scholarly journals A model for national assessment of barriers for implementing digital technology interventions to improve hypertension management in the public health care system in India

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shivani A. Patel ◽  
Kushagra Vashist ◽  
Prashant Jarhyan ◽  
Hanspria Sharma ◽  
Priti Gupta ◽  
...  
Keyword(s):  
Public Health ◽  
Healthcare System ◽  
Digital Health ◽  
District Level ◽  
Health Interventions ◽  
Hypertension Management ◽  
Staff Nurse ◽  
It Infrastructure ◽  
District Hospitals ◽  
Health Centres

Abstract Background There is substantial interest in leveraging digital health technology to support hypertension management in low- and middle-income countries such as India. The potential for healthcare infrastructure and broader context to support such initiatives in India has not been examined. We evaluated existing healthcare infrastructure to support digital health interventions and examined epidemiologic, socioeconomic, and geographical contextual correlates of healthcare infrastructure in 544 districts covering 29 states and union territories across India. Methods The study was a cross-sectional analysis of India’s Fourth District Level Household and Facility Survey (DLHS-4; 2012–2014), the most up-to-date nationally representative district-level healthcare infrastructure data. Facilities were the unit of analysis, and analyses accounted for clustering within states. The main outcome was healthcare system infrastructural context to implement hypertension management programs. Domains included diagnostics (functional BP instrument), medications (anti-hypertensive medication in stock), essential clinical staff (e.g., staff nurse, medical officer, pharmacist), and IT specific infrastructure (regular power supply, internet connection, computer availability). Descriptive analysis was conducted for infrastructure indicators based on the Indian Public Health Standards, and logistic regression was conducted to estimate the association between epidemiologic and geographical context (exposures) and the composite measure of healthcare system. Results Data from 32,215 government facilities were analyzed. Among lowest-tier subcenters, 30% had some IT infrastructure, while at the highest-tier district hospitals, 92% possessed IT infrastructure. At mid-tier primary health centres and community health centres, IT infrastructure availability was 28 and 51%, respectively. For all but sub-centres, the availability of essential staff was lower than the availability of IT infrastructure. For all but district hospitals, higher levels of blood pressure, body mass index, and urban residents were correlated with more favorable infrastructure. By region, districts in Western India tended towards having the best prepared health facilities. Conclusions IT infrastructure to support digital health interventions is more frequently lacking at lower and mid-tier healthcare facilities compared with apex facilities in India. Gaps were generally larger for staffing than physical infrastructure, suggesting that beyond IT infrastructure, shortages in essential staff impose significant constraints to the adoption of digital health interventions. These data provide early benchmarks for state- and district-level planning.

scholarly journals The Context of Hypertension Management in India: A National Assessment of the Potential for Digital Technology Interventions in the Public Health Care System

2020 ◽  
Author(s):  
Shivani A Patel ◽  
Kushagra Vashist ◽  
Prashant Jarhyan ◽  
Hanspria Sharma ◽  
Priti Gupta ◽  
...  
Keyword(s):  
Public Health ◽  
Healthcare System ◽  
Digital Health ◽  
District Level ◽  
Health Interventions ◽  
Hypertension Management ◽  
It Infrastructure ◽  
The Public ◽  
District Hospitals ◽  
Health Centres

Abstract ImportanceThere is substantial interest in leveraging digital health technology to support hypertension management in low- and middle-income countries such as India. The potential for healthcare infrastructure and broader context to support such initiatives in the public healthcare system in India has not been examined.ObjectiveWe evaluated existing healthcare infrastructure to support digital health interventions and examined epidemiologic, socioeconomic, and geographical contextual correlates of healthcare infrastructure in 544 districts covering 29 states and union territories across India.DesignCross-sectional analysis of India’s Fourth District Level Household and Facility Survey (DLHS-4; 2012-2014), the most up-to-date district-level healthcare infrastructure data. Facilities were the unit of analysis and analyses accounted for clustering within states.SettingNationally representative data of health facilities across India.ParticipantsThe target sample was all health facilities within the government healthcare system.ExposuresEpidemiologic, socioeconomic, and geographical context.Main Outcome(s) and Measure(s)Healthcare system infrastructural context to implement hypertension management programs. Domains included diagnostics (functional BP instrument) medications (anti-hypertensive medication in stock), essential clinical staff (e.g., staff nurse, medical officer, pharmacist), and IT specific infrastructure (regular power supply, internet connection, computer availability). Infrastructure indicators were based on the Indian Public Health Standards.ResultsData from 32,215 government facilities were analyzed. Among lowest-tier subcenters, 30% had some IT infrastructure, while at the highest-tier district hospitals, 92% possessed IT infrastructure. At mid-tier primary health centres and community health centres, IT infrastructure availability was 29% and 51%, respectively. For all but sub-centres, the availability of essential staff was lower than the availability of IT infrastructure. For all but district hospitals, higher levels of blood pressure, body mass index, and urban residents were correlated with more favorable infrastructure. By region, districts in Western India tended towards having the best prepared health facilities.Conclusions and RelevanceIT infrastructure to support digital health interventions is more frequently lacking at lower and mid-tier healthcare facilities compared with apex facilities in India. Gaps were generally larger for staffing than physical infrastructure, suggesting that beyond IT infrastructure, shortages in essential staff pose as significant constraints to the adoption of digital health interventions. These data provide early benchmarks for state- and district level planning.

scholarly journals Effect of public health interventions during the first epidemic wave of COVID-19 in Cyprus: a modelling study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ilias Gountas ◽  
Annalisa Quattrocchi ◽  
Ioannis Mamais ◽  
Constantinos Tsioutis ◽  
Eirini Christaki ◽  
...  
Keyword(s):  
Public Health ◽  
Healthcare System ◽  
Credible Interval ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Case Ascertainment ◽  
Dynamic Stochastic ◽  
The Republic ◽  
Republic Of Cyprus ◽  
The Impact

Abstract Background Cyprus addressed the first wave of SARS CoV-2 (COVID-19) by implementing non-pharmaceutical interventions (NPIs). The aims of this study were: a) to estimate epidemiological parameters of this wave including infection attack ratio, infection fatality ratio, and case ascertainment ratio, b) to assess the impact of public health interventions and examine what would have happened if those interventions had not been implemented. Methods A dynamic, stochastic, individual-based Susceptible-Exposed-Infected-Recovered (SEIR) model was developed to simulate COVID-19 transmission and progression in the population of the Republic of Cyprus. The model was fitted to the observed trends in COVID-19 deaths and intensive care unit (ICU) bed use. Results By May 8th, 2020, the infection attack ratio was 0.31% (95% Credible Interval [CrI]: 0.15, 0.54%), the infection fatality ratio was 0.71% (95% CrI: 0.44, 1.61%), and the case ascertainment ratio was 33.2% (95% CrI: 19.7, 68.7%). If Cyprus had not implemented any public health measure, the healthcare system would have been overwhelmed by April 14th. The interventions averted 715 (95% CrI: 339, 1235) deaths. If Cyprus had only increased ICU beds, without any social distancing measure, the healthcare system would have been overwhelmed by April 19th. Conclusions The decision of the Cypriot authorities to launch early NPIs limited the burden of the first wave of COVID-19. The findings of these analyses could help address the next waves of COVID-19 in Cyprus and other similar settings.

scholarly journals Hospital Preparedness and Resilience in Public Health Emergencies at District Hospitals and Community Health Centres

2020 ◽  
Vol 22 (2) ◽  
pp. 146-156
Author(s):  
Sandesh Kumar Sharma ◽  
Neeraj Sharma
Keyword(s):  
Public Health ◽  
Community Health ◽  
Emergency Preparedness ◽  
Healthcare Workers ◽  
Local Level ◽  
Community Health Centres ◽  
Public Health Emergencies ◽  
District Hospitals ◽  
Health Centres ◽  
Hospital Preparedness

Background: Public health emergencies (PHE) caused by natural hazards spread from one particular locality to adjacent geographic areas and then encompass the entire planet in today’s fast global connectivity mode. Each country, including India, has its own set of potential disasters based on the hazards present as well as the unique vulnerabilities of the community and community’s preparedness to respond to particular disasters. Currently, human history is observing a very critical time fighting an invisible enemy—COVID-19. Therefore, in this study, we seek to understand the standardised measures of public hospital preparedness and resilience at times of health emergencies, including a pandemic, the most current one being COVID-19. Methods: We conducted a descriptive, cross-sectional study among health officials of district hospitals (DHs) and community health centres (CHCs) of Rajasthan using a semi-structured online questionnaire, with COVID-19 in mind, and sending it to those who had attended a training programme on disaster preparedness in hospitals. Results: In all, questionnaires were sent to 80 health officials of DHs and CHCs, of which 58 responded, with a response rate of 72.5 per cent. We collected responses on public health emergency preparedness, training-related issues, the capacity to deal with emergencies and prior experience in managing an emergency. Conclusion: The resilience and preparedness of DHs and CHCs in Rajasthan appear to be limited. From the studies it has been revealed that proper training and education on disasters like the current COVID-19, which is of significant importance for healthcare workers, is limited to only 37.9 per cent of healthcare workers. It also emerges that the staff members whenever required could mark and perform in the triage area, but the Isolation room haven’t got the request facilities and equipped to stabilise a critical patient despite availability of emergency stock of medicine. The stated functional status of DHs and CHCs reveals that the level of emergency preparedness is between low and medium and also varies from hospital to hospital and from CHC to CHC. Hence, it is time to reassess and upgrade emergency preparedness plans, which include mitigation, preparedness, response and recovery. Federal-, state- and local-level emergency management agencies’ functioning has to be effective and well-coordinated with the local level of operation.

scholarly journals Effect of public health interventions during the first epidemic wave of COVID-19 in Cyprus: a modelling study

2021 ◽  
Author(s):  
Ilias Gountas ◽  
Annalisa Quattrocchi ◽  
Ioannis Mamais ◽  
Constantinos Tsioutis ◽  
Eirini Christaki ◽  
...  
Keyword(s):  
Public Health ◽  
Healthcare System ◽  
Credible Interval ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Case Ascertainment ◽  
Dynamic Stochastic ◽  
Republic Of Cyprus ◽  
The Impact ◽  
Pharmaceutical Interventions

AbstractBackgroundCyprus addressed the first wave of SARS CoV-2 (COVID-19) by implementing non-pharmaceutical interventions. The aims of this study were: a) to estimate epidemiological parameters of this wave including infection attack ratio, infection fatality ratio, and case ascertainment ratio, b) to assess the impact of public health interventions, and c) to examine what would have happened if those interventions had not been implemented.MethodsA dynamic, stochastic, individual-based Susceptible-Exposed-Infected-Recovered (SEIR) model was developed to simulate COVID-19 transmission and progression in the population of the Republic of Cyprus. The model was fitted to the observed trends in COVID-19 deaths and intensive care unit (ICU) bed use.ResultsBy May 8 2020th, the infection attack ratio was 0.31% (95% Credible Interval (CrI): 0.15%, 0.54%), the infection fatality ratio was 0.71% (95% CrI: 0.44%, 1.61%), and the case ascertainment ratio was 33.2% (95% CrI: 19.7%, 68.7%). If Cyprus had not implemented any public health measure, the healthcare system would have been overwhelmed by April 14th. The interventions averted 715 (95% CrI: 339, 1235) deaths. If Cyprus had only increased ICU beds, without any social distancing measure, the healthcare system would have been overwhelmed by April 19th.ConclusionsThe decision of the Cypriot authorities to launch early non-pharmaceutical interventions limited the burden of the first wave of COVID-19. The findings of these analyses could help address the next waves of COVID-19 in Cyprus and other similar settings.

scholarly journals Addressing equity in eHealth interventions for healthcare system users & patients, literature review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
V Ramel
Keyword(s):  
Health Promotion ◽  
Literature Review ◽  
Conceptual Framework ◽  
Conceptual Model ◽  
Healthcare System ◽  
Digital Health ◽  
Unintended Consequences ◽  
Health Interventions ◽  
Equity Issues ◽  
Ottawa Charter

Abstract Objective eHealth has great potential to improve access to health information and care but important barriers to equity still exist and a real digital divide threatens its use. It is therefore necessary to build a conceptual framework on digital health interventions aiming at promoting equity and to analyse the strategies and recommendations that arise through the literature. Such a conceptual framework has not been identified in the literature yet. Methods We carried out a scoping literature review of the scientific literature since 2000 in Western countries, in Scopus, PubMed, PsycArticles, SocIndex and PBSC. Results Strategies that take into account equity in eHealth for healthcare system users and patients can be presented in light of the five key action areas of the Ottawa Charter for Health Promotion. They deal with the policy level, the individual one, aim at creating supportive environments, at using the community level for eHealth promotion and focus on health services. Individuals-oriented interventions are the most reported, thus revealing a lack of systematic thinking and certainly a lack of understanding of the whole spectrum of health determinants. Conclusions Following Gibbons’ expression of “compunetics” (Information and Communication Technologies & ethics), interventions that truly consider the unintended consequences of eHealth on social and geographic health inequalities are absolutely necessary. The conceptual model analysing the whole literature on this interaction makes it easy to understand the types of interventions that are or could be carried out to tackle equity issues in digital health interventions. Its recommendations become easy to implement in the field and can be extremely helpful for decision-making. Key messages Strategies that take into account equity in eHealth for healthcare system users and patients can be presented in light of the five key action areas of the Ottawa Charter for Health Promotion. The conceptual model we elaborated makes it easy to understand the types of interventions that could be carried out to tackle equity issues in digital health interventions.

scholarly journals Evidence-Based Health Informatics as the Foundation for the COVID-19 Response: A Joint Call for Action

2021 ◽  
Author(s):  
Luis Fernandez-Luque ◽  
Andre W. Kushniruk ◽  
Andrew Georgiou ◽  
Arindam Basu ◽  
Carolyn Petersen ◽  
...  
Keyword(s):  
Public Health ◽  
Interest Groups ◽  
Special Interest ◽  
Health Informatics ◽  
Digital Health ◽  
Health Interventions ◽  
Digital Tools ◽  
Special Interest Groups ◽  
Evidence Based ◽  
Health Crisis

Abstract Background As a major public health crisis, the novel coronavirus disease 2019 (COVID-19) pandemic demonstrates the urgent need for safe, effective, and evidence-based implementations of digital health. The urgency stems from the frequent tendency to focus attention on seemingly high promising digital health interventions despite being poorly validated in times of crisis. Aim In this paper, we describe a joint call for action to use and leverage evidence-based health informatics as the foundation for the COVID-19 response and public health interventions. Tangible examples are provided for how the working groups and special interest groups of the International Medical Informatics Association (IMIA) are helping to build an evidence-based response to this crisis. Methods Leaders of working and special interest groups of the IMIA, a total of 26 groups, were contacted via e-mail to provide a summary of the scientific-based efforts taken to combat COVID-19 pandemic and participate in the discussion toward the creation of this manuscript. A total of 13 groups participated in this manuscript. Results Various efforts were exerted by members of IMIA including (1) developing evidence-based guidelines for the design and deployment of digital health solutions during COVID-19; (2) surveying clinical informaticians internationally about key digital solutions deployed to combat COVID-19 and the challenges faced when implementing and using them; and (3) offering necessary resources for clinicians about the use of digital tools in clinical practice, education, and research during COVID-19. Discussion Rigor and evidence need to be taken into consideration when designing, implementing, and using digital tools to combat COVID-19 to avoid delays and unforeseen negative consequences. It is paramount to employ a multidisciplinary approach for the development and implementation of digital health tools that have been rapidly deployed in response to the pandemic bearing in mind human factors, ethics, data privacy, and the diversity of context at the local, national, and international levels. The training and capacity building of front-line workers is crucial and must be linked to a clear strategy for evaluation of ongoing experiences.

An evaluation service for digital public health interventions: concepts, development and ways of working (Preprint)

2021 ◽  
Author(s):  
Kassandra Karpathakis ◽  
Gene Libow ◽  
Henry W W Potts ◽  
Simon Dixon ◽  
Felix Greaves ◽  
...  
Keyword(s):  
Public Health ◽  
Digital Health ◽  
Evaluation Framework ◽  
Health Interventions ◽  
Effective Intervention ◽  
User Needs ◽  
Structured Interviews ◽  
User Centred Design ◽  
Research Engagement ◽  
The Impact

BACKGROUND Digital health interventions have potential to improve public health by combining effective intervention and population reach. However, what biomedical researchers and digital developers consider an effective intervention differs, thereby creating an ongoing challenge to integrate their respective approaches when evaluating digital health interventions. OBJECTIVE Public Health England set out to operationalise an evaluation framework that combines biomedical and digital approaches, and demonstrates the impact, cost-effectiveness and benefit of digital health interventions to public health. METHODS A multidisciplinary project team, composed of service designers, academics and public health professionals, employed user-centred design methods such as qualitative research, engagement with end-users and stakeholders, and iterative learning. An iterative approach enabled the team to sequentially define the problem, understand user needs, identify opportunity areas, develop concepts, test prototypes, and plan service implementation. Outputs were critiqued by stakeholders, system leaders and a Working Group. RESULTS Semi-structured interviews (N=15) identified 26 themes and 82 user needs, expressed as 46 Jobs To Be Done, which were then validated across the journey of evaluation design for a digital health intervention. Seven essential concepts for evaluating digital health interventions were identified: (i) Evaluation Thinking; (ii) Evaluation Canvas; (iii) Contract Assistant; (iv) Testing Toolkit; (v) Development History; (vi) Data Hub, and (vii) Publish Health Outcomes. Three concepts were prioritised for further testing and development and subsequently refined into the proposed Public Health England Evaluation Service for public health digital health interventions. Testing with Public Health England's Couch-to-5K App digital team confirmed the viability, desirability and feasibility of both the evaluation approach and the Evaluation Service. CONCLUSIONS An iterative, user-centred design approach enabled Public Health England to combine the strengths of academic and biomedical disciplines alongside the expertise of non-academic and/or digital developers for evaluating digital health interventions. Design-led methodologies can add value in a public health setting. The subsequent service, now known as Evaluating Digital Health Products, is currently in use by health bodies in the United Kingdom and available to others tackling the problem of evaluating digital health interventions pragmatically and responsively.

scholarly journals Intervention strategies against COVID-19 and their estimated impact on Swedish healthcare capacity

2020 ◽  
Author(s):  
Jasmine M Gardner ◽  
Lander Willem ◽  
Wouter Van Der Wijngaart ◽  
Shina Caroline Lynn Kamerlin ◽  
Nele Brusselaers ◽  
...  
Keyword(s):  
Public Health ◽  
Intensive Care ◽  
Healthcare System ◽  
Healthcare Workers ◽  
Health Interventions ◽  
Parameter Estimates ◽  
List Type ◽  
Public Health Interventions ◽  
Social Distancing ◽  
Health Measures

AbstractObjectivesDuring March 2020, the COVID-19 pandemic has rapidly spread globally, and non-pharmaceutical interventions are being used to reduce both the load on the healthcare system as well as overall mortality.DesignIndividual-based transmission modelling using Swedish demographic and Geographical Information System data and conservative COVID-19 epidemiological parameters.SettingSwedenParticipantsA model to simulate all 10.09 million Swedish residents.Interventions5 different non-pharmaceutical public-health interventions including the mitigation strategy of the Swedish government as of 10 April; isolation of the entire household of confirmed cases; closure of schools and non-essential businesses with or without strict social distancing; and strict social distancing with closure of schools and non-essential businesses.Main outcome measuresEstimated acute care and intensive care hospitalisations, COVID-19 attributable deaths, and infections among healthcare workers from 10 April until 29 June.FindingsOur model for Sweden shows that, under conservative epidemiological parameter estimates, the current Swedish public-health strategy will result in a peak intensive-care load in May that exceeds pre-pandemic capacity by over 40-fold, with a median mortality of 96,000 (95% CI 52,000 to 183,000). The most stringent public-health measures examined are predicted to reduce mortality by approximately three-fold. Intensive-care load at the peak could be reduced by over two-fold with a shorter period at peak pandemic capacity.ConclusionsOur results predict that, under conservative epidemiological parameter estimates, current measures in Sweden will result in at least 40-fold over-subscription of pre-pandemic Swedish intensive care capacity, with 15.8 percent of Swedish healthcare workers unable to work at the pandemic peak. Modifications to ICU admission criteria from international norms would further increase mortality.What is already known?-The COVID-19 pandemic has spread rapidly in Europe and globally since March 2020.-Mitigation and suppression methods have been suggested to slow down or halt the spread of the COVID-19 pandemic. Most European countries have enacted strict suppression measures including lockdown, school closures, enforced social distancing; while Sweden has chosen a different strategy of milder mitigation as of today (10 April 2020).-Different national policy decisions have been justified by socio-geographic differences among countries. Such differences as well as the tempo and stringency of public-health interventions are likely to affect the impact on each country’s mortality and healthcare system.What this study adds?-Individual-based modelling of COVID-19 spread using Swedish demographics and conservative epidemiological assumptions indicates that the peak of the number of hospitalised patients with COVID-19 can be expected in early May under the current strategy, shifted earlier and attenuated with more stringent public health measures.-Healthcare needs are expected to substantially exceed pre-pandemic capacity even if the most aggressive interventions considered were implemented in the coming weeks. In particular the need for intensive care unit beds will be at least 40-fold greater than the pre-pandemic capacity if the current strategy is maintained, and at least 10-fold greater if strategies approximating the most stringent in Europe are introduced by 10 April.-Our model predicts that, using median infection-fatality-rate estimates, at least 96,000 deaths would occur by 1 July without mitigation. Current policies reduce this number by approximately 15%, while even more aggressive social distancing measures, such as adding household isolation or mandated social distancing can reduce this number by more than 50%.

scholarly journals FeverIQ - A Privacy-Preserving COVID-19 Symptom Tracker with 3.6 Million Reports

2020 ◽  
Author(s):  
Ankit Ranjan ◽  
Serena Li ◽  
Boyuan Chen ◽  
Alan Chiu ◽  
Karthik Jagadeesh ◽  
...  
Keyword(s):  
Public Health ◽  
Test Data ◽  
Digital Health ◽  
Privacy Preserving ◽  
Secure Multiparty Computation ◽  
Health Interventions ◽  
Multiparty Computation ◽  
User Privacy ◽  
Linear Classifier ◽  
Population Scale

Population-scale COVID-19 management benefits from timely and honest information from billions of people. Here, we provide a first report on the FeverIQ symptom tracker, a global effort to collect symptom and test data which has received more than 3.6 million submissions. Unlike other trackers, FeverIQ uses secure multiparty computation (SMC) to cryptographically guarantee user privacy while providing insights to scientists and public health efforts. We performed basic integrity checks of the FeverIQ dataset, such as by comparing it to other publicly released data. We then trained a linear classifier on diagnosis scores which were computed securely, without unprotected symptom data ever leaving a user's phone or computer. FeverIQ is currently the world's largest application of SMC in a health context, demonstrating the practicality of privacy-preserving analytics for population-scale digital health interventions.

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