Cost Savings Research Articles

Abstract 4134796: Safety of over 1000 consecutive, selected low risk patients with accelerated discharge from a chest pain unit with early generation cardiac troponin use, no cardiac functional or anatomic testing and no clinical risk scores

Introduction: Over 6 million patients (pts) present to US emergency departments annually with chest pain (CP), of which the majority are found to have no serious disease. Evaluation of these pts results in substantial costs for unnecessary hospitalization and extensive testing. We evaluated the utility of early discharge of selected low-risk (LR) CP pts from a chest pain unit (CPU) in which no predischarge testing or risk scores were used. Methods: This retrospective study analyzed 1,037 consecutive LR CP pts from a prospectively recorded database. LR was based on normal examination, stable hemodynamics, normal electrocardiograms (ECG), and negative cardiac troponin I, without pre-discharge functional or anatomic cardiac testing or risk scores. We assessed demographics, comorbidities, medications, and major cardiac events at 30 d and 6 mos post-discharge. Results: The study group of 1037 pts comprised 26% of the 4010 pts admitted to the CPU during the study interval from May 2005 to March 2015. Mean patient age was 55 yrs, 56% (n=575) were women, and comorbid conditions were frequent: hypertension (64.1%), dyslipidemia (46.1%), diabetes (25.7%), documented coronary artery disease (19.3%), previous revascularization (20.6%), previous myocardial infarction (10.1%). Length of stay (LOS) in the CPU to discharge was 10.4 hrs. Women received more discharge cardiac medications than men: antiplatelet agents, statins, beta blockers, ACE inhibitors, angiotensin II blockers, calcium channel blockers, and nitrates (p=0.0002 - 0.04). Follow-up (F/U) at 30 d was 91% (n=948) complete and revealed 0.3% (n=3) cardiac deaths, 0.6% (n=6) acute coronary syndromes (ACS), and 6.2% (n= 64) receiving revascularization. F/U at 6 mos was 90% (n=936) complete and total cumulative cardiac deaths were 0.9% (n=9), 0.7% (n=7) ACS and 6.3% (n=65) revascularization. Discussion: Cardiac events at both 30 d and 6 mos were very low and did not differ in men and women (P=0.8). LOS in CPU was minimized and patient safety was maintained. These selected LR pts remained at reduced risk for cardiac events despite a high rate of comorbidities. Early discharge of selected LR CP pts based on history, examination, ECG, and biomarker evaluation was safe and effective. Conclusion: This approach in selected LR pts has the potential to reduce unnecessary diagnostic testing and CPU LOS. This strategy could lead to substantial savings in healthcare costs without compromising patient safety.

Enhancing Resurrection Practices for Unusable General Inventory Items in Hospital Settings

Background: Effective patient care in hospitals relies on the proper functioning of medical equipment. Malfunctioning general inventory items, such as patient beds, wheelchairs, and saline stands, pose significant challenges to hospital operations and patient care. D.G.H. Negombo needs help maintaining these items due to limited financial resources and inadequate technical expertise.Objective: To improve the resurrection practices of selected unusable general inventory items at D.G.H. Negombo.Methodology: This cross-sectional descriptive study was conducted from August 1, 2022, to November 15, 2023, and involved three phases: pre-intervention (assessment), intervention (implementation), and post-intervention (evaluation). Data collection methods included key informant interviews (K.I.I.), self-administered questionnaires (S.A.Q.), and desk reviews. The study targeted general inventory items marked for condemnation and included unit heads and maintenance technicians in its scope.Results: Pre-intervention assessments identified key issues such as inadequate technical skills, poor coordination, and insufficient infrastructure. Interventions implemented included skill development workshops, improved documentation practices, and enhanced communication strategies. Post-intervention evaluations demonstrated significant improvements in repair times, resource availability, and satisfaction among unit heads. Notably, 78% of wheelchairs, 79% of patient trolleys, and 76% of patient beds were successfully resurrected.Conclusions: The interventions enhanced the resurrection of unusable general inventory items, extended equipment lifespans, and achieved substantial cost savings.

Minimum-Energy Scheduling of Flexible Job-Shop Through Optimization and Comprehensive Heuristic

This study considers a flexible job-shop scheduling problem where energy cost savings are the primary objective and where the classical objective of the minimization of the make-span is replaced by the satisfaction of due times for each job. An original two-level mixed-integer formulation of this optimization problem is proposed, where the processed flows of material and their timing are explicitly considered. Its exact solution is discussed, and, considering its computational complexity, a comprehensive heuristic, balancing energy performance and due time constraint satisfaction, is developed to provide acceptable solutions in polynomial time to the minimum-energy flexible job-shop scheduling problem, even when considering its dynamic environment. The proposed approach is illustrated through a small-scale example.

INNV-17. SAME-DAY DISCHARGE AFTER LASER INTERSTITIAL THERMAL THERAPY: A PROSPECTIVE COHORT PILOT STUDY WITH A MATCHED CONTROL GROUP

Abstract BACKGROUND Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive treatment modality for intracranial pathologies, offering precision and control over tissue damage. With implementation of enhanced recovery after surgery (ERAS) protocols within neurosurgery, identifying patients amenable for same-day discharge (SDD) is an important step towards streamlining perioperative care following LITT, and correspondingly, we aim to summarize our initial experience. METHODS We conducted a prospective study at the University of Miami Hospital of 7 patients who underwent LITT for intracranial pathologies and were discharged on the same day of ablation (post-ablation day 0, PAD0). We then performed a retrospective case-control study against a historic matched PAD1 cohort comparing categorical and continuous variables for statistical significance. RESULTS The mean age of the PAD0 cohort was 55 years with 71% males. Preoperative neurological status and comorbidities did not differ significantly between the PAD0 and PAD1 cohorts for KPS (median [IQR]: 80 [80-90] vs. 90 [80-90], p=0.40), mFI-5 (median [IQR]: 1 [1.5] vs. 0 [1], p=0.54), and mFI-11 (median [IQR]: 1 [1.5] vs. 1 [1], p=0.52). PAD0 outcomes demonstrated no immediate complications, neurosurgical readmissions, or significant neurological deficits within 6 months post-procedure and were non-significantly different than PAD1 patients. No PAD0 patient experienced intracranial hemorrhage or vasogenic edema following LITT that necessitated further intervention. CONCLUSIONS Our study demonstrates the safety and feasibility of same-day discharge following LITT for intracranial pathologies in the appropriately selected patient. Through meticulous patient selection and optimized perioperative protocols, expedited recovery without compromising patient outcomes was achieved. This approach holds potential for substantial cost savings and resource optimization within healthcare systems. Further research and quality improvement initiatives are warranted to refine patient selection criteria and maximize the benefits of same-day discharge in LITT practice.

Bridging the gap: opportunities, challenges, and future directions for teleradiology in rural healthcare

Teleradiology, the electronic transmission of radiological images and data for diagnostic purposes, holds significant promise for improving healthcare access in rural and underserved regions. This review explores the opportunities and challenges of implementing teleradiology in rural settings, where limited access to radiology services exacerbates healthcare disparities. Teleradiology offers multiple benefits, including improved access to timely diagnostics, enhanced decision-making, and cost savings for rural patients who would otherwise need to travel to urban centers for radiology services. It has shown positive outcomes globally, with examples in India, Mali, the Democratic Republic of Congo, and Brazil, demonstrating its feasibility and potential to reduce geographic health inequities. However, implementing teleradiology in these settings faces several challenges, such as technological limitations, workforce shortages, regulatory and legal barriers, data security concerns, and cultural acceptance issues. Solutions and recommendations include investments in infrastructure, workforce training, supportive regulatory frameworks, secure data management, and adaptable telehealth models that consider socioeconomic factors in rural areas. By addressing these challenges, stakeholders can enhance the impact of teleradiology in rural healthcare systems, ultimately contributing to reduced disparities and improved healthcare outcomes. This review provides a comprehensive overview of the current landscape and suggests actionable pathways for advancing teleradiology in rural settings worldwide.

Water Resource Recovery Facilities Empower the Electrolytic Hydrogen Economy.

The global transition to net-zero emissions necessitates the integration of clean hydrogen as a key solution. To facilitate the required expansion of clean hydrogen production, sustainable water sources are required to support the electrolysis process. Utilizing nontraditional water sources such as water resource recovery facility (WRRF) effluents could potentially alleviate the water constraints and create cobenefits, but the real-world feasibility has not been explored in depth. Here, we investigated the geospatial interplay between WRRFs and H2 users in a clean hydrogen economy. We developed an optimization framework for contiguous U.S. that would identify H2 users-WRRF pairing through techno-economic constraint and multicriteria decision analysis, and we found that utilizing reclaimed water from WRRFs could save 66% (62-99%) of freshwater for clean hydrogen economy while accumulating $758 (275-1162) million annual national cost savings. The added benefits from H2 users to WRRFs such as pure oxygen aeration would provide a compelling new opportunity for infrastructural symbiosis but warrant a future investigation on its technical and economic feasibilities.

Delivering a mental health response vehicle service in Wales: a pilot initiative.

NHS emergency services, including ambulance services and emergency departments (EDs), are under considerable pressure due, in part, to the lack of availability of alternative healthcare services. People with mental health issues often contact ambulance 999 services when they cannot access the care they require from other sources. Welsh Ambulance Services NHS Trust (WAST) employs mental health professionals in its 999 call centres to provide remote mental health triage and support. While this has been effective in reducing ambulance conveyance to EDs, many patients still require a face-to-face assessment. To address this, WAST explored the option of providing a mental health response vehicle (MHRV) service, which has been shown to be effective in some ambulance trusts in England. This article gives an overview of a pilot MHRV service that was delivered by WAST across the Aneurin Bevan University Health Board locality in south-east Wales in between January and March 2024. Results suggest that the MHRV service can reduce ED conveyance rates and potentially provide cost savings for WAST and the wider NHS in Wales.

Cost-Effectiveness of Vibrant System vs. Linaclotide in Chronic Idiopathic Constipation.

Chronic idiopathic constipation (CIC) is a common disorder that has a large unmet clinical need, affecting 8.0-12.0% of the US population and disproportionately affecting female individuals more than male individuals. Patients and physicians are equally dissatisfied with over-the-counter and prescription treatments. Physician dissatisfaction is at 78%. CIC has a significant negative impact on quality of life (QoL). The objective of this analysis was to compare the total cost and QoL of the Vibrant System vs. linaclotide, over 1-3years of treatment. Markov models were utilized to project 1-3-year US costs and health outcomes (quality adjusted life years, QALYs) comparing theVibrant System to the current standard of care pharmacologic therapy (linaclotide). One model examined direct (D) costs plus QALYs. Direct (D) costs included list price of product and medical treatment costs due to adverse events. Costs (D) were as of 2024; derived from themedical literature. A second model examined D as well as indirect (I)costs (absenteeism, presenteeism) [D + I] and QALYs. Longitudinal 12-month persistence prescription data for linaclotide was obtained from IQVIA claims data. The Vibrant System persistence data was derived from post market collection. One-way sensitivity analyses were also performed. Years1-3 direct costs were lower with Vibrant System with improved QALYs. Cumulative D + I data analysis for the Vibrant System at 12months, and for years2 and 3 show increased cost savings from $345 to $3866 with improved effectiveness. On the basis of lower costs and improved QALYs, the Vibrant System should be considered a first-line therapy for CIC and should be covered by insurers.

Spillover Effects of the SEC's Regulatory Oversight on Private Debt Contracting: Evidence from Cross‐listed Foreign Firms

ABSTRACTWe examine the effect of the Securities and Exchange Commission's (SEC) regulatory oversight on private debt contracting outcomes, using the signing of the multilateral memorandum of understanding (MMoU) as a natural experiment. The MMoU enables the SEC to take stricter punitive actions against wealth expropriation by cross‐listed firms’ insiders and enforce better compliance with applicable rules and regulations. We find that enhanced SEC oversight in the post‐MMoU regime lowers loan spreads by 36 basis points, thus saving an average cross‐listed firm approximately $9 million in direct loan costs over the life of a bank loan. Cross‐sectional analyses show that the effect is more pronounced for borrowers from countries with weaker institutions, borrowers with greater accounting discretion, and for loans arranged by top lenders or loans not secured by collateral. Conversely, the effect is less pronounced for borrowers who use IFRS or when the SEC faces greater budgetary constraints. Enhanced SEC oversight also leads to an increase in loan maturity and a decrease in financial covenants. Our evidence suggests that while the SEC's primary mandate is to protect public equity and bond investors, its supervision yields substantial borrowing cost savings and more lenient nonprice loan terms in the private debt markets as well.

Exploring Waqf Management Transformation: Opportunities and Challenges (Case Study in Ismuhu Yahya Foundation Pontianak)

This study aims to explore the impact of technology implementation on the efficiency of waqf management in the non-profit organization Ismuhu Yahya Foundation Pontianak. Currently, waqf is undergoing a transformation as a result of advances in digital technology. As one of the important social and humanitarian services, an in-depth understanding of the adaptation process is needed to make this digital transformation work. This research uses a qualitative approach with a case study method to explore the impact of waqf management transformation, as well as to understand the ongoing digitalization process. Through interviews, direct observation, and review of relevant documents, this research explores the changes that occurred in waqf management at Ismuhu Yahya Foundation Pontianak. The results show a significant improvement in the efficiency of waqf management, including administrative cost savings and increased transparency. In addition, this research provides some novelty and unique contributions. First, by raising the topic of digital transformation in waqf management, which has not been widely studied, this research brings novelty by introducing a theme that is relevant to current technological developments. Secondly, as an in-depth local case study, the selection of Ismuhu Yahya Foundation provides new value as not many researchers have explored local areas with a qualitative approach. Third, the specific opportunities and challenges faced during the transformation process. Fourth, this study also found changes in the interaction between waqif (waqf giver) and nazir (waqf recipient). Finally, this study can contribute to the development of theories on waqf management, particularly in the context of digital transformation, which can serve as a foundation for future research and implementation.

Advanced Design of Naval Ship Propulsion Systems Utilizing Battery-Diesel Generator Hybrid Electric Propulsion Systems

As advanced sensors and weapons require high power, naval vessels have increasingly adopted electric propulsion systems. This study aims to enhance the efficiency and operability of electric propulsion systems over traditional mechanical propulsion systems by analyzing the operational profiles of modern naval vessels. Consequently, a battery-integrated generator-based electric propulsion system was selected. Considering the purpose of the vessel, a specification selection procedure was developed, leading to the design of a hybrid electric propulsion system (comprising one battery and four generators). The power management control technique of the proposed propulsion system sets the operating modes (depending on the specific fuel oil consumption of the generators) to minimize fuel consumption based on the operating load. Additionally, load distribution control rules for the generators were designed to reduce energy consumption based on the load and battery state of charge. MATLAB/Simulink was used to evaluate the proposed system, with simulation results demonstrating that it maintained the same propulsion performance as existing systems while achieving a 12-ton (22%) reduction in fuel consumption. This improvement results in cost savings and reduced carbon dioxide emissions. These findings suggest that an efficient load-sharing controller can be implemented for various vessels equipped with electric propulsion systems, tailored to their operational profiles.

Management of COVID-19 in the community using virtual care: An Australian perspective.

Virtual care and remote monitoring were widely used during the COVID-19 pandemic. However, early evaluations of effectiveness were often inconclusive due to low rates of enrolment and limited data. The aim of this study was to evaluate the effectiveness of virtual care in managing individuals in community-based self-isolation and quarantine in Australia during this pandemic. A retrospective cross-sectional study was conducted of individuals admitted to a virtual hospital in Sydney who either tested positive for COVID-19 and required self-isolation, or tested negative but still needed to self-isolate, amidst the Delta wave of the COVID-19 pandemic. Outcome measures included health service utilisation, in-hospital mortality, patient-reported experience measures (PREM), and cost savings resulting from avoided emergency department (ED) presentations. Out of 9571 individuals admitted, 8544 (89.3%) had COVID-19. Clinical deterioration or acute illness occurred in 2477 (25.9%) individuals, of whom 890 (9.3%) were referred to ED for further assessment or investigation, and 614 (6.4%) were admitted for inpatient treatment. Overall mortality was 0.2%. Out of 1020 individuals who completed the PREM survey, 846 (82.9%) rated the overall virtual care experience as 'good' or 'very good'. Avoided ED presentations possibly resulted in cost savings estimated between AU$691,214 and AU$2,994,540. Virtual care was successfully used to manage a large number of individuals in community-based self-isolation and quarantine during the COVID-19 pandemic. Scalable pathways for triage, monitoring and clinical escalation via telehealth ensured patient safety and acceptability, and alleviated strain on the broader health system.

Innovative Cloud Architectures: Revolutionizing Enterprise Operations Through AI Integration

This article examines the transformative impact of artificial intelligence (AI) and machine learning (ML) integration in cloud computing architectures across enterprise operations. Through an analysis of 250+ enterprise deployments, we demonstrate significant improvements including a 42% reduction in operational costs and 53% enhancement in process efficiency. The article presents a comprehensive framework for implementing AI-enhanced cloud architectures, combining multi-cloud and hybrid approaches across major platforms including Microsoft Azure, AWS, and Google Cloud. Our findings highlight key advancements in predictive resource management (91% accuracy), automated scaling (67% reduction in overprovisioning), and intelligent security systems (99.7% threat detection accuracy). The article provides detailed implementation guidelines, security protocols, and best practices, supported by a case study of a Fortune 500 manufacturing corporation that achieved $4.2 million in annual maintenance cost savings and 52% improvement in resource allocation efficiency. The article also explores future developments in quantum computing integration and multi-cloud orchestration, establishing a roadmap for organizations seeking to leverage AI-enhanced cloud architectures for competitive advantage.

The Diverse Applications of Aerospace Drones: From Defense to Humanitarian and Commercial Uses

This research investigates the extensive applications of aerospace drones across defense, humanitarian, and commercial sectors, showcasing their transformative impact on modern industry. Aerospace drones have become pivotal tools in diverse settings—from defense and tactical operations to humanitarian aid and infrastructure management—offering operational efficiencies, cost savings, enhanced safety, and innovative solutions to complex challenges. This study explores defense applications such as military reconnaissance, where Vertical Take-Off and Landing (VTOL) drones enable effective surveillance in challenging terrains. In humanitarian settings, drones are utilized for disaster response in earthquake and flood zones, providing critical functions like search-and-rescue, real-time damage assessment, and medical supply delivery. Commercially, drones support long-range infrastructure inspections, smart agriculture, and environmental monitoring, driven by advancements in imaging and remote sensing. The project emphasizes the technical challenges and ethical considerations associated with drone deployment, particularly the need for robust AI and autonomous navigation systems in dynamic and unpredictable environments. Collaborations with international aerospace firms and humanitarian organizations have further refined drone integration strategies in both civilian and military contexts. The research concludes with a discussion on regulatory frameworks and environmental impacts, aiming to provide a comprehensive view of thefuture of aerospace drones and their role in addressing global challenges.

Circular agro-economies (CAE): reducing waste and increasing profitability in agriculture

This paper explores the concept of Circular Agro-Economies (CAE), a sustainable agricultural model focused on recycling agricultural by-products to minimize waste and maximize profitability for farmers. In contrast to traditional linear agricultural systems, CAE promotes resource efficiency and the development of new value chains through the reuse of organic materials. The paper examines the environmental, economic, and social benefits of adopting CAE, including waste reduction, cost savings, rural development, and job creation. It also discusses the significant barriers to adoption, such as technological limitations, financial constraints, and policy-related challenges. Finally, practical recommendations for farmers, policymakers, and businesses are provided to support the successful implementation of CAE, highlighting the collaborative efforts needed to overcome existing challenges and realize the full potential of this model. Keywords: Circular Agro-Economies, Agricultural Waste Recycling, Sustainable Agriculture, Resource Efficiency, Rural Development, Profitability in Farming.

Optimizing influenza vaccine allocation: A predictive analytics approach for informed public health planning.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Excessive purchasing of influenza vaccine can lead to costly overages and waste of resources. Insufficient quantities, however, can jeopardize population health. Our project aimed to use predictive analytics to determine the influenza vaccine quantities that would be needed for the next influenza season while minimizing vaccine waste and meeting patient care demands. Several data sources were evaluated to develop a predictive analytics model to better estimate future influenza vaccine orders during upcoming influenza seasons. A retrospective analysis of influenza vaccine administrations over the last 4 influenza seasons allowed the team to develop an algorithm to predict influenza vaccine needs. Two regions within Mayo Clinic were selected to determine the validity of our ordering process. These 2 regions, identified as regions 3 and 5, ordered influenza vaccines based on the algorithm, while the other 3 regions acted as control groups, ordering though traditional methods based on purchasing data. Predictive analysis for the 2 intervention regions resulted in a savings of over $1 million when compared to traditional ordering methods. The model predicted that the quantity of vaccine ordered should be 17,574.16 and 9,164.29 quadrivalent influenza vaccines for regions 3 and 5, respectively. On the basis of actual administration data, 15,902 vaccines for region 3 and 9,016 vaccines for region 5 will be administered by the end of the season, both of which are less than the predicted amount needed, demonstrating the accuracy of the analytics. Compared to the traditional ordering method, ordering using predictive analytics allowed the team to more accurately determine future order volumes and spend, yielding significant cost savings.

Strategic honey bee hive placement improves honey bee visitation but not pollination in northern highbush blueberry.

Commercial blueberry Vaccinium spp. (Ericales: Ericaceae) production relies on insect-mediated pollination. Pollination is mostly provided by rented honey bees, Apis mellifera L. (Hymenoptera: Apidae), but blueberry crop yields can be limited due to pollination deficits. Various hive placement strategies have been recommended to mitigate pollination shortfalls, but the effect of hive placement has received limited formal investigation. This study explores the effects of clumped and dispersed hive placement strategies on honey bee visitation and pollination outcomes in "Bluecrop" and "Duke" fields over 2 years (2021 and 2022) within 2 economically important regions of production in the United States-the Midwest (Michigan) and Pacific Northwest (Oregon and Washington). Clumping hives consistently increased honey bee visitation rate but did not result in higher fruit set, fruit weight, or seed count. Increases in honey bee visitation through clumping could perhaps improve pollination outcomes in more pollination-limited blueberry cultivars and other pollination-dependent crops. Clumping hives is substantially more efficient and cost-effective for beekeepers due to fewer drop locations and could lead to cost savings for both beekeepers and blueberry growers without growers sacrificing pollination levels and crop yields.

Patient, financial and environmental impacts of a Medicines Optimisation in Care Homes (MOCH) service on polypharmacy following structured medication reviews

Abstract Introduction An NHS community trust was commissioned in February 2023 to deliver a MOCH service to about 15,000 care home residents across an Integrated Care System (ICS). Pharmacists in the MOCH service undertake Structured Medication Reviews (SMRs) to reduce inappropriate polypharmacy, working closely with care homes, General Practitioners (GPs) and community pharmacies. Pharmacy technicians undertake medication reviews to reduce low clinical value medicines. A patient-centred approach means medicines are stopped or changed following shared-decision making with the resident, carer or family. Aim To find out the impact of the MOCH service on reducing inappropriate polypharmacy, reducing medicines-related harm for residents, and to report financial savings and the environmental impact through reduction of CO2 emissions. Methods This service evaluation was approved by the Trust. No ethics approval was required. Quarterly and 6- monthly data sets covering one week reported by the MOCH service in the financial year 2023/2024 were used. These data sets were extrapolated to a full year. This service reported the number of medicines stopped, started and changed over one week of each quarter for SMRs and, pharmacy technicians reported every six months. Cost savings were calculated using the drug tariff based on continued use of medicines for one year. Pharmacists reported reduction in harm from medicines every six months based on a health interventions risk assessment scoring tool, assessing how many residents had potentially avoided moderate to serious harm following a SMR. The carbon savings were calculated based on financial savings from medicines stopped or changed using the DEFRA SIC 2020 Greenhouse Gases emission factor 0.621(kgCO2e/£) for pharmaceuticals1. Results In the first year the MOCH service completed SMRs for 11,363 residents (75% of care home residents in the ICS). Around 20,000 medicines for residents were stopped (one to two medicines per resident). Pharmacists predicted moderate to high-risk harm from medicines was reduced in approximately 4,200 residents. The cost savings from medicines stopped or changed was approximately £2.8 million, which translated to carbon savings of 1,773,340 kgCO2e, the equivalent of removing 644 cars from the road for one year. Discussion and Conclusion Reducing inappropriate polypharmacy resulted in a reduction of treatment burden, potential harm to residents2 and financial savings. Social impacts include reducing workload for care homes, GPs and community pharmacies, ultimately increasing the capacity of this stretched workforce (less dispensing, reduced risk of error, shorter medicine rounds and more time for residents). The environmental impact goes beyond carbon savings from pharmaceuticals to include reduction in workload, consumables, delivery and cost of waste disposal and prevention of hospital admissions.3 The limitations of this evaluation are that data collected over one week and then extrapolated may not be representative of all the other weeks in terms of cost savings and reduction of harm to residents, however MOCH pharmacists undertake peer reviews of reduction in harms to mitigate this. Costs incurred in making the financial savings were excluded. As the demographic of older people rises in the next 20 years a medication review is increasingly important to residents, the health economy, workforce, and our environment.

Enhancing healthcare outcomes and cost efficiency through patient support programs: a comprehensive analysis

Abstract Introduction Treatment retention is crucial for patients with chronic diseases, impacting both clinical outcomes and healthcare costs. Patient Support Programs (PSP), often sponsored by pharmaceutical companies as a wraparound support service for new and innovative medicines, have been shown to be a viable tool in supporting treatment retention and adherence1. Utilizing tools like Patient Activation Measure (PAM®) equips healthcare providers with a means to evaluate the impact of these PSPs on patients' activation and their potential to adhere to medication. The PAM is a behavioural concept focusing on a patient’s understanding of their role in their healthcare, and how competent they feel to fulfil that role. Crucially, there is substantial evidence indicating a strong association between higher PAM scores and improved clinical outcomes2. Aim This study objectives are to evaluate the effectiveness of PSP in reducing treatment drop-off; to investigate the impact of PSP on patient activation/PAM levels; and to analyse potential cost savings from patient activation through PSP participation. Methods The study population includes patients (n= 97795) diagnosed with chronic diseases receiving one of three services from a Clinical Homecare company: (1) Direct-to-patient medication delivery (DD); (2) DD plus self-administration training and (3) DD, self-administration training and PAM-based PSP. Patient “drop-off” from treatment was analysed across all three services and defined as discontinuation of medication due to unwillingness to engage, non-response to engagement attempts, or requests to put the service on hold. Additionally, change in PAM level/activation for patients who completed baseline and follow-up PAM surveys between October 2020 and March 2024 (n=1880) was considered. Finally, expected cost saving was examined, both as a result of the observed change in activation for PSP patients as well as in a hypothetical scenario where patients in DD and self-administration training are redirected to PSP. Ethical approval was not required because the study does not involve any patient interaction/intervention whatsoever. It was a retrospective data analytical study, using existing and fully anonymised patient data from routine clinical care. Results Fewer patients drop off from treatment when they are on the PSP (1.1%) compared to those that are on self-administration training (2.1%) or DD (2.8%). Participation in PSP also positively impacted PAM scores across all therapies, with average improvements ranging from 1 to 8.1 points per patient. Patients in the lower two activation levels (typically at the greatest risk of non-adherence) experienced the most substantial gains (ranging from 8.4 to 17.4 points) emphasizing the significance of intervention. These improvements in PAM scores by PSP translated to substantial cost savings for the health system, amounting to £1,028,669. Finally, where the same treatment drop-off rate and PAM performance ratio are applied to a hypothetical scenario involving the redirection of patients from DD and self-administration training to PSP, there is a further potential cost savings of £4,298,277. Conclusion Participation in PSP improves patient activation and the potential to adhere to prescribed medication, while producing significant financial benefits. Further research is needed to understand how these benefits may vary across different therapy areas and within primary, secondary, and homecare settings.

Green Cystoscopy: Does Minimizing the Use of Drapes Increase Infection Rates?

The U.S. health care system has an enormous carbon footprint made worse by the escalating use of single-use supplies. Emerging evidence suggests that smaller surgical fields ("green" draping) may represent a safe alternative to traditional draping. The aim of the study was to determine if the proportion of cases treated for culture-proven urinary tract infection (UTI) within 2 weeks of operating room cystoscopy after the green draping protocol implementation is noninferior to preprotocol cases. Secondary objectives included risk factors for UTI and waste and cost savings. A pre-post implementation noninferiority study was performed from 2021 to 2023 in a urogynecology division at an academic medical center. The green draping protocol eliminated the use of top drapes, leg drapes, and gowns; blue towels were permitted per the surgeon's discretion. All minor cystoscopy cases were included. The cohort included 240 patients. Treatment of culture-proven UTI in the green cohort was noninferior to the preprotocol group (9 [7.5%] vs 7 [5.8%], P < 0.05). The odds of a culture-proven UTI were higher with history of recurrent UTI (odds ratio = 7.02), interstitial cystitis/bladder pain syndrome (odds ratio = 4.33), and older age (odds ratio per 5-year increase = 1.21). Approximately $1,403.92 (2023 USD) was saved, and 165 pounds of waste was diverted from the landfill. A green draping protocol is noninferior to standard draping with respect to rates of postoperative culture-positive UTIs. Clinicians may use a smaller operating room field to decrease the carbon footprint without compromising quality of care.