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PubMed2006

Accessibility of family planning services: impact of structural and organizational factors.

OBJECTIVES: This study sought to determine whether selected structural and organizational characteristics of publicly available family planning facilities are associated with greater availability. METHODS: A survey was sent to 726 publicly available family planning facilities in four states. These included local health departments, federally qualified health centers (FQHC), Planned Parenthood sites, hospital outpatient departments, and freestanding women's health centers. Usable responses were obtained from 526 sites for a response rate of 72.5%. Availability variables included the provision of primary care services; the contraceptives offered; professional staffing; scheduling, waiting time, and transportation; and cultural congruence and competency. The structural and organizational variables were state, type of organization, and funding source. RESULTS: Some states were more likely to offer emergency contraception while others were more likely to have weekend hours. FQHCs were most likely to provide primary care and Planned Parenthood sites most likely to offer emergency contraception. Title X funding was associated with increased likelihood of providing emergency contraception and staffing by midlevel practitioners and registered nurses. CONCLUSIONS: This study found that availability varied by structural and organizational variables, many of which are determined by federal and state policies. Revising some of these policies might increase utilization of family planning facilities.

Adolescent↗

PubMed1994

Adult immunization. Summary of the National Vaccine Advisory Committee Report.

In January 1994 the National Vaccine Advisory Committee adopted a report that reviewed the status of adult immunization in the United States. Vaccine-preventable infections of adults represent a continuing cause of morbidity and mortality. Their major impact is among older persons. Effective and safe vaccines against these diseases are available, but they are poorly used. Several reasons account for low immunization levels among adults, including inadequate awareness by health care providers and the public of the importance and benefits of vaccination. Health care providers often fail to take advantage of opportunities to immunize adults during office, clinic, and hospital contacts and fail to organize programs in medical settings that ensure adults are offered the vaccines they need. Inadequate reimbursement for adult immunization by public and private health insurers and a lack of federal programs to support vaccine delivery are also major problems. The National Vaccine Advisory Committee's report includes five goals and 18 recommendations for improving adult immunization. To reach the Public Health Service adult immunization goals for the year 2000, the Committee recommends (1) improvements in public and provider education; (2) major changes in clinical practice; (3) increased financial support by public and private health insurers; (4) improved surveillance of vaccine-preventable diseases and vaccine production and delivery; and (5) support for research on vaccine-preventable diseases, new and improved vaccines, immunization practices, and international programs for adult immunization.

Adult↗

PubMed2003

Trauma care systems in The Netherlands.

In the late 1980s the Dutch trauma surgeons (Dutch Trauma Society) expressed their concern about the quality of care to the (multi) trauma patients, in the prehospital as well as the in-hospital setting. The following intensive debate with the public health inspectorate and the government became the start point for major improvements in teaching and training (a.o. ATLS), reorganization, regionalization and implementation in which all partners in trauma care were involved. The regionalization of ambulance care, the introduction of mobile medical teams, the availability of trauma helicopters, the categorization of hospitals, the designation of trauma centres, the given responsibility of these centres in the regionalization of trauma care will and already have resulted in an important quality improvement, not only of the individual organizations but for all of the entire chain of trauma care. It has become a major step forward in the philosophy: get the individual trauma patient at the right time at the right hospital. Besides, initiatives have been taken to design a nationwide trauma registration data base in which all in-hospital trauma patients will be included. However serious concerns remain: shortage of intensive care beds, the impossibility to use the helicopter service at night, the shortage in the number of mobile medical teams at night and the slowness in executions of agreements between contracting parties. Many of the remaining problems are a matter of money. Not only (para) medical partners and hospitals but for all government and insurance companies should take their responsibility in this.

Ambulances↗

PubMed1984

The organization of services for chronically ill children and their families.

Despite a political climate that deters optimism for rapid growth in the field of maternal and child health, we believe that there are reasonable steps that can and ought to be taken in the years immediately ahead. These steps would lead to important and lasting changes in the delivery, organization, and financing of services to chronically ill children and their families. Furthermore, pediatricians can play important roles--as they have historically--in reshaping care for children with special needs. First, children with chronic illness and their families require a set of services substantially different from those required by the majority of the nation's children. Just as there is no escaping the presence of a chronic illness for a child and family, the health care system cannot escape its responsibility to provide these services. This nation has been extraordinarily attentive to the medical services that these children need. Advances in the diagnostic and medical treatment procedures for many chronic illnesses have been remarkable, allowing many children to live far longer and in much better health than anyone would have expected two decades ago. This nation has not been so attentive to other services. A child with diabetes may have the finest medical care available in the region, yet her family lacks the money for gas to visit her in the hospital. The cystic fibrosis specialist may develop a comprehensive management strategy for his patient, but it fails to have full effect because the family's local pediatrician remains uninformed. These and many other examples convince us that the first step toward improving the organization of services for these children and their families must involve sustained national attention to their broad and special needs. Pediatricians are in an excellent position for this effort. Though most pediatricians will not have in their practice many children with the same chronic illness, they are likely to be the only medical practitioners who will get to know a broad spectrum of chronically ill children and their families. Because of this perspective they can be a truly informed and effective voice, articulating to their local communities the need for special services for this population of children. Second, services should be organized in such a way as to de-emphasize dependence on expensive tertiary care hospitals and instead to foster the delivery of care closer to the child's and family's own community.(ABSTRACT TRUNCATED AT 400 WORDS)

Canada↗

PubMed2005

Public-private partnerships: an overview.

The development and marketing of medicines needed specifically to combat diseases of the developing world are commercially unattractive because the populations concerned are among the poorest on earth. Partnerships which bring together pharmaceutical companies, academics, not-for-profit organizations, philanthropists, governmental and inter-governmental agencies are an increasingly popular solution. These partnerships result in a complementarity of skills and resources that can accelerate the development and delivery of new medicines to those in need. Over the last 10 years or so, these public-private partnerships (PPPs) have grown significantly in number and diversity. However, they tend to cluster into two main groups: those dealing with product development (PD PPPs), and those concerned with improving the access of new medicines to target populations (Access PPPs). The Initiative on Public-Private Partnerships for Health was set up four years ago to monitor the performance of these new partnerships. After a series of studies of Access PPPs, it concluded that they provide significant benefits with very few side effects, particularly in the case of tropical diseases.

Developing Countries↗

PubMed1995

Cancer clinical trials in the community setting: a 20 year retrospective.

During the past two decades clinical cancer research in the United States has grown dramatically and has been significantly enhanced by the participation of community hospitals, practicing oncologists, and the creation of community cancer clinical trials organizations. More than 102,000 patients have been enrolled by these community based groups to important clinical trials which have answered questions that have improved cancer treatment in this country and worldwide (Figure 3, Table 8). Practicing oncologists are now well trained in the practice of clinical research and efforts should be directed to ensure that their participation in clinical research continues to increase. There are many obstacles to performing clinical cancer research, but none is greater than the issue of cost. We are currently facing the daunting prospect that health care reform may dramatically curtail or bias future cancer clinical trials. Consumers, providers, politicians, and the general public must be educated to protect and expand the cancer clinical research structure so that we can continue the pursuit of optimal cancer management.

Clinical Trials as Topic↗

PubMed2003

Public health considerations for the use of a first generation HIV vaccine. Report from a WHO-UNAIDS-CDC consultation, Geneva, 20-21 November 2002.

SUMMARY: To accelerate the development and future availability of safe, effective and affordable HIV vaccines it is essential to address not only the associated biomedical obstacles, but also the logistic aspects that would guide the introduction and use of those vaccines. It is likely that initial vaccines may only be partially effective, and their public health use will have to be carefully considered. This report summarizes the discussions from a consultation held in Geneva (20-21 November 2002) organized by the World Health Organization (WHO), the joint United Nations Programme on HIV/AIDS (UNAIDS) and the US Centers for Disease Control and Prevention (CDC). The group identified a number of logistic issues that need to be addressed to accelerate the development and future availability of HIV vaccines, and made broad recommendations in four different areas: (a) Vaccine manufacturing and licensing; (b) vaccination acceptability and social marketing; (c) immunisation strategies and delivery; and (d) access and economic issues. The implementation of these recommendations will require the participation of multiple stakeholders in the public and private sector, in industrialized and developing countries. These actions will be essential to ensure widespread and rapid access to HIV vaccines globally, soon after their efficacy is demonstrated in clinical trials.

AIDS Vaccines↗

PubMed2004

Treating people with intercurrent infection in HIV prevention trials. Report from a WHO/UNAIDS consultation, Geneva 17-18th July 2003.

While broad agreement now exists among sponsors of HIV prevention trials that antiretroviral therapy (ART) and a clinical care package should be provided to those who become infected during the conduct of a trial, certain practical issues remain unresolved, including Who should pay for ART? How long should ART be provided for? Does treatment extend outside of ART? What else should be included in the standard of care package and who should pay for it? Who should provide treatment and care? This report summarizes the discussions from a consultation held in Geneva (17-18 July 2003) organized by the World Health Organization (WHO) and the joint United Nations Programme on HIV/AIDS (UNAIDS). The group discussed issues related to the various types of HIV prevention trials covered - vaccines, microbicides, behavioural - the ethics and legal rational for providing treatment and care as well as relevant economic issues and developments around scale-up of treatment and care in middle- and lower-income countries. Also discussed were policies of certain research agencies, countries and international funding agencies. The implementation of the conclusions which came out of these discussions on the treatment and care for people who become infected during HIV prevention trials requires the active participation of members of the research community, funders of research, local and national governments and industry as well as the individuals or communities participating in the trials.

AIDS Vaccines↗

PubMed2004

Skin and colon cancer media campaigns in Utah.

The mission of the Utah Cancer Action Network is to reduce cancer incidence and mortality in Utah. Established in 2003, the network selected skin and colon cancers as the first priorities in its comprehensive plan. In its first year of operation, the network planned and implemented a cancer awareness campaign that was organized along two tracks: 1) marketing research, consisting of two telephone surveys, and 2) two advertising/awareness campaigns, one for colon cancer and one for skin cancer. The first telephone survey was conducted in January 2003 to obtain a baseline measurement of the Utah population's knowledge, attitudes, and behaviors. The advertising campaigns were launched in April 2003, and the second telephone survey was conducted in May. In January 2003, 18% of survey respondents reported seeing or hearing skin cancer prevention or sun protection announcements; in May, this percentage increased to 76%. In January, 36% indicated they had seen, read, or heard colorectal cancer early detection announcements; in May, this percentage increased to 79%.

Adult↗

PubMedDate not supplied

Understanding the central-local relationship in health care: a new approach.

One of the basic assumptions of governmental health planning policy is that the government can effectively take final responsibility for the development of the health care system. Failure to reach policy goals is explained in terms of inadequate planning technology and instruments to control implementation. In this article an alternative explanation is offered, based on the theory of strategic organizational behavior. According to this theory, the government must be seen as but one actor in a complex interorganizational network. From this, a different perspective on effective health planning policy is developed. Policies will fail if they are not based on a valid analysis of the policy space of health care institutions and the interdependencies between government and health care organizations. This article starts with an outline of the nature of the central-local relationship as seen from the perspective of strategic organizational behavior theory. Next, this theory is used to frame two cases in which Dutch health care institutions successfully pursued their own strategies that ran counter to the existing health planning policies. The article ends with a discussion of the implications of the theory of strategic organizational behavior for the development of effective central health care policies. This development starts with a thorough analysis of the policy space and interdependencies of all relevant actors in the health system, the government included. Following, policy makers can set the governmental goals and then have to start negotiations with health care institutions about mutual adaptation of their strategies and the governmental goals. The result is a negotiated health care order.

Decision Making, Organizational↗

PubMed2004

Achieving the Framework Convention on Tobacco Control's potential by investing in national capacity.

May 2003 marked a critical achievement in efforts to stem the global tobacco epidemic, as the member states of the World Health Organization unanimously endorsed the Framework Convention on Tobacco Control (FCTC). However, the adoption of the FCTC signifies only the end of the beginning of effective global action to control tobacco. Over the next several years the utility of the FCTC process and the treaty itself will be tested as individual countries seek to ratify and implement the treaty's obligations. Significant barriers to the treaty's long term success exist in many countries. It is crucial that the international tobacco control community now refocuses its efforts on national capacity building and ensures that individual countries have the knowledge, tools, data, people, and organisations needed to implement the convention and develop sustained tobacco control programmes. This paper provides a model of national tobacco control capacity and offers a prioritised agenda for action.

Cost of Illness↗

PubMed1996

A strategy for coping with change: an affiliation between a medical school and a managed care health system.

Case Western Reserve University School of Medicine (CWRU), a private research-focused medical school, and Henry Ford Health System (HFHS), an integrated health system with a preponderance of managed care, have established a formal, broad affiliation that includes substantial commitments that bind the two organizations. Among them are formal full-time faculty appointments at CWRU for qualified professional staff of HFHS, designation of an associate dean for CWRU at HFHS, election of HFHS faculty to key medical school committees such as admission, curriculum, and promotions and tenure, and the commitment of funds to the affiliation by both organizations: a grant from HFHS to CWRU for curriculum development, and investment from CWRU to HFHS. The alliance of two such organizations is made complex by a number of issues. They include differences of institutional cultures as well as traditional issues in academic health centers such as departmental authority over curriculum and faculty appointments, competition for academic preeminence, and competition among hospitals for patients. The affiliation was facilitated by shared commitments to education, agreement on the need to adapt student education to the emerging managed care environment, a shared commitment to health services research, investment in the concept that learners add value to a health care delivery setting, and the desire to develop graduates with knowledge of practice in managed care. The authors conclude that medical schools and integrated managed care health systems gain sufficiently from such an affiliation that the investment of time, effort, and resources is readily justified.

Academic Medical Centers↗

PubMed1977

Mode of payment and length of stay in the hospital: more work for PSROs?

The Professional Standards Review Organizations (PSROs) mandated by the Social Security Act aim to monitor and control hospital utilization by publicly funded patients, particularly those whose care is paid for by Medicare and Medicaid. One question to ask is, if PSROs prove successful in reducing suspected overutilization by public patients, would the principal private third parties, Blue Cross and commericial insurance plans, benefit by applying those techniques to their patients, as well. Data are presented from the Chicago Hospital Discharge Study, which was conducted in February, 1970, before PSRO activities were undertaken. They show that average length of stay for Medicaid patients is not consistently different from that for patients who pay by other means. Therefore, it is argued that, if it proves successful as applied to Medicaid patients, private third parties might benefit by using the PSRO mechanism to try to monitor and control the stays of their patients, as well.

Blue Cross Blue Shield Insurance Plans↗

PubMed1985

The influence of funding agencies on international health policy, research and programs.

Funding agencies, through the exercise of "strategic funding," are able to exert controlling influence in various fields of endeavor, and international health provides no exception to this general rule. A common way such control is exerted is to define the problem to be solved in a way that serves the vested interest of the funder. This is possible because the way a problem is defined determines the solution(s) to the problem. Currently, international health professionals are confronted with two contending definitions of health. The World Health Organization has defined health theoretically (to guide discussion) as "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity." This definition reflects a health-oriented conceptualization of health as primarily a social product, and hence leads to social-oriented solutions to problems of ill health in society. On the other hand, funding agencies have defined health operationally (to guide activity) as "the absence of disease or illness." This definition reflects a disease-oriented conceptualization of health, which therefore leads to biotechnical, individual-oriented solutions to disease and illness in society. To choose between these two definitions is to choose between two quite different problems to be solved, two very different sets of solution strategies and two very different sets of value structures. This choice represents a particularly difficult dilemma to international health professionals who are dependent on external funding agencies for their support.

Financing, Organized↗

PubMed1976

A network model for decentralized family practice residency training.

The organization of departments and divisions of family practice in a majority of medical schools in the United States has facilitated a recent trend toward increasing numbers of university affiliations with family practice residency programs in community hospitals. Many difficult issues arise when such affiliations are explored and developed. To date, the literature is meager on this important subject. This paper describes the elements of a network model for decentralized family practice residency training which has been in operation at the University of California Davis for over four years. Common issues are outlined, together with the various advantages of affiliation to the community hospital and the university. An active partnership between the medical school and community through a network of affiliated residency programs can effectively contribute to the quality of medical education and patient care on a regional basis and at the same time directly address the problem of physician maldistribution.

California↗

PubMed2001

Diversity in health administration doctoral education: alternative scenarios for the future.

Doctoral programs in health administration are characterized by extreme diversity in focus, format, content, and market. The observed diversity reflects two key structural attributes of health administration as a doctoral field of study: 1) its multidisciplinary base, and 2) its small size. These attributes leave doctoral programs vulnerable to a host of external pressures. The field lacks structure and organizing principles at the national or international level, and students, employers, and other stakeholders suffer some damaging consequences. Pressures from the institutional environment are weak and splintered (among the constituent disciplines of health administration), while the technical environment (economic forces such as competition for students and research funding) produces a powerful set of incentives that shape the form and substance of health administration doctoral education. As alternatives to the current hybrid nature of the field, two additional future scenarios are considered: Integration with Health Services Research, and Integration with Business Administration. The future of health administration doctoral education is interdependent with 1) the continued differentiation of health administration as a master's field of study; 2) trends in research funding; and 3) economies in the delivery of small-scale or individually customized doctoral education. At the least, programs and students currently would benefit from more information classifying program breadth and goals and reporting outcomes; more adequate information on careers and placement; and a modicum of workforce planning.

Education, Graduate↗

PubMed1996

Treatment of multidrug-resistant tuberculosis in China.

During the past decade the number and gravity of tuberculosis (TB) cases has continued to increase, both in developing and industrialized nations. Coupled with the recent emergence of multidrug-resistant tuberculosis (MDR-TB), the possibility that untreatable forms of the disease may become widespread has arisen. In China, the prevalence rate of smear-positive cases from three national surveys in 1979, 1984-1985 and 1990 was 187, 156 and 134/100,000, respectively, thus giving an annual average reduction rate of only 3.0%. This may be due to the accumulation of chronic cases, which is not surprising given that as many as 84.3% of new smear-positive cases received non-organized chemotherapy. To counteract this situation, a strategy was developed in Beijing to practice fully supervised chemotherapy for all new smear-positive cases. This is now 90% with a cure rate also of 90%. As a result, the prevalence rate of smear-positive cases has dropped, with an average annual reduction of 17%. Building upon this success, the World Bank Loan TB Control Project in China has been carried out in 12 provinces with 550 million people since 1992. The main objective of this project is to provide fully supervised, 6-month short-course chemotherapy for all newly detected smear-positive cases. The cure rate based on cohort analysis was 88% in 1993. Complete data are not available on resistance although the initial and acquired resistance rates were 28.1 and 41.1%, respectively. MDR-TB treated with ofloxacin has been increasing since 1992, with 317 cases reported during the period 1992-1995, of which 77% showed sputum conversion.

Antitubercular Agents↗

PubMed1990

The Missouri Elks Mobile Dental Program--dental care for developmentally disabled persons.

This article describes the origins, funding, organization, operation, utilization, and outreach program of a statewide mobile dental program for the disabled in Missouri. The article includes information based on analysis of productivity reports and patient records. Comparisons are made between the utilization by mentally retarded (MR) and other disabled patients (MCCS), their county of residence, and the location where service was provided (rural vs urban). The mean number of dental procedures provided per client was 7.3. More procedures (8.35) were provided to urban clients than rural clients (5.81). The utilization rate of urban MR clients was 63.9 percent, compared to 60 percent for rural MR clients. Other findings show 10.7 percent urban MCCS clients utilized the mobile dental program, versus 13.5 percent of the rural MCCS clients. The budgeted expenditures for providing care to this underserved group were $46,000 less than the estimated value of dental care provided in a private practice setting.

Adolescent↗