Extracting general practice data for timely vaccine coverage estimates: The England experience

In England, primary care providers use standardised coding systems to record health events such as vaccination as well as patient characteristics. This information can be automatically extracted to estimate coverage for vaccine programmes delivered through primary care, in the general population as well as in specific geographical, ethnic, age or clinical groups. This system provides timely vaccine coverage estimates as well as the flexibility to extract tailored data in order to directly inform a continuously evolving national vaccine programme. It is however limited by the quality and completeness of clinical coding in primary care. A centralised, individual-level register would however improve data quality, completeness and reliability and remains the gold standard.     

Mapping of reproductive health financing: methodological challenges

Low level of funding for reproductive health (RH) is a cause for concern, given that RH service utilization in the vast majority of the developing world is well below the desired level. Though there is an urgent need to track the domestic and international financial resource flows for RH, the instruments through which financial resources are tracked in developing countries are limited. In this paper we examined the methodological and conceptual challenges of monitoring financial resources for RH services at international and national level. At the international level, there are a number of estimates that highlights the need for financial resources for RH programmes but the estimates vary significantly. At the national level, Reproductive Health Accounts (RHA) in the framework of National Health Accounts (NHA) is considered to be the ideal source to track domestic financial flows for RH activities. However, the weak link between data production by the RHA and its application by the stakeholders as well as lack of political will impedes the institutionalization of RHA at the country level.     

District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries

IntroductionProspective clinical audit of trauma care improves outcomes for the injured in high-income countries (HICs). However, equivalent, context-appropriate audit filters for use in low- and middle-income country (LMIC) district-level hospitals have not been well established. We aimed to develop context-appropriate trauma care audit filters for district-level hospitals in Ghana, was well as other LMICs more broadly.MethodsConsensus on trauma care audit filters was built between twenty panellists using a Delphi technique with four anonymous, iterative surveys designed to elicit: (i) trauma care processes to be measured; (ii) important features of audit filters for the district-level hospital setting; and (iii) potentially useful filters. Filters were ranked on a scale from 0 to 10 (10 being very useful). Consensus was measured with average percent majority opinion (APMO) cut-off rate. Target consensus was defined a priori as: a median rank of ≥9 for each filter and an APMO cut-off rate of ≥0.8.ResultsPanellists agreed on trauma care processes to target (e.g. triage, phases of trauma assessment, early referral if needed) and specific features of filters for district-level hospital use (e.g. simplicity, unassuming of resource capacity). APMO cut-off rate increased successively: Round 1 – 0.58; Round 2 – 0.66; Round 3 – 0.76; and Round 4 – 0.82. After Round 4, target consensus on 22 trauma care and referral-specific filters was reached. Example filters include: triage – vital signs are recorded within 15 min of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation – a large bore IV was placed within 15 min of patient arrival; referral – if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer.ConclusionThis study proposes trauma care audit filters appropriate for LMIC district-level hospitals. Given the successes of similar filters in HICs and obstetric care filters in LMICs, the collection and reporting of prospective trauma care audit filters may be an important step towards improving care for the injured at district-level hospitals in LMICs.     

The Impact of Age of Transfer on Outcomes in the Transition From Pediatric to Adult Health Systems: A Systematic Review of Reviews

PurposeInternational guidance on health-care transition has existed for over a decade; however, many unanswered questions remain. This systematic review of reviews aimed to answer the question: is a later age of transfer from pediatric to adult health care associated with improved health and health service outcomes?MethodsWe included systematic reviews which considered at least one long-term condition and provided outcome data from adult services. Methodology of primary studies was not an exclusion criterion. We searched multiple databases and conducted an initial search in May 2015 which was repeated in May 2017. All reviews were assessed for quality using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool. Reviews that scored less than 22 were excluded.ResultsInitial searches identified 6,149 papers. Forty-three reviews met exclusion and inclusion criteria, and 15 reviews also met quality criteria. With one exception, primary studies from reviews which only considered quantitative evidence found that a delayed age of transfer resulted in improved outcomes. Qualitative and mixed-methods evidence supported the view that age 18 was an appropriate time of transfer.ConclusionWe found moderate evidence that models of transition which transfer young people in late adolescence or early adulthood can improve transition outcomes and patient satisfaction.     

The geographic harmonisation of Scotland's small area census data, 1981 to 2011

Previous research in Scotland used a merging approach to combine census boundary data for geographies specific to 1981, 1991 and 2001 to create Consistent Areas Through Time (CATTs) for the analysis of health and social data for small areas. In this paper, we adopt the same methodology to integrate the 2011 Scottish Output Areas to the CATTs. First, we overlaid the 2001 Output Areas upon the 2011 Output Areas to create SUPER OAs, which were then combined with SUPER EDs, which represented a consistent small area geography for 1981 and 1991. This resulted in 8,548 CATTs providing a consistent geography for the 1981, 1991, 2001 and 2011 Censuses in Scotland. We demonstrate the utility of the CATTs by exploring the correlations between deprivation, the proportion of the population who were permanently sick and those with degree qualifications, across the 4 censuses, a research angle impossible without consistent geographies. We have provided a resource that enables users to deepen their understanding of small area social changes in Scotland between the 1981 and 2011 Censuses.     

Protective behavioral strategies and alcohol-related outcomes: The moderating effects of drinking refusal self-efficacy and sex

The investigation of drinking refusal self-efficacy and alcohol protective behavioral strategies (PBSA) has revealed inconsistent results. Sex may be one factor that plays a role in these results given the demonstrable differences between the alcohol use behaviors of men and women. The current study examined the moderating effects of drinking refusal self-efficacy and sex on the relationships that PBSA subtypes have with alcohol outcomes for traditional age undergraduate students (18–25 years of age; 81% women; 60% White). Results showed negative associations between manner of drinking PBSA and alcohol consumption for individuals with high levels of drinking refusal self-efficacy but not low levels of drinking refusal self-efficacy. However, manner of drinking PBSA was positively associated with alcohol-related negative consequences for men but not for women. Results also showed negative associations between stopping and limiting drinking PBSA and alcohol related negative consequences for individuals with high levels of drinking refusal self-efficacy but not low levels of drinking refusal self-efficacy. It appears that addressing drinking refusal self-efficacy within the context of PBSA is valuable for traditional college students.