scholarly journals Transformation of the Tanzania medical store department through global fund support: an impact assessment study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040276
Author(s):  
Patrick Githendu ◽  
Linden Morrison ◽  
Rosemary Silaa ◽  
Sai Pothapregada ◽  
Sarah Asiimwe ◽  
...  
Keyword(s):  
Global Fund ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Monthly Basis ◽  
Quantitative And Qualitative Research ◽  
Before And After ◽  
The Cost ◽  
Study Participants ◽  
Health Commodities ◽  
The Impact

BackgroundThe Tanzania government sought support from The Global Fund to Fight AIDs, Tuberculosis and Malaria to reform its Medical Stores Department, with the aim of improving performance. The study sought to assess the impact of the reforms and document the lessons learnt.MethodsQuantitative and qualitative research methods were applied to assess the impact of the reforms. The quantitative part entailed a review of operational and financial data covering the period before and after the implementation of the reforms. Interrupted time series analysis was used to determine the change in average availability of essential health commodities at health zones. Qualitative data were collected through 41 key informant interviews. Participants were identified through stakeholder mapping, purposive and snowballing sampling techniques and responses were analysed through thematic content analysis.ResultsAvailability of essential health commodities increased significantly by 12.6% (95% CI 9.6% to 15.6%) after the reforms and continued to increase on a monthly basis by 0.2% (95%CI 0.0% to 0.3%) relative to the preintervention trend. Sales increased by 56.6% while the cost of goods sold increased by 88.6% between 2014/2015 and 2017/2018. Surplus income increased by 56.4% between 2014/2015 and 2017/2018 with reductions in rent and fuel expenditure. There was consensus among study participants that the reforms were instrumental in improving performance of the Medical Stores Department.ConclusionPositive results were realised through the reforms. However, despite the progress, there were risks such as the increasing government receivable that could jeopardise the sustainability of the gains. Therefore, multistakeholder efforts are necessary to make progress and expand public health.

scholarly journals Transformation of the Tanzania Medical Store Department through Global Fund support: lessons learned from the field

2020 ◽  
Author(s):  
Patrick Githendu ◽  
Linden Morrison ◽  
Rosemary Silaa ◽  
Sai Pothapregada ◽  
Sarah Asiimwe ◽  
...  
Keyword(s):  
Global Fund ◽  
Interrupted Time Series ◽  
Lessons Learned ◽  
Interrupted Time Series Analysis ◽  
Monthly Basis ◽  
Quantitative And Qualitative Research ◽  
Before And After ◽  
Multi Stakeholder ◽  
Health Commodities ◽  
The Impact

AbstractBackgroundThe Tanzania government sought support from The Global Fund to Fight AIDs, Tuberculosis and Malaria (Global Fund) to reform its Medical Stores Department (MSD), with the aim of improving performance. Our study aimed to assess the impact of the reforms and document the lessons learned.MethodsWe applied quantitative and qualitative research methods to assess the impact of the reforms. The quantitative part entailed a review of operational and financial data covering the period before and after the implementation of the reforms. We applied interrupted time series analysis to determine the change in average availability of essential health commodities at health zones. Qualitative data was collected through 41 key informant interviews. Participants were identified through stakeholder mapping, purposive and snowballing sampling techniques, and responses were analyzed through thematic content analysis.ResultsAvailability of essential health commodities increased significantly by 12.6% (95%CI, 9.6-15.6), after the reforms and continued to increase on a monthly basis by 0.2% (95%CI, 0.0-0.3) relative to the preintervention trend. Sales increased by 56.6% while the cost of goods sold increased by 88.6% between 2014/15 and 2017/18. Surplus income increased by 56.4% between 2014/15 and 2017/18, with reductions in rent and fuel expenditure. There was consensus among participants that the reforms, were instrumental in improving performance of MSD.ConclusionMany positive results were realized through the reforms at MSD. However, despite the progress, there were risks such as the increasing government receivable that could jeopardize the gains. Multi-stakeholder efforts are necessary, to sustain the progress and expand public health.

Vancomycin Use: Room for Improvement Among Hospitalized Children

2016 ◽  
Vol 30 (3) ◽  
pp. 296-299 ◽  
Author(s):  
Jessica Gillon ◽  
Meng Xu ◽  
James Slaughter ◽  
M. Cecilia Di Pentima
Keyword(s):  
Real Time ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Hospitalized Children ◽  
Interrupted Time Series Analysis ◽  
Prospective Audit ◽  
Children's Hospitals ◽  
Children’S Hospitals ◽  
Before And After ◽  
The Impact

Introduction: The use of vancomycin is common among hospitalized children. We sought to evaluate the impact of prospective audit with real-time feedback on vancomycin use and pharmacy costs. Methods: Vancomycin use was evaluated at Monroe Carell Jr Children’s Hospital at Vanderbilt (MCJCHV) before and after the implementation of prospective audit with intervention and feedback to providers in 2012. Antibiotic use was compared to academic children’s hospitals with established antimicrobial stewardship programs (ASPs). Two similar pediatric academic institutions without an ASP were used as nonintervention controls. Analysis of monthly days of antibiotic therapy (DoT) per 1000 patient-days was performed by interrupted time series analysis. Results: Monthly vancomycin use decreased from 114 DoTs/1000 patient-days to 89 DoTs/1000 patient-days ( P < .0001). We did not find significant differences in the slope of change in vancomycin use between MCJCHV and institutions with ASPs either before or after the intervention ( P = .86 and P = .71, respectively). When compared to children’s hospitals without ASPs, the use of vancomycin was significantly lower at MCJCHV ( P < .001). Conclusion: The use of vancomycin at academic children’s hospitals with an ASP is declining. In our experience, prospective audit with real-time intervention and feedback to providers significantly reduced the use and costs associated with vancomycin.

scholarly journals Assessing the impact of retraction on the citation of randomized controlled trial reports: an interrupted time-series analysis

2018 ◽  
Vol 24 (1) ◽  
pp. 44-51 ◽  
Author(s):  
Andrew Mott ◽  
Caroline Fairhurst ◽  
David Torgerson
Keyword(s):  
Time Series ◽  
Randomized Controlled Trial ◽  
Randomized Controlled Trials ◽  
Controlled Trial ◽  
Interrupted Time Series ◽  
Controlled Trials ◽  
Interrupted Time Series Analysis ◽  
Randomized Controlled ◽  
Before And After ◽  
The Impact

Objectives To assess the impact of retraction on the citation of randomized controlled trials. Methods We used an interrupted time-series with matched controls. PubMed, CINHAL, Google and the Retraction Watch Database were searched. We identified retracted publications reporting the results of randomized controlled trials involving human participants with two years of available data before and after retraction. We obtained monthly citation counts across all articles for the 24 months before and after retraction, from Web of Science. We used a Poisson segmented regression to detect changes in the level and trend of citation following retraction. We also undertook a matched control analysis of unretracted randomized controlled trials and a sensitivity analysis to account for cases of large-scale, well-advertised fraud. Results We identified 387 retracted randomized controlled trial reports, of which 218 (56.3%) were included in the interrupted time-series analysis. A reduction of 22.9% (95% CI 4.0% to 38.2%, p = 0.02) was observed in the number of citations in the month after retraction, and a further reduction of 1.9% (95% CI 0.4% to 3.5%, p = 0.02) per month in the following 24 months, relative to the expected trend. There was no evidence of a statistically significant reduction among the matched controls. Authors with a large number of retractions saw a 48.2% reduction at the time of retraction (95% CI 17.7% to 67.3%, p = 0.01). Other cases had a more gradual reduction with no change at the time of retraction and a 1.8% reduction per month in the following 24 months (95% CI 0.2% to 3.4%, p = 0.03). Conclusions Retractions of randomized controlled trial reports can be effective in reducing citations. Other factors, such as the scale of the retractions and media attention, may play a role in the effectiveness of the reduction.

Measuring the impact of step down intermediate care on delayed discharge: an interrupted time series analysis

2019 ◽  
Vol 73 (7) ◽  
pp. 674-679 ◽  
Author(s):  
Kate A Levin ◽  
Emilia Crighton
Keyword(s):  
Moving Average ◽  
Interrupted Time Series ◽  
Relative Reduction ◽  
Intermediate Care ◽  
Interrupted Time Series Analysis ◽  
Level Change ◽  
Before And After ◽  
Step Down ◽  
The Impact ◽  
Over Time

BackgroundIntermediate care (IC) acts as a bridging service between hospital and home, for those deemed medically fit for discharge but who are delayed in hospital. The aim of this study was to measure the effect of IC and a 72-hour discharge target on days delayed.MethodsRate of days delayed per 1000 population aged 75 years+ in Glasgow City was compared before and after onset of IC with a 6-month phase-in period, using segmented linear regression. Inverclyde and West Dunbartonshire (IWD) was a control. Autoregressive and moving average terms were included in the model, as well as a Fourier term to adjust for seasonality.ResultsPrior to IC, rate of days delayed increased in both Glasgow City and the rest of Scotland. There was a large reduction in rate of days delayed in Glasgow during the phase-in period, greater than the rest of Scotland but comparable with that observed in IWD, with subsequent increases thereafter. Adjusting for changes in IWD, the impact of IC and the discharge target in Glasgow City was a level change of −15.20 (95% CI −17.52 to –12.88) and a trend change of −0.29 (95% CI −0.55 to –0.02). This is equivalent to a predicted reduction due to IC of −16.04 days delayed per 1000 population per month, in June 2016, and a relative reduction of 35%.ConclusionIC and the 72-hour discharge target were associated with a reduction in days delayed. Rate of days delayed continued to increase over time, although at a slower rate than if IC had not been implemented.

Motor Vehicle Crashes Involving a Bicycle Before and After Introduction of a Bike Share Program in Philadelphia, Pennsylvania, 2010–2018

2020 ◽  
Vol 110 (6) ◽  
pp. 863-867
Author(s):  
Ghassan B. Hamra ◽  
Leah H. Schinasi ◽  
D. Alex Quistberg
Keyword(s):  
Motor Vehicle ◽  
Interrupted Time Series ◽  
Motor Vehicle Crashes ◽  
Vehicle Crashes ◽  
Interrupted Time Series Analysis ◽  
The Road ◽  
Before And After ◽  
On The Road ◽  
The Impact ◽  
Bike Share

Objectives. To quantify the impact of a citywide bicycle share program on rates of motor vehicle collisions involving a bicycle. Methods. We conducted an interrupted time series analysis, using crash records from the Pennsylvania Department of Transportation for Philadelphia County from 2010 through 2018. We also calculated summary statistics to illustrate annual and monthly trends in rates of motor vehicle crashes involving a bicycle. Results. The baseline rate of bike events was 106% greater (95% confidence interval [CI] = 1.25, 3.38) at the time bicycle share was implemented compared with January 2010. Before bicycle share implementation, the rate of bicycle events decreased 1% (95% CI = 0.95, 1.03) annually. After the bicycle share program started, the rate of bicycle events decreased 13% (95% CI = 0.82, 0.94) annually. Conclusions. In the long term, programs that increase the number of bicycles on the road, such as bike share, may reduce rates of motor vehicle crashes involving a bicycle.

scholarly journals The impact of Health Transformation Plan on natural vaginal delivery and cesarean section frequency in Iran: an interrupted time series analysis

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Farhad Lotfi ◽  
Saeed Lohivash ◽  
Zahra Kavosi ◽  
Sakine Owjimehr ◽  
Mohsen Bayati
Keyword(s):  
Interrupted Time Series ◽  
Fars Province ◽  
Cesarean Sections ◽  
Interrupted Time Series Analysis ◽  
Advantages And Disadvantages ◽  
Long Run ◽  
Vaginal Deliveries ◽  
Before And After ◽  
Short Run ◽  
The Impact

Abstract Objective This study was conducted to evaluate the effect of the Iran’s Health Transformation Plan on the frequency of natural vaginal deliveries (NVDs), cesarean sections (CSs), and total deliveries in the Fars province of Iran. Results Average number of total deliveries before and after the reform were 3946 and 3810, respectively (p  =  0.164). The ratio of CS to total deliveries in the first study month was 54%. This rate reached 47% in the last month (p  <  0.01). However, it had much fluctuation trend. The ITSA results showed that in the short-run, the NVD rate increased (β  =  492.79, p  <  0.01), the rate of CS decreased (β  =  − 407.09, p  <  0.01), and total deliveries increased (β  =  85.75, p  <  0.724). However, in the long-run, the NVD (β  =  5.74, p  <  0.423), CS (β  =  10.21, p  <  0.189), and total deliveries (β  =  15.96, p  <  0.256) had no significant changes after the reform. Encouraging the NVD package was influential in the short-run but not in the longrun in Iran. Pricing and supply-side policies could not reduce the rate of non-clinical CS on their own. Therefore, paying attention to demand-side policies and changes in consumer behaviors, such as educating the women at the age of pregnancy about the advantages and disadvantages of CS and NVD and correcting misconceptions, could be helpful.

scholarly journals The effect of lockdown on the COVID-19 epidemic in Brazil: evidence from an interrupted time series design

2020 ◽  
Vol 36 (10) ◽  
Author(s):  
Lucas Silva ◽  
Dalson Figueiredo Filho ◽  
Antônio Fernandes
Keyword(s):  
Time Series ◽  
Interrupted Time Series ◽  
Positive Trend ◽  
Interrupted Time Series Analysis ◽  
Observation Window ◽  
Social Distancing ◽  
Epidemic Curve ◽  
Incidence And Mortality ◽  
Before And After ◽  
The Impact

In response to the COVID-19 pandemic, governments worldwide have implemented social distancing policies with different levels of both enforcement and compliance. We conducted an interrupted time series analysis to estimate the impact of lockdowns on reducing the number of cases and deaths due to COVID-19 in Brazil. Official daily data was collected for four city capitals before and after their respective policies interventions based on a 14 days observation window. We estimated a segmented linear regression to evaluate the effectiveness of lockdown measures on COVID-19 incidence and mortality. The initial number of new cases and new deaths had a positive trend prior to policy change. After lockdown, a statistically significant decrease in new confirmed cases was found in all state capitals. We also found evidence that lockdown measures were likely to reverse the trend of new daily deaths due to COVID-19. In São Luís, we observed a reduction of 37.85% while in Fortaleza the decrease was 33.4% on the average difference in daily deaths if the lockdown had not been implemented. Similarly, the intervention diminished mortality in Recife by 21.76% and Belém by 16.77%. Social distancing policies can be useful tools in flattening the epidemic curve.

scholarly journals A mixed methods study of the impact of consultant overnight working in an English Emergency Department

2018 ◽  
Vol 36 (5) ◽  
pp. 298-302 ◽  
Author(s):  
Marion L Penn ◽  
Thomas Monks ◽  
Catherine Pope ◽  
Mike Clancy
Keyword(s):  
Negative Impact ◽  
Waiting Times ◽  
Interrupted Time Series ◽  
Well Being ◽  
Night Work ◽  
University Hospital ◽  
Interrupted Time Series Analysis ◽  
Additional Time ◽  
Before And After ◽  
The Impact

BackgroundThere is a growing expectation that consultant-level doctors should be present within an ED overnight. However, there is a lack of robust evidence substantiating the impact on patient waiting times, safety or the workforce.ObjectivesTo evaluate the impact of consultant-level doctors overnight working in ED in a large university hospital.MethodsWe conducted a controlled interrupted time series analysis to study ED waiting times before and after the introduction of consultant night working. Adverse event reports (AER) were used as a surrogate for patient safety. We conducted interviews with medical and nursing staff to explore attitudes to night work.ResultsThe reduction seen in average time in department relative to the day, following the introduction of consultant was non-significant (−12 min; 95% CI −28 to 4, p=0.148). Analysis of hourly arrivals and departures indicated that overnight work was inherited from the day. There were three (0.9%) moderate and 0 severe AERs in 1 year. The workforce reported that night working had a negative impact on sleep patterns, performance and well-being and there were mixed views about the benefits of consultant night presence. Additional time off during the day acted as compensation for night work but resulted in reduced contact with ED teams.ConclusionsOur single-site study was unable to demonstrate a clinically important impact of consultant night working on total time patients spend in the department. Our analysis suggests there may be more potential to reduce total time in department during the day, at our study site. Negative impacts on well-being, and likely resistance to consultant night working should not be ignored. Further studies of night working are recommended to substantiate our results.

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