Bill Doolin and Andrew W. Hamer
This chapter examines why managed clinical networks are an appropriate approach to sustainable healthcare, and discusses the conditions for the effectiveness of these…
Abstract
Purpose
This chapter examines why managed clinical networks are an appropriate approach to sustainable healthcare, and discusses the conditions for the effectiveness of these multi-stakeholder, clinician-led modes of organizing. It describes the development of a national clinical network to achieve system-wide improvement in the provision of publicly funded cardiac surgery services in New Zealand, and the subsequent evolution of a broader network encompassing the whole cardiac care patient pathway.
Design
The case study of the two cardiac clinical networks focuses on the emergence and evolution of the networks over a four-year period from 2009. Data were collected from interviews with key stakeholders of both networks and from internal and published documentary evidence. Analysis of the case study is informed by network theory and prior studies of managed clinical networks.
Findings
Progress made towards the achievement of the goals of the initial cardiac surgery network encouraged a broadening of focus to the entire cardiac care pathway and the establishment of the national cardiac network. An important benefit has been the learning and increase in understanding among the different stakeholders involved. Both clinical networks have demonstrated the value of clinician engagement and leadership in improving the delivery of health services, and serve as a best practice model for the development of further clinical networks for health services that require a national population base.
Originality and value
The case study analysis of the two cardiac clinical networks identifies five mutually reinforcing themes that underpin network effectiveness: network structure, management and governance, and internal and external legitimation. These themes encompass a number of factors suggestive of successful managed clinical networks, and offer insights into the use of such networks in organizing for sustainable healthcare.
Details
Keywords
P.W. MACFARLANE and T.D.V. LAWRIE
This paper briefly describes the technical aspects of ECG interpretation by computer, and thereafter discusses in detail the considerations involved in introducing the method into…
Abstract
This paper briefly describes the technical aspects of ECG interpretation by computer, and thereafter discusses in detail the considerations involved in introducing the method into a large hospital. One of the most important of these is that of educating physicians to accept 3‐lead ECG interpretations. Technical problems are discussed together with the question of staffing, and it is emphasized that the introduction of automation does not normally lead to any staff redundancy. The various shortcomings of existing methods are described but the benefits accruing from automation are discussed. The conclusion drawn is that the technique will prove to be of value in the near future when regional centres are established to cope with the ever increasing demand for ECG interpretations.
Michael Keaney and A.R. Lorimer
Clinical practice guidelines are increasingly being recognised as integral to the clinical effectiveness agenda. According to the recent Scottish White Paper, Scotland “leads the…
Abstract
Clinical practice guidelines are increasingly being recognised as integral to the clinical effectiveness agenda. According to the recent Scottish White Paper, Scotland “leads the way in clinical effectiveness”. The Scottish Intercollegiate Guidelines Network (SIGN), established in 1993, has produced over 20 clinical practice guidelines, and plans to produce at least as many more, while reviewing existing guidelines at a minimum of every two years. This represents a substantial investment of NHS resources. This paper investigates whether this investment is being recouped in Scottish NHS acute trusts via the implementation of SIGN guidelines, and whether their implementation is being audited properly. It is argued that without clinical audit, guideline implementation is unlikely to succeed. This has important ramifications for the implementation of clinical governance.
Details
Keywords
A.D. Millard, S. MacArthur and D. McLackland
The aims were to evaluate the impact of clinical audit on health professionals' clinical practice by measuring baseline participation levels for comparison with future studies of…
Abstract
The aims were to evaluate the impact of clinical audit on health professionals' clinical practice by measuring baseline participation levels for comparison with future studies of audit activity in Scottish health service trusts. A survey questionnaire on audit participation in the last year was distributed to a random sample of health professionals from an acute trust in central Scotland. The response rate was 73%. • Overall, 28.8% of respondents had some participation in uniprofessional audit and 23.1%. had some participation in multiprofessional audit. • A greater percentage of doctors participated compared with other professions. • The lowest levels of participation were among professions allied to medicine. • Participants are not normally involved in all the audit stages of a project. • The most usual type of involvement was in collecting data. • The most commonly mentioned benefits of audit were the educational ones. • Educational benefits were most highly valued by health professionals. • Participation in clinical audit projects in this 12‐month period was higher for uniprofessional than for multiprofessional audit. However 70‐80% of health professionals did not participate.
It is unknown whether data from observational studies can assist guideline developers in areas where scientific evidence is lacking. The purpose of this study is to develop a…
Abstract
Purpose
It is unknown whether data from observational studies can assist guideline developers in areas where scientific evidence is lacking. The purpose of this study is to develop a local clinical guideline for prophylaxis against venous thromboembolism based on observational study results.
Design/methodology/approach
The authors performed a classification tree analysis on original data from a cross‐sectional study of risk factors, prophylaxis, and prevalence of deep vein thrombosis in 818 medical in‐patients hospitalised in French teaching and community hospitals. The dependent variable was the use of pharmacological prophylaxis. The rate of any deep vein thrombosis detected by routine compression ultrasonography was used as an illustrative variable. Using group consensus of expert panelists, a practice guideline was developed based on the results of this study and a systematic review of the literature.
Findings
The resulting classification tree involved eight terminal subsets. The mean misclassification rate was 31 per cent in tenfold cross‐validation and the area under the ROC curve was 0.75. The classification tree was converted into graded recommendations. According to these recommendations, 455 patients (56 per cent) required prophylaxis. The corresponding rate of deep vein thrombosis was 11 per cent (28/245, [CI = 8‐16]) in 245 prophylaxis users and 11 per cent (23/210, [7‐16]) in 210 prophylaxis non‐users. Conversely, 363 patients (44 per cent) did not require prophylaxis: 63 actually received prophylaxis and six had deep vein thrombosis (2 per cent, [0.6‐4]).
Research limitations/implications
Further prospective validation of the guideline is important prior to its implementation.
Originality/value
Integrating data from observational studies may be an effective way to develop guidelines when robust scientific evidence is lacking.
Details
Keywords
Olawale Olusoga and Olumuyiwa Adegun
The purpose of this study is to explore the perceptions of built environment professionals on the benefits and impediments limiting the widespread acceptance of vertical greening…
Abstract
Purpose
The purpose of this study is to explore the perceptions of built environment professionals on the benefits and impediments limiting the widespread acceptance of vertical greening systems (VGSs) in Lagos, Nigeria. This study contributes to the knowledge on the adoption of VGSs from the socio-technical dimension.
Design/methodology/approach
The study employed a survey method. An online questionnaire was used to obtain information from the respondents. The questionnaire was divided into four (4) sections. The first section focused on the socio-demographic variables while the second section addressed knowledge of VGSs, willingness to educate clients on the use of VGS and the possibility of VGS improving city image in Lagos. Section three (3) focused on the VGS benefits, subdivided into environmental, economic and aesthetic qualities and measured on a five-point Likert scale. Lastly, section four (4) concentrated on the impediments to the use of VGS in Lagos.
Findings
Professionals are willing to adopt the use of VGSs if their clients agree to the benefits it delivers to occupants, the environment and the building fabric.
Originality/value
This paper fulfills an identified need to study the perceptions of professionals toward VGSs patronage.
Details
Keywords
Neale R. Chumbler, Ashley Foster, James W. Grimm and Philip Williams
The objective of this chapter was to advance the medical sociology theoretical literature on health lifestyle behaviors. This study investigated the influence of mid-life adult…
Abstract
The objective of this chapter was to advance the medical sociology theoretical literature on health lifestyle behaviors. This study investigated the influence of mid-life adult statuses (gender, marital status, parenthood, presence of children in the home, and employment status) and functional health status (general physical health, general mental health, vitality, and social functioning) on selected health-related behaviors. These behaviors included preventive medicine behaviors (routine physical exams, cholesterol checks, and blood pressure checks), risk-taking behaviors (driving above the speed limit, smoking, and consuming alcohol), health promoting behaviors (exercising, sleeping well, and relaxing), and medication usage (using prescribed medicines, over-the-counter medicines, and herbal supplements). The data were gathered through the Warren County Health Survey, a telephone survey of a randomly selected sample of residents from a county in Kentucky. Logistic regression was used to analyze the data. Results indicated that having children at home, being married, being fifty years old or older, and possessing better mental health and social functioning statuses were associated with a greater likelihood of practicing better health-related behaviors. In contrast, being both male and aged 49 and younger were correlated with a greater likelihood of engaging in poorer health-related behaviors. Based on these results, the authors offered several testable, theoretical propositions for future research to test the relationships between mid-life adult health statuses, functional health statuses, and health-related behaviors in other community-based samples.
D. Dutta and B. Ogunnaike
There is strong evidence for the use of HMG Co‐A reductase inhibitors (statins) for secondary prevention after myocardial infarction. Previous surveys suggest sub‐optimal use of…
Abstract
There is strong evidence for the use of HMG Co‐A reductase inhibitors (statins) for secondary prevention after myocardial infarction. Previous surveys suggest sub‐optimal use of such secondary prevention measures. The national service framework (NSF) for coronary heart disease (CHD) has now set new standards for preventing and treating CHD. In our audit of 182 survivors of myocardial infarction in 1999, 86.2 per cent had cholesterols measured on admission, but only 39 per cent had statins prescribed on discharge. Our data provide information about base‐line practice for the year immediately preceding the publication of the NSF and indicate that the average district general hospital may have a long way to go to meet the target set by the NSF.
Details
Keywords
J. Mark F. Temple and D.L. Fone
Standing Medical Advisory Committee (SMAC) guidance for prevention of coronary heart disease (CHD) and the National Service Framework – Coronary Heart Disease both require the…
Abstract
Standing Medical Advisory Committee (SMAC) guidance for prevention of coronary heart disease (CHD) and the National Service Framework – Coronary Heart Disease both require the identification of patients at high risk of CHD for targeted treatment with statins. Since the best method of identifying these patients is unknown, we compared population screening with opportunistic case finding in a discrete event computer simulation model of the population aged 45‐64 in one local health group in Wales. The main outcome measures were numbers of CHD and all‐cause deaths and extra patient‐years of drug treatment. Screening and case finding were of similar effectiveness in identifying high risk individuals to prevent CHD and all‐cause mortality during the five years simulated. The extra patient‐years of drug treatment required by a population screening programme suggests that screening would not be cost effective. Concludes that opportunistic case finding is the method of choice in primary care.
Details
Keywords
Sarah Long, Kenneth Laidlaw, Angus Lorimer and Nuno Ferreira
Although quality of life and attitudes to ageing have been explored in the context of mental and physical health problems in older adults, the interplay between these variables…
Abstract
Purpose
Although quality of life and attitudes to ageing have been explored in the context of mental and physical health problems in older adults, the interplay between these variables has received little attention. The purpose of this study is to explore how attitudes to ageing relate to and predict quality of life in an international sample of older people those of age 57 to 79 (youngest-old) and those over 80 years old (oldest-old).
Design/methodology/approach
A large international sample (n = 4,616) of participants recruited from 20 different countries completed a set of measures assessing several demographic variables, attitudes to ageing, older adult specific quality of life, general quality of life and depression.
Findings
Correlational and regression analysis showed that more positive attitudes to ageing were associated with and predicted better quality of life in older adults beyond demographic and depression variables. Those in the oldest-old group had significantly more negative attitudes to ageing and a poorer quality of life. However, positive attitudes to ageing remained a significant predictor of better quality of life in both the youngest-old and oldest-old age groups.
Originality/value
Attitudes to ageing play an important part in quality of life in older adults; however, the impact of these attitudes might be different according to age group. These results suggest that attitudes to ageing could be a possible clinical target in interventions aiming at improving quality of life in older adults.