Making decisions about antibiotic use in the Australian primary healthcare sector

Introduction Australia is contributing to the global problem of antimicrobial resistance with one of the highest rates of antibiotic use amongst OECD countries. Data from the Australian primary healthcare sector suggests unnecessary antibiotics were prescribed for conditions that will resolve without it. If left unchecked, this will result in more resistant micro-organisms, against which antibiotics will be useless. There is a lack of understanding about what is influencing decisions to use antibiotics – what factors influences general practitioners (GPs) to prescribe antibiotics, consumers to seek antibiotics, and pharmacists to fill old antibiotic prescriptions? It is also not clear how these individuals trade-off between the possible benefits that antibiotics may provide in the immediate/short term, against the longer term societal risk of antimicrobial resistance. Method This project will investigate (a) what factors drive decisions to use antibiotics for GPs, pharmacists and consumers, and (b) how these individuals discount the future. Factors will be gleaned from published literature and from a qualitative phase using semi-structured interviews, to inform the development of Discrete Choice Experiments (DCEs). Three DCEs will be constructed – one for each group of interest – to allow investigation of which factors are more important in influencing (a) GPs to prescribe antibiotics, (b) consumers to seek antibiotics, and (c) pharmacists to fill legally valid but old or repeat prescriptions of antibiotics. Regression analysis will be conducted to understand the relative importance of these factors. A Time Trade Off exercise will be developed to investigate how these individuals discount the future, and whether GPs and pharmacists display the same extent of discounting the future, as consumers. Expected Results Findings from the DCEs will provide an insight into which factors are more important in driving decision making in antibiotic use for GPs, pharmacists and consumers. Findings from the Time Trade Off exercise will show what individuals are willing to trade for preserving the miracle of antibiotics. Conclusion The emergence of antibiotic resistance is inevitable. This research will expand on what is currently known about influencing desired behaviour change in antibiotic use, in the fight against antibiotic resistance. Real World Implications Research findings will contribute to existing national programs to bring about a reduction in inappropriate use of antibiotic in Australia. Specifically, influencing (1) how key messages and public health campaigns are crafted to increase health literacy, and (2) clinical education and empowerment of GPs and pharmacists to play a more responsive role as stewards of antibiotic use in the community.

Adopting healthcare big data in Sri Lankan healthcare sector

The concept of big data has already outperformed traditional data management efforts in almost all industries. Other instances it has succeeded in obtaining promising results that provide value from large-scale integration and analysis of heterogeneous data sources for example Genomic and proteomic information. Big data analytics have become increasingly important in describing the data sets and analytical techniques in software applications that are so large and complex due to its significant advantages including better business decisions, cost reduction and delivery of new product and services [1]. In a similar context, the health community has experienced not only more complex and large data content, but also information systems that contain a large number of data sources with interrelated and interconnected data attributes. That have resulted in challenging, and highly dynamic environments leading to creation of big data with its enumerate complexities, for instant sharing of information with the expected security requirements of stakeholders. When comparing big data analysis with other sectors, the health sector is still in its early stages. Key challenges include accommodating the volume, velocity and variety of healthcare data with the current deluge of exponential growth. Given the complexity of big data, it is understood that while data storage and accessibility are technically manageable, the implementation of Information Accountability measures to healthcare big data might be a practical solution in support of information security, privacy and traceability measures. Transparency is one important measure that can demonstrate integrity which is a vital factor in the healthcare service. Clarity about performance expectations is considered to be another Information Accountability measure which is necessary to avoid data ambiguity and controversy about interpretation and finally, liability [2]. According to current studies [3] Electronic Health Records (EHR) are key information resources for big data analysis and is also composed of varied co-created values [3]. Common healthcare information originates from and is used by different actors and groups that facilitate understanding of the relationship for other data sources. Consequently, healthcare services often serve as an integrated service bundle. Although a critical requirement in healthcare services and analytics, it is difficult to find a comprehensive set of guidelines to adopt EHR to fulfil the big data analysis requirements. Therefore as a remedy, this research work focus on a systematic approach containing comprehensive guidelines with the accurate data that must be provided to apply and evaluate big data analysis until the necessary decision making requirements are fulfilled to improve quality of healthcare services. Hence, we believe that this approach would subsequently improve quality of life.

Making decisions about antibiotic use in the Australian primary healthcare sector

Background Australia has one of the highest rates of antibiotic use amongst OECD countries. Data from the Australian primary healthcare sector suggests unnecessary antibiotics were prescribed for self-resolving conditions. We need to better understand what drives general practitioners (GPs) to prescribe antibiotics, consumers to seek antibiotics, and pharmacists to fill repeat antibiotic prescriptions. It is also not clear how these individuals trade-off between the possible benefits that antibiotics may provide in the immediate/short term, against the longer term societal risk of antimicrobial resistance. This project investigates what factors drive decisions to use antibiotics for GPs, pharmacists and consumers, and how these individuals discount the future. Methods Factors will be gleaned from published literature and from semi-structured interviews, to inform the development of Discrete Choice Experiments (DCEs). Three DCEs will be constructed – one for each group of interest – to allow investigation of which factors are more important in influencing (a) GPs to prescribe antibiotics, (b) consumers to seek antibiotics, and (c) pharmacists to fill legally valid but old or repeat prescriptions of antibiotics. Regression analysis will be conducted to understand the relative importance of these factors. A Time Trade Off exercise will be developed to investigate how these individuals discount the future. Results Findings from the DCEs will provide an insight into which factors are more important in driving decision making in antibiotic use for GPs, pharmacists and consumers. Findings from the Time Trade Off exercise will show what individuals are willing to trade for preserving the miracle of antibiotics. Conclusion Research findings will contribute to existing national programs to bring about a reduction in inappropriate use of antibiotic in Australia. Specifically, influencing how key messages and public health campaigns are crafted, and clinical education and empowerment of GPs and pharmacists to play a more responsive role as stewards of antibiotic use in the community.

Is the public healthcare sector a more strenuous working environment than the private sector for a physician?

Aims: The present study examined the differences between physicians working in public and private health care in strenuous working environments (presence of occupational hazards, physical violence, and presenteeism) and health behaviours (alcohol consumption, body mass index, and physical activity). In addition, we examined whether gender or age moderated these potential differences. Methods: Cross-sectional survey data were compiled on 1422 female and 948 male randomly selected physicians aged 25-65 years from The Finnish Health Care Professionals Study. Logistic regression and linear regression analyses were used with adjustment for gender, age, specialisation status, working time, managerial position, and on-call duty. Results: Occupational hazards, physical violence, and presenteeism were more commonly reported by physicians working in the public sector than by their counterparts in the private sector. Among physicians aged 50 years or younger, those who worked in the public sector consumed more alcohol than those who worked in the private sector, whereas in those aged 50 or more the reverse was true. In addition, working in the private sector was most strongly associated with lower levels of physical violence in those who were older than 50 years, and with lower levels of presenteeism among those aged 40-50 years. Conclusions: The present study found evidence for the public sector being a more strenuous work environment for physicians than the private sector. Our results suggest that public healthcare organisations should pay more attention to the working conditions of their employees.

Campaign contributions to congressional candidates by the healthcare sector from 1990 to 2008

Stakeholder groups with special interests as donors to finance congressional campaigns have been a controversial issue in the United Sates. While previous studies concentrated on whether a connection existed between the campaign contributions provided by stakeholder groups and the voting behavior of congressional members, there is little evidence to show the trend of allocation of their campaign contributions to their favorite candidates during the elections. This issue has become increasingly important in the health sector since the health care reform bill was passed in early 2010.^ This study examined the long-term trend of campaign contributions offered by various top healthcare stakeholder groups to particular political parties (i.e. Democrat and Republican). The main focus of this paper was to observe and describe the financial donations provided by these healthcare stakeholder groups in the congressional election cycles from 1990 to 2008 in order to obtain an overview of their patterns of campaign contributions. Their contributing behaviors were characterized based on the campaign finance data collected by the Center for Responsive Politics (CRP). Specifically, I answered the questions: (1) to which political party did specific healthcare stakeholder groups give money and (2) what was the pattern of their campaign contributions from 1990 to 2008?^ The findings of my study revealed that the healthcare stakeholder groups had different political party preferences and partisanship orientations regarding the Democratic or Republican Party. These differences were obvious throughout the election cycles from 1990 to 2008 and their distinct patterns of financial contribution were evident across industries in the health sector as well. Among all the healthcare stakeholder groups in this study, physicians were the top contributors in the congressional election. The pharmaceutical industry was the only group where the majority of contribution funds were allocated to Republicans in every election period studied. This study found that no interest group has succeeded in electing the preferred congressional candidate by giving the majority of its financial support to the winning party in every election. Chiropractors, hospitals/nursing homes, and health services/HMOs performed better than other healthcare stakeholder groups by supporting the electoral winner 8 out of 9 election cycles.^

Cultural impact of wireless networks:emerging experiences in the healthcare sector

Culture defines collective behavior and interactions among people in groups. In organizations, it shapes group identity, work pattern, communication schemes, and interpersonal relations. Any change in organizational culture will lead to changes in these elements of organizational factors, and vice versa. From a managerial standpoint, how to cultivate an organizational culture that would enhance these aforementioned elements in organizational workplace should thus be taken into serious consideration. Based on cases studies in two hospitals, this paper investigates how organizational culture is shaped by a particular type of information and communication technology, wireless networks, a topic that is generally overlooked by the mainstream research community, and in turn implicates how such cultural changes in organizations renovate their competitiveness in the marketplace. Lessons learned from these cases provide valuable insights to emerging IT management and culture studies in general and in wireless network management in the healthcare sector in particular.

Managing wireless networks in the healthcare sector:emerging experiences of cultural impacts

The existing body of knowledge has generally supported that organizational culture plays a significant role in shaping group identity, work pattern, communication schemes, and interpersonal relations; all of these cultural elements are important organizational factors that shape workplaces and operational routines. In the context of emerging information technology, it has also been suggested that organizational culture could affect IT implementation and management. However, little is known about how emerging information technology shapes organizational culture, which in turn helps reshape the organization as a whole. The purpose of this paper is thus to build empirical understanding of how IT in general and emerging wireless networks in particular reshapes organizational culture. Case studies conducted in two hospitals situated in southwest U.S.A. illustrated that the implementation of wireless networks indeed helped shape and/or reshape organizational culture in the healthcare sector and in turn enhance healthcare organizations’ competitiveness in the marketplace. For IT managers and practitioners in healthcare institutions, effective strategy to plan and manage emerging ITs such as wireless networks will thus have long-term implications on cultivating organizational culture that could eventually reshape workplace and competitiveness.

Prevalence of chronic diseases in private healthcare sector of South Africa: A threat to public health

Purpose: To evaluate the prevalence of patients suffering from registered chronic disease list (CDL) conditions in a section of the South African private health sector from 2008 - 2012. Methods: This study was a retrospective analysis of the medicine claims database of a nationally (South African) representative Pharmacy Benefit Management (PBM) company data between 2008 and 2012. Statistical analysis was used to analyse the data. Descriptive analysis was performed to calculate the prevalence of CDL conditions for the entire population, and stratified by age and gender. However, MIXED linear modelling was used to determine changes in the average number of CDL conditions per patient, adjusted for age and gender from 2008 - 2012. Results: An increase of 0.20 in chronic diseases was observed from 2008 - 2012 in patients having any CDL condition, with an average of 1.57 (1.57 - 1.58, 95 % CI) co-morbid CDL conditions in 2008 and 1.77 (1.77 - 1.78, 95 % CI) in 2012. This increase in average number of CDL conditions per patient between 2008 and 2012 was statistically significant (p < 0.05), but with no large practical significance (d < 0.8). Conclusion: Prevalence of patients with CDL conditions along with risk of co-morbidity has been increasing with time in the private health sector of South Africa. Risk of increased co-morbidity with age and among different genders was prevalent.

Data privacy in interoperability environments – a case study in the Portuguese healthcare sector

Data sharing between organizations through interoperability initiatives involving multiple information systems is fundamental to promote the collaboration and integration of services. However, in terms of data, the considerable increase in its exposure to additional risks, require a special attention to issues related to privacy of these data. For the Portuguese healthcare sector, where the sharing of health data is, nowadays, a reality at national level, data privacy is a central issue, which needs solutions according to the agreed level of interoperability between organizations. This context led the authors to study the factors with influence on data privacy in a context of interoperability, through a qualitative and interpretative research, based on the method of case study. This article presents the final results of the research that successfully identifies 10 subdomains of factors with influence on data privacy, which should be the basis for the development of a joint protection program, targeted at issues associated with data privacy.

Quality of information for quality of life: Healthcare big data analytics

Big data analysis in healthcare sector is still in its early stages when comparing with that of other business sectors due to numerous reasons. Accommodating the volume, velocity and variety of healthcare data Identifying platforms that examine data from multiple sources, such as clinical records, genomic data, financial systems, and administrative systems Electronic Health Record (EHR) is a key information resource for big data analysis and is also composed of varied co-created values. Successful integration and crossing of different subfields of healthcare data such as biomedical informatics and health informatics could lead to huge improvement for the end users of the health care system, i.e. the patients.

Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language

Background Miscommunication in the healthcare sector can be life-threatening. The rising number of migrant patients and foreign-trained staff means that communication errors between a healthcare practitioner and patient when one or both are speaking a second language are increasingly likely. However, there is limited research that addresses this issue systematically. This protocol outlines a hospital-based study examining interactions between healthcare practitioners and their patients who either share or do not share a first language. Of particular interest are the nature and efficacy of communication in language-discordant conversations, and the degree to which risk is communicated. Our aim is to understand language barriers and miscommunication that may occur in healthcare settings between patients and healthcare practitioners, especially where at least one of the speakers is using a second (weaker) language. Methods/Design Eighty individual interactions between patients and practitioners who speak either English or Chinese (Mandarin or Cantonese) as their first language will be video recorded in a range of in- and out-patient departments at three hospitals in the Metro South area of Brisbane, Australia. All participants will complete a language background questionnaire. Patients will also complete a short survey rating the effectiveness of the interaction. Recordings will be transcribed and submitted to both quantitative and qualitative analyses to determine elements of the language used that might be particularly problematic and the extent to which language concordance and discordance impacts on the quality of the patient-practitioner consultation. Discussion Understanding the role that language plays in creating barriers to healthcare is critical for healthcare systems that are experiencing an increasing range of culturally and linguistically diverse populations both amongst patients and practitioners. The data resulting from this study will inform policy and practical solutions for communication training, provide an agenda for future research, and extend theory in health communication.

Sustainable me - a pharmacist’s role in reducing the carbon footprint of healthcare delivery

Introduction Climate change has been described as the most significant global health threat of the 21st century. Already, negative impacts on human health and wellbeing are being observed. These impacts present enormous challenges for the healthcare sector and the time has come for healthcare professionals to demonstrate leadership in addressing these challenges. Since any unsustainable organizational practices of healthcare organisations may ultimately have a negative impact on human health, there is an implicit moral obligation for these organisations and the people who work in them, to deliver healthcare more sustainably. If one considers that in 2010 pharmaceuticals comprised 22% of the carbon footprint of the NHS England (equating to 4.4 million tonnes of CO2 emissions) and 3% of England’s total carbon footprint (NHS Sustainable Development Unit, 2012), by reducing the carbon footprint of pharmaceuticals used in their healthcare organisations, pharmacists can have a significant impact on reducing the organisation’s total carbon footprint and ultimately on the public’s health. Aims The engagement of pharmacists with sustainability initiatives in the workplace has been largely unreported in international and national pharmacy journals. This paper aims to highlight the important role that pharmacists can play in helping to reduce the carbon footprint of healthcare delivery. Methods Literature was reviewed to identify areas where pharmacists could influence the more sustainable use of pharmaceuticals in their organisations. Discussion Much of the carbon footprint of pharmaceuticals is embedded carbon from their manufacture and delivery. Through efficient inventory management practices, pharmacists can reduce the number of orders and potentially reduce the number of deliveries required. Pharmacists can also help to reduce the amount of pharmaceutical waste generated. Of the waste that is generated, they can help improve the segregation of waste streams to increase the amount of non-contaminated packaging waste that is recycled and reduce the amount of pharmaceutical waste being incinerated or ending up in landfill. Reference NHS Sustainable Development Unit. (2012). Sustainability in the NHS Health Check 2012. NHS Sustainable Development Unit. Cambridge, UK: NHS Sustainable Devlopment Unit.

Process management in healthcare.Sant Camil Hospital case study

Nowadays due to the crisis, some government measures are aimed at reducing healthcare spending, affecting in some level or another the quality offered. Process management is said to be a useful tool for reducing healthcare costs by improving management without any additional economic investment. That is doing more with the same resources and without reducing the quality offered. In this study an empirical case of a Catalan hospital is presented. Overall, the usefulness of process management in the healthcare sector is shown and some tips are provided for those managers that want to implement this management system in their hospitals. This work is also interesting for those managers responsible for the National Healthcare System due to a big question is stated: what would happen if process management was implemented in the whole healthcare system?

Big data architecture for pervasive healthcare: a literature review

Pervasive healthcare aims to deliver deinstitutionalised healthcare services to patients anytime and anywhere. Pervasive healthcare involves remote data collection through mobile devices and sensor network which the data is usually in large volume, varied formats and high frequency. The nature of big data such as volume, variety, velocity and veracity, together with its analytical capabilities com-plements the delivery of pervasive healthcare. However, there is limited research in intertwining these two domains. Most research focus mainly on the technical context of big data application in the healthcare sector. Little attention has been paid to a strategic role of big data which impacts the quality of healthcare services provision at the organisational level. Therefore, this paper delivers a conceptual view of big data architecture for pervasive healthcare via an intensive literature review to address the aforementioned research problems. This paper provides three major contributions: 1) identifies the research themes of big data and pervasive healthcare, 2) establishes the relationship between research themes, which later composes the big data architecture for pervasive healthcare, and 3) sheds a light on future research, such as semiosis and sense-making, and enables practitioners to implement big data in the pervasive healthcare through the proposed architecture.