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O'Shea C, Manuel A, Te Ao B, Silwal PR, Harwood M, Murphy R, Ramke J. How have services for diabetes, eye, hearing and foot health been integrated for adults? Protocol for a scoping review. BMJ Open 2024; 14:e082225. [PMID: 38485479 PMCID: PMC10941158 DOI: 10.1136/bmjopen-2023-082225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION The global population is ageing, and by 2050, there will be almost 2.1 billion people over the age of 60 years. This ageing population means conditions such as diabetes are on the increase, as well as other conditions associated with ageing (and/or diabetes), including those that cause vision impairment, hearing impairment or foot problems. The aim of this scoping review is to identify the extent of the literature describing integration of services for adults of two or more of diabetes, eye, hearing or foot services. METHODS AND ANALYSIS The main database searches are of Medline and Embase, conducted by an information specialist, without language restrictions, for studies published from 1 January 2000 describing the integration of services for two or more of diabetes, eye, hearing and foot health in the private or public sector and at the primary or secondary level of care, primarily targeted to adults aged ≥40 years. A grey literature search will focus on websites of key organisations. Reference lists of all included articles will be reviewed to identify further studies. Screening and data extraction will be undertaken by two reviewers independently and any discrepancies will be resolved by discussion. We will use tables, maps and text to summarise the included studies and findings, including where studies were undertaken, which services tended to be integrated, in which sector and level of the health system, targeting which population groups and whether they were considered effective. ETHICS AND DISSEMINATION As our review will be based on published data, ethical approval will not be sought. This review is part of a project in Aotearoa New Zealand that aims to improve access to services for adults with diabetes or eye, hearing or foot conditions. The findings will be published in a peer-reviewed journal and presented at relevant conferences.
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Affiliation(s)
- Claire O'Shea
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand claire.o'
- Waikato Regional Diabetes Service, Health New Zealand - Te Whatu Ora, Hamilton, New Zealand
| | - Alehandrea Manuel
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Braden Te Ao
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Pushkar Raj Silwal
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Department of Medicine - Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jacqueline Ramke
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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Chabba N, Silwal PR, Bascaran C, McCormick I, Goodman L, Gordon I, Burton MJ, Keel S, Evans J, Ramke J. What is the coverage of retina screening services for people with diabetes? Protocol for a systematic review and meta-analysis. BMJ Open 2024; 14:e081123. [PMID: 38296278 PMCID: PMC10828834 DOI: 10.1136/bmjopen-2023-081123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/21/2023] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Diabetic retinopathy is a leading cause of vision impairment globally. Vision loss from diabetic retinopathy can generally be prevented by early detection and timely treatment. The WHO included a measure of service access for diabetic retinopathy as a core indicator in the Eye Care Indicator Menu launched in 2022: retina screening coverage for people with diabetes. The aim of this review is to provide a comprehensive global and regional summary of the available information on retina screening coverage for people with diabetes. METHODS AND ANALYSIS A search will be conducted in five databases without language restrictions for studies from any country reporting retina screening coverage for adults with any type of diabetes at the national or subnational level using data collected since 1 January 2000 until the search date. We will also seek reports and coverage statistics from government websites of all WHO member states. Two investigators will independently screen studies, extract relevant data and assess risk of bias of included studies. The results of the review will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. We will summarise the range of coverage definitions reported across included studies and present the median retina screening coverage in WHO regions and by World Bank country income level. Depending on the availability of data, we will conduct meta-analysis to assess disparities in retina screening coverage for people with diabetes by factors in the PROGRESS framework (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status and Social capital). ETHICS AND DISSEMINATION This review will only include published data thus no ethical approval will be sought. The findings of this review will be published in a peer-reviewed journal and presented at relevant conferences. PROTOCOL REGISTRATION NUMBER OSF registration 17/10/2023: https://osf.io/k5p69.
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Affiliation(s)
- Nimisha Chabba
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Pushkar Raj Silwal
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Goodman
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Iris Gordon
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Stuart Keel
- Department of Noncommunicable Disease, World Health Organization, Geneva, Switzerland
| | - Jennifer Evans
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacqueline Ramke
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
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Silwal PR, Lee AC, Squirrell D, Zhao J, Harwood M, Vincent AL, Murphy R, Ameratunga S, Ramke J. Use of public sector diabetes eye services in New Zealand 2006-2019: Analysis of national routinely collected datasets. PLoS One 2023; 18:e0285904. [PMID: 37200245 DOI: 10.1371/journal.pone.0285904] [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] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/03/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE To assess diabetes eye service use in New Zealand among people aged ≥15 years by estimating service attendance, biennial screening rate, and disparities in the use of screening and treatment services. METHODS We obtained Ministry of Health data from the National Non-Admitted Patient Collection on diabetes eye service events between 1 July 2006 and 31 December 2019 and sociodemographic and mortality data from the Virtual Diabetes Register and linked these using a unique patient identifier (encrypted National Health Index). We 1) summarized attendance at retinal screening and ophthalmology services, 2) calculated biennial and triennial screening rate, 3) summarized treatment with laser and anti-VEGF and used log-binomial regression to examine associations of all of these with age group, ethnicity, and area-level deprivation. RESULTS In total, 245,844 people aged ≥15 years had at least one diabetes eye service appointment attended or scheduled; half of these (n = 125,821, 51.2%) attended only retinal screening, one-sixth attended only ophthalmology (n = 35,883, 14.6%) and one-third attended both (n = 78,300, 31.8%). The biennial retinal screening rate was 62.1%, with large regional variation (73.9% in Southern District to 29.2% in West Coast). Compared with NZ Europeans, Māori were approximately twice as likely to never receive diabetes eye care or to access ophthalmology when referred from retinal screening, 9% relatively less likely to receive biennial screening and received the fewest anti-VEGF injections when treatment was commenced. Disparities in service access were also present for Pacific Peoples compared to NZ Europeans, younger and older age groups compared to those aged 50-59 years and those living in areas with higher deprivation. CONCLUSIONS Access to diabetes eye care is suboptimal, with substantial disparity between age groups, ethnicity groups, area level deprivation quintile and across districts. Efforts to improve access to and quality of diabetes eye care services must include strengthening data collection and monitoring.
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Affiliation(s)
- Pushkar Raj Silwal
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Arier C Lee
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Squirrell
- Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Jinfeng Zhao
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrea L Vincent
- Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
- Whitiora Diabetes Service, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Population Health Directorate, Counties Manukau Health, Auckland, New Zealand
| | - Jacqueline Ramke
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Silwal PR, Exeter D, Tenbensel T, Lee A. Understanding geographical variations in health system performance: a population-based study on preventable childhood hospitalisations. BMJ Open 2022; 12:e052209. [PMID: 35649589 PMCID: PMC9161092 DOI: 10.1136/bmjopen-2021-052209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate interdistrict variations in childhood ambulatory sensitive hospitalisation (ASH) over the years. DESIGN Observational population-based study over 2008-2018 using the Primary Health Organisation Enrolment Collection (PHO) and the National Minimum Dataset hospital events databases. SETTING New Zealand primary and secondary care. PARTICIPANTS All children aged 0-4 years enrolled in the PHO Enrolment Collection from 2008 to 2018. MAIN OUTCOME MEASURE ASH. RESULTS Only 1.4% of the variability in the risk of having childhood ASH (intracluster correlation coefficient=0.014) is explained at the level of District Health Board (DHB), with the median OR of 1.23. No consistent time trend was observed for the adjusted childhood ASH at the national level, but the DHBs demonstrated different trajectories over the years. Ethnicity (being a Pacific child) followed by deprivation demonstrated stronger relationships with childhood ASH than the geography and the health system input variables. CONCLUSION The variation in childhood ASH is explained only minimal at the DHB level. The sociodemographic variables also only partly explained the variations. Unlike the general ASH measure, the childhood ASH used in this analysis provides insights into the acute conditions sensitive to primary care services. However, further information would be required to conclude this as the DHB-level performance variations.
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Affiliation(s)
- Pushkar Raj Silwal
- Health Systems Department, The University of Auckland, Auckland, New Zealand
| | - Daniel Exeter
- Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Tim Tenbensel
- Health Systems Department, The University of Auckland, Auckland, New Zealand
| | - Arier Lee
- Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
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Olugbenga Ayeleke R, Tenbensel T, Silwal PR, Walton L. Like using a refrigerator to heat food: capacity and capability funding in primary care and the legacy of the Primary Health Organisation Performance Programme. J Prim Health Care 2020; 12:345-351. [PMID: 33349322 DOI: 10.1071/hc20012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/11/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In 2016, the New Zealand Ministry of Health introduced the System Level Measures (SLM) framework as a new approach to health system improvement that emphasised quality improvement and integration. A funding stream that was a legacy of past primary care performance management was repurposed as 'capacity and capability' funding to support the implementation of the SLM framework. AIM This study explored how the capacity and capability funding has been used and the issues and challenges that have arisen from the funding implementation. METHODS Semi-structured interviews with 50 key informants from 18 of New Zealand's 20 health districts were conducted. Interview transcripts were coded using thematic analysis. RESULTS The capacity and capability funding was used in three different ways. Approximately one-third of districts used it to actively support quality improvement and integration initiatives. Another one-third tweaked existing performance incentive schemes and in the remaining one-third, the funding was passed directly on to general practices without strings attached. Three key issues were identified related to implementation of the capacity and capability funding: lack of clear guidance regarding the use of the funding; funding perceived as a barrier to integration; and funding seen as insufficient for intended purposes. DISCUSSION The capacity and capability funding was intended to support collaborative integration and quality improvement between health sector organisations at the district level. However, there is a mismatch between the purpose of the capacity and capability funding and its use in practice, which is primarily a product of incremental and inconsistent policy development regarding primary care improvement.
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Affiliation(s)
- Reuben Olugbenga Ayeleke
- School of Population Health, The University of Auckland, Auckland, New Zealand; and Corresponding author.
| | - Timothy Tenbensel
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Pushkar Raj Silwal
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Lisa Walton
- School of Population Health, The University of Auckland, Auckland, New Zealand
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Pokharel R, Silwal PR. Social health insurance in Nepal: A health system departure toward the universal health coverage. Int J Health Plann Manage 2018; 33:573-580. [PMID: 29635799 DOI: 10.1002/hpm.2530] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 11/11/2022] Open
Abstract
The World Health Organization has identified universal health coverage (UHC) as a key approach in reducing equity gaps in a country, and the social health insurance (SHI) has been recommended as an important strategy toward it. This article aims to analyze the design, expected benefits and challenges of realizing the goals of UHC through the recently launched SHI in Nepal. On top of the earlier free health-care policy and several other vertical schemes, the SHI scheme was implemented in 2016 and has reached population coverage of 5% in the implemented districts in just within a year of implementation. However, to achieve UHC in Nepal, in addition to operationalizing the scheme, several other requirements must be dealt simultaneously such as efficient health-care delivery system, adequate human resources for health, a strong information system, improved transparency and accountability, and a balanced mix of the preventive, health promotion, curative, and rehabilitative services including actions to address the social determinants of health. The article notes that strong political commitment and persistent efforts are the key lessons learnt from countries achieving progressive UHC through SHI.
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Affiliation(s)
- Rajani Pokharel
- Support to the Health Sector Programme (S2HSP), Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Kathmandu, Nepal
| | - Pushkar Raj Silwal
- Support to the Health Sector Programme (S2HSP), Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Kathmandu, Nepal
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Abstract
OBJECTIVES Public hospitals in Nepal account for a major share of the total health budget. Therefore, questions are often asked about the performance of these hospitals. Existing measures of performance are limited to historical ratio analyses without any benchmarks. The objective of this study is to explore the trends in inputs, outputs and productivity changes in Nepalese public hospitals from 2011-2012 to 2013-2014. SETTING AND PARTICIPANTS The study was conducted among 32 Nepalese public hospitals (23 district level and 9 higher level) for the three fiscal years from 2011-2012 to 2013-2014. OUTCOME MEASURES First, basic ratio analyses were conducted for the input and output measures over the study years. Then, Malmquist productivity change scores were obtained using data envelopment analysis. Aggregated as well as separate analyses were conducted for district level and higher level hospitals. RESULTS Real expenditures of the sampled hospitals declined over the 3-year period from an average of US$ 371 000 in year 1 to US$ 368 730 in year 2 and US$ 328680 in year 3. The average aggregated hospital outputs increased marginally from 8276 in 2011-2012 to 8613 in 2013-2014. The total factor productivity of the study hospitals declined by 6.9% annually from 2011-2012 to 2013-2014. Of the total 32 hospitals, productivity increased in only 12 (37.5%) hospitals and declined in the remaining 20 hospitals. The total factor productivity loss was influenced by a decline in technology change, despite an increase in efficiency. CONCLUSIONS In general, productivity of the study hospitals declined over the study period. Availability and accessibility of accurate, detailed and consistent measures of hospital inputs and outputs is a major challenge for this type of analysis.
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Affiliation(s)
- Pushkar Raj Silwal
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Toni Ashton
- Health Systems Section, University of Auckland, Auckland, New Zealand
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