Pub Date : 2024-11-17DOI: 10.1016/j.hlpt.2024.100951
Ehab Kamal , Iman A. F. Aboelsaad , Yousra A. El-Maradny , Rasha Ashmawy , Nermeen Gawish , Ahmed K. Selem , Dina Fawzy Abd Elsadek , Khaled Abdelghaffar
<div><h3>Introduction</h3><div>Telemedicine has gained momentum in healthcare, particularly in response to the COVID-19 pandemic. In Egypt, a government collaboration introduced telemedicine in 2019 to transform healthcare delivery.</div></div><div><h3>Objective</h3><div>This study provides an overview of Egypt's telemedicine initiative, focusing on its infrastructure, utilization, and perceived impact over three years.</div></div><div><h3>Methods</h3><div>A cross-sectional anonymous online survey of Ministry of Health and Population (MoHP) physicians using telemedicine services was conducted. The survey estimated perceived cost savings and reductions in healthcare delivery wait times, along with identifying facilitators and barriers to telemedicine implementation. It captured sociodemographic characteristics and physician opinions on telemedicine benefits, including perceived face-to-face consultation costs and wait times. The descriptive analysis summarized these findings.</div></div><div><h3>Results</h3><div>Egypt's telemedicine system includes 200 Distance Medical Diagnosis Units (DMDUs) across governorates. By August 2023, over 97,000 consultations were completed, with consultations tripling in 2023 compared to 2020-2022. Dermatology, internal medicine, and pediatrics were the most requested specialties, with tuberculosis and clinical pharmacy added in 2023. Responses from 214 physicians revealed that nearly 90% estimated external consultation costs under 1000 EGP (32.4 USD), compared to the free telemedicine consultations available to patients. For inpatient consultations, 35% reported waiting times of a day or less. Challenges included technical issues and patient acceptance.</div></div><div><h3>Conclusion</h3><div>The study offers insights for policymakers to optimize telemedicine services, improve healthcare access, and reduce disparities in Egypt, showing telemedicine's potential to enhance healthcare delivery and patient outcomes.</div></div><div><h3>Public interest summary</h3><div>Telemedicine has become a crucial tool in healthcare, especially after the COVID-19 pandemic. In Egypt, a collaboration between government ministries launched a telemedicine initiative in 2019. This study explores its impact over three years, focusing on the benefits and challenges of telemedicine as perceived by physicians. The findings are based on a survey of 214 doctors from 21 governorates who use the Ministry of Health and Population's telemedicine services. Results showed that over 97,000 consultations had been performed by mid-2023, with specialties like dermatology and pediatrics in high demand. Most doctors reported significant cost savings for patients compared to face-to-face consultations. However, challenges remain, particularly technical issues and patient acceptance. The study highlights the potential of telemedicine to improve healthcare access and reduce costs, offering valuable insights for policymakers to optimize the system and promote
{"title":"An insight into the implementation, utilization, and evaluation of telemedicine e-consultation services in Egypt","authors":"Ehab Kamal , Iman A. F. Aboelsaad , Yousra A. El-Maradny , Rasha Ashmawy , Nermeen Gawish , Ahmed K. Selem , Dina Fawzy Abd Elsadek , Khaled Abdelghaffar","doi":"10.1016/j.hlpt.2024.100951","DOIUrl":"10.1016/j.hlpt.2024.100951","url":null,"abstract":"<div><h3>Introduction</h3><div>Telemedicine has gained momentum in healthcare, particularly in response to the COVID-19 pandemic. In Egypt, a government collaboration introduced telemedicine in 2019 to transform healthcare delivery.</div></div><div><h3>Objective</h3><div>This study provides an overview of Egypt's telemedicine initiative, focusing on its infrastructure, utilization, and perceived impact over three years.</div></div><div><h3>Methods</h3><div>A cross-sectional anonymous online survey of Ministry of Health and Population (MoHP) physicians using telemedicine services was conducted. The survey estimated perceived cost savings and reductions in healthcare delivery wait times, along with identifying facilitators and barriers to telemedicine implementation. It captured sociodemographic characteristics and physician opinions on telemedicine benefits, including perceived face-to-face consultation costs and wait times. The descriptive analysis summarized these findings.</div></div><div><h3>Results</h3><div>Egypt's telemedicine system includes 200 Distance Medical Diagnosis Units (DMDUs) across governorates. By August 2023, over 97,000 consultations were completed, with consultations tripling in 2023 compared to 2020-2022. Dermatology, internal medicine, and pediatrics were the most requested specialties, with tuberculosis and clinical pharmacy added in 2023. Responses from 214 physicians revealed that nearly 90% estimated external consultation costs under 1000 EGP (32.4 USD), compared to the free telemedicine consultations available to patients. For inpatient consultations, 35% reported waiting times of a day or less. Challenges included technical issues and patient acceptance.</div></div><div><h3>Conclusion</h3><div>The study offers insights for policymakers to optimize telemedicine services, improve healthcare access, and reduce disparities in Egypt, showing telemedicine's potential to enhance healthcare delivery and patient outcomes.</div></div><div><h3>Public interest summary</h3><div>Telemedicine has become a crucial tool in healthcare, especially after the COVID-19 pandemic. In Egypt, a collaboration between government ministries launched a telemedicine initiative in 2019. This study explores its impact over three years, focusing on the benefits and challenges of telemedicine as perceived by physicians. The findings are based on a survey of 214 doctors from 21 governorates who use the Ministry of Health and Population's telemedicine services. Results showed that over 97,000 consultations had been performed by mid-2023, with specialties like dermatology and pediatrics in high demand. Most doctors reported significant cost savings for patients compared to face-to-face consultations. However, challenges remain, particularly technical issues and patient acceptance. The study highlights the potential of telemedicine to improve healthcare access and reduce costs, offering valuable insights for policymakers to optimize the system and promote ","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 6","pages":"Article 100951"},"PeriodicalIF":3.4,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Value-based pricing (VBP) could improve allocation of healthcare resources. We created and evaluated a simple VBP method that qualitatively considers broad values for drugs.
Method
First, we established the value elements that determine the value of drugs. Then, we decided on the criteria for scoring the value elements, constructed a method for estimating daily drug prices from the value elements and the maximum number of patients, and used this framework to estimate daily drug prices.
Results
Four base value elements and 8 additional elements were identified. We applied our scoring criteria to calculate scores for 39 drugs already listed in Japan and estimated the daily drug price of each drug by creating a conversion table of base drug prices according to base points and maximum number of patients and adding points for additional elements. For all hepatitis C drugs, the estimated daily drug prices were lower than the actual prices, whereas for the other drugs, they were higher or, in some cases, lower.
Conclusion
Our VBP framework comprises 4 steps: 1. gathering information on value elements; 2. scoring value elements; 3. calculating the base drug price from the base points and the maximum number of patients by using the conversion table; and 4. calculating the daily drug price by adding points for additional value elements. Our framework, which we refer to as MARIE (multiple criteria qualitative value-based pricing framework), is a versatile, practical, and simple option for pricing new drugs that can be easily adapted to different healthcare environments.
Public Interest Summary
Drug prices do not necessarily reflect the values provided by drugs in Japanese current drug pricing system. It is not fully discussed how to quantify the value of drugs for prices by considering a broad range of value elements. We created and evaluated VBP method for drug pricing that would be applicable in Japan considering the current pharmaceutical regulations, medical environment, and availability of data at the timing of pricing negotiation process for new drugs. The study summarizes the value elements to be considered in determining drug prices and proposed VBP framework. It also revealed that qualitative factors can be used for drug pricing. Our proposed approach for drug pricing system enables to capture and reflect broader values of new drug.
{"title":"Multiple criteria qualitative value-based pricing framework “MARIE” for new drugs","authors":"Akina Takami , Masafumi Kato , Hisato Deguchi , Ataru Igarashi","doi":"10.1016/j.hlpt.2024.100928","DOIUrl":"10.1016/j.hlpt.2024.100928","url":null,"abstract":"<div><h3>Objectives</h3><div>Value-based pricing (VBP) could improve allocation of healthcare resources. We created and evaluated a simple VBP method that qualitatively considers broad values for drugs.</div></div><div><h3>Method</h3><div>First, we established the value elements that determine the value of drugs. Then, we decided on the criteria for scoring the value elements, constructed a method for estimating daily drug prices from the value elements and the maximum number of patients, and used this framework to estimate daily drug prices.</div></div><div><h3>Results</h3><div>Four base value elements and 8 additional elements were identified. We applied our scoring criteria to calculate scores for 39 drugs already listed in Japan and estimated the daily drug price of each drug by creating a conversion table of base drug prices according to base points and maximum number of patients and adding points for additional elements. For all hepatitis C drugs, the estimated daily drug prices were lower than the actual prices, whereas for the other drugs, they were higher or, in some cases, lower.</div></div><div><h3>Conclusion</h3><div>Our VBP framework comprises 4 steps: 1. gathering information on value elements; 2. scoring value elements; 3. calculating the base drug price from the base points and the maximum number of patients by using the conversion table; and 4. calculating the daily drug price by adding points for additional value elements. Our framework, which we refer to as MARIE (multiple criteria qualitative value-based pricing framework), is a versatile, practical, and simple option for pricing new drugs that can be easily adapted to different healthcare environments.</div></div><div><h3>Public Interest Summary</h3><div>Drug prices do not necessarily reflect the values provided by drugs in Japanese current drug pricing system. It is not fully discussed how to quantify the value of drugs for prices by considering a broad range of value elements. We created and evaluated VBP method for drug pricing that would be applicable in Japan considering the current pharmaceutical regulations, medical environment, and availability of data at the timing of pricing negotiation process for new drugs. The study summarizes the value elements to be considered in determining drug prices and proposed VBP framework. It also revealed that qualitative factors can be used for drug pricing. Our proposed approach for drug pricing system enables to capture and reflect broader values of new drug.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 6","pages":"Article 100928"},"PeriodicalIF":3.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142651572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.1016/j.hlpt.2024.100942
Valerie Boksa , Priyadarshini Pennathur
Objective
The prevalence of burnout among healthcare providers has been steadily increasing, with a call to action issued in 2019. Immediately following this call to action, the COVID-19 pandemic drastically changed demand. Use of telemedicine expanded in response to COVID-19 and changed the experience of care delivery for healthcare providers. The impact of telemedicine use during COVID-19 on provider well-being is less well known. This study aims to assess the prevalence of burnout in providers who used telemedicine and to better understand which aspects of telemedicine exacerbate or alleviate provider burnout.
Methods
Providers in urgent care clinics were invited to participate in a burnout assessment survey using the Maslach Burnout Inventory questionnaire. The prevalence of burnout, burnout profiles, and correlations were analyzed in the resulting data. Follow-up interviews provided further insight on contributing and mediating factors of telemedicine on provider burnout.
Results
Survey results showed that 25 % of the respondents reported one or more burnout manifestations. Contributing and mediating factors were categorized to provide a framework to understand the risk and benefits this technology can pose to workplace stress.
Discussion
The findings from this study provide technology- and organizational-level recommendations to prevent increased risk of burnout among telemedicine providers. Future research recommendations to better quantify the relationship between burnout and telemedicine use and to effectively design intervention and implementation strategies are discussed.
Public interest summary
Considering the high rates of burnout in the healthcare industry prior to the pandemic, the severe demands the COVID-19 pandemic had on healthcare workers, and the drastic workflow changes due to the widespread adoption of telemedicine, it is important to assess current provider burnout levels and collect frontline clinician insights on how telemedicine positively or negatively influences workplace stress. A survey was administered to assess burnout in healthcare workers who provided care via telemedicine. Interviews provided additional insight on how telemedicine affected workplace stress. Survey results showed that 25 % of the respondents reported one or more manifestations of burnout. A correlation was found between personal accomplishment scores and reported months of telemedicine use. Interview and literature findings identified telemedicine design and use characteristics that contributed to and/or alleviated burnout. Results address how organizations can best support their employees who administer care via telemedicine and recommend future studies for research.
{"title":"Assessing contributing and mediating factors of telemedicine on healthcare provider burnout","authors":"Valerie Boksa , Priyadarshini Pennathur","doi":"10.1016/j.hlpt.2024.100942","DOIUrl":"10.1016/j.hlpt.2024.100942","url":null,"abstract":"<div><h3>Objective</h3><div>The prevalence of burnout among healthcare providers has been steadily increasing, with a call to action issued in 2019. Immediately following this call to action, the COVID-19 pandemic drastically changed demand. Use of telemedicine expanded in response to COVID-19 and changed the experience of care delivery for healthcare providers. The impact of telemedicine use during COVID-19 on provider well-being is less well known. This study aims to assess the prevalence of burnout in providers who used telemedicine and to better understand which aspects of telemedicine exacerbate or alleviate provider burnout.</div></div><div><h3>Methods</h3><div>Providers in urgent care clinics were invited to participate in a burnout assessment survey using the Maslach Burnout Inventory questionnaire. The prevalence of burnout, burnout profiles, and correlations were analyzed in the resulting data. Follow-up interviews provided further insight on contributing and mediating factors of telemedicine on provider burnout.</div></div><div><h3>Results</h3><div>Survey results showed that 25 % of the respondents reported one or more burnout manifestations. Contributing and mediating factors were categorized to provide a framework to understand the risk and benefits this technology can pose to workplace stress.</div></div><div><h3>Discussion</h3><div>The findings from this study provide technology- and organizational-level recommendations to prevent increased risk of burnout among telemedicine providers. Future research recommendations to better quantify the relationship between burnout and telemedicine use and to effectively design intervention and implementation strategies are discussed.</div></div><div><h3>Public interest summary</h3><div>Considering the high rates of burnout in the healthcare industry prior to the pandemic, the severe demands the COVID-19 pandemic had on healthcare workers, and the drastic workflow changes due to the widespread adoption of telemedicine, it is important to assess current provider burnout levels and collect frontline clinician insights on how telemedicine positively or negatively influences workplace stress. A survey was administered to assess burnout in healthcare workers who provided care via telemedicine. Interviews provided additional insight on how telemedicine affected workplace stress. Survey results showed that 25 % of the respondents reported one or more manifestations of burnout. A correlation was found between personal accomplishment scores and reported months of telemedicine use. Interview and literature findings identified telemedicine design and use characteristics that contributed to and/or alleviated burnout. Results address how organizations can best support their employees who administer care via telemedicine and recommend future studies for research.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 6","pages":"Article 100942"},"PeriodicalIF":3.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-12DOI: 10.1016/j.hlpt.2024.100943
James A Strachan
Introduction
Satisfactory sensitivity in screening articles for appropriate inclusion in systematic reviews has not yet been achieved using the group of GPT artificial intelligence (AI) systems. One issue in designing prompts for article screening is that while most of the prompt can be validated before use, i.e. on previously published systematic reviews, the part containing the inclusion criteria cannot. This study aimed to advance work in this area by trying to identify a prompt that is robust to variations in the precise wording of inclusion criteria. Prompts with this property should be able to achieve more consistent performance when applied to similar systematic reviews of health topics.
Methods
A prompt, into which alternative wordings (variants) of inclusion criteria could be inserted, was tested on a training dataset of articles identified during the re-run of electronic searches for a single published review. Modification and re-testing of the prompt was undertaken until satisfactory screening sensitivity across six different inclusion criteria variants was achieved. This prompt was then validated by assessing its performance on three “test” datasets, derived from re-run electronic searches from three different reviews.
Results
A prompt was successfully developed using the training dataset that achieved sensitivities of 95.8 %, 100.0 % & 100.0 % respectively in the three test datasets derived from the three different reviews.
Discussion
Iterative design and testing on inclusion criteria variants produced a prompt that consistently achieved satisfactory screening sensitivity. The classification process was fast, cheap and had high specificity.
Public Interest Summary
Systematic reviews summarise all articles that have tried to answer scientific questions. They are usually the gold standard of evidence in medical science and widely inform healthcare policy. However, they are very expensive and time consuming to write. The initial stage of writing systematic reviews consists of reviewing potentially tens of thousands of scientific abstracts. This process may be able to be automated by artificial intelligence (AI) including GPT3 an AI system operated by OpenAI. Previous attempts to use closely related AI models have not worked likely in part because GPT3´s performance is strongly dependant on the exact instructions or “prompts” given to GPT3. This study investigated a new method of designing these prompts which consistently achieved satisfactory screening performance when tested on articles collected for three previously published systematic reviews.
{"title":"Designing GTP3 prompts to screen articles for systematic reviews of RCTs","authors":"James A Strachan","doi":"10.1016/j.hlpt.2024.100943","DOIUrl":"10.1016/j.hlpt.2024.100943","url":null,"abstract":"<div><h3>Introduction</h3><div>Satisfactory sensitivity in screening articles for appropriate inclusion in systematic reviews has not yet been achieved using the group of GPT artificial intelligence (AI) systems. One issue in designing prompts for article screening is that while most of the prompt can be validated before use, i.e. on previously published systematic reviews, the part containing the inclusion criteria cannot. This study aimed to advance work in this area by trying to identify a prompt that is robust to variations in the precise wording of inclusion criteria. Prompts with this property should be able to achieve more consistent performance when applied to similar systematic reviews of health topics.</div></div><div><h3>Methods</h3><div>A prompt, into which alternative wordings (variants) of inclusion criteria could be inserted, was tested on a training dataset of articles identified during the re-run of electronic searches for a single published review. Modification and re-testing of the prompt was undertaken until satisfactory screening sensitivity across six different inclusion criteria variants was achieved. This prompt was then validated by assessing its performance on three “test” datasets, derived from re-run electronic searches from three different reviews.</div></div><div><h3>Results</h3><div>A prompt was successfully developed using the training dataset that achieved sensitivities of 95.8 %, 100.0 % & 100.0 % respectively in the three test datasets derived from the three different reviews.</div></div><div><h3>Discussion</h3><div>Iterative design and testing on inclusion criteria variants produced a prompt that consistently achieved satisfactory screening sensitivity. The classification process was fast, cheap and had high specificity.</div></div><div><h3>Public Interest Summary</h3><div>Systematic reviews summarise all articles that have tried to answer scientific questions. They are usually the gold standard of evidence in medical science and widely inform healthcare policy. However, they are very expensive and time consuming to write. The initial stage of writing systematic reviews consists of reviewing potentially tens of thousands of scientific abstracts. This process may be able to be automated by artificial intelligence (AI) including GPT3 an AI system operated by OpenAI. Previous attempts to use closely related AI models have not worked likely in part because GPT3´s performance is strongly dependant on the exact instructions or “prompts” given to GPT3. This study investigated a new method of designing these prompts which consistently achieved satisfactory screening performance when tested on articles collected for three previously published systematic reviews.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 1","pages":"Article 100943"},"PeriodicalIF":3.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-10DOI: 10.1016/j.hlpt.2024.100941
Jan Domaradzki , Katarzyna Głodowska , Piotr Jabkowski
Objectives
Blood transfusions (BTs) are generally safe and potentially life-saving but come with risks. The World Health Organization advocates reducing unnecessary transfusions and using patient blood management strategies and techniques. However, providing bloodless medical care to patients who prefer to avoid blood-related treatments is a challenge. This is because healthcare professionals’ beliefs about blood transfusion may not align with those of their patients. This study delves into Polish nursing personnel's attitudes toward bloodless medicine (BM), highlighting the potential gap between their knowledge and patient needs.
Methods
We conducted an online survey amongst 202 Polish nurses on non-blood management techniques, risks related to BT and BM, and nurses’ educational needs regarding BM.
Results
Although many nurses had some knowledge of BM, Polish nurses’ awareness of non-blood management techniques is relatively low: while less than half knew alternative treatment methods and drugs used in BM, many were unaware of the various risks or side effects related to BM. It also shows that more than three-quarters of nurses believed that patients should have the right to make an informed refusal of BT. While 87.1 % of nurses rated their knowledge about BM insufficient or very poor, 66.3 % did not feel prepared to care for patients who require non-blood management techniques.
Conclusions
This study underscores the urgent need to educate nurses on blood conservation methods, blood substitutes, and techniques of non-blood management. Incorporating these into the nursing curriculum is crucial for patients’ safety and well-being and our healthcare system's effectiveness. The potential, impact of these findings on the healthcare system is significant, underlining the urgency and importance of addressing the knowledge gap in non-blood management techniques.
Public interest summary
Although the World Health Organization recommends using non-blood management techniques, most nurses providing bloodless medical care to patients who wish to avoid blood transfusion do not feel prepared to care for such patients. This study describes the attitudes of Polish nursing personnel toward bloodless medicine. It demonstrates that Polish nurses do not possess knowledge of non-blood management techniques, and their awareness of patient blood management methods and drugs used in bloodless medicine is low. However, it also reveals a positive aspect: Most Polish nurses are interested in broadening their knowledge of bloodless medicine. This strong motivation to improve their skills and knowledge in this area is encouraging and should be harnessed to drive positive change in the field of bloodless medicine.
{"title":"When blood is not an option. The awareness of bloodless medicine among Polish nurses","authors":"Jan Domaradzki , Katarzyna Głodowska , Piotr Jabkowski","doi":"10.1016/j.hlpt.2024.100941","DOIUrl":"10.1016/j.hlpt.2024.100941","url":null,"abstract":"<div><h3>Objectives</h3><div>Blood transfusions (BTs) are generally safe and potentially life-saving but come with risks. The World Health Organization advocates reducing unnecessary transfusions and using patient blood management strategies and techniques. However, providing bloodless medical care to patients who prefer to avoid blood-related treatments is a challenge. This is because healthcare professionals’ beliefs about blood transfusion may not align with those of their patients. This study delves into Polish nursing personnel's attitudes toward bloodless medicine (BM), highlighting the potential gap between their knowledge and patient needs.</div></div><div><h3>Methods</h3><div>We conducted an online survey amongst 202 Polish nurses on non-blood management techniques, risks related to BT and BM, and nurses’ educational needs regarding BM.</div></div><div><h3>Results</h3><div>Although many nurses had some knowledge of BM, Polish nurses’ awareness of non-blood management techniques is relatively low: while less than half knew alternative treatment methods and drugs used in BM, many were unaware of the various risks or side effects related to BM. It also shows that more than three-quarters of nurses believed that patients should have the right to make an informed refusal of BT. While 87.1 % of nurses rated their knowledge about BM insufficient or very poor, 66.3 % did not feel prepared to care for patients who require non-blood management techniques.</div></div><div><h3>Conclusions</h3><div>This study underscores the urgent need to educate nurses on blood conservation methods, blood substitutes, and techniques of non-blood management. Incorporating these into the nursing curriculum is crucial for patients’ safety and well-being and our healthcare system's effectiveness. The potential, impact of these findings on the healthcare system is significant, underlining the urgency and importance of addressing the knowledge gap in non-blood management techniques.</div></div><div><h3>Public interest summary</h3><div>Although the World Health Organization recommends using non-blood management techniques, most nurses providing bloodless medical care to patients who wish to avoid blood transfusion do not feel prepared to care for such patients. This study describes the attitudes of Polish nursing personnel toward bloodless medicine. It demonstrates that Polish nurses do not possess knowledge of non-blood management techniques, and their awareness of patient blood management methods and drugs used in bloodless medicine is low. However, it also reveals a positive aspect: Most Polish nurses are interested in broadening their knowledge of bloodless medicine. This strong motivation to improve their skills and knowledge in this area is encouraging and should be harnessed to drive positive change in the field of bloodless medicine.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 6","pages":"Article 100941"},"PeriodicalIF":3.4,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142651677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-07DOI: 10.1016/j.hlpt.2024.100940
Esther Chicharro-Luna , Gabriel Gijón-Nogueron , Angela M.F. Evans , Alfonso Martínez-Nova
Background
Sustainability in healthcare is crucial due to the sector's significant contribution to global greenhouse gas emissions. Medical practices must address environmental impact while maintaining high-quality care and equitable access. In podiatry, sustainable practices can reduce the environmental footprint of clinics and improve long-term healthcare outcomes by promoting prevention and resource efficiency.
Study design
Cross sectional study.
Method
We conducted an online survey with 357 practicing podiatrists, all registered with the General Council of Podiatrists of Spain and with at least one year of professional experience. The survey contained 26 questions focused on sustainability in healthcare, podiatry practices, and environmental impact. The questionnaire included both closed-ended questions and Likert-scale items. Responses were scored and categorized into arbitrary sustainability categories: low (<12), medium (12 to 25), and high (>25).
Results
Most respondents (82.6 %) did not regularly use public transport, and 14 % did not engage in any form of physical exercise. More than half of the sample were unaware of the United Nations Sustainable Development Goals (SDGs). Almost all (98 %) had not measured the carbon footprint of their clinics, yet 34.7 % planned to optimise energy consumption in their clinics. Overall, 41.7 % were categorized as low sustainability, 56.9 % medium, and 1.4 % met high sustainability.
Conclusions
Podiatry clinics in Spain demonstrate low sustainability actions and knowledge. Sustainable practice aligns with global environment healthcare urgency, and ensures more responsible podiatric services. This study provides the first baseline data for this issue, availing comparisons across global podiatric healthcare sectors.
{"title":"Evaluating sustainability awareness and practices in podiatry clinics in Spain: A path toward a healthy and sustainable future","authors":"Esther Chicharro-Luna , Gabriel Gijón-Nogueron , Angela M.F. Evans , Alfonso Martínez-Nova","doi":"10.1016/j.hlpt.2024.100940","DOIUrl":"10.1016/j.hlpt.2024.100940","url":null,"abstract":"<div><h3>Background</h3><div>Sustainability in healthcare is crucial due to the sector's significant contribution to global greenhouse gas emissions. Medical practices must address environmental impact while maintaining high-quality care and equitable access. In podiatry, sustainable practices can reduce the environmental footprint of clinics and improve long-term healthcare outcomes by promoting prevention and resource efficiency.</div></div><div><h3>Study design</h3><div>Cross sectional study.</div></div><div><h3>Method</h3><div>We conducted an online survey with 357 practicing podiatrists, all registered with the General Council of Podiatrists of Spain and with at least one year of professional experience. The survey contained 26 questions focused on sustainability in healthcare, podiatry practices, and environmental impact. The questionnaire included both closed-ended questions and Likert-scale items. Responses were scored and categorized into arbitrary sustainability categories: low (<12), medium (12 to 25), and high (>25).</div></div><div><h3>Results</h3><div>Most respondents (82.6 %) did not regularly use public transport, and 14 % did not engage in any form of physical exercise. More than half of the sample were unaware of the United Nations Sustainable Development Goals (SDGs). Almost all (98 %) had not measured the carbon footprint of their clinics, yet 34.7 % planned to optimise energy consumption in their clinics. Overall, 41.7 % were categorized as low sustainability, 56.9 % medium, and 1.4 % met high sustainability.</div></div><div><h3>Conclusions</h3><div>Podiatry clinics in Spain demonstrate low sustainability actions and knowledge. Sustainable practice aligns with global environment healthcare urgency, and ensures more responsible podiatric services. This study provides the first baseline data for this issue, availing comparisons across global podiatric healthcare sectors.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 6","pages":"Article 100940"},"PeriodicalIF":3.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142651574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-06DOI: 10.1016/j.hlpt.2024.100926
Jedidja Lok-Visser , Jobbe P.L. Leenen , Heleen M. den Hertog , Gina van Vemde , Jeroen Rekveldt , Jan W.K. van den Berg , Gijs A. Patijn , Judith R. Cornelisse-Vermaat , Gréanne Leeftink , Jan Gerard Maring
Objectives
To present a prospective cost analysis (PCA) model for estimating the financial impact of Connected Care interventions in hospitals to support managerial decision-making, and describe its application to three different care pathways.
Methods
Input of the developed PCA model consisted of standard of care input and intervention-specific input. The output of the model included: capacity benefits, costs, and reimbursements. The model was applied to three types of interventions in a large Dutch teaching hospital: 1) home telemonitoring for chronic patients (case (COPD), 2) remote aftercare for patients with acute illnesses (case: stroke), and 3) parenteral medication administration at home (case: prosthetic hip or knee joint infections).
Results
Output of the PCA model showed that the cost savings can exceed the intervention costs if an intervention decreases the length of stay of patients. For COPD telemonitoring 10.1 % of the healthcare utilization should be reduced to reach break-even, and for antibiotic treatment at home break-even is reached if 4.6 % of the length of stay is reduced. The cost savings of remote aftercare for stroke patients is focused on reducing outpatient visits, and in the current Dutch reimbursement system this does not completely cover the costs.
Conclusions
The PCA model is an easy to implement and useful tool for assessing the financial impact of CC interventions from a hospital perspective. It supports decision makers to prospectively assess the cost and capacity benefits of interventions and to inform decisions on implementation. Further studies are needed to extend the model across the entire healthcare continuum.
Public interest summary
We present a prospective cost analysis (PCA) model for estimating the financial impact of Connected Care interventions in hospitals to support managerial decision-making. Connected Care interventions are based on an integrated care approach utilizing digital health technologies to enhance patient-centred, collaborative care, where patients receive care at home. Examples are telemonitoring of chronic obstructive pulmonary disease (COPD) patients, remote aftercare for stroke patients and infusion treatment at home for orthopaedic patients with an infection. These interventions have additional costs, but also save part of the costs of the conventional care, and have benefits in terms of a decrease in outpatient visits or hospitalizations. We provide a model where a hospital can calculate the impact in costs and benefits of Connected Care interventions and test this on these three examples. We show that the cost savings are able to exceed the intervention costs if an intervention has impact on the hospitalization.
{"title":"A prospective cost analysis model for financial impact of Connected Care interventions on hospitals’ budget","authors":"Jedidja Lok-Visser , Jobbe P.L. Leenen , Heleen M. den Hertog , Gina van Vemde , Jeroen Rekveldt , Jan W.K. van den Berg , Gijs A. Patijn , Judith R. Cornelisse-Vermaat , Gréanne Leeftink , Jan Gerard Maring","doi":"10.1016/j.hlpt.2024.100926","DOIUrl":"10.1016/j.hlpt.2024.100926","url":null,"abstract":"<div><h3>Objectives</h3><div>To present a prospective cost analysis (PCA) model for estimating the financial impact of Connected Care interventions in hospitals to support managerial decision-making, and describe its application to three different care pathways.</div></div><div><h3>Methods</h3><div>Input of the developed PCA model consisted of standard of care input and intervention-specific input. The output of the model included: capacity benefits, costs, and reimbursements. The model was applied to three types of interventions in a large Dutch teaching hospital: 1) home telemonitoring for chronic patients (case (COPD), 2) remote aftercare for patients with acute illnesses (case: stroke), and 3) parenteral medication administration at home (case: prosthetic hip or knee joint infections).</div></div><div><h3>Results</h3><div>Output of the PCA model showed that the cost savings can exceed the intervention costs if an intervention decreases the length of stay of patients. For COPD telemonitoring 10.1 % of the healthcare utilization should be reduced to reach break-even, and for antibiotic treatment at home break-even is reached if 4.6 % of the length of stay is reduced. The cost savings of remote aftercare for stroke patients is focused on reducing outpatient visits, and in the current Dutch reimbursement system this does not completely cover the costs.</div></div><div><h3>Conclusions</h3><div>The PCA model is an easy to implement and useful tool for assessing the financial impact of CC interventions from a hospital perspective. It supports decision makers to prospectively assess the cost and capacity benefits of interventions and to inform decisions on implementation. Further studies are needed to extend the model across the entire healthcare continuum.</div></div><div><h3>Public interest summary</h3><div>We present a prospective cost analysis (PCA) model for estimating the financial impact of Connected Care interventions in hospitals to support managerial decision-making. Connected Care interventions are based on an integrated care approach utilizing digital health technologies to enhance patient-centred, collaborative care, where patients receive care at home. Examples are telemonitoring of chronic obstructive pulmonary disease (COPD) patients, remote aftercare for stroke patients and infusion treatment at home for orthopaedic patients with an infection. These interventions have additional costs, but also save part of the costs of the conventional care, and have benefits in terms of a decrease in outpatient visits or hospitalizations. We provide a model where a hospital can calculate the impact in costs and benefits of Connected Care interventions and test this on these three examples. We show that the cost savings are able to exceed the intervention costs if an intervention has impact on the hospitalization.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 6","pages":"Article 100926"},"PeriodicalIF":3.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142651676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1016/j.hlpt.2024.100939
Radwa Ahmed Batran , Mohab Kamel , Ayman Bahr , Ahmed Khalil , Mohamed Elsokary
The shift from volume-driven healthcare to value-driven healthcare, or value-based healthcare (VBHC), emerged in the 1990s, prioritizing healthcare quality over quantity. VBHC enjoys support from various healthcare stakeholders, emphasizing patient-centric outcomes that resonate with individual health experiences. Cancer is a major global cause of death, with low- and middle-income countries (LMICs) bearing a significant burden, particularly in the Middle East and North Africa (MENA) region, which is expected to witness a surge in cancer cases due to conflicts, changing demographics, and environmental factors. The MENA oncology market is poised for growth, fueled by biomarkers and targeted therapies. However, the MENA region's diversity leads to disparities in cancer care access and outcomes. Countries throughout the MENA region are presently in the midst of a substantial transformation of their healthcare systems. A number of MENA nations have taken steps to transition towards value-based care, recognizing its potential to reduce healthcare costs, enhance the quality of healthcare services, and promote healthier lifestyles among the populace. This review aims to highlight the ongoing initiatives within the MENA region toward implementing value-based cancer care. It also underscores the challenges associated with this transition while presenting a pragmatic and viable plan for the widespread adoption of value-based cancer care in the MENA region.
{"title":"Value-based healthcare in oncology: Can it drive transformative shifts in the Middle East and North Africa region?","authors":"Radwa Ahmed Batran , Mohab Kamel , Ayman Bahr , Ahmed Khalil , Mohamed Elsokary","doi":"10.1016/j.hlpt.2024.100939","DOIUrl":"10.1016/j.hlpt.2024.100939","url":null,"abstract":"<div><div>The shift from volume-driven healthcare to value-driven healthcare, or value-based healthcare (VBHC), emerged in the 1990s, prioritizing healthcare quality over quantity. VBHC enjoys support from various healthcare stakeholders, emphasizing patient-centric outcomes that resonate with individual health experiences. Cancer is a major global cause of death, with low- and middle-income countries (LMICs) bearing a significant burden, particularly in the Middle East and North Africa (MENA) region, which is expected to witness a surge in cancer cases due to conflicts, changing demographics, and environmental factors. The MENA oncology market is poised for growth, fueled by biomarkers and targeted therapies. However, the MENA region's diversity leads to disparities in cancer care access and outcomes. Countries throughout the MENA region are presently in the midst of a substantial transformation of their healthcare systems. A number of MENA nations have taken steps to transition towards value-based care, recognizing its potential to reduce healthcare costs, enhance the quality of healthcare services, and promote healthier lifestyles among the populace. This review aims to highlight the ongoing initiatives within the MENA region toward implementing value-based cancer care. It also underscores the challenges associated with this transition while presenting a pragmatic and viable plan for the widespread adoption of value-based cancer care in the MENA region.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 6","pages":"Article 100939"},"PeriodicalIF":3.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1016/j.hlpt.2024.100938
Vinaytosh Mishra , Zahiruddin Quazi Syed
Aim
This study aims to identify the criteria for the evaluation of medical technologies in diabetes screening and then perform health technology assessment (HTA) for two technologies: digital retina imaging (DRI) and Nailfold Capillaroscopy (NFC).
Methods
A multicriteria decision-making tool measuring attractiveness using a categorical-based evaluation technique (MACBETH) was used to calculate and compare alternatives. A focus group of ten decision-makers with more than ten years of experience in health technology was used for the decision-making. The Delphi Method was used to get a consensus about comparing criteria and alternatives to these criteria. The sampling method used in the study was the nonprobability purposive sampling method.
Results
The study concluded that clinical efficacy (0.42) is the most important criterion for evaluating medical technologies, followed by cost-effectiveness (0.27). At the same time, ethical considerations were found to be less important (0.03). The sensitivity analysis concluded that the decision is sensitive to clinical efficacy and cost-effectiveness changes. The study found that none of the alternatives dominates others as an option for early detection of diabetes through vascular changes.
Limitations
This study primarily uses systemic literature review methods to identify criteria for evaluating alternatives. There may be additional criteria for evaluation.
Conclusion
This study provides an approach for a multicriteria comparison of medical devices. The study findings are useful for public health professionals and health policymakers.
Plain language summary
This study assesses nailfold capillaroscopy (NFC) as a substitute for digital retina imaging (DRI) in diabetes screening using the MACBETH multicriteria decision-making tool. The research identifies five key evaluation criteria: clinical efficacy, cost-effectiveness, patient needs, user safety, and ethical considerations. A focus group of experienced health technology decision-makers was used to compare NFC and DRI. Results indicate that clinical efficacy and cost-effectiveness are the most critical factors, with NFC showing potential but not significantly outperforming DRI. Sensitivity analyses highlight the need for further research to validate NFC as an effective diabetes screening tool.
{"title":"Health technology assessment of nailfold capillaroscopy and digital retina imaging in diabetes screening","authors":"Vinaytosh Mishra , Zahiruddin Quazi Syed","doi":"10.1016/j.hlpt.2024.100938","DOIUrl":"10.1016/j.hlpt.2024.100938","url":null,"abstract":"<div><h3>Aim</h3><div>This study aims to identify the criteria for the evaluation of medical technologies in diabetes screening and then perform health technology assessment (HTA) for two technologies: digital retina imaging (DRI) and Nailfold Capillaroscopy (NFC).</div></div><div><h3>Methods</h3><div>A multicriteria decision-making tool measuring attractiveness using a categorical-based evaluation technique (MACBETH) was used to calculate and compare alternatives. A focus group of ten decision-makers with more than ten years of experience in health technology was used for the decision-making. The Delphi Method was used to get a consensus about comparing criteria and alternatives to these criteria. The sampling method used in the study was the nonprobability purposive sampling method.</div></div><div><h3>Results</h3><div>The study concluded that clinical efficacy (0.42) is the most important criterion for evaluating medical technologies, followed by cost-effectiveness (0.27). At the same time, ethical considerations were found to be less important (0.03). The sensitivity analysis concluded that the decision is sensitive to clinical efficacy and cost-effectiveness changes. The study found that none of the alternatives dominates others as an option for early detection of diabetes through vascular changes.</div></div><div><h3>Limitations</h3><div>This study primarily uses systemic literature review methods to identify criteria for evaluating alternatives. There may be additional criteria for evaluation.</div></div><div><h3>Conclusion</h3><div>This study provides an approach for a multicriteria comparison of medical devices. The study findings are useful for public health professionals and health policymakers.</div></div><div><h3>Plain language summary</h3><div>This study assesses nailfold capillaroscopy (NFC) as a substitute for digital retina imaging (DRI) in diabetes screening using the MACBETH multicriteria decision-making tool. The research identifies five key evaluation criteria: clinical efficacy, cost-effectiveness, patient needs, user safety, and ethical considerations. A focus group of experienced health technology decision-makers was used to compare NFC and DRI. Results indicate that clinical efficacy and cost-effectiveness are the most critical factors, with NFC showing potential but not significantly outperforming DRI. Sensitivity analyses highlight the need for further research to validate NFC as an effective diabetes screening tool.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 1","pages":"Article 100938"},"PeriodicalIF":3.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-03DOI: 10.1016/j.hlpt.2024.100937
Eren Demir , Usame Yakutcan , Adekunle Olatayo Adeoti , Christian Isichei , Shola Adeyemi
Objectives
People living with HIV/AIDS (PLWHA) benefit from mobile health (mHealth) technologies through self-managing and monitoring their disease with enhanced patient experience and health outcomes. However, the efficiency and cost-effectiveness of these interventions are yet to be studied. The study aims to assess the impact of mHealth on operational and cost metrics relevant to PLWHA and HIV service delivery.
Data Sources
Data were a mixture of primary and secondary data from the hospital setting, experts’ opinions, reports, and the literature.
Method
Using a web-based simulation platform, SmartHIV Manager™, for the management of HIV services, we tested scenarios based on four possible reductions in the number of clinic visits and four groups of PLWHA who can be offered a mobile device free of charge (16 scenarios in total). The study was conducted in collaboration with Faith Alive Foundation Hospital (Nigeria) using a mHealth app (BSmart Chart).
Results
In the worst-case scenario, the hospital anticipates a 14 % decrease in the number of visits from stable patients, nine fewer doctors to operate their service, and a 3 % savings in total cost after accounting for mHealth intervention expenses and mobile phone acquisition. With the service currently running at 161 % doctor capacity, this intervention alleviates staff pressure and ensures quality care.
Conclusion
The study shows significant system efficiency gains, fewer visits, better health outcomes, economic benefits for stable patients, and increased capacity. These findings apply to most HIV services worldwide, especially in times of limited resources.
Public Interest Summary
Mobile health (mHealth) technologies support people living with HIV/AIDS by helping them manage their health and receive remote monitoring. This study examines the impact of mHealth apps on the costs and operations of HIV services. Conducted in a rural HIV setting in Nigeria, where many patients face financial challenges, the research used a simulation-based decision support tool (known as SmartHIV Manager) to test the scenario of providing free mobile devices and reducing clinic visits for stable patients. Results indicated that this approach could reduce patient visits and healthcare costs while easing the workload of overburdened doctors. Globally, introducing mHealth apps could be impactful, given the constraints of limited healthcare staff and budgets.
目标艾滋病毒/艾滋病感染者（PLWHA）通过自我管理和监测疾病，从移动医疗（mHealth）技术中获益，从而改善患者的就医体验和健康状况。然而，这些干预措施的效率和成本效益还有待研究。本研究旨在评估移动医疗对 PLWHA 和 HIV 服务提供相关的运营和成本指标的影响。数据来源数据由医院环境、专家意见、报告和文献中的主要数据和次要数据混合而成。方法我们使用基于网络的模拟平台 SmartHIV Manager™ 来管理 HIV 服务，测试了基于四种可能减少的门诊次数和四组可免费获得移动设备的 PLWHA 的情景（共 16 种情景）。研究是与 Faith Alive Foundation 医院（尼日利亚）合作进行的，使用的是移动医疗应用程序（BSmart Chart）。结果在最坏的情况下，医院预计稳定期患者的就诊人数将减少 14%，运营服务的医生人数将减少 9 人，在计入移动医疗干预费用和手机购置费用后，总成本将节省 3%。该研究表明，系统效率显著提高、就诊人数减少、健康状况改善、稳定期患者获得经济收益以及服务能力提高。这些发现适用于全球大多数艾滋病服务机构，尤其是在资源有限的情况下。公益摘要移动医疗（mHealth）技术通过帮助艾滋病毒/艾滋病感染者管理健康和接受远程监控，为他们提供支持。本研究探讨了移动医疗应用程序对艾滋病服务成本和运营的影响。研究在尼日利亚的一个农村艾滋病环境中进行，那里的许多患者都面临着经济困难，研究使用了一种基于模拟的决策支持工具（称为 SmartHIV Manager）来测试提供免费移动设备和减少稳定期患者就诊次数的方案。结果表明，这种方法可以减少患者就诊次数，降低医疗成本，同时减轻不堪重负的医生的工作量。在全球范围内，由于医疗保健人员和预算有限，引入移动医疗应用程序可能会产生影响。
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