Engel Nora, Wachter Keri, Pai Madhukar, Gallarda Jim, Boehme Catharina, Celentano Isabelle, Weintraub Rebecca
Department of Health, Ethics & Society/CAPHRI, Maastricht University, Maastricht, The Netherlands.
Harvard Medical School, Global Health Delivery Project at Harvard University, Boston, Massachusetts, USA.
BMJ Glob Health. 2016 Dec 2;1(4):e000132. doi: 10.1136/bmjgh-2016-000132. eCollection 2016.
Several barriers challenge development, adoption and scale-up of diagnostics in low and middle income countries. An innovative global health discussion platform allows capturing insights from the global health community on factors driving demand and supply for diagnostics. We conducted a qualitative content analysis of the online discussion 'Advancing Care Delivery: Driving Demand and Supply of Diagnostics' organised by the Global Health Delivery Project (GHD) (http://www.ghdonline.org/) at Harvard University. The discussion, driven by 12 expert panellists, explored what must be done to develop delivery systems, business models, new technologies, interoperability standards, and governance mechanisms to ensure that patients receive the right diagnostic at the right time. The GHD Online (GHDonline) platform reaches over 19 000 members from 185 countries. Participants (N=99) in the diagnostics discussion included academics, non-governmental organisations, manufacturers, policymakers, and physicians. Data was coded and overarching categories analysed using qualitative data analysis software. Participants considered technical characteristics of diagnostics as smaller barriers to effective use of diagnostics compared with operational and health system challenges, such as logistics, poor fit with user needs, cost, workforce, infrastructure, access, weak regulation and political commitment. Suggested solutions included: health system strengthening with patient-centred delivery; strengthened innovation processes; improved knowledge base; harmonised guidelines and evaluation; supply chain innovations; and mechanisms for ensuring quality and capacity. Engaging and connecting different actors involved with diagnostic development and use is paramount for improving diagnostics. While the discussion participants were not representative of all actors involved, the platform enabled a discussion between globally acknowledged experts and physicians working in different countries.
在低收入和中等收入国家，多种障碍对诊断技术的开发、采用和推广构成挑战。一个创新的全球健康讨论平台能够收集全球健康界对于推动诊断技术供需的因素的见解。我们对哈佛大学全球健康交付项目（GHD）（http://www.ghdonline.org/）组织的在线讨论“推进医疗服务：推动诊断技术的供需”进行了定性内容分析。由12位专家小组成员推动的这场讨论，探讨了必须采取哪些措施来开发交付系统、商业模式、新技术、互操作性标准和治理机制，以确保患者在正确的时间获得正确的诊断。GHD在线（GHDonline）平台拥有来自185个国家的19000多名成员。诊断讨论的参与者（N = 99）包括学者、非政府组织、制造商、政策制定者和医生。使用定性数据分析软件对数据进行编码并分析总体类别。与物流、与用户需求不匹配、成本、劳动力、基础设施、可及性、监管薄弱和政治承诺等运营和卫生系统挑战相比，参与者认为诊断技术的技术特性是有效使用诊断技术的较小障碍。建议的解决方案包括：以患者为中心的交付加强卫生系统；加强创新流程；改善知识库；统一指南和评估；供应链创新；以及确保质量和能力的机制。让参与诊断技术开发和使用的不同行为者参与并建立联系对于改进诊断技术至关重要。虽然讨论参与者并不代表所有相关行为者，但该平台促成了全球公认的专家与在不同国家工作的医生之间的讨论。
