Single Visit Evaluation and Tympanostomy Tube Placement for the Treatment of Acute Otitis Media in Children.

OBJECTIVE: To review our experiences with development of a single visit surgery (SVS) program for children with recurrent acute otitis media (AOM) undergoing tympanostomy tube (TT) placement the same day as their otolaryngology surgical consultation. STUDY DESIGN: Retrospective cohort analysis. METHODS: Retrospective series of patients participating in SVS from inception March 1, 2014 to April 30, 2020 were analyzed, with attention to factors associated with increasing interest and participation in SVS and parent experiences/satisfaction. RESULTS: A total of 224 children had TT placed through SVS for AOM management. The average age of patients was 18.1 months (standard deviation 7.8 months), and 130 (58.0%) were male. The median interval between initial contact to schedule SVS, and the SVS date was 15 days (interquartile range 9-23 days). When analyzing year-over-year volumes from inception of SVS, notable increases were seen in 2016 and 2017 after a radio advertisement was played locally. A marked increase in volume was noted after implementation of a Decision Tree Scheduling (DTS) algorithm for children with recurrent AOM. Sixty-six (28.8%) procedures were performed after institution of DTS. A parent survey demonstrated high levels of satisfaction with the SVS experience. Estimations of savings to families in terms of time away from work demonstrated potential for indirect healthcare benefits. CONCLUSIONS: SVS for TT placement was a successful, alternative model of care for management of children with AOM. Marketing strategies regarding SVS, and the inclusion of SVS pathway in DTS platforms increased rates of interest and choice of this option. Parents of children undergoing TT through SVS were satisfied with the overall experience. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2823-2829, 2021.

Response hierarchy models and their application in health and medicine: understanding the hierarchy of effects.

BACKGROUND: Successful patient engagement pursuits naturally require healthcare providers to possess a detailed understanding of their target audiences, with one of the most important processes to comprehend being the manner in which they learn about particular establishments and decide to extend their patronage. While health services patronage pathways vary between and among consumers, general patronage patterns exist which can provide enlightenment regarding this important process. Achieving knowledge on this front can help healthcare providers maximize opportunities to engage audiences and acquire all-important market share. DISCUSSION: The discipline of marketing, in part, focuses on customer engagement practices and, in describing the patronage process, it often uses what are referred to as response hierarchy models. Also known as hierarchy of effects models, these representations can help healthcare providers to understand the course through which individuals become customers of given establishments, aiding them particularly in devising appeals that can accelerate the patronage process. This particular article describes response hierarchy models, presents examples, and discusses the benefits that they offer healthcare institutions in their efforts to engage patients. CONCLUSIONS: As institutional viability and vitality are predicated on abilities to successfully attract and retain patients, healthcare establishments must direct keen attention toward developing associated skills. This necessitates that health and medical providers possess a detailed understanding of their target audiences, notably including the stages through which they pass on their way to becoming patrons. Response hierarchy models present the patronage process, depicting given stages, permitting insights which can assist healthcare providers in their quests to hasten desired exchange and capture market share.

Reflecting on "Marketing communications in health and medicine: perspectives from Willis-Knighton Health System": understanding the big picture.

BACKGROUND: Willis-Knighton Health System's special supplement in BMC Health Services Research, "Marketing communications in health and medicine: perspectives from Willis-Knighton Health System," focuses on advertising, public relations, sales promotion, and related communicative avenues, associated theory, and more. Across the supplement's articles, insights from the institution's experiences are presented, addressing the components of the marketing communications mix, foundational elements of communication, the patronage process, and the necessity for integrating marketing communications. DISCUSSION: As an understanding of the big picture is crucial in marketing communications, especially given that many of its components must be effected simultaneously, this particular article takes the insights provided in the supplement and presents them in an operational framework, demonstrating the marketing communications process. This framework concisely summarizes the facets profiled in the associated articles, permitting readers to see how these pieces work in concert with one another in health and medical settings, providing a basic communications structure which healthcare establishments can use to advance their patient engagement initiatives. CONCLUSIONS: Health and medical providers must ensure that they possess a detailed understanding of core marketing communications facets, but as they acquire associated knowledge, they also must direct attention toward understanding the interrelationships between and among these facets, permitting a global perspective of communicative operations. This particular article summarizes insights from Willis-Knighton Health System's special supplement in BMC Health Services Research, providing a pathway toward realizing big picture marketing communications perspectives.

Integrated marketing communications: a strategic priority in health and medicine.

BACKGROUND: Healthcare establishments portray themselves to their patient populations using many communicative mechanisms. Perhaps the first avenues that come to mind are the outward conveyances of the marketing communications mix, including advertising, personal selling, sales promotion, public relations, and direct marketing. But other prominent communicators also exist, including the people employed by healthcare institutions, the places in which services are delivered, and the brands that represent given establishments. This wide variety of communicative mechanisms is somewhat of a mixed blessing, affording myriad options, but also necessitating extra care and attention in developing associated marketing communications. DISCUSSION: Now more than ever, health and medical establishments have at their disposal communications options capable of addressing most any conveyance want or need. The marketing communications mix, once somewhat limited due to industry tradition, is now fully accessible and widely used in the health services industry, providing immense opportunities to connect with patients. Options for signage, building designs, servicescape amenities, employee uniforms, and the like also are teeming, providing myriad avenues for making positive impressions. But burgeoning options while beneficial also intensify obligations for ensuring that marketing communications are properly integrated, with this particular article describing this imperative need and its implications for communicative success in the healthcare industry. CONCLUSIONS: By integrating marketing communications, health and medical providers are able to create synergies between and among selected conveyance mechanisms, amplifying performance and increasing the likelihood of reaching communicative goals. Achieving such cohesion requires devoted planning in an effort to coordinate verbal and visual manifestations to express desired imagery and appeals to target audiences. As extensive benefits are derived from integrated marketing communications, healthcare establishments should consider associated pursuits to be a strategic priority.

Foundational elements of communication in health and medicine: avenues for strengthening the marketing communications mix.

BACKGROUND: When one thinks of opportunities to engage patients, the marketing communications mix often is the first thing that comes to mind. Its five components of advertising, personal selling, sales promotion, public relations, and direct marketing represent tried and true pathways for establishing productive dialogues with customers of healthcare institutions. But in formulating and deploying the marketing communications mix, health and medical establishments must not neglect foundational elements which play vital communicative roles, impacting the perspectives of patients and influencing associated patronage. DISCUSSION: Many things communicate on behalf of healthcare organizations, including the people employed by them, the places in which they deliver services, and the brands that represent them. As foundational elements of communication, these must be addressed prior to formulating the marketing communications mix, as they influence and impact an institution's entire communicative potential. Their initial development, however, is just the beginning, as these elements must be managed and maintained continually over the course of organizational life. This article profiles foundational elements of communication and discusses their importance in healthcare marketing, generally, and marketing communications, specifically, providing useful insights for maximizing communicative synergies. CONCLUSIONS: Given the importance of engaging current and prospective patients, healthcare establishments must take steps to ensure exceptional prowess in this area, with communicative skills and abilities being of paramount importance. Proficient deployment of the marketing communications mix is essential, but healthcare providers must also be certain to direct attention toward foundational elements, ensuring that given institutions realize their full communicative potential.

How telemedicine integrated into China's anti-COVID-19 strategies: case from a National Referral Center.

INTRODUCTION: We present the integration of telemedicine into the healthcare system of West China Hospital of Sichuan University (WCH), one of the largest hospitals in the world with 4300 inpatient beds, as a means for maximising the efficiency of healthcare delivery during the COVID-19 pandemic. METHODS: Implemented on 22 January 2020, the telemedicine technology allowed WCH providers to conduct teleconsultations, telerounds, teleradiology and tele-intensive care unit, which in culmination provided screening, triage and treatment for COVID-19 and other illnesses. To encourage its adoption, the government and the hospital publicised the platform on social media and waived fees. DISCUSSION: From 1 February to 1 April 2020, 10557 online COVID-19 consultations were conducted for 6662 individuals; meanwhile, 32676 patients without COVID completed virtual follow-ups. We discuss that high-quality, secure, affordable and user-friendly telemedical platforms should be integrated into global healthcare systems to help decrease the transmission of the virus and protect healthcare providers from infection.

Attitudes and behaviours of physicians towards the relationship with the pharmaceutical industry in Saudi Arabia.

BACKGROUND: The relationship and interactions between physicians and the pharmaceutical industry can affect patient care. A physician's practice can be influenced by this relationship. It is believed that these interactions are common among doctors in Saudi Arabia. AIMS: This study was undertaken to assess the frequency of such relationships and physicians' attitudes and behaviours toward them. METHODS: This was a cross-sectional questionnaire survey completed by practicing physicians at four Saudi government and private tertiary care centres in Riyadh, Saudi Arabia. The questionnaire addressed the frequency of meetings with representatives of pharmaceutical companies (PRs) and of receiving gifts and considered the physicians' attitudes and behaviours towards PRs. RESULTS: A total of 300 completed questionnaires were obtained. Among the physicians surveyed, 223 (74.3%) met PRs one to three times per month. Up to 191 (64%) of physicians admitted receiving gifts. More than two thirds of physicians-192 (63%) have been invited to activities sponsored by pharmaceutical companies. Among the physicians, 239 (80%) agreed that PRs use promotional techniques in their approach and 251 (84%) of them stressed the need for expert physicians to attend presentations by PRs to correct the facts. CONCLUSION: The frequent meetings between physicians and PRs and the use of promotional techniques by PRs are concerning. Future studies should assess the impact of this involvement on medical practice and drugs prescription in Saudi Arabia.

Los seniors en la publicidad española: tensiones entre la investigación, planificación y la representación de los mayores en los anuncios / Senior citizens in Spanish advertising: tensions between research, planning and representation of the elderly in advertisements / Idosos na publicidade espanhola: tensões entre pesquisa, planejamento e representação dos mais velhos nos anúncios

El presente artículo analiza las continuidades y discontinuidades que se producen entre la investigación, la planificación de medios y la construcción de las representaciones sobre los mayores en la publicidad española. El estudio, centrado en los anuncios sobre envejecimiento, mayores y salud, se ha implementado desde una triangulación metodológica que incluye técnicas como el análisis del discurso, la encuesta y la revisión de literatura sobre segmentación publicitaria. Las conclusiones apuntan a una restricción de las representaciones puestas en juego en los anuncios respecto a la diversidad planteada por los profesionales y en la literatura científica. Se plantea el reto de superar las visiones excesivamente individualistas del mayor y de la gestión de su salud, al tiempo que emerge como alternativa la concepción de la salud como un espacio simbólico de conflicto y negociación.(AU)

The article analyzes the continuities and descontinuities that occur between research, media planning and the construction of representations of senior citizens in Spanish advertising. The study, centered on advertisements about aging, senior citizens and health, employed a methodological triangulation that included techniques like discourse analysis, research, and a literature review on segmentation in advertising. The conclusions point to a limitation of the representations called into play in advertisements regarding the diversity established by professionals and in the scientific literature. It is necessary to face the challenge of overcoming the excessively individualistic views of the elderly and of the management of their health. At the same time, the conception of health as a symbolic space of conflict and negotiation emerges as an alternative..(AU)

O presente artigo analisa as continuidades e descontinuidades que ocorrem entre a pesquisa, o planejamento de mídia e a construção das representações dos idosos na publicidade espanhola. O estudo, centrado nos anúncios sobre envelhecimento, idosos e saúde, foi implementado a partir de uma triangulação metodológica que incluiu técnicas como a análise do discurso, a pesquisa e a revisão de literatura sobre segmentação publicitária. As conclusões apontam para uma limitação das representações postas em jogo nos anúncios a respeito da diversidade estabelecida pelos profissionais e na literatura científica. Constitui-se o desafio de superar as visões excessivamente individualistas sobre o idoso e da gestão de sua saúde, ao tempo que emerge como alternativa a concepção da saúde como um espaço simbólico de conflito e negociação..(AU)

Preferred Single-Vendor Program for Total Joint Arthroplasty Implants: Surgeon Adoption, Outcomes, and Cost Savings.

BACKGROUND: In total joint arthroplasty, variation in implant use can be driven by vendor relationships, surgeon preference, and technological advancements. Our institution developed a preferred single-vendor program for primary hip and knee arthroplasty. We hypothesized that this initiative would decrease implant costs without compromising performance on quality metrics. METHODS: The utilization of implants from the preferred vendor was evaluated for the first 12 months of the contract (September 1, 2017, to August 31, 2018; n = 4,246 cases) compared with the prior year (September 1, 2016, to August 31, 2017; n = 3,586 cases). Per-case implant costs were compared using means and independent-samples t tests. Performance on quality metrics, including 30-day readmission, 30-day surgical site infection (SSI), and length of stay (LOS), was compared using multivariable-adjusted regression models. RESULTS: The utilization of implants from the preferred vendor increased from 50% to 69% (p < 0.001), with greater use of knee implants than hip implants from the preferred vendor, although significant growth was seen for both (from 62% to 81% for knee, p < 0.001; and from 38% to 58% for hip, p < 0.001). Adoption of the preferred-vendor initiative was greatest among low-volume surgeons (from 22% to 87%; p < 0.001) and lowest among very high-volume surgeons (from 61% to 62%; p = 0.573). For cases in which implants from the preferred vendor were utilized, the mean cost per case decreased by 23% in the program's first year (p < 0.001), with an associated 11% decrease in the standard deviation. Among all cases, there were no significant changes with respect to 30-day readmission (p = 0.449) or SSI (p = 0.059), while mean LOS decreased in the program's first year (p < 0.001). CONCLUSIONS: The creation of a preferred single-vendor model for hip and knee arthroplasty implants led to significant cost savings and decreased cost variability within the program's first year. Higher-volume surgeons were less likely to modify their implant choice than were lower-volume surgeons. Despite the potential learning curve associated with changes in surgical implants, there was no difference in short-term quality metrics. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

India's family planning market and opportunities for the private sector: An analysis using the total market approach.

The private (commercial) sector in India can complement public sector for family planning services, but the roadmap to engage these two sectors remains a challenge. The total market approach (TMA) offers a strategy by understanding the comparative advantage of public, commercial, and nonprofit sectors. We estimated TMA indicators using data of four rounds of the National Family Health Surveys: 1992-93, 1998-99, 2005-06, and 2015-16. The contraceptive prevalence of modern methods in India did not increase in recent years, but the number of users increased, and so did the market size for the commercial sector. In rural areas, the current market size in 2015-16 (75 million) failed to reach its potential size in 1992-93 (84 million). In urban areas, the market of modern contraceptives is mostly composed of the users from higher wealth, and a high percentage of users obtain contraceptives from subsidized sources. The family planning market of northern part of Bihar and Uttar Pradesh and of Northeast India are in the "early" stage and need more demand generation; "matured" markets are mostly concentrated in and around big metros. Subsidization in urban areas should be offered to the targeted population who need family planning products and services at low cost.

Timely, consistent, transparent assessment of market access evidence: implementing tools based on the HTA Core Model® in a pharmaceutical company.

OBJECTIVES: Evidence requirements and assessment methods access differ between health technology assessment (HTA) agencies. The HTA Core Model® provides a standardized approach to HTA, targeting evidence sharing and collaboration between participating HTA bodies. It is fit for purpose from an industry perspective and was used by pharmaceutical company Roche to develop a framework for internal assessment of evidence required for market access and coverage/reimbursement ("access evidence"). METHODS: Tools were developed to systematically scope, assess, plan, and summarize access evidence generation. The tools were based mainly on the first four HTA Core Model® domains and rolled-out in selected development teams in 2017. Five months after full implementation, the impact of tools was assessed in an internal survey. RESULTS: Systematic access evidence generation started with the Access Evidence Questionnaire, to scope evidence requirements and identify evidence gaps. Findings were summarized in the Access Evidence Metric, which assessed the alignment of available/planned evidence against HTA bodies' requirements and developed scope mitigation strategies. The Access Evidence Plan was then used to plan and document (additional) evidence generation. Once generated, evidence was summarized in the Access Evidence Dossier. A survey of twenty-seven Roche employees involved in evidence generation showed that the tools made discussions around access strategies and evidence more efficient and transparent. CONCLUSIONS: The HTA Core Model® provided a useful framework around which to optimize internal evidence generation and assessment. The benefits of using a standardized HTA approach in industry mirror those expected from implementing the HTA Core Model® in HTA agencies.

What, where and when? Using Google Trends and Google to investigate patient needs and inform pharmacy practice.

OBJECTIVES: The aim was to provide a comprehensive overview (using pertinent examples) of the various ways that Google Trends and Google data could inform pharmacy practice. The objectives were to: examine what type of information people search for in relation to a common class of medicines; ascertain where people are directed to (websites) following an initial search for a medicine or medical condition; and establish information about when they search. METHODS: The methodology differed depending on whether Google Trends or Google was being interrogated, but the search domain was always limited to the United Kingdom. Google Trends was queried, typically for a 5-year time frame, and data downloaded for many search inputs relating to medical conditions (self-treatable and non-self-treatable) and medicines (bought over-the-counter and prescribed). Google was queried and data collected for searches related to 'antibiotics'. KEY FINDINGS: Google Trends revealed a previously unknown seasonality pattern for irritable bowel syndrome. Related searches for 'antibiotics' revealed a high level of interest in the appropriateness of concomitant alcohol consumption and queries about what antibiotics are. Largely, people were being directed to reputable websites following their initial search input about a prescription-only medicine. However, searches for over-the-counter medicines were more likely to lead to commercial domains. CONCLUSIONS: This is one of the first studies to investigate use of Google Trends and Google in a pharmacy-specific context. It is relevant for practice as it could inform marketing strategies, public health policy and help tailor patient advice and counselling.

Marketing de serviços na odontologia: uma diagnóstico das aplicações e das necessidades dos cirurgiões dentistas do Vale do Paraíba / Services marketing in dentistry: a diagnosis of the applications and needs of dentists of Vale do Paraíba

A odontologia está inserida no setor de serviços onde a competitividade pela preferência dos clientes é agressiva. Nesse ambiente, os cirurgiões dentistas vivem o desafio de serem excelentes especialistas e empresários. Sendo assim, diariamente precisam tomar decisões de marketing inerentes ao seu negócio na odontologia. Este trabalho apresenta os resultados da pesquisa, que investigou as aplicações de marketing em clínicas e consultórios odontológicos do Vale do Paraíba. Foram investigadas as percepções, os conhecimentos e as práticas de marketing utilizadas pelos cirurgiões dentistas em suas atividades profissionais. A metodologia combinou revisão de literatura, pesquisa qualitativa e quantitativa onde, os participantes passaram por entrevistas em profundidade, grupo de foco, e um questionário-survey. Os resultados mostram que os cirurgiões dentistas definem marketing como propaganda, divulgação, publicidade e vendas, e 87,5% dos participantes, consideram que o marketing é essencial para o sucesso do seu negócio, porém, apenas 11,1% se consideram capacitados para administrar tais processos. Não conhecer as etapas de planejamento de marketing afeta o desempenho de diversas variáveis ligadas a esse tema, como a comunicação, a formação de preços etc. Entre esses profissionais, 88,7% buscam, por conta própria, a capacitação dessa área para planejar ações para aumentar a sua carteira de clientes. Este estudo permitirá ao cirurgião dentista, a compreensão da importância de conhecer o processo de planejamento de marketing e da sua interdependência com as demais áreas de uma clínica ou consultório. Como consequência, poderá atender melhor aos pacientes, aumentar a sua clientela de forma rentável e satisfatória para ambas as partes, percebendo a importância de atrair e capacitar funcionários, controlar custos, promover inovações, tanto para o alcance de objetivos relacionados aos negócios, quanto benefícios sociais(AU)

Dentistry is part of the service sector where competitiveness customer preference is aggressive. In this environment, dental surgeons face the challenge of being excellent experts and entrepreneurs. Therefore, they need to make marketing decisions inherent to their dental business on a daily basis. This paper presents the results of my research, which investigated the marketing applications in Paraíba Valley dental clinics. The perception, knowledge and marketing practices used by dentists in their professional activities were surveyed. The methodology combined literature review, qualitative and quantitative research where 88 respondents participated in in-depth interviews, focus group, and a survey questionnaire. The results show that dental surgeons define marketing as advertising, publicity, advertising and sales, where 87.5% of participants consider marketing essential to the success of their business, but only 11.1% consider themselves able to manage marketing processes. The survey showed that 89.9% of participants never had contact with any marketing discipline during their graduation, and that use 10 ways to meet the need for this knowledge. Dental surgeons have not learned about marketing during their training but are required to make important decisions in this area. Not knowing the marketing planning process affects the performance of several variables related to this theme, such as communication, pricing, etc. These professionals seek knowledge of this field to plan actions related to advertising, disclosure, advertising and sales to increase their customer base. However, 93.33% of respondents do not have a formal and detailed marketing plan to cover a 12-month period. They do not know how to execute this process, yet 88.7% do their own marketing actions on their own. This study will allow the dentist to understand the importance of knowing the marketing planning process and its interdependence with other areas of a clinic or consulting room. Thus, it will be able to better serve patients, increase their customers, in the profitable and satisfactory way for both sides. Also, it will help then to realize the importance of attracting and empowering employees, control costs promote innovations for their business goals and social benefits(AU)

Formulating productive marketing communications strategy: a major health system's experience.

BACKGROUND: Healthcare establishments serve as key community resources, bringing into locales a wealth of resources aimed at enhancing and improving health and wellness. Without effective communications, current and prospective patients will remain unaware of available offerings, foiling opportunities for mutually beneficial exchange. Today, healthcare organizations engage audiences by selecting from among the components of the marketing communications mix, but this wasn't always the case. There was a time not long ago when communications options were limited due to industry traditions, creating associated challenges. DISCUSSION: Willis-Knighton Health System faced a communications dilemma in the 1970s when, as a small healthcare provider desirous of growth, it could not achieve a satisfactory media presence via the usual and customary route of the day: submitting press releases to news media organizations, requesting conveyance of associated stories to their audiences. This forced the institution to explore other possibilities, ultimately leading it to experiment with and embrace advertising at a time period when its use was generally shunned in the industry. Willis-Knighton Health System's pioneering deployment of advertising helped the institution achieve its intended promotions goals, supplying mutual benefits and affording insights which influence its communications approach to this day. CONCLUSIONS: Deploying advertising years in advance of its widespread acceptance and use in the healthcare industry, Willis-Knighton Health System forged new pathways and acquired experience which fostered provider-patient engagement initiatives, affording an enduring marketing communications approach. Challenging situations are quite common in the healthcare industry and the one faced by Willis-Knighton Health System was no exception, but it supplied an immense opportunity to innovate, leading to communications prowess, resulting growth, informed audiences, and lasting mutual benefits.

Am I seeing things through the eyes of patients? An exercise in bolstering patient attentiveness and empathy.

BACKGROUND: Modern marketing thought heavily emphasizes the need for healthcare providers to possess a customer orientation, placing patients at the focal point of attention within health and medical establishments. This has motivated significant investments in tools and techniques that foster outstanding service, attention, and support. Such investments in isolation, however, offer no guarantees that a true customer orientation will emerge. Proper implementation also is required-and that falls on the shoulders of health and medical personnel. DISCUSSION: The most innovative and expensive of customer-oriented tools and techniques mean very little unless they are placed in the hands of capable individuals possessing the ability and desire to serve patients well. But the rigors of industry life complicate matters, resulting occasionally in lost focus, compromising the patient experience. One of the simplest and most effective methods for encouraging patient attentiveness rests with a reflective exercise that encourages staff members to see themselves and their actions from the perspective of patients. Asking the operative question, "Am I seeing things through the eyes of patients?" serves as an effective reminder of priorities, building empathy and motivating personnel to continually deliver their very best. CONCLUSIONS: Viewing one's actions from the perspective of patients can be very revealing, opening eyes wide and permitting opportunities for any necessary improvements, making for a simple but powerful learning experience. The "Am I seeing things through the eyes of patients?" reflective exercise helps well-intentioned staff members avoid tendencies which can lull them into states of complacency, ensuring that they remain focused on those in their care.