ORCID Profile
0000-0001-7394-7009
Current Organisations
University of Sheffield
,
University of Southampton
,
University of York
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Publisher: Springer Science and Business Media LLC
Date: 29-07-2010
Abstract: The purpose of this study was to assess the relationship between skill mix, patient outcomes, length of stay and service costs in older peoples' intermediate care services in England. We undertook multivariate analysis of data collected as part of the National Evaluation of Intermediate Care Services. Data were analysed on between 337 and 403 older people admitted to 14 different intermediate care teams. Independent variables were the numbers of different types of staff within a team and the ratio of support staff to professionally qualified staff within teams. Outcome measures include the Barthel index, EQ-5D, length of service provision and costs of care. Increased skill mix (raising the number of different types of staff by one) is associated with a 17% reduction in service costs (p = 0.011). There is weak evidence (p = 0.090) that a higher ratio of support staff to qualified staff leads to greater improvements in EQ-5D scores of patients. This study provides limited evidence on the relationship between multidisciplinary skill mix and outcomes in intermediate care services.
Publisher: Mark Allen Group
Date: 09-2008
DOI: 10.12968/IJTR.2008.15.9.30822
Abstract: The health workforce has undergone unprecedented change over the past decade. Several countries have introduced substantial workforce changes to address staffi ng shortages in medicine, nursing and the allied health professions, and in some cases, to improve the productivity and effi ciency of health services. This raft of changes, with various labels, including workforce redesign and re-engineering, has facilitated possibly the largest transformation in professional role boundaries in the history of the development of the professions. The result has been the introduction of new types of workers and new roles for several existing staff. The impact of these changes on service effectiveness and effi ciency remains largely unknown.
Publisher: Springer Science and Business Media LLC
Date: 09-2009
DOI: 10.2165/11314840-000000000-00000
Abstract: This paper reviews the role of patient preferences within the framework of cost-effectiveness analysis (CEA). CEA typically adopts a system-wide perspective by focusing upon efficiency across groups in the allocation of scarce healthcare resources, whereas treatment decisions are made over in iduals. However, patient preferences have been shown to have a direct impact on the outcome of an intervention via psychological factors or indirectly via patient adherence/compliance rates. Patient values may also be in conflict with the results of CEA through the valuation of benefits. CEA relies heavily on the QALY model to reflect in idual preferences, although the healthy year equivalent offers an alternative measure that may be better at taking in idual preferences into account. However, both measures typically use mean general population or mean patient values and therefore create conflict with in idual-level preferences. For CEA to reflect practice, it must take into account the impact of in idual patient preferences even where general population preferences are used to value the benefits of interventions. Patient preferences have implications for cost effectiveness through costs and outcomes, and it is important that cost-effectiveness models incorporate these through its structure (e.g. allowing for differing compliance rates) and parameter values, including clinical effectiveness. It will also be necessary to try to predict patient preferences in order to estimate any impact on cost effectiveness through analyses of revealed and stated preference data. It is recognized that policy makers are concerned with making interventions available to patients and not forcing them to consume healthcare. One way of moving towards this would be to adopt a two-part decision process: the identification of the most cost-effective therapy using mean general population values (i.e. the current rule), then also making available those treatments that are cheaper than the most cost-effective therapy.
Publisher: Springer Science and Business Media LLC
Date: 04-06-2018
Publisher: Springer Science and Business Media LLC
Date: 09-07-2020
DOI: 10.1186/S40814-020-00626-W
Abstract: Opioids, such as heroin, kill more people worldwide by overdose than any other type of drug, and death rates associated with opioid poisoning in the UK are at record levels (World Drug Report 2018 [Internet]. [cited 2019 Nov 19]. Available from: dr2018/ Deaths related to drug poisoning in England and Wales - Office for National Statistics [Internet]. [cited 2019 Nov 19]. Available from: www.ons.gov.uk eoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2018registrations ). Naloxone is an opioid antagonist which can be distributed in ‘kits’ for administration by witnesses in an overdose emergency. This intervention is known as take-home naloxone (THN). We know that THN can save lives on an in idual level, but there is currently limited evidence about the effectiveness of THN distribution on an aggregate level, in specialist drug service settings or in emergency service settings. Notably, we do not know whether THN kits reduce deaths from opioid overdose in at-risk populations, if there are unforeseen harms associated with THN distribution or if THN is cost-effective. In order to address this research gap, we aim to determine the feasibility of a fully powered cluster randomised controlled trial (RCT) of THN distribution in emergency settings. We will carry out a feasibility study for a RCT of THN distributed in emergency settings at four sites, clustered by Emergency Department (ED) and catchment area within its associated ambulance service. THN is a peer-administered intervention. At two intervention sites, emergency ambulance paramedics and ED clinical staff will distribute THN to adult patients who are at risk of opioid overdose. At two control sites, practice will carry on as usual. We will develop a method of identifying a population to include in an evaluation, comprising people at risk of fatal opioid overdose, who may potentially receive naloxone included in a THN kit. We will gather anonymised outcomes up to 1 year following a 12-month ‘live’ trial period for patients at risk of death from opioid poisoning. We expect approximately 100 patients at risk of opioid overdose to be in contact with each service during the 1-year recruitment period. Our outcomes will include deaths, emergency admissions, intensive care admissions, and ED attendances. We will collect numbers of eligible patients attended by participating in emergency ambulance paramedics and attending ED, THN kits issued, and NHS resource usage. We will determine whether to progress to a fully powered trial based on pre-specified progression criteria: sign-up of sites ( n = 4), staff trained (≥ 50%), eligible participants identified (≥ 50%), THN provided to eligible participants (≥ 50%), people at risk of death from opioid overdose identified for inclusion in follow-up (≥ 75% of overdose deaths), outcomes retrieved for high-risk in iduals (≥ 75%), and adverse event rate ( 10% difference between study arms). This feasibility study is the first randomised, methodologically robust investigation of THN distribution in emergency settings. The study addresses an evidence gap related to the effectiveness of THN distribution in emergency settings. As this study is being carried out in emergency settings, obtaining informed consent on behalf of participants is not feasible. We therefore employ novel methods for identifying participants and capturing follow-up data, with effectiveness dependent on the quality of the available routine data. ISRCTN13232859 (Registered 16/02/2018)
Publisher: Informa Healthcare
Date: 06-10-2005
Publisher: Springer Science and Business Media LLC
Date: 2006
DOI: 10.2165/00019053-200624010-00006
Abstract: Immunosuppressive therapy is required to prevent graft rejection. Calcineurin inhibitors such as tacrolimus are paradoxically toxic to the kidney, whereas sirolimus (rapamycin Rapamune) is not generally associated with the nephrotoxicity of CNIs. The purpose of this study was to evaluate the relative cost utility of sirolimus versus tacrolimus for the primary prevention of graft rejection in renal transplant recipients in the UK. A stochastic simulation model was constructed using clinical trial and observational data comparing the two treatments. Time duration was up to 20 years. Costs were from a UK NHS perspective, valued at 2003 prices and discounted at 6%. Benefits were discounted at 1.5%. Simulated events included patient and graft survival, haemodialysis, peritoneal dialysis, re-transplants and acute rejection. Costs were summed for events and various maintenance therapies. Utility was differentially accredited depending upon survival and using the alternative renal replacement therapies. Outcome was predicted using post-transplant creatinine levels up to 3 years. Extensive statistical economic and sensitivity analyses were undertaken. Over the 10-year horizon, sirolimus gained 0.72 years (discounted) of functioning graft over tacrolimus, resulting in an incremental cost per year of functioning graft that was dominant. Over a 20-year time horizon, the cost effectiveness of sirolimus over tacrolimus further improved with an average discounted gain in years of a functioning graft of 1.8 years, resulting in an incremental cost-utility ratio that was also dominant. The number of haemodialysis events was 48,243 for sirolimus recipients versus 127,829 for those receiving tacrolimus and peritoneal dialysis events 40,872 versus 105,249, respectively. Similar values were obtained when real-life observational data on tacrolimus use in Cardiff, Wales were entered into the model. Using data from Cardiff, sirolimus remained dominant over tacrolimus under all scenarios. Our study suggests that sirolimus may be more cost effective than tacrolimus for the primary prevention of graft rejection in renal transplant recipients in the UK. Sirolimus was economically 'dominant' under almost all scenarios investigated. This finding was robust using statistical economic analysis and univariate sensitivity analysis.
Publisher: Wiley
Date: 30-06-2013
DOI: 10.1111/HEX.12096
Publisher: Springer Science and Business Media LLC
Date: 14-03-2012
Publisher: BMJ
Date: 20-08-2010
DOI: 10.1136/BMJ.C4093
Publisher: National Institute for Health and Care Research
Date: 08-2015
DOI: 10.3310/HTA19660
Abstract: Acute bronchiolitis is the most common cause of hospitalisation in infancy. Supportive care and oxygen are the cornerstones of management. A Cochrane review concluded that the use of nebulised 3% hypertonic saline (HS) may significantly reduce the duration of hospitalisation. To test the hypothesis that HS reduces the time to when infants were assessed as being fit for discharge, defined as in air with saturations of 92% for 6 hours, by 25%. Parallel-group, pragmatic randomised controlled trial, cost–utility analysis and systematic review. Ten UK hospitals. Infants with acute bronchiolitis requiring oxygen therapy were allocated within 4 hours of admission. Supportive care with oxygen as required, minimal handling and fluid administration as appropriate to the severity of the disease, 3% nebulised HS every ± 6 hours. The trial primary outcome was time until the infant met objective discharge criteria. Secondary end points included time to discharge and adverse events. The costs analysed related to length of stay (LoS), readmissions, nebulised saline and other NHS resource use. Quality-adjusted life-years (QALYs) were estimated using an existing utility decrement derived for hospitalisation in children, together with the time spent in hospital in the trial. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and other databases from inception or from 2010 onwards, searched ClinicalTrials.gov and other registries and hand-searched Chest , Paediatrics and Journal of Paediatrics to January 2015. We included randomised/quasi-randomised trials which compared HS versus saline (± adjunct treatment) or no treatment. We used a fixed-effects model to combine mean differences for LoS and assessed statistical heterogeneity using the I 2 statistic. The trial randomised 158 infants to HS ( n = 141 analysed) and 159 to standard care ( n = 149 analysed). There was no difference between the two arms in the time to being declared fit for discharge [median 76.6 vs. 75.9 hours, hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.75 to 1.20] or to actual discharge (median 88.5 vs. 88.7 hours, HR 0.97, 95% CI 0.76 to 1.23). There was no difference in adverse events. One infant developed bradycardia with desaturation associated with HS. Mean hospital costs were £2595 and £2727 for the control and intervention groups, respectively ( p = 0.657). Incremental QALYs were 0.0000175 ( p = 0.757). An incremental cost-effectiveness ratio of £7.6M per QALY gained was not appreciably altered by sensitivity analyses. The systematic review comprised 15 trials ( n = 1922) including our own. HS reduced the mean LoS by –0.36 days (95% CI –0.50 to –0.22 days). High levels of heterogeneity ( I 2 = 78%) indicate that the result should be treated cautiously. In this trial, HS had no clinical benefit on LoS or readiness for discharge and was not a cost-effective treatment for acute bronchiolitis. Claims that HS achieves small reductions in LoS must be treated with scepticism. Well-powered randomised controlled trials of high-flow oxygen are needed. This study is registered as NCT01469845 and CRD42014007569. This project was funded by the NIHR Health Technology Assessment (HTA) programme and will be published in full in Health Technology Assessment Vol. 19, No. 66. See the HTA programme website for further project information.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Simon Dixon.