Browsing by Person "Lloyd-Sherlock, Peter"

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Addressing pressures on health services in Belo Horizonte, Brazil through community-based care for poor older people: a qualitative study
(Elsevier, 2023-10-28) Lloyd-Sherlock, Peter; Fialho de Carvalho, Poliana; Giacomin, Karla; Sempé, Lucas
Background In low and middle-income countries, there is growing interest in managing pressures on health services through community interventions for older people. Evidence on the effects of such interventions is scarce. We draw on qualitative data to examine these effects for a specific scheme, Programa Maior Cuidado (PMC) in the Brazilian city of Belo Horizonte. Methods Building on quantitative findings reported elsewhere, we use qualitative data to develop and test theories of change. These include data from 50 meetings with policymakers, managers and staff in 30 health centres and social assistance posts. Data collection was embedded in key informant interaction and knowledge coproduction. Data include participant and non-participant observation, focus groups and semi-structured interviews with key informants, as well as older people and carers from seven families. Findings The data reveal three theories of change. Theory 1 is PMC maintains older people’s health which reduces their need for inpatient or outpatient care. We find strong evidence to support this, through effects on use of medication, chronic disease management and risk prevention. Theory 2 is PMC promotes timely intervention by anticipating health problems, thus reducing demand for emergency and acute care. We find some evidence for this, but it was limited by limited availability of timely treatment or referral beyond PMC. Theory 3 is PMC facilitates hospital discharge. We find limited evidence for this, reflecting a lack of formal liaison between PMC and hospitals. Interpretation Schemes like PMC have potential to reduce pressures on health service utilisation by older people, if they are well articulated with wider health services.
Age discrimination, the right to life, and COVID-19 vaccination in countries with limited resources
(Wiley, 2022-09-30) Lloyd-Sherlock, Peter; Guntupalli, Aravinda; Sempé, Lucas
This paper seeks to develop and apply a simple yardstick based on remaining life expectancy to assess whether specific health policies unfairly discriminate against people on the basis of their age. This reveals that the COVID-19 vaccine prioritization policies of several countries have discriminated against older people. Conversely, the exclusion of older people from COVID-19 vaccine testing is shown to be non-discriminatory, as is some degree of age prioritization for limited acute COVID-19 care. Age discrimination in vaccine prioritization is shown to be embedded in wider ageist attitudes in health policy, which give the lives of older people a lower social value than the lives of people at younger ages.
Building the capacity of community health workers to support health and social care for dependent older people in Latin America: a pilot study in Fortaleza, Brazil
(BioMed Central, 2021-10-02) Neto, João Bastos Freire; de Moraes, Gerídice Lorna Andrade; de Souza Aredes, Janaína; Giacomin, Karla Cristina; de Melo, Luciane Ponte; Sempé, Lucas; Lloyd-Sherlock, Peter
Background Brazil is seeing rapid population ageing, which is leading to new demands on primary health care services. There is a need to develop and assess the effectiveness of new interventions to build the capacity of staff, including community health workers, to meet the needs of groups such as care-dependent older people and their care-givers. This study examines the feasibility of a small training intervention piloted in the Brazilian city of Fortaleza. Methods The study evaluated participants’ own assessments of key knowledge and skills related to the needs of care-dependent older people, both before and after the training intervention. It also assessed their capacity to implement a simple screening tool of geriatric risk factors. Results The participant self-assessments indicate significant improvements in their perceived knowledge and capacity in responding to the health needs of care-dependent older people. Additionally, participants were able to successfully conduct the home visits and screening for risk factors. Conclusions The study demonstrates the feasibility of developing interventions to enhance the capacity of community health workers to meet the needs of dependent older people in countries like Brazil. The evidence of effectiveness, though limited and subjective, provides justification for a larger, formally evaluated intervention. The experience of Fortaleza provides valuable lessons for other cities and countries in the region which are facing similar challenges.
Does vaccine ageism amount to gerontocide? [Correspondence]
(Elsevier, 2021-09-11) Lloyd-Sherlock, Peter; Lasco, Gideon; McKee, Martin; Perianayagam, Arokiasamy; Sempé, Lucas
The effects of an innovative integrated care intervention in Brazil on local health service use by dependent older people
(BioMed Central, 2022-02-11) Lloyd-Sherlock, Peter; Giacomin, Karla; Sempé, Lucas
Background Since 2011, the Brazilian city of Belo Horizonte has been operating an innovative scheme to support care-dependent older people in disadvantaged communities: Programa Maior Cuidado (PMC – Older Person’s Care Program). This paper examines two potential associations between inclusion in PMC on types of outpatient health service utilization by dependent older people. The first is that being in PMC is associated with a higher frequency of outpatient visits for physical rehabilitation. The second is that being in PMC is associated with a higher frequency of planned versus unplanned outpatient visits. Methods We apply a quasi-experimental design to a unique set of health administrative data recording visits to outpatient health services. We focus on comparisons of the universe of visits, transformed to ratios of planned/unplanned visits and rehabilitation/other reasons for visiting the outpatient service. First, we preprocess our sample through different matching techniques such as ‘coarsened exact matching’ (CEM), ‘nearest neighbor’ based on logit scores (NN), ‘optimal pair’ (OP) and ‘optimal full’ (OF) methods. Second, we estimate marginal effects of being in PMC on our outcomes of interest. We use Poisson regressions controlling for individual and community factors and use robust standard errors. Our results are presented as the comparative incidence ratio of PMC on rehabilitation and planned visits. Results We find significant positive incidence rates for belonging to PMC for both outcomes of interest under all matching specifications. Poisson models using CEM shows a higher incidence rate for planned visits in comparison to unplanned visits, 1.3 (95% CI 1.1–1.4), by PMC patients compared to the non-PMC controls, and a higher proportion of visits for rehabilitation, 3.4 (95% CI 1.7–6.8). Similar positive results are found across other matching methods and models. Conclusions Our analysis reveals significant positive associations between older people included in PMC and a matched set of controls for a greater ratio of making outpatient visits that were planned, rather than unplanned. We find similar associations for the proportion of visits made for rehabilitation, as opposed to other reasons. These findings indicate that PMC influences some elements of outpatient health service utilization by dependent older people.
An emergency strategy for managing COVID-19 in long-term care facilities in low and middle-income countries: the CIAT Framework (Version 2*)
(2020-11-24) Lloyd-Sherlock, Peter; Giacomin, Karla; Duarte, Meirelayne; Frank, Monica; Redondo, Nelida; Sempé, Lucas; Geffen, Leon; Kelly, Gabrielle; Montes de Oca, Veronica; Vivaldo, Marissa; Ocejo Rojo, Almudena; Sasat, Siriphan
An emergency strategy for managing COVID-19 in long-term care facilities in low and middle-income countries: the CIAT Framework (Version 3*)
(2021-07-20) Lloyd-Sherlock, Peter; Bastos, João; Duarte, Meirelayne; Frank, Monica; Geffen, Leon; Giacomin, Karla; Kelly, Gabrielle; Montes de Oca, Veronica; Rojo, Almudena Ocejo; Redondo, Nelida; Saddi, Fabiana; Sasat, Siriphan; Sempé, Lucas; Vivaldo, Marissa
Estimation of all-cause excess mortality by age-specific mortality patterns for countries with incomplete vital statistics: a population-based study of the case of Peru during the first wave of the COVID-19 pandemic
(Elsevier, 2021-08-20) Sempé, Lucas; Lloyd-Sherlock, Peter; Martínez, Ramón; Ebrahim, Shah; McKee, Martin; Acosta, Enrique
Background All-cause excess mortality is a comprehensive measure of the combined direct and indirect effects of COVID-19 on mortality. Estimates are usually derived from Civil Registration and Vital Statistics (CRVS) systems, but these do not include non-registered deaths, which may be affected by changes in vital registration coverage over time. Methods Our analytical framework and empirical strategy account for registered mortality and under-registration. This provides a better estimate of the actual mortality impact of the first wave of the COVID-19 pandemic in Peru. We use population and crude mortality rate projections from Peru's National Institute of Statistics and Information (INEI, in Spanish), individual-level registered COVID-19 deaths from the Ministry of Health (MoH), and individual-level registered deaths by region and age since 2017 from the National Electronic Deaths Register (SINADEF, in Spanish). We develop a novel framework combining different estimates and using quasi-Poisson models to estimate total excess mortality across regions and age groups. Also, we use logistic mixed-effects models to estimate the coverage of the new SINADEF system. Findings We estimate that registered mortality underestimates national mortality by 37•1% (95% CI 23% - 48•5%) across 26 regions and nine age groups. We estimate total all-cause excess mortality during the period of analysis at 173,099 (95% CI 153,669 - 187,488) of which 108,943 (95% CI 96,507 - 118,261) were captured by the vital registration system. Deaths at age 60 and over accounted for 74•1% (95% CI 73•9% - 74•7%) of total excess deaths, and there were fewer deaths than expected in younger age groups. Lima region, on the Pacific coast and including the national capital, accounts for the highest share of excess deaths, 87,781 (95% CI 82,294 - 92,504), while in the opposite side regions of Apurimac and Huancavelica account for less than 300 excess deaths. Interpretation Estimating excess mortality in low- and middle-income countries (LMICs) such as Peru must take under-registration of mortality into account. Combining demographic trends with data from administrative registries reduces uncertainty and measurement errors. In countries like Peru, this is likely to produce significantly higher estimates of excess mortality than studies that do not take these effects into account.
Evaluación del protocolo de visitas domiciliarias de Pensión 65 durante COVID-19
(Universidad Católica San Pablo, Arequipa, 2021) Sempé, Lucas; Lloyd-Sherlock, Peter
El año 2020 ha estado marcado por la expansión del COVID-19 en el país, al igual que por los esfuerzos realizados por el Estado Peruano para hacer frente a las consecuencias de esta pandemia. Esto ha obligado a las distintas entidades y programas públicos -entre ellas, Pensión 65- a modificar, actualizar y adaptar sus procesos operacionales para atender las necesidades de sus usuarios de la forma más adecuada y eficaz posible dentro de un difícil contexto que afecta tanto a la salud, lazos sociales y economía de las familias, especialmente de aquellos más vulnerables. Considerando que la morbilidad a causa de la pandemia alcanza índices desproporcionados especialmente dentro de la población adulta mayor -hecho conocido con anterioridad en países como Italia y España-, donde a la fecha de la presente investigación (21 de diciembre de 2020), el 70% de los fallecidos oficialmente reconocidos en nuestro país corresponde justamente a los adultos mayores 1 ; por este motivo, resulta de mayor relevancia estudiar las acciones propuestas por el Programa Pensión 65 con la finalidad de enfrentar los efectos del COVID-19. Este estudio se desarrolló como resultado del XXI Concurso Anual de Investigación CIES 2019, con el auspicio del Ministerio de Economía y Finanzas. Esta investigación también se encuentra dentro del repositorio REPEC
Integrating health and social care in Brazil
(Oxford University Press, 2020-09-30) Sempé, Lucas; Lloyd-Sherlock, Peter
Integrating health and social care is now a high priority for public health policy in high-income countries. It has received much less attention in low and middle-income country (LMIC) settings. There is particular value in assessing the potential to integrate care services for older adults, given the speed of population ageing in LMICs. The presentation provides findings of process and impact evaluations of novel local government initiatives to integrate care for older people in Brazil (drawing on a study co-funded by the UK MRC and CONFAP Brazil). Programa Maior Cuidado (PMC) was established in the Brazilian city of Belo Horizonte in 2011. It is jointly managed by the departments of health and of social assistance and involves close community-level collaboration between health posts and neighbourhood social service centres. A key element of PMC is the provision of paid trained lay carers to support family care for dependent older people in socially vulnerable families. We will present findings on the implementation process and operation of PMC, as well as its effects on the following outcomes of interest: reduced unnecessary hospitalisations, enhanced health status for older people and reduced care burden for family carers. Quasi-experimental analysis using spatial-based Propensity Score Matching shows promising results in terms of increasing planned attentions as well as access to rehabilitation services, which confirms the ability of the Program to improve interface with health services avoiding unplanned unnecessary attentions We will examine the implementation of similar interventions in other Brazilian cities, including Fortaleza and Contagem, and will study the role of national and international processes in dissemination, knowledge sharing and agenda-setting.
Meeting the complex challenge of health and social care provision for rapidly-ageing populations: introducing the concept of “avoidable displacement from home”
(SciELO - Scientific Electronic Library Online, 2020-04-03) Lloyd-Sherlock, Peter; Billings, Jenny; de Souza Aredes, Janaína; Freire Neto, João Bastos; Camarano, Ana Amélia; Macedo Coelho Filho, João; Firmo, Josélia Oliveira Araújo; Kalache, Alexandre; Macinko, James; Sempé, Lucas; Giacomin, Karla Cristina
The increasing numbers of people at very old ages pose specific policy challenges for health and social care and highlight the need to rethink established models of service provision. The main objective of this paper is to introduce the concept of “avoidable displacement from home” (ADH). The study argues that ADH builds on and adds value to existing concepts, offering a holistic, person-centered framework for integrated health and social care provision for older people. It also demonstrates that this framework can be applied across different levels, ranging from macro policymaking to organizational and individual decision-making. The paper pays attention to the Brazilian context but argues that ADH is a universally applicable concept.
Multidisciplinary interventions for reducing the avoidable displacement from home of frail older people: a systematic review
(BMJ Publishing Group, 2019-11-02) Sempé, Lucas; Billings, Jenny; Lloyd-Sherlock, Peter
Objectives To synthesise existing literature on interventions addressing a new concept of avoidable displacement from home for older people with multimorbidity or frailty. The review focused on home-based interventions by any type of multidisciplinary team aimed at reducing avoidable displacement from home to hospital settings. A second objective was to characterise these interventions to inform policy. Design A systematic search of the main bibliographic databases was conducted to identify studies relating to interventions addressing avoidable displacement from home for older people. Studies focusing on one specific condition or interventions without multidisciplinary teams were excluded. A narrative synthesis of data was conducted, and themes were identified by using an adapted thematic framework analysis approach. Results The search strategy was performed using the following electronic databases: the American National Library of Medicine and the National Institutes of Health (PubMed), Scopus, Cochrane Library (Central and CDRS), CINAHL, Social Care Online, Web of Science as well as the database of the Latin American and Caribbean Health Sciences Literature. The database search was done in September 2018 and completed in October 2018. Overall 3927 articles were identified and 364 were retained for full text screening. Fifteen studies were included in the narrative review. Four themes were identified and discussed: (1) types of interventions, (2) composition of teams, (3) intervention effectiveness and (4) types of outcomes. Within intervention types, three categories of care types were identified; transitional care, case-management services and hospital at home. Each individual article was assessed in terms of risk of bias following Cochrane Collaboration guidelines. Conclusions The review identified some potential interventions and relevant topics to be addressed in order to develop effective and sustainable interventions to reduce the avoidable displacement from home of older people. However the review was not able to identify robust impact evidence, either in terms of quantity or quality from the studies presented. As such, the available evidence is not sufficiently robust to inform policy or interventions for reducing avoidable displacement from home. This finding reflects the complexity of these interventions and a lack of systematic data collection.
Problems of Data Availability and Quality for COVID-19 and Older People in Low- and Middle-Income Countries
(Oxford University Press, 2020-10-06) Lloyd-Sherlock, Peter; Sempé, Lucas; McKee, Martin; Guntupalli, Aravinda
For all health conditions, reliable age-disaggregated data are vital for both epidemiological analysis and monitoring the relative prioritization of different age groups in policy responses. This is especially essential in the case of Coronavirus Disease-2019 (COVID-19), given the strong association between age and case fatality. This paper assesses the availability and quality of age-based data on reported COVID-19 cases and deaths for low- and middle-income countries. It finds that the availability of reliable data which permit specific analyses of older people is largely absent. The paper explores the potential of excess mortality estimates as an alternative metric of the pandemic’s effects on older populations. Notwithstanding some technical challenges, this may offer a better approach, especially in countries where cause of death data are unreliable.