ORCID Profile
0000-0003-4852-9854
Current Organisation
University of York
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Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.CTIM.2012.05.002
Abstract: The economic burden that chronic pain conditions impose on in iduals and society is significant. Acupuncture appears to be a clinically effective treatment for some chronic pain conditions. Given the need for policy decisions to be informed by economic evaluations, the objective of this systematic review was to synthesise data from economic evaluations to determine whether acupuncture for the treatment of chronic pain conditions is good value for money. A literature search was conducted using health and economics databases, with additional hand-searching. Economic evaluations conducted alongside randomised controlled trials were eligible. Eight economic evaluations were included in this review, seven cost-utility analyses and one cost-effectiveness analysis. Conditions treated included low back pain, neck pain, dysmenorrhoea, migraine and headache, and osteoarthritis. From the seven cost-utility analyses, acupuncture was found to be clinically effective but cost more. The cost per quality adjusted life year (QALY) gained ranged from £2527 to £14,976 per QALY, below the commonly quoted threshold used by the UK National Institute for Health and Clinical Excellence of £20,000 to £30,000. The one cost-effectiveness study indicated that there might be both clinical benefits and cost savings associated with acupuncture for migraine. There was heterogeneity across the eight trials in terms of professional who provided the acupuncture, style of acupuncture, and country of origin. The cost per QALY gained in all seven cost-utility studies was found to be below typical thresholds of willingness to pay. Acupuncture appears to be a cost-effective intervention for some chronic pain conditions.
Publisher: Springer Science and Business Media LLC
Date: 24-10-2012
Publisher: Springer Science and Business Media LLC
Date: 24-10-2012
Publisher: Springer Science and Business Media LLC
Date: 11-02-2019
Publisher: Springer Science and Business Media LLC
Date: 17-06-2010
Publisher: National Institute for Health and Care Research
Date: 06-2023
DOI: 10.3310/GRNM5147
Abstract: Computerised decision support systems (CDSS) are widely used by nurses and allied health professionals but their effect on clinical performance and patient outcomes is uncertain. Evaluate the effects of clinical decision support systems use on nurses’, midwives’ and allied health professionals’ performance and patient outcomes and sense-check the results with developers and users. Comparative studies (randomised controlled trials (RCTs), non-randomised trials, controlled before-and-after (CBA) studies, interrupted time series (ITS) and repeated measures studies comparing) of CDSS versus usual care from nurses, midwives or other allied health professionals. Nineteen bibliographic databases searched October 2019 and February 2021. Assessed using structured risk of bias guidelines almost all included studies were at high risk of bias. Heterogeneity between interventions and outcomes necessitated narrative synthesis and grouping by: similarity in focus or CDSS-type, targeted health professionals, patient group, outcomes reported and study design. Of 36,106 initial records, 262 studies were assessed for eligibility, with 35 included: 28 RCTs (80%), 3 CBA studies (8.6%), 3 ITS (8.6%) and 1 non-randomised trial, a total of 1318 health professionals and 67,595 patient participants. Few studies were multi-site and most focused on decision-making by nurses (71%) or paramedics (5.7%). Standalone, computer-based CDSS featured in 88.7% of the studies only 8.6% of the studies involved ‘smart’ mobile or handheld technology. Care processes – including adherence to guidance – were positively influenced in 47% of the measures adopted. For ex le, nurses’ adherence to hand disinfection guidance, insulin dosing, on-time blood s ling, and documenting care were improved if they used CDSS. Patient care outcomes were statistically – if not always clinically – significantly improved in 40.7% of indicators. For ex le, lower numbers of falls and pressure ulcers, better glycaemic control, screening of malnutrition and obesity, and accurate triaging were features of professionals using CDSS compared to those who were not. Allied health professionals (AHPs) were underrepresented compared to nurses systems, studies and outcomes were heterogeneous, preventing statistical aggregation very wide confidence intervals around effects meant clinical significance was questionable decision and implementation theory that would have helped interpret effects – including null effects – was largely absent economic data were scant and erse, preventing estimation of overall cost-effectiveness. CDSS can positively influence selected aspects of nurses’, midwives’ and AHPs’ performance and care outcomes. Comparative research is generally of low quality and outcomes wide ranging and heterogeneous. After more than a decade of synthesised research into CDSS in healthcare professions other than medicine, the effect on processes and outcomes remains uncertain. Higher-quality, theoretically informed, evaluative research that addresses the economics of CDSS development and implementation is still required. Developing nursing CDSS and primary research evaluation. This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in Health and Social Care Delivery Research 2023. See the NIHR Journals Library website for further project information. PROSPERO [number: CRD42019147773].
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Karen Bloor.