Introduction Patients and policy makers alike have high expectations for the use of digital technologies as tools to improve health care service quality at a sustainable cost. Many countries within the Organisation for Economic Co-operation and Development (OECD) are investing in telemedicine initiatives, and a large and growing body of peer-reviewed studies on the topic has developed, as a consequence. Nonetheless, telemedicine is still not used at scale within the OECD. Seeking to provide a snapshot of the evidence on the use of telemedicine in the OECD, this umbrella review of systematic reviews summarizes findings on four areas of policy relevance: clinical and cost-effectiveness, patient experience, and implementation. Methods This review followed a prior written, unregistered protocol. Four databases (PubMed/Medline, CRD, and Cochrane Library) were searched for systematic reviews or meta-analyses published between January 2014 and February 2019. Based on the inclusion criteria, 98 systematic reviews were selected for analysis. Due to substantial heterogeneity, a meta-analysis was not conducted. The quality of included reviews was assessed using the AMSTAR 2 tool. Results Most reviews (n = 53) focused on effectiveness, followed by cost-effectiveness (n = 18), implementation (n = 17) and patient experience (n = 15). Eighty-three percent of clinical effectiveness reviews found telemedicine at least as effective as face-to-face care, and thirty-nine percent of cost-effectivenss reviews found telemedicine to be cost saving or cost-effective. Patients reported high acceptance of telemedicine and the most common barriers to implementation were usability and lack of reimbursement. However, the methodological quality of most reviews was low to critically low which limits generalizability and applicability of findings. Conclusion This umbrella review finds that telemedicine interventions can improve glycemic control in diabetic patients; reduce mortality and hospitalization due to chronic heart failure; help patients manage pain and increase their physical activity; improve mental health, diet quality and nutrition; and reduce exacerbations associated with respiratory diseases like asthma. In certain disease and specialty areas, telemedicine may be a less effective way to deliver care. While there is evidence that telemedicine can be cost-effective, generalizability is hindered by poor quality and reporting standards. This umbrella review also finds that patients report high levels of acceptance and satisfaction with telemedicine interventions, but that important barriers to wider use remain.

BackgroundIn high-income countries, obesity prevalence (body mass index greater than or equal to 30 kg/m2) is highest among the poor, while overweight (body mass index greater than or equal to 25 kg/m2) is prevalent across all wealth groups. In contrast, in low-income countries, the prevalence of overweight and obesity is higher among wealthier individuals than among poorer individuals. We characterize the transition of overweight and obesity from wealthier to poorer populations as countries develop, and project the burden of overweight and obesity among the poor for 103 countries.Methods and findingsOur sample used 182 Demographic and Health Surveys and World Health Surveys (n = 2.24 million respondents) from 1995 to 2016. We created a standard wealth index using household assets common among all surveys and linked national wealth by country and year identifiers. We then estimated the changing probability of overweight and obesity across every wealth decile as countries’ per capita gross domestic product (GDP) rises using logistic and linear fixed-effect regression models. We found that obesity rates among the wealthiest decile were relatively stable with increasing national wealth, and the changing gradient was largely due to increasing obesity prevalence among poorer populations (3.5% [95% uncertainty interval: 0.0%–8.3%] to 14.3% [9.7%–19.0%]). Overweight prevalence among the richest (45.0% [35.6%–54.4%]) and the poorest (45.5% [35.9%–55.0%]) were roughly equal in high-income settings. At $8,000 GDP per capita, the adjusted probability of being obese was no longer highest in the richest decile, and the same was true of overweight at $10,000. Above $25,000, individuals in the richest decile were less likely than those in the poorest decile to be obese, and the same was true of overweight at $50,000. We then projected overweight and obesity rates by wealth decile to 2040 for all countries to quantify the expected rise in prevalence in the relatively poor. Our projections indicated that, if past trends continued, the number of people who are poor and overweight will increase in our study countries by a median 84.4% (range 3.54%–383.4%), most prominently in low-income countries. The main limitations of this study included the inclusion of cross-sectional, self-reported data, possible reverse causality of overweight and obesity on wealth, and the lack of physical activity and food price data.ConclusionsOur findings indicate that as countries develop economically, overweight prevalence increased substantially among the poorest and stayed mostly unchanged among the wealthiest. The relative poor in upper- and lower-middle income countries may have the greatest burden, indicating important planning and targeting needs for national health programs.

systems/health-working-papers.htm OECD Working Papers should not be reported as representing the official views of the OECD or of its member countries. The opinions expressed and arguments employed are those of the author(s). Working Papers describe preliminary results or research in progress by the author(s) and are published to stimulate discussion on a broad range of issues on which the OECD works. Comments on Working Papers are welcomed, and may be sent to health.contact@oecd.org. This series is designed to make available to a wider readership selected health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language-English or French-with a summary in the other. This document and any map included herein are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements in the West Bank under the terms of international law.

Background Antimicrobial resistance is widely considered an urgent global health issue due to associated mortality and disability, societal and healthcare costs. Aim To estimate the past, current and projected future proportion of infections resistant to treatment for eight priority antibiotic-bacterium combinations from 2000 to 2030 for 52 countries. Methods We collated data from a variety of sources including ResistanceMap and World Bank. Feature selection algorithms and multiple imputation were used to produce a complete historical dataset. Forecasts were derived from an ensemble of three models: exponential smoothing, linear regression and random forest. The latter two were informed by projections of antibiotic consumption, out-of-pocket medical spending, populations aged 64 years and older and under 15 years and real gross domestic product. We incorporated three types of uncertainty, producing 150 estimates for each country-antibiotic-bacterium-year. Results Average resistance proportions across antibiotic-bacterium combinations could grow moderately from 17% to 18% within the Organisation for Economic Co-operation and Development (OECD; growth in 64% of uncertainty sets), from 18% to 19% in the European Union/European Economic Area (EU/EEA; growth in 87% of uncertainty sets) and from 29% to 31% in Group of Twenty (G20) countries (growth in 62% of uncertainty sets) between 2015 and 2030. There is broad heterogeneity in levels and rates of change across countries and antibiotic-bacterium combinations from 2000 to 2030. Conclusion If current trends continue, resistance proportions are projected to marginally increase in the coming years. The estimates indicate there is significant heterogeneity in resistance proportions across countries and antibiotic-bacterium combinations.

systems/health-working-papers.htm JT03477600 OFDE This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. 2  DELSA/HEA/WD/HWP(2021)5 OECD HEALTH WORKING PAPER NO. 128 UnclassifiedOECD Health Working Papers http://www.oecd.org/els/health-systems/health-working-papers.htm OECD Working Papers should not be reported as representing the official views of the OECD or of its member countries. The opinions expressed and arguments employed are those of the author(s).Working Papers describe preliminary results or research in progress by the author(s) and are published to stimulate discussion on a broad range of issues on which the OECD works. Comments on Working Papers are welcomed, and may be sent to health.contact@oecd.org. This series is designed to make available to a wider readership selected health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language -English or Frenchwith a summary in the other. This document and any map included herein are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area.The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements in the West Bank under the terms of international law.