scholarly journals Implementation of a Novel Electronic Patient-Directed Smoking Cessation Platform for Cancer Patients: Interrupted Time Series Analysis (Preprint)

2018 ◽  
Author(s):  
Meredith Elana Giuliani ◽  
Geoffrey Liu ◽  
Wei Xu ◽  
Mihaela Dirlea ◽  
Peter Selby ◽  
...  
Keyword(s):  
Time Series ◽  
Smoking Cessation ◽  
Cancer Patients ◽  
Screening Program ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Effective Manner ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

BACKGROUND Continued smoking in cancer patients undergoing treatment results in significantly higher rates of treatment toxicities and persistent effects, increased risk of recurrence and second malignancy, and increased all-cause mortality. Despite this, routine tobacco use screening and the provision of smoking cessation treatment has yet to be implemented widely in the cancer setting. OBJECTIVE The objective of this study was to implement and evaluate the adoption and impact of an innovative Smoking Cessation e-referral System (CEASE) to promote referrals to smoking cessation programs in cancer patients. METHODS A patient-directed electronic smoking cessation platform (CEASE) was developed to promote smoking screening and referral and implemented at 1 of Canada’s largest cancer centers. The implementation and evaluation were guided by the Ottawa Model of Research Use. An interrupted time series design was used to examine the impact of CEASE on screening rates, referrals offered, and referrals accepted compared with a previous paper-based screening program. A subsample of smokers or recent quitters was also assessed and compared pre- and postimplementation to examine the effect of CEASE on subsequent contact with smoking cessation programs and quit attempts. RESULTS A total of 17,842 new patients attended clinics over the 20-month study period. The CEASE platform was successfully implemented across all disease sites. Screening rates increased from 44.28% (2366/5343) using the paper-based approach to 65.72% (3538/5383) using CEASE (P<.01), and referrals offered to smokers who indicated interest in quitting increased from 18.6% (58/311) to 98.8% (421/426; P<.01). Accepted referrals decreased from 41% (24/58) to 20.4% (86/421), though the overall proportion of referrals generated from total current/recent tobacco users willing to quit increased from 5.8% (24/414) to 20.2% (86/426) due to the increase in referrals offered. At 1-month postscreening, there was no significant difference in the proportion that was currently using tobacco and had not changed use in the past 4 weeks (pre: 28.9% [24/83] and post: 28.8% [83/288]). However, contact with the referral program increased from 0% to 78% in the postCEASE cohort (P<.001). CONCLUSIONS CEASE is an innovative tool to improve smoking screening and can be implemented in both a time- and cost-effective manner which promotes sustainability. CEASE was successfully implemented across all clinics and resulted in improvements in overall screening and referral rates and engagement with referral services.

CEASE: A novel patient directed electronic smoking cessation platform for cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6584-6584
Author(s):  
Jennifer M. Jones ◽  
Geoffrey Liu ◽  
Peter Selby ◽  
Lawson Eng ◽  
David Paul Goldstein ◽  
...  
Keyword(s):  
Time Series ◽  
Smoking Cessation ◽  
Cancer Patients ◽  
Tobacco Use ◽  
Self Report ◽  
Process Of Care ◽  
Referral Rates ◽  
Increased Risk ◽  
Patient Reported ◽  
The Impact

6584 Background: Continued smoking in cancer patients receiving treatment results in decreased efficacy, reduced survival, amd increased risk of recurrence. Despite ASCO and AACR policy statements, routine tobacco use screening and provision of smoking cessation treatment has not been widely implemented in the cancer setting. A paper-based tobacco use screening and clinician-dependent referral program for new ambulatory cancer patients was initiated at Princess Margaret Cancer Centre in 2013 resulting in moderate screen rates but low referral rates. In response, we developed and implemented a tailored patient directed electronic smoking cessation platform (CEASE) which included three elements:1) tobacco use assessment tool; 2) patient education on benefits of cessation; 3) a patient directed automatic referral system to smoking cessation programs. Methods: Interrupted time series design to examine the impact of CEASE on process of care (screening rates, referrals offered and accepted) and patient reported (quit attempts, smoking status, uptake of cessation programs) outcomes. Included 20 monthly intervals: 6 pre implementation (Apr-Sept 2015) (PRE), 8 gradual implementation across all tumour sites (Oct 2015-May 2016), and 6 postb implementation (Jun 2016-Nov 2016) (POST). A time series segmented linear regression was conducted to evaluate changes in process of care outcomes (excluding the implementation period). Pre-post self-report patient outcome data was also compared. Results: We assessed data from n = 3785 (PRE) and n = 4726 (POST) new patients. Screening rates increased from 44% using the paper-based approach to 65% with CEASE (p = 0.0019). Referrals offered to smokers who were willing to quit increased from 24% to 100% (p < 0.0001). Accepted referrals decreased from 45% to 26%; though the overall referral rate increased from 11% to 26% (p = 0.0001). The proportion of those using tobacco or attempting to quit did not differ at 3-months. However, engagement with the referral source increased from 4% to 62.5% (p < 0.001). Conclusions: CEASE was successfully implemented across all clinics and resulted in improvements in overall screening and referral rates and engagement with referral services.

scholarly journals Influence of Chinese National Centralized Drug Procurement on the price of policy-related drugs: an interrupted time series analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ni Wang ◽  
Ying Yang ◽  
Luxinyi Xu ◽  
Zongfu Mao ◽  
Dan Cui
Keyword(s):  
Time Series ◽  
Price Change ◽  
Interrupted Time Series ◽  
Chinese Government ◽  
Interrupted Time Series Analysis ◽  
Drug Procurement ◽  
Its Analysis ◽  
Significant Difference ◽  
The Impact ◽  
Alternative Drugs

Abstract Background The Chinese government implemented the first round of National Centralized Drug Procurement (NCDP) pilot (so-called “4 + 7” policy) in mainland China in 2019. This study aims to examine the impact of “4 + 7” policy on the price of policy-related drugs. Methods This study used drug purchasing order data from the Centralized Drug Procurement Survey in Shenzhen 2019, covering 24 months from January 2018 to December 2019. “4 + 7” policy-related drugs were selected as study samples, including 25 drugs in the “4 + 7” procurement list and 57 alternative drugs that have an alternative relationship with “4 + 7” List drugs in clinical use. “4 + 7” List drugs were then divided into bid-winning and bid-non-winning products according to the bidding results. Single-group Interruption Time Series (ITS) analysis was adopted to examine the change of Drug Price Index (DPI) for policy-related drugs. Results The ITS analysis showed that the DPI of winning (− 0.183 per month, p < 0.0001) and non-winning (− 0.034 per month, p = 0.046) products significantly decreased after the implementation of “4 + 7” policy. No significant difference was found for the immediate change of DPI for alternative drugs (p = 0.537), while a significant decrease in change trend was detected in the post-“4 + 7” policy period (− 0.003 per month, p = 0.014). The DPI of the overall policy-related drugs significantly decreased (− 0.261 per month, p < 0.0001) after “4 + 7” policy. Conclusions These findings indicate that the price behavior of pharmaceutical enterprises changed under NCDP policy, while the price linkage effect is still limited. It is necessary to further expand the scope of centralized purchased drugs and strengthen the monitoring of related drugs regarding price change and consumption structure.

scholarly journals Influence of Chinese National Centralized Drug Procurement on the Price of Policy-Related Drugs: An Interrupted Time Series Analysis

2021 ◽  
Author(s):  
Ni Wang ◽  
Ying Yang ◽  
Luxinyi Xu ◽  
Zongfu Mao ◽  
Dan Cui
Keyword(s):  
Time Series ◽  
Price Change ◽  
Interrupted Time Series ◽  
Chinese Government ◽  
Price Behavior ◽  
Interrupted Time Series Analysis ◽  
Drug Procurement ◽  
Significant Difference ◽  
The Impact ◽  
Pharmaceutical Enterprises

In 2019, Chinese government implemented the first round of National Centralized Drug Procurement (NCDP) pilot (so-called "4+7" policy) in mainland China, achieved a prominent price reduction of 52% on average for 25 bidding winning products. Under cross-price elasticity theory, the price behavior of pharmaceutical enterprises for policy-related drugs might change. This study used drug purchasing data from the Centralized Drug Procurement Survey in Shenzhen 2019, and applied single-group Interruption Time Series (ITS) design to examine the impact of "4+7" policy on the drug price index (DPI) of policy-related drugs. The ITS analysis showed that the DPI of winning (-0.183 per month, p&amp;lt;0.0001) and non-winning (-0.034 per month, p=0.046) products significantly decreased after the implementation of "4+7" policy. No significant difference was found for the immediate change of DPI for alternative drugs (p=0.537), while a significant decrease in change trend was detected in the post-"4+7" policy period (-0.003 per month, p=0.014). The DPI of the overall policy-related drugs significantly decreased (-0.261 per month, p&amp;lt;0.0001) after "4+7" policy. These findings indicate that the price behavior of pharmaceutical enterprises changed under NCDP policy, while the price linkage effect is still limited. It is necessary to further expand the scope of centralized purchased drugs and strengthen the monitoring of related drugs regarding price change and consumption structure.

scholarly journals Does admission prevalence change after reconfiguration of inpatient services? An interrupted time series analysis of the impact of reconfiguration in five centres

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joanne Martin ◽  
Edwin Amalraj Raja ◽  
Steve Turner
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Emergency Admission ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Emergency Admissions ◽  
Series Analysis ◽  
Inpatient Services ◽  
The Impact ◽  
Admission Prevalence

Abstract Background Service reconfiguration of inpatient services in a hospital includes complete and partial closure of all emergency inpatient facilities. The “natural experiment” of service reconfiguration may give insight into drivers for emergency admissions to hospital. This study addressed the question does the prevalence of emergency admission to hospital for children change after reconfiguration of inpatient services? Methods There were five service reconfigurations in Scottish hospitals between 2004 and 2018 where emergency admissions to one “reconfigured” hospital were halted (permanently or temporarily) and directed to a second “adjacent” hospital. The number of emergency admissions (standardised to /1000 children in the regional population) per month to the “reconfigured” and “adjacent” hospitals was obtained for five years prior to reconfiguration and up to five years afterwards. An interrupted time series analysis considered the association between reconfiguration and admissions across pairs comprised of “reconfigured” and “adjacent” hospitals, with adjustment for seasonality and an overall rising trend in admissions. Results Of the five episodes of reconfiguration, two were immediate closure, two involved closure only to overnight admissions and one with overnight closure for a period and then closure. In “reconfigured” hospitals there was an average fall of 117 admissions/month [95% CI 78, 156] in the year after reconfiguration compared to the year before, and in “adjacent” hospitals admissions rose by 82/month [32, 131]. Across paired reconfigured and adjacent hospitals, in the months post reconfiguration, the overall number of admissions to one hospital pair slowed, in another pair admissions accelerated, and admission prevalence was unchanged in three pairs. After reconfiguration in one hospital, there was a rise in admissions to a third hospital which was closer than the named “adjacent” hospital. Conclusions There are diverse outcomes for the number of emergency admissions post reconfiguration of inpatient facilities. Factors including resources placed in the community after local reconfiguration, distance to the “adjacent” hospital and local deprivation may be important drivers for admission pathways after reconfiguration. Policy makers considering reconfiguration might consider a number of factors which may be important determinants of admissions post reconfiguration.

Recession and risk of suicide in Denmark during the 2009 global financial crisis: an ecological register-based study

2021 ◽  
pp. 140349482110132
Author(s):  
Agnieszka Konieczna ◽  
Sarah Grube Jakobsen ◽  
Christina Petrea Larsen ◽  
Erik Christiansen
Keyword(s):  
Time Series ◽  
Financial Crisis ◽  
Time Series Analysis ◽  
Suicide Rate ◽  
Global Financial Crisis ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Prevention Programmes ◽  
The Impact

Aim: The aim of this study is to analyse the potential impact from the financial crisis (onset in 2009) on suicide rates in Denmark. The hypothesis is that the global financial crisis raised unemployment which leads to raising the suicide rate in Denmark and that the impact is most prominent in men. Method: This study used an ecological study design, including register data from 2001 until 2016 on unemployment, suicide, gender and calendar time which was analysed using Poisson regression models and interrupted time series analysis. Results: The correlation between unemployment and suicide rates was positive in the period and statistically significant for all, but at a moderate level. A dichotomised version of time (calendar year) showed a significant reduction in the suicide rate for women (incidence rate ratio 0.87, P=0.002). Interrupted time series analysis showed a significant decreasing trend for the overall suicide rate and for men in the pre-recession period, which in both cases stagnated after the onset of recession in 2009. The difference between the genders’ suicide rate changed significantly at the onset of recession, as the rate for men increased and the rate for women decreased. Discussion: The Danish social welfare model might have prevented social disintegration and suicide among unemployed, and suicide prevention programmes might have prevented deaths among unemployed and mentally ill individuals. Conclusions: We found some indications for gender-specific differences from the impact of the financial crises on the suicide rate. We recommend that men should be specifically targeted for appropriate prevention programmes during periods of economic downturn.

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