1
|
Prins H, Donia S, Rockall S, Hektner J, Hawes S, Laskin JJ, Chernesky J, Noonan VK. Implementing Lived Experience Workshops in Regional Areas of British Columbia to Enhance Clinicians' Confidence in Spinal Cord Injury Care: An Evaluation. Healthcare (Basel) 2024; 12:731. [PMID: 38610153 PMCID: PMC11011360 DOI: 10.3390/healthcare12070731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
In British Columbia (BC), there are challenges accessing specialized spinal cord injury care and resources. This paper evaluated the impact of spinal cord injury health educational workshops delivered in regional communities that were informed by persons with lived experience. A community survey was conducted with 44 persons with lived experience in a BC region to identify priority SCI health-related topics. Twenty-five topics were ranked from 1-14, with bowel and bladder management ranked 1 and 4, sexual health ranked 5, and pressure injuries ranked 7. Clinical perspectives on the priorities were collected from 102 clinicians in the BC region, who independently ranked 14 of these SCI topics and considered the former 4 topics to be lower clinical priority (ranked 11-14). These priorities informed a series of SCI clinical education workshops held at healthcare facilities in three regional cities. The goals were to improve clinicians' knowledge and confidence levels when managing spinal cord injury health and to facilitate person-centred care. Positive feedback demonstrated that educational workshops supported by lived experience perspectives effectively enhanced the clinicians' understanding of spinal cord injury and their priorities. Future plans include engaging more administrators as part of this initiative and conducting workshops in other regions of BC.
Collapse
Affiliation(s)
- Hannah Prins
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Scott Donia
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
| | - Shannon Rockall
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
| | - James Hektner
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
| | - Spring Hawes
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
| | - James J. Laskin
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - John Chernesky
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
| | - Vanessa K. Noonan
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
| |
Collapse
|
2
|
Volčanšek Š, Lunder M, Janež A. Health-Related Quality of Life Assessment in Older Patients with Type 1 and Type 2 Diabetes. Healthcare (Basel) 2023; 11:2154. [PMID: 37570394 PMCID: PMC10418676 DOI: 10.3390/healthcare11152154] [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: 06/07/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Type 1 (T1D) and type 2 diabetes (T2D) are determinants of health-related outcomes including health-related quality of life (HRQOL). We aimed to determine differences in HRQOL between older adults with T1D and T2D and specific factors influencing HRQOL in this age group. This study used a cross-sectional design with 56 age- and HbA1c-matched T1D and T2D patients (aged 68.9 ± 7.8 years; 55% had T2D). We employed several validated questionnaires (Short Form-36 (SF-36) and the EuroQol-5 Dimensions/Visual Analog Scale (VAS)) to investigate the relationships between HRQOL domains and diabetes type, glycemic control, complications, and comorbidities. T1D was associated with better self-reported general health (assessed with the SF-36 general health domain (p = 0.048) and the EuroQol-5 VAS (p = 0.002), whereas no significant differences in the other SF-36 domains, self-reported diabetes distress, anxiety, or depression were found. Most HRQOL domains were not associated with HbA1c or the presence of diabetes complications. The most significant reduction in HRQOL was experienced by patients with higher BMIs, irrespective of the diabetes type. The obtained HRQOL data could be used in clinical settings for evidence-based patient education focused on specific subgroups of patients, as well as in national healthcare policies, e.g., interventions designed to alleviate obesity.
Collapse
Affiliation(s)
- Špela Volčanšek
- Clinical Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia; (M.L.); (A.J.)
- Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Mojca Lunder
- Clinical Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia; (M.L.); (A.J.)
- Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Andrej Janež
- Clinical Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia; (M.L.); (A.J.)
- Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| |
Collapse
|
3
|
Pietrantonio F, Vinci A, Maurici M, Ciarambino T, Galli B, Signorini A, La Fazia VM, Rosselli F, Fortunato L, Iodice R, Materazzo M, Ciuca A, Cicerchia LCM, Ruggeri M, Manfellotto D, Rosiello F, Moriconi A. Intra- and Extra-Hospitalization Monitoring of Vital Signs-Two Sides of the Same Coin: Perspectives from LIMS and Greenline-HT Study Operators. Sensors (Basel) 2023; 23:5408. [PMID: 37420575 DOI: 10.3390/s23125408] [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] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND In recent years, due to the epidemiological transition, the burden of very complex patients in hospital wards has increased. Telemedicine usage appears to be a potential high-impact factor in helping with patient management, allowing hospital personnel to assess conditions in out-of-hospital scenarios. METHODS To investigate the management of chronic patients during both hospitalization for disease and discharge, randomized studies (LIMS and Greenline-HT) are ongoing in the Internal Medicine Unit at ASL Roma 6 Castelli Hospital. The study endpoints are clinical outcomes (from a patient's perspective). In this perspective paper, the main findings of these studies, from the operators' point of view, are reported. Operator opinions were collected from structured and unstructured surveys conducted among the staff involved, and their main themes are reported in a narrative manner. RESULTS Telemonitoring appears to be linked to a reduction in side-events and side-effects, which represent some of most commons risk factors for re-hospitalization and for delayed discharge during hospitalization. The main perceived advantages are increased patient safety and the quick response in case of emergency. The main disadvantages are believed to be related to low patient compliance and an infrastructural lack of optimization. CONCLUSIONS The evidence of wireless monitoring studies, combined with the analysis of activity data, suggests the need for a model of patient management that envisages an increase in the territory of structures capable of offering patients subacute care (the possibility of antibiotic treatments, blood transfusions, infusion support, and pain therapy) for the timely management of chronic patients in the terminal phase, for which treatment in acute wards must be guaranteed only for a limited time for the management of the acute phase of their diseases.
Collapse
Affiliation(s)
- Filomena Pietrantonio
- Internal Medicine Unit, Castelli Hospital, Asl Roma 6, 00072 Rome, Italy
- Departmental Faculty of Medicine, St. Camillus University of Medicine and Health Sciences, 00131 Rome, Italy
| | - Antonio Vinci
- Local Health Authority Roma 1, 00193 Rome, Italy
- Doctoral School in Nursing Science and Public Health, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Tiziana Ciarambino
- Department of Internal Medicine, Luigi Vanvitelli University, 81100 Caserta, Italy
| | - Barbara Galli
- Casa Circondariale Rebibbia, Nuovo Complesso Prison, 00185 Rome, Italy
| | - Alessandro Signorini
- Departmental Faculty of Medicine, St. Camillus University of Medicine and Health Sciences, 00131 Rome, Italy
| | - Vincenzo Mirco La Fazia
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX 78705, USA
- Department of Systems Medicine, Division of Cardiology, Tor Vergata University, 00133 Rome, Italy
| | - Francescantonio Rosselli
- Cardiology and Coronary Intensive Therapy Unit, San Francesco di Paola Hospital, 87027 Paola, Italy
| | | | | | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, 00100 Rome, Italy
- PhD Program in Applied Medical-Surgical Sciences, Breast Oncoplastic Surgery, University of Rome Tor Vergata, 00100 Rome, Italy
| | - Alessandro Ciuca
- Department of Infectious Disease and Public Health, Sapienza University of Rome, 00185 Roma, Italy
| | | | - Matteo Ruggeri
- Departmental Faculty of Medicine, St. Camillus University of Medicine and Health Sciences, 00131 Rome, Italy
- National Centre for Health Technology Assessment, National Health Institute, 00153 Rome, Italy
| | - Dario Manfellotto
- UOC Medicina Interna, Fatebenefratelli Isola Tiberina-Gemelli Hospital, 00186 Rome, Italy
- "Centro Studi" FADOI, 20123 Milan, Italy
| | - Francesco Rosiello
- Internal Medicine Unit, Castelli Hospital, Asl Roma 6, 00072 Rome, Italy
- Departmental Faculty of Medicine, St. Camillus University of Medicine and Health Sciences, 00131 Rome, Italy
- Department of Infectious Disease and Public Health, Sapienza University of Rome, 00185 Roma, Italy
- Department of Hystological, Anatomical Sciences and Legal Medicine, Sapienza-University of Rome, 00196 Rome, Italy
| | - Andrea Moriconi
- Department of Business and Management, LUISS University, 00197 Rome, Italy
| |
Collapse
|
4
|
Spanos S, Singh N, Laginha BI, Arnolda G, Wilkinson D, Smith AL, Cust AE, Braithwaite J, Rapport F. Measuring the quality of skin cancer management in primary care: A scoping review. Australas J Dermatol 2023; 64:177-193. [PMID: 36960976 PMCID: PMC10952799 DOI: 10.1111/ajd.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited.
Collapse
Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Nehal Singh
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Bela I. Laginha
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - David Wilkinson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
- National Skin Cancer CentresSouth BrisbaneQueenslandAustralia
| | - Andrea L. Smith
- The Daffodil CentreUniversity of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - Anne E. Cust
- The Daffodil CentreUniversity of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| |
Collapse
|
5
|
Silva ÍDS, Silva CRDV, Lopes RH, de Araújo AJ, de Figueirêdo RC, Bay ODG, Lapão LV, Xavier PB, Uchôa SADC. Digital health interventions and quality of home-based primary care for older adults: A scoping review protocol. Front Public Health 2023; 10:1022587. [PMID: 36699882 PMCID: PMC9870288 DOI: 10.3389/fpubh.2022.1022587] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction The use of digital health interventions has expanded, particularly in home-based primary care (HBPC), following the increase in the older adult population and the need to respond to the higher demand of chronic conditions, weakness and loss of autonomy of this population. There was an even greater demand with COVID-19 and subsequent isolation/social distancing measures for this risk group. The objective of this study is to map and identify the uses and types of digital health interventions and their reported impacts on the quality of HBPC for older adults worldwide. Methods and analysis This is a scoping review protocol which will enable a rigorous, transparent and reliable synthesis of knowledge. The review will be developed from the theoretical perspective of Arksey and O'malley, with updates by Levac and Peters and respective collaborators based on the Joanna Briggs Institute manual, and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Data from white literature will be extracted from multidisciplinary health databases such as: the Virtual Health Library, LILACS, MEDLINE/PubMed, Scopus, Web of Science, Cinahl and Embase; while Google Scholar will be used for gray literature. No date limit or language restrictions will be determined. The quantitative data will be analyzed through descriptive statistics and qualitative data through thematic analysis. The results will be submitted to stakeholder consultation for preliminary sharing of the study and will later be disseminated through publication in open access scientific journals, scientific events and academic and community journals. The full scoping review report will present the main impacts, challenges, opportunities and gaps found in publications related to the use of digital technologies in primary home care. Discussion The organization of this protocol will increase the methodological rigor, quality, transparency and accuracy of scoping reviews, reducing the risk of bias.
Collapse
Affiliation(s)
- Ísis de Siqueira Silva
- Postgraduate in Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil,*Correspondence: Ísis de Siqueira Silva ✉
| | | | - Rayssa Horácio Lopes
- Postgraduate in Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Osvaldo de Goes Bay
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Luís Velez Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Pedro Bezerra Xavier
- Postgraduate in Collective Health, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | | |
Collapse
|
6
|
Abstract
OBJECTIVE The COVID-19 pandemic resulted in medical institutes being shut down. Face-to-face activities were shifted to online medium. The unpredictability of the situation impacted medical faculty and students alike, creating panic and anxiety. Since these students are to take hold of the healthcare system of the country soon, it is important to learn their perspective on how COVID impacted them. Therefore, this study aimed to explore the lived experiences of Pakistani medical students in-depth by a qualitative observation of their personal and educational experiences. DESIGN A phenomenological qualitative study interviewing medical students of Pakistan was conducted. PARTICIPANTS/METHODOLOGY This study was designed to interview medical and dental students from various cities in Pakistan using a semistructured, open-ended questionnaire. A total of 34 interviews were recorded and transcripts were prepared. All authors (SI, SS, IA and MS) were involved in the thematic analysis of the data, whereby transcripts were read thoroughly, and codes were developed. Similar codes were then combined to generate themes. RESULTS Three major themes emerged after the analysis of results. The students' 'diverse experiences' of panic and anxiety or excitement were high initially but gradually reduced as time progressed. The 'unprecedented academic experiences' of students included teaching/learning, communication and technical challenges that they faced during online classes. Despite facing a lot of challenges, the students still saw 'light at the end of the tunnel' and looked forward to going back to their college. CONCLUSION The effects of COVID on the physical, psychological, social and academic life of medical students were enormous. It is highly recommended that institutes and faculty provide support for personal and professional development of students in these unprecedented times in the form of counselling, provision of technical facilities or leniency in fee process. Peer support is also considered crucial in reducing anxiety among students.
Collapse
Affiliation(s)
- Sundus Iftikhar
- Department of Medical Education, Shalamar Medical and Dental College, Lahore, Punjab, Pakistan
| | - Sarosh Saleem
- Department of Bioethics, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Iqra Aziz
- Department of Medical Education, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Momal Sana
- Department of Medicine, Quaid-e-Azam Medical College, Bahawalpur, Pakistan
| |
Collapse
|
7
|
Falkenstein L, Eckel N, Kadel SB, Koenig J, Litaker D, Eichinger M. Service provision and utilisation in German paediatric primary care practices during public health crises: Protocol of the mixed-methods COVID-19 PedCare Study. BMJ Open 2022; 12:e054054. [PMID: 36220317 PMCID: PMC9556743 DOI: 10.1136/bmjopen-2021-054054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/25/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Public health crises such as pandemics can cause serious disruptions to the utilisation and provision of healthcare services with negative effects on morbidity and mortality. Despite the important role of paediatric primary care in maintaining high-quality healthcare services during crises, evidence about service utilisation and provision remains limited especially in Germany. This study, therefore, explores the utilisation and provision of paediatric primary care services during the ongoing COVID-19 pandemic and their barriers and facilitators. METHODS AND ANALYSIS The study uses a convergent mixed-methods design and comprises online surveys to parents, adolescents and primary care paediatricians (PCPs) and semistructured interviews with parents and PCPs. We recruit parents and adolescents from paediatric primary care practices and PCPs via email using mailing lists of the German Professional Association of Paediatricians and the German Society of Ambulatory Primary Care Paediatrics. The parent and adolescent surveys assess, inter alia, the utilisation of paediatric primary care services and its correlates, aspects of parental and child health as well as socioeconomic characteristics. The PCP survey investigates the provision of paediatric primary care services and its correlates, aspects of PCP health as well as sociodemographic and practice characteristics. The semistructured interviews with parents and PCPs explore several aspects of the online surveys in more detail. We use descriptive statistics and generalised linear mixed models to assess service utilisation and provision and specific correlates covered in the online surveys and apply qualitative content analysis to explore barriers and facilitators of service utilisation and provision more broadly in the semistructured interviews. We will integrate findings from the quantitative and qualitative analyses at the interpretation stage. ETHICS AND DISSEMINATION The study was approved by the Medical Ethics Review Board of the Medical Faculty Mannheim at Heidelberg University (2020-650N). Study results will be published in journals with external peer-review.
Collapse
Affiliation(s)
- Lina Falkenstein
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
| | - Nathalie Eckel
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
| | - Simone B Kadel
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
| | - Jochem Koenig
- Institute of Medical Biostatistics, Epidemiology and Informatics, Division of Pediatric Epidemiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - David Litaker
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
| | - Michael Eichinger
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, Division of Pediatric Epidemiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| |
Collapse
|
8
|
Cossio-Gil Y, Omara M, Watson C, Casey J, Chakhunashvili A, Gutiérrez-San Miguel M, Kahlem P, Keuchkerian S, Kirchberger V, Luce-Garnier V, Michiels D, Moro M, Philipp-Jaschek B, Sancini S, Hazelzet J, Stamm T. The Roadmap for Implementing Value-Based Healthcare in European University Hospitals-Consensus Report and Recommendations. Value Health 2022; 25:1148-1156. [PMID: 35779941 DOI: 10.1016/j.jval.2021.11.1355] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Value-based healthcare (VBHC) aims at improving patient outcomes while optimizing the use of hospitals' resources among medical personnel, administrations, and support services through an evidence-based, collaborative approach. In this article, we present a blueprint for the implementation of VBHC in hospitals, based on our experience as members of the European University Hospital Alliance. METHODS The European University Hospital Alliance is a consortium of 9 large hospitals in Europe and aims at increasing the quality and efficiency of care to ultimately drive better outcomes for patients. RESULTS The blueprint describes how to prepare hospitals for VBHC implementation; analyzes gaps, barriers, and facilitators; and explores the most effective ways to turn patient pathways into a process that results in high-value care. Using a patient-centric approach, we identified 4 core minimum components that must be established as cornerstones and 7 organizational enablers to waive the barriers to implementation and ensure sustainability. CONCLUSION The blueprint guides through pathway implementation and establishment of key performance indicators in 6 phases, which hospitals can tailor to their current status on their way to implement VBHC.
Collapse
Affiliation(s)
- Yolima Cossio-Gil
- Department of Information Systems, Vall d'Hebron, Barcelona Hospital Campus, Barcelona, Spain
| | - Maisa Omara
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria and Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Carolina Watson
- Department of Information Systems, Vall d'Hebron, Barcelona Hospital Campus, Barcelona, Spain
| | | | | | | | - Pascal Kahlem
- Scientific Network Management S.L., Barcelona, Spain
| | | | | | | | | | - Matteo Moro
- Chief Medical Office, Ospedale San Raffaele, Milan, Italy
| | | | - Simona Sancini
- Chief Medical Office, Ospedale San Raffaele, Milan, Italy
| | - Jan Hazelzet
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria and Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria.
| |
Collapse
|
9
|
Brueckle MS, Dinh TS, Klein AA, Rietschel L, Petermann J, Brosse F, Schulz-Rothe S, Gonzalez-Gonzalez AI, Kramer M, Engler J, Mergenthal K, Muth C, Voigt K, van den Akker M. Development of an intervention to improve informational continuity of care in older patients with polypharmacy at the interface between general practice and hospital care: protocol for a participatory qualitative study in Germany. BMJ Open 2022; 12:e058016. [PMID: 35387829 PMCID: PMC8987787 DOI: 10.1136/bmjopen-2021-058016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Older patients with multimorbidity, polypharmacy and related complex care needs represent a growing proportion of the population and a challenge for healthcare systems. Particularly in transitional care (hospital admission and hospital discharge), medical errors, inappropriate treatment, patient concerns and lack of confidence in healthcare are major problems that may arise from a lack of information continuity. The aim of this study is to develop an intervention to improve informational continuity of care at the interface between general practice and hospital care. METHODS AND ANALYSIS A qualitative approach will be used to develop our participatory intervention. Overall, 32 semistructured interviews with relevant stakeholders will be conducted and analysed. The stakeholders will include healthcare professionals from the outpatient setting (general practitioners, healthcare assistants, ambulatory care nurses) and the inpatient setting (clinical doctors, nurses, pharmacists, clinical information scientists) as well as patients and informal caregivers. At a series of workshops based on the results of the stakeholder analyses, we aim to develop a participatory intervention that will then be implemented in a subsequent pilot study. The same stakeholder groups will be invited for participation in the workshops. ETHICS AND DISSEMINATION Ethical approval for this study was waived by the Ethics Committee of Goethe University Frankfurt because of the nature of the proposed study. Written informed consent will be obtained from all study participants prior to participation. Results will be tested in a pilot study and disseminated at (inter)national conferences and via publication in peer-reviewed journals. TRIAL REGISTATION NUMBER Clinical Trials Register: registration number DRKS00027649.
Collapse
Affiliation(s)
- Maria-Sophie Brueckle
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Truc Sophia Dinh
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | | | - Lisa Rietschel
- Department of General Practice, Dresden University of Technology, Dresden, Germany
| | - Jenny Petermann
- Department of General Practice, Dresden University of Technology, Dresden, Germany
| | - Franziska Brosse
- Department of General Practice, Dresden University of Technology, Dresden, Germany
| | - Sylvia Schulz-Rothe
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | | | - Martin Kramer
- Department of General Practice, Dresden University of Technology, Dresden, Germany
| | - Jennifer Engler
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Christiane Muth
- Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
| | - Karen Voigt
- Department of General Practice, Dresden University of Technology, Dresden, Germany
| | - Marjan van den Akker
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| |
Collapse
|
10
|
Rahiri JL, Tuhoe J, Harwood M, Koea J. Understanding surgical disease and care for Māori in Aotearoa: protocol for a scoping review. BMJ Open 2022; 12:e058784. [PMID: 35383085 PMCID: PMC8984033 DOI: 10.1136/bmjopen-2021-058784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Māori continue to experience inequitable healthcare and health outcomes compared with other New Zealanders. A narrative review conducted in 2016 described disparities in access to and through the surgical care pathway for Māori from a limited pool of small retrospective cohort studies. This review only targeted studies that specifically investigated surgical care for Māori; however, many other studies have performed subanalyses for Māori as part of bigger ethnographic epidemiological studies and Indigenous health has become more topical in Australasia since this review was conducted. Health disparities and inequities in surgical care for Māori are still not well understood. This scoping review aims to report the nature and extent of disparities in surgical disease and care for Māori. METHODS AND ANALYSIS A scoping review will be performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. This study will be informed by Kaupapa Māori research methodology. Electronic searches of PubMed, MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature Plus will be performed between 19 February and 19 March 2022. Two authors will independently identify and retrieve relevant texts in an iterative manner and examine how responsive each of the included studies are to Māori using the recently described Māori framework-a framework designed to guide researcher responsiveness to Māori. ETHICS AND DISSEMINATION Ethical approval has not been sought as our review will only include published and publicly accessible data. We will publish the review in an open access peer-reviewed surgical journal. This protocol has been registered in Open Science Framework (10.17605/OSF.IO/NP4H3).
Collapse
Affiliation(s)
- Jamie-Lee Rahiri
- Department of Surgery, Waitemata District Health Board, Takapuna, New Zealand
| | - Jason Tuhoe
- Department of General Practice, Royal New Zealand College of General Practitioners, Auckland, New Zealand
| | - Matire Harwood
- General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Jonathan Koea
- Department of Surgery, Waitemata District Health Board, Takapuna, New Zealand
| |
Collapse
|
11
|
Abstract
OBJECTIVES To determine the factors contributing to the junior doctor workforce retention crisis in the UK using evidence collected directly from junior doctors, and to develop recommendations for changes to address the issue. DESIGN Integrative review. DATA SOURCES Searches were conducted on Ovid Medline and HMIC to locate evidence published between January 2016 and April 2021. This was supplemented by publications from relevant national organisations. ELIGIBILITY CRITERIA English-language papers relating to UK junior doctor retention, well-being or satisfaction which contained data collected directly from junior doctors were included. Papers focusing solely on the pandemic, factors specific to one medical specialty, evaluation of interventions, or numerical data with no evidence relating to causation were excluded. Review papers were excluded. DATA EXTRACTION AND SYNTHESIS Data were extracted and coded on NVivo by FKL, then thematic analysis was conducted. RESULTS 47 papers were included, consisting of academic (qualitative, quantitative, mixed and commentary) and grey literature. Key themes identified were working conditions, support and relationships, and learning and development, with an overarching theme of lack of flexibility. The outcomes of these factors are doctors not feeling valued, lacking autonomy, having a poor work-life balance, and providing compromised patient care. This results in need for a break from medical training. CONCLUSION This review builds on findings of related literature regarding working environments, isolation, stigma, and desire for autonomy, and highlights additional issues around learning and training, flexibility, feeling valued, and patient care. It goes on to present recommendations for tackling poor retention of UK junior doctors, highlighting that the complex problem requires evidence-based solutions and a bottom-up approach in which junior doctors are regarded as core stakeholders during the planning of interventions.
Collapse
Affiliation(s)
| | - Daniele Carrieri
- College of Medicine and Health, University of Exeter, Exeter, UK
| |
Collapse
|
12
|
Teni FS, Wubishet BL, Yimenu DK. Systematic review and meta-analysis of medicine use studies in Ethiopia using the WHO patient care indicators with an emphasis on the availability of prescribed medicines. BMJ Open 2022; 12:e054521. [PMID: 35314470 PMCID: PMC8938701 DOI: 10.1136/bmjopen-2021-054521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To collate the findings of studies on patient care indicators in Ethiopia using the WHO/International Network for Rational Use of Drugs indicators with a focus on the availability of medicines to patients. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, Global Index Medicus, Google Scholar, Medline (via PubMed) and Web of Science. ELIGIBILITY CRITERIA Medicine use studies employing the WHO patient care indicators across health facilities in Ethiopia. DATA EXTRACTION AND SYNTHESIS Descriptive summary of the indicators and a random-effects meta-analysis were performed for quantitative synthesis of findings on the percentage of medicines actually dispensed. Meta-regression was performed to assess the moderator effects of different attributes of the studies. RESULTS A total of 25 studies conducted in 155 health facilities with 11 703 patient exit interviews were included. The median value of average consultation time was 5.1 min (25th-75th: 4.2-6.6) and that of average dispensing time was 78 s (25th-75th: 54.9-120.0). The median percentage of medicines with adequate labelling was 22.4% (25th-75th: 5.6%-50.0%). A concerning trend of decreasing dispensing times and adequacy of labelling were observed in more recent studies. The median percentage of patients with adequate knowledge of dosage schedules of medicines was 70.0% (25th-75th: 52.5%-81.0%). In the meta-analysis, the pooled estimate of medicine availability was 85.9% (95% CI: 82.1% to 89.0%). The multivariable meta-regression showed that geographical area and quality of study were statistically significant predictors of medicine availability. CONCLUSION Short consultation and dispensing times, inadequate labelling, inadequate knowledge of patients on medicines and suboptimal availability of medicines were identified in health facilities of Ethiopia. Studies aimed at further exploration of the individual indicators like problems of inadequate labelling and patients' knowledge of dispensed medicines are crucial to determine the specific reasons and improve medicine use. PROSPERO REGISTRATION NUMBER CRD42020157274.
Collapse
Affiliation(s)
- Fitsum Sebsibe Teni
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Dawit Kumilachew Yimenu
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
13
|
Burnett AM, Lee L, McGuinness M, Varga B, Perez Hazel Y, Ho SM. Quality of refractive error care (Q.REC) in Cambodia, Malaysia and Pakistan: protocol for a cross-sectional unannounced standardised patient study. BMJ Open 2022; 12:e057594. [PMID: 35288395 PMCID: PMC8921905 DOI: 10.1136/bmjopen-2021-057594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION There are 161 million people living with vision impairment, due to uncorrected refractive errors. A further 510 million people are living with near-vision impairment. There is a need for clearly defined indicators that capture the quality of refractive error service outputs and outcomes and provide insights to shape, change and stimulate action. This study aims to evaluate the quality of refractive error care (Q.REC) in Cambodia, Malaysia and Pakistan, by using unannounced standardised patients (USPs) to identify the proportion of prescribed and dispensed spectacles appropriate for people's refractive error needs and pinpoint/detail opportunities for quality improvement. METHOD AND ANALYSIS A cross-sectional Q.REC study will be conducted in randomly selected optical services in Cambodia (180 services, 900 USP visits), the Klang Valley in Malaysia (66 services, 198 USP visits) and in Jhang, Sahiwal and Khanewal districts of Punjab region/state in Pakistan (64 services, 256 USP visits). USPs will receive baseline refractions by three skilled study optometrists/refractionists trained in the Q.REC protocol. USPs will then visit individual optical services, undergo a refraction, purchase spectacles or lenses (if recommended) and record observations about which elements of a refraction and dispensing were conducted. The study optometrist/refractionist will assess each pair of dispensed spectacles by examining the USP's aided visual acuity and visual comfort at distance and/or near and compare the lens prescription to the averaged baseline refraction. ETHICS AND DISSEMINATION This study has been approved by the University of New South Wales Human Research Ethics Committee (HC210102), the National Ethics Committee for Health Research in Cambodia (043 NECHR), National Medical Research Registry and the Medical Research and Ethics Committee (NMRR-21-689-59279) in Malaysia and the College of Ophthalmology & Allied Vision Sciences Ethical Review Board (COAVS 545/2021) in Pakistan. Written informed consent will be obtained from USPs. Service owners will have the opportunity to opt-out verbally or in writing. Results will be disseminated locally through workshops including the relevant local ministry of health personnel and stakeholders, published in peer-reviewed publications and presented at national and international conferences.
Collapse
Affiliation(s)
- Anthea M Burnett
- The Fred Hollows Foundation, Melbourne, Victoria, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Ling Lee
- The Fred Hollows Foundation, Melbourne, Victoria, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Myra McGuinness
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Biostatistics, Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Beatrice Varga
- The Fred Hollows Foundation, Melbourne, Victoria, Australia
| | | | - Suit May Ho
- The Fred Hollows Foundation, Melbourne, Victoria, Australia
| |
Collapse
|
14
|
Morgano GP, Mbuagbaw L, Santesso N, Xie F, Brozek JL, Siebert U, Bognanni A, Wiercioch W, Piggott T, Darzi AJ, Akl EA, Verstijnen IM, Parmelli E, Saz-Parkinson Z, Alonso-Coello P, Schünemann HJ. Defining decision thresholds for judgments on health benefits and harms using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks: a protocol for a randomised methodological study (GRADE-THRESHOLD). BMJ Open 2022; 12:e053246. [PMID: 35273045 PMCID: PMC8915269 DOI: 10.1136/bmjopen-2021-053246] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The Grading of Recommendations Assessment, Development and Evaluation (GRADE) and similar Evidence to Decision (EtD) frameworks require its users to judge how substantial the effects of interventions are on desirable and undesirable people-important health outcomes. However, decision thresholds (DTs) that could help understand the magnitude of intervention effects and serve as reference for interpretation of findings are not yet available.The objective of this study is an approach to derive and use DTs for EtD judgments about the magnitude of health benefits and harms. We hypothesise that approximate DTs could have the ability to discriminate between the existing four categories of EtD judgments (Trivial, Small, Moderate, Large), support panels of decision-makers in their work, and promote consistency and transparency in judgments. METHODS AND ANALYSIS We will conduct a methodological randomised controlled trial to collect the data that allow deriving the DTs. We will invite clinicians, epidemiologists, decision scientists, health research methodologists, experts in Health Technology Assessment (HTA), members of guideline development groups and the public to participate in the trial. Then, we will investigate the validity of our DTs by measuring the agreement between judgments that were made in the past by guideline panels and the judgments that our DTs approach would suggest if applied on the same guideline data. ETHICS AND DISSEMINATION The Hamilton Integrated Research Ethics Board reviewed this study as a quality improvement study and determined that it requires no further consent. Survey participants will be required to read a consent statement in order to participate in this study at the beginning of the trial. This statement reads: You are being invited to participate in a research project which aims to identify indicative DTs that could assist users of the GRADE EtD frameworks in making judgments. Your input will be used in determining these indicative thresholds. By completing this survey, you provide consent that the anonymised data collected will be used for the research study and to be summarised in aggregate in publication and electronic tools. PROTOCOL REGISTRATION NUMBER NCT05237635.
Collapse
Affiliation(s)
- Gian Paolo Morgano
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jan L Brozek
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
- Center for Health Decision Science/Department of Health Policy and Management, Harvard TH Chan School of Public Health and MGH-ITA/Department of Radiology, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Antonio Bognanni
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Andrea J Darzi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | | | | | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Dipartimento di Scienze Biomediche, Humanitas University, Milan, Italy
| |
Collapse
|
15
|
Demessie MB, Berha AB. Prevalence and predictors of drug-related hospitalisation among patients visiting emergency departments of Addis Ababa city hospitals in Ethiopia: a multicentre prospective observational study. BMJ Open 2022; 12:e054778. [PMID: 35264351 PMCID: PMC8915323 DOI: 10.1136/bmjopen-2021-054778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES This study aimed to determine the prevalence, categories and predictors of drug-related hospitalisation (DRH) among patients visiting emergency departments of Addis Ababa city hospitals, Ethiopia. DESIGN A multicentre prospective observational study was conducted through patients' interview and chart review. SETTINGS The study was undertaken in three tertiary care hospitals in Addis Ababa, Ethiopia. PARTICIPANTS A total of 423 patients fulfilling the inclusion criteria were included. OUTCOME MEASURES Prevalence and preventability of DRH, categories of drug-related problems causing DRH, medications and diseases involved in DRH, and factors significantly associated with DRH. RESULT More than half of the patients (216, 51.1%) were female. The mean age (SD) was 47.50 (±17.21) years. The mean length of hospital stay (SD) was 10.29 (±8.99) days. Nearly 60% (249) of them were hospitalised due to drug-related problems, of which 87.8% were preventable. The cause for hospitalisation for more than half (130, 53%) of them was a failure to receive drugs, and 37.85 (94) patients were categorised as untreated indications. Age ≥65 years (adjusted OR (AOR)=7.451, 95% CI: 1.889 to 29.397), tertiary educational level (AOR=0.360, 95% CI: 0.141 to 0.923), participants who did not have any occupation (AOR=3.409, 95% CI: 1.120 to 10.374) and presence of comorbid conditions (AOR=2.004, 95% CI: 1.095 to 3.668) were predictors of DRH. CONCLUSION Nearly 90% of DRH was deemed to be preventable in the study settings. Older age, lower educational level, unemployment and presence of comorbid conditions in hospital as an inpatient were predictors of DRH.
Collapse
Affiliation(s)
- Mulate Belete Demessie
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemseged Beyene Berha
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
16
|
Malhotra N, Sakthivel P, Gupta N, Nischal N, Ish P. Telemedicine: a new normal in COVID era; perspective from a developing nation. Postgrad Med J 2022; 98:e79-e80. [PMID: 35232841 DOI: 10.1136/postgradmedj-2020-138742] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Nipun Malhotra
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Pirabu Sakthivel
- Department of Head and Neck Surgery & Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Nitesh Gupta
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Neeraj Nischal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pranav Ish
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| |
Collapse
|
17
|
Østervang C, Lassen AT, Øelund K, Coyne E, Dieperink KB, Jensen CM. Health professionals' perspectives of patients' and family members' needs in emergency departments and patient pathway improvement: a qualitative study in Denmark. BMJ Open 2022; 12:e057937. [PMID: 35228292 PMCID: PMC8886412 DOI: 10.1136/bmjopen-2021-057937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Besides working in a fast-paced environment, healthcare professionals (HCPs) in the emergency department (ED) are required to promptly respond to patients' needs and simultaneously achieve their organisational goals, which can be challenging. This study investigates how HCPs perceive and support the needs of patients discharged after a brief ED stay, as well as their family members. DESIGN The study used focus group discussions. The text material was analysed using systematic text condensation. SETTING Data were collected from two large EDs in Denmark. PARTICIPANTS Sixteen HCPs were sampled purposively to participate in three focus group discussions. RESULTS Three main themes were condensed: (1) creating a trustful and reassuring relationship; (2) responding to family members: a bother or a benefit; and (3) working as an interdisciplinary team. The study indicated the need for increased interdisciplinary collaboration to reduce discrepancies in information dissemination, to meet patient and family needs and to deliver a holistic approach. A technical solution was suggested to facilitate collaborative teamwork. CONCLUSION The study highlighted an existing gap between emergency HCPs' perceptions of patients' and family members' needs and the provision of the current patient and family support. Suggestions for future interventions include focusing on interdisciplinary teamwork, facilitated by a technical solution to support a person-centred and family-centred informative approach.
Collapse
Affiliation(s)
- Christina Østervang
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Annmarie Touborg Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Katrine Øelund
- Department of Emergency, Sygehus Lillebalt Kolding Sygehus, Kolding, Denmark
| | - Elisabeth Coyne
- Clinical Institute, University of Southern Denmark, Odense, Denmark
- Department of Nursing, Griffith University Faculty of Health, Brisbane, Queensland, Australia
| | - Karin Brochstedt Dieperink
- Clinical Institute, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Charlotte Myhre Jensen
- Clinical Institute, University of Southern Denmark, Odense, Denmark
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
18
|
Zhang D, Yan Y, Liu TF. Key factors influencing the effectiveness of hospital quality management tools: using the quality control circle as an example-a cross-sectional study. BMJ Open 2022; 12:e049577. [PMID: 35193899 PMCID: PMC8867332 DOI: 10.1136/bmjopen-2021-049577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the key factors influencing the effectiveness of hospital quality management tools and analyse the mechanisms needed for long-term scientific hospital management. METHODS In this cross-sectional study, a large number of participants in quality control circle (QCC) activities were investigated on site. Data were collected by the questionnaire during the sixth National Hospital Quality Control Circle Competition in Shandong, China, in October 2018. A total of 1500 participants were randomly selected, in which 1316 questionnaires were completed, yielding an overall response rate of 87.73%, and 1181 questionnaires were valid. We performed a stepwise regression analysis to identify the independent variables with explanatory ability. Then the total mean score of the organisational, group, and individual factors were introduced layer by layer, and a regression model with four levels was established. RESULTS The application effectiveness of QCC activities can be divided into three dimensions: individual factors, group factors and organisational factors. Utility perception was the most important individual factor. Inappropriate incentives and rewards had a negative effect on both organisational effectiveness and individual effectiveness. The attitude and ability of the circle monitor and counsellors, the specificity of the goals were the key group factors. Of the organisational factors, activity orientation had the greatest impact. Among the three dimensions, individual factors had the most significant influence on the effectiveness of QCCs, followed by group factors, then by organisational factors. CONCLUSION These results suggest that addressing the concerns of the leaders and implementing a safeguard system that protects the QCC tool from neglect or failure, that strengthening team building and using team rewards or non-material incentives to enhance enthusiasm, and that mobilising the enthusiasm of the circle members and even the whole hospital for using quality management tools are essential.
Collapse
Affiliation(s)
- Dan Zhang
- Institute for Hospital Management,Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Yue Yan
- Institute for Hospital Management,Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Ting-Fang Liu
- Institute for Hospital Management,Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| |
Collapse
|
19
|
Abstract
OBJECTIVE To explore the accessibility and quality of existing haemodialysis services in an urban setting. SETTING The study was conducted in Bangalore city, India. PARTICIPANTS A total of 28 stakeholders including 2 nephrologists, 7 duty doctors, 13 dialysis technicians and 6 patients on long-term haemodialysis were selected from 20 dialysis centres in Bangalore city. DESIGN AND METHODS Qualitative study using in-depth interviews. A thematic analysis was done using the Availability, Accessibility, Acceptability and Quality Framework of WHO and the Bruce's Quality of Care Framework. RESULTS The study found several gaps with regard to the access and quality of existing services for patients with end-stage kidney disease (ESKD). The charges for dialysis sessions across settings displayed a wide variance. Patients often started dialysis services in private and later shifted to government and non-governmental organisations-run centres and reduced the number of weekly dialysis sessions due to financial constraints. Most standalone dialysis centres did not have the facilities to manage any emergencies. Most centres did not admit patients with hepatitis or HIV. The quality of care in dialysis centres seemed to be variable and most centres were managed solely by dialysis technicians. There were no psychosocial interventions available to the patients irrespective of the settings. Cost-cutting practices such as employing underqualified technicians, reusing dialysis equipment and using substandard water for dialysis were common. CONCLUSION The study highlights the need for more financial and personnel investments in ESKD care in India to ensure optimal care for the growing patient population. The study points towards the need for comprehensive management practices, including diet counselling and psychosocial support. While there are comprehensive guidelines on the establishment and management of dialysis services, more policy attention needs to be on effective implementation of these, to ensure better accessibility and quality of existing services.
Collapse
Affiliation(s)
- Maya Annie Elias
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Wim Van Damme
- Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Edwin Wouters
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
20
|
Abstract
INTRODUCTION Injury accounts for 10% of the global burden of disease. While the literature is scarce, research investigating injury among Indigenous populations has found incidence and prevalence rates are higher, compared with non-Indigenous populations. New Zealand is no exception; Māori have higher rates of injury and disability compared with non-Māori. Given the burden of injury for Māori, this scoping review aims to identify, understand and map available literature related to the barriers and facilitators to accessing injury-related healthcare for Māori in New Zealand. METHODS AND ANALYSIS A scoping review will be conducted to identify the relevant literature and provide an opportunity to highlight key concepts and research gaps in the literature. This work will be guided by the scoping review framework developed by Arksey and O'Malley and will be underpinned by Kaupapa Māori research principles. The overall project is also be guided by a Māori advisory group. Database searches, for example, MEDLINE (Ovid), Scopus and Embase, will be used to identify empirical literature, and Google, New Zealand government websites and relevant non-government organisations will be used to identify relevant grey literature. ETHICS AND DISSEMINATION To the best of our knowledge, this scoping review is the first to systematically examine the currently available literature relating to the barriers and facilitators of accessing injury-related healthcare for Māori in New Zealand. Ethical approval was not required for this scoping review. Dissemination will include publication of the scoping review findings in a peer-reviewed journal, as well as presentations at conferences, to the project's advisory group, and staff working in the field of Māori disability and rehabilitation.
Collapse
Affiliation(s)
- Vicky Nelson
- Ngāi Tahu Māori Health Research Unit, Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, New Zealand
| | - Michelle Lambert
- Ngāi Tahu Māori Health Research Unit, Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, New Zealand
| | - Lauralie Richard
- General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Ngāi Tahu Māori Health Research Unit, Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, New Zealand
| | - Emma Wyeth
- Ngāi Tahu Māori Health Research Unit, Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, New Zealand
| |
Collapse
|
21
|
Curran JA, Gallant AJ, Wong H, Shin HD, Urquhart R, Kontak J, Wozney L, Boulos L, Bhutta Z, Langlois EV. Knowledge translation strategies for policy and action focused on sexual, reproductive, maternal, newborn, child and adolescent health and well-being: a rapid scoping review. BMJ Open 2022; 12:e053919. [PMID: 35039297 PMCID: PMC8765012 DOI: 10.1136/bmjopen-2021-053919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify knowledge translation (KT) strategies aimed at improving sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) and well-being. DESIGN Rapid scoping review. SEARCH STRATEGY A comprehensive and peer-reviewed search strategy was developed and applied to four electronic databases: MEDLINE ALL, Embase, CINAHL and Web of Science. Additional searches of grey literature were conducted to identify KT strategies aimed at supporting SRMNCAH. KT strategies and policies published in English from January 2000 to May 2020 onwards were eligible for inclusion. RESULTS Only 4% of included 90 studies were conducted in low-income countries with the majority (52%) conducted in high-income countries. Studies primarily focused on maternal newborn or child health and well-being. Education (81%), including staff workshops and education modules, was the most commonly identified intervention component from the KT interventions. Low-income and middle-income countries were more likely to include civil society organisations, government and policymakers as stakeholders compared with high-income countries. Reported barriers to KT strategies included limited resources and time constraints, while enablers included stakeholder involvement throughout the KT process. CONCLUSION We identified a number of gaps among KT strategies for SRMNCAH policy and action, including limited focus on adolescent, sexual and reproductive health and rights and SRMNCAH financing strategies. There is a need to support stakeholder engagement in KT interventions across the continuum of SRMNCAH services. Researchers and policymakers should consider enhancing efforts to work with multisectoral stakeholders to implement future KT strategies and policies to address SRMNCAH priorities. REGISTRATION The rapid scoping review protocol was registered on Open Science Framework on 16 June 2020 (https://osf.io/xpf2k).
Collapse
Affiliation(s)
- Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Allyson J Gallant
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Helen Wong
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia Kontak
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Etienne V Langlois
- The Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva, Switzerland
| |
Collapse
|
22
|
Abstract
OBJECTIVES We explore the cost of care of type 2 diabetes mellitus (T2DM) using time-driven activity-based costing (TDABC) and connect that cost to resulting patient health outcomes. DESIGN We construct six care pathways varying from low-risk to high-risk patients over a 12-month cycle of care. We collect time, resource and cost data on activities in each care pathway and compute a time-driven estimate of cost. Use of patient outcome data highlights the health outcomes achieved. SETTING Primary, secondary and tertiary care. PARTICIPANTS Medical staff involved in the care of patients with T2DM. PRIMARY AND SECONDARY MEASURES Primary: resources consumed to provide T2DM care. Secondary: health outcomes for representative patient within each patient category. RESULTS By computing cost of T2DM care and associated complications of chronic kidney disease, active foot disease, moderate risk of active foot disease and myocardial infarction, we show that when patients develop acute complications, significant costs are incurred, as compared with the cost of maintaining a patient at low or moderate risk. Variance analysis further informs decision making by showing the need to have the right personnel doing the right tasks at the right time to control costs. CONCLUSIONS A TDABC approach facilitates an understanding of the drivers of cost in chronic illness care. Our paper highlights the stages in the care pathway where different settings, decision making and a more optimal use of resources could assist with achievement of better patient outcomes.
Collapse
Affiliation(s)
- Gerardine Anne Doyle
- College of Business, University College Dublin, National University of Ireland, Dublin, Ireland
- Geary Institute for Public Policy, University College Dublin, National University of Ireland, Dublin, Ireland
| | - Shane O'Donnell
- College of Business, University College Dublin, National University of Ireland, Dublin, Ireland
- Geary Institute for Public Policy, University College Dublin, National University of Ireland, Dublin, Ireland
| | - Kate Cullen
- College of Business, University College Dublin, National University of Ireland, Dublin, Ireland
| | - Etáin Quigley
- Applied Research for Connected Health, University College Dublin, National University of Ireland, Dublin, Ireland
| | - Sarah Gibney
- Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
- Department of Health and Children, Dublin, Ireland
| |
Collapse
|
23
|
Tune SNBK, Islam BZ, Islam MR, Tasnim Z, Ahmed SM. Exploring the knowledge, attitudes, practices and lived experiences of frontline health workers in the times of COVID-19 : a qualitative study from Bangladesh. BMJ Open 2022; 12:e051893. [PMID: 35017240 PMCID: PMC8753096 DOI: 10.1136/bmjopen-2021-051893] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE This study explored Frontline Health Workers' (FLWs) knowledge, attitude and practice (KAP) on COVID-19 and their lived experiences, in both their personal and work lives, at the early stage of the pandemic in Bangladesh. DESIGN, SETTING AND PARTICIPANTS This was a qualitative study conducted through telephone interviews in May 2020. A total of 41 FLWs including physicians, nurses, paramedics, community healthcare workers and hospital support staff from 34 public and private facilities of both urban and rural parts of Bangladesh participated in the interview. A purposive sampling technique supplemented by a snowball sampling method was followed to select the participants. The in-depth interviews followed a semi-structured interview guide, and we applied the thematic analysis method for the qualitative data analysis. FINDINGS Except physicians, the FLWs did not receive any institutional training on COVID-19, including its prevention and management, in most instances. Also, they had no training in the use of personal protective equipment (PPE). Their common source of knowledge was the different websites or social media platforms. The FLWs were at risk while delivering services because patients were found to hide histories and not maintaining safety rules, including physical distancing. Moreover, inadequate supply of PPE, fear of getting infected, risk to family members and ostracisation by the neighbours were mentioned to be quite common by them. This situation eventually led to the development of mental stress and anxiety; however, they tried to cope up with this dire situation and attend to the call of humanity. CONCLUSION The uncertain work environment during the COVID-19 pandemic simultaneously affected FLWs' physical and emotional health in Bangladesh. However, they showed professional devotion in overcoming such obstacles and continued to deliver essential services. This could be further facilitated by a quick and targeted training package on COVID-19, and the provision of supplies for delivering services with appropriate safety precautions.
Collapse
Affiliation(s)
- Samiun Nazrin Bente Kamal Tune
- Centre of Excellence for Health Systems and Universal Health Coverage, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Bushra Zarin Islam
- Centre of Excellence for Health Systems and Universal Health Coverage, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mir Raihanul Islam
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Dhaka, Bangladesh
| | - Zarin Tasnim
- Centre of Excellence for Health Systems and Universal Health Coverage, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Syed Masud Ahmed
- Centre of Excellence for Health Systems and Universal Health Coverage, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| |
Collapse
|
24
|
Zewude SB, Ajebe TM. Magnitude of optimal adherence and predictors for a low level of adherence among HIV/AIDS-infected adults in South Gondar zone, Northwest Ethiopia: a multifacility cross-sectional study. BMJ Open 2022; 12:e056009. [PMID: 34980628 PMCID: PMC8724718 DOI: 10.1136/bmjopen-2021-056009] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study aims to identify levels of adherence to antiretroviral therapy (ART) drugs and factors associated with them in Northwest Ethiopia. We hypothesise that in the era of COVID-19, there would be suboptimal adherence to ART drugs. DESIGN An observational cross-sectional study was conducted. Factors associated with the level of adherence were selected for multiple logistic regressions at a p value of less than 0.2 in the analysis. Statistically significant associated factors were identified at a p value less than 0.05 and adjusted OR with a 95% CI. SETTING The study was conducted in one specialised hospital and three district hospitals found in the South Gondar zone, Northwest Ethiopia. PARTICIPANTS About 432 people living with HIV/AIDS receiving highly active ART in South Gondar zone public hospitals and who have been on treatment for more than a 3-month period participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES Levels of adherence to ART drugs and their associated factors. RESULTS Among 432 study participants, 81.5% (95% CI: 78% to 85.2%) of participants were optimally adherent to ART drugs. Determinants of a low level of adherence: stigma or discrimination (OR=0.4, p=0.016), missed scheduled clinical visit (OR=0.45, p=0.034), being on tuberculosis treatment (OR=0.45, p=0.01), recent CD4 cell count less than 500 cells/mm3 (OR=0.3, p=0.023) and patients who had been on WHO clinical stage III at the time of ART initiation (OR=0.24, p=0.027) were factors significantly associated with adherence to ART drugs. CONCLUSIONS Level of adherence was relatively low compared with some local studies. The intervention targeted to reduce discrimination, counselling before initiation of treatment and awareness regarding compliance is advised to improve adherence to antiretroviral regimens.
Collapse
Affiliation(s)
- Shimeles Biru Zewude
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tewodros Magegnet Ajebe
- Department of Midwifery, College Of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
25
|
Razanskaite V, Kallis C, Young B, Williamson PR, Bodger K. Heterogeneity in outcome assessment for inflammatory bowel disease in routine clinical practice: a mixed-methods study in a sample of English hospitals. BMJ Open 2021; 11:e056413. [PMID: 35679143 PMCID: PMC8719195 DOI: 10.1136/bmjopen-2021-056413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Knowledge of the extent of variation in outcome assessment for inflammatory bowel disease (IBD) in routine practice is limited. We aimed to describe and quantify variation in outcome coverage and to explore patient, clinician and practitioner factors associated with it. DESIGN Prospective exploratory mixed-methods study. SETTING IBD clinics at six hospitals in North West England with differing electronic health record (EHR) systems. METHODS Mixed-methods study comprising: (a) structured observations of outcomes elicited during consultations (102 patients consulting 24 clinicians); (b) retrospective analysis of outcomes recorded in the EHR (909 consultations; 127 clinicians) and (c) semistructured interviews with the 24 observed clinicians. We determined whether specific outcome 'sets' were elicited or recorded, including: (1) a minimum set of symptom pairs ('PRO-2'); (2) symptom sets from disease activity indices and (3) a reference list of 37 symptoms, signs and impacts. Factors associated with variation were explored in univariate and multivariate binary logistic regression analyses and from clinician interviews. RESULTS PRO-2 coverage was not invariable (elicited during 81% of observed consultations; recorded in 56% of EHR) and infrequent for complete activity indices (all domains from Harvey-Bradshaw Index: elicited, 18%; recorded, 5%). The median number of outcomes from the reference list elicited per consultation was 12 (13-fold variation) and recorded in EHR was 7 (>20-fold variation). Symptom quantification (PRO-2) seldom adhered closely to standardised descriptors and an explicit timeframe was defined rarely. PRO-2 recording in EHR was associated with a diagnosis of ulcerative colitis (OR: 2.09 (95% CI 1.15 to 3.80)) and nurse-led consultations (OR: 6.98 (95% CI 3.28 to 14.83)) and a three-way model suggested 26% of total variability lay between clinicians, 17% between patients but the remainder was unexplained. Most clinicians expressed preference for individualised health status evaluations versus standardised outcome assessments. CONCLUSIONS There was little evidence for standardised assessment and recording of IBD outcomes and substantial intra-clinician and inter-clinician variation from one consultation to another. Nurses demonstrated a greater tendency to standardised practice.
Collapse
Affiliation(s)
- Violeta Razanskaite
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Constantinos Kallis
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Bridget Young
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Paula R Williamson
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Keith Bodger
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
- Digestive Diseases Unit, Aintree University Hospital, Liverpool, UK
| |
Collapse
|
26
|
Chew KT, Kampan N, Shafiee MN. Perception and knowledge of human papillomavirus (HPV) vaccine for cervical cancer prevention among fully vaccinated female university students in the era of HPV vaccination: a cross-sectional study. BMJ Open 2021; 11:e047479. [PMID: 34876417 PMCID: PMC8655553 DOI: 10.1136/bmjopen-2020-047479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess the perception and knowledge of cervical cancer prevention among fully vaccinated female university students in the era of human papillomavirus (HPV) vaccination. DESIGN Cross-sectional using a validated questionnaire. SETTING Face-to-face interview at a public university in Malaysia. PARTICIPANTS 384 fully vaccinated female students were included in the study. RESULTS The total knowledge score in the questionnaire was 18 and was ranked according to score level into three groups: poor (score ≤5), moderate (score 6-10) and good (score ≥11). Mean score for knowledge of cervical cancer prevention was 8.24 (SD ±3.85), with 170 respondents (44.3%) scoring moderate knowledge level. The mean score for knowledge of HPV infection and its association with cervical cancer was 4.56±2.47, while the mean score for knowledge of HPV vaccination for cervical cancer prevention was 3.68 (SD ±1.98). A total of 186 (48.4%) respondents perceived that regular Pap smear was unnecessary after HPV vaccination. Respondents' perceived seriousness and susceptibility of HPV infection correlated well with knowledge of cervical cancer prevention. Two main reasons for their acceptance of HPV vaccine were self-health awareness and free vaccination. CONCLUSION The knowledge of HPV vaccination for cervical cancer prevention was average among vaccinated university students. Many of them had poor knowledge about Pap smear and did not consider regular Pap smear as an important cervical cancer screening tool following HPV vaccination. There is still a need for continued health education to improve the perception and knowledge about HPV infection and cervical cancer prevention among young adults in the community.
Collapse
Affiliation(s)
- Kah Teik Chew
- Obstetrics & Gynaecology, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Nirmala Kampan
- Obstetrics & Gynaecology, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Mohamad Nasir Shafiee
- Obstetrics & Gynaecology, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Malaysia
| |
Collapse
|
27
|
Mimmo L, Woolfenden S, Travaglia J, Strnadová I, Phillips MTAK, van Hoek MAD, Harrison R. Codesigning patient experience measures for and with children and young people with intellectual disability: a study protocol. BMJ Open 2021; 11:e050973. [PMID: 34872999 PMCID: PMC8650477 DOI: 10.1136/bmjopen-2021-050973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Children and young people with intellectual disability represent one of the most vulnerable groups in healthcare, yet they remain under-represented in projects to design, develop and/or improve healthcare service delivery. Increasingly, healthcare services are using various codesign and coproduction methodologies to engage children and young people in service delivery improvements. METHODS AND ANALYSIS This study employs an inclusive approach to the study design and execution, including two co-researchers who are young people with intellectual disability on the project team. We will follow an adapted experience-based co-design methodology to enable children and young people with intellectual disability to participate fully in the co-design of a prototype tool for eliciting patient experience data from children and young people with intellectual disability in hospital. ETHICS AND DISSEMINATION This study was granted ethical approval on 1 February 2021 by the Sydney Children's Hospitals Network Human Research Ethics Committee, reference number 2020/ETH02898. Dissemination plan includes publications, doctoral thesis chapter, educational videos. A summary of findings will be shared with all participants and presented at the organisation quality and safety committee.
Collapse
Affiliation(s)
- Laurel Mimmo
- Clinical Governance Unit, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
- Population Child Health, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- Population Child Health, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
| | - Joanne Travaglia
- Centre for Health Service Management, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Iva Strnadová
- Special Education and Disability Studies, School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
28
|
Amigo F, Dalmau-Bueno A, García-Altés A. Do hospitals have a higher mortality rate on weekend admissions? An observational study to analyse weekend effect on urgent admissions to hospitals in Catalonia. BMJ Open 2021; 11:e047836. [PMID: 34845065 PMCID: PMC8634026 DOI: 10.1136/bmjopen-2020-047836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND 'Weekend effect' is a term used to describe the increased mortality associated with weekend emergency admissions to hospital, in contrast with admission on weekdays. The objective of the present study is to determine whether the weekend effect is present in hospitals in Catalonia. METHODS We analysed all urgent admissions in Catalonia in 2018, for a group of pathologies. Two groups were defined (those admitted on a weekday and those admitted on a weekend). We obtained mortality at 3, 7, 15 and 30 days, and applied a proportions test to both groups. Additionally, we used Cox's regression for mortality at 30 days, using the admission on a weekend as the exposition, adjusting by socioeconomic and clinical variables. We used the hospital discharge database and the Central Registry of the Insured Population. RESULTS 72 427 admissions for the selected pathologies during 2018 were found. No statistically significant differences in mortality at 30 days (p=0.524) or at 15 days (p=0.119) according to the day of admission were observed. However, significant differences were found in mortality at 7 days (p=0.025) and at 3 days (p=0.002). The hazard rate associated with the weekend was 1.13 (95% CI: 1.04 to 1.23). By contrast, the adjusted HR of the weekend interaction with time was 0.99 (95% CI: 0.99 to 1.00). CONCLUSIONS There is a weekend effect, but it is not constant in time. This could suggest the existence of dysfunctions in the quality of care during the weekend.
Collapse
Affiliation(s)
| | | | - Anna García-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain
- Fundacio Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| |
Collapse
|
29
|
Rasti R, Brännström J, Mårtensson A, Zenk I, Gantelius J, Gaudenzi G, Alvesson HM, Alfvén T. Point-of-care testing in a high-income country paediatric emergency department: a qualitative study in Sweden. BMJ Open 2021; 11:e054234. [PMID: 34824122 PMCID: PMC8627407 DOI: 10.1136/bmjopen-2021-054234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/05/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES In many resource-limited health systems, point-of-care tests (POCTs) are the only means for clinical patient sample analyses. However, the speed and simplicity of POCTs also makes their use appealing to clinicians in high-income countries (HICs), despite greater laboratory accessibility. Although also part of the clinical routine in HICs, clinician perceptions of the utility of POCTs are relatively unknown in such settings as compared with others. In a Swedish paediatric emergency department (PED) where POCT use is routine, we aimed to characterise healthcare providers' perspectives on the clinical utility of POCTs and explore their implementation in the local setting; to discuss and compare such perspectives, to those reported in other settings; and finally, to gather requests for ideal novel POCTs. DESIGN Qualitative focus group discussions study. A data-driven content analysis approach was used for analysis. SETTING The PED of a secondary paediatric hospital in Stockholm, Sweden. PARTICIPANTS Twenty-four healthcare providers clinically active at the PED were enrolled in six focus groups. RESULTS A range of POCTs was routinely used. The emerging theme Utility of our POCT use is double-edged illustrated the perceived utility of POCTs. While POCT services were considered to have clinical and social value, the local routine for their use was named to distract clinicians from the care for patients. Requests were made for ideal POCTs and their implementation. CONCLUSION Despite their clinical integration, deficient implementation routines limit the benefits of POCT services to this well-resourced paediatric clinic. As such deficiencies are shared with other settings, it is suggested that some characteristics of POCTs and of their utility are less related to resource level and more to policy deficiency. To address this, we propose the appointment of skilled laboratory personnel as ambassadors to hospital clinics offering POCT services, to ensure higher utility of such services.
Collapse
Affiliation(s)
- Reza Rasti
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Paediatric Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
- Paediatric Immuno-psychiatry Unit, CAP Research Centre, Stockholm Healthcare Services, Stockholm, Sweden
| | - Johanna Brännström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Ingela Zenk
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | - Jesper Gantelius
- Division of Nanobiotechnology, Department of Protein Science, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
| | - Giulia Gaudenzi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Division of Nanobiotechnology, Department of Protein Science, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
| | | | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| |
Collapse
|
30
|
Kirkham H. Limp referrals? Improving ankle and foot radiograph referral appropriateness in a military primary care setting. BMJ Mil Health 2021; 169:286-287. [PMID: 34819360 DOI: 10.1136/bmjmilitary-2021-002038] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 11/04/2022]
|
31
|
Abstract
The healthcare industry compares unfavorably with other ultra-safe industries such as aviation and nuclear power plants, which address complexity by reducing the vulnerability of a single person and promoting teams and strong systems. A multidisciplinary tumor board (MTB) is an evidence-based organizational approach to implementing a more effective concept in oncology practice. Studies addressing the correlation between MTBs and cancer outcomes show promising results, and other potential benefits are also addressed. The objectives of this article are to define and characterize MTBs in modern oncology practice, review the current literature on MTBs effectiveness and address challenges to the implementation and maintenance of MTBs. In this commentary-type narrative review, the authors present their opinions and, whenever possible, substantiate recommendations by citing supportive literature.
Collapse
Affiliation(s)
- Max S Mano
- Grupo Oncoclínicas, São Paulo, Brazil.,Academy of Leadership Sciences Switzerland, Switzerland
| | | | - Paul Barach
- Academy of Leadership Sciences Switzerland, Switzerland.,Wayne State University School of Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA.,Interdisciplinary Research Institute for Health Law & Science, Sigmund Freud University, Vienna, Austria
| |
Collapse
|
32
|
Gao H, Yous ML, Connelly D, Hung L, Garnett A, Hay ME, Snobelen N, Salatino S. Virtual team-based care planning with older persons in formal care settings: a scoping review protocol. BMJ Open 2021; 11:e054900. [PMID: 34785560 PMCID: PMC8595297 DOI: 10.1136/bmjopen-2021-054900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION COVID-19 has necessitated greater adoption of virtual care (eg, telephone (audio), videoconference) delivery models. Virtual care provides opportunities for innovative practice in care planning with older persons and meaningful family engagement by synchronously involving multiple care providers. Nevertheless, there remains a paucity of summarising evidence regarding virtual team-based care planning for older persons. The purpose of this scoping review is to summarise evidence on the utilisation of virtual team-based care planning for older persons in formal care settings. Specifically, (1) what has been reported in the literature on the impact or outcomes of virtual team-based care planning? (2) What are the facilitators and barriers to implementation? METHODS AND ANALYSIS This scoping review will follow a rigorous and well-established methodology by the Joanna Briggs Institute, supplemented by the Arksey & O'Malley and Levac, Colquhoun, & O'Brien frameworks. A three-step search strategy will be used to conduct a search on virtual team-based care planning for older persons in formal care settings. Keywords and index terms will be identified from an initial search in PubMed and AgeLine, and used to conduct the full search in the databases PubMed, EMBASE, CINAHL, AgeLine, PsycInfo and Scopus. Reference lists of included articles and grey literature retrieved through Google and Google Scholar will also be reviewed. Three researchers will screen titles and abstracts, and will conduct full-text review for inclusion. Extracted data will be mapped in a table. ETHICS AND DISSEMINATION Research ethics approval is not required for data collection from publicly accessible information. Findings will be presented at conferences, submitted for open-access publication in a peer-reviewed journal and made accessible to multiple stakeholders. The scoping review will summarise the literature on virtual team-based care planning for the purpose of informing the implementation of a virtual PIECES™ intervention (Physical/Intellectual/Emotional health, Capabilities, Environment, and Social).
Collapse
Affiliation(s)
- Harrison Gao
- Faculty of Science, University of Western Ontario, London, Ontario, Canada
| | - Marie-Lee Yous
- McMaster University School of Nursing, Hamilton, Ontario, Canada
| | - Denise Connelly
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Lillian Hung
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Melissa Erin Hay
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Nancy Snobelen
- Registered Practical Nurses Association of Ontario, Mississauga, Ontario, Canada
| | | |
Collapse
|
33
|
Seligman WH, Fialho L, Sillett N, Nielsen C, Baloch FM, Collis P, Demedts IKM, Fleck MP, Floriani MA, Gabriel LEK, Gagnier JJ, Keetharuth A, Londral A, Ludwig IIL, Lumbreras C, Moscoso Daza A, Muhammad N, Nader Bastos GA, Owen CW, Powers JH, Russell AM, Smith MK, Wang TYP, Wong EK, Woodhouse DC, Zimlichman E, Brinkman K. Which outcomes are most important to measure in patients with COVID-19 and how and when should these be measured? Development of an international standard set of outcomes measures for clinical use in patients with COVID-19: a report of the International Consortium for Health Outcomes Measurement (ICHOM) COVID-19 Working Group. BMJ Open 2021; 11:e051065. [PMID: 34782342 PMCID: PMC8593274 DOI: 10.1136/bmjopen-2021-051065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has resulted in widespread morbidity and mortality with the consequences expected to be felt for many years. Significant variation exists in the care even of similar patients with COVID-19, including treatment practices within and between institutions. Outcome measures vary among clinical trials on the same therapies. Understanding which therapies are of most value is not possible unless consensus can be reached on which outcomes are most important to measure. Furthermore, consensus on the most important outcomes may enable patients to monitor and track their care, and may help providers to improve the care they offer through quality improvement. To develop a standardised minimum set of outcomes for clinical care, the International Consortium for Health Outcomes Measurement (ICHOM) assembled a working group (WG) of 28 volunteers, including health professionals, patients and patient representatives. DESIGN A list of outcomes important to patients and professionals was generated from a systematic review of the published literature using the MEDLINE database, from review of outcomes being measured in ongoing clinical trials, from a survey distributed to patients and patient networks, and from previously published ICHOM standard sets in other disease areas. Using an online-modified Delphi process, the WG selected outcomes of greatest importance. RESULTS The outcomes considered by the WG to be most important were selected and categorised into five domains: (1) functional status and quality of life, (2) mental functioning, (3) social functioning, (4) clinical outcomes and (5) symptoms. The WG identified demographic and clinical variables for use as case-mix risk adjusters. These included baseline demographics, clinical factors and treatment-related factors. CONCLUSION Implementation of these consensus recommendations could help institutions to monitor, compare and improve the quality and delivery of care to patients with COVID-19. Their consistent definition and collection could also broaden the implementation of more patient-centric clinical outcomes research.
Collapse
Affiliation(s)
- William H Seligman
- International Consortium for Health Outcomes Measurement, Boston, Massachusetts, USA
| | - Luz Fialho
- International Consortium for Health Outcomes Measurement, Boston, Massachusetts, USA
| | - Nick Sillett
- International Consortium for Health Outcomes Measurement, Boston, Massachusetts, USA
| | - Christina Nielsen
- International Consortium for Health Outcomes Measurement, Boston, Massachusetts, USA
| | | | | | | | - Marcelo P Fleck
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - John H Powers
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | | | | | - Tracy Y-P Wang
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Evan K Wong
- Providence Health Care, Seattle, Washington, USA
| | | | | | | |
Collapse
|
34
|
Smekal MD, Bello AK, Donald M, Zaidi D, McBrien K, Nicholson K, Novak E, Hemmelgarn B. Enhancing primary care capacity in chronic kidney disease management: a quality improvement educational initiative. BMJ Open 2021; 11:e046068. [PMID: 34753751 PMCID: PMC8578991 DOI: 10.1136/bmjopen-2020-046068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gaps in identification, medical management and appropriate referral for patients with chronic kidney disease (CKD) are evident. OBJECTIVE We designed and implemented an interactive educational intervention (accredited workshop) to improve primary care providers' awareness of tools to support guideline-concordant CKD management. DESIGN We used the Kern method to design the educational intervention and targeted the accredited workshops to primary care team members (physicians, nurses and allied health) in Alberta, Canada. We conducted anonymous pre-workshop and post-workshop surveys to identify practice-specific barriers to care, identify potential solutions, and evaluate provider confidence pre-intervention and post-intervention. We used non-parametric statistics to analyse Likert-type survey data and descriptive content analysis to categorise responses to open-ended survey questions. RESULTS We delivered 12 workshops to 114 providers from September 2017 through March 2019. Significant improvements (p<0.001) in confidence to appropriately identify, manage and refer patients with CKD were observed. Participants identified several patient-level, provider-level, and system-level barriers and potential solutions to care for patients with CKD; the majority of these barriers were addressed in the interactive workshop. CONCLUSIONS The Kern model was an effective methodology to design and implement an educational intervention to improve providers' confidence in managing patients with CKD in primary care. Future research is needed to determine if these perceived knowledge and confidence improvements affect patient outcomes and whether improvements are sustained long term.
Collapse
Affiliation(s)
| | - Aminu K Bello
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Deenaz Zaidi
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry McBrien
- Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Ellen Novak
- Alberta Kidney Care, Alberta Health Services, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
35
|
Breton M, Gaboury I, Sasseville M, Beaulieu C, Abou Malham S, Hudon C, Rodrigues I, Maillet L, Duhoux A, Deville-Stoetzel N, Haggerty J. Development of a self-reported reflective tool on advanced access to support primary healthcare providers: study protocol of a mixed-method research design using an e-Delphi survey. BMJ Open 2021; 11:e046411. [PMID: 34750148 PMCID: PMC8576468 DOI: 10.1136/bmjopen-2020-046411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Timely access is one of the cornerstones of strong primary healthcare (PHC). New models to increase timely access have emerged across the world, including advanced access (AA). Recently in Quebec, Canada, the AA model has spread widely across the province. The model has largely been implemented by PHC professionals with important variations; however, a tool to assess their practice improvement within AA is lacking. The general objective of this study is to develop a self-reported online reflective tool that will guide PHC professionals' reflection on their individual AA practice and formulation of recommendations for improvement. Specific objectives are: (1) operationalisation of the pillars and subpillars of AA; (2) development of a self-reported questionnaire; and (3) evaluation of the psychometrics. METHODS AND ANALYSIS The pillars composing Murray's model of AA will first be reviewed in collaboration with PHC professional and stakeholders, patients and researchers in a face-to-face meeting, with the goal to establish consensus on the pillars and subpillars of AA. Leading from these definitions, items will be identified for evaluation through an e-Delphi consultation. Three rounds are planned in 2020-2021 with a group of 20-25 experts. A repository of recommendations on how to improve one's AA practice will be populated based on the literature and enriched by our experts throughout the consultation. Median and measures of dispersions will be used to evaluate agreement. The resulting tool will then be evaluated by PHC professionals for psychometrics in 2021-2022. ETHICS AND DISSEMINATION The Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre Scientific Research Committee approved the protocol, and the Research Ethics Board provided ethics approval (2020-441, CP 980475). Dissemination plan is a mix of community diffusion through and for our partners and to the scientific community including peer-reviewed publications and conference presentations.
Collapse
Affiliation(s)
- Mylaine Breton
- Faculty of Medicine and Health Sciences, Department of Community Health, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Longueuil, Quebec, Canada
| | | | - Christine Beaulieu
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Sabina Abou Malham
- School of Nursing Sciences, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Catherine Hudon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabel Rodrigues
- Université de Montréal Faculté de Médecine, Montréal, Québec, Canada
| | - Lara Maillet
- École nationale d'administration publique - ENAP, Université du Québec à Montréal, Montreal, Québec, Canada
| | | | - Nadia Deville-Stoetzel
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Jeannie Haggerty
- Faculty of Medicine, McGill University, Montreal, Québec, Canada
| |
Collapse
|
36
|
Aimono Y, Kohyama N, Kamoshida T, Yamamoto T, Kogo M. Factors associated with a reduction in the quality of life of patients with chronic hepatitis C treated by ledipasvir/sofosbuvir therapy. Eur J Hosp Pharm 2021; 28:e29-e34. [PMID: 34728543 DOI: 10.1136/ejhpharm-2020-002215] [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: 01/15/2020] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE We investigated factors associated with a reduction in the quality of life and their OR of patients with chronic hepatitis C who underwent ledipasvir/sofosbuvir therapy. METHODS The subjects were 141 outpatients who had undergone ledipasvir/sofosbuvir therapy under a diagnosis of genotype I chronic hepatitis C or Child-Pugh A compensated cirrhosis at Hitachi General Hospital. The patient background before ledipasvir/sofosbuvir therapy, laboratory data and the Chronic Liver Disease Questionnaire scores during ledipasvir/sofosbuvir therapy were investigated. The Chronic Liver Disease Questionnaire consists of 29 questions, and the mean value is calculated as the overall score through a 7-step assessment by patients. Using two divisions: a Chronic Liver Disease Questionnaire score of <7 (symptoms are present) and that of 7 (no symptoms), as objective variables, patients with a Chronic Liver Disease Questionnaire score of <7 were defined as having a reduced quality of life. Independent factors significantly associated with a reduction in the quality of life were extracted using logistic regression analysis. RESULTS Based on the multivariate analysis, an alanine aminotransferase level of ≥23 U/L (OR: 4.380, 95% CI: 1.394 to 13.756) was extracted as an independent factor associated with a reduction in the quality of life (p<0.05). CONCLUSION An increase in the baseline level of alanine aminotransferase was found to play a role in the reduction in the quality of life of patients with chronic hepatitis C who had undergone ledipasvir/sofosbuvir therapy.
Collapse
Affiliation(s)
- Yuka Aimono
- Department of Pharmacy, Hitachi, Ltd, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Noriko Kohyama
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, School of Pharmacy, Showa University-Hatanodai Campus, Shinagawa-ku, Tokyo, Japan
| | - Toshiro Kamoshida
- Department of Medical Gastroenterology, Hitachi, Ltd, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | | | - Mari Kogo
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, School of Pharmacy, Showa University-Hatanodai Campus, Shinagawa-ku, Tokyo, Japan
| |
Collapse
|
37
|
Newman C, Kgosidialwa O, Dervan L, Bogdanet D, Egan AM, Biesty L, Devane D, O'Shea PM, Dunne F. Patient-reported outcomes (PROs) in randomised controlled trials in diabetes and pregnancy: protocol for a systematic review. BMJ Open 2021; 11:e052506. [PMID: 34728453 PMCID: PMC8565541 DOI: 10.1136/bmjopen-2021-052506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Diabetes mellitus is the most common metabolic complication of pregnancy and its prevalence worldwide is rising. The number of randomised controlled trials (RCTs) being conducted in people with diabetes is also increasing. Many studies preferentially publish findings on clinical endpoints and do not report patient-reported outcomes (PROs). In studies that do include PROs, PRO reporting is often of poor quality. METHODS We will conduct this systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using a combination of medical subject headings and keywords (combined using Boolean operators), we will search web-based databases (PubMed, Cochrane and EMBASE) for RCTs published in English between 2013 and 2021. Two reviewers will review titles and abstracts. We will review the full texts of any relevant abstracts and extract the following data: date of publication or recruitment period, journal of publication, country of study, multicentre or single centre, population and number of participants, type of intervention, frequency of PRO assessment and type of PRO (or PRO measurement) used. We will also record if the PRO was a primary, secondary or exploratory outcome. We will exclude reviews, observational studies, unpublished data for example, conference abstracts and trial protocols. Any published RCT that includes data on a PRO as a primary or secondary outcome will then be compared against the Consolidated Standards of Reporting Trials-Patient-Reported Outcome extension checklist, a structured and approved framework for the publication of results of PROs. ETHICS AND DISSEMINATION Ethical approval to conduct this study was obtained from the ethics committee at Galway University Hospitals on 24 March 2021 (CA 2592). We aim to publish our findings in a peer-reviewed journal and present our findings at national and international conferences. SYSTEMATIC REVIEW REGISTRATION This systematic review was registered prospectively with the International Prospective Register of Systematic Reviews (PROSPERO). Registration number CRD42021234917.
Collapse
Affiliation(s)
- Christine Newman
- National University of Ireland Galway College of Medicine Nursing and Health Sciences, Galway, Ireland
| | - Oratile Kgosidialwa
- National University of Ireland Galway College of Medicine Nursing and Health Sciences, Galway, Ireland
| | - Louise Dervan
- National University of Ireland Galway College of Medicine Nursing and Health Sciences, Galway, Ireland
| | - Delia Bogdanet
- Diabetes and Endocrinology, National University of Ireland Galway, Galway, Ireland
| | | | - Linda Biesty
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- HRB-Trials Methodology Research Network, National University of Ireland, Galway, Ireland
- INFANT Centre and Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
- Evidence Synthesis Ireland, National University of Ireland, Galway, Ireland
- Cochrane Ireland, National UNiversity of Ireland, Galway, Ireland
| | - Paula M O'Shea
- Biochemical Medicine, Galway University Hospitals, Galway, Ireland
| | - Fidelma Dunne
- National University of Ireland Galway College of Medicine Nursing and Health Sciences, Galway, Ireland
| |
Collapse
|
38
|
Abstract
OBJECTIVE Many studies have analysed gender bias in academic medicine; however, no comprehensive synthesis of the literature has been performed. We conducted a pooled analysis of the difference in the proportion of men versus women with full professorship among academic physicians. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Center and PsycINFO were searched from inception to 3 July 2020. STUDY SELECTION All original studies reporting faculty rank stratified by gender worldwide were included. DATA EXTRACTION AND SYNTHESIS Study screening, data extraction and quality assessment were performed by two independent reviewers, with a third author resolving discrepancies. Meta-analysis was conducted using random-effects models. RESULTS Our search yielded 5897 articles. 218 studies were included with 991 207 academic physician data points. Men were 2.77 times more likely to be full professors (182 271/643 790 men vs 30 349/251 501 women, OR 2.77, 95% CI 2.57 to 2.98). Although men practised for longer (median 18 vs 12 years, p<0.00002), the gender gap remained after pooling seven studies that adjusted for factors including time in practice, specialty, publications, h-index, additional PhD and institution (adjusted OR 1.83, 95% CI 1.04 to 3.20). Meta-regression by data collection year demonstrated improvement over time (p=0.0011); however, subgroup analysis showed that gender disparities remain significant in the 2010-2020 decade (OR 2.63, 95% CI 2.48 to 2.80). The gender gap was present across all specialties and both within and outside of North America. Men published more papers (mean difference 17.2, 95% CI 14.7 to 19.7), earned higher salaries (mean difference $33 256, 95% CI $25 969 to $40 542) and were more likely to be departmental chairs (OR 2.61, 95% CI 2.19 to 3.12). CONCLUSIONS Gender inequity in academic medicine exists across all specialties, geographical regions and multiple measures of success, including academic rank, publications, salary and leadership. Men are more likely than women to be full professors after controlling for experience, academic productivity and specialty. Although there has been some improvement over time, the gender disparity in faculty rank persists. PROSPERO REGISTRATION NUMBER CRD42020197414.
Collapse
Affiliation(s)
- Ben Li
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jean Jacob-Brassard
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Fahima Dossa
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Konrad Salata
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Teruko Kishibe
- Health Sciences Library, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Elisa Greco
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Mohammed Al-Omran
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
39
|
Romero NC, Cisneros-Caceres MJ, Granadillo E, Aragao E, Romero-Sandoval A, Barbosa C, Barreto de Oliveira AL, Rodriguez A, Pinheiro GP, Cruz A, Cooper P, Ferreira da Silva MR. Health workers' perspectives on asthma care coordination between primary and specialised healthcare in the COVID-19 pandemic: a protocol for a qualitative study in Ecuador and Brazil. BMJ Open 2021; 11:e052971. [PMID: 34725080 PMCID: PMC8561830 DOI: 10.1136/bmjopen-2021-052971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Asthma is a common long-term disorder and strategies to improve asthma control are still a challenge. Integrated delivery of health systems is critical for effective asthma care: there is limited information on experiences of care coordination for asthma from Latin America, especially on perspectives of health personnel and in the context of the COVID-19 pandemic. METHODS AND ANALYSIS This protocol details a qualitative approach to analyse health workers' perspectives of healthcare coordination for asthma control during COVID-19 pandemic in Ecuador and Brazil, at primary and specialised levels, through in-depth semistructured interviews using a video communications platform. The analysis will identify knowledge and perspectives based on coordination of clinical information, clinical management and administrative coordination. Theoretical sampling will be used to obtain approximately equal numbers of women and men within each level of healthcare; data saturation will be used to determine sample size. Transcripts will be analysed using content-coding procedures to mark quotations related to major topics and subthemes included in the interview guide, and narrative analysis will be based on a theoretical framework for healthcare coordination to identify new themes and subthemes. ETHICS AND DISSEMINATION Ethical approval was obtained from the ethics committees of Hospital General Docente Calderón, Quito, Ecuador; and Universidade Federal da Bahia, Salvador, Brazil. The findings of this study will be disseminated through peer-reviewed articles, conference presentations and condensed summaries for key stakeholders and partners.
Collapse
Affiliation(s)
- Natalia Cristina Romero
- School of Medicine, International University of Ecuador, Quito, Ecuador
- Department of Medicine, Red Groups in Latin America and Africa, Barcelona, Spain
| | | | - Emily Granadillo
- School of Medicine, International University of Ecuador, Quito, Ecuador
| | - Erika Aragao
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Adriana Romero-Sandoval
- Department of Medicine, Red Groups in Latin America and Africa, Barcelona, Spain
- School of Basic Sciences, International University of Ecuador, Quito, Ecuador
| | - Carolina Barbosa
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | | | | | | | - Alvaro Cruz
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Philip Cooper
- School of Medicine, International University of Ecuador, Quito, Ecuador
- Institute of Infection and Immunity, St George's University of London, London, UK
| | | |
Collapse
|
40
|
Tassew SG, Abraha HN, Gidey K, Gebre AK. Assessment of drug use pattern using WHO core drug use indicators in selected general hospitals: a cross-sectional study in Tigray region, Ethiopia. BMJ Open 2021; 11:e045805. [PMID: 34706944 PMCID: PMC8552154 DOI: 10.1136/bmjopen-2020-045805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Inappropriate use of medicine is a global challenge with greater impact on developing countries. Assessment of drug use pattern is used to identify gaps in medicine utilisation to implement strategies for promoting rational drug use. This study aimed to assess drug use pattern using the WHO drug use indicators in selected general hospitals in Tigray region, Ethiopia. DESIGN A cross-sectional study was conducted using WHO drug use indicators in two public hospitals located in Tigray. SETTING Prescriptions recorded from 1 January 2017 to 1 June 2019 were randomly selected, and participants who visited the public hospitals from 1 March 2019 to 30 August 2019 and hospital pharmacies were interviewed. PARTICIPANTS 100 patients who visited both outpatient clinics and hospital pharmacy departments of the public hospitals. RESULTS The average number of medicines per prescription was 1.69 (±0.81). Prescriptions containing antibiotics and injectables were 58.2% and 15.9%, respectively. The percentages of medicines prescribed with a generic name from essential medicines list of Ethiopia were 97.5% (974) and 88.1% (970) in Mekelle Hospital and Quiha Hospital, respectively. The patients spent an average of 6.6(±3.5) min with their general practitioners, while only 22.8 (±21.7) s with their pharmacists. Of the patients interviewed, 56.9% knew their dosing regimen and 32.7% of them had their medication labelled. CONCLUSION The finding of the present study revealed deviation of drug use pattern from the WHO optimal levels suggesting the hospitals had limitations in appropriate utilisation of medicines. Understanding the factors attributed to the observed gaps and implementing corrective measures are required to conform with the recommended standards of appropriate drug utilisation.
Collapse
Affiliation(s)
- Segen Gebremeskel Tassew
- Department of Clinical Pharmacy, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - Haftom Niguse Abraha
- Department of Clinical Pharmacy, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - Abadi Kahsu Gebre
- Department of Pharmacology and Clinical Toxicology, Mekelle University College Health Sciences, Mekelle, Ethiopia
| |
Collapse
|
41
|
Jones MP, Zhao Y, Guthridge S, Russell DJ, Ramjan M, Humphreys JS, Wakerman J. Effects of turnover and stability of health staff on quality of care in remote communities of the Northern Territory, Australia: a retrospective cohort study. BMJ Open 2021; 11:e055635. [PMID: 34667018 PMCID: PMC8527144 DOI: 10.1136/bmjopen-2021-055635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the relationship between markers of staff employment stability and use of short-term healthcare workers with markers of quality of care. A secondary objective was to identify clinic-specific factors which may counter hypothesised reduced quality of care associated with lower stability, higher turnover or higher use of short-term staff. DESIGN Retrospective cohort study (Northern Territory (NT) Department of Health Primary Care Information Systems). SETTING All 48 government primary healthcare clinics in remote communities in NT, Australia (2011-2015). PARTICIPANTS 25 413 patients drawn from participating clinics during the study period. OUTCOME MEASURES Associations between independent variables (resident remote area nurse and Aboriginal Health Practitioner turnover rates, stability rates and the proportional use of agency nurses) and indicators of health service quality in child and maternal health, chronic disease management and preventive health activity were tested using linear regression, adjusting for community and clinic size. Latent class modelling was used to investigate between-clinic heterogeneity. RESULTS The proportion of resident Aboriginal clients receiving high-quality care as measured by various quality indicators varied considerably across indicators and clinics. Higher quality care was more likely to be received for management of chronic diseases such as diabetes and least likely to be received for general/preventive adult health checks. Many indicators had target goals of 0.80 which were mostly not achieved. The evidence for associations between decreased stability measures or increased use of agency nurses and reduced achievement of quality indicators was not supported as hypothesised. For the majority of associations, the overall effect sizes were small (close to zero) and failed to reach statistical significance. Where statistically significant associations were found, they were generally in the hypothesised direction. CONCLUSIONS Overall, minimal evidence of the hypothesised negative effects of increased turnover, decreased stability and increased reliance on temporary staff on quality of care was found. Substantial variations in clinic-specific estimates of association were evident, suggesting that clinic-specific factors may counter any potential negative effects of decreased staff employment stability. Investigation of clinic-specific factors using latent class analysis failed to yield clinic characteristics that adequately explain between-clinic variation in associations. Understanding the reasons for this variation would significantly aid the provision of clinical care in remote Australia.
Collapse
Affiliation(s)
- Michael P Jones
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Yuejen Zhao
- Population and Digital Health, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Deborah J Russell
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Mark Ramjan
- Clinical Governance, Darwin Region & Strategic Primary Health Care, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - John S Humphreys
- School of Rural Health, Monash University, Bendigo, Victoria, Australia
| | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| |
Collapse
|
42
|
Abstract
OBJECTIVES We aimed to review the international literature to understand the enablers of and barriers to effective clinical supervision in the workplace and identify the benefits of effective clinical supervision. DESIGN A rapid evidence review. DATA SOURCES Five databases (CINAHL, OVID Embase, OVID Medline, OVID PsycInfo and ProQuest) were searched to ensure inclusion and breadth of healthcare professionals. ELIGIBILITY CRITERIA Studies identifying enablers and barriers to effective clinical supervision across healthcare professionals in a Western context between 1 January 2009 and 12 March 2019. DATA EXTRACTION AND SYNTHESIS An extraction framework with a detailed inclusion/exclusion criteria to ensure rigour was used to extract data. Data were analysed using a thematic qualitative synthesis. These themes were used to answer the research objectives. RESULTS The search identified 15 922 papers, reduced to 809 papers following the removal of duplicates and papers outside the inclusion criteria, with 135 papers being included in the full review. Enablers identified included regular supervision, occurs within protected time, in a private space and delivered flexibly. Additional enablers included supervisees being offered a choice of supervisor; supervision based on mutual trust and a positive relationship; a cultural understanding between supervisor and supervisee; a shared understanding of the purpose of supervision, based on individual needs, focused on enhancing knowledge and skills; training and feedback being provided for supervisors; and use of a mixed supervisor model, delivered by several supervisors, or by those trained to manage the overlapping (and potentially conflicting) needs of the individual and the service. Barriers included a lack of time, space and trust. A lack of shared understanding to the purpose of the supervision, and a lack of ongoing support and engagement from leadership and organisations were also found to be barriers to effective clinical supervision. CONCLUSIONS This review identified several enablers of and barriers to effective clinical supervision and the subsequent benefits of effective clinical supervision in a healthcare setting.
Collapse
Affiliation(s)
- Charlotte Rothwell
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Amelia Kehoe
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Sophia Farhene Farook
- Emergency Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Jan Illing
- Health Professions Education Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
43
|
Abstract
OBJECTIVES Disrespectful and poor treatment of newborns such as unnecessary separation from parents or failure to obtain parental consent for medical procedures occurs at health facilities across contexts, but little research has investigated the prevalence, risk factors or associated outcomes. This study examined these experiences and associations with healthcare satisfaction, use and breast feeding. DESIGN Prospective cohort study. SETTING 3 public hospitals, 2 private hospitals, and 1 health centre/dispensary in Nairobi and Kiambu counties in Kenya. PARTICIPANTS Data were collected from women who delivered in health facilities between September 2019 and January 2020. The sample included 1014 women surveyed at baseline and at least one follow-up at 2-4 or 10 weeks post partum. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Outcomes related to satisfaction with care and care utilisation; (2) continuation of post-discharge newborn care practices such as breast feeding. RESULTS 17.6% of women reported newborn separation at the facility, of whom 71.9% were separated over 10 min. 44.9% felt separation was unnecessary and 8.4% reported not knowing the reason for separation. 59.9% reported consent was not obtained for procedures on their newborn. Women separated from their newborn (>10 min) were 44% less likely to be exclusively breast feeding at 2-4 weeks (adjusted OR (aOR)=0.56, 95% CI: 0.40 to 0.76). Obtaining consent for newborn procedures corresponded with 2.7 times greater likelihood of satisfaction with care (aOR=2.71, 95% CI: 1.67 to 4.41), 27% greater likelihood of postpartum visit attendance for self or newborn (aOR=1.27, 95% CI: 1.05 to 1.55), and 33% greater likelihood of exclusive breast feeding at 10 weeks (aOR=1.33, 95% CI: 1.10 to 1.62). CONCLUSIONS Newborns, mothers and families have a right to high-quality, respectful care, including the ability to stay together, be informed and properly consent for care. The implications of these experiences on health outcomes a month or more after discharge illustrate the importance of a positive experience of postnatal care.
Collapse
Affiliation(s)
- Michelle Kao Nakphong
- Department of Community Health Sciences, University of California Los Angeles, Los Angeles, California, USA
- California Center for Population Research, University of California Los Angeles, Los Angeles, California, USA
| | - Emma Sacks
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - James Opot
- Innovations for Poverty Action, Nairobi, Kenya
| | - May Sudhinaraset
- Department of Community Health Sciences, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
44
|
Tse ETY, Lam CLK, Wong CKH, Chin WY, Etz RS, Zyzanski SJ, Stange KC. Exploration of the psychometric properties of the Person-Centred Primary Care Measure (PCPCM) in a Chinese primary care population in Hong Kong: a cross-sectional validation study. BMJ Open 2021; 11:e052655. [PMID: 34548365 PMCID: PMC8719180 DOI: 10.1136/bmjopen-2021-052655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the validity and psychometric properties of the Chinese Person-Centred Primary Care Measure (PCPCM) in a Chinese-speaking population. DESIGN A cross-sectional study. SETTING A primary care clinic in Hong Kong. PARTICIPANTS 300 Chinese adult patients (150 males and 150 females) were recruited from a primary care clinic to complete a questionnaire containing the PCPCM, Consultation and Relational Empathy (CARE), Patient Enablement Index (PEI) and Adult (short version) Primary Care Assessment Tool (PCAT). The Chinese PCPCM was readministered to 118 participants after 14 days for test-retest reliability. OUTCOME MEASURES The construct validity, reliability and sensitivity of the Chinese PCPCM. RESULTS The Chinese PCPCM was identified to have a one-factor construct, with good item fit and unidimensionality on Rasch analysis. Internal reliability was high (Cronbach's alpha >0.8) with moderate test-retest reliability (intraclass correlation coefficient=0.622, p<0.001). Significant correlations (0.58, 0.42, 0.48) between the PCPCM and CARE, PEI and Adult (short version) PCAT scores supported good convergent construct validity. PCPCM scores were higher among patients who had known their doctors for a longer period or who were more likely to be able to see the same doctor at every visit, and among those who self-reported to have 'better health' rather than 'worse health'. CONCLUSION The Chinese PCPCM appears to be a valid, reliable and sensitive instrument for evaluating the quality of person-centred care among primary care patients in Hong Kong. Further studies are needed to confirm the utility of this instrument in other Chinese-speaking populations around the world.
Collapse
Affiliation(s)
- Emily Tsui Yee Tse
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Family Medicine and Primary Care, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Family Medicine and Primary Care, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
- Department of Pharmacology and Pharmacy, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Rebecca S Etz
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Stephen J Zyzanski
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kurt C Stange
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| |
Collapse
|
45
|
Baumann AA, Hooley C, Goss CW, Mutabazi V, Brown AL, Schechtman KB, Twagirumukiza M, de Las Fuentes L, Reeds D, Williams M, Mutimura E, Bergström A, Nishimwe A, Ingabire C, Davila-Roman VG. Exploring contextual factors influencing the implementation of evidence-based care for hypertension in Rwanda: a cross-sectional study using the COACH questionnaire. BMJ Open 2021; 11:e048425. [PMID: 34548353 PMCID: PMC8458329 DOI: 10.1136/bmjopen-2020-048425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
IMPORTANCE Hypertension is the largest contributor to the Global Burden of Disease. In Rwanda, as in most low-income and middle-income countries, an increasing prevalence of hypertension and its associated morbidity and mortality is causing major healthcare and economic impact. Understanding healthcare systems context in hypertension care is necessary. OBJECTIVE To study the hypertension healthcare context as perceived by healthcare providers using the Context Assessment for Community Health (COACH) tool. DESIGN A cross-sectional cohort responded to the COACH questionnaire and a survey about hypertension training. SETTING Three tertiary care hospitals in Rwanda. PARTICIPANTS Healthcare professionals (n=223). PRIMARY OUTCOMES AND MEASURES The COACH tool consists of 49 items with eight subscales: resources, community engagement, commitment to work, informal payment, leadership, work culture, monitoring services for action (5-point Likert Scale) and sources of knowledge (on a 0-1 scale). Four questions surveyed training on hypertension. RESULTS Responders (n=223, 75% women; 56% aged 20-35 years) included nurses (n=142, 64%, midwives (n=42, 19%), primary care physicians (n=28, 13%) and physician specialists (n=11, 5%)). The subscales commitment to work, leadership, work culture and informal payment scored between 4.7 and 4.1 and the community engagement, monitoring services for action and organizational resources scored between 3.1 and 3.5. Sources of knowledge had a mean score of 0.6±0.3. While 73% reported having attended a didactic hypertension seminar in the past year, only 28% had received long-term training and 51% had <3-year experience working with hypertension care delivery. The majority (99%) indicated a need for additional training in hypertension care. CONCLUSIONS There is a need for increased and continuous training in Rwanda. Healthcare responders stated a commitment to work and reported supportive leadership, while acknowledging limited resources and no monitoring systems. The COACH tool provides contextual guidance to develop training strategies prior to the implementation of a sustainable hypertension care programme.
Collapse
Affiliation(s)
- Ana A Baumann
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, Utah, USA
| | - Charles W Goss
- Division of Biostatistics, Washington University in St. Louis, St Louis, Missouri, USA
| | | | - Angela L Brown
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St Louis, Missouri, USA
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Marc Twagirumukiza
- Regional Alliance for Sustainable Development, Kigali, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Lisa de Las Fuentes
- Washington University in St. Louis, Division of Biostatistics, St. Louis, MO, USA
- Washington University in St. Louis, School of Medicine, Cardiovascular Division, Department of Medicine, St. Louis, MO, USA
| | - Dominic Reeds
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, St. Louis, MO, USA
| | - Makeda Williams
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Eugene Mutimura
- Regional Alliance for Sustainable Development, Kigali, Rwanda
- National Council for Science and Technology, Kigali, Rwanda and to Regional Alliance for Sustainable Development, Kigali, Rwanda
| | - Anna Bergström
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dept of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Aurore Nishimwe
- Regional Alliance for Sustainable Development, Kigali, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Cecile Ingabire
- Regional Alliance for Sustainable Development, Kigali, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Victor G Davila-Roman
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St Louis, Missouri, USA
| |
Collapse
|
46
|
Morris ME, Brusco N, Woods J, Myles PS, Hodge A, Jones C, Lloyd D, Rovtar V, Clifford A, Atkinson V. Protocol for implementation of the 'AusPROM' recommendations for elective surgery patients: a mixed-methods cohort study. BMJ Open 2021; 11:e049937. [PMID: 34531213 PMCID: PMC8449982 DOI: 10.1136/bmjopen-2021-049937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Incorporating patient-reported outcome measures (PROMs) into usual care in hospitals can improve safety and quality. Gaps exist in electronic PROM (ePROM) implementation recommendations, including for elective surgery. The aims are to: (1) understand barriers and enablers to ePROM implementation in hospitals and develop Australian ePROM implementation recommendations (AusPROM); (2) test the feasibility and acceptability of the Quality of Recovery 15 item short-form (QoR-15) PROM for elective surgery patients applying the AusPROM and (3) establish if the QoR-15 PROM has concurrent validity with the EQ-5D-5L. METHODS AND ANALYSIS Phase I will identify staff barriers and facilitators for the implementation of the AusPROM recommendations using a Delphi technique. Phase II will determine QoR-15 acceptability for elective surgery patients across four pilot hospitals, using the AusPROM recommendations. For phase II, in addition to a consumer focus group, patients will complete brief acceptability surveys, incorporating the QoR-15, in the week prior to surgery, in the week following surgery and 4 weeks postsurgery. The primary endpoint will be 4 weeks postsurgery. Phase III will be the national implementation of the AusPROM (29 hospitals) and the concurrent validity of the QoR-15 and generic EQ-5D-5L. This protocol adopts the Guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trials Protocols guidelines. ETHICS AND DISSEMINATION The results will be disseminated via public forums, conferences and peer-reviewed journals. Ethics approval: La Trobe University (HEC20479). TRIAL REGISTRATION NUMBER ACTRN12621000298819 (Phase I and II) and ACTRN12621000969864 (Phase III).
Collapse
Affiliation(s)
- Meg E Morris
- Victorian Rehabilitation Centre, Healthscope Limited, Melbourne, Victoria, Australia
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, Victoria, Australia
| | - Natasha Brusco
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Woods
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
- Healthscope Limited, Melbourne, Victoria, Australia
| | - Paul S Myles
- Anaesthesia and Perioperative Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Anita Hodge
- Healthscope Limited, Melbourne, Victoria, Australia
| | - Cathy Jones
- Healthscope Limited, Melbourne, Victoria, Australia
| | - Damien Lloyd
- Healthscope Limited, Melbourne, Victoria, Australia
| | | | - Amanda Clifford
- School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | | |
Collapse
|
47
|
Abstract
OBJECTIVES We draw on institutional theory to explore the roles and actions of innovation teams and how this influences their behaviour and capabilities as 'institutional entrepreneurs (IEs)', in particular the extent to which they are both 'willing' and 'able' to facilitate transformational change in healthcare through service redesign. DESIGN A longitudinal qualitative study that applied a 'researcher in residence' as an ethnographic approach. SETTING The development and implementation of two innovation projects within a single public hospital setting in an Australian state jurisdiction. PARTICIPANTS Two innovation teams, with members including senior research fellows, PhD scholars and front-line clinicians (19 participants and 47 interviews). RESULTS Despite being from the same hospital, the two innovation teams occupied contrasting subject positions with one facilitating transformational improvements in service delivery, while the other sought more conservative improvements. Cast as 'IEs' we show how one team took steps to build legitimacy for their interventions enabling spread and scale in improvements and how, in the other case, failure to build legitimacy resulted in unintended consequences which undermined the sustainability of the improvements achieved. CONCLUSIONS Adopting an institutional approach provided insight into the 'willingness' and 'ability' to facilitate transformational change in healthcare through service redesign. The manner in which innovation teams operate from different subject positions influences the structural and normative legitimacy afforded to their activities. Specifically, we observed that those with the most power (organisational or professional) to bring about transformational change can be the least willing to do so in ways which challenge current practice. Those most willing to challenge the status quo (more peripheral organisation members or professionals) can be least able to deliver transformation. Better understanding of these insights can inform healthcare leaders in supporting innovation team efforts, considering their subject position.
Collapse
Affiliation(s)
- Angela Melder
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Ian Mcloughlin
- Monash Business School, Monash University, Clayton, Victoria, Australia
| | - Tracy Robinson
- School of Nursing, Paramedicine and Healthcare Science, Charles Sturt University, Albury, New South Wales, Australia
| | - Rick Iedema
- Centre for Team Based Practice & Learning in Health Care, King's College, London, UK
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
48
|
Zhang B, Yue J, Duan Z, Zhao Y, Williams S, Huang L, Zhang X, Wu W, Zhang L, Liu J, Zhao G. Maternal experience of intermittent kangaroo mother care for late preterm infants: a mixed-methods study in four postnatal wards in China. BMJ Open 2021; 11:e050221. [PMID: 34493519 PMCID: PMC8424842 DOI: 10.1136/bmjopen-2021-050221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe how mothers of late preterm infants experienced the provision of intermittent kangaroo mother care (KMC) in four postnatal wards in different hospitals in China, under a pilot KMC project. DESIGN A concurrent mixed-methods approach incorporating quantitative maternal questionnaires and qualitative semistructured interviews. SETTING Four postnatal wards in level-III hospitals based in different provinces of Southeast and Northwest China. PARTICIPANTS All 752 mothers who provided intermittent KMC to their late preterm newborns in the four participating postnatal wards consented to participate in the study (quantitative component), as well as six nurses, two obstetricians and two mothers from two of the participating postnatal wards (qualitative component). OUTCOME MEASURES Maternal KMC experiences during a hospital stay, patients' perceptions of KMC initiation, processes, benefits and challenges. RESULTS Most mothers had not heard of KMC before being introduced to it in the postnatal ward. On average, mothers and newborns stayed in postnatal wards for 3.6 days; during their stay, mothers provided an average of 3.5 KMC sessions, which is an average of 1.1 sessions a day. Each KMC session lasted an average of 68 min, though there was much variation in the length of a session. Common reasons given for discontinuing a KMC session included restroom use, infant crying and perceived time limitations. Some mothers would have preferred to provide KMC for longer periods of time and nurses encouraged this. Most mothers experienced no difficulty providing KMC, received support from family and medical staff and intended to continue with KMC postdischarge. CONCLUSION In order to improve the maternal experience of KMC, it is recommended that raising awareness of KMC should be included in antenatal care and after birth. Longer periods of KMC provision should be encouraged, greater privacy should be provided for mothers providing KMC in postnatal wards and family members should be encouraged to support KMC.
Collapse
Affiliation(s)
- Bo Zhang
- Peking University First Hospital, Beijing, China
| | - Jieya Yue
- Peking University First Hospital, Beijing, China
| | - Zhiying Duan
- Peking University First Hospital, Beijing, China
| | - Yingxi Zhao
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Limin Huang
- Hunan Provincial Maternal and Child Health Hospital, Hunan, China
| | - Xiaoqin Zhang
- Northwest Women & Children Hospital Department of Obstetrics, Shaanxi, China
| | - Wenli Wu
- Linyi Maternity and Child Health Hospital, Shandong, China
| | | | - Jun Liu
- Peking University First Hospital, Beijing, China
| | - Gengli Zhao
- Peking University First Hospital, Beijing, China
| |
Collapse
|
49
|
Abstract
OBJECTIVE Overview on risks of acupuncture-related adverse events (AEs). DESIGN Systematic review and meta-analyses of prospective studies. DATA SOURCES PubMed, Scopus and Embase from inception date to 15 September 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Prospective studies assessing AEs caused by needle acupuncture in humans as primary outcome published in English or German. DATA EXTRACTION AND SYNTHESIS Two independent researchers selected articles, extracted the data and assessed study quality. Overall risks and risks for different AE categories were obtained from random effects meta-analyses. MAIN OUTCOMES Overall risk of minor AEs and serious adverse events (SAEs) per patients and per treatments. RESULTS A total of 7679 publications were identified. Twenty-two articles reporting on 21 studies were included. Meta-analyses suggest at least one AE occurring in 9.31% (95% CI 5.10% to 14.62%, 11 studies) of patients undergoing an acupuncture series and in 7.57% (95% CI 1.43% to 17.95%, 5 studies) of treatments. Summary risk estimates for SAEs were 1.01 (95% CI 0.23 to 2.33, 11 studies) per 10 000 patients and 7.98 (95% CI 1.39 to 20.00, 14 studies) per one million treatments, for AEs requiring treatment 1.14 (95% CI 0.00 to 7.37, 8 studies) per 1000 patients. Heterogeneity was substantial (I2 >80%). On average, 9.4 AEs occurred in 100 treatments. Half of the AEs were bleeding, pain or flare at the needle site that are argued to represent intended acupuncture reaction. AE definitions and assessments varied largely. CONCLUSION Acupuncture can be considered among the safer treatments in medicine. SAEs are rare, and the most common minor AEs are very mild. AEs requiring medical management are uncommon but necessitate medical competence to assure patient safety. Clinical and methodological heterogeneity call for standardised AE assessments tools, clear criteria for differentiating acupuncture-related AEs from therapeutically desired reactions, and identification of patient-related risk factors for AEs. PROSPERO REGISTRATION NUMBER CRD42020151930.
Collapse
Affiliation(s)
- Petra Bäumler
- Multidisciplinary Pain Centre, Department of Anaesthesiology, University Hospital LMU Munich, Munich, Germany
| | - Wenyue Zhang
- School of Acupuncture, Moxibustion and Tuina, Beijing Rehabilitation Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Theresa Stübinger
- Multidisciplinary Pain Centre, Department of Anaesthesiology, University Hospital LMU Munich, Munich, Germany
| | - Dominik Irnich
- Multidisciplinary Pain Centre, Department of Anaesthesiology, University Hospital LMU Munich, Munich, Germany
| |
Collapse
|
50
|
Randell R, Wright JM, Alvarado N, Healey F, Dowding D, Smith H, Hardiker N, Gardner P, Ward S, Todd C, Zaman H, McVey L, Davey CJ, Woodcock D. What supports and constrains the implementation of multifactorial falls risk assessment and tailored multifactorial falls prevention interventions in acute hospitals? Protocol for a realist review. BMJ Open 2021; 11:e049765. [PMID: 34475173 PMCID: PMC8413962 DOI: 10.1136/bmjopen-2021-049765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Falls are the most common type of safety incident reported by acute hospitals and can cause both physical (eg, hip fractures) and non-physical harm (eg, reduced confidence) to patients. It is recommended that, in order to prevent falls in hospital, patients should receive a multifactorial falls risk assessment and be provided with a multifactorial intervention, tailored to address the patient's identified individual risk factors. It is estimated that such an approach could reduce the incidence of inpatient falls by 25%-30% and reduce the annual cost of falls by up to 25%. However, there is substantial unexplained variation between hospitals in the number and type of assessments undertaken and interventions implemented. METHODS AND ANALYSIS A realist review will be undertaken to construct and test programme theories regarding (1) what supports and constrains the implementation of multifactorial falls risk assessment and tailored multifactorial falls prevention interventions in acute hospitals; and (2) how, why, in what contexts and for whom tailored multifactorial falls prevention interventions lead to a reduction in patients' falls risk. We will first identify stakeholders' theories concerning these two topics, searching Medline (1946-present) and Medline In-Process & Other Non-Indexed Citations, Health Management Information Consortium (1983-present) and CINAHL (1981-present). We will then test these theories systematically, using primary studies to determine whether empirical evidence supports, refutes or suggests a revision or addition to the identified theories. ETHICS AND DISSEMINATION The study does not require ethical approval. The review will provide evidence for how to implement multifactorial falls risk assessment and prevention strategies in acute hospital settings. This will be disseminated to academic and clinical audiences and will provide the basis for a future multi-site study through which the theories will be further refined. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020184458.
Collapse
Affiliation(s)
- Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Judy M Wright
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Natasha Alvarado
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | | | - Dawn Dowding
- Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, UK
| | - Heather Smith
- Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Hardiker
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Peter Gardner
- Wolfson Centre for Applied Health Research, Bradford, UK
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Sue Ward
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Chris Todd
- Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, UK
| | - Hadar Zaman
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Lynn McVey
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | | | - David Woodcock
- Faculty of Health Studies, University of Bradford, Bradford, UK
| |
Collapse
|