Proceedings Chapter
Reference
Dealing with COVID-19 Barriers to Care: Digital Platform to support and monitor chronic patients
LAPAO, Luis Velez, et al.
LAPAO, Luis Velez, et al . Dealing with COVID-19 Barriers to Care: Digital Platform to support and monitor chronic patients. In: WCPH2020 - 16th World Congress on Public Health:
Public health for the future of humanity: analysis, advocacy, and action . 2020. p.
v30-31
DOI : 10.1093/eurpub/ckaa165.070
Available at:
http://archive-ouverte.unige.ch/unige:146784
Disclaimer: layout of this document may differ from the published version.
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Background:
In January/2020 the respiratory disease caused by the new coronavirus was declared as an international public health emergency. In Brazil, until June 22nd there were 1,11 million confirmed cases. In this context, the Telehealth Network of Minas Gerais (TNMG), a large-scale public telehealth service, acted quickly to assist professionals and the population in coping with the disease, mainly in low resource settings.
Aim:
To report the experience of a Brazilian public telehealth service in actions to manage COVID-19 and its impacts.
Methods:
Experience report.
Results:
The TNMG developed 15 infographics and 16 web lectures for health professionals and general population about key themes, such as respiratory syndromes, personal care and ventilatory support. Two of them were live, seen in real time by 13,422 professionals, mainly nurses (63.8%) and doctors (31.1%), from 45 medical specialties (most family physicians-34.0%), in all Brazilian states, especially the Southeast region (58.5%). All lectures were uploaded on TNMG’s Youtube channel, each one reaching 5,300 viewers on average. Specific to support health professionals: 2 guidelines were developed - one for primary care units and other to emergency/intensive care; a category for offline (second opinion) teleconsultations was created for doubts about coronavirus; and a list with 39 Frequently Asked Questions (FAQs) was developed. For the general population:
65 FAQs were developed; a health team from a low resource setting was trained to provide online teleconsultations; and a chatbot was released to automatically answer COVID-19 related doubts and/or evaluate a user’s health condition, indicating if emergency medical care was needed. All resources are freely available on TNMG’s website and on its social networks.
Conclusions:
Telehealth tools had a notable acceptance and were shown to be an effective way to disseminate information for profes- sionals and lay population throughout the country.
Key messages:
Telehealth tools have been proven to be an effective strategy to promote health education, for both professionals and the general population.
Telemedicine plays a fundamental role on dealing with public health issues, especially on low resource settings.
The practicality of telemedicine and telehealth during the COVID-19 global outbreak
Robin Ohannessian
R Ohannessian1, S Yaghobian1
1Te´le´me´decine 360, Paris, France
Contact: robin.ohannessian@telemedecine-360.com
On 30 January 2020, the WHO declared a Public Health Emergency of International Concern (PHEIC) for the COVID- 19 outbreak. On 7 March 2020, there were more than 100,000 confirmed cases in 88 countries. Telemedicine, otherwise known as telehealth, has been used at small scale in past outbreaks, including previous coronavirus outbreaks (SARS;
MERS) and other PHEICs (Ebola; Zika). The objective was to describe the global larger scale use and practicality of telehealth in the COVID-19 outbreak.
The 2015 conceptual framework of telemedicine during an outbreak for epidemiological assessment and clinical manage- ment (Ohannessian R.) was used to describe the use cases. A multi-country analysis from China, France, USA and UK was performed with a literature review using official institution websites, grey literature, media/business reports, as scientific articles were not yet published.
Video and chat consultations were used for symptomatic patient assessments through private telehealth providers in all countries. In the USA, the Telehealth Services During Certain
Emergency Periods Act of 2020 was voted by the Congress on 4 March 2020 to suspend restrictive rules of Medicare funding for telehealth home consultations. Triage via online auto- questionnaires were created by private providers and public authorities. In the UK, from 26 February to 2 March, 70,000 enquiries were made to a dedicated NHS111 online service. In China, teleradiology networks were also used for diagnostic of COVID-19 cases. Video consultation was used in France to monitor home isolated patients and non COVID-19 patients, to avoid risks of exposure.
Telehealth has been useful to the COVID-19 outbreak but efforts to better describe cases and evaluate impact on the public health response should be promoted. National and international health authorities should be aware of the opportunities offered by telehealth during outbreaks, and may consider its integration in public health emergencies preparedness plans.
Key messages:
Telehealth was useful for the public health response to COVID19 outbreak.
Telehealth should be integrated into public health prepared- ness plans.
Dealing with COVID-19 Barriers to Care: Digital Platform to support and monitor chronic patients
Luis Lapao
LV Lapao1, M Santos1, M Maia1, V Pedrosa1, J Seixas1, M Mira da Silva3, J Correia4, B Heleno2
1Global Health and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal
2Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
3Instituto Superior Te´cnico, Universidade de Lisboa, Lisbon, Portugal
4Geneva University Hospital, Geneva University, Geneva, Switzerland Contact: luis.lapao@ihmt.unl.pt
The Covid-19 pandemic is causing a set of disruptions, especially at the delivery of healthcare services. The pandemic has shown subsidiary health effects like, chronic care, mental health, surgeries, and deadlock in the other diseases’ treatment.
A digital health platform (PrimaryCare@COVID-19) was implemented to be used by primary care physicians, and nurses, to address both chronic care and COVID-19-related patients at home or traveling. It has been piloted in three Health centers at Lisbon Health Region and it could be scale- up to all primary care in Portugal in the near future. This project was funded by the National Science Foundation to address Primary Care consultations and chronic care services shortage. The clinical primary care processes were studied and a digital workflow was defined using Design Science Research Methods.
This project‘s innovative digital platform is already covering several dozens of chronic patients while at home and addressing the communication with COVID-19-related patients.
The health professionals (physicians and nurses) are able to safely and rigorously communicate with chronic patients and prescribe the required medicines, as well as inform them about the COVID-19 measures. In case of patients either on quarantine or in isolation this platform also allows for the monitoring and health evaluation.
This eHealth Digital Platform is an opportunity to manage chronic care during epidemics, allowing to follow-up patients, preventing them from becoming uncontrolled and having to go to emergency. The digital platform uses smart algorithms to deal with both medication interactions and vital signs alerts while monitoring, chronic and COVID-19 infected, patients, allowing health professionals to remotely consult these patients at home/travelers (by default with phone, but also via digital videoconferencing) and manage all health information about patients in a secure way (and following GDPR rules).
Key messages:
The digital platform uses smart algorithms to deal with both medication interactions and vital signs alerts while mon- itoring chronic and COVID-19 infected patients.
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Digital Platform is an opportunity to manage chronic care during epidemics, allowing to follow-up chronic patients,
preventing them from becoming uncontrolled and having to go to emergency.
2.B. Oral session: Drugs and marketing
Ensuring access to medicines at a fair price?
Innovative contracting experiences in France
Ines Alaoui
I Alaoui1, C Izambert1, A Toullier1
1AIDES, Pantin, France Contact: ialaoui@aides.org
Issue:
Innovative contracting models are developed to ease price- setting negotiations in case an extremely expensive drug has not proven sufficient efficiency in clinical trials. As disruptive HIV treatments are expected in the near future, French patient organizations evaluated the ability of these innovative contracts to ensure accessible medicines at a fair price.
Description:
Performance-based schemes condition prices paid by the State to the efficiency of the medicine observed through real-world data. In France, thirteen performance-based contracts have been concluded between 2008 and 2015. They are presented as a triple solution: innovative treatments are available to patients, manufacturers access markets, and states ensure healthcare within limited budgets. Establishing the added value of these models implies determining if they allow rapid access to treatments with substantial savings for payers, while ensuring rigorous price and cost transparency.
Results:
Performance-based contracts indeed ensure patient access to treatments, but other mechanisms (such as temporary use authorizations) already serve this purpose. Regarding expen- diture reduction however, these schemes have not proven their worth. The Court of Auditors’ evaluation showed they do not generate substantial savings, as final prices correspond to those that would have applied with the European price guarantee.
Lastly, as contracts are protected by business secrecy, the public cannot access neither to actual prices negotiated by payers, nor the amount of public investment that have been used for the research and development of the drug.
Lessons:
The derogatory nature of performance contracts invites us to consider them on a case-by-case basis if ensuring access to a specific innovation is necessary. These contracts are certainly innovative, but they cannot be presented as technologies providing access at a fair price. Finally, their contractual and derogatory nature raises serious transparency issues.
Key messages:
Performance-based contracts should be considered as alternatives to existing administrative channels provided that they lead to substantial savings and are drawn up in full transparency.
Patient organizations need to assess innovative schemes such as performance-based contracting to ensure access to treatments without undermining historical struggles for fair and transparent pricing.
Transforming food retail for better health: The Healthy Stores 2020 trial
Julie Brimblecombe
J Brimblecombe1, E McMahon2, K De Silva3, M Ferguson4, E Miles5, T Wycherley6, A Peeters7, L Minaker8, L Greenacre9, C Mah10
1Public Health Nutrition, Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
2Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Brisbane, Australia
3Arnhem Land Progress Aboriginal Corporation, Darwin, Northern Territory, Australia
4Public Health Nutrition, The University of Queensland, Brisbane, Queensland, Australia
5Menzies School of Health Research, Darwin, Australia
6School of Health Sciences, University of South Australia, Adelaide, Australia
7Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
8University of Waterloo, Waterloo, Ontario, Canada
9Department of Marketing, Monash University, Victoria, Australia
10Dalhousie University, Halifax, Nova Scotia, Canada Contact: julie.brimblecombe@monash.edu
Background:
How food is promoted in food retail settings impacts population diet. Foods high in sugar, fat and/or salt are promoted by retailers to attract impulse purchases. To combat the high burden of chronic disease and associated conditions confronting society we examined the impact of restricted retail merchandising (promotion and visibility) of discretionary food and beverages on sales and business outcomes.
Methods:
We conducted a pragmatic randomised controlled trial in partnership with a retail organisation operating stores in remote communities of Australia (the Arnhem Land Progress Aboriginal Corporation). Twenty consenting stores were allocated to the 12-week intervention (7-point Healthy Stores 2020 strategy) or to usual retail practice. Four intervention stores with retail competition implemented a modified 6-point strategy. Weekly sales data were used to assess intervention impact on free sugars (g) to energy (MJ) (primary outcome) derived from all purchased food and beverages. Impact on gross profit and sales of targeted food and beverages was also assessed. Managers of intervention stores were interviewed to determine their views on customer response and impact on retail practice.
Results:
Free sugars were reduced by a relative 2.8% (95% CI -4.8, - 0.7). There were significant reductions in free sugars from targeted beverages (-6.4%; -11.1, -1.5) and soft drinks (-12.5%;
-18.1, -6.5). Gross profit was not impacted adversely. Managers mostly viewed the strategy favourably and of benefit to the community.
Conclusions:
The public health and business relevant gains demonstrated by this novel trial have resulted in ALPA converting their stores to the Healthy Stores 2020 strategy and integrating the strategy in to their nutrition policy. Retail competition impedes complete implementation of the 7-point strategy. Tackling this will require collective agreement by retailers to implement the full strategy and/or government policy power.
Key messages:
Restricting merchandising of unhealthy foods can achieve both public health relevant and business relevant gains.
Working in partnership with retailers is critical to testing real-world interventions to impact population diet.
Marketing of alcoholic beverages: what can be done to protect the adults of the future?
Ana Sarasa-Renedo
A Sarasa-Renedo1, PA Maragkoudakis2, M Kokkorou3, R Cardoso4, B Torighelli1, J Wollgast1, S Caldeira1
1Joint Research Centre, European Commission, Ispra, Italy
2DG SANTE European Commission, Brussels, Belgium
3WCRF, London, UK
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