scholarly journals Use of antimicrobial dressings in England and the association with published clinical guidance: interrupted time series analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028727 ◽  
Author(s):  
Louise Hussey ◽  
Susan J Stocks ◽  
Paul Wilson ◽  
Jo C Dumville ◽  
Nicky Cullum
Keyword(s):  
Time Series ◽  
Financial Burden ◽  
Temporal Trends ◽  
Interrupted Time Series ◽  
Wound Dressings ◽  
Secondary Outcome ◽  
Prescription Data ◽  
Interrupted Time Series Analysis ◽  
Significant Drop ◽  
Clinical Guidance

ObjectivesIn healthcare systems, practices and products of unproven value and cost-effectiveness can decrease value and increase waste. Using the management of complex wounds, this study investigates temporal trends in the use of antimicrobials dressings, places this in the context of available evidence and discusses the potential impacts on the UK National Health Service (NHS).DesignSecondary descriptive and interrupted time series (ITS) analysis of NHS prescription data.SettingPrescribing Cost Analysis (PCA) details all NHS prescriptions dispensed in the community in England.InterventionsAn ITS design was used to compare annual changes in the expenditure and use of antimicrobial and non-antimicrobial dressings before and after the publication of the ‘intervention’ of key evidence-based Scottish Intercollegiate Guidelines Network (SIGN) guidance in 2010.Primary and secondary outcome measuresTrends in use and expenditure of antimicrobial dressings in relation to published clinical guidance.ResultsThere was a large increase in the prescribing of, and expenditure on, antimicrobial wound dressings between 1997 and 2016. In 1997, the total number of dressings prescribed was 5 792 700; increasing to 11 447 102 in 2009 with expenditure increasing from £1 960 386 to £32 841 263. During the year of the SIGN intervention (2010), there was a significant drop in the use of silver but there was no consistent ongoing reduction from 2011 to 2015.ConclusionsPrescribing data can be used to identify products of unproven benefit, which also impose a significant financial burden. This study quantifies the huge increase in the use of antimicrobial wound dressings over a 20-year period despite the lack of compelling evidence to support their routine use. There is some suggestion, however that the use and expenditure decreased after the publication of key guidance. Routine data can be used to as part of more systematic efforts to increase value and reduce waste in health systems.

scholarly journals Effects of Chinese Medical Pricing Reform on the Structure of Hospital Revenue and Healthcare Expenditure in County Hospital: An Interrupted Time Series Analysis

2021 ◽  
Author(s):  
Mengling Liu ◽  
Mingyuan Jia ◽  
Qian Lin ◽  
Jiawei Zhu ◽  
Dong Wang
Keyword(s):  
Time Series ◽  
Healthcare Expenditure ◽  
Financial Burden ◽  
Interrupted Time Series ◽  
Public Hospitals ◽  
Interrupted Time Series Analysis ◽  
Monthly Data ◽  
Hospital Revenue ◽  
Main Components ◽  
Interrupted Time Series Design

Abstract Background China has initiated a medical pricing reform to combat the overuse of drugs and relieve the financial burden of patients. This paper aims to analyze the effect of medical pricing reform on revenue structure and healthcare expenditure of county public hospitals in Guangdong province. Methods Based on the monthly data from January 2013 to August 2019, we use interrupted time series design to evaluate the effects of medical pricing reform on healthcare expenditure in both outpatients and inpatients. A counterfactual is also established to examine the net effect of the policy. Results The proportion of drug revenue decreased from 35% in 2015 to 29.7% in 2019, and the revenue from medical services and inspection increased 3.2% and 3% respectively. Meanwhile, the increasing trend of total expenditure and its main components is slowed down, especially the drug expense and medical consumable expense for inpatients after the Zero Mark-up Drug policy. However, the growth of inspection expense for outpatients continues to increase, while the healthcare expenditure for inpatients experiences an instant increase after the Zero Mark-up Medical Consumables policy. Conclusion The medical pricing reform is a valuable attempt in controlling the unreasonable increase of medical expenses. In the meantime, the unexpected increase in inspection expenditure and insufficient compensation from medical service adjustment should draw the attention of the policymakers.

scholarly journals Assessing the impact of the Provincial Reimbursement Scheme on the use of Targeted Anticancer Medications in Zhejiang, China: A Controlled Interrupted time-series Analysis

2020 ◽  
Author(s):  
Cong Huang ◽  
Carolina Oi Lam Ung ◽  
Haishaerjiang Wushouer ◽  
Ziyue Xu ◽  
Yichen Zhang ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Financial Burden ◽  
Interrupted Time Series ◽  
Control Group ◽  
Study Group ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Hospital Purchasing ◽  
The Impact

Abstract Background: High prices of targeted anticancer medications (TAMs) subject patients to extreme financial burden. To alleviate problems with access and affordability, 6 TAMs were newly listed in the Provincial Reimbursement Drug List (PRDL) in Zhejiang, China in February 2015. To evaluate the implementation of the PRDL policy, this study examined differences in the hospital purchasing volume (HPV) and the hospital purchasing spending (HPS) of 6 listed TAMs pre- and post-enlistment and comparing with 4 other unlisted TAMs. Methods: Interrupted time-series analysis was employed using the pharmaceutical procurement data of 6 newly listed TAMs (study group) and 4 unlisted TAMs (control group) from 22 tertiary hospitals in Zhejiang, China dated between January 2014 and March 2017. Results: After February 2015, the average HPV per month increased significantly by 34.6 defined daily doses (DDDs) (p<0.001) and the average HPS per month increased significantly by USD 6614.9 (p<0.001) for the listed TAMs in the study group (n=6); neither the average HPV nor the average HPS changed significantly for the unlisted TAMs in the control group (n=4). Although only 4 of the 6 listed TAMs exhibited significant decrease in the monthly HPV and HPS individually, the daily cost of each TAM decreased after enlistment. Conclusions: The PRDL policy has shown positive effect on promoting the access to and improving patients’ affordability of TAMs in Zhejiang. The government should conduct further price negotiations and include more TAMs with clinical benefits into reimbursement schemes to relief patients’ financial burden and promote access.

scholarly journals Prescription of anxiolytics, sedatives, hypnotics and antidepressants in outpatient, universal care during the COVID-19 pandemic in Portugal: a nationwide, interrupted time-series approach

2021 ◽  
pp. jech-2021-216732
Author(s):  
Marta Estrela ◽  
Tânia Magalhães Silva ◽  
Eva Rebelo Gomes ◽  
Maria Piñeiro ◽  
Adolfo Figueiras ◽  
...  
Keyword(s):  
Mental Health ◽  
Time Series ◽  
Elderly Women ◽  
Health Sector ◽  
Interrupted Time Series ◽  
Defined Daily Dose ◽  
Prescription Data ◽  
Interrupted Time Series Analysis ◽  
Prescribing Trends ◽  
The Impact

BackgroundThe COVID-19 pandemic has had a significant impact on the population’s mental health. However, its impact on the consumption of anxiolytics, sedatives, hypnotics and antidepressants remains to be evaluated. Hence, this article aims to assess the prescription trends of these drugs in Portugal, from January 2018 to March 2021, while critically examining whether the COVID-19 pandemic had an impact on these prescription trends or not.MethodsA nationwide interrupted time-series analysis of the prescription data of anxiolytics, sedatives, hypnotics and antidepressants in outpatient setting of the public health sector was conducted. The data encompassed the defined daily dose per month, age range and sex and were analysed following a segmented regression approach.ResultsThe pandemic preceded an immediate reduction in the prescription of anxiolytics, sedatives and hypnotics for children and adolescents. However, an increasing trend throughout the pandemic has been noted in the prescription of these drugs, especially among adults aged 65 years or above. A drop in antidepressant prescription was observed as an immediate effect of the pandemic among male and female adolescents and elderly women. From March 2020 to March 2021, a decreasing prescription trend has been noted among men.ConclusionsWhen analysing specific genders and age ranges, differences can be noted, in terms of both immediate impact and prescribing trends throughout 1 year of the COVID-19 pandemic. The impact of the pandemic on mental health and its association with the consumption trends of psychoactive drugs, and with the access to mental health treatments, should be further assessed.

scholarly journals Ramadan is not associated with increased infection risk in Pakistani and Bangladeshi populations: Findings from controlled interrupted time series analysis of UK primary care data

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262530
Author(s):  
Munerah Almulhem ◽  
Rasiah Thayakaran ◽  
Shahjehan Hanif ◽  
Tiffany Gooden ◽  
Neil Thomas ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Prescription Data ◽  
Interrupted Time Series Analysis ◽  
Electronic Health Record Data ◽  
Series Analysis

Background The effect of fasting on immunity is unclear. Prolonged fasting is thought to increase the risk of infection due to dehydration. This study describes antibiotic prescribing patterns before, during, and after Ramadan in a primary care setting within the Pakistani and Bangladeshi populations in the UK, most of whom are Muslims, compared to those who do not observe Ramadan. Method Retrospective controlled interrupted time series analysis of electronic health record data from primary care practices. The study consists of two groups: Pakistanis/Bangladeshis and white populations. For each group, we constructed a series of aggregated, daily prescription data from 2007 to 2017 for the 30 days preceding, during, and after Ramadan, respectively. Findings Controlling for the rate in the white population, there was no evidence of increased antibiotic prescription in the Pakistani/Bangladeshi population during Ramadan, as compared to before Ramadan (IRR: 0.994; 95% CI: 0.988–1.001, p = 0.082) or after Ramadan (IRR: 1.006; 95% CI: 0.999–1.013, p = 0.082). Interpretation In this large, population-based study, we did not find any evidence to suggest that fasting was associated with an increased susceptibility to infection.

scholarly journals Effects of Chinese medical pricing reform on the structure of hospital revenue and healthcare expenditure in county hospital: an interrupted time series analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mengling Liu ◽  
Mingyuan Jia ◽  
Qian Lin ◽  
Jiawei Zhu ◽  
Dong Wang
Keyword(s):  
Time Series ◽  
Healthcare Expenditure ◽  
Financial Burden ◽  
Interrupted Time Series ◽  
Public Hospitals ◽  
Interrupted Time Series Analysis ◽  
Monthly Data ◽  
Hospital Revenue ◽  
Main Components ◽  
Interrupted Time Series Design

Abstract Background China has initiated a medical pricing reform to combat the overuse of drugs and relieve the financial burden of patients. This paper aims to analyze the effect of medical pricing reform on revenue structure and healthcare expenditure of county public hospitals in Guangdong province. Methods Based on the monthly data from January 2013 to August 2019, we use interrupted time series design to evaluate the effects of medical pricing reform on healthcare expenditure in both outpatients and inpatients. A counterfactual is also established to examine the net effect of the policy. Results The proportion of drug revenue decreased from 35 % to 2015 to 29.7 % in 2019, and the revenue from medical services and inspection increased 3.2 and 3 % respectively. Meanwhile, the increasing trend of total expenditure and its main components is slowed down, especially the drug expense and medical consumable expense for inpatients after the Zero Mark-up Drug policy (coefficient = -18.76, p < 0.01; coefficient = -13.41, p < 0.01, respectively). However, the growth of inspection expense for outpatients continues to increase, while the healthcare expenditure for inpatients experiences an instant increase after the Zero Mark-up Medical Consumables policy. In terms of the net effect, most of healthcare expenditure in both outpatient and inpatient experienced a negative net growth from 2015 to 2019. Conclusions The medical pricing reform is a valuable attempt in controlling the unreasonable increase of medical expenses. In the meantime, the unexpected increase in inspection expenditure and insufficient compensation from medical service adjustment should draw the attention of the policymakers.

scholarly journals Does admission prevalence change after reconfiguration of inpatient services? An interrupted time series analysis of the impact of reconfiguration in five centres

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joanne Martin ◽  
Edwin Amalraj Raja ◽  
Steve Turner
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Emergency Admission ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Emergency Admissions ◽  
Series Analysis ◽  
Inpatient Services ◽  
The Impact ◽  
Admission Prevalence

Abstract Background Service reconfiguration of inpatient services in a hospital includes complete and partial closure of all emergency inpatient facilities. The “natural experiment” of service reconfiguration may give insight into drivers for emergency admissions to hospital. This study addressed the question does the prevalence of emergency admission to hospital for children change after reconfiguration of inpatient services? Methods There were five service reconfigurations in Scottish hospitals between 2004 and 2018 where emergency admissions to one “reconfigured” hospital were halted (permanently or temporarily) and directed to a second “adjacent” hospital. The number of emergency admissions (standardised to /1000 children in the regional population) per month to the “reconfigured” and “adjacent” hospitals was obtained for five years prior to reconfiguration and up to five years afterwards. An interrupted time series analysis considered the association between reconfiguration and admissions across pairs comprised of “reconfigured” and “adjacent” hospitals, with adjustment for seasonality and an overall rising trend in admissions. Results Of the five episodes of reconfiguration, two were immediate closure, two involved closure only to overnight admissions and one with overnight closure for a period and then closure. In “reconfigured” hospitals there was an average fall of 117 admissions/month [95% CI 78, 156] in the year after reconfiguration compared to the year before, and in “adjacent” hospitals admissions rose by 82/month [32, 131]. Across paired reconfigured and adjacent hospitals, in the months post reconfiguration, the overall number of admissions to one hospital pair slowed, in another pair admissions accelerated, and admission prevalence was unchanged in three pairs. After reconfiguration in one hospital, there was a rise in admissions to a third hospital which was closer than the named “adjacent” hospital. Conclusions There are diverse outcomes for the number of emergency admissions post reconfiguration of inpatient facilities. Factors including resources placed in the community after local reconfiguration, distance to the “adjacent” hospital and local deprivation may be important drivers for admission pathways after reconfiguration. Policy makers considering reconfiguration might consider a number of factors which may be important determinants of admissions post reconfiguration.

Recession and risk of suicide in Denmark during the 2009 global financial crisis: an ecological register-based study

2021 ◽  
pp. 140349482110132
Author(s):  
Agnieszka Konieczna ◽  
Sarah Grube Jakobsen ◽  
Christina Petrea Larsen ◽  
Erik Christiansen
Keyword(s):  
Time Series ◽  
Financial Crisis ◽  
Time Series Analysis ◽  
Suicide Rate ◽  
Global Financial Crisis ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Prevention Programmes ◽  
The Impact

Aim: The aim of this study is to analyse the potential impact from the financial crisis (onset in 2009) on suicide rates in Denmark. The hypothesis is that the global financial crisis raised unemployment which leads to raising the suicide rate in Denmark and that the impact is most prominent in men. Method: This study used an ecological study design, including register data from 2001 until 2016 on unemployment, suicide, gender and calendar time which was analysed using Poisson regression models and interrupted time series analysis. Results: The correlation between unemployment and suicide rates was positive in the period and statistically significant for all, but at a moderate level. A dichotomised version of time (calendar year) showed a significant reduction in the suicide rate for women (incidence rate ratio 0.87, P=0.002). Interrupted time series analysis showed a significant decreasing trend for the overall suicide rate and for men in the pre-recession period, which in both cases stagnated after the onset of recession in 2009. The difference between the genders’ suicide rate changed significantly at the onset of recession, as the rate for men increased and the rate for women decreased. Discussion: The Danish social welfare model might have prevented social disintegration and suicide among unemployed, and suicide prevention programmes might have prevented deaths among unemployed and mentally ill individuals. Conclusions: We found some indications for gender-specific differences from the impact of the financial crises on the suicide rate. We recommend that men should be specifically targeted for appropriate prevention programmes during periods of economic downturn.

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