Health Board Research Articles (Page 1)

Abstract Introduction The 2021 ‘National Overprescribing Review’ outlined the detrimental impact of polypharmacy and overprescribing at patient, system and environmental levels [1]. The National Director for Prescribing has outlined several strategies to address this problem, which includes structured medication reviews (SMRs) [2]. Our Health Board has many prescribing challenges, including overspend in the primary care medicines budget and poor performance on several high-risk national prescribing indicators e.g. opioids, gabapentinoids. While excellent primary care teams tackle this, it’s an overwhelming problem at scale. The skills of advanced secondary care pharmacists could be utilised for medication reviews to help with this dilemma, but high turnover and pressure in a hospital setting doesn’t provide consistent opportunity. The collaborative ‘Repeat Prescribing Toolkit’ also recommends improvements within prescribing systems [3]. However, for hospital teams that have not undergone newer multisector training, understanding of these system challenges will vary. Could supported primary care medication review/deprescribing clinics with secondary care pharmacists help address these issues? Scepticism around this idea was widespread, so a small proof of concept pilot was conducted. Aim Evaluate the impact of sessional medication review clinics delivered by advanced secondary care pharmacists within the general practice setting. Methodology Activity, adverse-event and cost-saving data between 4th November 2024 and 31st March 2025 was collected prospectively by the pharmacists using FDB CoordinateRx® prescribing software. Outcome data summaries were obtained on 26th May 2025. Intervention data was also analysed using Microsoft Excel 360®. Ethical approval was not required for this service evaluation. Results 46 sessions were completed by 3 different pharmacists. For this pilot, a session equated to 3 hours. A total of 117 reviews were carried out, with 167 medication interventions recorded. 33% (n = 34) of patients reviewed were in the age category of 75 to 84 years old, and 21% (n = 22) aged 85 to 94. 12-month drug savings were estimated to be £10,295. 52% of these medicines savings related to reviews of central nervous system drugs e.g. melatonin, opioids. Of the interventions documented on FDB coordinateRx®, 18% (n = 30) also generated adverse event data, with 12 month adverse-event cost savings estimated to be £6867. Interventions included stopping hypnotics, proton pump inhibitors, and reducing anticholinergic burden. The secondary care pharmacists, general practice host-site staff and tutor feedback acknowledges the wider benefits, such as an appreciation of interface and primary care prescribing challenges, improved communication and the opportunity to manage complex prescribing over longer-time periods. The pharmacists also recognise these clinics provide useful evidence for advanced practice portfolios. Discussion This evaluation has resulted in the project continuing, with extra sessions being arranged. While estimated cost-avoidance savings were not as high as those achieved by primary care medicines optimisation teams, they were still double the cost of the pharmacist time invested. Crucially, wider benefits around improved understanding of system challenges, cross-sector working and multidisciplinary networks are enough to continue. Also, majority of reviews were carried out in the older, most vulnerable age groups. Lack of patient experience data and small numbers are recognised limitations.

Scottish Consensus Clinical Management Guidelines for Merkel cell cancer.

ABSTRACT Alcohol-Related Brain Damage (ARBD) remains underdiagnosed and inconsistently managed across services, despite its significant impact on individuals. Improving access to appropriate support and treatment requires the integration of stakeholder perspectives. This study aimed to co-produce a service development pathway for ARBD in Wales through a structured consensus methodology.A hybrid World Café method was used. Stakeholders from health boards, local authorities, government, and third-sector organizations participated. Discussions focused on five key themes: identification and screening; diagnosis; referral and inclusion criteria; treatment and support; and training and confidence. Data were synthesized to produce actionable recommendations for service development.Key findings included the need for clearer referral pathways, consistent diagnostic processes, early and proactive screening, and improved access to both support. Participants emphasized gaps in workforce training and confidence, as well as the necessity of cross-sector collaboration.The findings demonstrate the value of stakeholder-led consensus approaches in addressing service gaps for ARBD. Key next steps include piloting pathway trials, establishing a center of excellence to coordinate practice and define roles, and investing in data infrastructure to support outcome monitoring and research. These efforts will be critical to ensuring scalable, sustainable improvements in ARBD care.

BackgroundCoeliac disease requires strict adherence to a gluten-free diet to prevent health complications. While gluten-free foods (GFF) are traditionally available on the National Health Service (NHS) prescriptions, the cost and limited product range have prompted consideration of alternatives. Wales is exploring replacing prescriptions with a subsidy card scheme, piloted and implemented by the Hywel Dda University Health Board. This study explores potential service users’ views on the advantages and challenges of transitioning to a subsidy card scheme, as well as their priorities as individuals with coeliac disease.MethodsA qualitative study was conducted with 23 participants from six Welsh health boards where the subsidy card scheme has not been implemented. Participants included individuals eligible for GFF prescriptions and carers of eligible individuals. Recruitment was via social media and Coeliac UK’s Wales mailing list, with purposive sampling to ensure diversity. Data were collected through semi-structured interviews (April-July 2024) and analysed thematically using NVivo software.ResultsFour themes and 20 subthemes were identified. Participants viewed the subsidy card as offering greater choice, autonomy in dietary management, and convenience compared to prescriptions, with the potential to better align with everyday shopping habits. Concerns centred on the card’s monetary value amid inflation, risks of technical or top-up failures, misuse, and limited retailer participation in rural areas. Sixteen participants expressed a clear interest in switching to the subsidy card system, six were ambivalent, and one expressed no interest. Participants also highlighted six key priorities that they felt were essential to improving GFF access and ensuring better support for people with coeliac disease. These priorities included: ease of access, variety and freedom of choice, a tasty and healthy diet, consistency, cost, and better awareness and education of coeliac disease.ConclusionsThe subsidy card model presents a promising, cost-effective, and patient-centred alternative to prescriptions, offering greater dietary autonomy and alignment with consumer practices. However, its success will depend on ensuring equity across geographic areas, addressing infrastructure and retailer participation, safeguarding nutritional adequacy, and maintaining prescription access during transition. Careful implementation will be essential to support diverse patient needs and optimise the scheme’s success.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13582-z.

Metastatic non-small cell lung cancer (mNSCLC) contributes to the economic burden. Over the past decade, treatment has evolved with the introduction of epidermal growth factor receptor (EGFR) anaplastic lymphoma kinase (ALK)-targeted, and immune-oncology (IO) drugs. However, limited evidence exists on the long-term costs of mNSCLC treatments in Sweden. Patient/material and methods: This population-based retrospective study used data from the National Board of Health and Welfare, identifying patients initially diagnosed with stage IV NSCLC between 2011 and 2020. Healthcare costs, including inpatient care, outpatient care, and drug expenses, were assessed using Diagnosis-Related Group (DRG) tariffs and prescription data. Drug expenses exceeding DRG tariff limits, such as IO drugs, were calculated separately based on retail list prices. Costs were analyzed over 5 years post-diagnosis and adjusted to 2023 values. A total of 17,107 patients were included. IO drug use increased sharply after 2016, becoming the predominant therapy. EGFR- and ALK-targeted drug use steadily increased. Overall costs rose over time, especially in the first year after diagnosis. The first-year mean cost was highest among patients receiving IO drugs (€105,286), primarily due to drug acquisition, but declined in subsequent years. ALK- and EGFR-targeted therapies also had high initial costs but remained stable thereafter. This study highlights the increasing economic burden of mNSCLC treatment in Sweden, driven by the targeted and IO drugs. While ALK-, EGFR-targeted, and IO drugs contribute to high first-year mean costs, IO drug costs decline significantly in subsequent years after diagnosis.

To achieve progression criteria for a definitive phase three randomised controlled trial (RCT). Prospective phase two multicentre parallel-group RCT. Participants recruited from secondary care respiratory clinics in two health boards in Scotland, United Kingdom. 110 adults with moderate-severe COPD and co-morbidities. Tailored Intervention for COPD and Co-morbidities by Pharmacists and Consultant Physicians (TICC-PCP): home visits (for a year) by generalist prescribing pharmacists collaborating with consultant respiratory physicians. Pharmacists assessed, prescribed, de-prescribed, and referred participants to health and social care services as appropriate, in addition to Usual Care (UC). Recruit ≥100 participants; deliver TICC-PCP to ≥70% intervention-arm participants; collect ≥90% in-person data; retain ≥80% participants until 21-months. Secondary outcomes include clinical and health service utilisation. Recruitment, data collection, retention and participant retention targets were achieved over 21 months. TICC-PCP delivery: the median number of contacts, nine per participant in one year, matched the a-priori target although fewer than expected (13 (27%)) received the planned schedule of contacts (monthly for six months then every other month for six months). Secondary outcomes included increased prescribing of bone strengthening medicines, de-prescribing of medicines associated with increasing falls risk; delayed time to emergency health care contacts, fewer exacerbations; improved health related quality of life and longer duration of hospitalisation. A definitive phase three RCT of TICC-PCP may improve outcomes for people with moderate-severe COPD and co-morbidities. Trial registration: The trial is registered with the UK Clinical Trials Registry (10.1186/ISRCTN43508703). Registration date: 3/1/2020.

ABSTRACT The present study explores the role that sanitary regulations in the urban space of nineteenth-century Mexico City fulfilled in the differentiation between the sale of sweets in public stalls and private high-class sweet shops. It argues that public health concerns upheld by the Board of Health, stated in the Sanitary Code of 1872, reinforced foregoing prejudices against lower-class production and consumption practices, particularly those of street candy vendors. This process of correlation between insalubrity and public sales was defined by a racial and class dimension, in which the need for differentiation was perpetuated through the stigmatization of products sold by lower-class and Indigenous vendors. Their merchandise, in opposition to the whitened, Europeanized private candy shops, fell under additional incrimination under hygienist interventions. Mexico City’s urban space was the basis on which this differentiation process through hygienization materialized, with street vendors being associated with the street’s contamination, and private candy shops and bakeries serving as controlled, enclosed, and Europeanized spaces.

BackgroundRobotic-assisted surgery is increasingly recognised as a viable alternative to conventional open and laparoscopic techniques in colorectal cancer (CRC) management. This study presents a single-centre initial experience with the Versius® robotic system for colorectal resections between April 2023 and March 2024.MethodologyA retrospective cohort study was conducted at a University Health Board in the United Kingdom, involving 56 patients who underwent robotic-assisted colorectal resections for CRC. Patients aged ≥18 years with radiologically and endoscopically confirmed non-metastatic CRC (American Joint Committee on Cancer stage T1-4, N0-2, M0) were included. Data on preoperative, intraoperative, and postoperative parameters were collected. Operative details included procedure type, console time, and estimated blood loss. Complications were graded using the Clavien-Dindo classification. Analyses were performed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Categorical variables were reported as frequencies and percentages; continuous variables as means ± SD or medians with interquartile ranges. Chi-square, independent t-tests, or Mann-Whitney U tests were used for group comparisons. A p-value <0.05 was considered significant.ResultsThe mean operative time was 131 ± 50.99 minutes. In-hospital complications occurred in 37.5% of patients, predominantly local (26.8%) over systemic (10.7%). No significant association was found between preoperative variables and postoperative complications. No perioperative mortality occurred.ConclusionsThe Versius® system demonstrates feasibility and safety for CRC resections, with acceptable complication rates and no mortality, supporting its use as a promising approach in robotic colorectal surgery.

Abstract Background Suicide and suicidal behaviors bring massive human, social and economic impacts. Estimates of the cost of suicide can give some guidance as to where research on developing new interventions might be focused to give the greatest potential gain. The aim of the study is to quantify the economic cost of suicide in Sweden in 2022. Methods Incidence of suicide attempts and mortality due to suicide, intentional and undetermined (ICD10 X60-X84 and Y10-Y34) were sourced from the Swedish National Board of Health and Welfare databases for 2022. Cost were estimated from a societal perspective, including costs for inpatient and outpatient care, medication, police and justice activities as well as productivity losses due to early mortality. Results In 2022, a total of 1,569 suicide death were registered in Sweden (1,102 men and 467 women). The incidence rate remains stable during the last ten years, 17 death per 100 000. In total, 18,854 patients (10, 359 women and 8,459 men) were treated in inpatient and outpatient hospital care with suicide-related diagnoses, generated 32,843 days in inpatient care and 11,471 outpatient care visits. Direct costs for suicide death including forensic examination, emergency services, police investigation and property damage were estimated as €8,8 million, while indirect costs for productivity losses totaled €917 million. Direct healthcare costs for suicide related treatment were estimated at €71.5 million. Overall, suicide and suicide attempts cost around €750 million per year to society. Conclusions Estimates of the economic burden of suicide are needed for the Swedish setting, and these amounted to €71 million in direct costs and €918 million in indirect costs in 2022. The cost might be underestimated because the societal cost of suicide bereaved persons was not considered. These cost estimates can provide useful inputs to a cost-effectiveness analysis Key messages • Economic burden of suicide is substantial for society. • Public health policies aimed at the prevention of suicide should be increased.

IntroductionAim to design and test a suitable risk‐targeted imaging protocol for follow‐up of complex renal cysts categorised IIF.Patients and MethodsThe Scottish Protocol was designed at a joint meeting with the Scottish Urological and Scottish Radiological societies according to published data on imaging modality, classification criteria and interval progression of Bosniak IIF renal cysts. Patients were listed prospectively to follow this protocol across five NHS health boards within Scotland. Patient data accessed between Aug 21 and Feb 22. All patients with a confirmed Bosniak IIF cyst on computerised tomography or magnetic resonance imaging after multi‐disciplinary team review were included. Patients were reviewed according to progression, interval, treatment and histology.ResultsA total of 160 patients were identified with Bosniak IIF cysts. 98 (61%) were male (age range 29–97, median 67, IQR 57–75). Thirty‐four patients completed the proposed 4‐year follow‐up. Seventeen patients advanced to treatment, with 15 patients having confirmed malignancy (9.4% of the total database). The mean time from diagnosis to intervention was 1 year and 2 months (range 34 to 1172 days). No patients developed metastatic disease during follow‐up.ConclusionsThe Scottish Complex Renal Cyst Protocol provides a risk‐targeted imaging framework that reliably identifies patients with progressive lesions prior to the development of advanced disease. Incidence of progression is consistent with published data of 9.4% most commonly within 2 years, and not beyond 4 years of surveillance.

Autism diagnosis in Wales: The case of governance-driven medicalisation in care pathways.

4.69 Addressing the Youth Mental Health Boarding Crisis

Predictors of missed pediatric ophthalmology appointments in a New Zealand cohort: the impact of gender, ethnicity, and socioeconomic deprivation.

Has the Centralization of Vascular Services Changed the 30-day Mortality in Elective Abdominal Aortic Aneurysm Repairs in North Wales?

Significant challenges promoting positive HIV testing behaviors among African immigrant communities in the U.S. persist, though existing community resources may be leveraged to improving these behaviors and increasing testing uptake. We conducted 30 key informant interviews and five focus group discussions (n = total 72 participants) among members of the Ethiopian, Somali, and Eritrean communities in Seattle, WA to identify these resources. Our findings highlight the following three main themes for responsive interventions: (1) capitalize on religious leaders and institutions as key facilitators; (2) leverage existing community resources, such as ethnic community centers, health boards, and healthcare professionals; and (3) utilize existing culturally-rich media for health promotion, centering on multi-linguality, -culturality, and -generationality. Our findings suggest that a wealth of community resources and resilience factors exist to leverage to improve HIV testing behaviors among African immigrant communities in the U.S.

Research indicates various barriers to cervical cancer screening for transgender people, contributing to cancer inequities. Further research is required to better understand how these barriers affect experiences along the screening trajectory, from engaging with information, through invitation and testing, to receiving test results. Research exploring how transgender people navigate these barriers is also required. To explore the experiences of cervical cancer screening in Sweden among transgender people who were assigned female at birth, and to identify touchpoints in need of improvement along the cervical cancer screening trajectory. Qualitative interview study inspired by journey mapping. Semi-structured interviews (n = 18) and interpretive description analysis. Five phases were identified comprising participants' cervical cancer screening journey, with touchpoints in each phase indicating key experiences, barriers, and strategies to navigate barriers. Experiences of touchpoints were affected by four interrelated dimensions: The embodied person-personal gender identity, relationship with own body, and transition process; System factors-policies, routines, and practices; Gender norms and transphobia; and Prior healthcare experiences. Significant barriers included a lack of trans-specific screening information; an invitation system that does not automatically invite male-registered individuals with a cervix; lack of trans competency among clinics and staff; female-centred clinics; gender dysphoria; anticipation or fear of being mistreated; distrust of healthcare authorities; and participant-staff power dynamics. To make cervical cancer screening more equitable for transgender people, barriers need to be addressed by considering the four dimensions that affect these barriers. Findings show that staff involved in policy and clinical practice can improve transgender people's experiences of cervical cancer screening by promoting agency and self-determination in each screening phase. This involves providing inclusive information, continuing invitations for male-registered individuals with a cervix, enhancing trans-competency, and addressing power dynamics in staff-participant interactions. The Standards of Reporting Qualitative Research (SRQR). Representatives from the Regional Cancer Centre Stockholm-Gotland were involved in the conceptualisation of this study. Representatives from trans and LGBTQI+ organisations, Regional Cancer Centres, and the National Board of Health and Welfare have provided feedback during the analysis and writing phases.

The aims of this study are to describe the current status of the heart failure nursing workforce in Aotearoa New Zealand, identify key challenges and provide recommendations. In March 2023, a survey coordinated by the Cardiac Society of Australia and New Zealand and the New Zealand Regional Heart Failure Working Group was distributed to all district health boards in Aotearoa New Zealand. The survey collected data on heart failure nursing resources, including full-time equivalent (FTE) per population, clinical versus non-clinical time, scope of practice, nurse-led services, and performance measures. A total of 23 hospital responded, yielding a 100% response rate and revealing varied resource allocation across district health boards. While FTE rates have generally increased, nearly half of the boards reported less than one FTE per 100,000 population, with only three reaching the recommended two FTE per 100,000 as endorsed by the British Society for Heart Failure. This foundational survey highlights the current status of the heart failure nursing workforce in Aotearoa New Zealand. It suggests that increasing the number of specialised nursing staff, particularly nurse practitioners (NP), to meet international standards would improve access to timely, effective and equitable treatment for all heart failure patients. Increasing NP FTE across hospital and community settings is likely to enhance healthcare and social outcomes, especially in under-served regions. Further research focussing on ethnicity, geographic distribution and workforce participation is recommended to guide targeted workforce development.

Adverse drug reactions (ADRs) are a key contributor to unplanned hospitalisations, particularly in patients with polypharmacy. Traditional detection methods, such as expert reviews or diagnostic coding, are limited in scalability and sensitivity. This study introduces and evaluates a novel scalable method, implied ADR-admissions, that links drug exposures to adverse events using administrative data to improve the detection of plausible drug-related hospitalisations. A retrospective cohort study was conducted using linked health data from 123,662 individuals aged ≥ 40 years with polypharmacy in two Scottish health boards. Implied ADR-admissions were defined as emergency hospitalisations with one of 15 adverse events plausibly linked to drug exposure (based on a structured consensus process) within the prior 90 days. Incidence was compared with three existing approaches: adverse event-admissions (regardless of drug exposure), explicit ADR-admissions (explicitly coded as ADRs) and preventable ADR-admissions (with prior medication error). Multivariate logistic regression was used to identify predictors of implied ADR-admissions. Over 1 year, 2.6% experienced an implied ADR-admission, compared with 5.7% with adverse event-admissions, and 0.4% with explicit ADR-admissions. For gastrointestinal bleeding, the implied ADR-admission incidence was 20 times higher than the preventable ADR-admission incidence. Key predictors for implied ADR-admissions included prior hypokalaemia-related hospitalisation and use of potentially inappropriate medications. The implied ADR-admission approach has improved specificity relative to broad adverse event definitions while enhancing sensitivity beyond methods that rely solely on explicit ADR codes or pre-specified medication errors. It offers a scalable automated tool for pharmacovigilance, though further validation is needed prior to routine use in medication safety monitoring.

Evaluation of Health Board Documents Referred to the Tertiary Hospital for Objection and Referral in Terms of Ophthalmology

Promoting family nurse resilience through Family Nurse Partnership education in Scotland: A continuous quality improvement initiative.