Health needs assessment Flashcards
WHO Def health
“Health is a state of complete physical, psychological, and social wellbeing and not simply the absence of disease or infirmity.”
WHta is a health needs assessment
Health needs assessment is a systematic assessment of the health issues facing a population leading to agreed priorities and resource allocation that will improve health and reduce inequalities
Over time populations and public expectations change existing services may not adapt to changing patterns. Meaning service provision may not be a good indicator of population healthcare needs
HNA are conducted to plan, negotiate and change services for the better
Domains of action in health
WHy undertake a health needs assessment
- HNA is a recommended public health tool to provide evidence about a population on which to plan services and address health inequalities
- HNA provides an opportunity to engage with specific populations and enable them to contribute to targeted service planning and resource allocation
- HNA provides an opportunity for cross-sectoral partnership working and developing creative and effective interventions
Health needs assessment and commisioning
- HNA linked with commissioning has been an integral task of health authorities since 1989. Saving lives: our healthier nation (DH, 1999) stresses the importance of the community’s role in identification of health needs and priorities; and Shifting the balance of power within the NHS: securing delivery (DH, 2001) gave specific responsibility to primary care trusts.
- The Wanless report Securing good health for the whole population (Wanless et al., 2004) also emphasises the importance of high levels of public engagement in order to achieve optimum gains in health outcomes and a reduction of health expenditure in the long term.
Def of need
- HNAs are conducted to inform service development so health problem only considered a health need if it can be addressed by effective intervention or service provision.
- Health problems may generate demand for services – influenced by patient expectations but demand does not necessarily indicate need
- Need= Ability to benefit from healthcare
WHy Health needs assessment are eimportant?
Ideally, health needs should arouse a proportionate and appropriate demand for health care, which can then be supplied in a systematic
This process is distorted by faulty perception of actual need; by failure of even perceived need to generate demand, while at the same time demands are made which bear little relation to need; and finally by the inappropriateness of some service provision to either need or demand
Steps to Healthc are needs assessment
- What pop? Goals? Who? What resources? Risks?: Defien main pop, the subgroups, why have you chosen them and are there specific issues.
- Identify health priorities:Population profiling Gathering data Perceptions of needs Identifying and assessing health conditions and determinant factors. Gather general information about the target population: How mnay, where are they, what data is available, what are ther emain experiences and differences and how does the pop perceive its needs (workshop/focus groups, interviews for key people, quiestionaires, consider reching out to exclued groups form main method
- Assessing a health priority for action:choosing health conditions and determinant factors wth the most significant size + severity impact. Determine effective + acceptable interventions + actions. Profie of important aspects of health conditiosn for target pop and agreed list health priorities. Why is this prioirty important and what canges you can make that will have a positive impact on the msot signfiicant issues affecting priority (acceptability - most acceptable for max pos impact and reosurce feasibility).
- Plannign for change:
Clarifying aims of intervention Action planning
Monitoring and evaluation strategy Risk-management strategy
- Process evaluation
- Outcome evaluation
- A risk-management strategy should be incorporated from the beginning of the project to evaluate and address the impact of risk to achieving the project’s aims and objectives. It should also be built into the planning of specific interventions. This might include:
- Identify potential risks to achieving project/intervention objectives
- Assess each risk according to both likelihood and impact as high, medium or low
Sources of informtion for health need (population health intelligence)
•Primary sources
- Registers of births, deaths, population size and structure
- Population surveys, e.g. Census, Health Survey for England, National Child Measurement Programme, ad hoc (local) surveys
- Social security/benefit claims, e.g. long-term unemployed
- Patient/disease registries, e.g. general practice registries, QOF indicators, cancer registries, hospital episode statistics, NHS Health Checks
- Stakeholder consultations, site visits, e.g. for specific groups – homeless, other ‘hard-to-reach’ groups
•Secondary
•Evidence synthesis and/or population health models/simulation, e.g. Global Burden of Disease, Office for National Statistics, Public Health England data and analysis tools, local/regional public health observatories
3 main components of epidemiologically based HNA population
- size of population - incidence prevalence
- review of the evidence for effectiveness and cost effectiveness of interventions and services
- current service provision
The Trianggle of health needs assessment
Over aim of health needs assessment is to provide information to plan, negotiate and change services for the better to improve health
- Using incidence and prevalence we can determine how many people need a service or intervention
- Need to work out the effectiveness and cost-effectiveness of an intervention (at the moment I am on a NICE committee developing the new OA guidelines and this is one of the key questions we ask about different management options). Do they work? What are the cost implications?
- What is already out there? I may need to reallocate resources for my new intervention
The rule of halves with health needs assessments
Evidence from one practice and from the literature suggest that approximately half of most common chronic disorders are undetected, that half of those detected are not treated, and that half of those treated are not controlled: the ‘rule of halves’.
Sources of Information - effectiveness and cost-effectivness of health + social care intevrentions
- Published original research articles
- Systematic reviews & meta-analyses, e.g. Cochrane library
- NICE evidence-based guidance & advice
- NICE guidelines
- Technology appraisals guidance
- Medical technologies and diagnostics guidance
- Interventional procedures guidance
On the NICE committee we have people who specialise in economic costings who will work out costs of recommended interventions and they work closely with trained accountants who produce models for service planners to assess the local cost implications in their region.
Global burden of diease project
The global burden of disease project looks at mortality and morbidity from major diseases, injuries and risk factors at global, national and regional levels.
Healht profiles
- Health Profiles provide a snapshot of health and well-being for each local authority in England
- They pull together existing information in one place and contain data on a range of indicators for local populations.
- Health Profiles are intended as ‘conversation starters’ to highlight local issues and priorities for members, and for discussion at Health and Well-being Boards.
Health triangle
- The health triangle is an analytical tool that can assist in:
- Identifying potentially important health issues for the population
- Reviewing the associations between health conditions, determinant factors and health functioning (see previous definitions)
- Structuring the collection and presentation of data to compile a useful profile.
Flow of Money through NHS
flow of money through the NHS is complicated
Money flows from the treasury to the DoH and social care
£11.7 billion goes to vaccinations, public health, training NHS staff, regulation
majority £112.7 goes to NHS England
£28.2 billion are for planned national spending eg rare cancer treatments
Majority goes to CCGs
Amount of money CCGs get depends on number of practices in the local area, age level of deprivation
Buy services from GP practices, mental health, community etc
It is changing
- NHS budget = £124.7b now, was lower
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Health economics rationing and priority setting
- Application of economic theory to healthcare
- Many decisions in healthcare are resource allocating decisions
- Economic evaluation is simply the comparative evaluation of both the cost and effects of two or more alternatives.
Economic evaluation
- A comparative analysis of alternative courses of action in terms of both costs and consequences
- Types:
- Cost-effectiveness (consequences in natural units, e.g.cost per stroke prevented)
- Cost-utility (consequences measured in QALYs)
- Cost-benefit (costs and consequences measured in monetary units
At the NICE committee we have people who will go away and do the evidence searches for clinical effectiveness, economic analyst who will work out the cost implications of certain interventions.
Once an intervention has been recommended there are accountants that will develop models so that service designers can work out the cost implications in their region. These tools can be found on the NICE website.
Cost utility ratio
•Cost–utility ratio =(Cost of Intervention A – Cost of Intervention B) /(No. of QALYs produced by Intervention A –No. of QALYs produced by Intervention B)
“In its current appraisal processes, NICE advises its appraisal committees to support the use of a new drug within a range of £20,000 to £30,000 per QALY. In exceptional circumstances more expensive treatments (up to about £50,000 per QALY) can be recommended.”
NICE 2014
An intervention that improves the life of one person by 1 QALY is valued the same as an intervention that improves the life of 100 individuals by 0.01 QALYs. (The distribution of the benefit)
So if you have 2 drugs that are equally effective you will want to know which is cheaper. And this changes all of the time.. Often related to drugs coming off patent. Things can change very quickly…..
Scarcity with resources
Opportuntiy cost
•The value of the consequences forgone by choosing to deploy resources in one way rather than in their best alternative use
e.g. opportunity cost of a therapist led rehab programme for stroke patients might be the benefits forgone for not being able to run an exercise programme for the frail elderly.
Rationing and prioirty setting
Priority setting policies for the fair distribution of health care resources
•Rationing – mechanisms that are used to allocate healthcare resources based on a limited amount of goods/services
- Entails withholding potentially beneficial treatments from some individuals. Rationing is unavoidable because need is limitless and resources are not. (e.g. ICU management)
- Equity - distribution of resources to consider fairness.
- Vertical equity - can be justified on the basis of morally relevant factors
- Horizontal equity
Implications of scarce resources
Implications of scarce resources….
- smoking cessation
- IVF criteria
- Capping no of minor procedures done in GP surgeries
- No funding removal of lumps, bumps, warts, skin tags
- No longer supposed to prescribe paracetamol acute prescription
Dangers with nice comitte
- Lack of evidence of effect is not the same as evidence of lack of effect
- Economic analysis provides information, it does not provide the answers
- Full costs and benefits may not all be taken into account(The result is only as good as the model!)
- Externalities
- One of the problems we have come across on the NICE committee is that there may be anecdotal evidence from panel members that certain interventions may work but there are limited RCTs available with supporting evidence that it works….
- Full costs and benefits may not be taken into account e.g. A new drug is introduced but it needs monitoring so cost analysis may not take into account repeated consultations for phlebotomy, nursing support, quite often GP consultations are not taken into account in economic models..
Decision-making – what to prioritise?
- Too often in the past we have devoted too much time and energy to analysing the problems and not enough to developing and delivering practical solutions that connect with real lives.’ (Choosing Health, page 14, DM, 2004)
- Health needs assessment just one consideration in prioritising services to commission (national priorities, local initiatives/evaluations etc.)
- Public voice and participation viewed as increasingly important
- Explicit vs implicit decision-making and rationing,
Moving on/review
- Learning from the project Measuring impact Choosing the next priority
- How effective was it?
- How could it have been improved?
- What were the main challenges/barriers?
- If appropriate, choose your next priority for assessment:
- Revisit the shortlist of priorities
- Is the priority still an issue? If so, return to step 3
The Inverse Care Law
- “The availability of good medical care tends to vary inversely with the need for the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.”
- “To the extent that health care becomes a commodity it becomes distributed just like champagne. That is rich people gets lots of it. Poor people don’t get any of it.”
- Julian Tudor Hart
