scholarly journals High Variability in Sepsis Guidelines in UK: Why Does It Matter?

2020 ◽  
Vol 17 (6) ◽  
pp. 2026
Author(s):  
Alison Bray ◽  
Emmanouela Kampouraki ◽  
Amanda Winter ◽  
Aaron Jesuthasan ◽  
Ben Messer ◽  
...  
Keyword(s):  
Large Scale ◽  
Care Pathway ◽  
Point Of Care ◽  
Early Warning Score ◽  
Economic Evaluations ◽  
Societal Costs ◽  
Potential Impact ◽  
The Uk ◽  
Point Of Care Tests ◽  
Clinical Audits

It is recommended that developers of Point Of Care Tests (POCTs) assess the care pathway of the patient population of interest in order to understand if the POCT fits within the pathway and has the potential to improve it. If the variation of the pathway across potential hospitals is large, then it is likely that the evaluation of effectiveness is harder and the route towards large-scale takes adoption longer. Evaluating care pathways can be a time-consuming activity when conducted through clinical audits or interviews with healthcare professionals. We have developed a more rapid methodology which extrapolates the care pathway from local hospital guidelines and assesses their variation. Sepsis kills 46,000 people per year in the UK with societal costs of up to £10 billion. Therefore, there is a clinical need for an optimized pathway. By applying our method in this field, we were able to assess the variation in current hospital guidelines for sepsis and infer the potential impact this may have on the evidence development on innovations in this applications. We obtained 15 local sepsis guidelines. Two independent reviewers extracted: use of the national early warning score (NEWS), signs and risk factors informing the decision to prescribe antibiotics, and the number of decisional steps up to this point. Considerable variation was observed in all the variables, which is likely to have an impact on future clinical and economic evaluations and adoption of POCT for the identification of patients with sepsis.

scholarly journals Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA

BMJ Open ◽  
2014 ◽  
Vol 4 (8) ◽  
pp. e005611-e005611 ◽  
Author(s):  
J. Howick ◽  
J. W. L. Cals ◽  
C. Jones ◽  
C. P. Price ◽  
A. Pluddemann ◽  
...  
Keyword(s):  
Primary Care ◽  
The Netherlands ◽  
Point Of Care ◽  
International Survey ◽  
The Usa ◽  
The Uk ◽  
Point Of Care Tests

scholarly journals Evaluating the effectiveness of the smartphone app, Drink Less, compared with the NHS alcohol advice webpage, for the reduction of alcohol consumption among hazardous and harmful adult drinkers in the UK at six-month follow-up: protocol for a randomised controlled trial

2020 ◽  
Author(s):  
Claire Garnett ◽  
Melissa Oldham ◽  
Colin Angus ◽  
Emma Beard ◽  
Robyn Burton ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Randomised Controlled Trial ◽  
Alcohol Consumption ◽  
Large Scale ◽  
Controlled Trial ◽  
Economic Evaluations ◽  
Intention To Treat ◽  
Randomised Controlled ◽  
The Uk

AbstractBackground and AimsDigital interventions are effective for reducing alcohol consumption but evidence is limited regarding smartphone apps. Drink Less is a theory- and evidence-informed app to help people reduce their alcohol consumption that has been refined in terms of its content and design for usability across the socio-demographic spectrum. We aim to evaluate the effectiveness and cost-effectiveness of recommending Drink Less at reducing alcohol consumption compared with usual digital care.DesignTwo-arm individually randomised controlled trial.SettingOnline trial in the UK.ParticipantsHazardous or harmful drinkers (Alcohol Use Disorders Identification Test score >=8) aged 18+, and want to drink less alcohol (n=5,562). Participants will be recruited from July 2020 to May 2022 using multiple strategies with a focus on remote digital methods.Intervention and comparatorParticipants will be randomised to receive either an email recommending that they use Drink Less (intervention) or view the NHS webpage on alcohol advice (comparator).MeasurementsThe primary outcome is change in self-reported weekly alcohol consumption between baseline and 6-month follow-up. Secondary outcomes include the proportion of hazardous drinkers; alcohol-related problems and injury; health-related quality of life, and use of health services assessed at 6-month follow-up. Effectiveness will be examined with one-way ANCOVAs, adjusting for baseline alcohol consumption, and using an intention-to-treat approach. A mixed-methods process evaluation will assess engagement, acceptability and mechanism of action. Economic evaluations will be conducted using both a short- and longer-term time horizon.CommentsThis study will establish the effectiveness and cost-effectiveness of the Drink Less app at reducing alcohol consumption among hazardous and harmful adult drinkers and will be the first RCT of an alcohol reduction app for the general population in the UK. This study will inform the decision on whether it is worth investing resources in large-scale implementation.

scholarly journals Qualitative analysis of stakeholder interviews to identify the barriers and facilitators to the adoption of point-of-care diagnostic tests in the UK

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042944
Author(s):  
Jeremy R Huddy ◽  
Melody Zhifang Ni ◽  
James Barlow ◽  
George B Hanna
Keyword(s):  
Resource Use ◽  
Point Of Care ◽  
Financial Resource ◽  
Barriers And Facilitators ◽  
Patient Factors ◽  
Laboratory Staff ◽  
Device Development ◽  
The Uk ◽  
Point Of Care Tests ◽  
Constant Comparative Analysis

ObjectivesThis study investigated the barriers and facilitators to the adoption of point-of-care tests (POCTs).DesignQualitative study incorporating a constant comparative analysis of stakeholder responses to a series of interviews undertaken to design the Point-of-Care Key Evidence Tool.SettingThe study was conducted in relation to POCTs used in all aspects of healthcare.ParticipantsForty-three stakeholders were interviewed including clinicians (incorporating laboratory staff and members of trust POCT committees), commissioners, industry, regulators and patients.ResultsThematic analysis highlighted 32 barriers in six themes and 28 facilitators in eight themes to the adoption of POCTs. Six themes were common to both barriers and facilitators (clinical, cultural, evidence, design and quality assurance, financial and organisational) and two themes contained facilitators alone (patient factors and other (non-financial) resource use).ConclusionsFindings from this study demonstrate the complex motivations of stakeholders in the adoption of POCT. Most themes were common to both barriers and facilitators suggesting that good device design, stakeholder engagement and appropriate evidence provision can increase the likelihood of a POCT device adoption. However, it is important to realise that while the majority of identified barriers may be perceived or mitigated some may be absolute and if identified early in device development further investment should be carefully considered.

scholarly journals What is the evidence base for ambulatory care for acute medical illness?

2018 ◽  
Vol 17 (3) ◽  
pp. 148-153
Author(s):  
Daniel Lasserson ◽  
◽  
C Harris ◽  
TNE Elias ◽  
JST Bowen ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Care Pathway ◽  
Point Of Care ◽  
National Policy ◽  
Healthcare Setting ◽  
Evidence Base ◽  
Policy Support ◽  
Medical Illness ◽  
Home Based ◽  
The Uk

Acute ambulatory care is a critical component of the emergency care pathway with national policy support and a dedicated NHS Improvement network. The evidence base for treating acute medical illness outside hospital is a diverse mix of randomised and observational studies with varying inclusion criteria, prognostic stratification, interventions and healthcare setting which limits synthesis of all available evidence and translation to the UK context. There is little consensus on the level of risk for home-based treatment for acute medical illness. Selection tools for referral to acute ambulatory care have been developed but there is limited evidence for their use. There are still research questions concerning optimal staffing, referral mechanisms, point of care diagnostic portfolio and tools for shared decision making.

Technology identities explain under- and non-adoption of community-based point-of-care tests in the UK NHS

2015 ◽  
Vol 4 (1) ◽  
pp. 68-77 ◽  
Author(s):  
Susan C. Peirce ◽  
Alex Faulkner ◽  
Selda Ulucanlar ◽  
Glyn Elwyn
Keyword(s):  
Point Of Care ◽  
Community Based ◽  
The Uk ◽  
Point Of Care Tests

scholarly journals Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out

2019 ◽  
Vol 36 (5) ◽  
pp. 287-292 ◽  
Author(s):  
Lauren J Scott ◽  
Niamh M Redmond ◽  
Joanna Garrett ◽  
Penny Whiting ◽  
Kate Northstone ◽  
...  
Keyword(s):  
Healthcare System ◽  
Early Warning ◽  
Large Scale ◽  
Acute Hospital ◽  
Early Warning Score ◽  
Limited Information ◽  
The West ◽  
Long Term Conditions ◽  
National Early Warning Score ◽  
The Uk

BackgroundEarly warning scores (EWS) were developed in acute hospital settings to improve recognition and response to patient deterioration. In 2012, the UK Royal College of Physicians developed the National Early Warning Score (NEWS) to standardise EWS across the NHS. Its use was also recommended outside acute hospital settings; however, there is limited information about NEWS in these settings. From March 2015, NEWS was implemented across the healthcare system in the West of England, with the aim that NEWS would be calculated for all patients prior to referral into acute care.AimTo describe the distribution and use of NEWS in out-of-hospital settings for patients with acute illness or long-term conditions, following system wide implementation.MethodAnonymised data were obtained from 115 030 emergency department (ED) attendances, 1 137 734 ambulance electronic records, 31 063 community attendances and 15 160 general practitioner (GP) referrals into secondary care, in the West of England. Descriptive statistics are presented.ResultsMost attendance records had NEWS=0–2: 80% in ED, 67% of ambulance attendances and 72% in the community. In contrast, only 8%, 18% and 11% of attendances had NEWS ≥5 (the trigger for escalation of care in-hospital), respectively. Referrals by a GP had higher NEWS on average (46% NEWS=0–2 and 30% NEWS ≥5). By April 2016, the use of NEWS was reasonably stable in ED, ambulance and community populations, and still increasing for GP referrals.ConclusionsNEWS ≥5 occurred in less than 20% of ED, ambulance and community populations studied and 30% of GP referrals. This suggests that in most out-of-hospital settings studied, high scores are reasonably uncommon.

scholarly journals Young people’s experiences with clinical care and preferences for delivery of new point-of-care tests for STIs in England

2019 ◽  
Author(s):  
Hannah McCulloch ◽  
Agata Pacho ◽  
Rebecca Geary ◽  
Syed Tariq Sadiq ◽  
Sebastian Fuller
Keyword(s):  
Young People ◽  
Clinical Pathways ◽  
Point Of Care ◽  
Clinical Care ◽  
Sex With Men ◽  
Sexual Health Clinics ◽  
The Uk ◽  
Point Of Care Tests ◽  
Implementation Plans ◽  
Precise Study

BackgroundYoung people in the UK are at high risk for sexually transmitted infections (STIs), despite STI testing being freely and confidentially available. Given multiple barriers they may face for attending sexual health clinics (SHCs), young people should be consulted regarding changes to care. Studies have shown that point-of-care tests (POCTs) for STIs, which can accurately diagnose and treat patients in one clinical visit, have potential for individual and public health benefits, yet patient opinions of changes to clinical practice associated with POCT implementation are less understood.MethodsThe Precise study explored patient experiences of UK SHC services and their opinions of POCT implementation plans; here we focus on young participants within the Precise study. Male and female attendees of three SHCs in England were purposively sampled and then invited to participate in a qualitative in-depth interview. Interviews were conducted one-on-one, in person or via telephone, were audio-recorded and transcribed. NVivo (V10) was used to organise data for our content-based analysis.ResultsTen young people aged 17-22 years, including: three women-who-have-sex-with-men, four men-who-have-sex-with-women and three men-who-have-sex-with-men were interviewed between June 2015 and February 2016. Participants reported SHCs as the best place to receive results because treatment could be stared immediately, with advice and information available. Participants discussed the potential for POCTs to reduce anxiety currently felt waiting for laboratory results. POCTs were found broadly acceptable, and were generally regarded as an innovation to improve SHC experiences. Participants with less previous SHC experience raised concerns that implementation of POCTs could negatively affect the amount and quality of time patients spend in consultations with clinicians and that changes to pathways may cause confusion in clinic.ConclusionsWe advise POCT implementation be accompanied by SHC staff communicating changes in clinical pathways to patients, including method and timeline for receiving results. Our participants valued face-to-face counselling and advice currently experienced in SHCs; these findings emphasise that POCT implementation plans safe-guard these aspects of care. Our findings suggest that POCT implementation in SHCs has potential to improve young people’s clinical experiences, which may facilitate attendance.

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