Health System Resources Research Articles

Blood Pressure and Stroke: A Review of Sex- and Ethnic/Racial-Specific Attributes to the Epidemiology, Pathophysiology, and Management of Raised Blood Pressure.

Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early adulthood, overtaken by females at middle age, consistently across all ethnicities/races. However, there are clear regional differences on when females overtake males. Higher BP among males is observed until the seventh decade of life in high-income countries, compared with almost 3 decades earlier in low- and middle-income countries. Females and males tend to have different cardiovascular disease risk profiles, and many lifestyles also influence BP and cardiovascular disease in a sex-specific manner. Although no hypertension guidelines distinguish between sexes in BP thresholds to define or treat hypertension, observational evidence suggests that in terms of stroke risk, females would benefit from lower BP thresholds to the magnitude of 10 to 20 mm Hg. More randomized evidence is needed to determine if females have greater cardiovascular benefits from lowering BP and whether optimal BP is lower in females. Since 1990, the number of people with hypertension worldwide has doubled, with most of the increase occurring in low- and-middle-income countries where the greatest population growth was also seen. Sub-Saharan Africa, Oceania, and South Asia have the lowest detection, treatment, and control rates. High BP has a more significant effect on the burden of stroke among Black and Asian individuals than Whites, possibly attributable to differences in lifestyle, socioeconomic status, and health system resources. Although pharmacological therapy is recommended differently in local guidelines, recommendations on lifestyle modification are often very similar (salt restriction, increased potassium intake, reducing weight and alcohol, smoking cessation). This overall enhanced understanding of the sex- and ethnic/racial-specific attributes to BP motivates further scientific discovery to develop more effective prevention and treatment strategies to prevent stroke in high-risk populations.

Pandemic reflection: Significant change is needed to tap into the power of primary care during times of crisis.

Context: As a front-line resource, primary care could function as an indispensable health system resource during pandemic crises. However, throughout COVID-19, Canada's primary care providers expressed concern over their ability to respond. This study investigates factors related to these concerns, suggesting key areas for future primary care system development. Objective: Assess specific areas where robust, well-supported primary care could contribute significantly to the health system's pandemic response, & factors that may have prevented it from doing so. Study Design: Online, self-report survey administered over 3 weeks, April-May, 2021. Survey invitations sent via email, with three reminders following initial contact. Setting or Dataset: The College of Family Physicians of Canada (CFPC) membership list was used to reach family physicians in diverse practice settings in all Canadian provinces and territories. Population studied: All active CFPC family physician (FP) members were included. Most FPs in Canada are CFPC members; 39,991 FPs received survey invitations; 3,409 replied, for an overall response rate of 9%. Outcome Measures: Percent of FP engaged in systems level, pandemic response measures, including: 1) reporting COVID-19 cases to public health authorities, 2) identifying priority patients for vaccination, 3) participating in COVID-19 task forces, & 4) contributing to COVID-19 research/clinical studies. Results: Overall, one-third (34%) of FPs say that family practices in their region report COVID-19 cases to public health authorities. Most FPs (55%) say that their practices have not been asked to identify priority cases for COVID-19 vaccination. Less than 1-in-5 (19%) FPs have been involved in COVID-19 advisory/planning committees, task forces or groups. Very few FPs (6%) contribute to COVID-19 research/clinical studies. Half of FPs (50%) are highly concerned about the lack of clarity from government regarding FP response to the pandemic. These findings vary across jurisdictions and practice/remuneration models. Conclusions: Canada's primary care system has not been adequately engaged in important COVID-19 response measures, including monitoring viral spread in the population, pandemic planning, vaccination roll out, and therapeutic research. Practice models and remuneration arrangements are related to primary care's responsiveness to the COVID-19 pandemic,& should be considered in future primary care health system development.

A task analysis of central line-associated bloodstream infection (CLABSI) surveillance in home infusion therapy

Barriers for home infusion therapy central line associated bloodstream infection (CLABSI) surveillance have not been elucidated and are needed to identify how to support home infusion CLABSI surveillance. We aimed to (1) perform a goal-directed task analysis of home infusion CLABSI surveillance, and (2) describe barriers to, facilitators for, and suggested strategies for successful home infusion CLABSI surveillance. We conducted semi-structured interviews with team members involved in CLABSI surveillance at 5 large home infusion agencies to explore work systems used by members of the agency for home infusion CLABSI surveillance. We analyzed the transcribed interviews qualitatively for themes. Twenty-one interviews revealed 8 steps for performing CLABSI surveillance in home infusion therapy. Major barriers identified included the need for training of the surveillance staff, lack of a standardized definition, inadequate information technology support, struggles communicating with hospitals, inadequate time, and insufficient clinician engagement and leadership support. Staff performing home infusion CLABSI surveillance need health system resources, particularly leadership and front-line engagement, access to data, information technology support, training, dedicated time, and reports to perform tasks. Building home infusion CLABSI surveillance programs will require support from home infusion leadership.

Analysis of regulatory documents regulating the fight against COVID-19 and other healthcare tools used to manage the COVID-19 pandemic in Kazakhstan

Purpose of the study. Explore organizational tools for managing health system resources to fight the COVID‑19 pandemic in Kazakhstan.Materials and methods. The analysis of regulatory documents (5 decrees of the chief sanitary doctors and 2 orders of the Ministry of Health of the Republic of Kazakhstan) regulating measures for the COVID‑19 pandemic was carried out. These legal acts were approved in the first months after the declaration of the state of emergency in the country after the detection of the first cases of coronavirus infection in Kazakhstan. These laws and regulations governed the provisions and measures to combat COVID‑19. And also the analysis of measures for the introduction of quarantine or restrictions based on the monitoring of the R number of the virus was carried out.Results. The article discusses the issues of resource provision to contain the spread of COVID‑19 in the country. The analysis of the regulatory legal acts regarding the types of assistance provided to the population to prevent the spread of infection, as well as the treatment strategy for patients suffering coronavirus infection. These laws regulate the introduction, weakening/strengthening or cancellation of restrictive measures in the regions, mainly related to the activities of organizations and public places where there is a high concentration of the population, as well as the movement of masses of people.Conclusion. The study showed what types of assistance are provided to the population to halt the COVID‑19 pandemic, ranging from tactics at the outpatient level to the deployment of care at the inpatient level. In addition, the monitoring of the R value of the virus can be a working tool for the authorities in the introduction of quarantine measures.

Disclosure, transparency, and accountability: a qualitative survey of public sector pharmaceutical committee conflict of interest policies in the World Health Organization South-East Asia Region

BackgroundWeak governance over public sector pharmaceutical policy and practice limits access to essential medicines, inflates pharmaceutical prices, and wastes scarce health system resources. Pharmaceutical systems are technically complex and involve extensive interactions between the private and public sectors. For members of public sector pharmaceutical committees, relationships with the private sector can result in conflicts of interest, which may introduce commercial biases into decision-making, potentially compromising public health objectives and health system sustainability. We conducted a descriptive, qualitative study of conflict of interest policies and practices in the public pharmaceutical sector in ten countries in the World Health Organization (WHO) South-East Asia Region (SEAR) (Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste) between September 2020 and March 2021.ResultsWe identified 45 policy and regulatory documents and triangulated documentary data with 21 expert interviews. Key informants articulated very different governance priorities and conflict of interest concerns depending on the features of their country’s pharmaceutical industry, market size, and national economic objectives related to the domestic pharmaceutical industry. Public sector pharmaceutical policies and regulations consistently contained provisions for pharmaceutical committee members to disclose relevant interests, but contained little detail about what should be declared, when, and how often, nor whether disclosures are evaluated and by whom. Processes for preventing or managing conflicts of interest were less well developed than those for disclosure except for a few key procurement processes. Where processes for managing conflicts of interest were specified, the dominant strategy was to recuse committee members with a conflict of interest from relevant work. Policies rarely specified that committee members should divest or otherwise be free from conflicts of interest.ConclusionsRobust processes for conflict of interest prevention and management could ensure the integrity of decision-making and build public trust in pharmaceutical processes to achieve public health objectives. Upstream approaches including supportive legislative frameworks, the creation of oversight bodies, and strengthening regulatory institutions can also contribute to building cultures of transparency, accountability, and trust.

Clinical practice guidelines: Recommendations for CRC screening in Argentinian population with average risk based on iFOBT

ObjectivesColon cancer (CRC) screening is a cost-effective strategy. A group of experts and methodologists addressed clinical questions to adapt recommendations and provide guidance for health care providers involved in the continuous care of individuals with average-risk for develop CRC. The development group focused on health system resources and implementation issues. MethodsFollowing PRISMA guidelines, we carried out a comprehensive systematic review and applied the GRADE-ADOLOPMENT tool. The selected guidelines were appraised through AGREE II tool. The certainty of evidence was rated using GRADE approach.Finally, we use the Evidence-to-Decision (EtD) frameworks providing by GRADE to discuss benefits and harms, values and preferences, feasibility, acceptability, and equity issues in Argentina to adopt, adapt and make de novo recommendations to the local setting. ResultsDue to the absence of direct evidence, the panel made their recommendations on simulation models to determine how the screening strategies might affect the population outcomes.The certainty of all the available evidence was very low due to models’ assumptions. Since the lack of data about CRC incidence in Argentina and the existing barriers, the panel did not suggest the beginning of screening before 50 years old. The panel highlighted the deficit of colonoscopy availability. Therefore, they suggest that the balance may favor using quantitative over qualitative iFOBT because of the higher specificity to detect CRC and the reduction in colonoscopy required. In our setting and considering adherence, the panel suggests that iFOBT being used annually rather than bi-annual driving an improvement on the loss of follow–up. ConclusionsThe panel the panel did not suggest the beginning of screening before 50 years old, they suggest that the balance may favor using quantitative over qualitative iFOBT and annually iFOBT.

Indirect impact of health disasters on maternal and child mortality

In times of epidemics and pandemics, depletion or diversion of health system resources from routine health care is common, posing serious threats to primary care. This study estimates the contemporaneous and long-run effects of health disasters on maternal and child mortality in 111 countries during 2000–2019 using two-way fixed-effects and two-step system general method of moments frameworks. We also provide evidence that indicates how health system capacity, public health infrastructure, health care coverage and financing, and social determinants of health can mitigate disaster effects. In low- and middle-income countries, health disasters increase maternal, under-5, and neonatal mortalities by 0.3%, 0.3%, and 0.2% instantaneously and by 35%, 80%, and 26% after one year, respectively. Our estimates show that emergency preparedness and response can prevent these effects. However, other mitigators, namely physician density, water, sanitation, and hygiene coverage, universal health coverage, education, gender equality, and financial inclusion have greater impact.

The Impact of Economic Crisis on Health of Greek Population and National Health System

PURPOSE: In this paper, we investigate the impact of the economic crisis on Greece's National Health System and population health. Also included is a critical assessment of the health policies implemented, as compared with other countries, and positive proposals. ΜETHODS: We used data from international, European, and Greek databases to conduct a literature review and to compile statistics. RESULTS: Greece spent less on health in 2012 than it did in 2007, as money from the health sector was used for another spending. During the period 2010-2015, both the Physical Health Index and the Mental Health Index showed a significant decline. Policy planning for health financing has become increasingly important since the crisis. In some countries, targeted policies are being implemented to protect the poor and avoid adverse employment effects. CONCLUSIONS: A time of financial crisis tends to require more, not less, resources for health systems to meet the greater need for health care and increase reliance on publicly funded services. During the financial crisis, fiscal and health policies differed between countries, reflecting policy decisions. In achieving fiscal balance, it is important not to sacrifice financial protection, access, efficiency, quality, health outcomes, or equality.

Inequality in Cosmetic Services and Surgery among Iranian Households in 2019: A Decomposition Analysis.

BackgroundThe demand for cosmetic surgery is on the rise worldwide, making it the common form of surgery globally while the use of cosmetic surgery being exponentially high in Iran. The aim of this study was to investigate inequality in the use of cosmetic services and surgery (CSS) among Iranian households concerning demographic and socio-economic characteristics.MethodsThis study used data of 38960 Iranian household from the income-expenditure survey of the statistical center of Iran (SCI) in 2019. Concentration index (C) was used to measure inequalities in the use of CSS. Microsoft Excel sheet 2019 was used to extract the data, and the analysis was performed using Stata statistical package version 14.2.ResultsHouseholds with female head, with single head, households with 3 - 4 people, headed with undergraduate education person, households with insurance coverage, with higher socio-economic quintiles, rural households and residents of northwestern Iran were accounted for the highest use of CSS. Also, according to the decomposition analysis, wealth and education level are the two main factors in creating inequality, with wealth, having the highest positive share (88.11%) and education level having the most negative share (-5.26%) in creating measured inequality.ConclusionThe use of CSS is more concentrated in well-off households in Iran. As the resources of health system are limited, the government and the policy makers should have defined plans with regards to CSS use especially taking factors like socioeconomic status and education status of target groups in to account.

Smoking cessation: health system challenges and opportunities

The systematic integration of evidence-based tobacco treatment has yet to be broadly viewed as a standard-of-care. The Framework Convention on Tobacco Control recommends the provision of support for tobacco cessation....

Global and regional spending on dementia care from 2000-2019 and expected future health spending scenarios from 2020-2050: An economic modelling exercise.

SummaryBackgroundThe global burden of dementia is increasing. As diagnosis and treatment rates increase and populations grow and age, additional diagnosed cases will present a challenge to healthcare systems globally. Even modelled estimates of the current and future healthcare spending attributable to dementia are valuable for decision makers and advocates to prepare for growing demand.MethodsWe modelled healthcare spending attributable to dementia from 2000 to 2019 and expected estimated future spending from 2020 to 2050 under multiple scenarios. Data were from the Global Burden of Diseases 2019 study and from two systematic literature reviews. We used meta-regression to estimate the fraction of dementia spending that is attributable to dementia for those receiving nursing home-based care and for those receiving community-based care. We used spatiotemporal Gaussian process regression to account for data missingness and model diagnosis and treatment rates, nursing home-based care and community-based care rates, and unit costs for the many countries without their own underlying estimates. Projections of future spending estimate a baseline scenario from 2020 to 2050 based on ongoing growth. Alternative scenarios assessed faster growth rates for dementia diagnosis and treatment rates, nursing home-based care, and healthcare costs. All spending is reported in 2019 United States dollars or 2019 purchasing-power parity-adjusted dollars.FindingsBased on observed and modelled inputs, we estimated that global spending on dementia increased by 4.5% (95% uncertainty interval: 3.4–5.4%) annually from 2000 to 2019, reaching $263 billion (95% uncertainty interval [UI] $199– $333) attributable to dementia in 2019. We estimated total healthcare spending on patients with dementia was $594 billion (95% UI $457–$843). Under the baseline scenario, we estimated that attributable dementia spending will reach $1.6 trillion (95% UI $0.9–$2.6) by 2050. We project it will represent 11% (95% UI 6–18%) of all expected health spending, although it could be as high as 17% (95% UI 10–26%) under alternative scenarios.InterpretationHealth systems will experience increases in the burden of dementia in the near future. These modelled direct cost estimates, built from a relatively small set of data and linear time trends, highlight the magnitude of health system resources expected to be used to provide care and ensure sufficient and adequate resources for aging populations and their caretakers. More data are needed to corroborate these important trends.

Pragmatic Randomized Study of Targeted Text Message Reminders to Reduce Missed Clinic Visits.

Missed clinic appointments ("no-shows") waste health system resources, decrease physician availability, and may worsen patient outcomes. Appointment reminders reduce no-shows, though evidence on the optimal number of reminders is limited and sending multiple reminders for every visit is costly. Risk prediction models can be used to target reminders for visits that are likely to be missed. We conducted a randomized quality improvement project at Kaiser Permanente Washington among patients with primary care and mental health visits with a high no-show risk comparing the effect of one text message reminder (sent 2 business days prior to the appointment) with 2 text message reminders (sent 2 and 3 days prior) on no-shows and same-day cancellations. We estimated the relative risk (RR) of an additional reminder using G-computation with logistic regression adjusted for no-show risk. Between February 27, 2019 and September 23, 2019, a total of 125,076 primary care visits and 33,593 mental health visits were randomized to either 1 or 2 text message reminders. For primary care visits, an additional text message reduced the chance of no-show by 7% (RR = 0.93, 95% CI: 0.89-0.96) and same-day cancellations by 6% (RR = 0.94, 95% CI: 0.90-0.98). In mental health visits, an additional text message reduced the chance of no-show by 11% (RR = 0.89, 95% CI: 0.86-0.93) but did not impact same-day cancellations (RR = 1.02, 95% CI: 0.96-1.11). We did not find effect modification among subgroups defined by visit or patient characteristics. Study findings indicate that using a prediction model to target reminders may reduce no-shows and spend health care resources more efficiently.

Preparing BSN students for a new workplace: Experiences in a COVID-19 designated unit as an RN extender.

Academic nursing programs were impacted by the onset of the pandemic with the challenges of social distancing, detecting, and controlling the spread of the virus. Many traditionally campus-based, face-to-face programs transitioned quickly to include virtual activities for classes, laboratories, and clinical experiences for students. Initially direct patient care clinical activities came to a halt due to concerns for student safety and overwhelming numbers of COVID-19 cases stressing health system resources. However, as COVID-19 cases began to rise and hospitals struggled with staffing shortages, it became necessary to explore how nursing students could contribute to relieving the staffing burden while obtaining critical education as RN Extenders. Students that participated in the RN Extender program were seniors entering the nursing workforce within the next two months. Significant student screening and preparation was provided to support students serving as RN Extenders in COVID-19 units.The prior working relationships and personal contact between academic and practice leaders, a sense of equal participation, clear and realistic expectations of the benefits and responsibilities of each group were crucial. Building ongoing and frequent opportunities for formal and informal communication among all stakeholders was vital and the major contributor to the success of this program.

Development of a capability maturity model for the establishment of children’s nursing training programmes in southern and eastern Africa

Establishing sustainable training to strengthen human resources for health for children’s nursing in Africa requires stakeholders to navigate complex pathways spanning multiple regulatory systems and sectors. Incomplete stakeholder insight threatens long-term sustainability of new training programmes. We drew on collective experiential knowledge of capacity building for children’s nursing in southern and eastern Africa to articulate a Capability Maturity Model (CMM), using a six-stage process to: identify necessary supportive conditions; specify levels of process maturity; develop domains; characterise levels of capability; consult with stakeholders; and finalise the model. We articulated a comprehensive CMM describing five levels of process maturity in relation to education, clinical and regulatory systems, human resources for health systems, and requirements related to overall stakeholder collaboration. The model makes visible the range of regulatory and associated processes involved in developing a new educational programme for specialist nurses, including educational standards, quality assurance, scopes of practice, and systems for licensing and registering specialist children’s nurses. Stakeholders can use the model as a map to identify where they are in the process, and establish the resources and actions needed to make further progress.

Detoxification vs non-detoxification before starting an anti-CGRP monoclonal antibody in medication overuse headache

BackgroundMedication overuse headache significantly contributes to the chronification process and treatment refractoriness of migraine. Currently, abrupt discontinuation of the overused medication still represents the best management strategy for these patients, challenging public health system resources.MethodsIn this prospective study, chronic migraine and medication overuse headache sufferers with at least 28 days of analgesic consumption per month were included. Assessment of efficacy outcomes at three months were compared among patients who underwent in-hospital abrupt discontinuation of overused acute medication (YES-DETOX group) and patients who did not (NO-DETOX group) before starting an anti-CGRP monoclonal antibody.ResultsOf 401 patients who received either erenumab or galcanezumab, 28% (n = 111) satisfied inclusion criteria (YES-DETOX n = 28; NO-DETOX n = 83). After three months of treatment, 59% (n = 65; 47/83 YES-DETOX; 18/28 NO-DETOX) patients reverted from medication overuse headache and 51% (n = 57; 42/83 YES-DETOX; 15/28 NO-DEOTX) achieved ≥50% reduction in monthly headache days; yet no statistical differences were observed between the two groups (p = 0.4788 and p = 0.8393, respectively). Monthly consumption of pain medication was the only baseline prognostic factor in multivariate analysis in the overall cohort (p = 0.016).ConclusionOur results support the emerging evidence that anti-CGRP monoclonal antibodies may be effective in medication overuse headache patients irrespective of detoxification, yet further studies are needed to draw definitive conclusions.

Cost-effectiveness and cost-utility evaluation of individual vs. group transdiagnostic psychological treatment for emotional disorders in primary care (PsicAP-Costs): a multicentre randomized controlled trial protocol

BackgroundEmotional disorders are common, and they have become more prevalent since the COVID-19 pandemic. Due to a high attendance burden at the specialized level, most emotional disorders in Spain are treated in primary care, where they are usually misdiagnosed and treated using psychotropic drugs. This contributes to perpetuate their illness and increase health care costs. Following the IAPT programme and the transdiagnostic approach, the PsicAP project developed a brief group transdiagnostic cognitive-behavioural therapy (tCBT) as a cost-effective alternative. However, it is not suitable for everyone; in some cases, one-on-one sessions may be more effective. The objective of the present study is to compare, in cost-benefit terms, group and individual tCBT with the treatment usually administered in Spanish primary care (TAU).MethodsA randomized, controlled, multicentre, and single-blinded trial will be performed. Adults with mild to moderate emotional disorders will be recruited and placed in one of three arms: group tCBT, individual tCBT, or TAU. Medical data and outcomes regarding emotional symptoms, disability, quality of life, and emotion regulation biases will be collected at baseline, immediately after treatment, and 6 and 12 months later. The data will be used to calculate incremental cost-effectiveness and cost-utility ratios.DiscussionThis trial aims to contribute to clinical practice research. The involvement of psychologists in primary care and the implementation of a stepped-care model for mental disorders are recommended. Group therapy and a transdiagnostic approach may help optimize health system resources and unblock waiting lists so that people can spend less time experiencing mental health problems.Trial registrationClinicalTrials.gov: NCT04847310; Protocols.io: bx2npqde. (April 19, 2021)

Differential diagnosis of hereditary anemias from a fraction of blood drop by digital holography and hierarchical machine learning

Anemia affects about the 25% of the global population and can provoke severe diseases, ranging from weakness and dizziness to pregnancy problems, arrhythmias and hearth failures. About 10% of the patients are affected by rare anemias of which 80% are hereditary. Early differential diagnosis of anemia enables prescribing patients a proper treatment and diet, which is effective to mitigate the associated symptoms. Nevertheless, the differential diagnosis of these conditions is often difficult due to shared and overlapping phenotypes. Indeed, the complete blood count and unaided peripheral blood smear observation cannot always provide a reliable differential diagnosis, so that biomedical assays and genetic tests are needed. These procedures are not error-free, require skilled personnel, and severely impact the financial resources of national health systems. Here we show a differential screening system for hereditary anemias that relies on holographic imaging and artificial intelligence. Label-free holographic imaging is aided by a hierarchical machine learning decider that works even in the presence of a very limited dataset but is enough accurate for discerning between different anemia classes with minimal morphological dissimilarities. It is worth to notice that only a few tens of cells from each patient are sufficient to obtain a correct diagnosis, with the advantage of significantly limiting the volume of blood drawn. This work paves the way to a wider use of home screening systems for point of care blood testing and telemedicine with lab-on-chip platforms.

Reaching the third 95 using community ART delivery models.

Differentiated service delivery of HIV care, defined as an approach that simplifies and adapts HIV services to better serve the needs of people with HIV and to optimise the available resources in health systems, 1 WHOUpdated recommendations on service delivery for the treatment and care of people living with HIV. https://www.who.int/publications/i/item/9789240023581Date: 2021 Date accessed: November 24, 2021 Google Scholar is increasingly becoming important to HIV epidemic control. These models aim to provide care that is tailored to the individual and reduce strain on health systems. Various models have been used, including multimonth dispensation, home-based antiretroviral therapy (ART) delivery, and community adherence groups. 2 Huber A Pascoe S Nichols B et al. Differentiated service delivery models for HIV treatment in Malawi, South Africa, and Zambia: a landscape analysis. Glob Health Sci Pract. 2021; 9: 296-307 Crossref PubMed Scopus (1) Google Scholar In The Lancet HIV, Mohammed Limbada and colleagues 3 Limbada M Macleod D Situmbeko V et al. Rates of viral suppression in a cohort of people with stable HIV from two community models of ART delivery versus facility-based HIV care in Lusaka, Zambia: a cluster-randomised, non-inferiority trial nested in the HPTN 071 (PopART) trial. Lancet HIV. 2021; (published online Nov 26.)https://doi.org/10.1016/S2352-3018(21)00242-3 Summary Full Text Full Text PDF PubMed Google Scholar report findings from their cluster-randomised, non-inferiority trial comparing viral load suppression in community models of ART delivery with standard of care. In this trial, which was done in Lusaka, Zambia, participants were assigned to receive ART at a health-care facility (SoC group), home-based delivery (HBD group), or via adherence clubs (AC group). 12 month viral suppression was 99·2% (95% CI 98·4–99·8) in the AC group, 98·7% (97·5–99·6) in the HBD group, and 98·3% (96·6–99·7) in the SoC group. Both differentiated models of ART delivery were found to be non-inferior to the SoC group (p<0·0001). In addition, the authors found that access to viral load measurement and retention in the community models were better compared with facility ART delivery. These findings suggest that scale up of such models of care could be beneficial in reaching viral suppression and improved retention. Rates of viral suppression in a cohort of people with stable HIV from two community models of ART delivery versus facility-based HIV care in Lusaka, Zambia: a cluster-randomised, non-inferiority trial nested in the HPTN 071 (PopART) trialCommunity models of ART delivery were as effective as facility-based care in terms of viral suppression. Full-Text PDF Open Access

Developing weight navigation program to support personalized and effective obesity management in primary care settings: protocol for a quality improvement program with an embedded single-arm pilot study.

Primary care providers (PCPs) are expected to help patients with obesity to lose weight through behavior change counseling and patient-centered use of available weight management resources. Yet, many PCPs face knowledge gaps and clinical time constraints that hinder their ability to successfully support patients' weight loss. Fortunately, a small and growing number of physicians are now certified in obesity medicine through the American Board of Obesity Medicine (ABOM) and can provide personalized and effective obesity treatment to individual patients. Little is known, however, about how to extend the expertise of ABOM-certified physicians to support PCPs and their many patients with obesity. To develop and pilot test an innovative care model - the Weight Navigation Program (WNP) - to integrate ABOM-certified physicians into primary care settings and to enhance the delivery of personalized, effective obesity care. Quality improvement program with an embedded, 12-month, single-arm pilot study. Patients with obesity and ≥1 weight-related co-morbidity may be referred to the WNP by PCPs. All patients seen within the WNP during the first 12 months of clinical operations will be compared to a matched cohort of patients from another primary care site. We will recruit a subset of WNP patients (n = 30) to participate in a remote weight monitoring pilot program, which will include surveys at 0, 6, and 12 months, qualitative interviews at 0 and 6 months, and use of an electronic health record (EHR)-based text messaging program for remote weight monitoring. Obesity is a complex chronic condition that requires evidence-based, personalized, and longitudinal care. To deliver such care in general practice, the WNP leverages the expertise of ABOM-certified physicians, health system and community weight management resources, and EHR-based population health management tools. The WNP is an innovative model with the potential to be implemented, scaled, and sustained in diverse primary care settings.

Analysis of financial resources for public health in Brazilian capitals: a time trend ecological study.

This study aimed to analyze part of the financial resources used to fund public health actions in the 26-Brazilian capitals, from 2008 to 2018. This is a time-trend ecological study involving revenue and expenditure indicators provided by the Information System on Public Budget for Health (SIOPS). The values were deflated based on the Extended National Consumer Price Index of 2018 in Brazil to allow the comparison over the years. The mean annual variation of health investments, in Brazilian Reais (BRL) was assessed using linear regressions. Pearson's correlation coefficients were estimated between federal revenues and expenditures with the capitals' resources. All capitals presented statistically significant positive correlations for the origin of the budget resource invested in health. The lowest coefficient was found in the capital city of Macapá (Amapá State) (r = 0.860) and the highest, in Fortaleza (Ceará State) (r = 0.997). Belo Horizonte (Minas Gerais State) was the capital with the highest annual increase in federal transfers (about BRL 67.91 per year) and Teresina (Piauí State) presented the highest annual increase in health expenditures among the capitals (about BRL 55.42 per year). We found a increase in the transfers of the Brazilian Unified National Health System (SUS) and municipal resources in almost all capitals, but there are still inequalities in the distribution of financial resources among Brazilian capitals from different regions. Health funding is affected by the municipalization of SUS and it is not the single factor affecting the access and quality of health services.