Adoption Of New Health Technologies Research Articles

Current approaches of health technologies introduction in Ukrainian hospitals

The study aimed to gather insights regarding current decision-making approaches and identify challenges and opportunities related to health technology implementation in Ukrainian hospitals. Materials and methods. A total of 28 respondents from three public hospitals across different regions of Ukraine participated in online semi-structured interviews conducted between September 2022 and March 2023. The respondents for this study encompassed a diverse range of stakeholders, including general managers, medical directors, economists, representatives from procurement departments, heads of clinical and diagnostic departments, clinicians, and pharmacists. To effectively guide the interview process, a comprehensive questionnaire was developed. The data collected from the respondents were analyzed and synthesized to results and conclusions. Results. The semi-structured interview study consistently revealed a common pattern in all the interviewed hospitals regarding the adoption of new health technologies. The process of introducing these technologies entails several stages, each demanding meticulous planning, coordination, and active engagement from various stakeholders. What stood out was that stakeholders from the same speciality were consistently involved in the same decision-making stage across all the hospitals we studied. The technical stages of implementing new health technologies, as outlined by the Law of Ukraine "On Public Procurement," are well-established in Ukrainian hospitals. However, there is room for improvement in selecting which type of health technology to procure. The current assessment process often relies on limited sources of information, lacking comprehensive literature reviews or robust comparisons with existing practices or placebos. This information gap hampers the ability to make well-informed decisions that account for all relevant factors. The study also identifies specific challenges for the future implementation of the Hospital Health Thechnology Assessment (HB-HTA) in Ukraine. These challenges necessitate investment in building HTA expertise at the hospital level, cultivating strong leadership support, providing professional staff training, and establishing robust data collection and management systems. Overcoming these obstacles is crucial for hospitals to bolster their capacity to effectively implement new health technologies and make informed decisions about their utilization. Conclusions. Our study has revealed that all the technical stages involved in implementing new health technologies in Ukraine are well established. It was observed that there is room for improvement in the process of selecting which new health technology to purchase. This stage, known as the decision-making process based on HTA, requires implementation at the hospital level. Our study highlights the evident interest and potential benefits associated with adopting HB-HTA in the hospitals under investigation. By integrating HB-HTA into existing practices and approaches, hospitals can significantly enhance their decision-making processes when introducing new health technologies. There is an urgent need to introduce the term "hospital-based HTA" into Ukrainian legislation, as well as to activate the training of HTA experts at the hospital level

The impact of digital communication and data exchange on primary health service delivery in a small island developing state setting

Tuvalu is one of the smallest and most remote countries in the world. Due partly to its geography, the limited availability of human resources for health, infrastructure weaknesses, and the economic situation, Tuvalu faces many health systems challenges to delivering primary health care and achieving universal health coverage. Advancements in information communication technology are anticipated to change the face of health care delivery, including in developing settings. In 2020 Tuvalu commenced installation of Very Small Aperture Terminals (VSAT) at health facilities on remote outer islands to allow the digital exchange of data and information between facilities and healthcare workers. We documented the impact that the installation of VSAT has had on supporting health workers in remote locations, clinical decision-making, and delivering primary health more broadly. We found that installation of VSAT in Tuvalu has enabled regular peer-to-peer communication across facilities; supported remote clinical decision-making and reduced the number of domestic and overseas medical referrals required; and supported formal and informal staff supervision, education, and development. We also found that VSAT's stability is dependent on access to services (such as a reliable electricity supply) for which responsibility sits outside of the health sector. We stress that digital health is not a panacea for all health service delivery challenges and should be seen as a tool (not the solution) to support health service improvement. Our research provides evidence of the impact digital connectivity offers primary health care and universal health coverage efforts in developing settings. It provides insights into factors that enable and inhibit sustainable adoption of new health technologies in low- and middle-income countries.

POSB423 Incident Versus Prevalent Population: Review of Guidelines to Estimate the Eligible Population for Budget Impact Analysis

Budget impact analysis (BIA) assesses the affordability of the addition or adoption of new health technologies. Defining and estimating the size of the eligible population is an essential process driving the change in the use of health resources (costs and outcomes) of such analyses. Therefore, determining whether disease incidence or prevalence should be used to drive the target model population is an essential step in accurately estimating the budget impact.

Physician-patient shared decision making, patient satisfaction, and adoption of new health technology in China.

To examine the association between physician-patient treatments shared decision making (SDM), patient satisfaction, and adoption of a new health technology. A cross-sectional study was conducted from July 2016 to October 2016 in Fujian Province and Shanghai, in Eastern China. A total of 542 physicians and 619 patients in eleven hospitals were surveyed. Patients and their treating physicians completed self-reported questionnaires on patient-physician SDM, satisfaction with treatment decision making and adoption of a new health technology. Correlation analysis, multivariate logistic regression and multivariate linear regression were performed. The majority (68.20 percent) of patients preferred SDM. Involvement of patients in SDM was positively associated with their satisfaction with treatment decision making (p < .001) and adoption of a new health technology (p < .05). Better concordance between their preference and actual SDM was positively associated with patients' adoption behavior (p < .05), but no statistically significant association was found between concordance and satisfaction. SDM was the most important predictor of patients' satisfaction with decision making and adoption of a new health technology. Therefore, better communication between physicians and patients is recommended to improve their SDM, increase patient satisfaction and to assist with the adoption of new technologies. Training healthcare provider and teaching communication skills in working with patients in the initial stage of technology diffusion is required.

HOSPITAL-BASED HEALTH TECHNOLOGY ASSESSMENT (HB-HTA): A 10-YEAR SURVEY AT ONE UNIT.

Hospital-based health technology assessment (HB-HTA) has been introduced to help hospital management in decision making about the adoption of new health technologies (HTs). We reviewed the accuracy of the expected medical impact of HTs assessed at our hospital, as well as the acceptance of this process by clinicians. For each HT adopted between 2002 and 2011, a semi-structured interview with the involved clinician was conducted, assessing (i) the perceived utility of the HB-HTA process, (ii) the accuracy of the new HT's expected medical impact as compared with observed patient data from the year 2012, and (iii) the compliance with the indications of the HB-HTA report. Over the 10-year period, forty HB-HTAs were carried out, of which thirty-four led to acceptance. Twenty-seven of the twenty-eight clinicians involved in these thirty-four HTs accepted the interview and 85 percent acknowledged the utility of the HB-HTA process. Five of the thirty-four HTs were no longer in use. For the twenty-nine remaining HTs, observed patients' number was as expected in eight, higher in four, lower in fifteen, and not available in two cases. Available average length of stay was 61 percent longer than expected. Two HTs had a higher complication rate and three a lower success rate. Indications evolved in 55 percent of HTs after a few years (seven restrictions, six broadenings, and three other changes). A HB-HTA process is useful to improve quality in decision making. Follow-up analysis should routinely be performed to adapt HB-HTA reports' conclusions to practical experience and new scientific evidence.

Analysis of the adoption of new health technology: the case of Dupuytren's disease

Health technology assessment focuses on clinical effectiveness and cost efficiency, but achieving these goals does not guarantee the adoption of a new technology if the incentives of individual decision makers (payers, patients, providers) are not aligned. This study creates a framework for the analysis of the adoption phase. The framework is tested in the case of a new, non-invasive treatment for Dupuytren's disease. The framework is developed based on existing operations management theories. The cost-benefit analysis in the case study utilises information on the Finnish healthcare system, detailed data on the process of the surgical and treatment for Dupuytren's from seven hospital districts and expert interviews on the non-surgical treatment process. The analysis suggests that the new technology will most likely be adopted, but it also shows that there are potential hindrances. The study shows that it is important to consider the incentives of individual operators within the healthcare system.

Reimbursement programs and health technology assessment for diabetes devices and supplies: a Canadian perspective.

The reimbursement model for medical devices and supplies used in the management of diabetes in Canada, along with the process for assessing new health technologies, can be complicated. Various provincial programs, including Ontario's Assistive Devices Program and the Ontario Monitoring for Health Program, reimburse the costs associated with certain devices and supplies for diabetes management. In addition, provincial advisory committees, such as the Ontario Health Technology Advisory Committee, review and make recommendations on the adoption of new health technologies in each province. This article provides an overview of the reimbursement programs available for diabetes devices and supplies and reviews the process for assessing new health technologies using the province of Ontario as an example.

Capturing Value from Health Technologies in Lean Times

The adoption of new health technologies brings potential improvements to quality of life as well as new costs for provincial healthcare systems. An appropriate evidence-based framework for adoption decisions therefore can go a long way to improving value for money in our health systems. While making decisions to adopt new technologies is a highly politicized process, these decisions must nonetheless strive to make use of all available evidence, including economic evaluations that consider all the costs and consequences of new technologies for society as a whole, including medical, ethical, legal, social and cultural. This Commentary focuses on an emerging, evidence-based policy tool called Health Technology Assessment (HTA). HTA helps inform decisionmaking on how to balance demand and supply pressures for new technologies within a health-system budget. The overarching objective is to obtain the greatest health gains within fiscal constraints by grounding decisions in a clear, transparent and coordinated process. In Canada, the number of entities engaged in various forms of HTA has been growing, and more and more people in healthcare are becoming exposed to the techniques involved. This progress and capacity growth is encouraging. However, rather than counting on a natural slowing of healthcare costs to relieve fiscal pressures, the provinces would be better off grounding their efforts in clear and coordinated HTA processes that incorporate economic evaluation and meaningful collaborative deliberation based on available evidence. This Commentary also looks at examples of HTA experience outside Canada and highlights lessons for Ottawa and the provinces. At present, the National Institute for Health and Care Excellence in the UK is by far the most advanced example of an attempt to utilize a consistent framework for technology adoption in a government-funded healthcare system. The UK’s current transition toward “value-based pricing” is another positive example of how HTA economic evaluation can be used to inform technology adoption in a more constructive way than with traditional “yes” or “no” recommendations. Canadian HTA agencies should draw as much as possible on existing international evidence – from randomized clinical trials, post-market assessments, clinical guidelines, etc. – and maintain close relationships with their counterparts in other countries and international organizations. Finally, HTA frameworks in Canada also must aim to encourage greater stakeholder participation and relationship development.

Tenofovir gel for HIV prevention for women: Perspectives of Key Opinion Leaders from India

ObjectivesCountry decision-making regarding adoption of new health technologies is a lengthy process that is informed by scientific, public health, and policy analyses. Key Opinion Leaders (KOLs), who include a range of influential individuals (e.g., Ministry of Health officials, leaders of medical and pharmacy associations, civil society representatives, donors), play a critical role in country decision-making around adoption and availability of new HIV-prevention tools. Their perspectives can shape public opinion and influence policy, programming, and procurement decisions. MethodsIn-depth face-to-face interviews with a dozen purposefully selected national KOLs in India were conducted to gain their perspectives around ARV-based prevention for women, focusing on microbicides in general and tenofovir vaginal gel specifically. Theme-based content emerged and was analyzed using ATLAS.ti software. ResultsWhile generally supportive, KOLs expressed caveats regarding the role tenofovir gel might play in the overall HIV-prevention program. Key outstanding issues that would need to be addressed include product effectiveness, potential for resistance, product cost, feasibility of HIV testing and re-testing, and effective targeting of key populations for public health impact. ConclusionsAs new HIV-prevention technologies advance through clinical trials, there is a concomitant necessity to engage in policy analysis exercises. Formative research with stakeholders early in the process is an important yet often overlooked step. The potential role that the tenofovir gel could play in India will depend in large part on epidemiological, public health, and economic factors. Understanding target populations' perspectives on the product will also be critical for its successful introduction.

Observing the Challenges of Implementing New Health ICT

Research into the development and adoption of new health technologies finds that information and communication technology (ICT) developers often fail to understand the clinical workplace, resulting in the implementation of costly systems that stakeholders reject. Here we report observations of the implementation of a well-designed new patient information system at a regional hospital. We used a combination of ethnographical and survey methods to assess stakeholders‘ uptake of and reactions to the new system. We found that even with a well-designed system, uptake can encounter challenges. We outline a number of important factors that may influence the success, or failure, of new ICT.

Development and implementation of health technology assessment in Argentina: Two steps forward and one step back

The objectives of this study are to review the financing and organization of the Argentine healthcare system, the licensing and drug price setting mechanisms, the benefit packages and coverage policies of pharmaceuticals and other medical technologies, as well as the development of HTA in Argentina, and the role of the Institute of Clinical Effectiveness and Health Policy (IECS) as an HTA agency. Finally, the perspectives and future of HTA as a tool to make resource-allocation decisions and priority setting in Argentina is discussed. The study is a discussion/review based largely on the experiences of the authors, but supported by available literature. Argentina is an upper-middle income country with major healthcare problems related to both equity and efficiency. Its healthcare system consists of a multitier system divided in three large sectors: public, social security, and private, where the federal Ministry of Health has a rather limited role in national health policy stewardship. Many of Argentina's shortcomings are due in part to its pluralistic and fragmented healthcare system. In the past decade, Argentina, like many other Latin American countries, has undergone a profound reform of its healthcare system. Whereas some of the objectives of the reforms were specific to each country, a common issue among all of them was to establish a mechanism that ensured a more efficient allocation of scarce resources, and guaranteed a wider provision of healthcare services on the basis of the local population needs and equity. Although some signals from the national government and congress show that there are plans to formally incorporate HTA to inform reimbursement policies, these signals are still very weak. Paradoxically, even though Argentina was the first country in the region to require formal health economic evidence for the adoption of technologies into the mandatory benefit package of the social security, this "fourth hurdle" is no longer required. Nevertheless, there is an increasing interest and demand for a more explicit and transparent resource-allocation process that include HTA as a formal tool to inform decision making, in most of Argentine healthcare stakeholders. In conclusion, what is needed in Argentina is a clear political will to push forward for a national agency of HTA that, similar to other developed countries, advance the regulation on the adoption of new health technologies to improve not only technical or allocative efficiency, but also health equity. Until this milestone is accomplished, the HTA production and use to inform healthcare coverage policies will continue to mirror the current fragmented healthcare system.

Transferring health technology to South Africa: the importance of traditional African culture

The transfer of new health technology to South Africa is occurring despite the fact that North American and European health care planners and entrepreneurs have a very limited understanding of traditional Black South African cultures which condition the health-related behaviors of the majority of the population. Consequently, relatively few people of African descent in this very diverse nation are, at least initially, benefiting from the new imported medical technology. This study gives an overview of traditional Black medicine in South Africa and, through the presentation of several case studies, discusses its implications for the societal adoption of new health technology received from the United States and other industrialized nations. The example of the successful application of cervical cancer exams in rural and urban clinics of the Eastern Cape is analyzed and institutional mechanisms that support successful transfer are identified.

Acute childhood diarrhoea and maternal time allocation in the northern central Sierra of Peru.

Interventions to improve child health depend, at least implicitly, on changing maternal knowledge and behaviour and a reallocation of maternal time. There have been few studies, however, of the time cost involved in the adoption of new health technologies and even fewer that examine changes in maternal activities in response to child illness. The present study examines maternal daytime activities and investigates changes that occur when children are ill. We examine the impact of acute childhood diarrhoea episodes on the activity patterns of the mother/caretaker in this setting. The results show that mothers alter their usual activity patterns only slightly in response to acute diarrhoea episodes in their children. They continue to perform the same variety of activities as when the children are healthy, although they are more likely to perform them with the child 'carried' on their back. There is some indication that diarrhoea perceived to be more severe did result in the mother acting as caretaker more frequently. These findings have important implications for health interventions that depend on changing the amount of maternal or caretaker time spent for child health technologies, but the implications may vary depending on the reasons for the observed lack of changes in caretaker activities.

Community Involvement in Social Marketing: Guineaworm Control

Social marketing as a health education strategy has the potential for encouraging the adoption of new health technologies. The focus on the individual, though, holds the risk of victim blaming. This can be overcome if the consumers/community are involved in the four major components of the marketing strategy-product design, price, distribution and promotion. The community of Idere, Nigeria, has recently been involved in marketing a monofilament nylon cloth filter to prevent the water-borne helminthic disease, guineaworm. Local tailors produced the filters. Volunteer primary health workers debated pricing, sold the product and educated each consumer. Coverage in those neighborhoods and farm settlements where primary health workers were resident was nearly double that of other sections showing the value of local action to market health changes.