Citizens’ perspective on ‘the right care in the right place’

Abstract Background Healthcare systems around the globe are facing challenges, from increasing demand and costs to a diminishing health workforce. Without change, healthcare will become unsustainable. In the Netherlands, the government aims to organize sustainable healthcare by among others the policy ‘the right care in the right place’. An important part of this policy is relocating healthcare, for instance, from the hospital to the general practitioner (GP) or from the GP to other healthcare providers or to citizens themselves. Relocation of care is expected to reduce costs and manpower shortages. There is, however, little known about how citizens think about this topic, although they are an important stakeholder. This research aims to investigate citizens’ perspectives on the right place for care. Methods A questionnaire was sent in December 2021 to 1.500 members of Nivel's Dutch Healthcare Consumer Panel, including 4 questions about the right care in the right place. The response was N = 796 (53%). In addition, two citizen platforms were organized in March 2022, to discuss the right care in the right place. A total of 23 citizens participated. Results First results indicate that most citizens related expertise and accessibility to the right care in the right place. Participants said that non-complex care could be relocated from the hospital to the GP if the GP has the right expertise. Expertise was mentioned as the most important aspect of care delivery. According to participants, care could be shifted from the GP to other primary care professionals, to social services or to self-sustainability, given that citizens know who to visit or what to do with health problems/worries. More results will be available by November. Conclusions Relocating care could be a possible solution to keep healthcare sustainable in the future in terms of costs and manpower. Among citizens, there seems to be support when certain conditions are met. Key messages • Citizens support the substitution of non-complex care from hospitals. • Citizens are willing to improve self-sustainability when they have the tools.


Background:
To face the second COVID-19 wave, Italy implemented a tiered restriction system with different risk levels (yellow = low; orange = medium, red = high). It is unknown whether the effect of the tiers was equal among provinces with varying levels of socioeconomic deprivation (SED). At each restriction level, we analyzed the impact of the province's SED on the SARS-CoV-2 daily reproduction number (Rt).

Methods:
We considered the Rt (Nov 2020-May 2021) as the dependent variable and the SED as the independent variable. The Rt was estimated using daily incidence data from the Civil Protection Department as the instantaneous Rt. The province SED was measured using the percentage of individuals whose yearly income was less than 10,000E (2019 data from the Ministry of Economy and Finance). We used multilevel linear regression models with random intercepts stratified by restriction level to estimate the effect of the SED on Rt (b) and its Standard Error (SE). Our analyses adjusted the estimates for the number of days into the tier first and then for other covariates.

Results:
We found different levels and trends of Rt by SED in every restriction. Days-adjusted models found a containing effect for the red and the orange tier, while the Rt had an increasing trend in yellow. Higher SED was associated with higher Rt: b was positive and significant in red (b = 0.004 SE = 0.001) and orange (b = 0.002 SE = 0.001) but not in the lowest tier (b = 0.001 SE = 0.001). We found a significant interaction between the number of days into the restriction and the SED in the complete models. Compared to less deprived, more deprived provinces had slower Rt reduction in the highest tier. However, they had steeper Rt reductions in orange and slower increasing trends in yellow.

Conclusions:
The highest restriction had milder effects in more deprived provinces, while lower tiers were more effective. These results underline the importance of accounting for SED when implementing public health measures.

Key messages:
Area-level deprivation can modify the effects of public health measures.
Socioeconomic characteristics of the areas should be considered when implementing policies aimed to prevent the spread of epidemics.

Background:
During the COVID-19 pandemic politics was in search of scientific evidence to underpin decision making like never before. It is remarkable that voices from public health were less noticeable than those of virologists or immunologists. The aim of our ongoing study is to explore how public health scientists perceive their role in the relationship of their discipline and politics.

Methods:
We conducted 10 reflexive interviews with epidemiologists and public health scientists from Germany and collected documents (official statements and policy briefs of scientific societies). Data from both sources were analysed using situational analysis (Clarke, 2018), an approach used to map and analyse discourses in complex situations. To ensure data quality we used respondent validation.

Results:
According to participants, (1) improving population health was the top priority. Politicians tended to focus on short-term goals rather than long-term consequences.
(2) Recognition of public health was increased by the pandemic in Germany. (3) 15th European Public Health Conference 2022 iii187