Impact of primary health care reforms in Quebec Health Care System: a systematic literature review protocol.

INTRODUCTION: During the last decade the Quebec Public Health Care System (QPHCS) had an important transformation in primary care planning activity. The increase of the service demand together with a significant reduction of supply in primary care may be at risk of reducing access to health care services, with a negative impact on costs and health outcomes. The aims of this systematic literature review are to map and aggregate existing literature and evidence on the primary care provided in Quebec, showing the benefits and limitations associated with the health policies developed in the last two decades, and highlighting areas of improvement. METHODS AND ANALYSIS: PubMed, EMBASE, Web of Science and CINAHL will be searched for articles and government reports between January 2000 and January 2022 using a prespecified search strategy. This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Protocols and has been registered with PROSPERO. A wide range of electronic databases and grey literature sources will be systematically searched using predefined keywords. The review will include any study design, with the exclusion of protocols, with a focus on the analysis of health care policies, outcomes, costs and management of the primary health care services, published in either English or French languages. Two authors will independently screen titles, abstracts, full-text articles and select studies meeting the inclusion criteria. A customised data extraction form will be used to extract data from the included studies. Results will be presented in tabular format developed iteratively by the research team. ETHICS AND DISSEMINATION: Research ethics approval is not required as exclusively secondary data will be used. Review findings will synthesise the characteristics and the impact of the reforms of QPHCS of the last two decades. Findings will therefore be disseminated in peer-reviewed journals, conference presentations and through discussions with stakeholders. PROSPERO REGISTRATION NUMBER: CRD42023421145.

Tracking malaria health disbursements by source in Zambia, 2009-2018: an economic modelling study.

BACKGROUND: Zambia has made profound strides in reducing both the incidence and prevalence of malaria followed by reducing malaria related deaths between 2009 and 2018. The number of partners providing malaria funding has significantly increased in the same period. The increasing number of partners and the subsequent reduction of the number of reported malaria cases in the Ministry of Health main data repository Health Management Information System (HMIS) stimulated this research. The study aimed at (1) identifying major sources of malaria funding in Zambia; (2) describe malaria funding per targeted interventions and (3) relating malaria funding with malaria disease burden. METHODS: Data was collected using extensive literature review of institutional strategic document between the year 2009 to 2018, assuming one-year time lag between investment and the health outcome across all interventions. The National's Health Management Information System (HMIS) provided information on annual malaria admission cases and outpatient clinic record. The statistical package for social sciences (SPSS) alongside Microsoft excel was used to analyze data in the year 2019. RESULTS: The investigation observed that about 30% of the funding came from PMI/USAID, 26% from the global funds, the government of Zambia contributed 17% and other partners sharing the remaining 27%. Multivariate regression analysis suggests a positive correlation between reducing reported malaria disease burden in HMIS 2009-2018 and concurrent increasing program/intervention funding towards ITNs, IRS, MDA, and Case Management with r2 = 77% (r2 > 0.77; 95% CI: 0.72-0.81). Furthermore, IRS showed a p-value 0.018 while ITNs, Case Management and MDA having 0.029, 0.030 and 0.040 respectively. CONCLUSION: Our findings highlight annual funding towards specific malaria intervention reduced the number of malaria admission cases.

A Comparative Study of the Health Care Delivery Systems in the Indian Ocean: What can Comoros Islands Learn from Mauritius and Seychelles?

In recent years, there have been significant efforts to examine the organization and performance of health systems. This study's main purpose is to compare health systems and analyze the health status of the citizens of Comoros, Mauritius, and Seychelles, with the intention of providing policy recommendations for Comoros. Peer-reviewed studies and reports published by non-governmental organizations and international agencies were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into the World Health Organization (WHO) building blocks framework. The literature review demonstrates that health outcomes have dramatically improved over the past decades in Mauritius and Seychelles but not in Comoros. As of 2015, Mauritius and Seychelles were among the few African countries to have achieved almost all the Millennium Development Goals, whereas Comoros still struggles to reduce child mortality and improve maternal health. In contrast, the total health expenditure of the three island states, as a percentage of gross domestic product (GDP), seemed similar over the studied time period.

An Overview of Healthcare Systems in Comoros: The Effects of Two Decades of Political Instability.

Background: There is ongoing scientific evidence pointing out the adverse effects of conflict on population health and development. Union of Comoros has experienced nearly two decades of political instability and military rule. This comprehensive review was carried out to ask whether the health crisis in Comoros is attributable to the consequences of the chronic political instability. Methods: This study involved a series of semi-structured interviews with key informants complemented by a comprehensive literature search of electronic databases and grey literature. A literature search was performed using all identified keywords associated with health indicators in Comoros to identify potential eligible publications in both English and French from 1975 to July 2020. Results: The analysis demonstrated that political instability and lack of proper leadership from the Government undermine the establishment of health policies which contributed dramatically to the decline in health performance. Additionally, the resurgence and emergence of old and new diseases such as cholera, chikungunya, malaria, HIV/AIDS as indicators of inadequate health services were most likely during political turmoil. Data also showed an out-migration of the health workforce and an increased overseas medical treatment demand, which indicate less attractive working conditions and weak health systems in the country. Meanwhile, an increasing performance of health status indicators was observed after the comprehensive peace process of the 2000-Fomboni Declaration. Conclusions: The chronic political instability in Comoros has contributed to the health crisis facing the Union of Comoros. It has hampered the implementation of proper institutions, which might guarantee the socio-economic development and prosperity of the population. Further studies were needed to evaluate the health burden associated with the two decades of political instability and military rule.

Barriers and facilitators for implementation of a patient prioritization tool in two specialized rehabilitation programs.

INTRODUCTION AND AIMS: Prioritization tools aim to manage access to care by ranking patients equitably in waiting lists based on determined criteria. Patient prioritization has been studied in a wide variety of clinical health services, including rehabilitation contexts. We created a web-based patient prioritization tool (PPT) with the participation of stakeholders in two rehabilitation programs, which we aim to implement into clinical practice. Successful implementation of such innovation can be influenced by a variety of determinants. The goal of this study was to explore facilitators and barriers to the implementation of a PPT in rehabilitation programs. METHODS: We used two questionnaires and conducted two focus groups among service providers from two rehabilitation programs. We used descriptive statistics to report results of the questionnaires and qualitative content analysis based on the Consolidated Framework for Implementation Research. RESULTS: Key facilitators are the flexibility and relative advantage of the tool to improve clinical practices and produce beneficial outcomes for patients. Main barriers are the lack of training, financial support and human resources to sustain the implementation process. CONCLUSION: This is the first study that highlights organizational, individual and innovation levels facilitators and barriers for the implementation of a prioritization tool from service providers' perspective.

A systematic review of patient prioritization tools in non-emergency healthcare services.

BACKGROUND: Patient prioritization is a strategy used to manage access to healthcare services. Patient prioritization tools (PPT) contribute to supporting the prioritization decision process, and to its transparency and fairness. Patient prioritization tools can take various forms and are highly dependent on the particular context of application. Consequently, the sets of criteria change from one context to another, especially when used in non-emergency settings. This paper systematically synthesizes and analyzes the published evidence concerning the development and challenges related to the validation and implementation of PPTs in non-emergency settings. METHODS: We conducted a systematic mixed studies review. We searched evidence in five databases to select articles based on eligibility criteria, and information of included articles was extracted using an extraction grid. The methodological quality of the studies was assessed by using the Mixed Methods Appraisal Tool. The article selection process, data extraction, and quality appraisal were performed by at least two reviewers independently. RESULTS: We included 48 studies listing 34 different patient prioritization tools. Most of them are designed for managing access to elective surgeries in hospital settings. Two-thirds of the tools were investigated based on reliability or validity. Inconclusive results were found regarding the impact of PPTs on patient waiting times. Advantages associated with PPT use were found mostly in relationship to acceptability of the tools by clinicians and increased transparency and equity for patients. CONCLUSIONS: This review describes the development and validation processes of PPTs used in non-urgent healthcare settings. Despite the large number of PPTs studied, implementation into clinical practice seems to be an open challenge. Based on the findings of this review, recommendations are proposed to develop, validate, and implement such tools in clinical settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018107205.

Patient prioritization tools and their effectiveness in non-emergency healthcare services: a systematic review protocol.

BACKGROUND: Waiting lists should be managed as fairly as possible to ensure that patients with greater or more urgent needs receive services first. Patient prioritization refers to the process of ranking referrals in a certain order based on various criteria with the aim of improving fairness and equity in the delivery of care. Despite the widespread use of patient prioritization tools (PPTs) in healthcare services, the existing literature on this subject has mainly focused on emergency settings. Evidence has not been synthesized with respect to all the non-emergency services. METHODS: This review aims to perform a systematic synthesis of published evidence concerning (1) prioritization tools' characteristics, (2) their metrological properties, and (3) their effect measures across non-emergency services. Five electronic databases will be searched (Cochrane Library, Ovid/MEDLINE, Embase, Web of Science, and CINAHL). Eligibility criteria guiding data selection will be (1) qualitative, quantitative, or mixed methods empirical studies; (2) patient prioritization in any non-emergency setting; and (3) discussing characteristic, metrological properties, or effect measures. Data will be sought to report tool's format, description, population, setting, purpose, criteria, developer, metrological properties, and outcome measures. Two reviewers will independently screen, select, and extract data. Data will be synthesized with sequential exploratory design method. We will use the Mixed Methods Appraisal Tool (MMAT) to assess the quality of articles included in the review. DISCUSSION: This systematic review will provide much-needed knowledge regarding patient prioritization tools. The results will benefit clinicians, decision-makers, and researchers by giving them a better understanding of the methods used to prioritize patients in clinical settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018107205.

[Regulators in access to anticancer drugs in Canada]. / Les régulateurs dans l’accès aux médicaments contre le cancer au Canada.

Based exclusively on drugs approved by provincial public health insurance systems, many authors have reported significant variability in terms of access to anticancer drugs (ACD) among Canadian citizens, raising problems of equal access to these drugs.In this paper, we emphasize that the mere presence on the list of public drug plans cannot be considered to be a sufficient indicator to determine the real availability of anticancer drugs (ACD) for the patient. We describe and compare four sets of regulators defined in each province and determine their effects on the accessibility of ACD for patients in each province. The term regulator comprises the conditions which must be observed for access via the public health insurance system as well as the rules (strategies) decided by the third-party payer for the management of these conditions.The results of our analyses lead to the conclusion that there is indeed a variation between provinces in terms of access to drugs financed by public funds, but that this variability primarily impacts less important treatments.

What is wrong with orphan drug policies?

The effects of orphan drug policies raise serious concerns among payer organizations and lead to often-tragic disappointment for patients who are denied much anticipated drug reimbursements. We evaluate the effects of orphan drug policies on the basis of this concern for real accessibility to drugs. We highlight two unforeseen effects of orphan drug policies: 1) they provide unique business opportunities for manufacturers and 2) drugs approved through these policies are often inaccessible because of their high price. We identify six causes of this emergence of effects. The first four are the direct result of incentives included in orphan drug policies. The fifth cause is the "off-label" use of orphan drugs. These emergent effects have several implications: 1) they raise doubts about the equity of access to drugs, 2) they highlight the limitations of the cohort paradigm in medicine, and c) they force third-party payers to make drugs accessible even when the prices of drugs are believed to be disproportionate to the clinical effects obtained.