scholarly journals Naturalistic study of the antipsychotic medication review service at the Maudsley Hospital

2002 ◽  
Vol 26 (8) ◽  
pp. 291-294 ◽  
Author(s):  
James Stone ◽  
Ruth Ohlsen ◽  
David Taylor ◽  
Lyn Pilowsky
Keyword(s):  
Antipsychotic Medication ◽  
Medication Review ◽  
Atypical Antipsychotics ◽  
Hospital Admissions ◽  
Cost Effective ◽  
Naturalistic Study ◽  
Global Assessment Scale ◽  
Global Function ◽  
Administration System ◽  
Patient Administration System

Aims and MethodTo evaluate the effectiveness of the antipsychotic medication review service (AMRS) at the Maudsley Hospital. Patient notes were analysed from the AMRS and estimates of Global Assessment Scale (GAS) scores were made from entries in the notes. Data on hospital admissions before and during attendance at the AMRS were obtained from the trust-wide computerised patient administration system.ResultsA statistically significant improvement in GAS scores was seen for patients who stayed in contact with the AMRS. Patients who did not respond to the first atypical drug often made a good response to an alternative atypical antipsychotic. Patients attending the AMRS had fewer hospital admissions than they did before attendance, although this was not statistically significant.Clinical ImplicationsAlthough more expensive on a dose-by-dose rate, atypical antipsychotics may be cost effective by improving compliance and reducing the number of relapses and hospital admissions. Specialised services with frequent patient contact can be effective in preventing relapse and improving global function.

scholarly journals Non-attendance rates among patients attending different grades of psychiatrist and a clinical psychologist within a community mental health clinic

2004 ◽  
Vol 28 (1) ◽  
pp. 5-7 ◽  
Author(s):  
Ronan McIvor ◽  
Emma Ek ◽  
Jerome Carson
Keyword(s):  
Health Clinic ◽  
Clinical Psychologist ◽  
Junior Doctors ◽  
Attendance Rates ◽  
Administration System ◽  
Medical Interventions ◽  
Community Mental Health Clinic ◽  
Linear Contrast ◽  
Patient Administration System

Aims and MethodTo examine non-attendance rates in patients seen by psychiatrists of different grades and a consultant clinical psychologist. Rates were obtained from the patient administration system over a 21-month period.ResultsA planned linear contrast showed that the clinical psychologist's patients had the lowest rate of non-attendance (7.8%), followed in turn by those of consultant psychiatrists (18.6%), specialist registrars (34%) and senior house officers (37.5%).Clinical ImplicationsFactors such as continuity of care, perceived clinical competence and the provision of non-medical interventions might have an impact on attendance rates. These results indicate the difficulty in reconciling the training needs of junior doctors with the provision of continuity and quality of care for patients. Reminder systems for people seeing training doctors might be an effective way of reducing non-attendance rates.

Serum prolactin levels and sexual dysfunctions in antipsychotic medication, such as risperidone: a review

2000 ◽  
Vol 12 (1) ◽  
pp. 19-26 ◽  
Author(s):  
H. Knegtering ◽  
P.A. Lambers ◽  
G. Prakken ◽  
C. ten Brink
Keyword(s):  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
University Hospital ◽  
Serum Prolactin ◽  
Sexual Dysfunctions ◽  
Receptor Blockade ◽  
Naturalistic Study ◽  
Serotonergic Receptor ◽  
Male Patients ◽  
The University

SUMMARYClassical antipsychotic drugs increase the level of serum prolactin. The atypical antipsychotic clozapine barely increases prolactin levels. An open naturalistic study in the University Hospital of Groningen suggests that treatment with risperidone in comparison to classical antipsychotics seems to increase the risk of erectile and ejaculatory disorders in male patients and to menstrual disturbances in female patients. In the literature reviewed, risperidone is associated with higher prolactin levels in comparison to classical antipsychotics. It is still unclear which mechanism is responsible for the increase of serum prolactin levels and sexual dysfunctions in patients using risperidone. Dopaminergic and serotonergic receptor blockade seems to play an important role. Other mechanisms are discussed.

scholarly journals Evaluation of the antipsychotic medication review process at four long-term facilities in Alberta

2016 ◽  
Vol Volume 9 ◽  
pp. 499-509
Author(s):  
Arden Birney ◽  
Paola Charland ◽  
Mollie Cole ◽  
Mubashir Aslam Arain
Keyword(s):  
Antipsychotic Medication ◽  
Medication Review ◽  
Review Process

scholarly journals Outpatient Care

2021 ◽  
pp. 21-33
Author(s):  
Ian Qianhuang Wu ◽  
Francesca Lorraine Wei Inng Lim ◽  
Liang Piu Koh
Keyword(s):  
T Cell ◽  
Cancer Care ◽  
Hospital Admissions ◽  
Care Delivery ◽  
Cost Effective ◽  
Outpatient Setting ◽  
Cancer Center ◽  
T Cell Therapy ◽  
Car T Cell Therapy ◽  
Near Future

AbstractManagement of haematology-oncology patients has historically been largely inpatient-based. With advances in the understanding of disease and improvements in supportive care, patients are increasingly being managed in the outpatient setting. This is especially evident in autologous stem cell transplantation, which is now routinely done as an outpatient procedure at various centres. As clinicians gain more experience in novel therapies such as chimeric antigen receptor (CAR)-T cell therapy and bispecific T cell engager (BiTE) therapy, these may potentially be administered in the outpatient setting in the near future with the adoption of a risk-stratified approach. Such a paradigm shift in the practice of haematology-oncology is inevitable and has been driven by several factors, including pressure from the institution/hospital to avoid unnecessary hospital admissions and for optimal use of inpatient resources to be more cost-effective and efficient. With favourable local regulations and funding, outpatient cancer care can be economically beneficial. The success of an outpatient cancer center is heavily dependent on planning the facility to be equipped with the appropriate infrastructure, together with the trained medical and supportive personnel in place. This, coupled with the utilization of emerging technology such as telemedicine, has the potential to revolutionize cancer care delivery in the outpatient setting.

Can We Trust the Quality of Routine Hospital Outpatient Information in the UK?

1998 ◽  
Vol 3 (4) ◽  
pp. 203-206 ◽  
Author(s):  
Alison Shaw ◽  
Maggie Somerset ◽  
Liz Dunn ◽  
Tim Peters ◽  
Alex Faulkner ◽  
...  
Keyword(s):  
Systematic Evaluation ◽  
Management Decision ◽  
Complete Agreement ◽  
Specific Data ◽  
Administration System ◽  
Hospital Outpatient ◽  
The Uk ◽  
Patient Administration System ◽  
Good Agreement

Background: A validation study of routine hospital outpatient data was carried out as part of a broader project focusing on outpatient re-attendance. The aim was to compare two patient administration system (PAS) data items with the same information collected directly from hospital clinicians. Methods: A total of 140 cases from four specialties at four National Health Service hospitals was randomly selected for comparison. The specific data items compared were the grade of doctor seen and the management decision taken following an outpatient appointment. The proportion of cases in which there was agreement was calculated, together with kappa values and relevant statistics indicating the accuracy of the PAS data when compared with information compiled immediately after the consultation by the relevant clinician. Results: There was agreement between the clinician's data and the PAS data in 118/140 (84.3%) cases for grade of doctor seen and in 105/139 (76.7%) cases for the management decision. There was complete agreement for both items in 88/139 (62.6%) cases. Kappa values indicated good agreement between the two data sources. However, ‘sensitivity’ statistics suggested that the likely accuracy of each data item varied. Conclusion: Although there was good agreement within individual categories between the two sources, 37% of patient computerised records held at least one inconsistency in this small study focusing on only two data items. Further systematic evaluation is needed to test the extent to which other items are similarly discrepant.

scholarly journals Universal Methicillin-ResistantStaphylococcus aureus(MRSA) Surveillance for Adults at Hospital Admission: An Economic Model and Analysis

2010 ◽  
Vol 31 (6) ◽  
pp. 598-606 ◽  
Author(s):  
Bruce Y. Lee ◽  
Rachel R. Bailey ◽  
Kenneth J. Smith ◽  
Robert R. Muder ◽  
Elsa S. Strotmeyer ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Cost Effective ◽  
Dominant Strategy ◽  
Reproductive Rate ◽  
Third Party ◽  
Computer Simulation Model ◽  
Surveillance Culture ◽  
Wide Range

Background.Methicillin-resistantStaphylococcus aureus(MRSA) transmission and infections are a continuing problem in hospitals. Although some have recommended universal surveillance for MRSA at hospital admission to identify and to isolate MRSA-colonized patients, there is a need for formal economic studies to determine the cost-effectiveness of such a strategy.Methods.We developed a stochastic computer simulation model to determine the potential economic impact of performing MRSA surveillance (ie, single culture of an anterior nares specimen) for all hospital admissions at different MRSA prevalences and basic reproductive rate thresholds from the societal and third party-payor perspectives. Patients with positive surveillance culture results were placed under isolation precautions to prevent transmission by way of respiratory droplets. MRSA-colonized patients who were not isolated could transmit MRSA to other hospital patients.Results.The performance of universal MRSA surveillance was cost-effective (defined as an incremental cost-effectiveness ratio of less than $50,000 per quality-adjusted life-year) when the basic reproductive rate was 0.25 or greater and the prevalence was 1% or greater. In fact, surveillance was the dominant strategy when the basic reproductive rate was 1.5 or greater and the prevalence was 15% or greater, the basic reproductive rate was 2.0 or greater and the prevalence was 10% or greater, and the basic reproductive rate was 2.5 or greater and the prevalence was 5% or greater.Conclusions.Universal MRSA surveillance of adults at hospital admission appears to be cost-effective at a wide range of prevalence and basic reproductive rate values. Individual hospitals and healthcare systems could compare their prevailing conditions (eg, the prevalence of MRSA colonization and MRSA transmission dynamics) with the benchmarks in our model to help determine their optimal local strategies.

scholarly journals The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

2015 ◽  
Vol 19 (81) ◽  
pp. 1-246 ◽  
Author(s):  
Janine Dretzke ◽  
Deirdre Blissett ◽  
Chirag Dave ◽  
Rahul Mukherjee ◽  
Malcolm Price ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Hospital Admissions ◽  
Cost Effective ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
The Cost ◽  
Effectiveness Studies

BackgroundChronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease characterised by non-reversible airflow obstruction. Exacerbations are a key cause of morbidity and mortality and place a considerable burden on health-care systems. While there is evidence that patients benefit from non-invasive ventilation (NIV) in hospital during an acute exacerbation, evidence supporting home use for more stable COPD patients is limited. In the UK, domiciliary NIV is considered on health economic grounds in patients after three hospital admissions for acute hypercapnic respiratory failure.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of domiciliary NIV by systematic review and economic evaluation.Data sourcesBibliographic databases, conference proceedings and ongoing trial registries up to September 2014.MethodsStandard systematic review methods were used for identifying relevant clinical effectiveness and cost-effectiveness studies assessing NIV compared with usual care or comparing different types of NIV. Risk of bias was assessed using Cochrane guidelines and relevant economic checklists. Results for primary effectiveness outcomes (mortality, hospitalisations, exacerbations and quality of life) were presented, where possible, in forest plots. A speculative Markov decision model was developed to compare the cost-effectiveness of domiciliary NIV with usual care from a UK perspective for post-hospital and more stable populations separately.ResultsThirty-one controlled effectiveness studies were identified, which report a variety of outcomes. For stable patients, a modest volume of evidence found no benefit from domiciliary NIV for survival and some non-significant beneficial trends for hospitalisations and quality of life. For post-hospital patients, no benefit from NIV could be shown in terms of survival (from randomised controlled trials) and findings for hospital admissions were inconsistent and based on limited evidence. No conclusions could be drawn regarding potential benefit from different types of NIV. No cost-effectiveness studies of domiciliary NIV were identified. Economic modelling suggested that NIV may be cost-effective in a stable population at a threshold of £30,000 per quality-adjusted life-year (QALY) gained (incremental cost-effectiveness ratio £28,162), but this is associated with uncertainty. In the case of the post-hospital population, results for three separate base cases ranged from usual care dominating to NIV being cost-effective, with an incremental cost-effectiveness ratio of less than £10,000 per QALY gained. All estimates were sensitive to effectiveness estimates, length of benefit from NIV (currently unknown) and some costs. Modelling suggested that reductions in the rate of hospital admissions per patient per year of 24% and 15% in the stable and post-hospital populations, respectively, are required for NIV to be cost-effective.LimitationsEvidence on key clinical outcomes remains limited, particularly quality-of-life and long-term (> 2 years) effects. Economic modelling should be viewed as speculative because of uncertainty around effect estimates, baseline risks, length of benefit of NIV and limited quality-of-life/utility data.ConclusionsThe cost-effectiveness of domiciliary NIV remains uncertain and the findings in this report are sensitive to emergent data. Further evidence is required to identify patients most likely to benefit from domiciliary NIV and to establish optimum time points for starting NIV and equipment settings.Future work recommendationsThe results from this report will need to be re-examined in the light of any new trial results, particularly in terms of reducing the uncertainty in the economic model. Any new randomised controlled trials should consider including a sham non-invasive ventilation arm and/or a higher- and lower-pressure arm. Individual participant data analyses may help to determine whether or not there are any patient characteristics or equipment settings that are predictive of a benefit of NIV and to establish optimum time points for starting (and potentially discounting) NIV.Study registrationThis study is registered as PROSPERO CRD42012003286.FundingThe National Institute for Health Research Health Technology Assessment programme.

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