Bmc Health Serv Res
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Bmc Health Serv Res · Nov 2015
Observational StudyErrors in cause-of-death statement on death certificates in intensive care unit of Kathmandu, Nepal.
Death certificates (DC) are one of the most important medico-legal documents that physicians work through. DCs are extensively used in health statistics for epidemiological studies, and in health policy planning as a public health resource tool. Cause-of-death (COD) statement, which is vulnerable to various errors, is the vital part of a DC that has the potential to mislead the policy makers and statisticians. Hence, we evaluated and analyzed the errors prevalent in COD statement of DC. ⋯ Prevalence of errors in DC was quite high. Most errors were committed in underlying cause of death, which is the most important part of DC. Complexity of the cases was the key factor that increased the risks of committing errors. Specific education should supersede general educational interventions to minimize the errors considerably in writing DC in complex cases.
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Bmc Health Serv Res · Nov 2015
Comparative StudyCost-effectiveness of dapagliflozin versus DPP-4 inhibitors as an add-on to Metformin in the Treatment of Type 2 Diabetes Mellitus from a UK Healthcare System Perspective.
Type 2 diabetes mellitus (T2DM) is a chronic, progressive condition where the primary treatment goal is to maintain control of glycated haemoglobin (HbA1c). In order for healthcare decision makers to ensure patients receive the highest standard of care within the available budget, the clinical benefits of each treatment option must be balanced against the economic consequences. The aim of this study was to assess the cost-effectiveness of dapagliflozin, the first-in-class sodium-glucose co-transporter 2 (SGLT2) inhibitor, compared with a dipeptidyl peptidase-4 inhibitor (DPP-4i), when added to metformin for the treatment of patients with T2DM inadequately controlled on metformin alone. ⋯ Dapagliflozin in combination with metformin was shown to be a cost-effective treatment option from a UK healthcare system perspective for patients with T2DM who are inadequately controlled on metformin alone.
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Bmc Health Serv Res · Nov 2015
An institutional ethnography of chronic pain management in family medicine (COPE) study protocol.
Patients with chronic conditions and multiple comorbidities represent a growing challenge for health care globally. Improved coordination of care is considered essential for providing more effective and cost-efficient care for these patients with complex needs. Osteoarthritis is one of the most common and debilitating chronic conditions, is the most frequent cause of chronic pain yet osteoarthritis care is often poorly-coordinated. Primary care is usually the first contact for patients requiring relief from chronic pain. Our previous work suggests discordance between the policy goals of improving patient care and the experience of osteoarthritis patients. We plan to investigate the empirical context of the primary care setting by focusing on primary physicians' conceptualizations and performance of their work in treating complex patients with chronic pain. This will allow for an exploration of how primary health care is - or could be - integrated with other services that play an important role in health care delivery. ⋯ Our study will allow us to identify how the work of coordinating care across multiple settings is accomplished, in practice as well as discursively and textually. Ultimately, we will identify links between everyday experience of care for patients with chronic pain, and broader discourses related to health care system inefficiencies, integration and patient-centred care. An expected outcome of this study will be the development of new, or augmentation of existing, models of care, that are based in the local realities of primary care practice.
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Bmc Health Serv Res · Oct 2015
Re-inventing care planning in mental health: stakeholder accounts of the imagined implementation of a user/carer involved intervention.
Despite an increase in mental health innovations designed to increase service user and carer involvement in services, there is evidence that service users and carers are still relatively marginalised. This study aimed to identify key informants operating with knowledge of both policy and practice related to future models of mental health management in order to explore the potential de-implementation of existing care planning and possibilities for the introduction of a training programme designed to implement a new user and carer involved and focussed process of mental health care planning. ⋯ The study demonstrated the value of incorporating the perspective of stakeholders not directly involved in service delivery in implementation research designed to inform an intervention at the point of design. Their contribution centred on the identification of factors that appeared not be obvious to those working in the system or emanated from political and policy arenas as well as developing the contextual understanding of themes raised by other stakeholders.
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Bmc Health Serv Res · Oct 2015
How many operating rooms are needed to manage non-elective surgical cases? A Monte Carlo simulation study.
Patients often wait to have urgent or emergency surgery. The number of operating rooms (ORs) needed to minimize waiting time while optimizing resources can be determined using queuing theory and computer simulation. We developed a computer program using Monte Carlo simulation to determine the number of ORs needed to minimize patient wait times while optimizing resources. ⋯ Monte Carlo simulation can guide decisions on how to balance resources for elective and non-elective surgical procedures.