Effect of a primary care based epilepsy specialist nurse service on quality of care from the patients' perspective: results at two-years follow-up.
Epilepsy specialist nurses have the potential to improve the quality of care of community-based patients with epilepsy, although evidence of their effectiveness is limited by the lack of formal or long-term evaluation. Results of a controlled trial that assessed the effectiveness of a primary care based specialist nurse-led service suggested improvements in communication and satisfaction but not health status at one-year follow-up. A second follow-up was conducted to assess the effects after two years. Patients who reported having seen the nurse at least once in the two years ('users') were compared with those who had not ('non-users'). Comparisons between users and non-users were adjusted for baseline differences. Results were based on 40% of all 595 adult patients known to have epilepsy in 14 general practices and who answered questionnaires at baseline and two years later. The new epilepsy service was used more by those with greatest needs for care. Users of the new service were significantly more likely than non-users to have discussed 8 of 11 topics asked about epilepsy [odds ratios (ORs) ranging from 2.42 to 7.91] with their general practitioner (GP), and 2 of the 11 topics with the hospital doctor (ORs 5.59, 5. 74). Service users were significantly less likely than non-users to feel their GP knew enough about epilepsy [OR 0.27, 95% confidence intervals (CI) 0.74-0.98], and significantly more likely to report epilepsy as having an adverse impact on 3 of 10 areas of everyday life (ORs ranging from 2.09 to 2.50). Users were more likely than non-users to have seen their GP for any reason in the previous year and to change their medication from use of more than one antiepileptic drug to monotherapy, although findings were not significant. Results suggest that the epilepsy specialist nurse service is not a cost-reducing substitute, particularly for general practitioner care, but it appears to improve communication and prescribing of monotherapy, and increases access for the most needy. The service may, however, have an adverse impact on patients' perceptions of the effects of epilepsy on aspects of everyday life. (+info)
Cost analysis of nurse telephone consultation in out of hours primary care: evidence from a randomised controlled trial.
OBJECTIVE: To undertake an economic evaluation of nurse telephone consultation using decision support software in comparison with usual general practice care provided by a general practice cooperative. DESIGN: Cost analysis from an NHS perspective using stochastic data from a randomised controlled trial. SETTING: General practice cooperative with 55 general practitioners serving 97 000 registered patients in Wiltshire, England. SUBJECTS: All patients contacting the service, or about whom the service was contacted during the trial year (January 1997 to January 1998). MAIN OUTCOME MEASURES: Costs and savings to the NHS during the trial year. RESULTS: The cost of providing nurse telephone consultation was 81 237 pound sterling per annum. This, however, determined a 94 422 pound sterling reduction of other costs for the NHS arising from reduced emergency admissions to hospital. Using point estimates for savings, the cost analysis, combined with the analysis of outcomes, showed a dominance situation for the intervention over general practice cooperative care alone. If a larger improvement in outcomes is assumed (upper 95% confidence limit) NHS savings increase to 123 824 pound sterling per annum. Savings of only 3728 pound sterling would, however, arise in a scenario where lower 95% confidence limits for outcome differences were observed. To break even, the intervention would have needed to save 138 emergency hospital admissions per year, around 90% of the effect achieved in the trial. Additional savings of 16 928 pound sterling for general practice arose from reduced travel to visit patients at home and fewer surgery appointments within three days of a call. CONCLUSIONS: Nurse telephone consultation in out of hours primary care may reduce NHS costs in the long term by reducing demand for emergency admission to hospital. General practitioners currently bear most of the cost of nurse telephone consultation and benefit least from the savings associated with it. This indicates that the service produces benefits in terms of service quality, which are beyond the reach of this cost analysis. (+info)
The effect of additional shots on the vaccine administration process: results of a time-motion study in 2 settings.
CONTEXT: The introduction of combination vaccines to the pediatric regimen offers the possibility of reducing the number of injections required to reach full vaccination status. Fewer injections benefit the patient/child and the parent/caregiver, and the healthcare provider may benefit from savings in personnel time associated with vaccine administration. To date, however, these savings have not been quantified. OBJECTIVE: To study the vaccine administration process in a managed care environment. STUDY DESIGN: We studied 2 settings in which vaccinations were administered: (1) a devoted injection room and (2) the examination room as part of the well-child examination. For each setting, we documented the vaccine administration process, identified vaccine-related activities, and quantified the time savings in each activity by reductions in the number of shots. PATIENTS AND METHODS: For vaccine recipients younger than 2 years, time-motion data on vaccine-related activities in 2 managed care settings were collected by a professional industrial engineering consultant. Activity time data by the number of shots administered were analyzed using linear regression adjusting for patient age. RESULTS: We observed 276 vaccination visits (137 in an examination room, and 139 in an injection room). Total nurse time associated with vaccine administration decreased by 2.4 and 1.7 minutes per shot eliminated in the examination room setting (P = .006) and in the injection room setting (P < .001), respectively. Significant time savings were realized for activities associated with vaccine preparation, vaccine injection, and administrative duties. In addition, infant crying time decreased by 1.0 and 0.4 minutes per shot eliminated in the examination room and injection room settings, respectively (P < or = .001 for both). CONCLUSIONS: Significant reductions in vaccine administration time could be achieved by eliminating injections during a well-child regimen. (+info)
A satisfaction and return-on-investment study of a nurse triage service.
OBJECTIVE: To assess patient satisfaction and a health plan's return on investment associated with a telephone-based triage service. STUDY DESIGN: A pre-post study design, with medical claims data, to assess changes in medical service utilization and health plan expenditures associated with members' use of the triage service. PATIENTS AND METHODS: This study is based on data on 60,000 members of a health plan. A telephone survey was conducted to assess member satisfaction and outcomes with the triage service. The plan's medical claims and encounter data were used to calculate medical utilization rates and plan expenditures for those services. The health plan's return-on-investment was evaluated using a pre/post study design to assess changes in medical service utilization between the baseline (December 1995 through November 1996) and program (December 1996 through November 1997) periods. RESULTS: The average nurse response time to a call was just less than 50 seconds, which indicates the service provided ready access to medical advice 24 hours per day, 7 days per week. More than 90% of users were satisfied, and utilization of hospital emergency department (ED) and physician office services decreased significantly after the service was implemented. The changes in medical service utilization resulted in reductions in health plan expenditures that exceeded the plan's costs of providing the service. The plan's estimated return for every dollar invested in the nurse triage service was approximately $1.70. CONCLUSIONS: The telephone-based nurse triage service appears to be a cost-effective intervention that improves access to medical advice, thereby encouraging appropriate use of medical services. The service is associated with reductions in utilization of hospital ED and physician office services and with high levels of member satisfaction. (+info)
Medicare program; civil money penalties, assessments, and revised sanction authorities. Final rule with comment period.
This final rule with comment period is a technical rule that updates our civil money penalty (CMP) regulations to add CMP authorities already enacted as part of the Balanced Budget Act of 1997 (BBA) and delegated to us. The rule delineates our authority to assess penalties for: failure to bill outpatient therapy services or comprehensive outpatient rehabilitation services (CORS) on an assignment-related basis, failure to bill ambulance services on an assignment-related basis, failure to provide an itemized statement for Medicare items and services to a Medicare beneficiary upon his/her request, and failure of physicians or nonphysician practitioners to provide diagnostic codes for items or services they furnish or failure to provide this information to the entity furnishing the item or service ordered by the practitioner. The rule also contains technical changes to further conform our current CMP rules to changes in the statute enacted by the BBA. (+info)
The future nursing voice.
Based on some articles in the journal Nursing Ethics, the author outlines some of the areas of major importance for nursing in the future. These areas--the care of elderly people, long-term home-based care, genetics, international research and conflict and war--demand a new voice of nursing, which is a political voice. The rationale for a political voice is the ICN Code of ethics for nurses and the fourfold responsibilities laid on nurses: to promote health, to prevent illness, to restore health, and to alleviate suffering. Some indications are given on how nurses can engage in political work. (+info)
Using Ontario's "Telehealth" health telephone helpline as an early-warning system: a study protocol.
BACKGROUND: The science of syndromic surveillance is still very much in its infancy. While a number of syndromic surveillance systems are being evaluated in the US, very few have had success thus far in predicting an infectious disease event. Furthermore, to date, the majority of syndromic surveillance systems have been based primarily in emergency department settings, with varying levels of enhancement from other data sources. While research has been done on the value of telephone helplines on health care use and patient satisfaction, very few projects have looked at using a telephone helpline as a source of data for syndromic surveillance, and none have been attempted in Canada. The notable exception to this statement has been in the UK where research using the national NHS Direct system as a syndromic surveillance tool has been conducted. METHODS/DESIGN: The purpose of our proposed study is to evaluate the effectiveness of Ontario's telephone nursing helpline system as a real-time syndromic surveillance system, and how its implementation, if successful, would have an impact on outbreak event detection in Ontario. Using data collected retrospectively, all "reasons for call" and assigned algorithms will be linked to a syndrome category. Using different analytic methods, normal thresholds for the different syndromes will be ascertained. This will allow for the evaluation of the system's sensitivity, specificity and positive predictive value. The next step will include the prospective monitoring of syndromic activity, both temporally and spatially. DISCUSSION: As this is a study protocol, there are currently no results to report. However, this study has been granted ethical approval, and is now being implemented. It is our hope that this syndromic surveillance system will display high sensitivity and specificity in detecting true outbreaks within Ontario, before they are detected by conventional surveillance systems. Future results will be published in peer-reviewed journals so as to contribute to the growing body of evidence on syndromic surveillance, while also providing an non US-centric perspective. (+info)
Nursing care according to women in abortion situations.
This qualitative study aimed to understand how women having an abortion experience the nursing care they receive. The statements of 13 hospitalized women were analyzed through content analysis. The central category "Nursing care experienced in situations of abortion" was constituted from 4 subcategories: care centered in physical needs; fear of judgment in abortion situations; legal aspects defining care; the need for support in abortion situations. These women identified nursing care as based on physical aspects, without contemplating their individuality and specificities. Results indicated the need to create an environment that stimulates listening, helping these women to elaborate their feelings and allowing professionals to behave closer to these women's reality, in order to reduce their own desires and conflicts and contemplate the integrality of care. (+info)