scholarly journals A 2019. évi ARIA kezelési irányelvek magyar adaptációja és a hazai alkalmazás lehetőségei allergiás rhinitisben

2020 ◽  
Vol 161 (49) ◽  
pp. 2059-2071
Author(s):  
Helga Kraxner ◽  
Andor Hirschberg ◽  
Kristóf Nékám
Keyword(s):  
Health Care ◽  
Allergic Rhinitis ◽  
Mobile Health ◽  
Health Care Systems ◽  
Cost Effective ◽  
Allergic Diseases ◽  
The European Union ◽  
Sentinel Network ◽  
Intranasal Corticosteroids ◽  
Care Systems

Összefoglaló. Az allergiás betegségekben szenvedő emberek száma világszerte, köztük Magyarországon is növekszik. Az egészségügyi ellátórendszerek azon dolgoznak, hogy minél hatékonyabban tudják felhasználni a rendelkezésre álló forrásokat. Az Allergic Rhinitis and its Impact on Asthma (ARIA) szervezet célja az allergiás náthában szenvedő betegek ellátásának javítása, szakmai ajánlások készítése, aktualizálása. Ennek egyik módja integrált betegellátási utak kidolgozása. Célunk ezek hazai elérhetővé tétele, az ajánlások széles körű elterjesztése az Európai Unió (EU) többi tagállamához hasonlóan Magyarországon is. Az ARIA más nemzetközi innovatív szervezetek bevonásával olyan integrált betegellátási utakat fejlesztett ki, amelyek allergiás nátha, esetleg társbetegsége, az asztma esetén támogatják a kezelést. Ezeket újgenerációs irányelvek kidolgozása útján alkották, amelyekhez felhasználták a mobiltechnológiából és pollenkamra-vizsgálatokból származó valós evidenciákat is. A gyógyszeres terápia optimalizálásához a vizuális analóg skálán alapuló, úgynevezett Mobil Légúti Figyelő Hálózat algoritmusát digitalizálták, és valós evidenciák felhasználásával tovább finomították. Allergén immunterápiára az ARIA a világon elsőként dolgozott ki integrált betegellátási utakat 2019-ben. A kezelési irányelvekhez való adherenciaszint alacsony, a betegek a tüneteik erőssége alapján módosítják a kezelést. A flutikazon-propionát–azelasztin kombináció hatása erősebb az intranasalis kortikoszteroidokénál, míg az utóbbi hatásosabb az oralis H1-antihisztaminoknál. A mobiltelefonokban tárolt elektronikus napló vagy más ’mobile health’ (mHealth) eszközök használata segíti a betegek kiválasztását allergén immunterápiára. Az ARIA által javasolt algoritmus megfelelőnek mutatkozott az allergiás rhinitis kezelésére, ezért ezek az irányelvek bekerülnek integrált betegellátási utakba, és részét fogják képezni az EU Egészségügyi és Élelmiszer-biztonsági Főigazgatósága digitalizált, személyközpontú gondozási anyagainak. Az allergén immunterápia hatékony az inhalatív allergének által okozott allergiás betegségekben, alkalmazását azonban korlátozni kell gondosan válogatott betegekre. Orv Hetil. 2020; 161(49): 2059–2071. Summary. The number of allergic patients is increasing all over the world, also in Hungary. Delivering effective and cost-effective health care is essential for all health care systems. ARIA (Allergic Rhinitis and its Impact on Asthma) aims to improve the care of patients who suffer from allergic rhinitis by setting up guidelines and updating them. Development of ICPs (integrated care pathways) can play an essential role in attaining this goal. Our aim is to make ICP-s developed by ARIA available also in Hungary, as is already the case in other countries of the European Union (EU). Together with other international initiatives, ARIA has worked out digitally-enabled ICPs to support care in allergic rhinitis and comorbid asthma. ICPs are based on new-generation guidelines using RWE (real-world evidence) from chamber studies and mobile technology. The MASK (Mobile Airways Sentinel NetworK) algorithm – based on visual analogue scale – was digitalized to support pharmacotherapy, and was refined by using RWE. ARIA was the first to develop ICPs for allergen immunotherapy (AIT) in 2019. Based on MASK data, patients did not follow guidelines and their adherence to treatment was poor. Patients would modify their treatments, depending on the disease control. The effect of fluticasone propionate–azelastine combination is superior to intranasal corticosteroids which are superior to oral H1-antihistamines. Electronic diaries obtained from cell phones and other ’mobile health’ (mHealth) devices help select patients for AIT. The ARIA algorithm for AR was found appropriate and no change is necessary. These guidelines will inform ICPs and will be included in the DG Santé digitally-enabled, person-centred care system. AIT is an effective treatment for allergic diseases caused by inhaled allergens. Its use should, however, be restricted to carefully selected patients. Orv Hetil. 2020; 161(49): 2059–2071.

scholarly journals Sustainability of Biosimilars in Europe: A Delphi Panel Consensus with Systematic Literature Review

2020 ◽  
Vol 13 (11) ◽  
pp. 400
Author(s):  
Arnold G. Vulto ◽  
Jackie Vanderpuye-Orgle ◽  
Martin van der Graaff ◽  
Steven R. A. Simoens ◽  
Lorenzo Dagna ◽  
...  
Keyword(s):  
Health Care ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Health Care Systems ◽  
Delphi Panel ◽  
The European Union ◽  
Modified Delphi ◽  
Care Systems ◽  
Supply Risks ◽  
The Impact

Introduction: Biosimilars have the potential to enhance the sustainability of evolving health care systems. A sustainable biosimilars market requires all stakeholders to balance competition and supply chain security. However, there is significant variation in the policies for pricing, procurement, and use of biosimilars in the European Union. A modified Delphi process was conducted to achieve expert consensus on biosimilar market sustainability in Europe. Methods: The priorities of 11 stakeholders were explored in three stages: a brainstorming stage supported by a systematic literature review (SLR) and key materials identified by the participants; development and review of statements derived during brainstorming; and a facilitated roundtable discussion. Results: Participants argued that a sustainable biosimilar market must deliver tangible and transparent benefits to the health care system, while meeting the needs of all stakeholders. Key drivers of biosimilar market sustainability included: (i) competition is more effective than regulation; (ii) there should be incentives to ensure industry investment in biosimilar development and innovation; (iii) procurement processes must avoid monopolies and minimize market disruption; and (iv) principles for procurement should be defined by all stakeholders. However, findings from the SLR were limited, with significant gaps on the impact of different tender models on supply risks, savings, and sustainability. Conclusions: A sustainable biosimilar market means that all stakeholders benefit from appropriate and reliable access to biological therapies. Failure to care for biosimilar market sustainability may impoverish biosimilar development and offerings, eventually leading to increased cost for health care systems and patients, with fewer resources for innovation.

Emergency Telehealth Services in the Correctional Setting

2021 ◽  
pp. 210-221
Author(s):  
Newton E. Kendig ◽  
David G. Ellis ◽  
Renoj Varughese ◽  
Obinna M. Ome Irondi
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Emergency Services ◽  
Point Of Care ◽  
Health Care Systems ◽  
Cost Effective ◽  
Correctional Setting ◽  
Correctional Health Care ◽  
Correctional Health ◽  
Care Systems

Millions of patients receive their primary health care in U.S. jails and prisons each year. Correctional health care systems frequently lack round-the-clock onsite physician services, and access to local hospital-based emergency services may be limited. Increasingly, correctional health care systems are relying on telehealth capabilities to improve their access to subspecialty services. Emergency telehealth services, however, are largely underutilized. Available reports suggest that emergency telehealth services can reduce outside medical trips and prove cost-effective in certain settings. Successful emergency telehealth programs emphasize the importance of a thorough diagnostic evaluation, effective communication with local correctional health care providers, and strategic use of point-of-care testing. This chapter provides practical recommendations for the telehealth evaluation and management of commonly occurring medical emergencies in the correctional setting.

Organizing a diabetes service

2011 ◽  
pp. 2005-2011
Author(s):  
Stephen C. L. Gough
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Cost Effective ◽  
Health Care Need ◽  
Delivery Of Care ◽  
Strategic Approach ◽  
Effective Manner ◽  
Care Systems ◽  
The Individual ◽  
The Uk

The increasing worldwide incidence and prevalence of diabetes is placing substantial pressures on health care systems and economies. As a consequence individuals involved in the care of people with diabetes are looking at services currently being provided and examining ways in which care can be organized in the most cost-effective manner. Whilst the degree to which diabetes care is delivered differs from country to country, similar fundamental questions are being asked by those involved in the delivery of care, including: What are we currently providing? What do we need to provide? What are we able to provide? Although the answers to these questions are quite different not just between countries but often within specific localities within a country, the ultimate aim is the same: to provide the best possible care to as many people with diabetes as possible. The global diversity of diabetes health care need is enormous and while the solutions will be equally diverse, the approach to the development of a diabetes service will, for many organizations, be similar. The main focus of this chapter is based upon the model or the strategic approach developed in the UK, but many of the individual component parts are present in most health care settings.

Die Bedeutung der EuGH-Rechtsprechung für die Nachfrage nach Gesundheitsleistungen in der EU

2003 ◽  
Vol 52 (3) ◽  
Author(s):  
Jörg Jasper ◽  
Ralf Tostmann
Keyword(s):  
Health Care ◽  
National Health ◽  
Health Care Systems ◽  
Economic Effects ◽  
Advanced Technology ◽  
The European Union ◽  
National Health Care ◽  
European Court ◽  
Care Systems ◽  
Principle Of Territoriality

AbstractIn this paper we analyze the economic effects of the European Court of Justice’s (CoJ’s) jurisdiction on national health care systems in Europe, especially in Germany. We focus on the CoJ’s decisions concerning European patients’ rights to choose freely among suppliers of medical treatment within the European Union. The results are that national health care systems will face an increasing pressure to comply with the rules of the European Treaty. For Germany, this means that some traditional traits of its regulatory framework, especially the principle of territoriality, will have to undergo a test of “Europe-friendliness”. Unlike these qualitative aspects, we find that quantitative effects will remain more or less negligible for the nearer future and will mostly be confined to the sector of advanced technology medicine.

scholarly journals PATIENT-CENTERED MEDICINE: BACKGROUND TO THE TRANSFORMATION AND COMPONENTS

2019 ◽  
Vol 23 (1) ◽  
pp. 104-114 ◽  
Author(s):  
R. A. Khalfin ◽  
V. V. Madyanova ◽  
O. E. Kachkova ◽  
I. D. Demina ◽  
T. I. Krishtaleva ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Health Care Systems ◽  
Developed Countries ◽  
The European Union ◽  
Patient Centered ◽  
Foreign Countries ◽  
Care Systems ◽  
Patient Centered Medicine ◽  
Quality Of Medical Care

Purpose of the study. To analyze the concept of creating patient-oriented medicine, the prerequisites for its emergence, the difficulties of introducing it into existing health systems based on foreign experience. Materials and methods. The main materials of the study were used sources of foreign literature, which presents the concept of patient-oriented medicine, analyzed the prerequisites for changing models of health care in the European Union, USA and Asia in accordance with the principles of patient-oriented medicine, as well as data on the components and levels of patient-oriented medicine in foreign countries Results. The analyzed literature quite fully describes the difficulties of introducing patient-oriented medicine into existing health care systems. Particular attention should be paid to a multidisciplinary approach, continuity at different levels of medical care and effective communication between the physician and the patient towards the integration of this model into clinical practice. The analysis of the availability of medical care in developed countries and its dependence on social status, ethnicity and disease of the patient. Conclusion. Patient-oriented medicine is a new model for planning, implementing and evaluating medical services, which is based on mutually beneficial partnerships between medical workers, patients and their families. Taking into account the current problems of domestic health care, the introduction of the patient-oriented model will significantly improve the quality of medical care provided to the population of our country. Globally, the implementation of the principles of this model is far from complete. In the Russian Federation, targeted work in this direction requires additional scientific research, systematization of available data, and development of new legal documents

scholarly journals Transformations and Reforms of European Health Care Systems: The Case of Estonia

2014 ◽  
Vol 17 (3) ◽  
pp. 123-142 ◽  
Author(s):  
Jadwiga Suchecka
Keyword(s):  
Health Care ◽  
Global Financial Crisis ◽  
Health Management ◽  
Health Care Systems ◽  
Mixed System ◽  
The European Union ◽  
Care Systems ◽  
European Health ◽  
The Global Financial Crisis ◽  
The Impact

The purpose of this article is to present the main directions of changes in the Estonian health care system following the transformation of the national economy and the accession of Estonia to the European Union. Special attention has been paid to the ways of sourcing, and the collection and redistribution of financial resources allocated to health care in different periods of the transformation. The initial changes introduced far-reaching decentralization of the health system, while further reforms led to his re-centralization. The intensity of the re-centralization of finance and health management processes was accelerated after 2008, when the impact of the global financial crisis on the condition of the economy of Estonia was significant. As a result of the introduced changes, Bismarck’s mixed system – a hybrid system – has been formed.

scholarly journals From heterogeneity to harmonization? Recent trends in European health policy

2007 ◽  
Vol 23 (suppl 2) ◽  
pp. S133-S142 ◽  
Author(s):  
Thomas Gerlinger ◽  
Hans-Jürgen Urban
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Health Care Systems ◽  
The European Union ◽  
Lisbon Strategy ◽  
Regulatory Requirements ◽  
Care Systems ◽  
European Health ◽  
Recent Trends ◽  
The Eu

In the European Union (EU), health policy and the institutional reform of health systems have been treated primarily as national affairs, and health care systems within the EU thus differ considerably. However, the health policy field is undergoing a dynamic process of Europeanization. This process is stimulated by the orientation towards a more competitive economy, recently inaugurated and known as the Lisbon Strategy, while the regulatory requirements of the European Economic and Monetary Union are stimulating the Europeanization of health policy. In addition, the so-called open method of coordination, representing a new mode of regulation within the European multi-level system, is applied increasingly to the health policy area. Diverse trends are thus emerging. While the Lisbon Strategy goes along with a strategic upgrading of health policy more generally, health policy is increasingly used to strengthen economic competitiveness. Pressure on Member States is expected to increase to contain costs and promote market-based health care provision.

scholarly journals Subcategorizing the Expected Value of Perfect Implementation to Identify When and Where to Invest in Implementation Initiatives

2020 ◽  
Vol 40 (3) ◽  
pp. 327-338
Author(s):  
Kasper Johannesen ◽  
Magnus Janzon ◽  
Tomas Jernberg ◽  
Martin Henriksson
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Expected Value ◽  
Net Benefit ◽  
Relative Value ◽  
Care Systems ◽  
The Absolute

Purpose. Clinical practice variations and low implementation of effective and cost-effective health care technologies are a key challenge for health care systems and may lead to suboptimal treatment and health loss for patients. The purpose of this work was to subcategorize the expected value of perfect implementation (EVPIM) to enable estimation of the absolute and relative value of eliminating slow, low, and delayed implementation. Methods. Building on the EVPIM framework, this work defines EVPIM subcategories to estimate the expected value of eliminating slow, low, or delayed implementation. The work also shows how information on regional implementation patterns can be used to estimate the value of eliminating regional implementation variation. The application of this subcategorization is illustrated by a case study of the implementation of an antiplatelet therapy for the secondary prevention after myocardial infarction in Sweden. Incremental net benefit (INB) estimates are based on published cost-effectiveness assessments and a threshold of SEK 250,000 (£22,300) per quality-adjusted life year (QALY). Results. In the case study, slow, low, and delayed implementation was estimated to represent 22%, 34%, and 44% of the total population EVPIM (2941 QALYs or SEK 735 million), respectively. The value of eliminating implementation variation across health care regions was estimated to 39% of total EVPIM (1138 QALYs). Conclusion. Subcategorizing EVPIM estimates the absolute and relative value of eliminating different parts of suboptimal implementation. By doing so, this approach could help decision makers to identify which parts of suboptimal implementation are contributing most to total EVPIM and provide the basis for assessing the cost and benefit of implementation activities that may address these in future implementation of health care interventions.

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