The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of standalone and linked national databases

Background: There are a lack of reliable data on the epidemiology and associated burden and costs of asthma. We sought to provide the first UK-wide estimates of the epidemiology, healthcare utilisation and costs of asthma. 

Methods: We obtained and analysed asthma-relevant data from 27 datasets: these comprised national health surveys for 2010-11, and routine administrative, health and social care datasets for 2011-12; 2011-12 costs were estimated in pounds sterling using economic modelling. 

Results: The prevalence of asthma depended on the definition and data source used. The UK lifetime prevalence of patient-reported symptoms suggestive of asthma was 29.5 % (95 % CI, 27.7-31.3; n = 18.5 million (m) people) and 15.6 % (14.3-16.9, n = 9.8 m) for patient-reported clinician-diagnosed asthma. The annual prevalence of patient-reported clinician-diagnosed-and-treated asthma was 9.6 % (8.9-10.3, n = 6.0 m) and of clinician-reported, diagnosed-and-treated asthma 5.7 % (5.7-5.7; n = 3.6 m). Asthma resulted in at least 6.3 m primary care consultations, 93,000 hospital in-patient episodes, 1800 intensive-care unit episodes and 36,800 disability living allowance claims. The costs of asthma were estimated at least £1.1 billion: 74 % of these costs were for provision of primary care services (60 % prescribing, 14 % consultations), 13 % for disability claims, and 12 % for hospital care. There were 1160 asthma deaths. 

Conclusions: Asthma is very common and is responsible for considerable morbidity, healthcare utilisation and financial costs to the UK public sector. Greater policy focus on primary care provision is needed to reduce the risk of asthma exacerbations, hospitalisations and deaths, and reduce costs.

A cross-sectional evaluation of community pharmacists’ perceptions of intermediate care and medicines management across the healthcare interface

Background Despite the importance placed on the concept of the multidisciplinary team in relation to intermediate care (IC), little is known about community pharmacists’ (CPs) involvement. 
Objective To determine CPs’ awareness of and involvement with IC services, perceptions of the transfer of patients’ medication information between healthcare settings and views of the development of a CP–IC service. 
Setting Community pharmacies in Northern Ireland. 
Methods A postal questionnaire, informed by previous qualitative work was developed and piloted. 
Main outcome measure CPs’ awareness of and involvement with IC. Results The response rate was 35.3 % (190/539). Under half (47.4 %) of CPs ‘agreed/strongly agreed’ that they understood the term ‘intermediate care’. Three quarters of respondents were either not involved or unsure if they were involved with providing services to IC. A small minority (1.2 %) of CPs reported that they received communication regarding medication changes made in hospital or IC settings ‘all of the time’. Only 9.5 and 0.5 % of respondents ‘strongly agreed’ that communication from hospital and IC, respectively, was sufficiently detailed. In total, 155 (81.6 %) CPs indicated that they would like to have greater involvement with IC services. ‘Current workload’ was ranked as the most important barrier to service development.
Conclusion It was revealed that CPs had little awareness of, or involvement with, IC. Communication of information relating to patients’ medicines between settings was perceived as insufficient, especially between IC and community pharmacy settings. CPs demonstrated willingness to be involved with IC and services aimed at bridging the communication gap between healthcare settings.

Responding to Fluctuating Demand for Healthcare Services

The level of demand for healthcare services can fluctuate quite strongly. Indeed, some parts of the healthcare service are renowned for having peaks of demand which challenge capacity. Dealing with fluctuations in demand is a common problem in many service industries. This article examines some of the strategies available for influencing the level of demand, including the use of price, communications and demand analysis. The article also outlines a wide variety of ways in which patients can be encouraged to be more tolerant of waiting to receive service from healthcare professionals. In particular, eight principles of waiting are discussed and illustrated in the context of healthcare services.

The Broader Impact of Disability Research: Aligning Public Policy with the Experiences of People with Disabilities and Healthcare Providers

Thesis (Ph.D.)--University of Washington, 2016-07

Healthcare Staffs’ Experiences and Perceptions of Caring for People with Dementia in the Acute Setting: Qualitative Evidence Synthesis

Background Dementia is a global issue, with increasing prevalence rates impacting on health services internationally. People with dementia are frequently admitted to hospital, an environment that may not be suited to their needs. While many initiatives have been developed to improve their care in the acute setting, there is a lack of cohesive understanding of how staff experience and perceive the care they give to people with dementia in the acute setting. Objectives The aim of this qualitative synthesis was to explore health care staffs’ experiences and perceptions of caring for people with dementia in the acute setting. Qualitative synthesis can bring together isolated findings in a meaningful way that can inform policy development. Settings A screening process, using inclusion/exclusion criteria, identified qualitative studies that focused on health care staff caring for people with dementia in acute settings. Participants Twelve reports of nine studies were included for synthesis. Data extraction was conducted on each report by two researchers. Methods Framework synthesis was employed using VIPS framework, using Values, Individualised, Perspective and Social and psychological as concepts to guide synthesis. The VIPS framework has previously been used for exploring approaches to caring for people with dementia. Quality appraisal was conducted using Critical Appraisal Skills Programme (CASP) and NVivo facilitated sensitivity analysis to ensure confidence in the findings. Results Key themes, derived from VIPS, included a number of specific subthemes that examined: infrastructure and care pathways, person-centred approaches to care, how the person interacts with their environment and other patients, and family involvement in care decisions. The synthesis identified barriers to appropriate care for the person with dementia. These include ineffective pathways of care, unsuitable environments, inadequate resources and staffing levels and lack of emphasis on education and training for staff caring for people with dementia. Conclusions This review has identified key issues in the care of people with dementia in the acute setting: improving pathways of care, creating suitable environments, addressing resources and staffing levels and placing emphasis on the education for staff caring for people with dementia. Recommendations are made for practice consideration, policy development and future research. Leadership is required to instil the values needed to care for this client group in an effective and personcentred way. Qualitative evidence synthesis can inform policy and in this case, recommends VIPS as a suitable framework for guiding decisions around care for people with dementia in acute settings.

Discrete-event Simulation and Optimization to Improve the Performance of a Healthcare System

Thesis (Ph.D.)--University of Washington, 2016-08

Capacity Management in Healthcare Services

The level of demand for healthcare services can fluctuate widely and this can place pressure on the capacity of service providers. This article examines some of the approaches used to influence the level of available capacity in the healthcare services sector. A number of strategies designed to flex capacity are discussed, including the development of flexible approaches to human resources; rapid responses to changes in demand; the use of self-service technology and self-care; and the use of temporary additional facilities.

The International <IR> Framework’s impact on the social and relationship disclosures in the healthcare industry

Abstract Background and Problem: The altering business world and the growing requests from stakeholders have resulted in the establishment of new reports. These are among others Sustainability reports and Integrated Reporting. On the contrary, traditional financial reports do not consider the significance of intangible assets in modern entities. The social and relationship capital has further shown to be important for firms, especially healthcare companies and pharmaceuticals, but is not as developed as other capitals within the <IR> framework and therefore not always included in annual reports. However too few disclosures within this area could lead to high liabilities. The IIRC launched the <IR> framework year 2013 as a solution, as it gives a more comprehensive view of the reporting entity. Within this framework there are six capitals: manufactured, human, financial, natural, intellectual and social and relationship.   Purpose: The purpose of this thesis is to find out how the International <IR> Framework has influenced the reporting of the social and relationship disclosures within the healthcare industry, to compare the reporting of the six medical firms chosen and to examine how the social concerns have been developed over time. Delimitations: This study is conducted over a period of three years, from year 2012 to year 2014. It only examines healthcare companies which use the International <IR> framework and it has solely focus on the social and relationship capital. All other capitals within the <IR> framework are excluded from the study. Method: This study has a qualitative research strategy and is based on information collected from published documents in form of annual reports. The annual reports from year 2010, 2011 and 2012 are used to find social and relationship disclosures and a disclosure scoreboard is used to find similarities, differences and patterns. Empirical Results and Conclusion: It has been found that the aggregated social and relationship disclosures have been reduced over time. The year followed by the release of the <IR> framework was seen to have the least disclosures and therefore conclusion was drawn that the <IR> framework had a negative influence on the social and relationship disclosures. There were also differences among the companies studied both in extent and content. The former could be linked to factors such as size and nationality and the latter could be linked to reputation preservation and legitimacy interests.

Bacterial biofilms, antibiotic resistance and healthcare-associated infections: a dangerous connection

In 2012, were estimated 6.7 million cases of healthcare-associated infections (HAI) either in long-term care facilities or acute-care hospitals from which result 37,000 deaths configuring a serious public health problem. The etiological agents are diverse and often resistant to antimicrobial drugs. One of the mechanisms responsible for the emergence of drug resistance is biofilm assembly. Biofilms are defined as thin layers of microorganisms adhering to the surface of a structure, which may be organic or inorganic, together with the polymers that they secrete. They are dynamic structures which experience different stages of organization with the ageing and are linked to an increase in bacterial resistance to host defense mechanisms, antibiotics, sterilization procedures other than autoclaving, persistence in water distribution systems and other surfaces. The understanding of bacteria organization within the biofilm and the identification of differences between planktonic and sessile forms of bacteria will be a step forward to fight HAIs.

A longitudinal qualitative exploration of healthcare and informal support needs among survivors of critical illness: the RELINQUISH protocol.

Introduction and background: Survival following critical illness is associated with a significant burden of physical, emotional and psychosocial morbidity. Recovery can be protracted and incomplete, with important and sustained effects upon everyday life, including family life, social participation and return to work. In stark contrast with other critically ill patient groups (eg, those following cardiothoracic surgery), there are comparatively few interventional studies of rehabilitation among the general intensive care unit patient population. This paper outlines the protocol for a sub study of the RECOVER study: a randomised controlled trial evaluating a complex intervention of enhanced ward-based rehabilitation for patients following discharge from intensive care. Methods and analysis: The RELINQUISH study is a nested longitudinal, qualitative study of family support and perceived healthcare needs among RECOVER participants at key stages of the recovery process and at up to 1 year following hospital discharge. Its central premise is that recovery is a dynamic process wherein patients’ needs evolve over time. RELINQUISH is novel in that we will incorporate two parallel strategies into our data analysis: (1) a pragmatic health services-oriented approach, using an a priori analytical construct, the ‘Timing it Right’ framework and (2) a constructivist grounded theory approach which allows the emergence of new themes and theoretical understandings from the data. We will subsequently use Qualitative Health Needs Assessment methodology to inform the development of timely and responsive healthcare interventions throughout the recovery process. Ethics and dissemination: The protocol has been approved by the Lothian Research Ethics Committee (protocol number HSRU011). The study has been added to the UK Clinical Research Network Database (study ID. 9986). The authors will disseminate the findings in peer reviewed publications and to relevant critical care stakeholder groups.

ROLE OF ENTERPRISE ARCHITECTURE IN HEALTHCARE ORGANIZATIONS AND KNOWLEDGE-BASED MEDICAL DIAGNOSIS SYSTEM

Enterprise architecture (EA) is a tool that aligns organization’s business-process with application and information technology (IT) through EAmodels. This EA model allows the organization to cut off unnecessary IT expenses and determines the future and current IT requirements and boosts organizational performance. Enterprise architecture may be employed in every firm where the firm or organization requires configurations between information technology and business functions. This research investigates the role of enterprise architecture in healthcare organizations and suggests the suitable EA framework for knowledge-based medical diagnostic system for EA modeling by comparing the two most widely used EA frameworks. The results of the comparison identified that the proposed EA has a better framework for knowledge-based medical diagnostic system.

HEALTHCARE INFORMATION SYSTEMS INTEGRATION USING SOA

The growing pressure to increase the quality of health services, as well as reducing costs, has caused healthcare organizations to increase the use of Information and Communication Technologies (ICT) through the development and adoption of Healthcare Information Systems (HIS). However, the need for exchange of information between HIS and between organizations has also increased, resulting in the problem of interoperability. This problem is considered complex, but the use of Service Oriented Architecture (SOA) appears as a good way to address this issue. This paper presents a systematic review, performed in order to find out how and in which contexts SOA is being used to ensure the interoperability of HIS.

Chronic low back pain among French healthcare workers and prognostic factors of return to work (RTW): a non-randomized controlled trial

International audience