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1.
Recurso de Internet en Español | LIS - Localizador de Información en Salud | ID: lis-48581

RESUMEN

El tema se centra en terminar con el estigma, la discriminación y el prejuicio en contra las personas afectadas por esta enfermedad. La campaña pretende crear conciencia sobre el impacto que la discriminación y el estigma social tienen en las personas afectadas por la Lepra, y sobre cómo estas actitudes obstaculizan los esfuerzos para detener la propagación de la enfermedad.


Asunto(s)
Lepra , Estrategias de eSalud
4.
Multimedia | Recursos Multimedia | ID: multimedia-9561

RESUMEN

Durante esta sesión, el equipo directivo de la RECAINSA, compartió las principales actividades realizadas durante el 2021 así como los resultados obtenidos, las lecciones aprendidas y las proyecciones de trabajo del 2022 de la Red.


Asunto(s)
Informática Médica , Estrategias de eSalud , Telemedicina
5.
Artículo en Español | PAHO-IRIS | ID: phr-55571

RESUMEN

[RESUMEN]. Objetivo. Estimar el impacto presupuestal de la vacunación contra COVID-19 en seis países de América Latina: Argentina, Brasil, Chile, Colombia, México y Perú, durante el periodo 2021-2022. Métodos. Se evaluaron las vacunas de Sinopharm (BBIBP-CorV), Janssen (JNJ-78436735), Instituto de Gamaleya (Gam-COVID-Vac), Sinovac (CoronaVac), CanSino (Convidecia), AstraZeneca (Vaxzevria), Moderna (mRNA-1273) y Pfizer (BNT162b2), según disponibilidad para cada país. Se adoptó la perspectiva del sistema de salud, de manera que solo se incluyeron costos médicos directos. El horizonte temporal se adoptó teniendo en cuenta los tiempos de implementación de cada plan de vacunación, excluyendo menores de 16 años y gestantes. Se incluyeron los siguientes costos: costo de la vacunación y aplicación, costos de la hospitalización general aislamiento, cuidado intermedio e intensivo. Se compararon dos escenarios de vacunación: 1) Población que desea vacunarse (según las encuestas nacionales) y 2) Población que debería vacunarse (total susceptible de vacunación). Los costos agregados para cada escenario de vacunación se compararon con el escenario de no vacunación. Adicionalmente, se realizaron análisis de sensibilidad determinísticos y probabilísticos. Resultados. Los diferentes esquemas de vacunación contra COVID-19 disponibles en América Latina generan ahorros potenciales que oscilan entre USD 100 y USD 1 500 millones de dólares por país para el período 2021-2022, asumiendo que se logra implementar en su totalidad el plan de vacunación previsto en cada país. Conclusiones. La vacunación contra COVID-19 es una estrategia que además de reducir la morbilidad y mortalidad para Latinoamérica, genera ahorros potenciales para los sistemas de salud en la región.


[ABSTRACT]. Objective. To estimate the budgetary impact of COVID-19 vaccination in six Latin American countries: Argentina, Brazil, Chile, Colombia, Mexico, and Peru, during the 2021-2022 biennium. Methods. Vaccines from Sinopharm (BBIBP-CorV), Janssen (JNJ-78436735), Gamaleya Institute (Gam-COVID-Vac), Sinovac (CoronaVac), CanSino (Convidecia), AstraZeneca (Vaxzevria), Moderna (mRNA-1273), and Pfizer (BNT162b2) were evaluated, according to their availability in each country. The health system perspective was adopted, so that only direct health care costs were included. The time horizon adopted took into account the implementation times of each vaccination plan, excluding children under 16 years of age and pregnant persons. The following costs were included: cost of vaccination/vaccine administration and costs of hospitalization (general isolation, stepdown care, and intensive care). Two vaccination scenarios were compared: 1) population wanting to be vaccinated (according to national surveys); and 2) population that should be vaccinated (total population susceptible to vaccination). The aggregate costs for each vaccination scenario were compared with the no-vaccination scenario. Deterministic and probabilistic sensitivity analyses were also performed. Results. The different COVID-19 vaccination regimens available in Latin America generate potential savings ranging from USD 100 million to USD 1.5 billion per country for the 2021-2022 biennium, assuming that the vaccination plan proposed for each country is fully implemented. Conclusions. COVID-19 vaccination is a strategy that not only reduces morbidity and mortality in Latin America, but also generates potential savings for health systems in the region.


[RESUMO]. Objetivo. Estimar o impacto orçamentário da vacinação contra a COVID-19 em seis países da América Latina: Argentina, Brasil, Chile, Colômbia, México e Peru, no período 2021-2022. Métodos. Foram avaliadas as vacinas da Sinopharm (BBIBP-CorV), Janssen (JNJ-78436735), Instituto Gamaleya (Gam-COVID-Vac), Sinovac (CoronaVac), CanSino (Convidecia), AstraZeneca (Vaxzevria), Moderna (mRNA-1273) e Pfizer (BNT162b2), conforme a disponibilidade para cada país. Adotou-se a perspectiva do sistema de saúde, de forma que só foram incluídos custos médicos diretos. O horizonte temporal foi adotado levando em consideração os tempos de implementação de cada plano de vacinação, excluindo crianças menores de 16 anos e gestantes. Foram incluídos os seguintes custos: custos de vacinação e aplicação, custos gerais de hospitalização, isolamento, e cuidados intermediários e intensivos. Compararam-se dois cenários de vacinação: 1) população disposta a se vacinar (com base em pesquisas nacionais) e 2) população que deveria ser vacinada (total elegível de vacinação). Os custos agregados para cada cenário de vacinação foram comparados com o cenário de não vacinação. Além disso, foram realizadas análises de sensibilidade determinísticas e probabilísticas. Resultados. Os diferentes esquemas de vacinação contra a COVID-19 disponíveis na América Latina geram economias potenciais entre 100 milhões e 1,5 bilhão de dólares por país para o período 2021-2022, considerando a implementação completa do plano de vacinação previsto em cada país. Conclusões. A vacinação contra a COVID-19 é uma estratégia que, além de reduzir a morbidade e a mortalidade na América Latina, gera economias potenciais para os sistemas de saúde da região.


Asunto(s)
Vacunación , Coronavirus , COVID-19 , SARS-CoV-2 , Costos de la Atención en Salud , Vacunas contra la COVID-19 , América Latina , Vacunación , Vacunas contra la COVID-19 , Costos de la Atención en Salud , América Latina , Vacunación , Vacunas contra la COVID-19 , Costos de la Atención en Salud
6.
Washington, D.C.; PAHO; 2022-01-11. (PAHO/HSS/HS/21-0014).
No convencional en Inglés | PAHO-IRIS | ID: phr-55564

RESUMEN

The measurement of health spending and the monitoring of resources through the SHA 2011 health accounts system represent invaluable tools for decision-making and the adoption of health policies. Knowing how much is being spent and how it is being spent allows, for example, to verify whether spending is linked to a country's policy priorities; if the resources of the system are translated into greater and better health benefits; and if the resources are allocated according to the specific health needs and therefore achieve the maximum potential for the population. This strategic information facilitates the monitoring of progress towards the objectives of access and universal coverage of the system from financing, with efficiency, equity and sustainability. This publication describes the data from a survey of health accountants in the Region of the Americas, with the objective of analyzing the key elements to improve the institutionalization strategies of health accounts in the countries. Thus, it was found that the frequency of staff turnover and insufficient resources represent obstacles to full institutionalization. The background to the establishment and expansion of the accounts in Latin America, and the disclosure practices of the most frequent results, are also described. It concludes with final thoughts and recommendations.


Asunto(s)
Sistemas de Salud , Servicios de Salud , Prioridades en Salud , Toma de Decisiones , Recursos Financieros en Salud , Financiación de los Sistemas de Salud , Américas
7.
Washington, D.C.; OPS; 2022-01-06. (OPS/EGC/COVID-19/21-0006).
No convencional en Español | PAHO-IRIS | ID: phr-55557

RESUMEN

La COVID-19 ha generado efectos catastróficos en los sistemas de salud y en la salud de las personas en la Región de las Américas, en especial en el caso de las mujeres y las niñas, cuyas condiciones han empeorado en todos los ámbitos. Las mayores preocupaciones al respecto se centran en las consecuencias directas (morbilidad y mortalidad) de la acción del virus sobre poblaciones definidas, en los resultados de las medidas orientadas a mitigar la propagación del virus y en el efecto indirecto sobre las condiciones socioeconómicas. En este complejo escenario, el enfoque de género, con sus consecuencias en el contexto actual, no ha recibido la debida atención durante la pandemia. El género es uno de los determinantes estructurales asociados a la salud, pero no aparece en los análisis de los efectos directos e indirectos de la pandemia. Además, es fundamental para reconocer y analizar los efectos diferenciales de la pandemia sobre hombres y mujeres y su interacción con los diferentes determinantes de la salud. El presente informe es una iniciativa de la Organización Panamericana de la Salud y apunta a generar un conjunto de conocimientos que permitan, por un lado, reconocer, entender e instalar la temática de género y salud en el contexto de la pandemia, y, por otro, comprender el comportamiento de la enfermedad y sus posibles efectos. El informe se cierra con una serie de conclusiones y recomendaciones sobre datos y evidencia, y sobre respuestas en planes y políticas.


Asunto(s)
COVID-19 , Coronavirus , Infecciones por Coronavirus , Género y Salud , Mujeres , Determinantes Sociales de la Salud , Mortalidad , Morbilidad , Factores Socioeconómicos , Pandemias , Sistemas de Salud , Política de Salud
8.
Washington, D.C.; OPS; 2022-01-04. (OPAS/HSS/HS/21-0014).
No convencional en Portugués | PAHO-IRIS | ID: phr-55551

RESUMEN

A mensuração dos gastos com saúde e o monitoramento dos recursos por meio do sistema de contas de saúde SHA 2011 representam ferramentas valiosas para a tomada de decisões e a adoção de políticas de saúde. Saber quanto está sendo gasto e como está sendo gasto permite, por exemplo, verificar se o gasto está vinculado às prioridades políticas de um país; se os recursos do sistema se traduzem em maiores e melhores benefícios à saúde; e se os recursos são alocados de acordo com as necessidades específicas de saúde e, portanto, atingem o máximo potencial de benefícios para a população. Essas informações estratégicas facilitam o monitoramento do andamento dos objetivos de acesso e cobertura universal do sistema a partir do financiamento, com eficiência, equidade e sustentabilidade. Esta publicação descreve os dados de uma pesquisa com contadores de saúde na Região das Américas com o objetivo de analisar os elementos-chave para melhorar as estratégias de institucionalização das contas de saúde nos países. Assim, constatou-se que a frequência de rotatividade de pessoal e a insuficiência de recursos representam entraves à plena institucionalização. Descreve também os antecedentes do estabelecimento e expansão das contas na América Latina e as práticas de divulgação dos resultados mais frequentes. Conclui com considerações finais e recomendações.


Asunto(s)
Sistemas de Salud , Rendición de Cuentas Financieras en Salud , Políticas, Planificación y Administración en Salud , Política de Salud , Gastos en Salud , Política Pública , Salud Pública , Cobertura Universal de Salud , Estrategias para Cobertura Universal de Salud , Recursos en Salud , Américas , América Latina
9.
Washington, D.C.; OPS; 2022-01-04. (OPS/HSS/HS/21-0014).
No convencional en Español | PAHO-IRIS | ID: phr-55550

RESUMEN

La medición del gasto en salud y el seguimiento de recursos a través del sistema de cuentas de salud SHA2011 representan herramientas invaluables para la toma de decisiones y la adopción de políticas de salud. Conocer cuánto se gasta y cómo se gasta permite, por ejemplo, verificar si el gasto se vincula con las prioridades de política de un país; si los recursos del sistema se traducen en mayores y mejores prestaciones de salud; y si los recursos son asignados de acuerdo con las necesidades de salud específicas y alcanzan, por tanto, el máximo potencial de beneficios para la población. Esta información estratégica facilita el monitoreo del avance hacia los objetivos de acceso y cobertura universal del sistema desde el financiamiento, con eficiencia, equidad y sostenibilidad. Esta publicación describe los datos de una encuesta realizada a contadores de salud de la Región de las Américas con el objetivo de analizar los elementos clave para mejorar las estrategias de institucionalización de las cuentas de salud en los países. Así, se constató que la frecuencia en la rotación de personal y la insuficiencia de recursos representan obstáculos para la plena institucionalización. También se describen los antecedentes del establecimiento y la ampliación de las cuentas en América Latina y las prácticas de divulgación de los resultados más frecuentes. Concluye con reflexiones finales y recomendaciones.


Asunto(s)
Sistemas de Salud , Rendición de Cuentas Financieras en Salud , Políticas, Planificación y Administración en Salud , Política de Salud , Gastos en Salud , Política Pública , Salud Pública , Cobertura Universal de Salud , Estrategias para Cobertura Universal de Salud , Recursos en Salud , América Latina , Américas
10.
Clin Infect Dis ; 2022 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-35015842

RESUMEN

Testing programs for SARS-CoV-2 have relied on high-throughput PCR laboratories and rapid antigen assays to meet diagnostic needs. Both technologies are essential, however issues of cost, accessibility, manufacturing delays and performance have limited their use in low resource settings and contributed to the global inequity in Covid-19 testing. Emerging low-cost, multi-disease point-of-care nucleic acid tests may address these limitations and strengthen pandemic preparedness, especially within primary healthcare where most cases of disease first present. Widespread deployment of these novel technologies will also help close long-standing test access gaps for other diseases, including tuberculosis, HIV, cervical cancer, viral hepatitis and sexually transmitted infections. We propose a more optimized testing framework based on greater use of point-of-care nucleic acid tests together with rapid immunologic assays and high-throughput laboratory molecular tests to improve the diagnosis of priority endemic and epidemic diseases, as well as strengthen the overall delivery of primary healthcare services.

11.
Int J Audiol ; : 1-10, 2022 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-35015968

RESUMEN

OBJECTIVE: Post-implant rehabilitation is limited for adult cochlear implant (CI) recipients. The objective of this research was to capture the perspectives of CI users and their coaches regarding their experiences with auditory-verbal intervention as an example of post-implant rehabilitation and their views on perceived benefits and challenges related to the intervention. DESIGN: This qualitative study involved semi-structured focus group interviews with adult CI users and their coaches who accompanied them in a 24-week auditory-verbal intervention program. STUDY SAMPLE: A total of 17 participants (eight CI users and nine coaches) contributed to the interviews. RESULTS: Three key topic areas emerged from the interviews capturing CI users' and coaches' experiences related to the intervention program: (1) benefits of the intervention, (2) factors affecting experiences, and (3) challenges and barriers. Benefits included increased confidence in hearing, communication, social participation, and new knowledge about technology and hearing. Factors affecting the experience were participants' motivation and the therapist's skills. The primary challenge was the time commitment for weekly therapy. CONCLUSIONS: Both CI users and coaches perceived a focussed auditory-verbal intervention to be beneficial in improving speech understanding, confidence in using hearing, social interaction, and knowledge about technology. Participants recommended reducing the intensity of intervention to facilitate participation.

12.
Fam Pract ; 2022 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-35016210

RESUMEN

BACKGROUND: General practice in the United Kingdom is experiencing a workforce crisis. Greater multidisciplinary working, including more general practice pharmacists, is seen as part of the solution. However, it is unknown what impact and cost-consequences that pharmacists may have in freeing general practitioner (GP) capacity. OBJECTIVE: To evaluate the cost-consequences of additional pharmacists in releasing GP capacity. METHODS: This cost-consequences evaluation of a prospective observational cohort study in 15 urban practices involving 69 GPs in 1 locality serving a population of 82,000 people. GPs recorded the time they spent addressing key targeted prescribing activities during 5 distinct 2-week audit periods. Pharmacists performed these key prescribing activities to release GP capacity. An additional 225 h of pharmacists' time per week was committed to the locality. Standardized staff costings were used to estimate the financial impact. Prescribing indicator performance was assessed against the other 7 localities within the health board. RESULTS: When compared with employing extra nonsalaried GPs this required an estimated additional investment of £16.73 (range £5.97-20.87) per h to free GP capacity. This achieved a sustainable 47% (73 h per week, F(4,56) = 16.05, P < 0.001) reduction in GP time spent on key prescribing activities; equating to 4.9 h (95% confidence interval 3.1-6.7) per practice per week. No significant step changes in locality safety and quality prescribing measures, and no negative effects on locality-level prescribing cost-efficiency work were observed. CONCLUSION: Appropriately resourced general practice pharmacy teams delivered prescribing cost-efficiencies as well as sustainably freeing GP capacity by performing key prescribing activities.


General practice in the United Kingdom is experiencing a workforce crisis, and is struggling to deliver services. Pharmacists have been shown to be effective in freeing general practitioner (GP) capacity. However, it is unknown how much it costs to do this. Therefore, we aimed to assess the cost-consequences of releasing GP capacity. All practices in 1 region took part. GPs recorded the time it routinely took them to address key prescribing activities, Spring 2016. Pharmacists then delivered the key prescribing activities. The region got an extra 225 h of pharmacists' time to do these activities. Then in Spring 2018, the GPs and pharmacists recorded the time took to do the key prescribing activities. Standard salary costs were used to estimate how much money was needed to free GP capacity with pharmacists. The impact on routine cost-effective work was also assessed. Pharmacists delivering key prescribing activities freed 73 h per week of GP time. This equalled an average of 5 h per week per practice. Freeing GP capacity was estimated to cost an extra £16.73 (range £5.97­20.87) per h. There were no negative effects on cost-efficiency work. Appropriately resourcing general practice with pharmacists delivers sustainable prescribing cost-efficiencies and frees GP capacity.

13.
J Manag Care Spec Pharm ; : 1-10, 2022 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-35016547

RESUMEN

Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.

14.
J Immunol ; 208(2): 197-202, 2022 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-35017208

RESUMEN

Minority groups face barriers in accessing quality health care, professional advancement, and representation in immunology research efforts as a result of institutional racism that if unaddressed can perpetuate a lack of diversity. In 2021, the AAI Minority Affairs Committee convened a cross section of academic and industry scientists from underrepresented groups at various stages of their professions to discuss how best to address the toll racism takes on study design and scientific careers. Panelists drew directly from their own experiences as scientists to share perspectives and strategies for countering a lack of representation in clinical research, responding to microaggressions, navigating academic advancement, and providing effective mentorship. The session reinforced the need for minority scientists to take an active role in advocating for diversity, engaging mentors, and taking responsibility to face rather than avoid institutional obstacles. Overall, increased dialogue and institutional awareness of the experience of scientists from underrepresented groups in research remain the best tools to ensure a health equity mindset and advancement of their careers.

15.
Artículo en Inglés | MEDLINE | ID: mdl-35017226

RESUMEN

BACKGROUND: Globally, access to safe abortion is limited. We aimed to assess the safety, effectiveness and acceptability of harm reduction counselling for abortion, which we define as the provision of information about safe abortion methods to pregnant persons seeking abortion. METHODS: We searched PubMed, EMBASE, ClinicalTrials.gov, Cochrane, Global Index Medicus and the grey literature up to October 2021. We included studies in which healthcare providers gave pregnant persons information on safe use of abortifacient medications without providing the actual medications. We conducted a descriptive summary of results and a risk of bias assessment using the ROBINS-I tool. Our primary outcome was the proportion of pregnant persons who used misoprostol to induce abortion rather than other methods among those who received harm reduction counselling. RESULTS: We included four observational studies with a total of 4002 participants. Most pregnant persons who received harm reduction counselling induced abortion using misoprostol (79%-100%). Serious complication rates were low (0%-1%). Uterine aspiration rates were not always reported but were in the range of 6%-22%. Patient satisfaction with the harm reduction intervention was high (85%-98%) where reported. We rated the risk of bias for all studies as high due to a lack of comparison groups and high lost to follow-up rates. DISCUSSION: Based on a synthesis of four studies with serious methodological limitations, most recipients of harm reduction counselling use misoprostol for abortion, have low complication rates, and are satisfied with the intervention. More research is needed to determine abortion success outcomes from the harm reduction approach. FUNDING: This work did not receive any funding. PROSPERO REGISTRATION NUMBER: We registered the review in the PROSPERO database of systematic reviews (ID number: CRD42020200849).

16.
BMJ Open ; 12(1): e053486, 2022 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-35017248

RESUMEN

OBJECTIVE: To assess the feasibility, usability and acceptability of two non-invasive, multiparameter, continuous physiological monitoring (MCPM) technologies for use in neonates within a resource-constrained healthcare setting in sub-Saharan Africa. DESIGN: A qualitative study using in-depth interviews and direct observations to describe healthcare professional and caregiver perspectives and experiences with investigational MCPM technologies from EarlySense and Sibel compared with selected reference technologies. SETTING: Pumwani Maternity Hospital is a public, high-volume, tertiary hospital in Nairobi, Kenya. PARTICIPANTS: In-depth interviews were conducted with five healthcare administrators, 12 healthcare providers and 10 caregivers. Direct observations were made of healthcare providers using the technologies on 12 neonates overall. RESULTS: Design factors like non-invasiveness, portability, ease-of-use and ability to measure multiple vital signs concurrently emerged as key themes supporting the usability and acceptability of the investigational technologies. However, respondents also reported feasibility challenges to implementation, including overcrowding in the neonatal unit, lack of reliable access to electricity and computers, and concerns about cost and maintenance needs. To improve acceptability, respondents highlighted the need for adequate staffing to appropriately engage caregivers and dispel misconceptions about the technologies. CONCLUSION: Study participants were positive about the usefulness of the investigational technologies to strengthen clinical care quality and identification of at-risk neonates for better access to timely interventions. These technologies have the potential to improve equity of access to appropriate healthcare services and neonatal outcomes in sub-Saharan African healthcare facilities. However, health system strengthening is also critical to support sustainable uptake of technologies into routine care. TRIAL REGISTRATION NUMBER: NCT03920761.

17.
BMJ Open ; 12(1): e057191, 2022 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-35017257

RESUMEN

INTRODUCTION: Inappropriate medication use is a leading cause of avoidable harm in health systems and is particularly severe in primary care settings. Evidence has shown that the integration of pharmacists into primary care clinics has favourable satisfaction and effectiveness in health outcomes. However, barriers to and facilitators of pharmacist services in these settings have not been comprehensively reviewed. Therefore, this scoping review aims to map and examine the literature available on the barriers to and facilitators of the implementation of pharmacist services in primary care clinics to guide future implementation research. METHODS AND ANALYSIS: This scoping review will be undertaken following the six-stage framework developed by Arksey and O'Malley and be guided by recommendations by Levac et al. Eight electronic databases (PubMed, Embase, Scopus, Web of Science, CINAHL, PsycINFO, CNKI and Wanfang) will be searched. Reference lists and related citations, and grey literature from websites will be searched manually. Available information that has been reported in Chinese or English up to 31 August 2021 will be included. Studies will be selected and screened by two reviewers independently. Findings from the included studies will be extracted by two independent reviewers and supervised by a third reviewer. A content analysis of the findings will be performed using MAXQDA 2020. ETHICS AND DISSEMINATION: Ethical approval will not be required for this scoping review, as all data and information will be obtained from publicly available literature. The findings of this scoping review will be shared with healthcare managers in primary care institutions and health authorities as well as disseminated via publication in a peer-reviewed journal.

18.
Tob Control ; 2022 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-35017262

RESUMEN

BACKGROUND: Policy simulation models (PSMs) have been used extensively to shape health policies before real-world implementation and evaluate post-implementation impact. This systematic review aimed to examine best practices, identify common pitfalls in tobacco control PSMs and propose a modelling quality assessment framework. METHODS: We searched five databases to identify eligible publications from July 2013 to August 2019. We additionally included papers from Feirman et al for studies before July 2013. Tobacco control PSMs that project tobacco use and tobacco-related outcomes from smoking policies were included. We extracted model inputs, structure and outputs data for models used in two or more included papers. Using our proposed quality assessment framework, we scored these models on population representativeness, policy effectiveness evidence, simulated smoking histories, included smoking-related diseases, exposure-outcome lag time, transparency, sensitivity analysis, validation and equity. FINDINGS: We found 146 eligible papers and 25 distinct models. Most models used population data from public or administrative registries, and all performed sensitivity analysis. However, smoking behaviour was commonly modelled into crude categories of smoking status. Eight models only presented overall changes in mortality rather than explicitly considering smoking-related diseases. Only four models reported impacts on health inequalities, and none offered the source code. Overall, the higher scored models achieved higher citation rates. CONCLUSIONS: While fragments of good practices were widespread across the reviewed PSMs, only a few included a 'critical mass' of the good practices specified in our quality assessment framework. This framework might, therefore, potentially serve as a benchmark and support sharing of good modelling practices.

19.
J Gen Intern Med ; 2022 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-35018561

RESUMEN

BACKGROUND: Financial distress is a barrier to cessation among low-income smokers. OBJECTIVE: To evaluate an intervention that integrated financial coaching and benefits referrals into a smoking cessation program for low-income smokers. DESIGN: Randomized waitlist control trial conducted from 2017 to 2019. PARTICIPANTS: Adult New York City residents were eligible if they reported past 30-day cigarette smoking, had income below 200% of the federal poverty level, spoke English or Spanish, and managed their own funds. Pregnant or breastfeeding people were excluded. Participants were recruited from two medical centers and from the community. INTERVENTION: The intervention (n = 208) offered smoking cessation coaching, nicotine replacement therapy, money management coaching, and referral to financial benefits and empowerment services. The waitlist control (n=202) was usual care during a 6-month waiting period. MAIN MEASURES: Treatment engagement, self-reported 7-day abstinence, and financial stress at 6 months. KEY RESULTS: At 6 months, intervention participants reported higher abstinence (17% vs. 9%, P=0.03), lower stress about finances (ß, -0.8 [SE, 0.4], P=0.02), and reduced frequency of being unable to afford activities (ß, -0.8 [SE, 0.4], P=0.04). Outcomes were stronger among participants recruited from the medical centers (versus from the community). Among medical center participants, the intervention was associated with higher abstinence (20% vs. 8%, P=0.01), higher satisfaction with present financial situation (ß, 1.0 [SE, 0.4], P=0.01), reduced frequency of being unable to afford activities (ß, -1.0 [SE, 0.5], P=0.04), reduced frequency in getting by paycheck-to-paycheck (ß, -1.0 [SE, 0.4], P=0.03), and lower stress about finances in general (ß, -1.0 [SE, 0.4], P = 0.02). There were no group differences in outcomes among people recruited from the community (P>0.05). CONCLUSIONS: Among low-income smokers recruited from medical centers, the intervention produced higher abstinence rates and reductions in some markers of financial distress than usual care. The intervention was not efficacious with people recruited from the community. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03187730.

20.
J Gen Intern Med ; 2022 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-35018563

RESUMEN

Amidst a substance use epidemic, hospitalizations and valve surgeries related to drug use-associated infective endocarditis (DU-IE) rose substantially in the last decade. Rates of reoperation and mortality remain high, yet in many hospitals patients are not offered valve surgery or evidence-based addiction treatment. A multidisciplinary team approach can improve outcomes in patients with infective endocarditis; however, the breadth of expertise that should be incorporated into this team is inadequately conceptualized. It is our opinion that incorporating addiction medicine services into the team may improve outcomes in DU-IE. Here, we describe our experience incorporating addiction medicine services into the multidisciplinary management of DU-IE and share implications for other hospitals and health systems looking to improve care for people with DU-IE.

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