FreshRSS

🔒
❌ Acerca de FreshRSS
Hay nuevos artículos disponibles. Pincha para refrescar la página.
AnteayerTus fuentes RSS

Determinants associated with completion of postdischarge follow-up survey among multimorbid patients: a secondary analysis of the non-randomised clinical In-HospiTOOL trial

Por: Thuraisingam · H. · Laager · R. · Gregoriano · C. · Schuetz · P. · Mueller · B. · Kutz · A.
Importance

Postdischarge surveys are critical in collecting patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs), but response rates vary and are often low.

Objective

To assess determinants that are associated with survey completion by phone in a complex medical care setting.

Design

Secondary analysis of a prospective controlled interrupted time series analysis.

Setting

As part of the non-randomised controlled In-HospiTOOL trial, a survey was conducted to gather data on PREMs and PROMs in multimorbid patients from seven hospitals in Switzerland.

Participants

31 103 medical acute care hospitalisations among seven intervention hospitals who were eligible for the survey.

Interventions

Over a 6-month pre-intervention phase (August 2017 through January 2018) and a subsequent 12-month intervention phase (February 2018 through January 2019), patients were contacted by phone 30 days after hospital admission.

Main outcomes and measures

The primary outcome was responsiveness to the survey. We assessed group differences between responders and non-responders, and associations of patient characteristics with survey completion were estimated using generalised estimating equations.

Results

Of 31 103 eligible patients, 25 557 (82.2%) completed the survey 30 days after hospital admission. Responders were marginally older than non-responders (median (IQR) age, 73 (60–82) years vs 72 (57–82); standardised mean difference (SMD), –0.08), were more likely to be Swiss (81.9% vs 74.4%; SMD, –0.18), to have private healthcare insurance (22.9% vs 17.9%; SMD, 0.12), to be living at home before admission (85.7% vs 78.6%; SMD, 0.18) and to be less frail (67.4% vs 59.1%; SMD, 0.18). A longer length of stay (OR 0.98; 95% CI 0.97 to 0.99), discharge to a non-home institution (OR 0.50; 95% CI 0.46 to 0.54) and rehospitalisation within 30 days (OR 0.78; 95% CI 0.68 to 0.89) is associated with a decreased responsiveness.

Conclusions

The study shows that achieving a high survey response rate among vulnerable acute care patients is feasible, which in turn allows for the effective identification of key determinants and enhances the collection of information on patients’ experiences and outcomes.

Trial registration number

ISRCTN83274049.

Study protocol for optimising antipsychotic prescribing among hospitalised patients in the acute care setting in Scotland: a national retrospective cohort study

Por: Goswami · C. · Mueller · T. · Wall · A. · Johnson · C. F. · Grosset · D. · Bennie · M. · Kurdi · A.
Introduction

Prescribing high-dose antipsychotics is typically reserved for individuals with treatment-resistant severe mental illnesses, such as schizophrenia, bipolar disorder and psychotic depression. It carries an increased risk of adverse drug effects, necessitating regular monitoring. Non-mental health specialist clinicians may not always be aware when the maximum recommended dose of antipsychotics is exceeded, leading to unintentional high-dose prescribing without recognising the need for additional monitoring or understanding the associated risks. Therefore, providing clinical decision support (CDS) tools to support clinicians and improve the appropriate prescribing of antipsychotics is important. The aim of this study is to understand current prescribing practices and assess the impact of high-dose antipsychotic prescribing on clinical outcomes among hospitalised patients. The findings from this study will shape a future project focused on developing an integrated computerised CDS tool.

Methods and analysis

This retrospective cohort study will examine antipsychotic prescribing among hospitalised patients using Hospital Electronic Prescribing and Medicines Administration data in Scotland from 2019 to 2023, in linkage with hospital records, Scottish Morbidity Records and primary care prescribing (Prescribing Information System). Patients will be grouped into those prescribed high-dose (exposed), defined as exceeding the 100% maximum recommended British National Formulary dose and normal-dose (unexposed) antipsychotics, followed from their first ever antipsychotic prescription date (index date) until the end of the study, study outcomes or death, whichever happens first. We will quantify high-dose antipsychotic prescribing, profile patient characteristics and use machine learning techniques to assess associations of high-dose antipsychotic prescribing with clinical outcomes, including harms and benefits, but will not attempt to establish causality.

Ethics and dissemination

The Health and Social Care Public Benefit and Privacy Policy Panel (HSC-PBPP) has granted ethical approval (ref. 2024-0239) following a Data Protection Impact Assessment, with data securely held and accessed in the National Safe Haven. The results will be published in international peer-reviewed journals and will be shared with clinicians.

Digitalisation of the guideline registry of the Association of Scientific Medical Societies in Germany for an open, guideline-based, trustworthy evidence ecosystem (Dissolve-E): a protocol of a before-after study with different user groups

Por: Nothacker · M. · Stegbauer · C. · Burckhardt · M. · Nink-Grebe · B. · Eisele-Metzger · A. · Meerpohl · J. · Mueller · I. · Kopp · I. · on behalf of the Dissolve-E study group · Litzkendorf · Knizia · Meyer · Kliemannel · Broge · Toews · Huneke · Bucher · Dincklage · Lichtner · Sta
Introduction

Internationally, the vision of a ‘Digital Trustworthy Evidence Ecosystem’ is being pursued with clinical practice guidelines (CPGs) as one element of such a system. Consequently, CPGs and CPG repositories need to be digitalised.

Methods and analysis

The objective of this prospective, before-after study is to evaluate the impact of digitalising a quality-assured CPG registry using the international data format standard ‘Fast Healthcare Interoperability Resources’ (FHIR). This includes the architecture of the registry, the format of individual guidelines and application programming interfaces to import and export CPG content. The study is guided by a scoping review.

The primary outcome is the usability of the digitalised CPG registry and CPG content for different user groups comprising CPG developers, CPG administrators, health care professionals and patients—including at the point of care in in- and outpatient settings—and technical professionals as users of CPG content in digital applications.

For the before-after comparison, semi-quantitative (surveys) and qualitative (focus groups) methods are applied. All user groups will be involved in a baseline analysis to assess user expectations and technical requirements. According to the results, the digitalised guideline registry will be implemented. The intervention comprises the testing of the digitalised registry with guideline content by all user groups. Analysis of outcomes will include formative and summative evaluation. Final results and further research needs will be discussed in a World Café with all stakeholders.

Ethics and dissemination

The Ethics Committee of the Berlin chamber of physicians, in accordance with its code of conduct §15 section 1 (Eth-KB-24-11) confirmed that no ethical approval is needed for this study. The study is registered in the German Clinical Trials Registry (No: DRKS00034111). Results will be presented at national and international conferences, published in peer-reviewed journals and on the website of the funding institution.

Trial registration number

German Clinical Trials Registry (No: DRKS00034111).

❌