scholarly journals A public health value-based healthcare paradigm for HIV

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Sebastian Vermeersch ◽  
Rémy P. Demeester ◽  
Nathalie Ausselet ◽  
Steven Callens ◽  
Paul De Munter ◽  
...  
Keyword(s):  
Public Health ◽  
Cost Of Care ◽  
Hiv Care ◽  
Practical Implementation ◽  
Value Drivers ◽  
Process Indicators ◽  
Healthcare Needs ◽  
Framework Approach ◽  
Core Value ◽  
Value Based Care

Abstract Background HIV patients face considerable acute and chronic healthcare needs and battling the HIV epidemic remains of the utmost importance. By focusing on health outcomes in relation to the cost of care, value-based healthcare (VBHC) proposes a strategy to optimize quality of care and cost-efficiency. Its implementation may provide an answer to the increasing pressure to optimize spending in healthcare while improving patient outcomes. This paper describes a pragmatic value-based healthcare framework for HIV care. Methods A value-based HIV healthcare framework was developed during a series of roundtable discussions bringing together 16 clinical stakeholder representatives from the Belgian HIV reference centers and 2 VBHC specialists. Each round of discussions was focused on a central question translating a concept or idea to the next level of practical implementation: 1) how can VBHC principles be translated into value-based HIV care drivers; 2) how can these value-based HIV care divers be translated into value-based care objectives and activities; and 3) how can value-based HIV care objectives and activities be translated into value-based care indicators. Value drivers were linked to concrete objectives and activities using a logical framework approach. Finally, specific, measurable, and acceptable structure, process and outcomes indicators were defined to complement the framework. Results Our framework identifies 4 core value areas where HIV care would benefit most from improvements: Prevention, improvement of the cascade of care, providing patient-centered HIV care and sustaining a state-of-the-art HIV disease management context. These 4 core value areas were translated into 12 actionable core value objectives. For each objective, example activities were proposed. Indicators are suggested for each level of the framework (outcome indicators for value areas and objectives, process indicators for suggested activities). Conclusions This framework approach outlines how to define a patient- and public health centered value-based HIV care paradigm. It proposes how to translate core value drivers to practical objectives and activities and suggests defining indicators that can be used to track and improve the framework’s implementation in practice.

scholarly journals A Public Health Value-Based Healthcare Paradigm for HIV

2021 ◽  
Author(s):  
Sebastian Vermeersch ◽  
Rémy P. Demeester ◽  
Nathalie Ausselet ◽  
Steven Callens ◽  
Paul De Munter ◽  
...  
Keyword(s):  
Public Health ◽  
Cost Of Care ◽  
Hiv Care ◽  
Practical Implementation ◽  
Value Drivers ◽  
Patient Centered ◽  
Healthcare Needs ◽  
Framework Approach ◽  
Core Value ◽  
Value Based Care

Abstract Background: HIV patients face considerable acute and chronic healthcare needs and battling the HIV epidemic remains of the utmost importance. By focusing on health outcomes in relation to the cost of care, value-based healthcare (VBHC) proposes a strategy to optimize quality of care and cost-efficiency. Its implementation may provide an answer to the increasing pressure to optimize spending in healthcare while improving patient outcomes. This paper describes a pragmatic value-based healthcare framework for HIV care. Methods: A value-based HIV healthcare framework was developed during a series of roundtable discussions bringing together clinical stakeholder representatives from the Belgian HIV reference centers and VBHC specialists. Each round of discussions was focused on a central question translating a concept or idea to the next level of practical implementation: 1) how can VBHC principles be translated into value-based HIV care drivers; 2) how can these value-based HIV care divers be translated into value-based care objectives and activities; and 3) how can value-based HIV care objectives and activities be translated into value-based care indicators. Value drivers were linked to concrete objectives and activities using a logical framework approach. Finally, specific, measurable, and acceptable structure, process and outcomes indicators were defined to complement the framework.Results: Our framework identifies 10 core value drivers focusing on 4 key areas where HIV care benefits most from improvements: Prevention, improvement of the cascade of care, providing patient-centered HIV care and sustaining a state-of-the-art HIV disease management context. Value drivers are further developed into objectives and activities. For each level of the framework (drivers, objectives and activities), process and outcome-based indicators are suggested.Conclusions: This framework approach outlines how to define a patient- and public health centered value-based HIV care paradigm. . It proposes how to translate core value drivers to practical objectives and activities and suggests defining indicators that can be used to track and improve the framework’s implementation in practice.

scholarly journals Young adults understanding and readiness to engage with palliative care: extending the reach of palliative care through a public health approach: a qualitative study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anita Mallon ◽  
Felicity Hasson ◽  
Karen Casson ◽  
Paul Slater ◽  
Sonja McIlfatrick
Keyword(s):  
Public Health ◽  
Palliative Care ◽  
Young Adults ◽  
Death And Dying ◽  
Population Based ◽  
Public Health Approach ◽  
Structured Interviews ◽  
Comfort Care ◽  
Positive Attitudes ◽  
Framework Approach

Abstract Background Moving palliative care from a solely clinical focus to a more population based and community orientated approach is the hallmark of a much advocated public health approach to palliative care. Young adults are a vital cohort of the public, yet their understanding of palliative care has not been investigated. This study aimed to explore young adults’ understanding of palliative care and identify factors that influence their engagement. Methods A purposive sample of young adults (n = 24) aged 18–29 years were recruited from one UK University. Semi-structured interviews were undertaken face to face or via telephone or Skype between November 2017 and February 2018. Thematic analysis using a framework approach and underpinned by a socioecological perspective was used to analyse the interviews. Results Three thematic categories were identified relating to intrapersonal and interpersonal influences, cultural and social influences and organisational and public policy influences. Palliative care was understood as supportive comfort care, delivered in the absence of cure, associated with the end of life and specifically focused on death and dying. Negative attitudes related to the context of care, which represented a static and hopeless situation. Whilst some reported positive attitudes, potential engagement was seen to be governed by a lack of knowledge and protective cultural norms. In terms of demonstrating readiness to engage with palliative care, participants requested clear information and suggested a normalising of palliative care through the education system. Conclusion Young adults in this study were ready to find out more about palliative care and identified social media as a platform upon which to engage this population. However, their perception of a society that views palliative care as a subject for those directly affected, creates a barrier to engagement. This study identified the ingredients of a public health message and mediums for disseminating the message. However, findings also suggest that a cultural shift is required to recognise the potential of engaging young adults in health issues that cross the life span, empowering them not only as individuals but as vital members of community and society.

scholarly journals Penile transplantation as an appropriate response to botched traditional circumcisions in South Africa: an argument against

2017 ◽  
Vol 44 (2) ◽  
pp. 86-90 ◽  
Author(s):  
Keymanthri Moodley ◽  
Stuart Rennie
Keyword(s):  
Public Health ◽  
South Africa ◽  
Male Circumcision ◽  
Resource Constraints ◽  
Cultural Practice ◽  
Public Health Response ◽  
Genital Mutilation ◽  
Ethical Implications ◽  
Healthcare Needs ◽  
Health Response

Traditional male circumcision is a deeply entrenched cultural practice in South Africa. In recent times, there have been increasing numbers of botched circumcisions by untrained and unscrupulous practitioners, leading to genital mutilation and often, the need for penile amputation. Hailed as a world’s first, a team of surgeons conducted the first successful penile transplant in Cape Town, South Africa in 2015. Despite the euphoria of this surgical victory, concerns about the use of this costly intervention in a context of severe resource constraints have been raised. In this paper, we explore some of the ethical implications of penile transplants as a clinical and public health response to the adverse consequences of traditional male circumcision. Given the current fiscal deficits in healthcare and public health sectors, how can one justify costly, high-technology interventions for conditions affecting a small section of the population? Since botched traditional male circumcisions are preventable, is a focus on penile transplantation as a form of treatment reasonable? Finally, do such interventions create undue expectations and false hope among a highly vulnerable and stigmatised group of young men? In this paper, we argue that given limited healthcare resources in South Africa and competing healthcare needs, prevention is a more appropriate response to botched traditional circumcisions than penile transplants.

Assessing health needs

2020 ◽  
pp. 42-53
Author(s):  
Andrew O’Shaughnessy ◽  
John Wright ◽  
Ben Cave
Keyword(s):  
Public Health ◽  
Health Professional ◽  
Policy Development ◽  
Professional Training ◽  
Health Sector ◽  
Service Planning ◽  
Health Needs ◽  
Health Needs Assessment ◽  
Healthcare Needs ◽  
Health Agencies

HNA (health needs assessment) is a systematic method of identifying the unmet health and healthcare needs of a population and recommending changes to meet these unmet needs. It is used to improve health and other service planning, priority setting, and policy development. HNA is an example of public health working outside the formal health sector and presenting back to colleagues. Successful HNAs will also ensure that non-health agencies benefit from their findings. This chapter will describe why HNA is important and what it means in practice. Professional training and clinical experience teach that a health professional must systematically assess a patient before administering any treatment that is believed to be effective. This systematic approach is often omitted when assessing the health needs of populations

scholarly journals Public Health, HIV Care and Prevention, Human Rights and Democracy at a Crossroad in Brazil

2019 ◽  
Vol 24 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Luiz Montenegro ◽  
Luciane Velasque ◽  
Sara LeGrand ◽  
Kathryn Whetten ◽  
Ricardo de Mattos Russo Rafael ◽  
...  
Keyword(s):  
Public Health ◽  
Human Rights ◽  
Hiv Care

scholarly journals Assessing the geographical distribution of comorbidity among commercially insured individuals in South Africa

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Cristina Mannie ◽  
Hadi Kharrazi
Keyword(s):  
Public Health ◽  
South Africa ◽  
Geographical Distribution ◽  
Healthcare Utilization ◽  
Risk Score ◽  
Disease Burden ◽  
Risk Scores ◽  
Individual Risk ◽  
Average Risk ◽  
Healthcare Needs

Abstract Background Comorbidities are strong predictors of current and future healthcare needs and costs; however, comorbidities are not evenly distributed geographically. A growing need has emerged for comorbidity surveillance that can inform decision-making. Comorbidity-derived risk scores are increasingly being used as valuable measures of individual health to describe and explain disease burden in populations. Methods This study assessed the geographical distribution of comorbidity and its associated financial implications among commercially insured individuals in South Africa (SA). A retrospective, cross-sectional analysis was performed comparing the geographical distribution of comorbidities for 2.6 million commercially insured individuals over 2016–2017, stratified by geographical districts in SA. We applied the Johns Hopkins ACG® System across the insurance claims data of a large health plan administrator in SA to measure comorbidity as a risk score for each individual. We aggregated individual risk scores to determine the average risk score per district, also known as the comorbidity index (CMI), to describe the overall disease burden of each district. Results We observed consistently high CMI scores in districts of the Free State and KwaZulu-Natal provinces for all population groups before and after age adjustment. Some areas exhibited almost 30% higher healthcare utilization after age adjustment. Districts in the Northern Cape and Limpopo provinces had the lowest CMI scores with 40% lower than expected healthcare utilization in some areas after age adjustment. Conclusions Our results show underlying disparities in CMI at national, provincial, and district levels. Use of geo-level CMI scores, along with other social data affecting health outcomes, can enable public health departments to improve the management of disease burdens locally and nationally. Our results could also improve the identification of underserved individuals, hence bridging the gap between public health and population health management efforts.

scholarly journals Locating People Diagnosed With HIV for Public Health Action: Utility of HIV Case Surveillance and Other Data Sources

2018 ◽  
Vol 133 (2) ◽  
pp. 147-154 ◽  
Author(s):  
Mabel Padilla ◽  
Christine L. Mattson ◽  
Susan Scheer ◽  
Chi-Chi N. Udeagu ◽  
Susan E. Buskin ◽  
...  
Keyword(s):  
Public Health ◽  
Hiv Infection ◽  
Additional Data ◽  
Data Sources ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Public Health Action ◽  
Staff Members ◽  
Contact Information ◽  
Health Action

Introduction: Human immunodeficiency virus (HIV) case surveillance and other health care databases are increasingly being used for public health action, which has the potential to optimize the health outcomes of people living with HIV (PLWH). However, often PLWH cannot be located based on the contact information available in these data sources. We assessed the accuracy of contact information for PLWH in HIV case surveillance and additional data sources and whether time since diagnosis was associated with accurate contact information in HIV case surveillance and successful contact. Materials and Methods: The Case Surveillance-Based Sampling (CSBS) project was a pilot HIV surveillance system that selected a random population-based sample of people diagnosed with HIV from HIV case surveillance registries in 5 state and metropolitan areas. From November 2012 through June 2014, CSBS staff members attempted to locate and interview 1800 sampled people and used 22 data sources to search for contact information. Results: Among 1063 contacted PLWH, HIV case surveillance data provided accurate telephone number, address, or HIV care facility information for 239 (22%), 412 (39%), and 827 (78%) sampled people, respectively. CSBS staff members used additional data sources, such as support services and commercial people-search databases, to locate and contact PLWH with insufficient contact information in HIV case surveillance. PLWH diagnosed <1 year ago were more likely to have accurate contact information in HIV case surveillance than were PLWH diagnosed ≥1 year ago ( P = .002), and the benefit from using additional data sources was greater for PLWH with more longstanding HIV infection ( P < .001). Practice Implications: When HIV case surveillance cannot provide accurate contact information, health departments can prioritize searching additional data sources, especially for people with more longstanding HIV infection.

scholarly journals Integrated care experiences and out-of-pocket expenditures: a cross-sectional survey of adults receiving treatment for HIV and hypertension in Malawi

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e032652
Author(s):  
Corrina Moucheraud ◽  
Matthew Hing ◽  
Juliet Seleman ◽  
Khumbo Phiri ◽  
Florence Chibwana ◽  
...  
Keyword(s):  
Integrated Care ◽  
Antihypertensive Medication ◽  
Cost Of Care ◽  
Hiv Care ◽  
Hiv Positive ◽  
Care Seeking ◽  
Cross Sectional Survey ◽  
Antihypertensive Medications ◽  
Cross Sectional ◽  
Medication Costs

ObjectivesAs HIV-positive individuals’ life expectancy extends, there is an urgent need to manage other chronic conditions during HIV care. We assessed the care-seeking experiences and costs of adults receiving treatment for both HIV and hypertension in Malawi.Design, setting and participantsA cross-sectional survey was conducted with HIV-positive adults with hypertension at a health facility in Lilongwe that offers free HIV care and free hypertension screening, with antihypertensives available for purchase (n=199). Questions included locations and costs of all medication refills and preferences for these refill locations. Respondents were classified as using ‘integrated care’ if they refilled HIV and antihypertensive medications simultaneously. Data were collected between June and December 2017.ResultsOnly half of respondents reported using the integrated care offered at the study site. Among individuals using different locations for antihypertensive medication refills, the most frequent locations were drug stores and public sector health facilities which were commonly selected due to greater convenience and lower medication costs. Although the number of antihypertensive medications was equivalent between the integrated and non-integrated care groups, the annual total cost of care differed substantially (approximately US$21 in integrated care vs US$90 for non-integrated care)—mainly attributable to differences in other visit costs for non-integrated care (transportation, lost wages, childcare). One-third of those in the non-integrated care group reported no expenditure for antihypertensive medication, and six people in each group reported no annual hypertension care-seeking costs at all.ConclusionsIndividuals using integrated care saw efficiencies because, although they were more likely to pay for antihypertensive medications, they did not incur additional costs. These results suggest that preferences and experiences must be better understood to design effective policies and programmes for integrated care among adults on antiretroviral therapy.

Unpacking ‘the cloud’: a framework for implementing public health approaches to palliative care

2019 ◽  
Vol 35 (1) ◽  
pp. 160-170 ◽  
Author(s):  
Kathryn A Pfaff ◽  
Lisa Dolovich ◽  
Michelle Howard ◽  
Deborah Sattler ◽  
Merrick Zwarenstein ◽  
...  
Keyword(s):  
Public Health ◽  
Population Health ◽  
Systems Of Care ◽  
Health Impact ◽  
Population Based ◽  
Public Health Approach ◽  
Healthcare Needs ◽  
Health Level ◽  
The Social ◽  
Development Evaluation

Summary Designing and implementing population-based systems of care that address the social determinants of health, take action on multiple levels, and are guided by evidence-based principles is a pressing priority, and an international challenge. Aging persons are a priority demographic whose health needs span physical, psychosocial and existential care domains, increase in the last year of life, are often poorly coordinated and therefore remain unmet. Compassionate communities (CCs) are an example of a public health approach that fully addresses the holistic healthcare needs of those who are aging and nearing end of life. The sharing of resources, tools, and innovations among implementers of CCs is occurring globally. Although this can increase impact, it also generates complexity that can complicate robust evaluation. When initiating population health level projects, it is important to clearly define and organize concepts and processes that are proposed to influence the health outcomes. The Health Impact Change Model (HICM) was developed to unpack the complexities associated with the implementation and evaluation of a Canadian CC intervention. The HICM offers utility for citizens, leaders and decision-makers who are engaged in the implementation of population health level strategies or other social approaches to care, such as compassionate cities and age or dementia-friendly communities. The HICM’s concepts can be adapted to address a community’s healthcare context, needs, and goals for change. We share examples of how the model’s major concepts have been applied in the development, evaluation and spread of a complex CC approach.

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