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2.
BMJ Open ; 10(10): e042392, 2020 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-33130573

RESUMO

OBJECTIVES: The suspension of elective surgery during the COVID-19 pandemic is unprecedented and has resulted in record volumes of patients waiting for operations. Novel approaches that maximise capacity and efficiency of surgical care are urgently required. This study applies Markov multiscale community detection (MMCD), an unsupervised graph-based clustering framework, to identify new surgical care models based on pooled waiting-lists delivered across an expanded network of surgical providers. DESIGN: Retrospective observational study using Hospital Episode Statistics. SETTING: Public and private hospitals providing surgical care to National Health Service (NHS) patients in England. PARTICIPANTS: All adult patients resident in England undergoing NHS-funded planned surgical procedures between 1 April 2017 and 31 March 2018. MAIN OUTCOME MEASURES: The identification of the most common planned surgical procedures in England (high-volume procedures (HVP)) and proportion of low, medium and high-risk patients undergoing each HVP. The mapping of hospitals providing surgical care onto optimised groupings based on patient usage data. RESULTS: A total of 7 811 891 planned operations were identified in 4 284 925 adults during the 1-year period of our study. The 28 most common surgical procedures accounted for a combined 3 907 474 operations (50.0% of the total). 2 412 613 (61.7%) of these most common procedures involved 'low risk' patients. Patients travelled an average of 11.3 km for these procedures. Based on the data, MMCD partitioned England into 45, 16 and 7 mutually exclusive and collectively exhaustive natural surgical communities of increasing coarseness. The coarser partitions into 16 and seven surgical communities were shown to be associated with balanced supply and demand for surgical care within communities. CONCLUSIONS: Pooled waiting-lists for low-risk elective procedures and patients across integrated, expanded natural surgical community networks have the potential to increase efficiency by innovatively flexing existing supply to better match demand.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Cadeias de Markov , Modelos Organizacionais , Pandemias , Medicina Estatal/organização & administração , Listas de Espera , Adulto , Betacoronavirus , Redes Comunitárias/organização & administração , Infecções por Coronavirus/epidemiologia , Eficiência Organizacional , Procedimentos Cirúrgicos Eletivos/classificação , Inglaterra/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Colaboração Intersetorial , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Medição de Risco , Medicina Estatal/estatística & dados numéricos
3.
Int J Equity Health ; 19(1): 189, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33109197

RESUMO

There has been mounting evidence of the disproportionate involvement of black, Asian and minority ethnic (BAME) communities by the Covid-19 pandemic. In the UK, this racial disparity was brought to the fore by the fact that the first 11 doctors to die in the UK from Covid-19 were of BAME background. The mortality rate from Covid-19 among people of black African descent in English hospitals has been shown to be 3.5 times higher when compared to rates among white British people. A Public Health England report revealed that Covid-19 was more likely to be diagnosed among black ethnic groups compared to white ethnic groups with the highest mortality occurring among BAME persons and persons living in the more deprived areas. People of BAME background account for 4.5% of the English population and make up 21% of the National Health Service (NHS) workforce. The UK poverty rate among BAME populations is twice as high as for white groups. Also, people of BAME backgrounds are more likely to be engaged in frontline roles. The disproportionate involvement of BAME communities by Covid-19 in the UK illuminates perennial inequalities within the society and reaffirms the strong association between ethnicity, race, socio-economic status and health outcomes. Potential reasons for the observed differences include the overrepresentation of BAME persons in frontline roles, unequal distribution of socio-economic resources, disproportionate risks to BAME staff within the NHS workspace and high ethnic predisposition to certain diseases which have been linked to poorer outcomes with Covid-19. The ethnoracialised differences in health outcomes from Covid-19 in the UK require urgent remedial measures. We provide intersectional approaches to tackle the complex racial disparities which though not entirely new in itself, have been often systematically ignored.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/terapia , Disparidades nos Níveis de Saúde , Grupos Minoritários/estatística & dados numéricos , Pneumonia Viral/etnologia , Pneumonia Viral/terapia , Medicina Estatal/organização & administração , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Humanos , Pandemias , Reino Unido/epidemiologia
6.
Br J Nurs ; 29(17): 1044-1045, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32972231

RESUMO

Lauren Oliver, formerly Clinical Nurse Advisor, NHS Nightingale North West, outlines the challenges faced by staff in providing good-quality end-of-life care for patients in a temporary hospital during the initial peak of the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/terapia , Hospitais Estaduais , Pandemias , Pneumonia Viral/terapia , Assistência Terminal/organização & administração , Infecções por Coronavirus/epidemiologia , Humanos , Recursos Humanos em Hospital/psicologia , Pneumonia Viral/epidemiologia , Medicina Estatal/organização & administração , Reino Unido/epidemiologia
9.
Aust Health Rev ; 44(5): 733-736, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32878685

RESUMO

The COVID-19 pandemic has resulted in multiple changes in the delivery of general practice services. In response to the threat of the pandemic and in order to keep their businesses safe and viable, general practices have rapidly moved to new models of care, embraced Medicare-funded telehealth and responded to uncertain availability of personal protective equipment with innovation. These changes have shown the adaptability of general practice, helped keep patients and practice staff safe, and undoubtedly reduced community transmission and mortality. The pandemic, and the response to it, has emphasised the potential dangers of existing fragmentation within the Australian health system, and is affecting the viability of general practice. These impacts on primary care highlight the need for improved integration of health services, should inform future pandemic planning, and guide the development of Australia's long-term national health plan.


Assuntos
Infecções por Coronavirus/diagnóstico , Diagnóstico Precoce , Medicina Geral/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Atenção Primária à Saúde/organização & administração , Medicina Estatal/organização & administração , Telemedicina/organização & administração , Austrália , Betacoronavirus/patogenicidade , Medicina Geral/métodos , Medicina Geral/estatística & dados numéricos , Humanos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Telemedicina/métodos
12.
J Rehabil Med ; 52(8): jrm00089, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32830284

RESUMO

OBJECTIVE: COVID-19 is a multisystem illness that has considerable long-term physical, psychological, cognitive, social and vocational sequelae in survivors. Given the scale of this burden and lockdown measures in most countries, there is a need for an integrated rehabilitation pathway using a tele-medicine approach to screen and manage these sequelae in a systematic and efficient way. METHODS: A multidisciplinary team of professionals in the UK developed a comprehensive pragmatic telephone screening tool, the COVID-19 Yorkshire Rehabilitation Screen (C19-YRS), and an integrated rehabilitation pathway, which spans the acute hospital trust, community trust and primary care service within the National Health Service (NHS) service model. RESULTS: The C19-YRS telephone screening tool, developed previously, was used to screen symptoms and grade their severity. Referral criteria thresholds were applied to the output of C19-YRS to inform the decision-making process in the rehabilitation pathway. A dedicated multidisciplinary COVID-19 rehabilitation team is the core troubleshooting forum for managing complex cases with needs spanning multiple domains of the health condition. CONCLUSION: The authors recommend that health services dealing with the COVID-19 pandemic adopt a comprehensive telephone screening system and an integrated rehabilitation pathway to manage the large number of survivors in a timely and effective manner and to enable the provision of targeted interventions.


Assuntos
Betacoronavirus , Serviços de Saúde Comunitária/organização & administração , Infecções por Coronavirus/reabilitação , Procedimentos Clínicos/organização & administração , Assistência à Saúde/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/reabilitação , Telemedicina/organização & administração , Serviços de Saúde Comunitária/métodos , Assistência à Saúde/métodos , Humanos , Pandemias , Encaminhamento e Consulta/organização & administração , Medicina Estatal/organização & administração , Sobreviventes , Telemedicina/métodos , Reino Unido
13.
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
14.
Open Heart ; 7(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32855212

RESUMO

OBJECTIVE: The COVID-19 pandemic resulted in prioritisation of National Health Service (NHS) resources to cope with the surge in infected patients. However, there have been no studies in the UK looking at the effect of the COVID-19 work pattern on the provision of cardiology services. We aimed to assess the impact of the pandemic on cardiology services and clinical activity. METHODS: We analysed key performance indicators in cardiology services in a single centre in the UK in the periods prior to and during lockdown to assess reduction or changes in service provision. RESULTS: There has been a greater than 50% drop in the number of patients presenting to cardiology and those diagnosed with myocardial infarction. All areas of cardiology service provision sustained significant reductions, which included outpatient clinics, investigations, procedures and cardiology community services such as heart failure and cardiac rehabilitation. CONCLUSIONS: As ischaemic heart disease continues to be the leading cause of death nationally and globally, cardiology services need to prepare for a significant increase in workload in the recovery phase and develop new pathways to urgently help those adversely affected by the changes in service provision.


Assuntos
Reabilitação Cardíaca , Cardiologia , Doenças Cardiovasculares , Infecções por Coronavirus , Assistência à Saúde , Pandemias , Pneumonia Viral , Medicina Estatal , Betacoronavirus/isolamento & purificação , Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/estatística & dados numéricos , Cardiologia/métodos , Cardiologia/organização & administração , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/reabilitação , Procedimentos Clínicos/tendências , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/reabilitação , Medicina Estatal/organização & administração , Medicina Estatal/tendências , Reino Unido
15.
J Laryngol Otol ; 134(8): 684-687, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32758307

RESUMO

BACKGROUND: The coronavirus disease 2019 pandemic has necessitated almost exclusive National Health Service focus on emergency work and cancer care. There are concerns that increased hospital and community pressures will lead to decreased referrals and worse outcomes for head and neck cancer patients. METHOD: This is a retrospective review of all cases referred for suspected head and neck cancer to our institution in January and April 2020. RESULTS: There was a 55 per cent decrease in referrals but diagnostic yield rose from 2.9 per cent in January to 8.06 per cent in April. In both months, 100 per cent of patients met the 31- and 62-day targets, with similar 14-day wait time success (97.83 per cent for January vs 98.33 per cent for April). Referrals for laryngopharyngeal reflux rose from 27.5 per cent to 41.9 per cent. Referrals for those aged over 60 years fell from 42 per cent to 26 per cent. CONCLUSION: It is suggested that further research be conducted into the reasons why fewer patients were referred, particularly elderly patients, and why laryngopharyngeal reflux is so prevalent in fast-track referrals.


Assuntos
Infecções por Coronavirus/transmissão , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Refluxo Laringofaríngeo/epidemiologia , Pneumonia Viral/transmissão , Encaminhamento e Consulta/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Estudos de Casos e Controles , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Neoplasias de Cabeça e Pescoço/epidemiologia , Humanos , Refluxo Laringofaríngeo/diagnóstico , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prevalência , Estudos Retrospectivos , Medicina Estatal/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Ultrassonografia/métodos , Reino Unido/epidemiologia
16.
Value Health ; 23(8): 1027-1033, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828214

RESUMO

OBJECTIVES: In many countries, future unrelated medical costs occurring during life-years gained are excluded from economic evaluation, and benefits of unrelated medical care are implicitly included, leading to life-extending interventions being disproportionately favored over quality of life-improving interventions. This article provides a standardized framework for the inclusion of future unrelated medical costs and demonstrates how this framework can be applied in England and Wales. METHODS: Data sources are combined to construct estimates of per-capita National Health Service spending by age, sex, and time to death, and a framework is developed for adjusting these estimates for costs of related diseases. Using survival curves from 3 empirical examples illustrates how our estimates for unrelated National Health Service spending can be used to include unrelated medical costs in cost-effectiveness analysis and the impact depending on age, life-years gained, and baseline costs of the target group. RESULTS: Our results show that including future unrelated medical costs is feasible and standardizable. Empirical examples show that this inclusion leads to an increase in the ICER of between 7% and 13%. CONCLUSIONS: This article contributes to the methodology debate over unrelated costs and how to systematically include them in economic evaluation. Results show that it is both important and possible to include future unrelated medical costs.


Assuntos
Análise Custo-Benefício/métodos , Gastos em Saúde/estatística & dados numéricos , Projetos de Pesquisa , Medicina Estatal/organização & administração , Fatores Etários , Inglaterra , Humanos , Expectativa de Vida , Modelos Econométricos , Anos de Vida Ajustados por Qualidade de Vida , Fatores Sexuais , Medicina Estatal/economia , País de Gales
17.
Br J Hosp Med (Lond) ; 81(8): 1-3, 2020 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-32845762

RESUMO

The UK death toll from COVID-19 is currently the fourth worst in the world behind the USA, Brazil and Mexico. Possible reasons include delays in lockdown, the provision of scientific advice to government and the decisions that government made based on the information they were given. When we review our performance and plan for the next public health crisis, we need to be brave enough to dare to challenge the NHS and its advisors.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Medicina Estatal/organização & administração , Betacoronavirus , Infecções por Coronavirus/mortalidade , Planejamento em Desastres/organização & administração , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Pandemias , Pneumonia Viral/mortalidade , Administração em Saúde Pública , Reino Unido/epidemiologia
18.
Acta Med Port ; 33(11): 768-774, 2020 Nov 02.
Artigo em Português | MEDLINE | ID: mdl-32692649

RESUMO

Since the detection of the first cases of COVID-19, reported by the People's Republic of China on the 31st December 2019, up to the confirmation of the first cases in Portugal, on the 2nd March, countries like Italy and Spain faced the collapse of their healthcare systems. Anticipating this possibility, the Portuguese National Health Service carried out measures to prepare for this reality. This paper describes the changes implemented in the Anesthesiology department of a tertiary hospital center in Portugal, aiming to ensure the safety of both patients and healthcare professionals. The measures implemented had to do mostly with scientific preparation and team reorganization; management of personal protective equipment; redesigning the department's clinical common areas, separation of patient circuits with creation of a designated COVID Operating Room, Post-Anesthetic Care Unit; rescheduling of elective surgery and testing all patients before anesthesia procedures and consulting other hospital departments. The reported data covers the period between the 2nd March and the 30th April of 2020. In this period, 64 cases with COVID-19 or with high clinical suspicion were approached. To date, there have been no cases of in-hospital spread to other patients or to professionals in this department. With this paper we intend to start a reflection that will end up with the optimization of strategies that allows health systems to deal better with COVID-19, keeping patients and health providers safe.


Assuntos
Anestesiologia/organização & administração , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Medicina Estatal/organização & administração , Centros de Atenção Terciária/organização & administração , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Portugal
20.
Health Care Manag Sci ; 23(3): 315-324, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32642878

RESUMO

Managing healthcare demand and capacity is especially difficult in the context of the COVID-19 pandemic, where limited intensive care resources can be overwhelmed by a large number of cases requiring admission in a short space of time. If patients are unable to access this specialist resource, then death is a likely outcome. In appreciating these 'capacity-dependent' deaths, this paper reports on the clinically-led development of a stochastic discrete event simulation model designed to capture the key dynamics of the intensive care admissions process for COVID-19 patients. With application to a large public hospital in England during an early stage of the pandemic, the purpose of this study was to estimate the extent to which such capacity-dependent deaths can be mitigated through demand-side initiatives involving non-pharmaceutical interventions and supply-side measures to increase surge capacity. Based on information available at the time, results suggest that total capacity-dependent deaths can be reduced by 75% through a combination of increasing capacity from 45 to 100 beds, reducing length of stay by 25%, and flattening the peak demand to 26 admissions per day. Accounting for the additional 'capacity-independent' deaths, which occur even when appropriate care is available within the intensive care setting, yields an aggregate reduction in total deaths of 30%. The modelling tool, which is freely available and open source, has since been used to support COVID-19 response planning at a number of healthcare systems within the UK National Health Service.


Assuntos
Infecções por Coronavirus/epidemiologia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Unidades de Terapia Intensiva/organização & administração , Modelos Teóricos , Pneumonia Viral/epidemiologia , Medicina Estatal/organização & administração , Betacoronavirus , Cuidados Críticos/organização & administração , Inglaterra/epidemiologia , Hospitais Públicos/organização & administração , Humanos , Pandemias
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