9 results found
Beaney T, Neves AL, Alboksmaty A, et al., 2022, Trends and associated factors for Covid-19 hospitalisation and fatality risk in 2.3 million adults in England, Nature Communications, Vol: 13, Pages: 1-9, ISSN: 2041-1723
The Covid-19 mortality rate varies between countries and over time but the extent to which this is explained by the underlying risk in those infected is unclear. Using data on all adults in England with a positive Covid-19 test between 1st October 2020 and 30th April 2021 linked to clinical records, we examined trends and risk factors for hospital admission and mortality. Of 2,311,282 people included in the study, 164,046 (7.1%) were admitted and 53,156 (2.3%) died within 28 days of a positive Covid-19 test. We found significant variation in the case hospitalisation and mortality risk over time, which remained after accounting for the underlying risk of those infected. Older age groups, males, those resident in areas of greater socioeconomic deprivation, and those with obesity had higher odds of admission and death. People with severe mental illness and learning disability had the highest odds of admission and death. Our findings highlight both the role of external factors in Covid-19 admission and mortality risk and the need for more proactive care in the most vulnerable groups.
Beaney T, Clarke J, Alboksmaty A, et al., 2022, Population level impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in the people with COVID-19 in England: a national analysis using a stepped wedge design, Emergency Medicine Journal, ISSN: 1472-0205
BackgroundTo identify the population level impact of a national pulse oximetry remote monitoring programme for COVID-19 (COVID Oximetry @home; CO@h) in England on mortality and health service use.MethodsWe conducted a retrospective cohort study using a stepped wedge pre- and post- implementation design, including all 106 Clinical Commissioning Groups (CCGs) in England implementing a local CO@h programme. All symptomatic people with a positive COVID-19 polymerase chain reaction test result from 1st October 2020 to 3rd May 2021, and who were aged ≥65 years or identified as clinically extremely vulnerable were included. Care home residents were excluded. A pre-intervention period before implementation of the CO@h programme in each CCG was compared to a post-intervention period after implementation. Five outcome measures within 28 days of a positive COVID-19 test: i) death from any cause; ii) any ED attendance; iii) any emergency hospital admission; iv) critical care admission; and v) total length of hospital stay.Results217,650 people were eligible and included in the analysis. Total enrolment onto the programme was low, with enrolment data received for only 5,527 (2.5%) of the eligible population. The period of implementation of the programme was not associated with mortality or length of hospital stay. The period of implementation was associated with increased health service utilisation with a 12% increase in the odds of ED attendance (95% CI: 6%-18%) and emergency hospital admission (95% CI: 5%-20%) and a 24% increase in the odds of critical care admission in those admitted (95% CI: 5%-47%). In a secondary analysis of CO@h sites with at least 10% or 20% of eligible people enrolled, there was no significant association with any outcome measure. ConclusionAt a population level, there was no association with mortality before and after the implementation period of the CO@h programme, and small increases in health service utilisation were observed. However, lower than
Alboksmaty A, Beaney T, Elkin S, et al., 2022, Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19: a systematic review., Lancet Digit Health, Vol: 4, Pages: e279-e289
The COVID-19 pandemic has led health systems to increase the use of tools for monitoring and triaging patients remotely. In this systematic review, we aim to assess the effectiveness and safety of pulse oximetry in remote patient monitoring (RPM) of patients at home with COVID-19. We searched five databases (MEDLINE, Embase, Global Health, medRxiv, and bioRxiv) from database inception to April 15, 2021, and included feasibility studies, clinical trials, and observational studies, including preprints. We found 561 studies, of which 13 were included in our narrative synthesis. These 13 studies were all observational cohorts and involved a total of 2908 participants. A meta-analysis was not feasible owing to the heterogeneity of the outcomes reported in the included studies. Our systematic review substantiates the safety and potential of pulse oximetry for monitoring patients at home with COVID-19, identifying the risk of deterioration and the need for advanced care. The use of pulse oximetry can potentially save hospital resources for patients who might benefit the most from care escalation; however, we could not identify explicit evidence for the effect of RPM with pulse oximetry on health outcomes compared with other monitoring models such as virtual wards, regular monitoring consultations, and online or paper diaries to monitor changes in symptoms and vital signs. Based on our findings, we make 11 recommendations across the three Donabedian model domains and highlight three specific measurements for setting up an RPM system with pulse oximetry.
Alboksmaty A, Beaney T, Elkin S, et al., 2021, Effectiveness and safety of pulse oximetry in remote home monitoring of COVID-19 patients: a systematic review, The Lancet Digital Health, ISSN: 2589-7500
The COVID-19 pandemic has led health systems to increase the use of tools for monitoring and triaging patients remotely. This study aims to assess the effectiveness and safety of pulse oximetry in Remote Patient Monitoring (RPM) of COVID-19 patients at home. We conducted a systematic review, searching five databases, Medline, Embase, Global Health, medRxiv, and bioRxiv, from inception to April 15, 2021. We included feasibility studies, clinical trials, observational studies, including preprints. We found 561 studies, of which 13 were included in our synthesis. The final studies were all observational cohorts and involved a total of 2,908 participants. A meta-analysis was not feasible due to the heterogeneity of the outcomes reported in the included studies. Our review confirmed the safety and potential of using pulse oximetry in monitoring COVID-19 patients at home. It can potentially save hospital resources for those who may benefit most from care escalation. However, we could not identify explicit evidence on the impact on health outcomes compared with other monitoring models that have not used pulse oximetry. Based on our findings, we make 11 recommendations and three measures for setting up an RPM system using pulse oximetry.
El-Osta A, Hennessey C, Pilot C, et al., 2021, A digital solution to streamline access to smoking cessation interventions in England; findings from a primary care pilot (STOPNOW study), Public Health in Practice, Vol: 2, ISSN: 2666-5352
Objectives:Despite the proven efficacy of several smoking cessation medications that have been shown to improve long-term abstinence rates, approximately two-thirds of smokers report not having used medication in their most recent quit attempt. A main barrier could be delayed access to pharmacological interventions. This study investigated the utility of a primary care linked online portal to streamline timely access to pharmacological support to patients who want to quit smoking by making an asynchronous request for treatment to their general practitioner.Study design:Prospective cohort study.Methods:An online portal with added functionality was developed, which allowed patients with a unique link to make an asynchronous request for treatment. Two GP practices identified a total of 4337 eligible patients who received an SMS or email invite to engage with an online portal including an electronic survey to capture information about smoking behaviours and to request treatment. Portal informatics and patient level data were analysed to measure the efficacy of the online system in reducing the time between making a formal request to treatment and access to pharmacological support. The primary outcome measure was the time between making a formal request for treatment and access to pharmacological support from a designated community pharmacy.Results:323 patients (7.4%) initiated the survey, but only 56 patients completed the survey and made a formal request for treatment. 94% of participants did not return to use the portal to make a second or follow-up request for treatment. Only 3 participants completed the 12-week pathway. A total of 75 medication items were prescribed and collected by 56 patients. The time difference between the formal request to treatment and GP review ranged between 20 h and 1 week. The time difference between approval of prescription by the GP and access to medication was 5 days ± 2.1 days (range = 1.9–7.0 days).Conclusion:The widespre
Alboksmaty A, Kumar S, Parekh R, et al., 2021, Management and patient safety of complex elderly patients in primary care during the COVID-19 pandemic in the UK—Qualitative assessment, PLoS One, Vol: 16, Pages: 1-17, ISSN: 1932-6203
ObjectivesThe study aims to investigate GPs’ experiences of how UK COVID-19 policies have affected the management and safety of complex elderly patients, who suffer from multimorbidity, at the primary care level in North West London (NWL).DesignThis is a service evaluation adopting a qualitative approach.SettingIndividual semi-structured interviews were conducted between 6 and 22 May 2020, 2 months after the introduction of the UK COVID-19 Action Plan, allowing GPs to adapt to the new changes and reflect on their impact.ParticipantsFourteen GPs working in NWL were interviewed, until data saturation was reached.Outcome measuresThe impact of COVID-19 policies on the management and safety of complex elderly patients in primary care from the GPs’ perspective.ResultsParticipants’ average experience was fourteen years working in primary care for the NHS. They stated that COVID-19 policies have affected primary care at three levels, patients’ behaviour, work conditions, and clinical practice. GPs reflected on the impact through five major themes; four of which have been adapted from the Safety Attitudes Questionnaire (SAQ) framework, changes in primary care (at the three levels mentioned above), involvement of GPs in policy making, communication and coordination (with patients and in between medical teams), stressors and worries; in addition to a fifth theme to conclude the GPs’ suggestions for improvement (either proposed mitigation strategies, or existing actions that showed relative success). A participant used an expression of “infodemic” to describe the GPs’ everyday pressure of receiving new policy updates with their subsequent changes in practice.ConclusionThe COVID-19 pandemic has affected all levels of the health system in the UK, particularly primary care. Based on the GPs’ perspective in NWL, changes to practice have offered opportunities to maintain safe healthcare as well as possible drawbacks that should b
Letaief M, Leatherman S, Tawfik L, et al., 2021, Quality of health care and patient safety in extreme adversity settings in the Eastern Mediterranean Region: a qualitative multicountry assessment, Eastern Mediterranean Health Journal, Vol: 27, Pages: 167-176, ISSN: 1020-3397
<jats:p>Background: Quality and patient safety are essential for the provision of effective health care services. Research on these aspects is lacking in settings of extreme adversity. Aims: This study aimed to explore the perception of health care stakeholders working in extreme adversity settings of the quality of health care and patient safety. Methods: This was a qualitative study conducted through semistructured interviews with 26 health care stakeholders from seven countries of the World Health Organization’s Eastern Mediterranean Region which are experiencing emergencies. The interviews explored the respondents’ perspectives of four aspects of quality and patient safety: definition of the quality of health care, challenges to the provision of good quality health care in emergency settings, priority health services and populations in emergency settings, and interventions to improve health care quality and patient safety. Results: The participants emphasized that saving lives was the main priority in extreme adversity settings. While all people living in emergency situations were vulnerable and at risk, the respondents considered women and children, poor and disabled people, and those living in hard-to-reach areas the priority populations to be targeted by improvement interventions. The challenges to quality of health care were: financing problems, service inaccessibility, insecurity of health workers, break down in health systems, and inadequate infrastructure. Respondents proposed interventions to improve quality, however, their effective implementation remains challenging in these exceptional settings. Conclusions: The interventions identified can serve as a basis for improvements in health care quality that could be adapted to extreme adversity settings.</jats:p>
Alboksmaty A, Agaku I, Odani S, et al., 2019, Prevalence and determinants of cigarette smoking relapse among US adult smokers: a longitudinal study, BMJ Open, Vol: 9, ISSN: 2044-6055
Objectives This research project aims at estimating the prevalence of cigarette smoking relapse and determining its predictors among adult former smokers in the USA.Setting This research analysed secondary data retrieved from the Tobacco Use Supplement-Current Population Survey 2010–2011 cohort in the USA.Participants Out of 18 499 participants who responded to the survey in 2010 and 2011, the analysis included a total sample size of 3258 ever smokers, who were living in the USA and reported quitting smoking in 2010. The survey’s respondents who never smoked or reported current smoking in 2010 were excluded from the study sample.Primary and secondary outcome measures Smoking relapse was defined as picking up smoking in 2011 after reporting smoking abstinence in 2010. The prevalence of relapse over the 12-month follow-up period was estimated among different subgroups. Multivariable logistic regression models were applied to determine factors associated with relapse.Results A total of 184 former smokers reported smoking relapse by 2011 (weighted prevalence 6.8%; 95% CI 5.7% to 8.1%). Prevalence and odds of relapse were higher among young people compared with elders. Former smokers living in smoke-free homes (SFHs) had 60% lower odds of relapse compared with those living in homes that allowed smoking inside (adjusted OR 0.40; 95% CI 0.25 to 0.64). Regarding race/ethnicity, only Hispanics showed significantly higher odds of relapse compared with Whites (non-Hispanics). Odds of relapse were higher among never married, widowed, divorced and separated individuals, compared with the married group. Continuous smoking cessation for 6 months or more significantly decreased odds of relapse.Conclusions Wider health determinants, such as race and age, but also living in SFHs showed significant associations with smoking relapse, which could inform the development of more targeted programmes to support those smokers who successfully quit, although further longitudinal s
Alboksmaty A, Agaku I, Odani S, et al., 2019, Prevalence and determinants of cigarette smoking relapse among US adult smokers - a longitudinal study, Tobacco Prevention & Cessation, Vol: 5
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