The future of health digitalization: The case of Primary Health Care in Portugal

Abstract Background The sustainability of Healthcare Services will depend on the proper implementation of the digital transformation of Primary Health Care (PHC) Services. COVID-19 Pandemic have shown precisely this, where there was pressure from health Professionals and managers for the integration of teleconsultations within the health work processes. This study aims at developing scenarios for the digitalization of PHC in the Portuguese Health System. Methods This study follows the methodology of scenario development, similar to the future of community pharmacy services scenario study. A conceptual model of PHC services was developed, based on the literature and a set of interviews. The target group was the primary healthcare professionals: family doctors, nurses, and operational assistants. The time horizon was 2032 and, by selecting actors from different regions of Portugal, it was possible to achieve broad representativeness. Results Three focus groups were conducted. The first enabled to identify the two driving forces that may influence the digitalization of PHCs in the next 10 years: 1) service innovation and 2) Governance and Regulations. These two driving forces enabled to design three plausible scenarios: a) Innovate or Fade-away; b) Isolated PHC and c) Digital PHC. These scenarios were developed, and their impacts were reflected upon. It was found that the role of human Resources is critical. Conclusions The process of reflection and discussion for the identification of the different driving forces made the different actors discuss the different points of view and find a meeting point to reach a conclusion. Furthermore, this study allowed the different stakeholders to understand the measures and actions to be taken for PHC digitization to be implemented in the most effective way, allowing the sustainability of the National Health Service in Portugal, which until this point were only ideas discussed at the institutional and individual level.


Background:
A better understanding of possible future developments is essential for policy makers to anticipate and influence these trends. Public health foresight studies (PHFS) are tools to support this. The current health crisis makes clear that PHFS are necessary more than ever to target possible future impacts resulting from SARS-COV-2 induced changes in e.g. regular health care services, lifestyle and socio-economic developments. To support European countries in doing their own foresight studies, PHIRI aims to strengthen foresight capacity. Methods: PHIRI follows a 4-step approach: 1. Making an inventory of current PHFS capacities and capacity needs across European countries using desk research and an online survey; 2. Providing PHFS capacity building via a training course and workshops; 3. Supporting the development of public health scenarios for the short term (0-5 years) and longer-term (5-20 years); 4. Supporting the identification of promising policy strategies, using policy dialogues.

Results:
The online survey was completed by participants of 21 countries and shed light on existing national PHFS and needs for capacity building. It also provided a basis for the development of a professional network on PHFS within the project. A PHFS capacity building course was developed, including videos posted on the PHIRI website and a template structuring the different foresight elements. Around 15 researchers undertook their own PHFS, covering a wide range of public health topics, using the material provided during the course. In addition, a compact guide was developed and provided, explaining the different foresight elements. Based on these studies, common challenges and promising policies are identified.

Conclusions:
Foresight in public health is gaining more and more interest, especially now in these times of crisis. PHIRI provides more insight in the wider public health impacts of the SARS-CoV-2 pandemic and in translating this into policy options.

Background:
The sustainability of Healthcare Services will depend on the proper implementation of the digital transformation of Primary Health Care (PHC) Services. COVID-19 Pandemic have shown precisely this, where there was pressure from health Professionals and managers for the integration of teleconsultations within the health work processes. This study aims at developing scenarios for the digitalization of PHC in the Portuguese Health System.

Methods:
This study follows the methodology of scenario development, similar to the future of community pharmacy services scenario study. A conceptual model of PHC services was developed, based on the literature and a set of interviews. The target group was the primary healthcare professionals: family doctors, nurses, and operational assistants. The time horizon was 2032 and, by selecting actors from different regions of Portugal, it was possible to achieve broad representativeness. Results: Three focus groups were conducted. The first enabled to identify the two driving forces that may influence the digitalization of PHCs in the next 10 years: 1) service innovation and 2) Governance and Regulations. These two driving forces enabled to design three plausible scenarios: a) Innovate or Fade-away; b) Isolated PHC and c) Digital PHC. These scenarios were developed, and their impacts were reflected upon. It was found that the role of human Resources is critical.

Conclusions:
The process of reflection and discussion for the identification of the different driving forces made the different actors discuss the different points of view and find a meeting point to reach a conclusion. Furthermore, this study allowed the different stakeholders to understand the measures and actions to be taken for PHC digitization to be implemented in the most effective way, allowing the sustainability of the National Health Service in Portugal, which until this point were only ideas discussed at the institutional and individual level. Background: Significant amount of disease burden could be averted by early detection and treatment of diseases. In the Czech Republic, National Screening Centre (NSC) of the Institute of Health Information and Statistics is responsible for informing public health policy in the field of early disease detection. The objective of the proposed early detection public health foresight study (PHFS) is to gather evidence, use available computational tools, utilise knowledge and opinions of stakeholders, and summarize it in a systematic manner to inform public health policies. The presentation outlines the approach undertaken within the proposed early detection PHFS.

Methods:
The key source of data for monitoring of population health status and healthcare system in the Czech Republic is the National Health Information System (NHIS). The study will also utilise external sources of data, namely demographic projections and data on global burden of disease, as well as qualitative data from stakeholders. The study will also utilise analytical tools and outputs developed by NSC (situational analyses, decision modelling, etc.). The conceptual model of the study will cover important underlying aspects like public policies, driving forces, population health and healthcare system, and health impact variables.

Results:
The proposal for early detection PHFS has been developed within the PHFS capacity building course, utilising the iii84 European Journal of Public Health, Volume 32 Supplement 3, 2022