Evidence about health-system arrangements
Evidence syntheses on this webpage are organized by:
- approach to COVID-19 vaccine roll-out
- approach to population-health management for COVID-19 and for those whose care is disrupted by COVID-19
- delivery arrangements (service planning for COVID-19 prevention, service planning for COVID-19 treatment, service planning for the ongoing management of other conditions, infrastructure planning and resource allocation, workforce planning and development, and service planning for ‘return to normal’)
- financial arrangements
- governance arrangements.
To complement the evidence about vaccine roll-out below, COVID-END prepares twice-a-month updates to a living evidence profile covering all vaccine roll-out elements, including supply, allocation, communication, administration, and surveillance.
We continue to add evidence syntheses to this webpage as we harvest and process weekly updates from ‘high-yield, high quality’ sources of evidence syntheses and as we add new sources. More details are available about the context for the inventory, our approach to developing and maintain it, and tips for using it. Similar webpages are available for evidence about public-health measures, the clinical management of COVID-19 and related conditions, and economic and social responses.
| Broad and specific decisions | Criteria for 'best evidence synthesis' | Details to support relevance assessment | Additional decision-relevant details | Citation | ||||||
| Date of last search | Quality (AMSTAR) rating | Evidence-certainty (e.g., GRADE) assessment available | Key findings | Living evidence synthesis | Type of synthesis | Type of question | ||||
| Approach to COVID-19 vaccine roll-out | ||||||||||
| Securing and distributing a reliable supply of vaccines and ancillary supplies | ||||||||||
| Allocating vaccines and ancillary supplies equitably | ||||||||||
| Communicating vaccine-allocation plans and the safety and effectiveness of vaccines | 2020-10-20 | 7/9 | No | A universal trend of increased vaccine hesitancy was found across different countries and society groups, although the framing of pandemic-related communications could motivate positive and collective pandemic responses [Review of studies of unknown quality] | No | Rapid review | Other | Lin C, Tu P, Beitsch LM. Confidence and receptivity for COVID-19 vaccines: A rapid systematic review. Vaccines (Basel). 2020;9(1):E16 | ||
| N/A (Protocol) | n/a | Yes | [Protocol - results not yet available] A review evaluating the impact of perceived risks and safety of available vaccines to explain vaccine acceptance and uptake is currently being conducted | No | Protocol | Other | Grieve K, McClatchey K, Jackson T. What is the impact of perceived risks and safety of vaccines and vaccination to vaccine acceptance and uptake? PROSPERO. 2021; CRD42021242148 | |||
| 2021-02-03 | 5/9 | No | Evidence shows that negative beliefs about vaccine efficacy and safety were associated with lower vaccination acceptance among healthcare workers, non-physician health professionals were more likely to have lower acceptance rates, and having a history of accepting influenza vaccination was associated with an increase COVID-19 vaccine acceptance rate [Review of studies of unknown quality conducted during the COVID-19 pandemic and before] | Yes (row content last checked on 2021-07-28) | Rapid review | Other | Crawshaw, J., Konnyu, K., Castillo, G., van Allen, Z., Grimshaw, JM., Presseau, J. Factors affecting healthcare worker COVID-19 vaccination acceptance and uptake: A living behavioural science evidence synthesis (v2, May 18th, 2021). Ottawa: Ottawa Hospital Research Institute, May 18, 2021. | |||
| 2021-04-20 | 5/9 | No | Studies show that vaccination acceptance rates varied in different geographical settings from 40 %to 92%, whereas capability factors, opportunity factors and motivation factors were key important factors driving vaccination acceptance among the general public [Review of studies of unknown quality] | Yes (row content last checked on 2021-07-28) | Rapid review | Other | Crawshaw, J., Konnyu, K., Castillo, G., van Allen, Z., Grimshaw, JM., Presseau, J. Factors affecting COVID-19 vaccination acceptance and uptake among the general public: A living behavioural science evidence synthesis (v1.0, Apr 30th, 2021). Ottawa: Ottawa Hospital Research Institute, Apr 30, 2021 | |||
| Administering vaccines in ways that optimize timely uptake | 2020-11-01 | 8/11 | No | Evidence suggests that refusal to get vaccinated against COVID-19 has increased over time, while being female, younger, of lower income or education level and belonging to an ethnic minority group are associated with less intention to be vaccinated [Review of studies of unknown quality] | No | Rapid review | Views and experiences | Robinson E, Jones A, Daly M. International estimates of intended uptake and refusal of COVID-19 vaccines: A rapid systematic review and meta-analysis of large nationally representative samples. medRxiv. 2020. | ||
| N/A (Protocol) | n/a | No | [Protocol - results not yet available] A review exploring practices to design, implement and scale immunization information systems in low-and middle-income countries in response to a pandemic situation is currently being conducted | No | Protocol | Other | Siribaddana P, Hewapathirana R, Sahay S. Best evidence practices in deploying electronic immunization information systems in low and middle income countries in response to COVID-19: a systematic review. PROSPERO. 2021;CRD42021229030. | |||
| 2020-07-01 | 4/9 | No | A review examining the role of community pharmacies in the COVID-19 vaccine roll-out identified barriers for decision-makers, community pharmacists, and pharmacy users [Review of studies of unknown quality conducting during the COVID-19 era and before] | No | Rapid review | How and why it works | Maidment ID, Young E, Macphee M, Booth A, Zaman H, Breen J, et al. A rapid realist review of the role of community pharmacy in the public health response to COVID-19. medRxiv. 2021. | |||
| 2021-04-14 | 6/9 | No | Safety, historical mistrust and accessibility may be important factors for seeking or not seeking vaccination, whereas collaboration with trusted leaders, effective risk-benefit communication from trusted sources and facilitating vaccine access probably encourage vaccine uptake among Indigenous communities, Black, African, Caribbean communities, and people experiencing homelessness [Review of studies conducted during the COVID-19 pandemic and before] | No | Full review | Views and preferences | National Collaborating Centre for Methods and Tools. Rapid review: What is known about reasons for vaccine confidence and uptake in populations experiencing inequities? McMaster University. 2021. | |||
| Surveillance, monitoring and evaluation, and reporting | ||||||||||
| Approach to population-health management for COVID-19 and for those whose care is disrupted by COVID-19 | ||||||||||
| Segmenting the population into groups with shared health and social needs | N/A (Protocol) | n/a | No | [Protocol - results not yet available] A review evaluating the symptoms and clinical outcomes of infection with the COVID-19 B.1.1.7 variant across black, asian and minority ethnic groups is currently being conducted | Yes (row content last updated on 2021-04-27) | Protocol | Other | Rycroft C & Underwood T. A living systematic review of the symptoms associated with the UK COVID-19 variant B117 and related clinical outcomes across Black, Asian and minority ethnic (BAME) groups. PROSPERO. 2021; CRD42021234358 | ||
| Re-designing care pathways and in-reach and out-reach services | ||||||||||
| Addressing barriers to implementation of pathways and services | N/A (Protocol) | n/a | No | [Protocol - results not yet available] A review on the factors affecting compliance with infant feeding practices to prevent respiratory infections is currently being conducted | Yes (row content last updated on 2020-12-07) | Protocol | Views and Experiences | Bick D, Fisher J, Chang Y, Sutcliffe P, Hillman S, Chien L. Barriers and Facilitators to Optimizing Parents’, Carers’ and Healthcare Workers’ Infant Feeding Hygiene Practices to Prevent Transmission of Respiratory Infectious
Diseases, Including COVID-19: a Living Systematic Review. PROSPERO 2020; CRD42020184750. | ||
| Addressing cultural safety in the implementation of pathways and services | 2020-05-20 | 7/10 | No | Although very little evidence is available to understand the impact of COVID-19 on Indigenous communities, the importance of having culturally appropriate responses to address the impact of the pandemic on this population is increasingly clear | Yes (row content last checked on 2021-07-28) | Rapid review | Other | National Collaborating Centre for Methods and Tools. Rapid review: What is known about the impact of the COVID-19 pandemic on Indigenous communities in Canada? Hamilton: National Collaborating Centre for Methods and Tools.; 2020. | ||
| Maintaining gains made in population-health management (e.g., population segmentation, virtual care) and spreading and scaling them | N/A (Protocol) | n/a | No | [Protocol - results not yet available] A review evaluating the changes in care processes, public health policies, and behaviours at different levels of health systems due to the COVID-19 pandemic is currently being conducted | Yes (row content last updated on 2021-06-07) | Protocol | Other | Lau V, Rewa O, Sebastianski M, Lewis K, Kula B, Niven D et al. Coronavirus disease (COVID-19) and outcomes associated with pandemic effects study (COPES): a living systematic review. PROSPERO. 2020;CRD42020201256. | ||
| Delivery arrangements | ||||||||||
| Overall service planning for COVID-19 preventing and treatment | ||||||||||
| Leveraging existing health-system arrangements | 2020-08-10 | 7/10 | No | The COVID-19 pandemic has resulted in an indirect effect of reducing the utilization of needed healthcare services to a greater extent than has been documented in pre-pandemic studies, although most recent studies might show an increasing trend in healthcare utilization [Review of studies of variable quality] | No | Full review | Other | Moynihan R, Sanders S, Michaleff ZA, Scott AM, Clark J, To EJ, et al. Impact of COVID-19 pandemic on utilisation of healthcare services: A systematic review. BMJ Open. 2021;11(3):e045343 | ||
| Service planning for COVID-19 prevention | ||||||||||
| Changing emergency-medical service procedures (ambulances, paramedics) | 2020-04-06 | 9/10 | Yes | A systematic review of indirect evidence finds uncertainty as to whether chest compression in patients with COVID-19 is aerosol generating or leads to infection transmission in cardiac arrest | No | Full review | Other | Couper K, Taylor-Phillips S, Grove A, Freeman K, Osokogu O, Court R, et al. COVID-19 in Cardiac Arrest and Infection Risk to Rescuers: A Systematic Review. Resuscitation 2020;151: 59-66. | ||
| Re-locating hospital-based ambulatory clinics, cancer treatments, etc. | ||||||||||
| Limiting access to health facilities | ||||||||||
| Changing hospital-discharge procedures | ||||||||||
| Changing long-term care procedures | 2020-06-26 | 7/10 | Yes | Outbreak investigations show that long-term care facilities are more vulnerable to the COVID-19 pandemic, in terms of disease spread and mortality rate | Yes (row content last checked on 2021-07-28) | Full review | Other | Salcher-Konrad M, Jhass A, Naci H, Tan M, El-Tawil Y, Comas-Herrera A. COVID-19 Related Mortality and Spread of Disease in Long-Term Care: First Findings from a Living Systematic Review of Emerging Evidence. MedRxiv 2020. | ||
| 2021-02-01 | 8/10 | No | Community incidence is probably the strongest factor associated with outbreaks in long-term care facilities, and PPE use and cleaning and hygiene measures may be associated with reduced outbreak risk | No | Rapid review | Other | National Collaborating Centre for Methods and Tools. Rapid review update 2: What risk factors are associated with COVID-19 outbreaks and mortality in long-term care facilities and what strategies mitigate risk? National Collaborating Centre for Methods and Tools. 2021; | |||
| 2020-07-27 | 9/11 | No | While mass testing of residents and staff as well as guidance on infection prevention and control measures were frequently implemented in long term care facilities their effects are uncertain [Review mainly based on observational studies of low quality] | No | Rapid review | Other | Frazer K, Mitchell L, Stokes D, Lacey E, Crowley E, Kelleher C. A rapid systematic review of measures to protect older people in long term care facilities from COVID-19. medRxiv. 2020. | |||
| 2021-01-26 | 8/10 | No | Although evidence shows that for-profit ownership in care homes for older people has not been consistently associated with COVID-19 outbreaks, some studies show that they accounted for a larger proportion of cumulative infections and deaths, which could be explained by less access to personal protection equipment in these facilities [Review of observational studies mainly of low quality] | Yes (row content last checked on 2021-07-28) | Full review | Other | Bach-Mortensen AM, Verboom B, Esposti MD. Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities. medRxiv. 2021. | |||
| 2020-09-28 | 9/11 | No | In aged-care facilities with a COVID-19 outbreak, an attack rate of 45% and a fatality rate of 23% was found, with limited evidence identified to inform effective prevention and control strategies [Review of studies of low to moderate quality with high heterogeneity among findings] | No | Full review | Other | Hashan MR, Smoll N, King C, Ockenden-Muldoon H, Walker J, Wattiaux A, et al. Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis. EClinicalMedicine. 2021. | |||
| Changing home and community care procedures | ||||||||||
| Service planning for COVID-19 treatment | ||||||||||
| Scaling up/down testing capacity | 2020-12-22 | 9/11 | Yes | The effects of mass testing with contact tracing compared to test and trace for effective suppression of COVID-19 are uncertain | No | Rapid review | Benefits and harms | Mbwogge M. Mass testing with contact tracing compared to test and trace for effective suppression of covid-19 in the uk: A rapid review. medRxiv. 2021. | ||
| Scaling up/down emergency-room capacity | ||||||||||
| Scaling up/down ICU capacity | 2020-05-01 | 8/11 | No | Studies show mortality rates among ICU patients is correlated with invasive ventilation, renal failure and acute respiratory distress syndrome, although absolute values have been shown to vary between regions. | No | Full review | Other | Chang R, Elhusseiny KM, Yeh Y, Sun W. COVID-19 ICU and mechanical ventilation patient characteristics and outcomes - A systematic review and meta-analysis. medRxiv 2020. | ||
| 2020-05-01 | 9/11 | No | A meta-analysis estimated that 62% of COVID-19 patients are required to remain in hospital after initial admission [Review of studies of variable quality and substantial heterogeneity] | No | Full review | Other | Jafari A, Falahatkar S, Yekta K, Mohammad H. COVID-19 clinical characteristics, complications and comorbidity: An updated systemic review and meta-analysis. The Lancet. 2020. | |||
| Scaling up/down post-ICU recovery capacity (e.g., hospital beds) | ||||||||||
| Scaling up/down palliative-care capacity | N/A (Protocol) | n/a | No | [Protocol - results not yet available] A review exploring best practices for supporting persons at end of life during COVID-19 is currently being conducted | No | Protocol | Other | Dowsett L, Clement F, Farkas B, Li J. Best practices for supporting persons at end of life during COVID-19: Rapid review. PROSPERO. 2020; CRD42020210943. | ||
| N/A (Protocol) | n/a | No | [Protocol - results not yet available] A review synthesizing mobile applications for helping patients in end-of-life care is currently being conducted | No | Protocol | Other | Longo M, Anomneze-Collins A, Mann M, Nelson A. In light of the COVID-19 pandemic, a realist synthesis of mobile application-enabled communication and care management for patients in end-of-life care. PROSPERO. 2021; CRD42021231535. | |||
| Scaling up/down COVID-19 sequelae-management capacity | ||||||||||
| Scaling up/down capacity to manage the pandemic-related impacts on health more generally (e.g., mental health and addictions) | N/A (Protocol) | n/a | No | [Protocol - results not yet available] A review evaluating the impacts of COVID-19 on health-related quality of life among Black, Asian, and minority ethnic groups is currently being conducted | Yes (row content last updated on 2021-06-07) | Protocol | Other | Rycroft C, King-Okoye M, Underwood T. A living systematic review of the impacts of COVID-19 on the health-related quality of life across Black, Asian and minority ethnic (BAME) groups. PROSPERO. 2021; CRD42021238645 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021238645 | ||
| Surge-management models | 2020-07-09 | 4/10 | No | Hospital surge capacity planning models differ in their planning horizon, age-stratification parameters, and patient care pathways | No | Full review | Other | Klein MG, Cheng CJ, Lii E, Mao K, Mesbahi H, Zhu T, et al. COVID-19 models for hospital surge capacity planning: A systematic review. Disaster Medicine and Public Health Preparedness. 2020:1-17. | ||
| Triage protocols | 2020-03-26 | 7/9 | Yes | Key factors affecting adherence to infection prevention and control guidelines among healthcare workers include their design and content, how they are communicated, and whether there is adequate organizational support, training, and access to personal prot | No | Rapid review | Other | Houghton C, Meskell P, Delaney H, et al. Barriers and Facilitators to Healthcare Workers' Adherence with Infection Prevention and Control (IPC) Guidelines for Respiratory Infectious Diseases: a Rapid Qualitative Evidence Synthesis. Cochrane Database Syst Rev 2020;4(4):CD013582. | ||
| 2020-04-21 | 7/11 | No | Initial results from attempts to develop a risk stratification and triage tool for patients with comorbid COVID-19 and cardiovascular disease indicate clinical history, physical examination, pulse oxymetry and other laboratory markers can help recognize high-risk patients in a timely manner, although validation of the tool in future studies is still needed | No | Full review | Other | Momtazmanesh S, Shobeiri P, Hanaei S, Mahmoud-Elsayed H, Dalvi B, Malakan Rad E. Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool. Egypt Heart
J. 2020;72(1):41. Published 2020 Jul 13. doi:10.1186/s43044-020-00075-z | |||
| Infection prevention and control measures in health facilities | 2020-06-08 | 8/10 | No | No evidence was found on the effectiveness of cohorting COVID-19 positive residents to shared rooms in healthcare facilities | No | Rapid review | Benefits and harms | Technical Advisory Committee, Health Agency of Canada. Rapid review: What is the effectiveness of cohorting virus-positive residents to shared rooms in care facilities? Hamilton, ON: National Collaborating Centre for Methods and Tools; 2020. | ||
| 2020-04-06 | 8/11 | No | Using preprocedural mouth rinse using tempered clorhexidine appears to be the preferred method to reduce the aerosol-related bacterial load in dental practice | No | Full review | Other | Koletsi D, Belibasakis GN, Eliades T. Interventions to Reduce Aerosolized Microbes in Dental Practice: A Systematic Review with Network Meta-analysis of Randomized Controlled Trials [published online ahead of print, 2020 Jul 13]. J Dent Res. 2020;22034520943574. doi:10.1177/0022034520943574 | |||
| 2020-05-27 | 6/10 | No | The evidence available is insufficient to evaluate the effectiveness of aerosol boxes and barrier enclosures for airway management in COVID-19 patients | No | Full review | Other | Sorbello M, Rosenblatt W, Hofmeyr R, Greif R, Urdaneta F. Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: A scoping review and narrative synthesis. British Journal of Anaesthesia. 2020. | |||
| 2020-06-22 | 7/9 | No | The limited number of low-quality studies available makes is difficult to determine which effective infection prevention and control practices can be used in inpatient psychiatric facilities | No | Rapid review | Other | National Collaborating Centre for Methods and Tools. What is known about best practices for infection prevention and control in inpatient psychiatric facilities? Hamilton, ON: National Collaborating Centre for Methods and Tools; 2020. | |||
| 2020-08-11 | 7/10 | No | A variable level of contamination was found among different droplet- and aerosol-generating procedures in dentistry, with the greatest levels of contamination found during procedures involving powered devices and water [Review of studies of variable quality] | No | Full review | Other | Innes N, Johnson IG, Al-Yaseen W, Harris R, Jones R, Kc S, et al. A systematic review of droplet and aerosol generation in dentistry. Journal of Dentistry. 2020;105:103556. | |||
| 2020-10-27 | 7/9 | No | Variable levels of air contamination with SARS-CoV-2 RNA were found in hospital settings, with greater contamination close to public areas (e.g., bathrooms, staff areas, etc.), although viable virus particles were rarely contained in samples [Review of studies of unknown quality] | No | Full review | Other | Birgand G, Peiffer-Smadja N, Fournier S, Kerneis S, Lescure FX, Lucet JC. Assessment of air contamination by SARS-CoV-2 in hospital settings. JAMA Netwwork Open. 2020;3(12):e2033232. | |||
| 2020-08-01 | 4/9 | No | Using negative pressure, HEPA filters, dedicated separate rooms, avoiding aerosol-generating procedures, and minimizing the number of staff are some of the risk-mitigation measures taken in orthopaedic operating rooms for treating COVID-19 patients [Review of studies of unknown quality] | No | Full review | Other | Tarun V, Anurag T, Yugal K, Raj K, Lalit M. Orthopaedic operating room considerations in covid-19 pandemic: A systematic review. Journal of Arthroscopy and Joint Surgery. 2021. | |||
| 2020-10-28 | 5/11 | No | Evidence shows that aerosol-generating procedures (particularly endotracheal intubation, non-invasive ventilation, and administering nebulized medications) increase the risk to healthcare workers of contracting SARS-CoV-2 and other coronaviruses [Review of studies of unclear quality conducted during the COVID-19 pandemic, MERS and SARS outbreaks] | No | Full review | Other | Chan VW, Ng HH, Rahman L, Tang A, Tang KP, Mok A et al. Transmission of Severe Acute Respiratory Syndrome Coronavirus 1 and Severe Acute Respiratory Syndrome Coronavirus 2 during aerosol-generating procedures in critical care: A systematic review and meta-analysis of observational studies. Crit Care Med. 2021. | |||
| Death certification | ||||||||||
| Handling dead bodies | ||||||||||
| Service planning for the ongoing management of other conditions | ||||||||||
| Changing acute care surgery and trauma-care procedures | N/A (Protocol) | n/a | Yes | [Protocol - results not yet available] A review examining the impact of COVID-19 on maxillofacial surgery practice is currently being conducted | No | Protocol | Other | Pagotto LEC & Pastore GP. Impact of COVID-19 on maxillofacial surgery practice: A systematic review. PROSPERO. 2021; CRD42021241303 | ||
| 2021-02-28 | 8/11 | No | Evidence shows that the COVID-19 pandemic has delayed timely care for ST-segment elevation myocardial infarction, with an increase in mortality only reported for low-and-middle income countries [Review of studies of unknown quality with important heterogeneity among some of their findings] | No | Full review | Other | Chew NW, Ow ZGW, Teo VXY, Heng RRY, Ng CH, Lee CH, et al. The global impact of the COVID-19 pandemic on STEMI care: A systematic review and meta-analysis. Canadian Journal of Cardiology. 2021. | |||
| 2020-11-13 | 8/11 | No | Evidence shows that the COVID-19 pandemic has globally impacted stroke care with a reduction in stroke admissions and delays in stroke treatment [Review of studies of unclear quality and substantial heterogeneity among their findings] | No | Full review | Other | Reddy ST, Satani N, Beauchamp JES, Selvaraj S, Rajan SS, Rahbar MH, et al. A meta-analysis of the global impact of the COVID-19 pandemic on stroke care & the Houston Experience. Annals of Clinical and Translational Neurology. 2021;8(4):929-937. | |||
| 2020-11-01 | 6/11 | No | The rate of application of non-operative management of acute appendicitis during the COVID-19 pandemic substantially varies across geographical regions, whereas it may be a safe, short-term alternative to surgery [Review of studies of mainly low quality with important heterogeneity among their findings] | No | Full review | Other | Emile SH, Hamid HKS, Khan SM, Davis GN. Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis. Journal of Gastrointestinal Surgery. 2021:1–11. | |||
| Changing cancer-treatment procedures | 2020-06-20 | 5/10 | No | A number of strategies to prevent the spread of COVID-19 among children with cancer have been implemented, but their effects are uncertain [Review mainly based on observational studies of low quality] | No | Rapid review | Other | Amicucci M, Mastronuzzi A, Ciaralli I, Piccioni F, Schiopu AC, Tiozzo E, Gawronski O, Biagioli V, Dall'Oglio I. The management of children with cancer during the COVID-19 pandemic: A rapid review. J Clin Med. 2020 Nov 21;9(11):3756. | ||
| 2020-07-02 | 8/9 | No | Evidence shows the COVID-19 pandemic has resulted in diverse impacts on cancer care, including delays and disruptions in cancer services which has had impacts on treatment, diagnoses and service processes [Review of studies of low to moderate quality] | No | Full review | Other | Riera R, Bagattini AM, Pacheco RL, Pachito DV, Roitberg F, Ilbawi A. Delays and disruptions in cancer health care due to COVID-19 pandemic: Systematic review. JCO Global Oncology. 2021;7:311-323. | |||
| 2020-07-14 | 9/11 | No | Although nine different strategies for mitigating delays and disruptions in cancer care due to COVID-19 were found, the methodological quality of the studies is too low to make certain conclusions [Review of observational studies of low and moderate quality] | No | Full review | Other | Pacheco RL, Martimbianco ALC, Roitberg F, Ilbawi A, Riera R. Impact of Strategies for Mitigating Delays and Disruptions in Cancer Care Due to COVID-19: Systematic Review. JCO Global Oncology. 2021 Feb;7:342-352. | |||
| N/A (Protocol) | n/a | Yes | [Protocol - results not yet available] A review evaluating the impact of the COVID-19 pandemic on cancer patients using an economic and social perspective is currently being conducted | No | Protocol | Other | Murphy A, Kirby A, Drummond F, Lawlor A. A systematic review of the impact of COVID-19 pandemic on cancer patients and survivors from an economic and social perspective. PROSPERO. 2021;CRD42021246651. | |||
| 2020-12-01 | 7/9 | No | The COVID-19 pandemic has impacted cancer patients and their caregivers mainly by creating barriers for screening and diagnosis, and increasing anxiety and fear [Review of studies of unknown quality] | No | Full review | Views and experiences | Dhada S, Stewart; D, Cheema E, Hadi MA, Paudyal V. Cancer services during the COVID-19 pandemic: Systematic review of patients' and caregivers' experiences. medRxiv. 2021. | |||
| 2020-12-14 | 10/11 | No | Poorer survival of colorectal cancer patients has been found when delaying elective surgeries (in response to pandemic lockdowns or other contexts), particularly after 3 months [Review of observational studies of low to moderate quality with moderate heterogeneity among their findings] | No | Full review | Benefits and harms | Whittaker TM, Abdelrazek MEG, Fitzpatrick AJ, Froud JLJ, Kelly JR, Williamson JS, et al. Delay to elective colorectal cancer surgery and implications for survival: A systematic review and meta-analysis. Colorectal Disease. 2021. | |||
| Changing reproductive care | 2021-01-08 | 8/11 | No | Evidence suggests that the COVID-19 pandemic might have increased maternal mortality, still birth, maternal stress and ruptured ectopic pregnancies, and some differences can be seen when comparing high-income countries with low- and middle-income countries [Review of studies of variable quality and substantial heterogeneity] | No | Full review | Other | Chmielewska B, Barratt I, Townsend R, Kalafat E, van der Meulen J, Gurol-Urganci I. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: A systematic review and meta-analysis. Lancet Global Health. 2021. | ||
| N/A (Protocol) | n/a | Yes | [Protocol - results not yet available] A review exploring the perceived social support of pregnant women and mothers during the COVID-19 pandemic is currently being conducted | No | Protocol | Other | Ulambayar S, Carandang RR, Sakamoto JL, Karel M, Shibanuma A, Yarotskaya E, et al. Perceived social support of pregnant women and mothers during the COVID-19 pandemic: A systematic review. PROSPERO. 2021;CRD42021246074. | |||
| 2020-12-10 | 8/11 | No | Evidence suggests that the highly variable rates of anxiety and depressive symptoms among women in the antenatal and postnatal periods have increased during the COVID-19 pandemic [Review of studies of moderate quality with important heterogeneity among their findings] | No | Full review | Other | Shorey SY, Ng ED, Chee CYI. Anxiety and depressive symptoms of women in the perinatal period during the COVID-19 pandemic: A systematic review and meta-analysis. Scand J Public Health. 2021:14034948211011793. | |||
| 2020-10-01 | 6/9 | No | Important variations were found in the impacts of COVID-19 on sexual and reproductive health globally; family planning services, sexual behavior, and maternal and child health services were found to be affected by the COVID-19 pandemic | No | Full review | Other | Bolarinwa OA, Ahinkorah BO, Seidu AA, Ameyaw EK, Saeed BQ, Hagan JE Jr, et al. Mapping evidence of impacts of COVID-19 outbreak on sexual and reproductive health: A scoping review. Healthcare. 2021;9(4):436. | |||
| Delaying return visits, elective procedures, etc. | 2020-07-01 | 6/9 | No | Surgical practice was affected by hospital lockdown, but no evidence was found on the impact of these surgical practice changes on patient outcomes [Review of studies conducted during COVID-19, Ebola, MERS and SARS outbreaks] | Yes (row content last checked on 2021-07-28) | Rapid review | Other | Lee Y, Kirubarajan A, Patro N, Sam Soon M, Doumouras AG, Hong D. Impact of hospital lockdown secondary to COVID-19 and past pandemics on surgical practice: A living rapid systematic review. American Journal of Surgery. 2020;S0002-9610(20)30742-X. | ||
| 2020-07-20 | 6/11 | No | There have been steep declines in certain orthopedic services including elective surgeries and outpatient services due to the impact of COVID-19 pandemic, although this decline hasn't been seen for trauma surgeries [Review of studies of variable quality] | No | Full review | Other | Ow ZGW, Cheong CK, Chin YH, Chin BZ. A look at the global impact of SARS CoV-2 on orthopedic services. Journal of Clinical Orthopaedics and Trauma. 2020. | |||
| 2021-02-11 | 4/9 | No | It is uncertain whether SARS-CoV-2 can be detected in abdominal tissues, fluids and surgical smoke associated with laparoscopies [Review of mainly case reports and series] | No | Full review | Other | Cheruiyot I, Sehmi P, Ngure B, Misiani M, Karau P, Olabu B, Henry BM, Lippi G, Cirocchi R, Ogeng'o J. Laparoscopic surgery during the COVID-19 pandemic: detection of SARS-COV-2 in abdominal tissues, fluids, and surgical smoke. Langenbeck's Archives of Surgery. 2021 Mar 6:1–8. | |||
| 2020-12-14 | 10/11 | No | Evidence suggests that delays to elective colorectal cancer surgery may have a negative impact on overall survival [Review of studies of low to moderate quality conducted during the COVID-19 pandemic and before, with moderate heterogeneity among their findings] | No | Full review | Other | Whittaker TM, Abdelrazek MEG, Fitzpatrick AJ, Froud JLJ, Kelly JR, Williamson JS, et al. Delay to elective colorectal cancer surgery and implications for survival: A systematic review and meta-analysis. Colorectal Disease. 2021. | |||
| 2020-07-08 | 4/10 | No | Evidence shows that most patients and caregivers waiting for procedures during the COVID-19 pandemic have experienced anxiety or depression, with women, young people, new immigrants, and those of lower socio-economic status particularly at risk [Review of studies of unclear quality] | No | Full review | Other | Gagliardi AR, Yip CYY, Irish J, Wright FC, Rubin B, Ross H, et al. The psychological burden of waiting for procedures and patient-centred strategies that could support the mental health of wait-listed patients and caregivers during the COVID-19 pandemic: A scoping review. Health Expectations. 2021. | |||
| Infrastructure planning and resource allocation | ||||||||||
| Personal protective equipment under shortage conditions (including N95 respirators for health workers) | 2020-06-04 | 7/11 | No | Stockpiling, extending use, and UV decontamination are promising strategies to address mask shortage during pandemics, although their effects remain uncertain [Review of studies conducting during COVID-19, Ebola, H1N1 and SARS outbreaks] | No | Full review | Other | Kirubarajan A, Khan S, Got T, Yau M, Bryan JM, Friedman SM. Mask shortage during epidemics and pandemics: A scoping review of interventions to overcome limited supply. BMJ Open. 2020;10(11):e040547. | ||
| For reusing or decontaminating PPE, see public-health measures | ||||||||||
| Ventilators for sick COVID-19 patients | 2020-05-01 | 6/9 | No | A number of decision-support tools exist to inform the allocation of ICU beds and ventilators during public-health emergencies including COVID-19 | No | Full review | Other | Cardona M, Dobler C, Koreshe E, Heyland DK, Nguyen R, Sim JPY, et al. Scoping review supporting decision-making on allocation of ICU beds and ventilators in pandemics. medRxiv. 2020. | ||
| N/A (protocol) | n/a | Yes | [Protocol - results not yet available] A review exploring the ethical implications of using severity scores for allocating ICU health resources is currently being conducted | No | Protocol | Other | Santos R, Rego S, Brito L. Micro allocation of health resources and ethical implications: A systematic review. PROSPERO. 2020; CRD42020214029. | |||
| Medications and other technologies (under shortage conditions due to disrupted supply chains) | 2020-06-30 | 5/9 | No | Multiple barriers and facilitators related to the provision of safe drug supply during pandemics have been identified [Review of studies of unknown quality conducted during the COVID-19 pandemic and before] | No | Full review | Other | Bonn M, Touesnard N, Cheng B, Pugliese M, Comeau E, Bodkin C, et al. Securing safe supply during COVID-19 and beyond: Scoping review and knowledge mobilization. CIHR. 2020; | ||
| Remote monitoring | 2020-05-31 | 4/9 | No | Patients who have received respiratory rehabilitation and have ongoing complications as a result of COVID-19 may require telemonitoring during the post-acute phase of their illness | Yes (row content last checked on 2021-07-28) | Full review | Other | de Sire A, Andrenelli E, Negrini F, Negrini S, Ceravolo M. Systematic Rapid Living Review on Rehabilitation Needs Due to Covid-19: Update to April 30th 2020. Eur J Phys Rehabil Med 2020. | ||
| 2020-06-01 | 6/10 | No | A number of COVID-19 mobile apps have shown benefits related to patient and provider information provision, and may help facilitate patient monitoring and follow-up [Review mainly based on observational studies of low quality] | No | Full review | Other | Kondylakis H, Katehakis DG, Kouroubali A, Logothetidis F, Triantafyllidis A, Kalamaras I, et al. COVID-19 mobile apps: A systematic review of the literature. Journal of Medical Internet Research. 2020. | |||
| Virtual visits | 2020-04-30 | 4/9 | No | Patients who have received respiratory rehabilitation and have ongoing complications as a result of COVID-19 may require telerehabilitation during the post-acute phase of their illness | Yes (row content last checked on 2021-07-28) | Full review | Other | de Sire A, Andrenelli E, Negrini F, Negrini S, Ceravolo M. Systematic Rapid Living Review on Rehabilitation Needs Due to Covid-19: Update to April 30th 2020. Eur J Phys Rehabil Med 2020. | ||
| 2020-04-08 | 5/9 | No | Studies from the pre-COVID era show that telehealth has been succesfully used to provide ongoing care for a number of urologic conditions, including prostate cancer and urinary infection | No | Full review | Other | Novara G, Checcucci E, Crestani A, Abrate A, Esperto F, Pavan N, et al. Telehealth in urology: A systematic review of the literature. How much can telemedicine be useful during and after the COVID-19 pandemic? European Urology. 2020;S0302-2838(20)30454-1. | |||
| 2020-04-05 | 4/9 | No | The use of telemedicine might be feasible for use in neurosurgical patients, although some results from resource-constrained settings show promise [Review of studies conducted during the pre-COVID era and beyond] | No | Full review | Other | Eichberg DG, Basil GW, Di L, Shah AH, Luther EM, Lu VM. Telemedicine in neurosurgery: Lessons learned from a systematic review of the literature for the COVID-19 era and beyond. Neurosurgery. 2020;nyaa306. | |||
| 2020-05-01 | 6/9 | No | Telemedicine for orthopaedics consultations can be safe, cost-effective, and be used to accurately diagnose patients, while having good acceptability among both patients and providers [Review based on studies of variable quality] | No | Full review | Benefits and harms | Haider Z, Aweid B, Subramanian P, Iranpour F. Telemedicine in orthopaedics and its potential applications during COVID-19 and beyond: A systematic review. Journal of telemedicine and telecare. 2020;1357633X20938241. | |||
| 2020-06-01 | 5/9 | No | Virtual care interventions appear most effective as a supplement to or facilitator of in-person trauma-focused care for psychological therapies to reduce the psychological symptoms associated with domestic violence or sexual assault [Review based on studies of unknown quality] | No | Rapid review | Benefits and harms | Montesanti S, Silverstone P, Wells L, Ghidei W. Examining the use of virtual care interventions to provide trauma-focused treatment to domestic violence and sexual assault populations. Edmonton, AB: Canadian Institutes of Health Research; 2020. | |||
| 2020-05-04 | 4/10 | No | Whereas limited evidence is available about impact of teleophtalmology during the COVID-19 pandemic, some studies have evaluated the implementation of the approach on multiple aspects of patient care [Review of studies of variable quality conducted during the COVID-19 pandemic and before] | No | Full review | Other | Chong JC, Tan CHN, Chen DZ. Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping review. Annals of the Academy of Medicine. 2021;50(1):61-76. | |||
| 2020-05-31 | 7/9 | No | Evidence has shown that genetic counseling using videoconferencing was equivalent to receiving face to face counselling in terms of patient satisfaction, knowledge, and psychosocial outcomes, while limited evidence is available on the effects on provider satisfaction and behavioral outcomes [Review of studies of low quality conducted during the COVID-19 pandemic and before] | No | Full review | Other | Brown EG, Watts I, Beales ER, Maudhoo A, Hayward J, Sheridan E et al. Videoconferencing to deliver genetics services: A systematic review of telegenetics in light of the COVID-19 pandemic. Genet Med. 2021:1–12. | |||
| 2020-04-01 | 7/11 | No | Evidence shows that virtual testing and assessment for cognitive conditions might have acceptable diagnostic accuracy compared to in-person assessment, while insufficient evidence was found on telephone assessment [Review of studies of unknown quality] | No | Full review | Other | Watt JA, Lane NE, Veroniki AA, Vyas MV, Williams C, Ramkissoon N et al. Diagnostic accuracy of virtual cognitive assessment and testing: Systematic review and meta-analysis. J Am Geriatr Soc. 2021. | |||
| Workforce planning (including workforce shortages management) and development | ||||||||||
| Recruitment | ||||||||||
| Role extensions | N/A (protocol) | n/a | No | [Protocol - results not yet available] A review evaluating the role of assistant in medicine for a workforce planning response to the COVID-19 pandemic is currently being conducted | No | Protocol | Other | Davids J, Monrouxe L, Hockey P, OMara D, Khanna P, Klinner C, et al. Assistant in medicine as a workforce planning response to the COVID-19 pandemic in New South Wales: Protocol for a realist approach to evaluation. PROSPERO. 2020; CRD42020210585. | ||
| 2020-05-26 | 5/9 | No | A number of different roles have been identified for medical students during pandemics and other global health emergencies, and they are often willing to provide support to the healthcare workforce in these contexts [Review of studies of unclear quality conducted before the COVID-19 pandemic] | No | Rapid review | Other | Martin A, Blom IM, Whyatt G, Shaunak R, Viva MIF, Banerjee L. A rapid systematic review exploring the involvement of medical students in pandemics and other global health emergencies. Disaster Medicine and Public Health Preparedness. 2020;1-30. | |||
| Training in new procedures | 2020-03-19 | 8/10 | No | Disaster-training programs for medical students seems to improve their knowledge, skills and pandemic preparedness; no evidence on clinical performance was identified [Review of observational studies] | No | Full review | Other | Ashcroft J, Byrne MHV, Brennan PA, et al Preparing medical students for a pandemic: a systematic review of student disaster training programmes. Postgraduate Medical Journal Published Online First: 09 June 2020. | ||
| 2020-05-18 | 5/9 | No | Online learning in medical education can be facilitated by using video conferencing synchronolousy, and giving instructors enough tools to adapt existing teaching strategies that enable the creation of a supportive learning environment | No | Rapid review | Other | Gordon M, Patricio M, Horne L, Muston A, Alston SR, Pammi M, et al. Developments in medical education in response to the COVID-19 pandemic: A rapid BEME systematic review: BEME Guide No. 63. Medical Teacher. 2020;1–14. | |||
| 2021-04-24 | 6/10 | No | Training in infection prevention and control has consistently been associated with a decreased risk of coronavirus infection among healthcare workers [Review of studies conducted during COVID-19, MERS and SARS outbreaks] | Yes (row content last checked on 2021-07-28) | Rapid review | Other | Chou R, Dana T, Buckley D, Selph S, Fu R, Totten A. Update alert 9: Epidemiology of and risk factors for coronavirus infection in health care workers. Ann Intern Med 2021; L21-0034. | |||
| 2020-12-01 | 7/10 | No | A review describes and reports the results of different approaches to training redeployed staff during the COVID-19 pandemic [Review of studies of observational studies of unknown quality] | No | Full review | Other | San Juan NV, Camilleri M, Jeans JP, Monkhouse A, Chisnall G, Vindrola-Padros C. Redeployment and training of healthcare professionals to intensive care during COVID-19: A systematic review. medRxiv. 2021. | |||
| 2020-06-01 | 6/10 | No | Resident medical education has been heavily affected by the COVID-19 pandemic, particularly in surgical specialties [Review of studies of unknown quality] | No | Full review | Other | Chasset F, Barral M, Steichen O, Legrand A. Immediate consequences and solutions used to maintain medical education during the COVID-19 pandemic for residents and medical students: A restricted review. Postgraduate Medical Journal. 2021. Epub ahead of print. | |||
| Replacements when sick | ||||||||||
| Re-deployment | 2020-12-01 | 7/10 | No | Evidence shows that developing staff work groups based on skills rather than specialty, maximizing the use of transferable skills, having a supportive environment, and developing flexible arrangements are key strategies to successful redeployment of staff to intensive care during the COVID-19 pandemic [Review of studies of observational studies of unknown quality] | No | Full review | Other | San Juan NV, Camilleri M, Jeans JP, Monkhouse A, Chisnall G, Vindrola-Padros C. Redeployment and training of healthcare professionals to intensive care during COVID-19: A systematic review. medRxiv. 2021. | ||
| Supports to unpaid caregivers | N/A (Protocol) | n/a | No | [Protocol - results not yet available] A review addressing technology-based health solutions for cancer caregivers is currently being conducted | No | Protocol | Other | Su Z, McDonnell D, Liang B, Kue J, Li X, Segalo S, et al. Technology-based health solutions for cancer caregivers to better shoulder the impact of COVID-19: A systematic review protocol. Research Square. 2020. | ||
| N/A (Protocol) | n/a | No | [Protocol - results not yet available] A review examining the effects of COVID-19 on caregivers of patients with chronic diseases is currently being conducted | No | Protocol | Other | Ruksakulpiwat S, Zhou W, Phianhasin L, Benjasirisan C, Fan Y, Su T. Effects of COVID-19 on caregivers of patients with chronic diseases: A systematic review. PROSPERO. 2021; CRD42021241081 | |||
| N/A (Protocol) | n/a | No | [Protocol - results not yet available] A review evaluating psychological interventions to support caregivers during the COVID-19 pandemic is currently being conducted | No | Protocol | Benefits and harms | Bertuzzi V, Bruno D, Usubini AG, Semonella M, Giusti EM, Cattivelli R, et al. Psychological interventions to support caregivers during COVID-19 pandemic: A systematic review. PROSPERO. 2021; CRD42021237827 | |||
| Volunteer engagement | ||||||||||
| Self-management supports | ||||||||||
| See Clinical management of pandemic-related impacts on health more generally/Burn-out and trauma in essential workers | ||||||||||
| Service planning for ‘return to normal’ | ||||||||||
| Sequencing of services re-starting, by sector, conditions, treatments (including diagnostics), and populations | 2020-06-08 | 4/9 | No | A review evaluating the evidence regarding the resumption of elective surgery only found modelling studies estimating the time needed to clear the backlog of deferred and cancelled procedures, and no assessments of the options available to efficiently resume these services were identified | No | Rapid review | Other | Health, N., 2020. Resuming Elective Surgery. [ebook] NSW Government. Available at: <https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0003/594516/20200713-Evidence-Check-Resume_Elec-Surg.pdf> [Accessed 23 July 2020]. | ||
| 2020-07-14 | 9/11 | No | Although nine different strategies for mitigating delays and disruptions in cancer care due to COVID-19 were found, the methodological quality of the studies is too low to make certain conclusions [Review of observational studies of low and moderate quality] | No | Full review | Other | Pacheco RL, Martimbianco ALC, Roitberg F, Ilbawi A, Riera R. Impact of Strategies for Mitigating Delays and Disruptions in Cancer Care Due to COVID-19: Systematic Review. JCO Global Oncology. 2021 Feb;7:342-352. | |||
| Wait-lists management | 2020-07-08 | 4/10 | No | Evidence shows that most patients and caregivers waiting for procedures during the COVID-19 pandemic have experienced anxiety or depression, with women, young people, new immigrants, and those of lower socio-economic status particularly at risk [Review of studies of unclear quality] | No | Full review | Other | Gagliardi AR, Yip CYY, Irish J, Wright FC, Rubin B, Ross H, et al. The psychological burden of waiting for procedures and patient-centred strategies that could support the mental health of wait-listed patients and caregivers during the COVID-19 pandemic: A scoping review. Health Expectations. 2021. | ||
| Financial arrangements | ||||||||||
| Financing health services | ||||||||||
| Funding organizations | ||||||||||
| Remunerating providers | ||||||||||
| New or adjusted fee codes for virtual care | ||||||||||
| Income replacement when virtual care is not possible (at the same scale) | ||||||||||
| Purchasing products and services | ||||||||||
| Governance arrangements (who can make what decisions) | ||||||||||
| Consumer and stakeholder involvement | ||||||||||
| Professional authority | ||||||||||
| Licensure changes to accommodate out-of-jurisdiction or retired health workers | 2020-08-31 | 6/10 | No | Evidence reports that the COVID-19 pandemic has impacted surgical training by reducing operative and clinical experience [Review of studies of unknown quality] | No | Full review | Other | Hope C, Reilly JJ, Griffiths G, Lund J, Humes D. The impact of COVID-19 on surgical training: A systematic review. Techniques in Coloproctology. 2021;1-16. | ||
| Commercial authority | ||||||||||
| Technology approvals, public-private partnerships | 2020-11-01 | 7/9 | No | Telemedicine is a useful tool to prevent contagion and overwhelmed health services during pandemics, whereas legislation remains a limitation to the implementation of telemedicine in different health systems [Review of studies of unknown quality] | No | Full review | Other | de Oliveira Andrade A, Soares AB, de Andrade Palis A, Cabral AM, Barreto CGL, de Souza DB, et al. On the use of telemedicine in the context of COVID-19: Legal aspects and a systematic review of technology. Research on Biomedical Engineering. 2021:1–19. | ||
| Organizational authority | ||||||||||
| Limits of number of staff sent in | ||||||||||
| Ownership | 2021-01-26 | 8/10 | No | Although evidence shows that for-profit ownership in care homes for older people has not been consistently associated with COVID-19 outbreaks, some studies show that they accounted for a larger proportion of cumulative infections and deaths, which could be explained by less access to personal protection equipment in these facilities [Review of observational studies mainly of low quality] | Yes (row content last checked on 2021-07-28) | Full review | Other | Bach-Mortensen AM, Verboom B, Esposti MD. Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities. medRxiv. 2021. | ||
| Policy authority | ||||||||||
| Strengthening health-system governance | ||||||||||
| Federal versus provincial | ||||||||||
| Adhering to the International Health Regulations | ||||||||||
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