Overview of national strategies for the prevention and management of non-communicable diseases

Background

Several countries have developed national strategies or policies for preventing and managing non-communicable diseases (NCDs) which are the leading cause of death worldwide. We aim to provide an overview of these strategies from selected countries and their implementation, focusing on chronic respiratory and cardiovascular diseases, diabetes and depression.

Methods

Using a comprehensive structured hand search, strategies from 8 countries (Germany, Switzerland, Netherlands, Finland, Ireland, United Kingdom, Canada, Australia) were identified and information on the main characteristics and implementation process of the strategies was extracted.

Results

A total of 18 strategies were included. Most of the strategies formulate rather broad overarching aims or visions (e.g., “stay healthy” or “living healthier lives”) as well as more specific targets that differ across strategies, e.g. focusing on improving quality of life and health literacy, reducing health inequalities or strengthening integrated care. The level of detail of information on implementation, monitoring and evaluation processes as well as financing is very heterogeneous. All strategies provide information on activities to achieve their aims, e.g. in the areas of health promotion/primary prevention, self-management, screening, integrated care, measures for specific risk groups or activities outside the health sector. Only a few strategies mention specific, already implemented (and evaluated) interventions, such as prevention or disease management programmes.

Conclusions

The included NCD strategies differ considerably in terms of level of detail, structure and implementation. We focused on interventions within the health sector and on adults as a target group. However, for the prevention and management of NCDs, it is important to start in early childhood and to adequately address the social determinants of health with a ‘Health in All Policies’ approach.

Key messages

Regulation and financing of prenatal screening and diagnostic tests for fetal anomalies in Europe

Background

Pregnant women frequently use prenatal screening and diagnostic tests to detect fetal structural and chromosomal anomalies; however, the regulation and financing of these examinations differ substantially across countries. In this paper we focus on the provision, financing and setting of the following tests in selected European countries: First Trimester Screening (FTS)/Combined Test (CT), Non-invasive Prenatal Test (NIPT), second-trimester ultrasound screening for fetal anomalies, amniocentesis/chorionic villus sampling.

Methods

We chose 6 European countries that differ in various criteria (e.g., health/insurance system, geographical location) to illustrate the range of possible regulations and forms of funding: Germany, Switzerland, Netherlands, United Kingdom, Norway, Italy. We conducted a comprehensive hand search and consulted experts from the 6 countries using a questionnaire.

Results

The results are based on 11 completed expert questionnaires and 22 published sources. The heterogeneity of the provision, regulation and financing of the tests concerns in particular the choice of the first-line screening test for fetal trisomies (FTS/CT, NIPT or the identification of risk factors), the implementation of the NIPT, the reimbursement of the tests, the uptake of the examinations, but also the professional groups responsible for antenatal care (midwives, gynaecologists). There are some similarities between countries, e.g., concerning the provision and financing of invasive tests and of the ultrasound screening for fetal anomalies in the second trimester.

Conclusions

The results highlight the significant heterogeneity between European countries regarding prenatal screening and diagnostic testing for fetal anomalies. Due to the many ethical aspects of the topic, a broad societal discourse with the relevant interest groups and stakeholders seems to be necessary. Decision-makers should pay particular attention to high-quality and non-directive counselling.

Key messages

Mental health during pregnancy and early childhood: recommendations from evidence-based guidelines

Background

Mental health problems are common during pregnancy and after birth and are therefore often addressed in the context of antenatal and postnatal care. The project is an update of previous work and aimed at identifying and summarising screening and counselling recommendations from evidence-based guidelines. Mental health was defined broadly and included topics such as substance use and domestic violence.

Methods

Relevant guidelines were identified by searching 2 databases (G-I-N, TRIP Database) and websites of relevant institutions and professional societies. Guidelines, that were published or updated within the last 5 years and fulfilled methodological quality criteria, were included.

Results

A total of 52 guidelines from 16 different institutions fulfilled the inclusion criteria. The guidelines (predominantly) advocate the following mental health screenings: Interviewing about psychosocial stress factors and support needs during pregnancy and after birth; screening for postpartum depression and anxiety disorders; interviewing pregnant women about substance use (smoking, alcohol, drugs) and appropriate counselling. With regard to domestic violence and child welfare risks, some guidelines recommend routine screening and some recommend increased awareness of signs and symptoms by health workers. Routine screening for specific mental and behavioural disorders in children is not recommended by included guidelines; however, if there are indications and symptoms, clarification should take place and attention should be paid to signs and symptoms during preventive examinations.

Conclusions

The included guidelines recommend screening and/or counselling for the majority of the topics addressed. The results of the report can be used as a basis for decision-making for updating national antenatal care and screening programmes.

Key messages

The majority of the included evidence-based guidelines strongly recommend addressing mental health issues during pregnancy and after birth by offering screening and/or counselling. The recommendations from evidence-based guidelines can serve as a decision support for developing national antenatal and postnatal care programmes.

Evaluation designs of outpatient health centres focusing on vulnerable patient groups

Background

Homeless and non-insured persons experience worse physical and mental health than comparable populations. Outpatient (public) health institutions, which are easily accessible, contribute considerably to the medical treatment of vulnerable patient groups. Sound evaluation methods, indicators and instruments are necessitated to target patients’ needs and to enable strategic health and social policy planning.

Methods

We conducted a systematic literature search in several databases (PubMed, EMBASE, PsycINFO etc.) for studies from 2000 to 2019 reporting on evaluations in outpatient health institutions for homeless and/ or non-insured patients. In addition, we contacted 5 Austrian public health/ research institutions dealing with complex interventions for relevant publications.

Results

12 evaluation studies and 7 evaluation reports met our inclusion criteria. Evaluation designs mostly considered various target groups and nearly all assessments pursued a ’mixed-method’ approach. 13 publications assessed socio-demographic data, 11 the use of health and social services and 7 patients’ health status. Further indicators related to ’satisfaction issues’ such as patients’ satisfaction with the provided range of health and social services (n = 7). 6 publications reported on health economic indicators. In total, 7 out of 19 studies reported on evaluation instruments; most instruments (n = 6) were on patients’ mental health status.

Conclusions

Patients represented the major target group in the included evaluations. There is little research on evaluation indicators directing on health professionals. Evaluations focusing on the intersectional levels (e.g. the impact of health programmes for vulnerable groups on various institutions) are lacking.

Key messages

Evaluation designs involving ‘hardly to reach populations’ shall consider a ‘participatory assessment approach’ to avoid drop-outs and to create a trustworthy evaluation situation. Hence, evaluation indicators shall be commonly selected and adequately reflect patients’ realities.

Screenings for children: international programmes & recommendations from evidence-based guidelines

Background

Children and adolescents are in general a healthy population group. However, they are exposed to a number of morbidities (physical illnesses and mental disorders) and social burdens (e.g. poverty, violence). In Austria, there are currently no routine screenings for children older than 6 years. The project aimed at providing an overview of international screening programmes and of recommendations from evidence-based guidelines for 6 to 14 years old children.

Methods

The overview of screening practices in nine selected (mostly European) countries is based on an (Internet) hand search and expert contacts. For the guideline overview, we conducted a search in guideline databases and on websites of institutions.

Results

We identified four main screenings that were predominantly offered in the analysed countries: screenings of body weight & height, hearing & vision disorders, dental disease and mental disorders. The services are provided in school and/or in doctors’ practices, involving physicians and/or nurses. 50 evidence-based guidelines from 16 institutions met our pre-defined inclusion criteria. We identified recommendations for 24 diseases or risk factors. We found most recommendations on screening for overweight and dental disease. Further guidelines addressed infectious diseases, mental disorders, health and risk behaviour, and counselling.

Conclusions

The results are now used as a basis for discussion for the development of a new screening programme in Austria. The overview provides an international and evidence-based view. However, social determinants of health, such as education and living conditions, were hardly considered in the identified screenings, but should be increasingly addressed in a comprehensive programme.

Key messages

Screenings for overweight and dental disease were central in both the selected countries’ programmes and the guideline recommendations. Comprehensive programmes should not only focus on physical parameters, but should also take into account the social determinants of health.