PHP94 IS IT COST-EFFECTIVE TO CHANGE THE BEHAVIOR OF HEALTH CARE PROFESSIONALS?

AbstractHealthcare as an industry is recognised as one of the most innovative. Despite heavy regulation, there is substantial scope for new technologies and care models to not only boost patient outcomes but to do so at reduced cost to healthcare systems and consumers. Promoting innovation within national health systems such as the National Health Service (NHS) in the United Kingdom (UK) has been set as a key target for health care professionals and policy makers. However, while the UK has a world-class biomedical research industry, several reports in the last twenty years have highlighted the difficulties faced by the NHS in encouraging and adopting innovations, with the journey from idea to implementation of health technology often taking years and being very expensive, with a high failure rate. This has led to the establishment of several innovation pathways within and around the NHS, to encourage the invention, development and implementation of cost-effective technologies that improve health care delivery. These pathways span local, regional and national health infrastructure. They operate at different stages of the innovation pipeline, with their scope and work defined by location, technology area or industry sector, based on the specific problem identified when they were set up. In this introductory review, we outline each of the major innovation pathways operating at local, regional and national levels across the NHS, including their history, governance, operating procedures and areas of expertise. The extent to which innovation pathways address current challenges faced by innovators is discussed, as well as areas for improvement and future study.

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Teleconsultations: who uses them and how?

Journal of Telemedicine and Telecare ◽

10.1258/135763302320939194 ◽

2002 ◽

Vol 8 (6) ◽

pp. 319-324 ◽

Cited By ~ 7

Author(s):

Pekka T Jaatinen ◽

Jari Forsström ◽

Pekka Loula

Keyword(s):

Health Care ◽

Data Protection ◽

Health Care Professionals ◽

Cost Effective ◽

Asynchronous Communication ◽

Literature Survey ◽

Patient Confidentiality ◽

Cost Effective Approach ◽

User Groups ◽

Primary Focus

A literature survey was carried out to identify papers describing teleconsulting applications. From 1259 potentially relevant articles identified through Medline, 128 articles were selected for review. The majority of these had been published in the Journal of Telemedicine and Telecare (50 articles, or 39%). We analysed different user groups, equipment and implementation issues, and the type of connections. In 101 studies (79%) the teleconsultations were between doctors, in 11 they were between patient and doctor, in seven between patient and nurse, and in nine between nurse and doctor. Studies of consultations between patients and health-care professionals were thus quite rare. Surgery was the most common specialty in which teleconsultation was described. The teleconsultations were realtime or mainly realtime in 72% of articles. In 39% of studies the primary focus was on videoconferencing. The most common means of connection was by ISDN digital lines (38%). There were very few mentions of how to ensure data protection or to maintain patient confidentiality. We conclude that, for the majority of teleconsultation needs, asynchronous communication is the most flexible and cost-effective approach. Realtime videoconferencing can be justified only in particular circumstances.

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Implementation of pre-exposure prophylaxis programme in Spain. Feasibility of four different delivery models

PLoS ONE ◽

10.1371/journal.pone.0246129 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246129

Author(s):

Carlos Iniesta ◽

Pep Coll ◽

María Jesús Barberá ◽

Miguel García Deltoro ◽

Xabier Camino ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Cost Effective ◽

Hiv Infections ◽

Sexually Transmitted ◽

Participant Satisfaction ◽

Prep Implementation ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Delivery Models

Background Pre-exposure prophylaxis (PrEP) is an effective and cost-effective strategy for HIV prevention. Spain carried out an implementation study in order to assess the feasibility of implementing PrEP programmes within its heterogeneous health system. Methods Observational longitudinal study conducted on four different types of health-care setting: a community centre (CC), a sexually transmitted infections clinic (STIC), a hospital-based HIV unit (HBHIVU) and a hospital-based STI unit (HBSTIU). We recruited gay, bisexual and other men who have sex with men (GBSM) and transgender women at risk of HIV infections, gave them PrEP and monitored clinical, behavioural PrEP-related and satisfaction information for 52 weeks. We collected perceptions on PrEP implementation feasibility from health-care professionals participating in the study. Results A total of 321 participants were recruited, with 99.1% being GBMSM. Overall retention was 87.2% and it was highest at the CC (92.6%). Condom use decreased during the study period, while STIs did not increase consistently. The percentage of people who did not miss any doses of PrEP during the previous week remained at over 93%. No HIV seroconversions occurred. We observed overall decreases in GHB (32.5% to 21.8%), cocaine (27.5% to 21.4%), MDMA (25.7% to 14.3%), speed (11.4% to 5.7%) and mephedrone use (10.7% to 5.0%). The overall participant satisfaction with PrEP was 98.6%. Health-care professionals’ perceptions of PrEP feasibility were positive, except for the lack of personnel. Conclusions PrEP implementation is feasible in four types of health-care settings. Local specificities have to be taken into consideration while implementing PrEP.

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Lessons Learnt during the COVID-19 Pandemic: For Patients with End-Stage Renal Disease, We Should Prioritize Home-Based Treatment and Telemedicine

Kidney & Blood Pressure Research ◽

10.1159/000512629 ◽

2021 ◽

pp. 1-6

Author(s):

Giuliano Brunori ◽

Gianpaolo Reboldi ◽

Filippo Aucella

Keyword(s):

Health Care ◽

Health Care Providers ◽

Health Care Professionals ◽

Care Delivery ◽

Cost Effective ◽

Care Providers ◽

Home Dialysis ◽

Digital Revolution ◽

Control Center ◽

Home Based

Backgrounds: The recent coronavirus disease 2019 (COVID-19) pandemic has placed worldwide health systems and hospitals under pressure, and so are the renal care models. This may be a unique opportunity to promote and expand alternative models of health-care delivery in patients undergoing renal replacement therapies. Summary: Despite the high risk of acquiring communicable diseases when undergoing in-centre treatments, only a small proportion of patients are currently being treated with home therapies. Recent data provided by the Italian Society of Nephrology (SIN), the REIN French Registry and the Wuhan Hemodialysis Quality Control Center clearly show that patients receiving hospital-based treatment have a 3- to 4-fold greater risk of infection, and a subsequent fatality proportion between 21 and 34%. On the other hand, home-based therapy can be managed remotely, there is little or no need for transport to and from the hospital, and it is less expensive. Besides, the digital revolution in health care with the development of virtual care systems can make home dialysis with telehealth a cost-effective solution for both patients and health-care providers. Such a transition would require specific training for physicians and health-care professionals and a functional re-organization of dialysis centres to improve the skills and expertise in caring for patients at home. Conclusion: The need for more widespread home treatment is the main lesson learnt by nephrologists by the COVID-19 pandemic.

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Identifying the Value of an eHealth Intervention Aimed at Cognitive Impairments: Observational Study in Different Contexts and Service Models

Journal of Medical Internet Research ◽

10.2196/17720 ◽

2020 ◽

Vol 22 (10) ◽

pp. e17720

Author(s):

Monika Jurkeviciute ◽

Lex van Velsen ◽

Henrik Eriksson ◽

Svante Lifvergren ◽

Pietro Davide Trimarchi ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Case Manager ◽

Cost Effective ◽

Physically Active ◽

Holistic View ◽

Clock Drawing Test ◽

Cost Efficient ◽

Ehealth Intervention

Background Value is one of the central concepts in health care, but it is vague within the field of summative eHealth evaluations. Moreover, the role of context in explaining the value is underexplored, and there is no explicit framework guiding the evaluation of the value of eHealth interventions. Hence, different studies conceptualize and operationalize value in different ways. Objective The objective of our study is to identify contextual factors that determine similarities and differences in the value of an eHealth intervention between 2 contexts. We also aim to reflect on and contribute to the discussion about the specification, assessment, and relativity of the “value” concept in the evaluation of eHealth interventions. Methods The study concerned a 6-month eHealth intervention targeted at elderly patients (n=107) diagnosed with cognitive impairment in Italy and Sweden. The intervention introduced a case manager role and an eHealth platform to provide remote monitoring and coaching services to the patients. A model for evaluating the value of eHealth interventions was designed as monetary and nonmonetary benefits and sacrifices, based on the value conceptualizations in eHealth and marketing literature. The data was collected using the Mini–Mental State Examination (MMSE), the clock drawing test, and the 5-level EQ-5D (EQ-5D-5L). Semistructured interviews were conducted with patients and health care professionals. Monetary data was collected from the health care and technology providers. Results The value of an eHealth intervention applied to similar types of populations but differed in different contexts. In Sweden, patients improved cognitive performance (MMSE mean 0.85, SD 1.62, P<.001), reduced anxiety (EQ-5D-5L mean 0.16, SD 0.54, P=.046), perceived their health better (EQ-5D-5L VAS scale mean 2.6, SD 9.7, P=.035), and both patients and health care professionals were satisfied with the care. However, the Swedish service model demonstrated an increased cost, higher workload for health care professionals, and the intervention was not cost-efficient. In Italy, the patients were satisfied with the care received, and the health care professionals felt empowered and had an acceptable workload. Moreover, the intervention was cost-effective. However, clinical efficacy and quality of life improvements have not been observed. We identified 6 factors that influence the value of eHealth intervention in a particular context: (1) service delivery design of the intervention (process of delivery), (2) organizational setup of the intervention (ie, organizational structure and professionals involved), (3) cost of different treatments, (4) hourly rates of staff for delivering the intervention, (5) lifestyle habits of the population (eg, how physically active they were in their daily life and if they were living alone or with family), and (6) local preferences on the quality of patient care. Conclusions Value in the assessments of eHealth interventions need to be considered beyond economic terms, perceptions, or behavior changes. To obtain a holistic view of the value created, it needs to be operationalized into monetary and nonmonetary outcomes, categorizing these into benefits and sacrifices.

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Integrating mHealth alcohol harm reduction into primary care: Protocol for an implementation trial (Preprint)

10.2196/preprints.31109 ◽

2021 ◽

Author(s):

Andrew R Quanbeck

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Health Care ◽

Health Care Professionals ◽

Cost Effective ◽

Human Interaction ◽

Drinking Patterns ◽

Mhealth Intervention ◽

Implementation Costs

BACKGROUND Primary healthcare systems are uniquely positioned to provide access to strategies for reducing alcohol misuse and high-risk drinking, strategies which include mHealth apps. The extent of human interaction needed to achieve effective and cost-effective use of mHealth apps in primary care remains largely unexamined. This study seeks to understand how varying levels of human interaction affect the ways in which an mHealth intervention for the prevention and treatment of alcohol use disorders works or does not work, for whom, and under what circumstances. OBJECTIVE The primary aim is to detect the effectiveness of an mHealth intervention by assessing differences in self-reported risky drinking patterns and quality of life between participants in three study groups (self-monitored, peer-supported, and clinically integrated). Each group reflects differences in the level of human touch provided to support use of the intervention. The cost-effectiveness of each approach will be assessed . METHODS This Hybrid 1 study is an unblinded patient-level randomized clinical trial testing the effects of using an evidence-based mHealth system on participants’ drinking patterns and quality of life. There are two groups of participants for this study: individuals receiving the intervention and health care professionals practicing in the broader primary care environment. The intervention is a smartphone app encouraging users to reduce their alcohol consumption within the context of integrative medicine using techniques to build healthy habits. Primary outcomes for quantitative analysis will be participant data on their risky drinking days and quality of life, as well as app usage from weekly and quarterly surveys. Cost measures include intervention and implementation costs. Cost per participant will be determined for each study arm with intervention and implementation costs separated within each group. There will also be a qualitative assessment of health care professionals’ engagement with the app as well as their thoughts on participant experience with the app. RESULTS This protocol was approved on November 18, 2019 by the Health Sciences Minimal Risk Institutional Review Board with subsequent annual reviews. Recruitment began on March 06, 2020 but was suspended on March 13, 2020 due to COVID-19 restrictions. Limited recruitment resumed on July 6, 2020. Trial status as of June 9, 2021: 257 participants are enrolled in the study toward a planned enrollment of 546 participants. CONCLUSIONS New knowledge gained from this study could have wide and lasting benefits related to the integration of mHealth systems for alcohol use disorders in primary healthcare systems. Results of the study will guide policy makers and providers to cost-effective ways to incorporate technology in health care. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT04011644

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Identifying the Value of an eHealth Intervention Aimed at Cognitive Impairments: Observational Study in Different Contexts and Service Models (Preprint)

10.2196/preprints.17720 ◽

2020 ◽

Author(s):

Monika Jurkeviciute ◽

Lex van Velsen ◽

Henrik Eriksson ◽

Svante Lifvergren ◽

Pietro Davide Trimarchi ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Case Manager ◽

Cost Effective ◽

P Value ◽

Physically Active ◽

Holistic View ◽

Clock Drawing Test ◽

Ehealth Intervention

BACKGROUND Value is one of the central concepts in health care, but it is vague within the field of summative eHealth evaluations. Moreover, the role of context in explaining the value is underexplored, and there is no explicit framework guiding the evaluation of the value of eHealth interventions. Hence, different studies conceptualize and operationalize value in different ways. OBJECTIVE The objective of our study is to identify contextual factors that determine similarities and differences in the value of an eHealth intervention between 2 contexts. We also aim to reflect on and contribute to the discussion about the specification, assessment, and relativity of the “value” concept in the evaluation of eHealth interventions. METHODS The study concerned a 6-month eHealth intervention targeted at elderly patients (n=107) diagnosed with cognitive impairment in Italy and Sweden. The intervention introduced a case manager role and an eHealth platform to provide remote monitoring and coaching services to the patients. A model for evaluating the value of eHealth interventions was designed as monetary and nonmonetary benefits and sacrifices, based on the value conceptualizations in eHealth and marketing literature. The data was collected using the Mini–Mental State Examination (MMSE), the clock drawing test, and the 5-level EQ-5D (EQ-5D-5L). Semistructured interviews were conducted with patients and health care professionals. Monetary data was collected from the health care and technology providers. RESULTS The value of an eHealth intervention applied to similar types of populations but differed in different contexts. In Sweden, patients improved cognitive performance (MMSE mean 0.85, SD 1.62, P<.001), reduced anxiety (EQ-5D-5L mean 0.16, SD 0.54, P=.046), perceived their health better (EQ-5D-5L VAS scale mean 2.6, SD 9.7, P=.035), and both patients and health care professionals were satisfied with the care. However, the Swedish service model demonstrated an increased cost, higher workload for health care professionals, and the intervention was not cost-efficient. In Italy, the patients were satisfied with the care received, and the health care professionals felt empowered and had an acceptable workload. Moreover, the intervention was cost-effective. However, clinical efficacy and quality of life improvements have not been observed. We identified 6 factors that influence the value of eHealth intervention in a particular context: (1) service delivery design of the intervention (process of delivery), (2) organizational setup of the intervention (ie, organizational structure and professionals involved), (3) cost of different treatments, (4) hourly rates of staff for delivering the intervention, (5) lifestyle habits of the population (eg, how physically active they were in their daily life and if they were living alone or with family), and (6) local preferences on the quality of patient care. CONCLUSIONS Value in the assessments of eHealth interventions need to be considered beyond economic terms, perceptions, or behavior changes. To obtain a holistic view of the value created, it needs to be operationalized into monetary and nonmonetary outcomes, categorizing these into benefits and sacrifices.

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Update on the UC San Diego Healer Education Assessment and Referral (HEAR) Program

Journal of Medical Regulation ◽

10.30770/2572-1852-104.2.17 ◽

2018 ◽

Vol 104 (2) ◽

pp. 17-26 ◽

Cited By ~ 5

Author(s):

William A. Norcross ◽

Christine Moutier ◽

Maria Tiamson-Kassab ◽

Pam Jong ◽

Judy E. Davidson ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

San Diego ◽

Screening Program ◽

Cost Effective ◽

Current Evidence ◽

Current Crisis ◽

Babylonian Talmud ◽

Education Assessment ◽

American Foundation

Burnout, depression and suicide are rampant amongst health care professionals. Current evidence shows the problem is worsening. In the aftermath of physician suicides, the Physician Wellbeing Committee created the UC San Diego Healer Education Assessment and Referral (HEAR) Program in 2009 in collaboration with the American Foundation for Suicide Prevention (AFSP). This article chronicles the HEAR program from inception through June 2017. Initially created to address medical students, residents and faculty physician duress, HEAR has now expanded to embrace pharmacists, nurses and clinical staff within UC San Diego Health. HEAR operates through two mechanisms: 1) a program of ongoing education and outreach, and 2) encouragement of all personnel to annually engage in the online, anonymous, interactive screening program, created by the AFSP (known as SDSQ at UC San Diego Health). Since inception in May 2009 through June 2017, 1,537 UC San Diego health care personnel have been screened, 320 individuals have dialogued with a counselor either in person, by phone or electronically, and more than 300 have been referred confidentially for evaluation and treatment by a mental health professional, usually a community psychiatrist. While tracking death by suicide remains challenging, we have reason to believe that the prevalence of suicide has diminished during this time. The UC San Diego HEAR Program is one cost-effective model for addressing this current crisis in U.S. health care. This AFSP model has been adopted by many other schools of medicine and is now ready for use with clinicians of all disciplines.And whoever saves a life, it is considered as if he saved an entire world.— Mishnah Sanhedrin 4:5; Babylonian Talmud Tractate Sanhedrin 37a

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Health Professions Digital Education on Antibiotic Management: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration (Preprint)

10.2196/preprints.14984 ◽

2019 ◽

Author(s):

Bhone Myint Kyaw ◽

Lorainne Tudor Car ◽

Louise Sandra van Galen ◽

Michiel A van Agtmael ◽

Céire E Costelloe ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Clinical Practice ◽

Health Care Professionals ◽

Antibiotic Prescription ◽

Cost Effective ◽

Traditional Education ◽

Controlled Trials ◽

Digital Education ◽

Antibiotic Management

BACKGROUND Inappropriate antibiotic prescription is one of the key contributors to antibiotic resistance, which is managed with a range of interventions including education. OBJECTIVE We aimed to summarize evidence on the effectiveness of digital education of antibiotic management compared to traditional education for improving health care professionals’ knowledge, skills, attitudes, and clinical practice. METHODS Seven electronic databases and two trial registries were searched for randomized controlled trials (RCTs) and cluster RCTs published between January 1, 1990, and September 20, 2018. There were no language restrictions. We also searched the International Clinical Trials Registry Platform Search Portal and metaRegister of Controlled Trials to identify unpublished trials and checked the reference lists of included studies and relevant systematic reviews for study eligibility. We followed Cochrane methods to select studies, extract data, and appraise and synthesize eligible studies. We used random-effect models for the pooled analysis and assessed statistical heterogeneity by visual inspection of a forest plot and calculation of the I2 statistic. RESULTS Six cluster RCTs and two RCTs with 655 primary care practices, 1392 primary care physicians, and 485,632 patients were included. The interventions included personal digital assistants; short text messages; online digital education including emails and websites; and online blended education, which used a combination of online digital education and traditional education materials. The control groups received traditional education. Six studies assessed postintervention change in clinical practice. The majority of the studies (4/6) reported greater reduction in antibiotic prescription or dispensing rate with digital education than with traditional education. Two studies showed significant differences in postintervention knowledge scores in favor of mobile education over traditional education (standardized mean difference=1.09, 95% CI 0.90-1.28; I2=0%; large effect size; 491 participants [2 studies]). The findings for health care professionals’ attitudes and patient-related outcomes were mixed or inconclusive. Three studies found digital education to be more cost-effective than traditional education. None of the included studies reported on skills, satisfaction, or potential adverse effects. CONCLUSIONS Findings from studies deploying mobile or online modalities of digital education on antibiotic management were complementary and found to be more cost-effective than traditional education in improving clinical practice and postintervention knowledge, particularly in postregistration settings. There is a lack of evidence on the effectiveness of other digital education modalities such as virtual reality or serious games. Future studies should also include health care professionals working in settings other than primary care and low- and middle-income countries. CLINICALTRIAL PROSPERO CRD42018109742; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=109742

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A NEED OF BETTER PHARMACOVIGILANCE SYSTEM IN INDIA

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i1.14797 ◽

2016 ◽

Vol 10 (1) ◽

pp. 22

Author(s):

Prajakta Pradeep Masurkar

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Adverse Drug Reaction Reporting ◽

Health Care Systems ◽

Herbal Medicines ◽

Cost Effective ◽

Pharmacovigilance System ◽

Regulatory Body ◽

Education Association ◽

Care Systems

ABSTRACTIndia is one of the top producers of generics globally and is currently being recognized as the “pharmacy of the world” for the generic drug products.Thus, there is a need that it has best health-care systems in place to regulate and provide better quality drugs by monitoring the possible riskassociated with the use of drugs. Being the generic hub, physicians, pharmacists, etc., should be erudite to provide an alternative cost-effective genericmedicine, which is one of the education-related aspects of pharmacovigilance. We need a more systematic approach to surveillance of drug-relatedproblems, which is at the heart of pharmacovigilance. The health-care system requires new processes to understand the risk-benefit ratio of drugs.The challenges in implementation of better pharmacovigilance in country due to nonavailability of trained staff in pharmacovigilance, lack of trainingof health-care professionals on drug safety, and adverse drug reaction reporting which comprises adverse interactions of medicines with chemicals,other medicines, and food are often neglected leading to under-reporting by health-care professionals as well as patients, lack of expertise, etc., shouldbe overcome by Indian regulatory body via practical oriented knowledge-based system. The web market monitoring, global electronic database,education, association of stakeholders and regulation of herbal medicines standards and allied medicinal systems are vital restructurings needed tobe introduced for a better pharmacovigilance system in India.Keywords: Pharmacovigilance, India.

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