BMJ Open Quality最新文献

{"title":"Impact of the US Food and Drug Administration warning regarding increased risk of aortic aneurysms or aortic dissections on fluoroquinolone prescribing trends.","authors":"John G Rizk, Julia F Slejko, Emily L Heil, Dominique Seo, Danya M Qato","doi":"10.1136/bmjoq-2024-002925","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002925","url":null,"abstract":"<p><strong>Background: </strong>The US Food and Drug Administration (FDA) issued a warning in December 2018 regarding an increased risk of aortic aneurysms and aortic dissections associated with fluoroquinolone (FQ) use. This warning specifically targeted older adults and patients with conditions such as hypertension, Marfan syndrome, Ehlers-Danlos syndrome, atherosclerosis, peripheral vascular disease and history of aneurysms.</p><p><strong>Objective: </strong>To evaluate the impact of the safety warning on prescribing trends of FQs in the targeted population.</p><p><strong>Methods: </strong>This cross-sectional study with an interrupted time series (ITS) analysis (January 2018-December 2019) used a 25% random sample of IQVIA PharMetrics^® Plus for Academics health plan claims database. The impact of the warning on FQ utilisation was quantified among the targeted population and a non-targeted population.</p><p><strong>Results: </strong>From 2018 to 2019, both study populations saw a decrease in the year-over-year percent change of FQ prescriptions per 100 000 beneficiaries (-11%, from 14 227 to 12 662, targeted; -15%, from 5227 to 4446, non-targeted) and proportion of FQ use versus other antibiotics (from 15.6% to 13.8%, targeted; from 9.4% to 8%, non-targeted). In the targeted population, the ITS analysis did not show a significant trend change, a change in level or postwarning trend in the monthly rate of FQ prescriptions per 1000 beneficiaries. A positive trend change was observed in the non-targeted population (0.07, <0.01-0.13), but there were no significant changes in level or post-warning trend.</p><p><strong>Conclusion: </strong>We did not find a change in FQ prescription rates after the warning. The utility of safety advisories as a primary tool for mitigating FQ use in high-risk populations should be revisited.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges, barriers and solutions for implementing clinical practice guidelines: a qualitative study in southern Iran.","authors":"Hedayat Salari, Fatemeh Najm, Mohammadreza Yazdankhahfard, Atefeh Esfandiari","doi":"10.1136/bmjoq-2023-002595","DOIUrl":"10.1136/bmjoq-2023-002595","url":null,"abstract":"<p><strong>Background: </strong>Identifying the challenges of implementing clinical practice guidelines (CPGs) can provide valuable information for decision-makers and health policymakers at the national and local levels. The implementation of CPGs requires the development of strategies to facilitate their use. This research aimed to determine the challenges, barriers and solutions for implementing CPGs from the expert point of view in Bushehr University of Medical Sciences.</p><p><strong>Methods: </strong>This qualitative research uses content analysis conducted in 2022 in southern Iran. In-depth interviews were conducted with the physicians and experts in the health system. Interviewing continued until reaching the saturation level. Altogether, 22 experts were interviewed. The interview guide was used to explore experts' opinions. All the interviews were recorded and then transcribed. Finally, coding and data analysis was done using MAXQDA 2022 software.</p><p><strong>Results: </strong>The analysis revealed 4 main themes and 20 subthemes. The four main themes included challenges related to physicians, medical education, the health system and patients. The most common themes were the lack of sufficient training (related to the medical education system), equipment and infrastructure, and the lack of adaptation of clinical guidelines (related to the health system). The solutions included 4 main themes and 19 subthemes.</p><p><strong>Conclusion: </strong>The most mentioned topic by the experts was training CPGs in medical schools. In Iran's current medical education system, the training of CPGs is not included in the curriculum. It is proposed to reform the medical education system in Iran. In addition, health inequalities such as lack of access to equipment, supplies and insurance in under-resourced areas and disparities in research/training/medical education should be addressed to improve the validity of guidelines.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Google star ratings of Canadian hospitals: a nationwide cross-sectional analysis.","authors":"Matthew P Tse, Irfan Dhalla, Dhruv Nayyar","doi":"10.1136/bmjoq-2023-002713","DOIUrl":"https://doi.org/10.1136/bmjoq-2023-002713","url":null,"abstract":"<p><strong>Background: </strong>Data on patients' self-reported hospital experience can help guide quality improvement. Traditional patient survey programmes are resource intensive, and results are not always publicly accessible. Unsolicited online hospital reviews are an alternative data source; however, the nature of online reviews for Canadian hospitals is unknown.</p><p><strong>Methods: </strong>We conducted a nationwide cross-sectional study of Canadian acute care hospitals with more than 10 Google Reviews during the 2018-2019 fiscal year. We characterised the volume and distribution of Google Reviews of Canadian hospitals, and assessed their correlation with hospital characteristics (teaching status, size, occupancy rate, length of stay, resource utilisation) and Canadian Patient Experience Survey on Inpatient Care (CPES-IC) scores.</p><p><strong>Results: </strong>167 out of 523 (31.9%) acute care hospitals in Canada met the inclusion criteria. Among included hospitals, there was a total of 10 395 Google Reviews and a median of 35 reviews per hospital. The mean Google Star Rating for included hospitals was 2.85 out of 5, with a range of 1.36-4.57. Teaching hospitals had significantly higher mean Google Star Ratings compared with non-teaching hospitals (3.16 vs 2.81, p <0.01). There was a weak, positive correlation between hospitals' Google Star Ratings and CPES-IC 'Overall Hospital Experience' scores (p =0.04), but no significant correlation between Google Star Ratings and other hospital characteristics or subcategories of CPES-IC scores.</p><p><strong>Interpretation: </strong>There is significant interhospital variation in patients' self-reported care experiences at Canadian acute care hospitals. Online reviews can serve as a readily accessible source of real-time data for hospitals to monitor and improve the patient experience.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Rapid Response Team implementation in a tertiary hospital in Egypt: an interventional study.","authors":"Rania Hosny, Rasha Saad Hussein, Wafaa Mohamed Hussein, Sally Adel Hakim, Ihab Shehad Habil","doi":"10.1136/bmjoq-2023-002540","DOIUrl":"10.1136/bmjoq-2023-002540","url":null,"abstract":"<p><strong>Background: </strong>Rapid response teams (RRTs) help in the early recognition of deteriorating patients in hospital wards and provide the needed management at the bedside by a qualified team. RRT implementation is still questionable because there is insufficient evidence regarding its effects. To date, according to our knowledge, no published studies have addressed the effectiveness of RRT implementation on inpatient care outcomes in Egypt.</p><p><strong>Objective: </strong>We aimed to assess the impact of an RRT on the rates of inpatient mortality, cardiopulmonary arrest calls and unplanned intensive care unit (ICU) admission in an Egyptian tertiary hospital.</p><p><strong>Methods: </strong>An interventional study was conducted at a university hospital. Data was evaluated for 24 months before the intervention (January 2018 till December 2019, which included 4242 admissions). The intervention was implemented for 12 months (January 2021 till December 2021), ending with postintervention evaluation of 2338 admissions.</p><p><strong>Results: </strong>RRT implementation was associated with a significant reduction in inpatient mortality rate from 88.93 to 46.44 deaths per 1000 discharges (relative risk reduction (RRR)=0.48; 95% CI, 0.36 to 0.58). Inpatient cardiopulmonary arrest rate decreased from 7.41 to 1.77 calls per 1000 discharges (RRR, 0.76; 95% CI, 0.32 to 0.92), while unplanned ICU admissions decreased from 5.98 to 4.87 per 1000 discharges (RRR, 0.19; 95% CI, -0.65 to 0.60).</p><p><strong>Conclusions: </strong>RRT implementation was associated with a significantly reduced hospital inpatient mortality rate, cardiopulmonary arrest call rate as well as reduced unplanned ICU admission rate. Our results reveal that RRT can contribute to improving the quality of care in similar settings in developing countries.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11256054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of peer comparison reporting and academic detailing sessions to reduce inappropriate antimicrobial prescribing rates in upper respiratory infections among family medicine prescribers.","authors":"Brian T Burroughs, Christina Carney, Kelsey Jensen","doi":"10.1136/bmjoq-2023-002619","DOIUrl":"10.1136/bmjoq-2023-002619","url":null,"abstract":"","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11284908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specification and de-labelling of unspecified allergic reactions to penicillins at a family medicine clinic.","authors":"Angie Nu Ton, Dan Ilges","doi":"10.1136/bmjoq-2024-002785","DOIUrl":"10.1136/bmjoq-2024-002785","url":null,"abstract":"","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11253760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fulfilling last wishes: improving the compassionate discharge process.","authors":"Rasidah Alias, Yi Ling Neo, Liyun Wang, Long Zhen Sie, Hwee Jin Goh, Mohamed Yazid Mohamed Hussein, Hasnah Abdullah, Yoke Ping Wong","doi":"10.1136/bmjoq-2023-002666","DOIUrl":"10.1136/bmjoq-2023-002666","url":null,"abstract":"<p><strong>Background: </strong>Compassionate discharges (ComD), commonly known as rapid discharges, are urgent one-way discharges for critically ill hospitalised patients with death expected within hours or less than 7 days, to die at their place of choice-usually in their own home. Challenges abound in this time-sensitive setting when multiple parties must work together to prepare medically unstable patients for discharge, yet healthcare staff are largely unaware of the process, resulting in delays.</p><p><strong>Methods: </strong>Process mapping, an Ishikawa diagram and a Pareto chart were used to identify barriers, which included timely acquisition of home equipment and medication and poor communication among stakeholders. In May 2020, the Quality Improvement (QI) team embarked on a pilot project to reduce family caregiver anxiety and delays in the ComD process while maintaining a success rate above 90% over a 12-month period.</p><p><strong>Interventions: </strong>Three Plan-Do-Study-Act (PDSA) cycles were used to refine a ComD resource package that was developed; this consisted of a checklist, a kit and caregiver resources. This was to support nurses, doctors and families during this difficult and emotional transition. Items in the ComD resource package were revised iteratively based on user feedback, with further data collected to measure its usefulness.</p><p><strong>Results: </strong>The 12-month ComD success rate over 3 PDSA cycles were 88.9%, 94.2% and 96.7%, respectively, after each cycle. There was a consistent reduction in the level of family anxiety before and after caregiver training and resources. Reasons for failed ComD included acute clinical deterioration or delays in obtaining home oxygen support.</p><p><strong>Conclusion: </strong>The ComD resource package allowed collaborative work across different disciplines, strengthening the safety and utility of ComD and allowing patients to die in their place of choice. These are ubiquitous across settings; this QI problem is thus relevant beyond our local institution.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11253726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Service development project to pilot a digital technology innovation for video direct observation of therapy in adult patients with asthma.","authors":"Katherine O'Neill, Cairine Gormley, Martin G Kelly, Rachel Huey, Glenda Fleming, Michael Scott, Michael Shields, James C McElnay","doi":"10.1136/bmjoq-2023-002626","DOIUrl":"https://doi.org/10.1136/bmjoq-2023-002626","url":null,"abstract":"<p><strong>Background: </strong>Adherence to pharmacotherapy and use of the correct inhaler technique are important basic principles of asthma management. Video- or remote-direct observation of therapy (v-DOT) could be a feasible approach to facilitate monitoring and supervising therapy, supporting the delivery of standard care.</p><p><strong>Objective: </strong>To explore the utility and the feasibility of v-DOT to monitor inhaler technique and adherence to treatment in adults attending the asthma outpatient service in a tertiary hospital in Northern Ireland.</p><p><strong>Method: </strong>The project evaluated use of the technology with 10 asthma patients. Patient and clinician feedback was obtained, in addition to measures of patient engagement and disease-specific clinical markers to assess the feasibility and utility of v-DOT technology in this group of patients.</p><p><strong>Results: </strong>The engagement rate with v-DOT for participating patients averaged 78% (actual video uploads vs expected video uploads) over a median 7 week usage period. Although 50% of patients reported a technical issue at some stage during the usage period, all patients and clinicians reported that the technology was easy to use and that they were satisfied with the outcomes. A range of positive impacts were observed, including optimised inhaler technique and an observed improvement in lung function. An increase in asthma control test scores aligned with clinical aims to promote adherence and alleviate symptoms.</p><p><strong>Conclusion: </strong>The v-DOT technology was shown to be a feasible method of assessing inhaler technique and monitoring adherence in this small group of adult asthma patients. A range of positive impacts for participating patients and clinicians were observed. Not all patients invited to join the project agreed to participate or engage with using the technology, highlighting that in this setting, digital modes of delivering care provide only one of the approaches in the necessary \"tool kit\" for clinicians and patients.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting victim-survivors during investigations of health practitioner misconduct: early learnings from a trauma-informed service.","authors":"Jacinta Evans, Katherine Piech, Eva Saar, Sarah Anderson","doi":"10.1136/bmjoq-2024-002765","DOIUrl":"10.1136/bmjoq-2024-002765","url":null,"abstract":"<p><strong>Objective: </strong>In 2021, the Australian Health Practitioner Regulation Agency established a support service to provide additional assistance to victim-survivors involved in complaints related to sexual boundary violations. This study evaluates the first stages of service delivery to understand participants' experiences with the service, gauge the service's reception, and improve support provided in future.</p><p><strong>Design: </strong>Programme data was analysed descriptively to understand uptake and participant engagement since inception. Semistructured interviews with a purposive convenience sample of participants who had recently completed service engagement were conducted over 6 months and analysed using reflexive thematic analysis. Findings were triangulated to judge the effectiveness of the support provided by the service and highlight learning and development opportunities.</p><p><strong>Results: </strong>During the study period, 275 participants were referred to the programme and 175 (64%) of those referred had engaged with the service. At the time of analysis, less than a quarter (21%) had refused support or disengaged following referral. Participants reported appreciation of and satisfaction with the support they received from the service and strongly reiterated the need for support in this context. Flexibility and quality communication as part of the service model was associated with participants feeling supported through three main themes: safety and connection, guidance and process navigation and representation and advocacy.</p><p><strong>Conclusion: </strong>Good uptake of the service and positive feedback from participants suggests that the programme has been a valuable and well-received initiative. Exploration of engagement trends as well as a more nuanced analysis of the benefits of support provided would augment these findings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11243277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141589544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How can interventions more directly address drivers of unprofessional behaviour between healthcare staff?","authors":"Justin A Aunger, Ruth Abrams, Russell Mannion, Johanna I Westbrook, Aled Jones, Judy M Wright, Mark Pearson, Jill Maben","doi":"10.1136/bmjoq-2024-002830","DOIUrl":"10.1136/bmjoq-2024-002830","url":null,"abstract":"<p><p>Unprofessional behaviours (UBs) between healthcare staff are widespread and have negative impacts on patient safety, staff well-being and organisational efficiency. However, knowledge of how to address UBs is lacking. Our recent realist review analysed 148 sources including 42 reports of interventions drawing on different behaviour change strategies and found that interventions insufficiently explain their rationale for using particular strategies. We also explored the drivers of UBs and how these may interact. In our analysis, we elucidated both common mechanisms underlying both how drivers increase UB and how strategies address UB, enabling the mapping of strategies against drivers they address. For example, social norm-setting strategies work by fostering a more professional social norm, which can help tackle the driver 'reduced social cohesion'. Our novel programme theory, presented here, provides an increased understanding of what strategies might be effective to adddress specific drivers of UB. This can inform logic model design for those seeking to develop interventions addressing UB in healthcare settings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11261740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}