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PubMed2004

Evidence based practice in population health: a regional survey to inform workforce development and organisational change.

STUDY OBJECTIVE: To assess current capacity to implement evidence based practice (EBP) in population health. DESIGN: Postal survey of a regional population health workforce in Sydney, Australia. SETTING: Division of Population Health, South Western Sydney Area Health Service. PARTICIPANTS: 104 population health staff (response rate: 73%). MAIN RESULTS: In the sample of regional population health practitioners, views about the current promotion of EBP were positive. Non-medical respondents with less that Masters degree were more likely to report "high self assessed need" to increase their capacity in EBP (p = 0.022). Confidence in understanding of EBP terminology was not associated with seniority but with highest level of education reached (p<0.000) and having medical qualifications (p<0.000). Occupational category was not associated with respondents' self assessed "need for evidence", "need for EBP skills" or "need to increase their capacity in EBP" in their current position. The proportion of participants "strongly" supporting implementation of a colorectal cancer screening programme whose benefit was expressed as relative risk reduction was greater than that so supporting a programme whose benefit was expressed as number needed to screen (p = 0.008). Most respondents referred to their immediate managers when seeking support for EBP. CONCLUSIONS: The findings provide a quantitative baseline for capacity building through workplace programmes. Managerial commitment has been increased and performance development is now underway.

Adult↗
PubMed2004

The roles of government in improving health care quality and safety.

BACKGROUND: Discussions surrounding the role of government have been and continue to be a favorite American pastime. A framework is provided for understanding the 10 roles that government plays in improving health care quality and safety in the United States. Examples of proposed federal actions to reduce medical errors and enhance patient safety are provided to illustrate the 10 roles: (1) purchase health care, (2) provide health care, (3) ensure access to quality care for vulnerable populations, (4) regulate health care markets, (5) support acquisition of new knowledge, (6) develop and evaluate health technologies and practices, (7) monitor health care quality, (8) inform health care decision makers, (9) develop the health care workforce, and (10) convene stakeholders from across the health care system. CONCLUSION: Government's responsibility to protect and advance the interests of society includes the delivery of high-quality health care. Because the market alone cannot ensure all Americans access to quality health care, the government must preserve the interests of its citizens by supplementing the market where there are gaps and regulating the market where there is inefficiency or unfairness. The ultimate goal of achieving high quality of care will require strong partnerships among federal, state, and local governments and the private sector. Translating general principles regarding the appropriate role of government into specific actions within a rapidly changing, decentralized delivery system will require the combined efforts of the public and private sectors.

Federal Government↗
PubMedDate not supplied

Specialist physicians providing primary care services in Colorado.

BACKGROUND: There is general consensus that the size of the US physician workforce now exceeds the health care needs of the American public. There is a greater proportion of specialists than primary care physicians, a specialty mix different from that of most other developed countries. METHODS: The Colorado Board of Medical Examiners sent a one-page questionnaire to all physicians licensed to practice in the state. It contained the question: "How many hours in the last week did you provide primary care services, defined as either preventive care, routine physical exams, or treatment of common ailments?" The responses of physicians who reported non-primary-care medical specialties were analyzed with respect to their personal and practice characteristics. RESULTS: Just under half (46.5%) of the 2745 specialist respondents reported having provided primary care services. As a group, however, 27.9% of specialist physicians' direct patient care time was devoted to primary care activities. The amount of primary care services being provided was greater among those not board-certified in their specialties, osteopathic physicians, and specialists spending less time in direct patient care. CONCLUSION: Additional evaluation is needed with a more comprehensive definition of primary care than used in this article, which includes important but difficult-to-measure elements, such as the integration of services, a sustained partnership with patients, and practice in the context of family and community. To the extent possible, this definition should not rely on physician self-definition of which examinations are routine and which ailments are common. However, the contribution of specialists should be considered in future primary care needs assessments, and specialists who experience low demand for their particular specialties may be especially inclined to provide primary care services.

Adult↗
PubMed1998

Profile of public health nutrition personnel: challenges for population/system-focused roles and state-level monitoring.

OBJECTIVE: Our 3 objectives were to document the current public health nutrition workforce in the United States, identify top public health nutrition priorities for the next 5 years, and assess the capacity of public health nutrition personnel to address these priorities and the nutrition-related objectives of Healthy People 2000. DESIGN: A census survey was distributed to public health nutrition personnel in all state and local health agencies and nonprofit and for-profit agencies funded by official health agencies throughout the United States and US territories. Also, state and territorial nutrition directors were sent a different questionnaire. SUBJECTS: Data were collected from 49 states, the District of Columbia, and 2 territories; 7,550 public health nutrition personnel were represented. STATISTICAL ANALYSIS: Data were analyzed using EpiInfo software. Descriptive statistics are presented. RESULTS: Almost half of the respondents worked in local or county health agencies and about two thirds were involved in direct care services. Only about 40% were registered dietitians and about one fourth had a master's degree. Almost 90% of all full-time equivalent positions were funded through federal dollars; 78% of all funding was from the Special Supplemental Nutrition Program for Women, Infants, and Children. Top health concerns identified were diet/nutrition to prevent chronic disease, low breast-feeding rates, low birth weight, iron deficiency anemia, and obesity/overweight. Public health nutrition personnel will be challenged to assume population/system-focused roles and state-level monitoring of Healthy People 2000 objectives. Only 2 of the 17 nutrition objectives of Healthy People 2000 were monitored by more than 50% of the states. APPLICATIONS: If official health agencies are to shift to public health core functions, as recommended by an Institute of Medicine report, then a substantial proportion of the public health nutrition workforce must not only change how they practice but also obtain the knowledge and skills to do so. Strategies to improve workforce capacity are discussed, including continuing education interventions through professional organizations, distance and on-campus educational opportunities through approved public health nutrition programs, and advocacy for new funding streams focused on public health core functions.

Dietetics↗
PubMed2003

Health inequalities in the workforce: the labour market core-periphery structure.

OBJECTIVES: To explore health inequalities between six labour market groups ranging from permanent employees to the long-term unemployed receiving minimum daily allowance. METHODS: A sample of 15 468 employees or job seekers from a population survey. Their perceived health, diseases, and depression were measured. RESULTS: Compared with permanent employees, the odds for poor health were highest among the unemployed with low incomes irrespective of adjustments, across all health indicators and in both men and women. High odds were also found among the less disadvantaged unemployed and the employed with atypical contracts, but not among fixed-term employees. CONCLUSIONS: Rather than between the employed and the unemployed, it seems that health inequalities prevail across different labour market groups within the employed and the unemployed. Future studies should employ a more detailed classification of employment situation.

Adult↗
PubMed1992

Management of human resources in health care: the Canadian experience.

Each of Canada's ten provinces has a publicly administered system of health insurance, funded by provincial and federal taxes, that is accessible to all citizens and covers all medically necessary services provided by physicians and hospitals. Canadians spend an estimated 9.2 percent of their gross national product on health care (about 2.8 percentage points below US spending), of which three quarters is public-sector spending. According to the Organization for Economic Cooperation and Development, Canada's health status is equal to or better than that of the United States, despite lower per capita health spending. About seven percent of the Canadian labour force works in health care, and attempts to introduce coordinated planning of human resources in health care have not as yet proceeded far. The predominant policy issue here is the supply and the role of physicians. It has been argued that entrenching within the system the fee-for-service method of paying physicians has created a disincentive to the delegation of responsibility to health personnel other than doctors. It is also argued that introduction of government-run health insurance provided the opportunity for human resource planning, but that the decision by governments to act only as the payer resulted in ad-hoc planning approaches. However, governments' concern over health care costs has led to a more direct role by them in the planning of the human resources in health. They are re-examining the autonomy and jurisdictional rights of the professions that deliver health care to Canadians.

Canada↗
PubMedDate not supplied

The effect of economic changes on health care and health in Chile.

The existence of possible associations between the economy and health in Chile, 1974-1992, is documented. The gross domestic product fell in 1975-1976 and again in 1982-1983; at both times, the public expenditure on health care followed those falls. In addition, the sources of financing public expenditure and the patterns of health expenditure changed during the decades under study. Several indicators of health care activity, and of health and nutrition status consistently suggest an impact which results from the economic difficulties. Staffing levels and pay factors apparently played a role as intervening variables. The differences between the two crises are discussed, and reveal that the organization and programmes of the public health system seem to have been seriously affected. At the same time, they may still have played an important role in protecting the people--particularly, mothers and small children--from further damage.

Chile↗
PubMed1975

The effect on future physician requirements of an HMO policy after national health insurance.

The questions examined in this paper are: What effect will the Health Maintenance Organization (HMO) have on future physician manpower? What is the likelihood of there being a substantial movement of medical practice to the HMO form? Answers indicate that national health insurance will produce a more regulated and constrained resource allocated to health services and, hence, the demonstrated efficiencies of the HMO form will have strong appeal. The reduced physician manpower use of this type of organization is described. The result of these interactions will probably be a substantial reduction in the ratio of physicians needed 20 years from now.

Allied Health Personnel↗
PubMed2005

Of disparities and diversity: where are we?

There has been remarkable improvement in the health of women over the past century; however, disparities among minority populations persist. While the reasons for the disparities, usually poorer health, are many and complex, such disparities are unacceptable. Because the reasons for disparities are multiple and complex, eliminating health disparities will require a multifaceted approach. Increasing research into health disparities, biologic, sociologic, and health services research, transforming the health care system into a culturally sensitive system, eliminating unequal treatment provided to minority populations, increasing diversity in the health care workforce, and assuring that health care providers provide culturally competent health care are needed.

Delivery of Health Care↗
PubMed1997

China's health care sector in transition: resources, demand and reforms.

Economic development and reforms have had profound impacts on China's health care sector. As a result, the health care sector in China is in transition. This report reviews the major changes, and the possible policy response to these changes in China's health care sector. It discusses resource availability in the Chinese health sector, and analyses the trend of household demand for health care goods and services. This study also examines the trade and investment situations in China's health sector and investigates the major forces that are driving the transition in health care and comments on the potential policy responses.

China↗
PubMedDate not supplied

[Human resources and the health system in Brazil].

This article discusses some questions related to human resources that act on Brazilian health system. At the beginning, it identifies the trends on health human resources in the last years. Then it shows on a brief discussion the health system reform, pointing out changes in the health model design through the implementation of the Family Health Program. This program tries to reorder the health care model, bringing the primary health care, in order to substitute the traditional model, designed to the cure of diseases and centered on hospitals. It also points out important changes on work conditions, such as: doctors' and dentists' no liberal work, low salaries, consultations paid by the HMO's, flexibilization of work, loss of work guarantees. Finally, it identifies serious problems in the Family Health Program, especially those related to the instability of work process and decreasing of social protection of workers who act on this program.

Brazil↗