Effectiveness of educational interventions for healthcare workers on vaccination dialogue with older adults: a systematic review.

BACKGROUND: Healthcare workers (HCW) significantly influence older adults' vaccine acceptance. This systematic review aimed to identify effective educational interventions for HCWs that could enhance their ability to engage in a dialogue with older adults on vaccination. METHODS: Medline, Scopus, Cochrane library and grey literature were searched for comparative studies investigating educational interventions concerning older adult vaccinations. The search encompassed all languages and publication years. Analysis was performed on the outcomes 'vaccines offered or ordered' and 'vaccination rates'. Whenever feasible, a sub-analysis on publication year was conducted. Methodological limitations were assessed using the RoB 2 for RCTs and the GRADE checklist for non-randomized studies. Study outcomes were categorized according to the four-level Kirkpatrick model (1996) for effectiveness: reaction, learning, behaviour, and results. RESULTS: In total, 48 studies met all inclusion criteria. Most studies included reminder systems signalling HCWs on patients due for vaccination. Other interventions included seminars, academic detailing and peer-comparison feedback. Four articles reporting on the reaction-level indicated that most HCWs had a favourable view of the intervention. Two of the six articles reporting on the learning-level observed positive changes in attitude or knowledge due to the intervention. Seventeen studies reported on the behaviour-level. An analysis on eleven out of seventeen studies focusing on vaccines 'ordered' or 'offered' outcomes suggested that tailored reminders, particularly those implemented before 2000, were the most effective. Out of 34 studies reporting on the result-level, 24 were eligible for analysis on the outcome 'vaccination rate', which showed that compared to usual care, multicomponent interventions were the most effective, followed by tailored reminders, especially those predating 2000. Nonetheless, tailored reminders often fell short compared to other interventions like standing orders or patient reminders. In both the behaviour-level and result-level 'education only' interventions frequently underperformed relative to other interventions. Seventeen out of the 27 RCTs, and seven of the 21 non-randomized studies presented a low-to-medium risk for bias in the studies' findings. CONCLUSIONS: Tailored reminders and multicomponent interventions effectively assist HCWs in addressing vaccines with older adults. However, education-only interventions appear to be less effective compared to other interventions rates, attitude, knowledge.

International practices in health technology assessment and public financing of digital health technologies: recommendations for Hungary.

Background: Evaluating and integrating digital health technologies is a critical component of a national healthcare ecosystem in the 2020s and is expected to even increase in significance. Design: The paper gives an overview of international practices on public financing and health technology assessment of digital health technologies (DHTs) in five European Union (EU) countries and outlines recommendations for country-level action that relevant stakeholders can consider in order to support uptake of digital health solutions in Hungary. A scoping review was carried out to identify and gather country-specific classifications and international practices on the financing DHTs in five pioneering EU countries: Germany, France, Belgium, the United Kingdom and Finland. Results: Several frameworks have been developed for DHTs, however there is no single, unified framework or method for classification, evaluation, and financing of digital health technologies in European context. European countries apply different taxonomy, use different assessment domains and regulations for the reimbursement of DHTs. The Working Group of the Hungarian Health Economic Society recommends eight specific points for stakeholders, importantly taking active role in shaping common clinical evidence standards and technical quality criteria across in order for common standards to be developed in the European Union single market. Conclusion: Specificities of national healthcare contexts must be taken into account in decisions to allocate public funds to certain therapies rather than others.

Countrywide survey on utilization of medical devices by GPs in Hungary: advantages of the cluster-practice model.

BACKGROUND: Expectations towards general practitioners (GPs) are continuously increasing to provide a more systematic preventive- and definitive-based care, a wider range of multidisciplinary team-based services and to integrate state-of-the-art digital solutions into daily practice. Aided by development programmes, Hungarian primary care is facing the challenge to fulfil its role as the provider of comprehensive, high quality, patient-centred, preventive care, answering the challenges caused by non-communicable diseases (NCDs). AIM: The article aims to provide an insight into the utilization of simple, digital, medical devices. We show the relationship between the primary health care (PHC) practice models and the used types of devices. We point at further development directions of GP practices regarding the utilization of evidence-based medical technologies and how such devices support the screening and chronic care of patients with NCDs in everyday practice. METHODS: Data were collected using an online self-assessment questionnaire from 1800 Hungarian GPs registered in Hungary. Descriptive statistics, Wilcoxon's test and χ2 test were applied to analyze the ownership and utilization of 32 types of medical devices, characteristics of the GP practices and to highlight the differences between traditional and cluster-based operating model. FINDINGS: Based on the responses from 27.7% of all Hungarian GPs, the medical device infrastructure was found to be limited especially in single GP-practices. Those involved in development projects of GP's clusters in the last decade reported a wider range and significantly more intensive utilization of evidence-based technologies (average number of devices: 5.42 versus 7.56, P<.001), but even these GPs are not using some of their devices (e.g., various point of care testing devices) due to the lack of financing. In addition, GPs involved in GPs-cluster development model programmes showed significantly greater willingness for sharing relatively expensive, extra workforce-demanding technologies (χ2 = 24.5, P<.001).