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Lingam R, Smithers-Sheedy H, Hodgson S, Hutchinson K, Meyers Morris T, Hu N, Nassar N, Schroeder EA, Rana R, Dickins E, Bula K, Zurynski Y. Evaluation of RuralkidsGPS; A Novel Integrated Paediatric Care Coordination Model of Care in Rural Australia - a Mixed-Methods Study Protocol. Int J Integr Care 2023; 23:10. [PMID: 38020416 PMCID: PMC10668883 DOI: 10.5334/ijic.7008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The Kids Guided Personalised Service (KidsGPS) is an integrated model of care coordination for children and young people (CYP) living with medical complexity. After successful implementation in an urban setting, the model of care will be rolled-out at scale to four rural regions in New South Wales, Australia to establish RuralKidsGPS. This paper describes the approach and methods for the outcome and implementation evaluation of RuralKidsGPS. Description The evaluation aims to assess health, economic and implementation outcomes and processes whilst identifying barriers and enablers to inform future rollouts. Measures of health service utilisation (primary outcome), child health related quality of life and parent/carer experiences will be assessed. The implementation evaluation will occur alongside the outcomes evaluation and is underpinned by the Consolidated Framework for Implementation Research and informed by validated quantitative measures and qualitative interviews with patients, families, healthcare providers and service managers. An economic analysis will determine incremental cost effectiveness ratios for the new model of care using health service utilisation data. Conclusion RuralKidsGPS, if effective, has the potential to improve equity of access to integrated care for CYP and their families and this protocol may inform other evaluations of similar models of care delivered at scale.
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Affiliation(s)
- Raghu Lingam
- Population Child Health Research Group, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
- The Sydney Children’s Hospitals Network, Sydney, NSW, Australia
| | - Hayley Smithers-Sheedy
- Population Child Health Research Group, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Karen Hutchinson
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Tammy Meyers Morris
- Population Child Health Research Group, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
- Department of Community Paediatrics, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Nan Hu
- Population Child Health Research Group, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth-Ann Schroeder
- Macquarie University Centre for the Health Economy, Australian Institute of Health Innovation, Macquarie University, Sydney NSW 2113, Australia
| | - Rezwanul Rana
- Macquarie University Centre for the Health Economy, Australian Institute of Health Innovation, Macquarie University, Sydney NSW 2113, Australia
| | - Emma Dickins
- The Sydney Children’s Hospitals Network, Sydney, NSW, Australia
| | - Kirsten Bula
- The Sydney Children’s Hospitals Network, Sydney, NSW, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Wybraniec M, Wrobel W, Wilkosz K, Wrona K, Bula K, Kolasa J, Mizia-Stec K. P1907Propensity score matched analysis of antazoline mesylate vs. amiodarone or propafenone for pharmacological cardioversion of short-duration atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Former studies corroborated promising quinidine-like properties of antazoline mesylate facilitating rapid cardioversion atrial fibrillation (AF). Still, paucity of data exists concerning direct comparison of antazoline to other antiarrhythmic agents.
Purpose
The study aimed to verify the hypothesis that intravenous antazoline is non-inferior to amiodarone and/or propafenone in terms of rhythm conversion rate and safety among patients with AF.
Methods
After reviewing 2344 consecutive medical records with I48 code of international classification of diseases (ICD), 505 eligible patients (21.5%) with paroxysmal or persistent AF who underwent emergent pharmacological cardioversion in the real-world setting of emergency department were enrolled in retrospective observational analysis. The choice of antiarrhythmic drug was left to the discretion of attending physician. Antazoline group was separately matched with corresponding amiodarone (n=218) and propafenone (n=90) cohort using propensity score matching (PSM) with nearest neighbor algorithm (ratio 1:1), adjusting for age, sex, arterial hypertension, diabetes, depressed left ventricular ejection fraction, coronary artery disease, history of stroke, AF ablation, CHA2DS2-VASc score, chronic kidney disease and duration of AF episode. The primary endpoint was restoration of sinus rhythm in the emergency department.
Results
The study population (mean age of 67 (59; 74) years; 53.7% females) was characterized by median AF episode duration of 10.5 (5; 24) hours. Antazoline alone was administered in 23.4% of patients (n=118); amiodarone in 47.5% (n=240); propafenone in 9.9% (n=50); while 19.2% (n=97) received ≥2 antiarrhythmic drugs. Before PSM adjustment, antazoline had comparable rhythm conversion rate to propafenone (85.6% vs. 80.0%; P=0.367) and higher than amiodarone treatment (vs. 66.7%, P=0.0002), and greater than combined amiodarone/propafenone group (68.6%; RR 1.25; 95% CI: 1.12–1.39, P=0.0001). After PSM, the use of antazoline was associated with the efficacy similar to propafenone (82.2% vs. 80.0%, RR 1.03; 95% CI: 0.84–1.25, P=0.788) and superior to amiodarone (85.3% vs. 67.0%, RR 1.27, 95% CI: 1.09–1.48, P=0.0019, number needed to treat 5.5; Figure). No major adverse actions were reported in the antazoline group.
Conclusion
Antazoline appears to be an efficacious and safe drug for pharmacological cardioversion of AF in real-life setting, which is at least non-inferior to existing antiarrhythmic drugs.
Acknowledgement/Funding
None
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Affiliation(s)
- M Wybraniec
- School of Medicine in Katowice, Medical University of Silesia, First Department of Cardiology, Katowice, Poland
| | - W Wrobel
- School of Medicine in Katowice, Medical University of Silesia, First Department of Cardiology, Katowice, Poland
| | - K Wilkosz
- School of Medicine in Katowice, Medical University of Silesia, First Department of Cardiology, Katowice, Poland
| | - K Wrona
- School of Medicine in Katowice, Medical University of Silesia, First Department of Cardiology, Katowice, Poland
| | - K Bula
- School of Medicine in Katowice, Medical University of Silesia, First Department of Cardiology, Katowice, Poland
| | - J Kolasa
- School of Medicine in Katowice, Medical University of Silesia, First Department of Cardiology, Katowice, Poland
| | - K Mizia-Stec
- School of Medicine in Katowice, Medical University of Silesia, First Department of Cardiology, Katowice, Poland
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