Use of digital health tools in Europe: Before, during and after COVID-19

Digital health tools hold the potential to improve the efficiency, accessibility and quality of care. Before the pandemic, efforts had been made to support implementation across Europe over many years, but widespread adoption in practice had been difficult and slow. The greatest barriers to adoption of digital health tools were not primarily technical in nature, but instead lay in successfully facilitating the required individual, organizational and system changes. During the COVID-19 pandemic many digital health tools moved from being viewed as a potential opportunity to becoming an immediate necessity, and their use increased substantially. Digital health tools have been used during the pandemic to support four main areas: communication and information, including tackling misinformation;surveillance and monitoring;the continuing provision of health care such as through remote consultations;and the rollout and monitoring of vaccination programmes. Greater use of digital health tools during the pandemic has been facilitated by: policy changes to regulation and reimbursement;investment in technical infrastructure;and training for health professionals. As the pandemic comes under control, if health systems are to retain added value from greater use of digital health tools, active strategies are needed now to build on the current momentum around their use. Areas to consider while developing such strategies include: Ensuring clear system-level frameworks and reimbursement regimes for the use of digital health tools, while allowing scope for co-design of digital health solutions by patients and health professionals for specific uses. Combining local flexibility with monitoring and evaluation to learn lessons and ensure that digital health tools help to meet wider health system goals.

Investigating prescribing errors in salbutamol nebulisers for acute asthma patients aged 5 and above in a district general hospital

1273 Figure 1The York and Scarborough Teaching Hospital’s Protocol for the Management of Acute Asthma in Children 5 years and over, showing the stict selection criteria used for determining if our patients were severe or Life-Threatening and if these patients followed the correct management plan[Figure omitted. See PDF] 1273 Figure 2 and 3ConclusionThis Audit shows the importance of having confident and experienced Paediatric trained clinicians in A&E, as well as showing that the presence of Paediatric ED nurses improves safe prescribing. It also highlights difficulties in keeping up-to-date with latest guidelines as registrar grades showed more deviation away from current guidelines than junior staff, showing their reliance on previous experience. Follow up will include auditing the department while incorporating a modern prototype laminated flipbook for acute/emergency Paediatric presentations following standardised WETFLAG numbers, conditions, and management requirements all by age and cross checked by Paediatric ED nurses to improve confidence and prescribing in A&E staff as well as teaching sessions for new starters to the department highlighting where to find departmental guidelines.[1] Protocol for the Management of Acute Asthma in Children 5 years and over, Authors Felicity Dick, Paediatric ED Sister & Jen Brownbridge, Paediatric Respiratory Nurse[2] SIGN158: British guideline on the management of asthma. Scottish Intercollegiate Guidelines Network, 2019.

Early health system responses to the COVID-19 pandemic in Mediterranean countries: A tale of successes and challenges.

This paper conducts a comparative review of the (curative) health systems' response taken by Cyprus, Greece, Israel, Italy, Malta, Portugal, and Spain during the first six months of the COVID-19 pandemic. Prior to the COVID-19 pandemic, these Mediterranean countries shared similarities in terms of health system resources, which were low compared to the EU/OECD average. We distill key policy insights regarding the governance tools adopted to manage the pandemic, the means to secure sufficient physical infrastructure and workforce capacity and some financing and coverage aspects. We performed a qualitative analysis of the evidence reported to the 'Health System Response Monitor' platform of the European Observatory by country experts. We found that governance in the early stages of the pandemic was undertaken centrally in all the Mediterranean countries, even in Italy and Spain where regional authorities usually have autonomy over health matters. Stretched public resources prompted countries to deploy "flexible" intensive care unit capacity and health workforce resources as agile solutions. The private sector was also utilized to expand resources and health workforce capacity, through special public-private partnerships. Countries ensured universal coverage for COVID-19-related services, even for groups not usually entitled to free publicly financed health care, such as undocumented migrants. We conclude that flexibility, speed and adaptive management in health policy responses were key to responding to immediate needs during the COVID-19 pandemic. Financial barriers to accessing care as well as potentially higher mortality rates were avoided in most of the countries during the first wave. Yet it is still early to assess to what extent countries were able to maintain essential services without undermining equitable access to high quality care.

Multicentre service evaluation of presentation of newly diagnosed cancers and type 1 diabetes in children in the UK during the COVID-19 pandemic.

Background: The COVID-19 pandemic led to changes in patterns of presentation to emergency departments. Child health professionals were concerned that this could contribute to the delayed diagnosis of life-threatening conditions, including childhood cancer (CC) and type 1 diabetes (T1DM). Our multicentre, UK-based service evaluation assessed diagnostic intervals and disease severity for these conditions. Methods: We collected presentation route, timing and disease severity for children with newly diagnosed CC in three principal treatment centres and T1DM in four centres between 1 January and 31 July 2020 and the corresponding period in 2019. Total diagnostic interval (TDI), patient interval (PI), system interval (SI) and disease severity across different time periods were compared. Results: For CCs and T1DM, the route to diagnosis and severity of illness at presentation were unchanged across all time periods. Diagnostic intervals for CCs during lockdown were comparable to that in 2019 (TDI 4.6, PI 1.1 and SI 2.1 weeks), except for an increased PI in January-March 2020 (median 2.7 weeks). Diagnostic intervals for T1DM during lockdown were similar to that in 2019 (TDI 16 vs 15 and PI 14 vs 14 days), except for an increased PI in January-March 2020 (median 21 days). Conclusions: There is no evidence of diagnostic delay or increased illness severity for CC or T1DM, during the first phase of the pandemic across the participating centres. This provides reassuring data for children and families with these life-changing conditions.

Governing health workforce responses during COVID-19

Countries in Europe have rapidly scaled-up, redeployed,repurposed, retrained and retained their workforce during COVID-19 to create surge capacity, protect the health and well-being of the workforce, and ensure effective implementation of vaccination programmes. Doing so has had enormous governance implications, including the need for intra-governmental and cross-organisational governance actions, increased transparency for planning, and delegated leadership to health employers and health workers. It is important that stakeholders continue to learn and share their experiences on the effectiveness of different workforce governance responses to allow the health workforce to recover, rebuild and repurpose.

Governing health workforce responses during COVID-19

Countries in Europe have rapidly scaled-up, redeployed,repurposed, retrained and retained their workforce during COVID-19 to create surge capacity, protect the health and well-being of the workforce, and ensure effective implementation of vaccination programmes. Doing so has had enormous governance implications, including the need for intra-governmental and cross-organisational governance actions, increased transparency for planning, and delegated leadership to health employers and health workers. It is important that stakeholders continue to learn and share their experiences on the effectiveness of different workforce governance responses to allow the health workforce to recover, rebuild and repurpose.