BACKGROUND: SMS texting systems have been considered a potential solution to reduce missed appointments in primary care. Existing research in this area focuses on qualitative studies investigating the attitudes of SMS text users and receivers.
OBJECTIVE: This study aimed to examine appointment data from an independent general practitioner (GP) surgery in Wrexham, United Kingdom, with approximately 15,000 patients, to determine the impact of text messaging systems on reducing missed appointments. The objective of this study was to investigate whether the use of text messages can effectively reduce missed appointments.
METHODS: To collect data for the study, SQL reports were run on EMIS Web, the United Kingdom\'s most widely used clinical system. The data spanned 10 years, from September 1, 2010, to March 31, 2020. Data accuracy was verified by cross-referencing with appointment diary records. Mann-Whitney and Kruskal-Wallis tests, chosen for their suitability in comparing groups in nonparametric settings, were conducted in Microsoft Excel due to its accessibility.
RESULTS: Statistical analyses were conducted to compare data before and after implementation of the text messaging system. The results revealed a significant 42.8% reduction in missed appointments (before: 5848; after: 3343; P<.001). Further analysis of demographic characteristics revealed interesting trends, with no significant difference in missed appointments between genders, and variations observed across different age groups. The median number of missed appointments was not significantly different between genders (women: 1.55, IQR 1.11-2.16; men: 1.61, IQR 1.08-2.12; P=.73). Despite the prevalence of mobile phone use among young adults aged 20-25 years, the highest rates of missed appointments (848/7256, 11.7%) were noted in this group, whereas the lowest rates were noted in the 75-80 years age group (377/7256; 5.2%; P<.001). Analysis by age and gender indicated inconsistencies: women aged 20-25 years (571/4216) and men aged 35-40 years (306/3040) had the highest rates of missed appointments, whereas women aged 70-75 years (177/4216) and men aged 75-80 years (129/3040) had the lowest rates (P<.001 for both).
CONCLUSIONS: This study demonstrates that SMS text messaging in primary care can significantly reduce missed appointments. Implementing technology such as SMS text messaging systems enables patients to cancel appointments on time, leading to improved efficiency in primary care settings.

In Spain, the public National Health Service provides care to Spaniards and other residents and is tailored for a decentralized state of autonomies. Each Autonomous Community has legislative capacity in its organization and management. We study the case of the collaboration between private hospitals and the public health service in La Rioja, an Autonomous Community of Spain located in the North of the Iberian Peninsula, due to the importance that this relationship has in health systems, in general. We applied the case study method as a methodological tool in a long-term local study. The interpretation was carried out within a national context, which allows us to understand its meaning and the historical keys to hospital development in this region. Primary sources have been reviewed (mainly reports, catalogs, and censuses of hospitals from the Ministry of Health and the Government of La Rioja) and other secondary sources, located in archives, libraries, Institute of Rioja Studies, and Department of Health. The hospital system in La Rioja was characterized by a predominance of public beds compared with private ones, although there has been a growing trend in the number of private beds from 2013 onwards due to the incorporation of health and social care convalescent hospitals (two). La Rioja has been promoting public-private collaboration (seen as a strategic alliance) and focusing on agreements in the socio-health space, particularly using the management service agreement and the concession of work formulas. The development of the public health service in La Rioja, from 1986 to 2019, has been determined by a progressive lower dependence on specialized hospitals from other health services of neighboring Autonomous Communities and by a mixed public-private hospital system.

The development of the new health screening service for Ukraine Refugees put in place by Powys Teaching Health Board in 2022 has seen extensive use from Ukrainian families in need of extra support from the National Health Service (NHS) and signposting to specific NHS departments. To discuss the experiences of the staff from Powys regarding their role in setting up the screening service and working within it, Research Assistants from Technology Enabled Care, Wales conducted interviews with two staff members. These clinical leads suggested improvements for the screening service, as captured through analysing the data collected via the interviews. This included recognition of benefits, challenges and future recommendations.

BACKGROUND: As health systems struggle to tackle the spread of Covid-19, resilience becomes an especially relevant attribute and research topic. More than strength or preparedness, to perform resiliently to emerging shocks, health systems must develop specific abilities that aim to increase their potential to adapt to extraordinary situations while maintaining their regular functioning. Brazil has been one of the most affected countries during the pandemic. In January 2021, the Amazonas state\'s health system collapsed, especially in the city of Manaus, where acute Covid-19 patients died due to scarcity of medical supplies for respiratory therapy.
METHODS: This paper explores the case of the health system\'s collapse in Manaus to uncover the elements that prevented the system from performing resiliently to the pandemic, by carrying out a grounded-based systems analysis of the performance of health authorities in Brazil using the Functional Resonance Analysis Method. The major source of information for this study was the reports from the congressional investigation carried out to unveil the Brazilian response to the pandemic.
RESULTS: Poor cohesion between the different levels of government disrupted essential functions for managing the pandemic. Moreover, the political agenda interfered in the abilities of the system to monitor, respond, anticipate, and learn, essential aspects of resilient performance.
CONCLUSIONS: Through a systems analysis approach, this study describes the implicit strategy of \"living with Covid-19\", and an in-depth view of the measures that hampered the resilience of the Brazilian health system to the spread of Covid-19.

Civil liability represents one of the main responsibilities for healthcare facilities; it is the legal responsibility of paying money for damage to a person\'s health. Even though this responsibility plays a key role in the economic sustainability of healthcare facilities, the literature does not enough investigate this responsibility in regional health services. The paper aims to define the evolution of compensation models for health civil liability adopted by regional health services. Through a longitudinal case study, the paper investigates the compensation model by a leading regional health service. The finding highlights the evolution of the compensation model for health civil liability adopted by a leading Regional Health Service from 1990 to 2021. It describes a transition from an insurance model to a mixed model based on self-coverage up to a set economic level, an insurance policy with self-insurance retention and deductible for all claims. The research contributes to the literature and practice throughout the definition of a compensation model for damages based on self-insurance of regional health service and insurance policies. The research promotes a compensation model used by a leading regional health service.

The United Kingdom\'s (UK) National Health Service (NHS) has a procedure, \'special measures\', which is used to implement changes to a Trust when there are concerns about the quality of care being delivered. This case study uses the London Protocol to analyse how a plethora of factors contributed to an \'inadequate\' rating and the subsequent initiation of the special measures procedure at Cambridge University Hospitals (CUH) in September 2015. External factors such as legal and political reform have a strong influence on healthcare as well as the substantial internal forces within the state-led NHS including finance, culture and management. Factors specific to CUH also had a significant role to play: the early adoption of a complete digital record system, costing over £200 m, adversely affected CUH Trust at this time and was implicated as a major factor in its inadequate performance. In addition, the Care Quality Commission (CQC) identified many other important shortcomings at CUH. The London Protocol is used to bring clarity and structure to the complexities of the Health Services Industry, both within and surrounding CUH during this period.

In the UK, the majority of offensive waste is disposed of at landfills. However, producers have a duty of care under the Waste Hierarchy to divert waste away from landfill. Using case studies from the East of England, the East Midlands and West Midlands in England, this study sought to quantify the waste arisings disposed of to landfill and to understand the reasons why. The findings show that offensive waste arisings, treatment method and costs varied by region, only a fraction of the waste disposed of to landfill in the East of England, compared with the majority being disposed of to landfill in the East Midlands and West Midlands. Despite the financial implications of landfilling being the lowest cost per tonne option, the key barriers to moving away from disposal to landfill was a lack of available alternatives, and it being the only option offered by the waste contractor.

Why is Italy one of the world\'s highest ranked for ability and quality of healthcare in relationship to the resources invested? The last decade has been characterized by many Italian Regions with Recovery Plans, whose main focus was on short-term issues with a high impact on healthcare costs. Italy is now leaving this phase and at the regional level there will be an increase of new hirings in the healthcare sectors, as stated by the Ministry of Health. There is a large amount of scientific literature that supports the role of factors such as lifestyles, diet and genetics as the base of population health. The success of the Italian National Health Service (INHS) function is rooted in the ability of a system to adapt to evolving situations, but it is also important to ensure a mechanism of positive feedback correction. In the future, INHS will require a new set of reforms, like the redefinition of structures and mechanisms of governance, the implementation of strategic plans that conjugate better clinical and financial issues. In this context, Health Data Entanglement could be an option to improve the effectiveness of the health governance system in order to develop better quality of care. In Public Health several criticisms could detonate the bomb, and above all the decreasing levels of primary prevention in the fight to obesity (promoting the Mediterranean Diet and physical activity), to smoking and alcohol consumption, as well as to infectious diseases (promoting high vaccination rates). Secondary prevention is also key to this function as a practical experience of re-engineering of the public expense, giving much attention to what works in terms of cost effectiveness, and in particular to cancer screening.

OBJECTIVE: There are no significant differences in outcomes between patients receiving inpatient and day-case lumbar microdiscectomy, but the latter is still underused in the NHS. Here we aimed to identify factors contributing to successful same-day discharge in day-case patients.
METHODS: This was a retrospective observational study of patients undergoing elective lumbar microdiscectomy between August 2012 and December 2014. Age, gender, day of surgery, distance to hospital, ASA grade, regular opiate use, smoking status, order on the operating list, and side and level of surgery were examined by logistic regression to assess their influence on same-day discharge.
RESULTS: 28/95 (29.5%) patients were discharged on the day of surgery. Age (p = 0.041), ASA grade (p = 0.016), distance to hospital (p = 0.011), and position on the list (p = 0.004) were associated with day-case discharge by univariate analysis. ASA grade (p = 0.032; OR 0.176), distance to hospital (p = 0.003; OR 0.965), and position on the operating list (morning case; p = 0.011; OR 8.901) remained significant in multivariate analysis. Thirteen (13.7%) patients were identified who could have been managed as day cases had they been listed for morning operations.
CONCLUSIONS: Day-case lumbar microdiscectomy is viable when patients are carefully selected. Younger, fit patients living close to the hospital and operated on in the morning are more likely to be discharged on the same day. Knowledge of these factors while planning elective lists can help optimise bed space and improve spinal services.

Evidence on the impact of user costs on healthcare demand in \'universal\' public National Health Services (NHS) is scarce. The changes in copayments and in the regulation of the provision of free patient transportation, introduced in early 2012 in Portugal, provide a natural experiment to evaluate that impact. However, those changes in user costs were accompanied with changes in the criteria that determine which patients are exempt from copayments, implying that simple comparisons of user rates would be biased. In this paper, we develop a new methodology to evaluate the impact of increases in direct and indirect user costs on the demand for emergency services (ES) in the presence of compositional changes in co-payment exempt and non-exempt populations. Our results show that the increase in copayments did not have an effect in moderating ES demand by paying users, but we find significant effects of the change in transport regulation. Thus, our results support the conclusion that indirect costs may be more important than direct costs in determining healthcare demand in NHS-countries where copayments are small and wide exemption schemes are in place, especially for older patients. Copyright © 2015 John Wiley & Sons, Ltd.