Waiting Lists, Waiting Times and Admissions: An Empirical Analysis at Hospital and General Practice Level

In recent years, the increase of average waiting times in waiting lists is an issue that has been felt in health institutions. Thus, the implementation of new administrative measures to improve the management of these organizations may be required. Hereupon, the aim of this present work is to support the decision-making process in appointments and surgeries waiting lists in a hospital located in the north of Portugal, through a pervasive Business Intelligence platform that can be accessed anywhere and anytime by any device connected within the hospital's private network. By representing information that facilitate the analysis of information and knowledge extraction, the Web tool allows the identification in real-time of average waiting times outside the outlined patterns. Thereby, the developed platform permits their identification, enabling their further understanding in order to take the necessary measures. Thus, the main purpose is to enable the reduction of average waiting times through the analysis of information in order to, subsequently, ensure the satisfaction of patients.

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Links between the amount of antipsychotic medication prescribed per population at general practice level, local demographic factors and medication selection

BMC Psychiatry ◽

10.1186/s12888-020-02915-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

A. H. Heald ◽

M. Stedman ◽

S. Farman ◽

C. Khine ◽

M. Davies ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Antipsychotic Medication ◽

Mental Illnesses ◽

Pharmacological Intervention ◽

Defined Daily Dose ◽

Practice Level ◽

Practice Population ◽

General Practices ◽

Antipsychotic Prescribing

Abstract Background Antipsychotic medications are the first-line pharmacological intervention for severe mental illnesses (SMI) such as schizophrenia and other psychoses, while also being used to relieve distress and treat neuropsychiatric symptoms in dementia. Our aim was to examine the factors relating to antipsychotic prescribing in general practices across England and how cost changes in recent years have impacted on antipsychotic prescribing. Methods The study examined over time the prescribing volume and prices paid for antipsychotic medication by agent in primary care. Monthly prescribing in primary care was consolidated over 5 years (2013–2018) and DDD amount from WHO/ATC for each agent was used to convert the amount to total DDD/practice. The defined Daily Dose (DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. Results We included 5750 general practices with practice population > 3000 and with > 30 people on their SMI register. In 2018/19 there were 10,360,865 prescriptions containing 136 million DDD with costs of £110 million at an average cost of £0.81/DDD issued in primary care. In 2017/18 there was a sharp increase in overall prices and they had not reduced to expected levels by the end of the 2018/19 evaluation year. There was a gradual increase in antipsychotic prescribing over 2013–2019 which was not perturbed by the increase in drug price in 2017/18. The strongest positive relation to increased prescribing of antipsychotics came from higher social disadvantage, higher population density (urban), and comorbidities e.g. chronic obstructive pulmonary disease (COPD). Higher % younger and % older populations, northerliness and non-white (Black and Minority Ethnic(BAME)) ethnicity were all independently associated with less antipsychotic prescribing. Higher DDD/general practice population was linked with higher proportion(%) injectable, higher %liquid, higher doses/prescription and higher %zuclopenthixol depot. Less DDD/population was linked with general practices using higher % risperidone and higher spending/dose of antipsychotic. Conclusions The levels of antipsychotic prescribing at general practice level are driven by social factors/comorbidities. We found a link between depot prescriptions with higher antipsychotic DDD and risperidone prescriptions with lower antipsychotic DDD. It is important that all prescribers are aware of these drivers / links.

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Telehealth interventions for reducing waiting lists and waiting times for specialist outpatient services: A scoping review

Journal of Telemedicine and Telecare ◽

10.1177/1357633x16670495 ◽

2016 ◽

Vol 22 (8) ◽

pp. 504-512 ◽

Cited By ~ 39

Author(s):

Liam J Caffery ◽

Mutaz Farjian ◽

Anthony C Smith

Keyword(s):

Scoping Review ◽

Outpatient Care ◽

Waiting Times ◽

Waiting Lists ◽

Referral Process ◽

Outpatient Services ◽

Face To Face ◽

Specialist Services ◽

Telehealth Intervention

We undertook a scoping review of the published literature to identify and summarise key findings on the telehealth interventions that influence waiting times or waiting lists for specialist outpatient services. Searches were conducted to identify relevant articles. Articles were included if the telehealth intervention restructured or made the referral process more efficient. We excluded studies that simply increased capacity. Two categories of interventions were identified – electronic consultations and image-based triage. Electronic consultations are asynchronous, text-based provider-to-provider consultations. Electronic consultations have been reported to obviate the need for face-to-face appointments between the patient and the specialist in between 34–92% of cases. However, it is often reported that electronic consultations are appropriate in less than 10% of referrals for outpatient care. Image-based triage has been used successfully to reduce unnecessary or inappropriate referrals and was used most often in dermatology, ophthalmology and otolaryngology (ENT). Reported reduction rates for face-to-face appointments by specialty were: dermatology 38–88%, ophthalmology 16–48% and ENT 89%. Image–based triage can be twice as effective as non-image based triage in reducing unnecessary appointments. Telehealth interventions can effectively be used to reduce waiting lists and improve the coordination of specialist services, and should be considered in conjunction with clinical requirements.

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Optimizing diabetes care regarding cardiovascular targets at general practice level: Direct@GP

Primary Care Diabetes ◽

10.1016/j.pcd.2010.09.006 ◽

2011 ◽

Vol 5 (1) ◽

pp. 19-24 ◽

Cited By ~ 5

Author(s):

Johan Wens ◽

Robert Gerard ◽

Hans Vandenberghe

Keyword(s):

General Practice ◽

Diabetes Care ◽

Practice Level

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MECHANISM FOR POWERLAWS WITHOUT SELF-ORGANIZATION

International Journal of Modern Physics C ◽

10.1142/s0129183102003036 ◽

2002 ◽

Vol 13 (02) ◽

pp. 133-136 ◽

Cited By ~ 15

Author(s):

DIDIER SORNETTE

Keyword(s):

Power Law ◽

Waiting Times ◽

Self Regulation ◽

Waiting Lists ◽

Self Organization ◽

Recent Claim

A recent claim has been made that there must be a self-regulation in the waiting times to see hospital consultants on the ground that the relative changes in the size of waiting lists follow a power law.4 In agreement with simulations of Frecketon and Sutherland, we explain the general nonself-regulating mechanism underlying this result and derive the exponent value -2 exactly. In addition, we provide links with related phenomena encountered in many other fields.

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Links between the amount of antipsychotic medication prescribed per population at general practice level, local demographic factors and medication selection

10.21203/rs.2.24127/v1 ◽

2020 ◽

Author(s):

Adrian Hugh Heald ◽

Mike Stedman ◽

Sanam Farman ◽

Chaw Khine ◽

Mark Davies ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Antipsychotic Medication ◽

Demographic Factors ◽

Mental Illnesses ◽

Pharmacological Intervention ◽

Practice Level ◽

Practice Population ◽

General Practices ◽

Antipsychotic Prescribing

Abstract BACKGROUND Antipsychotic medications are the first-line pharmacological intervention for severe mental illnesses(SMI) such as schizophrenia and other psychoses, while also being used to relieve distress and treat neuropsychiatric symptoms in dementia. Since 2014 many antipsychotic agents have moved to generic provision. In 2017_18 supplies of certain generic agents were affected by substantial price increases. Our aim was to examine factors relating to antipsychotic prescribing in general practices across England and how cost changes in recent years have impacted. METHODS The study examined over time the prescribing volume/prices paid for antipsychotic medication by agent in primary care. The NHS in England/Wales publishes each month the prescribing in general practice by BNF code. This was aggregated for the year 2018_19 using Defined Daily doses (DDD). Cost of each agent year-on-year was determined. Monthly prescribing in primary care was consolidated over 5 years(2013-2018) and DDD amount from WHO/ATC for each agent was used to convert the amount to total DDD/practice. RESULTS Description We included 5,750 general practices with practice population >3000 and with >30 people on their SMI register. In 2018_19 there were 10,360,865 prescriptions containing 136 million DDD with costs of £110 million at an average cost of £0.81/DDD issued in primary care. Effect of price In 2017_18 there was a sharp increase in overall prices. There was a gradual increase in antipsychotic prescribing over 2013-2019 which was not perturbed by the drug price increase in 2017/18. Regression Demographic factors The strongest positive relation to increased prescribing of antipsychotics came from higher social disadvantage, higher population density(urban), and comorbidities e.g. chronic obstructive pulmonary disease(COPD). Higher %younger and %older populations, northerliness and non-white (Black and Minority Ethnic (BME)) ethnicity were all independently associated with less antipsychotic prescribing. Prescribing Factors Higher DDD/general practice population was linked with higher %injectable, higher %liquid, higher doses/prescription and higher %zuclopenthixol depot. Less DDD/population was linked with general practices using higher %risperidone and higher spending/dose of antipsychotic. CONCLUSIONS Levels of antipsychotic prescribing at general practice level are driven by social factors/comorbidities. We found a contrasting link between depot prescriptions with higher DDD and risperidone prescriptions with lower DDD.

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Sodium‐glucose co‐transporter‐2 inhibitors, the latest residents on the block: Impact on glycaemic control at a general practice level in England

Diabetes Obesity and Metabolism ◽

10.1111/dom.13281 ◽

2018 ◽

Vol 20 (7) ◽

pp. 1659-1669 ◽

Cited By ~ 5

Author(s):

Adrian H. Heald ◽

Anthony A. Fryer ◽

Simon G. Anderson ◽

Mark Livingston ◽

Mark Lunt ◽

...

Keyword(s):

General Practice ◽

Glycaemic Control ◽

Practice Level

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Patient experience of general practice and use of emergency hospital services in England: regression analysis of national cross-sectional time series data

BMJ Quality & Safety ◽

10.1136/bmjqs-2017-007174 ◽

2018 ◽

Vol 27 (8) ◽

pp. 643-654 ◽

Cited By ~ 7

Author(s):

Thomas E Cowling ◽

Azeem Majeed ◽

Matthew J Harris

Keyword(s):

Time Series ◽

General Practice ◽

Regression Analysis ◽

Patient Experience ◽

Sensitivity Analyses ◽

Hospital Services ◽

Cross Sectional ◽

Emergency Admissions ◽

Emergency Hospital ◽

Practice Level

BackgroundThe UK Government has introduced several national policies to improve access to primary care. We examined associations between patient experience of general practice and rates of visits to accident and emergency (A&E) departments and emergency hospital admissions in England.MethodsThe study included 8124 general practices between 2011–2012 and 2013–2014. Outcome measures were annual rates of A&E visits and emergency admissions by general practice population, according to administrative hospital records. Explanatory variables included three patient experience measures from the General Practice Patient Survey: practice-level means of experience of making an appointment, satisfaction with opening hours and overall experience (on 0–100 scales). The main analysis used random-effects Poisson regression for cross-sectional time series. Five sensitivity analyses examined changes in model specification.ResultsMean practice-level rates of A&E visits and emergency admissions increased from 2011–2012 to 2013–2014 (310.3–324.4 and 98.8–102.9 per 1000 patients). Each patient experience measure decreased; for example, mean satisfaction with opening hours was 79.4 in 2011–2012 and 76.6 in 2013–2014. In the adjusted regression analysis, an SD increase in experience of making appointments (equal to 9 points) predicted decreases of 1.8% (95% CI −2.4% to −1.2%) in A&E visit rates and 1.4% (95% CI −1.9% to −0.9%) in admission rates. This equalled 301 174 fewer A&E visits and 74 610 fewer admissions nationally per year. Satisfaction with opening hours and overall experience were not consistently associated with either outcome measure across the main and sensitivity analyses.ConclusionsAssociations between patient experience of general practice and use of emergency hospital services were small or inconsistent. In England, realistic short-term improvements in patient experience of general practice may only have modest effects on A&E visits and emergency admissions.

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