Abstract Background Mixed-skills for digital health transformation are critical for human resources for health (HRH). This study aimed to inform the design of new training programmes that address soft, hard and digital health skills. Methods Using a mixed-methods design science approach, focus groups were conducted by invitation and with informed consent, online or in-person. A script was prepared with key questions for orientation and facilitation, addressing the topics of current situation, desired situation, desired skills, practical and organisational needs to implement continuous training in healthcare. The collected data were analysed using Nvivo. Results Focus groups (14) had 87 participants (Norway, Latvia, Belgium, Italy and Portugal): 26 healthcare professionals (nurses, midwives, nutritionists, pharmacists, assistants and doctors); 27 managers or directors of hospitals and care centres; 34 experts (digital health specialists, researchers, technical officers, members of professional societies and national authorities). Real needs were identified, with 2 direct sub-themes that were best related to each other (Pearson coefficient, p > 0.40 - cluster analysis): 1. ‘Current situation’: Cybersecurity (eg. privacy, law and ethics); Time (work time versus private time, p = 0.69); Type (informal versus formal training, p = 0.32); Programmes (graduation, continuing education and post-graduation levels). 2. ‘Desired situation: Desired skills (eg. digital - basic ICT, data analysis, soft - communication, emotional intelligence, and hard skills - medication administration, catheters, ECG, vital signs, telehealth - digital stethoscope); Learning design and objectives (eg. collective learning, simulations, location - peer-to-peer and hybrid); Emergency care and the link between primary and secondary levels of care were considered important. Conclusions These findings of convergence among HRH inform Program design process to support the training programs and course syllabus design. Key messages • The identified needs and priorities inform Program design further to support Digital Health Transformation training programs and course syllabus design. • Real needs points to Current and Desired situation, where HRH give important insights that need to be considered to engage people to perform training courses.

Background Mobile health is gradually revolutionizing the way medical care is delivered worldwide. In Mozambique, a country with a high human immunodeficiency virus prevalence, where antiretroviral treatment coverage is 77% accompanied by a 67% of retention rate, the use of mobile health technology may boost the antiretroviral treatment, by delivering care beyond health facilities and reaching underrepresented groups. Leveraging new technologies is crucial to reach the 95–95-95 United Nations target by 2030. The design, development, implementation, and evaluation of a mobile health platform called Infomóvel were covered in this article. Its intended use involves collaboration with community health workers and aims to increase human immunodeficiency virus patient access, adherence, and retention to care. Methods Using the Design Science Research Methodology, Infomóvel was created, as well as this publication. The explanation of various actions includes everything from problem description to observational study and goal-following for a solution, which results in the design and development of a platform proposal. Before the utility assessment of Infomóvel was conducted to make adjustments, a demonstration phase was conducted in one region of Mozambique. Results The initial subjects of the Infomóvel flowchart and physical process design were patients receiving antiretroviral medication who were enrolled in the patients tracking system and who had consented to home visits. The case manager examines the file before importing it into the Infomóvel database stored on a cloud server using the website www.commcarehq.org . The case manager application synchronises with the Infomóvel server database, enabling the import of latest data and access to the lists of new patients and community health workers. The community health worker uses his phone to access his application, which allows him to record the geographic coordinates and sort the list of patients by priority and type of visit. Conclusion Results from Infomóvel add to the growing body of data showing that mobile health techniques are beneficial for managing stable individuals with chronic conditions in Mozambique. These approaches can be scaled up and better utilised. However, additional studies should be conducted to quantify the resources needed to implement on a larger scale.

Abstract Background The existing digital healthcare solutions demand a service development approach that assesses needs, experience, and outcomes, to develop high-value digital healthcare services. The objective of this study was to develop a digital transformation of the patients’ follow-up service after cardiac surgery, based on a remote patient monitoring service that would respond to the real context challenges. Methods The study followed the Design Science Research methodology framework and incorporated concepts from the Lean startup method to start designing a minimal viable product (MVP) from the available resources. The service was implemented in a pilot study with 29 patients in 4 iterative develop-test-learn cycles, with the engagement of developers, researchers, clinical teams, and patients. Results Patients reported outcomes daily for 30 days after surgery through Internet-of-Things (IoT) devices and a mobile app. The service’s evaluation considered experience, feasibility, and effectiveness. It generated high satisfaction and high adherence among users, fewer readmissions, with an average of 7 ± 4.5 clinical actions per patient, primarily due to abnormal systolic blood pressure or wound-related issues. Conclusions We propose a 6-step methodology to design and validate a high-value digital health care service based on collaborative learning, real-time development, iterative testing, and value assessment.

Abstract Issue The use of Telemedicine (TM) to provide remote care is an important strategic resource for reducing inequalities in access to Public Health globally. Many countries with a high prevalence of Tropical Diseases (TD) have an insufficient number of physicians, but this potential for remote assistance is still largely untapped. Description of the problem A Scoping Review was combined with the SWOT technique (Strengths, Weaknesses, Opportunities, and Threats), which is a strategic analysis tool that enables action planning based on the evaluation of the interaction between the internal capacities of a process and external influencing factors. The SWOT analysis matrix of this study was based on a bibliographic research on the topic of TM applied to the clinical management of TD. It sought to obtain a characterization of the current global scenario, identifying (I) the contexts in which initiatives are being implemented and (II) the main gaps in the evidence. The objective is to subsidize action planning by healthcare systems, taking advantage of the expansion pandemic trend. Results A Scoping Review selected 41 studies. As strengths, the advances in the development of m-health tools for clinical and epidemiological monitoring of TD stood out, as well as some successful local experiences in implementing targeted TM systems. Among the weaknesses are infrastructure limitations and a lack of international cooperation initiatives. As for the opportunities, the context of the COVID-19 pandemic increased the importance of the topic on the health systems agenda and boosted investments in the sector. Regarding the threats, the scarcity of specific clinical guidelines and protocols and robust evidence on cost-effectiveness may be highlighted. Lessons The incorporation of TM in the qualification of clinical care for TD can have a relevant impact on the improvement of global public health indicators. The experience in such services is still scarce but represents an opportunity. Key messages There is a relevant potential in using Telemedicine to improve global access to Public Health in TD endemic areas. To support telemedicine there is the need to raise the awareness of managers, health workers and researchers about innovation in Tropical Diseases.

Abstract The Covid-19 pandemic is causing a set of disruptions, especially at the delivery of healthcare services. The pandemic has shown subsidiary health effects like, chronic care, mental health, surgeries, and deadlock in the other diseases’ treatment. A digital health platform (PrimaryCare@COVID-19) was implemented to be used by primary care physicians, and nurses, to address both chronic care and COVID-19-related patients at home or traveling. It has been piloted in three Health centers at Lisbon Health Region and it could be scale-up to all primary care in Portugal in the near future. This project was funded by the National Science Foundation to address Primary Care consultations and chronic care services shortage. The clinical primary care processes were studied and a digital workflow was defined using Design Science Research Methods. This project‘s innovative digital platform is already covering several dozens of chronic patients while at home and addressing the communication with COVID-19-related patients. The health professionals (physicians and nurses) are able to safely and rigorously communicate with chronic patients and prescribe the required medicines, as well as inform them about the COVID-19 measures. In case of patients either on quarantine or in isolation this platform also allows for the monitoring and health evaluation. This eHealth Digital Platform is an opportunity to manage chronic care during epidemics, allowing to follow-up patients, preventing them from becoming uncontrolled and having to go to emergency. The digital platform uses smart algorithms to deal with both medication interactions and vital signs alerts while monitoring, chronic and COVID-19 infected, patients, allowing health professionals to remotely consult these patients at home/travelers (by default with phone, but also via digital videoconferencing) and manage all health information about patients in a secure way (and following GDPR rules). Key messages The digital platform uses smart algorithms to deal with both medication interactions and vital signs alerts while monitoring chronic and COVID-19 infected patients. Digital Platform is an opportunity to manage chronic care during epidemics, allowing to follow-up chronic patients, preventing them from becoming uncontrolled and having to go to emergency.

Abstract Background Antibiotic stewardship services (ABS) contribute to antibiotic resistance (AR) global monitoring. Aiming at co-implement an ABS network within the Portuguese-speaking setting (CPLP), by enabling the evidence translation and second opinion between the countries, we surveyed Cape Verdean (CV) health professionals (HP) perceptions about AR prevention and control, assessing ABS opportunities. Methods A Design Science with Participatory Action Research establishes a contextualized ABS process. This mixed-method study addressed the first 2 stages, the problem and objectives. Quantitative study considered the HP’s answers (56 HP; 2 hospitals) to a questionnaire, about their perception on AR and ABS. Qualitative study set-up 10 open-ended structured interviews, clinical shift observation in 2 pilot-services (1 hospital), and meetings with key-elements for ABS, including leadership. Results Key-stakeholders for ABS multidisciplinary teamwork were identified. Preliminary results are: 1. HP reveal some knowledge but lack of awareness on AR and ABS (eg. 34% don’t recognize the AR local threat); 2. The absence of guidelines and lack of access to key-information affect prescribing confidence (eg. only 46% HP consider microbiology results in deciding antibiotherapy); 3. Priorities for a pilot service are the lack of qualified HP, the need to optimize material resources management and stock procurement, and the need for better access to patient’s clinical and prescription information; 4. Digital resources and telemedicine system can be facilitators. Top-down communication and support are essential for the ABS process sustainability. Conclusions A Global ABS network can be important in promoting prevention and effective control of AR, reducing differences between the CPLP countries. In CV, an educational program to support the co-design of ABS service and a decision-support information system are identified priorities. Digital health, like telemedicine, can be ABS facilitators. Key messages The implementation of a Global Antibiotic Stewardship network, aiming at reducing Portuguese-speaking Countries differences, could be leveraged by a Participatory Action Research process. An educational program, a decision-support information system and the telemedicine are key for the Global Antibiotic Stewardship network implementation success.

Abstract Background Sound and reliable information is fundamental to decision-making across all health system. New information technologies can contribute to a more accurate and efficient public health action, requiring new and more sophisticated skills to support this change. Considering the European context, where public health professionals vary by country and cover different areas, and the need for a skilled workforce, the objective of this study is to identify the basic educational components required for a public health information specialist. This study is part of the ongoing research under INFACT Joint Action. Methods A scope review (Pubmed/Ebsco, free access texts, no time restrictions) was carried out in order to answer the following question: Considering the set of activities of public health, what are the main topics and trends of the literature on both Human Resources and Health Information Systems (HIS) training? Abstracts were read by two reviewers and the select texts analyzed using HOT-FIT framework for HIS. Results Among the 53 records, it was possible to identify different study designs and elements related to different contexts and HIS. There is a trend for new publications, with a significant increase since 2014. The content analysis showed more frequent themes in three main categories - Human, Organization and Technology, allowing identifying a wide range of public health professionals and their educational needs. Conclusions Results reinforce the link between information systems and public health, showing the importance of regular HIS as data source for monitoring population health, specific events and determinants, management and research activities and during the stages of the planning cycle of public health activities. The proper workforce capacitation emerges as a success factor for HIS implementation, as well as several professional profiles that carry out public health activities and the areas where it is necessary to strengthen their training. Key messages There’s growing interest in the use of technologies for the development of public health information systems. Workforce needs to develop specific skills for the technological challenges in Public Health.

In October 2004, the U.S. Food and Drug Administration (FDA) issued a boxed warning about an increased risk of suicidality (i.e., suicidal ideation, behavior, or attempts) related to all antidepressants in children and adolescents.To describe national antidepressant prescribing patterns in children and adolescents before, during, and after the introduction of the FDA boxed warning.Cross-sectional data from the 2002–2009 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to describe antidepressant prescribing patterns within a nationally-representative sample of 4035 physician visits for children and adolescents diagnosed with depression or other psychiatric disorder(s) [i.e., anxiety disorders or attention deficit/hyperactivity disorder (ADHD)].In 2002–2003, antidepressants were prescribed in 4.1 million (36.1%) visits, followed by 3.2 million (28.8%) visits in 2004–2005 and 2.8 million (26.8%) visits in 2006–2007. However, antidepressant prescribing patterns reversed during 2008–2009, with an increase to 3.6 million (32.5%) visits. Compared to the period preceding the FDA boxed warning (2002–2003), a significant decline in visits related to antidepressant prescribing detected in the immediate post-FDA boxed warning period (2006–2007) (AOR = 0.67, 95% CI: 0.47–0.96). No association between the FDA boxed warning and antidepressant prescribing visits was detected during the FDA boxed warning period (2004–2005) (AOR = 0.80, 95% CI: 0.53–1.21) and in the late post-FDA boxed warning period (2008–2009) (AOR = 1.01, 95% CI: 0.63–1.60).After a 2-year lag period, antidepressant prescribing for visits of children and adolescents diagnosed with depression or other psychiatric disorder(s) in community-based and outpatient clinic settings declined when compared to the period preceding the FDA boxed warning. This decline was not sustained in the period of five years after implementation of the FDA boxed warning.