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Journal articles on the topic 'Efficience hospitalière'
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1
SAHLI, Allel, Omar BAFDEL, Ali BENAZZA, Abdelmalek OUAHEB, Khemissi HALIMI, and Abdelhak LAMARA. "Evaluation of general outpatient surgery in adults at Batna Teaching Hospital." Batna Journal of Medical Sciences (BJMS) 6, no. 1 (July 1, 2019): 31–35. http://dx.doi.org/10.48087/bjmsoa.2019.6109.
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Introduction : La chirurgie ambulatoire est un concept d’organisation spécifique liée à une durée de séjour réglementairement inférieure à une journée de travail « working day ». Deux motivations sont à l’origine du développement de cette alternative à l’hospitalisation traditionnelle : le désengorgement des lits et la réduction des coûts hospitaliers. Ainsi, nous voulons par ce travail évaluer la chirurgie générale en ambulatoire chez l’adulte au CHU de Batna. Matériel et méthodes : Nous avons mené une étude au CHU de Batna concernant 315 malades opérés selon le mode ambulatoire comparés à un deuxième groupe de 315 patients opérés en hospitalisation classique, ceci de Janvier 2014 à Mars 2016. Résultats : L’âge moyen est de 45,15 ± 15,81 ans dans le groupe A et de 47,18 ± 16,23 ans dans le groupe B (18- 86), sex ratio M/F = 1,46 dans le groupe A et 1,35 dans le groupe B). L’Indice de masse corporelle (IMC) moyen est de 27,71 ± 2,53 % dans le groupe A et 27,48 ± 2,41 % dans le groupe B. Le délai d’attente dans le groupe A est en moyenne de 30,8 jours et de 38,66 jours groupe B. La majorité des patients des deux groupes appartenaient au score ASA I ou II, avec une faible proportion de score ASA III. Discussion : Les patients âgés ou en surpoids restent éligibles à la chirurgie ambulatoire. La chirurgie ambulatoire a réduit de façon considérable le délai d’attente des patients. La morbidité postopératoire est liée aux NVPO et aux DPO qui sont les principales causes de réadmission non programmées. Enfin, la satisfaction est un excellent indicateur de l’efficacité globale de la chirurgie ambulatoire ; La chirurgie ambulatoire est perçue comme un élément de contribution à la diminution des dépenses hospitalière. Conclusion : La chirurgie ambulatoire est une chirurgie sûre et de qualité associant sécurité et efficience.
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Dupont, Danielle, Ariel Beresniak, Dipak Kalra, Pascal Coorevits, and Georges De Moor. "Intérêt des dossiers de santé électroniques hospitaliers pour la recherche clinique." médecine/sciences 34, no. 11 (November 2018): 972–77. http://dx.doi.org/10.1051/medsci/2018235.
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Les dossiers de santé électroniques hospitaliers contribuent à l’amélioration de la qualité des soins en permettant une meilleure gestion des informations cliniques. Les bases de données numériques ainsi constituées facilitent l’échange des informations de santé avec les prestataires de soins et optimisent la coordination multidisciplinaire pour de meilleurs résultats thérapeutiques. Le projet européen EHR4CR (electronic health records for clinical research) a développé une plateforme pilote innovante permettant de réutiliser ces données numériques pour la recherche clinique. En améliorant et en accélérant les procédures de recherche clinique, cette approche permet d’envisager la réalisation d’études cliniques de manière plus efficiente, plus rapide et plus économique.
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Weir, Robin, Gina Browne, Carolyn Byrne, Jacqueline Roberts, Amiram Gafni, Arlene Thompson, Marian Walsh, and Lynda McColl. "The Efficacy and Efficiency of the Quick Response Program: A Randomized Controlled Trial." Canadian Journal on Aging / La Revue canadienne du vieillissement 17, no. 3 (1998): 272–95. http://dx.doi.org/10.1017/s0714980800010205.
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RÉSUMÉLes programmes d'intervention rapide ont été institués dans le but d'amoindrir les coûts des centres hospitaliers en diminuant le nombre d'admissions non nécessaires dans ces établissements grâce à la prompte coordination de soins à domicile. Aucune évaluation économique formelle de l'impact de cette réorientation des services n'a été réalisée. Ce document expose un essai contrôlé qui a été réalisé dans le but de comparer les coûts et les conséquences entre des patients comparables du service des urgences soignés selon le programme d'intervention rapide par rapport aux services de départements habituels. Les patients ont été évalués au moment de leur admission et dix jours après avoir reçu leur congé de l'urgence spécifiquement pour leur état de santé, pour la charge du dispensateur de soins, pour la satisfaction des soins reçus et pour les coûts. Le programme d'intervention rapide s'est avéré un choix acceptable par rapport aux services de l'urgence pour un faible pourcentage de patients et ne s'est pas avéré plus cher pour l'ensemble des coûts bien qu'il y ait eu un réacheminement des dépenses de l'hôpital vers les soins à domicile. À cause de l'échantillonnage restreint, la capacité de détecter les différences importantes dans l'état de santé, sur le plan clinique, s'est établie à 60 pour cent.
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Ledoux, S., J. Aron-Wisnewsky, F. Tissier, P. Blaizot van Wijk, N. Gourmelon, H. Hama, J. M. Oppert, S. Czernichow, and V. Garnier. "Projet OBEPAR article 51 : vers une amélioration de l’organisation et du financement du parcours de soins du patient candidat à la chirurgie bariatrique." Obésité 15, no. 1-2 (March 2020): 20–27. http://dx.doi.org/10.3166/obe-2020-0088.
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Actuellement, 60 000 interventions de chirurgie bariatrique sont réalisées par an en France. Les recommandations nationales concernant la prise en charge médicale encadrant l’acte chirurgical ne sont pas toujours suivies, en partie en raison d’une mauvaise coordination des ressources hospitalières et ambulatoires. L’accès aux soins est également limité par le non-remboursement de certains actes indispensables à la prise en charge. Cela favorise les perdus de vue, la survenue de complications et les reprises de poids à long terme. Le projet Obepar, porté par les quatre CSO d’Île-de-France vise donc à améliorer la qualité de cette prise en charge et à diminuer le nombre de complications, tout en en limitant les coûts. Pour répondre à ces objectifs, il est proposé une prise en charge au forfait englobant l’ensemble des actes réalisés en pré- et en postopératoire, y compris ceux actuellement non remboursés. L’expérimentation s’appuiera sur une cellule de coordination qui favorisera les interactions ville–hôpital, limitera les perdus de vue et permettra de collecter des informations. Il est prévu d’inclure 2 000 patients en cinq ans, en ciblant les patients les plus courants, ne présentant pas de pathologie sévère. Le projet a été validé par l’ARS et le ministère. Cependant, un certain nombre d’actions restent à finaliser avant sa mise en oeuvre qui, nous l’espérons, démontrera son efficience, dans le but d’une généralisation au niveau national, afin d’améliorer le rapport bénéfice/risque de la chirurgie bariatrique sur notre territoire.
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Bima, Paolo, Emanuele Pivetta, Denise Baricocchi, Jacopo Davide Giamello, Francesca Risi, Matteo Vesan, Michela Chiarlo, et al. "Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department." Journal of Clinical Medicine 11, no. 11 (May 27, 2022): 3032. http://dx.doi.org/10.3390/jcm11113032.
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In the Emergency Department (ED), the decision to hospitalize or discharge COVID-19 patients is challenging. We assessed the utility of lung ultrasound (LUS), alone or in association with a clinical rule/score. This was a multicenter observational prospective study involving six EDs (NCT046291831). From October 2020 to January 2021, COVID-19 outpatients discharged from the ED based on clinical judgment were subjected to LUS and followed-up at 30 days. The primary clinical outcome was a composite of hospitalization or death. Within 393 COVID-19 patients, 35 (8.9%) reached the primary outcome. For outcome prognostication, LUS had a C-index of 0.76 (95%CI 0.68–0.84) and showed good performance and calibration. LUS-based classification provided significant differences in Kaplan–Meier curves, with a positive LUS leading to a hazard ratio of 4.33 (95%CI 1.95–9.61) for the primary outcome. The sensitivity and specificity of LUS for primary outcome occurrence were 74.3% (95%CI 59.8–88.8) and 74% (95%CI 69.5–78.6), respectively. The integration of LUS with a clinical score further increased sensitivity. In patients with a negative LUS, the primary outcome occurred in nine (3.3%) patients (p < 0.001 vs. unselected). The efficiency for rule-out was 69.7%. In unvaccinated ED patients with COVID-19, LUS improves prognostic stratification over clinical judgment alone and may support standardized disposition decisions.
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Blouin-Delisle, Charles Hubert, Renee Drolet, Serge Gagnon, Stephane Turcotte, Sylvie Boutet, Martin Coulombe, and Eric Daneau. "Improving flow in the OR." International Journal of Health Care Quality Assurance 31, no. 2 (March 12, 2018): 150–61. http://dx.doi.org/10.1108/ijhcqa-01-2017-0014.
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Purpose The purpose of this paper is to increase efficiency in ORs without affecting quality of care by improving the workflow processes. Administrative processes independent of the surgical act can be challenging and may lead to clinical impacts such as increasing delays. The authors hypothesized that a Lean project could improve efficiency of surgical processes by reducing the length of stays in the recovery ward. Design/methodology/approach Two similar Lean projects were performed in the surgery departments of two hospitals of the Centre Hospitalier Universitaire de Québec: Hôtel Dieu de Quebec (HDQ) and Hôpital de l'Enfant Jesus (HEJ). The HDQ project designed around a Define, Measure, Analyse, Improve and Control process revision and a Kaizen workshop focused on patients who were hospitalized in a specific care unit after surgery and the HEJ project targeted patients in a post-operative ambulatory context. The recovery ward output delay was measured retrospectively before and after project. Findings For the HDQ Lean project, wasted time in the recovery ward was reduced by 62 minutes (68 percent reduction) between the two groups. The authors also observed an increase of about 25 percent of all admissions made in the daytime after the project compared to the time period before the project. For the HEJ Lean project, time passed in the recovery ward was reduced by 6 min (29 percent reduction). Originality/value These projects produced an improvement in the flow of the OR without targeting clinical practices in the OR itself. They demonstrated that change in administrative processes can have a great impact on the flow of clinical pathways and highlight the need for comprehensive and precise monitoring of every step of the elective surgery patient trajectory.
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Ahouingnan, N. F. M. Hounkponou, A. Tonato Bagnan, Sidi RI, Vodouhe M., Obossou AAA, Laourou H., P. P. Ntankeu Tankoua, and Salifou K. "Salbutamol Versus Nifedipine Dans Le Traitement De La Menace D’accouchement Premature A La Maternite Du Centre Hospitalier Universitaire Et Departemental Du Borgou." European Scientific Journal, ESJ 13, no. 6 (February 28, 2017): 439. http://dx.doi.org/10.19044/esj.2017.v13n6p439.
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Introduction: The threat of the premature birth (TPB) raises a problem of public health in Benin in general and in Parakou in particular. Objective: The aim of this research paper is to compare the efficiency of salbutamol and nifedipine in the treatment of the threat of premature birth at the maternity hospital of CHUD-Borgou. Framework and methodological approach: It is about a comparative prospective study with analytical view, within a period of six (06) months, going from 1, March 2016 to 1, September 2016. The target population is composed of all the pregnant women admitted to the maternity hospital of CHUD-B during the period of the study. Results: The 60 pregnant women have been divided into two groups of 30 pregnant women. The average age of the pregnant women is 26.50 years with the extremes of 16 years and 38 years. The women who have between two and three pregnancies are the most represented with 56.67% of the cases; just as much as the women who have between two and three deliveries with 36.67%. From the total number, 21. 67% had antecedents of spontaneous miscarriages and 6, 67% antecedents of premature birth delivery. With 90% of the cases, the gestational age is between 28 weeks of amenorrhoea and 33weeks of amenorrhoea plus six (06) days. The pregnancy is twin in 16.67% of the cases. At the admission, 90% of the cases after assessment of the Coefficient of Risk of Premature birth Delivery. (CRPD), had a potential risk of prematurity and 85% had a score of Baumgarten between 3 and 6. The most discovered aetiology is malaria with 46.67% of the pregnant women. The side effect of usage of nifedipine, in order to relieve the uterus, has been noticed with 16.67% pregnant women who have received nifedipine treatment against 30% pregnant women who have received the treatment of Salbutamol. There is no difference statistically significant. For the nifedipine, there is 90% of success against 10% of failure. For salbutamol, there is respectively 56.67% and 43.33%. We have no case of intolerance. Conclusion: The study shows neat efficiency of nifedipine in relation to salbutamol during the treatment of the threats of premature birth delivery.
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Ducassou, Stéphane, Nathalie Aladjidi, Corinne Pondarre, Thierry Leblanc, Hervé Chambost, Armari-Alla Corinne, Pasquet Marlene, et al. "Rituximab in 42 Cases of French Childhood Auto-Immune Haemolytic Anaemia: High Efficiency but Caution Required." Blood 118, no. 21 (November 18, 2011): 2100. http://dx.doi.org/10.1182/blood.v118.21.2100.2100.
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Abstract Abstract 2100 Background: Autoimmune hemolytic anemia (AIHA) in children is in more than half cases characterized by a severe course, with prolonged need of immunosuppressive therapy. Rituximab is a chimeric anti-CD20 monoclonal antibody increasingly used for treating severe autoimmune diseases. Paediatric experience in AIHA is only made of case reports and short series. The Rare Disease Plan gave us the opportunity to conduct national studies on those rare pediatric diseases. Design and methods: At the end point of August 1, 2011, data from the CEREVANCE French national prospective cohort of auto-immune cytopenia were extracted, and a retrospective study of children who underwent rituximab for isolated AIHA was conducted. Patients with post bone marrow transplantation AIHA or underlying characterised primitive immune deficiency were excluded. Medical data and procedures were checked from patients' medical records. Complete remission (CR) was defined by haemoglobin count of more than 11 g/dL and reticulocytes count of less than 120 G/L, continuous complete remission (CCR) was defined as CR with no relapse or treatment for at least one year (Aladjidi et al, Haematologica 2011). Efficiency, safety and immunologic tests were evaluated after therapy. Results: Rituximab was administered in 42 children with isolated AIHA between 1999 and 2010. Associated immunologic disorders were noticed in 16 children before AIHA or during the follow-up. The median age at rituximab initiation was 5.4 years (0.1 to 17.5), with 15 children being younger than 2. The median duration of AIHA before rituximab was 6.2 months (0.1 to 74). The number of lines of treatments before rituximab varied from 1 (steroids alone for 23 children) to 5. Nineteen children received 4 weekly doses of 375 mg/m2, 6 received less than 4 courses and 7 received more than 4 courses (6 to 12). Rituximab allowed CR obtention in 85% of evaluable children, and all immunosuppressive treatment cessation in 67%. For failure or relapse, 21 children required 1 to 3 further lines of treatments. Systematic intravenous immunoglobulin (IVIg) substitution was administered in 55% of children, for a median duration of 18 months (1–140). Rituximab was well tolerated and severe neutropenia with sepsis happened in one child 6 months after rituximab. With a median follow-up of 3.6 years (0.2 to 11.3) after rituximab treatment, 22 children were in CCR, 7 children were in CR without treatment, 10 children were in CR with continuous treatment, 2 children were not in remission, 1 child died from associated giant cell hepatitis. Six children still required IgIV substitution at the last follow up, mainly younger and heavily treated children. Comparisons with rituximab efficiency and tolerance in chronic ITP and in AIHA/Evans syndrome are available from this national cohort. Conclusion: This collaborative national study confirms the excellent benefit-risk ratio of rituximab for childhood refractory AIHA. Early introduction could allow avoiding prolonged steroid treatments. However, the benefit of more than 4 courses was not demonstrated in this cohort. AIHA and chronic ITP are different diseases: the prolonged IVIg substitution required in 14% of children imposes to carefully search prior underlying immune deficiency before beginning an anti-CD20 treatment. Acknowledgments to the Association Française pour le Syndrome d'Evans (AFSE), the GIS-Institut des Maladies Rares-INSERM, and the French Health Ministry (Programme Hospitalier de Recherche Clinique 2005, Rare Diseases Plan 2007). Disclosures: No relevant conflicts of interest to declare.
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Gogognon, Patrick, and Béatrice Godard. "Asymétrie de pouvoir dans les partenariats de recherche en santé mondiale : étude qualitative auprès de chercheurs en Côte d’Ivoire." Global Health Promotion 27, no. 1 (May 3, 2018): 92–101. http://dx.doi.org/10.1177/1757975918764311.
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Résumé : Contexte : L’asymétrie de pouvoir dans les partenariats de recherche en santé mondiale constitue un enjeu de justice et d’équité pour les institutions de recherche, les chercheurs et les communautés, en particulier dans les pays en développement. Pour les chercheurs, l’asymétrie de pouvoir peut constituer un obstacle pour une recherche efficiente et équitable et ils sont à risque d’être en situation de vulnérabilité. Objectifs : Ces enjeux sont largement discutés dans la littérature mais ce phénomène reste encore étudié au plan théorique et peu de données empiriques sont disponibles, particulièrement dans les pays en développement. Cette étude a donc pour objectifs d’identifier les facteurs et les mécanismes de l’asymétrie de pouvoir en recherche en santé mondiale dans la perspective de chercheurs dans un pays du sud. Méthodologie : Une étude qualitative a été menée auprès de 19 chercheurs dans le domaine de la santé en Côte d’Ivoire. Tous les participants poursuivaient une carrière universitaire d’enseignement et recherche, dont 17 cliniciens en Centre Hospitalier Universitaire et 2 chercheurs non cliniciens. Des entrevues semi-dirigées ont été réalisées pour évaluer leur perception sur les facteurs qui influencent l’asymétrie de pouvoir et les mécanismes par lesquels ils opèrent. Résultats : Deux thèmes principaux émergent de l’analyse des données : les défis du financement et la complexité des relations interpersonnelles dans les partenariats. Discussion : Cette étude montre que la pression sur l’accès aux ressources contribue à détériorer les conditions dans lesquelles les partenariats sont mis en œuvre. Par ailleurs, l’environnement institutionnel de la recherche montre des liens de subordination qui font peser des risques sur l’autonomie des jeunes chercheurs et l’intégrité de leurs travaux. À cet égard nous recommandons une analyse approfondie de l’environnement dans lequel ces partenariats sont mis en œuvre notamment sur les dimensions de reddition de comptes, d’imputabilité et d’intégrité professionnelle.
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Mbog Mbog, Severin, Jacob Bidias, Olivier T. Sosso Mayi, Dieudonne Bitondo, and Innocent Ndoh Mbue. "Evaluation de la gestion des déchets solides hospitaliers: cas de l’hôpital Jamôt de Yaoundé et de l’hôpital de district de Biyem-Assi." Journal of the Cameroon Academy of Sciences 16, no. 2 (January 27, 2021): 77–86. http://dx.doi.org/10.4314/jcas.v16i2.1.
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RésuméL’objectif général de cet étude est d’améliorer la gestion des déchets solides au sein de l’Hôpital de district de Biyem-Assi et à l’hôpital Jamôt de Yaoundé. La démarche méthodologique menée de juillet 2012 à septembre 2013e adoptée, a consisté à des entretiens et des observations directes et l’administration des questionnaires semi-structurés. Cette méthodologie a permis de réaliser l’étude en trois phases la recherche documentaire, la collecte et le traitement des données:Les résultats obtenus font ressortir deux grandes catégories de déchets : les déchets assimilables aux ordures ménagères (DAOM); les déchets d’activités de soins à risques (DASRI), 24,46 % est assimilable aux (DAOM) et 75,54 % (DASRI) à l’Hôpital Jamôt de Yaoundé. Tandis qu’à l’Hôpital de District de Biyem-Assi 86,23 % est assimilable aux (DAOM) et 13,77 % (DASRI). Par contre l’appréciation de l’efficacité du système de gestion des déchets solides révèle qu’à l’HJY après des interviews démontre que le système est mauvais: tandis qu’à l’HDB, le système est plus pris en charge par le personnel. Au vu des observations et constats faites, une amélioration du système de gestion des déchets solides et l’accroissement de la sensibilisation du personnel et des usagers sur les modes de gestion des déchets solides s’imposent.
AbstractThe general objective of this study is to improve the management of the solid waste within Biyem-AssiDistrict Hospital and the Jamôt Hospital , Yaoundé.The work was carried out from July 2012 to September 2013,and consisted to interviews and the direct observations and the administration of semi-structured questionnaires. This methodology permitted us to achieve the survey in three phases: the documentary research, the collection and the treatment of the data:The results obtained revealed two big categories of garbage taken out again: the garbage assimilated to the household waste (HhW); hospital waste (HoW). About 24, 46 % was assimilated to (HhW) and 75, 54 % (HoW) in the Yaounde Jamôt Hospital. While to the hospital of District of Biyem-Assi 86, 23 % is assimilated to them (HhW) and 13, 77% (DHoW). On the other hand the appreciation of the efficiency of the system of management of the solid waste reveals that to the HJY after interviews demonstrates that the system is bad: while to the HDB, the system is taken more in charge by the staff. Within sight of the observations and reports made, an improvement of the system of management of the strong garbage and the growth of the sensitization of the staff and users on the fashions of management of the strong garbage impose themselves.
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Martel, Alain Y. "Home Intravenous Self-Injection of Antibiotic Therapy." Canadian Journal of Infectious Diseases 5, suppl c (1994): 51C—55C. http://dx.doi.org/10.1155/1994/673183.
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The current medical climate has forced all health care providers to search for alternative methods for the delivery of health care. This search has led to the use of sites outside the conventional hospital walls for peritoneal dialysis, parenteral hyperalimentation, blood or blood product transfusions, etc. Home intravenous self-injection of antibiotics is such an alternative to prolonged and/or repeated hospitalization for patients requiring intravenous antibiotics administration only. This alternative was started as a pilot study and soon became a usual service in the Centre hospitalier de l’Université Laval following receipt of a grant from the National Health Research and Development Program. After careful development of inclusion/exclusion criteria and a teaching manual for patient and health care providers. and the standardization of medical. pharmaceutical and nursing approach, a clinical, psychosocial and economical analysis of patients who agreed to participate in a clinical study comparing the two methods of health care delivery (hospital versus home) was started. Patients who met inclusion/exclusion criteria, agreeing to finish their treatment at home instead of staying hospitalized to receive intravenous antibiotics only, were taught the various techniques of intravenous self-injection. Once they were judged to be able to self-administer the antibiotics, they were sent home with the material needed to carry on their treatment, To date, more than 100 patients have participated in the home-treatment, of which 50 were analyzed. The duration of home treatment varied from two days to several months. Most patients had osteomyelitis, septic arthritis, septic bursitis, bacterial cellulitis or lung infections. The therapy allowed some newly defined patients with complicated infections (AIDS patients with cytomegalovirus retinitis) to continue their treatment at home. The clinical outcome of patients treated at home was identical to the outcomes of those treated in the hospital. Side effects were comparable with the hospital treatment and were mainly catheter-related. Compared with hospitalization. home treatment was preferred by the majority of patients. Psychological analysis of the patients showed that those who choose home therapy had a higher internal “locus of control” than those who preferred to stay in the hospital for the entire length of therapy. The economical analysis showed a potential reduction of cost varying between $941.00 and $3325.00 per treatment. Home intravenous self-injection of antibiotics allowed health self-monitoring by the patients or/and their friends or family and increased health care efficiency.
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Belan, Matea, Belina Carranza-Mamane, Youssef AinMelk, Marie-Helene Pesant, Farrah Jean-Denis, Marie-France Langlois, Thomas G. Poder, and Jean-Patrice Baillargeon. "Cost-Effectiveness Analysis of an Interdisciplinary Lifestyle Intervention Targeting Women With Obesity and Infertility in Comparison to Usual Care." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A730. http://dx.doi.org/10.1210/jendso/bvab048.1485.
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Abstract Although lifestyle modification is considered as the first-line treatment for women with obesity and infertility, these women generally do not have access to a program supporting them in adopting healthy habits that is integrated to fertility care. Implementing such a program requires to demonstrate its efficiency. The purpose of this study was to conduct a cost-effectiveness analysis (CEA) of an interdisciplinary lifestyle intervention (Fit-for-Fertility (FFF) program) for women with obesity and infertility, in comparison with the usual care protocol, i.e. fertility treatments. Methods: A CEA was conducted alongside a randomized controlled trial, recruiting women at the fertility clinic of the Centre hospitalier universitaire de Sherbrooke. Women were randomized to: i) the intervention group (IG): FFF program alone for 6 months (individual follow-ups every 6 weeks and 12 group sessions), and in combination with usual care for infertility after 6 months if not pregnant; or ii) control group (CG): usual care from the outset. Data were collected in both groups, during 18 months or until the end of the pregnancy for those who became pregnant. Costs related to the management of infertility, obesity, pregnancy and childbirth, and the FFF program were considered and collected by self-reported questionnaires, review of medical records and administrative databases. Live birth (LB) rate was used to assess effectiveness. The CEA’s parameter of interest was the incremental cost-effectiveness ratio (ICER), calculated by non-parametric bootstrap with 5,000 iterations. All costs are in Canadian dollars, 2019. Results: A total of 130 women were randomized (65 CG, 65 IG). We present results for the 108 women (57 CG, 51 IG) who completed at least 6 months in the study. We observed an absolute difference of 14.2% (p=0.328) in LB rate between groups (IG: 51.0%; CG: 36.8%). Total mean costs per patient were significantly higher in the IG vs the CG for healthcare system’s ($5,660 ± $3,200 vs $3,631 ± $3,389; p=0.002) and society’s ($9,745 ± $5,899 vs $6,898 ± 7,021; p=0.026) perspectives. We observed an ICER of $12,633 per additional LB [$5,319-$19,947] from the healthcare system’s perspective, and $5,980 [$3,086-$8 874] from the patients’ perspective. Overall, the ICER for the society’s perspective, which includes both previous perspectives, was estimated at $24,393 per additional LB [$15,509-$33,276]. Conclusion: According to our results, a lifestyle intervention may be clinically more effective than the usual protocol of care for women with obesity and infertility, but generates higher costs as well, resulting in a positive ICER (of $12,600 per additional life birth for the healthcare system). Such an intervention could be considered efficient compared to the usual standard of care, but studies are needed to assess the willingness to pay of stakeholders for this type of intervention.
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Aladjidi, Nathalie, Raoul Santiago, Pondarré Corinne, Anne Lambilliote, Guy Leverger, Claire Godard Sebillotte, Helder Fernandes, et al. "Revisiting Splenectomy in Childhood Chronic Immune Thrombocytopenia At the Era of New Therapies: The French Experience." Blood 118, no. 21 (November 18, 2011): 2227. http://dx.doi.org/10.1182/blood.v118.21.2227.2227.
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Abstract Abstract 2227 Background: While splenectomy is the gold standard treatment for adult's refractory primary immune thrombocytopenia (ITP), its place remains debated in children. The Rare Disease Plan gave us the opportunity to conduct a French collaborative work aiming to study efficiency, tolerance and prognostic factors associated with success of this procedure in childhood ITP. Design and methods: A retrospective study was conducted in France, of less than 18 years old children and adolescents who underwent a splenectomy for ITP during a 9-year period (2000–2009). Data from both the CEREVANCE national cohort and systematic requests to 30 paediatric units were reviewed. Medical data and procedures were checked from patients' medical records. Complete remission (CR) was defined by platelet count of more than 100 G/L, continuous complete remission (CCR) was defined as CR with no relapse or treatment for at least one year (Aladjidi et al, Haematologica 2011). Relapse-free survival was assessed by Kaplan Meier method. Results: For 78 children in 16 units, the median ages at diagnosis of ITP and at splenectomy were respectively 9.6 (0.8–16.5) and 12.4 (3.5–17.4) years. The median duration of ITP before splenectomy was 24 months (1–162), 62 children had chronic ITP of more than 12 months duration. The surgical procedure was laparoscopy in 81% of children. Four patients experienced post-operative complications: 1 severe intra-abdominal hemorrhage requiring open surgery twelve hours after laparoscopy, 1 pleural and peritoneal hemorrhage after laparotomy, 1 mesenteric and splenic thrombosis and 1 pulmonary atelectasia. With a median follow up of 41 months (1–109), CR and CCR were achieved respectively for 83% and 75% of 62 children with chronic ITP. No overwhelming sepsis was reported during the follow-up. Isotopic platelet studies were available in 10 of the 16 units and assessed in 30 of the 44 concerned children. CR was obtained in 77% of 26 cases with predominant splenic destruction, and in 0% of 2 cases with non splenic destruction. Five-year relapse-free survival was 35% in children of less than 10 years old and 81% in children of more than 10 years old at initial diagnosis of ITP (p=0.0002). Conclusion: This collaborative national study confirms the excellent benefit-risk ratio of splenectomy for refractory chronic ITP, especially in older children. Even if our own results are limited by the small number of patients, prior isotopic platelet studies is useful when locally available. Long term respect of anti-infectious measures is recommended. Acknoledgements to the Association Française pour le Syndrome d'Evans (AFSE), the GIS - Institut des Maladies Rares - INSERM, and the French Health Ministry (Programme Hospitalier de Recherche Clinique 2005, Rare Diseases Plan 2007). Disclosures: No relevant conflicts of interest to declare.
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Kollo, Nzima Brice, Aboubakar Bamba, Aboubacar Condé, Irène Mendo, Nina Kpami, Yaya Coulibaly, Abidou Kawélé Coulibaly, et al. "Facteurs Associés à la Consommation des AINS en Automédication chez les Patients vus en Rhumatologie à Abidjan." European Scientific Journal, ESJ 20, no. 9 (March 31, 2024): 236. http://dx.doi.org/10.19044/esj.2024.v20n9p236.
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Objectif: Identifier les facteurs associés à la consommation des AINS en automédication par les patients vus en rhumatologie à Abidjan.
Méthodologie: Etude transversale et analytique menée au sein du service de rhumatologie du CHU de Cocody (Abidjan) du 1er Février 2023 au 31 Juillet 2023, portant sur 388 patients présentant des douleurs ostéoarticulaires venus en consultation de rhumatologie et ayant pratiqué une automédication aux AINS quel que soit la voie d’administration, la durée de consommation et l’ancienneté. Nous avons recherché une corrélation entre les facteurs socio-démographiques, cliniques et l’automédication aux AINS.
Résultats : La fréquence hospitalière de consommation des AINS en automédication était de 76,67% soit 388 sur 506 personnes recensées pendant la période d’étude. L’effectif comprenait 257 femmes (66,20%) et 131 hommes (33,80%) avec un âge moyen de 52 +/- 16 ans [Extrêmes : 8 et 84 ans]. La catégorie socio-professionnelle dominante était le secteur informel (35,80%). La majorité des patients était scolarisée (85,10%) avait un niveau socio-économique bas (77,30%) et vivait en milieu urbain (88,90%). Les AINS étaient consommés en majorité pour des rachialgies (70,10%) et des rachialgies avec radiculalgies (64,17%), chroniques (75,50%) mécaniques (63,70%) d’installation progressive (85,80%). Le diclofénac appartenant à la famille des arylcarboxyliques (89,20%) était l’AINS le plus utilisé (76,28%) pour une durée de consommation de moins de 14 jours (75,20 %). Le lieu de prédilection de fourniture en AINS des patients était la pharmacie (76%) et la rue (51,50%) avec une efficacité partielle sur la douleur (79,90%). Les patients avaient une satisfaction mitigée après la prise des AINS (64,70%) et jugeaient leur attitude d’automédication mauvaise (70,60%). Les principales raisons motivant l’automédication étaient l’accessibilité (66,85%) et le conseil d’un tiers (52,83). Le niveau d’étude (p =0,046), le niveau socio-économique (p=0,039) et l’intensité de la douleur (p=0,011) influençaient la prise d’AINS en automédication.
Conclusion: La fréquence de consommation des AINS en automédication est très élevée à Abidjan et les facteurs déterminant cette consommation sont le niveau d’étude, le niveau socio-économique et l’intensité de la douleur.
Objective: To identify the factors associated with self-medication with NSAIDs by patients seen in rheumatology in Abidjan.
Methodology: A cross-sectional, analytical study was conducted in the rheumatology department of the CHU of Cocody (Abidjan) from 1st February 2023 to 31st July 2023, involving 388 patients with osteoarticular pain seen in rheumatology consultations who had done self-medication with NSAIDs, irrespective of the route of administration, duration of use and length of time on the drug. We looked for a correlation between socio-demographic, clinical factors, and self-medication with NSAIDs.
Results: The hospital frequency of self-medication with NSAIDs was 76.67%, i.e. 388 out of 506 people surveyed during the study period. There were 257 women (66.20%) and 131 men (33.80%) with an average age of 52 +/- 16 years [extremes: 8 and 84 years]. The dominant socio-professional category was the informal sector (35.80%). The majority of patients were educated (85.10%), had a low socioeconomic level (77.30%) and lived in urban areas (88.90%). NSAIDs were mainly used for chronic (75.50%), mechanical (63.70%) and progressive (85.80%) rachialgia (70.10%) and rachialgia with radiculalgia (64.17%). Diclofenac, a member of the arylcarboxylic family (89.20%), was the most commonly used NSAID (76.28%), with a duration of use of less than 14 days (75.20%). The preferred place of supply for NSAIDs was the pharmacy (76%) and the street (51.50%), with partial efficiency on pain (79.90%). Patients had mixed satisfaction after taking NSAIDs (64.70%) and considered their self-medication attitude to be poor (70.60%). The main reasons for self-medication were accessibility (66.85%) and advice from a third party (52.83%). Level of education (p=0.046), socioeconomic status (p=0.039) and pain intensity (p=0.011) influenced self-medication with NSAIDs.
Conclusion: The frequency of self-medication with NSAIDs is very high in Abidjan, and the factors determining this consumption are level of education, socio-economic status and pain intensity.
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Diaco, Tommaso, Geremia Milanesi, Daniela Zaniboni, Massimo Gritti, Gianna Zavatteri, Marco Claus, and Francesco Velo. "Proposal of resources optimization in the hospital treatment of heart failure by an increased utilization of cardiac rehabilitation." Monaldi Archives for Chest Disease 66, no. 4 (February 4, 2016). http://dx.doi.org/10.4081/monaldi.2006.520.
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weight on social cost. An improved resources utilization could promote a reduction of the new hospitalization and a of medical costs. Working hypotesis: To analyze a model of increased utilization of our Cardiac Rehabilitation (CR) Unit, aiming at improving the cost/profit ratio through a better use of resources and a better assignment of care. With a reduction of average length of stay in the Operative Units for acute patients, we could promote a demand of post-acute hospitalization of 950.7 days of hospitalization that could be assigned to Cardiologic Rehabilitation Unit. Results: With the transfer of patients the utilization rate of CR would increase to 97%. With a mean period in bed of 15.3 days we could hospitalize 62 additional patients and the total margin of contribution would became positive: 69.817 euro. The break even analysis applied to costs and returns of the Unit shows a further indication to increase the hospitalization number in CR Unit with patients transfered from acute patient units. Under the same costs the recovery of efficiency leads to a reduction of variable costs. In the same time there is an increase of returns due to an increase of mean value for case and an increase of services. Conclusion: The increase in the efficiency in the utilization of CR Unit leads to an increase of the Hospital efficiency. The transfer of patients from acute units to CR Unit would allow an increased hospitalization rate for acute patients without requiring additional resources.
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Drapeau, Florent, Caroline Rossard, Béatrice Darricau, Gilles Hoarau, Nicolas Bouscaren, Luciano Hoarau, Sabrina Rosbicki, and Françoise Chan-Ou-Teung. "Evaluation of the Surface Contamination by Cytotoxic Agents of a Chemotherapy Reconstitution Unit: From Analysing Work Practices to Preventive and Corrective Actions." Pharmaceutical Technology in Hospital Pharmacy 1, no. 4 (January 1, 2016). http://dx.doi.org/10.1515/pthp-2016-0021.
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AbstractIntroduction:The staff handling the cytotoxics are exposed to contamination as an occupational hazard. The unit of the Centre Hospitalier Universitaire (C.H.U) of Saint Pierre is ISO9001 certified. In a constant effort to improve the quality of our work, samples of the work surface were collected and allowed us, in a first step, to evaluate the contamination in a CRU in Reunion Island. As a result, corrective and preventive actions were implemented in the work routines.Material and method:53 samples of the work surface, collected in December 2015 and in March and April 2016 in seven different spots, were treated in this observational study. The 5-FU was chosen as example and analysed and quantified by using liquid chromatography associated with a mass spectrometer with a detection limit of 2 ng/pf.Results:We observed a great difference in contamination; 29 samples were positive, the isolator container was the location with the highest level of contamination, including manipulator gloves under the isolator, work surface and the inside of the isolator bin. The contamination was reduced after a first clean-up with water only.The overwrapping bags and the manipulator gloves are only a little or not at all contaminated.ConclusionsIn order to reduce the exposure to cytotoxic residuals, corrective actions have been implemented: more frequent changes of manipulator gloves, the use of closed systems, and cleaning of the isolator with water. The efficiency of these modifications of work practices will be evaluated again in a few months.
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Faiella, Antonio, Livia Onofrio, Filomena Liccardi, Fiorella Paladino, Martina Chiurazzi, Ferdinando Riccardi, and Bruno Chiurazzi. "Oncological Assistance in the Emergency Room Setting: The Role of a Dedicated Oncology Unit." International Journal of Cancer Management 14, no. 7 (August 7, 2021). http://dx.doi.org/10.5812/ijcm.110512.
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Background: The appearance of symptoms that may be related to the worsening of the disease, as well as the toxicity of chemotherapy treatment or an acute complication, are the most frequent reasons for access to the emergency room (ER) for patients with cancer. To date, the Italian territorial health services, as well as local preventive medicine, are unable to provide adequate management of patients with cancer and, for this reason, diagnostic delays and inappropriate hospitalization in the oncology departments have occurred; moreover, it has been observed that many patients receive the first diagnosis of cancer directly in the ER, where the experience in the oncology field is often inadequate. Objectives: Cardarelli Hospital, in Naples, started twenty-two month Experimental Oncological Emergency Service, under the supervision of its own Oncology Department, with the double main objectives of encouraging de-hospitalization and improving diagnostic and therapeutic performance. Methods: We have developed a methodological protocol for patients’ admission to the ER, assuming that the host physician transfers patients with suspected cancer to a new hospital figure, the ER oncologist, who acts as supervisor and coordinator. The first consultation was carried out together with one or more specialists, identified by the supervisor. Based on their characteristics, the patients were divided into 4 categories: (1) Patients with a known diagnosis of cancer and already undergoing anticancer treatments; (2) patients who show complications due to ongoing cancer treatments; (3) patients who no longer respond to anticancer treatments due to the worsening of the disease; (4) patients who are first diagnosed with cancer in the ER. Each individual cohort of patients was directed towards what we have called diagnostic-therapeutic assistance paths (PDTA), specific protocols for each type of patient, which allowed us to reduce the time to diagnosis. Results: According to the data, the average hospitalization time for patients with lung cancer who followed the study was 10 days, compared to 16 days for patients who did not undergo cancer screening in the ER. Another relevant result demonstrated the improvement in the quality and efficiency of medical services by including first aid in the management of cancer patients regards de-hospitalization. In fact, thanks to the experimental protocol we applied, we were able to de-hospitalize 484 patients directly from the ER, which are over 34% of the total. Conclusions: Close integration between hospital medical fields and territorial medicine could improve the quality of cancer treatment and the efficiency of health services management. All of this without affecting the costs of public healthcare because of the considerable improvement in performance which allowed important savings.
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Brice, Kollo Nzima, Bamba Aboubakar, Condé Aboubacar, Mendo Irène, Kpami Nina, Coulibaly Yaya, Coulibaly Abidou Kawélé, et al. "Facteurs Déterminant la Consommation des AINS en Automédication chez les Patients vus en Rhumatologie à Abidjan." European Scientific Journal ESJ 26 (February 29, 2024). http://dx.doi.org/10.19044/esipreprint.2.2024.p511.
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Objectif: Identifier les facteurs déterminant la consommation des AINS en automédication par les patients vus en rhumatologie à Abidjan. Méthodologie: Etude transversale et analytique menée au sein du service de rhumatologie du CHU de Cocody (Abidjan) du 1er Février 2023 au 31 Juillet 2023, portant sur 388 patients présentant des douleurs ostéoarticulaires venus en consultation de rhumatologie et ayant pratiqué une automédication aux AINS quel que soit la voie d’administration, la durée de consommation et l’ancienneté. Nous avons recherché une corrélation entre les facteurs sociodémographiques, cliniques et l’automédication aux AINS. Résultats: La fréquence hospitalière de consommation des AINS en automédication était de 76,67% soit 388 sur 560 personnes recensées pendant la période d’étude. L’effectif comprenait 257 femmes (66,20%) et 131 hommes (33,80%) avec un âge moyen de 52 +/- 16 ans [Extrêmes : 8 et 84 ans]. La catégorie socio-professionnelle dominante était le secteur informel (35,80%). La majorité des patients était scolarisée (85,10%) avait un niveau socio-économique bas (77,30%) et vivait en milieu urbain (88,90%). Les AINS étaient consommés en majorité pour des rachialgies (70,10%) et des rachialgies avec radiculalgies (64,17%), chroniques (75,50%) mécaniques (63,70%) d’installation progressive (85,80%). Le diclofénac appartenant à la famille des arylcarboxyliques (89,20%) était l’AINS le plus utilisé (76,28%) pour une durée de consommation de moins de 14 jours (75,20 %). Le lieu de prédilection de fourniture en AINS des patients était la pharmacie (76%) et la rue (51,50%) avec une efficacité partielle sur la douleur (79,90%). Les patients avaient une satisfaction mitigée après la prise des AINS (64,70%) et jugeaient leur attitude d’automédication mauvaise (70,60%). Les principales raisons motivant l’automédication étaient l’accessibilité (66,85%) et le conseil d’un tiers (52,83). Le niveau d’étude (p =0,046), le niveau socio-économique (p=0,039) et l’intensité de la douleur (p=0,011) influençaient la prise d’AINS en automédication. Conclusión: La fréquence de consommation des AINS en automédication est très élevée à Abidjan et les facteurs déterminant cette consommation sont le niveau d’étude, le niveau socio-économique et l’intensité de la douleur. Objective: To identify the factors determining self-medication with NSAIDs by patients seen in rheumatology in Abidjan. Methodology: Cross-sectional, analytical study was conducted in the rheumatology department of the CHU of Cocody (Abidjan) from 1st February 2023 to 31st July 2023, involving 388 patients with osteoarticular pain seen in rheumatology consultations who had done self-medication with NSAIDs, irrespective of the route of administration, duration of use and length of time on the drug. We looked for a correlation between sociodemographic, clinical factors and self-medication with NSAIDs. Results: The hospital frequency of self-medication with NSAIDs was 76.67%, i.e. 388 out of 560 people surveyed during the study period. There were 257 women (66.20%) and 131 men (33.80%) with an average age of 52 +/- 16 years [extremes: 8 and 84 years]. The dominant socio-professional category was the informal sector (35.80%). The majority of patients were educated (85.10%), had a low socioeconomic level (77.30%) and lived in urban areas (88.90%). NSAIDs were mainly used for chronic (75.50%), mechanical (63.70%) and progressive (85.80%) rachialgia (70.10%) and rachialgia with radiculalgia (64.17%). Diclofenac, a member of the arylcarboxylic family (89.20%), was the most commonly used NSAID (76.28%), with a duration of use of less than 14 days (75.20%). The preferred place of supply for NSAIDs was the pharmacy (76%) and the street (51.50%), with partial efficiency on pain (79.90%). Patients had mixed satisfaction after taking NSAIDs (64.70%) and considered their self-medication attitude to be poor (70.60%). The main reasons for selfmedication were accessibility (66.85%) and advice from a third party (52.83%). Level of education (p=0.046), socioeconomic status (p=0.039) and pain intensity (p=0.011) influenced self-medication with NSAIDs. Conclusion: The frequency of self-medication with NSAIDs is very high in Abidjan, and the factors determining this consumption are level of education, socio-economic status and pain intensity.
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Attfield, Emma, Matthew P. Swankhuizen, Nicole Bruchet, Richard Slavik, and Sean K. Gorman. "Improving the Clinical Pharmacist Handover Process in the Intensive Care Unit with a Pharmacotherapy-Specific Tool: The I-HAPPY Study." Canadian Journal of Hospital Pharmacy 71, no. 2 (May 2, 2018). http://dx.doi.org/10.4212/cjhp.v71i2.1861.
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<p><strong>ABSTRACT</strong></p><p><strong>Background: </strong>Pharmacists in the intensive care unit (ICU) provide pharmaceutical care to critically ill patients. Identification and resolution of drug therapy problems improves outcomes for these patients. To maintain continuity of care, pharmacotherapy plans should be transferred to a receiving pharmacist upon discharge of patients from the ICU. No previous studies have addressed the development or evaluation of a systematic, standardized clinical handover tool and process for pharmacists.</p><p><strong>Objectives: </strong>To assess pharmacists’ satisfaction with and utilization of a pharmacotherapy-specific handover tool and process.</p><p><strong>Methods: </strong>Plan–do–study–act methodology was employed to develop a clinical handover tool and process, which were implemented in a Canadian health authority. For evaluation of the tool and process, a multicentre, online survey questionnaire was distributed to 14 clinical pharmacists in the ICU and ward settings at 5 hospitals between February 15 and April 22, 2016.</p><p><strong>Results: </strong>Thirteen of the pharmacists completed the survey. All 13 pharmacists (100%) were satisfied with usability; 12 (92%) were satisfied with training, organization, and accuracy of the process; and 11 (85%) were satisfied with completeness and efficiency. Most pharmacists conducted 1 or 2 handovers per week, with each having a duration of 3–5 min. Seven (54%) of the respondents reported that they communicated handovers mostly or exclusively by telephone, and 6 (46%) reported using mostly or exclusively face-to-face communication. However, 6 (46%) reported a preference for face-to-face communication, and 3 (23%) reported a preference for the telephone; the remaining 4 (31%) had no preference for mode of communication.</p><p><strong>Conclusions: </strong>Respondents were highly satisfied with the handover tool and process. ICU pharmacists appeared more satisfied with the training, organization, and completeness of handover, whereas ward pharmacists appeared more satisfied with the accuracy and efficiency of handover. Workload requirements were minimal, and face-to-face interaction, although slightly less well utilized than the telephone, was the preferred method of communication.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte : </strong>Les pharmaciens exerçant dans les unités de soins intensifs (USI) prodiguent des soins pharmaceutiques aux patients gravement malades. Or, déceler et résoudre les problèmes pharmacothérapeutiques améliore les résultats cliniques pour ces patients. Afin de maintenir la continuité des soins, les plans pharmacothérapeutiques doivent être communiqués au moment du congé des patients de l’USI à un autre pharmacien qui prendra ensuite le relais. Aucune étude n’avait auparavant étudié la mise au point ou l’évaluation d’un outil et d’un processus normalisés de transfert des soins à être utilisés systématiquement par les pharmaciens.</p><p><strong>Objectifs : </strong>Évaluer le taux de satisfaction des pharmaciens à l’égard d’un outil et d’un processus destinés au transfert des soins pharmacothérapeutiques et en analyser leur utilisation.</p><p><strong>Méthodes : </strong>La méthodologie planifier-exécuter-étudier-agir a été employée pour mettre au point un outil et un processus de transfert clinique introduits dans une régie de santé canadienne. Afin d’évaluer l’outil et le processus, un sondage en ligne a été présenté à 14 pharmaciens cliniciens travaillant soit dans les USI soit dans d’autres services intrahospitaliers de 5 hôpitaux, entre le 15 février et le 22 avril 2016.</p><p><strong>Résultats : </strong>Treize pharmaciens ont rempli le sondage. Les 13 (100 %) étaient satisfaits de la facilité d’emploi; 12 (92 %) étaient satisfaits de la formation, de l’organisation et de l’exactitude du processus; et 11 (85 %) étaient satisfaits du degré d’exhaustivité et de l’efficacité. La plupart des pharmaciens réalisaient 1 ou 2 transferts par semaine, chacun d’une durée de 3 à 5 minutes. Sept (54 %) répondants ont indiqué qu’ils communiquaient les transferts surtout ou seulement par téléphone et 6 (46 %) ont dit le faire surtout ou uniquement en personne. Or, 6 (46 %) ont indiqué une préférence pour la communication en personne et 3 (23 %) ont dit préférer la voie téléphonique. Les 4 (31 %) autres étaient indifférents au mode de communication utilisé.</p><p><strong>Conclusions : </strong>Les répondants étaient grandement satisfaits de l’outil et du processus de transfert. Les pharmaciens exerçant dans les USI semblaient plus satisfaits de la formation, de l’organisation et du degré d’exhaustivité du transfert alors que les pharmaciens travaillant dans d’autres services intra-hospitaliers semblaient plus satisfaits de l’exactitude et de l’efficacité du transfert. La charge de travail était minimalement accrue et la communication en personne, bien qu’utilisée moins fréquemment que celle par téléphone, était le mode préféré.</p>
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Burke, Natasha, James M. Bowen, Sue Troyan, Jathishinie Jegathisawaran, Carolyn Gosse, Marita Tonkin, Sandra Kagoma, Ron Goeree, and Anne Holbrook. "Management of Hospital Formularies in Ontario: Challenges within a Local Health Integration Network." Canadian Journal of Hospital Pharmacy 69, no. 3 (June 30, 2016). http://dx.doi.org/10.4212/cjhp.v69i3.1554.
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<p><strong>ABSTRACT</strong></p><p><strong>Background: </strong>Expenditures on drugs dispensed and administered to patients in Canadian hospitals have been estimated at $2.4 billion per year. Pharmacy and therapeutics (P&T) committees play a key role in the evaluation and management of drug therapies in this setting. Hospitals differ with respect to the composition of these committees, their members’ expertise, and the processes used for making formulary decisions.</p><p><strong>Objectives: </strong>To examine the current processes for formulary drug review from the perspective of P&T committees and their individual members, and to examine the needs and preferences of these stakeholders related to evidence review and potential collaborative drug review processes within a large Local Health Integration Network (LHIN) in Ontario.</p><p><strong>Methods: </strong>Twenty-three sites within 10 hospital corporations in LHIN 4 (Hamilton Niagara Haldimand Brant) were recruited. A 2-part questionnaire was developed and pretested for clarity and comprehensiveness. The institution profile section of the questionnaire was to be completed by pharmacy directors and the P&T section by committee members.</p><p><strong>Results: </strong>Ten pharmacy directors and 28 committee members representing 10 P&T committees responded. A mean of 6.4 new drug requests were reviewed annually by each P&T committee. Across the LHIN, the workload associated with reviewing submissions for new drugs to be added to the formulary represented 0.84 full-time equivalent. The quality of clinical evidence in the drug submissions was rated more favourably than the quality of economic evidence; furthermore, the use of economic evidence was limited by a lack of health economics expertise within the committees. A centralized review process for the LHIN was perceived as beneficial to improve efficiency, the quality of review, and standardization, and also to reduce costs.</p><p><strong>Conclusions: </strong>Across the Hamilton Niagara Haldimand Brant LHIN, considerable time and resources are spent on the review of potential new drugs for addition to the hospitals’ formularies. A standardized formulary review process, with greater use of provincial and national drug reviews, would likely benefit all LHINs.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte : </strong>Les dépenses pour les médicaments distribués et administers aux patients dans les hôpitaux canadiens ont été évaluées à 2,4 milliards de dollars par année. Les comités de pharmacologie et de thérapeutique jouent un rôle central dans l’analyse et la prise en charge des pharmacotherapies dans ce milieu. La composition de ces comités et l’expertise de leurs membres varient d’un hôpital à l’autre, tout comme les processus qui y sont employés pour prendre des décisions à propos de la liste des médicaments.</p><p><strong>Objectifs : </strong>Étudier les processus actuels d’ajout de médicaments à la liste locale du point de vue des comités de pharmacologie et de thérapeutique et de leurs membres. Examiner les besoins et préférences de ces parties prenantes quant à l’analyse des données probantes et aux potentiels processus collaboratifs d’évaluation des médicaments au sein d’un important réseau local d’intégration des services de santé (RLISS) ontarien.</p><p><strong>Méthodes : </strong>Vingt-trois établissements dans 10 organisations hospitalières du RLISS 4 (Hamilton Niagara Haldimand Brant) ont été retenus. On a élaboré un questionnaire de deux parties qui a été testé au préalable pour en vérifier la clarté et l’exhaustivité. La section sur le profil de l’établissement devait être remplie par les directeurs de pharmacie et celle sur la pharmacologie et la thérapeutique devait l’être par les membres des comités.</p><p><strong>Résultats : </strong>Dix directeurs de pharmacie et 28 membres représentant 10 comités de pharmacologie et de thérapeutique ont répondu. En moyenne, 6,4 nouvelles demandes d’ajout de médicament étaient analysées annuellement par chaque comité. Dans l’ensemble du RLISS, la charge de travail nécessaire à l’analyse des demandes d’ajout de nouveaux médicaments à la liste locale représentait 0,84 d’un poste équivalent temps plein. La qualité des données cliniques probantes dans les demandes d’ajout était considérée plus favorablement que celle des données économiques. De plus, comme les membres des comités ne possédaient pas l’expertise nécessaire en économie de la santé, l’utilisation des données probantes à ce sujet était limitée. Un processus centralisé d’analyse pour le RLISS était perçu comme avantageux pour améliorer l’efficience, la qualité de l’analyse et la normalization ainsi que pour réduire les coûts.</p><p><strong>Conclusions : </strong>Dans l’ensemble du RLISS de Hamilton Niagara Haldimand Brant, beaucoup de ressources et de temps sont accordés à évaluer l’ajout de médicaments à la liste locale. Tous les RLISS tireraient sûrement profit d’un processus normalisé d’ajout à la liste locale des médicaments ainsi que d’une meilleure utilisation des évaluations réalisées par les organismes provinciaux et national.</p>
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Vuong, Vincent, Ramola Bhojwani, Anjana Sengar, and Allan Mills. "Prescription Modification by Pharmacists in a Hospital Setting: Are Ontario Pharmacists Ready?" Canadian Journal of Hospital Pharmacy 74, no. 3 (July 5, 2021). http://dx.doi.org/10.4212/cjhp.v74i3.3151.
Full textAbstract:
Background: Under Ontario’s Public Hospitals Act, the scope of professional practice of hospital pharmacists is approved by each hospital’s medical advisory committee. Some Ontario hospitals have adopted policies or medical directives related to prescription modification, allowing pharmacists to broadly adapt, discontinue, hold, or renew prescriptions as part of their clinical scope of practice. Objectives: The primary objective of this study was to describe Ontario hospital pharmacists’ perception of their readiness to independently modify prescriptions. The secondary objectives of this study were to gather opinions on the perceived benefits, drawbacks, facilitators, and barriers to prescription modification by pharmacists and to determine how various factors affect perceived readiness. Methods: A confidential web-based survey with Likert-type quantitative questions and qualitative open-ended questions was distributed to 936 hospital pharmacists in Ontario between May and July 2019. Mean scores were calculated for the following constructs affecting prescription modification: self-efficacy, support from the practice environment, and support from interprofessional relationships. Independent t tests were conducted to compare responses between subgroups of interest. The answers to open-ended questions were analyzed thematically. Results: The survey had a 29% response rate (n = 271). The mean self-efficacy score was 5.2 out of 7 (standard deviation [SD] 1.0, Cronbach α = 0.88), equivalent to “quite sure”. The mean score for support from the practice environment was 3.3 out of 5 (SD 0.4, Cronbach α = 0.75), equivalent to “not a factor”. The mean score for support from interprofessional relationships was 4.2 out of 5 (SD 0.1, Cronbach α = 0.80), equivalent to “weak support”. Improved efficiency of care, timelier interventions to improve medication safety and efficacy, and improved interprofessional collaboration were cited as benefits of prescription modification by pharmacists. Potential for inappropriate decision-making and miscommunication were cited as concerns. Respondents in hospitals who were already performing prescription modification reported higher self-efficacy to modify prescriptions in clinical areas of both familiarity and unfamiliarity and greater support from prescribers. Conclusions: A large proportion of respondents to a survey of Ontario hospital pharmacists expressed an encouraging level of readiness to independently modify prescriptions. Responses to open-ended questions in this study provided valuable insights to inform widespread adoption of this practice change. RÉSUMÉ Contexte : En vertu de la Loi sur les hôpitaux publics de l’Ontario, le comité consultatif de chaque hôpital approuve l’élargissement de la pratique professionnelle des pharmaciens d’hôpitaux. Certains hôpitaux de l’Ontario ont adopté des politiques ou des directives médicales concernant la modification de la prescription. Celles-ci autorisent les pharmaciens à adapter, cesser, suspendre ou renouveler largement les prescriptions dans le cadre de leur champ de pratique. Objectifs : L’objectif principal de cette étude visait à décrire la perception des pharmaciens d’hôpitaux de l’Ontario de leur degré de préparation à modifier des prescriptions de manière indépendante. Les objectifs secondaires consistaient à recueillir les opinions sur les avantages, les inconvénients, les éléments de facilitation et les obstacles perçus par les pharmaciens au sujet de la modification de la prescription et de définir comment divers facteurs influençaient la perception de leur degré de préparation. Méthodes : Entre mai et juillet 2019, 936 pharmaciens d’hôpitaux en Ontario ont reçu une enquête confidentielle menée sur Internet comportant des questions quantitatives de type Likert et des questions ouvertes qualitatives. Les scores médians ont été calculés pour les concepts suivants liés à la modification de la prescription : l’autoefficacité, le soutien de l’environnement de pratique et le soutien des relations interprofessionnelles. Des tests t indépendants ont été menés pour comparer les réponses entre les sous-groupes sous-groupes qui intéressaient les auteurs. Les réponses aux questions ouvertes ont été analysées par thème. Résultats : Le taux de réponses à l’enquête se montait à 29 % (n = 271). Le score moyen pour le thème « Autoefficacité » était de 5,2 sur 7 (écart type [ET] 1, Cronbach α = 0,88), ce qui équivaut à la réponse « Assez certain ». Le score moyen pour le thème « Soutien de l’environnement de pratique » était de 3,3 sur 5 (ET 0,4, Cronbach α = 0,75), ce qui équivaut à la réponse « N’est pas un facteur ». Le score moyen pour le thème « Relations interprofessionnelles » était de 4,2 sur 5 (ET 0,1, Cronbach α = 0,80), ce qui équivaut à la réponse « Soutien faible ». Les pharmaciens ont cité l’amélioration de l’efficacité des soins, les interventions en temps opportun visant à améliorer l’innocuité et l’efficacité des médicaments ainsi que l’amélioration de la collaboration interprofessionnelle comme étant des avantages de la modification indépendante des prescriptions. Ils ont aussi indiqué que le risque de prise de décision inappropriée ainsi que la mauvaise communication constituaient pour eux un sujet de préoccupation. Les répondants qui pratiquaient déjà la modification de la prescription en milieu hospitalier ont indiqué un gain d’autoefficacité de la modification des prescriptions dans des domaines cliniques qui leur sont familiers ou non, ainsi qu’un plus grand soutien de la part des prescripteurs. Conclusions : Une grande partie des répondants à une enquête menée auprès de pharmaciens d’hôpitaux de l’Ontario ont jugé que leur degré de préparation à la modification indépendante des ordonnances était prometteur. Les réponses aux questions ouvertes de cette étude fournissent des éclaircissements précieux sur l’adoption généralisée de ce changement de pratique.