Pub Date : 2023-11-21DOI: 10.1007/s44250-023-00050-w
Valentina Bellini, Enrico Ori, F. Coccolini, E. Bignami
{"title":"Evidence pyramid and artificial intelligence: a metamorphosis of clinical research","authors":"Valentina Bellini, Enrico Ori, F. Coccolini, E. Bignami","doi":"10.1007/s44250-023-00050-w","DOIUrl":"https://doi.org/10.1007/s44250-023-00050-w","url":null,"abstract":"","PeriodicalId":72826,"journal":{"name":"Discover health systems","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139251098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-13DOI: 10.1007/s44250-023-00054-6
Champika Pattullo, Benita Suckling, William Dace, Peter Donovan, Lisa Hall
Abstract Background The increased awareness of opioid-related harms has resulted in a proliferation of safety strategies and hospital-based quality improvement initiatives, often referred to as ‘opioid stewardship’ interventions. The effective translation of these interventions into more widespread practice relies on understanding and adapting important details of the implementation process. However, as with many healthcare quality improvement studies, the context, and details of the implementation are often absent from the published literature, limiting the scale and spread of practice. Aim To systematically review studies describing opioid stewardship interventions in acute hospital settings and assess the reporting of their implementation. Method A literature search of opioid stewardship interventions in MEDLINE/PubMed, EMBASE, Web of Science and the Cochrane Library from January 2000 to August 2020 was performed. We used Preferred Reporting Items for Systematic Reviews and Meta-analyses. Studies were screened initially for an evaluation of the intervention and subsequently for the inclusion of implementation reporting. The latter was coded using the four Normalisation Process Theory (NPT) domains. Results The database searches identified a total of 4031 publications, of which 372 underwent a full text review and 13 studies were included in the final analysis. The main reasons for exclusion during full-text review were insufficient details of the intervention (n = 90/354, 25%) or implementation (n = 215/354, 61%) to undergo an NPT analysis. When evaluating the potential for scale and spread of an intervention, all studies (n = 13) met the criteria for coherence, cognitive participation, and collective action, but only 3 reported on reflexive monitoring. Conclusion We identified only a small number of opioid stewardship studies that described the implementation processes of the reported interventions. This may be a barrier to effective translation of interventions into broader practice, limiting the potential for impact and benefit to patients and the wider community. Future studies of opioid stewardship interventions should consider using implementation science e.g., NPT across all aspects of knowledge translation and reporting.
{"title":"A systematic review of implementation reporting in opioid stewardship literature","authors":"Champika Pattullo, Benita Suckling, William Dace, Peter Donovan, Lisa Hall","doi":"10.1007/s44250-023-00054-6","DOIUrl":"https://doi.org/10.1007/s44250-023-00054-6","url":null,"abstract":"Abstract Background The increased awareness of opioid-related harms has resulted in a proliferation of safety strategies and hospital-based quality improvement initiatives, often referred to as ‘opioid stewardship’ interventions. The effective translation of these interventions into more widespread practice relies on understanding and adapting important details of the implementation process. However, as with many healthcare quality improvement studies, the context, and details of the implementation are often absent from the published literature, limiting the scale and spread of practice. Aim To systematically review studies describing opioid stewardship interventions in acute hospital settings and assess the reporting of their implementation. Method A literature search of opioid stewardship interventions in MEDLINE/PubMed, EMBASE, Web of Science and the Cochrane Library from January 2000 to August 2020 was performed. We used Preferred Reporting Items for Systematic Reviews and Meta-analyses. Studies were screened initially for an evaluation of the intervention and subsequently for the inclusion of implementation reporting. The latter was coded using the four Normalisation Process Theory (NPT) domains. Results The database searches identified a total of 4031 publications, of which 372 underwent a full text review and 13 studies were included in the final analysis. The main reasons for exclusion during full-text review were insufficient details of the intervention (n = 90/354, 25%) or implementation (n = 215/354, 61%) to undergo an NPT analysis. When evaluating the potential for scale and spread of an intervention, all studies (n = 13) met the criteria for coherence, cognitive participation, and collective action, but only 3 reported on reflexive monitoring. Conclusion We identified only a small number of opioid stewardship studies that described the implementation processes of the reported interventions. This may be a barrier to effective translation of interventions into broader practice, limiting the potential for impact and benefit to patients and the wider community. Future studies of opioid stewardship interventions should consider using implementation science e.g., NPT across all aspects of knowledge translation and reporting.","PeriodicalId":72826,"journal":{"name":"Discover health systems","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136282445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-10DOI: 10.1007/s44250-023-00053-7
E. Mangrio, Maria Hjortsjö
{"title":"Meeting families in various social situations: reflections from healthcare staff working with an extended home-visiting program in Sweden","authors":"E. Mangrio, Maria Hjortsjö","doi":"10.1007/s44250-023-00053-7","DOIUrl":"https://doi.org/10.1007/s44250-023-00053-7","url":null,"abstract":"","PeriodicalId":72826,"journal":{"name":"Discover health systems","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139281690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-08DOI: 10.1007/s44250-023-00052-8
Alfred Eboh, Aderonke Omotayo Adebayo
Abstract Background Malaria is a significant public health concern, particularly in sub-Saharan Africa. This study examined the impact of health care expenditure and access to basic sanitation services on malaria incidence in 28 selected African countries from 2000 to 2019. Methods The study was anchored on Health Production Function [HPF] model while General Panel Linear Model was adopted to examine the relationships between the variables. The retrospective research design was utilised. The statistical diagnostics tests were performed to check for multicollinearity, hereroskedasticity, normality and model specification using correlation matrix, Breusch Pagan/Cook Weisberg, Shapiro–Wilk and the Hausman specification. The hypotheses were tested at the 5% significance level and the analysis of the data was aided by the use of the STATA 13.0. Results Domestic Government General Health Expenditure [DGGHE] had a positive relationship with Malaria Incidence [MI], although it was not statistically significant [coefficient = 0.0454708, p -value = 0.604]. Out-Of-Pocket Health Expenditure [OOPHE] demonstrated a statistically significant positive association with MI [coefficient = 0.2839394, p -value = 0.009]. External Health Expenditure [EHE] showed a statistically significant negative relationship with MI [coefficient = − 0.1452344, p -value = 0.012]. Moreover, People using at least Basic Sanitation Services [PBSS] exhibited a statistically significant negative relationship with MI [coefficient = − 0.3854207, p -value = 0.000]. Conclusions The results suggested that while government health expenditure alone may not significantly impact malaria incidence, increased out-of-pocket expenditure and external health expenditure, as well as improved access to basic sanitation services, are associated with a higher likelihood of reducing malaria incidence in the selected African countries. Addressing malaria incidence in Africa requires a comprehensive approach that includes adequate government health care expenditure, reduction of out-of-pocket costs, increased external funding, and improved access to basic sanitation services. By implementing these recommendations, policymakers can make significant progress in reducing the burden of malaria and improving public health outcomes in affected African countries.
{"title":"Addressing malaria incidence in Africa through health care expenditure and access to basic sanitation services","authors":"Alfred Eboh, Aderonke Omotayo Adebayo","doi":"10.1007/s44250-023-00052-8","DOIUrl":"https://doi.org/10.1007/s44250-023-00052-8","url":null,"abstract":"Abstract Background Malaria is a significant public health concern, particularly in sub-Saharan Africa. This study examined the impact of health care expenditure and access to basic sanitation services on malaria incidence in 28 selected African countries from 2000 to 2019. Methods The study was anchored on Health Production Function [HPF] model while General Panel Linear Model was adopted to examine the relationships between the variables. The retrospective research design was utilised. The statistical diagnostics tests were performed to check for multicollinearity, hereroskedasticity, normality and model specification using correlation matrix, Breusch Pagan/Cook Weisberg, Shapiro–Wilk and the Hausman specification. The hypotheses were tested at the 5% significance level and the analysis of the data was aided by the use of the STATA 13.0. Results Domestic Government General Health Expenditure [DGGHE] had a positive relationship with Malaria Incidence [MI], although it was not statistically significant [coefficient = 0.0454708, p -value = 0.604]. Out-Of-Pocket Health Expenditure [OOPHE] demonstrated a statistically significant positive association with MI [coefficient = 0.2839394, p -value = 0.009]. External Health Expenditure [EHE] showed a statistically significant negative relationship with MI [coefficient = − 0.1452344, p -value = 0.012]. Moreover, People using at least Basic Sanitation Services [PBSS] exhibited a statistically significant negative relationship with MI [coefficient = − 0.3854207, p -value = 0.000]. Conclusions The results suggested that while government health expenditure alone may not significantly impact malaria incidence, increased out-of-pocket expenditure and external health expenditure, as well as improved access to basic sanitation services, are associated with a higher likelihood of reducing malaria incidence in the selected African countries. Addressing malaria incidence in Africa requires a comprehensive approach that includes adequate government health care expenditure, reduction of out-of-pocket costs, increased external funding, and improved access to basic sanitation services. By implementing these recommendations, policymakers can make significant progress in reducing the burden of malaria and improving public health outcomes in affected African countries.","PeriodicalId":72826,"journal":{"name":"Discover health systems","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135340921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.1007/s44250-023-00042-w
Anthony Amoah
Abstract The aim of this study is to examine the factors influencing compliance with COVID-19 preventive management strategies in sub-Saharan Africa (SSA). To address the lack of national data associated with this study, a comprehensive cross-sectional panel dataset by GeoPoll, encompassing 12 SSA countries, is used. The study employs a novel index and a cross-sectional pooled logit econometric regression with predicted margins to identify the determinants of behavioural responses to COVID-19 management strategies. The findings reveal that demographic factors, institutional measures, and country-specific characteristics significantly impact compliance with COVID-19 management strategies in SSA. Additionally, a gender analysis of disaggregated COVID-19 pandemic management protocols revealed that females exhibit different compliance behaviours compared to males, specifically in relation to public transport, hygiene practices, handwashing, and social distancing. However, no significant gender differences are observed in behaviours such as avoiding public places and working from home. Surprisingly, the composite index, which measures overall compliance with all protocols, does not demonstrate any gender differences. Based on the findings, policies aimed at enhancing compliance should consider demographic, institutional, and country-specific factors while also accounting for gender differences in specific compliance behaviours.
{"title":"Know, comply, and live: the implications of protocols for COVID-19 management in sub-Saharan Africa","authors":"Anthony Amoah","doi":"10.1007/s44250-023-00042-w","DOIUrl":"https://doi.org/10.1007/s44250-023-00042-w","url":null,"abstract":"Abstract The aim of this study is to examine the factors influencing compliance with COVID-19 preventive management strategies in sub-Saharan Africa (SSA). To address the lack of national data associated with this study, a comprehensive cross-sectional panel dataset by GeoPoll, encompassing 12 SSA countries, is used. The study employs a novel index and a cross-sectional pooled logit econometric regression with predicted margins to identify the determinants of behavioural responses to COVID-19 management strategies. The findings reveal that demographic factors, institutional measures, and country-specific characteristics significantly impact compliance with COVID-19 management strategies in SSA. Additionally, a gender analysis of disaggregated COVID-19 pandemic management protocols revealed that females exhibit different compliance behaviours compared to males, specifically in relation to public transport, hygiene practices, handwashing, and social distancing. However, no significant gender differences are observed in behaviours such as avoiding public places and working from home. Surprisingly, the composite index, which measures overall compliance with all protocols, does not demonstrate any gender differences. Based on the findings, policies aimed at enhancing compliance should consider demographic, institutional, and country-specific factors while also accounting for gender differences in specific compliance behaviours.","PeriodicalId":72826,"journal":{"name":"Discover health systems","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135589384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-02DOI: 10.1007/s44250-023-00049-3
Katijah Khoza-Shangase, Julia Nesbitt
Abstract While progress has been made in reducing vertical Mother to Child Transmission (MTCT) of HIV, limited research exists on the health needs of HIV-exposed uninfected (HEU) neonates, particularly in the field of audiology. This lack of research and evidence could impact early detection and intervention efforts. This study aimed to establish relationships and compare outcomes between case history factors and audiological screening results in HEU and HIV-unexposed neonates at a district-level hospital in Gauteng, South Africa. A non-experimental quantitative, descriptive, cross-sectional, comparative research design was employed. Data was collected with a sample size of 212 participants (100 HEU, 112 HIV-unexposed neonates) recruited using quota sampling. The hearing screening process involved case history assessment, medical file review, otoscopy, tympanometry testing, Distortion Product Evoked Otoacoustic Emissions (DPOAE), and Automated Auditory Brainstem Response (AABR) measurements. Descriptive and inferential statistics, including measures of central tendency and parametric tests, were used for data analysis. The findings indicated that 43% of HEU neonates exhibited refer findings on DPOAE, and 43% on AABR, compared to 26% and 25% respectively in the HIV-unexposed neonatal group. Therefore, a statistically significant relationship was established when comparing audiological results between the HEU and HIV-unexposed groups. Case history factors such as mode of delivery, birth weight, and Apgar scores were not associated with hearing loss in either group. However, in the HEU group, a higher proportion of participants referred on the overall screening in the maternal Retroviral Disease (RVD) stage IV group, although statistical significance was not established. This study fills an evidence gap regarding HEU neonates and highlights the need to include this vulnerable population in policy and clinical guidelines related to early hearing detection, intervention, and preventive audiology initiatives.
{"title":"Case history factors and audiological screening outcomes in HEU and HIV unexposed neonates at a district level hospital in Gauteng, South Africa","authors":"Katijah Khoza-Shangase, Julia Nesbitt","doi":"10.1007/s44250-023-00049-3","DOIUrl":"https://doi.org/10.1007/s44250-023-00049-3","url":null,"abstract":"Abstract While progress has been made in reducing vertical Mother to Child Transmission (MTCT) of HIV, limited research exists on the health needs of HIV-exposed uninfected (HEU) neonates, particularly in the field of audiology. This lack of research and evidence could impact early detection and intervention efforts. This study aimed to establish relationships and compare outcomes between case history factors and audiological screening results in HEU and HIV-unexposed neonates at a district-level hospital in Gauteng, South Africa. A non-experimental quantitative, descriptive, cross-sectional, comparative research design was employed. Data was collected with a sample size of 212 participants (100 HEU, 112 HIV-unexposed neonates) recruited using quota sampling. The hearing screening process involved case history assessment, medical file review, otoscopy, tympanometry testing, Distortion Product Evoked Otoacoustic Emissions (DPOAE), and Automated Auditory Brainstem Response (AABR) measurements. Descriptive and inferential statistics, including measures of central tendency and parametric tests, were used for data analysis. The findings indicated that 43% of HEU neonates exhibited refer findings on DPOAE, and 43% on AABR, compared to 26% and 25% respectively in the HIV-unexposed neonatal group. Therefore, a statistically significant relationship was established when comparing audiological results between the HEU and HIV-unexposed groups. Case history factors such as mode of delivery, birth weight, and Apgar scores were not associated with hearing loss in either group. However, in the HEU group, a higher proportion of participants referred on the overall screening in the maternal Retroviral Disease (RVD) stage IV group, although statistical significance was not established. This study fills an evidence gap regarding HEU neonates and highlights the need to include this vulnerable population in policy and clinical guidelines related to early hearing detection, intervention, and preventive audiology initiatives.","PeriodicalId":72826,"journal":{"name":"Discover health systems","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135933619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-02DOI: 10.1007/s44250-023-00051-9
Periklis Charalampous, Juanita A. Haagsma, Sarah Cuschieri, Brecht Devleesschauwer, Sara M. Pires, Suzanne Polinder, Grant M. A. Wyper, Amalia Hatziyianni, Elena Pallari
Abstract Knowledge about the extent of the COVID-19 mortality burden is important to inform policy-making decisions. To gain greater insights into the population health impact of COVID-19 mortality, Years of Life Lost (YLL) can be estimated. We aimed to determine YLL linked to COVID-19 over the first two years (March 2020–March 2022) of the pandemic in Cyprus, by areas, and by age and sex. COVID-19 YLL was estimated by multiplying COVID-19 mortality counts by age-conditional life expectancy from the 2019 Global Burden of Disease life table. COVID-19 accounted for 16,704 YLL over the first two years of the pandemic—approximately 18.5 years lost per individual who died due to COVID-19 and 1881 YLL per 100,000 population. YLL per 100,000 was higher among males compared to females (2485 versus 1303 per 100,000) and higher among older than younger individuals. COVID-19 deaths and YLL per 100,000 were higher in high population-dense areas of Cyprus, such as Limassol. Continued evaluations of COVID-19 YLL are needed to inform on the proportionate population impact of COVID-19, over time and across areas of Cyprus.
{"title":"Estimating Years of Life Lost due to COVID-19 over the first two years of the pandemic in Cyprus: comparisons across areas, age, and sex","authors":"Periklis Charalampous, Juanita A. Haagsma, Sarah Cuschieri, Brecht Devleesschauwer, Sara M. Pires, Suzanne Polinder, Grant M. A. Wyper, Amalia Hatziyianni, Elena Pallari","doi":"10.1007/s44250-023-00051-9","DOIUrl":"https://doi.org/10.1007/s44250-023-00051-9","url":null,"abstract":"Abstract Knowledge about the extent of the COVID-19 mortality burden is important to inform policy-making decisions. To gain greater insights into the population health impact of COVID-19 mortality, Years of Life Lost (YLL) can be estimated. We aimed to determine YLL linked to COVID-19 over the first two years (March 2020–March 2022) of the pandemic in Cyprus, by areas, and by age and sex. COVID-19 YLL was estimated by multiplying COVID-19 mortality counts by age-conditional life expectancy from the 2019 Global Burden of Disease life table. COVID-19 accounted for 16,704 YLL over the first two years of the pandemic—approximately 18.5 years lost per individual who died due to COVID-19 and 1881 YLL per 100,000 population. YLL per 100,000 was higher among males compared to females (2485 versus 1303 per 100,000) and higher among older than younger individuals. COVID-19 deaths and YLL per 100,000 were higher in high population-dense areas of Cyprus, such as Limassol. Continued evaluations of COVID-19 YLL are needed to inform on the proportionate population impact of COVID-19, over time and across areas of Cyprus.","PeriodicalId":72826,"journal":{"name":"Discover health systems","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135933194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.1007/s44250-023-00046-6
Madlen Scheibe, Andreas Knapp, Lorenz Harst, Jochen Schmitt
Abstract Background In October 2020, digital health applications (DiGAs) became part of standard care in Germany. For approval, DiGA manufacturers must demonstrate medical benefit or patient-relevant improvement of structure and processes (PISP). PISP refers to an innovative outcome core area in terms of proof of benefits and reimbursement decisions. These are subdivided into 9 outcome domains, including for example health literacy, facilitating access to care, and coping with illness-related difficulties in everyday life. Their implementation aims at empowering patients, encouraging shared decision-making, and increasing patient-centeredness in healthcare delivery. Given the novelty of PISP, no standardized set of outcomes and outcome measurement instruments currently exists to operationalize the domains. Learning from previous evaluation studies can help operationalize and standardize PISPs for evaluation studies of digital health applications. Therefore, we investigated the outcomes and outcome measurement instruments, used in controlled trials to assess DiGA-compliant applications, published before the Digital Health Applications Ordinance of April 2020. Methods We conducted a systematic review of studies published between 01/2015 and 04/2020, via MEDLINE and Embase, complemented by forward/backward searches. Controlled trials assessing interventions adhering to the definition of DiGA were eligible, if they applied a validated outcome measurement instrument, and if results were presented in German or English. Title-abstract screening, full-text screening, data extraction and narrative synthesis were conducted independently by two researchers. Results Out of 2,671 references identified, 6 studies collecting a total of 48 outcomes were included. 14 outcomes (29.2%) addressed PISP by using 13 different measurement instruments. The outcomes corresponded to 5 of 9 PISP outcome domains with health literacy being the most common (7/14, 50.0%). Conclusions This review provides an overview of the characteristics of PISPs used in previous evaluation studies of DiGA-compliant applications. It shows which outcomes and validated outcome measurement instruments can be used to measure PISP and where knowledge is still lacking. These results serve as a starting point for operationalizing and standardizing PISPs and help to increase the outcome measurement quality of PISPs.
{"title":"Outcome domains and measurement instruments of patient-relevant improvement of structure and processes as a new set of outcomes for evaluating and approving digital health applications: systematic review","authors":"Madlen Scheibe, Andreas Knapp, Lorenz Harst, Jochen Schmitt","doi":"10.1007/s44250-023-00046-6","DOIUrl":"https://doi.org/10.1007/s44250-023-00046-6","url":null,"abstract":"Abstract Background In October 2020, digital health applications (DiGAs) became part of standard care in Germany. For approval, DiGA manufacturers must demonstrate medical benefit or patient-relevant improvement of structure and processes (PISP). PISP refers to an innovative outcome core area in terms of proof of benefits and reimbursement decisions. These are subdivided into 9 outcome domains, including for example health literacy, facilitating access to care, and coping with illness-related difficulties in everyday life. Their implementation aims at empowering patients, encouraging shared decision-making, and increasing patient-centeredness in healthcare delivery. Given the novelty of PISP, no standardized set of outcomes and outcome measurement instruments currently exists to operationalize the domains. Learning from previous evaluation studies can help operationalize and standardize PISPs for evaluation studies of digital health applications. Therefore, we investigated the outcomes and outcome measurement instruments, used in controlled trials to assess DiGA-compliant applications, published before the Digital Health Applications Ordinance of April 2020. Methods We conducted a systematic review of studies published between 01/2015 and 04/2020, via MEDLINE and Embase, complemented by forward/backward searches. Controlled trials assessing interventions adhering to the definition of DiGA were eligible, if they applied a validated outcome measurement instrument, and if results were presented in German or English. Title-abstract screening, full-text screening, data extraction and narrative synthesis were conducted independently by two researchers. Results Out of 2,671 references identified, 6 studies collecting a total of 48 outcomes were included. 14 outcomes (29.2%) addressed PISP by using 13 different measurement instruments. The outcomes corresponded to 5 of 9 PISP outcome domains with health literacy being the most common (7/14, 50.0%). Conclusions This review provides an overview of the characteristics of PISPs used in previous evaluation studies of DiGA-compliant applications. It shows which outcomes and validated outcome measurement instruments can be used to measure PISP and where knowledge is still lacking. These results serve as a starting point for operationalizing and standardizing PISPs and help to increase the outcome measurement quality of PISPs.","PeriodicalId":72826,"journal":{"name":"Discover health systems","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135813149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-30DOI: 10.1007/s44250-023-00047-5
Edwin Onyango Ochomo, David Masinde, Collins Ouma
Abstract Background The global burden of cervical cancer continue to rise with the low- and middle-income countries bearing the greatest burden. East Africa recorded about 54560 cases and 36497 deaths attributed to cervical cancer in 2020 with 5236 cases and 3211 deaths being reported annually. This high burden can be attributed to low screening rates and late diagnosis, which lead to undesirable outcomes. Kenya still has low screening rates with only 16.4% of the eligible women screened against the WHO target of 70% by 2030. Kisumu has a lower screening rate of about 5.7% according to KHIS 2019 data. This low screening rate is due to lack of proper community health education. We evaluated the effectiveness of dialogue-based training in improving community health volunteers’ (CHV) knowledge on cervical cancer in Nyando. Methods The study adopted a pre-and-post, longitudinal study design. The CHVs knowledge was assessed before and after the training. We calculated the proportion net change in the number of CHVs with improved knowledge after the intervention. Statistical significance was assessed at p ≤ 0.05. Results The pre-test mean score was 30.1%, this improved to 53.4% at post-test following the dialogue-based training of the CHVs. The knowledge on the various aspects: risk factors ( p < 0.0001), signs and symptoms ( p < 0.0001) and screening ( p < 0.0001) significantly improved at the post-test following the dialogue-based training. The overall score also significantly improved (p < 0.0001) following the training among the CHVs. Occupation ( p < 0.0001) was found to be significantly associated with knowledge on cervical cancer. Conclusion The CHVs’ knowledge was inadequate but significantly improved following the dialogue-based training.
{"title":"Improving community health volunteers’ knowledge on cervical cancer using dialogue-based training in rural Kisumu County","authors":"Edwin Onyango Ochomo, David Masinde, Collins Ouma","doi":"10.1007/s44250-023-00047-5","DOIUrl":"https://doi.org/10.1007/s44250-023-00047-5","url":null,"abstract":"Abstract Background The global burden of cervical cancer continue to rise with the low- and middle-income countries bearing the greatest burden. East Africa recorded about 54560 cases and 36497 deaths attributed to cervical cancer in 2020 with 5236 cases and 3211 deaths being reported annually. This high burden can be attributed to low screening rates and late diagnosis, which lead to undesirable outcomes. Kenya still has low screening rates with only 16.4% of the eligible women screened against the WHO target of 70% by 2030. Kisumu has a lower screening rate of about 5.7% according to KHIS 2019 data. This low screening rate is due to lack of proper community health education. We evaluated the effectiveness of dialogue-based training in improving community health volunteers’ (CHV) knowledge on cervical cancer in Nyando. Methods The study adopted a pre-and-post, longitudinal study design. The CHVs knowledge was assessed before and after the training. We calculated the proportion net change in the number of CHVs with improved knowledge after the intervention. Statistical significance was assessed at p ≤ 0.05. Results The pre-test mean score was 30.1%, this improved to 53.4% at post-test following the dialogue-based training of the CHVs. The knowledge on the various aspects: risk factors ( p < 0.0001), signs and symptoms ( p < 0.0001) and screening ( p < 0.0001) significantly improved at the post-test following the dialogue-based training. The overall score also significantly improved (p < 0.0001) following the training among the CHVs. Occupation ( p < 0.0001) was found to be significantly associated with knowledge on cervical cancer. Conclusion The CHVs’ knowledge was inadequate but significantly improved following the dialogue-based training.","PeriodicalId":72826,"journal":{"name":"Discover health systems","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136023155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.1007/s44250-023-00044-8
Kwadwo Arhin, Eric Fosu Oteng-Abayie, Jacob Novignon
Abstract Primary health care (PHC) is a universally accepted key strategy to achieve universal health coverage (UHC) and Sustainable Development Goal 3 (SDG 3) due to its potential to produce a range of economic benefits through improved health outcomes, health quality, and health system efficiency. However, little evidence exists about the cost efficiency of primary health care facilities (PHCFs) in Sub-Saharan Africa. This study evaluates the cost efficiency of two main types of PHCFs in Ghana that are at the forefront of delivering PHC services to a greater proportion of the population: Community Health Centers (HCs) and Community-Based Health Planning Services (CHPS) compounds. The dataset we used for this study included 39 HCs and 55 CHPS facilities. Furthermore, it examines the factors that influence the cost efficiency of these facilities. The study applies the stochastic frontier analysis (SFA) technique to panel data. The estimated cost efficiency for HCs and CHPS is 61.6% and 85.8%, respectively. The study further revealed that facility size, medical staff density, and facility age are the main factors that explain the differences in the cost efficiency of PHCFs in Ghana. The study's policy recommendation is that the Ghana Health Service should consider utilizing modern technology such as telehealth and telemedicine to enhance access to PHC services for people living in hard-to-reach and densely populated communities. This strategic approach can significantly contribute to improving the cost-efficiency of PHCFs.
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