bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP95 Engagement Of Local Policymakers In HTA With Positive Results
Authors: Elias Flavia , Gallo Luciana , Pereira Ana Carolina , Silva Erica , Girardi Juliana , Pereira Daniella 
Published: January 2019

Introduction:São Paulo city in Brazil has implemented social and health care for homeless people with pulmonary tuberculosis since 2007. We conducted a health technology assessment (HTA) of the interventions provided based on a national theoretical model using 2015 data and an overview of systematic reviews. The HTA was requested by national policymakers. The results demonstrated that the interventions for pulmonary tuberculosis were satisfactory. The municipal secretariat implemented actions to improve the national treatment recommendations and adopted incentives to increase adherence to treatments. Our objective was to describe the feedback process for the Health Secretariat.Methods:The feedback was categorized as: (i) an executive abstract with key messages (i.e. ninety-seven percent of notified cases underwent sputum smears, nineteen percent were hospitalized, and fifty-nine percent were cured) reported to policymakers involved in the surveillance program; and (ii) three meetings were organized jointly by the research group and local policymakers.Results:In 2016 we conducted a meeting to present the results. Thirty-nine professionals involved in the primary care team working on the streets (thirty-five percent) and the Tuberculosis Surveillance and Control Program (five percent) were present. The main barriers presented by the professionals were issues of human resources (i.e. suboptimal professional staff and having two different social organizations responsible for health care). The main facilitators presented by professionals were: (i) using homeless-peers as healthcare workers; (ii) having a network linking the primary care and surveillance programs; and (iii) periodic training.Conclusions:In addition to the positive results, the HTA presented an opportunity to discuss the sustainability of incentives for adhering to treatments adopted by the policymakers, such as meal allowances and housing support, to improve social conditions among the homeless.
PP97 Delineating Key Components Of Community Paramedicine Programs
Authors: Yan Charles , Guo Bing , Corabian Paula 
Published: January 2019

Introduction:Population growth, epidemiological and demographic transition, and a shortage of healthcare workers are affecting health care systems in Australia, Canada, the United Kingdom (UK), and the United States (US). Community paramedicine (CP) programs provide a bridge between primary care and emergency care to address the needs of patients with low acuity but lack of access to primary care. However, how to capture the key characteristics of these programs and present them in a meaningful way is still a challenge. The objective of this presentation is to identify and describe the characteristics of currently existing CP programs in the four countries to inform policy-making on CP program development in Alberta.Methods:Information was obtained from systematic reviews, health technology assessments, general reviews, and government documents identified through a comprehensive literature search. The characteristics of the CP programs are described using a framework originally developed in Australia with three categories: (i) the primary health care model, (ii) the health integration model (in Australia, called the substitution model), and (iii) the community coordination model.Results:In general, Australia emphasizes rural/remote paramedics, whereas Canada, the UK, and the US implement expanded paramedic practice within different environments including rural, remote, regional, and metropolitan settings. Extended care provider programs have been intensively investigated and widely implemented in the UK. While the identified CP programs vary in terms of program components, designation of providers, skill mix, target population, and funding model, the majority of these CP programs fall under the primary health care category of the Australian framework.Conclusions:Transitioning from hospital-based to community-based health care requires careful consideration of all key factors that could contribute to future program success. Delineating key components of CP programs using the Australian framework will help Alberta decision-makers design, develop, and implement appropriate CP programs that adequately address local needs.
PP102 Developing A Contextually-Informed Deprescribing Intervention
Authors: Ronquillo Charlene , Stein Ken 
Published: January 2019

Introduction:Deprescribing – a process for reducing or stopping drugs when the balance of benefits and harms may no longer be in a person's interests – is a key aspect of managing multimorbidity and polypharmcacy in older people. Several deprescribing interventions have been developed (e.g. in Australia and Canada), although significant challenges for successful implementation remain. Through key stakeholder consultation in the care home setting in South West England, we take the initial steps to develop a context-informed deprescribing approach. Engaging stakeholders from the outset gains insight into acceptability, feasibility, and relevance of deprescribing interventions developed elsewhere informing co-production of an effective, implementable approach.Methods:Consultation workshops were held with two groups of stakeholders: (i) care home residents and their families; (ii) care home staff and health care professionals (general practitioners, medical specialists, pharmacists, nurses, allied health professionals). Focus groups were held with each group separately to understand perspectives on: deprescribing in general; contextual considerations; and, perspectives on deprescribing interventions developed in other countries. A combined focus group then considered components of a deprescribing intervention for care homes. Qualitative data were audio recorded, transcribed, and thematically coded.Results:Participants described the nature of local relationships, dynamics, structures, and resources, as important considerations in the development of a deprescribing approach in care homes. Perspectives and concerns around deprescribing among the stakeholder groups varied, although the importance of eliciting local stakeholder feedback in the early stages of developing a deprescribing intervention was a common thread.Conclusions:Early engagement and co-production are crucial in developing an approach to deprescribing in care homes. The combination of stakeholder involvement and qualitative research is important for developing an effective, contextually relevant intervention as the balance between interests can be incorporated into the approach. Leveraging the experience in other countries is a novel and valuable step.
PP113 Towards A Systemic Approach of Value Judgment In HTA
Authors: Legault Georges-Auguste , Patenaude Johane , Bédard Suzanne Kocsis , Béland Jean-Pierre , Bellemare Christian , Dagenais Pierre , Daniel Charles-Etienne , Gagnon Hubert 
Published: January 2019

Introduction:The fact that HTA is a value-laden process is recognized in the literature. This is one of the reasons for promoting a better integration of ethics in HTA processes. Although what is meant by value-judgment (VJ) and how it can be used in HTA is not clear for some authors; others have proposed the elicitation of implicit VJs, to make them more explicit, as one way for clarifying the role ethics may play in HTA. In order to clarify what a VJ is, a conceptual analysis is needed to distinguish it from a factual-judgment and see how they diverge on certain aspects and converge on others.Methods:The distinction between VJs and factual-judgments was debated in the fifties. At the core of the philosophy of language was a distinction between factual-scientific assertions about facts, considered objective, and VJs on what is right/wrong-good/bad, considered subjective. In speech-act theory these distinctions were treated as two different operations: assertive and evaluative. A conceptual analysis of VJs, considering them as specific speech-acts, was used for clarifying/deciphering the role of VJs in HTA.Results:VJs are intrinsically embedded in decision-making since they are the reasons justifying decisions. This is why implicit VJs can be identified at every decision-step in the HTA process. Assessment is usually considered objective while appraisal seems subjective. Since VJs are entrenched in the decisions taken throughout the assessment process, the results are not completely objective. Ethical analysis also distinguishes two types of VJs, those based on normative criteria and those based on various degrees of value actualization. Furthermore, since evaluation requires criteria based on a rational process, VJs are not totally subjective.Conclusions:Elicitation of VJs in HTA is one way of integrating ethics in HTA and offers decision-makers a more thorough picture of the ethical issues involved in their decision.
PP119 How Much Evidence Is Enough For Action – ‘Adaptive Approach’ Helps?
Authors: Pwu Raoh-Fang , Wu Grace , Yang Wen-Wen 
Published: January 2019

Introduction:Aiming for hepatitis C elimination by 2030, Taiwan has set up a mid-term goal of “over 50 percent of patients treated by 2025.” Among various aspects of evidence that are needed, the target number to be treated is difficult to estimate with certainty due to great geographical heterogeneity of hepatitis C prevalence, and the absence of a nation-wide large scale prevalence survey.Methods:A broad estimate of the number of patients to be treated with high uncertainty was calculated, and reimbursement criteria were set for year 2017 given limited data and treatment budget. In the meanwhile, various sources and approaches to estimate the target number to be treated, and to identify the high prevalence areas, were collected and synthesized for future planning through a systematic review of published data and consulting experts for unpublished data. An expert panel was consulted for the level of confidence and completeness of the evidence. A plan for using real-world data to reduce the uncertainty after initial actions of national program was also in place.Results:Eight thousand patients who fulfilled the reimbursement criteria were treated in 2017 as planned. Strategic steps were identified based on the collected data, and the treatment target, namely 200,000 patients to be treated during 2018 to 2025, was then set for appropriate action plans. National registry infrastructure is planned for supporting future policy modification.Conclusions:Hepatitis C elimination is an important public health task and it requires immediate actions. The expected expenses are high, yet the number of patients is difficult to estimate with precision. How to deal with this uncertainty (financially and in care program design) will be the most challenging part. An adaptive approach (“evidence”-”action”-”more evidence”-”modified action”) could be the pragmatic way to move forward without sacrificing the quality of decision-making.
PP121 Relationship Of Self-Reported Sleep Quality To Disease Status In Japan
Authors: Takeshima Tomomi , Iwasaki Kosuke , Kanazawa Daiki , Kuno Yoshiyuki 
Published: January 2019

Introduction:Self-reported outcomes are considered to be useful to understand physical and mental conditions in daily life. Sleep quality is an important factor related to healthy lifestyle and work productivity, as well as to diseases. We examined the relationship of sleep condition with lifestyle and diseases based on self-reported sleep.Methods:A Japanese employee-based health insurance claims database with annual medical check-up data was used. Individuals were questioned about sleep quality as: “Do you get enough rest by sleeping?” during the medical check-up. The prevalence of diseases and medical check-up data were compared between those who answered “Yes” or “No”.Results:Among 1,310,157 individuals who answered about sleep quality, 540,564 (41.3 percent) answered “No”. The female ratio was around 38 percent for both answers, and the average age was lower for those who answered “No” (45.3) than “Yes” (47.3). Matched individuals for same examination year, sex, and age were 536,218 in each group. Individuals diagnosed with sleep disorder were 8.7 percent of those who answered “No”, representing the highest relative risk (RR=1.64), followed by other anxiety disorders (RR = 1.47), and depressive episode (RR = 1.45), with statistical significance. Other diseases diagnosed in more than 200,000 patients, and which had significantly higher RRs in patients who answered “No”, included vasomotor and allergic rhinitis (RR = 1.09), disorders of refraction and accommodation (RR =1.02), acute upper respiratory infections (RR = 1.11), gastritis and duodenitis (RR = 1.17), and acute bronchitis (RR = 1.13). The RR of other diseases of the liver (RR = 1.13), diabetes (RR = 1.12), hypertension (RR = 1.08), and disorders of lipoprotein metabolism and other lipidaemias (RR = 1.06) were also significantly higher for those who answered “No”.Conclusions:Sleep quality is suggested to be associated with various chronic diseases as well as mental disorders. Therefore, self-reported outcomes should be a useful tool to understand health-condition, prevent the onset and progression of diseases, and evaluate patient-centered care.
PP152 Options To Approach Health Litigation In Brazil: A Policy Brief
Authors: Biella Carla , Raynal Fabiana , Pereira Viviane , Boeira Laura , Carvalho Marcel , Santos Vania Canuto , Petramale Clarice , de Brito Artur Felipe , Barreto Jorge 
Published: January 2019

Introduction:In Brazil, health is a constitutional right and the government is responsible for its guarantee. The Brazilian health system is characterized by universality, equality, and integrality, but citizens still strive to guarantee their rights through litigation. This work aimed to develop an evidence brief to support the decision-making process of judges with respect to health technologies, based on scientific evidence.Methods:Support tools from the Evidence-Informed Policy Network (EVIPNet) were used to develop the evidence brief. After defining and describing the problem, a comprehensive search was conducted in PubMed, Health Systems Evidence, The Campbell Library, The Cochrane Library, Rx for Change, and PDQ-Evidence for systematic reviews published from 2010 to 2016. Nine systematic reviews were found. Review selection and quality appraisal were conducted independently by two reviewers. Three strategies for addressing the health litigation were defined. Evidence was summarized on benefits, harms, resource use, cost-effectiveness, uncertainties, and implementation. Implementation barriers and facilitators were also described.Results:Three strategies were found: (i) Rapid response services to support evidence-informed decision making in health technology decisions—educational activities and materials were described as an effective way to involve different stakeholders and inform decision making, even when financial reallocation is needed; (ii) Continuing education programs focused on developing health technology assessment knowledge among law workers—continued education and educational outreach may be effective in knowledge and ability acquisition and retention, changing professional practices. Eventual lack of interest from or availability of the professionals can be addressed by involving leaders and opinion makers, as well as offering multimedia educational materials and activities adapted for the public; and (iii) Restorative justice conferencing (RJC) focused on the litigation of health technologies—the use of RJC through face-to-face meetings or social councils involves citizens in the decision-making process, including resource management. There are multiple barriers to this option (e.g. a lack of understanding among the public, conflicts of interest, a lack of professionals capable of conducting RJCs, and the need for legal reformulation) because of its unprecedented use in the healthcare setting. Opinion leaders should be invited to facilitate communication and the decision-making process among citizens, government, and the law.Conclusions:This evidence brief will be debated among interested parties and presented to the health minister and state secretaries in order to implement the strategy options, once regional specificities are taken into account.
PP155 Telemedicine Enhance Universal Coverage Of Diagnostic Services
Authors: Galvan Pedro , Velazquez Miguel , Rivas Ronald , Benitez Gualberto , Ortellado Jose , Barrios Antonio , Hilario Enrique 
Published: January 2019

Introduction:Through the telemedicine, advantageous telediagnostic systems can be developed to improve the health care of remote populations that don't have access to specialists. However, evidence on how such innovation technology can enhance universal coverage of diagnostic services in rural communities is limited. The usability of telemedicine to improve the coverage of diagnostic services in public health in Paraguay was investigated.Methods:This descriptive study was carried out by the Telemedicine Unit of the Ministry of Public Health and Social Welfare (MSPBS) in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute (IICS-UNA) and the University of the Basque Country (UPV / EHU) to evaluate the utility of a telediagnostic system for universal coverage in public health. For this purpose, the results obtained by the telediagnosis system implemented in fifty-six public countryside hospitals were analyzed and compared to a “face to face” diagnosis.Results:The results obtained by the telediagnosis system implemented in fifty-six public countryside hospitals were analyzed. In that sense, 293,142 remote diagnoses were performed between January 2014 and September 2017. Of the total, 37.29 percent (109,311) corresponded to tomography studies, 61.44 percent (180,108) to electrocardiography (ECG), 1.26 percent (3,704) to electroencephalography (EEG) and 0.01 percent (19) to ultrasound. There were no significant differences between the remote and the “face to face” diagnosis. With the remote diagnosis a reduction of the cost was obtained, that supposes an important benefit for each citizen of the interior of the country.Conclusions:The results show that the use of telemedicine can significantly enhance the universal coverage of diagnostic services and health programs, maximizing professional time and productivity, increasing access and equity, and reducing costs. However, before carrying out its systematic implementation, a contextualization with the regional epidemiological profile must be performed.
PD16 Riociguat In Pulmonary Arterial Hypertension: A Systematic Review
Authors: Mosegui Gabriela , Vianna Cid , Faria Gabrielle , Tavares Cristiano , Cordeiro Benedito 
Published: January 2019

Introduction:Pulmonary Hypertension is a silent disease and its diagnosis often occurs when it is already at an advanced stage. Pharmacological treatment of Pulmonary Arterial Hypertension (PAH) can be performed with: calcium channel blockers; phosphodiesterase-5 inhibitors; prostanoids; endothelin-receptor antagonists; and, soluble guanylate cyclase stimulators. The use of Riociguat was approved in Brazil by the National Sanitary Surveillance Agency on October 5, 2015 for use in patients with PAH. The objective was to perform a systematic review (SR) of the efficacy of pharmacological treatment of Pulmonary Arterial Hypertension comparing Riociguat with other available medications or with placebo.Methods:Following the steps described in the PRISMA guideline, a search for randomized controlled clinical trials was conducted, in which Riociguat was used alone or in combination with other therapies, in databases MEDLINE, LILACS, Web of Science, Science Direct, Cochrane Library Wiley and in the gray literature (Google Scholar, Capes Bank of Theses and Clinical Trials). EndNote and Mendeley were used as reference managers. Outcomes analyzed were: death; six-minute walk distance (6MWD); World Health Organization (WHO) functional class (improvement, stabilization or worsening); hemodynamic variables (pulmonary vascular resistance, cardiac index and pulmonary-artery pressure); clinical worsening; hospitalization; and, quality of life.Results:Four hundred and sixty-seven articles were obtained which reduced to 379 after the duplicated articles were removed. After exclusion by title and abstract by two independent reviewers, forty-seven studies remained. Through the gray literature, six studies were obtained, resulting in fifty-three articles being retrieved for full-text review. Five studies were selected to compose the SR. Compared with placebo, Riociguat showed improvements in 6MWD, pulmonary vascular resistance, WHO functional class and time to clinical worsening. Efficacy was maintained after one year of use. Subgroup analysis was performed comparing of treatment-naive patients and patients on background PAH-targeted therapy.Conclusions:This work may be used as a management and decision support tool, based on the same methodology of a Health Technology Assessment, and may contribute to quality decisions to be taken in relation to the incorporation of new technology.
PD33 Incorporation Of New Medicines In Brazil: A Descriptive Analysis
Authors: Custódio Pedro , Santos André , Ruas Cristina 
Published: January 2019

Introduction:Health Technology Assessment (HTA) is important to the rational decision in healthcare systems. In Brazil, HTA is carried out by the national commission for the incorporation of technologies in the public system (Conitec), which issues reports with recommendations. This work aims to describe these recommendations and the factors influencing them.Methods:A descriptive analysis was conducted on Conitec's reports of incorporation of medicines between 2012 and 2016. The medicines were classified according to the Anatomical Therapeutic Chemical system (ATC).Results:One hundred and twenty-eight reports were assessed. Most requests were issued by the pharmaceutical industry (n=72; 47 percent), followed by the Ministry of Health (n=63; 41 percent). More reports issued by the Ministry of Health had positive recommendations compared to manufacturers (n=22 vs. n=50; χ2=30.231, df=1, p<0.001). Other antivirals were the most common class with requisitions (n=16), followed by TNF-α inhibitors (n=14) and selective immunosuppressants (n=12). Other antivirals had the most positive recommendations (n=12; 75 percent), followed by TNF-α inhibitors (n=7; 50 percent) and selective immunosuppressants (n=7; 58 percent). The difference was significant (χ2=88.65, df=63, p=0.02). TNF-α inhibitors was the class with the most negative recommendations (n=7; 50 percent), followed by monoclonal antibodies (n=6; 67 percent). Sixty-two reports contained economic assessments. Fifty-four presented incremental cost-effectiveness ratio (ICER) data and 57 presented the budget impact. Twenty-three reports showed data indicating dominance of the medicine, but only five of these were recommended for incorporation. Drugs for cancer have been recommended despite high ICER values. Decision makers accepted all the recommendations issued by Conitec.Conclusions:Data suggest that the economic evaluation is secondary to the decision of incorporation. The pharmaceutical industry is the largest applicant for the incorporation of medicines, but these requests are significantly less accepted than those made by the Ministry of Health. Conitec's recommendations are well-accepted by policy-makers. It was not possible to determine an implicit cost-effectiveness threshold.