Search

Aims: The potential harm associated with medication errors is widely reported, but data on actual harm are limited. When actual harm has been measured, assessment processes are often poorly described, limiting their ability to be reproduced by other studies. Our aim was to design and implement a new process to assess actual harm resulting from medication errors in paediatric inpatient care. Methods: Prescribing errors were identified through retrospective medical record reviews (n = 26 369 orders) and medication administration errors through direct observation (n = 5137 administrations) in a tertiary paediatric hospital. All errors were assigned potential harm severity ratings on a 5‐point scale. Multidisciplinary panels reviewed case studies for patients assigned the highest three potential severity ratings and determined the following: actual harm occurrence and severity level, plausibility of a link between the error(s) and identified harm(s) and a confidence rating if no harm had occurred. Results: Multidisciplinary harm panels (n = 28) reviewed 566 case studies (173 prescribing related and 393 administration related) and found evidence of actual harm in 89 (prescribing = 22, administration = 67). Eight cases of serious harm cases were found (prescribing = 1, administration = 7) and no cases of severe harm. The panels were very confident in 65% of cases (n = 302) where no harm was found. Potential and actual harm ratings varied. Conclusions: This harm assessment process provides a systematic method for determining actual harm from medication errors. The multidisciplinary nature of the panels was critical in evaluating specific clinical, therapeutic and contextual considerations including care delivery pathways, therapeutic dose ranges and drug–drug and drug–disease interactions. [ABSTRACT FROM AUTHOR]

Objective To assess the comparability of out-of-pocket (OOP) payment and catastrophic health expenditure (CHE) estimates from different household surveys in India. Methods Data on CHE, outpatient and inpatient OOP payments and other expenditure from all major national or multi-state surveys since 2000 were compared. These included two consumer expenditure surveys (the National Sample Survey for 2004-05 [NSS 2004- 05] and 2009-10 [NSS 2009-10]) and three health-focused surveys (the World Health Survey 2003 [WHS 2003]; the National Sample Survey on Morbidity, Health Care and the Condition of the Aged 2004 [NSS 2004]; and the Study on Global Ageing and Adult Health 2007-08 [SAGE 2007-08]). All but the NSS 2004-05 and the NSS 2009-10 used different questionnaires. Findings CHE estimates from WHS 2003 and SAGE 2007-08 were twice as high as those from NSS 2004-05, NSS 2009-10 and NSS 2004. Inpatient OOP payment estimates were twice as high in WHS 2003 and SAGE 2007-08 because in these surveys a much higher proportion of households reported such payments. However, estimates of expenditures on other items were half as high in WHS 2003 as in the other surveys because a very small number of items was used to capture these expenditures. Conclusion The wide variations observed in CHE and OOP payment estimates resulted from methodological differences. Survey methods used to assess CHE in India need to be standardized and validated to accurately track CHE and assess the impact of recent policies to reduce it. Objectif Evaluer la comparabilite des paiements directs (PD) et estimer les depenses de sante catastrophiques (DSC) a partir de differentes enquetes menees aupres des menages en Inde. Methocles Les donnees recueillies dans toutes les grandes enquetes nationales ou multi-regionales depuis 2000 et portant sur les DSC, les paiements directs pour hospitalisation interne et externe et autres depenses, ont ete comparees. Parmi ces etudes, figurent notamment deux enquetes portant sur les depenses des consommateurs (l'enquete nationale pour 2004-2005 [NSS 2004-05] et pour 20092010 [NSS 2009-10]), et trois enquetes axees sur la sante (l'enquete sur la sante dans le monde 2003 [WHS 2003]; l'enquete nationale sur la morbidite, les soins de sante et la condition des personnes agees 2004 [NSS 2004]; et l'etude sur le vieillissement et la sante des adultes 2007-2008 [SAGE 2007-08]).Toutes ces enquetes, a l'exception de la NSS 2004-05 et de la NSS 2009-10, ont utilise des questionnaires differents. Resultats Dans les enquetes WHS 2003 et SAGE 2007-08, les DSC etaient deux fois plus elevees que celles relevees dans les enquetes NSS 2004-05, NSS 2009-10 et NSS 2004. Les paiements directs pour une hospitalisation interne etaient deux fois plus eleves dans les enquetes WHS 2003 et SAGE 2007-08, car, dans ces enquetes, une proportion beaucoup plus elevee de menages ont declare ces paiements. Cependant, d'autres depenses estimees etaient deux fois moins elevees dans l'enquete WHS 2003 que dans les autres enquetes, car un tres petit nombre de questions ont ete utilisees pour rendre compte de ces depenses. Conclusion Les grandes variations observees dans les DSC et les estimations de paiements directs resultent de differences methodologiques. Les methodes d'enquete utilisees pour evaluer les DSC en Inde doivent etre standardisees et validees pour evaluer les DCS avec precision et mesurer l'impact des politiques recentes pour les reduire. Objetivo Evaluar la comparabilidad de las estimaciones del pago por el propio paciente (OOP) y los gastos sanitarios catastroficos (CHE) a partir de distintas encuestas a hogares de la India. Metodos Se compararon los datos sobre los gastos sanitarios catastroficos (CHE), los pagos por el propio paciente (OOP) por el cuidado sanitario ambulatorio y hospitalario, asi como otros gastos de las principales encuestas nacionales o plurinacionales desde 2000. Estos incluyen dos encuestas sobre los gastos de consumo (la Encuesta Nacional por Muestreo de 2004-05 [ENM 2004-05] y 2009-10 [ENM 2009-10]) y tres encuestas sobre salud (la Encuesta Mundial de Salud de 2003 [EMS 2003], la Encuesta Nacional por Muestreo de morbilidad, cuidado sanitario y de las condiciones de la tercera edad de 2004 [ENM 2004], y el Estudio sobre el Envejecimiento mundial de la poblacion y la salud de los adultos de 2007-08 [SAGE 2007-08]). Se emplearon cuestionarios diferentes en cada una de ellas, excepto para la ENM 2004-05 y la ENM 2009-10. Resultados Las estimaciones de los gastos sanitarios catastroficos (CHE) de la EMS 2003 y del Estudio sobre el Envejecimiento mundial de la poblacion y la salud de los adultos (SAGE) de 2007-08 fueron dos veces mas altas que las de la ENM 2004-05, ENM 2009-10 y ENM 2004. Las estimaciones del pago por el propio paciente (OOP) fueron dos veces mas altas en la EMS 2003 y el SAGE 2007-08 debido a que en estos estudios una proporcion mucho mayor de los hogares informo acerca de dichos pagos. Sin embargo, otros gastos estimados fueron la mitad en la EMS 2003 y en las otras encuestas porque se utilizo un numero muy pequeno de elementos para captar dichos gastos. Conclusion Las grandes variaciones observadas en las estimaciones de los gastos sanitarios catastroficos (CHE) y los pagos por el propio paciente (OOP) se debieron a diferencias metodologicas. Es necesario estandarizar y validar los metodos de encuesta utilizados para evaluar los gastos sanitarios catastroficos (CHE) en la India a fin de realizar un seguimiento preciso sobre dichos gastos y evaluar el impacto de las politicas recientes para reducirlos., Introduction Out-of-pocket (OOP) payments are the primary source of health-care financing in many countries. (1) In 2004-05, OOP payments in India were estimated to account for approximately two thirds of [...]

Objective To examine the availability of data measuring noncommunicable disease (NCD) risk factor indicators from household surveys conducted in India from 2000 to 2009. Methods Questionnaires and publications used in household surveys were identified through internet and PubMed searches and examined to determine which core NCD risk factor indicators recommended by the World Health Organization (WHO) for NCD monitoring were being measured. Surveys with a sample size of 5000 or more were included to ensure a certain level of precision. The completeness of core indicator measurement and the geographical representativeness of the surveys were assessed. Findings Twenty six surveys met the inclusion criteria. Among the WHO-recommended core behavioural risk factor indicators, those monitoring tobacco use were measured completely in national and subnational surveys; those assessing dietary intake and physical inactivity were measured only in subnational surveys, and those assessing alcohol use were not measured at all, Among WHO-recommended core biological risk factors, only body mass index was measured in national and subnational surveys, whereas blood pressure, fasting blood glucose and blood cholesterol were measured only in subnational surveys. Due to the use of non-standard indicator definitions, measurement of core indicators in some of the national and subnational surveys was incomplete. Conclusion The availability of data on core risk factor indicators to monitor the increasing burden of NCDs is inadequate in India. These indicators using standardized definitions should be included in the periodic national household health surveys to provide data at the national and disaggregated levels. [TEXT NOT REPRODUCIBLE IN ASCII.] Disponibilite des donnees pour la surveillance des facteurs de risque des maladies non transmissibles en Inde Objectif Examiner la disponibilite des donnees mesurant les indicateurs de facteurs de risque des maladies non transmissibles (MNT) a partir d'enquetes aupres des menages realisees en Inde de 2000 a 2009. Methodes Les publications et questionnaires utilises dans les enquetes aupres des menages ont ete recenses par des recherches sur Internet et PubMed. Ils ont ensuite ete etudies afin de determiner quels indicateurs principaux de facteurs de risque de MNT recommandes par l'Organisation mondiale de la Sante (OMS) pour la surveillance des MNT ils mesuraient. Les enquetes ayant eu un echantillon superieur ou egal a 5 000 ont ete incluses afin d'assurer un certain niveau de precision. L'exhaustivite de la mesure des principaux indicateurs et la representativite geographique des enquetes ont ete evaluees. Resultats Vingt-six enquetes repondaient aux criteres d'inclusion. Parmi les indicateurs de facteurs de risque comportemental principaux recommandes par l'OMS, ceux verifiant la consommation de tabac etaient integralement mesures par les enquetes nationales et infranationales, ceux evaluant les apports alimentaires et le manque d'activite physique etaient uniquement mesures dans les enquetes infranationales, enfin, ceux evaluant la consommation d'alcool n'etaient aucunement mesures. Parmi les principaux facteurs de risque biologique recommandes par l'OMS, seul l'indice de masse corporelle etait mesure dans les enquetes nationales et infranationales, alors que la tension arterielle, la glycemie ajeun et le cholesterol sanguin n'etaient mesures que dans les enquetes infranationales. En raison de l'utilisation de definitions d'indicateurs non standardisees, la mesure des indicateurs principaux etait incomplete dans certaines enquetes nationales et infranationales. Conclusion La disponibilite de donnees sur les indicateurs des principaux facteurs de risque permettant de surveiller la charge croissante des MNT est insuffisante en Inde. Ces indicateurs, utilisant des definitions standardisees, devraient etre inclus dans les enquetes nationales periodiques sur la sante des menages pour fournir des donnees nationales et ventilees. [TEXT NOT REPRODUCIBLE IN ASCII.] Disponibilidad de datos para la supervision de los factores de riesgo de enfermedades no transmisibles en India objetivo Examinar la disponibilidad de datos que miden los indicadores de factores de riesgo para enfermedades no transmisibles (ENT) a partir de las encuestas domesticas realizadas entre los anos 2000 y 2009 en India. Metodos A traves de busquedas en Internet y en PubMed se identificaron los cuestionarios y publicaciones empleados en las encuestas domesticas. A continuacion, se examinaron para determinar que indicadores fundamentales de factores de riesgo se habian medido para las ENT siguiendo las recomendaciones de la Organizacion Mundial de la Salud (OMS) para la supervision de enfermedades no transmisibles. Se incluyeron encuestas con un tamano de muestra de 5000 personas o mas para garantizar un nivel de precision adecuado. Se evaluaron la integridad de la medicion del indicador principal y la representatividad geografica de las encuestas. Resultados Veintiseis encuestas cumplieron los criterios de inclusion. De los principales indicadores de factores de riesgo conductuales recomendados por la OMS, los que controlaban el consumo de tabaco se midieron en su totalidad en encuestas nacionales y regionales; los que evaluaban la dieta y el sedentarismo se midieron unicamente en encuestas regionales y los que evaluaban el consumo de alcohol no se midieron en absoluto. De los principales factores de riesgo biologicos recomendados por la OMS, solo se midio el indice de masa corporal en las encuestas nacionales y regionales, mientras que la presion arterial, los niveles de glucosa en sangre en ayunas y los de colesterol en sangre se midieron unicamente en encuestas regionales. Debido al uso de definiciones de indicadores no estandarizadas, la medicion de los indicadores principales en algunas de las encuestas nacionales y regionales fue incompleta. Conclusion La disponibilidad de datos en India sobre los principales indicadores de factores de riesgo para controlar la creciente carga de enfermedades no transmisibles es insuficiente. Estos indicadores que emplean definiciones estandarizadas se deben incluir en las encuestas domesticas que se realizan periodicamente en el pais para proporcionar datos a nivel nacional y desagregado., Introduction Noncommunicable diseases (NCDs) were estimated to account for over 50% of the deaths and 43% of the disability-adjusted life years (DALYs) lost in India in 2004 (1) and they [...]

Abstract Background An understanding of how public health research output from India is changing in relation to the disease burden and public health priorities is required in order to inform relevant research development. We therefore studied the trends in the public health research output from India during 2001-2008 that was readily available in the public domain. Methods The scope and type of the published research from India in 2007 that was included in the PubMed database was assessed and compared with a previous similar assessment for 2002. Papers were classified based on the review of abstracts and original public health research papers were assessed in detail. Impact factors for the journals were used to compute quality-adjusted research output. The websites of governmental organizations, academic and research institutions and international organizations were searched in order to identify and review reports on original public health research produced in India from 2001 to 2008. The reports were classified based on the topics covered and quality and their trends over time were assessed. Results The number of original health research papers from India in PubMed doubled from 4494 in 2002 to 9066 in 2007. This included a 3.1-fold increase in public health research papers, but these comprised only 5% of the total papers in 2007. Within public health, the increase was lowest for the health system and policy category. Several major causes of disease burden in India continued to be underrepresented in the quality-adjusted public health research output in 2007. The number of papers evaluating population health interventions increased from 2002 to 2007, but there were none on the leading non-communicable causes of disease burden or on road traffic injuries. The number of identified original public health research reports increased by 64.7% from 204 in 2001-2004 to 336 in 2005-2008. The proportion of reports on reproductive and child health was very high but decreased slightly from 38.7% of the total in 2001-2004 to 31.5% in 2005-2008 (P = 0.09); those on the leading chronic non-communicable conditions and injuries increased from 6.4% to 13.4% (P = 0.01) but this was still much lower than their contribution to the disease burden. Health system/policy issues were the topic in 27.4% reports but health information issues were covered in a miniscule 0.6% reports. The proportion of reports that were evaluations increased slightly from 26% in 2001-2004 to 31.5% in 2005-2008, with this proportion being higher among the reports commissioned by international organizations (P < 0.001). The proportion of reports commissioned by Indian governmental organizations alone, or in collaboration with international organizations, doubled from 2001-2004 to 2005-2008 (P < 0.001). Only 25% of the total 540 reports had a quality score of adequate or better. The quality of reports produced by collaborations between Indian and international organizations was higher than those produced by Indian or international organizations alone (P < 0.001). Conclusion This is the first analysis from India that includes research reports in addition to published papers. It provides the most up-to-date understanding of public health research output from India. The increase in available public health research output and the increase in commissioning of this research by Indian governmental organizations are encouraging. However, the distribution of research topics and the quality of research reports continue to be unsatisfactory. It is necessary for health policy to address these continuing deficits in public health research in order to reduce the very large disease burden in India.

Abstract Background Health information and statistics are important for planning, monitoring and improvement of the health of populations. However, the availability of health information in developing countries is often inadequate. This paper reviews the essential health information available readily in the public domain on the internet for India in order to broadly assess its adequacy and inform further development. Methods The essential sources of health-related information for India were reviewed. An extensive search of relevant websites and the PubMed literature database was conducted to identify the sources. For each essential source the periodicity of the data collection, the information it generates, the geographical level at which information is reported, and its availability in the public domain on the internet were assessed. Results The available information related to non-communicable diseases and injuries was poor. This is a significant gap as India is undergoing an epidemiological transition with these diseases/conditions accounting for a major proportion of disease burden. Information on infrastructure and human resources was primarily available for the public health sector, with almost none for the private sector which provides a large proportion of the health services in India. Majority of the information was available at the state level with almost negligible at the district level, which is a limitation for the practical implementation of health programmes at the district level under the proposed decentralisation of health services in India. Conclusion This broad review of the essential health information readily available in the public domain on the internet for India highlights that the significant gaps related to non-communicable diseases and injuries, private health sector and district level information need to be addressed to further develop an effective health information system in India.

Objective: To conduct a systematic review and meta-analysis to assess: 1) changes in medication error rates and associated patient harm following electronic medication system (EMS) implementation; and 2) evidence of system-related medication errors facilitated by the use of an EMS.Materials and Methods: We searched Medline, Scopus, Embase, and CINAHL for studies published between January 2005 and March 2019, comparing medication errors rates with or without assessments of related harm (actual or potential) before and after EMS implementation. EMS was defined as a computer-based system enabling the prescribing, supply, and/or administration of medicines. Study quality was assessed.Results: There was substantial heterogeneity in outcomes of the 18 included studies. Only 2 were strong quality. Meta-analysis of 5 studies reporting change in actual harm post-EMS showed no reduced risk (RR: 1.22, 95% CI: 0.18-8.38, P = .8) and meta-analysis of 3 studies reporting change in administration errors found a significant reduction in error rates (RR: 0.77, 95% CI: 0.72-0.83, P = .004). Of 10 studies of prescribing error rates, 9 reported a reduction but variable denominators precluded meta-analysis. Twelve studies provided specific examples of system-related medication errors; 5 quantified their occurrence.Discussion and Conclusion: Despite the wide-scale adoption of EMS in hospitals around the world, the quality of evidence about their effectiveness in medication error and associated harm reduction is variable. Some confidence can be placed in the ability of systems to reduce prescribing error rates. However, much is still unknown about mechanisms which may be most effective in improving medication safety and design features which facilitate new error risks. [ABSTRACT FROM AUTHOR]