Addressing prioritization in healthcare amidst a global pandemic

Abstract

Trade-offs abound in healthcare yet depending on where one stands relative to the stages of a pandemic, choice making may be more or less constrained. During the early stages of COVID-19 when there was much uncertainty, healthcare systems faced greater constraints and focused on the singular criterion of “flattening the curve.” As COVID-19 progressed and the first wave diminished (relatively speaking depending on the jurisdiction), more opportunities presented for making explicit choices between COVID and non-COVID patients. Then, as the second wave surged, again decision makers were more constrained even as more information and greater understanding developed. Moving out of the pandemic to recovery, choice making becomes paramount as there are no set rules to lean back into historical patterns of resource allocation. In fact, the opportunity at hand, when using explicit tools for priority setting based on economic and ethical principles, is significant.

An analysis of how health systems integrated priority-setting in the pandemic planning in a sample of Latin America and the Caribbean countries

“…In this difficult scenario, health policy-makers from LAC must determine how to allocate the meagre resources among competing interventions, populations, healthcare settings, and geographical regions [ 13 , 14 ]. In addition, local authorities have to make decisions as to which groups to prioritize for care, including prioritizing groups for ventilators, personal protective equipment (PPE), therapeutics and vaccines [ 15 ]. In these contexts of severe resource constraint, there is a need for systematic priority-setting so that urgent decisions and actions are taken in ways that make the best use of resources, address the primary areas of concern, and avoid harming the most vulnerable groups [ 10 , 16 ].…”

Was priority setting included in the Canadian COVID-19 pandemic planning and preparedness? A comparative analysis of COVID-19 pandemic plans from eight provinces and three territories

“…Hence, there is a need for Canadian provinces and territories to integrate priority setting in their routine practice. In so doing, the relevant stakeholders, the acceptable approach, the criteria, the process, and evidence are already institutionalized and could easily pivot in response to emergency situations [41] . Regular evaluation of the instituted priority setting processes would provide a context through which lessons can be harnessed and improvement strategies developed [42] .…”

Outsourcing practice-based education: The role of industry representatives and implications for clinical expertise

“…As health systems emerge from the COVID-19 pandemic and grapple with prioritization, 17 these findings can inform analyses of opportunity costs when vital educational activities increasingly are shifted to industry representatives. Participants in this study recognized that industry representatives possessed unique and important knowledge about the functioning and maintenance of their products, devices, and equipment.…”