Healthcare Stakeholders Research Articles

Trauma System in Albania. A challenge that Requires long-term and Sustainable Solutions.


 
 
 
 
 
 
 
 
 
 
 
 Introduction Developing an effective trauma care system is an ongoing challenge in Albania, as it is in many countries. Trauma remains a significant cause of morbidity and mortality, particularly among the younger population in Albania. While the need for a structured trauma system has been recognized, several challenges need to be addressed.
 Lack of a Formalized Trauma System: Albania lacks a formalized and well-structured trauma system that can efficiently manage trauma cases from the scene of the injury to rehabilitation. The absence of such a system can lead to delays in care and suboptimal outcomes.
 Inconsistent Data Collection and Quality Improvement: Uniform data collection, quality improvement programs, and trauma verification processes are not consistently implemented. This results in fragmented and inconsistent trauma care, making it challenging to track and improve outcomes.
 Shortage of Specialized Trauma Care Personnel: The scarcity of healthcare professionals with specialized training in trauma care, including trauma surgeons and emergency medicine specialists, presents a significant hurdle. Trauma care requires a multidisciplinary approach with expertise in various aspects of care, from initial resuscitation to surgical intervention.
 Infrastructure and Resource Limitations: Many healthcare facilities, especially in rural areas, lack the necessary infrastructure, equipment, and resources to provide optimal trauma care. This includes deficiencies in trauma centers, emergency departments, and pre-hospital care.
 Challenges in Transportation and Prehospital Care: Efficient prehospital care and transportation of trauma patients are critical for improving outcomes. In Albania, challenges related to transportation and the availability of trained paramedics can hinder the timely delivery of care.
 Public Awareness and Injury Prevention: Raising public awareness about injury prevention and safety measures is essential. Efforts to reduce the incidence of trauma, especially road traffic accidents, can have a significant impact on overall trauma rates.
 Coordination Among Healthcare Facilities: Effective coordination among healthcare facilities, from local clinics to major hospitals, is crucial for seamless patient transfer and continuity of care.
 Advocacy and Government Support: Advocacy efforts by healthcare professionals and organizations are needed to emphasize the importance of a formalized trauma system. Government support and funding are essential for building and maintaining a trauma care infrastructure.
 Conclusion: establishing a comprehensive trauma system in Albania is a multifaceted challenge that requires collaboration among healthcare stakeholders, advocacy, resource allocation, and a commitment to improving trauma care from the moment of injury through rehabilitation. This ongoing challenge is critical for reducing trauma-related morbidity and mortality in the country.
 
 
 
 
 
 
 
 
 
 
 
 
 

PP40 Structuring Unstructured Medical Device Reimbursement In India

IntroductionAs India makes rapid strides towards universal health coverage, focusing on medical device reimbursement is key to ensuring patient access to device-based technologies. The nascent medical device reimbursement process offers a promising opportunity for interventions driven by a diverse group of stakeholders. We conducted policy research to capture these diverse perspectives and highlight key elements to develop a structured framework for reimbursement.MethodsThis research was a two-part process, including secondary research with expert interviews followed by policy research using focus group discussions (FGDs) through an online workshop with key stakeholders. We developed a white paper proposing changes to the reimbursement pathway, based on a benchmarking study of global markets and interviews with experts in the field. As a next step, key changes proposed in the white paper were deliberated upon by three focus groups (six to eight participants). Group participants were selected by quota sampling and represented key stakeholders in the reimbursement process. A discussion guide was used to capture participants’ opinions and an addendum to the white paper was released highlighting small, actionable, and impactful changes to the reimbursement process.ResultsFGDs with key stakeholders highlighted the need to establish a more structured, inclusive, and transparent process. Accordingly, we proposed key recommendations to the medical device reimbursement process in India. A first change is the creation of an online submission portal allowing different healthcare stakeholders to submit new technologies for consideration through a streamlined pathway. Secondly, we proposed enhancing evaluation transparency by improving availability of publicly shared information on the evaluation process, metrics, and assessment timelines. We also suggested adoption of adaptive health technology assessments to leverage existing evidence for faster, efficient decision-making.ConclusionsThrough this process, we created a pragmatic and concrete call for a stronger voice from care-providers and patient groups in the evaluation process. Consecutively, the proposed innovative framework introducing value-based incentives for implantable medical devices will be instrumental in enabling access to quality health care for poor patients. These strategies follow the principles of value-based care and will go a long way in achieving better health outcomes for the population. The scientific initiative has been made possible with the support of St. Jude Medical India Pvt Ltd (now Abbott).

Analytic Approach in Accessing Trends and Impacts of Medicaid-Medicare Dual Enrollment in the United States

The landscape of Medicaid and Medicare enrollment in the United States is undergoing dynamic changes, driven by intricate policies, shifting demographic trends, and evolving healthcare access criteria. This publication serves as a beacon, illuminating the multifaceted terrain of Medicaid and Medicare dual enrollment and offering a comprehensive understanding of its complexities and challenges. The primary objective is to advocate for the adoption of a centralized data-driven decision support system, recognizing its transformative potential. By harnessing the power of data, we can revolutionize enrollment management, streamline administrative processes, and facilitate the timely adjustment of policies, ensuring more efficient and effective healthcare access. Empowerment is at the heart of our mission. We aim to equip all healthcare stakeholders, from government agencies and insurance providers to healthcare institutions and enrollees, with knowledge and insights. Informed decisions driven by data will lead to improved healthcare access, ultimately catalyzing positive change within the Medicaid and Medicare landscape. This publication represents a call to action, urging all players in the healthcare ecosystem to embrace data-driven solutions, adapt to the evolving landscape, and work collaboratively to advance the cause of accessible and effective healthcare for all.

Unveiling the Digital Landscape of CAR-T Therapies in Multiple Myeloma Using Social Media Insights

Introduction: The rapid evolution of novel chimeric antigen receptor T-cell (CAR-T) therapies, including Carvykti (ciltacabtagene autoleucel) and Abecma (idecabtagene vicleucel), have revolutionized the treatment landscape for multiple myeloma (MM) patients. These cutting-edge therapies have demonstrated remarkable efficacy in clinical trials, representing a significant advancement in the field. However, their real-world impact on patient and physician experiences, and perceptions remain important topics of ongoing investigation. In recent years, social media platforms have emerged as valuable sources of real-time data and patient perspectives, providing an unprecedented opportunity for researchers to gain insights into physician and patient perceptions around these emerging CAR-T therapies. This study aims to perform a comprehensive digital analysis to measure sentiment expression by different health care stakeholders and to identify health information needs related to MM CAR-T therapies. Methods: This digital analysis utilized publicly available data related to CAR-T therapies approved for the treatment of relapsed or refractory MM from various online sources related to CAR-T therapies. The data was captured using the web indexing tool Talkwalker. The analysis covered the time period from May 21, 2021 to May 21, 2023. Quantitative analysis involved applying filters and Boolean search terms to segment the data and generate figures such as share of voice, language and media type distribution, and treatment and MM mentions over time. Additionally, a qualitative assessment was conducted by reviewing posts related to the key topics of interest. Individuals who self-identify as healthcare professionals (HCPs) based on their bio, social media name, byline in news articles, or other indications were included in stakeholder analysis. Results: Out of the 471.5K MM posts generated over the 2-year study period, 47,909 posts (10%) were about CAR-T therapy, and 13,117 posts specifically commented on either Carvykti (55%) or Abecma (45%). In terms of specialty, hematologists were the primary contributors (47%), followed by oncologists (16%) and pharmacists (6%). CAR-T therapy was most referenced in posts discussing efficacy, safety, duration, and time to cytokine release syndrome (CRS), with a higher number of posts mentioning Carvykti (57%) compared to Abecma (43%). The most prominent key themes of pressing challenges and needs mentioned among CAR-T therapy posts were cost (60.5%), post-CAR-T care (38.6%), access (37.5%), education (6.7%), and quality of life (6.4%). Both Carvykti and Abecma were frequently mentioned alongside access and cost, although access (60%) was more prominent with Carvykti and cost (61%) with Abecma. Among HCPs, the most significant key theme of pressing challenges and needs was post-CAR-T infusion care considerations (58.6%), such as extended hospital stays to manage immune-mediated toxicities such as CRS and neurotoxicity, the risk of cytopenia and infections, and strategies to mitigate these risks. Management strategies mentioned included earlier and more aggressive supportive care, the use of cytokine-targeting therapies such as tocilizumab for any grade CRS, steroids such as dexamethasone for immune effector cell-associated neurotoxicity syndrome, and prophylactic antiseizure medications for all patients regardless of neurotoxicity. In the category of Diversity, Equity, & Inclusion, both Carvykti and Abecma were mentioned similarly on various topics, including access to CAR-T therapies (87% vs. 74%), diversity in clinical trials (19% vs. 17%), geographic location implications (9% vs. 15%), and racial disparities (3% vs. 4%). Conclusions: The study findings highlight the importance of demystifying cost perceptions against the added value to patients, HCPs and payers, and implementing comprehensive post-CAR-T care protocols aligned with the concerns expressed in social media discussions for improvement in CAR-T therapies for multiple myeloma. By leveraging the power of social media data, this study offers valuable real-world insights that can inform clinical decision-making, enhance patient-centered care, and contribute to the development of strategies to overcome challenges associated with CAR-T therapies in multiple myeloma.

Barriers and enablers for oral health promotion programs amongst primary healthcare stakeholders in Qatar – a qualitative investigation

BackgroundOral health of preschool children remains a concern globally. Primary healthcare providers are in a vital position to support preventive oral care programmes. This study explored current practices, perception and barriers of primary health care professionals towards oral health promotion program of children in Qatar.MethodsThe qualitative research used focus group discussions and interviewed a total of 108 participants that were audio recorded and transcribed verbatim. Four major themes emerged and were analysed to explore contextual patterns within the data.ResultsParticipants acknowledged the high prevalence of caries in children and identified the causes in the local context which included parental practices, poor dietary habits, impact of culture lack of oral health knowledge, limitations in the healthcare system, and negative role of the media. However, complex barriers were exposed, including lack of time and ownership, system coordination between organizations, and lack of policy.ConclusionHealth professionals and bureaucrats involved in decision-making held a positive attitude towards oral health prevention programs and were enthusiastic to initiate and support these programs.

Mitigating Physician Emigration in Nigeria by Improving the Internship Experience

Nigeria faces a critical shortage of health workers, exacerbated by a growing of physician emigration. This study explored the negative internship experiences that drive Nigerian interns to migrate abroad, with a focus on the COVID-19 pandemic's impact. Interns cite excessive workload and burnout, lack of professional development opportunities, challenging work environment, and mistreatment as key reasons for considering emigration. The COVID-19 pandemic has exacerbated these challenges, leading to shortages of personal protective equipment, limited screening services, and poor hazard allowances. The paper emphasizes the importance of adopting policies that make destination countries attractive to emigrating interns. These includes creating a supportive work environment with fair compensation, professional development opportunities, and adequate resources to retain interns in the country. It also highlights the significance of addressing mistreatment and bullying in the workplace. Collaboration between healthcare organizations, policy reforms, and increased healthcare financing are suggested as potential strategies to mitigate the brain drain and ensure a sustainable healthcare system in Nigeria. Improving internship conditions and addressing the shortcomings of managing the COVID-19 pandemic are essential to retaining Nigerian doctors and combatting physician emigration. This requires a coordinated effort from healthcare systems, policymakers, and stakeholders.

Social Media-Delivered Lifestyle Interventions Among Individuals Living with Diabetes and Prediabetes: A Scoping Review.

There is a lack of synthesized evidence on social media-delivered lifestyle interventions for managing and preventing diabetes. This scoping review aims to evaluate recently reported lifestyle interventions delivered on social media for individuals with diabetes and prediabetes. Twelve studies were included in this review. A team of multidisciplinary healthcare professionals coordinated most interventions, half of which lasted for 6months, and used a combination of videos, texts, images or audio to deliver the educational materials. The glycosylated hemoglobin (HbA1c) level improved in most of the studies, followed by diabetes self-care and fasting plasma glucose. The dietary intakes were only assessed in two interventions among the individuals with prediabetes and showed promising improvements. This scoping review provides a holistic overview of the recent designs of lifestyle interventions for diabetes management and prevention on social media. This is essential for various healthcare professionals and stakeholders to formulate and implement population-based, cost-effective interventions in combating diabetes using social media.

Navigating Challenges: The Profound Impact of Nursing Shortage on Patient Care and Healthcare Systems

In the wake of a global healthcare crisis, the shortage of nursing professionals has emerged as a pivotal challenge, profoundly affecting patient care and the efficiency of healthcare systems. This article, offers an in-depth analysis of this complex issue. It traces the historical evolution of the nursing shortage, examining its origins and the factors that have contributed to its current state. The paper presents comprehensive data to illustrate the extent of the shortage worldwide, highlighting trends in nursing education and workforce demographics. A significant focus is placed on the impact of this shortage on patient care, including a discussion on patient safety, care quality, and outcomes. The strain on healthcare systems is also scrutinized, with an analysis of the financial and operational implications for healthcare providers. The article explores the varying effects and responses to the nursing shortage across different countries, offering a global perspective. Innovative solutions and strategies are reviewed, showcasing successful interventions and the potential role of technology in addressing the crisis. The article concludes with a future outlook, offering predictions for the nursing workforce and potential shifts in healthcare delivery models. This comprehensive exploration aims to provide insights and foster discussions among healthcare professionals, policymakers, and stakeholders to address and mitigate the impact of the nursing shortage

Implementation strategy for advanced practice nursing in Gabon: A multicenter mixed-method study.

To describe the expectations, acceptability, and challenges identified by nurses and key healthcare stakeholders regarding the implementation of advanced practice nursing in Gabon. Advanced practice nursing presents an opportunity to address the epidemiological transition and the shortage of healthcare professionals in Africa. In anticipation of establishing a master's degree program in advanced practice nursing and its subsequent implementation, it is important to understand Gabon's specific needs and characteristics. This study used a multicenter cross-sectional mixed-method design. From April to May 2022, a total of 187 healthcare professionals were included from two hospitals and two universities in Gabon. Data were collected through questionnaires and complemented by focus group discussions, guided by the existing literature, the PEPPA framework, and Hamric's model. The implementation of advanced practice nursing was generally well accepted. Factors influencing acceptability included being female, awareness of advanced practice nursing, and supporting the role of advanced practice nurses in diagnosing chronic diseases. Barriers to implementation included the absence of a legal framework for the profession and a lack of recognition of nursing skills by both nurses and doctors. Facilitators included the establishment of a master's degree program, formalization of a legal framework, raising awareness, providing training to medical doctors and other healthcare professionals about advanced practice nursing, and the development of nursing leadership. Advanced practice nursing can play a crucial role in addressing healthcare resource shortages and the dual burden of chronic and infectious diseases in Gabon, as well as in other African countries. To successfully implement advanced practice nursing in Gabon and French-speaking Africa, it is essential to regulate the nursing and advanced nursing professions by creating a legal framework and establishing nursing councils. An effective implementation strategy for advanced practice nurses should be based on the specific needs of the country. COREQ, STROBE.

Determinants of Consumers’ Willingness to Purchase Generic Medicines

In Malaysia healthcare costs have posed challenges to the sustainability of the country's dual healthcare system, it is crucial to learn about the factors influencing consumer preferences for generic medicines. The public healthcare system predominantly uses generic drugs, private healthcare providers often prescribe originator brands to their patients. This practice places financial burdens on patients who must fund their medication independently or through private medical insurance. Therefore, the main objective of this paper is to investigate the determinants affecting consumers' willingness to purchase generic medicine in Malaysia. Using convenience sampling, a total of 436 responses was obtained. Descriptive statistics and bivariate logistic regression analysis were employed to examine the influence of sociodemographic factors and individual knowledge on the willingness to purchase generic medicine. The results indicate that age, ethnicity, marital status, education level, household size and income significantly influence the consumers' willingness to purchase generic medicine. Notably, higher education levels and greater income were associated with a higher willingness to opt for generic medicine. Unexpectedly, variables measured by the Theory of Planned Behavior did not contribute substantially to the findings of this study. Nonetheless, individual knowledge was revealed as a significant determinant. To increase the uptake of generic medicines, this study recommends educational programs for both healthcare providers and patients, emphasizing the benefits and safety of generic medicine. This research contributes to the broader discussion on cost-effective healthcare solutions and informs policymakers and healthcare stakeholders in Malaysia.

Nurses Job Crafting: Correlation Between Organizational Identification and Workplace Attachment Among Nurses.

The aim of this study was to investigate the relationship between nurses' job crafting, organizational identification, and work attachment. Job crafting is a proactive activity in which nurses adapt the physical, cognitive, or social aspects of their jobs to make them more meaningful. Nurses are considered fundamental healthcare stakeholders who are able to transform initiatives implemented by the healthcare organization into valuable work outcomes. Nurses' perceptions of their jobs shape the community's opinion toward an organization. This is a descriptive correlational study. Two hundred seventy nurses were recruited from 1 governmental hospital in Egypt. Respondents completed the self-administered, printed questionnaires. Measures included job crafting, organizational identification, and work attachment questionnaires. Findings were investigated via descriptive and inferential statistics. Over half of the nurses reported a moderate level of job crafting, whereas none of the nurses reported a high level of organizational identification. More than half of the nurses reported low levels of work attachment. Job crafting is significantly related to nurses' organizational identification and work attachment.

Abstract 11930: Using Implementation Science to Develop a Familial Hypercholesterolemia Screening Program in Primary Care: The CARE-FH Study

Introduction: Cholesterol screening in primary care is necessary to identify children and young adults with familial hypercholesterolemia (FH). Research question: What is the current state of FH screening and what barriers exist to screening? What implementation strategies informed by human centered design can be utilized to improve FH screening in primary care? Aim: We partnered with key stakeholders to sequentially define the current state of FH screening, assess acceptability, feasibility, and appropriateness of implementing an FH screening program, and select clinically usable strategies to be deployed as a package in the CARE-FH clinical trial. Methods: Data on the perspectives of primary care clinicians to implement an FH screening program were collected. Methods informed by implementation science and human centered design for data collections included: contextual inquiries, surveys, and deliberative engagement sessions. Results: Current screening for FH occurred rarely, and then only after a cardiovascular event or sometimes in primary care due to a family history of high cholesterol or early heart attack. Surveys of primary care clinicians suggested FH screening in primary care was acceptable, appropriate, and feasible. Reported and observed barriers and facilitators to screening identified where improvement in FH screening and diagnosis could occur. Data from the current state and perspectives on FH screening were used to identify multilevel implementation strategies that were presented to and modified by clinician and healthcare stakeholders. This package of strategies was pilot tested in one primary care clinic and further refined to a final implementation strategy package to be tested in a geographical cluster randomized stepped wedge trial. Conclusion: We created an implementation strategy package to be deployed and evaluated in the CARE-FH clinical trial to improve FH awareness, identification, and initiate guideline-based care.

Characterizing Real-World Implementation of Consumer Wearables for the Detection of Undiagnosed Atrial Fibrillation in Clinical Practice: Targeted Literature Review

Background Atrial fibrillation (AF), the most common cardiac arrhythmia, is often undiagnosed because of lack of awareness and frequent asymptomatic presentation. As AF is associated with increased risk of stroke, early detection is clinically relevant. Several consumer wearable devices (CWDs) have been cleared by the US Food and Drug Administration for irregular heart rhythm detection suggestive of AF. However, recommendations for the use of CWDs for AF detection in clinical practice, especially with regard to pathways for workflows and clinical decisions, remain lacking. Objective We conducted a targeted literature review to identify articles on CWDs characterizing the current state of wearable technology for AF detection, identifying approaches to implementing CWDs into the clinical workflow, and characterizing provider and patient perspectives on CWDs for patients at risk of AF. Methods PubMed, ClinicalTrials.gov, UpToDate Clinical Reference, and DynaMed were searched for articles in English published between January 2016 and July 2023. The searches used predefined Medical Subject Headings (MeSH) terms, keywords, and search strings. Articles of interest were specifically on CWDs; articles on ambulatory monitoring tools, tools available by prescription, or handheld devices were excluded. Search results were reviewed for relevancy and discussed among the authors for inclusion. A qualitative analysis was conducted and themes relevant to our study objectives were identified. Results A total of 31 articles met inclusion criteria: 7 (23%) medical society reports or guidelines, 4 (13%) general reviews, 5 (16%) systematic reviews, 5 (16%) health care provider surveys, 7 (23%) consumer or patient surveys or interviews, and 3 (10%) analytical reports. Despite recognition of CWDs by medical societies, detailed guidelines regarding CWDs for AF detection were limited, as was the availability of clinical tools. A main theme was the lack of pragmatic studies assessing real-world implementation of CWDs for AF detection. Clinicians expressed concerns about data overload; potential for false positives; reimbursement issues; and the need for clinical tools such as care pathways and guidelines, preferably developed or endorsed by professional organizations. Patient-facing challenges included device costs and variability in digital literacy or technology acceptance. Conclusions This targeted literature review highlights the lack of a comprehensive body of literature guiding real-world implementation of CWDs for AF detection and provides insights for informing additional research and developing appropriate tools and resources for incorporating these devices into clinical practice. The results should also provide an impetus for the active involvement of medical societies and other health care stakeholders in developing appropriate tools and resources for guiding the real-world use of CWDs for AF detection. These resources should target clinicians, patients, and health care systems with the goal of facilitating clinician or patient engagement and using an evidence-based approach for establishing guidelines or frameworks for administrative workflows and patient care pathways.

How can health technology assessment be improved to optimise access to medicines? Results from a Delphi study in Europe

IntroductionAccess to medicines is a shared goal across healthcare stakeholders. Since health technology assessment (HTA) informs funding decisions, it shapes access to medicines. Despite its wide implementation, significant access variations due to HTA are observed across Europe. This paper elicited the opinions of European stakeholders on how HTA can be improved to facilitate access.MethodsA scoping review identified HTA features that influence access to medicines within markets and areas for improvement, while three access dimensions were identified (availability, affordability, timeliness). Using the Delphi method, we elicited the opinions of European stakeholders to validate the literature findings.ResultsNineteen participants from 14 countries participated in the Delphi panel. Thirteen HTA features that could be improved to optimise access to medicines in Europe were identified. Of these, 11 recorded a positive impact on at least one of the three access dimensions. HTA features had mostly a positive impact on timeliness and a less clear impact on affordability. ‘Early scientific advice’ and ‘clarity in evidentiary requirements’ showed a positive impact on all access dimensions. 'Established ways to deal with uncertainty during HTA’ could improve medicines’ availability and timeliness, while more ‘reliance on real-world evidence’ could expedite time to market access.ConclusionsOur results reiterate that increased transparency during HTA and the decision-making processes is essential; the use of and reliance on new evidence generation such as real-world evidence can optimise the availability of medicines; and better collaborations between regulatory institutions within and between countries are paramount for better access to medicines.

Decentralized Healthcare System using Blockchain

Abstract—This research paper explores the integration of blockchain technology in healthcare to establish a decentralized system that enhances security, privacy, and patient control over health data. The proposed framework utilizes blockchain's tamper-resistant ledger to create a transparent and secure repository for patient records, ensuring data integrity and confidentiality. Smart contracts enable automated and controlled data sharing, fostering collaboration among healthcare stakeholders. Real-world implementations and case studies illustrate the potential impact of this decentralized healthcare system in revolutionizing data management, research collaboration, and patient outcomes. The findings highlight the significance of blockchain in addressing critical challenges in traditional healthcare systems, presenting a promising solution for a more secure and patient-centric future. Keywords—Distributed Ledger, Smart Contracts, Data Integrity, Patient Control, User interface, Regulatory compliance, Immutable Ledger

Blockchain technology in Cardiovascular Medicine: a glance to the future? Results from a social media survey and future perspectives.

The leverage of digital facilities in medicine for disease diagnosis, monitoring, and medical history recording has become increasingly pivotal. However, the advancement of these technologies poses a significant challenge regarding data privacy, given the highly sensitive nature of medical information. In this context, the application of Blockchain technology, a digital system where information is stored in blocks and each block is linked to the one before, has the potential to enhance existing technologies through its exceptional security and transparency. This paradigm is of particular importance in cardiovascular medicine, where the prevalence of chronic conditions leads to the need for secure remote monitoring, secure data storage and secure medical history updating. Indeed, digital support for chronic cardiovascular pathologies is getting more and more crucial. This paper lays its rationale in three primary aims: 1) to scrutinize the existing literature for tangible applications of blockchain technology in the field of cardiology; 2) to report results from a survey aimed at gauging the reception of blockchain technology within the cardiovascular community, conducted on social media; 3) to conceptualize a web application tailored specifically to cardiovascular care based on blockchain technology. We believe that Blockchain technology may contribute to a breakthrough in healthcare digitalization, especially in the field of cardiology; in this context, we hope that the present work may be inspiring for physicians and healthcare stakeholders.

Using crowdsourcing approach to obtain real-world insights to improve access to cancer medicine.

135 Background: Barriers of access to cancer medicines vary tremendously among practice settings. Our initiative is aimed at obtaining insights about the challenges and potential solutions to improve access to cancer medicine from a wide range of stakeholders and front-line practitioners across the world. Methods: We used a two-step approach. The first step is to convene a panel of distinguished international experts to identify key stakeholders and pertinent issues to cover during crowdsourcing process. The second step is to run a crowdsourcing (Hackathon) through a virtual platform (Within3, Lakewood, Ohio, USA). The platform was divided into four rooms, each moderated by one expert posing a series of questions related to the following themes: Access to affordable quality medicines; reliable, verifiable, and sustainable supply chain; guidelines and the rationale use of medicines; and measuring and validating quality standards. Results: Between June 8 and July 8, 2022, 78 participants from 33 countries joined the platform. Participants responded to questions by reporting local/ regional experiences and suggested solutions. Participants were able to comment on others’ posts or like a specific comment. The contributions revealed the disparities in access to medicines and highlighted the needs for cooperation across borders and among healthcare systems and stakeholder organizations and emphasized the needs to improve communications, education and accurate data generation and experience sharing. Questions that generated the most responses related to access to quality essential medicines (n=25) and the use of treatment guidelines based on essential cancer medicines (n=22). Solutions that generated the most “likes” related to actions that can be taken to make medicines more affordable and accessible and actions to engage diverse audiences in efforts to improve access to medicines. The importance of creating practical and relevant guidelines was clearly highlighted. Conclusions: Crowdsourcing is an innovative and practical approach to gain insights from stakeholders of different backgrounds professionally, geographically and practice settings. It creates an opportunity for interested individuals to participate in asynchronous ways in easily accessible platform at their convenience over extended period of time. A follow-up plan is underway to crystalize the most practical next steps to build on the complied information.

Quality of Life of People Living with HIV on Antiretroviral Therapy: A Cross-Sectional Study in Monastir, Tunisia.

Despite the benefits of an efficient antiretroviral therapy (ART), HIV/AIDS epidemic still represents the most seriousaffection worldwide that negatively impacts people's quality of life (QoL). As no studies exist on QoL in Tunisia, the aim of the present work was i: to assess, based on WHOQOL-HIV BREF tool, the perception of QoL of people living with HIV (PLHIV) receiving ART and ii: to investigate the relationship between socio-demographic features, disease-related variables and QoL domains' mean scores. This cross-sectional study was conducted at the department of infectious diseases of F. Bourguiba Teaching Hospital in Monastir, Tunisia. One hundred and five participants receiving ART were involved. QoL assessment was based on the WHOQOL-HIV Bref including six domains with 29 items with scores ranged from the lowest (4) to the highest (20). Results were reported as frequencies and means (±SD). The Student's t-test for independent samples and the one-way ANOVA were performed to assess differences in QoL mean scores. Linear regression analysis was used to investigate predictors of QoL. The confidence interval was set at 95%. Clients' mean age was 39.20±10.18 years old with a male to female sex ratio of 3.12. Low mean scores were seen with the environment (12.34±2.90), social relations (12.58±3.94) and psychological domains (12.76±3.31), and moderate mean scores were noted for the physical (14.11±3.52), the spiritual (14.05±3.78) and the level of independence (13.98±3.57) domains. Regression analysis showed that health status and feeling healthy were related to all QoL domains and that profession, marital status and the presence of a confident person were related to environment and spiritual domains. QoL of PLHIV on ART is affected. Concrete measures and strategies should be undertaken by healthcare stakeholders to improve QoL determinants.

Enhancing the Security and Privacy of eHealth Records through Blockchain-based Management: A Comprehensive Framework

Progress in information technology is transforming the healthcare sector with the goal of enhancing medical services, diagnostics, and continuous monitoring through wearable devices, among other benefits, while also lowering expenses. This digital transformation enhances the convenience of computing, storing, and retrieving medical records, ultimately leading to improved treatment experiences for patients. Electronic health record systems have come under fire for centralized control, faults, and attack points with transferring data custodians. These systems are frequently utilized for the interchange of health information among healthcare stakeholders. The main objective is to overcome information asymmetry and data breaches commonly encountered in the Electronic Health Record (EHR) system. This study introduces a decentralized and trustless architecture aimed at securely storing patients' medical records and granting access to authorized individuals, including healthcare providers and patients themselves. The research primarily focuses on bolstering the security and privacy of healthcare data management systems using blockchain technology. To address the issue of blockchain scalability, an off-chain scaling approach is proposed, utilizing an underlying medium to store large volumes of data. This is achieved through the integration of Elliptic Curve Cryptography (ECC) and the Interplanetary File System (IPFS). The proposed system provides a secure and efficient method for storing and sharing sensitive healthcare data while ensuring confidentiality and data integrity.

Experiences and Perceptions of Healthcare Stakeholders in Disclosing Errors and Adverse Events to Historically Marginalized Patients.

We sought to assess the experiences and perceptions of healthcare stakeholders involved in the response to historically marginalized patients who have been harmed in healthcare. We investigated the challenges in disclosing errors and adverse events and the types of tools and resources that would better address the needs of historically marginalized patient populations. We conducted separate focus groups with two healthcare stakeholder groups: (1) frontline clinicians directly involved in the clinical care of historically marginalized patients and (2) risk and patient safety professionals involved in the hospital response to care breakdowns. We conducted an inductive analysis of the qualitative data to identify thematic clusters. We interviewed 7 clinicians and 5 risk safety professionals, with a total sample size of 12 participants. Participants shared multilevel challenges in responding to historically marginalized patients after harm (system-, organizational-, and patient-level), such as fragmentation of care, lack of standardized protocols, and patient mistrust. Participants also identified their desired tools and resources for disclosure to meet the needs of historically marginalized patients, which included culturally appropriate toolkits, disclosure training, and the inclusion of multidisciplinary healthcare team members in the disclosure process. Our results suggest that multiple interventions will be needed to achieve the goal of prompt disclosure of errors and adverse events across all populations engaged in health care. Future studies should investigate the perspectives of historically marginalized patients and their family members on how error and adverse event disclosure conversations should unfold.