New concept for primary care (Supply mandates)

Research area: HTA-methods & steering instruments

Duration: April 2016 – December 2016
Topic submitted by: Federation of Austrian Social Security Institutions
Publication: LBI-HTA Project report No. 88: https://eprints.aihta.at/1110/

Language: German

Background:
In 2013 the Austrian Federal Ministry of Health started a comprehensive health reform. The heart of the reform is a target control system (2015) for achieving targets in partnership which will guarantee better coordination between doctors in hospitals and those in private practices. The Federal Target Control Commission defined several strategic targets in the „Target Control – Health“ document[i]. Accordingly, the strategic target „Supply mandates and the distribution of roles for all levels of care (primary care, ambulatory specialised care and hospitalised care)” needs to be considered with regard to the „Best Point of Service”. Furthermore, several operative targets were set.

Since then various committees, working groups and institutions have been working on the planning, respectively, the first steps towards the implementation of these targets.

Apart from these planning activities, the LBI-HTA, as an external health care institute, has been commissioned to answer some fundamental questions on a theoretical meta-level.

Aim of the project:
The aim of the project is the provision of a theoretical input, including a model demonstrating available international policies (incl. experiences, methods, decision trees, frameworks, pathways, etc.) to identify/define:

the adequate setting for a provision of health care in the outpatient sector („Best Point of Service“; level of care) and
the adequate, respectively, authorized health care providers (from various medical disciplines and health professions)

for health services in the outpatient sector. In this context the project will focus on the health service content (“What is defined?”) per se, as well as on the process design (“How is it defined?”) framing the definition of new concepts for primary care. In case international procedures for an adequate „service localisation” cannot be identified, the project will propose basic reflections on the provision of health service needs requirements (incl. considerations of epidemiology, setting requirements etc.).

The second part of the project will

analyse the extent to which the „organisational domain“ (see EUnetHTA core model[ii]) can provide appropriate support (for the planning of supply mandates), in general;
give an overview of the efficacy and safety of two specific health interventions (bloodletting/phlebotomy and electrostimulation in the urogenital area; which are commissioned by the Main Association of Austrian Social Security Institutions - HVB) in various therapeutic areas;
involve the extraction of information relating to the „organisational domain“ in order to outline concrete experiences. (for instance, setting variables, “By whom is it applied?”)

The concluding part of the project intends to apply the theoretical setting reflections to the proposed health interventions (bloodletting/phlebotomy and electrostimulation in the urogenital area).

Methods:
Scoping with the initiator (20.4.2016 and further meetings to specify the questions) and searching for information of previous activities in the area of supply mandates (federal government / GÖG; countries)

Part 1: (selective) literature search, contacting experts

Part 2: systematic literature search (step-by-step approach)

Search for evidence-based guidelines, which include recommendations of the two interventions, in the guideline database NGC and GIN;
Search for systematic reviews and HTA-reports;
- (search for primary studies (RCTs) if relevant outcomes cannot be identified in the first two steps)
Additional hand search on the websites of the scientific institutions
Selection of literature
Extraction of
- the recommendations of the guidelines incl. „level of evidence (LoE)“ and „grade of recommendation (GoR)“;
- the (main) efficacy / safety outcomes from the systematic reviews (for each indication);
- the framework (organisational aspects) from the guidelines / systematic reviews (if necessary from the primary studies)

PICO:

Population	No restrictions
Intervention	Bloodletting / phlebotomy	Electrostimulation in the urogenital area
Control	No restrictions
Result parameters / Outcome	Guidelines: recommendations (LoE, GoR) information for the organisational domain SR/HTAs/ (respectively RCTs): primary efficacy outcomes primary safety outcomes information for the organisational domain
Setting	Outpatient sector, industrial countries
Observation period	No restrictions
Types of studies	Guidelines; systematic reviews, meta-analysis and HTA-reports, respectively RCTs (English and German)
Publication period	Guidelines from 2011 (or affirmed as up-to-date) Systematic reviews and individual studies from 2006