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Category: 2017
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Stakeholder Views Do Matter: A Conceptual Framework for Medication Safety Measurement
Ng, J; Scahill, S; Harrison, J; (2017)
Journal of Pharmaceutical Health Services Research Sep 2017; DOI; 10.1111/jphs.12203
View abstractMany patients are harmed by medications intended to help them. Significant efforts have been directed toward the improvement of medication safety. Policymakers, clinicians, researchers and consumers are interested in knowing the progress of medication safety but it is unclear whether it is safer than before.
Part of the challenge has been the achievement of a common understanding of what medication safety means to multi-stakeholders, and then developing a measurement framework. Existing approaches to measurement have been narrow and piecemeal, failing to encompass diverse stakeholder beliefs and preferences.
A multi-stakeholder derived conceptual framework for medication safety measurement was required. The interview method was used to elicit and explore stakeholder views in-depth. Stakeholders were selected by purposive sampling on the basis of their job role or expertise in the area of medication safety in the New Zealand public hospital setting. Snowball sampling was also used and data collection was continued until data saturation which occurred after interviewing 30 people.
Transcripts were thematically analysed and interpreted with the aid of NVivo and mind maps using a general inductive approach. The developed multi-stakeholder derived conceptual framework for medication safety measurement consists of seven key dimensions meaningful to multi-stakeholders in the New Zealand public hospital setting. These are:
1) Outcome goals of medication safety;
2) Financial costs and effectiveness;
3) Medications available for and their use;
4) Safety culture;
5) Technical components of the medication use system;
6) Factors affecting medication use by patients; and
7) Staff competency.The contribution to knowledge has been the development of a multi-stakeholder derived conceptual framework for medication safety measurement. As a consequence of this research, the measurement of medication safety should change from one which has been narrow and fragmented, to one which is multi-dimensional and holistic.
The developed framework incorporates diverse multi-stakeholder views and preferences increasing its relevance in the local context and is important for engagement and buy-in. It draws together all meaningful dimensions and facets providing a necessary and robust single theoretical frame to measure medication safety. Understanding stakeholders’ priorities and beliefs for medication safety can also be used to facilitate improvement programmes.
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An Organisational Study into the Impact of Mobile Devices on Clinician and Patient Experience in Auckland, New Zealand
Bohot, Kelly L.; Hammond, Rebecca C.; and Stanbrook, Teresa A (2017)
Patient Experience Journal 2017; 4(1):9
http://pxjournal.org/journal/vol4/iss1/9
View abstractMobile technology has potential to improve workflow, patient safety and quality of care, and has been identified as an important enabler of community services. However, little is known about the impact of mobile device use on clinician and patient experiences. Eleven community allied health clinicians were provided with live access to electronic health records, their email and electronic calendar, peer reviewed education and therapy mobile applications via a mobile device.
Three data measures were collected over 19-weeks. First, quantitative time and motion data was gathered at baseline and follow-up to enable longitudinal analysis of clinician workflow. Second, a questionnaire consisting of rateable statements, multi-choice and open questions was completed at baseline and follow-up to enable analysis of clinician experience. Third, a short questionnaire was completed with a convenience sample of 101 patients who experienced mobile device use in their home. Clinicians and patients reported positive experiences associated with access to electronic health information at the point of care and the use of pictures, diagrams and videos to support clinical interactions. There was a significant reduction in time spent on patient related administration (p<0.0001) and a significant increase in direct patient contact time (p<0.0001) following 15 weeks of mobile device use.
This study indicates that mobile device use has potential to improve clinician and patient experiences of community allied health through improvements in workflow and efficiency, improved clinician-patient interactions and improvements in health information flow.
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Development of a Culturally Tailored Text Message Maternal Health Programme (TextMATCH)
Dobson, R; Whittaker, R; Bartley, H; Connor, A; Chen, R; Ross, M; McCool, J (2017)
JMIR mHealth & uHealth Apr 2017; 5(4):e49. DOI:10.2196/mhealth.7205
https://www.ncbi.nlm.nih.gov/pubmed/28428159
View abstractBACKGROUND: Mobile phones are increasingly being used to deliver health information and health services globally. Mobile health (mHealth) interventions may be well-suited for minority groups with greater barriers to accessing traditional health services. However, little has been written about the process of culturally adapting interventions for multiple ethnic and cultural minorities within a population.
OBJECTIVE: This study describes the process of developing a culturally tailored text message-based maternal health program (TextMATCH: Text for MATernal and Child Health) for Māori, Pacific, Asian, and South Asian families living in New Zealand. We report on engagement and acceptability of the TextMATCH program.
METHODS: Program data was examined to describe engagement with the program 18 months after implementation. Telephone interviews were conducted with a sample of participants who consented to provide feedback on acceptability and relevance of the program.
RESULTS: A total of 1404 participants enrolled in TextMATCH over 18 months, with 18.52% (260) actively opting out at some point (after 0 to 17 months of messages). It was found that 356 (70.9%) of the 502 eligible participants actively switched from the initial pregnancy program to the baby program after delivery. Phone interviews were conducted with 29 participants including 6 who had withdrawn (duration of program from 3 to 16 months). Only 2 participants reported that the program was not useful, with the remainder rating the usefulness of messages positively (average 4.24 out of 5). All participants stated that the messages were relevant, culturally appropriate, and easy to understand. Most were happy with the specific advice and the language options provided.
CONCLUSIONS: We have demonstrated the importance of an intensive approach to the development of a culturally adapted and tailored mHealth program for multiple different cultural minority groups within our population.
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Getting the Foundations Right for the Measurement of Medication Safety: the Need for a Meaningful Conceptual Frame
Ng, J; Scahill, S; Harrison, J (2017)
NZ Medical Journal 2017; 130(1452):54-62
View abstractA number of initiatives aimed at improving medication safety in and across New Zealand public hospitals have been introduced over recent years. Clinicians, policymakers and patients now want to know whether patients are safer today from medicine use than they have been in the past.
The challenge has been determining exactly what should be measured. In this viewpoint, we critically examine the suitability of adverse drug events (ADE) as a primary metric for assessing the progress of medication safety improvement. We provide an overview of contemporary dialogue on medication safety measurement and highlight the emergent challenges.
Finally, we reflect on how New Zealand has approached medication safety measurement so far and argue the need for a multi-stakeholder informed conceptual framework with a view to further enhancing meaningful assessment of medication safety.
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Effectiveness of the YourCall™ Text Message Intervention to Reduce Harmful Drinking in Patients Discharged from Trauma Wards: Protocol for a Randomised Controlled Trial
Ameratunga, S; Kool, B; Sharpe, S; Reid, P; Lee, A; Civil, I; Smith, G; Thornton, V; Walekr, M; Whittaker, R (2017)
BMC Public Health 2017; 17:48. DOI:10.1186/s12889-016-3967-z
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223477/
View abstractBACKGROUND: Behavioural brief interventions (BI) can support people to reduce harmful drinking but multiple barriers impede the delivery and equitable access to these. To address this challenge, we developed YourCall™, a novel short message service (SMS) text message intervention incorporating BI principles. This protocol describes a trial evaluating the effectiveness of YourCall™ (compared to usual care) in reducing hazardous drinking and alcohol related harm among injured adults who received in-patient care.
METHODS/DESIGN: Participants recruited to this single-blind randomised controlled trial comprised patients aged 16-69 years in three trauma-admitting hospitals in Auckland, New Zealand. Those who screened positive for moderately hazardous drinking were randomly assigned by computer to usual care (control group) or the intervention. The latter comprised 16 informational and motivational text messages delivered using an automated system over the four weeks following discharge. The primary outcome is the difference in mean AUDIT-C score between the intervention and control groups at 3 months, with the maintenance of the effect examined at 6 and 12 months follow-up. Secondary outcomes comprised the health and social impacts of heavy drinking ascertained through a web-survey at 12 months, and further injuries identified through probabilistic linkage to national databases on accident insurance, hospital discharges, and mortality. Research staff evaluating outcomes were blinded to allocation. Intention-to-treat analyses will include assessment of interactions based on ethnicity (Māori compared with non-Māori).
DISCUSSION: If found to be effective, this mobile health strategy has the potential to overcome current barriers to implementing equitably accessible interventions that can reduce harmful drinking.