scholarly journals Integrated Care Programs for People with Multimorbidity in European Countries: eHealth Adoption in Health Systems

2020 ◽  
Vol 2020 ◽  
pp. 1-23 ◽  
Author(s):  
Maria Gabriella Melchiorre ◽  
Roberta Papa ◽  
Sabrina Quattrini ◽  
Giovanni Lamura ◽  
Francesco Barbabella ◽  
...  
Keyword(s):  
Older People ◽  
Health System ◽  
Integrated Care ◽  
Health Systems ◽  
National Health ◽  
European Countries ◽  
Financing System ◽  
Major Barrier ◽  
Case Study Methodology ◽  
System Characteristics

Introduction. eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics. Materials and Methods. In 2014, in the framework of the ICARE4EU project, expert organizations in 24 European countries identified 101 integrated care programs. Managers of the selected programs completed an online questionnaire on several dimensions, including the use of eHealth. We analyzed data from this questionnaire, in addition to qualitative information from six innovative programs which were studied in depth through case study methodology, according to characteristics of national health systems: a national health model (financing system), overall strength of primary care (PC) (structure/service delivery process), and level of (de)centralization of health system (executive powers in a country). Results. 85 programs (out of 101) adopted at least one eHealth tool, and 42 of these targeted explicitly older people. In most cases, Electronic Health Records (EHRs) were used and some benefits emerged like improved care management and integration, although inadequate funding mechanisms represented a major barrier. The analysis by health system characteristics showed a greater adoption of eHealth applications in decentralized countries, in countries with a National Health Service (NHS) model, and in countries with a strong/medium level of PC development. Conclusions. Although in the light of some limitations, findings indicate a relation between implementation of care programs using eHealth tools and basic characteristics of health systems, with decentralization of a health system, NHS model, and strong/medium PC having a key role. However adaptations of European health systems seem necessary, in order to provide a more innovative and integrated care.

scholarly journals Health system gaps in cardiovascular disease prevention and management in Nepal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Archana Shrestha ◽  
Rashmi Maharjan ◽  
Biraj Man Karmacharya ◽  
Swornim Bajracharya ◽  
Niharika Jha ◽  
...  
Keyword(s):  
Human Resources ◽  
Health System ◽  
Health Systems ◽  
National Health ◽  
Task Force ◽  
Health Spending ◽  
Building Blocks ◽  
Critical System ◽  
Government Organizations ◽  
The Government

Abstract Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

scholarly journals Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross-sectional survey

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022904 ◽  
Author(s):  
Michael Harris ◽  
Peter Vedsted ◽  
Magdalena Esteva ◽  
Peter Murchie ◽  
Isabelle Aubin-Auger ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Factor Analysis ◽  
Health System ◽  
Health Systems ◽  
European Countries ◽  
Cancer Symptoms ◽  
Referral Decision ◽  
System Factors ◽  
Primary Care Practitioners

ObjectivesCancer survival and stage of disease at diagnosis and treatment vary widely across Europe. These differences may be partly due to variations in access to investigations and specialists. However, evidence to explain how different national health systems influence primary care practitioners’ (PCPs’) referral decisions is lacking.This study analyses health system factors potentially influencing PCPs’ referral decision-making when consulting with patients who may have cancer, and how these vary between European countries.DesignBased on a content-validity consensus, a list of 45 items relating to a PCP’s decisions to refer patients with potential cancer symptoms for further investigation was reduced to 20 items. An online questionnaire with the 20 items was answered by PCPs on a five-point Likert scale, indicating how much each item affected their own decision-making in patients that could have cancer. An exploratory factor analysis identified the factors underlying PCPs’ referral decision-making.SettingA primary care study; 25 participating centres in 20 European countries.Participants1830 PCPs completed the survey. The median response rate for participating centres was 20.7%.Outcome measuresThe factors derived from items related to PCPs’ referral decision-making. Mean factor scores were produced for each country, allowing comparisons.ResultsFactor analysis identified five underlying factors: PCPs’ ability to refer; degree of direct patient access to secondary care; PCPs’ perceptions of being under pressure; expectations of PCPs’ role; and extent to which PCPs believe that quality comes before cost in their health systems. These accounted for 47.4% of the observed variance between individual responses.ConclusionsFive healthcare system factors influencing PCPs’ referral decision-making in 20 European countries were identified. The factors varied considerably between European countries. Knowledge of these factors could assist development of health service policies to produce better cancer outcomes, and inform future research to compare national cancer diagnostic pathways and outcomes.

Pharmaceutical Prescriptions in Italy

1995 ◽  
Vol 11 (3) ◽  
pp. 417-427 ◽  
Author(s):  
Silvio Garattini
Keyword(s):  
United Kingdom ◽  
Health System ◽  
National Health ◽  
National Health System ◽  
European Countries ◽  
Economic Implications ◽  
The United Kingdom ◽  
First Time ◽  
Substantial Change

AbstractPharmaceutical prescriptions are quite different in four European countries: Italy, France, Germany, and the United Kingdom. In particular, in 1992, among the 50 most sold products by value, only seven active principles are common to these four countries. In Italy, in 1994, there has been a substantial change in pharmaceutical prescriptions, since, for the first time, drugs have been reimbursed by the National Health System (NHS) on the basis of efficacy. As a result of this new policy, the 50 most-sold products by value have changed dramatically in the first five months of 1994. The pharmacologic and economic implications of this change are discussed.

Rights of access to healthcare for undocumented migrants: understanding the Italian and British national health systems

2018 ◽  
Vol 11 (4) ◽  
pp. 232-243 ◽  
Author(s):  
Danielle da Costa Leite Borges ◽  
Caterina Francesca Guidi
Keyword(s):  
Health System ◽  
Health Systems ◽  
National Health ◽  
Universal Access ◽  
Research Question ◽  
Access To Healthcare ◽  
Health Policies ◽  
Undocumented Migrants ◽  
Content Type ◽  
British Health

Purpose The purpose of this paper is to analyse the levels of access to healthcare available to undocumented migrants in the Italian and British health systems through a comparative analysis of health policies for this population in these two national health systems. Design/methodology/approach It builds on textual and legal analysis to explore the different meanings that the principle of universal access to healthcare might have according to literature and legal documents in the field, especially those from the human rights domain. Then, the concept of universal access, in theory, is contrasted with actual health policies in each of the selected countries to establish its meaning in practice and according to the social context. The analysis relies on policy papers, data on health expenditure, legal statutes and administrative regulations and is informed by one research question: What background conditions better explain more universal and comprehensive health systems for undocumented migrants? Findings By answering this research question the paper concludes that the Italian health system is more comprehensive than the British health system insofar it guarantees access free of charge to different levels of care, including primary, emergency, preventive and maternity care, while the rule in the British health system is the recovering of charges for the provision of services, with few exceptions. One possible legal explanation for the differences in access between Italy and UK is the fact that the right to health is not recognised as a fundamental constitutional right in the latter as it is in the former. Originality/value The paper contributes to ongoing debates on Universal Health Coverage and migration, and dialogues with recent discussions on social justice and welfare state typologies.

scholarly journals COVID-19 and healthcare-associated infections

2020 ◽  
Vol 31 (4) ◽  
pp. 181-182 ◽  
Author(s):  
Andrea Cioffi ◽  
Raffaella Rinaldi
Keyword(s):  
Health System ◽  
Health Systems ◽  
Economic Crisis ◽  
National Health ◽  
National Health System ◽  
Healthcare Associated Infections ◽  
Economic Stability ◽  
Health Crisis ◽  
Exponential Increase ◽  
Healthcare Associated

National Health Systems are facing a very serious health emergency related to COVID-19. In this phase of emergency, it is essential to ensure the care of all affected patients but also to ensure the economic stability of the National Health System. This stability is undermined by the potential exponential increase in claims caused by healthcare-associated infections related to COVID-19. That is why it will be essential to use all means necessary to prevent this economic crisis, which could overlap with the health crisis.

scholarly journals Health reforms in Greece, Italy and Spain: studies on the Mediterranean paradigm

Dynamis ◽  
2019 ◽  
Vol 39 (1) ◽  
Author(s):  
Enrique Perdiguero-Gil
Keyword(s):  
Twentieth Century ◽  
National Health Service ◽  
Health Service ◽  
Health Systems ◽  
National Health ◽  
Health Reform ◽  
European Countries ◽  
Reform Processes ◽  
The Mediterranean ◽  
Southern European Countries

This dossier focuses on some characteristics of the health reform processes in three southern European countries —Greece, Italy and Spain— over the second half of the twentieth century. We are interested in the proposals, projects and debates that sought to reorganise the health systems of these three countries. The paper on Italy analyses some aspects of the discussion that led to a national health service in 1978–

scholarly journals What’s the “Secret Sauce”? How Implementation Variation Affects the Success of Colorectal Cancer Screening Outreach

2020 ◽  
Author(s):  
Jennifer Coury ◽  
Edward J. Miech ◽  
Patricia Styer ◽  
Amanda F. Petrik ◽  
Kelly E. Coates ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health System ◽  
Health Systems ◽  
Descriptive Analysis ◽  
Regression Line ◽  
System Size ◽  
Crc Screening ◽  
Mailing Lists ◽  
One Year ◽  
System Characteristics

Abstract Background: Mailed fecal immunochemical testing (FIT) programs can improve colorectal cancer (CRC) screening rates, but health systems vary how they implement (i.e., adapt) these programs for their organizations. A health insurance plan implemented a mailed FIT program (named BeneFIT) and participating health systems could adapt the program. This multi-method study explored which program adaptations might have resulted in higher screening rates.Methods: First, we conducted a descriptive analysis of CRC screening rates by key health system characteristics and program adaptations. Second, we generated an overall model by fitting a weighted regression line to our data. Third, we applied Configurational Comparative Methods (CCMs) to determine how combinations of conditions were linked to higher screening rates. The main outcome measure was CRC screening rates.Results: Seventeen health systems took part in at least one year of BeneFIT. The overall screening completion rate was 20% (4%–28%) in Year 1, and 25% (12%–35%) in Year 2 of the program. Health systems that used two or more adaptations had higher screening rates, and no single adaptation clearly led to higher screening rates. In Year 1, small systems, with just one clinic, that used phone reminders (n=2) met the implementation success threshold (≥19% screening rate) while systems with >1 clinic were successful when offering a patient incentive (n=4), scrubbing mailing lists (n=4), or allowing mailed FIT returns with no other adaptations (n=1). In Year 2, larger systems with 2-4 clinics were successful with a phone reminder (n=4) or a patient incentive (n=3). Of the 10 systems that implemented BeneFIT in both years, seven improved their CRC screening rates in Year 2.Conclusions: Health systems can choose among many adaptations and successfully implement a health plan’s mailed FIT program. Different combinations of adaptations led to success with health system size emerging as an important contextual factor.

scholarly journals Psychological treatments delivered by community health workers in low-resource government health systems: effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda

2018 ◽  
Vol 48 (15) ◽  
pp. 2573-2583 ◽  
Author(s):  
Byamah B. Mutamba ◽  
Jeremy C. Kane ◽  
Joop T. V. M. de Jong ◽  
James Okello ◽  
Seggane Musisi ◽  
...  
Keyword(s):  
Health System ◽  
Community Health ◽  
Community Health Workers ◽  
Health Systems ◽  
National Health ◽  
Health Workers ◽  
Interpersonal Psychotherapy ◽  
Post Intervention ◽  
Psychological Treatments ◽  
Low Resource

BackgroundDespite increasing evidence for the benefits of psychological treatments (PTs) in low- and middle-income countries, few national health systems have adopted PTs as standard care. We aimed to evaluate the effectiveness of a group interpersonal psychotherapy (IPT-G) intervention, when delivered by lay community health workers (LCHWs) in a low-resource government health system in Uganda. The intended outcome was reduction of depression among caregivers of children with nodding syndrome, a neuropsychiatric condition with high morbidity, mortality and social stigma.MethodsA non-randomized trial design was used. Caregivers in six villages (n = 69) received treatment as usual (TAU), according to government guidelines. Caregivers in seven villages (n = 73) received TAU as well as 12 sessions of IPT-G delivered by LCHWs. Primary outcomes were caregiver and child depression assessed at 1 and 6 months post-intervention.ResultsCaregivers who received IPT-G had a significantly greater reduction in the risk of depression from baseline to 1 month [risk ratio (RR) 0.25, 95% confidence interval (CI) 0.10–0.62] and 6 months (RR 0.33, 95% CI 0.11–0.95) post-intervention compared with caregivers who received TAU. Children of caregivers who received IPT-G had significantly greater reduction in depression scores than children of TAU caregivers at 1 month (Cohen's d = 0.57, p = 0.01) and 6 months (Cohen's d = 0.54, p = 0.03). Significant effects were also observed for psychological distress, stigma and social support among caregivers.ConclusionIPT-G delivered within a low-resource health system is an effective PT for common mental health problems in caregivers of children with a severe neuropsychiatric condition and has psychological benefits for the children as well. This supports national health policy initiatives to integrate PTs into primary health care services in Uganda.

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