scholarly journals Development of a framework for reporting health service models for managing rheumatoid arthritis

2009 ◽  
Vol 29 (2) ◽  
pp. 151-165 ◽  
Author(s):  
Siobhan O’Donnell ◽  
Linda C. Li ◽  
Judy King ◽  
Chantal Lauzon ◽  
Heather Finn ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Service ◽  
Service Models

scholarly journals Acute mental health service use is increased in rheumatoid arthritis and ankylosing spondylitis: a population-based cohort study

2020 ◽  
Vol 12 ◽  
pp. 1759720X2092171
Author(s):  
Bindee Kuriya ◽  
Vivian Tia ◽  
Jin Luo ◽  
Jessica Widdifield ◽  
Simone Vigod ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Mental Health ◽  
Ankylosing Spondylitis ◽  
Health Service ◽  
Service Use ◽  
Population Based ◽  
System Level ◽  
Health Service Use ◽  
Increased Risk ◽  
Ed Visits

Background: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are associated with mental illness. Whether acute mental health (MH) service utilization (i.e. emergency visits or hospitalizations) is increased in RA or AS is not known. Methods: Two population-based cohorts were created where individuals with RA ( n = 53,240) or AS ( n = 13,964) were each matched by age, sex, and year to unaffected comparators (2002–2016). Incidence rates per 1000 person-years (PY) were calculated for a first MH emergency department (ED) presentation or MH hospitalization. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated, adjusting for demographic, clinical, and health service use variables. Results: Individuals with RA had higher rates of ED visits [6.59/1000 person-years (PY) versus 4.39/1000 PY in comparators] and hospitalizations for MH (3.11/1000 PY versus 1.80/1000 PY in comparators). Higher rates of ED visits (7.92/1000 PY versus 5.62/1000 PY in comparators) and hospitalizations (3.03/1000 PY versus 1.94/1000 PY in comparators) were also observed in AS. Overall, RA was associated with a 34% increased risk for MH hospitalization (HR 1.34, 95% CI 1.22–1.47) and AS was associated with a 36% increased risk of hospitalization (HR 1.36, 95% CI 1.12–1.63). The risk of ED presentation was attenuated, but remained significant, after adjustment in both RA (HR 1.08, 95% CI 1.01–1.15) and AS (HR 1.14, 95% CI 1.02–1.28). Conclusions: RA and AS are both independently associated with a higher rate and risk of acute ED presentations and hospitalizations for mental health conditions. These findings underscore the need for routine evaluation of MH as part of the management of chronic inflammatory arthritis. Additional research is needed to identify the underlying individual characteristics, as well as system-level variation, which may explain these differences, and to help plan interventions to make MH service use more responsive to the needs of individuals living with RA and AS.

scholarly journals Translating the Strengthening and Stretching for Rheumatoid Arthritis of the Hand Programme from clinical trial to clinical practice: An effectiveness–implementation study

Hand Therapy ◽  
2020 ◽  
Vol 25 (3) ◽  
pp. 87-97
Author(s):  
Esther Williamson ◽  
Cynthia Srikesavan ◽  
Jacqueline Thompson ◽  
Eda Tonga ◽  
Lucy Eldridge ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trial ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Routine Care ◽  
Service Organizations ◽  
Implementation Study ◽  
Health Service Organizations

Introduction The Strengthening and Stretching for Rheumatoid Arthritis of the Hand programme is a hand exercise programme for people with rheumatoid arthritis. It was clinically effective when delivered during a clinical trial but there was a need to evaluate translation into routine care. Methods We conducted an effectiveness–implementation study. We adapted the trial training into an online format for National Health Service hand therapists. Educational outcomes included confidence and capability to deliver the programme. Implementation outcomes included training reach and adoption. Therapists were invited to collect clinical outcomes. Patients receiving the programme provided data on function (Michigan Hand Questionnaire function scale), pain and grip strength at baseline, treatment discharge and four-month follow-up. Results A total of 790 therapists (188 National Health Service organizations) enrolled in the training; 584/790 (74%) therapists (162 National Health Service organizations) completed the training; 448/790 therapists (145 National Health Service organizations) (57%) evaluated the training and were confident (447/448, 99.8%) and capable (443/448, 99%) to deliver the programme with 85% intending to adopt it (379/448). Follow-up data were provided by 116/448 (26%) therapists. Two-thirds (77/116; 51 National Health Service organizations) reported adopting the programme. One hundred and eighteen patients (15 National Health Service trusts) participated. Patients reported improved function (mean change Michigan Hand Questionnaire scores: 10 (95% CI 6.5–13.6) treatment discharge; 7 (95% CI 3.8–10.2) 4-month follow-up). Grip strength increased 24.5% (left) and 31% (right). Pain was stable. Discussion Online training was an effective way to train therapists with good reach. Clinical outcomes were similar to the clinical trial providing preliminary evidence of successful translation into routine care.

scholarly journals Road to better health and integration: a Delphi study on health service models for Hong Kong migrants

2014 ◽  
Vol 13 (1) ◽  
Author(s):  
William CW Wong ◽  
Petula SY Ho ◽  
Jun Liang ◽  
Eleanor A Holroyd ◽  
Cindy LK Lam ◽  
...  
Keyword(s):  
Hong Kong ◽  
Health Service ◽  
Delphi Study ◽  
Service Models

scholarly journals Clinical effectiveness – a series of perspectives

1997 ◽  
Vol 21 (7) ◽  
pp. 389-389
Author(s):  
Sarah Marriott
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Clinical Effectiveness ◽  
Effective Practice ◽  
Healthcare Provision ◽  
Service Models

Ensuring clinically effective practice and service models is now a major challenge for the National Health Service. It requires a clear focus on the purpose of healthcare provision – care which is most likely to result in the best possible individual or population outcomes within existing resources.

Global Rural and Remote Patients with Rheumatoid Arthritis

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Emilie Pianarosa ◽  
Kelsey Chomistek ◽  
Ralph Hsiao ◽  
Salman Anwar ◽  
Valerie Umaefulam ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Service ◽  
Clinical Outcomes ◽  
Service Use ◽  
Care Delivery ◽  
Health Service Use ◽  
Rural And Remote ◽  
Urban Populations ◽  
Increased Risk ◽  
Diagnostic Time

Introduction: Rural and remote patients with rheumatoid arthritis (RA) are at risk for inequities in health outcomes based on differences in physical environments and healthcare access potential compared to urban populations. The aim of this systematic review was to synthesize epidemiology, clinical outcomes and health service use reported for global populations with RA residing in rural/remote locations. Methods: Medline, EMBASE, Healthstar, CINAHL and Cochrane were searched from inception to June 2019 using librarian-developed search terms for RA and rural/remote populations. Peer-reviewed published manuscripts were included if they reported on any of an epidemiology, clinical or health service use outcomes. Results: 54 articles were included for data synthesis, representing studies from all continents. In 11 studies where there was an appropriate urban population comparator, rural/remote populations were not at increased risk for RA, 1 study reported increased and 5 studies reported decreased prevalence in rural/remote populations. Clinical characteristics of rural/remote populations in studies with an appropriate urban comparator showed no significant differences in disease activity measures or disability, but with 1 study reporting worse physical function and health-related quality of life in rural/remote populations. Studies reporting on health service use provided evidence that rural/remote residence impacts diagnostic time, ongoing follow-up, access to RA-care related practitioners and services, and with variation in medication access and use. Conclusion: This synthesis highlights that RA epidemiology and clinical outcomes are not necessarily different between rural/remote and urban populations, however rural/remote patients face greater barriers to care which increases the risk for inequities in outcomes. From a public health perspective, we need leadership to implement structures and policies to support better outcomes in rural and remote populations. Access to health services is a recognized determinant of health, which presents the opportunity for actionable strategies and approaches to resolve inequities in care delivery.

scholarly journals You pays your money and you takes your choice

1996 ◽  
Vol 20 (5) ◽  
pp. 272-274 ◽  
Author(s):  
Robert Davey ◽  
Stephen Littlewood
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Health Services ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Regional Level ◽  
Adolescent Psychiatrist ◽  
Service Models ◽  
Adolescent Mental Health Service

Health services are now commissioned at a local rather than a regional level. It is essential for local consultants to have an input to the planning and commissioning process. For the child and adolescent psychiatrist this task is complicated by an absence of nationally agreed guidelines on the level of resourcing required for a district child and adolescent mental health service. This paper describes an approach to advising purchasers which offers them a choice of service models that differ in their levels of resourcing. Each of the service models is described briefly. The advantages and flexibility of this approach are discussed.

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