Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care

Maniatopoulos, Gregory; Haining, Shona; Allen, John; Wilkes, Scott

doi:10.1186/s12913-019-4477-3

Cited by 8 publications

(7 citation statements)

References 31 publications

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“…In NHS England, there is no direct connection between the DTAC or ESH frameworks certification and reimbursement. A positive endorsement from NICE can support the acceptance and adoption of the health app by providers and Clinical Commissioning Groups (CCGs) ( 25 ). CCGs are primary care-led groups that include the GP groups in a particular area and represent statutory NHS bodies responsible for the planning and commissioning of health care services for their area, that might provide reimbursement for a digital technology depending on their strategy.…”

Section: Resultsmentioning

confidence: 99%

Success Factors for Scaling Up the Adoption of Digital Therapeutics Towards the Realization of P5 Medicine

et al. 2022

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IntroductionDigital therapeutics (DTx) can be a valuable contribution to the successful scale up of P5 Medicine (personalized, participatory, predictive, preventive, precision medicine) as they offer powerful means of delivering personalization and active patient participation in disease self-management. We investigated how the approval and adoption of DTx within health systems have been approached in five selected European countries and regions, with a view to proposing success factors scaling up their adoption.MethodologyPreliminary research established best countries or region candidates as being Germany, UK, France, Belgium, and the Spanish Region of Catalonia. The research was informed by a literature review, interviews with public bodies and industry, and a multi-stakeholder workshop to validate the findings and fill in existing gaps.ResultsTo authorize the use of digital technologies, the countries and regions passed legislation and developed policy instruments, appointed bodies to assess and certify the products and formalized mechanisms for permitting reimbursement. While DTx is not a commonly used nomenclature, there are digital health technology types defined that have similar requirements as DTx. Assessment and certification frameworks are usually built around the Medical Device Regulation with additional criteria. Reimbursement considerations often observe reimbursement of therapeutic devices and/or medicines. To be integrated into reimbursement systems, countries require manufacturers to demonstrate clinical value and cost-effectiveness. As there are currently very few DTx approved in practice, there is resistance toward clinical acceptance and organizational change, and change management is highly needed to integrate DTx into healthcare systems. The integration and secondary use of DTx data is not encountered in daily practice. Although some enablers exist, there remain technical and legal barriers.DiscussionDTx strategies should be considered as an integral part of digital health strategies and legislation, and specific DTx pathways with clear and transparent assessment and guidelines that balance regulation and innovation should be defined. To help manufacturers, countries should recommend and list methods that are widely accepted and ensure scientific robustness, aligned to the MDR requirements to support transfer of relevant and comparable data across countries. To facilitate rapid uptake of innovation, countries should add flexibility to the framework by allowing temporary market authorization to enable data collection that can support the clinical and socio-economic evaluation and data gathering phase. Certification should trigger rapid price setting and reimbursement mechanisms, and dynamic ways to adjust price and reimbursement levels in time should be established. Relevant stakeholders should be approached on the potential impacts of DTx through transparent communication and change management strategies should be considered. These findings should be validated with a wider range of stakeholders.

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Section: Resultsmentioning

confidence: 99%

Success Factors for Scaling Up the Adoption of Digital Therapeutics Towards the Realization of P5 Medicine

et al. 2022

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“…Uniquely, we have shown that evidence is not used solely as a source of information by commissioners, but also as a tool to effect change and stimulate improvements, as well as a warrant for convincing others and justifying decision-making. Overall, the commissioning of healthcare services and the related contexts is an understudied topic, [ 1 , 50 ] and we believe have made a new contribution to the literature by applying the analytical lens of a realist evaluation to this topic.…”

Section: Discussionmentioning

confidence: 99%

“…NHS primary care commissioning involves the planning, contracting, and monitoring of primary care services (GP, dentistry, pharmacy, and ophthalmology services) [ 1 , 2 ]. Although the NHS has a documented ‘commissioning cycle’ consisting of nine discrete steps and activities, [ 3 ] in practice, commissioning is ‘messy and fragmented,’ [ 4 ] and only some activities undertaken by commissioners overlap with the official nine-step ‘commissioning cycle’ [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

The usage of data in NHS primary care commissioning: a realist evaluation

Jager,

Papoutsi,

Wong

2023

BMC Prim. Care

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Background To improve health outcomes and address mounting costs pressures, policy-makers have encouraged primary care commissioners in the British National Health Service (NHS) to increase the usage of data in decision-making. However, there exists limited research on this topic. In this study, we aimed to understand how and why primary care commissioners use data (i.e. quantitative, statistical information) to inform commissioning, and what outcomes this leads to. Methods A realist evaluation was completed to create context-mechanism-outcome configurations (CMOs) relating to the contexts influencing the usage of data in primary care commissioning. Using a realist logic of analysis and drawing on substantive theories, we analysed qualitative content from 30 interviews and 51 meetings (51 recordings and 19 accompanying meeting minutes) to develop CMOs. Purposive sampling was used to recruit interviewees from diverse backgrounds. Results Thirty-five CMOs were formed, resulting in an overarching realist programme theory. Thirteen CMOs were identical and 3 were truncated versions of those formed in an existing realist synthesis on the same topic. Seven entirely new CMOs, and 12 refined and enhanced CMOs vis-à-vis the synthesis were created. The findings included CMOs containing contexts which facilitated the usage of data, including the presence of a data champion and commissioners’ perceptions that external providers offered new skillsets and types of data. Other CMOs included contexts presenting barriers to using data, such as data not being presented in an interoperable way with consistent definitions, or financial pressures inhibiting commissioners’ abilities to make evidence-based decisions. Conclusions Commissioners are enthusiastic about using data as a source of information, a tool to stimulate improvements, and a warrant for decision-making. However, they also face considerable challenges when using them. There are replicable contexts available to facilitate commissioners’ usage of data, which we used to inform policy recommendations. The findings of this study and our recommendations are pertinent in light of governments’ increasing commitment to data-driven commissioning and health policy-making.

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“…Also, in the United Kingdom, the analysis and commissioning of the decision-making process so that public services are planned and contracted in order to meet unique needs, focused on innovative health technologies, specifically that of diagnostic innovation for the treatment of vascular disease in PHC. The results show that decisions are subject to the micro-policies of the organizational environment, competing agendas, interests, priorities, demands and personal inclinations to be persuasive and convincing, instead of adopting a simple technical rationality 34 .…”

Section: /21mentioning

confidence: 97%

Technosociality and Health Promotion in the Daily Lives of Primary Care Users: A Scoping Review

Nascimento

Campos

Figueiredo

et al. 2021

Texto contexto - enferm.

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Objective: to map available evidence on the use of technologies by Primary Health Care users in the context of health promotion. Method: this is a scoping review according to Joanna Briggs Institute, and the recommendations of the international guide Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were followed. The PCC strategy (participants, concept and context) was used. The search in the databases was carried out from January to April 2020. Results: a total of 5,267 studies were retrieved and 28 articles were selected for review. The article origin was diverse, with the largest number being from the United States of America (7), the predominant language is English, the year was 2018 and the level of evidence 2. Studies show that users obtain benefits in health care through the use of technologies. Conclusion: health interventions, using technology, positively impact people’s behavior and lifestyle, focusing on the prevention and control of chronic diseases. It is noteworthy that technologies used in isolation cannot overcome behavioral barriers and their use does not replace one-to-one care and monitoring.

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Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care

Cited by 8 publications

References 31 publications

Success Factors for Scaling Up the Adoption of Digital Therapeutics Towards the Realization of P5 Medicine

Success Factors for Scaling Up the Adoption of Digital Therapeutics Towards the Realization of P5 Medicine

The usage of data in NHS primary care commissioning: a realist evaluation

Technosociality and Health Promotion in the Daily Lives of Primary Care Users: A Scoping Review

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