Health utilities among Aboriginal people attending residential rehabilitation services in New South Wales, Australia: An observational follow-up study.

INTRODUCTION: There have been no published studies reporting health utilities among Aboriginal people attending residential rehabilitation for substance use treatment. This study aims to examine health utilities for Aboriginal people in residential rehabilitation and investigate the association between health utilities and length of stay. METHODS: EuroQol-5 Dimension 5-level (EQ-5D-5L) raw data collected from three residential rehabilitation services in New South Wales, Australia was transferred into a quality-adjusted health index using EQ-5D-5L Crosswalk Index Value Calculator. Clients were categorised into two groups based on their length of stay in treatment: ≤60 days or more than 60 days. Among people who stay longer than 60 days, we also examined health utilities by exit status (yes/no). Bootstrapping was used to examine the difference in improvement in health utilities from baseline to the latest assessment in both groups. RESULTS: Our study included 91 clients (mean age 32 years old SD: 9). Mean health utility at baseline was 0.76 (SD 0.25) and at the latest assessment was 0.88 (SD 0.16). For clients staying 60 days, the incremental health utility was 0.13 (95% confidence interval [CI] 0.06-0.20; p < 0.01). For clients staying less than or equal to 60 days, the incremental health utility was 0.12 (95% CI 0.00-0.24; p = 0.06). For the total sample, the incremental health utility was 0.12 (95% CI 0.06-0.19; p < 0.01). DISCUSSION AND CONCLUSIONS: There is a significant improvement in health utilities for people staying longer in residential rehabilitation. Strategies to improve treatment retention could potentially increase quality of life for Aboriginal people in residential rehabilitation.

Management of personal protective equipment during the COVID-19 pandemic in England and the state of New York: A comparative case study.

BACKGROUND: The COVID-19 crisis placed extraordinary demands on the supply of personal protective equipment (PPE) at the beginning of 2020. These were coupled with shocks to the supply chain resulting from the disease. Many typically well-resourced health systems faced subsequent shortages of equipment and had to implement new strategies to manage their stocks. Stockpiles of protective equipment were held in both the United States and United Kingdom intended to prevent shortages. METHOD: Cross-comparative case study approach by applying Pettigrew and Whipp's framework for change management. SETTING: The health systems of England and New York state from January 2020 to the end of April 2020. RESULTS: Both cases reacted slowly to their outbreaks and faced problems with supplying enough PPE to their health systems. Their stockpiles were not enough to prevent shortages, with many distribution problems resulting from inadequate governance mechanisms. No sustainable responses to supply disruptions were implemented during the study period in either case. Health systems planned interventions along each part of the supply chain from production and importing, to usage guidelines. CONCLUSION: Global supply chains are vulnerable to disruptions caused by international crises, and existing mitigation strategies have not been wholly successful. The existence of stockpiles is insufficient to preventing shortages of necessary equipment in clinical settings. Both the governance and quality of stockpiles, as well as distribution channels are important for preventing shortages. At the time of writing, it is not possible to judge the strength of strategies adopted in these cases.