Expert consultation using the on-line Delphi method for the revision of syndromic groups compiled from emergency data (SOS Médecins and OSCOUR®) in France

Background

Consultation data from emergency general practitioners known as SOS Médecins and emergency departments (ED) from OSCOUR® network to the French syndromic surveillance system SurSaUD® (Surveillance sanitaire des urgences et décès). These data are aggregated and monitored on a daily basis through groupings of one or more medical symptoms or diagnoses (“syndromic groups” (SG)).

The objective of this study was to evaluate, revise and enrich the composition of SGs through a consensus of experts who contributed or have experience in syndromic surveillance.

Methods

Three rounds of a Delphi survey were organised, involving 15 volunteers from SOS Médecins and 64 ED physicians in the OSCOUR® network as well as 8 international epidemiologists. Thirty-four SOS Médecins and 40 OSCOUR® SGs covering major medical specialities were put to the experts, along with their diagnostic codes and their surveillance objectives. In each round, the experts could retain or reject the codes according to the surveillance objective. The panel could also put forward new diagnostic codes in the 1st round, included in subsequent rounds. Consensus was reached for a code if 80% of participants had chosen to keep it, or less than 20% to reject it.

Results

A total of 12 SOS Médecins doctors (80%), 30 ED doctors (47%) and 4 international experts (50%) participated in the three rounds. All of the SGs presented to the panel included 102 initial diagnostic codes and 73 additional codes for SOS Médecins, 272 initial diagnostic codes and 204 additional codes for OSCOUR®. At the end of the 3 rounds, 14 SOS Médecins (40%) and 11 OSCOUR® (28%) SGs achieved a consensus to maintain all of their diagnostic codes. Among these, indicators of winter seasonal surveillance (bronchiolitis and gastroenteritis) were included.

Conclusion

This study involved a panel of national experts with international representation and a good level of involvement throughout the survey. In the absence of a standard definition, the Delphi method has been shown to be useful in defining and validating syndromic surveillance indicators.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14157-x.

Impact of Continuing Care on Recovery From Substance Use Disorder

Continuing care is widely believed to be an important component of effective treatment for substance use disorder, particularly for those individuals with greater problem severity. The purpose of this review was to examine the research literature on continuing care for alcohol and drug use disorders, including studies that addressed efficacy, moderators, mechanisms of action, and economic impact. This narrative review first considered findings from prior reviews (published through 2014), followed by a more detailed examination of studies published more recently. The review found that research has generally supported the efficacy of continuing care for both adolescents and adults, but the picture is complex. Reviews find relatively small effects when results from individual studies are combined. However, continuing care of longer duration that includes more active efforts to keep patients engaged may produce more consistently positive results. Moreover, patients at higher risk for relapse may benefit to a greater degree from continuing care. Several newer approaches for the provision of continuing care show promise. These include incentives for abstinence and automated mobile health interventions to augment more conventional counselor-delivered interventions. Primary care can be used to provide medications for opioid and alcohol use disorders over extended periods, although more research is needed to determine the optimal mix of behavioral treatments and other psychosocial services in this setting. Regardless of the intervention selected for use, the status of most patients will change and evolve over time, and interventions need to include provisions to assess patients on a regular basis and to change or adapt treatment when warranted.

[Quality of treatment outcomes in alcohol- and substance-related disorders: an evaluation of inpatients from ten psychiatric hospitals]

AIM OF THE STUDY

Alcohol and substance-related disorders (ICD 10 F1x.x) are among the most frequent diagnoses made in hospitalized patients requiring somatic and psychiatric care. In order to assess the success of treatment, it is important to establish and implement outcome indicators in practice.

METHOD

In 2016, global treatment indicators for admission and at discharge were collected at 10 Vitos clinics in Hesse (CGI and GAF). More than 10,000 patients with ICD10 F1x diagnoses were included in the evaluation.

RESULTS

The evaluations show significant improvements of the clinical status as well as differences in treatment duration, remissions and gender differences.

CONCLUSION

The study suggests that global indicators of outcome quality are useful in the assessment of treatment success of alcohol and substance-related disorders. Limitations of the study design, instruments and sample are critically reviewed.

Quality Indicators in Care of Patients With Atopic Dermatitis: Consensus Document of the Spanish Academy of Dermatology and Venereology

No information is currently available on whether the available clinical practice guidelines on the management of atopic dermatitis are known or being applied in Spain. The aim of this study was to improve the care of patients with atopic dermatitis by developing a set of quality indicators based on existing clinical practice guidelines. Relevant clinical practice guidelines identified through a literature search were submitted to a panel of 11 specialists, who selected the highest quality guidelines using the AGREE (Appraisal of Guidelines for Research & Evaluation) II instrument. The panel then defined a subset of the recommendations supported by a high level of evidence and proposed a health care quality indicator for each one together with a standard for measuring degree of adherence. Consensus was achieved on 21 of the 150 proposed indicators using the modified Delphi method. The aim of implementing the indicators that achieved consensus in this study is to standardize the actions of health professionals providing care for patients with atopic dermatitis and ultimately to improve the quality of the care delivered.

Primary health care quality indicators: An umbrella review

Nowadays, evaluating the quality of health services, especially in primary health care (PHC), is increasingly important. In a historical perspective, the Department of Health (United Kingdom) developed and proposed a range of indicators in 1998, and lately several health, social and political organizations have defined and implemented different sets of PHC quality indicators. Some systematic reviews in PHC quality indicators are reported but only in specific contexts and conditions. The aim of this study is to characterize and provide a list of indicators discussed in the literature to support managers and clinicians in decision-making processes, through an umbrella review on PHC quality indicators. The methodology was performed according to PRISMA Statement. Indicators from 33 eligible systematic reviews were categorized according to the dimensions of care, function, type of care, domains and condition contexts. Of a total of 727 indicators or groups of indicators, 74.5% (n = 542) were classified in process category and 89.5% (n = 537) with chronic type of care (n = 428; 58.8%) and effective domain (n = 423; 58.1%) with the most frequent values in categorizations by dimensions. The results of this overview of reviews are valuable and imply the need for future research and practice regarding primary health care quality indicators in the most varied conditions and contexts to generate new discussions about their use, comparison and implementation.