Search

Background The damage inflicted by the coronavirus diseases 2019 (COVID-19) pandemic upon humanity is and will continue to be considerable. Unprecedented progress made in global health over the past 20 years has reverted and economic growth has already evaporated, giving rise to a global recession, the likes of which we may not have experienced since the Second World War. Our aim is to draw the attention of the neglected tropical disease (NTD) community towards some of the major emerging economic opportunities which are quickly appearing on the horizon as a result of COVID-19. Main text This scoping review relied on a literature search comprised of a sample of articles, statements, and press releases on initiatives aimed at mitigating the impact of COVID-19, while supporting economic recovery. Of note, the donor scenario and economic development agendas are highly dynamic and expected to change rapidly as the COVID-19 pandemic unfolds, as are donor and lender priorities. Conclusions The NTD community, particularly in low- and middle-income countries (LMICs), will need to work quickly, diligently, and in close collaboration with decision-makers and key stakeholders, across sectors at national and international level to secure its position. Doing so might enhance the odds of grasping potential opportunities to access some of the massive resources that are now available in the form of contributions from corporate foundations, trust funds, loans, debt relieve schemes, and other financial mechanisms, as part of the ongoing and future economic development agendas and public health priorities driven by the COVID-19 pandemic. This paper should serve as a starting point for the NTD community to seek much needed financial support in order to sustain and revitalize control and elimination efforts pertaining to NTDs in LMICs.

This paper presents the position of the Latin American working group of the International Foundation for Integrated Care (IFIC). The working group brings together various Latin American actors and organizations in support of actions that facilitate the transformation of health systems in the region towards integrated systems that focus on people not as isolated individuals but as subjects of law in the complex social and environmental contexts where they live and interact. The working group proposes nine pillars of integrated care to be used as a conceptual framework for policy development and changes in practices: 1) shared vision and values; 2) population health; 3) people and communities as partners; 4) resilient communities; 5) capacities of human resources for health; 6) governance and leadership; 7) digital solutions; 8) aligned payment systems; and 9) public transparency. Based on these pillars, lines of work are proposed to strengthen alliances and networks, advocacy, research, and capacity-building, in order to help develop health and social systems that are effectively integrated and focused not only on people but also on communities in Latin America.Este artigo apresenta o posicionamento do grupo de trabalho latino-americano da Fundação Internacional de Cuidados Integrados (1) (IFIC, na sigla em inglês). A IFIC reúne diversos atores e organizações da América Latina com o fim de apoiar ações que facilitem a transformação dos sistemas de saúde na região para sistemas integrados e centrados nas pessoas, não como indivíduos isolados, mas como sujeitos de direito, nos complexos contextos sociais e ambientais em que vivem e participam. O grupo de trabalho propõe nove pilares de atenção integrada a serem utilizados como marco conceitual na elaboração de políticas e de mudanças nas práticas: 1) visão e valores compartilhados, 2) saúde das populações, 3) pessoas e comunidades como parceiros, 4) comunidades resilientes, 5) capacitação de talento humano em saúde, 6) governança e liderança, 7) soluções digitais, 8) sistemas de pagamento alinhados e 9) transparência perante a população. Com base nesses pilares, são propostas linhas de trabalho nas áreas de fortalecimento de alianças e redes, incidência política, pesquisa e capacitação, que contribuam para materializar na América Latina sistemas sociais e de saúde efetivamente integrados e centrados não só nas pessoas, como também nas comunidades.

Summary box The year 2020 will be regarded as the year when the SARS-CoV-2 resulted in the COVID-19 pandemic that spread globally, catching most countries unprepared. Amid untold suffering, COVID-19 presents the opportunity to galvanise support for long due social, political and economic reforms to address the root causes of ill-health and inequities, but also to radically transform health and social protection systems to enable more effective performance and resilience to systemic shocks.1 Like neglected tropical diseases (NTDs), the COVID-19 pandemic has a poverty-related dimension, hitting hardest at marginalised populations.2 This paper argues that NTDs offer valuable insights for building back better health systems for pandemic preparedness, while also providing an important barometer for progress in health and social protection. The COVID-19 pandemic has exposed serious failures in health and care systems in high-income, middle-income and low-income countries alike. Fragmentation and a lack of intersectoral responses have prevented countries from responding effectively. For example, information and data collection systems are usually not integrated, comprehensive or rapid enough to provide a full picture of the pandemic’s impact to readily inform decision-makers, even for such basic indicators as mortality. The failure to implement community-based surveillance and response has made it difficult to manage the spread of SARS-CoV-2. Moreover, public health communication has been weak in most places, confusing and misleading in others. Part of the problem …

ICC is a resilience-oriented approach that seeks to strengthen communities by tackling the determinants of health. It assumes accountability towards a territorially defined population, creating new cross-sectoral and interdisciplinary partnerships and taking a population health approach with a focus on prevention. In ICC, a new power dynamic and relationship is forged: people and communities co-design and co-produce health and care; the role of government is that of an equalizer (ensuring resources are allocated to those most in need) and investor in public services; and the traditional boundaries between informal and formal care are blurred.

Background: Digital Health Europe is funding a twinning scheme that supports the European Commission’s Digital Single Market's three priorities for the Digital Transformation of Health and Care initiative: 1) citizens’ secure access to and sharing of health data across borders 2) better data to advance research, disease prevention and personalised health and care 3) digital tools for citizen empowerment and person-centred care. Up to 45 twinnings opportunities – between more than 90 organisations – will be organised. The activities will take place between September 2019-August 2020. There are four different types of digital solutions supporting the delivery of integrated care twinnings: 1) knowledge exchange 2) adaptation 3) partial adoption and 4) full adoption or acquisition. Aim: To elicit from the twinning sites themselves, particularly the adopters, what their capacity-building requirements and expectations are throughout 2020 to help the DHE team provide the best support possible. Method: Recognising that both digital maturity and readiness to integrate care services are crucial conditions for the success of the twinning projects, desk-top research was carried out on technology-readiness and capacity-building tools, as well as integrated care maturity and implementation models. To enable the DHE team to elicit the necessary information it became clear that a ‘tailored’ self-assessment exercise would be required. This was achieved through merging elements of the NHS England Digital Maturity Assessment (for the aspects related to maturity to adopt a digital solution) with components of the main tools currently available to measure maturity to deliver integrated care, in particular the SCIROCCO Maturity Model and the Optimity Advisors’ Health Check Readiness. Highlights: A self-assessment exercise was developed to be completed by twinning adopters at the start of the twinning scheme to establish a baseline and then again, at the end of the project (end of 2020) so that the DHE team can assess whether the support provided was useful or not and describe and refine the building blocks for scaling up DH solutions. Implementation: Adopters will be encouraged to complete the exercise as a team, bringing the key stakeholders involved in the twinning together, rather than as individuals as this will foster collaboration and knowledge exchange from the outset. Conclusion: Although there are a number of tools and frameworks available which facilitate different types of self-assessment exercises, it is important to understand your project’s specific requirements and develop a tailored approach if necessary. Any self-assessment should not be seen as a binary checklist, but rather as a key aspect of a programme’s plan. It should be designed to support continuous improvement and facilitate the further enhancement and expansion of digitally-enabled integrated care. The information gained following the analysis of the completed DHE self-assessment surveys will enable the twinnings to receive tailored capacity building support from project partners. It is also anticipated that expertise within the twinning sites will be identified through the exercise and shared with other twinnings where appropriate.

Background Health and care services are becoming increasingly strained and healthcare authorities worldwide are investing in integrated care in the hope of delivering higher-quality services while containing costs. The cost-effectiveness of integrated care, however, remains unclear. This systematic review and meta-analysis aims to appraise current economic evaluations of integrated care and assesses the impact on outcomes and costs. Methods CINAHL, DARE, EMBASE, Medline/PubMed, NHS EED, OECD Library, Scopus, Web of Science, and WHOLIS databases from inception to 31 December 2019 were searched to identify studies assessing the cost-effectiveness of integrated care. Study quality was assessed using an adapted CHEERS checklist and used as weight in a random-effects meta-analysis to estimate mean cost and mean outcomes of integrated care. Results Selected studies achieved a relatively low average quality score of 65.0% (± 18.7%). Overall meta-analyses from 34 studies showed a significant decrease in costs (0.94; CI 0.90–0.99) and a statistically significant improvement in outcomes (1.06; CI 1.05–1.08) associated with integrated care compared to the control. There is substantial heterogeneity in both costs and outcomes across subgroups. Results were significant in studies lasting over 12 months (12 studies), with both a decrease in cost (0.87; CI 0.80–0.94) and improvement in outcomes (1.15; 95% CI 1.11–1.18) for integrated care interventions; whereas, these associations were not significant in studies with follow-up less than a year. Conclusion Our findings suggest that integrated care is likely to reduce cost and improve outcome. However, existing evidence varies largely and is of moderate quality. Future economic evaluation should target methodological issues to aid policy decisions with more robust evidence on the cost-effectiveness of integrated care.

Introduction: The aim of this review is to systematically assess the methodological quality of economic evaluations in integrated care and to identify challenges with conducting such studies. Theory and methods: Searches of grey-literature and scientific papers were performed, from January 2000 to December 2018. A checklist was developed to assess the quality of economic evaluations. Authors’ statements of challenges encountered during their evaluations were qualitatively coded. Results: Forty-four articles were eligible for inclusion. The review found that study design, measurement of cost and outcomes, statistical analysis and presentation of data were the areas with most quality variation. Authors identified challenges mostly related to time horizon of the evaluation, inadequate or lack of comparator group, contamination bias, and a post-hoc evaluation culture. Discussion: Our review found significant differences in quality, with some studies showing poor methodological rigor; challenging conclusions on the cost-effectiveness of integrated care. Conclusion: It is essential for evaluators to use best-practice standards when planning and conducting economic evaluations, in order to build a reliable evidence base for decision-making in integrated care.

Introduction: In an era of fiscal constraint, economic evaluations are increasingly playing a role in resource allocation decisions to invest in integrated care IC approaches. Posing significant ethical concerns are healthcare investments informed by misleading or biased evidence due to poor methodological quality. We conducted a systematic review to assess the quality of economic evaluations in IC interventions, and identified the challenges associated with the evaluations. Theory/Methods: English publications that reported the concepts of “integrated care” and “economic evaluations”, were searched from the period 2000 to August 2017 in the following databases: PubMed, EMBASE, CINAHL, Web of Science and Scopus. The methodological rigor of the studies was assessed independently by two reviewers using a 30 item-check list adapted from the Consolidated Health Economic Evaluation Reporting Standards CHEERS. Descriptive statements about the challenges experienced when evaluating IC interventions, as reported by authors, were also thematically analysed. Results: We included 40 studies in this review, however, approximately half were considered full economic evaluations; often as part of randomized control trials. Four studies that stated that their research objectives were to examine the cost-effectiveness of the IC interventions, did not perform an incremental cost-effectiveness ratio or a net benefit regression analysis. Of the cohort studies that performed cost comparisons, only one study controlled for potential confounding differences between the intervention and standard care. Valuation of the effects of the IC intervention in the full economic evaluations was often measured using quality-adjusted-life years. In some scenarios where this was challenging to ascertain; particularly in large cohort studies, natural units were used, such as estimated depression-free days. There was variability in the perspectives used, with a minority of the evaluations considering the societal impacts, such as cost shifting between sectors or the economic burden on caregivers. The long-term costs and effects of the interventions were limited in the analyses due to the short observation periods range of 3 months to 5 years. However, some studies attempted to address this through modelling estimated lifetime costs and health outcomes associated with the intervention. Discussions: The complex nature of IC can challenge the application of traditional economic evaluation, making it important to identify these methodological gaps and learn from best-practices. However, other factors may explain the heterogeneous quality of the studies. These may include; the need for further guidance on the methods, the substantial human and financial resources required for data collection and conducting the evaluations, and a lack of economic evaluation culture. Conclusions: This review intended to highlight some of the gaps and opportunities for applying the fundamentals of economic evaluation to IC interventions. Benchmarking economic evaluations against guidelines such as the CHEERS checklist can be a potential catalyst for more consistent and higher quality evidence for decision makers. Limitations: A limitation is the subjective interpretations of the quality of the studies by the reviewers, which could influence how they were rated based on the criteria. However, a major strength is that two-blinded reviewers assessed the studies and based the quality scoring on a consensus.

New Zealand has one of the highest incidences of rectal cancer in the world, and its optimal management requires a multidisciplinary approach. A National Rectal Cancer Summit was convened in August 2013 to discuss management of rectal cancer in the New Zealand context, to highlight controversies and discuss domestic priorities for the future. This paper summarises the priorities for treatment, research and policy for rectal cancer services in New Zealand identified as part of the Summit in August. The following priorities were identified: - Access to high-quality information for service planning, review of outcomes, identification of inequities and gaps in provision, and quality improvement; - Engagement with the entire sector, including private providers; - Focus on equity; - Emerging technologies; - Harmonisation of best practice; - Importance of multidisciplinary team meetings. In conclusion, improvements in outcomes for patients with rectal cancer in New Zealand will require significant engagement between policy makers, providers, researchers, and patients in order to ensure equitable access to high quality treatment, and strategic incorporation of emerging technologies into clinical practice. A robust clinical information framework is required in order to facilitate monitoring of quality improvements and to ensure that equitable care is delivered.

Gynaecological cancer services in New Zealand have followed an evolutionary process rather than being centrally organised according to evidence on best practice. A report was recently commissioned by the Ministry of Health to review gynaecological cancer services and to provide guidance on the most efficient and effective way to delivery high quality, equitable care for women diagnosed with gynaecological cancers. It is apparent the sustainability of current services is compromised by disparities in access to evidence-based multidisciplinary care, significant workforce shortages and a lack of standardised formal referral protocols. Key recommendations of the report include the establishment of an overarching national gynaecological cancer steering group and ultimately a four centre hub and spoke model of care provision.