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PubMed2005

Process, rationale, and interventions of Pakistan's National Action Plan on Chronic Diseases.

Most developing countries do not comprehensively address chronic diseases as part of their health agendas because of lack of resources, limited capacity within the health system, and the threat that the institution of national-level programs will weaken local health systems and compete with other health issues. An integrated partnership-based approach, however, could obviate some of these obstacles. In Pakistan, a tripartite public-private partnership was developed among the Ministry of Health, the nongovernmental organization (NGO) Heartfile, and World Health Organization. This was the first time an NGO participated in a national health program; NGOs typically assume a contractual role. The partnership developed a national integrated plan for health promotion and the prevention and control of noncommunicable diseases (NCDs), which as of January 2006 is in the first stage of implementation. This plan, called the National Action Plan on NCD Prevention, Control, and Health Promotion (NAP-NCD), was released on May 12, 2004, and attempts to obviate the challenges associated with addressing chronic diseases in countries with limited resources. By developing an integrated approach to chronic diseases at several levels, capitalizing on the strengths of partnerships, building on existing efforts, and focusing primary health care on chronic disease prevention, the NAP-NCD aims to mitigate the effects of national-level programs on local resources. The impact of the NAP-NCD on population outcomes can only be assessed over time. However, this article details the plan's process, its perceived merits, and its limitations in addition to discussing challenges with its implementation, highlighting the value of such partnerships in facilitating the missions and mandates of participating agencies, and suggesting options for generalizability.

Adult↗
PubMed2005

Implementing interoperable secure health information systems.

Ensuring the privacy and confidentiality of individuals has made security an indispensable component of health information systems. Delivery of healthcare services beyond the enterprise level to the regional, national or cross-border area places new challenges for security implementation. We review the current status and uptake of security measures in healthcare settings across European countries and examine in more detail some of the leading eHealth applications. Drawing on the findings of this analysis, we propose a generic model for streamlining the security implementation process on any level -local, regional, national or cross-border. Finally, we address the future prospects and requirements for advancing secure delivery of healthcare services across European borders.

Computer Security↗
PubMed2005

The Whanaungatanga Model of Care.

The 1988 Royal Commission on Social Policy recommended that the Treaty of Waitangi ('the Treaty'), be "enshrined" within social policy. Subsequently health care organisations have integrated the Treaty principles as defined by the Royal Commission (1988)--partnership, protection and participation--into the philosophies underpinning their services. Through the Treaty partnership at Tauranga Hospital a unique secondary health service evolved, one that is delivered by Maori for Maori. The Kaupapa nursing service at Te Puna Hauora implements an indigenous health model, the Whanaungatanga Model of Care, to guide nursing practice. This paper describes the Kaupapa Service and the model it uses. It also explores the benefits and challenges associated with implementing such a model.

Community Health Nursing↗
PubMed2004

The HIV/AIDS epidemic in China: history, current strategies and future challenges.

This article reviews the epidemic of HIV infection and AIDS, the Chinese national policy development in response to the epidemic, and disparities between policies and the need for AIDS prevention in China. The HIV epidemic in China has gone through three phases, and it is now at the rapid expansion phase. Since 1988, HIV/AIDS has been addressed from a legal perspective, but in the early stages laws and regulations actually hindered HIV control efforts. Since 1995 efforts have been made to improve policy decisions. Two major strategic plans were issued in 1998 and 2001, with increased government funding for implementation. Although the challenges facing HIV/AIDs control in China are many, the Chinese government is making a stronger commitment for implementing effective AIDS control measures in the country.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Non-ionizing radiation safety program management--one corporation's approach.

Development and implementation of non-ionizing radiation safety programs differ from ionizing radiation safety programs primarily due to the absence of prescriptive state and federal regulations. Industry consensus standards and research publications provide the basis for non-ionizing radiation safety program development. This work discusses the methodology used to develop a non-ionizing radiation safety program suitable, with minimal modification, for use both in research and industrial facilities. This program includes identification of industry consensus standards, measurement of actual or potential exposure, establishment of engineering and administrative controls, training and orientation of the workforce, and tracking of changes. Implementation of the program involves cooperation between a small corporate staff and many individuals representing various environmental, safety and health as well as manufacturing and research disciplines located in the facilities that contain the actual radiation sources. Challenges in program implementation include the wide variation in types, numbers, and uses of non-ionizing sources in numerous facilities located throughout the United States. Additional opportunities include providing advice and support to facilities located outside of the United States.

Equipment Failure Analysis↗
PubMed2006

Provider-specific report cards: a tool for health sector accountability in developing countries.

In most health care systems in most countries, providers are not adequately held accountable - by governments, purchasers, provider professional associations or civil society - for the quality of care. One approach to improve provider accountability that is being debated and implemented in a subset of developed countries and a smaller group of developing countries is provider-specific comparative performance reporting. This review discusses universal design options for report cards, summarizes the evidence base, presents developing country examples, reviews challenges and outlines implementation steps. The ultimate aim is to provoke thoughtful debate about if and how comparative performance reporting fits within a developing country's broader framework of strategies to promote quality of care.

Delivery of Health Care↗
PubMed1996

Lessons from the front: implementing outcomes projects.

These issues are representative of the challenges facing those wishing to implement outcomes evaluations in the dramatically different settings of today's behavioral healthcare. To maintain acceptable levels of credibility, difficult issues such as these need to be addressed openly and assertively. We remain optimistic about the value of measuring the effects of behavioral healthcare interventions. Such measurement facilitates the development of communication across service providers and creates accountability where once there was none. When standards of quality research are applied, outcomes management offers great potential benefit to consumers, providers, and behavioral healthcare organizations.

Cost-Benefit Analysis↗
PubMed2026

Pricing Combination Therapies: A Systematic Review of Value Attribution, Cost-Sharing Mechanisms and Policy Frameworks.

BACKGROUND: Combination therapies are increasingly central to modern pharmacotherapy, particularly in oncology and other high-burden diseases. However, pharmaceutical pricing and reimbursement systems remain largely designed for single-product-single-indication interventions. When multiple patented medicines are used together, especially when owned by different manufacturers, conventional pricing frameworks may struggle to align prices with the value of the combination while preserving incentives for innovation and timely patient access. OBJECTIVE: To identify, describe, and critically assess the methods, models, and policy frameworks proposed in the literature to establish prices for combination therapies, with particular attention to value attribution mechanisms, cost-sharing arrangements between manufacturers, and budget impact considerations. METHODS: A systematic literature review was conducted in accordance with PRISMA guidelines and a pre-registered Open Science Framework protocol. Searches were performed in MEDLINE, Scopus, Web of Science, EconLit, CRD databases, and grey literature sources for publications up to July 2025. Eligible studies analysed pricing approaches, economic models, reimbursement mechanisms, or policy frameworks relevant to combination therapies, including more recent multi-indication pricing literature. Given the heterogeneity of the literature, findings were synthesized using a structured narrative and thematic approach. RESULTS: Sixty-nine studies met the inclusion criteria. The literature was dominated by conceptual and policy analyses, with relatively few empirical or implementation-oriented studies. Value attribution emerged as the central methodological challenge in pricing combination therapies. Several complementary approaches were proposed to operationalise value attribution, including adaptations of indication- or pathway-based pricing, manufacturer cost-sharing arrangements, managed entry agreements, and outcome-based reimbursement mechanisms. Empirical evidence suggests that health systems continue to rely primarily on pragmatic and often partial solutions rather than fully specified pricing frameworks. A complementary review of the multi-indication pricing literature indicates that, although the two fields address different pricing problems, they share important methodological and institutional lessons that can inform the development of pricing frameworks for combination therapies. CONCLUSIONS: The literature provides a growing repertoire of conceptual approaches for pricing combination therapies but limited empirical evidence on implementation. Pricing frameworks should place value attribution at their core while combining complementary policy mechanisms adapted to national pricing and reimbursement systems. Lessons from multi-indication pricing provide a valuable foundation but require additional governance mechanisms to address value attribution, multi-manufacturer negotiation, and implementation challenges specific to combination therapies.

Journal Article↗
PubMed2006

Who is in charge of patient safety? Work practice, work processes and utopian views of automatic drug dispensing systems.

In June 2003, a large, Canadian tertiary care facility introduced automatic drug dispensing machines on all units when it opened up a new building. In this paper, we provide an overview of the automatic drug dispensing system (ADS) implementation at the hospital. Our findings, based on daily field observations and interviews during and after implementation, with regular follow-up visits to the field site illustrate how the introduction of the ADS brought to light work practices that sometimes compromised patient safety. We suggest that utopian views of automatic drug dispensing machines obfuscate the challenges inherent to implementing such systems, and deter stakeholders from performing rigorous evaluation of the costs (both social and economic) and benefits of investing in such systems. Our work contributes to debates about the socio-technical efficacy of automating medication dispensing and delivery, and suggests that the balance of power in the patient safety equation lies in the work context and implementation issues, and not just the technology. For technology implementations to be successful considering that technologies frequently cross over jurisdictional boundaries, planning and implementation have to be conducted at a system wide level.

Canada↗
PubMed2005

STAR: a dementia-specific training program for staff in assisted living residences.

PURPOSE: This article describes, and provides data on, an innovative, comprehensive, dementia-specific training program designed to teach direct care staff in assisted living residences to improve care and reduce problems in residents with dementia. DESIGN AND METHODS: STAR-which stands for Staff Training in Assisted living Residences-provides two 4-hr workshops augmented by four individualized on-site consultations and three leadership sessions. Developed by means of an iterative process of implementation and revision, it was then evaluated in a small randomized controlled trial. A total of 114 staff and 120 residents in 15 residences participated. RESULTS: STAR was exceptionally well received. Training details are provided with a discussion of unique challenges inherent in implementation. Following training, STAR residents evidenced significantly reduced levels of affective and behavioral distress compared with control residents. Furthermore, STAR residents improved whereas control residents worsened (p < .05). Staff with STAR staff training reported less adverse impact and reaction to residents' problems (p < .05) and more job satisfaction (p < .10) compared with control staff. IMPLICATIONS: STAR is an effective training program for direct care staff working with dementia residents in assisted living. The importance of continued development and investigation of STAR efficacy and effectiveness is underscored by the growing numbers of residents with dementia who are receiving care in these settings.

Assisted Living Facilities↗
PubMed2006

Overcoming barriers to adherence to HPV vaccination recommendations.

Human papillomavirus (HPV) is a critical factor in the development of cervical cancer and can lead to genital warts and other clinical sequelae. Two vaccines against HPV have been developed recently that have shown to be safe and effective. The use of HPV vaccines holds promise for alleviating the burden of illness related to HPV infection. However, barriers specific to HPV vaccines, as well as barriers related to adolescent vaccination in general, may pose challenges to widespread implementation. Among these are: (1) lack of knowledge among the US population about HPV transmission and its relation to cervical cancer and other anogenital diseases; (2) parental concerns about vaccines in general and about vaccinating minors against sexually transmitted diseases; (3) financing by the government and private insurers for newly recommended vaccines; (4) challenges related to adolescents' healthcare-seeking behavior and health insurance coverage; and (5) barriers related to the dynamics of HPV infection (eg, protection against only certain types of HPV, duration of immunity, immunization schedules). Addressing these concerns will be critical in effective implementation of HPV vaccines and, potentially, vaccines, against other sexually transmitted diseases.

Adolescent↗
PubMed1998

Revisiting community participation.

Community participation in health is a complex entity that has been examined extensively in the literature and continues to be of great interest among community health workers. The genesis of the idea and its conceptual development are primarily attributed to large multinational health institutions, particularly the World Health Organization. However, the implementation of community participation is the ultimate responsibility of local health programme initiators. It is therefore at the local level where day to day realities of incorporating community participation into health service delivery are confronted. This paper reviews the value of community participation in health and provides a detailed examination of the challenges facing its implementation and sustainability. In 1978, the World Health Organization placed community participation squarely at the centre of their strategy to achieve Health For All By The Year 2000. As the year 2000 nears, it is time to critically re-examine the notion of community participation and the most pressing challenges to its viability.

Community Health Planning↗
PubMed2001

The Legnano radiology picture archiving and communication system/radiology information system project implementation.

The necessity to meet the ever-increasing diagnostic and interventional demands in the most cost-effective and efficient way led to the decision to turn the Department of Radiology at Legnano City Hospital nearly filmless. Crucial for the implementation of this challenging project was the development of a sophisticated and efficient digital architecture along with a nearly global renovation of the whole department, connecting it in the meantime to the hospital asynchronous transfer mode (ATM) backbone. The highlights and drawbacks faced in the implementation of the project are described and discussed.

Computer Systems↗
PubMed2002

Business associates: a HIPAA compliance challenge.

The final rule implementing the privacy standards mandated by the Health Insurance Portability and Accountability Act (HIPAA) of 1996 imposes substantial requirements on covered entities with respect to their business associates--those parties providing certain services to, or on behalf of, the covered entities. A covered entity must develop a contract with each of its business associates that sets forth the conditions under which the business associate may use or disclose the protected health information it receives from the covered entity. The contract also must delineate the covered entity's obligations with respect to the business associate, which include ensuring individuals' access to their protected health information and taking certain steps to respond to a breach of the privacy standards by the business associate. The business associate requirements do not apply to the covered entity's workforce, disclosures to providers for treatment purposes, certain financial transactions, certain jointly administered government programs, and, provided that certain other restrictions are met, disclosures made by group health plans to plan sponsors.

Commerce↗
PubMed2006

Advances and challenges in liquid chromatography-mass spectrometry-based proteomics profiling for clinical applications.

Recent advances in proteomics technologies provide tremendous opportunities for biomarker-related clinical applications; however, the distinctive characteristics of human biofluids such as the high dynamic range in protein abundances and extreme complexity of the proteomes present tremendous challenges. In this review we summarize recent advances in LC-MS-based proteomics profiling and its applications in clinical proteomics as well as discuss the major challenges associated with implementing these technologies for more effective candidate biomarker discovery. Developments in immunoaffinity depletion and various fractionation approaches in combination with substantial improvements in LC-MS platforms have enabled the plasma proteome to be profiled with considerably greater dynamic range of coverage, allowing many proteins at low ng/ml levels to be confidently identified. Despite these significant advances and efforts, major challenges associated with the dynamic range of measurements and extent of proteome coverage, confidence of peptide/protein identifications, quantitation accuracy, analysis throughput, and the robustness of present instrumentation must be addressed before a proteomics profiling platform suitable for efficient clinical applications can be routinely implemented.

Biomarkers↗