1
|
Söling S, Pfaff H, Karbach U, Ansmann L, Köberlein-Neu J, Kellermann-Mühlhoff P, Düvel L, Beckmann T, Hammerschmidt R, Jachmich J, Leicher E, Brandt B, Richard J, Meyer F, Flume M, Müller T, Gerlach FM, Muth C, Gonzalez-Gonzalez AI, Chapidi K, Brünn R, Ihle P, Meyer I, Timmesfeld N, Trampisch HJ, Klaaßen-Mielke R, Basten J, Greiner W, Suhrmann B, Piotrowski A, Beifuß K, Meyer S, Grandt D, Grandt S. How is leadership behavior associated with organization-related variables? Translation and psychometric evaluation of the implementation leadership scale in German primary healthcare. BMC Health Serv Res 2022; 22:1065. [PMID: 35986273 PMCID: PMC9391066 DOI: 10.1186/s12913-022-08434-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Implementation Leadership Scale (ILS) was developed to assess leadership behavior with regard to being proactive, knowledgeable, supportive, or perseverant in implementing evidence-based practices (EBPs). As part of a study on the implementation of a digitally supported polypharmacy management application in primary care, the original ILS was translated and validated for use in the German language. Rationale This study aimed to translate the original ILS into German and evaluate its psychometric properties. Methods The validation sample consisted of 198 primary care physicians in a cluster-randomized controlled trial in which the intervention group implemented a digitally supported clinical decision support system for polypharmacy management. The ILS was assessed using a 12-item scale. The study included a process evaluation with two evaluation waves between 2019 and 2021. The ILS was used within this process evaluation study to assess the leadership support with regard to the implementation of the polypharmacy management. The ILS was translated in a multi-step process, including pre-testing of the instrument and triple, back-and-forth translation of the instrument. We tested the reliability (Cronbach’s alpha) and validity (construct and criterion-related validity) of the scale. Results The four-dimensional structure of the instrument was confirmed (comparative fit index = .97; root mean square error of approximation = .06). Convergent validity was demonstrated by correlations with organizational innovation climate, social capital, and workload, which was consistent with the proposed hypothesis. Criterion-related validity of the ILS was demonstrated by predicting the organizational readiness for change scores using structural equation modeling. The reliability of the scale was good (α = .875). Conclusion The German version of the ILS created in this study is a reliable and valid measure. The original four-dimensional structure of the ILS was confirmed in a primary care setting. Further psychometric testing is needed to establish the validity and reliability of the ILS and to transfer it to other health care settings. It is a useful tool for identifying the areas for implementation leadership development. Further research is needed on how, why, and when distinct types of leadership behaviors have different effects on healthcare organizations in implementation processes.
Collapse
|
2
|
Flume M, Bardou M, Capri S, Sola-Morales O, Cunningham D, Levin LA, Postma MJ, Touchot N. Approaches to manage 'affordability' of high budget impact medicines in key EU countries. J Mark Access Health Policy 2018; 6:1478539. [PMID: 29915664 PMCID: PMC5998770 DOI: 10.1080/20016689.2018.1478539] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/14/2018] [Indexed: 05/24/2023]
Abstract
Background: The launch of hepatitis C (HCV) drugs such as sofosbuvir or ledipasvir has fostered the question of affordability of novel high budget impact therapies even in countries with high domestic product. European countries have developed a variety of mechanisms to improve affordability of such therapies, including 'affordability thresholds', price volume agreements or caps on individual product sales, and special budgets for innovative drugs. While some of these mechanisms may help limit budget impact, there are still significant progresses to be made in the definition and implementation of approaches to ensure affordability, especially in health systems where the growth potential in drug spending and/or in the patient contribution to health insurance are limited. Objectives: In this article, we will review how seven countries in western Europe are approaching the question of affordability of novel therapies and are developing approaches to continue to reward new sciences while limiting budget impact. We will also discuss the question of affordability of cost-effective but hugely expensive therapies and the implications for payers and for the pharmaceutical industry. Results: There is clearly not one solution that is used consistently across countries but rather a number of 'tools' that are combined differently in each country. This illustrates the difficulty of managing affordability within different legal frameworks and within different health care system architectures.
Collapse
Affiliation(s)
- Mathias Flume
- Kassenärztliche Vereinigung Westfalen-Lippe (KVWL), Dortmund, Germany
| | - Marc Bardou
- CIC INSERM 1432, CHU CHU Dijon-Bourgogne, Dijon Cedex, France
| | - Stefano Capri
- School of Economics and Management, Cattaneo-LIUC University, Castellanza (Varese), Italy
| | | | | | - Lars-Ake Levin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maarten J. Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | |
Collapse
|
3
|
de Solà-Morales O, Cunningham D, Flume M, Overton PM, Shalet N, Capri S. DEFINING INNOVATION WITH RESPECT TO NEW MEDICINES: A SYSTEMATIC REVIEW FROM A PAYER PERSPECTIVE. Int J Technol Assess Health Care 2018; 34:224-240. [PMID: 29987996 DOI: 10.1017/s0266462318000259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The aim of this study was to investigate how innovation is defined with respect to new medicines. METHODS MEDLINE, Embase, and EconLit databases were searched for articles published between January 1, 2010 and May 25, 2016 that described a relevant definition of innovation. Identified definitions were analyzed by mapping the concepts described onto a set of ten dimensions of innovation. RESULTS In total, thirty-six articles were included, and described a total of twenty-five different definitions of innovation. The most commonly occurring dimension was therapeutic benefit, with novelty and the availability of existing treatments the second and third most common dimensions. Overall, there was little agreement in the published literature on what characteristics of new medicines constitute rewardable innovation. CONCLUSIONS Alignment across countries and among regulators, health technology assessment bodies and payers would help manufacturers define research policies that can drive innovation, but may be challenging, as judgements about what aspects of innovation should be rewarded vary among stakeholders, and depend on political and societal factors.
Collapse
|
4
|
de Groot F, Capri S, Castanier JC, Cunningham D, Flamion B, Flume M, Herholz H, Levin LÅ, Solà-Morales O, Rupprecht CJ, Shalet N, Walker A, Wong O. Ethical Hurdles in the Prioritization of Oncology Care. Appl Health Econ Health Policy 2017; 15:119-126. [PMID: 27766548 PMCID: PMC5343076 DOI: 10.1007/s40258-016-0288-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
With finite resources, healthcare payers must make difficult choices regarding spending and the ethical distribution of funds. Here, we describe some of the ethical issues surrounding inequity in healthcare in nine major European countries, using cancer care as an example. To identify relevant studies, we conducted a systematic literature search. The results of the literature review suggest that although prevention, access to early diagnosis, and radiotherapy are key factors associated with good outcomes in oncology, public and political attention often focusses on the availability of pharmacological treatments. In some countries this focus may divert funding towards cancer drugs, for example through specific cancer drugs funds, leading to reduced expenditure on other areas of cancer care, including prevention, and potentially on other diseases. In addition, as highly effective, expensive agents are developed, the use of value-based approaches may lead to unacceptable impacts on health budgets, leading to a potential need to re-evaluate current cost-effectiveness thresholds. We anticipate that the question of how to fund new therapies equitably will become even more challenging in the future, with the advent of expensive, innovative, breakthrough treatments in other therapeutic areas.
Collapse
Affiliation(s)
- Folkert de Groot
- ToendersdeGroot B.V, Boomstede 281, 3608 AN, Maarssen, The Netherlands.
| | - Stefano Capri
- School of Economics and Management, LIUC University, Castellanza, Italy
| | | | | | | | - Mathias Flume
- Kassenärztliche Vereinigung Westfalen Lippe, Dortmund, Germany
| | | | - Lars-Åke Levin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | | | | | | | | |
Collapse
|
5
|
Flume M, Bardou M, Capri S, Sola-Morales O, Cunningham D, Levin LA, Touchot N. Feasibility and attractiveness of indication value-based pricing in key EU countries. J Mark Access Health Policy 2016; 4:30970. [PMID: 27226845 PMCID: PMC4864834 DOI: 10.3402/jmahp.v4.30970] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 05/25/2023]
Abstract
Indication value-based pricing (IBP) has been proposed in the United States as a tool to capture the differential value of drugs across indications or patient groups and is in the early phases of implementation. In Europe, no major country has experimented with IBP or is seriously discussing its use. We assessed how the reimbursement and pricing environment allows for IBP in seven European countries, evaluating both incentives and hurdles. In price setting countries such as France and Germany, the Health Technology Assessment and pricing process already accounts for differences of value across indications. In countries where differential value drives coverage decisions such as the United Kingdom and Sweden, IBP is likely to be used, at least partially, but not in the short-term. Italy is already achieving some form of differential value through managed entry agreements, whereas in Spain the electronic prescription system provides the infrastructure necessary for IBP but other hurdles exist.
Collapse
Affiliation(s)
- Mathias Flume
- Kassenärztliche Vereinigung Westfalen-Lippe, Dortmund, Germany
| | - Marc Bardou
- CIC INSERM 1432, CHU du Bocage, Dijon, France
| | - Stefano Capri
- School of Economics and Management, Cattaneo–LIUC University, Castellanza, Italy
| | | | | | - Lars-Ake Levin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | | |
Collapse
|
6
|
Affiliation(s)
| | - Mathias Flume
- Kassenärztliche Vereinigung Westfalen Lippe, Prescription Management, Dortmund, Germany
| |
Collapse
|
7
|
Jurke A, Flume M, Köck R, Friedrich AW. Trends in regional outpatient antibiotic prescription data and interventions in the Dutch-German EURSAFETY HEALTH-NET-project. BMC Proc 2011. [PMCID: PMC3239560 DOI: 10.1186/1753-6561-5-s6-p144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|