scholarly journals Enablers for the adoption of e-health solutions: A knowledge synthesis (Preprint)

2020 ◽  
Author(s):  
Linn Nathalie Støme ◽  
Christian Ringnes Wilhelmsen ◽  
Kari Jorunn Kværner
Keyword(s):  
Data Management ◽  
User Involvement ◽  
Feasibility Studies ◽  
Lifestyle Changes ◽  
Sensor Technology ◽  
Public Healthcare ◽  
Successful Implementation ◽  
Health Coverage ◽  
User Friendliness ◽  
Health Technologies

BACKGROUND Globally, public healthcare is under increasing pressure, an economic burden currently amplified by the Covid-19 outbreak. With the recognition that Universal Health Coverage (UHC) improves the health of a population and reduces health inequalities, UHC has been acknowledged as a priority goal. To meet the global needs in a population with increased chronic illness and longer life expectancy, the healthcare system is in dire need of new, emerging technologies. New approaches to the delivery of e-health solutions have the potential to enhance quality of care and reduce health care costs. To guide us in the right direction to prioritize for sustainability, promising solutions are highlighted. If implemented sub-optimally the effectiveness of e-health can be compromised. OBJECTIVE This study aims to explore and thematically categorize early studies on e-health technologies that are under development or undergoing testing. Further, to assess enablers and barriers of e-health implementation. METHODS A structured search was performed in PubMed, Medline and Cochrane to identify and provide insight of current e-health technology and methodology under development. This review attempts to both highlight the future potential direction of e-health technologies and to present enablers and barriers of e-health implementation. RESULTS In total, 27 articles were included in this review and the clinical studies were categorized thematically by illness into the four technology types mobile apps/tablets & web-based technology, sensor technology, virtual reality and television. All e-health assessment and implementation studies were categorized by usability, scaling and data management. Assessment methods were divided into feasibility studies, qualitative studies and heuristic assessments. Studies focusing on usability (16/27) mainly addressed user involvement and learning curve issues, the majority of scaling studies (6/27) on strategical organization aspects of e-health. Studies focusing on data management (5/27) emphasized barriers to overcome in connection to unstructured data sets and data sensitivity. Data security and data processing, user involvement and feedback and transitioning from small- to largescale implementation were the most important factors considered critical for successful implementation of e-health. CONCLUSIONS E-health interventions have considerable potential to improve lifestyle changes and adherence to treatment recommendations. To be implemented and scaled, factors such as individualization, data management, user-friendliness and accessibility need to be addressed. E-health should be assessed during its development into health services. The wide variation in interventions and methodology makes comparison of the results challenging and calls for standardization of methods.

scholarly journals Socioeconomic and demographic trends in the prevalence of type 2 diabetes in India

2016 ◽  
Vol 04 (02) ◽  
pp. 090-101 ◽  
Author(s):  
Bikrant Kindo ◽  
Rana Himanshu ◽  
K. Parmar ◽  
S. Dube ◽  
J. Ramesh
Keyword(s):  
Diabetes Management ◽  
Lifestyle Changes ◽  
Essential Medicines ◽  
Noncommunicable Diseases ◽  
Public Healthcare ◽  
Chronic Obstructive ◽  
Health Coverage ◽  
Epidemiologic Transition ◽  
Unhealthy Lifestyle ◽  
The Government

AbstractNoncommunicable diseases (NCDs), also known as chronic diseases, are not passed from person to person. They are of long duration and generally slow progression. The four main types of NCDs are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes. The rapid demographic and epidemiologic transition that India is facing today is paralleled by a massive increase in NCD prevalence, of which diabetes remains the most dominant. Besides genetic and environmental factors, an increase in life expectancy, urbanization, influenced unhealthy lifestyle changes, affluence associated with dietary excess, and reduced physical activity appear to be major drivers for increased burden of diabetes in India. Inappropriate nutrition and physical inactivity lead to obesity, a positive predictor for diabetes. Moreover, early onset of diabetes accompanied by prevailing poverty, low awareness, and poor health consciousness across socioeconomic and demographic strata is reflected in the large burden of undiagnosed cases of diabetes. In addition, reversal of socioeconomic gradient of disease burden observed in India can have serious health and financial implications on individual and healthcare system, which, if left unaddressed, may result in an adverse impact on the nation's economy. Keeping in view, a major shift in India's burden of disease, there is an imperative need for robust, systematic measures for data reporting supported by effective public healthcare interventions to reduce the burden of diabetes. Comprehensive multisectoral actions prioritizing identification of risk factors, early diagnosis, and effective implementation of cost-effective interventions can curb the epidemic of diabetes. A multifaceted approach for implementation of evidence-based policy measures involving various departments of the government and nongovernmental agencies is required to address both preventive and curative aspects of diabetes management. Policies that ensure better surveillance and increase in access to affordable and essential medicines providing universal health coverage should be developed. Policymakers should take lead in the development or strengthening the existing policies and see that they are not only implemented but also evaluated for their effectiveness. A strong commitment from both public and private sectors toward implementation and intensification of population-based prevention strategies through proven programs and policies is required to address the growing burden of diabetes.

scholarly journals As predicted by theory: choice and competition in a publicly funded and regulated regional health system yield improved access and cost control

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jonas Wohlin ◽  
Clara Fischer ◽  
Karin Solberg Carlsson ◽  
Sara Korlén ◽  
Pamela Mazzocato ◽  
...  
Keyword(s):  
Cost Control ◽  
Care Quality ◽  
Patient Choice ◽  
Public Healthcare ◽  
Successful Implementation ◽  
Publicly Funded ◽  
Public And Private ◽  
Bundled Payment ◽  
Private Providers ◽  
Number Of Patients

Abstract Background New Public Management (NPM) has been widely used to introduce competition into public healthcare. Results have been mixed, and there has been much controversy about the appropriateness of a private sector-mimicking governance model in a public service. One voice in the debate suggested that rather than discussing whether competition is “good” or “bad” the emphasis should be on exploring the conditions for a successful implementation. Methods We report a longitudinal case study of the introduction of patient choice and allowing private providers to enter a publicly funded market. Patients in need of hip or knee replacement surgery are allowed to choose provider, and those are paid a fixed reimbursement for the full care episode (bundled payment). Providers are financially accountable for complications. Data on number of patients, waiting lists and times, costs to the public purchaser, and complications were collected from public registries. Providers were interviewed at three points in time during a nine-year follow-up period. Time-series of the quantitative data were exhibited and the views of actors involved were explored in a thematic analysis of the interviews. Results The policy goals of improving access to care and care quality while controlling total costs were achieved in a sustained way. Six themes were identified among actors interviewed and those were consistent over time. The design of the patient choice model was accepted, although all providers were discontent with the level of reimbursement. Providers felt that quality, timeliness of service and staff satisfaction had improved. Public and private providers differed in terms of patient-mix and developed different strategies to adjust to the reimbursement system. Private providers were more active in marketing and improving operation room efficiency. All providers intensified cooperation with referring physicians. Close attention was paid to following the rules set by the purchaser. Discussion and conclusions The sustained cost control was an effect of bundled payment. What this study shows is that both public and private providers adhere long-term to regulations by a public purchaser that also controls entrance to the market. The compensation was fixed and led to competition on quality, as predicted by theory.

scholarly journals ‘The nurse did not even greet me’: how informed versus non-informed patients evaluate health systems responsiveness in South Africa

2021 ◽  
Vol 6 (4) ◽  
pp. e004360
Author(s):  
Dumisani MacDonald Hompashe ◽  
Ulf-G Gerdtham ◽  
Carmen S Christian ◽  
Anja Smith ◽  
Ronelle Burger
Keyword(s):  
Health Systems ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Quality Care ◽  
Public Healthcare ◽  
Health Coverage ◽  
Access To Health Services ◽  
Healthcare Provision ◽  
Healthcare Facilities ◽  
Patients Experience

Introduction Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients’ experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction. Methods Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients’ exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients’ experiences of non-clinical dimensions. Results We show that when real patients (RPs) reported being satisfied (vs dissatisfied) with a visit, it was associated with a 30% increase in the probability that a patient is greeted at the facilities. Likewise, when the RPs reported being satisfied (vs dissatisfied) with the visit, it was correlated with a 15% increase in the prospect that patients are pleased with healthcare workers’ explanations of health conditions. Conclusion Informed patients are better equipped to assess health-systems responsiveness in healthcare provision. Insights into responsiveness could guide broader efforts aimed at targeted education and empowerment of primary healthcare users to strengthen health systems and shape expectations for appropriate care and conduct.

scholarly journals Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals

2021 ◽  
Vol 18 (16) ◽  
pp. 8700
Author(s):  
Reuben Ng ◽  
Kelvin Bryan Tan
Keyword(s):  
Hospital Admissions ◽  
Public Hospitals ◽  
Gradient Boosting ◽  
Care Utilization ◽  
Public Healthcare ◽  
Successful Implementation ◽  
Discharge Process ◽  
Gradient Boosting Machine ◽  
Cumulative Length ◽  
Risk Patients

Singapore is one of the first known countries to implement an individual-centric discharge process across all public hospitals to manage frequent admissions—a perennial challenge for public healthcare, especially in an aging population. Specifically, the process provides daily lists of high-risk patients to all public hospitals for customized discharge procedures within 24 h of admission. We analyzed all public hospital admissions (N = 150,322) in a year. Among four models, the gradient boosting machine performed the best (AUC = 0.79) with a positive predictive value set at 70%. Interestingly, the cumulative length of stay (LOS) in the past 12 months was a stronger predictor than the number of previous admissions, as it is a better proxy for acute care utilization. Another important predictor was the “number of days from previous non-elective admission”, which is different from previous studies that included both elective and non-elective admissions. Of note, the model did not include LOS of the index admission—a key predictor in other models—since our predictive model identified frequent admitters for pre-discharge interventions during the index (current) admission. The scientific ingredients that built the model did not guarantee its successful implementation—an “art” that requires the alignment of processes, culture, human capital, and senior management sponsorship. Change management is paramount, otherwise data-driven health policies, no matter how well-intended, may not be accepted or implemented. Overall, our study demonstrated the viability of using artificial intelligence (AI) to build a near real-time nationwide prediction tool for individual-centric discharge, and the critical factors for successful implementation.

scholarly journals History of health technology assessment: Spain

2009 ◽  
Vol 25 (S1) ◽  
pp. 163-173 ◽  
Author(s):  
Laura Sampietro-Colom ◽  
Jose Asua ◽  
Eduardo Briones ◽  
Jordi Gol ◽  
Keyword(s):  
Health Care ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Policy Decision ◽  
Health Technology ◽  
Policy Coordination ◽  
Public Healthcare ◽  
Regional Government ◽  
Health Care Environment ◽  
Health Technologies

Objectives: The aim of this study was to describe the characteristics of the introduction and diffusion of health technology assessment (HTA) in Spain.Methods: A survey to summarize the evolution of HTA was sent to representatives of different HTA initiatives in Spain.Results: HTA was introduced in the late 1980s. The main factors were the trend to an increase in healthcare expenditure, concerns regarding efficiency in providing health care, as well as in the level of rationality introducing high technology. Spain has direct (i.e., regulation) and indirect (i.e., payment systems, evidence-based programs, HTA) mechanisms to control health technologies. A recent high priority regulation has established the need of HTA to decide the introduction of a new health technology in the lists of public healthcare coverage, although similar regulations existed in the past and were scarcely implemented. HTA initiatives started at the regional government level. Its introduction followed a progressive pattern among regions. In the beginning, resources were scarce and expertise limited, with work done at intramural level. With time, expertise increase, and promotion of commissioned work was implemented. HTA knowledge transfer in the healthcare system has been carried out through courses, publications, and commissioned research. Currently, there are seven HTA units/agencies, which coordinate their work.Conclusions: HTA in Spain is in its maturity. Facing the unavoidable change of health care environment over time, HTA is also evolving and, currently, there is a trend to broaden the areas of influence of HTA by devolving capacity to hospitals and applying principles to very early phases of health technology development, under the umbrella of regional HTA units/agencies. However, there are two main challenges ahead. One is to have a real impact at the highest level of healthcare policy coordination among Spanish regions, which is done at the Central Ministry of Health. The other is to avoid the influence of political waves in the level of recognition of HTA at the policy decision-making level and to have an adequate and stable funding of HTA initiatives.

VP32 Improving The Efficiency Of Early Awareness For Non-Drugs In Spain

2017 ◽  
Vol 33 (S1) ◽  
pp. 162-163
Author(s):  
Iñaki Gutiérrez-Ibarluzea ◽  
Leonor Varela-Lema ◽  
Elena Baños ◽  
Setefilla Luengo-Matos ◽  
Aurora Llanos ◽  
...  
Keyword(s):  
Mass Media ◽  
Health System ◽  
New Technologies ◽  
Health Coverage ◽  
Benefit Package ◽  
Early Assessment ◽  
Public Provision ◽  
Health Technologies ◽  
Gynecology And Obstetrics ◽  
The Impact

INTRODUCTION:Early awareness and alert systems (EAAS) try to anticipate the impact of new technologies in the healthcare systems. Spain, which has a decentralized health system with public provision and universal health coverage, has been a pioneer in establishing EAAS activities. From 2006 a network of regional agencies coordinated EAAS activities. Taking into account the individual agencies scarce resources and in order to improve efficiency, this collaboration decided to distribute tasks when identifying and early assessment of new and emerging health technologies. The aim was to inform the common benefit package of the Spanish public health system.METHODS:Four out of eight Spanish Health Technology Assessment (HTA) agencies had EAAS in Spain (AETS-Carlos III Institute; AETSA-Andalusia; Avalia-t-Galicia; Osteba-Basque Country). Each agency has taken care of different sources for the identification of new and emerging non-drug health technologies: industry and innovator contacts, health expert networks, mass media and EAAS databases. Members of the network used the same filtration criteria to reach the final list. The system will run in parallel to a biannual identification process in major databases.RESULTS:In 2016, the network identified and filtered sixty-three technologies: ten by mass media; five by health experts; thirty-five other EAAS and thirteen by direct contact with industry and innovators. Main represented specialties were: endocrinology (seven); gynecology and obstetrics (six); cardiology and cardiac surgery (five); emergency medicine (four); dermatology (three) and pneumology (three). Technologies were grouped by specialty in order to inform the different commissions that discuss inclusion in the Spanish Benefit Package. Specialty monographs will be published to inform stakeholders.CONCLUSIONS:The approach is feasible, and increases the capacity of individual agencies to address the needs of the national and regional systems by improving their efficiency. There is a need to previously define the methods and the criteria that will be used for the identification and filtration.

scholarly journals Exploring the barriers and facilitators for the use of digital health technologies for the management of COPD: a qualitative study of clinician perceptions

QJM ◽  
2019 ◽  
Author(s):  
P Slevin ◽  
T Kessie ◽  
J Cullen ◽  
M W Butler ◽  
S C Donnelly ◽  
...  
Keyword(s):  
Digital Literacy ◽  
Resource Constraints ◽  
Digital Health ◽  
User Involvement ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Chronic Obstructive ◽  
Snowball Sampling ◽  
University Hospitals ◽  
Health Technologies

Abstract Background Digital health technology (DHT) promises to support patients and healthcare professionals (HCPs) to optimize the management of chronic obstructive pulmonary disease (COPD). However, there is a lack of evidence demonstrating the effectiveness of DHT for the management of COPD. One reason for this is the lack of user-involvement in the development of DHT interventions in COPD meaning their needs and preferences are rarely accounted for in the design phase. Although HCP adoption issues have been identified in relation to DHT, little is known about the challenges perceived by HCPs providing care to COPD patients. Therefore, this study aims to qualitatively explore the barriers and facilitators HCPs perceive for the use of DHT in the management of COPD. Methods Participants (n = 32) were recruited using snowball sampling from two university hospitals and several general practitioner clinics. A semi-structured interview was conducted with each participant. NVivo 12 software was used to complete thematic analysis on the data. Results Themes identified include: data quality; evidence-based care; resource constraints; and digital literacy presented as barriers; and facilitators include the following themes: digital health training and education; improving HCP digital literacy; and Personalized prescribing. Patient-centered approaches, such as pulmonary rehabilitation and shared decision-making were suggested as implementation strategies to ease the adoption of digital health for the management of COPD. Conclusion These findings contribute new insights about the needs and preferences of HCPs working in COPD regarding DHT. The findings can be used to help mitigate user-experience issues by informing the design of person-centered implementation and adoption strategies for future digital health interventions in COPD.

A Study of User Participation in Information Systems Development

1994 ◽  
Vol 9 (1) ◽  
pp. 51-60 ◽  
Author(s):  
Eva Y.W. Wong ◽  
Graham Tate
Keyword(s):  
System Development ◽  
User Involvement ◽  
User Participation ◽  
Successful Implementation ◽  
Implementation Success ◽  
Future Developments ◽  
Computer Based ◽  
Participation Process ◽  
Insight Into

User participation in information system development is considered to be an important factor influencing implementation success or failure. The ETHICS (Effective Technical and Human Implementation of Computer-based Systems) method was developed as a guide to user involvement in system design. A case study of successful implementation which did not use the ETHICS method explicitly is described. The case study and the ETHICS methodology are then compared and contrasted in an attempt to gain greater insight into user participation and to understand why the implementation was successful. Furthermore, techniques of software process modelling are applied to both ETHICS and the case study with the intention of more closely defining the user participation process and potentially also guiding it in future developments. The case study is used as a vehicle both to examine user participation and also to investigate the modelling of user participation.

scholarly journals DEVELOPMENT OF COVERAGE WITH EVIDENCE DEVELOPMENT FOR MEDICAL TECHNOLOGIES IN SWITZERLAND FROM 1996 TO 2012

2014 ◽  
Vol 30 (3) ◽  
pp. 253-259 ◽  
Author(s):  
Urs Brügger ◽  
Andreas Ruckstuhl ◽  
Bruno Horisberger ◽  
Alois Gratwohl
Keyword(s):  
Time Frame ◽  
National Registry ◽  
Successful Implementation ◽  
Final Decision ◽  
Health Technologies ◽  
Factors Associated ◽  
Medical Technologies ◽  
Initial Decision ◽  
Federal Department ◽  
Coverage With Evidence Development

Objectives: The aim of this study was to assess incidence, time frame, and outcome of “Coverage with Evidence Development” (CED) decisions in the Swiss Basic Health Insurance scheme.Methods: Analysis of all controversial medical technologies submitted to review by the Swiss Federal Office of Public Health (FOPH) from 1996 to 2012 with focus on decisions with constraints. Description of types of technology, type of initial decision, duration of evaluation period, final decision, and search for potential factors associated with changes over time.Results: Forty-five (37.5 percent) of 120 controversial health technologies were classified as “yes, in evaluation, reimbursed” for a certain period of time and thirty-five (29.2 percent) as “no, in evaluation, not reimbursed” by the Federal Department of Home Affairs from 1996 to 2012. The rate of CED decisions ranged between zero and nine per year and was influenced by type of technology and calendar year. Forty-four of forty-five decisions were subject to further restrictions, to a “center or a specialist” (76 percent), “indications” (49 percent), “registry” (31 percent), or “other” (49 percent). The time to a final decision ranged from 1.5 to 11 years (median, 6 years). No factors associated with initial decision and final outcome could be identified.Conclusions: CED as a reality in Switzerland might have enabled patients to obtain access to promising technologies early in their life cycle. CED might have acted as a trigger to a successful implementation of a comprehensive national registry. The lack of qualitative data stresses the urgent need for evaluation of the HTA decisions and their impact on patient outcome and costs.

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