Publications
86 results found
El-Osta A, Rowe C, Majeed A, 2022, Developing a shared definition of Self-Driven Healthcare to enhance the current healthcare delivery paradigm
Self-Driven Healthcare (SDH) is an umbrella term introduced by Innovate UK to conceptualise aspects of healthcare delivery that can support people in becoming more engaged in their own health and wellbeing management rather than being passive receivers of healthcare. The defining characteristics of SDH solutions include activities that empower people to play a more effective role in maintaining their own health and wellbeing, including those activities concerned with primary prevention and health promotion (e.g., to detect diseases earlier and proactively collaborate with a growing range of healthcare professionals to manage their illnesses). Innovate UK is interested in developing thought leadership around the emergent concept of SDH, and to determine if this is an area it should in invest in. The commentary introduces the concept of SDH and discusses the possible challenges and barriers that need to be addressed to realise the full potential of this approach.
El-Osta A, 2022, MEETING SUMMARY: An SRH Self-Care Measurement Tool, The Evidence and Learning Working Group of the Self Care Trailblazer Group’s Measurement Expert Working Group (MEWG) Meeting on SRHR Self-Care
The Measurement Sub-Working Group of SCTG’s Evidence and Learning Working Group (ELWG) convened a meeting of over 70 global experts in measurement of sexual and reproductive health self-care in November. The purpose of the 3-day meeting was to develop standardized guidance for monitoring and evaluation of three priority self-care interventions: DMPA-SC self-injection, HIV self-testing, and self-managed abortion. The tool, which will include a set of priority indicators for each intervention, is being designed to meet the needs for self-care monitoring and evaluation by national stakeholders, including ministries of health and national HMIS programs. The finalized measurement tool is expected in Q1 of 2023. In the meantime, read more about outcomes of the expert working group meeting here.
Sivarajasingam V, Webber I, Riboli-Sasco E, et al., 2022, Investigating public awareness, prevailing attitudes and perceptions towards domestic violence and abuse in the United Kingdom: a qualitative study, BMC PUBLIC HEALTH, Vol: 22
Riboli-Sasco E, El-Osta A, Alaa A, et al., 2022, Triage and diagnostic accuracy of Online Symptom Checkers: a systematic review, Publisher: JMIR Publications
Background:In the context of a deepening global shortage of health workers, and particularly the COVID-19 pandemic, there is growing international interest in and use of online symptom checkers (OSCs). However, the evidence surrounding the safety and accuracy of OSCs remains inconclusive so far. The triage and diagnostic accuracy of these tools is an essential aspect that needs to be addressed before pushing any further implementation.Objective:This systematic review aimed to summarize the existing peer-reviewed literature evaluating the triage accuracy (directing users to appropriate services based on their presenting symptoms) and diagnostic accuracy of OSCs aimed at lay users for general health concerns.Methods:Searches were conducted in Medline, Embase, CINAHL, HMIC and Web of Science. We included peer-reviewed studies published in English between 1 January 2010 and 17 February 2022 with a quantitative assessment of triage and/or diagnostic accuracy of OSCs directed at lay users. We excluded tools supporting health professionals, and disease- or speciality-specific OSCs. Screening and data extraction were carried out independently by two reviewers for each study. We performed a descriptive narrative synthesis.Results:21,284 studies were screened and 15 were included. Six studies reported on both triage and diagnostic accuracy, eight focused on triage accuracy, and one on diagnostic accuracy. Diagnostic and triage accuracy varied between studies and OSCs; most studies showed suboptimal diagnostic and triage accuracy. Frequency and urgency of the condition were the main variables that affected the levels of diagnostic and triage accuracy, along with specific features of the OSCs. The impact of each variable differed across tools and studies, making it difficult to draw any solid conclusions. Included studies had either a moderate or high risk of bias according to the revised tool for the Quality Assessment of Diagnostic Accuracy Studies 2.Conclusions:While OSCs ha
Karki M, El-Osta A, El Asmar M, et al., 2022, What is the potential of public libraries to promote public mental health & wellbeing? Findings from a cross-sectional study of community-dwelling adults
<jats:p><p> The role of public libraries has changed significantly over the last few decades, but they remain popular and are increasingly well-positioned to support the mental health and wellbeing needs of members of the community. We conducted a cross-sectional online survey and interview-based study with community-dwelling adults to explore the potential of libraries as community hubs to tackle health and digital inequalities and promote mental and physical health and wellbeing. We analysed data from electronic survey and interviews to gauge perceptions. Descriptive statistics and thematic analysis were used to identify key trends and emergent themes. Our study findings show that libraries remain popular and are considered a 'safe place' by community members, irrespective of whether they are frequent users of services. Libraries already offer a variety of resources that either directly or indirectly support health and wellbeing, but public awareness of these services is limited and acts as a hurdle to improving community health and wellbeing. Targeted engagement with residents is needed to increase awareness of the services libraries offer, including community interventions to help tackle loneliness and inequalities in digital and health literacy. There was a clarion call for library staff to be more involved in decision-making. By acting as community hubs, libraries are ideally suited to deliver interventions to help tackle the existing and emergent health and digital inequalities following the advent of the COVID-19 pandemic. </p></jats:p>
Painter A, Hayhoe B, Riboli-Sasco E, et al., 2022, Online symptom checkers: recommendations for a vignette-based clinical evaluation standard, Journal of Medical Internet Research, Vol: 24, ISSN: 1438-8871
The use of patient-facing online symptom checkers (OSCs) has expanded in recent years, but their accuracy, safety, and impact on patient behaviors and health care systems remain unclear. The lack of a standardized process of clinical evaluation has resulted in significant variation in approaches to OSC validation and evaluation. The aim of this paper is to characterize a set of congruent requirements for a standardized vignette-based clinical evaluation process of OSCs. Discrepancies in the findings of comparative studies to date suggest that different steps in OSC evaluation methodology can significantly influence outcomes. A standardized process with a clear specification for vignette-based clinical evaluation is urgently needed to guide developers and facilitate the objective comparison of OSCs. We propose 15 recommendation requirements for an OSC evaluation standard. A third-party evaluation process and protocols for prospective real-world evidence studies should also be prioritized to quality assure OSC assessment.
El-Osta A, Ribolis-Sasco E, Kerr G, et al., 2022, Evaluation of BP@Home Initiative (pan-London): Key findings from mixed methods evaluation
Painter A, Hayhoe B, Riboli-Sasco E, et al., 2022, Online symptom checkers: Recommendations for a vignette-based clinical evaluation standard (Preprint), Publisher: JMIR Publications Inc.
The use of patient-facing online symptom checkers (OSCs) has expanded in recent years, but their accuracy, safety, and impact on patient behaviours and healthcare systems remains unclear. The lack of a standardised process of clinical evaluation has resulted in significant variation in approaches to OSC validation and objective evaluation of outcomes. The aim of this paper is to characterise a set of congruent requirements for a standardised vignette-based clinical evaluation process of OSCs. Discrepancies in the findings of comparative studies to date suggest that different steps in OSC evaluation methodology can significantly influence outcomes. A standardised process with a clear specification for vignette-based clinical evaluation is urgently needed to guide developers and to facilitate the objective comparison of OSCs. We propose 15 recommendation requirements for an OSC evaluation standard. A third-party evaluation process and protocols for prospective real-world evidence studies should also be prioritised to quality assure OSC assessment.
El-Osta A, Riboli-Sasco E, Kerr G, 2022, BP@home Pan-London Evaluation: Report Presented to NHSE I & LCEG (London), Publisher: Self-Care Academic Research Unit (SCARU), Imperial College London
Report objectives:This report summarises the key findings of a Pan-London evaluation to assess levels of implementation and identify key barriers and enablers to the streamlined implementation of the BP@home program across London. Specifically, we mapped the reception and distribution of BP@home monitors, investigated the views and experiences of primary care workers involved in the implementation of the programme, and quantify changes in outcomes using SNOMED codes. This data was synthesised and used to develop a list of evidence-based recommendations for the consideration of NHSE leadership team.Methods:We used a mixed methods research approach and six phases of investigation to address these aims, including desktop research, personal interviews and focus groups, action research, data analysis, synthesis and reporting.Results:The evaluation showed that there are different levels of readiness and implementation across the 5 London ICSs. The roll-out of BP@home programme has been challenging due to a number of key factors across the pathway, including the limited IT infrastructure, insufficient human and financial resources, and the lack of adequate and specific SNOMED codes. These challenges were further increased by the competing demands on limited capacity in Primary Care, especially during the Covid-19 pandemic. However, respondents also identified some facilitators, including the onboarding material provided by NHSE, the inclusion of the UCLP criteria the EHR and the provision of conditional incentives in certain ICSs. A more structured and holistic approach to onboarding patients is needed to ensure high quality compliance and satisfactory results for patients. Another key recommendation devised by respondents was to offer BP monitors on prescription, along with the creation of specific SNOMED codes.Conclusion:At the time of redaction of this report, there are local evaluation plans in each ICS & a national evaluation of @Home programme was recently commis
El-Osta A, Iman W, Manisha K, et al., 2022, Public perceptions on routine use of screening tools for domestic abuse in health and social care settings: an exploratory cross-sectional study, BMC Public Health, ISSN: 1471-2458
BackgroundDomestic violence and abuse (DVA) is a rising societal concern with increased prevalence since the national lockdowns and remains largely under-detected by the medical community. Although screening increases early detection of abuse, current NICE guidelines which were produced before the advent of COVID-19 do not recommend routine DVA screening in primary care. Little is known about patient views regarding DVA screening in UK primary care. This exploratory survey assesses the public’s experiences and their views on routine DVA screening.MethodsAn open, easily accessible anonymous 27-item eSurvey made available on the Imperial College London Qualtrics platform between 8 March and 27 September 2021 was used to collect data from community dwelling adults. Potentially eligible participants were contacted via email through community groups in Northwest London catchment area, and using adverts on social media. The survey targeted a wider population in the community, including those who were 18 years and over, living in the UK and spoke English. The eSurvey also included information on accessible support services. Data were summarised using frequencies and percentages. Regression analysis explored the association between WAST-short questions and previous exposure to abuse.ResultsData from 298 community-dwelling adults was analysed. A third of respondents confirmed having experienced DVA, and another 6.4% declined disclosure. The univariable analysis suggested that those with a history of abuse compared to those with no history were 11 times more likely to have tension in the relationship and nine times more likely to have difficulty working out arguments. After adjusting for a-priori confounders (age, gender and ethnicity), those who answered ‘would rather not say’ appeared to be 34 times more likely to have tension in the relationship, and 17 times more likely to have difficulty working out arguments. Nearly two-thirds of the study population r
El-Osta A, Mummery D, 2022, The Future of Self-Care in the 21st Century NHS, Society for Academic Primary Care
Currently there are approximately one million Primary Care appointments a day in the UK, and this is unlikely to increase without a surge in recruitment and training of General Practitioners and nurses. In some parts of the UK 40% of GP posts are unfilled, and with an emerging recruitment crisis in General Practice, it seems unlikely currently that there will be very large numbers of extra GPs and nurses in the coming years to help to manage this demand. The Government, with the current economic and financial situation in the UK, also seems unlikely to increase overall funding for the NHS, and Primary Care in particular in the coming years, to a significant degree. Part of the reason for the endless demand for medical services, it seems is that over the last few decades there has been a shift from individual responsibility for management of simple ailments, such as self-limiting illness, to professional responsibility for this. Imperial SCARU (Self Care Academic Research Unit), based at the Department Primary Care and Public Health is the first University unit in the world looking at the totality of self care relating to health, and has formulated the "self care matrix" as a tool and lens to analyse self care interventions. https://www.imperial.ac.uk/school-public-health/primary-care-and-public-health/research/scaru/
El-Osta A, Webber I, Alaa A, 2022, What is the suitability of clinical vignettes in benchmarking the performance of online symptom checkers? An audit study (vol 12, e053566, 2022), BMJ OPEN, Vol: 12, ISSN: 2044-6055
Gibson H, Huang D, Hayhoe B, et al., 2022, A virtual group consultation model of care for menopause treatment, New England Journal of Medicine, Vol: 3, ISSN: 0028-4793
El-Osta A, Qualter P, Goldman N, 2022, Loneliness & Society 5.0, Mental Health Awareness Week 2022
El-Osta A, Webber I, Alaa A, et al., 2022, What is the suitability of clinical vignettes in benchmarking the performance of online symptom checkers? An audit study, BMJ Open, Vol: 12, ISSN: 2044-6055
Objective: Assess the suitability of clinical vignettes in benchmarking the performance of online symptom checkers (OSCs).Design: Observational study using a publicly available free OSC.Participants: Healthily OSC, which provided consultations in English, was used to record consultation outcomes from two lay and four expert inputters using 139 standardised patient vignettes. Each vignette included three diagnostic solutions and a triage recommendation in one of three categories of triage urgency. A panel of three independent general practitioners interpreted the vignettes to arrive at an alternative set of diagnostic and triage solutions. Both sets of diagnostic and triage solutions were consolidated to arrive at a final consolidated version for benchmarking.Main outcome measures: Six inputters simulated 834 standardised patient evaluations using Healthily OSC and recorded outputs (triage solution, signposting, and whether the correct diagnostic solution appeared first or within the first three differentials). We estimated Cohen’s kappa to assess how interpretations by different inputters could lead to divergent OSC output even when using the same vignette or when compared with a separate panel of physicians.Results: There was moderate agreement on triage recommendation (kappa=0.48), and substantial agreement on consultation outcomes between all inputters (kappa=0.73). OSC performance improved significantly from baseline when compared against the final consolidated diagnostic and triage solution (p<0.001).Conclusions: Clinical vignettes are inherently limited in their utility to benchmark the diagnostic accuracy or triage safety of OSC. Real-world evidence studies involving real patients are recommended to benchmark the performance of OSC against a panel of physicians.
Sivarajasingam V, Webber I, Alaa A, et al., 2022, Investigating public awareness, prevailing attitudes and perceptions towardsdomestic violence and abuse: a qualitative study in the United Kingdom, BMC Public Health, ISSN: 1471-2458
Background:Reported Domestic Violence and Abuse (DVA) cases have increased since the advent of the COVID-19 pandemic and ensuing lockdown. Understanding the general public’s view about DVA is vital, as it would help develop targeted interventions and effective public policies to tackle DVA. We investigated public awareness, attitudes and perceptions towards DVA, and explored mechanisms to tackle DVA in the community setting.Methods: In-depth personal interviews were conducted with 29 participants who responded to study invitations and adverts on social media. A topic guide was used to ensure consistency across the interviews, which were audio-recorded, transcribed and analysed thematically to detect emergent themes concerning DVA.Results:All respondents were aware of the concept of abuse. Thirty-eight percent declared either having experienced DVA directly or that they knew someone close to being abused. More than half of the respondents were not aware of existing DVA supportive services in the UK. Overarching themes generated from the contextual analysis included contributing factors for DVA, challenges and barriers facing victims and proposals for future interventions.Conclusions:The public has a broad understanding of the impacts of DVA. Simultaneously, the public fail to recognise specific instances or events in their daily lives. Raising public awareness, particularly in children through the school curriculum, highlighting existing support services and introducing the routine use of short screening tools for DVA in primary care can increase awareness, early identification and effective interventions. Sustained, multi-level community facing interventions are recommended to reduce stigma and fear associated with DVA.
Poe M, Vegas R, El-Osta A, 2022, Empowering self-care: A handbook for pharmacists, International Pharmaceutical Federation (FIP)
Supporting and empowering individuals to responsibly engage in self-care is an important part of pharmacists’ daily practice around the world. Self-care spans the whole wellness spectrum, from disease prevention to the management of symptoms and common ailments. It also encompasses interventions ranging from advice on non-prescription medicines and medical devices (often described as “over the counter”) to education on healthy diets, hygiene and mindfulness practices.1 The ability to engage in self-care empowers individuals to act on their own health and well-being, and it encourages the inclusion of their input and specific needs when making healthcare decisions. Self-care empowers people and societies to transform health. Moreover, to promote health equity, health literacy is needed, and there is significant room for improvement and for greater research in this field.Self-care has been conceptualised through internationally recognised frameworks.2 The Self-Care Matrix is a widely accessible framework that conveys the concept of the “totality” of self-care by highlighting the inter-relationships between four cardinal dimensions of self-care. These dimensions are: 1. Person-centred self-care activities; 2. Self-care behaviours; 3. Self-care in the context of resource utilisation; and4. The prevailing environment as a key enabler of self-care practice.Self-care is an important contributor to universal health coverage (UHC) through savings in healthcare expenditure and the reallocation of resources by means of reduced use and pressure on healthcare systems.For example, patient education and assessment conducted by pharmacists in addition to supporting the informed choice of non-prescription medicines could relieve the burden placed on healthcare systems, such as in primary care facilities or emergency departments, from patients seeking consultation for minor ailments, and lessen the reliance on prescription-only medicines.
Poe M, Viegas R, El-Osta A, 2022, Empowering self-care: A handbook for pharmacists, Empowering self-care: A handbook for pharmacists, Publisher: International Pharmaceutical Federation (FIP)
Supporting and empowering individuals to responsibly engage in self-care is an important part of pharmacists’ daily practice around the world. Self-care spans the whole wellness spectrum, from disease prevention to the management of symptoms and common ailments. It also encompasses interventions ranging from advice on non-prescription medicines and medical devices (often described as “over the counter”) to education on healthy diets, hygiene and mindfulness practices.1 The ability to engage in self-care empowers individuals to act on their own health and well-being, and it encourages the inclusion of their input and specific needs when making healthcare decisions. Self-care empowers people and societies to transform health. Moreover, to promote health equity, health literacy is needed, and there is significant room for improvement and for greater research in this field.Self-care has been conceptualised through internationally recognised frameworks.2 The Self-Care Matrix is a widely accessible framework that conveys the concept of the “totality” of self-care by highlighting the inter-relationships between four cardinal dimensions of self-care. These dimensions are:1. Person-centred self-care activities;2. Self-care behaviours;3. Self-care in the context of resource utilisation; and4. The prevailing environment as a key enabler of self-care practice.Self-care is an important contributor to universal health coverage (UHC) through savings in healthcare expenditure and the reallocation of resources by means of reduced use and pressure on healthcare systems. For example, patient education and assessment conducted by pharmacists in addition to supporting the informed choice of non-prescription medicines could relieve the burden placed on healthcare systems, such as in primary care facilities or emergency departments, from patients seeking consultation for minor ailments, and lessen the reliance on prescription-only medicines.
World Health Organisation WHO, 2022, Classification of self-care interventions for health: a shared language to describe the uses of self-care interventions, Publisher: World Health Organization, ISBN: 978 92 4 003946 9
The classification of self-care interventions is health systems focused and aims to promote an accessible and bridging language for researchers, policy-makers, donors and health programme managers in five key areas:synthesizing evidence and research;promoting advocacy and communication;conducting national inventories and landscape analyses;articulating needs based on identified health system challenges;formulating operational considerations for implementation guidance.The classification aligns with a people-centred approach to health and well-being outlined in the WHO conceptual framework for self-care interventions and Guideline on Self-Care Interventions for Health and Well-being.This ‘living’ document will evolve as new models of self-care interventions and evidence-based best practices become available. It has been developed following an extensive consultative process guided by a panel of global experts.
Pickett K, Taylor-Robinson D, Qualter P, et al., 2021, The Child of the North: Building a fairer future after COVID-19 report.Pickett K., Taylor-Robinson D., et al (2021) The Child of the North: Building a fairer future after COVID-19, the Northern Health Science Alliance and N8 Research Partnership.
The considerable costs to society and the UK’s economy of rising inequality are outlined in The Child of the North: Building a fairer future after COVID-19 report, produced by the N8 Research Partnership and Northern Health Science Alliance (NHSA), and written by over 40 leading academics from across the North of England.The report looks at a wide range of factors, from child poverty to children in care, to build up a picture of the Child of the North. It sets out 18 clear recommendations that can be put in place to tackle the widening gap between the North and the rest of England.
Donnat C, Bunbury F, Liu D, et al., 2021, Predicting COVID-19 transmission to inform the management of mass events: a model-based approach, JMIR Public Health and Surveillance, Vol: 7, ISSN: 2369-2960
Background:Modelling COVID-19 transmission at live events and public gatherings is essential to control the probability of subsequent outbreaks and communicate to participants their personalised risk. Yet, despite the fast-growing body of literature on COVID transmission dynamics, current risk models either neglect contextual information on vaccination rates or disease prevalence or do not attempt to quantitatively model transmission.Objective:This paper attempts to bridge this gap by providing informative risk metrics for live public events, along with a measure of their uncertainty.Methods:Building upon existing models, our approach ties together three main components: (a) reliable modelling of the number of infectious cases at the time of the event, (b) evaluation of the efficiency of pre-event screening, and (c) modelling of the event’s transmission dynamics and their uncertainty along using Monte Carlo simulations.Results:We illustrate the application of our pipeline for a concert at the Royal Albert Hall and highlight the risk’s dependency on factors such as prevalence, mask wearing, or event duration. We demonstrate how this event held on three different dates (August 20th 2020, January 20th 2021, and March 20th 2021) would likely lead to transmission events that are similar to community transmission rates (0.06 vs 0.07, 2.38 vs 2.39, and 0.67 vs 0.60, respectively). However, differences between event and background transmissions substantially widen in the upper tails of the distribution of number of infections (as denoted by their respective 99th quantiles: 1 vs 1, 19 vs 8, and 6 vs 3 for our three dates), further demonstrating that sole reliance on vaccination and antigen testing to gain entry would likely significantly underestimate the tail risk of the event.Conclusions:Despite the unknowns surrounding COVID-19 transmission, our estimation pipeline opens the discussion on contextualized risk assessment by combining the best tools at hand to as
Global Self-Care Federation, 2021, Self-care readiness index, Publisher: Global Self-Care Federation
Harris M, Kreindler J, Donnat C, et al., 2021, Rapid response to BMJ: Are vaccine passports and covid passes a valid alternative to lockdown?, BMJ: British Medical Journal, Vol: 375, ISSN: 0959-535X
El-Osta A, Hennessey C, Pilot C, et al., 2021, A digital solution to streamline access to smoking cessation interventions in England; findings from a primary care pilot (STOPNOW study), Public Health in Practice, Vol: 2, ISSN: 2666-5352
Objectives:Despite the proven efficacy of several smoking cessation medications that have been shown to improve long-term abstinence rates, approximately two-thirds of smokers report not having used medication in their most recent quit attempt. A main barrier could be delayed access to pharmacological interventions. This study investigated the utility of a primary care linked online portal to streamline timely access to pharmacological support to patients who want to quit smoking by making an asynchronous request for treatment to their general practitioner.Study design:Prospective cohort study.Methods:An online portal with added functionality was developed, which allowed patients with a unique link to make an asynchronous request for treatment. Two GP practices identified a total of 4337 eligible patients who received an SMS or email invite to engage with an online portal including an electronic survey to capture information about smoking behaviours and to request treatment. Portal informatics and patient level data were analysed to measure the efficacy of the online system in reducing the time between making a formal request to treatment and access to pharmacological support. The primary outcome measure was the time between making a formal request for treatment and access to pharmacological support from a designated community pharmacy.Results:323 patients (7.4%) initiated the survey, but only 56 patients completed the survey and made a formal request for treatment. 94% of participants did not return to use the portal to make a second or follow-up request for treatment. Only 3 participants completed the 12-week pathway. A total of 75 medication items were prescribed and collected by 56 patients. The time difference between the formal request to treatment and GP review ranged between 20 h and 1 week. The time difference between approval of prescription by the GP and access to medication was 5 days ± 2.1 days (range = 1.9–7.0 days).Conclusion:The widespre
El-Osta A, Mezzich J, Snaeldal J, 2021, Self-Care, Inter-Care and Wellbeing in COVID-19 Times at the 13th Geneva Conference on Person Centered Medicine, Self-Care, Inter-Care and Wellbeing in COVID-19 Times at the 13th Geneva Conference on Person Centered Medicine, Publisher: World Medical Association, ISSN: 1047-1928
Powell RA, Kendall K, Cislaghi B, et al., 2021, Self-care, social norms and anomie during COVID-19: from contestation of the greater good to building future normative resilience in the UK, Journal of Epidemiology and Community Health, Vol: 75, Pages: 925-926, ISSN: 0143-005X
El-Osta A, Webber I, Alaa A, et al., 2021, What is the suitability of clinical vignettes in benchmarking the performance of online symptom checkers? An audit study, Publisher: Cold Spring Harbor Laboratory
Objective To assess the suitability of primary care vignettes in benchmarking the performance of online symptom checkersDesign Observational study using publicly available, free online symptom checkersParticipants Three symptom checkers (Healthily, Ada and Babylon) that provided consultations in English. 139 standardized patient vignettes were compiled by RCGP. Three independent GPs interpreted the vignettes to arrive at a “Gold Standard” consisting of 3 dispositions and divided into one of three categories of triage urgency: (1) emergency care required, (2) primary care required and (3) self-care.Main outcome measures Six professional non-medical and lay inputters simulated 2774 standardized patient evaluations using 3 online symptom checkers (OSC). We recorded when OSC provided a triage recommendation and whether it correctly recommended the appropriate triage recommendation across three categories of triage urgency (emergency care, primary care or self-care). We collected data on whether the solution appeared within the first 3 dispositions in each of the standards across 2774 standardized patient evaluations.Results When benchmarked against the Gold Standard, Healthily provided an appropriate triage recommendation 61.9% of the time compared to 45.3% and 42.4% of the time for Babylon and Ada respectively. There was poor agreement between OSC consultation outcome and Gold Standard dispositions. When compared to the Gold Standard, Healthily gave an unsafe “under-triage” recommendation 28.6% of the time overall across the three categories compared to 43.3% for Ada and 47.5% for Babylon (P<0.001).Conclusions OSCs recommended ‘very unsafe’ triages only <4% of the time suggesting that the online consultation tools are generally working at a safe level of risk. Primary care vignettes are a helpful tool to support development of OSC, but not ideally suited to benchmark the performance of different OSC. Real-world evidence studies
Symington E, El-Osta A, Birrell F, 2021, Supported self-care is integral to lifestyle medicine: Can virtual group consultations promote them both?, Lifestyle Medicin Journal, Vol: 2, Pages: 1-5, ISSN: 2688-3740
WHO, 2021, WHO Guideline on Self-Care Interventions for Health and Well-Being, https://www.ncbi.nlm.nih.gov/books/NBK572699/
Self-care interventions are among the most promising and exciting new approaches to improve health and well-being, both from a health systems perspective and for people who use these interventions.The World Health Organization (WHO) uses the following working definition of self-care: Self-care is the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health worker. The scope of self-care as described in this definition includes health promotion; disease prevention and control; self-medication; providing care to dependent persons; seeking hospital/specialist/primary care if necessary; and rehabilitation, including palliative care. It includes a range of self-care modes and approaches. While this is a broad definition that includes many activities, it is important for health policy to recognize the importance of self-care, especially where it intersects with health systems and health professionals.Worldwide, an estimated shortage of 18 million health workers is anticipated by 2030, a record 130 million people are currently in need of humanitarian assistance, and disease outbreaks are a constant global threat. At least 400 million people worldwide lack access to the most essential health services, and every year 100 million people are plunged into poverty because they have to pay for health care out of their own pockets. There is an urgent need to find innovative strategies that go beyond the conventional health sector response.While “self-care” is not a new term or concept, self-care interventions have the potential to increase choice, when they are accessible and affordable, and they can also provide more opportunities for individuals to make informed decisions regarding their health and health care. In humanitarian settings, for example, due to lack of or limited health infrastructure and medical services in the crisis-affected areas
Harris M, Kreindler J, El-Osta A, et al., 2021, Safe management of full-capacity live/mass events in COVID19 will require mathematical, epidemiological and economic modelling, Journal of the Royal Society of Medicine, Vol: 114, Pages: 290-294, ISSN: 0141-0768
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