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Objectives: In treat to target (T2T), the patient is treated to reach and maintain specified and sequentially measured goals, such as remission or low disease activity. T2T in psoriatic arthritis (PsA) has demonstrated improved clinical and patient-reported outcomes and is recommended in European guidelines. However, most clinicians do not use T2T in PsA. This study examined the barriers and enablers to implementation in practice.Methods: Sequential mixed methods comprising a qualitative design (interviews and focus group) to inform a quantitative design (survey). Qualitative data were analysed thematically, and quantitative statistics were analysed descriptively.Results: Nineteen rheumatology clinicians participated in telephone interviews or a face-to-face focus group. An overarching theme 'Complexity' (including 'PsA vs Rheumatoid Arthritis', 'Measurement' and 'Resources') and an underpinning theme 'Changes to current practice' (including 'Reluctance due to organisational factors' and 'Individual determination to make changes') were identified. 153 rheumatology clinicians responded to an online survey. Barriers included limited clinical appointment time to collect outcome data (54.5%) and lack of training in assessing skin disease (35%). Enablers included provision of a protocol (86.4%), a local implementation lead (80.9%), support in clinic to measure outcomes (83.3%) and training in T2T (69.8%). The importance of regular audit with feedback, specialist PsA clinics and a web-based electronic database linked to hospital/national information technology (IT) systems were also identified as enablers.Conclusions: Implementation of T2T in PsA requires an integrated approach to address the support, training and resource needs of individual clinicians, rheumatology teams, local IT systems and service providers to maximise success. [ABSTRACT FROM AUTHOR]

Objective To describe available evidence from systematic reviews of alternative healthcare delivery arrangements relevant to high-income countries to inform decisions about healthcare system improvement. Design Scoping review of systematic reviews. Data sources Systematic reviews of interventions indexed in Pretty Darn Quick-Evidence. Eligibility criteria All English language systematic reviews evaluating the effects of alternative delivery arrangements relevant to high-income countries, published between 1 January 2012 and 20 September 2017. Eligible reviews had to summarise evidence on at least one of the following outcomes: patient outcomes, quality of care, access and/or use of healthcare services, resource use, impacts on equity and/or social outcomes, healthcare provider outcomes or adverse effects. Data extraction and synthesis Journal, publication year, number and design of primary studies, populations/ health conditions represented and types of outcomes were extracted. Results Of 829 retrieved records, 531 reviews fulfilled our inclusion criteria. Almost all (93%) reviews reported on patient outcomes, while only about one-third included resource use as an outcome of interest. Just over a third (n=189, 36%) of reviews focused on alternative information and communications technology interventions (including 162 reviews on telehealth). About one-quarter (n=122, 23%) of reviews focused on alternative care coordination interventions. 15% (n=80) of reviews examined interventions involving changes to who provides care and how the healthcare workforce is managed. Few reviews investigated the effects of interventions involving changes to how and when care is delivered (n=47, 9%) or interventions addressing a goal-focused question (n=38, 7%). Conclusion A substantial body of evidence about the effects of a wide range of delivery arrangements is available to inform health system improvements. The lack of economic evaluations in the majority of systematic reviews of delivery arrangements means that the value of many of these models is unknown. This scoping review identifies evidence gaps that would be usefully addressed by future research. [ABSTRACT FROM AUTHOR]

Objectives To compare the characteristics of populations admitted to hospital-at-home services with the population admitted to hospital and assess the association of these services with healthcare costs and mortality. Design In a retrospective observational cohort study of linked patient level data, we used propensity score matching in combination with regression analysis. Participants Patients aged 65 years and older admitted to hospital-at-home or hospital. Interventions Three geriatrician-led admission avoidance hospital-at-home services in Scotland. Outcome measures Healthcare costs and mortality. Results Patients in hospital-at-home were older and more socioeconomically disadvantaged, had higher rates of previous hospitalisation and there was a greater proportion of women and people with several chronic conditions compared with the population admitted to hospital. The cost of providing hospital-at-home varied between the three sites from £628 to £2928 per admission. Hospital-at-home was associated with 18% lower costs during the follow-up period in site 1 (ratio of means 0.82; 95% CI: 0.76 to 0.89). Limiting the analysis to costs during the 6 months following index discharge, patients in the hospital-at-home cohorts had 27% higher costs (ratio of means 1.27; 95% CI: 1.14 to 1.41) in site 1, 9% (ratio of means 1.09; 95% CI: 0.95 to 1.24) in site 2 and 70% in site 3 (ratio of means 1.70; 95% CI: 1.40 to 2.07) compared with patients in the control cohorts. Admission to hospital-at-home was associated with an increased risk of death during the follow-up period in all three sites (1.09, 95% CI: 1.00 to 1.19 site 1; 1.29, 95% CI: 1.15 to 1.44 site 2; 1.27, 95% CI: 1.06 to 1.54 site 3). Conclusions Our findings indicate that in these three cohorts, the populations admitted to hospital-at-home and hospital differ. We cannot rule out the risk of residual confounding, as our analysis relied on an administrative data set and we lacked data on disease severity and type of hospitalised care received in the control cohorts. [ABSTRACT FROM AUTHOR]

Introduction Costs associated with the delivery of healthcare services are growing at an unsustainable rate. There is a need for health systems and healthcare providers to consider the economic impacts of the service models they deliver and to determine if alternative models may lead to improved efficiencies without compromising quality of care. The aim of this protocol is to describe a scoping review of the extent, range and nature of available synthesised research on alternative delivery arrangements for health systems relevant to high-income countries published in the last 5 years. Design We will perform a scoping review of systematic reviews of trials and economic studies of alternative delivery arrangements for health systems relevant to highincome countries published on 'Pretty Darn Quick' (PDQ)-Evidence between 1 January 2012 and 20 September 2017. All English language systematic reviews will be included. The Cochrane Effective Practice and Organisation of Care taxonomy of health system interventions will be used to categorise delivery arrangements according to: how and when care is delivered, where care is provided and changes to the healthcare environment, who provides care and how the healthcare workforce is managed, coordination of care and management of care processes and information and communication technology systems. This work is part of a 5-year Partnership Centre for Health System Sustainability aiming to investigate and create interventions to improve health-system-performance sustainability. Ethics and dissemination No primary data will be collected, so ethical approval is not required. The study findings will be published and presented at relevant conferences. [ABSTRACT FROM AUTHOR]

The article discusses the ways for improving the reporting of healthcare interventions in clinical research reports. It states that there should be a description of interventions in the method sections of a medical protocol. As suggested, the role of both clinician and participant should be described in the report. It informs that one of the methods for the identification of active ingredients of an intervention is their systematic specification with the help of standardized taxonomies and the usage of meta-regression method. It offers several tips for improving the usefulness of a research report. A flowchart depicting the methods for developing a physical therapy treatment schedule is also presented. INSET: Actions to improve usefulness of research reports.

Part I. Examines and compares the outcome of patients who receive hospital at home care to that of those who receive inpatient hospital care. Methods used to assess the outcome of the patients; Increase in demand for acute hospital beds; Reference to the increase in the number of emergency medical admissions. INSET: Key messages.

This article provides answers to questions related to medical care including the importance of providing patients with in-depth treatment descriptions, what the most commonly missed elements of treatment descriptions are and how this missed information can be supplied.

Abstract: Objectives To explore the attitudes of men with confirmed or suspected prostate cancer to testing for prostate specific antigen. Design: Qualitative interview study with a purposive sample. Setting: Great Britain. Participants: 52 men with suspected or confirmed prostate cancer, recruited through general practitioners, urologists, patient support groups, and charities. Results: Almost all men remembered their prostate specific antigen test but recalled being given little information beforehand. Arguments in favour of increased access to testing included the belief that early diagnosis would reduce mortality, improve quality of life, and save the NHS money. Men also thought that a national screening programme should be available because symptoms can be ambiguous, screening for cancer is responsible health behaviour, and screening would encourage men to be tested. Four men who opposed a screening programme had gathered information alerting them to uncertainty about the benefits of treatment, and two regretted that they had been tested. Others thought that access to testing is restricted in the United Kingdom because of a lack of government backing, concerns about the accuracy of the test, and a lack of resources. Conclusions: The few men in this study who subscribed to the argument that evidence of the benefits of treatment is a prerequisite for a screening programme did not want to see screening introduced. Men who proposed an alternative set of principles for testing gave reasons that did not all relate to overoptimism about the benefits of early diagnosis. People who plan services and people who respond to requests for testing need to understand men's perspectives and concerns. INSETS: Box 1;Box 2. [ABSTRACT FROM AUTHOR]

Deals with the development of consumer health information. Sources of consumer health information in Great Britain; Tools for assessing the quality of consumer health information.

Editorial. Discusses online health information. How information on the Internet does not differ from information available in other forms of media; Assumption that inaccurate information can be found in printed form as well as on the Internet; Change in consumer involvement in decisions about health care; Thoughts on how to mark information on the Internet as accurate, by using seals of approval; Strategies to help Internet users.

Comments on the hospital at home scheme in Great Britain. Provision of services traditionally associated with secondary care in the community; Response to the increasing demand for hospital beds; Overwhelming support of authorities to the hospital at home scheme.

Presents a study which compared a near patient influenza test in children in primary care with laboratory based reverse transcription polymerase chain reaction (RT-PCR) testing of nasopharyngeal aspirates. Findings.