Dataset Information

Use of health outcome and health service utilization indicators as an outcome of access to medicines in Brazil: perspectives from a literature review.

ABSTRACT:

Background

To guarantee the right to health, the health system must also ensure access to medicines. Several financial arrangements to provide these technologies are implemented and range from the direct (either total or partial) to indirect payment by the patient, being necessary to evaluate its effect on access to medicines. However, to ensure access to medicines is not just about ensuring its availability, as this only materializes in its use. Thus, evaluation studies of interventions in access to medicines have been using indicators related to the health results and use of health services as its outcomes. Furthermore, as this relationship is not direct, it is important to critically assess the adequacy of these tools to measure this phenomenon and, additionally, the ability to use it in the Brazilian scenario. Therefore, this study sought to identify, describe, and analyze the use of these indicators as medicine access outcomes, through a review of the scientific literature.

Methods

An extensive literature review was done using a bibliographic database for a systematic review. The references were selected based on inclusion and exclusion criteria, and the indicators from the papers retained were analyzed using the parameters of validity, measurability, reliability, and relevance.

Results

We have analyzed over 12,000 references of which 30 references were included, describing the use of 49 health outcomes and health service use indicators. The majority reported the use of health service utilization measures. In our evaluation, the best indicators for assessing the effects of co-payment intervention on access are the ones aimed at specific populations or symptomatic health conditions in which the response to the therapeutic treatment is known and occurs in a short period of time. It was evident the lack of information on the indicators analyzed as well as the limitation of the Brazilian secondary databases for its calculation.

Conclusions

This research showed the variety and heterogeneity of the indicators used in scientific studies. The best indicators for access to medicines are sought to measure the use of health services for symptomatic health conditions that are quickly responsive to pharmacological treatment, while the indicators related to worker productivity loss was the most suitable for health outcomes.

SUBMITTER: Arueira Chaves L

PROVIDER: S-EPMC6902426 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Use of health outcome and health service utilization indicators as an outcome of access to medicines in Brazil: perspectives from a literature review.

Arueira Chaves Luisa L de Souza Serio Dos Santos Danielle Maria DM Rodrigues Campos Monica M Luiza Vera Lucia VL

Public health reviews 20191209

<h4>Background</h4>To guarantee the right to health, the health system must also ensure access to medicines. Several financial arrangements to provide these technologies are implemented and range from the direct (either total or partial) to indirect payment by the patient, being necessary to evaluate its effect on access to medicines. However, to ensure access to medicines is not just about ensuring its availability, as this only materializes in its use. Thus, evaluation studies of interventions ...[more]

PMID: 31867131

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Project description:BackgroundThe European Core Health Indicators (ECHI) are a key source of comparable health information for the European Union (EU) and its Member States (MS). The ECHI shortlist contains 88 indicators which were developed by experts from MS and international organisations. Most indicators are derived from data sources at the EU's statistical office (Eurostat), the World Health Organisation (WHO) and the Organisation for Economic Co-operation and Development (OECD) and are available for most MS. The remaining indicators on the shortlist are at different stages of conceptual and/or methodological development. The indicators have been reviewed in the past against scientific developments, changes in data collections and emerging policy needs, yet not as part of a systematic and sustainable procedure. There is also no regular inventory of problems met by the MS in collecting the necessary data. Work package 4 of the BRIDGE Health project aimed at updating and improving the existing ECHI-indicator knowledge and expertise and at strengthening the scientific base that supports the effective development and use of health indicators for health policy evaluation and prioritization by the EU and its MS. The aim of this paper is to present a first overview of its outcomes and to explore issues concerning the ECHI data availability, content and policy relevance, update process and accessibility to stakeholders, in light of working towards a sustainable future.MethodsTwo surveys were conducted within the framework of the BRIDGE Health project to reassess the status of the ECHI shortlist. The first survey focused on data availability in EU MS, candidate countries and European Free Trade Association (EFTA) countries. The second survey evaluated current needs and criteria with respect to content and policy relevance of the ECHI shortlist. Exploring potential new indicator topics was part of both surveys. All evaluations were supported by an advisory network of national and international experts.ResultsOf the 36 countries (EU MS, candidate and EFTA countries) contacted for the data availability mapping, 23 countries (63%) participated in the survey. Data availability from preferred data sources varied between chapters. Availability was highest for the chapter on demography and socio-economic situation, followed by the chapter on health status, where data were available for most indicators from more than 90% of the participating countries. Problems experienced by MS relating to the incorporation of ECHI into their health systems were also identified through the survey. Findings from the survey on policy relevance point at the need for strengthening the links with policy (priorities) and for exploring a possible format change of the list to accommodate actionability. It also showed support for embedding ECHI in a sustainable health information structure; this may practically be aided by a web-based single point of access to an information repository.ConclusionPolicy relevance is an essential but not systematically developed criterion for the inclusion of indicators into the ECHI shortlist. Data availability is crucial for the actual implementation of indicators and has considerably increased for ECHI in the last decade. The data availability mapping provides a structured overview of the current status of data availability for implemented indicators. The ECHI shortlist can contribute to the collection of comparable policy-relevant health data in Europe, foster evidence-based public health and contribute to Member States learning from each other. Flexible and systematic incorporation of policy relevance in the ECHI shortlist review and revision process may substantiate ECHI as a core component of a future sustainable European health information infrastructure.

Project description:BACKGROUND:Access to neurology specialty care can influence outcomes in individuals with multiple sclerosis (MS), but may vary based on patient sociodemographic characteristics, including immigration status. OBJECTIVE:To compare health services utilization in the year of MS diagnosis, one year before diagnosis and two years after diagnosis in immigrants versus long-term residents in Ontario, Canada. METHODS:We identified incident cases of MS among adults aged 20-65 years by applying a validated algorithm to health administrative data in Ontario, Canada, a region with universal health insurance and comprehensive coverage. We separately assessed hospitalizations, emergency department (ED) visits, outpatient neurology visits, other outpatient specialty visits, and primary care visits. We compared rates of health service use in immigrants versus long-term residents using negative binomial regression models with generalized estimating equations adjusted for age, sex, socioeconomic status, urban/rural residence, MS diagnosis calendar year, and comorbidity burden. RESULTS:From 2003 to 2014, there were 13,028 incident MS cases in Ontario, of whom 1,070 (8.2%) were immigrants. As compared to long-term residents, rates of hospitalization were similar (Adjusted rate ratio (ARR) 0.86; 95% CI: 0.73-1.01) in immigrants the year before MS diagnosis, but outpatient neurology visits (ARR 0.93; 95% CI: 0.87-0.99) were slightly less frequent. However, immigrants had higher rates of hospitalization during the diagnosis year (ARR 1.20, 95% CI: 1.04-1.39), and had greater use of outpatient neurology (ARR 1.17, 95% CI: 1.12-1.23) but fewer ED visits (ARR 0.86; 95% CI: 0.78-0.96). In the first post-diagnosis year, immigrants continued to have greater numbers of outpatient neurology visits (ARR 1.16; 95% CI: 1.10-1.23), but had fewer hospitalizations (ARR 0.79; 95% CI: 0.67-0.94). CONCLUSIONS:Overall, our findings were reassuring concerning health services access for immigrants with MS in Ontario, a publicly funded health care system. However, immigrants were more likely to be hospitalized despite greater use of outpatient neurology care in the year of MS diagnosis. Reasons for this may include more severe disease presentation or lack of social support among immigrants and warrant further investigation.

Project description:BackgroundNearly 15% of pregnancies end in fatal perinatal obstetric complications including bleeding, infections, hypertension, obstructed labour and complications of abortion. Globally, an estimated 10.7 million women have died due to obstetric complications in the last two decades, and two thirds of these deaths occurred in sub-Saharan Africa. Though the majority of maternal mortalities can be prevented, different factors can hinder women's access to emergency obstetric services. Therefore, this review is aimed at synthesizing current evidence on barriers to access and utilization of emergency obstetric care in sub-Saharan Africa.MethodsArticles were searched from MEDLINE, CINAHL, EMBASE, and Maternity and Infant Care databases using predefined search terms and strategies. Articles published in English, between 2010 and 2017, were included. Two reviewers (AG and AM) independently screened the articles, and data extraction was conducted using the Joanna Briggs Institute data extraction format. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The identified barriers were qualitatively synthesized and reported using the Three Delays analytical framework. The PRISMA checklist was employed to present the findings.ResultThe search of the selected databases returned 3534 articles. After duplicates were removed and further screening undertaken, 37 studies fulfilled the inclusion criteria. The identified key barriers related to the first delay included younger age, illiteracy, lower income, unemployment, poor health service utilization, a lower level of assertiveness among women, poor knowledge about obstetric danger signs, and cultural beliefs. Poorly designed roads, lack of vehicles, transportation costs, and distance from facilities led to the second delay. Barriers related to the third delay included lack of emergency obstetric care services and supplies, shortage of trained staff, poor management of emergency obstetric care provision, cost of services, long waiting times, poor referral practices, and poor coordination among staff.ConclusionsA number of factors were found to hamper access to and utilization of emergency obstetric care among women in sub-Saharan Africa. These barriers are inter-dependent and occurred at multiple levels either at home, on the way to health facilities, or at the facilities. Therefore, country-specific holistic strategies including improvements to healthcare systems and the socio-economic status of women need to be strengthened. Further research should focus on the assessment of the third delay, as little is known about facility-readiness.Systematic review registrationPROSPERO CRD42017074102.

Dataset Information

Use of health outcome and health service utilization indicators as an outcome of access to medicines in Brazil: perspectives from a literature review.

Background

Methods

Results

Conclusions

Publications

Use of health outcome and health service utilization indicators as an outcome of access to medicines in Brazil: perspectives from a literature review.

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