19 research outputs found
Randomized database studies: a combination of the strengths of observational studies and randomized clinical trials?
Before a drug is allowed into clinical practice, randomized clinical trial (RCT)
have been conducted in order to demonstrate effi cacy and safety. The RCT
method uses random treatment allocation to achieve comparable study
groups and is further characterized by strict patient inclusion criteria, and
strict follow-up schemes of the study groups.2,3
Once a drug enters the market, the drug is prescribed to a large number of
heterogeneous patients who have concomitant diseases and drug use. As a
result, unknown side effects may emerge (e.g., rare side effects, side effects
due to interactions or comorbidity). In addition, the effectiveness of the
drug in clinical practice is not the same as the effi cacy of the drug in clinical
studies, mostly because usage patterns can be quite different. Postmarketing
surveillance is the fi eld that studies the benefi cial and negative effects of
drugs after they have been marketed.
In post-marketing studies, both experimental and observational methods
can be applied to study drug safety and effectiveness. Both methods have
advantages and disadvantages. We will fi rst briefl y discuss these methods.
Experimental MethodsPragmatic or naturalistic trials are suggested as a possible solution to the
low generalisability of pre-marketing RCTs. In a pragmatic trial treatment is
assigned randomly but patient inclusion is more liberal (less strict inclusion
criteria) and the treatment modalities are not organized as strictly as in RCTs
(corresponding with regular patient care).5 Therefore the results of pragmatic
trials show effectiveness rather than effi cacy and better refl ect routine care
practice. However, pragmatic trials often fail (or are not even considered as
a possible alternative) because the implementation is time consuming and
disrupts daily care processes or is ethically diffi cult.6,7Observational methodsObservational post-marketing studies typically are based on data that are
collected for other purposes such as claims data or electronic medical records.The main objective of this thesis was to implement and test the randomized database study, which conceptually should bridge the gap between observational studies and randomzed clinical trials
Spironolactone and risk of upper gastrointestinal events: population based case-control study
OBJECTIVE: To confirm and quantify any association between spironolactone
and upper gastrointestinal bleeding and ulcers. DESIGN: Population based
case-control study. SETTING: A primary care information database in the
Netherlands. PARTICIPANTS: All people on the database who were aged 18 or
more between 1 January 1996 and 30 September 2003. Patients with a history
of alcoholism or gastrointestinal cancer were excluded. Ten controls were
matched to each case of gastroduodenal ulcer or upper gastrointestinal
bleeding by age (year of birth), sex, and index date. MAIN OUTCOME
MEASURES: The occurrence of an upper gastrointestinal event (bleeding or
ulcers), adjusted for potential confounders with conditional logistic
regression analysis. RESULTS: Within the source population of 306 645
patients, 523 cases of gastric or duodenal ulcer or upper gastrointestinal
Strategies for improving patient recruitment to focus groups in primary care: a case study reflective paper using an analytical framework
<p>Abstract</p> <p>Background</p> <p>Recruiting to primary care studies is complex. With the current drive to increase numbers of patients involved in primary care studies, we need to know more about successful recruitment approaches. There is limited evidence on recruitment to focus group studies, particularly when no natural grouping exists and where participants do not regularly meet. The aim of this paper is to reflect on recruitment to a focus group study comparing the methods used with existing evidence using a resource for research recruitment, PROSPeR (Planning Recruitment Options: Strategies for Primary Care).</p> <p>Methods</p> <p>The focus group formed part of modelling a complex intervention in primary care in the Resources for Effective Sleep Treatment (REST) study. Despite a considered approach at the design stage, there were a number of difficulties with recruitment. The recruitment strategy and subsequent revisions are detailed.</p> <p>Results</p> <p>The researchers' modifications to recruitment, justifications and evidence from the literature in support of them are presented. Contrary evidence is used to analyse why some aspects were unsuccessful and evidence is used to suggest improvements. Recruitment to focus group studies should be considered in two distinct phases; getting potential participants to contact the researcher, and converting those contacts into attendance. The difficulty of recruitment in primary care is underemphasised in the literature especially where people do not regularly come together, typified by this case study of patients with sleep problems.</p> <p>Conclusion</p> <p>We recommend training GPs and nurses to recruit patients during consultations. Multiple recruitment methods should be employed from the outset and the need to build topic related non-financial incentives into the group meeting should be considered. Recruitment should be monitored regularly with barriers addressed iteratively as a study progresses.</p
A clinical trial alert tool to recruit large patient samples and assess selection bias in general practice research
A randomized database study in general practice yielded quality data but patient recruitment in routine consultation was not practical
Toegenomen kans op gastro-intestinale bloedingen of ulcera bij gebruik van spironolacton: patient-controlestudie
Spironolactone and risk of upper gastrointestinal events: population based case-control study
A technical infrastructure to conduct randomized database studies facilitated by a general practice research database
Perceived barriers and facilitators of structural reimbursement for remote patient monitoring, an exploratory qualitative study
Objective: Structural reimbursement can be an important factor for large-scale implementing and upscaling of remote patient monitoring (RPM). During the COVID-19 pandemic, the Dutch Healthcare Authority expanded regulations, creating novel opportunities to reimburse RPM. Despite these regulations, barriers to the reim-bursement of RPM remain. This study aimed to identify the barriers and facilitators of structural reimbursement of RPM in hospital care in the Netherlands and to propose actionable recommendations.Methods: This is an exploratory qualitative study with relevant stakeholders in the Dutch purchasing market: the Dutch Healthcare Authority, health insurers, and healthcare providers. Semi-structured interviews were held between October and December of 2020. All interviews were conducted using a digital medium, transcribed verbatim, and thematically analyzed.Results: Multiple perceived barriers were mentioned: wrong pocket problems (i.e. the entity that bears the costs of implementation does not receive the benefits), no uniform quality and outcome indicators, lack of willingness to redesign care pathways by providers, and difficulties implementing cross-sector models. Perceived facilitators included interdisciplinary cooperation and transparency, the use of alternative payment models, increase in the total number of patients per RPM project, and the optional reimbursement scheme. Conclusion: Our interviews found barriers and facilitators concerning structural reimbursement of RPM in hos-pital settings in the Netherlands. Our results emphasize that the successful integration of structural reimburse-ment requires: 1) understanding the improvement potential of RPM by creating business cases, 2) co-creation (redesigning care paths) from the outset of an RPM project, 3) and allocating financial risk by providers and insurers.Public Interest Summary: The COVID-19 pandemic has demonstrated the strong potential of consultation and monitoring patients at a distance. Remote patient monitoring -the use of information technologies for moni-toring patients at a distance -is seen as a potential solution to urgent challenges in the healthcare system. Nevertheless, embedding remote patient monitoring innovations into routine healthcare is often challenging, partly due to difficulties in reimbursing these initiatives. Barriers to reimbursing remote patient monitoring included organizational factors, no uniform quality and outcome indicators, and difficulties using different payment models. Perceived facilitators included an increase in the total number of patients per project, better interdisciplinary cooperation and transparency, and help from the Dutch Healthcare Authority. Introducing these insights into healthcare policy dialogues could support reimbursement of remote patient monitoring and stim-ulate the collaboration of healthcare stakeholders responsible for implementing and scaling up remote patient monitoring projects.Prevention, Population and Disease management (PrePoD)Public Health and primary car
Perceived barriers and facilitators of structural reimbursement for remote patient monitoring, an exploratory qualitative study
Objective: Structural reimbursement can be an important factor for large-scale implementing and upscaling of remote patient monitoring (RPM). During the COVID-19 pandemic, the Dutch Healthcare Authority expanded regulations, creating novel opportunities to reimburse RPM. Despite these regulations, barriers to the reim-bursement of RPM remain. This study aimed to identify the barriers and facilitators of structural reimbursement of RPM in hospital care in the Netherlands and to propose actionable recommendations.Methods: This is an exploratory qualitative study with relevant stakeholders in the Dutch purchasing market: the Dutch Healthcare Authority, health insurers, and healthcare providers. Semi-structured interviews were held between October and December of 2020. All interviews were conducted using a digital medium, transcribed verbatim, and thematically analyzed.Results: Multiple perceived barriers were mentioned: wrong pocket problems (i.e. the entity that bears the costs of implementation does not receive the benefits), no uniform quality and outcome indicators, lack of willingness to redesign care pathways by providers, and difficulties implementing cross-sector models. Perceived facilitators included interdisciplinary cooperation and transparency, the use of alternative payment models, increase in the total number of patients per RPM project, and the optional reimbursement scheme. Conclusion: Our interviews found barriers and facilitators concerning structural reimbursement of RPM in hos-pital settings in the Netherlands. Our results emphasize that the successful integration of structural reimburse-ment requires: 1) understanding the improvement potential of RPM by creating business cases, 2) co-creation (redesigning care paths) from the outset of an RPM project, 3) and allocating financial risk by providers and insurers.Public Interest Summary: The COVID-19 pandemic has demonstrated the strong potential of consultation and monitoring patients at a distance. Remote patient monitoring -the use of information technologies for moni-toring patients at a distance -is seen as a potential solution to urgent challenges in the healthcare system. Nevertheless, embedding remote patient monitoring innovations into routine healthcare is often challenging, partly due to difficulties in reimbursing these initiatives. Barriers to reimbursing remote patient monitoring included organizational factors, no uniform quality and outcome indicators, and difficulties using different payment models. Perceived facilitators included an increase in the total number of patients per project, better interdisciplinary cooperation and transparency, and help from the Dutch Healthcare Authority. Introducing these insights into healthcare policy dialogues could support reimbursement of remote patient monitoring and stim-ulate the collaboration of healthcare stakeholders responsible for implementing and scaling up remote patient monitoring projects