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Masava B, Nyoni CN, Botma Y. Usability of Standards for Scaffolding in a Health Sciences Programme: A feasibility Study. BMC Nurs 2024; 23:309. [PMID: 38715024 PMCID: PMC11075252 DOI: 10.1186/s12912-024-01975-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Standards contribute to comprehensive and programmatic implementation of educational strategies, such as scaffolding. Although the development of educational standards follows a rigorous consensus approach, they are socially constructed and could result in varied interpretations by users. Reports of varied implementation of standards in health professions education underscore the need to test the developed standards for scaffolding in health sciences programmes. Usability entails determining whether a product like standards works as intended under the expected conditions and contexts. This study aimed to describe the usability of standards for scaffolding in a health sciences programme through a pilot study. METHODS A multi-method design employing user and expert-based usability evaluation techniques sought to describe the usability of the standards for scaffolding in a three-year pre-registration nursing programme. The user sample of nurse educators drawn from the programme, conducted a self-assessment on scaffolding practices in the programme using a developed standards checklist. For the expert sample, three-panel members with an understanding of the discipline and programme context were purposively sampled. These panelists studied the users' self-assessment reports before completing an author-generated heuristics checklist to support or refute any of the standards. Descriptive statistics, comparative and content analysis were applied to analyse data from users' interviews and expert's completed heuristics checklist, determining the standards' usability, and identifying the usability flaws or strengths. RESULTS The users had three or more years of teaching experience in the competency-based curriculum for nursing. The experts shared an average of 16 years of experience in teaching in higher education, and seven years of experience in quality assurance and programme accreditation. The four standards had a usability score of above average (68%). Seven usability strengths and four usability flaws were identified. Usability flaws related to misinterpretation of some criteria statements and terminologies, multiple meanings, and users' challenges in generating evidence for some criteria. CONCLUSIONS The pilot study revealed the context-based 'truth' regarding the fidelity of a health sciences programme evaluation on scaffolding, as well as identifying the ideal contextual conditions in which the standards for scaffolding health sciences programmes would work best. The identified usability flaws highlighted the need for further revisions of the standards. Future research on the feasibility of the standards in other health sciences programmes and contexts is recommended.
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Affiliation(s)
- Beloved Masava
- School of Nursing, University of the Free State, P.O. Box 339, 9300, Bloemfontein, South Africa.
| | - Champion N Nyoni
- School of Nursing, University of the Free State, P.O. Box 339, 9300, Bloemfontein, South Africa
| | - Yvonne Botma
- School of Nursing, University of the Free State, P.O. Box 339, 9300, Bloemfontein, South Africa
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Oyugi B, Audi-Poquillon Z, Kendall S, Peckham S. Examining the quality of care across the continuum of maternal care (antenatal, perinatal and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya: a mixed-methods study. BMJ Open 2024; 14:e082011. [PMID: 38697765 PMCID: PMC11086406 DOI: 10.1136/bmjopen-2023-082011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Kenya still faces the challenge of mothers and neonates dying from preventable pregnancy-related complications. The free maternity policy (FMP), implemented in 2013 and expanded in 2017 (Linda Mama Policy (LMP)), sought to address this challenge. This study examines the quality of care (QoC) across the continuum of maternal care under the LMP in Kenya. METHODS We conducted a convergent parallel mixed-methods study across multiple levels of the Kenyan health system, involving key informant interviews with national stakeholders (n=15), in-depth interviews with county officials and healthcare workers (HCWs) (n=21), exit interview survey with mothers (n=553) who utilised the LMP delivery services, and focus group discussions (n=9) with mothers who returned for postnatal visits (at 6, 10 and 14 weeks). Quantitative data were analysed descriptively, while qualitative data were analysed thematically. All the data were triangulated at the analysis and discussion stage using a framework approach guided by the QoC for maternal and newborns. RESULTS The results showed that the expanded FMP enhanced maternal care access: geographical, financial and service utilisation. However, the facilities and HCWs bore the brunt of the increased workload and burnout. There was a longer waiting time for the initial visit by the pregnant women because of the enhanced antenatal care package of the LMP. The availability and standards of equipment, supplies and infrastructure still posed challenges. Nurses were multitasking and motivated despite the human resources challenge. Mothers were happy to have received care information; however, there were challenges regarding respect and dignity they received (inadequate food, over-crowding, bed-sharing and lack of privacy), and they experienced physical, verbal and emotional abuse and a lack of attention/care. CONCLUSIONS Addressing the negative aspects of QoC while strengthening the positives is necessary to achieve the Universal Health Coverage goals through better quality service for every woman.
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Affiliation(s)
- Boniface Oyugi
- Western Heights, The Mint Nairobi, M and E Advisory Group, Nairobi, Kenya
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Zilper Audi-Poquillon
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
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Giese A, Khanam R, Nghiem S, Staines A, Rosemann T, Boes S, Havranek MM. Assessing the excess costs of the in-hospital adverse events covered by the AHRQ's Patient Safety Indicators in Switzerland. PLoS One 2024; 19:e0285285. [PMID: 38315675 PMCID: PMC10843032 DOI: 10.1371/journal.pone.0285285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/19/2023] [Indexed: 02/07/2024] Open
Abstract
There currently exists no comprehensive and up-to date overview on the financial impact of the different adverse events covered by the Patient Safety Indicators (PSIs) from the Agency for Healthcare Research and Quality. We conducted a retrospective case-control study using propensity score matching on a national administrative data set of 1 million inpatients in Switzerland to compare excess costs associated with 16 different adverse events both individually and on a nationally aggregated level. After matching 8,986 cases with adverse events across the investigated PSIs to 26,931 controls, we used regression analyses to determine the excess costs associated with the adverse events and to control for other cost-related influences. The average excess costs associated with the PSI-related adverse events ranged from CHF 1,211 (PSI 18, obstetric trauma with instrument) to CHF 137,967 (PSI 10, postoperative acute kidney injuries) with an average of CHF 27,409 across all PSIs. In addition, adverse events were associated with 7.8-day longer stays, 2.5 times more early readmissions (within 18 days), and 4.1 times higher mortality rates on average. At a national level, the PSIs were associated with CHF 347 million higher inpatient costs in 2019, which corresponds to about 2.2% of the annual inpatient costs in Switzerland. By comparing the excess costs of different PSIs on a nationally aggregated level, we offer a financial perspective on the implications of in-hospital adverse events and provide recommendations for policymakers regarding specific investments in patient safety to reduce costs and suffering.
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Affiliation(s)
- Alice Giese
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Rasheda Khanam
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Son Nghiem
- College of Health & Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anthony Staines
- IFROSS Institute, University of Lyon III, Lyon, France
- Hospital Federation of Vaud, Prilly, Vaud, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Stefan Boes
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Michael M. Havranek
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Mosqueiro BP, Costa MDA, Caribé AC, Oliveira e Oliveira FH, Pizutti L, Zimpel RR, Baldaçara L, da Silva AG, Moreira-Almeida A. Brazilian Psychiatric Association guidelines on the integration of spirituality into mental health clinical practice: Part 1. Spiritual history and differential diagnosis. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 45:506-517. [PMID: 37718460 PMCID: PMC10897776 DOI: 10.47626/1516-4446-2023-3056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/25/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To present evidence-based guidelines for clinical practice regarding religiosity and spirituality in mental health care in Brazil. METHODS A systematic review was conducted to identify potentially eligible articles indexed in the PubMed, PsycINFO, SciELO, LILACS, and Cochrane databases. A summary of recommendations and their levels of evidence was produced in accordance with Oxford Centre for Evidence-Based Medicine guidelines. RESULTS The systematic review identified 6,609 articles, 41 of which satisfied all inclusion criteria. Taking a spiritual history was found to be an essential part of a compassionate and culturally sensitive approach to care. It represents a way of obtaining relevant information about the patient's religiosity/spirituality, potential conflicts that could impact treatment adherence, and improve patient satisfaction. Consistent evidence shows that reported perceptual experiences are unreliable for differentiating between anomalous experiences and psychopathology. Negative symptoms, cognitive and behavioral disorganization, and functional impairment are more helpful for distinguishing pathological and non-pathological anomalous experiences. CONCLUSION Considering the importance of religiosity/spirituality for many patients, a spiritual history should be routinely included in mental health care. Anomalous experiences are highly prevalent, requiring a sensitive and evidence-based approach to differential diagnosis.
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Affiliation(s)
- Bruno Paz Mosqueiro
- Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
| | - Marianna de Abreu Costa
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES), Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - André C. Caribé
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
- Hospital Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Fabrício H.A. Oliveira e Oliveira
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES), Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Leandro Pizutti
- Departamento de Psiquiatria e Espiritualidade, Associação de Psiquiatria do Rio Grande do Sul (APRS), Porto Alegre, RS, Brazil
| | - Rogério R. Zimpel
- Departamento de Psiquiatria e Espiritualidade, Associação de Psiquiatria do Rio Grande do Sul (APRS), Porto Alegre, RS, Brazil
| | - Leonardo Baldaçara
- Universidade Federal do Tocantins, Palmas, TO, Brazil
- ABP, Rio de Janeiro, RJ, Brazil
| | - Antônio Geraldo da Silva
- ABP, Rio de Janeiro, RJ, Brazil
- Asociación Psiquiátrica de América Latina, Santo Domingo, Dominican Republic
| | - Alexander Moreira-Almeida
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES), Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
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Lizán Tudela C, Cuevas Sáiz I, Abad de Velasco L, Gregori Navarro L, Comellas M, Pérez-Sádaba FJ, Lizán L. The Perspective of Patients and Health Professionals on the Prioritization of Assisted Reproductive Techniques. The PRIOFER Study. Patient Prefer Adherence 2023; 17:2641-2653. [PMID: 37927341 PMCID: PMC10624199 DOI: 10.2147/ppa.s421041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose To determine the perspective of patients and professionals in Assisted Reproduction Units (ARU) on the importance of assisted reproductive techniques (ART) compared to other elective procedures, to highlight the relevance of ART as an elective procedure and the impact of delayed interventions on patients. Design Patients and Methods An observational, descriptive, cross-sectional, online survey-based study was conducted in infertility patients and partners (n=98) and ARU healthcare professionals (n=83). The survey included a best-worst scaling (BWS) experiment and an ad-hoc questionnaire to analyze the pandemic impact on ART management and infertility patients in Spain. In the BWS, each respondent established priorities choosing which patient profile should be rated as the highest and lowest priority profile on a waiting list. To understand the importance that they give to assisted reproduction compared to other procedures, three very common elective procedures involving different patient profiles were selected: cataract surgery, knee arthroplasty, and varicose vein surgery. For each procedure, three hypothetical patient profiles corresponding to three different degrees of severity on a waiting list were designed. Results Patients attributed greater importance to ART profiles (BWS score: patients 0.14 vs professionals -0.05; p<0.01) whereas professionals prioritized cataract surgery (patients 0.06 vs professionals 0.23; p<0.01). Concerning the profile severity, more severe profiles were prioritized in all procedures by both groups. Patients' and professionals' perspectives on the impact of the pandemic were similar, with exceptions: information received for resuming ART; health care provision in crisis situations; and reduction of parenting options. The pandemic affected patients' ability to conceive a child (70.4% of those surveyed), their psychological well-being (75.5%), and partner, social, and work relationships (69.4%). Conclusion Preference studies involving patients and professionals can provide important information to define framework criteria for the management of waiting lists for elective procedures, and to prioritize interventions during pandemic periods. The pandemic impact on infertility patients highlights the relevance of developing measures and strategies to cope with similar future situations in the most appropriate way.
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Affiliation(s)
- César Lizán Tudela
- Department of Paediatrics, Obstetrics and Gynaecology, Hospital Clínico Universitario, Valencia, 46010, Spain
| | - Irene Cuevas Sáiz
- Department of Paediatrics, Obstetrics and Gynaecology, Consorcio Hospital General Universitario de Valencia, Valencia, 46014, Spain
| | - Lorenzo Abad de Velasco
- Department of Paediatrics, Obstetrics and Gynaecology, Consorcio Hospital General Universitario de Valencia, Valencia, 46014, Spain
| | - Laura Gregori Navarro
- Department of Paediatrics, Obstetrics and Gynaecology, Hospital Clínico Universitario, Valencia, 46010, Spain
| | | | | | - Luis Lizán
- Outcomes 10 SLU, Castellón de la Plana, Spain
- Department of Medicine, Jaume I University, Castellón de la Plana, Spain
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Karalliedde J, French O, Burnhill G, Malhotra B, Spellman C, Jessel M, Ayotunde A, Newcombe L, Smith A, Thomas S, Rajasingam D. A pragmatic digital health informatics based approach for aiding clinical prioritisation and reducing backlog of care: A study in cohort of 4022 people with diabetes. Diabetes Res Clin Pract 2023; 203:110834. [PMID: 37478978 DOI: 10.1016/j.diabres.2023.110834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/17/2023] [Accepted: 07/17/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND AND AIMS The backlog of care in resource stretched healthcare systems requires innovative approaches to aid clinical prioritisation. Our aim was to develop an informatics tool to identify and prioritise people with diabetes who are likely to deteriorate whilst awaiting an appointment to optimise clinical outcomes and resources. MATERIALS AND METHODS Using data from electronic health care records we identified 6 risk-factors that could be addressed in 4022 people (52% male, 30% non-Caucasian) with diabetes attending a large university hospital in London. The risk-factors were new clinical events/data occurring since their last routine clinic visit. To validate and compare data-led prioritisation tool to a traditional 'clinical approach' a sample of 450 patients were evaluated. RESULTS Of the 4022 people, 549 (13.6%) were identified as having one or more risk events/factors. People with risk were more likely to be non-Caucasian and had greater socio-economic deprivation. Taking clinical prioritisation as the gold standard, informatics tool identified high risk patients with a sensitivity of 83% and lower risk patients with a specificity of 81%. An operational pilot pathway over 3 months using this approach demonstrated in 101 high risk people that 40% received interventions/care optimisation to prevent deterioration in health. CONCLUSION A pragmatic data-driven method identifies people with diabetes at highest need for clinical prioritisation within restricted resources. Health informatics systems such as our can enhance care and improve operational efficiency and better healthcare delivery for people with diabetes.
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Affiliation(s)
- J Karalliedde
- Guy's & St Thomas' NHS Foundation Trust London UK; School of Cardiovascular Medicine and Sciences, King's College London, London UK.
| | - O French
- Factor 50 Limited, Nottingham UK
| | | | - B Malhotra
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - C Spellman
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - M Jessel
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - A Ayotunde
- Guy's & St Thomas' NHS Foundation Trust London UK
| | | | - A Smith
- Factor 50 Limited, Nottingham UK
| | - S Thomas
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - D Rajasingam
- Guy's & St Thomas' NHS Foundation Trust London UK
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Powers J, McGree JM, Grieve D, Aseervatham R, Ryan S, Corry P. Managing surgical waiting lists through dynamic priority scoring. Health Care Manag Sci 2023; 26:533-557. [PMID: 37378722 PMCID: PMC10484819 DOI: 10.1007/s10729-023-09648-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/01/2023] [Indexed: 06/29/2023]
Abstract
Prioritising elective surgery patients under the Australian three-category system is inherently subjective due to variability in clinician decision making and the potential for extraneous factors to influence category assignment. As a result, waiting time inequities can exist which may lead to adverse health outcomes and increased morbidity, especially for patients deemed to be low priority. This study investigated the use of a dynamic priority scoring (DPS) system to rank elective surgery patients more equitably, based on a combination of waiting time and clinical factors. Such a system enables patients to progress on the waiting list in a more objective and transparent manner, at a rate relative to their clinical need. Simulation results comparing the two systems indicate that the DPS system has potential to assist in managing waiting lists by standardising waiting times relative to urgency category, in addition to improving waiting time consistency for patients of similar clinical need. In clinical practice, this system is likely to reduce subjectivity, increase transparency, and improve overall efficiency of waiting list management by providing an objective metric to prioritise patients. Such a system is also likely to increase public trust and confidence in the systems used to manage waiting lists.
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Affiliation(s)
- Jack Powers
- School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, 2 George St, Brisbane, QLD, 4000, Australia.
- Centre for Data Science, Queensland University of Technology, 2 George St, Brisbane, QLD, 4000, Australia.
| | - James M McGree
- School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, 2 George St, Brisbane, QLD, 4000, Australia
- Centre for Data Science, Queensland University of Technology, 2 George St, Brisbane, QLD, 4000, Australia
| | - David Grieve
- Department of General Surgery, Surgical and Critical Care Directorate, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, QLD, 4575, Australia
- School of Medicine, Griffith University, 6 Doherty Street, Birtinya, 4575, QLD, Australia
| | - Ratna Aseervatham
- Department of General Surgery, Surgical and Critical Care Directorate, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, QLD, 4575, Australia
| | - Suzanne Ryan
- Department of General Surgery, Surgical and Critical Care Directorate, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, QLD, 4575, Australia
| | - Paul Corry
- School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, 2 George St, Brisbane, QLD, 4000, Australia
- Centre for Data Science, Queensland University of Technology, 2 George St, Brisbane, QLD, 4000, Australia
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Ghorbani S, Rezapour A, Eisavi M, Barahman M, Bagheri Faradonbeh S. Cost-benefit Analysis of Breast Cancer Screening with Digital Mammography: A Systematic Review. Med J Islam Repub Iran 2023; 37:89. [PMID: 37750094 PMCID: PMC10518066 DOI: 10.47176/mjiri.37.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Indexed: 09/27/2023] Open
Abstract
Background Breast cancer is a non-communicable and common disease that accounts for a high percentage of deaths. Early diagnosis of this disease reduces the death rate. Screening methods such as digital mammography can help prevent or identify the disease earlier. Therefore, this study aims to analyze the cost-benefit of breast cancer using digital mammography. Methods This systematic review was conducted based on PRISMA 2020 checklist. PubMed, Scopus, Web of Science, ProQuest, Cochrane Library, and Google Scholar were searched without any time limitation on June 2022. The quality of the studies was evaluated with the CHEERS checklist. After data extraction, the results were synthesized by thematic content analysis. Results During the search, 3468 records were identified, of which 1061 were duplicates. 2407 titles and abstracts screened in terms of inclusion criteria. Finally, after studying 20 fulltexts, three of them were included in the study. The quality of these articles was scored between 10 and 16. These studies were from Spain, Denmark, and the United States from 2000 to 2019. Two studies showed that digital mammography is not as effective as other screening methods. Conclusion The results of this study showed that digital mammography is not very cost-benefit for the health care system. An increase in its repetition frequency imposes more costs on the health system and doesn't have more benefits for it.
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Affiliation(s)
- Salar Ghorbani
- Department of Health Economics, School of Health Management and Information
Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research
Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Eisavi
- Department of Economics, Faculty of Economics, Allameh Tabatabai University,
Tehran, Iran
| | - Maedeh Barahman
- Department of Radiotherapy, School of Medicine, Firoozgar General Hospital, Iran
University of Medical Sciences, Tehran, Iran
| | - Saeed Bagheri Faradonbeh
- Department of Healthcare Services Management, School of Health, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran
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Hailemariam T, Yimer G, Mohammed H, Bisrat H, Ajeme T, Belina M, Oljira L, Roba KT, Belay F, Andrias T, Ngadaya E, Manyazewal T. Chest X-ray predicts cases of pulmonary tuberculosis among women of reproductive age with acute respiratory symptoms: A multi-center cross-sectional study. J Clin Tuberc Other Mycobact Dis 2023; 32:100383. [PMID: 37389013 PMCID: PMC10302112 DOI: 10.1016/j.jctube.2023.100383] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Background Tuberculosis (TB) prevalence is increasing among women of reproductive age (WRA) in sub-Saharan Africa, yet undiagnosed and untreated cases remain rather high with serious health and socio-economic consequences. We aimed to assess the prevalence and predictors of TB in WRA seeking health care for acute respiratory symptoms. Methods We consecutively enrolled outpatient WRA with acute respiratory symptoms seeking care at four healthcare facilities in Ethiopia between July 2019 and December 2020. Data on sociodemographic characteristics and clinical information were collected using a structured questionnaire administered by trained nurses. Posteroanterior chest X-ray was performed in non-pregnant WRA and interpreted independently by two radiologists. Sputum samples were collected from all patients and tested for pulmonary TB using Xpert MTB/RIF and/or smear microscopy. Predictors of bacteriologically confirmed TB cases were determined using binary logistic regression, with clinically relevant variables included in the final Firth's multivariate-penalized logistic regression model. Results We enrolled 577 participants, of whom 95 (16%) were pregnant, 67 (12%) were living with HIV, 512 (89%) had cough of less than 2 weeks, and 56 (12%) had chest-x-ray findings suggestive of TB. The Overall prevalence of TB was 3% (95% CI: 1.8%-4.7%) with no significant difference observed between patient groups categorized by duration of cough or HIV serostatus (P-value = 0.9999). In multivariable analysis, TB-suggestive CXR abnormality (AOR 18.83 [95% CI, 6.20-57.18]) and history of weight loss (AOR 3.91 [95% CI, 1.25-12.29]) were associated with bacteriologically-confirmed TB cases. Conclusions We found a high TB prevalence among low-risk women of reproductive age with acute respiratory symptoms. Routine CXR may improve early case detection and thereby TB treatment outcomes.
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Affiliation(s)
- Tesfahunegn Hailemariam
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Getnet Yimer
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Center for Global Genomics and Health Equity, Department of Genetics, Perelman School of Medicine, University of Pennsylvania, USA
| | - Hussen Mohammed
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Haileleul Bisrat
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Tigist Ajeme
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Merga Belina
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekadu Belay
- Wachemo University, College of Medicine and Health Sciences, Department of Pediatrics and Child Health, Hossana, Ethiopia
| | | | - Esther Ngadaya
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Saalam, Tanzania
| | - Tsegahun Manyazewal
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
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Sun K, Tan JY, Thomson PJ, Choi SW. Influence of time between surgery and adjuvant radiotherapy on prognosis for patients with head and neck squamous cell carcinoma: A systematic review. Head Neck 2023; 45:2108-2119. [PMID: 37194205 DOI: 10.1002/hed.27401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 02/06/2023] [Accepted: 04/30/2023] [Indexed: 05/18/2023] Open
Abstract
The timing of postoperative radiotherapy following surgical intervention in patients with head and neck cancer remains a controversial issue. This review aims to summarize findings from available studies to investigate the influence of time delays between surgery and postoperative radiotherapy on clinical outcomes. Articles between 1 January 1995 and 1 February 2022 were sourced from PubMed, Web of Science, and ScienceDirect. Twenty-three articles met the study criteria and were included; ten studies showed that delaying postoperative radiotherapy might negatively impact patients and lead to a poorer prognosis. Delaying the start time of radiotherapy, 4 weeks after surgery did not result in poorer prognoses for patients with head and neck cancer, although delays beyond 6 weeks might worsen patients' overall survival, recurrence-free survival, and locoregional control. Prioritization of treatment plans to optimize the timing of postoperative radiotherapy regimes is recommended.
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Affiliation(s)
- Kaiyuan Sun
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Jia Yan Tan
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Peter James Thomson
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Siu-Wai Choi
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pokfulam, Hong Kong, China
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11
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Kaneko M, Ikeda T, Inoue M, Sugiyama K, Saito M, Ohta R, Cooray U, Vingilis E, Freeman TR, Mathews M. Development and validation of a rurality index for healthcare research in Japan: a modified Delphi study. BMJ Open 2023; 13:e068800. [PMID: 37336534 DOI: 10.1136/bmjopen-2022-068800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES Rural-urban healthcare disparities exist globally. Various countries have used a rurality index for evaluating the disparities. Although Japan has many remote islands and rural areas, no rurality index exists. This study aimed to develop and validate a Rurality Index for Japan (RIJ) for healthcare research. DESIGN We employed a modified Delphi method to determine the factors of the RIJ and assessed the validity. The study developed an Expert Panel including healthcare professionals and a patient who had expertise in rural healthcare. SETTING The panel members were recruited from across Japan including remote islands, mountain areas and heavy snow areas. The panel recruited survey participants whom the panel considered to have expertise. PARTICIPANTS The initial survey recruited 100 people, including rural healthcare providers, local government staff and residents. PRIMARY OUTCOME MEASURES Factors to include in the RIJ were identified by the Expert Panel and survey participants. We also conducted an exploratory factor analysis on the selected factors to determine the factor structure. Convergent validity was examined by calculating the correlation between the index for physician distribution and the RIJ. Criterion-related validity was assessed by calculating the correlation with average life expectancy. RESULTS The response rate of the final survey round was 84.8%. From the Delphi surveys, four factors were selected for the RIJ: population density, direct distance to the nearest hospital, remote islands and whether weather influences access to the nearest hospital. We employed the factor loadings as the weight of each factor. The average RIJ of every zip code was 50.5. The correlation coefficient with the index for physician distribution was -0.45 (p<0.001), and the correlation coefficients with the life expectancies of men and women were -0.35 (p<0.001) and -0.12 (p<0.001), respectively. CONCLUSION This study developed the RIJ using a modified Delphi method. The index showed good validity.
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Affiliation(s)
- Makoto Kaneko
- Department of Health Data Science, Yokohama City University, Yokohama, Japan
| | - Takaaki Ikeda
- Department of Health Policy Science, Yamagata University, Yamagata, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Machiko Inoue
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kemmyo Sugiyama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | | | - Ryuichi Ohta
- Department of Community Care, Unnan City Hospital, Unnan, Shimane, Japan
| | - Upul Cooray
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Evelyn Vingilis
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Maria Mathews
- Department of Family Medicine, Western University, London, Ontario, Canada
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12
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Ferrari A, Giannini A, Seghieri C, Simoncini T, Vainieri M. Regional practice variation in pelvic organ prolapse surgery in Tuscany, Italy: a retrospective cohort study on administrative health data. BMJ Open 2023; 13:e068145. [PMID: 36882257 PMCID: PMC10008403 DOI: 10.1136/bmjopen-2022-068145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVES To explore determinants of practice variation in both access, and quality and efficiency of surgical care for pelvic organ prolapse (POP). DESIGN AND SETTING A retrospective cohort study employing administrative health data from the Tuscany region, Italy. PARTICIPANTS All women over 40 years hospitalised for apical/multicompartmental POP reconstructive surgery (excluding anterior/posterior colporrhaphy without concomitant hysterectomy) from January 2017 to December 2019. OUTCOMES We first computed treatment rates just for women residing in Tuscany (n=2819) and calculated the Systematic Component of Variation (SCV) to explore variation in access to care among health districts. Then, using the full cohort (n=2959), we ran multilevel models for the average length of stay and reoperations, readmissions and complications, and computed the intraclass correlation coefficient to assess the individual and hospital determinants of efficiency and quality of care provided by hospitals. RESULTS The 5.4-fold variation between the lowest-rate (56/100 000 inhabitants) and the highest-rate (302/100 000) districts and the SCV over 10% confirmed high systematic variation in the access to care. Higher treatment rates were driven by greater provisions of robotic and/or laparoscopic interventions, which showed highly variable usage rates. Both individual and hospital factors influenced quality and efficiency provided by hospitals, but just low proportions of variation were explained by hospital and patient characteristics. CONCLUSIONS We found high and systematic variation in the access to POP surgical care in Tuscany and in quality and efficiency provided by hospitals. Such a variation may be mainly explained by user and provider preferences, which should be further explored. Also, supply-side factors may be involved, suggesting that wider and more uniform dissemination of robotic/laparoscopic procedures may reduce variation.
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Affiliation(s)
- Amerigo Ferrari
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Chiara Seghieri
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Milena Vainieri
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
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Parekh S, Livingstone C, Jani YH. Evaluation of the England Community Pharmacy Quality Scheme (2018-2019 and 2019-2020) in reducing harm from NSAIDs in older patients. BMJ Open Qual 2023; 12:bmjoq-2022-002002. [PMID: 36593072 PMCID: PMC9809222 DOI: 10.1136/bmjoq-2022-002002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/08/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for their analgesic and anti-inflammatory action, but the gastrointestinal (GI) adverse effects are a known cause of preventable harm. A medication safety audit was incentivised for community pharmacies in England in 2 successive years as part of the Pharmacy Quality Scheme (PQS) to address GI safety of NSAIDs. AIMS To evaluate community pharmacy's contributions to NSAID safety and determine any change between audit 1 (2018-2019) and audit 2 (2019-2020). METHOD Patients aged 65 years or over prescribed an NSAID were included in both audits. The audit tool assessed compliance with national standards relating to co-prescribed gastroprotection, referrals to the prescriber and patient advice on long-term NSAID use and effects, with responses submitted via an online portal. Descriptive analyses were performed to explore differences between the years and tested for significance using Χ2 tests. Qualitative data were analysed using an inductive thematic approach. KEY FINDINGS Data from 91 252 patients in audit 1 and 73 992 in audit 2 were analysed. More patients were prescribed gastroprotection in audit 2 (85.0%) than audit 1 (80.7%, p<0.001). More patients without gastroprotection in audit 2 had a current or recent referral (67.5%) than in audit 1 (58.8%, p<0.001). Verbal or other communications between pharmacists and patients about their NSAID medication were reported more frequently in audit 2 (76.0% vs 63.5%, p<0.001). CONCLUSION During two audits, community pharmacists in England reported referring more than 15 000 patients at risk of preventable harm from NSAIDs to prescribers for review. The audits demonstrated significant potential for year-on-year improvement in GI safety for a large cohort of older patients prescribed NSAIDs. This evaluation provides evidence of how the PQS can effectively address a specific aspect of medicines safety and the place of community pharmacy more broadly in improving medicines safety.
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Affiliation(s)
- Sejal Parekh
- Primary, Community and Personalised Care Directorate, NHS England, London, UK
| | - Carina Livingstone
- Primary, Community and Personalised Care Directorate, NHS England, London, UK,Medicines Use and Safety, NHS Specialist Pharmacy Service, Worthing, UK
| | - Yogini H Jani
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK,Department of Practice & Policy, UCL School of Pharmacy, London, UK
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Hoseini Kasnavieh M, Kookli K, Veisi M, Amerzadeh M, Hosseinifar H, Tahmasebi A. Investigating the Rate and Affecting Factors of Unnecessary Cervical Collar Use in Trauma Patients. Bull Emerg Trauma 2023; 11:178-183. [PMID: 38143523 PMCID: PMC10743316 DOI: 10.30476/beat.2023.98793.1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/05/2023] [Accepted: 08/29/2023] [Indexed: 12/26/2023] Open
Abstract
Objective This study aimed to investigate the necessity of cervical collars in patients with neck problems. Methods This cross-sectional study was conducted on 114 patients who were admitted to the Haft Tir and Rasoul Akram Hospitals (Tehran, Iran) from August to September 2022. The Nexus protocol was used to select the patients with cervical collars. According to the protocol, a cervical collar was required for individuals who had at least one symptom. If none of these symptoms existed, the cervical collar was deemed unnecessary. The data were analyzed using the Chi-square test and Fisher's exact test. Results Of the 114 trauma patients, the cervical collar was used unnecessarily by 49 (43%) patients. Tenderness was the most common complication in 62 patients (54.4%). The prevalence of unnecessary cervical collar use was 37.5% in female trauma patients and 43.88% in male trauma patients, which was not statistically significant (p=0.63). The prevalence of unnecessary cervical collar use in trauma patients with multiple trauma was 39.42% and 80% in patients without multiple trauma, which was statistically significant (p=0.018). Patients with a medical history had a higher rate of unnecessary use of the cervical collar (47.96%) than those without a history (12.5%), and this difference was statistically significant (p=0.008). Conclusion The guidelines for using cervical collars need to be updated by the EMS. Due to the large number of trauma patients in Iran, cervical collars for necessary conditions can help to reduce the healthcare expenses and injuries caused by unnecessary cervical collars.
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Affiliation(s)
| | - Keihan Kookli
- International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad Veisi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amerzadeh
- Department of Health Services Management, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hossein Hosseinifar
- Evidence-Based Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Tahmasebi
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
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15
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Brenk-Franz K, Leonhardt LJ, Strauß B. Attachment and patient activation as predictors of the interest and use of telemedical health applications –results of an observational study in primary health care. BMC PRIMARY CARE 2022; 23:96. [PMID: 35488203 PMCID: PMC9052500 DOI: 10.1186/s12875-022-01711-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Telemedicine applications are becoming more accepted and offer great potential to support physicians and patients. However, there is an increasing need for research, especially in personal predictors that determine the interest and use of telemedicine and e-health applications. This study aims to identify if attachment and patient activation are potential predictors of the interest in and the use of e-health applications in primary care patients.
Methods
We used data from the cross-sectional observational Weimar TelMed study on 192 patients treated by general practitioners from a practice of family medicine in Thuringia, the middle of Germany. The adult attachment was measured using the ECR-RD12 and patient activation with the PAM-13D. Multiple regression analysis by the General Linear Model was used to evaluate the association between attachment, patient activation, and interest in and use of e-health applications.
Results
Patient activation was associated with a higher interest in e-health care. The attachment dimension avoidance was a potential predictor of interest in e-health and e-health-care use.
Conclusion
Adult attachment is an essential predictor of different ways of healthcare use. While avoidant patients evade contact with general practitioners, self-determined access via e-health seems to improve the health care of these patients. A personalized view might be a basis for the evaluation of individual approaches in Primary Care.
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16
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Mashkani O, Ernst AT, Thiruvady D, Gu H. Minimizing patients total clinical condition deterioration in operating theatre departments. ANNALS OF OPERATIONS RESEARCH 2022; 328:1-37. [PMID: 36415820 PMCID: PMC9672660 DOI: 10.1007/s10479-022-05046-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
The operating theatre is the most crucial and costly department in a hospital due to its expensive resources and high patient admission rate. Efficiently allocating operating theatre resources to patients provides hospital management with better utilization and patient flow. In this paper, we tackle both tactical and operational planning over short-term to medium-term horizons. The main goal is to determine an allocation of blocks of time on each day to surgical specialties while also assigning each patient a day and an operating room for surgery. To create a balance between improving patients welfare and satisfying the expectations of hospital administrators, we propose six novel deterioration rates to evaluate patients total clinical condition deterioration. Each deterioration rate is defined as a function of the clinical priorities of patients, their waiting times, and their due dates. To optimize the objective functions, we present mixed integer programming (MIP) models and two dynamic programming based heuristics. Computational experiments have been conducted on a novel well-designed and carefully chosen benchmark dataset, which simulates realistic-sized instances. The results demonstrate the capability of the MIP models in finding excellent solutions (maximum average gap of 4.71% across all instances and objective functions), though, requiring large run-times. The heuristic algorithms provide a time-efficient alternative, where high quality solutions can be found in under a minute. We also analyse each objective function's ability in generating high quality solutions from different perspectives such as patients waiting times, the number of scheduled patients, and operating rooms utilization rates. We provide managerial insights to the decision makers in cases where their intention is to meet KPIs and/or maintaining trade-offs between patients and administrators expectations, more fair assignments, or ensuring that the most urgent patients are taken care of first.
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Affiliation(s)
- Omolbanin Mashkani
- School of Mathematical and Physical Sciences, University of Technology Sydney, Ultimo, Sydney, NSW 2000 Australia
| | - Andreas T. Ernst
- School of Mathematics, Monash University, Clayton, Melbourne, VIC 3800 Australia
| | - Dhananjay Thiruvady
- School of Information Technology, Deakin University, Waurn Ponds, Geelong, VIC 3216 Australia
| | - Hanyu Gu
- School of Mathematical and Physical Sciences, University of Technology Sydney, Ultimo, Sydney, NSW 2000 Australia
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17
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Reeve NF, Best V, Gillespie D, Hughes K, Lugg-Widger FV, Cannings-John R, Torabi F, Wootton M, Akbari A, Ahmed H. Myocardial infarction and stroke subsequent to urinary tract infection (MISSOURI): protocol for a self-controlled case series using linked electronic health records. BMJ Open 2022; 12:e064586. [PMID: 36137640 PMCID: PMC9511592 DOI: 10.1136/bmjopen-2022-064586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION There is increasing interest in the relationship between acute infections and acute cardiovascular events. Most previous research has focused on understanding whether the risk of acute cardiovascular events increases following a respiratory tract infection. The relationship between urinary tract infections (UTIs) and acute cardiovascular events is less well studied. Therefore, the aim of this study is to determine whether there is a causal relationship between UTI and acute myocardial infarction (MI) or stroke. METHODS AND ANALYSIS We will undertake a self-controlled case series study using linked anonymised general practice, hospital admission and microbiology data held within the Secure Anonymised Information Linkage (SAIL) Databank. Self-controlled case series is a relatively novel study design where individuals act as their own controls, thereby inherently controlling for time-invariant confounders. Only individuals who experience an exposure and outcome of interest are included.We will identify individuals in the SAIL Databank who have a hospital admission record for acute MI or stroke during the study period of 2010-2020. Individuals will need to be aged 30-100 during the study period and be Welsh residents for inclusion. UTI will be identified using general practice, microbiology and hospital admissions data. We will calculate the incidence of MI and stroke in predefined risk periods following an UTI and in 'baseline' periods (without UTI exposure) and use conditional Poisson regression models to derive incidence rate ratios. ETHICS AND DISSEMINATION Data access, research permissions and approvals have been obtained from the SAIL independent Information Governance Review Panel, project number 0972. Findings will be disseminated through conferences, blogs, social media threads and peer-reviewed journals. Results will be of interest internationally to primary and secondary care clinicians who manage UTIs and may inform future clinical trials of preventative therapy.
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Affiliation(s)
- Nicola F Reeve
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Victoria Best
- Population Data Science, Swansea University Medical School, Swansea, UK
| | | | - Kathryn Hughes
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | | | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Haroon Ahmed
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Bouthillier ME, Perron C, Roigt D, Fortin JS, Pimont M. The Implementation of Assisted Dying in Quebec and Interdisciplinary Support Groups: What Role for Ethics? HEC Forum 2022; 34:355-369. [PMID: 36074196 DOI: 10.1007/s10730-022-09484-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 10/14/2022]
Abstract
The purpose of this text is to tell the story of the implementation of the Act Respecting End-of-Life Care, referred to hereafter as Law 2 (Gouvernement du Québec, 2014) with an emphasis on the ambiguous role of ethics in the Interdisciplinary Support Groups (ISGs), created by Quebec's Ministère de la santé et des services sociaux (MSSS). As established, ISGs provide "clinical, administrative and ethical support to health care professionals responding to a request for Medical aid in dying (MAiD)" (Gouvernement du Québec, 2015). It is suggested that their composition includes the participation of a person with an expertise in ethics. These ISGs represent an important innovation for stakeholders involved in MAiD. To date, no scientific research has specifically addressed ISGs and little research has been conducted in other jurisdictions on the roles, operations and practices of MAiD support structures, especially the implication of ethics. Several ISGs have certainly developed promising practices that could benefit all stakeholders in the wider field of ethics and end of life. We will explore the development of ISGs in Quebec as a support structure for MAiD by highlighting the role that ethics has played (and should play) in these morally and humanly challenging situations.
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Affiliation(s)
- Marie-Eve Bouthillier
- Bureau de l'éthique Clinique et Département de Médecine de Famille et de Médecine d'urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada. .,Centre d'éthique, Direction Qualité, Évaluation, Performance et Éthique, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, Québec, Canada.
| | - Catherine Perron
- Centre d'éthique, Direction Qualité, Évaluation, Performance et Éthique, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, Québec, Canada
| | - Delphine Roigt
- Centre d'éthique, Direction Qualité, Évaluation, Performance et Éthique, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, Québec, Canada
| | - Jean-Simon Fortin
- Centre d'éthique, Direction Qualité, Évaluation, Performance et Éthique, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, Québec, Canada
| | - Michelle Pimont
- Centre d'éthique, Direction Qualité, Évaluation, Performance et Éthique, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, Québec, Canada
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Giosa JL, Saari M, Holyoke P, Hirdes JP, Heckman GA. Developing an evidence-informed model of long-term life care at home for older adults with medical, functional and/or social care needs in Ontario, Canada: a mixed methods study protocol. BMJ Open 2022; 12:e060339. [PMID: 35953249 PMCID: PMC9379487 DOI: 10.1136/bmjopen-2021-060339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [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 The COVID-19 pandemic exacerbated existing challenges within the Canadian healthcare system and reinforced the need for long-term care (LTC) reform to prioritise building an integrated continuum of services to meet the needs of older adults. Almost all Canadians want to live, age and receive care at home, yet funding for home and community-based care and support services is limited and integration with primary care and specialised geriatric services is sparse. Optimisation of existing home and community care services would equip the healthcare system to proactively meet the needs of older Canadians and enhance capacity within the hospital and residential care sectors to facilitate access and reduce wait times for those whose needs are best served in these settings. The aim of this study is to design a model of long-term 'life care' at home (LTlifeC model) to sustainably meet the needs of a greater number of community-dwelling older adults. METHODS AND ANALYSIS An explanatory sequential mixed methods design will be applied across three phases. In the quantitative phase, secondary data analysis will be applied to historical Ontario Home Care data to develop unique groupings of patient needs according to known predictors of residential LTC home admission, and to define unique patient vignettes using dominant care needs. In the qualitative phase, a modified eDelphi process and focus groups will engage community-based clinicians, older adults and family caregivers in the development of needs-based home care packages. The third phase involves triangulation to determine initial model feasibility. ETHICS AND DISSEMINATION This study has received ethics clearance from the University of Waterloo Research Ethics Board (ORE #42182). Results of this study will be disseminated through peer-reviewed publications and local, national and international conferences. Other forms of knowledge mobilisation will include webinars, policy briefs and lay summaries to elicit support for implementation and pilot testing phases.
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Affiliation(s)
- Justine L Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - Margaret Saari
- SE Research Centre, SE Health, Markham, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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20
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Adelabu A, Akinyemi O, Adebayo A, Oladokun B. Assessment of the level and distribution of health system responsiveness in Oyo State, Nigeria. BMC Health Serv Res 2022; 22:905. [PMID: 35831823 PMCID: PMC9281151 DOI: 10.1186/s12913-022-08276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health systems need to be evaluated to ascertain if they are meeting their objectives. There is an increased interest in health system responsiveness (HSR) as a means to appraise health systems. This becomes vital as we put people at the centre of integrated health systems and put a premium on their rights and perspectives. Thus, this study assessed the levels, distribution and factors associated with HSR in Oyo State. METHODS The study was a cross-sectional study with 717 adults, who had used an out-patient health facility in the preceding 12 months, interviewed using a semi-structured, interviewer-administered questionnaire. HSR was measured on a multi-domain and multi-item (7 domains and 20 items) 5-point Likert scale that was developed by the WHO to measure HSR globally. Summary scores were computed for level, distribution and the most important domains of HSR. Determinants of poor HSR were determined using binomial logistic regression. The level of statistical significance was set at 5%. RESULTS The overall level of HSR was 47%. The highest-rated domains were confidentiality (72%), dignity (64%) and choice (60%), while the least rated were prompt attention (43%) and communication (52%). The overall distribution of HSR was 0.228 (range of 0 to 1) with the domains of prompt attention (0.595) and choice (0.506) being the most unequally distributed. The most important domains were communication, prompt attention and dignity. The least important domains were choice and confidentiality. The factors associated with poor HSR (overall) were no formal education, (OR = 2.81; 95% CI: 1.35-5.86), primary education as the highest level of education (OR = 2.19; 95% CI: 1.28-3.75), poor socioeconomic class (OR = 1.86; 95% CI: 1.23-2.80), using a government-owned facility (OR = 1.56; 95% CI: 1.11-2.19) and not using the usual health facility (OR = 1.69; 95% CI: 1.13-2.53). CONCLUSIONS The overall level of HSR in Oyo State was low with the domains of prompt attention, communication and autonomy being the least rated domains. Therefore, concerted efforts should be targeted at improving HSR as this will improve wellbeing, health system utilization, and the overall health system.
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Affiliation(s)
| | - Oluwaseun Akinyemi
- Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayodeji Adebayo
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Blessing Oladokun
- Department of Mathematics and Statistics, East Tennessee State University, Tennessee, USA
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Ji M, Wang S, Peng C, Li J. Two-stage robust telemedicine assignment problem with uncertain service duration and no-show behaviours. COMPUTERS & INDUSTRIAL ENGINEERING 2022; 169:108226. [PMID: 35634093 PMCID: PMC9124295 DOI: 10.1016/j.cie.2022.108226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
The current pandemic of COVID-19 has caused significant strain on medical center resources, which are the main plac healthcare managers to make an effective assignment plan for the patients and telemedical doctors when providing telemedicine services. Motivated by this, we present the first comprehensive study of a two-stage robust telemedicine assignment problem when three different sources of uncertainty are incorporated, including uncertain service duration, no-show behaviours of both patients and telemedical doctors. From an algorithmic viewpoint, we propose an efficient nested column-and-constraint generation (C&CG) solution scheme that decomposes the model into an outer level problem and an inner level problem. Our results show that we can solve the problems of realistic sizes within a reasonable time (e.g., up to 100 patients, 10 telemedical doctors, and 200 scenarios within two hours). On the empirical side, we demonstrate how the hyper-parameters make a balance between cost management and the coverage level of the served patients in the presence of three different sources of uncertainty. Our comparison with a two-stage stochastic programming model implies that our model is not overly conservative and seems to provide a relatively cheaper modeling alternative that requires much less information support when hedging against three different sources of uncertainty under a worst-case situation.
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Affiliation(s)
- Menglei Ji
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
| | - Shanshan Wang
- Department of Decision Sciences, HEC Montréal & GERAD, Montréal H3T 2A7, Canada
| | - Chun Peng
- Department of Decision Sciences, HEC Montréal & GERAD, Montréal H3T 2A7, Canada
| | - Jinlin Li
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
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22
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Abstract
In Chile and the world, the supply of medical hours to provide care has been reduced due to the health crisis caused by COVID-19. As of December 2021, the outlook has been critical in Chile, both in medical and surgical care, where 1.7 million people wait for care, and the wait for surgery has risen from 348 to 525 days on average. This occurs mainly when the demand for care exceeds the supply available in the public system, which has caused serious problems in patients who will remain on hold and health teams have implemented management measures through prioritization measures so that patients are treated on time. In this paper, we propose a methodology to work in net for predicting the prioritization of patients on surgical waiting lists (SWL) embodied with a machine learning scheme for a high complexity hospital (HCH) in Chile. That is linked to the risk of each waiting patient. The work presents the following contributions; The first contribution is a network method that predicts the priority order of anonymous patients entering the SWL. The second contribution is a dynamic quantification of the risk of waiting patients. The third contribution is a patient selection protocol based on a dynamic update of the SWL based on the components of prioritization, risk, and clinical criteria. The optimization of the process was measured by a simulation of the total times of the system in HCH. The prioritization strategy proposed savings of medical hours allowing 20% additional surgeries to be performed, thus reducing SWL by 10%. The risk of waiting patients could drop by up to 8% annually. We hope to implement this methodology in real health care units.
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Hamon JK, Kambanje M, Pryor S, Kaponda AS, Mwale E, Burchett HED, Mayhew SH, Webster J. Integrated delivery of family planning and childhood immunisation services: a mixed methods assessment of service responsiveness. BMC Health Serv Res 2022; 22:572. [PMID: 35484622 PMCID: PMC9052445 DOI: 10.1186/s12913-022-07983-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Postpartum women represent a considerable share of the global unmet need for modern contraceptives. Evidence suggests that the integration of family planning (FP) with childhood immunisation services could help reduce this unmet need by providing repeat opportunities for timely contact with FP services. However, little is known about the clients’ experiences of FP services that are integrated with childhood immunisations, despite being crucial to contraceptive uptake and repeat service utilisation. Methods The responsiveness of FP services that were integrated with childhood immunisations in Malawi was assessed using cross-sectional convergent mixed methods. Exit interviews with clients (n=146) and audits (n=15) were conducted in routine outreach clinics. Responsiveness scores across eight domains were determined according to the proportion of clients who rated each domain positively. Text summary analyses of qualitative data from cognitive interviewing probes were also conducted to explain responsiveness scores. Additionally, Spearman rank correlation and Pearson’s chi-squared test were used to identify correlations between domain ratings and to examine associations between domain ratings and client, service and clinic characteristics. Results Responsiveness scores varied across domains: dignity (97.9%); service continuity (90.9%); communication (88.7%); ease of access (77.2%); counselling (66.4%); confidentiality (62.0%); environment (53.9%) and choice of provider (28.4%). Despite some low performing domains, 98.6% of clients said they would recommend the clinic to a friend or family member interested in FP. The choice of provider, communication, confidentiality and counselling ratings were positively associated with clients’ exclusive use of one clinic for FP services. Also, the organisation of services in the clinics and the providers’ individual behaviours were found to be critical to service responsiveness. Conclusions This study establishes that in routine outreach clinics, FP services can be responsive when integrated with childhood immunisations, particularly in terms of the dignity and service continuity afforded to clients, though less so in terms of the choice of provider, environment, and confidentiality experienced. Additionally, it demonstrates the value of combining cognitive interviewing techniques with Likert questions to assess service responsiveness.
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Affiliation(s)
- Jessie K Hamon
- Department of Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK.
| | | | | | | | | | - Helen E D Burchett
- Department of Public Health, Environments and Society, LSHTM, London, UK
| | | | - Jayne Webster
- Department of Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
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24
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Mulla RT, Turcotte LA, Wellens NI, Angevaare MJ, Weir J, Jantzi M, Hébert PC, Heckman GA, van Hout H, Millar N, Hirdes JP. Prevalence and predictors of influenza vaccination in long-term care homes: a cross-national retrospective observational study. BMJ Open 2022; 12:e057517. [PMID: 35437252 PMCID: PMC9016404 DOI: 10.1136/bmjopen-2021-057517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To compare facility-level influenza vaccination rates in long-term care (LTC) homes from four countries and to identify factors associated with influenza vaccination among residents. DESIGN AND SETTING Retrospective cross-sectional study of individuals residing in LTC homes in New Brunswick (Canada), New Zealand, Switzerland, and the Netherlands between 2017 and 2020. PARTICIPANTS LTC home residents assessed with interRAI assessment system instruments as part of routine practice in New Brunswick (n=7006) and New Zealand (n=34 518), and national pilot studies in Switzerland (n=2760) and the Netherlands (n=1508). End-of-life residents were excluded from all country cohorts. OUTCOMES Influenza vaccination within the past year. RESULTS Influenza vaccination rates among LTC home residents were highest in New Brunswick (84.9%) and lowest in Switzerland (63.5%). For all jurisdictions where facility-level data were available, substantial interfacility variance was observed. There was approximately a fourfold difference in the coefficient of variation for facility-level vaccination rates with the highest in Switzerland at 37.8 and lowest in New Brunswick at 9.7. Resident-level factors associated with vaccine receipt included older age, severe cognitive impairment, medical instability, health conditions affecting a greater number of organ systems and social engagement. Residents who displayed aggressive behaviours and smoke tobacco were less likely to be vaccinated. CONCLUSION There are opportunities to increase influenza vaccine uptake at both overall country and individual facility levels. Enhanced vaccine administration monitoring programmes in LTC homes that leverage interRAI assessment systems should be widely adopted.
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Affiliation(s)
- Reem T Mulla
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Luke Andrew Turcotte
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Nathalie Ih Wellens
- HES-SO La Source Institute and School of Nursing, Lausanne, Switzerland
- Public Health and Social Affairs of the Canton of Vaud, Directorate General of Health, Lausanne, Switzerland
| | - Milou J Angevaare
- Department of Medicine for Older People & Department of General Practice, Amsterdam Public Health research institute, Amsterdam UMC - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Julie Weir
- New Brunswick Association of Nursing Homes, Fredericton, New Brunswick, Canada
| | - Micaela Jantzi
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul C Hébert
- Université de Montréal, Montreal, Québec, Canada
- Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Hein van Hout
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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25
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Schultz É, Mignot L, Ward JK, Boaventura Bomfim D, Chabannon C, Mancini J. Public perceptions of the association between drug effectiveness and drug novelty in France during the COVID-19 pandemic. Therapie 2022; 77:693-701. [PMID: 35599194 PMCID: PMC9077798 DOI: 10.1016/j.therap.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/11/2022] [Accepted: 05/02/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES During the coronavirus disease 2019 (COVID-19) pandemic, public debates overtly addressed the promises of new innovative drugs. Many of these debates pitted those who advocated for the development of new drugs by pharmaceutical companies against those who favored the repositioning of existing drugs. Our study explored perceptions of the association between drug novelty and effectiveness as well as perceptions of the role of the pharmaceutical industry in drug development. METHODS Data were collected in January 2021 from a quota sample of the French population aged 18-75years (n=1,000) during the second round of the "Health Literacy Survey 2019" (HLS19). RESULTS We tested the hypothesis that individuals with a high level of familiarity with the health care system and those with a high level of trust in institutions are more likely to agree that new drugs are more effective than old ones and that drug development should be driven by the pharmaceutical industry. A quarter (25%) of respondents agreed that new drugs are always more effective than old ones. Agreement with this statement was stronger among respondents with a high level of familiarity with the health care system (as measured by the navigational health literacy score, OR 3.34 [2.13-5.24]). Respondents with a low level of trust in pharmaceutical companies or politicians were two times less likely to agree that new drugs are always more effective than old ones (OR 0.63 [0.42-0.95] and OR 0.68 [0.49-0.94], respectively). A high level of trust in pharmaceutical companies was reported by 42% of respondents, and 43% agreed that drug development should be driven by the pharmaceutical industry. CONCLUSION Our study shows that the perceived effectiveness of innovative drugs is associated with familiarity with the health care system and trust in institutions.
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Affiliation(s)
- Émilien Schultz
- Université Paris Cité, IRD, Ceped, 75006 Paris, France,SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS team (équipe labellisée LIGUE 2019), Aix-Marseille Université, Inserm, IRD, 13009 Marseille, France,Corresponding. CEPED, 45, rue des Saints-Pères, 75006 Paris, France
| | - Léo Mignot
- University of Bordeaux, CNRS, CED, UMR 5116, 33600 Pessac, France,Sciences Po Bordeaux, CNRS, CED, UMR 5116, 33600 Pessac, France
| | - Jeremy K. Ward
- CERMES3, Inserm, CNRS, EHESS, Université de Paris Cité, 94801 Villejuif, France,VITROME, Aix-Marseille University, IRD, AP-HM, SSA, 13005 Marseille, France
| | - Daniela Boaventura Bomfim
- University of Bordeaux, CNRS, CED, UMR 5116, 33600 Pessac, France,SIRIC BRIO, CHU de Bordeaux, Institut Bergonié, Université of Bordeaux, Inserm, CNRS, 33000 Bordeaux, France
| | - Christian Chabannon
- Module Biothérapies du Centre d’Investigations Cliniques en Biothérapies, Inserm CBT-1409, Aix-Marseille Université, Institut Paoli-Calmettes comprehensive cancer center, 13005 Marseille, France
| | - Julien Mancini
- SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS team (équipe labellisée LIGUE 2019), Aix-Marseille Université, Inserm, IRD, 13009 Marseille, France,BioSTIC, AP–HM, Timone, 13005 Marseille, France
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Mondal S, Bhojani U, Lobbo S, Law S, Maioni A, Van Belle S. Using social network analysis to understand multisectoral governance in district-level tobacco control programme implementation in India. BMJ Glob Health 2022; 7:e006471. [PMID: 34992075 PMCID: PMC8739058 DOI: 10.1136/bmjgh-2021-006471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/20/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Interest in multisectoral policies has increased, particularly in the context of low-income and middle-income countries and efforts towards Sustainable Development Goals, with greater attention to understand effective strategies for implementation and governance. The study aimed to explore and map the composition and structure of a multisectoral initiative in tobacco control, identifying key factors engaged in policy implementation and their patterns of relationships in local-level networks in two districts in the state of Karnataka, India. METHODS Social network analysis (SNA) was used to examine the structure of two district tobacco control networks with differences in compliance with the India's national tobacco control law. The survey was administered to 108 respondents (n=51 and 57) in two districts, producing three distinct network maps about interaction, information-seeking and decision-making patterns within each district. The network measures of centrality, density, reciprocity, centralisation and E-I index were used to understand and compare across the two districts. RESULTS Members from the department of health, especially those in the District Tobacco Control Cell, were the most frequently consulted actors for information as they led district-level networks. The most common departments engaged beyond health were education, police and municipal. District 1's network displayed high centralisation, with a district nodal officer who exercised a central role with the highest in-degree centrality. The district also exhibited greater density and reciprocity. District 2 showed a more dispersed pattern, where subdistrict health managers had higher betweenness centrality and acted as brokers in the network. CONCLUSION Collaboration and cooperation among sectors and departments are essential components of multisectoral policy. SNA provides a mechanism to uncover the nature of relationships and key actors in collaborative dynamics. It can be used as a visual learning tool for policy planners and implementers to understand the structure of actual implementation and concentrate their efforts to improve and enhance collaboration.
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Affiliation(s)
- Shinjini Mondal
- Family Medicine, McGill University Faculty of Medicine, Montreal, Québec, Canada
- Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | - Upendra Bhojani
- Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | | | - Susan Law
- Institute for Better Health, Trillium Health Partners, Ontario, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Antonia Maioni
- Institute for Health and Social Policy, McGill University, Montreal, Québec, Canada
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Antwerpen, Belgium
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Language proficiency and warfarin-related adverse events in older immigrants and Canadian residents: a population-based cohort study. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00877-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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James M, Marchant E, Defeyter MA, Woodside J, Brophy S. Impact of school closures on the health and well-being of primary school children in Wales UK: a routine data linkage study using the HAPPEN Survey (2018-2020). BMJ Open 2021; 11:e051574. [PMID: 34625414 PMCID: PMC8503919 DOI: 10.1136/bmjopen-2021-051574] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aimed to explore the relationship between initial school closures and children's health by comparing health and well-being outcomes collected during school closures (April-June 2020) via HAPPEN (the Health and Attainment of Pupils in a Primary Education Network) with data from the same period in 2019 and 2018 via the HAPPEN Survey. SETTING The study was conducted online with 161 primary schools across Wales involved in the 'HAPPEN At Home' Survey. PARTICIPANTS Data were collected via the 'HAPPEN At Home' Survey capturing the typical health behaviours of children aged 8-11 years from 1333 participants across Wales. These data were compared with data in 2018 and 2019 also collected between April and June, from HAPPEN (2019 (n=1150) and 2018 (n=475)). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes included validated measures of physical activity, screen time, diet and dental health, as well as well-being, competency and autonomy. Free school meal (FSM) status was used as a proxy for socioeconomic deprivation. Analyses were repeated stratifying by FSM. RESULTS Comparing responses between April-June in 2020 (n=1068), 2019 (n=1150) and 2018 (n=475), there were improvements in physical activity levels, sleep time, happiness and general well-being for children during school closures compared with previous years. However, children on FSM ate fewer fruits and vegetables (21% less at five or more portions of fruits and vegetables (95% CI: 5.7% to 37%)) and had lower self-assessed school competence compared with 2019. Compared with those not on FSM, they also spent less time doing physical activity (13.03%, 95% CI: 3.3% to 21.7%) and consumed more takeaways (16.3%, 95% CI: 2% to 30%) during school closures. CONCLUSIONS This study suggests that schools are important in reducing inequalities in physical health. The physical health (eg, physical activity and diet) of children eligible for FSM may be affected by prolonged school closures.
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Affiliation(s)
| | | | | | - Jayne Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Rathnayake D, Clarke M, Jayasinghe V. Patient prioritisation methods to shorten waiting times for elective surgery: A systematic review of how to improve access to surgery. PLoS One 2021; 16:e0256578. [PMID: 34460854 PMCID: PMC8404982 DOI: 10.1371/journal.pone.0256578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Concern about long waiting times for elective surgeries is not a recent phenomenon, but it has been heightened by the impact of the COVID-19 pandemic and its associated measures. One way to alleviate the problem might be to use prioritisation methods for patients on the waiting list and a wide range of research is available on such methods. However, significant variations and inconsistencies have been reported in prioritisation protocols from various specialties, institutions, and health systems. To bridge the evidence gap in existing literature, this comprehensive systematic review will synthesise global evidence on policy strategies with a unique insight to patient prioritisation methods to reduce waiting times for elective surgeries. This will provide evidence that might help with the tremendous burden of surgical disease that is now apparent in many countries because of operations that were delayed or cancelled due to the COVID-19 pandemic and inform policy for sustainable healthcare management systems. METHODS We searched PubMed, EMBASE, SCOPUS, Web of Science, and the Cochrane Library, with our most recent searches in January 2020. Articles published after 2013 on major elective surgery lists of adult patients were eligible, but cancer and cancer-related surgeries were excluded. Both randomised and non-randomised studies were eligible and the quality of studies was assessed with ROBINS-I and CASP tools. We registered the review in PROSPERO (CRD42019158455) and reported it in accordance with the PRISMA statement. RESULTS The electronic search in five bibliographic databases yielded 7543 records (PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane) and 17 eligible articles were identified in the screening. There were four quasi-experimental studies, 11 observational studies and two systematic reviews. These demonstrated moderate to low risk of bias in their research methods. Three studies tested generic approaches using common prioritisation systems for all elective surgeries in common. The other studies assessed specific prioritisation approaches for re-ordering the waiting list for a particular surgical specialty. CONCLUSIONS Explicit prioritisation tools with a standardised scoring system based on clear evidence-based criteria are likely to reduce waiting times and improve equitable access to health care. Multiple attributes need to be considered in defining a fair prioritisation system to overcome limitations with local variations and discriminations. Collating evidence from a diverse body of research provides a single framework to improve the quality and efficiency of elective surgical care provision in a variety of health settings. Universal prioritisation tools with vertical and horizontal equity would help with re-ordering patients on waiting lists for elective surgery and reduce waiting times.
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Affiliation(s)
- Dimuthu Rathnayake
- Centre of Public Health, School of Medicine Dentistry and Biological Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Mike Clarke
- Centre of Public Health, School of Medicine Dentistry and Biological Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Viraj Jayasinghe
- South Eastern Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
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GPs' perceptions of their relationship with the pharmaceutical industry: a qualitative study. BJGP Open 2021; 5:BJGPO.2021.0057. [PMID: 34353789 PMCID: PMC8596315 DOI: 10.3399/bjgpo.2021.0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022] Open
Abstract
Background The pharmaceutical industry invests heavily in promoting medications to physicians. This promotion may influence physicians’ prescribing behaviour and lead to inappropriately increased prescribing rates. Aim To understand GPs’ experience of interacting with the pharmaceutical industry, and explore their views and perceptions of the impact of this interaction in general practice in Ireland. Design & setting A qualitative design was used, and GPs practicing in Ireland were eligible. Method A combination of purposive and snowball sampling techniques was applied and semi-structured interviews were conducted. Thematic analysis was used to develop themes from the data. Results Twenty-one GPs and one GP trainee participated. Five themes were developed: 1) GP and pharmaceutical industry interface; 2) the industry’s methods of influence; 3) the uncomfortable relationship between GPs and industry; 4) GPs’ perceptions of being unconsciously influenced; and 5) GPs’ lack of knowledge of relevant regulations. Participants interacted with pharmaceutical representatives in their surgery and through continuing professional development (CPD). Reported methods of influence included biased information and the offer of gifts. Most participants felt their prescribing was unconsciously influenced. A minority felt that they were only influenced in a way that improved their prescribing. Conclusion The study shows that there can be a lack of clarity among GPs about relevant regulations and about the potential impact on prescribing of interactions with the pharmaceutical industry. Education of trainees and GPs has the potential to address this. Restrictions on interactions with the pharmaceutical industry may also play a role, although alternative CPD funding sources would need to be established.
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Iyengar KP, Monga P, Elbana H, Singh B. Orthopaedic surgical prioritisation: can it be made fairer to minimise clinical harm? Postgrad Med J 2021; 98:e61-e62. [PMID: 37066593 DOI: 10.1136/postgradmedj-2021-140272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 11/03/2022]
Affiliation(s)
| | - Puneet Monga
- Department of Orthopaedics, Wrightington Hospital, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Husam Elbana
- Department of Orthopaedics, Royal Lancaster Infirmary, Lancaster, UK
| | - Bijayendra Singh
- Department of Orthopaedics, Medway NHS Foundation Trust Surgical Services, Gillingham, UK
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Fun WH, Tan EH, Sararaks S, Md. Sharif S, Ab Rahim I, Jawahir S, Eow VHY, Sibert RMY, Fadzil MM, Mahmud SH. Implications of Dual Practice on Cataract Surgery Waiting Time and Rescheduling: The Case of Malaysia. Healthcare (Basel) 2021; 9:healthcare9060653. [PMID: 34072671 PMCID: PMC8228072 DOI: 10.3390/healthcare9060653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Dual practice was implemented in selected Ministry of Health Malaysia hospitals to reduce brain drain and provide an alternative for patients willing to pay higher user fees to seek prompt treatment from the specialist of their choice. This study aimed to assess the implications of dual practice on waiting time and rescheduling for cataract surgery. Methods: A retrospective study was conducted in a referral hospital. Inpatient medical records of patients who underwent cataract procedures were used to study the waiting times to surgery and rescheduling between private and public groups. Results: Private patients had a considerably shorter waiting time for cataract surgery, seven times shorter compared to public patients where all surgeries were conducted after hours on weekdays or weekends. Additionally, 14.9% of public patients experienced surgery rescheduling, while all private patients had their surgeries as planned. The main reason for surgery rescheduling was the medical factor, primarily due to uncontrolled blood pressure and upper respiratory tract infection. Conclusion: Private service provision utilizing out-of-office hours slots for cataract surgery optimizes public hospital resources, allowing shorter waiting times and providing an alternative to meet healthcare needs.
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Affiliation(s)
- Weng Hong Fun
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (E.H.T.); (S.S.); (S.M.S.); (I.A.R.); (S.J.); (V.H.Y.E.); (S.H.M.)
- Correspondence:
| | - Ee Hong Tan
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (E.H.T.); (S.S.); (S.M.S.); (I.A.R.); (S.J.); (V.H.Y.E.); (S.H.M.)
| | - Sondi Sararaks
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (E.H.T.); (S.S.); (S.M.S.); (I.A.R.); (S.J.); (V.H.Y.E.); (S.H.M.)
| | - Shakirah Md. Sharif
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (E.H.T.); (S.S.); (S.M.S.); (I.A.R.); (S.J.); (V.H.Y.E.); (S.H.M.)
| | - Iqbal Ab Rahim
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (E.H.T.); (S.S.); (S.M.S.); (I.A.R.); (S.J.); (V.H.Y.E.); (S.H.M.)
| | - Suhana Jawahir
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (E.H.T.); (S.S.); (S.M.S.); (I.A.R.); (S.J.); (V.H.Y.E.); (S.H.M.)
| | - Vivien Han Ying Eow
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (E.H.T.); (S.S.); (S.M.S.); (I.A.R.); (S.J.); (V.H.Y.E.); (S.H.M.)
| | | | | | - Siti Haniza Mahmud
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (E.H.T.); (S.S.); (S.M.S.); (I.A.R.); (S.J.); (V.H.Y.E.); (S.H.M.)
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Moore JL, Bjørkli C, Havdahl RT, Lømo LL, Midthaug M, Skjuve M, Klokkerud M, Nordvik JE. A qualitative study exploring contributors to the success of a community of practice in rehabilitation. BMC MEDICAL EDUCATION 2021; 21:282. [PMID: 34001073 PMCID: PMC8130156 DOI: 10.1186/s12909-021-02711-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Communities of Practice (CoPs) focus on learning, knowledge sharing, and creation, and research indicates they can improve healthcare performance. This article describes the development of a CoP that focused on synthesizing and adapting evidence in Physical Medicine and Rehabilitation (PM&R). This study aimed to investigate the CoP members' experiences and perceived barriers and enablers of CoP success in the early phase of a CoP. METHODS Physical therapists and a physician (n = 10) volunteered for a CoP that synthesized literature of PM&R evidence. CoP members participated in education and training on critical appraisal and knowledge synthesis, practiced critical appraisal skills, and summarized literature. Three months after CoP initiation, semi-structured interviews were conducted to understand the CoP members' experiences and reflections. Members also completed an online survey that included the Evidence-Based Practice Confidence scale (EPIC), questions related to CoP activities, and demographics before CoP initiation. We utilized the Capability, Opportunity, and Motivation Model of Behaviour (COM-B) to explore how these experiences related to the behavioral adaptation and participation. RESULTS Ten themes related to the potential contributors to CoP success and failure were identified. These included project management, technological solutions, efficacy, organizational support, interaction, the bigger picture, self-development, time, and motivation. CONCLUSIONS Contributors to CoP success may include clearly articulated project goals and participant expectations, education and training, reliable technology solutions, organizational support, face-to-face communication, and good project management. Importantly, CoP members need time to participate in activities.
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Affiliation(s)
- Jennifer L. Moore
- Regional Center for Knowledge translation in Rehabilitation South Eastern Region, Sunnaas Sykehus, Nesodden, Oslo, Norway
- Institute for Knowledge Translation, Carmel, IN USA
| | - Cato Bjørkli
- University of Oslo, Department of Psychology, Oslo, Norway
| | - Richard Tidemann Havdahl
- Regional Center for Knowledge translation in Rehabilitation South Eastern Region, Sunnaas Sykehus, Nesodden, Oslo, Norway
- University of Oslo, Department of Psychology, Oslo, Norway
- AFF at the Norwegian School of Economics, Oslo, Norway
| | - Linn Lien Lømo
- Regional Center for Knowledge translation in Rehabilitation South Eastern Region, Sunnaas Sykehus, Nesodden, Oslo, Norway
- University of Oslo, Department of Psychology, Oslo, Norway
- AFF at the Norwegian School of Economics, Oslo, Norway
| | - Mari Midthaug
- Regional Center for Knowledge translation in Rehabilitation South Eastern Region, Sunnaas Sykehus, Nesodden, Oslo, Norway
- University of Oslo, Department of Psychology, Oslo, Norway
- Hartmark Executive Search, Oslo, Norway
| | - Marita Skjuve
- University of Oslo, Department of Psychology, Oslo, Norway
| | - Mari Klokkerud
- Regional Center for Knowledge translation in Rehabilitation South Eastern Region, Sunnaas Sykehus, Nesodden, Oslo, Norway
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Lennox L, Barber S, Stillman N, Spitters S, Ward E, Marvin V, Reed JE. Conceptualising interventions to enhance spread in complex systems: a multisite comprehensive medication review case study. BMJ Qual Saf 2021; 31:31-44. [PMID: 33990462 PMCID: PMC8685660 DOI: 10.1136/bmjqs-2020-012367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 12/14/2022]
Abstract
Background Advancing the description and conceptualisation of interventions in complex systems is necessary to support spread, evaluation, attribution and reproducibility. Improvement teams can provide unique insight into how interventions are operationalised in practice. Capturing this ‘insider knowledge’ has the potential to enhance intervention descriptions. Objectives This exploratory study investigated the spread of a comprehensive medication review (CMR) intervention to (1) describe the work required from the improvement team perspective, (2) identify what stays the same and what changes between the different sites and why, and (3) critically appraise the ‘hard core’ and ‘soft periphery’ (HC/SP) construct as a way of conceptualising interventions. Design A prospective case study of a CMR initiative across five sites. Data collection included: observations, document analysis and semistructured interviews. A facilitated workshop triangulated findings and measured perceived effort invested in activities. A qualitative database was developed to conduct thematic analysis. Results Sites identified 16 intervention components. All were considered essential due to their interdependency. The function of components remained the same, but adaptations were made between and within sites. Components were categorised under four ‘spheres of operation’: Accessibility of evidence base; Process of enactment; Dependent processes and Dependent sociocultural issues. Participants reported most effort was invested on ‘dependent sociocultural issues’. None of the existing HC/SP definitions fit well with the empirical data, with inconsistent classifications of components as HC or SP. Conclusions This study advances the conceptualisation of interventions by explicitly considering how evidence-based practices are operationalised in complex systems. We propose a new conceptualisation of ‘interventions-in-systems’ which describes intervention components in relation to their: proximity to the evidence base; component interdependence; component function; component adaptation and effort.
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Affiliation(s)
- Laura Lennox
- Primary Care and Public Health, Imperial College London, London, UK.,NIHR ARC Northwest London, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Susan Barber
- Primary Care and Public Health, Imperial College London, London, UK.,NIHR ARC Northwest London, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Neil Stillman
- Primary Care and Public Health, Imperial College London, London, UK
| | - Sophie Spitters
- Primary Care and Public Health, Imperial College London, London, UK
| | - Emily Ward
- Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Vanessa Marvin
- Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Julie E Reed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden .,Julie Reed Consultancy Ltd, London, UK
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Patients’ Prioritization on Surgical Waiting Lists: A Decision Support System. MATHEMATICS 2021. [DOI: 10.3390/math9101097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Currently, in Chile, more than a quarter-million of patients are waiting for an elective surgical intervention. This is a worldwide reality, and it occurs as the demand for healthcare is vastly superior to the clinical resources in public systems. Moreover, this phenomenon has worsened due to the COVID-19 sanitary crisis. In order to reduce the impact of this situation, patients in the waiting lists are ranked according to a priority. However, the existing prioritization strategies are not necessarily systematized, and they usually respond only to clinical criteria, excluding other dimensions such as the personal and social context of patients. In this paper, we present a decision-support system designed for the prioritization of surgical waiting lists based on biopsychosocial criteria. The proposed system features three methodological contributions; first, an ad-hoc medical record form that captures the biopsychosocial condition of the patients; second, a dynamic scoring scheme that recognizes that patients’ conditions evolve differently while waiting for the required elective surgery; and third, a methodology for prioritizing and selecting patients based on the corresponding dynamic scores and additional clinical criteria. The designed decision-support system was implemented in the otorhinolaryngology unit in the Hospital of Talca, Chile, in 2018. When compared to the previous prioritization methodology, the results obtained from the use of the system during 2018 and 2019 show that this new methodology outperforms the previous prioritization method quantitatively and qualitatively. As a matter of fact, the designed system allowed a decrease, from 2017 to 2019, in the average number of days in the waiting list from 462 to 282 days.
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Pouget AM, Civade E, Cestac P, Rouzaud-Laborde C. From hospitalisation to primary care: integrative model of clinical pharmacy with patients implanted with a PICC line-research protocol for a prospective before-after study. BMJ Open 2021; 11:e039490. [PMID: 33827827 PMCID: PMC8031034 DOI: 10.1136/bmjopen-2020-039490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Clinical pharmacy improves patient safety and secures drug management using information, education and good clinical practices. However, medical device management is still unexplored, and proof of effectiveness is needed. A PICC line (peripherally inserted central catheter) is a medical device for infusion. It accesses the central venous system after being implanted in a peripheral vein. However, complications after implantation often interfere with smooth execution of the treatment. We hypothesise that clinical pharmacy for medical devices could be as effective as clinical pharmacy for medications. The main objective is to assess the effectiveness of clinical pharmacy activities on the complication rate after PICC line implantation. METHODS AND ANALYSIS This is a before-after prospective study. The study will begin with an observational period without clinical pharmacy activities, followed by an interventional period where pharmacists will intervene on drug and medical device management and provide personalised follow-up and advice. Sixty-nine adult patients will be recruited in each 6-month period from all traditional care units. The main inclusion criteria will be the implantation of a PICC line. The primary outcome is the decrease in the number of complications per patient and per month. Secondary outcomes are the consultation and hospital readmission rates, the acceptance rate of pharmaceutical interventions, the patients' quality of life, the direct hospital induced or avoided costs and the participants' satisfaction. Data will be collected using case report forms during hospitalisation and telephone follow-up after discharge. The analysis will compare these criteria during the two periods. ETHICS AND DISSEMINATION The study has received the approval of our Ethics Committee (Clermont-Ferrand Southeast VI, France, number AU1586). Results will be made available to the patients or their caregivers, the sponsor and other researchers when asked, as described in the consent form. TRIAL REGISTRATION NUMBER NCT04359056.
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Affiliation(s)
- Alix Marie Pouget
- Department of Pharmacy, University Hospital Centre Toulouse, Toulouse, Occitanie, France
- INSERM unit 1048, I2MC, Toulouse, Occitanie, France
| | - Elodie Civade
- Department of Pharmacy, University Hospital Centre Toulouse, Toulouse, Occitanie, France
| | - Philippe Cestac
- Department of Pharmacy, University Hospital Centre Toulouse, Toulouse, Occitanie, France
| | - Charlotte Rouzaud-Laborde
- Department of Pharmacy, University Hospital Centre Toulouse, Toulouse, Occitanie, France
- INSERM unit 1048, I2MC, Toulouse, Occitanie, France
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Molenaar CJL, Janssen L, van der Peet DL, Winter DC, Roumen RMH, Slooter GD. Conflicting Guidelines: A Systematic Review on the Proper Interval for Colorectal Cancer Treatment. World J Surg 2021; 45:2235-2250. [PMID: 33813632 DOI: 10.1007/s00268-021-06075-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Timely treatment for colorectal cancer (CRC) is a quality indicator in oncological care. However, patients with CRC might benefit more from preoperative optimization rather than rapid treatment initiation. The objectives of this study are (1) to determine the definition of the CRC treatment interval, (2) to study international recommendations regarding this interval and (3) to study whether length of the interval is associated with outcome. METHODS We performed a systematic search of the literature in June 2020 through MEDLINE, EMBASE and Cochrane databases, complemented with a web search and a survey among colorectal surgeons worldwide. Full-text papers including subjects with CRC and a description of the treatment interval were included. RESULTS Definition of the treatment interval varies widely in published studies, especially due to different starting points of the interval. Date of diagnosis is often used as start of the interval, determined with date of pathological confirmation. The end of the interval is rather consistently determined with date of initiation of any primary treatment. Recommendations on the timeline of the treatment interval range between and within countries from two weeks between decision to treat and surgery, to treatment within seven weeks after pathological diagnosis. Finally, there is no decisive evidence that a longer treatment interval is associated with worse outcome. CONCLUSIONS The interval from diagnosis to treatment for CRC treatment could be used for prehabilitation to benefit patient recovery. It may be that this strategy is more beneficial than urgently proceeding with treatment.
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Affiliation(s)
- Charlotte J L Molenaar
- Department of Surgery, Máxima MC, De Run 4600, P.O. Box 7777, 5504 DB, Veldhoven, The Netherlands.
| | - Loes Janssen
- Department of Surgery, Máxima MC, De Run 4600, P.O. Box 7777, 5504 DB, Veldhoven, The Netherlands
| | - Donald L van der Peet
- Department of Surgery, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Desmond C Winter
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, D04T6F4, Ireland
| | - Rudi M H Roumen
- Department of Surgery, Máxima MC, De Run 4600, P.O. Box 7777, 5504 DB, Veldhoven, The Netherlands
| | - Gerrit D Slooter
- Department of Surgery, Máxima MC, De Run 4600, P.O. Box 7777, 5504 DB, Veldhoven, The Netherlands
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Valente R, Di Domenico S, Mascherini M, Santori G, Papadia F, Orengo G, Gratarola A, Cafiero F, De Cian F. A new model to prioritize waiting lists for elective surgery under the COVID-19 pandemic pressure. Br J Surg 2021; 108:e12-e14. [PMID: 33640936 PMCID: PMC7799261 DOI: 10.1093/bjs/znaa028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Indexed: 11/14/2022]
Affiliation(s)
- R Valente
- Department of Surgery, Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genoa, Italy.,Division of Surgery and Interventional Science, University College London, London, UK
| | - S Di Domenico
- Department of Surgery, Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genoa, Italy
| | - M Mascherini
- Department of Surgery, Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genoa, Italy
| | - G Santori
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - F Papadia
- Department of Surgery, Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - G Orengo
- Hospital Leadership Department, Policlinico San Martino, Genoa, Italy
| | - A Gratarola
- Department of Emergency, Anaesthesia and Intensive Care, Policlinico San Martino, Genoa, Italy
| | - F Cafiero
- Department of Surgery, Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genoa, Italy.,Regional Inter-Trust Surgical Departments, Regional Healthcare Trust, Liguria Region Health Administration, Italy
| | - F De Cian
- Department of Surgery, Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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Rand S, Smith N, Jones K, Dargan A, Hogan H. Measuring safety in older adult care homes: a scoping review of the international literature. BMJ Open 2021; 11:e043206. [PMID: 33707269 PMCID: PMC7957135 DOI: 10.1136/bmjopen-2020-043206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Safety is a key concern in older adult care homes. However, it is a less developed concept in older adult care homes than in healthcare settings. As part of study of the collection and application of safety data in the care home sector in England, a scoping review of the international literature was conducted. OBJECTIVES The aim of the review was to identify measures that could be used as indicators of safety for quality monitoring and improvement in older adult residential or nursing care homes. SOURCES OF EVIDENCE Systematic searches for journal articles published in English language from 1 January 1970, without restriction to the study location or country, were conducted in Web of Science, Scopus and PubMed on 28 July 2019. ELIGIBILITY CRITERIA Inclusion criteria were: peer-reviewed journal articles; qualitative or quantitative studies of older adult nursing and/or residential care homes; and related to any aspect of safety in care homes, including the safety of healthcare provision in the care home. A total of 45 articles were included after review of the title/abstract or full text against the inclusion criteria. CHARTING METHODS Key information was extracted and charted. These findings were then mapped to the Safety Measurement and Monitoring Framework in healthcare (SMMF), adapted by the research team to reflect the care home context, to determine the coverage of different aspects of safety, as well as potential gaps. RESULTS AND CONCLUSIONS Systematic searches for journal articles published in English language from 1 January 1970, without restriction to the study location or country, were conducted in Web of Science, Scopus and PubMed on 28 July 2019. Inclusion criteria were: peer-reviewed journal articles; qualitative or quantitative studies of older adult nursing and/or residential care homes; and related to any aspect of safety in care homes, including the safety of healthcare provision in the care home.A total of 45 articles were included after review of the title/abstract or full text against the inclusion criteria. Key information was extracted and charted. These findings were then mapped to the Safety Measurement and Monitoring Framework in healthcare (SMMF), adapted by the research team to reflect the care home context, to determine the coverage of different aspects of safety, as well as potential gaps.The findings indicate that there are a range of available safety measures used for quality monitoring and improvement in older adult care homes. These cover all five domains of safety in the SMMF. However, there are potential gaps. These include user experience, psychological harm related to the care home environment, abusive or neglectful care practice and the processes for integrated learning. Some of these gaps may relate to challenges and feasibility of measurement in the care home context.
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Affiliation(s)
- Stacey Rand
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Nick Smith
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Karen Jones
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Alan Dargan
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Wathes R, Malhotra K, Flott K, Nath A, Urch C. Towards a standardised method of patient prioritisation that accounts for clinical harm. Future Healthc J 2021; 8:e42-e46. [PMID: 33791474 DOI: 10.7861/fhj.2020-0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
COVID-19 has highlighted the need for a standardised approach for prioritising patients requiring elective care. The Royal College of Surgeons of England (RCS) developed guidance at the start of the pandemic for prioritising surgical patients based on the urgency of different procedures. Imperial College Healthcare NHS Trust (ICHT) has extended this to all aspects of elective care to enable standardised decision-making based on clinical priority, clinical harm and patient vulnerability. This was a clinically led project that involved close collaboration with lay partners, who were concerned that the RCS guidance lacked the sensitivity to reflect individual patients' needs. Our novel elective care recovery matrix is designed to be applicable across all elective care services and at Trust or system level. Implementation at ICHT progressed rapidly: as of 28 August 2020 >200 consultants have received training on the process and 58% of all surgical orders have been prioritised using the new framework (5,134/8,800). While COVID-19 was the driver, the applicability can be wider and could inform new ways of working. The framework enables rapid quantification of individual patient care requirements, thus enabling clinicians to target more accurately those patients with the greatest need and those who would see the greatest benefit.
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Affiliation(s)
| | | | | | | | - Catherine Urch
- cardiovascular and cancer and trust cancer lead, Imperial College Healthcare NHS Trust, London, UK
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Déry J, Ruiz A, Routhier F, Bélanger V, Côté A, Ait-Kadi D, Gagnon MP, Deslauriers S, Lopes Pecora AT, Redondo E, Allaire AS, Lamontagne ME. A systematic review of patient prioritization tools in non-emergency healthcare services. Syst Rev 2020; 9:227. [PMID: 33023666 PMCID: PMC7541289 DOI: 10.1186/s13643-020-01482-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient prioritization is a strategy used to manage access to healthcare services. Patient prioritization tools (PPT) contribute to supporting the prioritization decision process, and to its transparency and fairness. Patient prioritization tools can take various forms and are highly dependent on the particular context of application. Consequently, the sets of criteria change from one context to another, especially when used in non-emergency settings. This paper systematically synthesizes and analyzes the published evidence concerning the development and challenges related to the validation and implementation of PPTs in non-emergency settings. METHODS We conducted a systematic mixed studies review. We searched evidence in five databases to select articles based on eligibility criteria, and information of included articles was extracted using an extraction grid. The methodological quality of the studies was assessed by using the Mixed Methods Appraisal Tool. The article selection process, data extraction, and quality appraisal were performed by at least two reviewers independently. RESULTS We included 48 studies listing 34 different patient prioritization tools. Most of them are designed for managing access to elective surgeries in hospital settings. Two-thirds of the tools were investigated based on reliability or validity. Inconclusive results were found regarding the impact of PPTs on patient waiting times. Advantages associated with PPT use were found mostly in relationship to acceptability of the tools by clinicians and increased transparency and equity for patients. CONCLUSIONS This review describes the development and validation processes of PPTs used in non-urgent healthcare settings. Despite the large number of PPTs studied, implementation into clinical practice seems to be an open challenge. Based on the findings of this review, recommendations are proposed to develop, validate, and implement such tools in clinical settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018107205.
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Affiliation(s)
- Julien Déry
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Angel Ruiz
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada.,Faculty of Business Administration, Université Laval, Québec, Canada.,Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Valérie Bélanger
- Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada.,Department of Logistics and Operations Management, HEC Montréal, Montréal, Canada
| | - André Côté
- Faculty of Business Administration, Université Laval, Québec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Centre de recherche en gestion des services de santé, Université Laval, Québec, Canada
| | - Daoud Ait-Kadi
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada.,Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada.,Department of Mechanical Engineering, Université Laval, Québec, Canada
| | - Marie-Pierre Gagnon
- Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Faculty of Nursing, Université Laval, Québec, Canada
| | - Simon Deslauriers
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Ana Tereza Lopes Pecora
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Eduardo Redondo
- Faculty of Business Administration, Université Laval, Québec, Canada.,Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada
| | - Anne-Sophie Allaire
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Marie-Eve Lamontagne
- Department of Rehabilitation, Université Laval, Québec, Canada. .,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada.
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Graversen DS, Huibers L, Christensen MB, Bro F, Collatz Christensen H, Vestergaard CH, Pedersen AF. Communication quality in telephone triage conducted by general practitioners, nurses or physicians: a quasi-experimental study using the AQTT to assess audio-recorded telephone calls to out-of-hours primary care in Denmark. BMJ Open 2020; 10:e033528. [PMID: 32220912 PMCID: PMC7170599 DOI: 10.1136/bmjopen-2019-033528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [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
OBJECTIVES To compare the quality of communication in out-of-hours (OOH) telephone triage conducted by general practitioners (GPs), nurses using a computerised decision support system and physicians with different medical specialities, and to explore the association between communication quality and efficiency, length of call and the accuracy of telephone triage. DESIGN Natural quasi-experimental cross-sectional study. SETTING Two Danish OOH services using different telephone triage models: a GP cooperative and the medical helpline 1813. PARTICIPANTS 1294 audio-recorded randomly selected OOH telephone triage calls from 2016 conducted by GPs (n=423), nurses using CDSS (n=430) and physicians with different medical specialities (n=441). MAIN OUTCOME MEASURES Twenty-four physicians assessed the calls. The panel used a validated assessment tool (Assessment of Quality in Telephone Triage, AQTT) to measure nine aspects of communication, overall perceived communication quality, efficiency and length of call. RESULTS The risk of poor quality was significantly higher in calls triaged by GPs compared with calls triaged by nurses regarding 'allowing the caller to describe the situation' (GP: 13.5% nurse: 9.8%), 'mastering questioning techniques' (GP: 27.4% nurse: 21.1%), 'summarising' (GP: 33.0% nurse: 21.0%) and 'paying attention to caller's experience' (GP: 25.7% nurse: 17.0%). The risk of poor quality was significantly higher in calls triaged by physicians compared with calls triaged by GPs in five out of nine items. GP calls were significantly shorter (2 min 57 s) than nurse calls (4 min 44 s) and physician calls (4 min 1 s). Undertriaged calls were rated lower than optimally triaged calls for overall quality of communication (p<0.001) and all specific items. CONCLUSIONS Compared with telephone triage by GPs, the communication quality was higher in calls triaged by nurses and lower in calls triaged by physicians with different medical specialities. However, calls triaged by nurses and physicians were longer and perceived less efficient. Quality of communication was associated with accurate triage.
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Affiliation(s)
- Dennis Schou Graversen
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Flemming Bro
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Helle Collatz Christensen
- Emergency Medical Services, Copenhagen, Copenhagen, Denmark
- Danish Clinical Quality Program (RKKP), Copenhagen, Denmark
| | | | - Anette Fischer Pedersen
- Research Unit for General Practice, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Sæther SMM, Heggestad T, Heimdal JH, Myrtveit M. Long Waiting Times for Elective Hospital Care - Breaking the Vicious Circle by Abandoning Prioritisation. Int J Health Policy Manag 2020; 9:96-107. [PMID: 32202092 PMCID: PMC7093047 DOI: 10.15171/ijhpm.2019.84] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 09/28/2019] [Indexed: 12/01/2022] Open
Abstract
Background: Policies assigning low-priority patients treatment delays for care, in order to make room for patients of higher priority arriving later, are common in secondary healthcare services today. Alternatively, each new patient could be granted the first available appointment. We aimed to investigate whether prioritisation can be part of the reason why waiting times for care are often long, and to describe how departments can improve their waiting situation by changing away from prioritisation. Methods: We used patient flow data from 2015 at the Department of Otorhinolaryngology, Haukeland University Hospital, Norway. In Dynaplan Smia, Dynaplan AS, dynamic simulations were used to compare how waiting time, size and shape of the waiting list, and capacity utilisation developed with and without prioritisation. Simulations were started from the actual waiting list at the beginning of 2015, and from an empty waiting list (simulating a new department with no initial patient backlog). Results: From an empty waiting list and with capacity equal to demand, waiting times were built 7 times longer when prioritising than when not. Prioritisation also led to poor resource utilisation and short-lived effects of extra capacity. Departments where prioritisation is causing long waits can improve their situation by temporarily bringing capacity above demand and introducing "first come, first served" instead of prioritisation. Conclusion: A poor appointment allocation policy can build long waiting times, even when capacity is sufficient to meet demand. By bringing waiting times down and going away from prioritisation, the waiting list size and average waiting times at the studied department could be maintained almost 90% below the current level – without requiring permanent change in the capacity/demand ratio.
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Affiliation(s)
- Solbjørg Makalani Myrtveit Sæther
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Torhild Heggestad
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - John-Helge Heimdal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Clinic of Surgery, Haukeland University Hospital, Bergen, Norway
| | - Magne Myrtveit
- Dynaplan AS, Manger, Norway (https://www.dynaplan.com/en/)
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Ogassavara NC, Magalhães Dias JG, Pajecki D, de Oliveira Siqueira J, Santo MA, Tess BH. The Edmonton Obesity Staging System: assessing a potential tool to improve the management of obesity surgery in the Brazilian public health services. Surg Obes Relat Dis 2020; 16:40-47. [DOI: 10.1016/j.soard.2019.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/07/2019] [Accepted: 10/18/2019] [Indexed: 02/05/2023]
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Gall A, Anderson K, Adams J, Matthews V, Garvey G. An exploration of healthcare providers' experiences and perspectives of Traditional and complementary medicine usage and disclosure by Indigenous cancer patients. Altern Ther Health Med 2019; 19:259. [PMID: 31533782 PMCID: PMC6751784 DOI: 10.1186/s12906-019-2665-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 08/30/2019] [Indexed: 11/10/2022]
Abstract
Background Traditional and complementary medicines (T&CM) are any form of medicine, practice, treatment, product, technology, knowledge system or ceremony outside of conventional medical practice that aims to prevent and/or treat illness and/or promote well-being. Alongside conventional cancer treatments, T&CM usage is increasing; with 19% of indigenous Australians with cancer reporting using T&CM. There is limited evidence surrounding T&CM use and disclosure by indigenous patients. Our aim was to explore healthcare providers’ views about usage, disclosure/non-disclosure of T&CM by Indigenous cancer patients. Methods Semi-structured, in-depth interviews with 18 healthcare providers, including three indigenous providers, at a large urban hospital providing care to Indigenous cancer patients were conducted to explore providers’ experiences and attitudes towards T&CM use by Indigenous cancer patients. An interpretive phenomenological approach was used to thematically analyse the data. Results Analysis revealed six themes: concern about risk; no ‘real’ benefits; perception of T&CM and conventional medicine as antithetical; barriers to disclosure; ‘patients’ choice’ a double-edged sword; and providers’ lack of knowledge about T&CM. Healthcare providers perceived discord between T&CM and conventional medicine. Most lacked knowledge of T&CM, and had concerns around negative-interactions with conventional treatments. They considered T&CM outside their role, citing this as reasoning for their lack of knowledge. Indigenous healthcare providers had greater understanding and openness towards T&CM. Conclusions Given the potential usage of T&CM by Indigenous cancer patients, providers need a more comprehensive understanding of T&CM in order to inform discussion and facilitate effective disclosure on this topic. If indigenous Australians with cancer feel that cancer care providers are unreceptive to discussing T&CM, patient care risks being compromised; particularly given the potential for negative interactions between T&CM and conventional cancer treatments. Fostering health care interactions where indigenous patients feel comfortable to discuss T&CM usage should be a priority for all cancer care services.
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Effa EE, Oduwole O, Schoonees A, Hohlfeld A, Durao S, Kredo T, Mbuagbaw L, Meremikwu M, Ongolo-Zogo P, Wiysonge C, Young T. Priority setting for new systematic reviews: processes and lessons learned in three regions in Africa. BMJ Glob Health 2019; 4:e001615. [PMID: 31406592 PMCID: PMC6666801 DOI: 10.1136/bmjgh-2019-001615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/10/2019] [Accepted: 06/29/2019] [Indexed: 12/22/2022] Open
Abstract
Priority setting to identify topical and context relevant questions for systematic reviews involves an explicit, iterative and inclusive process. In resource-constrained settings of low-income and middle-income countries, priority setting for health related research activities ensures efficient use of resources. In this paper, we critically reflect on the approaches and specific processes adopted across three regions of Africa, present some of the outcomes and share the lessons learnt while carrying out these activities. Priority setting for new systematic reviews was conducted between 2016 and 2018 across three regions in Africa. Different approaches were used: Multimodal approach (Central Africa), Modified Delphi approach (West Africa) and Multilevel stakeholder discussion (Southern-Eastern Africa). Several questions that can feed into systematic reviews have emerged from these activities. We have learnt that collaborative subregional efforts using an integrative approach can effectively lead to the identification of region specific priorities. Systematic review workshops including discussion about the role and value of reviews to inform policy and research agendas were a useful part of the engagements. This may also enable relevant stakeholders to contribute towards the priority setting process in meaningful ways. However, certain shared challenges were identified, including that emerging priorities may be overlooked due to differences in burden of disease data and differences in language can hinder effective participation by stakeholders. We found that face-to-face contact is crucial for success and follow-up engagement with stakeholders is critical in driving acceptance of the findings and planning future progress.
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Affiliation(s)
- Emmanuel E Effa
- Internal Medicine, Faculty of Medicine, University of Calabar, Calabar, Nigeria
| | - Olabisi Oduwole
- Cochrane Nigeria, Calabar Institute of Tropical Disease Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Anel Schoonees
- Centre for Evidence-based Health Care, Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Ameer Hohlfeld
- Cochrane South Africa, Medical Research Council of South Africa, Tygerberg, South Africa
| | - Solange Durao
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Lawrence Mbuagbaw
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Pierre Ongolo-Zogo
- Centre for Development of Best Practices in Health, Central Hospital of Yaounde, Yaounde, Cameroon
| | - Charles Wiysonge
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Taryn Young
- Centre for Evidence-based Health Care, Division Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Bachelet VC, Goyenechea M, Carrasco VA. Policy strategies to reduce waiting times for elective surgery: A scoping review and evidence synthesis. Int J Health Plann Manage 2019; 34:e995-e1015. [PMID: 30793372 DOI: 10.1002/hpm.2751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The purpose of this evidence-based review is to identify and describe the interventions that have been implemented to reduce waiting times for major elective surgery. METHODS Scoping review and presentation of the results according to the SUPPORT tools. We searched MEDLINE/PubMed, Embase, Cochrane Library, SciELO, DARE-HTA, and Google Scholar. The inclusion criteria for research design were comprehensive. RESULTS We identified 5200 records. After eliminating duplicates and screening by title and abstract, 171 records remained for full-text assessment, of which 12 were ultimately included for this review because they reported specific interventions and 96 records were included for further reference. The included studies show significant variability regarding elective procedures, population, and type of provider, as well as in the characteristics of the interventions and the settings. All the studies had methodological limitations. We graded the certainty of the evidence as very low. CONCLUSIONS According to the evidence found for this review, interventions most likely should be multidimensional, with prioritization strategies on the waiting lists to incorporate equity criteria, together with quality management improvements of the surgical pathways and the use of operating rooms, as well as improvements in the planning of the surgical schedule.
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Affiliation(s)
- Vivienne C Bachelet
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile.,Medwave Estudios Limitada, Santiago, Chile
| | | | - Víctor A Carrasco
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile.,Medwave Estudios Limitada, Santiago, Chile
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Weingessel B, Wahl M, Vécsei-Marlovits PV. Patients' maximum acceptable waiting time for cataract surgery: a comparison at two time-points 7 years apart. Acta Ophthalmol 2018; 96:88-94. [PMID: 28371427 DOI: 10.1111/aos.13439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/16/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the maximum acceptable waiting time (MAWT) of cataract patients and assess the determinants of their perception of MAWT at two time-points 7 years apart. METHODS In 2007 (prior to the transformation of our cataract service to a day case unit) and 2014, 500 consecutive patients with cataract were asked to fill in a preoperative questionnaire addressing their MAWT to undergo cataract surgery. The patients' visual impairment (VF-14 score), education and social status were evaluated. RESULTS The mean MAWT was 3.2 months in both periods, whereas the actual waiting time decreased significantly by 1.7 months (p < 0.001). Patients who had self-noted visual impairment were nearly four times (p < 0.001) more likely to accept only an MAWT of <3 months in 2007. In both periods, patients with a VF-14 score lower than the mean were more likely to accept a shorter MAWT (p = 0.002 and p = 0.034). Living together with children or having relatives close by was associated with a greater acceptance of an MAWT longer than 3 months (p = 0.002 and p = 0.023). CONCLUSION Reducing the actual mean waiting time had no impact on the mean MAWT. Patients with poor tolerance of waiting had greater self-reported difficulty with vision. Social support was also a strong predictor from the patients' perspective. The VF-14 score had a greater impact than clinical visual acuity (VA) testing. Considering the implementation of standards for waiting lists, objective criteria to guarantee a transparent system should be taken into account.
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Affiliation(s)
- Birgit Weingessel
- Department of Ophthalmology; KH Hietzing; Vienna Austria
- Karl Landsteiner Institute for Process Optimization and Quality Management in Cataract Surgery; Vienna Austria
| | - Michael Wahl
- Department of Ophthalmology; KH Hietzing; Vienna Austria
- Karl Landsteiner Institute for Process Optimization and Quality Management in Cataract Surgery; Vienna Austria
| | - Pia V. Vécsei-Marlovits
- Department of Ophthalmology; KH Hietzing; Vienna Austria
- Karl Landsteiner Institute for Process Optimization and Quality Management in Cataract Surgery; Vienna Austria
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Landi S, Ivaldi E, Testi A. Socioeconomic status and waiting times for health services: An international literature review and evidence from the Italian National Health System. Health Policy 2018; 122:334-351. [PMID: 29373188 DOI: 10.1016/j.healthpol.2018.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 12/01/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
Abstract
In the absence of priority criteria, waiting times are an implicit rationing instrument where the absence or limited use of prices creates an excess of demand. Even in the presence of priority criteria, waiting times may be unfair because they reduce health care demand of patients in lower socio-economic conditions due to high opportunity costs of time or a decay in their health level. Significant evidence has shown a relationship between socioeconomic status and the length of waiting time. The first phase of the study involved an extensive review of the existent literature for the period of 2002-2016 in the main databases (Scopus, PubMed and Science Direct). Twenty-eight met the eligibility criteria. The 27 papers were described and classified. The e mpirical objective of this study was to determine whether socioeconomic characteristics affect waiting time for different health services in the Italian national health system. The services studied were specialist visits, diagnostics tests and elective surgeries. A classification tree and logistic regression models were implemented. Data from the 2013 Italian Health National Survey were used. The analysis found heterogeneous results for different types of service. Individuals with lower education and economic resources have a higher risk of experiencing excessive waiting times for diagnostic and specialist visits. For elective surgery, socioeconomic inequalities are present but appear to be lower.
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Affiliation(s)
- Stefano Landi
- Department of Economics and Business Studies, University of Genoa, Genoa, Italy; Department of Political Science, University of Genoa, Genoa, Italy; Department of Management, University "Ca' Foscari" Venice, Venice, Italy.
| | - Enrico Ivaldi
- Department of Political Science, University of Genoa, Genoa, Italy
| | - Angela Testi
- Department of Economics and Business Studies, University of Genoa, Genoa, Italy
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Hetlevik Ø, Hustoft M, Uijen A, Aßmus J, Gjesdal S. Patient perspectives on continuity of care: adaption and preliminary psychometric assessment of a Norwegian version of the Nijmegen Continuity Questionnaire (NCQ-N). BMC Health Serv Res 2017; 17:760. [PMID: 29162089 PMCID: PMC5698962 DOI: 10.1186/s12913-017-2706-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 11/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background Continuity of care is regarded as a core quality element in healthcare. Continuity can be related to one or more specific caregivers but also applies to collaboration within a team or across boundaries of healthcare. Measuring continuity is important to identify problems and evaluate quality improvement of interventions. This study aimed to assess the feasibility and psychometric properties of a Norwegian version of the Nijmegen Continuity Questionnaire (NCQ). Methods The NCQ was developed in The Netherlands. It measures patients’ experienced continuity of care across multiple care settings and as a multidimensional concept regardless of morbidity. The NCQ comprises 28 items categorised into three subscales; two personal continuity scales, “care giver knows me” and “shows commitment”, asked regarding the patient’s general practitioner (GP) and the most important specialist; and one “team/cross boundary continuity” scale, asked regarding primary care, specialised care and cooperation between GP and specialist, with a total of seven factors. The NCQ was translated and adapted to Norwegian (NCQ-N) and distributed among patients referred to somatic rehabilitation (N = 984, response rate 34.5%). Confirmatory factor analyses (CFA), Cronbach’s alpha, intra-class correlation (ICC) and Bland–Altman plots were used to assess psychometric properties. Results All patients (N = 375) who had responded to all parts of the NCQ-N were included in CFA. The CFA fit indices (CFI 0.941, RMSEA 0.064 (95% CI 0.059–0.070), SRMR 0.041) support a seven-factor structure in the NCQ-N based on the three subscales of the original NCQ. Cronbach’s alpha showed internal consistency (0.84–0.97), and was highest for the team/cross-boundary subscales. The NCQ-N showed overall high reliability with ICC 0.84–91 for personal continuity factors and 0.67–0.91 for team factors, with the lowest score for team continuity within primary care. Conclusions Psychometric assessment of the NCQ-N supports that this instrument, based on the three subscales of the original Dutch NCQ, captures the concept of “continuity of care” among adult patients with a variety of longstanding medical conditions who use healthcare on a regular basis. However, its usefulness among varied patient groups, including younger people, patients with acute disorders and individuals with mental health problems, should be further evaluated. Electronic supplementary material The online version of this article (10.1186/s12913-017-2706-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Øystein Hetlevik
- Department of Global Health and Primary Health Care, University of Bergen, PO-box 7804, N-5020, Bergen, Norway.
| | - Merethe Hustoft
- Department of Global Health and Primary Health Care, University of Bergen, PO-box 7804, N-5020, Bergen, Norway.,Centre for Habilitation and Rehabilitation in Western Norway, Bergen Local Health Authority, Bergen, Norway
| | - Annemarie Uijen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jörg Aßmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Sturla Gjesdal
- Department of Global Health and Primary Health Care, University of Bergen, PO-box 7804, N-5020, Bergen, Norway
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