Health System Approach Research Articles

Health Systems Approach to Strengthen Rehabilitation

Health Systems Approach to Strengthen Rehabilitation

Rural Residence Associated with Receipt of Recommended Post-Discharge COPD Care among a Cohort of U.S. Veterans.

Individuals with chronic obstructive pulmonary disease (COPD) in rural areas experience inequitable access to care. To assess whether rural residence is associated with receipt of recommended post-discharge COPD care. We conducted a cohort study of all U.S. Veterans discharged from a VA Medical Center following COPD hospitalization from 2010 to 2019. Rural residence was defined by Rural Urban Commuting Area classification. Our primary outcome was the proportion of recommended care received within 90 days of hospital discharge, including: smoking cessation therapy; appropriate management of supplemental oxygen; appropriate prescription of inhaled therapy; and pulmonary rehabilitation. We conducted multi-variable linear regression between rural residence and the proportion of recommended care received, adjusting for age, sex, race, ethnicity, comorbidities, and primary care facility type. We tested multi-variable linear probability models for each of the recommended therapies. Of 67,649 patients, 7,370 (10.8%) resided in rural areas, and 2,000 (3.0%) in highly rural areas. Overall, the proportion of recommended COPD treatments received was low (mean 15.0%, standard deviation 21.0%). Compared with urban residence, patients with rural and highly rural residence received fewer recommended COPD care treatments (rural estimate [adjusted % difference (95% CI)]: -1.1 (-1.6, -0.6); highly rural estimate: -1.2 (-2.1, -0.3)). Rural and highly rural residence were associated with lower likelihood of receiving appropriate inhaled therapy escalation (rural estimate: -4.0 (-5.1, -3.0); highly rural estimate: -3.0 (-5.0, -1.1)) and pulmonary rehabilitation referral (rural estimate: -1.2 (-1.6, -0.9); highly rural estimate: -2.1 (-2.7, -1.4)), but a higher likelihood of receiving smoking cessation therapy (rural estimate: 5.4 (3.3, 7.5); highly rural estimate: 7.2 (3.3, 11.2)). There was no significant difference in appropriate oxygen management (rural estimate: -1.0 (-2.8, 0.9); highly rural estimate: 3.1 (-0.7, 6.9)). Patients across the rural-urban spectrum received few recommended post-discharge COPD treatments. Health systems approaches are needed to address widespread underutilization of evidence-based COPD care.

Children and Youth with Special Health Care Needs: Progress Towards More Family-Centered Systems of Care.

Children and youth with special health care needs have increasingly been included in community and society over the past 50 years. Changing definitions and programs in the education, health, and public health/Title V sectors document this greater inclusion. The most profound change was in the education system, with the passage of legislative mandates for inclusion and parental rights. Although the health system has no similar universal mandate, the sequential passage of Medicaid, Children's Health Insurance Plan, and the Patient Protection and Affordable Care Act led to expanded health care coverage with no pre-existing conditions and lifetime caps. Title V of the Social Security Act, originally passed in 1935, evolved from a focus on individual medical services to a public health systems approach focusing on building family-centered, coordinated, comprehensive care in community settings. Most of the changes in all the sectors are the result of the advocacy and engagement of parents and families; the Maternal and Child Health Bureau was a supportive and innovative leader for family-professional partnerships. Much work on understanding disparities across the sectors has led to more recent focus on equity.

Barriers and enablers to effective weight management for people living with overweight and obesity: A rapid scoping review.

A scoping review was conducted to identify barriers and enablers to effective weight management in healthcare settings for people living with overweight and obesity in English-speaking high-income countries. Peer-reviewed and gray literature were systematically searched in June 2024. Data were analyzed using inductive thematic analysis. Of the 15,684 unique articles identified and screened for relevance, 216 studies were included. Healthcare-related barriers and enablers to weight management were organized under three themes: a) healthcare provider-related factors, b) provision of care, and c) policy/funding. Prominent barriers included healthcare provider knowledge deficits and low prioritization of obesity management, mainly in the primary care setting. Weight management beyond the primary care setting was found to be especially challenging, with poor referral pathways, service fragmentation, lack of multidisciplinary practice, and restricted eligibility criteria, hindering the accessibility of services. Developing consistent policies and guidelines, improving the education of healthcare providers, and increasing funding to provide low-cost comprehensive care, were identified as enablers to access and uptake of weight management services. Considerable overlap in the identified barriers existed across healthcare providers and settings. A whole health system approach to minimize barriers and strengthen enablers to weight management services is needed, to address rising obesity rates.

1.Q. Round table: Primary healthcare workforce crisis in Europe: global policy discourse and national implementation

Abstract Background Primary healthcare (PHC) has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. Recent WHO efforts have underscored the challenges in aligning the global PHC-oriented model with national health systems, highlighting the need for tailored approaches to fulfil diverse needs and contexts. Although significant progress has been made in advancing PHC, some gaps persist, particularly surrounding the integration of PHC and healthcare workforce debates and its prioritisation within national health agendas. These gaps lead to disconnects between PHC policy implementation and workforce considerations, exasperating the existing workforce crisis and obstructing effective service delivery. Objectives This workshop bridges the gap between PHC workforce policy and the ongoing healthcare workforce crisis, focusing on the European region and different types of health systems, socio-economic conditions, health labour markets and workforce compositions. We apply a health system and multi-level governance approach, arguing the need for greater attention to the implementation of global policy concepts and the diverse national and regional conditions, interests, and needs. The workshop begins with an overview of the PHC workforce situation, presenting novel results drawn from European comparative research and nine selected country case studies, followed by a panel discussion. The panellists provide in-depth evidence on various PHC workforce challenges and introduce illustrative examples of policy interventions and good-practice models coming from the case countries. Insights from the WHO Centre for Primary Health Care advance the debate by highlighting strategies and capacity for transformative PHC workforce policies, and the need for further investigation to critically align global and national approaches. The policy recommendations emerging from the panel will be critically reflected in a plenary discussion. The workshop will stimulate debate and improve knowledge exchange across countries, in particular in the WHO European region, as well as between research, policy and practice. It will strengthen both the PHC model and the healthcare workforce, and finally advance the building of resilient health systems. Key messages • Shift the primary healthcare debate from idealistic attributes to actionable implementation strategies, emphasising policy dynamics, political contexts, and diverse stakeholder interests. • Understand the various PHC-oriented models and their dynamics to determine the necessary quantity, competencies, and composition of HCWs and how they can be governed effectively to implement PHC.

The primary healthcare workforce crisis: a comparative assessment of the European region

Abstract Background The healthcare workforce crisis strongly affects the primary healthcare sector, worsening the work conditions of healthcare workers and hampering service delivery and health system resilience. This study introduces a health system and governance approach to identify transformative capacities in health system contexts. Methods A qualitative comparative methodology was employed, and a rapid assessment of the primary healthcare workforce was conducted across nine countries: Denmark, Germany, Kazakhstan, Netherlands, Portugal, Romania, Serbia, Switzerland, and the United Kingdom/ England. Results Our findings reveal both convergence and pronounced diversity across the healthcare systems, with none fully aligning with the ideal attributes of primary healthcare suggested by WHO. However, across all categories, Denmark and the Netherlands, and to a lesser extent also Kazakhstan, depict closer alignment to this model than the other countries. Workforce composition and skill-mix vary strongly, while disparities persist in education and data availability, particularly within Social Health Insurance systems. Policy responses and interventions span governance, organisational, and professional realms, although with weaknesses in the implementation of policies and a systematic lack of data and evaluation. The WHO primary healthcare model only marginally informs policy decisions, but it may receive some more attention in Kazakhstan. Conclusions We conclude that aligning primary healthcare and workforce considerations within the broader health system context may help move the debate forward and build governance capacities to improve resilience in both areas. Speakers/Panelists Tiago Correia NOVA IHMT, Lisbon, Portugal Viola Burau Aarhus University, Aarhus C, Denmark Marius-Ionuț Ungureanu Babeș-Bolyai University, Cluj-Napoca, Romania Anna Sagan WHO European Centre for Primary Health Care, Almaty, Kazakhstan

9.X.1. Protecting the mental health of healthcare workers: evidence, policy and implementation challenges

Abstract Background There is growing evidence that highlights increasing stress levels and declining mental health among the global healthcare workforce, exacerbated by challenges within workplace environments, labour market and policy frameworks. These conditions place additional strain on an already vulnerable healthcare workforce and consequently threaten the stability of health systems as a whole, given the escalating challenges in retaining, recruiting and reactivating healthcare workers. Although the problems are evident, awareness is increasing and international organisations such as the WHO have advanced policy recommendations, comprehensive and context-specific interventions effectively addressing these problems at varying levels are missing. Objectives This innovative workshop offers a platform for bridging the gap between research evidence and policy interventions, stimulating policy learning and knowledge exchange across countries. The session provides an overview of existing knowledge and engages representatives of academia as well as national policymaking, and international organisations to critically discuss challenges as well as good practice experiences with a focus on implementation and problem-solving. The following major questions will be explored: What evidence is available regarding the mental health and wellbeing needs of the healthcare workforce? How are different countries responding to these needs and supporting healthcare workers more effectively? What are some best practice cases focusing on improving mental health support for healthcare workers across various groups, considering diverse needs, gender-inclusiveness, and minority groups? Finally, how can evidence-based policymaking be improved, and how can the implementation of these policies be advanced in a more effective manner? Thesession will encourage critical debate and identify major policy recommendations, focusing on governance and implementation strategies. In the second half of the session, the panel will engage the audience in an interactive discussion to explore novel solutions that prioritise the wellbeing of healthcare workers and effectively address the healthcare workforce crisis in a more person-centred and ‘humanised’ manner. The workshop supports cross-country learning and networking opportunities. Key messages • Mental health and wellbeing of the healthcare workforce is crucial for health system resilience and needs stronger advocacy for coordinated multi-level governance action. • Establish a health system and governance approach together with comprehensive monitoring and qualitative comparative workforce studies to identify transformational policies in contextual settings.

Rethinking electronic health records implementation in Germany: a value-based health system approach

Abstract Problem The Digital Act (Digital-Gesetz) in Germany stipulates that electronic health records (elektronische Patientenakte; ePA) will be set up for all persons under the statutory health insurance (SHI) in 2025; those who do not wish to use ePA can object. This opt-out approach aims to increase the coverage of ePA among the SHI population to 80%, which has been ca. 1.5% since its launch in 2021. According to law, ePA is managed solely by the patient and does not replace the conventional patient file stored in the medical practice management system. Without appropriate measures, it is likely that multiple parallel patient files are created, with the risk of ePA being side-lined over time. Description The Ministry of Health aims to make ePA the central platform for patients’ healthcare provision throughout their life. With ePA, patients should receive useful information about their healthcare as well as reminders and tailor-made medical advice. For healthcare providers, ePA should become an essential part of the healthcare process with containing reliable information and supporting the treatment. However, understanding ePA as more than a digital health solution, factors beyond technical interoperability must be considered for its successful implementation. Results The full potential of ePA and its positive impact on healthcare to tackle the fragmentation issue can only be realised when it is viewed as a helpful tool of collaboration for all involved parties. The existing regulatory frameworks in Germany create disincentives for greater integration, coordination, and interconnection, with each sector following its own reimbursement system and reinforcing the division between them. This contradicts with the idea of ePA fostering patient-centredness and inter-sectoral collaboration. Lessons How a health system functions and how health services are governed and remunerated have a substantial impact on the healthcare providers’ acceptance of digital services. Key messages • Changes in the governance of health systems may be necessary when implementing electronic health records to bring person-centred care and overcome the separation of in-patient and out-patient sectors. • Rather than a paternalistic approach, the relationship between the patient and healthcare provider should move towards a partnership model, based on the motivation of keeping individuals healthy.

Healthcare in police custody: a conceptual framework for measuring and improving quality of care

Abstract Background Individuals in police custody are often in poor (mental) health and can be in need of medical attention. The delivery of primary healthcare in police custody differs from other custodial and non-custodial settings, due to its short-term character and the reliance on custody officers and healthcare professionals to access care. Therefore, medical care for detainees in police custody requires its own standards and indicators to measure the quality of care. We aimed to develop a conceptual framework for (actionable) indicators to measure the quality of care for people detained in short-term police custody settings in the Netherlands. Methods We conducted a scoping review and consulted with experts. The scoping review involved Embase, Medline, PsycINFO, CINAHL, Criminal Justice Abstracts, PiCarta and Cochrane, and was supplemented with grey literature searches. We consulted twenty-seven stakeholders with a wide variety of expertise in the field of healthcare in police custody to discuss and validate the conceptual framework. Results The conceptual framework consists of 14 domains of structures (e.g. staff and facilities), processes (e.g. triage and coordination of care) and outcomes (e.g. effectiveness and satisfaction) that need to be considered when developing quality indicators for the healthcare provision in police custody. The scoping review yielded 68 publications providing information on common health issues and recommendations related to quality assurance or improvement. Conclusions The conceptual framework will guide the development of (actionable) quality indicators, which will be evaluated on relevance and measurability. These are crucial for monitoring care quality and enhancing a learning health systems approach. This study fills a gap in the existing scientific literature by shedding light on the factors contributing to the quality of primary healthcare provision for people detained in short-term custody settings. Key messages • The conceptual framework guides the development of (actionable) quality indicators for healthcare in police custody. • This study contributes to the creation of a learning health system for healthcare in short-term police custody settings.

Digital CRM in Nagpur's Primary and Secondary Schools: A Health Systems Approach to Enhancing Student Wellbeing in the Digital Transformation Era

Over the last couple of years, a significant increase in the use of educational technologies has changed the ways of student relationships and students’ well-being management. This study aims at establishing the extent and nature of utilization of Digital CRM system in primary and secondary schools in Nagpur from a health systems perspective, and the effects on students health. The research explores the effectiveness of the adopted digital CRM platforms to enhance more friendly, effective communication, and to create supportive mental and physical health student centred programs. The study utilizes survey questionnaires and short interviews with school administrators, teachers and students to determine the extent in which the digital CRM systems are effective and the difficulties encountered in the learning environment. Other relevant areas of interest include improvement in the services available to students, parents and strengthening of efficient mechanisms of collecting student health data for policy formulation. The details will describe the implication of the future digital CRM tools on the present issues related to the Nagpur students’ needs and the implications of health systems integration among schools. Based on this study it is suggested that digital CRM can greatly enhance the capacity of the school to support and respond to students’ needs through timely interventions, accessible collaboration communication, and a positive school climate. However, the program maintains several difficulties which have the potential to hinder valuable implementation: Data protection issue; Training of the system for the stakeholders; and Resource issues. Based on integrating the concepts of digital CRM with health systems the following recommendations for development of student’s wellbeing in the conceptual normal of digital transformation have been formulated by this research for the policymakers, educators, and technology suppliers.

Learning health systems to implement chronic disease prevention programs: A novel framework and perspectives from an Australian health service.

Chronic diseases are a considerable burden to health systems, communities, and patients. Much of this burden, however, could be prevented if interventions effective in reducing chronic disease risks were routinely implemented. The aim of this paper is to discuss the role of public health agencies in preventing chronic disease through the application of learning health system (LHS) approaches to improve the implementation of evidence-based interventions. We draw on the literature and our experience operating a local LHS in Australia that has achieved rapid improvements in the implementation of chronic disease prevention interventions. The proposed LHS framework has been adapted to be both implementation and chronic disease prevention focused. The framework describes both broad improvement processes, and the infrastructure and other support (pillars) recommended to support its core functions. The framework serves as a basis for further exploration of the potentially transformative role LHS's may have in addressing the chronic disease health crisis.

Development and implementation of autoverification standardization in the adult and pediatric emergency department.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. This project utilized the guidance of the American Society of Health-System Pharmacists (ASHP) autoverification toolkit to refine our health system's approach to autoverification and contribute to the literature regarding appropriate use of autoverification technology in a pediatric and adult emergency department (ED). This single-center quality improvement study was conducted in an academic medical center ED that has 33 pediatric beds and 77 adult beds. A team consisting of clinical pharmacy specialists in emergency medicine, medication safety and informatics personnel, operational managers, and pharmacy leadership was identified to develop and implement autoverification best practices in the ED utilizing practices outlined within the ASHP autoverification toolkit. Before implementation of best practices, defined as the "preoptimization" state, autoverification took place for most medications available in the automated dispensing cabinets (ADCs). By anchoring the autoverification rule on ADC inventory, it was challenging to optimize both inventory practices and autoverification best practices. This project focused on redesigning the autoverification rules in the electronic health record, defined as the "postoptimization" state. In the postoptimization state, autoverification in the ED was updated to better align with regulatory standards. Autoverification metrics and the percentage of orders that autoverified vs required pharmacist verification were analyzed in the preoptimization and postoptimization states. This project utilized the guidance from ASHP's autoverification toolkit to refine our health system's approach to autoverification. High-alert medications (eg, insulin, extended-release opioids, digoxin) were taken off autoverification following implementation. Optimization of autoverification rules allows more orders for high-alert medications to be reviewed by a pharmacist.

Medicine needs of children not addressed in the National Cancer Strategic Framework: insights from a triangulation study

Aim A better understanding of the scope of the National Cancer Strategic Framework (NCSF) could lead to improvements aiding the framework’s ultimate objective of reducing the burden of cancer. Accordingly, this report evaluates whether the 2017-2022 NCSF adequately addressed issues related to childhood cancer treatment, in particular paediatric oncology medicines. Methods To identify determinants of current access to childhood oncology medicines in South Africa, in-depth interviews were conducted with 29 stakeholders in South Africa’s public and private healthcare sectors. Key health system stakeholders included policy makers and regulators, medical insurance scheme informants, medicine suppliers, healthcare providers and civil society stakeholders. Identified barriers were categorised according to the components of the pharmaceutical value chain, and combined with a health systems approach to acknowledge the linkages of medicines with other building blocks of the health system. Identified barriers were then compared to the limitations and interventions as discussed in the 2017-2022 NCSF to identify areas for improvement in the framework. Findings Three recurrent gaps in the NCSF in relation to childhood cancers were identified, representing a range of issues throughout the pharmaceutical value chain: 1) childhood cancers are neglected compared to adult cancers, in both the policy arena and the organisation of healthcare services; 2) there are particular challenges for childhood cancers due to their rarity, thus requiring targeted interventions (e.g., regulatory incentives, tailored pricing solutions, and customised evidence requirements by decision-making bodies); and 3) children must be accompanied by a caregiver during treatment, causing several social and financial issues for their families. Conclusions There is a pressing need for a strategic cancer plan that makes proper provisions for children. Such an endeavour must commence with acknowledging the areas in which childhood cancers are different from adult cancers, and which demand targeted intervention in an update of the NCSF.

Diversity in Combating Complex, Chronic, and Costly Conditions Using a Learning Health System Approach: A Scoping Review.

The purpose of this scoping review was to investigate in the literature how a learning health system (LHS) can be implemented in cases of complex, costly, chronic (3C) conditions. A scoping review of literature published in English since 2007 was conducted using Medline, Cumulative Index to Nursing and Allied Health Literature, and Scopus. Two authors screened the resulting articles and two authors extracted study details on the structure, process, and outcome of each LHS. Eligibility criteria included studies of LHSs that focused on populations experiencing a complex chronic health condition. A narrative synthesis of data was conducted using deductive qualitative methods. Application of the authors' search strategy resulted in 656 publications that were analyzed for this review. The authors included 17 studies that focused on 13 LHSs. The structure of the LHSs had many components, and many included data from either patient surveys or patient charts. The processes varied widely, from engaging patients in the process to exclusively analyzing the data. The outcomes were largely patient-reported, though several clinical outcomes were also used to benchmark the success of the LHS. Our review shows that LHS definitions, structures, processes, and outcomes in 3C applications vary widely. Many have shown substantial potential to be implemented and improve care in 3C populations. To deliver on this goal, future work will need to focus on better specification, formalization, and definition of LHS approaches, as well as better design of their structures, processes, and outcomes to fit the needs of the intended population.

Quality Enhancement Research Initiative Rapid Response Teams: A learning health system approach to addressing emerging health system challenges.

Quality Enhancement Research Initiative Rapid Response Teams: A learning health system approach to addressing emerging health system challenges.

Unmasking the complexities of healthcare access in low-resource settings: a health systems approach to obstetric and under-5 healthcare in rural settings of Eastern Uganda

ABSTRACT Background Access to appropriate obstetric and under-5 healthcare services in low-resource settings is a challenge in countries with high mortality rates. However, the interplay of multiple factors within an ecological system affects the effectiveness of the health system in reaching those in need. Objective This study examined how multiple factors concurrently affect access to obstetric and child healthcare services in resource-poor settings Methods The research used social autopsies [in-depth interview] with mothers who experienced newborn death [n = 29], focus group discussions [n = 8] with mothers [n = 32], and fathers [n = 28] of children aged 6–59 months, and the author’s field observations in Eastern Uganda’s rural settings. The research employed narrative and inductive thematic analysis, guided by concepts of social interactions, behaviour, and health institutional systems drawn from system theory. Results The study unmasked multiple concurrent barriers to healthcare access at distinct levels. Within families, the influence of mothers-in-law and gender dynamics constrains women’s healthcare-seeking autonomy and agency. At the community level, poor transport system, characterised by long distances and challenging road conditions, consistently impede healthcare access. At the facility level, attitudes, responsiveness, and service delivery of health workers critically affect healthcare access. Negative experiences at health facilities profoundly discourage the community from seeking future health services. Conclusion The findings emphasise the persistent influence of structural and social factors that, although well documented, are often overlooked and continue to limit women’s agency and autonomy in healthcare access. Enhancing universal access to appropriate healthcare services requires comprehensive health systems interventions that concurrently address the healthcare access barriers.

Global Neurosurgery: A Path Forward Through Health System Strengthening.

The future of global neurosurgery should focus on addressing the unmet neurosurgical need from a health system approach should we hope to achieve sustainable and ethical change. In this article, we review the global building blocks, as defined by the World Health Organization, and use this framework to propose strategies to strengthen neurosurgical care on the global frontier. The targets for Universal Healthcare Coverage by 2030, as outlined by the United Nations Sustainable Development Goals, are reviewed, and the role of neurosurgeons in addressing the global targets is discussed. Surgical indicators according to the Lancet Commission on Global Surgery are also reviewed, and neurosurgical indicators are proposed according to the 6 surgical indicators of the commission. The execution of these global targets and indicators within the context of health system strengthening will be a persistent challenge, given the complexity of health system and its components. The neurosurgical community must continue to support, promote, and diversify collaborations, especially among deserts of neurosurgical care across the world. Innovative technology and education are essential to this global dilemma.

How can health systems approach reducing health inequalities? An in-depth qualitative case study in the UK

BackgroundAddressing socioeconomic inequalities in health and healthcare, and reducing avoidable hospital admissions requires integrated strategy and complex intervention across health systems. However, the understanding of how to create effective systems to reduce socio-economic inequalities in health and healthcare is limited. The aim was to explore and develop a system’s level understanding of how local areas address health inequalities with a focus on avoidable emergency admissions.MethodsIn-depth case study using qualitative investigation (documentary analysis and key informant interviews) in an urban UK local authority. Interviewees were identified using snowball sampling. Documents were retrieved via key informants and web searches of relevant organisations. Interviews and documents were analysed independently based on a thematic analysis approach.ResultsInterviews (n = 14) with wide representation from local authority (n = 8), NHS (n = 5) and voluntary, community and social enterprise (VCSE) sector (n = 1) with 75 documents (including from NHS, local authority, VCSE) were included. Cross-referenced themes were understanding the local context, facilitators of how to tackle health inequalities: the assets, and emerging risks and concerns. Addressing health inequalities in avoidable admissions per se was not often explicitly linked by either the interviews or documents and is not yet embedded into practice. However, a strong coherent strategic integrated population health management plan with a system’s approach to reducing health inequalities was evident as was collective action and involving people, with links to a “strong third sector”. Challenges reported include structural barriers and threats, the analysis and accessibility of data as well as ongoing pressures on the health and care system.ConclusionWe provide an in-depth exploration of how a local area is working to address health and care inequalities. Key elements of this system’s working include fostering strategic coherence, cross-agency working, and community-asset based approaches. Areas requiring action included data sharing challenges across organisations and analytical capacity to assist endeavours to reduce health and care inequalities. Other areas were around the resilience of the system including the recruitment and retention of the workforce. More action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.

9-8-8: Suicide Crisis Helpline - Implementing a Pan-Canadian Program to Prevent Suicide.

The 9-8-8: Suicide Crisis Helpline was launched in Canada in November 2023, aligned with an international movement to ensure access to crisis supports as part of a public health approach to suicide prevention. We describe the planning and implementation of 9-8-8 in Canada using the RE-AIM framework, considering the Reach, Effectiveness, Adoption, Implementation and Maintenance of 9-8-8 within the first six months of service (Glasgow et al. 2019). There is evidence of reach and adoption of 9-8-8 across Canada, and we discuss evidence-based strategies to evaluate and enhance effectiveness, implementation and maintenance. We also consider the importance of evaluating 9-8-8 within the larger socio-ecological and health system contexts. 9-8-8 must cultivate a learning health system approach and be part of a larger learning health system focused on reducing suicide in Canada.

Epidemiology of cardiometabolic health in Latin America and strategies to address disparities.

In Latin America and the Caribbean (LAC), sociodemographic context, socioeconomic disparities and the high level of urbanization provide a unique entry point to reflect on the burden of cardiometabolic disease in the region. Cardiovascular diseases are the main cause of death in LAC, precipitated by population growth and ageing together with a rapid increase in the prevalence of cardiometabolic risk factors, predominantly obesity and diabetes mellitus, over the past four decades. Strategies to address this growing cardiometabolic burden include both population-wide and individual-based initiatives tailored to the specific challenges faced by different LAC countries, which are heterogeneous. The implementation of public policies to reduce smoking and health system approaches to control hypertension are examples of scalable strategies. The challenges faced by LAC are also opportunities to foster innovative approaches to combat the high burden of cardiometabolic diseases such as implementing digital health interventions and team-based initiatives. This Review provides a summary of trends in the epidemiology of cardiometabolic diseases and their risk factors in LAC as well as context-specific disease determinants and potential solutions to improve cardiometabolic health in the region.