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Winkler, R. and Rosian, K. (2016): Supply Mandates. HTA-Projektbericht 88.

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Demographic change, technological developments and changes in socioeconomic frameworks affect various social levels as well as healthcare systems. In the context of supply structures, fundamental questions are established, which are being discussed in two parts of this LBI-HTA report:

Part I is based on definitions, models and approaches towards the potential content of a "Best point of service" (BPoS). This part discusses the BPoS for the outpatient area at a conceptual level (definitions, involved actors and constituent aspects).

In Part II, two concrete health interventions (phlebotomy and electrostimulation in the urogenital area (ES)) are presented alongside the evidence of the effectiveness and safety of these interventions. Furthermore, the analysis intends to involve organisational information regarding the service provision (using the "organisational domain" of the EUnetHTA Core Model®).

In order to answer the research questions, a literature and hand search was performed in Part I as well as an e-mail questionnaire was sent to experts; in Part II intervention-specific systematic literature searches were carried out.

Overall, no international experience or policies could be identified that could be useful for the identification of a BPoS in the context of the Austrian healthcare system. In principle, it can be stated that the operationalisation of target groups for a BPoS – for example along the basic health need, the particular disease or the defined competence profiles (such as defined in the medical training regulations) of the service providers is of central importance. The frequency and economic size of healthcare activities should be taken into account in the operationalisation of a BPoS.

With regard to the effectiveness and safety of phlebotomy, the results show that this intervention is considered safe and a preferred therapy option for patients who tolerate such treatment (e.g. patients with hereditary hemochromatosis). The evidence analysis suggests that phlebotomy involves more benefit than harm. The effectiveness of ES in the urogenital area, to improve urinary incontinence, depends upon the type of disease (e.g. stress incontinence or overactive bladder) and the provided therapy (e.g. therapy frequency, duration, or intensity).

Furthermore, the analysis shows that ES is neither superior nor inferior to other forms of therapy with respect to certain endpoints. In summary, ES can be used primarily in combination with behavioural therapy/biofeedback. With regard to the evidence overview on the effectiveness and safety of phlebotomy or ES in the urogenital area, only very limited results are available.
Regarding both interventions, no specific BPoS framework could be identified using the ORG domain ("organisational domain"). The choice of a BPoS depends on the particular patient group and the underlying health problem. Thus, the content of a BPoS concept should also take into account the frequency of care events and their economic importance.

Item Type:Project Report
Keywords:Supply mandates, best point of service, theoretical concepts, phlebotomy, electrostimulaton in the urogenital area, organisational framework
Subjects:WA Public health > WA 525-590 Health administration and organisation
W Health professions > W 100-275 Medical, dental and pharmaceutical service plans
WJ Urogenital system > WJ 140-160 Urologic diseases
W Health professions > W 85 Patients and patient advocacy
WH Hemic and lymphatic systems
W Health professions > W 84 Health services. Quality of health care
Series Name:HTA-Projektbericht 88
Deposited on:19 Dec 2016 14:28
Last Modified:15 Jul 2020 17:55

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