Local Health Board Research Articles

Collaboration strategies affecting implementation of a cross-systems intervention for child welfare and substance use treatment: a mixed methods analysis.

Collaboration strategies refer to policies and practices used to align operations and services across organizations or systems. These strategies can influence implementation of cross-system interventions focused on improving integration of care, but remain under-specified and under-examined. This study identifies collaboration strategies and the conditions under which they affected implementation of Sobriety Treatment and Recovery Teams (START), an evidence-based intervention focused on integrating child welfare and behavioral health services for families involved with both systems. Our study sample included 17 county child welfare agencies that implemented START. Data on collaboration strategies and organizational context were obtained from key informant interviews, frontline worker surveys, and contracts. Contextual data were drawn from secondary data, and fidelity data were drawn from an administrative database. Qualitative and quantitative data were integrated using coincidence analysis, and used to identify combinations of conditions that uniquely differentiated agencies with higher and lower fidelity to START. Fidelity was lower for intervention components requiring cross-system collaboration. Although key informants acknowledged the importance of collaboration for START implementation, few agencies used formal collaboration strategies other than staff co-location or reported high communication quality between frontline staff in child welfare and behavioral health. In coincidence analysis, four conditions differentiated agencies with higher and lower fidelity with 100% consistency and 88% coverage. We found that either strong leadership support or, in high need communities, third-party resource support from local behavioral health boards were sufficient for high fidelity. Similarly, in high need communities, absence of third-party resource support was sufficient for low fidelity, while in low need communities, absence of communication quality was sufficient for low fidelity. Administrators, frontline workers, and interested third parties (i.e., other stakeholders not directly involved in implementation) can use collaboration strategies to facilitate implementation. However, the effectiveness of collaboration strategies depends on local context. In agencies where internal leadership support for implementation is low but need for intervention is high, third-party resource support may still be sufficient for high fidelity. Further research is needed to test effectiveness of collaboration strategies in different conditions and on a broader range of process and implementation outcomes. ClinicalTrials.gov, NCT03931005, Registered 04/29/2019, https://classic. gov/ct2/show/NCT03931005 .

A governance framework for facilitating cross-agency data sharing

Linking data across local authorities and health boards has the potential to reduce inequalities and improve outcomes. However, cross-agency data sharing leads to complexities around data ownership, legal conditions for processing, organisational controls and risk assessments to ensure privacy and confidentiality of subjects whilst facilitating research and service improvements. We share a governance framework for cross-agency data sharing between a local authority and regional health board in Scotland. A cross-sector Child Neglect working group was established with representation from public sector agencies, the NHS, University researchers and a Trusted Research Environment to support research on children’s mental health prescribing and secondary specialist services provision and linking to the Aberdeen City Council Child Protection Register. Lessons learned were captured throughout the governance, data transfer and data linkage phases. Communication is the most important driver, with key individuals, deputies and routes of escalation agreed and involved throughout for clarity of roles and expectation setting. Key lessons learned include requiring input from all parties at the project initiation stage, particularly IG teams, including agreements on necessary templates. Knowledge exchange is required between the research team, data owners and data processors to ensure research protocol requirements are correctly understood and data transfer is supported. If possible, internal and/or external validation of data should also be performed before data is linked. Cross-agency data sharing is a vital means to understanding and improving outcomes for individuals and populations. Critical to this is establishing an action plan and formalised project process to achieve outcomes.

Edwin Chadwick: A Pioneer of Public Health Reform and His Role in Sanitary Awakening.

Edwin Chadwick (1800-1890) was a central figure in the 19th-century public health reform movement in Britain. His work was instrumental in the sanitary awakening, a movement that revolutionized public health through the systematic improvement of urban sanitation and hygiene. As a lawyer by training, Chadwick was deeply influenced by Jeremy Bentham's welfare maximization theory, which emphasized the greatest good for the greatest number. His most significant contribution was his 1842 publication, "The Report on the Sanitary Condition of the Labouring Population," in which he documented the deplorable conditions faced by the working class and the link between poor sanitation and disease. Chadwick's advocacy led to the passage of the Public Health Act of 1848, which established local health boards and marked the beginning of modern public health systems. His focus on clean water, efficient sewage systems, and waste management not only reduced the spread of diseases like cholera and typhoid but also set the stage for future public health initiatives globally. The sanitary awakening, largely driven by Chadwick's efforts, highlighted the critical connection between environment and health, a principle that continues to underpin public health practices today. Chadwick's legacy lives on in the ongoing efforts to improve urban living conditions and prevent disease through public health infrastructure.

Exploring prescribing volume among pharmacist independent prescribers in community pharmacies across Wales

Abstract Introduction In a 2019 document titled ‘Delivering a Healthier Wales’, the Welsh Government presented a transformative vision for healthcare that emphasises a shift from hospital-centred healthcare to community-based care.[1] As part of this vision, independent prescribing (IP) is to be implemented in every community pharmacy by 2030.[1] Recently, the independent prescribing service (IPS) has allowed pharmacists to manage and treat patient conditions within the community pharmacy, offering a potential solution to the increasing demand for general practitioners (GPs). A substantial increase in IP consultations is evident, with 16,005 consultations recorded across 33 out of the 713 community pharmacies in Wales since 2016.[2] Aim This study aimed to explore, for the first time, the number of items prescribed by community pharmacists across Wales and in each of the seven local health boards (LHBs), as well as determining from which British National Formulary (BNF) chapter the medicines were prescribed. Methods A retrospective secondary data analysis of community pharmacy prescription data was conducted. Monthly prescription data of prescribed items were obtained from the Comparative Analysis System for Prescribing Audit (CASPA) from January 2020 to December 2022 and analysed on a three-monthly basis. To compare changes in prescribing volume across LHBs, the number of items per 100,000 population was calculated. The CASPA data were categorised into BNF chapters, and a Pareto analysis was performed to determine the most prescribed therapeutic areas. These accounted for 80% of total prescribing, which was used for further analysis. LHBs were coded as LHB1, LHB2, etc., to ensure anonymity. Results There were considerable variations in prescribed items across LHBs. Despite LHB 1 having the largest number of prescribed items in the overall population (n=13,982), it ranked third (n=1,988) in the number of prescribed items according to the number of items per 100,000 population, LHB 2 (n=2,542) and LHB 3 (n=2,659) ranked first and second, respectively. LHB 7 had the lowest number of prescribed items in the overall population (n=51) and per 100,000 (n=38). Based on the Pareto analysis, 80% of the items prescribed during the study period fell into the following six BNF chapters: Infection; Eye, Ear–Nose–Oropharynx; Skin; Obstetrics–Gynaecology–Urinary Tract Disorders; Appliances; and Central Nervous System. The infection chapter had the highest number of prescribed items (n=20,107), with most of the items being antibacterial (n=19,583, 96%). Nitrofurantoin was the most prescribed antibacterial agent (n=5,682). Conclusion This study explored the increase in prescribed items in community pharmacies across Wales, aligning with the 2030 vision for a healthier Wales. IPS plays a crucial role in pharmacist-led care for conditions such as urinary tract infections, potentially alleviating some of the burden facing GPs. While CASPA data captured prescribed and dispensed items specifically for community pharmacies, items prescribed but not dispensed are not accounted for in the data analyses. This study lacks information regarding the appropriateness of consultations. Further research is needed to examine prescribing appropriateness and patient outcomes.

Selective serotonin reuptake inhibitors (SSRIs) in women of reproductive age: a systematic review of local formularies.

Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, postpartum haemorrhage (PPH), and persistent pulmonary hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice. To review all local prescribing formularies with respect to prescribing SSRIs in women of reproductive age, during pregnancy, and during breastfeeding. A systematic review of prescribing formularies in England and Wales. A systematic keyword search of all clinical commissioning group and Integrated Care Board websites in England and Local Health Board websites in Wales was undertaken between December 2021-22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs. Seventy-four prescribing formularies were reviewed. Of these, 14.9% (n = 11/74) provided links to the Medicines and Healthcare products Regulatory Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (n = 21/74) provided links to guidance on PPH risk, and 1.4% (n = 1/74) provided links to guidance on PPHN. Specific local guidance was given on SSRI prescribing for women of reproductive age, during pregnancy, and during breastfeeding in 12.2% (n = 9/74), 23.0% (n = 17/74), and 21.6% (n = 16/74) of formularies, respectively. Our results suggest that prescribers may be poorly informed by local formularies about the risks of SSRI use around pregnancy. This could place babies at increased risk of unintentional SSRI exposure.

The politics of airing grievances: an analysis of air quality knowledge and ignorance in Pittsburgh

ABSTRACT Pittsburgh's airshed is among the most surveilled and studied in the United States, yet its residents continue to endure some of the worst air quality in the United States. In 2016, in response to the decades-long failure of the local Board of Health to take decisive action against regional polluters, Pittsburgh residents began documenting their air quality complaints using the Smell Pittsburgh app. Drawing from an analysis of thousands of Smell Pittsburgh users’ reports, interviews with local air activists, and observations of Board of Health meetings, we investigate why air quality authorities dismiss the information generated by Smell Pittsburgh. By examining the Smell Pittsburgh data and asking what is being ignored by environmental regulators, we show that the app is threatening insofar as it serves as a repository of uncomfortable knowledge that testifies to the extent of environmental suffering generated by the region's hazardous air.

Optimising Same Day Emergency Care (SDEC) Delivery Within a Leading Tertiary Cancer Centre in Southeast Wales

Expansion and enhancement of Same Day Emergency Care at Velindre Cancer Centre during 2022 compromises of Ambulatory Care Unit, Assessment Unit, Patient Support Unit and Immunotherapy toxicities service.
 To provide better value-based healthcare we have introduced an Immunotherapy Toxicities service plus expanded the existing Ambulatory Care Unit and Patient Support Unit providing 12-hour weekday working including a weekend service. 
 The need for a dedicated Immunotherapy service was highlighted following NHS data which anticipated a growth of 240% in Immunotherapy treatments over the next 5 years with Immunotherapy treatments having already increased by 49% from 2018/19 to 2020/21. 
 Without investment this would have led to increasing admissions in South East Wales Health Boards by over 320 patients per annum. This increase would perpetuate the strain on the Ambulatory Unit within VCC and Local Health Boards emergency departments due to the need to admit the patients experiencing toxic side-effects with no viable alternative.
 The development of the Immunotherapy service has allowed for a clear alternative to emergency/unscheduled admission by ensuring robust pathways are in place, 24/7 resilience and support of toxicities, increased patient and staff education in managing toxicities and rapid treatment and management of patients. 
 The Ambulatory Care provision has expanded working hours as well as supporting a weekend service to ensure more timely interventions for patients on a same day basis, enhancing care and clinical outcomes plus removing additional demand on Local Health Boards by preventing admission. 
 Since 2019 the Patient Support Unit has seen a 51% reduction for inpatient admissions for head and neck cancer with the average monthly bed days for patients reduced by 45%. Through service expansion it has been predicted that admissions and length of stay are likely to reduce by a further 10-15%. This will further decrease the burden on external services such as acute hospitals with an ever growing demand on the services.
 The expansion has improved access to a skilled multidisciplinary team including specialist nurses, dieticians, speech and language therapists, physiotherapists and occupational therapists who will all work together to ensure all patients are cared for through robust interventions with timely follow ups.
 The model of delivery is innovative and forward thinking and endorsed by patients and staff alike. The joint MDT allows professionals to anticipate, ameliorate and treat complex and rapidly changing symptoms as an outpatient. 
 The services discussed are essential in reducing the burden on internal and external services whilst ensuring the patient has the best possible outcome. Through clear robust pathways and an upskilled workforce, the service will be sustainable for years to come whilst patients are dealt with in the best way possible in an Ambulatory manner.
 The outcome is a sustainably funded, evidence-based patient-centred service offered in a day case setting, that anticipates and manages complex toxicities and challenging symptoms that develop at different points during the treatment pathway. With these side effects managed on an ambulatory basis, it prevents patients requiring prolonged inpatient admission, a wider benefit for our partners in Local Health Boards.

The integration journey in Wales – moving below the waterline. Fitting with the conference theme of ‘Change management implementation' this presentation will explore the journey so far in Wales in creating structural, legislative and system change. 

In 2014 the ground-breaking Social Services and Wellbeing Wales Act set out a new vision for social care which was built on the principles of prevention, service user voice and control, co-production and integration. This was further supported by the vision set out in a Healthier Wales; our 10 year plan for Health and Social Care.
 This legislation placed a legal duty on Local Authorities and Local Health Boards to ‘co-operate’ in meeting the care and support needs of their population. It saw the creation of seven Regional Partnership Boards (RPBs) which brought together Health, Social Care, Housing and Third Sector partners with service providers, service users and unpaid carers to strategically plan care and support in their area. 
 Six years on RPBs have made some notable progress including integrated needs analysis and planning arrangements and the development of integrated service delivery models. However more work is needed to embed integration into our heath and social care system. 
 RPBs are increasingly being viewed as an iceberg, with partnership working so far being progressed ‘above the waterline’ with the small group of people and organisations committed to the integration journey. This presentation will set the ambition in Wales for moving ’below the waterline’ and engaging with wider stakeholders and partner organisations to mainstream integration.
 RPBs are made up of a wide range of stakeholders including service users and unpaid carers. They have all contributed to the integration journey so far and in 2022 these stakeholders have been working closely with Welsh Government officials to review and strengthen current structural arrangements.
 Recent work has included the co-production of an engagement charter to support the effective engagement of services users, carers and third sector organisations in the work of Regional Partnership Boards as true partners.
 
 Work has also been completed to fully align the strategic work of RPBs with Local Primary Care Cluster arrangements in order to ensure strategy and locality based delivery inform and complement each other. 
 Evidence to understand and shape the journey so far has also been provided by Audit Wales, a KPMG review of pooled budget arrangements across Wales and evaluations of the Integrated Care Fund and the Transformation Fund. These two evaluations provided the learning to shape the five year Regional Integration Fund (RIF) launched by Welsh Government in April 2022. The £144.6m a year RIF will seek to create sustainable system change through the integration of health and social care services so that by the end of the five year programme, we will have established and mainstreamed six new national models of integrated care. 
 This presentation will highlight the progress made in Wales in relation to creating structural, legislative and system change but will also raise the question of how to secure the necessary behavioural change to mainstream the integration of health and social care. It will focus on the importance of having the right balance and alignment between systems, structures and people, resources to lever change and the need for a new style of leadership. 

Food Systems Transformation in Scotland—The Journey to, Vision of, and Challenges Facing the New Good Food Nation (Scotland) Act

Building on growing global and local calls for food systems transformation, and years of policy and legislative consultation (2009–2022), the Scottish Parliament unanimously passed transformational food systems legislation in June 2022. Built on a clear vision, clarity of purpose, a common set of outcomes, an agreed direction of travel, strong partnership working, sufficient time, and independent oversight, the Good Food Nation (GFN) (Scotland) Act is an innovative legislative framework designed to foster a healthier, fairer, and more sustainable Scottish food system for all. It places, for the first time, statutory responsibilities on the Scottish Government and relevant authorities (all Scottish local authorities and public health boards) to develop and implement national and local GFN plans, and importantly, makes provision for the establishment of a new independent, statutory Scottish Food Commission to oversee the implementation, with significant powers of oversight and scrutiny and a formal remit to make recommendations to any Scottish ministers and relevant authorities regarding issues/actions relevant to the Good Food Nation Plans. This paper outlines Scotland’s agriculture, food, and drink sector, reviews its food policy and GFN journey since the establishment of the Scottish parliament in 1999, critiques the core principles, stated outcomes, key provisions, and planned timescales of the GFN (Scotland) Act, reflects on its transformational potential, and considers unresolved concerns and remaining tensions.

1024 Current Adherence to Local Health Board Guidelines for Venous Thromboembolism Risk Assessment in Orthopaedic Trauma Lists

Abstract Aim This audit aims to assess the current adherence to the local health board guidelines for Venous Thromboembolism (VTE) risk assessment in Orthopaedic Trauma lists. Method Data was collected for all patients who underwent operation on trauma lists between 1st June 2022 and 31st June 2022. Data collected included the operation type, if VTE risk assessment was completed on admission and pre-operatively. Plan post-operatively and on discharge was also noted as well as the length of VTE prophylaxis prescribed. Results There were 172 patients in total, 117 lower limb procedures and 55 upper limb procedures. Of these procedures 42 lower limb patients and two upper limb patients had risk assessments on admission. 110 patients with lower limb injuries received VTE prophylaxis on admission compared to eight of the non-day case upper limb. Seven lower limb patients and five upper limb did not have a VTE plan post-operatively. There was variation in length of prophylaxis prescribed post-operatively in relation to procedure and guidelines ranging from nine days to six weeks. Conclusions As per local health board guidelines all patients that are admitted or undergo operation as part of the Orthopaedic Department should have VTE assessment carried out. This audit concludes that approximately 25% of VTE assessments on admission are clearly documented. Despite the lack of formal assessment most patients receive VTE prophylaxis but questions whether prescription is appropriate. We also conclude that most patients have a well-documented post-operative VTE plan. Re-audit with intervention is due to end 4th January 2023.

Increasing access to psychologically-informed care: A Cognitive Behavioural Therapy informed programme for multidisciplinary staff working in older peoples’ community mental health teams

BackgroundIncreasing psychological skills and therapies in the wider workforce is essential for psychologists working with finite resources and a growing older adult population. While much of the focus within older peoples’ multidisciplinary teams (MDT) and training initiatives in Scotland are on memory and dementia, there is a need to consider the changing demand which may come from older people who are increasingly socialised to seeking support with mood difficulties.AimsA Cognitive Behaviour Therapy (CBT) informed programme was co-developed with multidisciplinary colleagues with the aim of developing a sustainable and ongoing infrastructure that would increase the competence and confidence of attendees in delivering psychologically informed care for older people experiencing common mood difficulties (anxiety and depression).MethodA one-day teaching session with six-weekly coaching groups was delivered. Outcome measures related to engagement and ‘benefit’; measured via a vignette assessing competence in CBT-based knowledge and skills and via subjective confidence ratings on CBT-based competencies. Acceptability and feasibility was tested via a pilot in 2018; and has subsequently ran in its present form since 2019.ResultsFrom 2019 to 2022, programme attendees have almost doubled and average coaching group attendance has increased from 30 per cent to 58 per cent. Competence and confidence scores have similarly increased. Qualitative feedback reflects patient-centred benefits including an increase in goal-focused interventions, collaborative working and formulation-based (rather than diagnosis-led) discussions during MDT meetings.Conclusions & ReflectionsThe programme outcomes indicate MDT acceptability and effectiveness. A model of teaching and follow-up coaching allows for ongoing knowledge and skill development and is believed to be an effective model for facilitating application of knowledge and skills to practice. Within the local health board, the programme has contributed to an infrastructure for psychologically informed care, increased knowledge of therapies for older people and provided a governance framework which is workable for an older adult psychology service to sustain. A key reflection has been the importance of modelling the CBT approach throughout the programme.

Lost lives and opportunities for the legacy of harm reduction in Scotland, UK

Lost lives and opportunities for the legacy of harm reduction in Scotland, UK

Diabetes in the cost‐of‐living crisis

Diabetes in the cost‐of‐living crisis

Identifying the Barriers to Universal Cervical Length Screening for Preterm Birth Prevention at a Tertiary Hospital in Thailand (Physician Perspectives): Implementation Research.

To identify physicians' views on the barriers to measuring cervical length for preventing preterm deliveries. This prospective, descriptive implementation study had three phases. In Phase I, 20 physicians were interviewed. Phase II comprised questionnaire development and data validation. The questionnaire was distributed to 120 Phase III participants. All 120 participants responded. In 44 cases, the physicians received support from their local Maternal and Child Health Boards for preterm-birth-prevention programs; the other 76 physicians did not. The doctors tended to believe that cervical length screening plays no role in preventing preterm births (4/44 (9.1%) and 24/76 (31.6%); OR, 4.615; 95% CI, 1.482-14.373; p = 0.005). They were unsure about the correct measurement procedures (13/44 (29.5%) and 37/76 (48.7%); OR, 2.262; 95% CI, 1.028-4.977; p = 0.040). A lack of cost-free drug support (progesterone) for women with short cervices was identified as a barrier to preventing preterm births (30/44 (68.2%) and 32/76 (42.1%); OR, 0.339; 95% CI, 0.155-0.741; p = 0.006). Many physicians are unconvinced that measuring cervical length prevents premature births, and are unsure about the correct measurement procedures. There is a lack of government funding for hormone-usage programs.

How does discharge against medical advice affect risk of mortality and unplanned readmission? A retrospective cohort study set in a large UK medical admissions unit

ObjectivesTo assess the frequency of discharge against medical advice (DAMA) in a large UK teaching hospital, explore factors which increase the risk of DAMA and identify how DAMA impacts patient...

Real-world effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab on preventing hospital admission among higher-risk patients with COVID-19 in Wales: A retrospective cohort study

To compare the effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab with no treatment in preventing hospital admission or death in higher-risk patients infected with SARS-CoV-2 in the community. Retrospective cohort study of non-hospitalized adult patients with COVID-19 using the Secure Anonymised Information Linkage (SAIL) Databank. A real-world cohort study was conducted within the SAIL Databank (a secure trusted research environment containing anonymised, individual, population-scale electronic health record (EHR) data) for the population of Wales, UK. Adult patients with COVID-19 in the community, at higher risk of hospitalization and death, testing positive for SARS-CoV-2 between 16th December 2021 and 22nd April 2022. Molnupiravir, nirmatrelvir-ritonavir, and sotrovimab given in the community by local health boards and the National Antiviral Service in Wales. All-cause admission to hospital or death within 28 days of a positive test for SARS-CoV-2. Cox proportional hazard model with treatment status (treated/untreated) as a time-dependent covariate and adjusted for age, sex, number of comorbidities, Welsh Index of Multiple Deprivation, and vaccination status. Secondary subgroup analyses were by treatment type, number of comorbidities, and before and on or after 20th February 2022, when omicron BA.1 and omicron BA.2 were the dominant subvariants in Wales. Between 16th December 2021 and 22nd April 2022, 7013 higher-risk patients were eligible for inclusion in the study. Of these, 2040 received treatment with molnupiravir (359, 17.6%), nirmatrelvir-ritonavir (602, 29.5%), or sotrovimab (1079, 52.9%). Patients in the treatment group were younger (mean age 53 vs 57 years), had fewer comorbidities, and a higher proportion had received four or more doses of the COVID-19 vaccine (36.3% vs 17.6%). Within 28 days of a positive test, 628 (9.0%) patients were admitted to hospital or died (84 treated and 544 untreated). The primary analysis indicated a lower risk of hospitalization or death at any point within 28 days in treated participants compared to those not receiving treatment. The adjusted hazard rate was 35% (95% CI: 18-49%) lower in treated than untreated participants. There was no indication of the superiority of one treatment over another and no evidence of a reduction in risk of hospitalization or death within 28 days for patients with no or only one comorbidity. In patients treated with sotrovimab, the event rates before and on or after 20th February 2022 were similar (5.0% vs 4.9%) with no significant difference in the hazard ratios for sotrovimab between the time periods. In higher-risk adult patients in the community with COVID-19, those who received treatment with molnupiravir, nirmatrelvir-ritonavir, or sotrovimab were at lower risk of hospitalization or death than those not receiving treatment.

Fall of viral and bacterial pneumonia hospitalizations following COVID-19 pandemic mitigation strategies: a central Italian Region retrospective study

Community-Acquired Pneumonia (CAP) represents one of the first causes of hospitalization and death in the elderly all over the world and weighs heavily on public health system. Since the beginning of the COVID-19 (CoronaVirus Disease-19) pandemic, everybody’s behavior was forced to change, as the result of a global lockdown strategy and the obligation of using personal protection equipment (PPE). We aimed to evaluate how the mitigation strategies adopted to fight SARS-CoV-2 (Severe Acute Respiratory Coronavirus Syndrome 2) infection have influenced hospitalizations due to CAP in two different Local Health Boards (LHBs) of central Italy. We considered two main periods of observation: before and after the national start of lockdown, in two Abruzzo’s LHBs. We analyzed 19,558 hospital discharge records of bacterial and viral CAP. Excluding SARS-CoV2 infection, a significant decrease in CAP hospitalizations was observed. Through the analysis of Diagnosis Related Group (DRG) values, we highlighted a significant saving of founds for the Regional Health Service. The enactment of social distancing measures to contain COVID-19 spread, brought down admissions for bacterial and viral pneumonia. Our study emphasizes that costs for hospitalizations due to CAP could be drastically reduced by mask wearing and social distancing.

Association Between Local Boards of Health Authority Over Budgets and PHAB Accreditation Standard Score

This study examined the relationship between local board of health authority and local health departments' budget-related activities and performance scores in the Public Health Accreditation Board standards while considering the governance structure under which the local health agencies operate. Data from 250 local health departments were obtained from the Public Health Accreditation Board and were combined with data from the 2016 National Association of County and City Officials Profile Survey. Multilevel regression analysis was used to examine the relationship between local board of health authority on local health departments' budget-related activities, using the governance structure as the group-level variable. Analyses identified positive associations between local board of health authority on local health departments' budget-related activities and local health departments' aggregate average performance scores in Public Health Accreditation Board accreditation. No apparent association was found between the type of governance structure under which a local health department operates and performance scores in Public Health Accreditation Board accreditation standards, perhaps attributable to variation in the characteristics and roles of their governing bodies. The analyses suggest that local boards of health with authority related to local health departments' budgets appear to have an influential role in budget-related activities and may improve local health departments' performance scores in Public Health Accreditation Board accreditation standards. However, vast variations in more specific local boards of health roles and characteristics exist across local health departments and for which there are no national data. More research is thus needed to control for or examine the influences of specific local boards of health characteristics before the benefits of expanded local boards of health authority over local health departments' budgetary decision making on local health departments' performance can be fully understood.

Pharmacies report three-fold increase in patients seeking emergency medicine

Community pharmacies in North Wales saw a more than three-fold increase in patients seeking emergency medicine in December 2022, figures from a local health board show. In a press release from Betsi Cadwaladr University Health Board (BCUHB), published on 27 January 2023, the board said there had been a 345% increase in the number of […]

My digital journey: from GP pharmacist to clinical lead for NHS 111

I was still working as a GP pharmacist in North Cardiff when a colleague in the local health board forwarded an email to me. For the first time, there was some funding available from Health Education and Improvement Wales (HEIW) for practice-based pharmacists to take advanced and extended practice courses. I have had an interest […]