scholarly journals Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK

BMJ Open ◽  
2014 ◽  
Vol 4 (7) ◽  
pp. e005322-e005322 ◽  
Author(s):  
E. J. Adams ◽  
A. Ehrlich ◽  
K. M. E. Turner ◽  
K. Shah ◽  
J. Macleod ◽  
...  
Keyword(s):  
Resource Use ◽  
Point Of Care ◽  
Standard Testing ◽  
Patient Pathways ◽  
Genitourinary Medicine ◽  
The Uk

scholarly journals Qualitative analysis of stakeholder interviews to identify the barriers and facilitators to the adoption of point-of-care diagnostic tests in the UK

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042944
Author(s):  
Jeremy R Huddy ◽  
Melody Zhifang Ni ◽  
James Barlow ◽  
George B Hanna
Keyword(s):  
Resource Use ◽  
Point Of Care ◽  
Financial Resource ◽  
Barriers And Facilitators ◽  
Patient Factors ◽  
Laboratory Staff ◽  
Device Development ◽  
The Uk ◽  
Point Of Care Tests ◽  
Constant Comparative Analysis

ObjectivesThis study investigated the barriers and facilitators to the adoption of point-of-care tests (POCTs).DesignQualitative study incorporating a constant comparative analysis of stakeholder responses to a series of interviews undertaken to design the Point-of-Care Key Evidence Tool.SettingThe study was conducted in relation to POCTs used in all aspects of healthcare.ParticipantsForty-three stakeholders were interviewed including clinicians (incorporating laboratory staff and members of trust POCT committees), commissioners, industry, regulators and patients.ResultsThematic analysis highlighted 32 barriers in six themes and 28 facilitators in eight themes to the adoption of POCTs. Six themes were common to both barriers and facilitators (clinical, cultural, evidence, design and quality assurance, financial and organisational) and two themes contained facilitators alone (patient factors and other (non-financial) resource use).ConclusionsFindings from this study demonstrate the complex motivations of stakeholders in the adoption of POCT. Most themes were common to both barriers and facilitators suggesting that good device design, stakeholder engagement and appropriate evidence provision can increase the likelihood of a POCT device adoption. However, it is important to realise that while the majority of identified barriers may be perceived or mitigated some may be absolute and if identified early in device development further investment should be carefully considered.

scholarly journals Costs and outcomes in evaluating management of unhealed surgical wounds in the community in clinical practice in the UK: a cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022591 ◽  
Author(s):  
Julian F Guest ◽  
Graham W Fuller ◽  
Peter Vowden
Keyword(s):  
Clinical Practice ◽  
Health Outcomes ◽  
Resource Use ◽  
Initial Presentation ◽  
Health Improvement ◽  
Emergency Procedures ◽  
Surgical Wounds ◽  
Patient Pathways ◽  
The Uk

ObjectiveTo evaluate the patient pathways and associated health outcomes, resource use and corresponding costs attributable to managing unhealed surgical wounds in clinical practice, from initial presentation in the community in the UK.MethodsThis was a retrospective cohort analysis of the records of 707 patients in The Health Improvement Network (THIN) database whose wound failed to heal within 4 weeks of their surgery. Patients’ characteristics, wound-related health outcomes and healthcare resource use were quantified, and the total National Health Service (NHS) cost of patient management was estimated at 2015/2016 prices.ResultsInconsistent terminology was used in describing the wounds. 83% of all wounds healed within 12 months from onset of community management, ranging from 86% to 74% of wounds arising from planned and emergency procedures, respectively. Mean time to healing was 4 months per patient. Patients were predominantly managed in the community by nurses and only around a half of all patients who still had a wound at 3 months were recorded as having had a follow-up visit with their surgeon. Up to 68% of all wounds may have been clinically infected at the time of presentation, and 23% of patients subsequently developed a putative wound infection a mean 4 months after initial presentation. Mean NHS cost of wound care over 12 months was £7300 per wound, ranging from £6000 to £13 700 per healed and unhealed wound, respectively. Additionally, the mean NHS cost of managing a wound without any evidence of infection was ~£2000 and the conflated cost of managing a wound with a putative infection ranged from £5000 to £11 200.ConclusionSurgeons are unlikely to be fully aware of the problems surrounding unhealed surgical wounds once patients are discharged into the community, due to inconsistent recording in patients’ records coupled with the low rate of follow-up appointments. These findings offer the best evidence available with which to inform policy and budgetary decisions pertaining to managing unhealed surgical wounds in the community.

scholarly journals Healthcare pathways and resource use: mapping consequences of ambulance assessment for direct care with alternative healthcare providers

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sofi Varg ◽  
Veronica Vicente ◽  
Maaret Castren ◽  
Peter Lindgren ◽  
Clas Rehnberg
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Resource Use ◽  
Healthcare Providers ◽  
Healthcare Utilisation ◽  
Direct Care ◽  
Care Centre ◽  
Decision System ◽  
Geriatric Ward ◽  
Patient Pathways

Abstract Background A decision system in the ambulance allowing alternative pathways to alternate healthcare providers has been developed for older patients in Stockholm, Sweden. However, subsequent healthcare resource use resulting from these pathways has not yet been addressed. The aim of this study was therefore to describe patient pathways, healthcare utilisation and costs following ambulance transportation to alternative healthcare providers. Methods The design of this study was descriptive and observational. Data from a previous RCT, where a decision system in the ambulance enabled alternative healthcare pathways to alternate healthcare providers were linked to register data. The receiving providers were: primary acute care centre or secondary geriatric ward, both located at the same community hospital, or the conventional pathway to the emergency department at an acute hospital. Resource use over 10 days, subsequent to assessment with the decision system, was mapped in terms of healthcare pathways, utilisation and costs for the 98 included cases. Results Almost 90% were transported to the acute care centre or geriatric ward. The vast majority arriving to the geriatric ward stayed there until the end of follow-up or until discharged, whereas patients conveyed to the acute care centre to a large extent were admitted to hospital. The median patient had 6 hospital days, 2 outpatient visits and costed roughly 4000 euros over the 10-day period. Arrival destination geriatric ward indicated the longest hospital stay and the emergency department the shortest. However, the cost for the 10-day period was lower for cases arriving to the geriatric ward than for those arriving to the emergency department. Conclusions The findings support the appropriateness of admittance directly to secondary geriatric care for older adults. However, patients conveyed to the acute care centre ought to be studied in more detail with regards to appropriate level of care.

scholarly journals Pilot study of use of the BioStar Optical ImmunoAssay GC point-of-care test for diagnosing gonorrhoea in men attending a genitourinary medicine clinic

2014 ◽  
Vol 63 (8) ◽  
pp. 1111-1112 ◽  
Author(s):  
Amanda Samarawickrama ◽  
Emily Cheserem ◽  
Michelle Graver ◽  
Jim Wade ◽  
Sarah Alexander ◽  
...  
Keyword(s):  
Pilot Study ◽  
Point Of Care ◽  
Medicine Clinic ◽  
Point Of Care Test ◽  
Genitourinary Medicine

Point-of-care testing for C-reactive protein in acute cough presentations in primary care

2020 ◽  
Vol 12 (1) ◽  
pp. 1-7
Author(s):  
Simon Searle-Barnes ◽  
Peter Phillips
Keyword(s):  
Primary Care ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
C Reactive Protein ◽  
Acute Cough ◽  
Reactive Protein ◽  
The United Kingdom ◽  
Viral Aetiology ◽  
Prescription Rates ◽  
The Uk

Acute cough is one of the most common illnesses in the UK, with an estimated 48 million cases per annum. The majority of these presentations are thought to be of viral aetiology and self-limiting in nature, yet some studies report antibiotic prescription rates of approximately 65% in the UK. Clincians' decision-making process can be influenced by both patient expectations and difficulty in differentiating between viral and bacterial aetiologies by clinical examination alone. This article will consider the feasibility, efficacy, benefits and limitations of using point-of-care testing of C-reactive protein within primary care in the United Kingdom to help inform management of acute cough.

scholarly journals Effect of public-private interface agency in Patna and Mumbai, India: Does it alter durations and delays in care seeking for drug-sensitive pulmonary tuberculosis?

2020 ◽  
Vol 4 ◽  
pp. 32
Author(s):  
Sanchi Shah ◽  
Shimoni Shah ◽  
Sheela Rangan ◽  
Sonukumar Rai ◽  
Eunice Lobo ◽  
...  
Keyword(s):  
Point Of Care ◽  
Critical Mass ◽  
Population Based ◽  
Care Seeking ◽  
Disease Awareness ◽  
Intervention Models ◽  
Patient Pathways ◽  
Private And Public ◽  
Effective Network ◽  
Hub Model

Background: Public–private interface agency (PPIA) intervention models in Patna (E. India) and Mumbai (W. India) for pulmonary drug-sensitive (DS) tuberculosis (TB) patients were evaluated over 2 years after maturity to examine effect on reduction of patient pathways and retention.  The models engaged private providers, diagnostic facilities and pharmacies into an effective network providing free diagnostic tests and treatment. Methods: A population-based retrospective study was undertaken to assess effectiveness of the PPIA model in care pathways of 64 (Patna) and 86 (Mumbai) patients through in-depth interviews conducted within 6 months of initiation treatments to identify types and facilities accessed, duration to diagnosis and treatment. Median durations based on facilities accessed were statistically analysed.  Comparisons were made with baseline values and endline pathways of patients accessing PPIA engaged/non-engaged facilities in private and public sectors. Results: Compared to non-engaged facilities, persons accessing engaged facilities at first point-of-care had shorter pathways (Mumbai: 32 vs 43 days), (Patna: 15 vs 40 days).  Duration for first care-seeking was considerably shorter for patients accessing PPIA in Patna and for both engaged and non-engaged private facilities in Mumbai (4 days).  Whilst PPIA engaged facilities diagnosed more cases than others, the RNTCP in Mumbai provided diagnosis early.  There was good retention of patients by PPIA-engaged (1st) facilities (90% post-diagnosis in Patna) but this was affected by the hub-spoke referral system in Mumbai (13%). Second diagnosis is a common feature in Mumbai.  The spoke-hub model in Mumbai contributed considerably to treatment delay; PPIA-engaged providers were better at retaining patients post treatment initiation 11/25 (44%). Conclusion: PPIA-engaged facilities, accessed at onset, result in marked reduction in pathway durations.  Such initiatives should engage a critical mass of competent providers, proximal investigation facilities with enhanced disease awareness and literacy efforts amongst communities.  Patient movement should be minimized for early treatment and retention.

Economic analysis of the randomised assessment of treatment using panel assay of cardiac markers trial

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A5.2-A5
Author(s):  
Steve Goodacre
Keyword(s):  
Economic Analysis ◽  
Resource Use ◽  
Standard Care ◽  
Point Of Care ◽  
Acute Chest Pain ◽  
Cost Effective ◽  
Health Utility ◽  
Cardiac Markers ◽  
Life Years ◽  
Care Costs

BackgroundThe randomised Assessment of Treatment using Panel Assay of Cardiac markers (RATPAC) trial showed that diagnostic assessment with a point-of-care biomarker panel increased successful discharges among patients presenting to hospital with acute chest pain. We aimed to determine whether point-of-care panel assessment reduced healthcare costs and whether it was likely to be cost-effective.MethodsEconomic analysis was undertaken using individual patient resource use data from the RATPAC trial (n=2263) and health utility measured on the EQ-5D at one and 3 months. Resource use was valued using national unit costs. Quality-adjusted life years (QALYs) were calculated from EQ-5D scores using the trapezium rule. Mean costs and QALYs accrued after point-of-care and standard care were compared and cost-effectiveness estimated in terms of probability of dominance and incremental cost per QALY.ResultsPoint-of-care panel assessment was associated with higher emergency department costs, coronary care costs and cardiac intervention costs, but lower general inpatient costs. Mean costs per patient were £1217 with point-of-care versus £1006 with standard care (p=0.047), while mean QALYs were 0.158 versus 0.161 (p=0.250). The probability of standard care being dominant (ie, cheaper and more effective) was 0.888, while the probability of the point-of-care panel being dominant was 0.004. These probabilities were not markedly altered by sensitivity analysis varying the costs of the point-of-care panel and excluding intensive care costs.ConclusionPoint-of-care panel assessment does not reduce costs despite reducing admissions and may even increase costs. It is unlikely to be considered a cost-effective use of national healthcare resources.

PP147 Physician And Patient Reported Anxiety And Depression In Hemophilia

2017 ◽  
Vol 33 (S1) ◽  
pp. 138-139 ◽  
Author(s):  
Ian Jacob ◽  
Charlotte Camp ◽  
Jamie O'Hara ◽  
Mark Skinner ◽  
Shaun Walsh
Keyword(s):  
Mental Health ◽  
Point Of Care ◽  
Anxiety And Depression ◽  
Health State ◽  
Severe Hemophilia ◽  
Severe Condition ◽  
Patient Reported ◽  
Illness Study ◽  
Related Quality ◽  
The Uk

INTRODUCTION:Anxiety and depression are major drivers of health-related quality of life, adherence to therapy, and motivation to self-manage chronic conditions. A number of studies have shown rates of anxiety and depression to be higher among individuals with hemophilia compared to that of the general population (1). As the primary point of care for persons with hemophilia, hematologists are well-placed to assess the mental health state of their patients (2). The aim of this study is to explore physician- and patient-reported rates of anxiety and depression among a cohort with severe hemophilia.METHODS:Data were drawn from the Cost of Haemophilia across Europe – a Socioeconomic Survey (CHESS), a cost-of-illness study in severe hemophilia A and B across five European countries (France, Germany, Italy, Spain, and the UK) (3). Physicians provided clinical and sociodemographic information for 1,285 adult patients, 551 of whom completed corresponding questionnaires, including EuroQol EQ-5D-3L. We compared the self-reported EQ-5D with physician reports of anxiety and depression.RESULTS:Across the five countries, physicians recorded a diagnosis of anxiety disorder in 189 patients (15 percent; range 4 percent-28 percent) and depression in 178 patients (14 percent; range 10 percent-28 percent). Seventy-three patients (6 percent) recorded comorbid anxiety and depression. Forty-six percent of patients with anxiety and 58 percent of patients with depression were receiving some form of treatment for their condition.Within the EQ-5D measure, 42 percent of individuals recorded problems with anxiety or depression, with 6 percent of patients reporting “extreme” anxiety or depression. Twenty-two percent of individuals with a self-reported problem were not recorded with a corresponding diagnosis by their hematologist; 39 percent of patients reporting “extreme” anxiety or depression were absent of any physician-reported diagnosis.CONCLUSIONS:Anxiety and depression are notable conditions within the hemophilia community, particularly so among those with severe condition. The mental health of individuals with hemophilia is an important aspect in ensuring therapy adherence and overall wellbeing and should be considered as part of a multidisciplinary approach to management of the condition.

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