SACM - United Kingdom
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9667
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Item Restricted Delivering a carbon net zero NHS at UCLH through more sustainable inhaler prescribing in the trust(University College London, 2024) Aldosari, Bodour; Roy, KayBackground Climate change, driven by anthropogenic greenhouse gas emissions, significantly impacts global health. The National Health Service (NHS) is committed to achieve net-zero carbon emissions by 2040, targeting reductions in healthcare-related emissions, including those from respiratory inhalers. Short acting beta agonist (SABA) are major contributors to the NHS’s carbon footprint due to their propellant gases. The North Central London has set key performance indicators to increase the use of lower-carbon inhalers. This project aims to primarily optimize asthma care within University College London Hospital (UCLH) by implementing sustainable inhaler prescribing practices in the emergency department (ED) and acute medical unit (AMU), aligning with these environmental goals. Methods Inhaler-sustainability champions delivered a regular education programme with interval performance of prescribing reported, following BTS-asthma 4 and surveys evaluating staff confidence pre- and post-training. Carbon footprint in NCL was calculated at community practice level and department level within UCLH to identify where more attention required. Teaching supported good disease management through prescribing of inhaled steroids and reduction in Salbutamol over-reliance with effective inhaler technique and adherence checks. We collected data pre and post interventions such as teaching to assess the impact of the educational interventions on clinical practice. Results There was an 18% and 40% reduction in SABA prescriptions in the ED and AMU respectively, cutting down carbon emissions by over 1,640 kg. Maintenance and reliever therapy prescriptions increased by 8.6% and 48% in ED and AMU, respectively. The Asthma 4 bundle application improved in the AMU. A staff surveys revealed overall improvement in knowledge and understanding after the educational intervention. Conclusion The implementation of sustainable inhaler prescribing practices in the ED and AMU at UCLH has led to a reduction in carbon emissions and improvements in clinical practice. Additionally, the educational interventions resulted in enhanced staff knowledge and understanding around optimal asthma care. These outcomes highlight the potential for such quality improvement initiatives in achieving both clinical excellence and environmental sustainability within healthcare settings8 0Item Restricted Follow-Up Survey on Challenges in Delivering Endodontic Treatment in NHS Primary Dental Care Settings in Scotland(University of Glasgow, 2024-08) Molla, Fahad Osamah; Robertson, DouglasAbstract: Endodontics, a specialized field within dentistry, is dedicated to diagnosing, preventing and treating conditions affecting the dental pulp and root canal system of teeth. A common procedure within endodontics is root canal therapy, which involves removing infected or damaged pulp, thoroughly disinfecting the root, and then sealing it to prevent further infection.(Ng, Mann, & Gulabivala, 2010) The primary goal of the NHS in dentistry is to promote and protect the health of the population it serves. This includes preserving natural teeth and controlling infections whenever possible(Steele, 2009). Preserving natural teeth aligned with broader health goals such as improving overall oral health, maintaining proper chewing function, preserving aesthetics, and enhancing the quality of life for patients. It also helps prevent serious dental problems arising from tooth loss, such as bone resorption in the jaw, shifting of adjacent teeth, and potential impacts on speech and nutrition. Additionally, maintaining natural teeth can be more cost-effective in the long term compared to tooth replacement options such as dental implants bridges(Fejerskov, Escobar, Jøssing, & Baelum, 2013). Previous research has highlighted significant financial and systemic barriers to delivering optimal endodontic treatment within NHS primary dental care settings. A notable issue is the gap between the compensation received by dental professionals and the costs associated with providing these treatments, which poses challenges for practitioners and raises concerns about equitable access to quality dental care(Khamuani, Ross, & Robertson, 2022; McColl, Smith, Whitworth, Seccombe, & Steele, 1999). This follow-up research aims to investigate the impact of the newly implemented remuneration system on the provision of endodontic care within NHS primary dental care settings in Scotland. The objectives of this study are to assess the impact of the new remuneration system on barriers faced by dental practitioners and to investigate specific challenges in adapting to this system, exploring how these challenges affect the ability to provide optimal endodontic care.17 0Item Restricted Predicting the Uptake of a New Medicine in England using Classification(Saudi Digital Library, 2023-12-01) Alsoghayer, Sara; Tabassum, FaizaThe National Healthcare Service (NHS) is experiencing delays of the uptake of a new medicine within their formularies, despite the National Institute for Health and Care Excellence (NICE) recommendations. Such delays not only affect pharmaceutical companies’ during the launch stage but also contribute to potential harm in patients’ health, and low global competitiveness in the life sciences sector. This study investigates the viability of predicting the speed of uptake of a new drug on a formulary level using classification algorithms. Three types of machine learning models: XGBoost, random forest, and logistic regression were employed and evaluated. The results suggest the predictive model, XGBoost, is operating on a market entry level, showing generalized predictions across various formularies. The findings also indicate there is no correlation between the formulary medicine uptake and the number of partnered organizations of a formulary, or the size of patient population.51 0Item Restricted Three Studies in Healthcare Costing and Quality. New evidence from England and Wales on the Impact of the Reference Cost Index and Payment by Result Systems(2023-04-21) Alotaibi, Abdullah; Guven-Uslu, Pinar & Malagueno, RicardoHealthcare provision accounts for a high proportion of public finances worldwide. Therefore, efficiency, quality and value for money are paramount. This thesis focuses on healthcare resource usage in the National Health Service (NHS), in England and Wales where reforms have long sought to ensure value for money and accountability. However, evaluating healthcare performance is complex. Since 1997, the National Reference Cost Index (NRCI) costing system has been applied to generate reliable data for all NHS clinical treatments and to drive improvements to the system. This thesis encompasses three studies. Study 1 Contributes to knowledge in the field of healthcare accounting by presenting an updated mapping of RCIs and an examination of trends within the NHS trusts. The study investigated trends and changes to RCIs, trust1 numbers, trust types and variations between the mean RCI of each group (i.e., region, type and foundation status) from the national average. Descriptive statistics were used, from 1997 (the introduction of the Reference Cost system) to 2016: for 1997 to 2009 data were collected from the National Archives of the Department of Health website; data for 2010 to 2016 were collected from the NHS Reference Costs Collection website. Furthermore, the study’s focus is on NHS trusts’ characteristics rather than patient characteristics or productivity which have attracted previous research attention, extending our understanding of healthcare costs, trends, patterns figures and differences between foundation and non-foundation trusts over the various regions and trust types, for the first 20 years of NRCI application. Study 2 examines cost variations between 2009 and 2016 by analysing the relationship between specific organisational characteristics (i.e., location, the type of service, foundation status and size), which were taken as individual uncontrollable variables, and RCIs. The National Archives of the Department of Health website provided the data for 2009, while NHS Reference Costs Collection website were used for data from 2010 to 2016. Size data was from England NHS website. Patient classification and gender, collected from NHS Digital website, were taken as control variables. Ordinary Least Square (OLS) regression technique was used and cost differences across trusts were identified. The study is distinct from previous work in this field as it focuses on trust characteristics and, to the author’s knowledge, is the first to analyse the associations between combined trust characteristics and RCIs over an extended time period. Furthermore, the study uses data for all HRGs, rather than selecting specific categories, as previous research has done. Study 2 takes contingency theory as its theoretical framework, since it suggests that applying a single cost system for organisations which differ as to their geography, type, size, ownership and technology may not be appropriate and that variations should be taken into account. Study 3 examines the relationship between RCI reduction and the quality of trust services provided, in the context of the introduction of Payment by Results (PbR) in the NHS to improve the cost efficiency of trust management. The study applied seven quality measures: mortality rates, Same-day Discharge (SDD), infection rates, mean Length of Stay (LOS), emergency and in-patient and out-patient waiting times. Data were collected from three NHS websites for the period 2010 to 2016. Data for RCIs and foundation status were from the NHS Reference Costs Collection website. Data for the dependent and other control variables were extracted from the NHS Digital website and the National Archives of the Department of health. Study 3 uses panel fixed effect regression. This study contributes to the fields of costing and healthcare quality by examining the association between cost and the quality of trust services provided. Study 3 is the first, to the researcher’s knowledge, to use infection rates as a measure of quality, or to evaluate quality while making a distinction between trusts at the upper and lower ends of the RCI scale.6 0