37221033 DOI: 10.1136/bmjopen-2022-069775] [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] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVES The aim of this study was to examine the odds of readmission and mortality after discharge against medical advice (DAMA) in the Veneto region of Northeast Italy, drawing on data from the regional archives of emergency department records and hospital discharge records. DESIGN A retrospective cohort study. SETTING Hospital discharges, Veneto region, Italy. PARTICIPANTS All patients discharged after being admitted to a public or accredited private hospital between January 2016 and 31 January 2021 in the Veneto region were considered. A total of 3 574 124 index discharges were examined for inclusion in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES Readmission and overall mortality at 30 days after the index discharge against admission. RESULTS In our cohort, 7.6‰ of patients left hospital against their doctor's advice (n=19 272). These DAMA patients were more likely to be younger (mean age: 45.5 vs 55.0), foreign (22.1% vs 9.1%). The adjusted odds of readmission after DAMA was 2.76 (CI 95% 2.62-2.90) at 30 days (9.5% DAMA vs 4.6% not-DAMA), and the highest readmission rate was recorded in the first 24 hours after the index discharge. Mortality was higher for DAMA patients after adjusting for patient-level and hospital-level characteristics (with adjusted ORs of 1.40 for in-hospital mortality and 1.48 for overall mortality). CONCLUSIONS The present study shows that DAMA patients are more likely to die and to need hospital readmission than patients discharged by their doctors. DAMA patients should be more committed to a proactive and diligent postdischarge care.
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Affiliation(s)
- Mario Saia
- Clinical Governance Unit, Azienda Zero, Padua, Italy
| | - Laura Salmaso
- Clinical Governance Unit, Azienda Zero, Padua, Italy
| | | | - Andrea Miatton
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Silvia Cocchio
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Tatjana Baldovin
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Alessandra Buja
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padua, Italy
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Abstract
OBJECTIVES The aim of this scoping review was to identify and review current evidence-based practice (EBP) models and frameworks. Specifically, how EBP models and frameworks used in healthcare settings align with the original model of (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the outcomes of change, along with patient values and preferences and clinical skills. DESIGN A Scoping review. INCLUDED SOURCES AND ARTICLES Published articles were identified through searches within electronic databases (MEDLINE, EMBASE, Scopus) from January 1990 to April 2022. The English language EBP models and frameworks included in the review all included the five main steps of EBP. Excluded were models and frameworks focused on one domain or strategy (eg, frameworks focused on applying findings). RESULTS Of the 20 097 articles found by our search, 19 models and frameworks met our inclusion criteria. The results showed a diverse collection of models and frameworks. Many models and frameworks were well developed and widely used, with supporting validation and updates. Some models and frameworks provided many tools and contextual instruction, while others provided only general process instruction. The models and frameworks reviewed demonstrated that the user must possess EBP expertise and knowledge for the step of assessing evidence. The models and frameworks varied greatly in the level of instruction to assess the evidence. Only seven models and frameworks integrated patient values and preferences into their processes. CONCLUSION Many EBP models and frameworks currently exist that provide diverse instructions on the best way to use EBP. However, the inclusion of patient values and preferences needs to be better integrated into EBP models and frameworks. Also, the issues of EBP expertise and knowledge to assess evidence must be considered when choosing a model or framework.
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Affiliation(s)
- Jarrod Dusin
- Department of Evidence Based Practice, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- Therapeutic Science, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrea Melanson
- Department of Evidence Based Practice, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Lisa Mische-Lawson
- Therapeutic Science, The University of Kansas Medical Center, Kansas City, Kansas, USA
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Birru E, Ndayizigiye M, McBain R, Mokoena M, Koto M, Augusto O, Casmir E, Puttkammer N, Mukherjee J. Effects of primary healthcare reform on routine health information systems (RHISs): a mixed-methods study in Lesotho. BMJ Open 2023; 13:e071414. [PMID: 37208141 DOI: 10.1136/bmjopen-2022-071414] [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] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The Ministry of Health of Lesotho and Partners In Health piloted the Lesotho National Primary Health Care Reform (LPHCR) from July 2014 to June 2017 to improve quality and quantity of service delivery and enhance health system management. This initiative included improvement of routine health information systems (RHISs) to map disease burden and reinforce data utilisation for clinical quality improvement. METHODS AND ANALYSIS The WHO Data Quality Assurance framework's core indicators were used to compare the completeness of health data before versus after the LPHCR in 60 health centres and 6 hospitals across four districts. To examine change in data completeness, we conducted an interrupted time series analysis using multivariable logistic mixed-effects regression. Additionally, we conducted 25 key informant interviews with healthcare workers (HCWs) at the different levels of Lesotho's health system, following a purposive sampling approach. Interviews were analysed using deductive coding based on the Performance of Routine Information System Management framework, which inspected organisational, technical and behavioural factors influencing RHIS processes and outputs associated with the LPHCR. RESULTS In multivariable analyses, trends in monthly data completion rate were higher after versus before the LPHCR for: documenting first antenatal care visit (adjusted OR (AOR): 1.24, 95% CI: 1.14 to 1.36) and institutional delivery (AOR: 1.19, 95% CI: 1.07 to 1.32). When discussing processes, HCWs highlighted the value of establishing clear roles and responsibilities in reporting under a new organisational structure, improved community programmes among district health management teams, and enhanced data sharing and monitoring by districts. CONCLUSION The Ministry of Health had a strong data completion rate pre-LPHCR, which was sustained throughout the LPHCR despite increased service utilisation. The data completion rate was optimised through improved behavioural, technical and organisational factors introduced as part of the LPHCR.
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Affiliation(s)
- Ermyas Birru
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Partners In Health Lesotho, Maseru, Lesotho
| | | | - Ryan McBain
- Partners In Health, Boston, Massachusetts, USA
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Eduardo Mondlane University, Maputo, Mozambique
| | - Edinah Casmir
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Nancy Puttkammer
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Joia Mukherjee
- Partners In Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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