Health Foundation

Background: Major depression affects at least 10% of adults, yet evidence-based treatments have modest clinical effectiveness and acceptability. In recent years, outdoor swimming has grown increasingly popular and emerging quantitative and qualitative evidence suggests potential as an intervention for depression, however, there is yet to be a full-scale randomised controlled trial (RCT). This is a protocol to assess the safety and test the clinical- and cost-effectiveness of an 8-session outdoor swimming course (in addition to usual care) on depression symptom severity in adults experiencing major depression, in comparison to usual care alone. Methods: This study is a pragmatic, parallel group, superiority RCT with 1:1 allocation comparing the outdoor swimming intervention (in addition to treatment as usual) with treatment as usual, aiming to recruit 480 adult participants meeting diagnostic criteria for major depression. Recruitment will take place across 21 sites with blind post treatment and follow up assessments. The primary outcome is depression symptom severity at T1 post-intervention, 12 weeks post-randomisation (the primary end point) using the Patient Health Questionnaire 9 (PHQ-9). Secondary clinical outcomes are anxiety (Generalised Anxiety Disorder 7 at T1 and T2 [38 weeks post-randomisation] and PHQ-9 at T2), mindfulness is measured as a potential mechanism at all timepoints (Five Facet Mindfulness Questionnaire 15). Health economic measures at all time points are: EQ-5D-5L, Recovering Quality of Life (ReQoL), Client Service Receipt Inventory and the Productivity Cost Questionnaire. A qualitative study will examine the experience of participants during and after the swim course. Discussion: If the 8-session outdoor swim course is safe, clinically- and cost-effective, findings will support national implementation, offering an evidence-based intervention to those affected by depression, while potentially reducing healthcare costs. Furthermore, this may pave the way for other outdoor activities to support people with poor mental health to be developed and evaluated as interventions. Trial registration: Controlled trial registration number is ISRCTN registration number 24759023. Registered on 21 February 2024 (https://www.isrctn.com/ ISRCTN24759023 ).

Most of the literature describing sun protection for children is based on population surveys and questionnaires, and these have shown that parents have considerable knowledge about sun exposure, its correlation with skin cancer, and proper protection. We conducted research to evaluate the habits not of the individual but of the families and the degree to which children and their parents understand sun protection and sun exposure. A cross-sectional descriptive study included the parents of children aged 8 to 10 years attending primary schools. Each student was given a simple questionnaire by the teacher and was instructed to take it to their parents for completion. The questions addressed the type and duration of vacation, knowledge of damage that can be caused by sun exposure, and the use of sun protection devices both in the city and in other situations. Of the 2,985 distributed questionnaires, 1,288 were returned, resulting in a final sample of 1,288 families included in the analysis. Most families reported taking either one week (44%) or two weeks (41%) of holiday. During holidays, 53% stated that they applied sunscreen more than once per day on days with typical sun exposure; however, 72% reported adopting no additional preventive measures during outdoor activities. Considering that most families take no more than two weeks of holiday per year, they remain without adequate protection during outdoor activities for approximately 97% of the year. This suggests a need for more targeted education and awareness campaigns, emphasizing the importance of sun protection measures in various settings, including urban environments and year-round activities.

In England, care homes are the primary providers of long-term care for older adults. The increasing recognition of the importance of social care underscores the importance of collaboration between the National Health Service and care homes. The lack of data sharing among stakeholders limits opportunities for co-ordinated care, service development and research. Identify how to support research, service development and innovation in care homes. Combine existing evidence with care home-generated resident data to create a minimum data set that is relevant and usable for stakeholders, including residents, relatives, practitioners, researchers, regulators and commissioners. The study used a mixed-methods approach, structured into five work packages, supported by patient and public involvement and engagement with residents, carers and staff: Work package 1: Conducted two evidence reviews on outcome measures and factors enhancing research productivity in care homes. Work package 2: Created a trial archive for secondary data analysis. Work package 3: Conducted a scoping review, a realist review and a national survey to define minimum data set content and assess implementation challenges in English care homes. Work package 4: Linked residents' data from National Health Service and social care data sets with data from study care homes, deriving useful minimum data set variables and assessing data quality. Work package 5: Piloted the minimum data set at two points in care homes within three integrated care systems, conducted focus groups and interviews with care home and integrated care system staff. Three national consultations explored how stakeholders use resident information, measure quality of life and minimum data set usefulness. Additionally, subprojects examined data availability in domiciliary settings, staff reasoning when assessing resident well-being and completing research during rapid policy changes. The reviews revealed significant heterogeneity in outcome measurement and questioned the appropriateness of some methods and measures used for care home research. The Virtual International Care Home Trials Archive merged data from 6 United Kingdom randomised controlled trials with 5674 residents across 308 care homes. International minimum data set studies are a valuable resource for international comparative research. The wide range of measures used are mostly clinical with under-representation of measures important to care homes (e.g. quality of life). A national survey of care homes demonstrated the range of information, including clinical measures being routinely collected. The realist review identified motivation, front-line staff monitoring and embedded recording systems as important for minimum data set implementation. The pilot study recruited 996 residents from 45 care homes, with 727 residents' data included in the minimum data set. Residents' digital care records were linked to statutory health and social care data sets, creating a viable minimum data set prototype with metadata as resource. The study provided an evidence-based critique of care home research and a resource for secondary data analysis for future research. It developed a prototype minimum data set linking National Health Service, social care and care home data, demonstrating its importance as a basis for discussions between health and care staff. The COVID-19 pandemic disrupted relationships and recruitment. Governance challenges prevented linking residents' data to general practitioner records. Future research should assess whether the care home minimum data set improves resident outcomes, service delivery, staff experience, cross-sector collaboration, resource use and digital technology implementation. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR127234.

ObjectiveTo describe patients with severe asthma treated with or eligible for monoclonal antibodies, assessing the health and economic burden using the Italian National Healthcare Service (SSN) administrative data.MethodsFrom 4.6 million inhabitants, among patients with asthma from 1 January to 31 December 2022, those with severe asthma were identified by monoclonal antibody dispensation (cohort A) and by eligibility for monoclonal antibodies, defined as continuous treatment with medium- or high-dose inhaled corticosteroids and long-acting beta agonists and the occurrence of exacerbations (cohort B-narrow and cohort B-broad according to "narrow" and" broad" definitions, respectively). One-year exacerbations, healthcare utilization, and direct costs were assessed.ResultsOf the 128,621 patients with asthma (51.8% women; mean age, 54 years), patients with severe asthma were identified as follows: cohort A (n = 3046; 2.4%), cohort B-narrow (n = 3517; 2.7%), and cohort B-broad (n = 7621; 5.6%). Compared with cohort A, patients in cohorts B-narrow and B-broad were older, had more comorbidities, experienced more moderate/severe exacerbations (70.9%-57.3% vs. 46.7%), and had higher hospitalization rates and greater drug use but fewer specialist visits. The annual SSN costs averaged €7512 for cohort A versus €2911-€2351 for cohorts B-narrow and B-broad. Cohort A incurred higher costs for asthma drugs, whereas cohorts B-narrow and B-broad incurred higher costs for concomitant drugs, hospitalizations, and specialist care.ConclusionsA significant disease burden exists in patients with uncontrolled severe asthma who are potentially eligible for monoclonal antibodies in Italy.

Abstract Background Hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs) are thought to be avoidable with effective preventive care and early disease management, usually delivered in community-based ambulatory care settings. These hospitalizations are both costly and sensitive to the socioeconomic situation of patients. Understanding whether different health systems mitigate the sensitivity of ACSCs to socioeconomic gradients may direct attention to equity-improving approaches to ambulatory health care. This study sought to identify differences in the gradient of Ambulatory Care Sensitive Conditions (ACSC) relative to socioeconomic status across nine countries, namely Australia, Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). Methods The nine countries participating in the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) calculated age—and sex-specific ACSC hospitalization rates between January 1, 2019, and December 31, 2019, based on data from national data sources on hospitalization and sociodemographic information at small-area levels. We used a common definition of ACSC indicators developed through a literature review of indicators routinely used in healthcare performance monitoring. We employed linear regression models to assess inequalities in ACSC association with area-level socioeconomic deprivation and income using the Slope Index of Inequality and the Relative Index of Inequality. Results A persistent pattern higher ACSC hospitalization rates for individuals in most disadvantaged areas remained irrespective of the socioeconomic status measure used. There was, however, considerable variation in relative equity gradients in ACSC hospitalizations between countries. The greatest inequalities were observed in England (RII = 0.26) while the least inequalities in ACSC hospitalizations were observed in Spain (RII = 0.68). Conclusions A consistent equity gradient in ACSC hospitalizations was observed across high-income countries included in this study. Addressing these inequities with targeted policies can reduce the cost of care while improving access to high quality care.

Endometriosis affects 1 in 10 women globally. We aimed to determine health provider involvement and preferred methods of obtaining an endometriosis diagnosis across international jurisdictions. A global cross‐sectional survey, distributed through formal and informal FIGO Reproductive Medicine, Endocrinology, and Infertility (REI) committee networks from September through October 2024. A total of 445 respondents from 76 countries began the survey, with 360 completions. Of the respondents, 63.9% were female, with most being gynecologists. Academics and/or researchers comprised 6.7%, with 39.2% involved in research in some capacity. Endometriosis was largely diagnosed by gynecologists (95.0%), with most respondents overall describing ultrasound as the most common method of diagnosis (77.8%). Of those surveyed, 93.6% stated clinicians in their country used non‐invasive imaging (predominantly ultrasound) to diagnose endometriosis before surgery. One third of respondents did not feel confident distinguishing between routine gynecological scans and specialist endometriosis imaging. Significant barriers for uptake of imaging diagnostics included access to training, cost, and geographical accessibility. Regarding adoption of non‐invasive imaging in clinical care, “game‐changing” effects were described, including improvements in surgical preoperative mapping, and patient‐centered care, with concerns that it could increase clinical workloads. Significantly, shifts in endometriosis diagnosis, from visualization of lesions at laparoscopy to non‐invasive imaging diagnostics, were observed internationally. Policies should aim to overcome barriers to uptake of imaging‐based diagnostics by supporting training initiatives, reducing associated costs, and improving geographical accessibility. Respondents predicted transformative changes in endometriosis care once non‐invasive endometriosis diagnostics are effectively adopted.

Patients with heart failure (HF) often have difficulty obtaining life-saving medications due to coverage barriers, such as prior authorizations and high out-of-pocket costs. To promote better coverage for high value therapies and inform policymakers about cost effectiveness, the American Heart Association/American College of Cardiology/Heart Failure Society of America added Value Statements to HF guidelines. We assessed whether these guidelines influenced Medicare drug coverage policies for 2 life-saving, costly HF medications: angiotensin receptor neprilysin inhibitors (ARNI-guideline "high value") and sodium glucose cotransporter-2 inhibitors (SGLT2i-guideline "intermediate value"). We performed an observational study using Medicare prescription drug plan formulary files from April 2020 to April 2023 to separately assess for changes in coverage barriers to ARNI and SGLT2i after Value Statement publication (April 2022), and subsequent Medicare plan online update (October 2022). The primary outcome was the percentage of plans each month with any barrier to drug coverage (prior authorizations, tier ≥3 out-of-pocket cost-sharing, step therapy, or no coverage). Analyses used interrupted time series and difference-in-differences approaches. Difference-in-differences analyses used direct oral anticoagulants as a control due to their comparable cost and use as ARNI and SGLT2i, but without a Value Statement. Among 7396 Medicare drug plans, monthly rates of any coverage barrier ranged from 94.3% to 97.4% for ARNI and 93.2% to 96.6% for SGLT2i. Most barriers were due to tier ≥3 out-of-pocket cost-sharing requirements (ARNI: 94.3%-95.8%; SGLT2i: 93.2%-95.6%). Coverage barriers remained stable in April 2022 and declined slightly in October 2022. In difference-in-differences analyses, the presence of a Value Statement was associated with a ~1 percentage point decline in coverage barriers for both ARNI (difference-in-differences estimate, -1.07% [95% CI, -1.44% to -0.70%]) and SGLT2i (-1.32% [95% CI, -1.63% to -1.00%]). Coverage barriers to ARNI and SGLT2i were common and changed only slightly after publication of Value Statements in HF guidelines. There is a critical need for robust strategies to improve access to life-saving HF medications.

Universal access to essential health services is a global commitment; however, it remains a major challenge in low-income countries. Primary health care (PHC) is widely recognized as the most effective platform for delivering basic health interventions and essential public health functions. Assessing the capacity and performance of PHC provides critical information on the state of the PHC system and supports evidence-based decision-making to inform the design of targeted interventions. The capacity and performance of the Ethiopian PHC system was assessed using a customized version of World Health organization's PHC Measurement Framework and Indicators (PHCMFI). PHC capacity was assessed across the domains of governance, financing, and input. PHC performance was assessed across domains of service availability and readiness, service quality, utilization, and coverage. Data were primarily obtained from secondary databases, supplemented by primary data collected through sixty-five key informant interviews from all regions of Ethiopia. A review of grey literature and national surveys was also conducted. Indicators for each domain were selected from the PHCMFI, and an unweighted average score was computed for each domain. PHC oriented policies and strategies exist at national and regional levels but with limited implementation capacity. PHC accounted for 78% of the total health expenditure, the per capita PHC expenditure was 28.3 USD and 40% of the source was from out-of-pocket. The average infrastructure score was 55%, essential medicines and basic laboratory diagnostic tests were available in 39% and 48% of facilities, respectively. The health workforce density for core health professional categories was 1.23 per 1,000 population and the average health-information system score was 38%. The average service availability score was 64%. Only 22% of health facilities had trained staff to provide antenatal care (ANC). ANC four or more visit coverage was only 43% and pentavalent 3 coverage was 55.2%. The assessment revealed that the capacity of the Ethiopian PHC is limited in delivering quality health services, and its overall performance remains insufficient to progress towards achieving universal health coverage. The findings call for increasing funding for PHC, improving the availability of basic amenities at PHC units, strengthening logistics management system, designing, and implementing workforce development and motivation mechanisms and improving the availability and readiness of health services at health facilities.