Suchergebnisse

Imagine a health professional in any European country who fell asleep in 1960 and awoke in a health facility in 2019. Much of what the observer saw would be quite different. There would be many more patients who were surviving into old age thanks to advances in therapy. Many of the treatments that they were receiving would be much more complex, involving radically new techniques such as laparoscopic or even robotic surgery, and they would be amazed by the advances in diagnostic capacity. Yet, in many health systems, some things would have changed very little. Among them would be the traditional roles of different types of health worker, with responsibility for certain task being reserved for those with particular qualifications based on custom and practice rather than on evidence. This opinion argues that this situation must change. There is now an impressive body of evidence that things can often be done differently. This does not mean that they should be. Change is only appropriate where it helps to achieve the goals of the health system and allows it to provide better care in ways that are more responsive to the needs of users. Tasks can be shifted from health workers to patients and their carers, to machines, and to other health workers. Where these shifts have been evaluated, they often, but not always, are associated with outcomes that are as good or even better than with the status quo. However, the results are often context dependent, and it cannot be assumed that what works in one situation will apply equally to another. What matters is the evidence, rather than traditional, but often obsolete rules. If a health system can ensure that tasks are being undertaken by those most appropriate to do them, it will enhance patient care. However, change is often difficult. Those involved must be convinced of the rationale for change and must be supported in implementing it. This should recognise that any change in roles will have implication for their status and thus existing hierarchies. It may also be necessary to challenge outdated legislative or regulatory barriers. Finally, it is essential the changes are evaluated, results are documented, and lessons are learned, both in relation to what works and in what circumstances. Task shifting, where it is based on robust evidence and implemented effectively, can make a major contribution to health outcomes and to the sustainability of health systems. It is not, however, a panacea for all of the challenges health systems face. ; Představte si zdravotnického odborníka v kterékoli evropské zemi, který usnul v roce 1960 a probudil se ve zdravotnickém zařízení v roce 2019. Hodně z toho, co by pozorovatel viděl, by bylo úplně jiné. Bylo by mnohem více pacientů, kteří přežili do stáří díky pokrokům v terapii. Mnoho z ošetření, které dostávali, by bylo mnohem složitější, zahrnovalo radikálně nové techniky, jako je laparoskopická nebo dokonce robotická chirurgie, a byl by ohromen pokrokem v diagnostickém rozsahu. Přesto by se v mnoha zdravotnických systémech některé věci změnily jen velmi málo. Mezi nimi by byly tradiční role různých typů zdravotnických pracovníků, přičemž odpovědnost za určitý úkol by byla vyhrazena těm, kteří mají zvláštní kvalifikaci založenou spíše na zvyklostech a praxi než na důkazech. Toto stanovisko tvrdí, že se tato situace musí změnit. Nyní existuje impozantní soubor důkazů, že věci lze často dělat jinak. To neznamená, že by měli být jinak dělány. Změna je vhodná pouze tam, kde pomáhá dosahovat cílů zdravotnického systému a umožňuje jí poskytovat lepší péči způsoby, které lépe reagují na potřeby uživatelů. Úkoly lze převádět ze zdravotnických pracovníků na pacienty a jejich pečovatele, na stroje a další zdravotnické pracovníky. Tam, kde byly tyto posuny vyhodnoceny, jsou často, ale ne vždy, spojeny s výsledky, které jsou stejně dobré nebo dokonce lepší než za současného stavu. Výsledky jsou však často závislé na kontextu a nelze předpokládat, že to, co funguje v jedné situaci, se bude vztahovat stejně na jiné. Důležitý je důkaz spíše než tradiční, ale často zastaralá pravidla. Pokud zdravotní systém může zajistit, že osoby, které jsou pro ně nejvhodnější, plní správně alokované úkoly, zlepší se péče o pacienty. Změna je však často obtížná. Zúčastněné strany musí být přesvědčeny o důvodech změny a musí být podporovány při jejich provádění. Musí uznat, že každá změna rolí bude mít dopad na jejich stav, a tedy na existující hierarchie. Může být také třeba změnit zastaralé legislativní nebo regulační překážky. Nakonec je nezbytné, aby byly změny vyhodnoceny, výsledky zdokumentovány a vedly k ponaučení, co funguje a za jakých okolností. Posun úkolů, činností a kompetencí, pokud je založen na spolehlivých důkazech a je účinně prováděn, může významně přispět k lepším výsledkům v oblasti zdraví a k udržitelnosti zdravotních systémů. Nejedná se však o všelék na všechny výzvy, kterým zdravotnické systémy čelí. ; Imagine a health professional in any European country who fell asleep in 1960 and awoke in a health facility in 2019. Much of what the observer saw would be quite different. There would be many more patients who were surviving into old age thanks to advances in therapy. Many of the treatments that they were receiving would be much more complex, involving radically new techniques such as laparoscopic or even robotic surgery, and they would be amazed by the advances in diagnostic capacity. Yet, in many health systems, some things would have changed very little. Among them would be the traditional roles of different types of health worker, with responsibility for certain task being reserved for those with particular qualifications based on custom and practice rather than on evidence. This opinion argues that this situation must change. There is now an impressive body of evidence that things can often be done differently. This does not mean that they should be. Change is only appropriate where it helps to achieve the goals of the health system and allows it to provide better care in ways that are more responsive to the needs of users. Tasks can be shifted from health workers to patients and their carers, to machines, and to other health workers. Where these shifts have been evaluated, they often, but not always, are associated with outcomes that are as good or even better than with the status quo. However, the results are often context dependent, and it cannot be assumed that what works in one situation will apply equally to another. What matters is the evidence, rather than traditional, but often obsolete rules. If a health system can ensure that tasks are being undertaken by those most appropriate to do them, it will enhance patient care. However, change is often difficult. Those involved must be convinced of the rationale for change and must be supported in implementing it. This should recognise that any change in roles will have implication for their status and thus existing hierarchies. It may also be necessary to challenge outdated legislative or regulatory barriers. Finally, it is essential the changes are evaluated, results are documented, and lessons are learned, both in relation to what works and in what circumstances. Task shifting, where it is based on robust evidence and implemented effectively, can make a major contribution to health outcomes and to the sustainability of health systems. It is not, however, a panacea for all of the challenges health systems face.

The Expert Panel provides its analysis and recommendations on the following points: (a) What are the mechanisms for strengthening the implementation of health promotion within health systems, how can health systems incorporate, integrate and foster health promotion efforts and paradigms, and what policies need to be in place to make this happen from a health-in-all policies perspective? (b) As public health services and primary health care are operating in an increasingly integrated way, how can this joint approach contribute to action and implementation of health promotion and improved health literacy and how could this development be linked to social care? (c) What could be the success factors for further integration from a conceptual, organisational and financing point of view? And what are the main obstacles and challenges to address? ; Panel odborníků poskytuje svou analýzu a doporučení k následujícím bodům: a) Jaké jsou mechanismy pro posílení provádění podpory zdraví v rámci zdravotních systémů, jak je mohou zdravotní systémy začlenit, integrovat a podporovat úsilí a paradigmata podpory zdraví a jaké politiky je třeba zavést, aby se toto odvíjelo z perspektivy politiky "Health-in-all"? b) Jak veřejné zdravotnické služby a primární zdravotní péče fungují stále integrovanějším způsobem, jak může tento společný přístup přispět k akci a provádění podpory zdraví a zlepšení zdravotní gramotnosti a jak by mohl být tento vývoj spojen se sociální péčí? c) Jaké by mohly být faktory úspěchu pro další integraci z hlediska koncepčního, organizačního a finančního? A jaké hlavní překážky a výzvy je třeba řešit? ; The Expert Panel provides its analysis and recommendations on the following points: (a) What are the mechanisms for strengthening the implementation of health promotion within health systems, how can health systems incorporate, integrate and foster health promotion efforts and paradigms, and what policies need to be in place to make this happen from a health-in-all policies perspective? (b) As public health services and primary health care are operating in an increasingly integrated way, how can this joint approach contribute to action and implementation of health promotion and improved health literacy and how could this development be linked to social care? (c) What could be the success factors for further integration from a conceptual, organisational and financing point of view? And what are the main obstacles and challenges to address?

BACKGROUND: Family medicine (FM) is a relatively new discipline in sub-Saharan Africa (SSA), still struggling to find its place in the African health systems. The aim of this review was to describe the current status of FM in SSA and to map existing evidence of its strengths, weaknesses, effectiveness and impact, and to identify knowledge gaps. METHODS: A scoping review was conducted by systematically searching a wide variety of databases to map the existing evidence. Articles exploring FM as a concept/philosophy, a discipline, and clinical practice in SSA, published in peer-reviewed journals from 2000 onwards and in English language, were included. Included articles were entered in a matrix and then analysed for themes. Findings were presented and validated at a Primafamed network meeting, Gauteng 2018. RESULTS: A total of 73 articles matching the criteria were included. FM was first established in South Africa and Nigeria, followed by Ghana, several East African countries and more recently additional Southern African countries. In 2009, the Rustenburg statement of consensus described FM in SSA. Implementation of the discipline and the roles and responsibilities of family physicians (FPs) varied between and within countries depending on the needs in the health system structure and the local situation. Most FPs were deployed in district hospitals and levels of the health system, other than primary care. The positioning of FPs in SSA health systems is probably due to their scarcity and the broader mal-distribution of physicians. Strengths such as being an "all- round specialist", providing mentorship and supervision, as well as weaknesses such as unclear responsibilities and positioning in the health system were identified. Several studies showed positive perceptions of the impact of FM, although only a few health impact studies were done, with mixed results. CONCLUSIONS: FM is a developing discipline in SSA. Stronger evidence on the impact of FM on the health of populations requires a critical mass of FPs and shared clarity of their position in the health system. As FM continues to grow in SSA, we suggest improved government support so that its added value and impact on health systems in terms of health equity and universal health coverage can be meaningfully explored.

The impact of digitalization of health services has been profound and is expected to be even more profound in the future. It is important to evaluate whether digital health services contribute to health system goals in an optimal way. This should be done at the level of the service, not the 'digital transformation'. Decisions to adopt new digital health services, at different levels of the health care system, are ideally based on evidence regarding their performance in light of health system goals. In order to evaluate this, a broad perspective should be taken in evaluations of digital health services. Attainment of the broad health system goals, including quality, efficiency and equity, are objectives against which to judge new digital health services. These goals in a broad sense are unaltered by the process of digitalization. Governance should be designed and tailored in such a way to capture all relevant changes in an adequate way. When evaluating digital health services many specific aspects need to be considered. Like for other innovations and (new) technologies, such promises may or may not materialize and potential benefits may also be accompanied by unintended and/or negative (side) effects in the short or long term. Hence, the introduction, implementation, use and funding of digital health technologies should be carefully evaluated and monitored. Governments should play a more active role in the further optimization both of the process of decision making (both at the central and decentral level) and the related outcomes. They need to find a balance between centralized and decentralized activity. Moreover, the broader preparation of the health care system to be able to deal with digitalization, from education, through financial and regulatory preconditions, to implementation of monitoring systems to monitor its effects on health system performance remains important.

The impact of digitalization of health services has been profound and is expected to be even more profound in the future. It is important to evaluate whether digital health services contribute to health system goals in an optimal way. This should be done at the level of the service, not the 'digital transformation'. Decisions to adopt new digital health services, at different levels of the health care system, are ideally based on evidence regarding their performance in light of health system goals. In order to evaluate this, a broad perspective should be taken in evaluations of digital health services. Attainment of the broad health system goals, including quality, efficiency and equity, are objectives against which to judge new digital health services. These goals in a broad sense are unaltered by the process of digitalization. Governance should be designed and tailored in such a way to capture all relevant changes in an adequate way. When evaluating digital health services many specific aspects need to be considered. Like for other innovations and (new) technologies, such promises may or may not materialize and potential benefits may also be accompanied by unintended and/or negative (side) effects in the short or long term. Hence, the introduction, implementation, use and funding of digital health technologies should be carefully evaluated and monitored. Governments should play a more active role in the further optimization both of the process of decision making (both at the central and decentral level) and the related outcomes. They need to find a balance between centralized and decentralized activity. Moreover, the broader preparation of the health care system to be able to deal with digitalization, from education, through financial and regulatory preconditions, to implementation of monitoring systems to monitor its effects on health system performance remains important.