Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 14 de 14
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Artigo em Inglês | MEDLINE | ID: mdl-33043359

RESUMO

OBJECTIVE: We sought to examine co-design in 3 contrasting case studies of technology-supported change in health care and explain its role in influencing project success. MATERIALS AND METHODS: Longitudinal case studies of a seizure detection and reporting technology for epilepsy (Southern England, 2018-2019), a telehealth service for heart failure (7 UK sites, 2016-2018), and a remote video consultation service (Scotland-wide, 2019-2020). We carried out interviews with 158 participants and collected more than 200 pages of field notes from observations. Within- and cross-case analysis was informed by sociotechnical theory. RESULTS: In the epilepsy case, co-design prioritized patient-facing features and focused closely around a specific clinic, which led to challenges with sustainability and mainstreaming. In the heart failure case, patient-focused co-design produced an accessible and usable patient portal but resulted in variation in uptake between clinical sites. Successful scale-up of video consultations was explained by a co-design process involving not only the technical interface, but also careful reshaping of work practices. DISCUSSION: A shift is needed from co-designing with technology users to co-designing with patients as service users, and with healthcare staff as professionals. Good co-design needs to involve users, including those who engage with the technology-supported service bothdirectly and indirectly. It requires sensitivity to emergence and unpredictability in complex systems. Healthcare staff need to be supported to accommodate iterative change in the service. Adequate resourcing and infrastructures for systems-focused co-design are essential. CONCLUSIONS: If co-design focuses narrowly on the technology, opportunities will be missed to coevolve technologies alongside clinical practices and organizational routines.

2.
BMJ Open Qual ; 9(3)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32855158

RESUMO

Reforming the delivery of outpatient appointments (OPA) was high on the healthcare policy agenda prior to COVID-19. The current pandemic exacerbates the financial and associated resource limitations of OPA. Videoconsulting provides a safe method of real-time contact for some remotely residing patients with hospital-based clinicians. One factor in failing to move from introduction of service change to its general adoption may be lack of patient and public involvement. This project, based in the largest Island in the Inner Hebrides of Scotland, aimed to codesign the use of the NHS Near Me video consulting platform for OPA to take place in the patient's home. A codesign model was used as a framework. This included: step 1-presenting a process flow map of the current system of using Near Me to public participants and establishing their ideas on various steps in the process, step 2-conducting numerous Plan, Do, Study, Act (PDSA) tests and creating a current process flow diagram based on learning and step 3-conducting telephone interviews and thematic analysis of transcripts (n=7) to explore participants' perceptions of being involved in the codesign process. Twenty-five adaptations were made to the Near Me at Home video appointment process from participants' PDSA testing. Four themes were identified from thematic analysis of participants' feedback of the codesign process, namely: altruistic motivation, valuing community voices, the usefulness of the PDSA cycles and the power of 'word of mouth'. By codesigning the use of Near Me with people living in a remote area of Scotland, multiple adaptations were made to the processes to suit the context in which Near Me at Home will be used. Learning from testing and adapting with the public will likely be useful for others embarking on codesign approaches to improve spread and sustainability of quality improvement projects.


Assuntos
Assistência Ambulatorial/organização & administração , Agendamento de Consultas , Serviços de Assistência Domiciliar/organização & administração , Consulta Remota/organização & administração , Comunicação por Videoconferência/organização & administração , Infecções por Coronavirus/epidemiologia , Reforma dos Serviços de Saúde , Política de Saúde , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Melhoria de Qualidade/organização & administração , Escócia/epidemiologia , Medicina Estatal/organização & administração
6.
BMJ Open Qual ; 7(3): e000303, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30057956

RESUMO

Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with more emergency hospital admissions due to adverse drug reactions than any other class of medicine. One way to tackle this is to ensure that patients understand how to take their NSAIDs in the safest way possible. The aim of this project was to ensure that key safety information is given to every patient, every time an NSAID is sold or dispensed. The project started as part of the Scottish Patient Safety Programme's Pharmacy in Primary Care Collaborative. An NSAIDs bundle was developed, tested and implemented using the Model for Improvement as a framework, including multiple Plan, Do, Study, Act cycles. The bundle, and associated improvement package, was developed during phase I of the project and tested by seven teams (five pharmacies and two dispensing practices). Phase II tested the spread of the defined improvement package across an additional five community pharmacies and eight dispensing general practitioner practices. The project has resulted in the development of a simple package to improve communication with patients about NSAIDs, which should enable patients to take NSAIDs safely. Three key safety messages were developed, typical for a care bundle approach, and simple tools were employed to ensure every patient received these three key messages every time. The project aim of 95% compliance with the NSAIDs bundle within the seven initial sites by December 2015 was achieved (when an exclusion was applied). The spread of the defined improvement package to a further 13 sites was achieved by December 2016. By December 2017, all 81 community pharmacies in National Health Service (NHS) Highland had agreed to implement the NSAIDs bundle. In June 2018, a national NSAIDs bundle, based on the NHS Highland work, was introduced in community pharmacies across Scotland. We also believe that the approach could be replicated for other high-risk medicines.

7.
Fam Pract ; 34(4): 491-499, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28334910

RESUMO

Background: The Highlands and the Western Isles are the two most remote and rural areas of Scotland, with many medical practices in areas where pharmacies would not be viable. Recent regulations state that that dispensing medical practices in these areas must receive pharmacist support for patients who would benefit. Objective: This study aimed to evaluate pilot services, which centred on the provision of patient centred pharmaceutical care. Methods: A realist type evaluation was conducted by an independent research team comprising collecting quantitative data around what occurred during the consultation followed by interviews with purposive samples of staff (n = 14) and patients (n = 18). Results: A total of 873 medicines related issues were identified in 473 patients reviewed, with the main issue being 'inappropriate dose, frequency, duration'. Just under half (39.7%) of issues were managed by the pharmacist without any medical input. Interviews indicated a high level of appreciation, although there was an increase in workload for some staff. While the need for telephone based pharmacist consultations for some patients was understood, there was a preference for face to face. All were supportive of continuing and extending the service. Conclusion: The clinical pharmacist service was both needed and valued highly by staff and patients. In Scotland, this aligns with the Government vision and action plan, 'Prescription for Excellence', that by 2023 all patient facing pharmacists will be independent prescribers with those in remote and rural areas entitled to 'equity of access to such expertise'.


Assuntos
Acesso aos Serviços de Saúde/normas , Assistência Farmacêutica/provisão & distribução , Farmacêuticos/provisão & distribução , Farmacêuticos/estatística & dados numéricos , Serviços de Saúde Rural , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Encaminhamento e Consulta , Escócia
8.
Conserv Biol ; 31(4): 818-827, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-27696549

RESUMO

Conservation of biodiversity, including birds, continues to challenge natural-area managers. Stated-preference methods (e.g., choice experiment [CE]) are increasingly used to provide data for valuation of natural ecosystems. We used a CE to calculate birders' willingness to pay for different levels of bioecological attributes (threatened species, endemic species, and diversity) of birding sites with hypothetical entry fees. The CE was delivered at popular birding and avitourism sites in Australia and the United Kingdom. Latent-class modeling results revealed heterogeneous preferences among birders and correspondingly variable willingness to pay. Four clear groups were apparent: quantity-driven birders, special-birds seekers, confused respondents, and price-is-no-object birders. Quantity-driven birders were attracted to sites that deliver high levels of diversity and endemic species for which they were willing to pay $135 and $66 to visit, respectively, above what they were willing to pay to visit a site with low levels of diversity and few endemic and threatened species . Special-bird seekers valued threatened species and high levels of endemic species most (willingness to pay $45 and $46, respectively). Confused respondents' preferences were difficult to determine, but they were the most sensitive to the hypothetical entry fees, unlike the price-is-no-object birders, who were not at all sensitive to cost. Our findings demonstrate that birders are amenable to paying for their preferred birding experience. These payments could provide an alternative source of funding in some avitourism sites on both public and private land. Such alternative revenue streams should be explored and given full consideration in increasingly competitive conservation-financing environments.


Assuntos
Aves , Financiamento de Capital , Conservação dos Recursos Naturais/economia , Animais , Austrália , Comportamento de Escolha , Espécies em Perigo de Extinção , Motivação , Reino Unido
9.
PLoS One ; 11(2): e0147988, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26886876

RESUMO

Many threatened species rely on ecotourism for conservation funding, but simultaneously suffer direct ecological impacts from ecotourism. For a range of IUCN-Redlisted terrestrial and marine bird and mammal species worldwide, we use population viability analyses to calculate the net effects of ecotourism on expected time to extinction, in the presence of other anthropogenic threats such as poaching, primary industries and habitat loss. Species for which these calculations are currently possible, for one or more subpopulations, include: orangutan, hoolock gibbon, golden lion tamarin, cheetah, African wild dog, New Zealand sealion, great green macaw, Egyptian vulture, and African penguin. For some but not all of these species, tourism can extend expected survival time, i.e., benefits outweigh impacts. Precise outcomes depend strongly on population parameters and starting sizes, predation, and ecotourism scale and mechanisms. Tourism does not currently overcome other major conservation threats associated with natural resource extractive industries. Similar calculations for other threatened species are currently limited by lack of basic population data.


Assuntos
Ecossistema , Espécies em Perigo de Extinção , Viagem , Animais , Dinâmica Populacional , Especificidade da Espécie
10.
PLoS One ; 10(12): e0144445, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26701779

RESUMO

Formal protected areas will not provide adequate protection to conserve all biodiversity, and are not always designated using systematic or strategic criteria. Using a systematic process, the Important Bird and Biodiversity Area (IBA) network was designed to highlight areas of conservation significance for birds (i.e. IBA trigger species), and more recently general biodiversity. Land use activities that take place in IBAs are diverse, including consumptive and non-consumptive activities. Avitourism in Australia, generally a non-consumptive activity, is reliant on the IBA network and the birds IBAs aim to protect. However, companies tend not to mention IBAs in their marketing. Furthermore, avitourism, like other nature-based tourism has the potential to be both a threatening process as well as a conservation tool. We aimed to assess the current use of IBAs among Australian-based avitour companies' marketing, giving some indication of which IBAs are visited by avitourists on organised tours. We reviewed online avitour itineraries, recorded sites featuring in descriptions of avitours and which IBA trigger species are used to sell those tours. Of the 209 avitours reviewed, Queensland is the most featured state (n = 59 tours), and 73% feature at least one IBA. Daintree (n = 22) and Bruny Island (n = 17) IBAs are the most popular, nationally. Trigger species represent 34% (n = 254 out of 747) of species used in avitour descriptions. The most popular trigger species' are wetland species including; Brolga (n = 37), Black-necked Stork (n = 30) and Magpie Goose (n = 27). Opportunities exist to increase collaboration between avitour companies and IBA stakeholders. Our results can provide guidance for managing sustainability of the avitourism industry at sites that feature heavily in avitour descriptions and enhance potential cooperation between avitour companies, IBA stakeholders and bird conservation organisations.


Assuntos
Biodiversidade , Aves/fisiologia , Conservação dos Recursos Naturais , Recreação , Animais , Austrália , Espécies em Perigo de Extinção , Geografia , Marketing
11.
Drugs Real World Outcomes ; 2(3): 261-271, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27747572

RESUMO

BACKGROUND: Adverse drug reactions are a recognised cause of hospital admissions. A small group of medicines carry a higher risk of adverse outcomes and are more frequently involved in hospital admissions than other medicines. These 'high-risk medicines' have been identified in previous research. However, it is less clear how to reduce the risks associated with these known high-risk medicines, or which high-risk medicines should be prioritised when implementing risk reduction interventions. Previous research has questioned the efficacy of pharmacist-led medication reviews in reducing hospital admissions and drug-related morbidity and mortality. OBJECTIVES: In this study, we aimed to identify high-risk medicines through medication review to reduce iatrogenic disease; to determine a short list of high-risk medicines to target in medication reviews to achieve the greatest impact on reducing iatrogenic disease and patient harm; and to determine whether pharmacist-conducted medication reviews of high-risk medicines are safe and effective. METHODS: A prospective cohort study was undertaken in 16 general practices in one Scottish health board. All patients prescribed a high-risk medicine were identified and received a medication review from a pharmacist (3643 patients from a total population of 38,399). The pharmacist decided whether it was appropriate to continue the high-risk medicine, or if the medicine should be stopped or amended. The pharmacist made recommendations to the patient's general practitioner (GP) for medicines to be stopped or amended, which the GP could choose to accept or not. Patient outcomes for all of the pharmacist's recommendations were identified 1 year later to determine the effectiveness of the recommendations. RESULTS: High-risk medicines were prescribed to 3643 patients from a total population of 38,399 patients. The pharmacist made 440 recommendations for GPs to stop or amend high-risk medicines. GPs accepted 214 recommendations and rejected 226, giving an acceptance rate of 49 %. The 440 recommendations were then followed up 1 year later. The risk of having an adverse outcome was significantly reduced when the pharmacist's recommendation to stop or amend a high-risk medicine was followed compared with rejecting the pharmacist's recommendation and continuing the high-risk medicine unchanged (p < 0.001). A total of 22 adverse outcomes occurred when the pharmacist's advice was rejected. Of these, 21 would have been prevented if the pharmacist's recommendation had been followed and three resulted in hospital admission. CONCLUSIONS: This study demonstrated that medication reviews for high-risk medicines are safe and effective, with results achieved within 1 year of the initial review. It identified six high-risk medicines that could form the basis of targeted medication reviews in order to reduce iatrogenic disease. It also demonstrated that pharmacists are safe and effective at delivering medication reviews.

12.
PLoS One ; 7(9): e43757, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22984440

RESUMO

Protected areas are critical for the conservation of many threatened species. Despite this, many protected areas are acutely underfunded, which reduces their effectiveness significantly. Tourism is one mechanism to promote and fund conservation in protected areas, but there are few studies analyzing its tangible conservation outcomes for threatened species. This study uses the 415 IUCN critically endangered frog species to evaluate the contribution of protected area tourism revenue to conservation. Contributions were calculated for each species as the proportion of geographic range inside protected areas multiplied by the proportion of protected area revenues derived from tourism. Geographic ranges were determined from IUCN Extent of Occurrence maps. Almost 60% (239) of critically endangered frog species occur in protected areas. Higher proportions of total range are protected in Nearctic, Australasian and Afrotopical regions. Tourism contributions to protected area budgets ranged from 5-100%. These financial contributions are highest for developing countries in the Afrotropical, Indomalayan and Neotropical regions. Data for both geographic range and budget are available for 201 critically endangered frog species with proportional contributions from tourism to species protection ranging from 0.8-99%. Tourism's financial contributions to critically endangered frog species protection are highest in the Afrotropical region. This study uses a coarse measure but at the global scale it demonstrates that tourism has significant potential to contribute to global frog conservation efforts.


Assuntos
Conservação dos Recursos Naturais/economia , Espécies em Perigo de Extinção/economia , Ranidae/crescimento & desenvolvimento , Viagem/economia , Animais , Biodiversidade , Orçamentos , Geografia , Especificidade da Espécie
13.
Environ Manage ; 49(5): 929-41, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22441695

RESUMO

Recovery planning is a key component of many threatened species conservation initiatives and can be a powerful awareness raising tool. One of the largest impediments to conservation efforts in the Pacific region however, is the lack of ecological data and its subsequent effects on the development of feasible and useful recovery plans for threatened species. Without these plans, the understaffed, underfunded and often technically ill-equipped conservation agencies face huge difficulties in planning, prioritizing and conducting conservation activities to adequately protect biodiversity. The Fiji sago palm, Metroxylon vitiense, is an endemic endangered palm species whose survival is heavily dependent on a feasible species recovery plan. It is geographically restricted and threatened by habitat destruction and overexploitation for thatch for the tourism industry and palm heart consumption by local consumers. Despite its threatened status, M. vitiense is not currently protected by national or international legislation. Recent field surveys and extensive stakeholder consultation have resulted in the production of a species recovery plan highlighting the importance of the species and advocating sustainable harvesting rather than complete bans to promote conservation. This article summarizes the recovery plan and its current effects on the status of M. vitiense in Fiji. We also discuss the role of different stakeholders in the conservation of M. vitiense, including the absence of significant behavioral changes by the largest consumer - the tourism industry, and the importance of recovery plans for biodiversity conservation in the Pacific.


Assuntos
Arecaceae/crescimento & desenvolvimento , Conservação dos Recursos Naturais/métodos , Desenvolvimento de Programas/métodos , Conservação dos Recursos Naturais/legislação & jurisprudência , Conservação dos Recursos Naturais/tendências , Espécies em Perigo de Extinção/legislação & jurisprudência , Espécies em Perigo de Extinção/tendências , Fiji , Agricultura Florestal/legislação & jurisprudência , Agricultura Florestal/métodos , Agricultura Florestal/organização & administração , Órgãos Governamentais , Regulamentação Governamental , Técnicas de Planejamento , Dinâmica Populacional
14.
Integr Environ Assess Manag ; 4(2): 215-36, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18237227

RESUMO

The purpose of this paper is to present a new risk-based approach developed by Environment Canada for ranking pesticides and their potential risk to aquatic life. These rankings are compared to those generated using a more traditional score-based approach. Two hundred and twelve active ingredients registered in Canada for use in agricultural field crops were included in this assessment. For each major aquatic taxon assessed (fish, insects, crustaceans, algae, and macrophytes), risk was calculated by dividing the 96-h estimated environmental concentration (modeled using parameters such as the application rate and method as well as physicochemical properties) by HC5 values (obtained through calculations of species sensitivity distribution-based toxicity endpoints). The traditional approach assigned scores based on toxicity endpoints in standard test species as well as physicochemical properties associated with the potential for aquatic contamination. A number of similarities were observed between the rankings but also notable differences. Only 22 active ingredients were common to the top 50 ranking positions from both approaches. The main reasons that accounted for the discrepancies between both rankings were the choice of toxicity endpoints, whether based on single or multiple species; the taxonomic breadth of retained data; the use of scores versus risk quotients; and the choices made in situations where multiple data points were available. We conclude that a risk-based approach that considers a broad representation of species toxicity data and estimates of runoff and drift concentration in receiving aquatic systems (even from generic application scenarios) is a more realistic representation of potential toxicological effects and a superior method of ranking products for the risk they pose to the aquatic environment.


Assuntos
Praguicidas/toxicidade , Medição de Risco/métodos , Poluentes Químicos da Água/toxicidade , Agricultura , Animais , Canadá , Crustáceos/efeitos dos fármacos , Eucariotos/efeitos dos fármacos , Peixes , Insetos/efeitos dos fármacos , Praguicidas/classificação , Plantas/efeitos dos fármacos , Poluentes Químicos da Água/classificação
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...