1
|
Lek D, Sokomar N, Samphornarann T, Rideout J, Hassan SED, Bunkea T, Ath SS, Seng R, Hustedt J, Peto TJ, Hughes J, Kimmen K, Dy K, Adhikari B. Impact of targeted drug administration and intermittent preventive treatment for forest goers using artesunate-pyronaridine to control malaria outbreaks in Cambodia. Trop Med Health 2024; 52:42. [PMID: 38863067 PMCID: PMC11165738 DOI: 10.1186/s41182-024-00607-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION The national malaria programme of Cambodia targets the rapid elimination of all human malaria by 2025. As clinical cases decline to near-elimination levels, a key strategy is the rapid identification of malaria outbreaks triggering effective action to interrupt local transmission. We report a comprehensive, multipronged management approach in response to a 2022 Plasmodium falciparum outbreak in Kravanh district, western Cambodia. METHODS The provincial health department of Pursat in conjunction with the Center for Parasitology, Entomology and Malaria Control (CNM) identified villages where transmission was occurring using clinical records, and initiated various interventions, including the distribution of insecticide-treated bed nets, running awareness campaigns, and implementing fever screening with targeted drug administration. Health stations were set up at forest entry points, and later, targeted drug administrations with artesunate-pyronaridine (Pyramax) and intermittent preventive treatment for forest goers (IPTf) were implemented in specific village foci. Data related to adherence and adverse events from IPTf and TDA were collected. The coverage rates of interventions were calculated, and local malaria infections were monitored. RESULTS A total of 942 individuals were screened through active fever surveillance in villages where IPTf and TDA were conducted. The study demonstrated high coverage and adherence rates in the targeted villages, with 92% (553/600) coverage in round one and 65% (387/600) in round two. Adherence rate was 99% (551/553) in round one and 98% (377/387) in round two. The study found that forest goers preferred taking Pyramax over repeated testing consistent with the coverage rates: 92% in round one compared to 65% in round two. All individuals reachable through health stations or mobile teams reported complete IPTf uptake. No severe adverse events were reported. Only six individuals reported mild adverse events, such as loss of energy, fever, abdominal pain, diarrhoea, and muscle aches. Two individuals attributed their symptoms to heavy alcohol intake following prophylaxis. CONCLUSIONS The targeted malaria outbreak response demonstrated high acceptability, safety, and feasibility of the selected interventions. Malaria transmission was rapidly controlled using the available community resources. This experience suggests the effectiveness of the programmatic response for future outbreaks.
Collapse
Affiliation(s)
- Dysoley Lek
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia.
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.
| | - Nguon Sokomar
- Cambodia Malaria Elimination Project2, University Research Company Ltd., Phnom Penh, Cambodia
| | - Top Samphornarann
- Cambodia Malaria Elimination Project2, University Research Company Ltd., Phnom Penh, Cambodia
| | - Jeanne Rideout
- Cambodia Malaria Elimination Project2, University Research Company Ltd., Phnom Penh, Cambodia
| | - Saad El-Din Hassan
- Cambodia Malaria Elimination Project2, University Research Company Ltd., Phnom Penh, Cambodia
| | - Tol Bunkea
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Saing Sam Ath
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Rothpisey Seng
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - John Hustedt
- Cambodia Malaria Elimination Project2, University Research Company Ltd., Phnom Penh, Cambodia
- FHI 360, Phnom Penh, Cambodia
| | - Thomas J Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jayme Hughes
- Clinton Health Access Initiative, Phnom Penh, Cambodia
| | - Ke Kimmen
- Provincial Health Department, Pursat, Cambodia
| | - Khoy Dy
- Clinton Health Access Initiative, Phnom Penh, Cambodia
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| |
Collapse
|
2
|
McCullum LB, Karagoz A, Dede C, Garcia R, Nosrat F, Hemmati M, Hosseinian S, Schaefer AJ, Fuller CD. Markov models for clinical decision-making in radiation oncology: A systematic review. J Med Imaging Radiat Oncol 2024. [PMID: 38766899 DOI: 10.1111/1754-9485.13656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/03/2024] [Indexed: 05/22/2024]
Abstract
The intrinsic stochasticity of patients' response to treatment is a major consideration for clinical decision-making in radiation therapy. Markov models are powerful tools to capture this stochasticity and render effective treatment decisions. This paper provides an overview of the Markov models for clinical decision analysis in radiation oncology. A comprehensive literature search was conducted within MEDLINE using PubMed, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only studies published from 2000 to 2023 were considered. Selected publications were summarized in two categories: (i) studies that compare two (or more) fixed treatment policies using Monte Carlo simulation and (ii) studies that seek an optimal treatment policy through Markov Decision Processes (MDPs). Relevant to the scope of this study, 61 publications were selected for detailed review. The majority of these publications (n = 56) focused on comparative analysis of two or more fixed treatment policies using Monte Carlo simulation. Classifications based on cancer site, utility measures and the type of sensitivity analysis are presented. Five publications considered MDPs with the aim of computing an optimal treatment policy; a detailed statement of the analysis and results is provided for each work. As an extension of Markov model-based simulation analysis, MDP offers a flexible framework to identify an optimal treatment policy among a possibly large set of treatment policies. However, the applications of MDPs to oncological decision-making have been understudied, and the full capacity of this framework to render complex optimal treatment decisions warrants further consideration.
Collapse
Affiliation(s)
- Lucas B McCullum
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aysenur Karagoz
- Department of Computational Applied Mathematics & Operations Research, Rice University, Houston, Texas, USA
| | - Cem Dede
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Raul Garcia
- Department of Computational Applied Mathematics & Operations Research, Rice University, Houston, Texas, USA
| | - Fatemeh Nosrat
- Department of Computational Applied Mathematics & Operations Research, Rice University, Houston, Texas, USA
| | - Mehdi Hemmati
- School of Industrial and Systems Engineering, The University of Oklahoma, Norman, Oklahoma, USA
| | | | - Andrew J Schaefer
- Department of Computational Applied Mathematics & Operations Research, Rice University, Houston, Texas, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Computational Applied Mathematics & Operations Research, Rice University, Houston, Texas, USA
| |
Collapse
|
3
|
Sinha S, Haq MA, Ahmad R, Banik S, Kumar S, Haque M. Unmasking the Hidden Burden: A Delayed Diagnosis of Leprosy Patients With Grade 2 Disability and Its Effects on the Healthcare System in Bangladesh. Cureus 2024; 16:e58708. [PMID: 38651088 PMCID: PMC11033826 DOI: 10.7759/cureus.58708] [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] [Accepted: 04/22/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Leprosy remains a significant cause of preventable disability worldwide. Early diagnosis and treatment of leprosy are critical not only to stop its spread but also to prevent physical and social complications and reduce the disease burden. Objectives The study aims to evaluate the factors that lead to a delayed leprosy diagnosis. Methods This study was conducted in the outpatient departments of Leprosy Control Institute and Hospital, Dhaka, Bangladesh, and at Medical College for Women and Hospital, Dhaka, Bangladesh, from March 2023 to June 2023. A total number of 252 male (148) and female (104) patients were selected with any sign of leprosy, including disability, age ranging from 15 to 74 years. Data was collected in a pre-designed structured questionnaire by the researchers. To assess the risk of independent exposures of Grade 2 leprosy disabilities, we used a logistic regression model. A chi-square test showed the association between significant effects and leprosy disabilities. A p-value of 0.05 was considered as significant. For statistical analysis, STATA version 15 (StataCorp LLC, College Station, Texas, USA) was used. Results The study participants exhibited a higher percentage of disability, with a rate of 25.8% for Grade 2 disabilities. In addition to this, males represented a more considerable proportion, 58.7%, than females among leprosy and disability patients across all levels of disability. In our study, lack of money and painless symptoms showed a significant association (p<0.001) with Grade 2 disability. Conclusion The study reveals that Grade 2 disabilities are more common in males and are particularly prevalent in lower socioeconomic groups.
Collapse
Affiliation(s)
- Susmita Sinha
- Physiology, Khulna City Medical College and Hospital, Khulna, BGD
| | | | - Rahnuma Ahmad
- Physiology, Medical College for Women and Hospital, Dhaka, BGD
| | - Suman Banik
- Administration, Directorate General of Health Services (DGHS), Dhaka, BGD
| | - Santosh Kumar
- Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Mainul Haque
- Therapeutics, Karnavati Scientific Research Center (KSRC), School of Dentistry, Karnavati University, Gandhinagar, IND
- Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| |
Collapse
|
4
|
Dysoley L, Callery JJ, Bunreth V, Vanna M, Davoeung C, Sovann Y, You S, Ol S, Tripura R, Chew R, Chandna A, Christiansen-Jucht C, Hughes J, Sokomar N, Sophornarann T, Rideout J, Veyvath T, Sarith O, Puthy T, Sothearoth H, An SS, Zaman SI, von Seidlein L, Vanthy L, Sodavuth P, Vannak C, Dondorp AM, Lubell Y, Maude RJ, Peto TJ, Adhikari B. Expanding the roles of community health workers to sustain programmes during malaria elimination: a meeting report on operational research in Southeast Asia. Malar J 2024; 23:2. [PMID: 38166839 PMCID: PMC10759643 DOI: 10.1186/s12936-023-04828-4] [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: 10/17/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
In Southeast Asia malaria elimination is targeted by 2030. Cambodia aims to achieve this by 2025, driven in large part by the urgent need to control the spread of artemisinin-resistant falciparum malaria infections. Rapid elimination depends on sustaining early access to diagnosis and effective treatment. In much of Cambodia, rapid elimination will rely on a village malaria worker (VMW) network. Yet as malaria declines and is no longer a common cause of febrile illness, VMWs may become less popular with febrile patients, as VMWs do not diagnose or treat other conditions at present. There is a risk that VMWs become inactive and malaria rebounds before the complete interruption of transmission is achieved.During 2021-23 a large-scale operational research study was conducted in western Cambodia to explore how a VMW network could be sustained by including health activities that cover non-malarial illnesses to encourage febrile patients to continue to attend. 105 VMWs received new rapid diagnostic tests (including dengue antigen-antibody and combined malaria/C-reactive protein tests), were trained in electronic data collection, and attended health education packages on hygiene and sanitation, disease surveillance and first aid, management of mild illness, and vaccination and antenatal care.In August 2023 the National Malaria Control Programme of Cambodia convened a stakeholder meeting in Battambang, Cambodia. Findings from the study were reviewed in the context of current malaria elimination strategies. The discussions informed policy options to sustain the relevance of the VMW network in Cambodia, and the potential for its integration with other health worker networks. This expansion could ensure VMWs remain active and relevant until malaria elimination is accomplished.
Collapse
Affiliation(s)
- Lek Dysoley
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.
- National Institute for Public Health, Phnom Penh, Cambodia.
| | - James J Callery
- Mahidol‑Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Moul Vanna
- Action for Health Development, Battambang, Cambodia
| | | | - Yok Sovann
- Provincial Health Department, Pailin, Cambodia
| | - Sles You
- Provincial Health Department, Battambang, Cambodia
| | - Sam Ol
- Action for Health Development, Battambang, Cambodia
- President's Malaria Initiative, Phnom Penh, Cambodia
| | - Rupam Tripura
- Mahidol‑Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Rusheng Chew
- Mahidol‑Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Arjun Chandna
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | | | - Jayme Hughes
- Clinton Health Access Initiative, Phnom Penh, Cambodia
| | - Nguon Sokomar
- Cambodia Malaria Elimination Project 2, Phnom Penh, Cambodia
- University Research Company Ltd, Phnom Penh, Cambodia
- United States Agency for International Development, Phnom Penh, Cambodia
| | - Top Sophornarann
- Cambodia Malaria Elimination Project 2, Phnom Penh, Cambodia
- University Research Company Ltd, Phnom Penh, Cambodia
- United States Agency for International Development, Phnom Penh, Cambodia
| | - Jeanne Rideout
- Cambodia Malaria Elimination Project 2, Phnom Penh, Cambodia
- University Research Company Ltd, Phnom Penh, Cambodia
- United States Agency for International Development, Phnom Penh, Cambodia
| | - Tat Veyvath
- Provincial Health Department, Battambang, Cambodia
| | - Oum Sarith
- Provincial Health Department, Pailin, Cambodia
| | - Thaung Puthy
- Provincial Health Department, Battambang, Cambodia
| | | | - Sen Sam An
- Cambodia Malaria Elimination Project 2, Phnom Penh, Cambodia
- University Research Company Ltd, Phnom Penh, Cambodia
- United States Agency for International Development, Phnom Penh, Cambodia
| | - Sazid Ibna Zaman
- Mahidol‑Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Lorenz von Seidlein
- Mahidol‑Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Lim Vanthy
- Action for Health Development, Battambang, Cambodia
| | - Preap Sodavuth
- United Nations Office for Project Services, Phnom Penh, Cambodia
| | - Chrun Vannak
- United Nations Office for Project Services, Phnom Penh, Cambodia
| | - Arjen M Dondorp
- Mahidol‑Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Yoel Lubell
- Mahidol‑Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Richard J Maude
- Mahidol‑Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- The Open University, Milton Keynes, UK
| | - Thomas J Peto
- Mahidol‑Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Bipin Adhikari
- Mahidol‑Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
| |
Collapse
|
5
|
Evans L, Acton JH, Hiscott C, Gartner D. An operations research approach to automated patient scheduling for eye care using a multi-criteria decision support tool. Sci Rep 2023; 13:553. [PMID: 36631506 PMCID: PMC9832406 DOI: 10.1038/s41598-022-26755-1] [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: 05/16/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Inefficient management of resources and waiting lists for high-risk ophthalmology patients can contribute to sight loss. The aim was to develop a decision support tool which determines an optimal patient schedule for ophthalmology patients. Our approach considers available booking slots as well as patient-specific factors. Using standard software (Microsoft Excel and OpenSolver), an operations research approach was used to formulate a mathematical model. Given a set of patients and clinic capacities, the model objective was to schedule patients efficiently depending on eyecare measure risk factors, referral-to-treatment times and targets, patient locations and slot availabilities over a pre-defined planning horizon. Our decision support tool can feedback whether or not a patient is scheduled. If a patient is scheduled, the tool determines the optimal date and location to book the patients' appointments, with a score provided to show the associated value of the decisions made. Our dataset from 519 patients showed optimal prioritization based on location, risk of serious vision loss/damage and the referral-to-treatment time. Given the constraints of available slots, managers can input hospital-specific parameters such as demand and capacity into our model. The model can be applied and implemented immediately, without the need for additional software, to generate an optimized patient schedule.
Collapse
Affiliation(s)
- Luke Evans
- grid.5600.30000 0001 0807 5670School of Mathematics, Cardiff University, Cardiff, UK
| | - Jennifer H. Acton
- grid.5600.30000 0001 0807 5670School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Carla Hiscott
- grid.464526.70000 0001 0581 7464Aneurin Bevan University Health Board, Newport, UK
| | - Daniel Gartner
- grid.5600.30000 0001 0807 5670School of Mathematics, Cardiff University, Cardiff, UK ,grid.464526.70000 0001 0581 7464Aneurin Bevan University Health Board, Newport, UK
| |
Collapse
|
6
|
Kidwai-Khan F, Rentsch CT, Pulk R, Alcorn C, Brandt CA, Justice AC. Pharmacogenomics driven decision support prototype with machine learning: A framework for improving patient care. Front Big Data 2022; 5:1059088. [DOI: 10.3389/fdata.2022.1059088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
IntroductionA growing number of healthcare providers make complex treatment decisions guided by electronic health record (EHR) software interfaces. Many interfaces integrate multiple sources of data (e.g., labs, pharmacy, diagnoses) successfully, though relatively few have incorporated genetic data.MethodThis study utilizes informatics methods with predictive modeling to create and validate algorithms to enable informed pharmacogenomic decision-making at the point of care in near real-time. The proposed framework integrates EHR and genetic data relevant to the patient's current medications including decision support mechanisms based on predictive modeling. We created a prototype with EHR and linked genetic data from the Department of Veterans Affairs (VA), the largest integrated healthcare system in the US. The EHR data included diagnoses, medication fills, and outpatient clinic visits for 2,600 people with HIV and matched uninfected controls linked to prototypic genetic data (variations in single or multiple positions in the DNA sequence). We then mapped the medications that patients were prescribed to medications defined in the drug-gene interaction mapping of the Clinical Pharmacogenomics Implementation Consortium's (CPIC) level A (i.e., sufficient evidence for at least one prescribing action) guidelines that predict adverse events. CPIC is a National Institute of Health funded group of experts who develop evidence based pharmacogenomic guidelines. Preventable adverse events (PAE) can be defined as a harmful outcome from an intervention that could have been prevented. For this study, we focused on potential PAEs resulting from a medication-gene interaction.ResultsThe final model showed AUC scores of 0.972 with an F1 score of 0.97 with genetic data as compared to 0.766 and 0.73 respectively, without genetic data integration.DiscussionOver 98% of people in the cohort were on at least one medication with CPIC level a guideline in their lifetime. We compared predictive power of machine learning models to detect a PAE between five modeling methods: Random Forest, Support Vector Machine (SVM), Extreme Gradient Boosting (XGBoost), K Nearest neighbors (KNN), and Decision Tree. We found that XGBoost performed best for the prototype when genetic data was added to the framework and improved prediction of PAE. We compared area under the curve (AUC) between the models in the testing dataset.
Collapse
|
7
|
Noorain S, Paola Scaparra M, Kotiadis K. Mind the gap: a review of optimisation in mental healthcare service delivery. Health Syst (Basingstoke) 2022; 12:133-166. [DOI: 10.1080/20476965.2022.2035260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
8
|
Applying Discrete Event Simulation to Reduce Patient Wait Times and Crowding: The Case of a Specialist Outpatient Clinic with Dual Practice System. Healthcare (Basel) 2022; 10:healthcare10020189. [PMID: 35206804 PMCID: PMC8871892 DOI: 10.3390/healthcare10020189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 11/17/2022] Open
Abstract
Long wait times and crowding are major issues affecting outpatient service delivery, but it is unclear how these affect patients in dual practice settings. This study aims to evaluate the effects of changing consultation start time and patient arrival on wait times and crowding in an outpatient clinic with a dual practice system. A discrete event simulation (DES) model was developed based on real-world data from an Obstetrics and Gynaecology (O&G) clinic in a public hospital. Data on patient flow, resource availability, and time taken for registration and clinic processes for public and private patients were sourced from stakeholder discussion and time-motion study (TMS), while arrival times were sourced from the hospital’s information system database. Probability distributions were used to fit these input data in the model. Scenario analyses involved configurations on consultation start time/staggered patient arrival. The median registration and clinic turnaround times (TT) were significantly different between public and private patients (p < 0.01). Public patients have longer wait times than private patients in this study’s dual practice setting. Scenario analyses showed that early consultation start time that matches patient arrival time and staggered arrival could reduce the overall TT for public and private patients by 40% and 21%, respectively. Similarly, the number of patients waiting at the clinic per hour could be reduced by 10–21% during clinic peak hours. Matching consultation start time with staggered patient arrival can potentially reduce wait times and crowding, especially for public patients, without incurring additional resource needs and help narrow the wait time gap between public and private patients. Healthcare managers and policymakers can consider simulation approaches for the monitoring and improvement of healthcare operational efficiency to meet rising healthcare demand and costs.
Collapse
|
9
|
Gibbs N, Angus C, Dixon S, Parry C, Meier P. Effects of minimum unit pricing for alcohol in South Africa across different drinker groups and wealth quintiles: a modelling study. BMJ Open 2021; 11:e052879. [PMID: 34373316 PMCID: PMC8354280 DOI: 10.1136/bmjopen-2021-052879] [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
OBJECTIVES To quantify the potential impact of minimum unit pricing (MUP) for alcohol on alcohol consumption, spending and health in South Africa. We provide these estimates disaggregated by different drinker groups and wealth quintiles. DESIGN We developed an epidemiological policy appraisal model to estimate the effects of MUP across sex, drinker groups (moderate, occasional binge, heavy) and wealth quintiles. Stakeholder interviews and workshops informed model development and ensured policy relevance. SETTING South African drinking population aged 15+. PARTICIPANTS The population (aged 15+) of South Africa in 2018 stratified by drinking group and wealth quintiles, with a model time horizon of 20 years. MAIN OUTCOME MEASURES Change in standard drinks (SDs) (12 g of ethanol) consumed, weekly spend on alcohol, annual number of cases and deaths for five alcohol-related health conditions (HIV, intentional injury, road injury, liver cirrhosis and breast cancer), reported by drinker groups and wealth quintile. RESULTS We estimate an MUP of R10 per SD would lead to an immediate reduction in consumption of 4.40% (-0.93 SD/week) and an increase in spend of 18.09%. The absolute reduction is greatest for heavy drinkers (-1.48 SD/week), followed by occasional binge drinkers (-0.41 SD/week) and moderate drinkers (-0.40 SD/week). Over 20 years, we estimate 20 585 fewer deaths and 9 00 332 cases averted across the five health-modelled harms.Poorer drinkers would see greater impacts from the policy (consumption: -7.75% in the poorest quintile, -3.19% in richest quintile). Among the heavy drinkers, 85% of the cases averted and 86% of the lives saved accrue to the bottom three wealth quintiles. CONCLUSIONS We estimate that MUP would reduce alcohol consumption in South Africa, improving health outcomes while raising retail and tax revenue. Consumption and harm reductions would be greater in poorer groups.
Collapse
Affiliation(s)
- Naomi Gibbs
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon Dixon
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Charles Parry
- Alcohol, Tobacco and Other Drugs Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| |
Collapse
|
10
|
Silal SP. Operational research: A multidisciplinary approach for the management of infectious disease in a global context. EUROPEAN JOURNAL OF OPERATIONAL RESEARCH 2021; 291:929-934. [PMID: 32836716 PMCID: PMC7377991 DOI: 10.1016/j.ejor.2020.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/04/2020] [Accepted: 07/19/2020] [Indexed: 05/04/2023]
Abstract
Infectious diseases, both established and emerging, impose a significant burden globally. Successful management of infectious diseases requires considerable effort and a multidisciplinary approach to tackle the complex web of interconnected biological, public health and economic systems. Through a wide range of problem-solving techniques and computational methods, operational research can strengthen health systems and support decision-making at all levels of disease control. From improved understanding of disease biology, intervention planning and implementation, assessing economic feasibility of new strategies, identifying opportunities for cost reductions in routine processes, and informing health policy, this paper highlights areas of opportunity for operational research to contribute to effective and efficient infectious disease management and improved health outcomes.
Collapse
Affiliation(s)
- Sheetal Prakash Silal
- Modelling and Simulation Hub, Africa, University of Cape Town, Cape Town, South Africa
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| |
Collapse
|
11
|
Wai B, Vasarhelyi K, Rutherford AR, Buchner C, Gustafson R, Compton M, Hull M, Williams J, Barrios R. A qualitative model of the HIV care continuum in Vancouver, Canada. Health Syst (Basingstoke) 2021; 11:84-97. [DOI: 10.1080/20476965.2021.1906762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Benny Wai
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | - Krisztina Vasarhelyi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Vancouver Coastal Health Research Institute, Vancouver Coastal Health, Vancouver, Canada
| | | | - Chris Buchner
- Population and Public Health, Fraser Health, Surrey, Canada
| | - Reka Gustafson
- Vancouver Coastal Health Research Institute, Vancouver Coastal Health, Vancouver, Canada
| | - Miranda Compton
- Vancouver Coastal Health Research Institute, Vancouver Coastal Health, Vancouver, Canada
| | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jf Williams
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| |
Collapse
|
12
|
Vieira B, Demirtas D, van de Kamer JB, Hans EW, Jongste W, van Harten W. Radiotherapy treatment scheduling: Implementing operations research into clinical practice. PLoS One 2021; 16:e0247428. [PMID: 33606831 PMCID: PMC7894882 DOI: 10.1371/journal.pone.0247428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/05/2021] [Indexed: 12/24/2022] Open
Abstract
Background Every week, radiotherapy centers face the complex task of scheduling hundreds of treatment sessions amongst the available linear accelerators. With the increase in cancer patient numbers, manually creating a feasible and efficient schedule has shown to be a difficult, time-consuming task. Although operations research models have been increasingly reported upon to optimize patient care logistics, there is almost no scientific evidence of implementation in practice. Methods A mathematical operations research model was adapted to generate radiotherapy treatment schedules in two Dutch centers. The model was iteratively adjusted to fulfill the technical and medical constraints of each center until a valid model was attained. Patient data was collected for the planning horizon of one week, and the feasibility of the obtained schedules was verified by the staff of each center. The resulting optimized solutions are compared with the ones manually developed in practice. Results The weekly schedule was improved in both centers by decreasing the average standard deviation between sessions’ starting times from 103.0 to 50.4 minutes (51%) in one center, and the number of gaps in the schedule from 18 to 5 (72%) in the other. The number of patients requiring linac switching between sessions has also decreased from 71 to 0 patients in one center, and from 43 to 2 in the other. The automated process required 5 minutes and 1.5 hours of computation time to find an optimal weekly patient schedule, respectively, as opposed to approximately 1.5 days when performed manually for both centers. Conclusions The practical application of a theoretical operations research model for radiotherapy treatment scheduling has provided radiotherapy planners a feasible, high-quality schedule in an automated way. Iterative model adaptations performed in small steps, early engagement of stakeholders, and constant communication proved to facilitate the implementation of operations research models into clinical practice.
Collapse
Affiliation(s)
- Bruno Vieira
- Department of Radiation Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands
| | - Derya Demirtas
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands
- Faculty of Behavioural Management and Social Sciences, Department Industrial Engineering and Business Information Systems, University of Twente, Enschede, The Netherlands
| | - Jeroen B. van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Erwin W. Hans
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands
- Faculty of Behavioural Management and Social Sciences, Department Industrial Engineering and Business Information Systems, University of Twente, Enschede, The Netherlands
| | | | - Wim van Harten
- Department of Radiation Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Health Technology and Services Research, School of Governance and Management, University of Twente, Enschede, The Netherlands
- * E-mail:
| |
Collapse
|
13
|
Lamé G, Crowe S, Barclay M. “What’s the evidence?”—Towards more empirical evaluations of the impact of OR interventions in healthcare. Health Syst (Basingstoke) 2020; 11:59-67. [PMID: 35127059 PMCID: PMC8812794 DOI: 10.1080/20476965.2020.1857663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite an increasing number of papers reporting applications of operational research (OR) to problems in healthcare, there remains little empirical evidence of OR improving healthcare delivery in practice. Without such evidence it is harder both to justify the usefulness of OR to a healthcare audience and to learn and continuously improve our approaches. To progress, we need to build the evidence-base on whether and how OR improves healthcare delivery through careful empirical evaluation. This position paper reviews evaluation standards in healthcare improvement research and dispels some common myths about evaluation. It highlights the current lack of robust evaluation of healthcare OR and makes the case for addressing this. It then proposes possible ways for building better empirical evaluations of OR interventions in healthcare.
Collapse
Affiliation(s)
- Guillaume Lamé
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
- Laboratoire Génie Industriel, Université Paris-Saclay, CentraleSupélec, Gif-sur-Yvette, France
| | - Sonya Crowe
- Clinical Operational Research Unit, University College London, London, UK
| | - Matthew Barclay
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| |
Collapse
|
14
|
Gibbs N, Kwon J, Balen J, Dodd PJ. Operational research to support equitable non-communicable disease policy in low-income and middle-income countries in the sustainable development era: a scoping review. BMJ Glob Health 2020; 5:e002259. [PMID: 32605934 PMCID: PMC7328817 DOI: 10.1136/bmjgh-2019-002259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Non-communicable diseases (NCDs) represent a growing health burden in low-income and middle-income countries (LMICs). Operational research (OR) has been used globally to support the design of effective and efficient public policies. Equity is emphasised in the Sustainable Development Goal (SDG) framework introduced in 2015 and can be analysed within OR studies. METHODS We systematically searched MEDLINE, Embase, Scopus and Web of Science for studies published between 2015 and 2018 at the intersection of five domains (OR, LMICs, NCDs, health and decision-making and/or policy-making). We categorised the type of policy intervention and described any concern for equity, which we defined as either analysis of differential impact by subgroups or, policy focus on disadvantaged groups or promoting universal health coverage (UHC). RESULTS A total of 149 papers met the inclusion criteria. The papers covered a number of policy types and a broad range of NCDs, although not in proportion to their relative disease burden. A concern for equity was demonstrated by 88 of the 149 papers (59%), with 8 (5%) demonstrating differential impact, 47 (32%) targeting disadvantaged groups, and 68 (46%) promoting UHC. CONCLUSION Overall, OR for NCD health policy in the SDG era is being applied to a diverse set of interventions and conditions across LMICs and researchers appear to be concerned with equity. However, the current focus of published research does not fully reflect population needs and the analysis of differential impact within populations is rare.
Collapse
Affiliation(s)
- Naomi Gibbs
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Joseph Kwon
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Julie Balen
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Peter J Dodd
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| |
Collapse
|
15
|
Besar Sa'aid H, Mathew S, Richardson M, Bielecki JM, Sander B. Mapping the evidence on health equity considerations in economic evaluations of health interventions: a scoping review protocol. Syst Rev 2020; 9:6. [PMID: 31915067 PMCID: PMC6950907 DOI: 10.1186/s13643-019-1257-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/18/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Equity in health has become an important policy agenda around the world, prompting health economists to advance methods to enable the inclusion of equity in economic evaluations. Among the methods that have been proposed to explicitly include equity are the weighting analysis, equity impact analysis, and equity trade-off analysis. This is a new development and a comprehensive overview of trends and concepts of health equity in economic evaluations is lacking. Thus, our objective is to map the current state of the literature with respect to how health equity is considered in economic evaluations of health interventions reported in the academic and gray literature. METHODS We will conduct a scoping review to identify and map evidence on how health equity is considered in economic evaluations of health interventions. We will search relevant electronic, gray literature and key journals. We developed a search strategy using text words and Medical Subject Headings terms related to health equity and economic evaluations of health interventions. Articles retrieved will be uploaded to reference manager software for screening and data extraction. Two reviewers will independently screen the articles based on their titles and abstracts for inclusion, and then will independently screen a full text to ascertain final inclusion. A simple numerical count will be used to quantify the data and a content analysis will be conducted to present the narrative; that is, a thematic summary of the data collected. DISCUSSION The results of this scoping review will provide a comprehensive overview of the current evidence on how health equity is considered in economic evaluations of health interventions and its research gaps. It will also provide key information to decision-makers and policy-makers to understand ways to include health equity into the prioritization of health interventions when aiming for a more equitable distribution of health resources. SYSTEMATIC REVIEW REGISTRATION This protocol was registered with Open Science Framework (OSF) Registry on August 14, 2019 (https://osf.io/9my2z/registrations).
Collapse
Affiliation(s)
- Hafizah Besar Sa'aid
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada. .,Faculty of Business and Management, Universiti Teknologi MARA (UiTM), Sungai Petani, Kedah, Malaysia. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Sharon Mathew
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marina Richardson
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Joanna M Bielecki
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| |
Collapse
|
16
|
Hanney SR, González-Block MA. 'Knowledge for better health' revisited - the increasing significance of health research systems: a review by departing Editors-in-Chief. Health Res Policy Syst 2017; 15:81. [PMID: 28965493 PMCID: PMC5623979 DOI: 10.1186/s12961-017-0248-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 01/22/2023] Open
Abstract
How can nations organise research investments to obtain the best bundle of knowledge and the maximum level of improved health, spread as equitably as possible? This question was the central focus of a major initiative from WHO led by Prof Tikki Pang, which resulted in a range of developments, including the publication of a conceptual framework for national health research systems - Knowledge for better health - in 2003, and in the founding of the journal Health Research Policy and Systems (HARPS). As Editors-in-Chief of the journal since 2006, we mark our retirement by tracking both the progress of the journal and the development of national health research systems. HARPS has maintained its focus on a range of central themes that are key components of a national health research system in any country. These include building capacity to conduct and use health research, identifying appropriate priorities, securing funds and allocating them accountably, producing scientifically valid research outputs, promoting the use of research in polices and practice in order to improve health, and monitoring and evaluating the health research system. Some of the themes covered in HARPS are now receiving increased attention and, for example, with the assessment of research impact and development of knowledge translation platforms, the journal has covered their progress throughout that expansion of interest. In addition, there is increasing recognition of new imperatives, including the importance of promoting gender equality in health research if benefits are to be maximised. In this Editorial, we outline some of the diverse and developing perspectives considered within each theme, as well as considering how they are held together by the growing desire to build effective health research systems in all countries.From 2003 until mid-June 2017, HARPS published 590 articles on the above and related themes, with authors being located in 76 countries. We present quantitative data tracing the journal's growth and the increasing external recognition of its role. We thank the many colleagues who have kindly contributed to the journal's success, and finish on an exciting note by welcoming the new Editors-in-Chief who will take HARPS forward.
Collapse
Affiliation(s)
- Stephen R. Hanney
- Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH United Kingdom
| | - Miguel A. González-Block
- Universidad Anáhuac, Av. Universidad Anáhuac 46, Lomas Anáhuac, 52786 Huixquilucan Mexico City, Mexico
| |
Collapse
|