Role of health technology assessment in pharmaceutical market access in developed countries

Introduction and use of a health technology in a health care setting has clinical, economic, as well as organizational, social-cultural, legal and ethical impacts. Health Technology Assessment (HTA) is a multidisciplinary field that addresses these impacts, considering healthcare context as well as available alternatives. HTA mainly aims to inform policy and clinical decision making. While systematically evaluating the effects of the health technology, HTA addresses direct and intended effects as well as the indirect and unintended effects. It is a multidisciplinary field with well-developed systematic processes and method

Outcome-based reimbursement in Central-Eastern Europe and Middle-East

Outcome-based reimbursement models can effectively reduce the financial risk to health care payers in cases when there is important uncertainty or heterogeneity regarding the clinical value of health technologies. Still, health care payers in lower income countries rely mainly on financial based agreements to manage uncertainties associated with new therapies. We performed a survey, an exploratory literature review and an iterative brainstorming in parallel about potential barriers and solutions to outcome-based agreements in Central and Eastern Europe (CEE) and in the Middle East (ME). A draft list of recommendations deriving from these steps was validated in a follow-up workshop with payer experts from these regions. 20 different barriers were identified in five groups, including transaction costs and administrative burden, measurement issues, information technology and data infrastructure, governance, and perverse policy outcomes. Though implementing outcome-based reimbursement models is challenging, especially in lower income countries, those challenges can be mitigated by conducting pilot agreements and preparing for predictable barriers. Our guidance paper provides an initial step in this process. The generalizability of our recommendations can be improved by monitoring experiences from pilot reimbursement models in CEE and ME countries and continuing the multistakeholder dialogue at national levels

Impact of laboratory test use strategies in a Turkish hospital

Objectives: Eliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH) and calculate potential savings in costs. Methods: A collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months. Results: Laboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6-85.0%) was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars. Conclusion: Hospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory test

Türkiye'de bir konteyner kentteki Suriyeli mülteciler: Birinci basamak başvurularının retrospektif değerlendirilmesi

Objective: The aim of this study was to collect and share information about primary care (PC) services provided to the Syrian refugees in Kilis container city and to evaluate their situation excluding preventive services. We also tried to determine further needs. Methods: This is a retrospective type descriptive study. Data about PC services provided to Syrian refugees in Öncüpınar was collected by personal contacts and observation besides summarizing our own experience. The container cities have a manual system. For the take of the analysis, information from the paper files was transferred to an electronic database. The study covered the period between April 2012- where settling of Syrians started- and 20th December 2012 when admissions were recorded. Total number of admissions to the PC center was 17399 during this period. Results: Health care services are provided through a PC center, 112 medical emergency service stations and a tent hospital. Most of the admissions were in 12-59 month age group (20.2%), followed by 20-29 years age group (16.6%),46% of all admissions were acute problems including respiratory tract infections, gastrointestinal system problems, soft tissue infections and pain. Hypertension was the most common diagnosis among chronic conditions. Of all admissions, 10.8 % ended up with referral, 17.5 % of the patients were referred to the emergency service where the remaining were referred to different specialty services. Conclusion: This is the first study of the PC services provided to the Syrian refugees in Turkey and identifies main causes of admissions and referrals. Day by day living in the host country, all requirements are increasing and changing occasionally. Therefore the situation should be reviewed constantly and plan should be done for the current and future needs.Amaç: Bu çalışmanın amacı, Suriyeli mültecilere sunulan önleyici hizmetler hariç olmak üzere birinci basamak sağlık hizmetleri hakkında Kilis konteyner kentindeki mültecilerin durumunu paylaşmak, bilgi toplamak ve durumu değerlendirmektir. Ayrıca gelecekteki ihtiyaçları belirlemeye çalıştık. Yöntem: Çalışma retrospektif tipte tanımlayıcı bir çalışmadır. Öncüpınar'daki Suriyeli mültecilere birinci basamak hizmetleri hakkındaki kendi tecrübelerimizi özetlemenin yanı sıra kişisel görüşmeler ve gözlemler yaparak veri toplandı. Konteyner şehirlerin manuel bir sistemi bulunmaktadır. Analizler için, kâğıt dosyalardan gelen bilgiler elektronik bir veri-tabanına aktarıldı. Çalışma Suriyelilerin yerleşiminin başladığı Nisan 2012’den itibaren 20 Aralık 2012 tarihine kadar kayıtların kaydedildiği süreyi kapsamaktadır. Bu dönemde birinci basamak sağlık merkezine başvuruların toplam sayısı 17399 idi. Bulgular: Sağlık hizmetleri birinci basamak hizmetleri, 112 acil tıbbi servis istasyonu ve bir çadır hastane aracılığıyla sağlanmaktadır. Başvuruların çoğu 12-59 aylık grupta (% 20,2), 20-29 yaş grubunda (% 16,6) yapılmıştı. Başvuruların büyük çoğunluğu solunum yolu enfeksiyonları, gastrointestinal sistem sorunları, yumuşak doku enfeksiyonları ve ağrı gibi akut problemlerdi. Kronik durumlar arasında hipertansiyon en sık görülen tanıydı. Tüm başvuruların % 10,8'i sevk ile sonuçlandı. Hastaların% 17,5'i acil servise, geri kalan hastalar ise farklı uzmanlık servislerine sevk edildi. Sonuç: Bu çalışma, Türkiye'deki Suriyeli mültecilere sunulan birinci basamak hizmetleriyle ilgili ilk çalışma olup, başvuruların temel nedenleri belirlenmiştir. Günden güne mültecilerin gereksinimleri artmakta ve değişmektedir. Bu nedenle durum sürekli gözden geçirilmeli ve mevcut ve gelecekteki ihtiyaçlar için planlamalar yapılmalıdır

Weight Loss Experiences Of Obese Individuals; Qualitative Study

Objective: Obesity is a leading preventable cause of death worldwide. Being overweight or obese has a serious impact on health. Treatment of obesity needs a comprehensive approach. Biopsychosocial approach of family physicians is invaluable in obesity management. In this study, we aimed to evaluate experiences of obese individuals during their weight-losing attempts and to explore the factors affecting success and failure of different approaches. Methods: We conducted indepth, semi-structured, face to face interviews with 30 participants whose Body Mass Index was higher than 30). Interviews were audio-recorded and transcribed, and qualitatively analysed using a thematic framework method. Results: 26 women and 4 men have accepted to join our study. Analysis of in depth interviews emerged 5 major themes which were: the different perception of obesity among individuals; awareness of obesity; loss of self-confidence; belief in treatment and effects on quality of life. Conclusions: Each patient has a different need and different expectation while controlling weight. As a part of biopsychosocial approach the family physician needs to understand the factors that bring the patient to current condition and see which approach would be the best for individual patient for weight management.Wo