1
|
Karlsson I, Sandman L, Axén I, Kwak L, Sernbo E, Björk Brämberg E. Ethical challenges from a problem-solving intervention with workplace involvement: a qualitative study among employees with common mental disorders, first-line managers, and rehabilitation coordinators. Int J Qual Stud Health Well-being 2024; 19:2308674. [PMID: 38324667 PMCID: PMC10851822 DOI: 10.1080/17482631.2024.2308674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
PURPOSE This study aims to explore ethical challenges potentially arising from a problem-solving intervention with workplace involvement (PSI-WPI) in primary health care (with first-line manager involvement) for employees on sickness absence due to common mental disorders. METHODS A qualitative design guided by the theoretical framework for systematic identification of ethical aspects of healthcare technologies. Semi-structured interviews were performed with coordinators (n = 6), employees (n = 13), and first-line managers (n = 8). Reflexive thematic analysis was used to analyse and interpret themes. RESULTS A main theme was identified "the workplace and healthcare hold different organizational value logics" and four sub-themes: "the PSI-WPI challenged the organizational goals and values of the workplace and healthcare", "the PSI-WPI challenged organizational values on fairness", "the PSI-WPI challenged the professional roles of first-line managers and rehabilitation coordinators" and "the PSI-WPI introduced a need for the employee to juggle the employee and patient roles". CONCLUSION Different organizational value logics, values, and goals can introduce ethical challenges. We advise clarifying stakeholders' roles and preparing employees and managers for the return to work process by providing sufficient information. The ethical challenges and suggested measures to minimize them, should be considered when planning return to work interventions that involve several stakeholders.
Collapse
Affiliation(s)
- Ida Karlsson
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| | - Lars Sandman
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Iben Axén
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| | - Lydia Kwak
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Sernbo
- Faculty of Social Sciences, Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Björk Brämberg
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Otte M, Dauben HP, Ahn J, Gutierrez Ibarluzea I, Drummond M, Simoens S, Kaló Z, Suh DC. Value based healthcare and Health Technology Assessment for emerging market countries: joint efforts to overcome barriers. Expert Rev Pharmacoecon Outcomes Res 2024:1-6. [PMID: 39221874 DOI: 10.1080/14737167.2024.2398482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION This paper summarizes the results from a forum of healthcare experts, academia representatives, and public agency officials from emerging and established market countries on Value-Based Healthcare (VBHC) and Health Technology Assessment (HTA). Presentations from experts provided insights into current developments and challenges, followed by interactive roundtable discussions. Emerging markets have unique healthcare systems, patient populations, resource constraints and needs. AREAS COVERED Each roundtable explored specific topics including the role of HTA and Real-world evidence (RWE) in healthcare decision-making, challenges in biosimilar value assessment and incorporating non-price criteria reflecting context-related specifications of emerging markets such as the multifaceted nature of value in healthcare decision-making, emphasizing stakeholder perspectives and system complexities. EXPERT OPINION RWE emerged as important in understanding biosimilar value recognition and decision-making processes, with insights into its applications and challenges. Recommendations were provided for utilizing Multi-Criteria Decision Analysis (MCDA) in pharmaceutical procurement, particularly for off-patent medicines, underscoring the importance of comprehensive evaluation frameworks and adherence to value-based principles. Overall findings suggest avenues for collaboration between industry, academia, and public agencies to address implementation barriers and promote equitable, efficient, and high-quality healthcare systems in emerging markets through public-private partnerships, joint capacity building and training initiatives, and knowledge transfers.
Collapse
Affiliation(s)
| | | | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, South Korea
| | | | | | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | - Dong-Churl Suh
- Korea Institute for Pharmaceutical Policy Affairs, Seoul, South Korea
| |
Collapse
|
3
|
DiStefano MJ, Pearson SD, Rind DM, Zemplenyi A. How Do the Institute for Clinical and Economic Review's Assessments of Comparative Effectiveness Compare With the German Federal Joint Committee's Assessments of Added Benefit? A Qualitative Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:1066-1072. [PMID: 38679288 DOI: 10.1016/j.jval.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES We compared the Institute for Clinical and Economic Review's (ICER) ratings of comparative clinical effectiveness with the German Federal Joint Committee's (G-BA) added benefit ratings, and explored what factors may explain the disagreement between the 2 organizations. METHODS We included drugs if they were assessed by ICER under its 2020 to 2023 Value Assessment Framework and had a corresponding assessment by G-BA as of January 2024 for the same indication, patient population, and comparator drug. To compare assessments, we modified ICER's proposed crosswalk between G-BA and ICER benefit ratings to account for G-BA's certainty ratings. We also determined whether each pair was based on similar evidence. Assessment pairs exhibiting disagreement based on the modified crosswalk despite a similar evidence base were qualitatively analyzed to identify reasons for disagreement. RESULTS Out of 15 drug assessment pairs matched on indication, patient subgroup, and comparator, none showed agreement in their assessments when based on similar evidence. Disagreement was attributed to differences in evidence evaluation, including evaluations of safety, generalizability, and study design, as well as G-BA's rejection of the available evidence in 4 cases as unsuitable. CONCLUSIONS The findings demonstrate that even under conditions where populations and comparators are identical and the evidence base is consistent, different assessors may arrive at divergent conclusions about comparative effectiveness, thus underscoring the presence of value judgments within assessments of clinical effectiveness. To support initiatives that seek to facilitate the exchange of value assessments between countries, these value judgments should always be transparently presented and justified in assessment summaries.
Collapse
Affiliation(s)
- Michael J DiStefano
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | | | - David M Rind
- Institute for Clinical and Economic Review, Boston, MA, USA
| | - Antal Zemplenyi
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
4
|
Bloemen B, Oortwijn W, van der Wilt GJ. Understanding the Normativity of Health Technology Assessment: Ontological, Moral, and Epistemological Commitments. HEALTH CARE ANALYSIS 2024:10.1007/s10728-024-00487-x. [PMID: 38884685 DOI: 10.1007/s10728-024-00487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Abstract
The inherent normativity of HTA can be conceptualized as a result of normative commitments, a concept that we further specify to encompass moral, epistemological and ontological commitments at play in the practice of HTA. Based on examples from literature, and an analysis of the example of assessing Non-Invasive Prenatal Testing (NIPT), we will show that inevitable normative decisions in conducting an assessment commits the HTA practitioner to moral (regarding what makes a health technology desirable), ontological (regarding which effects of health technology are conceivable), and epistemological (regarding how to obtain reliable information about health technology) norms. This highlights and supports the need for integrating normative analysis and stakeholder participation, providing guidance to HTA practitioners when making normative choices. This will foster a shared understanding between those who conduct, use, or are impacted by assessments regarding what are conceivable and desirable outcomes of using health technology, and how to collect reliable information to assess whether these outcomes are (going to be) realized. It also provides more insight into the implications of different normative choices.
Collapse
Affiliation(s)
- Bart Bloemen
- Department IQ Health Science, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Wija Oortwijn
- Department IQ Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Department IQ Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
5
|
Kulembekova L, Hailey D, Kulzhanov M, Tabarov A, Georgiev S, Jaworzynska M, Yanakieva AY, Kosherbayeva L. Stakeholders' Involvement in Health Technology Assessment in Kazakhstan, Poland and Bulgaria. Patient Prefer Adherence 2024; 18:1009-1015. [PMID: 38798950 PMCID: PMC11128218 DOI: 10.2147/ppa.s455838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
Background In recent years, involvement of healthcare stakeholders in health technology assessment (HTA) has been discussed as helping the inclusion of social values in the decision-making process. The aim of our research was to identify and compare details from Kazakhstan, Poland and Bulgaria on their stakeholders' involvement in the HTA process. Information was sought on their identification, responsibilities, and regulation. Methods We conducted a survey of seven types of stakeholders in the healthcare systems of Kazakhstan, Poland, and Bulgaria. They included patients and the public, providers, purchasers, payers, policy makers, product makers, and principal investigators. They were questioned on their involvement in the HTA process, and on the objectives of their participation. Results Levels of involvement of different kinds of stakeholder varied between countries, reflecting political and administrative developments. There was full or partial agreement on the objectives of stakeholder participation. All respondents agreed that representatives of the ministry of health should be involved in selection of stakeholders for HTA. Conclusion Progress has been made in the involvement of stakeholders, with interest in further development in all three countries.
Collapse
Affiliation(s)
- Lyazzat Kulembekova
- Health Policy and Management Department, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - David Hailey
- School of Information Sciences and Computer Technology, University of Wollongong, Wollongong, Australia
| | - Maksut Kulzhanov
- Health Policy and Management Department, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Adlet Tabarov
- Deputy Director of the National Center for Health Development, Ministry of Health, Astana, Kazakhstan
| | - Svetlin Georgiev
- Department HTA, Faculty of Public Health “prof. Tzecomir Vodenitcharov, MD, PhD, Dsc”, Medical University, Sofia, Bulgaria
| | | | - Antoniya Yordanova Yanakieva
- Department HTA, Faculty of Public Health “prof. Tzecomir Vodenitcharov, MD, PhD, Dsc”, Medical University, Sofia, Bulgaria
| | - Lyazzat Kosherbayeva
- Health Policy and Management Department, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
- Department of Health Policy and Organization, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| |
Collapse
|
6
|
Bloemen B, Oortwijn W. Assessing medical devices: a qualitative study from the validate perspective. Int J Technol Assess Health Care 2024; 40:e29. [PMID: 38654522 DOI: 10.1017/s0266462324000254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Our objective was to explore procedures and methods used at health technology assessment (HTA) agencies for assessing medical devices and the underlying views of HTA practitioners about appropriate methodology to identify challenges in adopting new methodologies for assessing devices. We focused on the role of normative commitments of HTA practitioners in the adoption of new methods. METHODS An online survey, including questions on procedures, scoping, and assessments of medical devices, was sent to members of the International Network of Agencies for Health Technology Assessment. Interviews were conducted with survey respondents and HTA practitioners involved in assessments of transcatheter aortic valve implantation to gain an in-depth understanding of choices made and views about assessing medical devices. Survey and interview questions were inspired by the "values in doing assessments of health technologies" approach towards HTA, which states that HTA addresses value-laden questions and information. RESULTS The current practice of assessing medical devices at HTA agencies is predominantly based on procedures, methods, and epistemological principles developed for assessments of drugs. Both practical factors (available time, demands of decision-makers, existing legal frameworks, and HTA guidelines), as well as commitments of HTA practitioners to principles of evidence-based medicine, make the adoption of a new methodology difficult. CONCLUSIONS There is a broad recognition that assessments of medical devices may need changes in HTA methodology. In order to realize this, the HTA community may require both a discussion on the role, responsibility, and goals of HTA, and resulting changes in institutional context to adopt new methodologies.
Collapse
Affiliation(s)
- Bart Bloemen
- IQ Health Science Department, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wija Oortwijn
- IQ Health Science Department, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
7
|
Bayón-Yusta JC, Gutiérrez-Iglesias A, Galnares-Cordero L, Gutiérrez-Ibarluzea I. Synthesis of relevant information around non-core domains to support Multi-Criteria Decision Analysis (MCDA) for decision making. GMS HEALTH INNOVATION AND TECHNOLOGIES 2024; 18:Doc02. [PMID: 38655192 PMCID: PMC11035910 DOI: 10.3205/hta000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Countries fundamentally base macro and micro decision making in the field of health on economic considerations, the budgetary impact of technologies being a major criterion. Nevertheless, the value of the technology of interest and its dimensions are more complex if we seek to take decisions based on the value itself. The use of structured and explicit approaches that require the assessment of multiple criteria that reflect the dimensions of this value may significantly improve the quality of the decision making. Multi-criteria decision analysis (MCDA) is a complementary decision-making tool that is able to systematically incorporate dimensions or domains such as ethical, organisational, legal, environmental and social considerations, as well as costs and benefits of medical interventions, together with the distinct perspectives of the interested parties. The objective of this article is to propose the implementation of analysis of non-core domains, in reports of Health Technology Assessment (HTA) agencies/units. To assess the scientific evidence on MCDA techniques a systematic review was conducted using structured searches in biomedical databases and websites of various HTA organisations. A consensus group was held using the nominal group technique and involving users of healthcare services, providers, managers and academics. Complementary, a survey was sent to HTA agencies to ascertain the degree of implementation of MCDA in their methods. 42 articles reporting the use of non-core criteria for the assessment of health technologies were included in the analysis. From these articles, a total of 216 non-core criteria were retrieved and categorised into domains by the researchers, and of these, 56 were classified as socioeconomic, 59 as organisational, 10 as legal, 8 as environmental and 47 as ethical, while 36 were considered to relate to other domains. The consensus group, based on the 216 non-core criteria obtained from the systematic review, proposed, and defined 26 criteria that participants considered necessary for decision making in healthcare. The consensus group did not consider that any of the domains should be given more weight than others or that any individual criteria should dominate. These approaches can serve as a framework of reference for a well-structured systematic discussion concerning the basis of individual criteria and the evidence supporting them.
Collapse
Affiliation(s)
- Juan Carlos Bayón-Yusta
- Basque Foundation for Health Innovation and Research (BIOEF), Barakaldo, Spain
- Osteba, Basque Office for HTA, Barakaldo, Spain
| | - Asun Gutiérrez-Iglesias
- Osteba, Basque Office for HTA, Barakaldo, Spain
- Ministry for Health, Basque Government, Vitoria-Gasteiz, Spain
| | - Lorea Galnares-Cordero
- Basque Foundation for Health Innovation and Research (BIOEF), Barakaldo, Spain
- Osteba, Basque Office for HTA, Barakaldo, Spain
| | | |
Collapse
|
8
|
Jakab I, Dimitrova M, Houÿez F, Bereczky T, Fövényes M, Maravic Z, Belina I, Andriciuc C, Tóth K, Piniazhko O, Hren R, Gutierrez-Ibarluzea I, Czech M, Tesar T, Niewada M, Lorenzovici L, Kamusheva M, Manova M, Savova A, Mitkova Z, Tachkov K, Németh B, Petykó ZI, Dawoud D, Delnoij D, Knies S, Goettsch W, Kaló Z. Recommendations for patient involvement in health technology assessment in Central and Eastern European countries. Front Public Health 2023; 11:1176200. [PMID: 37465169 PMCID: PMC10350487 DOI: 10.3389/fpubh.2023.1176200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/09/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction Meaningful patient involvement in health technology assessment (HTA) is essential in ensuring that the interests of the affected patient population, their families, and the general public are accurately reflected in coverage and reimbursement decisions. Central and Eastern European (CEE) countries are generally at less advanced stages of implementing HTA, which is particularly true for patient involvement activities. As part of the Horizon2020 HTx project, this research aimed to form recommendations for critical barriers to patient involvement in HTA in CEE countries. Methods Built on previous research findings on potential barriers, a prioritisation survey was conducted online with CEE stakeholders. Recommendations for prioritised barriers were formed through a face-to-face workshop by CEE stakeholders and HTx experts. Results A total of 105 stakeholders from 13 CEE countries completed the prioritisation survey and identified 12 of the 22 potential barriers as highly important. The workshop had 36 participants representing 9 CEE countries, and 5 Western European countries coming together to discuss solutions in order to form recommendations based on best practices, real-life experience, and transferability aspects. Stakeholder groups involved in both phases included HTA organisation representatives, payers, patients, caregivers, patient organisation representatives, patient experts, health care providers, academic and non-academic researchers, health care consultants and health technology manufacturers/providers. As a result, 12 recommendations were formed specified to the CEE region's context, but potentially useful for a broader geographic audience. Conclusion In this paper, we present 12 recommendations for meaningful, systematic, and sustainable patient involvement in HTA in CEE countries. Our hope is that engaging more than a hundred CEE stakeholders in the study helped to spread awareness of the importance and potential of patient involvement and that the resulting recommendations provide tangible steps for the way forward. Future studies shall focus on country-specific case studies of the implemented recommendations.
Collapse
Affiliation(s)
- Ivett Jakab
- Syreon Research Institute, Budapest, Hungary
- Patient advocate, Budapest, Hungary
| | - Maria Dimitrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - François Houÿez
- European Organisation for Rare Diseases (EURORDIS), Paris, France
| | | | | | | | - Ivica Belina
- Coalition of Associations in Healthcare, Zagreb, Croatia
| | | | - Krisztina Tóth
- Syreon Research Institute, Budapest, Hungary
- Bridge of Health Alliance against Breast Cancer Association, Budapest, Hungary
| | - Oresta Piniazhko
- Health Technology Assessment Department of State Expert Centre, Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Rok Hren
- Syreon Research Institute, Budapest, Hungary
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
| | | | - Marcin Czech
- Head of Pharmacoeconomic Department, Institute of Mother and Child, Warsaw, Poland
| | - Tomas Tesar
- Department of Organisation and Management in Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - László Lorenzovici
- Syreon Research Romania, Tirgu Mures, Romania
- Department of Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Targu Mures, Romania
| | - Maria Kamusheva
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Manoela Manova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
- National Council on Prices and Reimbursement of Medicines, Sofia, Bulgaria
| | - Alexandra Savova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
- National Council on Prices and Reimbursement of Medicines, Sofia, Bulgaria
| | - Zornitsa Mitkova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | | | | | - Zsuzsanna Ida Petykó
- Syreon Research Institute, Budapest, Hungary
- Centre for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Dalia Dawoud
- Science, Policy and Research Programme, National Institute for Health and Care Excellence, London, United Kingdom
| | - Diana Delnoij
- National Health Care Institute (ZIN), Diemen, Netherlands
| | - Saskia Knies
- National Health Care Institute (ZIN), Diemen, Netherlands
| | - Wim Goettsch
- National Health Care Institute (ZIN), Diemen, Netherlands
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Centre for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| |
Collapse
|
9
|
Torres-Castaño A, Abt-Sacks A, Toledo-Chávarri A, Suarez-Herrera JC, Delgado-Rodríguez J, León-Salas B, González-Hernández Y, Carmona-Rodríguez M, Serrano-Aguilar P. Ethical, Legal, Organisational and Social Issues of Teleneurology: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3694. [PMID: 36834388 PMCID: PMC9962592 DOI: 10.3390/ijerph20043694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. Teleneurology (TN) allows neurology to be applied when the doctor and patient are not present in the same place, and sometimes not at the same time. In February 2021, the Spanish Ministry of Health requested a health technology assessment report on the implementation of TN as a complement to face-to-face neurological care. METHODS A scoping review was conducted to answer the question on the ethical, legal, social, organisational, patient (ELSI) and environmental impact of TN. The assessment of these aspects was carried out by adapting the EUnetHTA Core Model 3.0 framework, the criteria established by the Spanish Network of Health Technology Assessment Agencies and the analysis criteria of the European Validate (VALues In Doing Assessments of healthcare TEchnologies) project. Key stakeholders were invited to discuss their concerns about TN in an online meeting. Subsequently, the following electronic databases were consulted from 2016 to 10 June 2021: MEDLINE and EMBASE. RESULTS 79 studies met the inclusion criteria. This scoping review includes 37 studies related to acceptability and equity, 15 studies developed during COVID and 1 study on environmental aspects. Overall, the reported results reaffirm the necessary complementarity of TN with the usual face-to-face care. CONCLUSIONS This need for complementarity relates to factors such as acceptability, feasibility, risk of dehumanisation and aspects related to privacy and the confidentiality of sensitive data.
Collapse
Affiliation(s)
- Alezandra Torres-Castaño
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Analía Abt-Sacks
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Ana Toledo-Chávarri
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - José Carlos Suarez-Herrera
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- UNITWIN/UNESCO Chair, Research, Planning and Development of Local Health Systems, Department of Clinical Sciences, University of Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain
| | - Janet Delgado-Rodríguez
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
- Department of Philosophy I, University of Granada, 18071 Granada, Spain
| | - Beatriz León-Salas
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Yadira González-Hernández
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Montserrat Carmona-Rodríguez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
- Health Technology Assessment Agency, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pedro Serrano-Aguilar
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Institute of Biomedical Technologies, University of La Laguna, 38200 Tenerife, Spain
| |
Collapse
|
10
|
Wale JL, Sehmi K, Kamoga R, Ssekubugu R. Civil society and medical product access in Africa: Lessons from COVID-19. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1091425. [PMID: 36824260 PMCID: PMC9941705 DOI: 10.3389/fmedt.2023.1091425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Understanding health as a human right creates a legal obligation on countries to ensure access to timely, acceptable, and affordable health care. We highlight the importance of a meaningful role for civil society in improving access to well-regulated quality medical products in Africa; to support and be part of a regional social contract approach following the access issues that have been particularly evident during the COVID-19 pandemic. We argue that African communities have a clear participatory role as important stakeholders in the regulatory lifecycle. Solidarity is important for a cohesive approach as formal government healthcare infrastructure may be minimal for some countries, with little training of communities available for disease management and insufficient money to fund people to organise and deliver health care. Some of the issues for civil society engagement with multi-stakeholders, and possible mitigating strategies, are tabulated to initiate discussion on facilitators and concerns of governments and other stakeholders for meaningful participation by patients, communities and civil society within a regional regulatory lifecycle approach. Solidarity is called for to address issues of equity, ethics and morality, stigmatisation and mutual empowerment - to sustainably support the region and national governments to develop greater self-sufficiency throughout the regulatory lifecycle. By creating a participatory space, patients, communities and civil society can be invited in with clear missions and supported by well-defined guidance to create a true sense of solidarity and social cohesion. Strong leadership coupled with the political will to share responsibilities in all aspects of this work is key.
Collapse
Affiliation(s)
- Janet L. Wale
- Independent Researcher, Brunswick, VIC, Australia,Correspondence: Janet L. Wale
| | - Kawaldip Sehmi
- International Alliance of Patients' Organisations, London, United Kingdom
| | - Regina Kamoga
- Uganda Alliance of Patients Organizations (UAPO), World Patient Alliance (WPA), CHAIN, Kampala, Uganda
| | - Robert Ssekubugu
- Rakai Health Sciences Program Research Institute in Kalisizo, Kalisizo, Uganda
| |
Collapse
|
11
|
Health technology assessment: A matter of facts and values. Int J Technol Assess Health Care 2022; 38:e53. [DOI: 10.1017/s0266462322000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The unique task and contribution of health technology assessment (HTA) is to help identify those health technologies and their uses that are most likely to preserve and restore a population’s health in a way that is consonant with its values, including, for example, equity and access to high-quality care (1). Such a task is challenging for at least two reasons. First, because of the vast and constantly evolving number and diversity of health technologies and their applications. Second, because of the usual wide variety of competing views within communities and their stakeholders regarding what strategies are likely to be conducive to the goal of preserving and restoring population health. Although perhaps tempting, it would be a grave mistake to hold that the controversies that result from such competing views can be resolved by taking recourse to the facts only. For such controversies are usually fueled by different notions of health and disease and different specifications of values such as equity and individual and collective responsibility for health. For this reason, they cannot be resolved in a satisfactory way without also addressing those normative issues and their interplay with empirical analysis.*
Collapse
|
12
|
Learning and practicing more value-reflective, problem-setting Health Technology Assessment - Experiences and lessons from the VALIDATE project. Int J Technol Assess Health Care 2022; 38:e63. [PMID: 35726526 DOI: 10.1017/s0266462322000204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|