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At least 55 records · Page 3Linked to original sources
PubMed2000

The reorientation of market-oriented reforms in Swedish health-care.

Sweden was an important pioneer of market-oriented reform in publicly funded health-care systems. Yet by the mid-1990s the county councils, which fund and manage most health-care, had substantially scaled back reforms based on provider competition while continuing to constrain health budgets. As policy makers faced new issues, they turned increasingly to longer-term and more cooperative contracts to define relations between hospitals and the county councils. Growing regionalization of government and hospital mergers further reconfigured acute care and limited opportunities for competition between hospitals. We seek to explain this reorientation of market-oriented reforms between 1989 and 1996 in terms of shifts in the positions taken by powerful policy actors, and in particular by county council politicians. During this period, elections moved liberal and conservative politicians, who were the most enthusiastic supporters of market-oriented reform, in and out of control of most county governments. Meanwhile many Social Democratic politicians gradually turned from initial support of competitive reform toward opposition. Politicians and county administrators from all parties were particularly concerned about controlling health expenditures during a period of recession. In addition, the public, politicians in the counties and municipalities, and health professionals resisted steps that threatened health sector employment and would have allowed market mechanisms, rather than governments, to determine the prices and distribution of health services. During the years under study Sweden's market-oriented reforms followed a course of development similar to that taken by other management and policy fashions (Abrahamson E. Management fashion, Academy of Management Review 1996;21: 254-85). At first the reforms enjoyed uncritical support by a broad spectrum of stakeholders. Gradually participants in the reform process recognized inherent tensions among the goals of the reform, conflicts between reform programs and fundamental social and political values, unrealistic assumptions about the effects of competition, technical and organizational obstacles to implementation, and threats to interest groups. Since 1998, there have been indications that Sweden may be entering yet another stage of experimentation with market-oriented reform.

Catchment Area, Health↗
PubMed1998

[North Rhine-Westphalia Scientific Rehabilitation Group--"future strategies for rehabilitation"].

This Northrine-Westfalian integrated research system in rehabilitation aims at the development of future strategies for medical rehabilitation. The well known deficits of rehabilitation have led to different complementary projects. These comprise research on the lack of evidence in efficacy, predictors for outcomes, international cooperation, university related curricula in training, implementation of health economics and disease management, and finally the need for an actual adaptation of social legislation. The research topics have been transformed into key themes which will be coherently integrated by additional external expert knowledge acquired in workshops organized by a task force group for the development of future strategies.

Forecasting↗
PubMed1989

Nutrition policy development and implementation in Malta.

The paper highlights experiences in the development and implementation of the food and nutrition policy in Malta. As one could expect there has been tangible progress in certain areas but less so in others. Some background information on the food and health status of the Maltese population is given first as this was the reason for the establishment of the policy in Malta in the first place.

Female↗
PubMed2003

Recommendations and guidance for practice in youth tobacco cessation.

OBJECTIVE: To summarize recommendations from Youth Tobacco Cessation: A Guide for Making Informed Decisions for careful consideration, selection, implementation, and evaluation of youth cessation interventions. METHODS: Recommendations were developed from an evidence review and consensus from a multidisciplinary advisory panel. RESULTS: Identified essential elements for selecting, planning, delivering, and evaluating youth cessation interventions. CONCLUSIONS: Until there is more evidence for effectiveness of youth specific cessation interventions, clinicians and practitoners should adopt treatments that use cognitive-behavioral approaches for youth cessation interventions that require careful planning and rigorous evaluation.

Adolescent↗
PubMed2002

Moving from recommendation to implementation and audit: part 2. Review of interventions and audit.

There are multiple interventions available that may help to control the development and spread of resistance to antimicrobial agents in bacteria implicated in community-acquired respiratory tract infections. Unfortunately, very few studies have assessed the effectiveness of these interventions using objective end-points, such as reduction in resistance rates and improvement in clinical outcomes. Most interventions are centered on reducing inappropriate or unnecessary use of antibiotics; others focus on reducing disease burden and bacterial colonization. With regard to antibiotic use, efforts should be concentrated at both the prescriber and consumer levels. Interventions that target prescribers include: provision of educational materials; strategies and tools to improve diagnosis; implementation of practice guidelines; personalized interactive sessions with feedback on the practice profile; and use of delayed prescription and alternative prescribing strategies. Optimal results are usually obtained when these interventions are combined with consumer education. Regulatory interventions (e.g. licensing regulations and controlled access to drugs), restrictions in the use of agents for growth promotion in animals, and use of nonantimicrobial therapies (e.g. probiotics) may help further to reduce inappropriate antibiotic use and thereby decrease the selective pressure for development of resistance. Infection-control strategies, public health measures, vaccination programs, and new antibiotics all have a role in minimizing the spread of resistant organisms. Ideally, resistance-control programs should include predefined criteria for success and integral audit processes based on objective end-points (antibiotic use, resistance trends, and health outcomes). Standardization of data collection is imperative so that the relative merits of various interventions can be compared. Effective implementation and audit of interventions is often difficult in developing countries owing to poor health-care infrastructures, lack of resources, poor education/training, and minimal regulatory controls on the supply and quality of antimicrobials. Substantial support from governments and health-care organizations across the globe is required to initiate and sustain effective intervention programs to control antimicrobial resistance.

Anti-Bacterial Agents↗
PubMed1995

Collaborative AIDS prevention research in the developing world: the CAPS experience.

BACKGROUND: Prevention through behavior change is the only way to control the spread of HIV infection in the developing world. Success in prevention requires consistent and persistent intervention over time, a clear understanding of the realities of target populations and involvement of members of these populations in prevention efforts. Applied local research is urgently needed, especially in the developing world, to design interventions that meet these criteria and to test their effectiveness. CENTER FOR AIDS PREVENTION STUDIES (CAPS) MODEL OF INTERNATIONAL COLLABORATIVE RESEARCH: Each year, eight to 10 scientists from developing countries visit CAPS in San Francisco for 10 weeks of intensive learning and collaboration. The main emphasis is on designing a protocol for a research project related to AIDS prevention in the visiting scientist's home country. CAPS provides pilot study funding and technical assistance to implement the project. RESULTS: The quality of the resulting collaborative research is represented by the articles published in this volume and by the many alumni of the program who have undertaken additional research projects and/or assumed leadership positions in AIDS control efforts in their countries.

Acquired Immunodeficiency Syndrome↗
PubMed2006

The role of evidence in formulating public health programs to prevent oral disease and promote oral health in the United States.

A major goal of federal, state, and local health agencies is to reduce the burden of disease in populations. To obtain sufficient resources to achieve this goal, they must document the importance of the health problems addressed and the impact and efficiency of programs. CDC supports core activities within state and local health departments to promote health and prevent disease. This presentation will focus on the need for evidence to document the effectiveness of these activities that include routine monitoring of oral health, risk behaviors, and other factors; implementing effective population-based interventions; and evaluating programs to ensure successful translation of interventions. CDC supports research to build the evidence for innovative strategies to promote oral health in communities. This presentation should increase awareness of evidence-based tools and activities that are supported by CDC to strengthen public health practice within states.

Centers for Disease Control and Prevention, U.S.↗
PubMed1998

Detroit's East Side Village Health Worker Partnership: community-based lay health advisor intervention in an urban area.

In recent years, there have been few reports in the literature of interventions using a lay health advisor approach in an urban area. Consequently, little is known about how implementation of this type of community health worker model, which has been used extensively in rural areas, may differ in an urban area. This article describes the implementation of the East Side Village Health Worker Partnership, a lay health advisor intervention, in Detroit, Michigan, and notes how participatory action research methods and principles for community-based partnership research are being used to guide the intervention. Findings are presented on how the urban context is affecting the design and implementation of this intervention. Implications of the findings for health educators are also presented and include the utility of a participatory action research approach, the importance of considering the context and history of a community in designing a health education intervention, and the importance of recognizing and considering the differences between rural and urban settings when designing a health education intervention.

Adult↗
PubMed2007

Proposal for fulfilling strategic objectives of the U.S. Roadmap for national action on clinical decision support through a service-oriented architecture leveraging HL7 services.

Despite their demonstrated effectiveness, clinical decision support (CDS) systems are not widely used within the U.S. The Roadmap for National Action on Clinical Decision Support, published in June 2006 by the American Medical Informatics Association, identifies six strategic objectives for achieving widespread adoption of effective CDS capabilities. In this manuscript, we propose a Service-Oriented Architecture (SOA) for CDS that facilitates achievement of these six objectives. Within the proposed framework, CDS capabilities are implemented through the orchestration of independent software services whose interfaces are being standardized by Health Level 7 and the Object Management Group through their joint Healthcare Services Specification Project (HSSP). Core services within this framework include the HSSP Decision Support Service, the HSSP Common Terminology Service, and the HSSP Retrieve, Locate, and Update Service. Our experiences, and those of others, indicate that the proposed SOA approach to CDS could enable the widespread adoption of effective CDS within the U.S. health care system.

Computer Systems↗
PubMed2006

Norms for mental health services in South Africa.

BACKGROUND: In the aftermath of apartheid, South Africa has inherited a fragmented, under-resourced and inequitable public sector mental health service. Attempts are being made to reform mental health services, in keeping with new health policy, which proposes the downscaling of psychiatric institutions and the development of community-based services. This study set out to develop a set of service norms for the care of people with severe psychiatric conditions (SPC) in South Africa, to assist the implementation of the new policy. METHODS: A national situation analysis of current public sector mental health services was conducted. A model was developed for estimating the mental health service resource needs of people with SPC. Following consultation with provincial stakeholders, a set of service norms were developed taking into account national indicators from the situation analysis (as a baseline level) and proposals of the model (as a target level). RESULTS: The study recommends an increase in the number of acute psychiatric beds in general hospitals; development of community-based residential care; redistribution of staff from hospital to community services, particularly in rural areas; and the development of information systems to monitor the transitions to community-based care. CONCLUSIONS: The norms proposals presented in this study express mental health service needs in terms of quantifiable service resource and utilisation levels. In doing so, the study attempts to make explicit the assumptions and values on which planning is based.

Community Mental Health Services↗
PubMed2002

Planning for major burns incidents by implementing an accelerated Delphi technique.

OBJECTIVE: This paper presents a series of practical guides for use in planning and responding to a major incident involving large numbers of burns casualties. METHOD: The guidance is based on the findings of an expert Delphi study published as an accompanying paper. RESULTS: The guidance covers preparation and all aspects of the response from prehospital care and hospital care to resolution recovery. Emphasis is placed on the management of the secondary/tertiary care interface as this is the point at which significant difficulties may arise. The importance of local interpretation of guidelines is emphasised. CONCLUSION: This practical guide for emergency planners will improve the preparation and response to a major incident involving burns.

Burn Units↗
PubMed2005

Findings from a survey on GIS use in the UK National Health Service: organisational challenges and opportunities.

The use of geographical information systems (GIS) in a variety of application areas points to an increasing interest in the spatial aspects of health policies. Despite the fact that most public sector organisations in the United Kingdom (UK) have access to such software tools, there has not been a comprehensive review of take-up within the health sector. In this paper, we report on a recently completed mixed-method research project that has examined the current levels of GIS use in the UK National Health Service, and focus our discussion on health authorities (HAs). Couched within the context of previous studies that have been concerned with outlining the types of factors influencing IT implementation in the health sector, we illuminate the importance of behavioural, cultural and organisational factors on the diffusion of GIS in the UK National Health Service. It is noted that very few organisations had a GIS strategy and we contend that if GIS is to play a wider role in addressing issues surrounding 'joined-up' government, more advice and guidance is needed on policies promoting the exchange of geographical data between agencies concerned with tackling health issues. We conclude by drawing attention to the perceived lack of national guidance on GIS matters, more generally, within the UK health sector.

Data Collection↗
PubMed2001

[Environmental medicine in public health service--a social responsibility and its consequences].

The special committee for "Environmental Medicine" established by the Federal Association of Doctors in the German Public Health Service presents its paper entitled "Environmental Medicine in the Public Health Service--A Social Responsibility and its Consequences: Propositions with regard to the situation, aims, strategies, and opportunities for action". The paper includes core ideas and responsibilities in the public health service. It aims at providing a number of guidelines for implementing "Environment and Health" ("Umwelt und Gesundheit"), an action programme by the Federal Ministry of Environmental Protection and the Ministry of Health, as well as "Health 21" ("Gesundheit 21"), the framework concept "Health for all" for the WHO's European Region. The paper also aims at initiating and facilitating steps for joint action by the Public Health Service. These theses were passed on to Mrs. Andrea Fischer, the Federal Minister of Health, during a meeting with the Board of the Association. In Germany, environment-related public health protection is well established in the Public Health Departments and state institutes/departments within the scope of public health provision and disease prevention. Typical responsibilities include environmental hygiene and environment-related medical services which have increased in importance. The range of responsibilities and its current political importance are a result of environment-related public health risks, the social situation of the population, also with regard to health issues, and the scope of responsibilities and competencies by doctors and staff in the public health departments. With the people's demands for health, quality of life and life expectancy, this need for action increases. In this paper, judicial, professional, and personal consequence are presented which arise as public health authorities assume these responsibilities.

Conservation of Natural Resources↗
PubMed2006

A qualitative analysis of the planning, implementation and management of a PDS scheme: lessons for local commissioning of dental services.

AIM: To identify the experiences of primary care trust employees, the dental teams and other key individuals of the planning, implementation and management of a Personal Dental Services scheme. METHOD: A thematic analysis of a series of qualitative interviews with 29 individuals who were involved in the planning, implementation and management of a PDS scheme in South East London. FINDINGS: Nine key themes were analysed from the data. For each theme perspectives could be identified for both the employees of the primary care trusts and the dental team. These perspectives differ in key respects. CONCLUSIONS: Practitioners value the PDS scheme and consider it a positive experience. They suggest that it has led to an increase in quality of care, and a more professional management approach to the practice. The practice team felt that they have benefited from an enhanced working environment. The main concern expressed was that patient registrations were not being accurately assessed. Those involved in the management of the PDS scheme, while endorsing local commissioning arrangements, were concerned that it was not known whether PDS was meeting local needs. There was little quality benchmarking, which would have allowed robust measure of success. The contract model and outcomes should have been more sensitively designed. There was concern expressed that the small number of practices who participated in the pilot scheme prohibits the possibility of thoroughly analysing the impact of local commissioning. Future local commissioning should identify mechanisms for ensuring the effective planning, management and evaluation of the impact of the schemes. A core element of this will be the specification of appropriate goals for commissioning.

Attitude of Health Personnel↗
PubMed1994

Pandemic planning in Canada.

A Canadian plan for pandemic influenza was completed by the National Advisory Committee on Immunization in 1988. Its development took several years and involved consultation with provincial public health and laboratory authorities, the licensing body, manufacturers of influenza vaccine and antiviral agents, and representatives in the USA and UK. Key decisions in creating the pandemic plan include: (1) aiming for federal-provincial consensus on use of vaccine and antiviral drugs, (2) a selective vaccination approach (high-risk persons plus essential workers), (3) bulk purchasing and distribution of vaccine through the public sector, (4) leaving antiviral drugs on the open market, (5) careful planning of the communications strategy, and (6) increasing inter-pandemic use of flu vaccine in target groups. The plan addresses recognition of a pandemic; activation of a Pandemic Influenza Committee whose membership and responsibilities are spelled out; the federal-provincial decision making process; influenza vaccine considerations; amantadine and other antiviral agents; estimates of target group size, vaccine uptake, manufacturing capabilities and time frames; and communication considerations. Since 1988, influenza vaccine use has increased considerably in Canada and experience has been gained with amantadine. Manufacturing capability within Canada for influenza vaccine has also been enhanced. It is now time to update the plan, especially the targets, and to make sure that everyone involved remains aware of the assigned roles.

Amantadine↗
PubMed2004

Evidence-based medicine breaking the borders--a working model for the European Union to facilitate evidence-based health care.

The promotion of evidence-based health care to improve quality of care has become an important political agenda worldwide. In April 2003 the European Commission acknowledged the lack of evidence-based health care in the European Union. Nevertheless, neither the new eHealth 2005 Action Plan nor the Public Health Program 2003 explicitly state the facilitation of evidence-based health care as a goal. This article proposes a working model for a network of institutions and databases within the European Union to facilitate evidence-based health care. The model strives to adapt existing U.S. examples of institutions in the field of evidence-based medicine, like Evidence-based Practice Centers, and the National Guideline Clearinghouse to the heterogeneous and legally restrictive environment of the European Union, particularly Article 152 of the European Union Treaty. In addition to increasing efficiency and decreasing redundancy, coordinating national efforts in best practice will also facilitate information sharing and knowledge transfer. The establishment of databases in native languages could also break down one of the main barriers existing between care providers and evidence-based medicine while adhering to the overall concepts of eHealth 2005.

Databases as Topic↗
PubMed2005

After the innovation: outcomes from the Texas behavioral data project.

The Texas Department of Health and University of Texas Southwestern staff, using formative assessment data, developed a set of innovative methods and tools to increase the use of behavioral and epidemiologic data in decision-making about HIV prevention interventions by HIV prevention community planning groups (CPGs) and HIV prevention providers. Semistructured interviews, mail surveys, meeting observations, and content analysis of funding proposals were used to measure the results of the multifaceted intervention. Compared to baseline measures, CPG members reported that data played a more central and desired role in their decision-making. HIV prevention providers exposed to the project's materials were more likely to choose evidence-based interventions to conduct. The tools and structural intervention methods of this project were diffused and had an impact on the use of behavioral data by community planning groups and HIV prevention providers. The structural interventions were not sufficient without the additional effect of the trained peers acting as advocates and intervention innovators.

Community Health Planning↗