scholarly journals The public health and health system implications of changes in the utilisation of acute hospital care in Ireland during the first wave of COVID-19: Lessons for recovery planning

2021 ◽  
Vol 4 ◽  
pp. 67
Author(s):  
Louise Marron ◽  
Sara Burke ◽  
Paul Kavanagh
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Health System ◽  
Population Health ◽  
Rate Ratio ◽  
Hospital Admissions ◽  
Healthcare Utilisation ◽  
Acute Hospital ◽  
P Value ◽  
Recovery Planning

Background: Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study is to quantify and characterise changes in acute hospital healthcare utilisation in Ireland during the first wave of COVID-19 to inform healthcare system planning and recovery. Methods: A retrospective, population-based, interrupted time-trend study was conducted using two national datasets, Patient Experience Time (PET) and Hospital In-Patient Enquiry (HIPE). The study period was 6th January to 5th July 2020. Results: Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%) than expected based on pre-COVID-19 activity. Reductions were greatest at the peak of population-level restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, acute hospital healthcare utilisation remained below pre-COVID-19 levels, however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028). Discussion: While public health implications of delayed and lost care will only become fully apparent over time, recovery planning must begin immediately. In the short-term, backlogs in care need to be managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses. In the long-term, COVID-19 highlights health system weakness and is an opportunity to progress health system reform to deliver a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.

scholarly journals A public health perspective on mental health: lessons for population health in the 21st century

2021 ◽  
pp. 1-4
Author(s):  
James V. Lucey
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Population Health ◽  
Royal College ◽  
Public Support ◽  
Healthcare Systems ◽  
Lessons Learned ◽  
Public Health Perspective ◽  
The World ◽  
Shared Commitment

In December 2019, clinicians and academics from the disciplines of public health and psychiatry met in Dublin at the Royal College of Surgeons in Ireland (RCSI), to restate their shared commitment to population health. The purpose of this review is to bring our discussion to a wider audience. The meeting could not have been more timely. Six weeks later, the COVID-19 emergency emerged in China and within 12 months it had swept the world. This paper, the contents of which were presented at that meeting in December recommended that future healthcare would be guided more by public health perspectives and informed by an understanding of health economics, population health and the lessons learned by psychiatry in the 20th century. Ultimately two issues are at stake in 21st century healthcare: the sustainability of our healthcare systems and the maintenance of public support for population health. We must plan for the next generation of healthcare. We need to do this now since it is clear that COVID-19 marks the beginning of 21st century medicine.

scholarly journals How does general practitioner discontinuity affect healthcare utilisation? An observational cohort study of 2.4 million Norwegians 2007–2017

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042391
Author(s):  
Lena Janita Skarshaug ◽  
Silje Lill Kaspersen ◽  
Johan Håkon Bjørngaard ◽  
Kristine Pape
Keyword(s):  
Cohort Study ◽  
General Practitioner ◽  
Service Use ◽  
Hospital Admissions ◽  
Age Groups ◽  
Healthcare Utilisation ◽  
Acute Hospital ◽  
Secondary Outcome ◽  
Out Of Hours ◽  
Adult Age

ObjectivesPatients may benefit from continuity of care by a personal physician general practitioner (GP), but there are few studies on consequences of a break in continuity of GP. Investigate how a sudden discontinuity of GP care affects their list patients’ regular GP consultations, out-of-hours consultations and acute hospital admissions, including admissions for ambulatory care sensitive conditions (ACSC).DesignCohort study linking person-level national register data on use of health services and GP affiliation with data on GP activity and GP characteristics.SettingPrimary care.Participants2 409 409 Norwegians assigned to the patient lists of 2560 regular GPs who, after 12 months of stable practice, had a sudden discontinuity of practice lasting two or more months between 2007 and 2017.Primary and secondary outcome measuresMonthly GP consultations, out-of-hours consultations, acute hospital admissions and ACSC admissions in periods during and 12 months after the discontinuity, compared with the 12-month period before the discontinuity using logistic regression models.ResultsAll patient age groups had a 3%–5% decreased odds of monthly regular GP consultations during the discontinuity. Odds of monthly out-of-hours consultations increased 2%–6% during the discontinuity for all adult age groups. A 7%–9% increase in odds of ACSC admissions during the period 1–6 months after discontinuity was indicated in patients over the age of 65, but in general little or no change in acute hospital admissions was observed during or after the period of discontinuity.ConclusionsModest changes in health service use were observed during and after a sudden discontinuity in practice among patients with a previously stable regular GP. Older patients seem sensitive to increased acute hospital admissions in the absence of their personal GP.

Burden of hospitalisation among older people in the Brazilian public health system: a big data analysis from 2009 to 2015

2019 ◽  
Vol 73 (6) ◽  
pp. 537-543 ◽  
Author(s):  
Roger Daglius Dias ◽  
Jacson Venancio de Barros
Keyword(s):  
Public Health ◽  
Hospital Mortality ◽  
Older People ◽  
Health System ◽  
Hospital Admissions ◽  
Public Health System ◽  
Average Length ◽  
Admission Rate ◽  
Older Population ◽  
Icu Admission

BackgroundThe world’s population is progressively ageing, and this trend imposes several challenges to society and governments. The aim of this study was to investigate the burden generated by the hospitalisation of older (>60 years) compared with non-older population, as well as the epidemiology of these hospital admissions.MethodsUsing the Brazilian Unified Health System (known as ‘Sistema Único de Saúde’ (SUS)), an analysis of all hospital admissions of adult patients in the SUS from 2009 to 2015 was undertaken. The following indicators were used: hospital admission rate, intensive care unit (ICU) admission rate, average length of hospital and ICU stay, hospital mortality and average reimbursement per hospitalisation.ResultsA total of 61 958 959 admissions during the 7-year period, were analysed, encompassing 17 893 392 (28.9%) older patients. Elderly represent 15% (n=21 294 950) of the Brazilian adult population, but are responsible for 29% (n=17 893 392) of hospitalisations, 52% (n=1 731 299) of ICU admissions and 66% (n=1 885 291) of hospital mortality. Among the adults, elderly represents 39% of the total reimbursement made related to admission/hospitalisation. For 2009 to 2015, while the older population increased 27%, ICU admission rate increased 20%; the average length of ICU stay was 12% higher in 2015 (6.5 days) compared with 2009 (5.8 days); and the hospital mortality increased from 9.8% to 11.2%.ConclusionThese findings illustrate the current panorama of the burden due to hospitalisation of older people in the Brazilian public health system, and evidence the consolidation of the epidemiological transition toward the predominance of non-communicable diseases as the main cause of hospitalisation among the elderly in Brazil.

scholarly journals Mental health system costs, resources and constraints in South Africa: a national survey

2019 ◽  
Vol 34 (9) ◽  
pp. 706-719 ◽  
Author(s):  
Sumaiyah Docrat ◽  
Donela Besada ◽  
Susan Cleary ◽  
Emmanuelle Daviaud ◽  
Crick Lund
Keyword(s):  
Public Health ◽  
Mental Health ◽  
South Africa ◽  
Health System ◽  
National Survey ◽  
Mental Health System ◽  
Scale Up ◽  
Health Spending ◽  
Mental Healthcare ◽  
Mental Health Expenditure

Abstract The inclusion of mental health in the Sustainable Development Goals represents a global commitment to include mental health among the highest health and development priorities for investment. Low- and middle-income countries (LMICs), such as South Africa, contemplating mental health system scale-up embedded into wider universal health coverage-related health system transformations, require detailed and locally derived estimates on existing mental health system resources and constraints. The absence of these data has limited scale-up efforts to address the burden of mental disorders in most LMICs. We conducted a national survey to quantify public expenditure on mental health and evaluate the constraints of the South African mental health system. The study found that South Africa’s public mental health expenditure in the 2016/17 financial year was USD615.3 million, representing 5.0% of the total public health budget (provincial range: 2.1–7.7% of provincial health budgets) and USD13.3 per capita uninsured. Inpatient care represented 86% of mental healthcare expenditure, with nearly half of total mental health spending occurring at the psychiatric hospital-level. Almost one-quarter of mental health inpatients are readmitted to hospital within 3 months of a previous discharge, costing the public health system an estimated USD112 million. Crude estimates indicate that only 0.89% and 7.35% of the uninsured population requiring care received some form of public inpatient and outpatient mental healthcare, during the study period. Further, mental health human resource availability, infrastructure and medication supply are significant constraints to the realization of the country’s progressive mental health legislation. For the first time, this study offers a nationally representative reflection of the state of mental health spending and elucidates inefficiencies and constraints emanating from existing mental health investments in South Africa. With this information at hand, the government now has a baseline for which a rational process to planning for system reforms can be initiated.

Reflections on happiness

2018 ◽  
Vol 17 (2) ◽  
pp. 90-91
Author(s):  
Woody Caan
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Population Health ◽  
Design Methodology ◽  
First Century ◽  
Field Of Study ◽  
Content Type ◽  
Psychological Therapies ◽  
Twenty First Century

Purpose The purpose of this paper is to assess the twenty-first century reach and impact of “happiness” work by one individual (Professor Lord Richard Layard). Design/methodology/approach The author approaches his work as a public health case study, with the caveat that the author knew this “Case” personally, which could influence the author’s assessment. Findings During 2005-2018, Richard Layard stimulated discussion of “happiness” as a field of study. This field now has global relevance to mental health, although its relationship to practice for population health is still debated. Originality/value Layard’s ideas are behind many initiatives, such as Improving Access to Psychological Therapies.

scholarly journals Community-Engaged Research: Common Themes and Needs Identified by Investigators and Research Teams at an Emerging Academic Learning Health System

2021 ◽  
Vol 18 (8) ◽  
pp. 3893
Author(s):  
Megan B. Irby ◽  
Keena R. Moore ◽  
Lilli Mann-Jackson ◽  
DeWanna Hamlin ◽  
Isaiah Randall ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Population Health ◽  
Southeastern United States ◽  
Academic Learning ◽  
Structured Interviews ◽  
Research Teams ◽  
Community Engaged Research ◽  
Learning Health System ◽  
Academic Partnerships

Community-engaged research (CEnR) has emerged within public health and medicine as an approach to research designed to increase health equity, reduce health disparities, and improve community and population health. We sought to understand how CEnR has been conducted and to identify needs to support CEnR within an emerging academic learning health system (aLHS). We conducted individual semi-structured interviews with investigators experienced in CEnR at an emerging aLHS in the southeastern United States. Eighteen investigators (16 faculty and 2 research associates) were identified, provided consent, and completed interviews. Half of participants were women; 61% were full professors of varied academic backgrounds and departments. Interviews were audio-recorded, transcribed, coded, and analyzed using constant comparison, an approach to grounded theory. Twenty themes emerged that were categorized into six domains: Conceptualization and Purpose, Value and Investment, Community-Academic Partnerships, Sustainability, Facilitators, and Challenges. Results also identified eight emerging needs necessary to enhance CEnR within aLHSs. The results provide insights into how CEnR approaches can be harnessed within aLHSs to build and nurture community-academic partnerships, inform research and institutional priorities, and improve community and population health. Findings can be used to guide the incorporation of CEnR within aLHSs.

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