An economic analysis of the national shared emergency care summary in Scotland

2009 ◽  
Vol 15 (3) ◽  
pp. 129-131 ◽  
Author(s):  
Tom Jones ◽  
Alexander Dobrev ◽  
Jonathan Cameron ◽  
Libby Morris ◽  
Karl A Stroetmann ◽  
...  
Keyword(s):  
Economic Analysis ◽  
Emergency Care ◽  
Health Care Professionals ◽  
Drug Reactions ◽  
Demographic Information ◽  
Out Of Hours ◽  
Accident And Emergency ◽  
Help Line ◽  
Care Information ◽  
Net Benefits

The Emergency Care Summary (ECS) in Scotland provides essential clinical and demographic information about patients needing unscheduled or emergency care. Information about patients’ medications, adverse drug reactions and allergies is transferred twice every day from GP systems to the ECS. Access is then available to authorised health-care professionals at the national help line, at out-of-hours services and in accident and emergency departments. An economic analysis of the ECS implementation showed that annual benefits exceeded annual costs after about seven years. Approximately 77% of the benefits were non-financial and 23% from redeployed finance. No cash savings were planned and none were realised. As ECS utilisation increased from 2006, the net benefits became positive. This relationship between utilisation and net benefits is a common feature of successful e-health investment.

Prioritization and management of calls from older people to GP out-of-hours services

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Suzanne Smith ◽  
Lucia Carragher
Keyword(s):  
Older People ◽  
Service Provision ◽  
Emergency Services ◽  
Oldest Old ◽  
Community Dwelling ◽  
Third Party ◽  
Older Person ◽  
Out Of Hours ◽  
Accident And Emergency ◽  
Community Dwelling Older People

Abstract Background Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours services including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. Objective The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. Methods An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. Results Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also reflected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The findings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. Conclusion Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP office hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living.

scholarly journals Analysis of spontaneously reported adverse drug reactions to pharmacovigilance cell of a tertiary care hospital

2018 ◽  
Vol 7 (8) ◽  
pp. 1551
Author(s):  
Kaksha J. Patel ◽  
Ashwin K. Panchasara ◽  
Manish J. Barvaliya ◽  
C. B. Tripathi
Keyword(s):  
Health Care ◽  
Adverse Drug Reactions ◽  
Health Care Professionals ◽  
Geriatric Patients ◽  
Tertiary Care ◽  
Care Hospital ◽  
Drug Reactions ◽  
Adr Reporting ◽  
Common Group ◽  
Selection Of

Background: The objective of the study was to study the clinical patterns, causality and severity of adverse drug reactions in a tertiary care hospital.Methods: Total 131 ADR forms were collected from January 2012 to December 2012 and evaluated. Patient’s characteristics, ADR and drug characteristics, causality, severity and preventability of collected ADR were analyzed.Results: Total 131 ADR forms were evaluated. Male patient experiencing ADR were more (73, 55.7%) than female (58, 44.2%). Adult patients (12-60 years) experienced 110 (84%) ADR followed by pediatric patients (< 12 years) 11 (8.4%) and geriatric patients (>60 years) 10 (7.63%). Antimicrobial were the most common group of drugs responsible for ADR followed by NSAIDs and antipsychotic group.Conclusions: Present study shows lack of awareness among health care professionals for reporting of an ADR. Training and collaboration of health care professionals are needed for improvement in ADR reporting. Appropriate feedback from ADR reporting will help in selection of drug and promotes safer use of drugs.

scholarly journals PATTERN OF ADVERSE DRUG REACTIONS AND ITS MANAGEMENT IN FEMALE CANCER PATIENTS IN A PRIVATE HOSPITAL IN TELANGANA, INDIA

2018 ◽  
Vol 6 (4) ◽  
pp. 45-53
Author(s):  
Kishore P ◽  
G Meghana ◽  
B. Pratap Reddy ◽  
K V Raghavaiah ◽  
D Sudheer Kumar
Keyword(s):  
Radiation Therapy ◽  
Adverse Drug Reactions ◽  
Cancer Chemotherapy ◽  
Health Care Professionals ◽  
Private Hospital ◽  
Therapeutic Window ◽  
Pharmacovigilance System ◽  
Drug Reactions ◽  
System Use ◽  
Female Cancer Patients

ABSTRACT Chemotherapy and radiation are one of the important components of treatment for many cancers. Anti-neoplastic agents are used with caution due to their high toxicity and narrow therapeutic window. Studies describing pattern of adverse drug reactions in cancer chemotherapy and radiation therapy patients are less in India. This study aims to evaluate the pattern of ADR’s due to cancer chemotherapy and radiation therapy in hospitalized patients and to assess the causality and severity of these reactions in Telangana state, India. This was a prospective observational study conducted in a private hospital in Telangana region from January to august. Two thousand three hundred and forty two ADR’s were recorded from 254 patients. Most common ADR’s were vomiting (10.7 %), nausea (10.7 %) and fatigue (10.7 %). Majority of the ADR’s (53.5 %) were affecting the Gastro-intestinal system. Naranjo scale for causality assessment showed 54.3 % of the reaction to be “definite”, 36.8 % to be “probable”. Modified Hartwig and Siegel scale for severity showed most reaction (84.1 %) to be of “moderate level”, while 13.3 % of reactions were of “mild level”. There is an immediate need to create awareness among health care professionals regarding the importance of the pharmacovigilance system. Use of preventive measures is to be enhanced in order to reduce the incidence and severity of ADR’s. This study showed most ADR’s are preventable with effective ADR monitoring. Keywords: Adverse drug reaction (ADR), ADR monitoring, Pharmacovigilance, chemotherapy, radiation therapy.

scholarly journals A prospective observational pharmacovigilance study of adverse drug reaction monitoring in patients of MDR-TB at tertiary care hospital

2018 ◽  
Vol 7 (7) ◽  
pp. 1291
Author(s):  
Mirza Shiraz Baig ◽  
Monali Raghunath Kale ◽  
Avinash Lamb
Keyword(s):  
Adverse Drug Reactions ◽  
Health Care Professionals ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Treatment Withdrawal ◽  
Care Hospital ◽  
Drug Reactions ◽  
Medical College ◽  
Mdr Tb

Background: The emergence of drug resistant mycobacteria has become a significant public health problem world over creating an obstacle to effective TB control. ADRs are common in patients of MDR-TB on DOTs-Plus drug regimen. Present study was carried out in tertiary care hospital. Identification of types and frequency of adverse drug reactions in Intensive and continuation phase of MDR-TB Patients.Methods: It was a prospective observational study conducted in Department of TB- Chest and Medicine, Govt. Medical College, Aurangabad, Maharashtra, India. All the MDR-TB patients admitted at the directly observed treatment, short course plus (DOTS plus) Center at Medical College Hospital were enrolled and were monitored for ADRs. The causality and severity of the reactions were determined using Naranjo algorithm and Hartwig questionnaire, respectively.Results: A total of 121 tuberculosis patients of MDR-TB on DOTS therapy were enrolled for the study. Out of 121 patients, 13 were dropouts, 6 died, 7 defaulted so 108 patients assessed for ADRs, 48 patients developed 61 (56.48%) adverse drug reactions. The higher numbers of ADRs were observed in age group 31-40yrs followed by 21-30yrs which were more common in men. Majority of adverse drug reactions were Gastrointestinal (GI) problems 32 (52.45%), followed by Ototoxicity 7 (11.48%) and Psychiatric Manifestations 6 (9.84%) and skin problems 3 (4.92%). On evaluation of the causality of ADRs, majority were found to be Possible (59.02%). The severity assessment showed that most of the patients ADRs were of moderate level (50.82%).Some patients required treatment withdrawal and replacement with other drug and most of the patients were managed with supportive medication without removing anti-tubercular drug from their treatment regimen.Conclusions: ADRs are major factor limiting completion of drug therapy under RNTCP and occurrence of drug resistance which requires attention of all health care professionals.

scholarly journals A Tool to Assess the Trustworthiness of Evidence-Based Point-of-Care Information for Health Care Professionals (CAPOCI): Design and Validation Study (Preprint)

2021 ◽  
Author(s):  
Gerlinde Lenaerts ◽  
Geertruida E Bekkering ◽  
Martine Goossens ◽  
Leen De Coninck ◽  
Nicolas Delvaux ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Delphi Study ◽  
Critical Appraisal ◽  
Point Of Care ◽  
Scoring Systems ◽  
Likert Scale ◽  
Ordinal Scale ◽  
Evidence Based ◽  
Care Information

BACKGROUND User-friendly information at the point of care for health care professionals should be well structured, rapidly accessible, comprehensive, and trustworthy. The reliability of information and the associated methodological process must be clear. There is no standard tool to evaluate the trustworthiness of such point-of-care (POC) information. OBJECTIVE We aim to develop and validate a new tool for assessment of trustworthiness of evidence-based POC resources to enhance the quality of POC resources and facilitate evidence-based practice. METHODS We designed the Critical Appraisal of Point-of-Care Information (CAPOCI) tool based on the criteria important for assessment of trustworthiness of POC information, reported in a previously published review. A group of health care professionals and methodologists (the authors of this paper) defined criteria for the CAPOCI tool in an iterative process of discussion and pilot testing until consensus was reached. In the next step, all criteria were subject to content validation with a Delphi study. We invited an international panel of 10 experts to rate their agreement with the relevance and wording of the criteria and to give feedback. Consensus was reached when 70% of the experts agreed. When no consensus was reached, we reformulated the criteria based on the experts’ comments for a next round of the Delphi study. This process was repeated until consensus was reached for each criterion. In a last step, the interrater reliability of the CAPOCI tool was calculated with a 2-tailed Kendall tau correlation coefficient to quantify the agreement between 2 users who piloted the CAPOCI tool on 5 POC resources. Two scoring systems were tested: a 3-point ordinal scale and a 7-point Likert scale. RESULTS After validation, the CAPOCI tool was designed with 11 criteria that focused on methodological quality and author-related information. The criteria assess authorship, literature search, use of preappraised evidence, critical appraisal of evidence, expert opinions, peer review, timeliness and updating, conflict of interest, and commercial support. Interrater agreement showed substantial agreement between 2 users for scoring with the 3-point ordinal scale (τ=.621, <i>P</i>&lt;.01) and scoring with the 7-point Likert scale (τ=.677, <i>P</i>&lt;.01). CONCLUSIONS The CAPOCI tool may support validation teams in the assessment of trustworthiness of POC resources. It may also provide guidance for producers of POC resources.

scholarly journals Promoting adverse drug reaction reporting: comparison of different approaches

2016 ◽  
Vol 50 (0) ◽  
Author(s):  
Inês Ribeiro-Vaz ◽  
Cristina Costa Santos ◽  
Ricardo Cruz-Correia
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Cost Effectiveness ◽  
Adverse Drug Reactions ◽  
Health Care Professionals ◽  
Adverse Drug Reaction Reporting ◽  
Pharmacovigilance Centre ◽  
Drug Reactions ◽  
Educational Approach ◽  
Reaction Reporting

ABSTRACT OBJECTIVE To describe different approaches to promote adverse drug reaction reporting among health care professionals, determining their cost-effectiveness. METHODS We analyzed and compared several approaches taken by the Northern Pharmacovigilance Centre (Portugal) to promote adverse drug reaction reporting. Approaches were compared regarding the number and relevance of adverse drug reaction reports obtained and costs involved. Costs by report were estimated by adding the initial costs and the running costs of each intervention. These costs were divided by the number of reports obtained with each intervention, to assess its cost-effectiveness. RESULTS All the approaches seem to have increased the number of adverse drug reaction reports. We noted the biggest increase with protocols (321 reports, costing 1.96 € each), followed by first educational approach (265 reports, 20.31 €/report) and by the hyperlink approach (136 reports, 15.59 €/report). Regarding the severity of adverse drug reactions, protocols were the most efficient approach, costing 2.29 €/report, followed by hyperlinks (30.28 €/report, having no running costs). Concerning unexpected adverse drug reactions, the best result was obtained with protocols (5.12 €/report), followed by first educational approach (38.79 €/report). CONCLUSIONS We recommend implementing protocols in other pharmacovigilance centers. They seem to be the most efficient intervention, allowing receiving adverse drug reactions reports at lower costs. The increase applied not only to the total number of reports, but also to the severity, unexpectedness and high degree of causality attributed to the adverse drug reactions. Still, hyperlinks have the advantage of not involving running costs, showing the second best performance in cost per adverse drug reactions report.

scholarly journals Reducing Diagnostic Errors in Musculoskeletal Trauma by Reviewing Non-Admission Orthopaedic Referrals in the Next-Day Trauma Meeting

2007 ◽  
Vol 89 (7) ◽  
pp. 692-695 ◽  
Author(s):  
H Sharma ◽  
S Bhagat ◽  
WJ Gaine
Keyword(s):  
False Positive Rate ◽  
False Negative ◽  
Diagnostic Errors ◽  
District General Hospital ◽  
X Rays ◽  
Out Of Hours ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
Positive Rate ◽  
Musculoskeletal Trauma

INTRODUCTION Diagnostic errors in orthopaedics are usually caused by missing a fracture or misreading radiographs. The aim of this study was to document the pick-up rate of the wrong diagnoses by reviewing X-rays and casualty notes in the next-day trauma meeting. PATIENTS AND METHODS The casualty notes and radiographs of 503 patients were prospectively reviewed in the daily trauma meeting between August 2002 and December 2002 in a district general hospital. The relevant data were collected and analysed by a single assessor. RESULTS The false positive rate for making an orthopaedic diagnosis was 12.6% (i.e.) diagnosing a fracture, when none existed). The false negative (missing) rate was 4%, while 2.4% incidental findings were missed, or at least not documented, after reading the X-rays. There were 7.8% wrong diagnoses made. The majority of the patients were seen by the senior house officers. CONCLUSIONS The medicolegal significance of false negative diagnosis is obviously greater. In a busy emergency department, where a large number of patients are seen, there is a greater risk. This study shows the importance in a small-to-medium sized accident and emergency unit as well, where there is no senior cover available out-of-hours for final radiological interpretation. A morning trauma meeting which covers reviewing admitted patients as well as non-admission orthopaedic referrals has an effective risk management solution to early detection of missed and wrong diagnoses.

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