Health System Innovation Research Articles

Logic model for mental health interventions: the recovery College Model in Quebec, Canada

The Recovery College (RC) model represents a worldwide innovation in health systems. First appeared in England and now established in five continents, the RC model proposes a mental health educational approach in the community, emphasizingco-production, co-learning, and equity between theoretical/clinic knowledge and experiential knowledge (1-3). All participants(individuals with or without mental health challenges, their relatives, mental health professionals, health and education service providers, citizens) have access to mental health, recovery, and well-being training(4). Both participants and trainers collectively learn and reflect on their mental health attitudes, behaviors, and practices. This article reports on the co-construction process followed by Quebec's RC team, the first to have developed a RC logic model. The logic model conception followed six steps/strategies: 1) Participant observations, 2) Analysis of administrative documents, 3) Informal interviews and meetings with stakeholders (trainers, health service managers, and partner organizations) to better understand the implicit assumptions of the intervention, 4) Review of the literature related to the recovery college model, 5) Co-construction of causal links between resources, activities, and outcomes, 6) Validation and synthesis of the logic model. Finally, the logic model was disseminated, highlighting the relationships between the strategic resources needed for the key activities of the intervention to produce the expected outcomes.

Personalized medicine in Brazil: a new paradigm, old problems

PurposePersonalized medicine (PM) encompasses a set of procedures, technologies and medications; the term became more prominent from the 2000s onwards and stems from the mapping of the human genome. The purposes of this study were to analyse the development stage of the process of technological innovation for PM and the obstacles that prevent PM from being adopted in the public health system in Brazil.Design/methodology/approachAs a research method, this paper opts for a case study carried out at the Hospital das Clínicas, which belongs to São Paulo Medical School. In total, 22 in-depth interviews were carried out at the hospital to identify current practices in PM, future prospects and barriers imposed to the adoption of PM technologies in public health.FindingsPersonalized or precision medicine is already a reality for a small portion of the Brazilian population and is gradually gaining ground in public health care. One finding is that such changes are occurring in a disjointed manner in an incomplete and under development health innovation system. The analysis pointed out that the obstacles identified in Brazil are the same as those faced by high-income countries such as regulation, lack of clinical studies and need to adapt clinical studies to PM. They appear in all stages of the innovation cycle, from research to widespread use.Research limitations/implicationsThe research method was a case study, so the findings cannot be extrapolated to other contexts. A limited number of professionals were interviewed, their opinions may not reflect those of their organizations.Originality/valueThere are several studies that discuss how health-care systems in high-income countries could incorporate these new technologies, but only a few focuses on low or middle-income countries such as Brazil.

LESSONS FROM PRIMARY HEALTH CARE IN THE UNITED KINGDOM

The health system in Indonesia is facing the persistent burden of maternal mortality and infectious diseases (including COVID-19) and an increasing burden of non-communicable diseases. Thus, health system reform and innovations at all levels are needed, including through lessons learned from other countries. There are at least five lessons from primary health care in the United Kingdom: easy access, digital and online services, continuity of care, managing chronic conditions, and referral and counter-referral system. There are lessons that policymakers and stakeholders at the national and local (city/district) level could potentially learn from. Despite the differences between the UK and Indonesia (e.g. country income level, national health systems), these lessons could be adapted or piloted in some settings.

Rural Hospitals and Rural Health Challenges: An Analysis of Recent National Health Rankings and Hospital Data

Rural hospitals play a critical role in providing acute care and other essential medical services to rural populations. However, they are increasingly unable to meet the needs for health services in rural communities. This paper utilizes the data from the recent County Health Rankings and Definitive Healthcare to identify the health care challenges in rural counties and evaluate the operating and financial condition of rural hospitals in the context of the health care needs in rural areas and in comparison with urban hospitals. Our data analysis finds that while there are major health challenges and increased needs for hospital service in rural areas, the operating and financial performance of rural hospitals has been worsening in key aspects. We argue that continued policy support as well as health system innovations will be critically important to address the health care needs of rural America.

Contextualizing Evidence for Action on Diabetes in Low-Resource Settings-Project CEAD Part-II, Strengthening the Health System: A Mixed-Methods Study Protocol.

Diabetes is a major public health problem, increasingly affecting low- and middle-income countries. The project CEAD (Contextualizing Evidence for Action in Diabetes in low-resource settings) aims to evaluate the implementation of comprehensive diabetes care in two low-resource settings in Ecuador and to stimulate context-led health systems innovations to improve diabetes care and reduce inequity. The mixed-methods approach includes a 24-month retrospective study to assess the current level of implementation of comprehensive diabetes care and participants will be followed up prospectively for two years to assess changes in healthcare and clinical outcomes from the outset of the research. We will include individuals diagnosed with type-2 diabetes aged over 18 years, who are accessing diabetes care in health facilities in the study districts. Varied stakeholders (patients and family members, community members, healthcare workers and decision-makers) will interpret the underlying causes of the observed weaknesses and propose solutions to strengthen diabetes-related healthcare in focus group discussions (FG). A second set of FG will analyze perceived improvements in healthcare based on prospective cohort findings and consider the success/failure of any context-led innovations occurring throughout the research. Our study will demonstrate how evidence can be contextualized to stimulate local innovations and overcome weaknesses of diabetes-related healthcare in low resource settings.

Concept and development of an interactive tool for trial recruitment planning and management

BackgroundPredicting and monitoring recruitment in large, complex trials is essential to ensure appropriate resource management and budgeting. In a novel partnership between clinical trial investigators of the South African Medical Research Council and industrial engineers from the Stellenbosch University Health Systems Engineering and Innovation Hub, we developed a trial recruitment tool (TRT). The objective of the tool is to serve as a computerised decisions-support system to aid the planning and management phases of the trial recruitment process.MethodThe specific requirements of the TRT were determined in several workshops between the partners. A Poisson process simulation model was formulated and incorporated in the TRT to predict the recruitment duration. The assumptions underlying the model were made in consultation with the trial team at the start of the project and were deemed reasonable. Real-world data extracted from a current cluster trial, Project MIND, based in 24 sites in South Africa was used to verify the simulation model and to develop the monitoring component of the TRT.ResultsThe TRT comprises a planning and monitoring component. The planning component generates different trial scenarios for predicted trial recruitment duration based on user inputs, e.g. number of sites, initiation delays. The monitoring component uses and analyses the data retrieved from the trial management information system to generate different levels of information, displayed visually on an interactive, user-friendly dashboard. Users can analyse the results at trial or site level, changing input parameters to see the resultant effect on the duration of trial recruitment.ConclusionThis TRT is an easy-to-use tool that assists in the management of the trial recruitment process. The TRT has potential to expedite improved management of clinical trials by providing the appropriate information needed for the planning and monitoring of the trial recruitment phase. This TRT extends prior tools describing historic recruitment only to using historic data to predict future recruitment. The broader project demonstrates the value of collaboration between clinicians and engineers to optimise their respective skillsets.

90232 Implementing the innovative academic Learning Health System Scholars (aLHSS) Postdoctoral Training Program (TL1) at Wake Forest University Health Sciences (WFUHS)

ABSTRACT IMPACT: Learning Health System (LHS) Science that trains postdoctoral scholars from diverse professional backgrounds in methodological and professional skills to implement rigorous research in health care systems and populations, and to disseminate the findings of such research to improve healthcare delivery OBJECTIVES/GOALS: The WFUHS CTSA developed an innovative TL1 in Learning Health System (LHS) Science that trains postdoctoral scholars from diverse professional backgrounds in methodological and professional skills to implement rigorous research in health care systems and populations, and to disseminate the findings of such research to improve healthcare delivery METHODS/STUDY POPULATION: Training is centered around formal LHS science coursework and mentored research projects that address a pressing health system issue. Projects are closely guided by a primary mentor and a multidisciplinary mentoring team. Program mission and competencies were carefully evaluated in a competency-course matrix to design new courses for the LHS Certificate and MS program in Translational and Health System Science (THSS). Course domains include biomedical informatics; improvement and implementation science; system science and organizational change management; stakeholder engagement, leadership, and research management; ethics of health systems research; and health systems research methods. Scholars set up Individual Development Plans (IDP) and self-assess 7 domains of LHS core competencies. RESULTS/ANTICIPATED RESULTS: The first professionally diverse group of scholars (MD, PhD, DrPH, PharmD) began the program in Summer 2020; onboarding was conducted virtually. Scholars currently conduct most of their research and training in a virtual, synchronous format. Each developed a detailed IDP and LHS research project, which was reviewed by their LHS mentoring teams (includes a primary mentor, co-mentor, TL1 core faculty mentor, peer mentor, and health system mentor). Coursework, leading to a 1-year certificate or 2-year MS degree, was selected based on individual background and career goals and was begun in August 2020. In addition to the courses noted above, Scholars are embedded in a healthcare improvement team. We use the process of a LHS and hold weekly TL1 leadership meetings to swiftly address challenges and implement improvements DISCUSSION/SIGNIFICANCE OF FINDINGS: We envision that TL1 Scholars will build independent LHS research programs or lead health system innovation. Program evaluation includes assessments of Scholar fluency in LHS competencies and attainment of key milestones during and after training. Annual TL1 faculty retreats will address program fidelity and implementation of program refinements

A Mobile App to Facilitate Socially Distanced Hospital Communication During COVID-19: Implementation Experience.

BackgroundCOVID-19 has significantly altered health care delivery, requiring clinicians and hospitals to adapt to rapidly changing hospital policies and social distancing guidelines. At our large academic medical center, clinicians reported that existing information on distribution channels, including emails and hospital intranet posts, was inadequate to keep everyone abreast with these changes. To address these challenges, we adapted a mobile app developed in-house to communicate critical changes in hospital policies and enable direct telephonic communication between clinical team members and hospitalized patients, to support social distancing guidelines and remote rounding.ObjectiveThis study aimed to describe the unique benefits and challenges of adapting an app developed in-house to facilitate communication and remote rounding during COVID-19.MethodsWe adapted moblMD, a mobile app available on the iOS and Android platforms. In conjunction with our Hospital Incident Command System, resident advisory council, and health system innovation center, we identified critical, time-sensitive policies for app usage. A shared collaborative document was used to align app-based communication with more traditional communication channels. To minimize synchronization efforts, we particularly focused on high-yield policies, and the time of last review and the corresponding reviewer were noted for each protocol. To facilitate social distancing and remote patient rounding, the app was also populated with a searchable directory of numbers to patient bedside phones and hospital locations. We monitored anonymized user activity from February 1 to July 31, 2020.ResultsOn its first release, 1104 clinicians downloaded moblMD during the observation period, of which 46% (n=508) of downloads occurred within 72 hours of initial release. COVID-19 policies in the app were reviewed most commonly during the first week (801 views). Users made sustained use of hospital phone dialing features, including weekly peaks of 2242 phone number dials, 1874 directory searches, and 277 patient room phone number searches through the last 2 weeks of the observation period. Furthermore, clinicians submitted 56 content- and phone number–related suggestions through moblMD.ConclusionsWe rapidly developed and deployed a communication-focused mobile app early during COVID-19, which has demonstrated initial and sustained value among clinicians in communicating with in-patients and each other during social distancing. Our internal innovation benefited from our team’s familiarity with institutional structures, short feedback loops, limited security and privacy implications, and a path toward sustainability provided by our innovation center. Challenges in content management were overcome through synchronization efforts and timestamping review. As COVID-19 continues to alter health care delivery, user activity metrics suggest that our solution will remain important in our efforts to continue providing safe and up-to-date clinical care.

Editorial


 
 
 Welcome to this two-part guest edition of the International Journal of Indigenous Health (IJIH), produced by the First Nations Health Authority (FNHA) in the province of British Columbia (BC), Canada. As guest co-editors, we are pleased to present to you this collection of research, promising and wise practices, innovations, and Indigenous Knowledge on health and wellness. These papers constitute a substantive contribution to, as our call for submissions framed it, “Health Systems Innovation: Privileging Indigenous Knowledge, Ensuring Respectful Care, and Ending Racism toward Indigenous Peoples in Service Delivery.”
 
 

Editorial


 
 
 Welcome to this two-part guest edition of the International Journal of Indigenous Health (IJIH), produced by the First Nations Health Authority (FNHA) in the province of British Columbia (BC), Canada. As guest co-editors, we are pleased to present to you this collection of research, promising and wise practices, innovations, and Indigenous Knowledge on health and wellness. These papers constitute a substantive contribution to, as our call for submissions framed it, “Health Systems Innovation: Privileging Indigenous Knowledge, Ensuring Respectful Care, and Ending Racism toward Indigenous Peoples in Service Delivery.”
 
 

Introduction


 
 
 On behalf of the First Nations Health Authority (FNHA) in British Columbia (BC), and FNHA’s Board of Directors, we welcome you to this two-part guest edition of the International Journal of Indigenous Health (IJIH): “Health Systems Innovation: Privileging Indigenous Knowledge, Ensuring Respectful Care, and Ending Racism toward Indigenous Peoples in Service Delivery.” This guest edition encompasses two issues, “Honouring the Sacred Fire: Ending SystemicRacism toward Indigenous Peoples” and “Wisdom of the Elders: Honouring Spiritual Laws in Indigenous Knowledge,” which address significant determinants of Indigenous Peoples’ health, and issues in health systems here in Canada and globally.
 
 

Technological Innovations in New Type Coronavirus and Health System

The new type of Coronavirus disease-19 (COVID-19) spreads rapidly as a global epidemic and affects health, economic and social systems Increasing the number of patients in COVID-19 hospitals negatively affects the health system by causing insufficient materials and health workers to be exposed to the risk of infection Ethical dilemmas regarding providing healthcare to all patients are more difficult due to uncertainties caused by the disease, change in social life, stress, emotional deterioration, having to work for a long time, insufficient intensive care conditions and mechanical ventilation during the pandemic period In this process, new and creative approaches are needed in the health system to effectively meet the health needs of individuals Telemedicine applications, mobile applications, web-based applications and psychological support applications are among these approaches In this paper, a new type of COVID-19 pandemic in the world and Turkey was referred to the process of innovation in the health care system (English) [ABSTRACT FROM AUTHOR] Yeni tip koronavirusun (COVID-19), kuresel bir pandemi olarak hizla yayilmakta olup saglik, ekonomik ve sosyal sistemleri etkiledigi gorulmektedir COVID-19 hastanelerdeki hasta sayisinin artmasi, malzeme yetersizligi ve saglik calisanlarinin enfeksiyon riskine maruz kalmasina neden olarak saglik sistemini olumsuz yonde etkilemektedir Pandemi doneminde hastaligin neden oldugu belirsizlikler, sosyal yasamdaki degisim, stres, duygusal cokuntu, uzun sure calismak zorunda kalma, yetersiz yogun bakim sartlari ve mekanik ventilator nedeniyle tum hastalara gereken saglik hizmetini vermeye iliskin etik ikilemler, bu sureci daha guc hale getirmektedir Bu surecte bireylerin saglik bakim gereksinimlerinin etkin sekilde karsilanmasi icin, saglik bakim sisteminde yeni ve yaratici yaklasimlara gereksinim duyulmaktadir Teletip uygulamalari, mobil uygulamalar, web tabanli uygulamalar ve psikolojik destek uygulamalari bu yaklasimlar arasinda yer almaktadir Bu derlemede, dunyada ve Turkiye'de COVID-19 pandemi surecinde saglik sistemlerinde yapilan yeniliklere deginildi (Turkish) [ABSTRACT FROM AUTHOR] Copyright of Bezmialem Science is the property of Galenos Yayinevi Tic LTD STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Adoption of Health System Innovations: Evidence of Urban-Rural Disparities from the Ohio Primary Care Marketplace.

Accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and the meaningful use of electronic health records (EHRs) generated particular attention during the last decade. Translating these reforms into meaningful increases in population health depends on improving the quality and clinical integration of primary care providers (PCPs). However, if these innovations spread more quickly among PCPs in urban and wealthier areas, then they could potentially worsen existing geographic disparities in health outcomes. To determine the market penetration of Medicare Shared Savings Program (MSSP) ACOs, PCMHs, and the meaningful use of EHRs among PCPs across urban and rural counties in Ohio. Retrospective, observational study of the percent of PCPs in a county who are affiliated with PCMH, ACO, and meaningful use (MU) of EHR. PCPs in all of Ohio's 88 counties from 2011 to 2015. Primary care market penetration of ACO, PCMH, and meaningful use of EHR KEY RESULTS: In 2015, the Ohio primary care market penetration of PCMH was 23.4%, ACO was 27.7%, MU stage 1 was 55.8%, and MU stage 2 was 26.6%. During the study period, PCMH and ACO market penetration increased faster in urban counties relative to rural counties, and market penetration of meaningful use of EHR increased faster in rural counties. Market penetration of PCMH and ACOs increased faster in urban markets compared to rural markets. However, the adoption of EHRs increased faster in rural markets. The results are a cause for optimism as well as a call to action: although recent efforts to increase PCMH and ACO adoption were less effective among the rural population in Ohio, federal programs to accelerate adoption of EHRs were overwhelmingly successful in rural areas.

Implementation and Evaluation of an IPAC SWAT Team Mobilized to Long-Term Care and Retirement Homes During the COVID-19 Pandemic: A Pragmatic Health System Innovation

Long-term care facilities (LTCFs), retirement homes (RHs), and other congregate care settings in Canada and worldwide have experienced significant COVID-19 outbreaks. As a health system response, our acute care hospital in Toronto, Ontario, Canada, developed and mobilized an onsite Infection Prevention and Control (IPAC) SWAT team (IPAC-SWAT) to regional settings on outbreak and implemented a strategy of support through education, training, and engagement.Between April 28, 2020, and June 30, 2020, IPAC-SWAT assessed 7 LTCFs and 10 RHs for IPAC preparedness and actively managed 10 of 13 COVID-19 outbreaks (LTCF n=5; RH n=5). IPAC-SWAT strategies were multi-interventional and intended to mitigate further viral transmission or prevent outbreaks. Dedicated training of local “IPAC champions” was facilitated at 7 sites (LTCF = 5; RH = 2) using a “train-the-trainer” approach to promote local knowledge, autonomy, and site-led audits and feedback.

New digital technologies, financialization, and the Covid-19 pandemic: changes in the global productivity dynamics, the role of the State, and impacts on HEIC

This article analyzes the recent changes in the global productivity and innovation dynamics and its impacts on the industrial and innovation public policies since the beginning of the millennium. Arguably, the main feature that singles out the current state of globalization is the strengthening of the financialization process. This has had significant impacts on transnational firms and the outreach of National States' actions. This article also discusses to what extent the Covid-19 pandemic is affecting the economy, the society, and the measures adopted by National States to face the current crisis. The role of new digital technologies in global changes, the industrial and innovation policies, especially in the health productivity and innovation system, are other discussion topics. Finally, this study highlights the structural changes in the global economy against the background of the Covid-19 pandemic and investigates the main challenges and opportunities for HEIC worldwide and in Brazil.

Simposio 20: Telesalud y pie diabético

Simposio 20: Pie diabético: ¿Qué hemos aprendido?Telesalud y pie diabéticoSegún la Organización Mundial de la Salud (OMS), telesalud involucra entrega de servicios de salud usando las TICS cuando la distancia es un obstáculo para la accesibilidad, abarca teleconsultoría, teleducación y teleinvestigación en un entramado de telegestión.Es una innovación de los sistemas de salud de todo el mundo que llegó para quedarse basada en el concepto de redes integradas de salud brindando equidad y acceso a la salud. Las manifestaciones cutáneas en diabetes son numerosas y variadas; oscilan entre el 30 al 70%, y si se consideran los efectos metabólicos sobre la microcirculación, los cambios en el colágeno de la piel y los relacionados a neuropatía, estas cifras aumentarían a un 100%.

Catalyzing Digital Health Innovation in Ontario: The Role of an Academic Medical Centre.

Overcoming barriers to health system innovation is an ongoing challenge in Canada. A total of 51 participants attended a digital health symposium in October 2017 to discuss the role of an academic medical centre (AMC) in advancing innovation. The conversation centred around (i) the current state of innovation in healthcare; (ii) the need for an innovation catalyst; and (iii) the roadmap for an AMC to drive change. AMCs can address the barriers to digital health innovation in Canada by providing a centralized network and infrastructure that supports innovation throughout its journey from "bench to bedside" as well as supporting educational reform.

Understanding patient transfers across multiple clinics in Zambia among HIV infected adults.

Many patients in HIV care in Africa considered lost to follow up (LTFU) at one facility are reportedly accessing care in another. The success of these unofficial transfers as measured by time to re-entry at the new-facility, prevalence of treatment interruptions, speed of ART-initiation, and overall continuity of care is not well characterized but may reveal opportunities for improvement. We traced a random sample of LTFU HIV-infected patients in Zambia. Among those found alive and reported in care at a new-facility, we reviewed records at the receiving facility to verify transfer; and when verified, documented the transfer experience. We used Kaplan-Meier methods to examine incidence of ART-initiation after transfer to new clinic. We assessed demographic and clinical characteristics, official and cross-provincial transfer for associations with HIV treatment re-engagement using Poisson regression models and associations between official-transfer and same-day ART initiation at the new-facility. Among 350 LTFU-patients, 178 (51%) were successfully verified through chart review at the new-facility. 132 (74.2%) were female, 72 (40.4%) aged 25–35, and 51% were ever recorded as previously being on ART. 110 patients (61.8%) were registered under new ART-IDs and 97 (54.5%) received a new HIV test. 54% of those previously on ART-initiated on the same-day. Using the same ART-ID was associated with same-day initiation compared to those receiving a new ART-ID (p = 0.07). 80% (n = 91) of those ever on ART had evidence of medication initiation at new clinic. Among these, initiation reached 66% (95% CI: 56–75) by 30 days, 77.5% (95% CI: 68–86) by 90 days after new-facility presentation. Many patients use new identifiers at new facilities, indicative of inefficiencies. Re-entry into new facilities among the unofficial-transfer population is often delayed and timely treatment initiation is inconsistent, suggesting interruptions in treatment. Health systems innovations to ensure smooth and safe transfers are needed to maintain quality HIV care.

'Hybrid' top down bottom up health system innovation in rural China: A qualitative analysis.

China has made considerable progress with health system reforms in recent years. Rural China, however, has lagged behind as the diversity of needs of China's 3,000 rural counties were not always well addressed by national top-down reforms. China's Rural Health Reform Project Health XI (HXI) piloted a hybrid process of top down and bottom up implementation of health system reforms which were tailored to rural county level needs and covered a population of more than 21 million. Different studies provide evidence that HXI counties have achieved substantial benefits given the relatively limited investment. The Effectiveness of HXI subsequently raises the question how the hybrid approach may have resulted in effective implementation of interventions. We answer this question to advance understanding of hybrid approaches in general and in the rural Chinese context in particular, where the bottom-up elements might match poorly with the traditional organisational culture and learning style. We conducted an in-depth qualitative analysis in three 'best practice' counties, performing document-analyses, observations, semi-structured individual and group interviews. In alignment with the research question, this study is of an explorative nature and follows a sequence of deductive and inductive steps. HXI struggled initially as counties had difficulties to take initiative and autonomously select and adapt their own reforms. The initial reforms required multiple improvement iterations before achieving the planned results. The effectiveness of these bottom up reform processes has been aided by tight top down supervision and extensive domestic expert involvement. County level leadership is seen as essential to align the top down and bottom up structures and processes. Where successful, HXI has changed mind-sets and counties developed generic health improvement capabilities. Tailoring innovations to fit local needs formed a severe challenge for the three 'best practice' counties studied. A 'change of mindset' to actively take initiative and assume autonomy was needed to advance. Top down supervision and extensive support of experts was required to overcome the barriers. The studied counties finally achieved sustainable improvements and developed double loop learning capabilities beyond HXI objectives. Taken together, the above findings suggest that the continuum of healthcare reform implementation approaches in which hybrid approaches reside-from bottom up to top down-has two dimensions: a content dimension and a procedural dimension. Enabled by top down procedures, counties were able to bottom up tailor the content of best practice innovations to fit local needs.

Allopurinol-induced severe cutaneous adverse drug reactions: Risk minimization measures in Malaysia.

To describe risk minimization measures (RMMs) implemented in Malaysia for allopurinol-induced severe cutaneous adverse drug reactions (SCARs) and examine their impact using real-world data on allopurinol usage and adverse drug reaction (ADR) reports associated with allopurinol. Data on allopurinol ADR reports (2000-2018) were extracted from the Malaysian ADR database. We identified RMMs implemented between 2000 and 2018 from the minutes of relevant meetings and the national pharmacovigilance newsletter. We obtained allopurinol utilization data (2004-2018) from the Pharmaceutical Services Programme. To determine the impact of RMMs on ADR reporting, we considered ADR reports received within 1 year of RMM implementation. We used the Pearson χ2 test to examine the relation between the implementation of RMMs and allopurinol ADR reports. The 16 RMMs for allopurinol-related SCARs implemented in Malaysia involved nine risk communications, four prescriber or patient educational material, and three health system innovations. Allopurinol utilization decreased by 21.5% from 2004 to 2018. ADR reporting rates for all drugs (n = 144 507) and allopurinol (n = 1747) increased. ADR reports involving off-label use decreased by 6% from 2011. SCARs cases remained between 20% and 50%. RMMs implemented showed statistically significant reduction in ADR reports involving off-label use for August 2014 [χ2(1, N = 258) = 5.32, P = .021] and October 2016 [χ2(1, N = 349) = 3.85, P = .0499]. RMMs to promote the appropriate use of allopurinol and prescriber education have a positive impact. We need further measures to reduce the incidence and severity of allopurinol-induced SCARs, such as patient education and more research into pharmacogenetic screening.