A Systematic Review of the Impact of Healthcare Reforms on Access to Emergency Department and Elective Surgery Services

2017 ◽  
Vol 48 (1) ◽  
pp. 81-105 ◽  
Author(s):  
Sandeep Reddy ◽  
Peter Jones ◽  
Harsha Shanthanna ◽  
Raechel Damarell ◽  
John Wakerman
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Emergency Department ◽  
United Kingdom ◽  
Elective Surgery ◽  
Grey Literature ◽  
Unintended Consequences ◽  
Health Care Reforms ◽  
The United Kingdom ◽  
The Impact

This systematic review sought to identify whether health care reforms led to improvement in the emergency department (ED) length of stay (LOS) and elective surgery (ES) access in Australia, Canada, New Zealand, and the United Kingdom. The review was registered in the PROSPERO database (CRD42015016343), and nine databases were searched for peer-reviewed, English-language reports published between 1994 and 2014. We also searched relevant “grey” literature and websites. Included studies were checked for cited and citing papers. Primary studies corresponding to national and provincial ED and ES reforms in the four countries were considered. Only studies from Australia and the United Kingdom were eventually included, as no studies from the other two countries met the inclusion criteria. The reviewers involved in the study extracted the data independently using standardized forms. Studies were assessed for quality, and a narrative synthesis approach was taken to analyze the extracted data. The introduction of health care reforms in the form of time-based ED and ES targets led to improvement in ED LOS and ES access. However, the introduction of targets resulted in unintended consequences, such as increased pressure on clinicians and, in certain instances, manipulation of performance data.

scholarly journals P070: Mixed effectiveness of emergency department diversion strategies: a systematic review

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S102
Author(s):  
S.W. Kirkland ◽  
A. Soleimani ◽  
B.H. Rowe ◽  
A.S. Newton
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Emergency Department ◽  
Health Care Services ◽  
Grey Literature ◽  
Study Data ◽  
Care Utilization ◽  
Alternative Source ◽  
Increased Risk ◽  
The Impact

Introduction: Diverting patients away from the emergency department (ED) has been proposed as a solution for reducing ED overcrowding. The objective of this systematic review is to examine the effectiveness of diversion strategies designed to either direct patients seeking care at an ED to an alternative source of care. Methods: Seven electronic databases and grey literature were searched. Randomized/controlled clinical trials and cohort studies assessing the effectiveness of pre-hospital and ED-based diversion interventions with a comparator were eligible for inclusion. Two reviewers independently screened the studies for relevance, inclusion, and risk of bias. Intervention effects are reported as proportions (%) or relative risks (RR) with 95% confidence intervals (CI). Methodological and clinical heterogeneity prohibited pooling of study data. Results: From 7,306 citations, ten studies were included. Seven studies evaluated a pre-hospital diversion strategy and three studies evaluated an ED-based diversion strategy. The impact of diversion on subsequent health services was mixed. One study of paramedic practitioners reported increased ED attendance within 7 days (11.9% vs. 9.5%; p=0.049) but no differences in return visits for similar conditions (75.2% vs. 72.1%; p=0.64). The use of paramedic practitioners was associated with an increased risk of subsequent contact with health care services (RR=1.21, 95% CI 1.06, 1.38), while the use of deferred care was associated with no increase in risk of subsequently seeking physician care (RR=1.09, 95% CI 0.23, 5.26). While two studies reported that diverted patients were at significantly reduced risk for hospitalization, two other studies reported no significant differences between diverted or standard care patients. Conclusion: The evidence regarding the impact of pre-hospital and ED-based diversion on ED utilization and subsequent health care utilization is mixed. Additional high-quality comparative effectiveness studies of diversion strategies are required prior to widespread implementation.

scholarly journals The Impact of Brexit on the Pharmaceutical Supply Chain of the United Kingdom: Scoping Review Protocol (Preprint)

2020 ◽  
Author(s):  
Madison Milne-Ives ◽  
Ching Lam ◽  
Michelle van Velthoven ◽  
Edward Meinert
Keyword(s):  
United Kingdom ◽  
Supply Chain ◽  
Scoping Review ◽  
Grey Literature ◽  
Healthcare Management ◽  
Risk Of Bias ◽  
Pharmaceutical Supply Chain ◽  
The United Kingdom ◽  
The Uk ◽  
The Impact

BACKGROUND The continuing uncertainty around Brexit has caused concern in the pharmaceutical industry and among health care professionals and patients. The exact consequences of Brexit on the pharmaceutical supply chain in the United Kingdom will depend on whether a deal is reached and what it entails, but it is likely to be affected by the withdrawal of the United Kingdom from the European Union. Regulatory issues and delays in supply have the potential to negatively affect the ability of UK residents to receive an adequate and timely supply of necessary medicines. OBJECTIVE The purpose of this protocol is to provide an overview and critical analysis of current perspectives on the effect of Brexit on the UK pharmaceutical supply chain. METHODS The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines will be used to structure this protocol. A systematic search of MEDLINE, EMBASE, PsycINFO, Healthcare Management Information Consortium (HMIC), Cochrane, Web of Science, Business Source Complete, EconLit, and Economist Intelligence Unit will be conducted, as well as a Google and Nexis.UK search for grey literature such as reports, opinion pieces, and press releases. Two reviewers will independently screen the titles and abstracts of identified references and select studies according to the eligibility criteria. Any discrepancies will then be discussed and resolved. One reviewer will extract data from the included studies into a standardized form, which will be validated by a second reviewer. Risk of bias will be assessed using the Cochrane Collaboration Risk of Bias tool for any randomized controlled trials; quality will be assessed using the relevant Critical Appraisal Skills Programme (CASP) checklists; and grey literature will be assessed using the Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) checklist. Outcomes include the agreement between sources on the potential, likelihood, and severity of the consequences of Brexit on the UK pharmaceutical supply chain. RESULTS Results will be included in the scoping review, which will be published in 2020. CONCLUSIONS This scoping review will summarize the currently expected consequences of Brexit on the UK pharmaceutical supply chain. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/17684

Interventions to Decrease Use in Prehospital and Emergency Care Settings Among Super-Utilizers in the United States: A Systematic Review

2019 ◽  
Vol 77 (2) ◽  
pp. 99-111 ◽  
Author(s):  
Samantha Iovan ◽  
Paula M. Lantz ◽  
Katie Allan ◽  
Mahshid Abir
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Acute Care ◽  
Emergency Care ◽  
Grey Literature ◽  
The United States ◽  
Care Utilization ◽  
Regression To The Mean ◽  
High Quality ◽  
The Impact

Interest in high users of acute care continues to grow as health care organizations look to deliver cost-effective and high-quality care to patients. Since “super-utilizers” of acute care are responsible for disproportionately high health care spending, many programs and interventions have been implemented to reduce medical care use and costs in this population. This article presents a systematic review of the peer-reviewed and grey literature on evaluations of interventions to decrease prehospital and emergency care use among U.S. super-utilizers. Forty-six distinct evaluations were included in the review. The most commonly evaluated intervention was case management. Although a number of interventions reported reductions in prehospital and emergency care utilization and costs, methodological and study design weaknesses—especially regression to the mean—were widespread and call into question reported positive findings. More high-quality research is needed to accurately assess the impact of interventions to reduce prehospital and emergency care use in the super-utilizer population.

Competition and Containment in Health Care

2000 ◽  
Vol 30 (2) ◽  
pp. 257-284 ◽  
Author(s):  
Ben Griffith
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Cost Effectiveness ◽  
Transaction Costs ◽  
Health Care Services ◽  
Internal Markets ◽  
Care Services ◽  
The United Kingdom ◽  
Additional Funding ◽  
The Impact

In the United Kingdom and elsewhere, the preconditions for well-functioning internal markets (in relation to market structure, transaction costs, and information) may not exist in health care. Similar doubts exist about the impact of internal markets on cost-effectiveness. While the quantity of health care has increased, the effects on quality are ambiguous and costs have not been successfully restrained. With respect to equity of health care, fears have been raised that sections of the population may be discriminated against. In the United Kingdom, resources have been shifted away from deprived areas and toward the more affluent. Health care services are once again being reformed, by New Labour in the United Kingdom and similar administrations elsewhere. The rhetoric of competition has given way to talk of partnership. The imposition of new forms of rationing has been reshaped, not abandoned. Additional funding is required, along with an effective commitment to the pursuit of equity and quality in health care.

scholarly journals A Systematic Review of Hospital Efficiency and Productivity Studies: Lessons from Australia, UK and Canada.

2020 ◽  
Author(s):  
Bonnie Eklom ◽  
Emily Callander
Keyword(s):  
Systematic Review ◽  
United Kingdom ◽  
Health System ◽  
Grey Literature ◽  
Health Sector ◽  
Performance Measure ◽  
Full Time ◽  
The United Kingdom ◽  
Google Search ◽  
Efficiency And Productivity

Abstract BackgroundAgeing populations, more expensive technology, growing rates of chronic disease and increasing consumer expectations are expected to lead to increased demand for health services and a rise in health expenditure within Australia. Productivity and efficiency analysis of Australia’s health system could provide valuable insight into the performance of the health system and assist stakeholders to reduce unnecessary growth in public hospital expenditure. This review describes efficiency and productivity analyses of hospitals in Australia, Canada and the United Kingdom. Methods We conducted a systematic literature review of efficiency and productivity analyses of hospitals in Australia, Canada and the United Kingdom. The search was conducted in two stages; (1) a search of the grey literature using a Google search engine; and (2) a traditional systematic review method search of academic databases. It is uncommon for grey literature to have abstracts, therefore, executive summaries, table of contents or subheadings were screened. Titles and Abstracts of journal articles were screened. DiscussionWithin Australia and key comparator nations, the number of efficiency and analysis studies is small. There is no clear consensus on the most suitable analysis technique to measure efficiency and productivity of hospitals. However, selection of inputs is similar across all studies identified in this review, consisting of measures of labour (most commonly relating to full time equivalent employees), goods and services (e.g. purchased consumables, such as drugs), and capital. Similarly, the majority of studies struggled to identify output measures that could capture improvements in patient outcomes, a key performance measure for any hospital. Instead, most studies utilised proxy measures relating to hospital throughputs (number of separations) or population health measurements. Of note, only one study demonstrated active engagement with the health sector in study development. Conclusion There is considerable scope for the further development of efficiency and productivity analysis techniques that can adequately capture relevant production factors, allow for robust comparisons across hospitals and time periods and which meaningfully engage with the health sector to inform improvements in efficiency and productivity.

Medical Technology in the United Kingdom

1988 ◽  
Vol 4 (2) ◽  
pp. 171-183 ◽  
Author(s):  
Barbara Stocking
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Medical Technology ◽  
New Technology ◽  
Financing System ◽  
Significant Control ◽  
Diffusion Of Technology ◽  
Medical Technologies ◽  
The United Kingdom ◽  
The Impact

This article describes and explains the impact of the National Health Service bureaucracy on the diffusion of medical technology in the United Kingdom. Through case studies of six medical technologies, the author demonstrates how health care authorities may exercise significant control by using the central financing system to dampen the general diffusion of technology. However, the United Kingdom has less control in specific cases due to the absence of a bureaucratic body to coordinate the evaluation and introduction of new technology.

scholarly journals A Systematic Review on the Prevalence of Physical Activity, and Barriers and Facilitators to Physical Activity, in Informal Carers in the United Kingdom

2021 ◽  
Vol 18 (2) ◽  
pp. 212-218
Author(s):  
Joanna Horne ◽  
Nichola Kentzer ◽  
Lee Smith ◽  
Mike Trott ◽  
Jitka Vseteckova
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
United Kingdom ◽  
Meta Analysis ◽  
Adult Population ◽  
Grey Literature ◽  
Barriers And Facilitators ◽  
The United Kingdom ◽  
Informal Carers ◽  
The Uk

Background: It is estimated that 17% of the UK adult population are informal carers, usually for a family member, with a majority reporting that they are not able to engage in physical activity as much as they would like. The aim of this review is to provide a greater understanding of the prevalence of, and barriers and facilitators to, physical activity of informal carers in the United Kingdom. Methods: A systematic review of relevant databases and grey literature was undertaken, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidance, from its inception until July 17, 2020. Results: Barriers to physical activity include increasing aging, not wanting to leave the caree alone, the caree being unable to take part in activities, health conditions, fatigue, lack of time, and difficulties in changing the routine for the caree. Facilitators include an appreciation of the benefits of engaging in exercise, previous participation in activities, group activities with similar people, and having some free time. Conclusions: Due to the paucity of research into the prevalence of, and barriers and facilitators to, physical activity in informal carers in the United Kingdom, this systematic review highlights the need for further research, focusing primarily on the physical activity of informal carers caring for individuals with a range of conditions. A further systematic review exploring these issues internationally is warranted.

scholarly journals Non-medical prescribing policy in the United Kingdom National Health Service: systematic review and narrative synthesis

2019 ◽  
Author(s):  
Emma Graham-Clarke ◽  
Alison Rushton ◽  
Timothy Noblet ◽  
John Marriott
Keyword(s):  
Systematic Review ◽  
United Kingdom ◽  
Health Service ◽  
Narrative Analysis ◽  
Improve Patient Care ◽  
Policy Position ◽  
Healthcare Provision ◽  
Policy Documents ◽  
The United Kingdom ◽  
The Impact

AbstractNon-medical prescribing was introduced into the United Kingdom (UK) to improve patient care, through extending healthcare professionals’ roles. More recent government health service policy focuses on the increased demand and the need for efficiency. This systematic review aimed to describe any changes in government policy position and the role that non-medical prescribing plays in healthcare provision.The systematic review and narrative analysis included policy and consultation documents that describe independent non-medical prescribing. A pre-defined protocol was registered with PROSPERO (CRD42015019786). Professional body websites, other relevant websites and the following databases were searched to identify relevant papers: HMIC, Lexis Nexis, UK Government Web Archive, UKOP, UK Parliamentary Papers and Web of Science. Papers published between 2006 and February 2018 were included.Following exclusions, 45 papers were selected for review; 23 relating to policy or strategy and 22 to consultations. Of the former, 13/23 were published 2006-2010 and the remainder since 2013. Two main themes are identified: chronological aspects and healthcare provision. The impact of government change and associated major healthcare service reorganisation resulted in the publication gap for policy documents. The role of non-medical prescribing has evolved to support efficient service delivery, and cost reduction. For many professions, prescribing appears embedded into practice; however, pharmacy continues to produce policy documents, suggesting that prescribing is not yet perceived as normal practice.Prescribing appears to be more easily adopted into practice where it can form part of the overall care of the patient. Where new roles are required to be established, then prescribing takes longer to be universally adopted. While this research concerns policy and practice in the UK, this aspect of role adoption has wider potential implications.

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