Proactive Management Of Patients Research Articles

CARDIAC HYDATID CYST: A RARE CASE REPORT

Introduction: Hydatidosis, an anthropozoonosis prevalent in many sheep-farming countries, continues to pose a significant health concern. Cardiac localization represents a rare and distinctive manifestation, accounting for less than 2% of total cases. This report details a case where surgical intervention, coupled with antiparasitic chemotherapy, was used for effective treatment. Patients and Methods: A 36-years-old female, residing in a rural area renowned for agricultural and livestock activities, was under cardiology supervision due to rheumatic polyvalvulopathy. Having undergone hepatic hydatid cyst surgery one year earlier, The reason for her consultation in cardiology was exertional dyspnea, left thoracic pain, palpitations, afebrility, and asthenia. The disease diagnosis relied on imaging findings.Treatment involved the urgent surgical excision of the cyst, followed by the oral administration of albendazole at 400mg x 2 per day, initiated 48 hours postoperatively. With no contraindications, the patient underwent continuous biological monitoring during hospitalization, reporting no adverse effects. The antiparasitic regimen persisted for 4 months. Conclusion: Albendazole, whether used as a standalone therapy or in combination, remains a highly effective treatment. It can either substitute for or complement surgical approaches, offering the flexibility of extended treatment durations. Vigilant monitoring of hepatic function is imperative in these instances to identify potential adverse effects. Two-dimensional transthoracic echocardiography plays a pivotal role in tracking patient progress and evaluating treatment efficacy.Prevention stands out as the most effective strategy against hydatid cysts, emphasizing collective awareness and proactive patient management to avert cyst dissemination.

Radical prostatectomy readmissions: Causes, risk factors, national rates, & costs

IntroductionReadmissions have substantial clinical and financial impacts on the healthcare system. Radical prostatectomy (RP) is considered a standard treatment in the management of clinically localized prostate cancer. Yet, there is a paucity of research evaluating readmissions for RP in a national dataset. Patients and methodsPatients with histologically confirmed prostate cancer managed with RP were identified within the 2016 to 2018 Nationwide Readmissions Database. Patient factors, facility factors, and surgical characteristics were evaluated for associations with readmission using univariable and multivariable analyses. ResultsA total of 133,727 patients receiving RP were identified. Early (30-day) and late (31–90-day) readmission rates were 4.2% and 1.8% respectively. The most common cause of early readmission was postoperative digestive system complication (10%) and the most common cause of late readmission was septicemia (13%). On multivariable logistic regression, factors associated with both early and late readmission include nonroutine discharge at index (early: OR 1.877, 95% CI 1.667–2.113; late: OR 1.801, 95% CI 1.490–2.183), and circulatory system comorbidity (early: OR 1.29, 95% CI 1.082–1.538); late: OR 1.515, 95% CI 1.157–1.984). ConclusionsOur findings regarding factors associated with readmission provide insight for RP counseling and may inform postoperative care pathways. Elucidation of readmission trends may allow the identification and proactive management of patients at higher risk for readmission.

MP32-02 RADICAL PROSTATECTOMY READMISSIONS: CAUSES, RISK FACTORS, NATIONAL RATES, & COSTS

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II (MP32)1 Sep 2021MP32-02 RADICAL PROSTATECTOMY READMISSIONS: CAUSES, RISK FACTORS, NATIONAL RATES, & COSTS Shiva Balasubramanian, Xi Wang, An-Lin Cheng, Jignesh H. Shah, and William P. Parker Shiva BalasubramanianShiva Balasubramanian More articles by this author , Xi WangXi Wang More articles by this author , An-Lin ChengAn-Lin Cheng More articles by this author , Jignesh H. ShahJignesh H. Shah More articles by this author , and William P. ParkerWilliam P. Parker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002036.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Readmissions have substantial clinical and financial impacts on the healthcare system. Radical prostatectomy (RP) is considered a standard treatment in the management of clinically localized prostate cancer. Yet there is a paucity of research evaluating readmissions for RP in a national dataset. We sought to evaluate 30-day and 90-day readmission rates and risk factors for RP using the 2018 Nationwide Readmissions Database (NRD) – a longitudinal database that represents over 58% of all US hospitalizations. METHODS: Using the NRD, patients with histologically confirmed prostate cancer managed with radical prostatectomy were identified and clinicopathologic data were abstracted for patients and facilities. The primary end-point was 30-day and 90-day readmissions. Patient and facility factors were assessed for associations with readmission using univariable and multivariable analyses. RESULTS: Between January and September 2018, a total of 33,351 patients were identified. Readmission rates for 30 and 90 days were 5.1% and 7.0% respectively. The most common cause of readmission at both timepoints was complication (12.59% and 12.78% respectively) followed by septicemia (12.2% and 10.76% respectively). The most frequent procedure performed during both 30 and 90 day readmission hospitalizations was abdominal drainage (18.38% and 19.03% respectively). Mean index cost for RP was $15,602. On multivariable logistic regression, factors associated with both 30 and 90 day readmission include nonroutine discharge (30 Day: OR 1.96, 95% CI 1.642, 2.34; 90 Day: OR 2.066, 95% CI 1.748, 2.441), lymphadenectomy (30 Day: OR 1.203, 95% CI 1.006, 1.439; 90 Day: OR 1.215, 95% CI 1.057, 1.399), index admission cost > 75th Percentile (30 Day: OR 1.335, 95% CI 1.138, 1.567; 90 Day: OR 1.287, 95% CI 1.120, 1.479), and index admission length of stay > 75th Percentile (30 Day: OR 1.536, 95% CI 1.319, 1.789; 90 Day: OR 1.464, 95% CI 1.290, 1.661). CONCLUSIONS: Our findings regarding predictors of readmission provide insight for preoperative counseling of patients receiving RP. Additionally, the results of this study may impact postoperative care guidelines. Elucidation of readmission trends enables the identification and proactive management of patients at higher risk for readmission. Source of Funding: UMKC Sarah Morrison Student Research Award © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e564-e565 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shiva Balasubramanian More articles by this author Xi Wang More articles by this author An-Lin Cheng More articles by this author Jignesh H. Shah More articles by this author William P. Parker More articles by this author Expand All Advertisement Loading ...

Potential of inpatient cases of a university hospital for orthopedics and trauma surgery for outpatient care

HintergrundDurch das Reformgesetz des Medizinischen Dienstes der Kassen (MDK) soll u. a. eine Verlagerung bislang stationär erbrachter Leistungen in den ambulanten Versorgungsektor bzw. die Versorgung nach §115b SGB V umgesetzt werden. Ziel dieser Arbeit ist die Untersuchung bestimmter Gruppen stationärer Fälle eines universitären Maximalversorgers für Unfallchirurgie und Orthopädie, die das Risiko einer operativen Ambulantisierung tragen.MethodikDie Datenerfassung mittels SAP Data Warehouse umfasst alle stationären Fälle 2017–2019. Es erfolgt die Subgruppenanalyse der Krankenhausleistungsparameter von 3 potenziellen Risikogruppen (RG): 1) primäre Fehlbelegungen, 2) Katalogleistungen der AOP-Kategorie 1 und/oder 2 sowie 3) elektive Eintagesfälle als hypothetische Risikogruppe. Zudem erfolgt eine Analyse epidemiologischer und ökonomischer Parameter.ErgebnisseEine primäre Fehlbelegung (RG 1) wurde vom MDK in 245 Fällen beanstandet. RG 2 umfasst 764 Fälle und RG 3 891 Fälle. Das Kollektiv wies ein Durchschnittsalter von 45,5 ± 17,7 Jahren auf und zeigte in 90 % keine relevanten Nebendiagnosen (PCCL 0). Der Hauptanteil der Fälle ließ sich den DRG I23B und I21Z (Entfernung von Osteosynthesematerial, 15–23 %) zuordnen, nachfolgend offenen oder arthroskopischen Eingriffen an den Extremitäten (DRG I32F, I32G, I24Z, I18B, 6–9 %). Im Falle einer zunehmenden Ambulantisierung ergibt sich ein potenzielles Erlösrisiko 2017 von 1.049.207 €, 2018 von 1.076.727 € und 2019 von 923.163 €.SchlussfolgerungEinzelne Gruppen haben ein erhöhtes Transferpotenzial in bestimmten DRG für ambulante Operationen. Eine proaktive Patientensteuerung in Bezug auf ambulante vs. stationäre Behandlung sowie ein besonderes Management personeller und räumlicher Ressourcen sind notwendig, um nachgelagerte Erlöskürzungen zu antizipieren.

Artificial intelligence-powered remote monitoring of patients with chronic obstructive pulmonary disease.

Artificial intelligence-powered remote monitoring of patients with chronic obstructive pulmonary disease.

Analysis of core processes of the MRI workflow for improved capacity utilization

PurposeTo analyze core processes of the MRI workflow and to evaluate efficiency for improved patient throughput and capacity utilization. MethodProspective data collection was conducted during a four-week time period and a total sum of 160 working hours for each of the two 1.5 T MRI scanners. Three core processes defined the value stream of patient handling before, during and after the MRI examination: i) Scheduling & Registration, ii) Organization & Preparation, and iii) MR scan. Quantitative data was collected for six essential time intervals of the MRI workflow. ResultsA total of 302 MRI examinations were assessed. The workflow analysis revealed that effective utilization of scan capacity during operating hours varied by scanner (Scanner 1: 77 % / Scanner 2: 85 %). Mean process times for were: patient preparation time 18.9 min (±15.1) p = 0.11, scan preparation time 5.7 min (±4.0) p = 0,015, effective scan time 39.6 min (±18.0) p < 0.0001, scan room occupation time 50.9 min (±21.0) p < 0.0001, clean-up time 5.6 min (±3.2) p = 0.001, total patient handling time 69.7 min (±26.3) p < 0.0001, turnover time 13.4 min (±21.4) p = 0.65. ConclusionsThis study demonstrates the utility and applicability of a standardized core processes analyses for MRI scanning, which identified underutilization of scanning capacities, related to multiple factors, such as punctuality of patients, the number of same day cancellations, the process of placing an IV access and patient transport contribute to underutilization of MRI scanners. Furthermore, proactive patient management and effective communication with patients and referring physicians might have relevant time saving potential in the scan room.

Management of toxicity to isoform α-specific PI3K inhibitors.

Alterations in the phosphoinositide 3-kinase (PI3K)/AKT pathway are frequently found in cancer and are especially common in breast cancer, where it is estimated that 70% of tumors have some type of genetic alteration that could lead to pathway hyperactivation. A variety of PI3K pathway inhibitors have been developed in an attempt to target this pathway and improve cancer control. One of the challenges in treating patients with PI3K/AKT pathway inhibitors is the associated toxicity from on-target and off-target effects. Such side-effects are common, but reversible, and include hyperglycemia, rash, stomatitis, diarrhea, nausea, and fatigue. As a result, dose reductions, treatment delays, and treatment discontinuation are frequently reported. This impairs not only patients’ quality of life but also treatment efficacy. Most side-effects are reversible with drug interruption, since these drugs typically have a short half-life and are manageable with early intervention. An interdisciplinary approach with proactive management of patients receiving PI3K pathway inhibitors should include comprehensive education of patients about the range of toxicities, frequent monitoring, early toxicity recognition, active intervention, as well as prophylactic strategies.

A discrete event simulation model to evaluate the treatment pathways of patients with cataract in the United Kingdom

BackgroundThe number of people affected by cataract in the United Kingdom (UK) is growing rapidly due to ageing population. As the only way to treat cataract is through surgery, there is a high demand for this type of surgery and figures indicate that it is the most performed type of surgery in the UK. The National Health Service (NHS), which provides free of charge care in the UK, is under huge financial pressure due to budget austerity in the last decade. As the number of people affected by the disease is expected to grow significantly in coming years, the aim of this study is to evaluate whether the introduction of new processes and medical technologies will enable cataract services to cope with the demand within the NHS funding constraints.MethodsWe developed a Discrete Event Simulation model representing the cataract services pathways at Leicester Royal Infirmary Hospital. The model was inputted with data from national and local sources as well as from a surgery demand forecasting model developed in the study. The model was verified and validated with the participation of the cataract services clinical and management teams.ResultsFour scenarios involving increased number of surgeries per half-day surgery theatre slot were simulated. Results indicate that the total number of surgeries per year could be increased by 40% at no extra cost. However, the rate of improvement decreases for increased number of surgeries per half-day surgery theatre slot due to a higher number of cancelled surgeries. Productivity is expected to improve as the total number of doctors and nurses hours will increase by 5 and 12% respectively. However, non-human resources such as pre-surgery rooms and post-surgery recovery chairs are under-utilized across all scenarios.ConclusionsUsing new processes and medical technologies for cataract surgery is a promising way to deal with the expected higher demand especially as this could be achieved with limited impact on costs. Non-human resources capacity need to be evenly levelled across the surgery pathway to improve their utilisation. The performance of cataract services could be improved by better communication with and proactive management of patients.

PRM108 - EVALUATION OF CATARACT TREATMENT IN THE UNITED KINGDOM USING A PATIENT PATHWAY DISCREET EVENT SIMULATION MODEL

An aging population is resulting in increased demand for cataract procedures in the UK. This increased demand together with current budgetary pressures on the NHS, mean that efficiencies in the delivery of cataract services must be identified if more patients are to be treated using existing NHS resources. This study aimed to evaluate whether changes in the treatment of cataract patients will enable more patients to be treated without the need for additional resources. A Discrete Event Simulation model representing the cataract services pathways at Leicester Royal Infirmary Hospital was developed. Data to run the model was sourced from national and local sources as well as from a cataract procedure demand forecasting model developed in the study. Validation and verification of the model was achieved with the participation of the cataract services clinical and management teams. Using new treatments that reduce the time taken to perform cataract procedures, four scenarios involving an increased number of procedures per half-day theatre slots were simulated using the model. Results indicated that the total number of procedures per year could be increased by 40% at no extra cost. However, the rate of improvement decreases for increased number of procedures per half-day theatre slot due to a higher number of cancelled procedures. Productivity is expected to improve as the total number of doctors and nurses hours will increase by 12% and 18% respectively. However, non-human resources such as pre-surgery rooms and post-surgery recovery chairs are under-utilized across all scenarios. Using new technologies for cataract procedures could help address the increased demand especially as this would be achieved with limited impact on costs. Non-human resources capacity needs to be evenly levelled across the cataract pathway to improve their utilisation. The performance of cataract services could be improved by better communication with and proactive management of patients.

Restraints utilization in a psychiatric emergency room

ABSTRACTThe utilization of restraints is an important quality measure of psychiatric services including the emergency and inpatient services. The practice, however, continues to generate controversy and differing opinions in terms of its ethics and clinical utility. Prompt identification of patient and environmental factors that are most frequently associated with the need for restraints may provide useful tools to help clinicians as they triage patients in psychiatric emergency settings. Proactive measures such as behavioral interventions can reduce the need for restraints and improve the quality of care provided to patients. We conducted a systematic retrospective review of all restraint orders between January 2016 and June 2016 in the psychiatry emergency of a community hospital in an urban setting. Data was analyzed using descriptive statistics and Chi-square to determine associations between patient demographic characteristics, primary diagnoses and the use of restraints. Results show that 2.9 percent of patients in the present study required restraints. Manual hold was by far the most utilized (88.4%); 53.7 percent of all the patients had a positive urine toxicology for illicit substances, mostly Marijuana (31.6%). We also reported a significant association between the patient’s primary diagnosis and the frequency of restraints (p = 0.004), the most frequent diagnosis being the schizophrenia spectrum (69.5%).In conclusion, our study presents characteristics and descriptors of patients who required restraints. An early identification of patients’ diagnosis and any co-morbid substance abuse and a prompt and proactive management of patients may reduce the need for restraints in psychiatric emergency room settings.

Telemedicine-based proactive patient management during positive airway pressure therapy: Impact on therapy termination rate.

BackgroundAdherence to positive airway pressure (PAP) therapy is essential for the benefits of therapy to be realised. Telemedicine-based strategies provide a new option for enhanced monitoring and intervention to promote adherence during PAP. This study investigated the impact of telemedicine-based proactive patient management on PAP therapy termination rates versus standard care.MethodsObservational data were obtained from ResMed Germany Healthcare, a German homecare provider. Patients were undergoing routine homecare using either a standard or proactive management strategy. The proactive strategy used data from AirView™, a cloud-based remote monitoring system, to prompt patient contact and information sharing/education. Patients receiving their first PAP therapy were included and analysed in matched pairs.ResultsIn all, 3401 patients were included in each group. In the first year of PAP therapy, overall therapy termination rate was significantly lower (5.4% vs 11.0%; p < 0.001) and time to therapy termination was significantly longer (348 ± 58 vs 337 ± 76 days; p < 0.05) in the proactive versus standard care group. Cox proportional hazard analysis revealed a significantly reduced risk of PAP termination in the proactive versus the standard care group (hazard ratio 0.48, 95% confidence interval 0.4–0.57). Findings were consistent in subanalyses according to gender, type of device and insurance status, and in patients aged ≥40 years. However, in the subgroup of patients aged younger than 40 years, the risk of PAP termination was similar in the proactive and standard groups.ConclusionA telemedicine-based proactive management strategy compared with standard care of PAP patients was associated with a lower long-term therapy termination rate.

Strengthening a competent health workforce for the provision of coordinated/ integrated health services

Finding more efficient, innovative and responsive ways of engaging the health workforce to manage patients is key to ensuring integrated care. Systems that are transforming their services to be more integrated must ensure that health professionals are ready to fill the new roles assigned to them in prevention and pro-active patient management, manage health and care rather than disease and cure, work in teams across professions and sectors, work along a continuum of care, protect and advocate the most vulnerable, ensure equitable service delivery, optimize communication that has an emphasis on compassion and empathy and develop more than one vertical expertise.Securing a health workforce that “wants and feels” and has the theoretical knowledge and skills to work more efficiently and effectively is not enough in ensuring integrated health services. What is needed is a guarantee that health professionals who enter the workplace will apply their knowledge and skills with sound judgment (i.e. that they will have competencies) and that they will refine and maintain these over the course of their career (consolidate competencies). To date the focus on competencies has been limited to looking at education institutions (i.e. college and universities) where initial exposure to competencies takes place. Indeed important strides have been taken since the Lancet review on transforming health professional education to be more competency-oriented. The lack of a clear definition on what competencies are, how they are governed and strengthened beyond initial training settings has however resulted in misplacing competencies of the health workforce as merely a problem for training institutions. Without a deeper exploration into what competencies are and how they can be strengthened at both the service and systems level important conversations on the relevance of competencies to health systems have been missed. This has been explored in our paper for the World Health Organization Regional Office for Europe "Strengthening a competent health workforce for the provision of coordinated/ integrated health services" (http://www.euro.who.int/en/health-topics/Health-systems/health-service-delivery/publications/2015/strengthening-a-competent-health-workforce-for-the-provision-of-coordinated-integrated-health-services).A systematic review of the literature was conducted resulting in the identification of 5 core competencies for integrated care. Their consolidation over the course of a health professional's career is conceptualized and a framework proposed that addresses actors and their responsibilities at both the service delivery level and the systems level. 13 important entry points for the assurance and improvement of competencies. Having done this, the paper shows how competencies are the responsibility of a range of stakeholders - service managers, policy makers, regulatory bodies, and patient and professional associations- and how they can work more closely with each other. Most notably the paper proposes that accountability for the consolidation of competencies of the health workforce lies with executives of health services. Without such clarity of roles and responsibilities, governance of the health workforce will continue to be challenged by poor accountability, corruption, limited involvement of communities in policy-making, ineffective management strategies and ultimately poor health outcomes.A workshop is proposed to discuss:- what participants think of the five proposed integrated care competencies listed;- what the participant's experiences with the five proposed integrated care competencies in their individual countries are;- the proposed conceptual framework for competency consolidation and the identified 13 entry points;and- experiences with barriers/facilitators and opportunities for implementation of the competencies and the entry points.The workshop will take a particular focus on the service delivery level and discuss examples and tools for the service-specific entry points for governing competency consolidation.

Scleroderma renal crisis and renal involvement in systemic sclerosis.

Scleroderma renal crisis (SRC) is a rare, potentially life-threatening complication that affects 2-15% of patients with systemic sclerosis (SSc, also known as scleroderma). SRC typically presents in patients with early, rapidly progressive, diffuse cutaneous SSc within the first 3-5 years after the onset of a non-Raynaud sign or symptom. SRC is characterized by an acute, usually symptomatic increase in blood pressure, a rise in serum creatinine levels, oliguria and thrombotic microangiopathy in about 50% of patients. The prognosis of SRC substantially improved in the 1980s with the introduction of angiotensin-converting-enzyme inhibitors for rapid blood pressure control, with additional antihypertensive agents as required. However, the survival of patients with SRC can still be improved. Current patient survival is 70-82% at 1 year, but decreases to 50-60% at 5 years despite dialysis support. Patients with SRC who show no signs of renal functional recovery despite timely blood pressure control are candidates for transplantation. In this Review, we discuss progress made in the identification and proactive management of patients at risk of SRC and make recommendations aimed at optimizing management for those who progress to chronic kidney failure.

Standardizing Management of Adults with Delirium Hospitalized on Medical-Surgical Units.

Delirium is common among inpatients aged 65 years and older and is associated with multiple adverse consequences, including increased length of stay (LOS). However, delirium is frequently unrecognized and poorly understood. At one hospital, baseline management of delirium on medical-surgical units varied greatly, and psychiatric consultations focused exclusively on crisis management. To implement a multidisciplinary program for rapid identification and proactive management of patients with delirium on medical-surgical units. A pilot from September 2010 to July 2012 included 920 unique patients, of whom 470 were seen by the delirium management team. A delirium management team included a redesigned role for consulting psychiatrists and a new clinical nurse specialist role; the team provided assistance with diagnosis and recommendations for nonpharmacologic and pharmacologic management of delirium. Multidisciplinary education focused on delirium identification and management and nurses' use of appropriate assessment tools. Electronic health record functions supported accurate problem list coding, referrals to the team, and standardized documentation. Length of stay. During the study period, average LOS in the target population decreased from 8.5 days to 6.5 days (p = 0.001); average LOS for the Medical Center remained stable. Compared with patients whose delirium was diagnosed during the baseline period, patients who received a delirium diagnosis during the pilot period had a higher illness burden and were likelier to have a history of delirium and diagnosed dementia. Program implementation was associated with reduced LOS among older inpatients with delirium. The delirium team is an effective model that can be quickly implemented with few additional resources.

Understanding the Impact of Electronic Medical Record Use on Practice-Based Population Health Management: A Mixed-Method Study.

BackgroundPractice-based population health (PBPH) management is the proactive management of patients by their primary care clinical team. The ability of clinics to engage in PBPH and the means by which they incorporate it in a clinical setting remain unknown.ObjectiveWe conducted the Canadian Population Health Management Challenge to determine the capacity and preparedness of primary care settings to engage in PBPH using their existing medical record systems and to understand the complexities that may exist in PBPH implementation.MethodsWe recruited a sample of electronic medical record (EMR) -enabled and paper-based clinics from across Canada to participate in the challenge. The challenge required clinic staff and physicians to complete time-controlled, evidence-based practice reviews of their patients who may benefit from evidence-informed care, treatment, or interventions across five different areas (immunization, postmyocardial infarction care, cancer screening, diabetes management, and medication recall). We formulated a preparedness index to measure the capacity of clinics to engage in PBPH management. Finally, we conducted follow-up qualitative interviews to provide richer understanding of PBPH implementation and related issues (ie, challenges and facilitators).ResultsA total of 11 primary care clinics participated, representing 21 clinician practices. EMR-enabled clinics completed a full review of charts in an average of 1.37 hours. On the contrary, paper-based clinics reviewed nearly 10% of their charts in an average of 3.9 hours, hinting that they would have required an estimated 40 hours to complete a review of charts in their practice. Furthermore, the index revealed a major gap in preparedness between the EMR and paper-based clinics (0.86–3.78 vs 0.05–0.12), as well as a broad range among the EMR clinics. Finally, building on the results of the qualitative analysis, we identified factors facilitating the integration of PBPH.ConclusionsOur results suggest that EMR usage is pivotal in setting the foundation to support PBPH. The wide range of performance variation among EMR-enabled clinics suggests that EMR functionality and optimization, its support of clinical practice workflow, and policy issues to ensure adoption of standards are critical issues to facilitate PBPH.

Psychiatrists&amp;#39; awareness of partial and nonadherence to antipsychotic medication in schizophrenia: results from an Asia&amp;ndash;Pacific survey

BackgroundNonadherence is a well-known problem among schizophrenia patients, among whom relapse is fivefold more likely, adversely affecting health, employment, and social functioning. The Spanish Adherencia Terapéutica en la Esquizofrenia (ADHES) survey was developed to determine the scope and causes of medication nonadherence in schizophrenia.MethodsThe 20-question ADHES survey was distributed to 19,370 psychiatrists in 13 Asia–Pacific countries in January–April 2012, to ascertain psychiatrists’ perceptions of antipsychotic medication adherence levels among their schizophrenia patients, reasons for partial/nonadherence, their preferred methods of assessing adherence, and strategies to improve adherence. Responses are reported as mean and range across countries.ResultsFour thousand, six hundred sixty one psychiatrists (24% of recipients) completed the survey (highest contributors: People’s Republic of China, 1854; India, 1616). Psychiatrists perceived that 56% (range, 30%–71%) of schizophrenia patients were non- or partially adherent to medication. Patients discontinue medication primarily due to lack of insight into their condition (mean, 37%; 1%–65%) and because patients consider medication unnecessary when feeling better (mean, 27%; 15%–68%). Over half of psychiatrists (mean, 55%; 42%–99%) assess medication adherence at every visit, almost exclusively (81%) by asking their patients, versus quantitative measures. One in three psychiatrists expressed their preference to switch to or add a long-acting antipsychotic to improve adherence (15%–82%).ConclusionsThe substantial prevalence of partial/nonadherence to medication demonstrates that more proactive management of patients with schizophrenia is needed to improve adherence and thereby treatment outcomes.RegistrationRegistration of this study was not required.

Psychiatrists&amp;rsquo; awareness of adherence to antipsychotic medication in patients with schizophrenia: results from a survey conducted across Europe, the Middle East, and Africa

BackgroundNonadherence is common among patients with schizophrenia, although the rates vary according to means of assessment and patient population. Failure to adhere to medication can have a major impact on the course of illness and treatment outcomes, including increasing the risk of relapse and rehospitalization. Understanding psychiatrists’ perception of the causes and consequences of nonadherence is crucial to addressing adherence problems effectively.MethodsThe Europe, the Middle East, and Africa (EMEA) Spanish Adherencia Terapéutica en la Esquizofrenia (ADHES) survey was conducted by questionnaire during January–March 2010 among psychiatrists treating patients with schizophrenia in 36 countries. The survey comprised 20 questions. In addition to recording the demographic details of the 4722 respondents (~12% response rate), it canvassed their preferred methods of assessing adherence, their perceptions of adherence rates, reasons for nonadherence, and strategies to improve adherence.ResultsPsychiatrists estimated that 53% of their patients with schizophrenia were partially/nonadherent during the previous month. They estimated only one-third of patients who deteriorated after stopping medication were able to attribute this to nonadherence. Psychiatrists assessed adherence most often by patient interview. Lack of insight was viewed as the most important cause of medication discontinuation, followed by patients feeling better and thinking their medication unnecessary, and experiencing undesirable side effects. Considerably fewer psychiatrists viewed insufficient efficacy, cognitive impairment, or drug/alcohol abuse as the most important reasons for their patients stopping medication.ConclusionPsychiatrists throughout EMEA recognize the impact of partial/nonadherence to medication, with patient enquiry being the most commonly used means of assessment. There remains a need for more proactive management of patients with schizophrenia, particularly in increasing patient insight of their illness in order to improve adherence and minimize the consequences of relapse. Strategies focused on raising awareness of the importance of adherence are also warranted, with the aim of improving patient outcomes in schizophrenia.

Continuity of care: important, but only the first step

Continuity of care is critical to achieving the best outcomes, especially for patients with chronic conditions. Israel’s strong commitment to primary care as a central organizing concept of the health system, accompanied by investments in health information technology and training primary care physicians, has contributed to its impressive levels of continuity of care. Taking the next steps toward a comprehensive system of patient- and population-centered care for proactive management of patients with chronic conditions has much potential to further enhance outcomes and reduce costs.

P98 Improving diagnosis and management of COPD: learning from a programme of national improvement projects

IntroductionChronic Obstructive Pulmonary Disease (COPD) represents an increasing burden for the NHS. National data indicate significant variation in the quality and consistency of diagnosis and management of COPD, with low...

PGI7 Impact of Complications from Dysphagia on Hospital Charges in the United States

Unmanaged dysphagia exposes patients to risk of malnutrition, dehydration, urinary tract infections (UTI) and aspiration pneumonia. It has been demonstrated that dysphagia screening and management may reduce the risk of developing complications and incurring increased hospital charges. The objective of this analysis is to quantify the additional charges associated with common complications of dysphagia. Using 2008 Health Care Utilization Project (HCUP) data, individuals with a recorded diagnosis of dysphagia (ICD-9 CM: 438.82, 787.2-787.29) were identified. The mean (10% trimmed) hospital charges for individuals with and without a recorded comorbid diagnosis of malnutrition, dehydration, UTI and aspiration pneumonia were compared. As there was a significant interaction between number of comorbidities and hospital charge in the UTI and pneumonia sample, an analysis of covariance (ANCOVA) model was employed to adjust the UTI and pneumonia analyses for this influence. The model was adjusted for complication diagnosis as a factor and both 1) number of comorbidities, and 2) complication diagnosis and number of comorbidities interaction as covariates. The most common complications reported in patients with a recorded diagnosis of dysphagia were UTI (27%, n=3424), pneumonia (26%, n=3348), dehydration (12%, n=1507), and malnutrition (8%, n=1027). Dysphagia patients with complications had significantly higher mean hospital charges than those without the complications UTI ($35,358 vs. $30,373, p<0.001), pneumonia ($33,085 vs. $31,184, p<0.001), dehydration ($28,093 vs. $20,850, p<0.001), and malnutrition ($37,192 vs. $34,747, p<0.001), and MS ($32,406 vs. $23,726, p<0.001). Our results demonstrate that having to treat the complications of dysphagia adds significantly to the cost of hospital care. Proactive management of patients with dysphagia may confer substantial savings to hospitals.