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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 25155

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Special Issue Editors

Prof. Dr. Devidas Menon

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Guest Editor

School of Public Health, University of Alberta, Edmonton, AB T6G 2V2, Canada
Interests: health policy; health technologies; health technology assessment; access with evidence development

Dr. Tania Stafinski

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Guest Editor

School of Public Health, University of Alberta, Edmonton, AB T6G 2V2, Canada
Interests: health technologies; rare diseases; values in resource allocation; health technology assessment methods

Special Issue Information

Dear Colleagues,

A health technology is defined by international health technology assessment authorities as an intervention developed to prevent, diagnose, or treat medical conditions; promote health; provide rehabilitation; or organize healthcare delivery. It can be a test, device, medicine, vaccine, procedure, program, or system. Over the past 50 years, health systems worldwide have become increasingly health-technology-reliant. The speed of technological innovation around the world has seen the development of a wide range of health technologies that continue to push the frontiers of healthcare organization, delivery, and financing. Although they are generally designed to improve health outcomes, many of them raise much broader questions of ethics, access, values, etc., particularly when choices have to be made between technologies in the face of limited budgets. This Special Issue is intended to provoke thought into these broader impacts of health technologies on health systems. We welcome papers that deal with the following topics:

How health systems encourage technological innovation;
Studies on health system transformation through the adoption of health technologies;
Cross-jurisdictional studies on the implementation of innovative technologies;
The impact of health technologies on the health workforce;
Whole systems approaches to technology adoption and implementation;
Alternative approaches to financing health technologies;
The impact of COVID-19 on health technology development;
Technology decision-making processes in health systems;
Approaches to measuring the broad impact of health technologies on health systems.

However, our solicitation is not limited to the above topics, and manuscripts on other relevant topics are also welcome.

Prof. Dr. Devidas Menon
Dr. Tania Stafinski
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

technology innovation in health systems
health system transformation
decision-making on new technologies
health technology financing
impact of technologies on the workforce
comparative studies of health technologies

Published Papers (12 papers)

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Research

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17 pages, 1157 KiB

Open AccessArticle

by Tomas Gabriel Bas, Paula Astudillo, Daniel Rojo and Angel Trigo

Int. J. Environ. Res. Public Health 2023, 20(6), 4839; https://doi.org/10.3390/ijerph20064839 - 09 Mar 2023

Cited by 2 | Viewed by 1829

Abstract

The research evaluated the opinion of those in charge of the administrative management of the logistics and supply chain of medical and pharmaceutical stocks of health care centers in the north of Chile and a potential improvement of their operations through the use of artificial intelligence (AI). The identification of the problem arose from the empirical analysis, where serious deficiencies in the manual handling and management of the stock of medicines and hospital supplies were evidenced. This deficiency does not allow a timely response to the demand of the logistics and supply chain, causing stock ruptures in health centers. Based on this finding, we asked ourselves how AI was observed as the most efficient tool to solve this difficulty. The results were obtained through surveys of personnel in charge of hospital and pharmacy supplies. The questions focused on the level of training, seniority in positions related to the problem, knowledge of regulations, degree of innovation in the procedures used in logistics and supply chain and procurement. However, a very striking fact was related to the importance of the use of AI, where, very surprisingly, 64.7% considered that it would not help to reduce human errors generated in the areas analyzed. Full article

(This article belongs to the Special Issue Health Technologies in Health Systems)

10 pages, 599 KiB

Open AccessArticle

Organisational Impact of a Remote Patient Monitoring System for Heart Failure Management: The Experience of 29 Cardiology Departments in France

by Sarah Alami, Laurène Courouve, Guila Lancman, Pierrette Gomis, Gisele Al-Hamoud, Corinne Laurelli, Hélène Pasche, Gilles Chatellier, Grégoire Mercier, François Roubille, Cécile Delval and Isabelle Durand-Zaleski

Int. J. Environ. Res. Public Health 2023, 20(5), 4366; https://doi.org/10.3390/ijerph20054366 - 28 Feb 2023

Cited by 1 | Viewed by 1456

Abstract

Remote patient monitoring (RPM) for the management of patients with chronic heart failure (CHF) has been widely studied from clinical and health-economic points of view. In contrast, data on the organisational impact of this type of RPM are scarce. The objective of the present study of cardiology departments (CDs) in France was to describe the organisational impact of the Chronic Care Connect^TM (CCC^TM) RPM system for CHF. An organisational impact map for health technology assessment was used to identify and define the criteria evaluated in the present survey, including the care process, equipment, infrastructure, training, skill transfers, and the stakeholders’ abilities to implement the care process. In April 2021, an online questionnaire was sent to 31 French CDs that were using CCC^TM for CHF management: 29 (94%) completed the questionnaire. The survey results showed that CDs progressively modified their organisational structures upon or shortly after the implementation of the RPM device. Twenty-four departments (83%) had created a dedicated team, sixteen (55%) had provided dedicated outpatient consultations for patients with an emergency alert, and twenty-five (86%) admitted patients directly (i.e., avoiding the need to attend the emergency department). The present survey is the first to have assessed the organisational impact of the implementation of the CCC^TM RPM device for CHF management. The results highlighted the variety of organisational structures, which tended to structure with the use of the device. Full article

(This article belongs to the Special Issue Health Technologies in Health Systems)

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13 pages, 498 KiB

Open AccessArticle

Implementing Technologies: Assessment of Telemedicine Experiments in the Paris Region: Reasons for Success or Failure of the Evaluations and of the Deployment of the Projects

by Alicia Le Bras, Kevin Zarca, Maroua Mimouni, Isabelle Durand-Zaleski and ARS Ile de France Telemedicine Group

Int. J. Environ. Res. Public Health 2023, 20(4), 3031; https://doi.org/10.3390/ijerph20043031 - 09 Feb 2023

Viewed by 1020

Abstract

Background: Telemedicine is increasingly viewed as a tool to provide a wide range of health services. This article presents policy lessons drawn from the evaluation of telemedicine experiments conducted in the Paris region. Methods: We used a mixed method design to study telemedicine projects commissioned by the Paris Regional Health Agency between 2013 and 2017. We combined data analysis of the telemedicine projects, review of the protocols, and interviews with stakeholders. Results: We identified the following reasons for disappointing outcomes: the outcome measure was requested too early during the experiments because payers required information for budgetary decisions; and the learning curve, technical problems, diversion of use, insufficient number of inclusions, and a lack of adherence prevented the demonstration of successful outcomes of the projects. Conclusion: The evaluation of telemedicine should be undertaken after sufficient uptake to ensure barriers to implementation are overcome, and to obtain the sample size necessary for statistical power and reduce the average cost for one telemedicine request. Randomized controlled trials should be encouraged with appropriate funding and the follow-up period should be extended. Full article

(This article belongs to the Special Issue Health Technologies in Health Systems)

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13 pages, 312 KiB

Open AccessArticle

Moving beyond the Court of Public Opinion: A Citizens’ Jury Exploring the Public’s Values around Funding Decisions for Ultra-Orphan Drugs

by Tania Stafinski, Jacqueline Street, Andrea Young and Devidas Menon

Int. J. Environ. Res. Public Health 2023, 20(1), 633; https://doi.org/10.3390/ijerph20010633 - 30 Dec 2022

Cited by 1 | Viewed by 1437

Abstract

Health system decision-makers need to understand the value of new technology to make “value for money” decisions. Typically, narrow definitions of value are used. This paper reports on a Canadian Citizens’ Jury which was convened to elicit those aspects of value that are important to the public. The criteria used by the public to determine value included those related to the patient, those directly related to caregivers and those directly created for society. Their choices were not binary (e.g., cost vs. health gained), but rather involved multiple factors (e.g., with respect to patient factors: disease severity, health gained with the drug, existence of alternatives, life expectancy, patient age and affordability). Overall, Jurors prioritized funding treatments for ultra-rare disease populations when the treatment offered significant improvements in health and quality of life, and when the pre-treatment health state was considered extremely poor. The prevalence of the disease by itself was not a factor in the choices. Some of the findings differ from previous work, which use survey methods. In our Citizens’ Jury, Jurors were able to become more familiar with the question at hand and were exposed to a broad and balanced collection of viewpoints before and throughout engaging in the exercises. This deliberative approach allows for a more nuanced approach to understanding value. Full article

(This article belongs to the Special Issue Health Technologies in Health Systems)

19 pages, 2298 KiB

Open AccessArticle

WtsWrng Interim Comparative Effectiveness Evaluation and Description of the Challenges to Develop, Assess, and Introduce This Novel Digital Application in a Traditional Health System

by Laura Sampietro-Colom, Carla Fernandez-Barcelo, Ismail Abbas, Blanca Valdasquin, Nicolau Rabasseda, Borja García-Lorenzo, Miquel Sanchez, Mireia Sans, Noemi Garcia and Alicia Granados

Int. J. Environ. Res. Public Health 2022, 19(21), 13873; https://doi.org/10.3390/ijerph192113873 - 25 Oct 2022

Viewed by 2276

Abstract

Science and technology have evolved quickly during the two decades of the 21st century, but healthcare systems are grounded in last century’s structure and processes. Changes in the way health care is provided are demanded; digital transformation is a key driver making healthcare systems more accessible, agile, efficient, and citizen-centered. Nevertheless, the way healthcare systems function challenges the development (Innovation + Development and regulatory requirements), assessment (methodological guidance weaknesses), and adoption of digital applications (DAs). WtsWrng (WW), an innovative DA which uses images to interact with citizens for symptom triage and monitoring, is used as an example to show the challenges faced in its development and clinical validation and how these are being overcome. To prove WW’s value from inception, novel approaches for evidence generation that allows for an agile and patient-centered development have been applied. Early scientific advice from NICE (UK) was sought for study design, an iterative development and interim analysis was performed, and different statistical parameters (Kappa, B statistic) were explored to face development and assessment challenges. WW triage accuracy at cutoff time ranged from 0.62 to 0.94 for the most frequent symptoms attending the Emergency Department (ED), with the observed concordance for the 12 most frequent diagnostics at hospital discharge fluctuating between 0.4 to 0.97; 8 of the diagnostics had a concordance greater than 0.8. This experience should provoke reflective thinking for DA developers, digital health scientists, regulators, health technology assessors, and payers. Full article

(This article belongs to the Special Issue Health Technologies in Health Systems)

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14 pages, 552 KiB

Open AccessArticle

The Use of Evidence-Informed Deliberative Processes for Health Benefit Package Design in Kazakhstan

by Wija Oortwijn, Gavin Surgey, Tanja Novakovic, Rob Baltussen and Lyazzat Kosherbayeva

Int. J. Environ. Res. Public Health 2022, 19(18), 11412; https://doi.org/10.3390/ijerph191811412 - 10 Sep 2022

Viewed by 1646

Abstract

Kazakhstan strives to obtain Universal Health Coverage (UHC) by using health technology assessment (HTA) for determining their health benefit package. This paper reports on employing evidence-informed deliberative processes (EDPs), a practical and stepwise approach to enhance legitimate health benefit package design in Kazakhstan. Methods: The Ministry of Health of Kazakhstan approved the operationalization and application of EDPs during March 2019 and December 2020. We used a combination of desk research, conducting HTA, online surveys as well as a face-to-face workshop in Nur-Sultan, Kazakhstan, and two online workshops to prioritize 25 selected health technologies. During the latter, we tested two alternative approaches to prioritization: quantitative multicriteria decision analysis (MCDA) and the use of decision rules. Results: For each of the HTA reports, evidence summaries were developed according to the decision criteria (safety, social priority disease, severity of disease, effectiveness, cost-effectiveness, level of evidence, financial risk protection and budget impact). When appraising the evidence, the advisory committee preferred using quantitative MCDA, and only when this would result in any controversy could decision rules be applied. Conclusions: Despite several challenges, including a partial disruption because of the COVID-19 pandemic, implementation of the process will likely play a key role in determining an evidence-informed and transparent health benefit package. Full article

(This article belongs to the Special Issue Health Technologies in Health Systems)

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15 pages, 775 KiB

Open AccessArticle

Possibilities of Implementing Hospital-Based Health Technology Assessment (HB-HTA) at the Level of Voivodeship Offices in Poland

by Maciej Furman, Małgorzata Gałązka-Sobotka, Damian Marciniak and Iwona Kowalska-Bobko

Int. J. Environ. Res. Public Health 2022, 19(18), 11235; https://doi.org/10.3390/ijerph191811235 - 07 Sep 2022

Cited by 1 | Viewed by 1691

Abstract

The Health Technology Assessment is based on the evaluation of the characteristics and effects of health technologies to properly spend resources in healthcare. For the needs of hospitals, a special HTA department, Hospital-Based Health Technology Assessment (HB-HTA), has been established. The objective of the article is to assess the possibility of implementing a functional model with the coordinating role of Health Departments of the Voivodeship Offices with the support of the National Health Fund and the HTA Agency in Poland. Ten semi-structured interviews were conducted with representatives from eight Voivodeship Offices. The interviews consisted of nine questions related to the possibility of introducing a functional model with the participation of the Voivodeship Office. The material was divided into seven codes relating to the questions included in the topic guide. From the perspective of Voivodeship Offices, HB-HTA could contribute to the improvement of the methodology used in the Evaluation Instrument of Investment Motions in Health. The lack of personnel in the Voivodeship Offices was identified as one of the greatest barriers to the implementation of HB-HTA. These public administration units should not be involved in the hospital health technology assessment process. Full article

(This article belongs to the Special Issue Health Technologies in Health Systems)

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12 pages, 343 KiB

Open AccessArticle

Evaluating Patients’ Experiences with Healthcare Services: Extracting Domain and Language-Specific Information from Free-Text Narratives

by Barbara Jacennik, Emilia Zawadzka-Gosk, Joaquim Paulo Moreira and Wojciech Michał Glinkowski

Int. J. Environ. Res. Public Health 2022, 19(16), 10182; https://doi.org/10.3390/ijerph191610182 - 17 Aug 2022

Cited by 4 | Viewed by 1734

Abstract

Evaluating patients’ experience and satisfaction often calls for analyses of free-text data. Language and domain-specific information extraction can reduce costly manual preprocessing and enable the analysis of extensive collections of experience-based narratives. The research aims were to (1) elicit free-text narratives about experiences with health services of international students in Poland, (2) develop domain- and language-specific algorithms for the extraction of information relevant for the evaluation of quality and safety of health services, and (3) test the performance of information extraction algorithms’ on questions about the patients’ experiences with health services. The materials were free-text narratives about health clinic encounters produced by English-speaking foreigners recalling their experiences (n = 104) in healthcare facilities in Poland. A linguistic analysis of the text collection led to constructing a semantic–syntactic lexicon and a set of lexical-syntactic frames. These were further used to develop rule-based information extraction algorithms in the form of Python scripts. The extraction algorithms generated text classifications according to predefined queries. In addition, the narratives were classified by human readers. The algorithm-based and the human readers’ classifications were highly correlated and significant (p < 0.01), indicating an excellent performance of the automatic query algorithms. The study results demonstrate that domain-specific and language-specific information extraction from free-text narratives can be used as an efficient and low-cost method for evaluating patient experiences and satisfaction with health services and built into software solutions for the quality evaluation in health care. Full article

(This article belongs to the Special Issue Health Technologies in Health Systems)

14 pages, 1614 KiB

Open AccessArticle

Traditional Heart-Healthy Diet and Medication Adherence in the Norton Sound Region: An 18-Month Telehealth Intervention

by Marily Oppezzo, Mariah Knox, Jordan Skan, Amy Chieng, Maria Crouch, Rachael C. Aikens, Neal L. Benowitz, Matthew Schnellbaecher and Judith J. Prochaska

Int. J. Environ. Res. Public Health 2022, 19(16), 9885; https://doi.org/10.3390/ijerph19169885 - 11 Aug 2022

Cited by 1 | Viewed by 1662

Abstract

Introduction. Innovations are needed for preventing cardiovascular disease (CVD) and for reaching diverse communities in remote regions. The current study reports on a telemedicine-delivered intervention promoting a traditional heart-healthy diet and medication adherence with Alaska Native men and women residing in the Norton Sound region of Alaska. Methods. Participants were 299 men and women with high blood pressure or high cholesterol smoking daily who were randomized to receive telemedicine-delivered counseling and printed materials on diet and medication adherence or on smoking and physical activity. Intervention contacts were at baseline and 3-, 6-, and 12-months follow-up, with a final assessment at 18 months. Nutrition outcomes were the ratio of heart-healthy foods and traditional heart-healthy foods relative to all foods reported on a 34-item food frequency questionnaire. Recent and typical adherence for heart medications were self-reported. Results. Intervention effects were significant for the heart-healthy foods ratio at 6 months only (p = 0.014) and significant for the traditional heart-healthy foods ratio at 6 months only for those aged 47+ (p = 0.031). For recent and typical medication adherence, there were no significant group differences by time. Discussion. In a remote region of Alaska, telemedicine proved feasible and acceptable for engaging Alaska Native men and women in counseling on CVD risk behaviors. The findings indicate that more touchpoints may be necessary to impart comprehensive lasting change in heart-healthy eating patterns. Medication adherence group differences were not significant; however, medication adherence was high overall. Full article

(This article belongs to the Special Issue Health Technologies in Health Systems)

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21 pages, 426 KiB

Open AccessArticle

Older Adults’ Perspectives of Smart Technologies to Support Aging at Home: Insights from Five World Café Forums

by Jackie Street, Helen Barrie, Jaklin Eliott, Lucy Carolan, Fidelma McCorry, Andreas Cebulla, Lyn Phillipson, Kathleen Prokopovich, Scott Hanson-Easey, Teresa Burgess and on behalf of the Smart Ageing Research Group

Int. J. Environ. Res. Public Health 2022, 19(13), 7817; https://doi.org/10.3390/ijerph19137817 - 25 Jun 2022

Cited by 13 | Viewed by 3931

Abstract

Globally, there is an urgent need for solutions that can support our aging populations to live well and reduce the associated economic, social and health burdens. Implementing smart technologies within homes and communities may assist people to live well and ‘age in place’. To date, there has been little consultation with older Australians addressing either the perceived benefits, or the potential social and ethical challenges associated with smart technology use. To address this, we conducted five World Cafés in two Australian states, aiming to capture citizen knowledge about the possibilities and challenges of smart technologies. The participants (n = 84) were aged 55 years and over, English-speaking, and living independently. Grounding our analysis in values-based social science and biomedical ethical principles, we identified the themes reflecting the participants’ understanding, resistance, and acceptance of smart technologies, and the ethical principles, including beneficence, non-maleficence, autonomy, privacy, confidentiality, and justice. Similar to other studies, many of the participants demonstrated cautious and conditional acceptance of smart technologies, while identifying concerns about social isolation, breaches of privacy and confidentiality, surveillance, and stigmatization. Attention to understanding and incorporating the values of older citizens will be important for the acceptance and effectiveness of smart technologies for supporting independent and full lives for older citizens. Full article

(This article belongs to the Special Issue Health Technologies in Health Systems)

Other

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8 pages, 310 KiB

Open AccessOpinion

How We Might Further Integrate Considerations of Environmental Impact When Assessing the Value of Health Technologies

by Barbara Greenwood Dufour, Laura Weeks, Gino De Angelis, Dave K. Marchand, David Kaunelis, Melissa Severn, Melissa Walter and Nicole Mittmann

Int. J. Environ. Res. Public Health 2022, 19(19), 12017; https://doi.org/10.3390/ijerph191912017 - 22 Sep 2022

Cited by 9 | Viewed by 2103

Abstract

There is growing awareness of the impact health technologies can have on the environment and the negative consequences of these environmental impacts on human health. However, health system decision-makers may lack the expertise, data, or resources to incorporate environmental considerations when making decisions about the adoption and use of health technologies. In this article, we describe how health technology assessment (HTA) is evolving to address climate change by providing health system decision-makers with the information they can use to reduce the impact of health care systems on the environment. Our objective is to consider approaches for including the environment domain when conducting an HTA—in particular, the use of the deliberative process—and for determining when the domain should be included. We explore the challenges of gathering the relevant data necessary to assess the environmental impact of a health technology, and we describe a “triage” approach for determining when an in-depth environmental impact assessment is warranted. We also summarize related initiatives from HTA agencies around the world. Full article

(This article belongs to the Special Issue Health Technologies in Health Systems)

16 pages, 425 KiB

Open AccessPerspective

Virtual Care and the Inverse Care Law: Implications for Policy, Practice, Research, Public and Patients

by Hassane Alami, Pascale Lehoux, Sara E. Shaw, Chrysanthi Papoutsi, Sarah Rybczynska-Bunt and Jean-Paul Fortin

Int. J. Environ. Res. Public Health 2022, 19(17), 10591; https://doi.org/10.3390/ijerph191710591 - 25 Aug 2022

Cited by 7 | Viewed by 3325

Abstract

Virtual care spread rapidly at the outbreak of the COVID-19 pandemic. Restricting in-person contact contributed to reducing the spread of infection and saved lives. However, the benefits of virtual care were not evenly distributed within and across social groups, and existing inequalities became exacerbated for those unable to fully access to, or benefit from virtual services. This “perspective” paper discusses the extent to which challenges in virtual care access and use in the context of COVID-19 follow the Inverse Care Law. The latter stipulates that the availability and quality of health care is inversely proportionate to the level of population health needs. We highlight the inequalities affecting some disadvantaged populations’ access to, and use of public and private virtual care, and contrast this with a utopian vision of technology as the “solution to everything”. In public and universal health systems, the Inverse Care Law may manifests itself in access issues, capacity, and/or lack of perceived benefit to use digital technologies, as well as in data poverty. For commercial “Direct-To-Consumer” services, all of the above may be encouraged via a consumerist (i.e., profit-oriented) approach, limited and episodic services, or the use of low direct cost platforms. With virtual care rapidly growing, we set out ways forward for policy, practice, and research to ensure virtual care benefits for everyone, which include: (1) pay more attention to “capabilities” supporting access and use of virtual care; (2) consider digital technologies as a basic human right that should be automatically taken into account, not only in health policies, but also in social policies; (3) take more seriously the impact of the digital economy on equity, notably through a greater state involvement in co-constructing “public health value” through innovation; and (4) reconsider the dominant digital innovation research paradigm to better recognize the contexts, factors, and conditions that influence access to and use of virtual care by different groups. Full article

(This article belongs to the Special Issue Health Technologies in Health Systems)

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