Objective To identify a set of measurable key performance indicators (KPIs) demonstrating hospital clinical pharmacy's contribution to patient care that can be used for benchmarking in the New Zealand setting. Methods Data sources were key stakeholders from public hospitals in each of the 21 District Health Boards in New Zealand. Surveys with selected KPIs thought to represent clinical pharmacy's contribution to patient care were sent to the Chief Pharmacist, Chief Medical Officer, Director of Nursing, senior management team and Quality and Risk Manager of each District Health Board, who were asked to rate each KPI based on relevance to clinical pharmacy's contribution to patient care and ease of measurement in their organisation. Mailed survey data were ranked and analysed using Microsoft Excel and SPSS. Key findings The response rate was 43%. The top two ranked KPIs were concerning chart review and medication reconciliation. Only three of 52 KPIs were rated ‘easily’ measurable. No statistically significant differences were seen between professional groups or hospital sizes. Conclusions The top ranked KPIs reflected the pharmacist's central role in improving the individual patient's medicines use. Measurability appeared to be a major issue due to resource constraints. This study has provided the platform for future nationwide hospital clinical pharmacy KPIs.
Objectives With a view to advance medication safety assessment in and across New Zealand (NZ) hospitals, we aimed to develop a single multistakeholder‐informed conceptual framework to guide meaningful and cohesive measurement. Methods Stakeholder viewpoints on the dimensions and metrics important to include for measurement were canvassed using semi‐structured in‐depth interviews. Stakeholders (n = 30) were purposively selected on the basis of their job role and expertise. Transcribed audio data were thematically analysed using a general inductive approach with the aid of NVivo and mindmaps. Key findings The conceptual framework for measurement consists of seven key dimensions requiring multiple metrics relating to the following: (1) outcome goals; (2) financial costs and effectiveness; (3) medications and their use; (4) safety culture; (5) technical components; (6) factors affecting medication use by patients; and (7) staff competency. Conclusions Stakeholders require complex information across multiple dimensions to assess medication safety in its entirety. Our research, for the first time, canvasses and brings together the meaningful dimensions for measurement under a single conceptual frame. The developed framework incorporates wide NZ stakeholder views, increasing its relevance in the local context. It can be used to organise national measurement efforts in a more cohesive manner to better monitor medication safety progress over time.
PurposeNon‐steroidal anti‐inflammatory drugs (NSAIDs) are associated with many serious complications and they are widely used in New Zealand (NZ). However, differences in NSAID‐associated risk for these complications between ethnic groups are largely unknown. We assessed ethnic disparities in risk of hospital admission for upper gastrointestinal bleeding (UGIB), heart failure, and acute kidney failure (AKF) in NZ's primary care population prescribed and dispensed NSAIDs.MethodsRetrospective cohort study utilising national pharmaceutical dispensing and hospital admissions data 2007 to 2015. Patient follow‐up included 90‐day periods following the dispensing of NSAIDs. Risk for each adverse outcome in Maori, Pacific, European, and Asian patients was estimated using multivariable Poisson regression adjusting for age, sex, deprivation, comorbidity and concurrent drug use.Results3 023 067 patients were dispensed NSAIDs between 2008 and 2015. Their total intended duration of NSAID treatment encompassed 2 353 140 patient‐years. Maori, Pacific and Asian patients were younger than European patients (all P < .001). After adjusting for other risk factors, Maori (rate ratio: 2.54, 95% confidence interval: 2.23‐2.90) and Pacific patients (3.17, 2.69‐3.74) were more likely to be hospitalised for UGIB than Europeans (reference), and heart failure (Maori: 2.48, 2.24‐2.74; Pacific: 1.97, 1.69‐2.30). Risk of AKF was higher in Maori (1.46, 1.23‐1.74). Higher risk for UGIB and HF in Maori and Pacific patients was most pronounced in males and patients aged <60 years.ConclusionsInequalities exist in the incidence of serious adverse outcomes experienced by different ethnic groups in NZ while using NSAIDs. Interventions to promote safer use of these medicines are required to reduce this inequity.
Background The literature regarding diverticular disease of the intestines (DDI) almost entirely concerns hospital-based care; DDI managed in primary care settings is rarely addressed. Aim To estimate how often DDI is managed in primary care, using antibiotics dispensing data. Design and setting Hospitalisation records of New Zealand residents aged 30+ years during 2007–2016 were individually linked to databases of community-dispensed oral antibiotics. Method Patients with an index hospital admission 2007–2016 including a DDI diagnosis (ICD-10-AM = K57) were grouped by acute/non-acute hospitalisation. We compared use of guideline-recommended oral antibiotics for the period 2007–2016 for these people with ten individually-matched non-DDI residents, taking the case’s index date. Multivariable negative binomial models were used to estimate rates of antibiotic use. Results From almost 3.5 million eligible residents, data were extracted for 51,059 index cases (20,880 acute, 30,179 non-acute) and 510,581 matched controls; mean follow-up = 8.9 years. Dispensing rates rose gradually over time among controls, from 47 per 100 person-years (/100py) prior to the index date, to 60/100py after 3 months. In comparison, dispensing was significantly higher for those with DDI: for those with acute DDI, rates were 84/100py prior to the index date, 325/100py near the index date, and 141/100py after 3 months, while for those with non-acute DDI 75/100py, 108/100py and 99/100py respectively. Following an acute DDI admission, community-dispensed antibiotics were dispensed at more than twice the rate of their non-DDI counterparts for years, and were elevated even before the index DDI hospitalisation. Conclusion DDI patients experience high use of antibiotics. Evidence is needed that covers primary-care and informs self-management of recurrent, chronic or persistent DDI.
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