1
|
Soundararajan R, Khan T, Dadelszen PV. Pre-eclampsia challenges and care in low and middle-income countries: Understanding diagnosis, management, and health impacts in remote and developing regions. Best Pract Res Clin Obstet Gynaecol 2024:102525. [PMID: 38964990 DOI: 10.1016/j.bpobgyn.2024.102525] [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: 11/21/2023] [Revised: 01/20/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
As an example of a low- and middle-income country (LMIC), India ranks pre-eclampsia among the top three causes of maternal mortality, following haemorrhage and infections. It is one of the primary concerns for maternal and perinatal health in LMICs. Many LMICs lack clear consensus and guidelines for the prevention, diagnosis, and management of hypertensive disorders in pregnancy, including pre-eclampsia. The International Society for the Study of Hypertension in Pregnancy 2021 guidelines address LMIC applications, offering customisable solutions. Atypical presentations of pre-eclampsia contribute to diagnostic delays, resulting in additional adverse maternal and perinatal outcomes. Implementing management strategies faces challenges in both urban and rural settings. Adapting global research involving local populations is imperative, with the potential for cost-effective adoption of international guidelines. Prevention, early diagnosis, and education dissemination are essential, involving healthcare providers and advocacy initiatives. Encouraging government investment in pre-eclampsia management as a public health initiative is important. This article explores socio-economic, cultural, and legislative factors influencing the management of pre-eclampsia in LMICs, addressing emerging challenges and potential partnerships for healthcare provision.
Collapse
Affiliation(s)
- Revathi Soundararajan
- Chief Consultant [Maternal Fetal Medicine], Managing Director, Mirror Health, Secretary, SMFM (I), Co-Chair, PEN (I), Bengaluru, India.
| | - Tamkin Khan
- Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
| | | |
Collapse
|
2
|
Cross JG, May BR, Mai PQM, Anderson E, Welsh C, Chandran S, Chorath KT, Herr S, Gonzalez D. A systematic review and evaluation of post-stroke depression clinical practice guidelines. J Stroke Cerebrovasc Dis 2023; 32:107292. [PMID: 37572601 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVE Post-stroke depression is a depressive mood disorder that follows a cerebrovascular accident and is a burden on stroke patients. Its management is included in clinical practice guidelines focused on stroke, and the recommended treatment is selective serotonin reuptake inhibitors in conjunction with psychotherapy. Clinical practice guidelines are recommendations used to standardize best medical practice, but there is no current evaluation of guidelines containing post stroke depression recommendations. Thus, the objective is to appraise the selected guidelines manner of development and quality. MATERIALS AND METHODS A systematic literature review across three databases and a manual google search was performed to collect guidelines that included recommendations on the management of post-stroke depression. 1236 guidelines were screened, and 27 were considered for inclusion. Considered guidelines were manually reviewed by the authors, and ultimately, 7 met inclusion criteria. The appraisal of guidelines for research and evaluation was used to evaluate these guidelines' recommendations around post-stroke depression. RESULTS Three guidelines met the threshold considered "High", with all of them having five or more quality domains eclipse the cutoff score of 70%. Across all guidelines, the highest scoring domains were "Scope and Purpose", "Clarity of Presentation", and "Editorial Independence" with scores of 76.98%, 73.81%, and 91.36% respectively. The lowest scoring domains were "Applicability", "Rigor of Development", and "Stakeholder Involvement" with respective scores of 58.73%, 54.02%, and 43.90%. CONCLUSIONS The domains "Applicability", "Rigor of Development," and "Stakeholder Involvement" were the lowest scoring domains. These specific domains represent areas in which future guidelines could be more developed.
Collapse
Affiliation(s)
| | - Brandon R May
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Peter Q M Mai
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Elizabeth Anderson
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Connor Welsh
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Kevin T Chorath
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Shelby Herr
- Creighton University School of Medicine, Phoenix, Arizona, USA
| | - Daniel Gonzalez
- Department of Neurovascular & Stroke Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA.
| |
Collapse
|
3
|
Mathew JL. Efficiency, Economy and Excellence: Experimental Exploration of Evidence-based Guideline Development in Resource-Constrained Settings. Indian J Pediatr 2023:10.1007/s12098-023-04575-z. [PMID: 37106227 PMCID: PMC10139904 DOI: 10.1007/s12098-023-04575-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/17/2023] [Indexed: 04/29/2023]
Abstract
Development of clinical practice guidelines is a scientific process based on a thorough review and appraisal of the global evidence, but factoring in local contextually relevant issues. It is highly resource intensive, demanding considerable time, human skills, and finances- making it challenging in resource-constrained settings. This article summarizes a unique attempt to develop evidence-based guidelines in such settings. This was made possible by mentoring and monitoring a group of committed healthcare professionals with limited prior expertise in evidence-based guideline development. The various steps included an online training workshop to build knowledge and skills. This was followed by a systematic process of identifying topics requiring evidence-based guidelines. Thereafter, the topics were prioritized through a Delphi process. Formal clinical questions were framed using the PICOTS (Patient/ Population, Intervention/ Exposure, Comparison, Outcome, Time-frame, Setting) format. The guideline development process was made time and resource efficient by starting with a formal search for existing guidelines whose recommendations could be adopted, adapted, or adoloped to the local setting. If such guidelines were unavailable, high quality secondary evidence (systemic reviews) was accessed to find answers to the clinical questions. If unavailable, de novo systematic reviews of primary research studies were undertaken. The evidence base was critically appraised and graded. Formal evidence-to-decision formats were used to enable translation of the evidence to recommendations implementable in the local setting. The entire guideline development process was completed with zero financial allocation. This model focusing on efficiency, economy, and excellence, can be emulated in diverse resource-constrained settings.
Collapse
Affiliation(s)
- Joseph L Mathew
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| |
Collapse
|
4
|
Rajwar E, Pundir P, Parsekar SS, D S A, D'Souza SRB, Nayak BS, Noronha JA, D'Souza P, Oliver S. The utilization of systematic review evidence in formulating India's National Health Programme guidelines between 2007 and 2021. Health Policy Plan 2023; 38:435-453. [PMID: 36715073 PMCID: PMC10089070 DOI: 10.1093/heapol/czad008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/29/2022] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Evidence-informed policymaking integrates the best available evidence on programme outcomes to guide decisions at all stages of the policy process and its importance becomes more pronounced in resource-constrained settings. In this paper, we have reviewed the use of systematic review evidence in framing National Health Programme (NHP) guidelines in India. We searched official websites of the different NHPs, linked to the main website of the Ministry of Health and Family Welfare (MoHFW), in December 2020 and January 2021. NHP guideline documents with systematic review evidence were identified and information on the use of this evidence was extracted. We classified the identified systematic review evidence according to its use in the guideline documents and analysed the data to provide information on the different factors and patterns linked to the use of systematic review evidence in these documents. Systematic reviews were mostly visible in guideline documents addressing maternal and newborn health, communicable diseases and immunization. These systematic reviews were cited in the guidelines to justify the need for action, to justify recommendations for action and opportunities for local adaptation, and to highlight implementation challenges and justify implementation strategies. Guideline documents addressing implementation cited systematic reviews about the problems and policy options more often than citing systematic reviews about implementation. Systematic reviews were linked directly to support statements in few guideline documents, and sometimes the reviews were not appropriately cited. Most of the systematic reviews providing information on the nature and scale of the policy problem included Indian data. It was seen that since 2014, India has been increasingly using systematic review evidence for public health policymaking, particularly for some of its high-priority NHPs. This complements the increasing investment in research synthesis centres and procedures to support evidence-informed decision making, demonstrating the continued evolution of India's evidence policy system.
Collapse
Affiliation(s)
- Eti Rajwar
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka 576104, India
- The George Institute for Global Health, 308, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi 110025, India
| | - Prachi Pundir
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka 576104, India
- The George Institute for Global Health, 308, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi 110025, India
| | - Shradha S Parsekar
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka 576104, India
| | - Anupama D S
- Department of Obstetrics and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka 576104, India
| | - Sonia R B D'Souza
- Department of Obstetrics and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka 576104, India
| | - Baby S Nayak
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka 576104, India
| | - Judith Angelitta Noronha
- Department of Obstetrics and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka 576104, India
| | - Preethy D'Souza
- EPPI-Centre, Social Science Research Unit, UCL Social Research Institute, University College London, 10 Bedford Way, London WC1H 0AL, UK
| | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, UCL Social Research Institute, University College London, 10 Bedford Way, London WC1H 0AL, UK
- Africa Centre for Evidence, Faculty of Humanities, University of Johannesburg, PO Box 524, Auckland Park 2006, Johannesburg, South Africa
| |
Collapse
|
5
|
Dhurjati R, Sagar V, Kanukula R, Rehana N, Mohanan PP, Huffman MD, Bhaumik S, Salam A. Quality of the Indian clinical practice guidelines for the management of cardiovascular conditions. JRSM Open 2022; 13:20542704221127178. [PMID: 36506268 PMCID: PMC9730011 DOI: 10.1177/20542704221127178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To assess the quality of Indian clinical practice guidelines (CPG)s for the management of cardiovascular conditions, MEDLINE, Embase, Google Scholar and websites of relevant medical associations and government organisations were searched, from inception until August 2020, to identify Indian CPGs for the management of cardiovascular disease (CVD) conditions, produced in or between 2010 and 2019. Excluded were CPGs that were not specific to India, focused on alternative systems of medicine, of non-CVD conditions (even if they included a component of CVD), and those related to the electronic devices, cardiac biomarkers, or diagnostic procedures. Quality of the each included CPG was assessed using the AGREE II tool by four reviewers in duplicate, independently. Each AGREE II domain score and overall quality score was considered low (≤40%), moderate (40.1%-59.9%), and high (≥60%). Of the 23 CPGs included, six (26%) were reported to be adapted from other CPGs. Fourteen (61%) CPGs were produced by medical associations, six (26%) by individual authors and three (13%) by government agencies. Based on the AGREE II overall quality score, two (9%) CPGs were of high quality, four (17%) and seventeen (74%) CPGs were of moderate and low quality, respectively. Except for scope and purpose, and clarity of presentation all other domains were rated low. The quality of most Indian CPGs for managing CVD conditions assessed using the AGREE II tool was moderate-to-low. Combined efforts from different stakeholders are needed to develop, disseminate and implement high-quality CPGs while identifying and addressing barriers to their uptake to optimize patient care and improve outcomes.
Collapse
Affiliation(s)
| | - Vidya Sagar
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Raju Kanukula
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Nusrath Rehana
- The George Institute for Global Health, New Delhi, Delhi, India
| | | | - Mark D. Huffman
- Washington University in St. Louis, St Louis, MO, USA,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Soumyadeep Bhaumik
- The George Institute for Global Health, New Delhi, Delhi, India,Meta-research & Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, Delhi, India
| | - Abdul Salam
- The George Institute for Global Health, New Delhi, Delhi, India,Manipal Academy of Higher Education, Manipal, Karnataka, India,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia,Abdul Salam.
| |
Collapse
|
6
|
Nayak PR, Oswal K, Pramesh CS, Ranganathan P, Caduff C, Sullivan R, Advani S, Kataria I, Kalkonde Y, Mohan P, Jain Y, Purushotham A. Informal Providers-Ground Realities in South Asian Association for Regional Cooperation Nations: Toward Better Cancer Primary Care: A Narrative Review. JCO Glob Oncol 2022; 8:e2200260. [PMID: 36315923 PMCID: PMC9812474 DOI: 10.1200/go.22.00260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE South Asian Association for Regional Cooperation (SAARC) nations are a group of eight countries with low to medium Human Development Index values. They lack trained human resources in primary health care to achieve the WHO-stated goal of Universal Health Coverage. An unregulated service sector of informal health care providers (IPs) has been serving these underserved communities. The aim is to summarize the role of IPs in primary cancer care, compare quality with formal providers, quantify distribution in urban and rural settings, and present the socioeconomic milieu that sustains their existence. METHODS A narrative review of the published literature in English from January 2000 to December 2021 was performed using MeSH Terms Informal Health Care Provider/Informal Provider and Primary Health Care across databases such as Medline (PubMed), Google Scholar, and Cochrane database of systematic reviews, as well as World Bank, Center for Global Development, American Economic Review, Journal Storage, and Web of Science. In addition, citation lists from the primary articles, gray literature in English, and policy blogs were included. We present a descriptive overview of our findings as applicable to SAARC. RESULTS IPs across the rural landscape often comprise more than 75% of primary caregivers. They provide accessible and affordable, but often substandard quality of care. However, their network would be suitable for prompt cancer referrals. Care delivery and accountability correlate with prevalent standards of formal health care. CONCLUSION Acknowledgment and upskilling of IPs could be a cost-effective bridge toward universal health coverage and early cancer diagnosis in SAARC nations, whereas state capacity for training formal health care providers is ramped up simultaneously. This must be achieved without compromising investment in the critical resource of qualified doctors and allied health professionals who form the core of the rural public primary health care system.
Collapse
Affiliation(s)
- Prakash R. Nayak
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Priya Ranganathan
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, United Kingdom
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, United Kingdom
| | | | - Ishu Kataria
- Public Health Centre for Global Non-communicable Diseases, RTI International, New Delhi, India
| | - Yogeshwar Kalkonde
- Sangwari-People's Association for Equity and Health, Ambikapur, Chhattisgarh, India
| | | | | | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, United Kingdom,Arnie Purushotham, MD, 3rd Floor Bermondsey Wing, Guy's Hospital, School of Cancer and Pharmaceutical Sciences, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom; e-mail:
| |
Collapse
|
7
|
Sengar M, Pramesh CS, Mehndiratta A, Shah S, Munshi A, Vijaykumar DK, Puri A, Mathew B, Arora RS, Kumari T P, Deodhar K, Menon S, Epari S, Shetty O, Cluzeau F. Ensuring quality in contextualised cancer management guidelines for resource-constraint settings: using a systematic approach. BMJ Glob Health 2022; 7:bmjgh-2022-009584. [PMID: 35985695 PMCID: PMC9396157 DOI: 10.1136/bmjgh-2022-009584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/16/2022] [Indexed: 11/03/2022] Open
Abstract
To address the wide variation in access to cancer care in India requires strengthening of infrastructure, trained oncology workforce, and minimisation of out-of-pocket expenditures. However, even with major investments, it is unlikely to achieve the same level of infrastructure and expertise across the country. Therefore, a resource stratified approach driven by evidence-based and contextualised clinical guidelines is the need of the hour. The National Cancer Grid has been at the forefront of delivery of standardised cancer care through several of its initiatives, including the resource-stratified guidelines. Development of new guidelines is resource and time intensive, which may not be feasible and can delay the implementation. Adaptation of the existing standard guidelines using the transparent and well-documented methodology with involvement of all stakeholders can be one of the most reasonable pathways. However, the adaptation should be done keeping in mind the context, resource availability, budget impact, investment needed for implementation and acceptability by clinicians, patients, policymakers, and other stakeholders. The present paper provides the framework for systematically developing guidelines through adaptation and contextualisation. The process can be used for other health conditions in resource-constraint settings.
Collapse
Affiliation(s)
- Manju Sengar
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - C S Pramesh
- Tata Memorial Centre, Mumbai, India .,Homi Bhabha National Institute, Mumbai, India
| | | | - Sudeep Shah
- P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | | | - D K Vijaykumar
- Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Ajay Puri
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Beela Mathew
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Ramandeep Singh Arora
- Max Institute of Cancer Care, Max Super Speciality Hospital, New Delhi, New Delhi, India
| | - Priya Kumari T
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Kedar Deodhar
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Santosh Menon
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Sridhar Epari
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Omshree Shetty
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | | |
Collapse
|
8
|
Chen Y, Gao Y, Zhang J, Niu M, Liu X, Zhang Y, Tian J. Quality and clinical applicability of recommendations for incontinence-associated dermatitis: A systematic review of guidelines and consensus statements. J Clin Nurs 2022; 32:2371-2382. [PMID: 35411654 DOI: 10.1111/jocn.16306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 12/20/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to assess methodological quality of all currently available guidelines and consensus statements for IAD using the Appraisal of Guidelines, Research and Evaluation (AGREE) II and the AGREE Recommendation Excellence (AGREE-REX) instruments. BACKGROUND Globally, incontinence-associated dermatitis (IAD) is a significant health challenge. IAD is a complex healthcare problem that reduces quality of life of patients, increases healthcare costs and prolongs hospital stays. Several guidelines and consensus statements are available for IAD. However, the quality of these guidelines and consensus statements remains unclear. DESIGN A systematic review of guidelines and consensus statements. METHODS Our study was undertaken using PRISMA guidelines. We searched seven electronic databases. Guidelines and consensus statements had to be published in English, Chinese or German languages. Five independent reviewers assessed the methodological quality of guidelines and consensus statements using the AGREE II and AGREE-REX instruments. Mean with standard deviation (SD) and median with interquartile range (IQR) were calculated for descriptive analyses. We generated bubble plots to describe the assessment results of each domain of each guideline and consensus statement. RESULTS We included ten guidelines and consensus statements. The NICE guidelines, obtained the highest scores, fulfilled 86.11%-98.61% of criteria in AGREE II and 76.67%-91.11% for AGREE-REX. In the domains 'Stakeholder Involvement' (4.39 ± 1.64), 'Rigor of Development' (3.38 ± 1.86), 'Applicability' (3.62 ± 1.64), 'Editorial Independence' (3.91 ± 2.56) and 'Values and Preferences' (2.98 ± 1.41), the remaining guidelines and consensus statements showed deficiencies. CONCLUSIONS Altogether, this study demonstrated that the currently available guidelines and consensus statements for IAD have room for methodological improvement. NICE guidelines on faecal incontinence and urinary incontinence have better quality. Remaining guidelines and consensus statements showed substantial methodological weaknesses, especially the domains of 'Stakeholder Involvement', 'Rigor of Development', 'Applicability', 'Editorial independence' and 'Values and Preferences'. This study was registered on INPLASY. (Registration number: INPLASY202190078). RELEVANCE TO CLINICAL PRACTICE The currently available guidelines and consensus statements on IAD have room for methodological improvement.
Collapse
Affiliation(s)
- Yamin Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Ya Gao
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China.,School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jiaoyan Zhang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Mingming Niu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Xiaofeng Liu
- Department of Nursing, Jingning People's Hospital, Pingliang, China
| | - Yuqin Zhang
- Department of Dermatology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China.,School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| |
Collapse
|
9
|
Yao X, Xia J, Jin Y, Shen Q, Wang Q, Zhu Y, McNair S, Sussman J, Wang Z, Florez ID, Zeng XT, Brouwers M. Methodological approaches for developing, reporting, and assessing evidence-based clinical practice guidelines: A systematic survey. J Clin Epidemiol 2022; 146:77-85. [PMID: 35271968 DOI: 10.1016/j.jclinepi.2022.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 12/08/2022]
Abstract
OBJECTIVE To produce a mapping and feature summary of approaches and tools available for the CPG community to develop, report, or assess four types of CPGs: (1) Standard original (or de novo) CPG, (2) Rapid original CPG, (3) Adapted/adopted CPGs, and (4) Updated CPGs. STUDY DESIGN The systematic literature search was conducted using Embase and PubMed, covering the period from January 2010 to October 13 2020. Two websites that collect and recommend approaches/tools to develop, report, or assess CPGs were also searched: Guidelines International Network and Equator Network. We screened the search results to include methodological papers that aimed to develop specific approaches/tools to develop, report, or assess any of the aforementioned four CPG types. RESULTS Among 10,581 citations, 46 papers reporting 46 approaches/tools were included. Of these 46 approaches/tools, 33 were about CPG development, seven were for CPG reporting, and six for CPG assessment. Among the 33 development approaches/tools, 26 did not state usability or validity information; but nine from 13 reporting or assessment approaches/tools did. CONCLUSIONS This study provides a mapping and feature summary of the current available approaches/tools, which serves to improve users' understanding to pave the way for informed choice and application.
Collapse
Affiliation(s)
- Xiaomei Yao
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Center for Clinical Practice Guideline Conduction and Evaluation, Children's Hospital of Fudan University, Shanghai, China
| | - Jun Xia
- Nottingham Ningbo GRADE Centre, The University of Nottingham Ningbo, Ningbo, Zhejiang, China; School of Medicine, The University of Nottingham, United Kingdom
| | - Yinghui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Quan Shen
- School of Health Science, Wuhan University, Wuhan, Hubei, China
| | - Qi Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ying Zhu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sheila McNair
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Zhiwen Wang
- School of Nursing, Health Science Centre for Evidence-Based Nursing, Peking University School of Nursing, Beijing, China
| | - Ivan D Florez
- Department of Pediatrics, University of Antioquia, Colombia; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada;.
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
| | - Melissa Brouwers
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canad
| |
Collapse
|
10
|
Sreelakshmi PR, Iype T, Varma R, Moloney S, Babu V, Krishnapilla V, Kutty VR, Robinson L. Exploring the barriers for guideline-based management of dementia amongst consultants in Kerala, South India: A qualitative study. Indian J Med Res 2022; 155:311-314. [PMID: 35946210 PMCID: PMC9629520 DOI: 10.4103/ijmr.ijmr_3_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- P Raghunath Sreelakshmi
- Department of Community Medicine, SUT Academy of Medical Sciences, Vattappara, Thiruvananthapuram 695 028, Kerala, India
| | - Thomas Iype
- Department of Neurology, Government Medical College, Thiruvananthapuram 695 011, Kerala, India
| | - Raviprasad Varma
- Department of Public Health, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram 695 011, Kerala, India
| | - Susan Moloney
- NIHR Global Health Research Group on Dementia Prevention & Enhanced Care, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE4 5PL, United Kingdom
| | - Veena Babu
- Health Action by People, Thiruvananthapuram 695 011, Kerala, India
| | - Vijayakumar Krishnapilla
- Department of Community Medicine, Amrita Institute of Medical Sciences, Edappally, Kochi 682 041, Kerala, India
| | - V Raman Kutty
- Department of Public Health, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences & Technology; Health Action by People, Thiruvananthapuram 695 011, Kerala, India
| | - Louise Robinson
- Department of Primary Care & Ageing, Population Health Sciences Institute, Newcastle University Institute for Ageing, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom
| |
Collapse
|
11
|
Shaikh A, Bhatia A, Yadav G, Hora S, Won C, Shankar M, Heerboth A, Vemulapalli P, Navalkar P, Oswal K, Heaton C, Saunik S, Khanna T, Balsari S. Applying Human-Centered Design Principles to Digital Syndromic Surveillance at a Mass Gathering in India: Viewpoint. J Med Internet Res 2022; 24:e27952. [PMID: 35006088 PMCID: PMC8787658 DOI: 10.2196/27952] [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: 02/15/2021] [Revised: 08/23/2021] [Accepted: 09/25/2021] [Indexed: 11/13/2022] Open
Abstract
In the wake of the COVID-19 pandemic, digital health tools have been deployed by governments around the world to advance clinical and population health objectives. Few interventions have been successful or have achieved sustainability or scale. In India, government agencies are proposing sweeping changes to India's digital health architecture. Underpinning these initiatives is the assumption that mobile health solutions will find near universal acceptance and uptake, though the observed reticence of clinicians to use electronic health records suggests otherwise. In this practice article, we describe our experience with implementing a digital surveillance tool at a large mass gathering, attended by nearly 30 million people. Deployed with limited resources and in a dynamic chaotic setting, the adherence to human-centered design principles resulted in near universal adoption and high end-user satisfaction. Through this use case, we share generalizable lessons in the importance of contextual relevance, stakeholder participation, customizability, and rapid iteration, while designing digital health tools for individuals or populations.
Collapse
Affiliation(s)
- Ahmed Shaikh
- Institute for Critical Care Medicine, Mount Sinai Hospital, New York, NY, United States
| | - Abhishek Bhatia
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,India Digital Health Network, Lakshmi Mittal and Family South Asia Institute, Harvard University, Cambridge, MA, United States
| | - Ghanshyam Yadav
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Shashwat Hora
- Articulate Labs, Inc, San Francisco, CA, United States
| | - Chung Won
- Department of Emergency Medicine, Memorial Hermann Hospital -Baylor College of Medicine, Houston, TX, United States
| | - Mark Shankar
- Department of Emergency Medicine, Jacobi Medical Center, New York, NY, United States
| | - Aaron Heerboth
- India Digital Health Network, Lakshmi Mittal and Family South Asia Institute, Harvard University, Cambridge, MA, United States
| | - Prakash Vemulapalli
- University Hospitals Center for Emergency Medicine, Cleveland Medical Center, Cleveland, OH, United States
| | | | - Kunal Oswal
- Department of Public Health Dentistry, Sharad Pawar Dental College, Maharashtra, India
| | - Clay Heaton
- India Digital Health Network, Lakshmi Mittal and Family South Asia Institute, Harvard University, Cambridge, MA, United States
| | - Sujata Saunik
- Department of General Administration, Government of Maharashtra, Mumbai, India.,Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Tarun Khanna
- Harvard Business School, Boston, MA, United States
| | - Satchit Balsari
- India Digital Health Network, Lakshmi Mittal and Family South Asia Institute, Harvard University, Cambridge, MA, United States.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, United States.,Department of Emergency Medicine, Beth Israel Deaconess- Harvard Medical School, Boston, MA, United States
| |
Collapse
|
12
|
Nicolotti CA, Lacerda JTD. Avaliação da organização e práticas de assistência ao parto e nascimento em três hospitais de Santa Catarina, Brasil. CAD SAUDE PUBLICA 2022; 38:e00052922. [DOI: 10.1590/0102-311xpt052922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
O objetivo foi avaliar a assistência hospitalar ao parto e ao nascimento, analisando aspectos de gestão e assistência desde a admissão das mulheres para o parto até o pós-parto. Foi realizada uma pesquisa avaliativa dos aspectos de gestão e práticas de assistência ao parto e nascimento, desenvolvida no período de novembro de 2019 a fevereiro de 2020, em três hospitais de Santa Catarina, Brasil, com melhor desempenho em uma avaliação nacional de boas práticas de assistência ao parto e ao nascimento. A coleta de dados envolveu análise documental, observação e entrevistas com profissionais da gestão, assistência e puérperas. Foram analisados 30 indicadores, que compuseram uma matriz de análise e julgamento, agrupados nas dimensões Político-Organizacional e Tático-Operacional. O julgamento orientou-se pela comparação entre a pontuação observada e a pontuação máxima esperada em cada um dos componentes da matriz avaliativa. A assistência ao parto e ao nascimento foi parcialmente satisfatória nos hospitais 2 e 3 e insatisfatória no hospital 1. A dimensão Político-Organizacional foi classificada como insatisfatória e a Tático-Operacional parcialmente satisfatória nos três hospitais. Nenhum hospital obteve avaliação satisfatória em mais de 40% dos indicadores. Os hospitais analisados ainda não conseguiram consolidar as mudanças no modelo assistencial na perspectiva do cuidado humanizado, orientado por evidências científicas e direitos.
Collapse
|
13
|
Lahariya C, Sharma S, Agnani M, de Graeve H, Srivastava JN, Bekedam H. Attributes of Standard Treatment Guidelines in Clinical Settings and Public Health Facilities in India. Indian J Community Med 2022; 47:336-342. [PMID: 36438529 PMCID: PMC9693950 DOI: 10.4103/ijcm.ijcm_665_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 03/09/2022] [Indexed: 12/26/2022] Open
Abstract
Background Standard Treatment Guidelines (STGs) are time-tested tool to improve healthcare quality and patient safety. This study was done to review the available guidelines and assess their essential attributes using AGREE reporting checklist 2016. Methods Publications from PubMed, World Health Organization, Global Health Regional Libraries, Index Medicus, Google, Google Scholar, and insurers, state/central government portals were searched. Results In total, 241 STGs met the inclusion criteria. A range of developers with a varying focus and priorities developed these guidelines (government mostly under national programs 134 (56%); professional associations 67 (28%), academic/research institutions 36 (15%); international agencies 4 [2%]). The government-led guidelines focused on program operations (mainly infections, maternal, and childcare), whereas insurers focused on surgical procedures for protection against fraudulent intentions for claims. The available STGs varied largely in terms of development process rigor, end-user involvement, updation, applicability, etc.; 12% guidelines developed documented GRADE criteria for evidence. Most guidelines focused on the primary care, and only 27 and 7% included treatment at tertiary and secondary levels, respectively, focused on general practitioners. Conclusion There is a need for coordinated, and collaborative efforts to generate evidence-based guidelines, facilitate periodic revisions, standardized development process, and the standards for monitoring embedded in the guidelines. A single designated authority for the standard treatment guidelines development and a central web-based repository with free access for clinicians/users will ensure wide access to quality guidelines enhancing acceptance and stewardship.
Collapse
Affiliation(s)
- Chandrakant Lahariya
- World Health Organization (WHO) Country Office for India, New Delhi, India,Address for correspondence: Dr. Chandrakant Lahariya, National Professional Officer, World Health Organization Country Office for India, Fifth Floor, Nirman Bhawan, New Delhi - 110 011, India. E-mail:
| | - Sangeeta Sharma
- Institute of Human Behaviour and Allied Sciences (IHBAS) and Delhi Society for Promotion of Rational Use of Drugs (DSPRUD), Delhi, India
| | - Manohar Agnani
- National Health Mission, Ministry of Health and Family Welfare, Govt of India, New Delhi, India
| | - Hilde de Graeve
- World Health Organization (WHO) Country Office for India, New Delhi, India
| | | | - Henk Bekedam
- World Health Organization (WHO) Country Office for India, New Delhi, India
| |
Collapse
|
14
|
Song Y, Ballesteros M, Li J, Martínez García L, Niño de Guzmán E, Vernooij RWM, Akl EA, Cluzeau F, Alonso-Coello P. Current practices and challenges in adaptation of clinical guidelines: a qualitative study based on semistructured interviews. BMJ Open 2021; 11:e053587. [PMID: 34857574 PMCID: PMC8640632 DOI: 10.1136/bmjopen-2021-053587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aims to better understand the current practice of clinical guideline adaptation and identify challenges raised in this process, given that published adapted clinical guidelines are generally of low quality, poorly reported and not based on published frameworks. DESIGN A qualitative study based on semistructured interviews. We conducted a framework analysis for the adaptation process, and thematic analysis for participants' views and experiences about adaptation process. SETTING Nine guideline development organisations from seven countries. PARTICIPANTS Guideline developers who have adapted clinical guidelines within the last 3 years. We identified potential participants through published adapted clinical guidelines, recommendations from experts, and a review of the Guideline International Network Conference attendees' list. RESULTS We conducted ten interviews and identified nine adaptation methodologies. The reasons for adapting clinical guidelines include developing de novo clinical guidelines, implementing source clinical guidelines, and harmonising and updating existing clinical guidelines. We identified the following core steps of the adaptation process (1) selection of scope and source guideline(s), (2) assessment of source materials (guidelines, recommendations and evidence level), (3) decision-making process and (4) external review and follow-up process. Challenges on the adaptation of clinical guidelines include limitations from source clinical guidelines (poor quality or reporting), limitations from adaptation settings (lacking resources or skills), adaptation process intensity and complexity, and implementation barriers. We also described how participants address the complexities and implementation issues of the adaptation process. CONCLUSIONS Adaptation processes have been increasingly used to develop clinical guidelines, with the emergence of different purposes. The identification of core steps and assessment levels could help guideline adaptation developers streamline their processes. More methodological research is needed to develop rigorous international standards for adapting clinical guidelines.
Collapse
Affiliation(s)
- Yang Song
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Monica Ballesteros
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jing Li
- Research Institute (VHIR), Universitat Autònoma de Barcelona, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
15
|
Marshall AI, Archer R, Witthayapipopsakul W, Sirison K, Chotchoungchatchai S, Sriakkpokin P, Srisookwatana O, Teerawattananon Y, Tangcharoensathien V. Developing a Thai national critical care allocation guideline during the COVID-19 pandemic: a rapid review and stakeholder consultation. Health Res Policy Syst 2021; 19:47. [PMID: 33789671 PMCID: PMC8011047 DOI: 10.1186/s12961-021-00696-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/07/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND At the height of the COVID-19 pandemic, Thailand had almost depleted its critical care resources, particularly intensive care unit (ICU) beds and ventilators. This prompted the necessity to develop a national guideline for resource allocation. This paper describes the development process of a national guideline for critical resource allocation in Thailand during the COVID-19 pandemic. METHODS The guideline development process consisted of three steps: (1) rapid review of existing rationing guidelines and literature; (2) interviews of Thai clinicians experienced in caring for COVID-19 cases; and (3) multi-stakeholder consultations. At steps 1 and 2, data was synthesized and categorized using a thematic and content analysis approach, and this guided the formulation of the draft guideline. Within step 3, the draft Thai critical care allocation guideline was debated and finalized before entering the policy-decision stage. RESULTS Three-order prioritization criteria consisting of (1) clinical prognosis using four tools (Charlson Comorbidity Index, Sequential Organ Failure Assessment, frailty assessment and cognitive impairment assessment), (2) number of life-years saved and (3) social usefulness were proposed by the research team based on literature reviews and interviews. At consultations, stakeholders rejected using life-years as a criterion due to potential age and gender discrimination, as well as social utility due to a concern it would foster public distrust, as this judgement can be arbitrary. It was agreed that the attending physician is required to be the decision-maker in the Thai medico-legal context, while a patient review committee would play an advisory role. Allocation decisions are to be documented for transparency, and no appealing mechanism is to be applied. This guideline will be triggered only when demand exceeds supply after the utmost efforts to mobilize surge capacity. Once implemented, it is applicable to all patients, COVID-19 and non-COVID-19, requiring critical care resources prior to ICU admission and during ICU stay. CONCLUSIONS The guideline development process for the allocation of critical care resources in the context of the COVID-19 outbreak in Thailand was informed by scientific evidence, medico-legal context, existing norms and societal values to reduce risk of public distrust given the sensitive nature of the issue and ethical dilemmas of the guiding principle, though it was conducted at record speed. Our lessons can provide an insight for the development of similar prioritization guidelines, especially in other low- and middle-income countries.
Collapse
Affiliation(s)
- Aniqa Islam Marshall
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Rachel Archer
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Kanchanok Sirison
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Pisit Sriakkpokin
- The National Health Commission Office, Ministry of Public Health, Nonthaburi, Thailand
| | - Orapan Srisookwatana
- The National Health Commission Office, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore, Singapore, Singapore
| | | |
Collapse
|
16
|
Haque M, Kumar S, Charan J, Bhatt R, Islam S, Dutta S, Abhayanand JP, Sharma Y, Sefah I, Kurdi A, Wale J, Godman B. Utilisation, Availability and Price Changes of Medicines and Protection Equipment for COVID-19 Among Selected Regions in India: Findings and Implications. Front Pharmacol 2021; 11:582154. [PMID: 33628172 PMCID: PMC7898674 DOI: 10.3389/fphar.2020.582154] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022] Open
Abstract
Background: COVID-19 has already claimed a considerable number of lives worldwide. However, there are concerns with treatment recommendations given the extent of conflicting results with suggested treatments and misinformation, some of which has resulted in increased prices and shortages alongside increasing use and prices of personal protective equipment (PPE). This is a concern in countries such as India where there have been high patient co-payments and an appreciable number of families going into poverty when members become ill. However, balanced against pricing controls. Community pharmacists play a significant role in disease management in India, and this will remain. Consequently, there is a need to review prices and availability of pertinent medicines during the early stages of the COVID-19 pandemic in India to provide future direction. Objective: Assess current utilisation and price changes as well as shortages of pertinent medicines and equipment during the early stages of the pandemic. Our Approach: Multiple approach involving a review of treatments and ongoing activities across India to reduce the spread of the virus alongside questioning pharmacies in selected cities from early March to end May 2020. Our Activities: 111 pharmacies took part, giving a response rate of 80%. Encouragingly, no change in utilisation of antimalarial medicines in 45% of pharmacies despite endorsements and for antibiotics in 57.7% of pharmacies, helped by increasing need for a prescription for dispensing. In addition, increased purchasing of PPE (over 98%). No price increases were seen for antimalarials and antibiotics in 83.8 and 91.9% of pharmacies respectively although shortages were seen for antimalarials in 70.3% of pharmacies, lower for antibiotics (9.9% of pharmacies). However, price increases were typically seen for PPE (over 90% of stores) as well as for analgesics (over 50% of pharmacies). Shortages were also seen for PPE (88.3%). Conclusion: The pandemic has impacted on utilisation and prices of pertinent medicines and PPE in India but moderated by increased scrutiny. Key stakeholder groups can play a role with enhancing evidenced-based approaches and reducing inappropriate purchasing in the future.
Collapse
Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Rohan Bhatt
- Department of Pediatric Dentistry, Karnavati University, Gandhinagar, India
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Bangladesh
| | - Siddhartha Dutta
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | | | - Yesh Sharma
- Department of Conservative Dentistry and Endodontics, Rajasthan University of Health Sciences, Jaipur, India
| | - Israel Sefah
- Pharmacy Department, Ghana Health Service, Keta Municipal Hospital, Keta-Dzelukope, Ghana
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| |
Collapse
|
17
|
Linan Z, Qiusha Y, Chuan Z, Chao H, Hailong L, Chunsong Y, Mao L, Liang H, Dan L, Deying K, Guanjian L, Qiaolan L, Rongsheng Z, Junhua Z, Youping L, Hanmin L, Qiang W, Lingli Z. An instrument for evaluating the clinical applicability of guidelines. J Evid Based Med 2020; 14:75-81. [PMID: 33090726 PMCID: PMC7984040 DOI: 10.1111/jebm.12416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/29/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To establish an instrument for evaluating the clinical applicability of guidelines from the guideline-users' perspective. METHODS We established this instrument through forming a working group, forming an initial list of items based on a qualitative systematic review, establishing initial instrument via two rounds of modified Delphi surveys, and external review the initial instrument. RESULTS The results of modified Delphi surveys establishing appraisal aspects, appraisal items, general information of the evaluator met the preset requirements. The instrument includes three parts: general information of the evaluator (12 items), evaluation of clinical applicability (12 items, including items on the availability, readability, acceptability, feasibility, and overall applicability of guideline), and scoring scheme. CONCLUSIONS The instrument for evaluating the clinical applicability of guidelines from the guideline-users' perspective provides criteria and methods for improving the clinical applicability of guidelines during development and updating.
Collapse
Affiliation(s)
- Zeng Linan
- Department of Pharmacy/Evidence‐Based Pharmacy CentreWest China Second University Hospital, Sichuan UniversityChengduP.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenMinistry of EducationChengduP.R. China
| | - Yi Qiusha
- Department of Pharmacy/Evidence‐Based Pharmacy CentreWest China Second University Hospital, Sichuan UniversityChengduP.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenMinistry of EducationChengduP.R. China
- West China School of MedicineSichuan UniversityChengduP.R. China
| | - Zhang Chuan
- Department of Pharmacy/Evidence‐Based Pharmacy CentreWest China Second University Hospital, Sichuan UniversityChengduP.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenMinistry of EducationChengduP.R. China
| | - Huang Chao
- Medical Management Service Guidance CenterNational Health Commission of the People's Republic of ChinaBeijingP.R. China
| | - Li Hailong
- Department of Pharmacy/Evidence‐Based Pharmacy CentreWest China Second University Hospital, Sichuan UniversityChengduP.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenMinistry of EducationChengduP.R. China
| | - Yang Chunsong
- Department of Pharmacy/Evidence‐Based Pharmacy CentreWest China Second University Hospital, Sichuan UniversityChengduP.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenMinistry of EducationChengduP.R. China
| | - Lin Mao
- Department of Pharmacy/Evidence‐Based Pharmacy CentreWest China Second University Hospital, Sichuan UniversityChengduP.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenMinistry of EducationChengduP.R. China
- West China School of PharmacySichuan UniversityChengduP.R. China
| | - Huang Liang
- Department of Pharmacy/Evidence‐Based Pharmacy CentreWest China Second University Hospital, Sichuan UniversityChengduP.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenMinistry of EducationChengduP.R. China
- West China School of PharmacySichuan UniversityChengduP.R. China
| | - Liu Dan
- Department of Pharmacy/Evidence‐Based Pharmacy CentreWest China Second University Hospital, Sichuan UniversityChengduP.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenMinistry of EducationChengduP.R. China
| | - Kang Deying
- Chinese Evidence‐Based Medicine Center, West China HospitalSichuan UniversityChengduP.R. China
| | - Liu Guanjian
- Chinese Evidence‐Based Medicine Center, West China HospitalSichuan UniversityChengduP.R. China
| | - Liu Qiaolan
- West China School of Public HealthSichuan UniversityChengduP.R. China
| | - Zhao Rongsheng
- Department of PharmacyPeking University Third HospitalBeijingP.R. China
- Evidence‐Based Pharmacy CommitteeChinese Pharmaceutical AssociationBeijingP.R. China
| | - Zhang Junhua
- Centre for Evidence‐Based MedicineTianjin University of TCMTianjinP.R. China
| | - Li Youping
- Chinese Evidence‐Based Medicine Center, West China HospitalSichuan UniversityChengduP.R. China
| | - Liu Hanmin
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenMinistry of EducationChengduP.R. China
- Department of PediatricsWest China Second University Hospital, Sichuan UniversityChengduP.R. China
| | - Wang Qiang
- Medical Management Service Guidance CenterNational Health Commission of the People's Republic of ChinaBeijingP.R. China
| | - Zhang Lingli
- Department of Pharmacy/Evidence‐Based Pharmacy CentreWest China Second University Hospital, Sichuan UniversityChengduP.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenMinistry of EducationChengduP.R. China
- Evidence‐Based Pharmacy CommitteeChinese Pharmaceutical AssociationBeijingP.R. China
| |
Collapse
|
18
|
Colpani V, Kowalski SC, Stein AT, Buehler AM, Zanetti D, Côrtes G, de Melo Junior EV, Ebeidalla JE, de Oliveira NB, Guerra RL, Silva SN, Duncan BB, Falavigna M, Schünemann HJ. Clinical practice guidelines in Brazil - developing a national programme. Health Res Policy Syst 2020; 18:69. [PMID: 32552692 PMCID: PMC7302389 DOI: 10.1186/s12961-020-00582-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
In Brazil, governmental and non-governmental organisations develop practice guidelines (PGs) in order to optimise patient care. Although important improvements have been made over the past years, many of these documents still lack transparency and methodological rigour. In order to conduct a critical analysis and define future steps in PG development in Brazil, we carried out a structured assessment of strengths, weaknesses, opportunities and threats (SWOT analysis) for the development of a national guideline programme. Participants consisted of academia, methodologists, medical societies and healthcare system representatives. In summary, the PG development process has improved in Brazil and current investments in methodological research and capacity-building are ongoing. Despite the centralised processes for public PGs, standardised procedures for their development are not well established and human resources are insufficient in number and capacity to develop the amount of trustworthy documents needed. Brazil’s capacity could be strengthened and initial efforts have been made such as the adoption of standards proposed by world-renowned institutions in PG development and enhancement of the involvement of key stakeholders. Further steps involve the alignment between health technology assessment and PG processes for synergy and the development of a national network to promote the interaction between groups involved in the development of PGs. The lessons learned from this paper could be used to foster debate on guideline development, especially for countries facing similar threats on this topic.
Collapse
Affiliation(s)
- Verônica Colpani
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, 3° andar, Porto Alegre, RS, 90035-001, Brazil.
| | - Sérgio Candido Kowalski
- Department of Internal Medicine, Division of Rheumatology, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Airton Tetelbom Stein
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA); Program in Health Technology Assessment, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
| | - Anna Maria Buehler
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - Daniel Zanetti
- Department of Management and Incorporation of Health Technology (DGITIS), Executive Secretariat, National Committee for Health Technology Incorporation (CONITEC); Secretariat of Science, Technology and Strategic Inputs (SCTIE); Brazilian Ministry of Health, Brasília, DF, Brazil
| | - Gabriel Côrtes
- CONITEC; Plenary member, Special Secretary of Indigenous Health (SESAI), Brazilian Ministry of Health, Brasília, DF, Brazil
| | - Edison Vieira de Melo Junior
- DGITIS; Executive Secretariat, CONITEC; Secretariat of Science, SCTIE, Brazilian Ministry of Health, Brasília, DF, Brazil
| | - Jorgiany Emerick Ebeidalla
- DGITIS; Executive Secretariat, CONITEC; Secretariat of Science, SCTIE, Brazilian Ministry of Health, Brasília, DF, Brazil
| | - Natiela Beatriz de Oliveira
- General Coordination, Environmental Health Surveillance (CGVAM); Department of Environmental Health, Worker and Emergency Public Health Surveillance (DSASTE); Secretariat of Health Surveillance (SVS); Brazilian Ministry of Health, Brasília, DF, Brazil
| | - Renata Leborato Guerra
- Health Technology Assessment Unit (NATS), National Institute of Cancer (INCA), Rio de Janeiro, RJ, Brazil
| | - Sarah Nascimento Silva
- DGITIS; Executive Secretariat, CONITEC; Secretariat of Science, SCTIE, Brazilian Ministry of Health, Brasília, DF, Brazil
| | - Bruce B Duncan
- School of Medicine, Hospital de Clínicas de Porto Alegre (HCPA), Instituto de Avaliação de Tecnologia em Saúde (IATS), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Maicon Falavigna
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, 3° andar, Porto Alegre, RS, 90035-001, Brazil.,IATS, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Holger Jens Schünemann
- Department of Health Research Methods, Evidence and Impact and of Medicine, McMaster GRADE Centre, McMaster University Health Sciences Centre, Hamilton, Canada
| |
Collapse
|
19
|
Swami S, Srivastava T. Role of Culture, Values, and Politics in the Implementation of Health Technology Assessment in India: A Commentary. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:39-42. [PMID: 31952672 DOI: 10.1016/j.jval.2019.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 10/05/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
India is a diverse land with different cultures, social norms, castes, religions, faiths, languages, politics, and a complex healthcare system. As a step to enhance healthcare, the government of India announced a move toward universal health coverage to increase accessibility and affordability of health-related services. Recently, there has been an introduction of health technology assessment (HTA) in India to help inform evidence-based decision making in cases of limited resources and budgets. Nevertheless, there are challenges related to biased decision making, an unregulated healthcare framework, and the lack of data and capacity that will (directly or indirectly) affect the use of HTA in India. For HTA to be successful in India and in similar low- and middle-income countries, it is important that the decision makers acknowledge these challenges and embrace differences in ideologies, cultures, and politics instead of ignoring them. Drawing lessons from countries with well-developed HTA bodies may help, but these need to be modified for the country-specific context. Ensuring quality and transparency is key to building trust in medical decision making. Improved coordination at all levels of healthcare is vital to ensure the long-term success of HTA in India. This is challenging but achievable by spreading awareness among stakeholders and achieving moderate health-sector regulation that can combat corruption. HTA will prosper in India if it incorporates cultural and institutional diversity, alongside tackling socioeconomic inequalities.
Collapse
Affiliation(s)
- Shilpi Swami
- Department of Health Sciences, University of York, York, England, UK; Evidera, London, England, UK
| | - Tushar Srivastava
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
| |
Collapse
|
20
|
Song Y, Darzi A, Ballesteros M, Martínez García L, Alonso-Coello P, Arayssi T, Bhaumik S, Chen Y, Cluzeau F, Ghersi D, Padilla PF, Langlois EV, Schünemann HJ, Vernooij RWM, Akl EA. Extending the RIGHT statement for reporting adapted practice guidelines in healthcare: the RIGHT-Ad@pt Checklist protocol. BMJ Open 2019; 9:e031767. [PMID: 31551391 PMCID: PMC6773334 DOI: 10.1136/bmjopen-2019-031767] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The adaptation of guidelines is an increasingly used methodology for the efficient development of contextualised recommendations. Nevertheless, there is no specific reporting guidance. The essential Reporting Items of Practice Guidelines in Healthcare (RIGHT) statement could be useful for reporting adapted guidelines, but it does not address all the important aspects of the adaptation process. The objective of our project is to develop an extension of the RIGHT statement for the reporting of adapted guidelines (RIGHT-Ad@pt Checklist). METHODS AND ANALYSIS To develop the RIGHT-Ad@pt Checklist, we will use a multistep process that includes: (1) establishment of a Working Group; (2) generation of an initial checklist based on the RIGHT statement; (3) optimisation of the checklist (an initial assessment of adapted guidelines, semistructured interviews, a Delphi consensus survey, an external review by guideline developers and users and a final assessment of adapted guidelines); and (4) approval of the final checklist. At each step of the process, we will calculate absolute frequencies and proportions, use content analysis to summarise and draw conclusions, discuss the results, draft a report and refine the checklist. ETHICS AND DISSEMINATION We have obtained a waiver of approval from the Clinical Research Ethics Committee at the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain). We will disseminate the RIGHT-Ad@pt Checklist by publishing into a peer-reviewed journal, presenting to relevant stakeholders and translating into different languages. We will continuously seek feedback from stakeholders, surveil new relevant evidence and, if necessary, update the checklist.
Collapse
Affiliation(s)
- Yang Song
- Iberoamerican Cochrane Centre-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Andrea Darzi
- AUB GRADE Center, American University of Beirut, Beirut, Lebanon
| | | | - Laura Martínez García
- Iberoamerican Cochrane Centre-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Department of Health Research Methods, Evidence, and Impact, McMaster GRADE center, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Francoise Cluzeau
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Davina Ghersi
- National Health and Medical Research Council, Canberra, Australian Capital Territory, Australia
| | - Paulina F Padilla
- Facultad de Medicina y Odontología, Universidad de Antofagasta, Antofagasta, Chile
| | - Etienne V Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, Geneve, Switzerland
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster GRADE center, McMaster University, Hamilton, Ontario, Canada
| | - Robin W M Vernooij
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Elie A Akl
- AUB GRADE Center, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster GRADE center, McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
21
|
Dubey M, Rastogi S, Awasthi A. Hypertension prevalence as a function of different guidelines, India. Bull World Health Organ 2019; 97:799-809. [PMID: 31819288 PMCID: PMC6883270 DOI: 10.2471/blt.19.234500] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 12/16/2022] Open
Abstract
Objective To determine the effect of different hypertension management guidelines and of basing diagnosis on a single reading of blood pressure on the hypertension prevalence in the Indian population. Methods We performed a secondary analysis of data acquired as part of the Fourth national family health survey, 2015 to 2016, over all districts in India. We calculated the proportion of the population within three different age groups (18 to 34, 35 to 49 and 18 to 49 years of age) with raised blood pressure according to six different guidelines, and how prevalence changed if diagnoses were based on a single blood pressure measurement. Findings We observed that the Government of India and the American College of Cardiology/American Heart Association guidelines consistently yielded the lowest and highest prevalence of raised blood pressure; in the combined age group, we calculated the proportion of the population categorized as having raised blood pressure as 7.5% (95% confidence interval (CI): 7.4 to 7.7) and 40.1% (95% CI: 39.7 to 40.7), respectively. When basing diagnosis on a single reading of blood pressure only, a total of 56 million individuals would be erroneously categorized as hypertensive following the Government of India guidelines. We also showed that prevalence of hypertension in India varies with guidelines adhered to; in the combined age group, the national hypertension prevalence was three times higher when following the American College of Cardiology/American Heart Association compared with the Government of India guidelines. Conclusion To optimize current clinical practice, health-care providers need to follow universally agreed, evidence-based methods of diagnosing hypertension.
Collapse
Affiliation(s)
| | | | - Ashish Awasthi
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram, 122002, India
| |
Collapse
|
22
|
Friebel R, Molloy A, Leatherman S, Dixon J, Bauhoff S, Chalkidou K. Achieving high-quality universal health coverage: a perspective from the National Health Service in England. BMJ Glob Health 2018; 3:e000944. [PMID: 30613424 PMCID: PMC6304094 DOI: 10.1136/bmjgh-2018-000944] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/17/2018] [Accepted: 10/28/2018] [Indexed: 02/06/2023] Open
Abstract
Governments across low-income and middle-income countries have pledged to achieve universal health coverage by 2030, which comes at a time where healthcare systems are subjected to multiple and persistent pressures, such as poor access to care services and insufficient medical supplies. While the political willingness to provide universal health coverage is a step into the right direction, the benefits of it will depend on the quality of healthcare services provided. In this analysis paper, we ask whether there are any lessons that could be learnt from the English National Health Service, a healthcare system that has been providing comprehensive and high-quality universal health coverage for over 70 years. The key areas identified relate to the development of a coherent strategy to improve quality, to boost public health as a measure to reduce disease burden, to adopt evidence-based priority setting methods that ensure efficient spending of financial resources, to introduce an independent way of inspecting and regulating providers, and to allow for task-shifting, specifically in regions where staff retention is low.
Collapse
Affiliation(s)
- Rocco Friebel
- Department of Health Policy, The London School of Economics and Political Science, London, UK
- Center for Global Development, Washington, District of Columbia, USA
| | - Aoife Molloy
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sheila Leatherman
- Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Sebastian Bauhoff
- Center for Global Development, Washington, District of Columbia, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kalipso Chalkidou
- Center for Global Development, Washington, District of Columbia, USA
- School of Public Health, Imperial College London, London, UK
| |
Collapse
|
23
|
Dabak SV, Pilasant S, Mehndiratta A, Downey LE, Cluzeau F, Chalkidou K, Luz ACG, Youngkong S, Teerawattananon Y. Budgeting for a billion: applying health technology assessment (HTA) for universal health coverage in India. Health Res Policy Syst 2018; 16:115. [PMID: 30486827 PMCID: PMC6262968 DOI: 10.1186/s12961-018-0378-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND India recently launched the largest universal health coverage scheme in the world to address the gaps in providing healthcare to its population. Health technology assessment (HTA) has been recognised as a tool for setting priorities as the government seeks to increase public health expenditure. This study aims to understand the current situation for healthcare decision-making in India and deliberate on the opportunities for introducing HTA in the country. METHODS A paper-based questionnaire, adapted from a survey developed by the International Decision Support Initiative (iDSI), was administered on the second day of the Topic Selection Workshop that was conducted as part of the HTA Awareness Raising Workshop held in New Delhi on 25-27 July, 2016. Participants were invited to respond to questions covering the need, demand and supply for HTA in their context as well as the role of their organisation vis-à-vis HTA. The response rate for the survey was about 68% with 41 participants having completed the survey. RESULTS Three quarters of the respondents (71%) stated that the government allocated healthcare resources on the basis of expert opinion. Most respondents indicated reimbursement of individual health technologies and designing a basic health benefit package (93% each) were important health policy areas while medical devices and screening programmes were cited as important technologies (98% and 92%, respectively). More than half of the respondents noted that relevant local data was either not available or was limited. Finally, technical capacity was seen as a strength and a constraint facing organisations. CONCLUSION The findings from this study shed light on the current situation, the opportunities, including potential topics, and challenges in conducting HTA in India. There are limitations to the study and further studies may need to be conducted to inform the role that HTA will play in the design or implementation of universal health coverage in India.
Collapse
Affiliation(s)
| | - Songyot Pilasant
- Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
| | - Abha Mehndiratta
- Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Laura Emily Downey
- Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Francoise Cluzeau
- Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Kalipso Chalkidou
- Global Health and Development Group, Imperial College London, London, United Kingdom
- Center for Global Development, London, United Kingdom
| | | | - Sitaporn Youngkong
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
- National Health Foundation, Bangkok, Thailand
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), Singapore, Singapore
| |
Collapse
|