1
|
Hernandez Woodbine MJ, Fernández-Niño JA, Rodríguez-Villamizar LA, Rojas-Botero ML. COVID-19 vaccination plans in Latin America and the Caribbean: a multi-country comparative analysis of prioritization strategies. Public Health 2024; 228:162-170. [PMID: 38364676 DOI: 10.1016/j.puhe.2023.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/02/2023] [Accepted: 12/28/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVES This study aimed to synthesize and compare the prioritization strategies outlined in the national vaccination plans (NVPs) against Coronavirus Disease 2019 (COVID-19) developed by countries in the Latin America and Caribbean (LAC) region. STUDY DESIGN We conducted a comparative policy analysis based on COVID-19 NVPs. METHODS We conducted a search strategy in three stages to identify NVPs for COVID-19 across 41 countries/territories in the LAC region. Sources included official governmental repositories, complementary Google searches, and less formal documentation. We extracted key variables and conducted a comparative policy analysis based on the prioritization criteria and specific prioritization groups. RESULTS The study identified 52 NVPs for COVID-19, corresponding to 27 (65.8 %) out of 41 countries/territories in the LAC region. Official national websites yielded documents for 12 countries. All NVPs included frontline healthcare personnel in the first prioritization phase/stage, whilst some included residents of long-term healthcare facilities, adults aged 60 years or more, and people with disabilities. The decision criteria for prioritization were declared in 14 countries/territories. Ethical considerations declared in five NVPs included human welfare, equality, solidarity, equity, and social justice as values. CONCLUSION The early stages of vaccination rollout in LAC countries prioritized protection of the healthcare system and epidemiological risk for severe disease. Few countries included ethical considerations in their NVPs, and global inequities in vaccine access and distribution led to varied protections for vulnerable populations across LAC. This analysis highlights the need for improved emergency-response capacity, planning, and enhanced multilateral cooperation in the LAC region for future public health emergencies.
Collapse
Affiliation(s)
| | - J A Fernández-Niño
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Departamento de Salud Pública, Universidad del Norte, Barranquilla, Colombia.
| | | | - M L Rojas-Botero
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| |
Collapse
|
2
|
Lloyd-Johnsen C, Hampton A, Stubbs E, Moore S, Eades S, D'Aprano A, Goldfeld S. "I want to see them thrive!": exploring health service research priorities for young Aboriginal children growing up in Alice Springs - a qualitative study. BMC Health Serv Res 2024; 24:205. [PMID: 38355508 PMCID: PMC10868103 DOI: 10.1186/s12913-024-10642-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
To better understand the specific influences of early life on the long-term health and well-being of local Aboriginal children in Alice Springs, high-quality local longitudinal data is required. The Central Australian Aboriginal Congress and the Murdoch Children's Research Institute are exploring the feasibility of establishing a cohort study to fill this gap. A nested qualitative study was conducted to identify priority issues that can be translated into research questions answerable through the proposed cohort study. Semi-structured interviews and focus group discussions (FGDs) were conducted with a range of key community stakeholders, parents and caregivers of young Aboriginal children from Alice Springs in the Northern Territory between 2020 and 2021. Two Aboriginal and two non-Aboriginal researchers conducted 27 interviews and 3 FGDs with 42 participants. Three broad themes were constructed through reflexive thematic analysis representing the areas of focus community stakeholders and parents want future research to prioritise: (1) social determinants of health (2) building positive connections, and (3) making sure kids grow up strong and healthy. Priority setting for future research should be driven by Aboriginal and Torres Strait Islander peoples in order to be of practical benefit to their community. This qualitative study found that housing, transport and positive connections through nurturing and engaged parents were some of the most important issues raised. Participants also wanted future research to focus on issues specific to children such as nutrition, hearing loss, language development and capacity to learn. These findings will guide future work led by local Aboriginal researchers to co-design the proposed cohort study.
Collapse
Affiliation(s)
- C Lloyd-Johnsen
- Centre for Community Child Health, Murdoch Children's Research Institute, Flemington Rd, Parkville, Melbourne, VIC, 3052, Australia.
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
| | - A Hampton
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - E Stubbs
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - S Moore
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
- Menzies School of Health Research, Darwin, NT, Australia
- Flinders University, Adelaide, SA, Australia
| | - S Eades
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - A D'Aprano
- Centre for Community Child Health, Murdoch Children's Research Institute, Flemington Rd, Parkville, Melbourne, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - S Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, Flemington Rd, Parkville, Melbourne, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| |
Collapse
|
3
|
Verdonck C, Van Daele E, Willems R, Borgermans L, Boeckxstaens P. Underlying motivations hampering Flemish primary care physicians from overcoming the barriers in osteoporosis care: an EMR-facilitated clinical reasoning study. BMC Health Serv Res 2023; 23:1428. [PMID: 38104093 PMCID: PMC10725585 DOI: 10.1186/s12913-023-10441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Over half of the European population aged minimum 65 years presents with at least two chronic diseases. Attention towards these diseases exhibits disparities, with limited primary care physician (PCP) attention for osteoporosis. This was confirmed in a previous integrated osteoporosis care (IOC) project in which notable difficulties to enlist PCPs arose. Consequently, this study was initiated in Flemish PCPs for in-depth analysis of underlying mechanisms hampering PCPs to fully commit to osteoporosis care. METHODS A qualitative Electronic Medical Record (EMR)-facilitated clinical reasoning study was conducted. A semi-structured interview guide was employed to guide PCPs from reflections on their own patients to broader views regarding osteoporosis care. An inductive thematic analysis was performed using NVivo 12. RESULTS Thirteen PCPs were interviewed. They stated that osteoporosis patients often had complex (medical) profiles. PCPs emphasised the ongoing necessity for prioritisation within this context. This leads to a competition for PCP attention during consultations at three levels: i. between acute versus preventive care; ii. between primary fracture prevention and other preventive services and iii. between secondary fracture prevention and other preventive services; spanning eight areas of competition: disease significance, perceived impact, PCP awareness, the patient agenda, PCP competence, PCP support, perceived patient burden, and efficiency of care provision. Applicability of these areas of competition differed between levels. CONCLUSION The intricate context in which PCPs operate, creates a competition for PCP attention leading to a lack of attention for fracture prevention. To preserve efforts in fracture prevention, areas of competition should be systematically addressed. TRIAL REGISTRATION Approval for the study has been provided by the Ghent University Hospital Ethics Committee (BC-09797).
Collapse
Affiliation(s)
- Caroline Verdonck
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10 - Entrance 42 - 4thFloor, 9000, Ghent, Belgium.
| | - Ellis Van Daele
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10 - Entrance 42 - 4thFloor, 9000, Ghent, Belgium
| | - Ruben Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10 - Entrance 42 - 4thFloor, 9000, Ghent, Belgium
| | - Liesbeth Borgermans
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10 - Entrance 42 - 4thFloor, 9000, Ghent, Belgium
| | - Pauline Boeckxstaens
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10 - Entrance 42 - 4thFloor, 9000, Ghent, Belgium
| |
Collapse
|
4
|
Soon JA, To YH, Alexander M, Trapani K, Ascierto PA, Athan S, Brown MP, Burge M, Haydon A, Hughes B, Itchins M, John T, Kao S, Koopman M, Li BT, Long GV, Loree JM, Markman B, Meniawy TM, Menzies AM, Nott L, Pavlakis N, Petrella TM, Popat S, Tie J, Xu W, Yip D, Zalcberg J, Solomon BJ, Gibbs P, McArthur GA, Franchini F, IJzerman M. A tailored approach to horizon scanning for cancer medicines. J Cancer Policy 2023; 38:100441. [PMID: 38008488 DOI: 10.1016/j.jcpo.2023.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/18/2023] [Accepted: 08/17/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Horizon scanning (HS) is the systematic identification of emerging therapies to inform policy and decision-makers. We developed an agile and tailored HS methodology that combined multi-criteria decision analysis weighting and Delphi rounds. As secondary objectives, we aimed to identify new medicines in melanoma, non-small cell lung cancer and colorectal cancer most likely to impact the Australian government's pharmaceutical budget by 2025 and to compare clinician and consumer priorities in cancer medicine reimbursement. METHOD Three cancer-specific clinician panels (total n = 27) and a consumer panel (n = 7) were formed. Six prioritisation criteria were developed with consumer input. Criteria weightings were elicited using the Analytic Hierarchy Process (AHP). Candidate medicines were identified and filtered from a primary database and validated against secondary and tertiary sources. Clinician panels participated in a three-round Delphi survey to identify and score the top five medicines in each cancer type. RESULTS The AHP and Delphi process was completed in eight weeks. Prioritisation criteria focused on toxicity, quality of life (QoL), cost savings, strength of evidence, survival, and unmet need. In both curative and non-curative settings, consumers prioritised toxicity and QoL over survival gains, whereas clinicians prioritised survival. HS results project the ongoing prevalence of high-cost medicines. Since completion in October 2021, the HS has identified 70 % of relevant medicines submitted for Pharmaceutical Benefit Advisory Committee assessment and 60% of the medicines that received a positive recommendation. CONCLUSION Tested in the Australian context, our method appears to be an efficient and flexible approach to HS that can be tailored to address specific disease types by using elicited weights to prioritise according to incremental value from both a consumer and clinical perspective. POLICY SUMMARY Since HS is of global interest, our example provides a reproducible blueprint for adaptation to other healthcare settings that integrates consumer input and priorities.
Collapse
Affiliation(s)
- Jennifer A Soon
- Centre for Health Policy, Cancer Health Services Research, University of Melbourne, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Yat Hang To
- Gibbs Laboratory, Walter and Eliza Hall Institute of Research, Parkville, Australia
| | - Marliese Alexander
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Karen Trapani
- Centre for Health Policy, Cancer Health Services Research, University of Melbourne, Melbourne, Australia
| | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Sophy Athan
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | - Michael P Brown
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, Australia; School of Medicine, The University of Adelaide, Adelaide, Australia; Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
| | - Matthew Burge
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Department of Medical Oncology, Prince Charles Hospital, Chermside, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Brett Hughes
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Department of Medical Oncology, Prince Charles Hospital, Chermside, Australia; The University of Queensland, Brisbane, Australia
| | - Malinda Itchins
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, Australia; Northern Clinical School, The University of Sydney, St Leonards, Australia
| | - Thomas John
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Steven Kao
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, Australia; School of Medicine, The University of Sydney, Sydney, Australia
| | - Miriam Koopman
- Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Bob T Li
- Memorial Sloan Kettering Cancer Centre and Weill Cornell Medicine, New York, USA
| | - Georgina V Long
- School of Medicine, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | | | - Ben Markman
- Department of Medical Oncology, Alfred Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Tarek M Meniawy
- Sir Charles Gairdner Hospital and the University of Western Australia, Nedlands, Australia
| | - Alexander M Menzies
- School of Medicine, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, Sydney, Australia
| | - Louise Nott
- Royal Hobart Hospital, Hobart, Australia; Icon Cancer Centre, Hobart, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, Australia; School of Medicine, The University of Sydney, Sydney, Australia
| | | | - Sanjay Popat
- Lung Unit, The Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Jeanne Tie
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Gibbs Laboratory, Walter and Eliza Hall Institute of Research, Parkville, Australia
| | - Wen Xu
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Garran, Australia; School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - John Zalcberg
- Department of Medical Oncology, Alfred Health, Melbourne, Australia; Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
| | - Benjamin J Solomon
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Gibbs
- Gibbs Laboratory, Walter and Eliza Hall Institute of Research, Parkville, Australia
| | - Grant A McArthur
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | - Fanny Franchini
- Centre for Health Policy, Cancer Health Services Research, University of Melbourne, Melbourne, Australia
| | - Maarten IJzerman
- Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
| |
Collapse
|
5
|
Hoekstra D, Gerhardus A, Lhachimi SK. Priority setting to support a public health research agenda: a modified Delphi study with public health stakeholders in Germany. Health Res Policy Syst 2023; 21:86. [PMID: 37641128 PMCID: PMC10463880 DOI: 10.1186/s12961-023-01039-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 08/10/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Research priority setting (RPS) studies are necessary to close the significant gap between the scientific evidence produced and the evidence stakeholders need. Their findings can make resource allocation in research more efficient. However, no general framework for conducting an RPS study among public health stakeholders exists. RPS studies in public health are rare and no such study has been previously conducted and published in Germany. Therefore, we aimed to investigate which research topics in public health are prioritised by relevant stakeholders in Germany. METHODS Our RPS study consisted of a scoping stage and a Delphi stage each split into two rounds. Firstly, we invited members of the German Public Health Association to gather expert insights during two initial workshops. Next, we defined the relevant stakeholder groups and recruited respondents. Thereafter, we collected research topics and assessment criteria with the respondents in the first Delphi round and aggregated the responses through content analysis. Finally, we asked the respondents to rate the research topics with the assessment criteria in the second Delphi round. RESULTS In total, 94 out of the 140 invited public health organisations nominated 230 respondents for the Delphi study of whom almost 90% participated in both Delphi rounds. We compiled a comprehensive list of 76 research topics that were rated and ranked by several assessment criteria. We split the research topics into two types, substantive research topics and methodological-theoretical research topics respectively, to ensure the comparability among the research topics. In both types of research topics-substantive research topics and methodological-theoretical research topics-the respective top five ranked research topics hardly differed between public health researchers and public health practitioners. However, clear differences exist in the priority ranking of many (non-top priority) research topics between the stakeholder groups. CONCLUSIONS This research demonstrates that it is possible, with limited resources, to prioritise research topics for public health at the national level involving a wide range of pertinent stakeholders. The results can be used by research funding institutions to initiate calls for research projects with an increased relevance for health and/or scientific progress.
Collapse
Affiliation(s)
- Dyon Hoekstra
- Research Group for Evidence-Based Public Health, Leibniz-Institute for Prevention Research and Epidemiology (BIPS) & Institute for Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany.
- Health Sciences Bremen, University of Bremen, Bremen, Germany.
- Department of Special Needs Education and Rehabilitation, Carl Von Ossietzky University of Oldenburg, Oldenburg, Germany.
| | - Ansgar Gerhardus
- Health Sciences Bremen, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute for Public Health and Nursing Research (IPP), University Bremen, Bremen, Germany
| | - Stefan K Lhachimi
- Research Group for Evidence-Based Public Health, Leibniz-Institute for Prevention Research and Epidemiology (BIPS) & Institute for Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute for Public Health and Nursing Research (IPP), University Bremen, Bremen, Germany
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, 17033, Neubrandenburg, Germany
| |
Collapse
|
6
|
Neill R, Shawar YR, Ashraf L, Das P, Champagne SN, Kautsar H, Zia N, Michlig GJ, Bachani AM. Prioritizing rehabilitation in low- and middle-income country national health systems: a qualitative thematic synthesis and development of a policy framework. Int J Equity Health 2023; 22:91. [PMID: 37198596 DOI: 10.1186/s12939-023-01896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND There is a large and growing unmet need for rehabilitation - a diverse category of services that aim to improve functioning across the life course - particularly in low- and middle-income countries. Yet despite urgent calls to increase political commitment, many low- and middle-income country governments have dedicated little attention to expanding rehabilitation services. Existing policy scholarship explains how and why health issues reach the policy agenda and offers applicable evidence to advance access to physical, medical, psychosocial, and other types of rehabilitation services. Drawing from this scholarship and empirical data on rehabilitation, this paper proposes a policy framework to understand national-level prioritization of rehabilitation in low- and middle-income countries. METHODS We conducted key informant interviews with rehabilitation stakeholders in 47 countries, complemented by a purposeful review of peer-reviewed and gray literature to achieve thematic saturation. We analyzed the data abductively using a thematic synthesis methodology. Rehabilitation-specific findings were triangulated with policy theory and empirical case studies on the prioritization of other health issues to develop the framework. RESULTS The novel policy framework includes three components which shape the prioritization of rehabilitation on low- and middle-income countries' national government's health agendas. First, rehabilitation lacks a consistent problem definition, undermining the development of consensus-driven solutions which could advance the issue on policy agendas. Second, governance arrangements are fragmented within and across government ministries, between the government and its citizens, and across national and transnational actors engaged in rehabilitation service provision. Third, national legacies - particularly from civil conflict - and weaknesses in the existing health system influences both rehabilitation needs and implementation feasibility. CONCLUSIONS This framework can support stakeholders in identifying the key components impeding prioritization for rehabilitation across different national contexts. This is a crucial step for ultimately better advancing the issue on national policy agendas and improving equity in access to rehabilitation services.
Collapse
Affiliation(s)
- Rachel Neill
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA.
| | - Yusra Ribhi Shawar
- Department of International Health, Johns Hopkins University Blomberg School of Public Health, Baltimore, MD, USA
- Paul H. Nitze School of Advanced International Studies, Johns Hopkins University, Washington, DC, USA
| | - Lamisa Ashraf
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Priyanka Das
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Sarah N Champagne
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Hunied Kautsar
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Georgia J Michlig
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| |
Collapse
|
7
|
Peiró S, Meneu R, Hernández I. [Health policy priorities. SESPAS meeting at the XXXIII School of Public Health of Menorca]. Gac Sanit 2023; 37:102300. [PMID: 37060727 DOI: 10.1016/j.gaceta.2023.102300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVE In September 2022, the Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS) brought together a panel of experts with the aim of defining and prioritizing health policy proposals, from the perspective of the Spanish State as a whole, to adapt the National Health System (NHS) to current risks and to contemporary/present-day society. METHOD Expert meeting structured using a mix of procedures adapted from brainstorming, nominal group and Rand consensus method techniques. Relevance and feasibility of proposals identified were assessed individually by each panelist. Proposals were then ordered thematically and ranked according to the median and quartile deviation of relevance scores. RESULTS Panelists identified and prioritized several proposals in different areas: governance and funding of the NHS, reform of the portfolio of services and benefits and of the NHS human resources, public health and health policy, actions against inequality and poverty, and healthcare delivery reform, including socio-sanitary, primary and end-of-life care. CONCLUSIONS The results of the meeting show the urgent need to address in-depth changes in many state-wide health policies, including a major reconfiguration of governance, public health, and health care structures. They also point out potential areas of improvement, constituting a tentative guide of prioritized issues to be addressed.
Collapse
Affiliation(s)
- Salvador Peiró
- Unidad de Investigación en Servicios de Salud y Farmacoepidemiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), València, España; Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), València, España; Fundación Instituto de Investigación en Servicios de Salud (fIISS), València, España.
| | - Ricard Meneu
- Fundación Instituto de Investigación en Servicios de Salud (fIISS), València, España
| | - Ildefonso Hernández
- Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Elche, Alicante, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| |
Collapse
|
8
|
Holmér S, Nedlund AC, Thomas K, Krevers B. How health care professionals handle limited resources in primary care - an interview study. BMC Health Serv Res 2023; 23:6. [PMID: 36597086 PMCID: PMC9808951 DOI: 10.1186/s12913-022-08996-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Health care systems around the world are struggling with limited resources, in relation to the prevailing health care need. An accessible primary care is an important part of the solution for how to provide affordable care for the population and reduce pressure on the overall health care system such as unnecessary hospital stays and associated costs. As primary care constitutes an important first line of healthcare, the task of prioritising and deciding what to do and for whom lies in practice, primarily with the primary care professionals. Thus, the decisions and behaviour of primary care professionals have a central role in achieving good and equal health in the population. The aim of this study is to explore how primary health care professionals handle situations with limited resources and enhance our knowledge of priorities in practice. METHODS: Semi-structured interviews with 14 health care professionals (7 nurses, 7 physicians) working in Swedish primary care were interviewed. Data were analysed inductively with content analysis. FINDINGS Three main categories were found: Influx of patients; Structural conditions; and Actions. Each category illustrates an important aspect for what primary care professionals do to achieve good and equal care. The influx of patients concerned what the professionals handled in terms of patients' healthcare needs and patient behaviour. Structural conditions consisted of policies and goals set for primary care, competence availability, technical systems, and organisational culture. To handle situations due to limited resources, professionals performed different actions: matching health care needs with professionals' competency, defining care needs to suit booking systems appointments, giving care at the inappropriate health care level, rearranging workhours, and passing on the decision making. CONCLUSION Priorities in primary care are not, "one fits all" solution. Our study shows that priorities in primary care comprise of ongoing daily processes that are adapted to the situation, context of patient influx, and structural conditions. Healthcare professional's actions for how influx of patients' is handled in relation to limited resources, are created, and shaped within this context which also sets the boundaries for their actions.
Collapse
Affiliation(s)
- Suzana Holmér
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 7, 581 83 Linköping, Sweden ,grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Swedish National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden
| | - Ann- Charlotte Nedlund
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 7, 581 83 Linköping, Sweden ,grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Swedish National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 7, 581 83 Linköping, Sweden
| | - Barbro Krevers
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 7, 581 83 Linköping, Sweden ,grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Swedish National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden
| |
Collapse
|
9
|
Harmon BE, San Diego ERN, Pichon LC, Powell TW, Rugless F, West NT, Minor L, McNeal S, McCann L, Hales LS, Davis R, Lewis J. Congregational health needs by key demographic variables: Findings from a congregational health needs assessment tool. Eval Program Plann 2022; 94:102138. [PMID: 35820287 PMCID: PMC9464720 DOI: 10.1016/j.evalprogplan.2022.102138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/26/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
Health needs assessments identify important issues to be addressed and assist organizations in prioritizing resources. Using data from the Mid-South Congregational Health Survey, top health needs (physical, mental, social determinants of health) were identified, and differences in needs by key demographic variables (age, sex, race/ethnicity, education) were examined. Church leaders and members (N = 828) from 92 churches reported anxiety/depression (65 %), hypertension/stroke (65 %), stress (62 %), affordable healthcare (60 %), and overweight/obesity (58 %) as the top health needs in their congregations. Compared to individuals < 55 years old and with a college degree, individuals ≥ 55 years old (ORrange=1.50-1.86) and with ≤ high school degree (ORrange=1.55-1.91) were more likely to report mental health needs (anxiety/depression; stress). African Americans were less likely to report physical health needs (hypertension/stroke; overweight/obesity) than individuals categorized as Another race/ethnicity (ORrange=0.38-0.60). Individuals with ≤ high school degree were more likely to report affordable healthcare as a need compared to individuals with some college or a college degree (ORrange=1.58). This research highlights the need for evaluators and planners to design programs that are comprehensive in their approach to addressing the health needs of congregations while also considering demographic variation that may impact program participation and engagement.
Collapse
Affiliation(s)
- Brook E Harmon
- Division of Social and Behavioral Sciences, The University of Memphis, School of Public Health, Memphis, TN, USA.
| | - Emily Rose N San Diego
- Division of Social and Behavioral Sciences, The University of Memphis, School of Public Health, Memphis, TN, USA.
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, The University of Memphis, School of Public Health, Memphis, TN, USA.
| | - Terrinieka W Powell
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Fedoria Rugless
- Research and Quality, Church Health, Memphis, TN, USA; College of Health Sciences, The University of Memphis, Memphis, TN, USA.
| | - Nathan T West
- Division of Social and Behavioral Sciences, The University of Memphis, School of Public Health, Memphis, TN, USA.
| | - Lottie Minor
- National Faith-Based Mobilization Network (Faith MoNet), Hernando, MS, USA.
| | - Sterling McNeal
- Faith Community Engagement, Church Health, Memphis, TN, USA.
| | - Lauren McCann
- Community Programs, Methodist Le Bonheur Healthcare, Memphis, TN, USA.
| | - Lauren S Hales
- Faith Community Engagement, Church Health, Memphis, TN, USA.
| | - Rachel Davis
- Faith and Health Programs, Church Health, Memphis, TN, USA.
| | - Jonathan Lewis
- Community Partnerships, Methodist Le Bonheur Healthcare, Memphis, TN, USA.
| |
Collapse
|
10
|
Fystro JR, Hofmann B, Feiring E. On the person in personal health responsibility. BMC Med Ethics 2022; 23:64. [PMID: 35752782 DOI: 10.1186/s12910-022-00802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
In this paper, we start by comparing the two agents, Ann and Bob, who are involved in two car crashes. Whereas Ann crashes her car through no fault of her own, Bob crashes as a result of reckless driving. Unlike Ann, Bob is held criminally responsible, and the insurance company refuses to cover the car's damages. Nonetheless, Ann and Bob both receive emergency hospital treatment that a third party covers, regardless of any assessment of personal responsibility. What warrants such apparent exceptionalism with respect to personal responsibility in the healthcare context? We turn our attention to an understudied aspect of the debate on personal health responsibility, namely, the conceptualisation of the person in need of emergency hospital treatment. Drawing on the research of Joshua Knobe and Shaun Nichols, we propose that a context-dependent conceptualisation of the person may help explain a reluctance to ascribe responsibility to the individual for negative health outcomes.
Collapse
|
11
|
Hershberger PJ, Castle A, Soliman MM, Conway K. Social Accountability and Regional Health Priorities in Medical Education. Med Sci Educ 2022; 32:683-686. [PMID: 35818615 PMCID: PMC9270508 DOI: 10.1007/s40670-022-01560-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 06/03/2023]
Abstract
Social accountability in medical education refers to the commitment of medical schools to address priority health concerns of the community. Over a 2-year period, 200 Family Medicine clerkship students ranked the topics most emphasized in the first 2 years of medical school. These rankings did not align with the community health priorities of the region in which the medical school is located. While the basic science and introductory clinical material covered early in medical school is necessary, our data suggest that emphasizing the implications of this foundational curricula for addressing the regions' health priorities is worthy of greater consideration.
Collapse
Affiliation(s)
- Paul J. Hershberger
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, 725 University Blvd, Dayton, OH 45435 USA
| | - Angie Castle
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, 725 University Blvd, Dayton, OH 45435 USA
| | - Miriam M. Soliman
- Boonshoft School of Medicine, Wright State University, 725 University Blvd, Dayton, OH 45435 USA
| | - Katharine Conway
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, 725 University Blvd, Dayton, OH 45435 USA
| |
Collapse
|
12
|
Kurasz AM, Smith GE, Curiel RE, Barker WW, Behar RC, Ramirez A, Armstrong MJ. Patient values in healthcare decision making among diverse older adults. Patient Educ Couns 2022; 105:1115-1122. [PMID: 34509339 PMCID: PMC8980797 DOI: 10.1016/j.pec.2021.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To provide high-quality healthcare, it is essential to understand values that guide the healthcare decisions of older adults. We investigated the types of values that culturally diverse older adults incorporate in medical decision making. METHODS Focus groups were held with older adults who varied in cognitive status (mildly impaired versus those with normal cognition) and ethnicity (Hispanic and non-Hispanic). Investigators used a qualitative descriptive approach to analyze transcripts and identify themes. RESULTS Forty-nine individuals (49% with cognitive impairment; 51% Hispanic) participated. Participants expressed a wide range of values relating to individual factors, familial/cultural beliefs and expectations, balancing risks and benefits, receiving decisional support, and considering values other than their own. Participants emphasized that values are individual-specific, influenced by aging, and change throughout life course. Participants described barriers and facilitators that interfere with or promote value solicitation and incorporation during medical encounters. CONCLUSION Study findings highlight that in older adults with various health experiences, cognitive and physical health status, and sociocultural backgrounds, medical decisions are influenced by a variety of values. PRACTICAL IMPLICATIONS Clinicians should take time to elicit, understand, and reassess the different types of values of older adults.
Collapse
Affiliation(s)
- Andrea M Kurasz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Glenn E Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Rosie E Curiel
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Warren W Barker
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Raquel C Behar
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Alexandra Ramirez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
| |
Collapse
|
13
|
Mohamed AA, Lantz K, Ahmed YA, Osman A, Nur MA, Nur O, Njeru JW, Sia IG, Wieland ML. An Assessment of Health Priorities Among a Community Sample of Somali Adults. J Immigr Minor Health 2022; 24:455-460. [PMID: 33740189 PMCID: PMC7975235 DOI: 10.1007/s10903-021-01166-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
Somali immigrants are one of the largest African populations to resettle in the United States since 1990. There is an emerging literature base of disease-specific studies among Somali immigrants. However, we are aware of no studies on the health priorities for Somalis from the community's perspective. Somali adults in Minnesota completed a survey conducted by a community-based participatory research partnership on individual and community health priorities. Data were reported as counts and frequencies. 646 participants completed the survey. The most important health issues for individuals and their families were health behaviors (22.7%), diabetes (18.2%), and hypertension (14.4%), while those of the community were diabetes (22.5%), hypertension (18.8%) and weight (15.9%). This study found a significant overlap of health priorities among Somali individuals and their families compared to the community. These health priorities underscore the need to focus on non-communicable diseases among Somali immigrants.
Collapse
Affiliation(s)
- Ahmed A Mohamed
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Kiley Lantz
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Yahye A Ahmed
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Ahmed Osman
- Intercultural Mutual Assistance Association, Rochester, MN, USA
| | - Mohamud A Nur
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Omar Nur
- Somali American Social Service Association, Rochester, MN, USA
| | - Jane W Njeru
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Irene G Sia
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Mark L Wieland
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| |
Collapse
|
14
|
Hoerger M, Alonzi S, Mossman B. Scenario planning: a framework for mitigating uncertainty in implementing strategic behavioral medicine initiatives during the COVID-19 pandemic. Transl Behav Med 2021; 12:486-488. [PMID: 34893916 PMCID: PMC8689730 DOI: 10.1093/tbm/ibab155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, LA, USA.,Department of Palliative Medicine and Supportive Care, University Medical Center, New Orleans, LA, USA.,Departments of Psychiatry and Medicine, Tulane Cancer Center, and Freeman School of Business, Tulane University, New Orleans, LA, USA
| | - Sarah Alonzi
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Brenna Mossman
- Department of Psychology, Tulane University, New Orleans, LA, USA
| |
Collapse
|
15
|
Pichon-Riviere A, Augustovski F, García Martí S, Alcaraz A, Alfie V, Sampietro-Colom L. Identification and selection of health technologies for assessment by agencies in support of reimbursement decisions in Latin America. Int J Technol Assess Health Care 2021; 37:e80. [PMID: 34392842 DOI: 10.1017/S0266462321000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is no health system that has the resources to evaluate all technologies. The presence of a clear process to prioritize health technologies for assessment by health technology assessment (HTA) agencies is a good practice principle recognized at the international level. The objective of Health Technology Assessment International's 2020 Latin American Policy Forum (LatamPF) was to explore how to improve the way HTA agencies in Latin America identify and prioritize technologies for assessment. METHODS This paper is based on a background document, a survey, and the deliberations of the members of the LatamPF (forty-six participants from eleven countries) using a design thinking methodology. RESULTS Participants agreed that a lack of clear prioritization mechanisms results in HTA processes and decisions that are perceived to be of low transparency and overly exposed to political or interest group pressures. The LatamPF identified barriers and recommended actions to improve HTA prioritization mechanisms in Latin America. The criteria identified as the most important to be taken into consideration by HTA agencies in the region when prioritizing a technology for assessment were: the burden of illness, the potential clinical benefit, the alignment with national health priorities, the potential impact on equity, a lack of treatment alternatives for patients, and the potential economic impact. CONCLUSIONS Forum participants agreed that the establishment of transparent prioritization processes is a key element for all health systems. Improvements in these processes will strengthen HTA and provide greater legitimacy to decision making.
Collapse
|
16
|
Sanabria AJ, Alonso-Coello P, McFarlane E, Niño de Guzman E, Roqué M, Martínez García L. The UpPriority tool supported prioritization processes for updating clinical guideline questions. J Clin Epidemiol 2021; 139:149-159. [PMID: 34363971 DOI: 10.1016/j.jclinepi.2021.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aim to 1) use the UpPriority tool to identify which clinical questions (CQs) within the clinical guidelines (CGs) need to be prioritized for updating and 2) assess the implementation of the tool in a real-world set of CGs. STUDY DESIGN AND SETTING We systematically assessed CQs from a sample of CGs developed in the Spanish National Health System CG program. We applied the UpPriority tool to each CG using a step-by-step process that included: 1) establishment of the UpPriority Implementation Working Group, 2) mapping of the original CG questions and recommendations, 3) development of a survey to prioritize CQs, 4) assessment of CQ's priority according to six items, 5) calculation and ranking of priority scores, 6) decision of prioritized CQs for updating, and 7) development of the priority report. We assessed the tool implementation process (appraisers' experience when using the tool) and the inter-observer reliability of the tool, and we provided suggestions for improvement. RESULTS We included four CGs with a total of 107 CQs on the following topics: chronic heart failure (10 CQs), inherited retinal dystrophies (39 CQs), menopause (20 CQs), and open-angle glaucoma (38 CQs). We included a total of 30 participants, most of them clinicians that were members of the original CG development groups. CQs were classified in three groups: 1) high priority (CQs prioritized for updating [16/107; 15.0%]), 2) medium priority (CQs that could be prioritized for updating [47/107; 43.9%]), and low priority (CQs that were not prioritized for updating [44/107; 41.1%]). The mean time each appraiser needed to assess the CQs with the tool was 3.8 hours (range 0.5 to 10). Agreement among the appraisers varied among the CGs. Appraisers considered that the tool was useful. We suggest some areas for consideration when using the tool including: 1) identification of key appraisers, 2) customization of training materials, 3) establishment of priority thresholds, and 4) provision of methodological support. CONCLUSION The UpPriority is a useful tool to identify which CQs within a CG need to be prioritized for update in a real-world scenario. Recruitment and training of topic experts are the main challenges when using the tool.
Collapse
Affiliation(s)
- Andrea Juliana Sanabria
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Manchester, UK
| | - Ena Niño de Guzman
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Marta Roqué
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | | |
Collapse
|
17
|
Abstract
BACKGROUND Demographic change, medical progress, pandemics, and mass casualty events may cause an increased demand for intensive and emergency medical care resources. There is thus a definite need for fair allocation criteria. OBJECTIVE The rationale, structure, and criteria for allocation of intensive and emergency medical care resources are presented and discussed. MATERIALS AND METHODS Analysis and discussion of German literature about the topic. RESULTS AND CONCLUSIONS Decisions on the allocation of intensive and emergency medical care resources are made on different levels (micro-, meso-, and macrolevel). They shall fulfill minimum demands in terms of procedure and content. Consequent and careful examination of indication and evidence of therapeutic decisions as well as consequent and careful examination of the patient's definite or presumed consent helps to take responsibility for fair allocation decisions.
Collapse
Affiliation(s)
- J Dutzmann
- Universitätsklinik und Poliklinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
| | - S Nuding
- Universitätsklinik und Poliklinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
| |
Collapse
|
18
|
El-Harakeh A, Morsi RZ, Fadlallah R, Bou-Karroum L, Lotfi T, Akl EA. Prioritization approaches in the development of health practice guidelines: a systematic review. BMC Health Serv Res 2019; 19:692. [PMID: 31615509 PMCID: PMC6792189 DOI: 10.1186/s12913-019-4567-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/27/2019] [Indexed: 12/20/2022] Open
Abstract
Background Given the considerable efforts and resources required to develop practice guidelines, developers need to prioritize what topics and questions to address. This study aims to identify and describe prioritization approaches in the development of clinical, public health, or health systems guidelines. Methods We searched Medline and CINAHL electronic databases in addition to Google Scholar. We included papers describing prioritization approaches in sufficient detail allowing for reproducibility. We synthesized findings in a semi-quantitative way. We followed an iterative process to develop a common framework of prioritization criteria that captures all of the criteria reported by each included study. Results Our search captured 33,339 unique citations out of which we identified 10 papers reporting prioritization approaches for guideline development. All of the identified approaches focused on prioritizing guideline topics but none on prioritizing recommendation questions or outcomes. The two most frequently reported steps of the development process for these approaches were reviewing the grey literature (9 out of 10, 90%) and engaging various stakeholders (9 out of 10, 90%). We derived a common framework of 20 prioritization criteria that can be used when prioritizing guideline topics. The most frequently reported criteria were the health burden of disease which was included in all of the approaches, practice variation (8 out of 10, 80%), and impact on health outcomes (7 out of 10, 70%). Two of the identified approaches stood out as being comprehensive and detailed. Conclusions We described 10 prioritization approaches in the development of health practice guidelines. There is a need to assess the effectiveness, efficiency and transparency of the identified approaches and to develop standardized and validated priority setting tools.
Collapse
Affiliation(s)
- Amena El-Harakeh
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Z Morsi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Racha Fadlallah
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lama Bou-Karroum
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Tamara Lotfi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Global Evidence Synthesis Initiative (GESI) Secretariat, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon. .,Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon. .,Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada. .,Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad-El-Solh Beirut 1107 2020, Beirut, Lebanon.
| |
Collapse
|
19
|
Frutos Pérez-Surio A, Gimeno-Gracia M, Alcácera López MA, Sagredo Samanes MA, Pardo Jario MDP, Salvador Gómez MDT. Systematic review for the development of a pharmaceutical and medical products prioritization framework. J Pharm Policy Pract 2019; 12:21. [PMID: 31452901 PMCID: PMC6702737 DOI: 10.1186/s40545-019-0181-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/15/2019] [Indexed: 12/04/2022] Open
Abstract
Objective To identify and analyze the criteria, approaches, and conceptual frameworks, used for national/international priority setting. Data sources We performed a search of the main biomedical databases (Medline/PubMed, Embase, Centre for Reviews and Dissemination, and Cochrane), and we reviewed assessment agency websites, among other sources. Study design An systematic review of the literature was carried out. Data collection Eligibility criteria for inclusion were based on set of predefined criteria. Systematic reviews and/or qualitative studies (interviews, surveys, expert consensus, etc) that aimed to identify prioritization criteria or develop general operational frameworks for the selection of health priorities were included. A critical analysis is made of all the aspects that may be useful for any public body that intends to establish priorities in health. Principal findings We found that there are no standardized criteria for priority setting, although common trends have been identified regarding key elements. Eight key domains were identified: 1) need for intervention; 2) health outcomes; 3) type of benefit of the intervention; 4) economic consequences; 5) existing knowledge on the intervention/quality and uncertainties of the regarding evidence; 6) implementation and complexity of the intervention/feasibility; 7) justice and ethics; and 8) overall context. Conclusions Our review provides a thorough analysis of the relevant issues and offers key recommendations regarding considerations for developing a national prioritization framework. Findings are envisioned to be useful for different public organizations that are aiming to establish healthcare priorities. Electronic supplementary material The online version of this article (10.1186/s40545-019-0181-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alberto Frutos Pérez-Surio
- Department of Hospital Pharmacy, University Clinical Hospital Lozano Blesa. Avda. San Juan Bosco 15, 50009 Zaragoza, Spain.,2Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, C/Domingo Miral s/n 50009, Zaragoza, Spain
| | - Mercedes Gimeno-Gracia
- Department of Hospital Pharmacy, University Clinical Hospital Lozano Blesa. Avda. San Juan Bosco 15, 50009 Zaragoza, Spain.,3IIS Aragón, Zaragoza, Spain
| | - Ma Aránzazu Alcácera López
- Department of Hospital Pharmacy, University Clinical Hospital Lozano Blesa. Avda. San Juan Bosco 15, 50009 Zaragoza, Spain
| | - Ma Asunción Sagredo Samanes
- Department of Hospital Pharmacy, University Clinical Hospital Lozano Blesa. Avda. San Juan Bosco 15, 50009 Zaragoza, Spain
| | - Ma Del Puerto Pardo Jario
- Department of Hospital Pharmacy, University Clinical Hospital Lozano Blesa. Avda. San Juan Bosco 15, 50009 Zaragoza, Spain
| | - Ma Del Tránsito Salvador Gómez
- Department of Hospital Pharmacy, University Clinical Hospital Lozano Blesa. Avda. San Juan Bosco 15, 50009 Zaragoza, Spain
| |
Collapse
|
20
|
Paz-Pascual C, Artieta-Pinedo I, Grandes G; ema.Q Group. Consensus on priorities in maternal education: results of Delphi and nominal group technique approaches. BMC Pregnancy Childbirth 2019; 19:264. [PMID: 31340770 DOI: 10.1186/s12884-019-2382-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/26/2019] [Indexed: 02/04/2023] Open
Abstract
Background Maternal education is wide-ranging and covers many areas from pregnancy to the immediate postpartum period and childrearing. However, for it to be effective, more resources need to be assigned to key topics. The goal of this study was to identify and prioritize the most important issues in maternal education, so that specific objectives could subsequently be set and learning outcomes evaluated. Methods We drew up a comprehensive list of topics addressed in existing maternal education programs, based on a systematic review of information obtained from the Internet and the experience of the research team. The topics were presented to a multidisciplinary panel whose members were asked to rate them from 1 to 9, and consensus of opinion was reached using a two-round Delphi survey, with consensus defined beforehand as 80% agreement among panelists in awarding a score of 7, 8 or 9. The most highly-rated topics were then discussed and again prioritized by a multidisciplinary team of healthcare and non-healthcare experts, using a nominal group technique. Results Initially, 650 topics were identified and grouped into 80 categories which were then prioritized by 54 healthcare and non-healthcare experts using a Delphi survey with a study participation rate of around 20%. 63 topics were considered very important, so criteria were restricted and only the 24 highest-scoring selected (95% of agreement on scores ≥7 or 80% of agreement on scores ≥8). Using the nominal group technique, a group of 12 experts identified the following priorities: initiation and establishment of breastfeeding, development of a birth plan, identification of problems and self-care postpartum, nutrition and a healthy lifestyle, options for pain management in labor and birth and characteristics of a normal newborn/looking after a newborn baby. Conclusion This study, with a Delphi study and the Consensus among Experts: the nominal group technique, has succeeded in identifying priority topics in maternal education. We need to assess women’s needs in relation to these topics, design an intervention to respond to these needs and evaluate its effectiveness.
Collapse
|
21
|
Choi BCK, Maza RA, Mujica OJ. The Pan American Health Organization-adapted Hanlon method for prioritization of health programs. Rev Panam Salud Publica 2019; 43:e61. [PMID: 31363360 PMCID: PMC6611209 DOI: 10.26633/rpsp.2019.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/03/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives. To document the underlying science of how the Pan American Health Organization (PAHO) adapted the Hanlon method, which prioritizes disease control programs, to its wider range of program areas and used it to implement the PAHO Strategic Plan 2014 – 2019. Methods. In 2014, PAHO established a Strategic Plan Advisory Group (SPAG) with representatives from 12 Member States to work closely with the PAHO Technical Team to adapt the Hanlon method to disease and non-disease control programs. Three meetings were held in 2015 – 2016 during which SPAG reviewed existing priority-setting methods, assessed the original Hanlon method and subsequent revisions, and developed the adapted method. This project was initiated by Member States, facilitated by PAHO, and conducted jointly in transparent and horizontal technical cooperation. Results. From the original Hanlon equation, the PAHO-adapted method maintains components A (size of problem), B (seriousness of problem), and C (effectiveness of intervention), drops component D (PEARL – Propriety, Economics, Acceptability, Resources, and Legality), and adds component E (inequity) and F (institutional positioning). The PEARL score was dropped because it serves a purpose for pre-screening process, but not in the priority-setting process for PAHO. Conclusions. The PAHO-adapted Hanlon method provides a refined approach for prioritizing public health programs that include disease and non-disease control areas. The method may be useful for the World Health Organization and country governments with similar needs.
Collapse
Affiliation(s)
- Bernard C K Choi
- Public Health Agency of Canada Public Health Agency of Canada OttawaOntario Canada Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Rony A Maza
- Pan American Health Organization, Regional Office of the World Health Organization for the Americas Pan American Health Organization, Regional Office of the World Health Organization for the Americas Washington, DC United States of America Pan American Health Organization, Regional Office of the World Health Organization for the Americas, Washington, DC, United States of America
| | - Oscar J Mujica
- Pan American Health Organization, Regional Office of the World Health Organization for the Americas Pan American Health Organization, Regional Office of the World Health Organization for the Americas Washington, DC United States of America Pan American Health Organization, Regional Office of the World Health Organization for the Americas, Washington, DC, United States of America
| | | | | |
Collapse
|
22
|
Clark J, Carter M, Scott AM, Brassey J, Del Mar C. The TRIP database showed most acute respiratory infections questions were already addressed by Cochrane reviews. J Clin Epidemiol 2018; 107:60-65. [PMID: 30439545 DOI: 10.1016/j.jclinepi.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/11/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Cochrane systematic reviews require more methodological support from Cochrane Review Groups (CRGs) than is customarily received by authors from journals; CRGs must therefore prioritize reviews to conserve resources. The TRIP database provided a data set of questions to guide prioritization for the acute respiratory infections (ARIs) CRG. STUDY DESIGN AND SETTING We extracted the ARI searches from the TRIP database (2010 to 2017) that contained at least one disease and one clinical management term, (defined as a "search"), and tabulated these by frequency. RESULTS There were 314,346 ARI searches from which we inferred 45,497 clinical questions, covering 365 topics. Two-thirds (30,541) of these addressed 20 clinical questions, of which treatment were the most frequent, followed by diagnosis, mortality, and prognosis. The five most frequent clinical questions were "Influenza + Vaccination" 4,989 (12.1%), "acute otitis media + antibiotics" 3,578 (8.7%), "common cold + vitamin C" 3,528 (8.6%), "meningitis + corticosteroids" 1,910 (4.6%), and "pneumonia + general treatment" 1,765 (4.3%). The 20 most frequent clinical questions were addressed by Cochrane reviews or protocols. CONCLUSION ARI questions are common and repeated often. Most may have been addressed by Cochrane reviews. The remainder form the basis of a priority list to assign resources for future Cochrane topics.
Collapse
Affiliation(s)
- Justin Clark
- Centre for Research in Evidence-Based Practice, Bond University, Robina 4226, Australia.
| | - Matt Carter
- Centre for Research in Evidence-Based Practice, Bond University, Robina 4226, Australia
| | - Anna Mae Scott
- Centre for Research in Evidence-Based Practice, Bond University, Robina 4226, Australia
| | | | - Chris Del Mar
- Centre for Research in Evidence-Based Practice, Bond University, Robina 4226, Australia
| |
Collapse
|
23
|
Cole CB, Trolle S, Edwards DJ. Developing the latest framework to measure and incentivise pharmaceutical industry contributions to health research and development. Health Res Policy Syst 2018; 16:73. [PMID: 30071858 PMCID: PMC6090890 DOI: 10.1186/s12961-018-0332-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/29/2018] [Indexed: 11/10/2022] Open
Abstract
Major pharmaceutical companies contribute important expertise to health research and development (R&D), particularly in their ability to develop and bring pharmaceuticals to market. The Access to Medicine Index evaluates how 20 of the world's largest pharmaceutical companies are directing R&D efforts towards the needs of people living in low- and middle-income countries. In dissemination of its findings, the Index stimulates pharmaceutical companies to expand R&D activities in this direction. The Index methodology is reviewed every 2 years, most recently for the 2018 Index, to ensure their R&D activity is benchmarked against current health R&D priorities as defined by the global health community. The review is based on consensus-building processes involving global health stakeholders. In the latest review, two main changes to the methodology were made that will further deepen the Index's analysis of (1) how far companies' R&D activity aligns with global health priorities; and (2) whether companies make plans to ensure resulting innovations reach populations in need globally. These changes will be applied in the 2018 Access to Medicine Index. Importantly, the methodology review process highlighted the need for further prioritisation from the global health community, in particular to emphasise to innovators which product innovations are needed most critically to address the burden of non-communicable diseases in low- and middle-income countries. Should such prioritisations be developed, the Index can play an important role in tracking and stimulating company contributions towards them.
Collapse
Affiliation(s)
- Clarke B Cole
- Access to Medicine Foundation, Naritaweg 227A, 1043 CB, Amsterdam, The Netherlands
| | - Stine Trolle
- Access to Medicine Foundation, Naritaweg 227A, 1043 CB, Amsterdam, The Netherlands
| | - Danny J Edwards
- Access to Medicine Foundation, Naritaweg 227A, 1043 CB, Amsterdam, The Netherlands.
| |
Collapse
|
24
|
García-Altés A, Peiró M, Artells JJ. [Prioritising measures for consolidating shared decision-making in the services rendered by the Spanish National Health System]. Gac Sanit 2018; 33:408-414. [PMID: 30033094 DOI: 10.1016/j.gaceta.2018.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/22/2018] [Accepted: 04/24/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Identify and prioritize according to their relevance, measures, interventions and indispensable instruments to support the establishment of a strategic framework in the Spanish National Health System to enable the responsible and informed exercise of the autonomy of its users and patients for shared decision-making. METHOD Group consultation, structured according to procedures adapted from brainstorming techniques, nominal group and Rand consensus method. RESULTS The 10 panellists proposed 53 possible actions focusing on "macro" structural measures (legal support and explicit prioritization of shared decision-making on health policy, curricular measures of the teaching system and dynamisation of cultural change), "meso" (generation and dissemination of accredited information by specific research lines and instruments to help shared decision-making), and "micro" activities (measures to stimulate the introduction of shared decision-making in the agency relationship with citizen and users of the healthcare system). CONCLUSIONS The consensus emerging from the consultation points to the need to incorporate into the strategic priorities of health policy, structural measures that support and encourage the development of shared decision-making in a number of specific areas of evolution and change in the relationship between health professionals and patients as an attribute of quality in access to the benefits and services of the public healthcare system.
Collapse
Affiliation(s)
- Anna García-Altés
- Agència de Qualitat i Avaluació Sanitària de Catalunya, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau, Barcelona, España.
| | - Manel Peiró
- Institute for Healthcare Management, ESADE Business School, Barcelona, España
| | | |
Collapse
|
25
|
Eftekhari MB, Mirabzadeh A, Falahat K, Sajjadi H, Vameghi M, Harouni GG. Priorities of positive mental health promotion in the Iranian community: a qualitative study. Electron Physician 2018; 10:7120-7131. [PMID: 30128105 PMCID: PMC6092136 DOI: 10.19082/7120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/03/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Positive Mental Health (PMH) enables people to cope with the common stresses of life and adversity to achieve their full potential and humanity. In many communities, promoting PMH via prioritized interventions has been considered as a key component of public health policies to optimize mental well-being. OBJECTIVE To set the priorities of interventional programs of Iranian PMH promotion according to the World Health Organization (WHO) Priority Public Health Condition (PPHC) analytical framework. METHODS This qualitative study was implemented in 2017 in Tehran, Iran and had two main phases. In a qualitative needs-assessment phase, needs of the community's PMH were collected through eight focus group discussions with a general population aged 30 to 60 years-old. In a priority-setting phase, the priorities of PMH were extracted through an expert panel consisting of mental health professionals and policy makers. Data gathering was implemented based on purposeful sampling according to inclusion criteria. Data were analyzed based on directional content analysis using Dedoose software version 7.6.6. RESULTS Fifty-one people and ten mental health professionals and policymakers participated in this study. The process of data analyzing, categorized PMH needs in 4 main categories, 15 subcategories and 46 codes. The four categories were financial security, social security, healthy lifestyle and promoting psychological factors. In the expert panel, first, the indicators of PMH priority setting were determined and then based on the priority public health condition analytical framework of the World Health Organization, the most important of PMH priority in each level was indicated as "creating job positions" in socioeconomic level, "providing proper working conditions" in differential exposure, "promoting practical life skills training" in the differential vulnerability, "easy and affordable access to mental health services" in differential healthcare outcome. CONCLUSION Appropriate policymaking and regulation at national level regarding employment, promoting working conditions, and reducing unemployment, promote community PMH as well as expanding accessible and affordable mental health services in the national healthcare system and empowering the community through providing practical life skill courses.
Collapse
Affiliation(s)
- Monir Baradaran Eftekhari
- Ph.D. of Social Determinants of Health, Assistant Professor, Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Arash Mirabzadeh
- M.D., Psychiatrist, Professor, Social Determinants of Health Research Center and Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Katayoun Falahat
- Ph.D. Student of Social Determinants of Health, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Homeira Sajjadi
- M.D., National Board in Community Medicine, Associate Professor, Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Meroe Vameghi
- M.D., Psychiatrist, Associate Professor, Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Gholamreza Ghaedamini Harouni
- Ph.D. of Social Welfare, Assistant Professor, Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| |
Collapse
|
26
|
Pichon-Riviere A, Soto N, Augustovski F, Sampietro-Colom L. STAKEHOLDER INVOLVEMENT IN THE HEALTH TECHNOLOGY ASSESSMENT PROCESS IN LATIN AMERICA. Int J Technol Assess Health Care 2018; 34:248-53. [PMID: 29888698 DOI: 10.1017/S0266462318000302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Latin American countries are taking important steps to expand and strengthen universal health coverage, and health technology assessment (HTA) has an increasingly prominent role in this process. Participation of all relevant stakeholders has become a priority in this effort. Key issues in this area were discussed during the 2017 Latin American Health Technology Assessment International (HTAi) Policy Forum. METHODS The Forum included forty-one participants from Latin American HTA agencies; public, social security, and private insurance sectors; and the pharmaceutical and medical device industry. A background paper and presentations by invited experts and Forum members supported discussions. This study presents a summary of these discussions. RESULTS Stakeholder involvement in HTA remains inconsistently implemented in the region and few countries have established formal processes. Participants agreed that stakeholder involvement is key to improve the HTA process, but the form and timing of such improvements must be adapted to local contexts. The legitimization of both HTA and decision-making processes was identified as one of the main reasons to promote stakeholder involvement; but to be successful, the entire system of assessment and decision making must be properly staffed and organized, and certain basic conditions must be met, including transparency in the HTA process and a clear link between HTA and decision making. CONCLUSIONS Participants suggested a need for establishing clear rules of participation in HTA that would protect HTA producers and decision makers from potentially distorting external influences. Such rules and mechanisms could help foster trust and credibility among stakeholders, supporting actual involvement in HTA processes.
Collapse
|
27
|
Pichon-Riviere A, Soto NC, Augustovski FA, García Martí S, Sampietro-Colom L. HEALTH TECHNOLOGY ASSESSMENT FOR DECISION MAKING IN LATIN AMERICA: GOOD PRACTICE PRINCIPLES. Int J Technol Assess Health Care 2018; 34:241-7. [PMID: 29888696 DOI: 10.1017/S0266462318000326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of this study was to identify good practice principles for health technology assessment (HTA) that are the most relevant and of highest priority for application in Latin America and to identify potential barriers to their implementation in the region. METHODS HTA good practice principles proposed at the international level were identified and then explored during a deliberative process in a forum of assessors, funders, and product manufacturers. RESULTS Forty-two representatives from ten Latin American countries participated. Good practice principles proposed at the international level were considered valid and potentially relevant to Latin America. Five principles were identified as priority and with the greatest potential to be strengthened at this time: transparency in the production of HTA, involvement of relevant stakeholders in the HTA process, mechanisms to appeal decisions, clear priority-setting processes in HTA, and a clear link between HTA and decision making. The main challenge identified was to find a balance between the application of these principles and the available resources in a way that would not detract from the production of reports and adaptation to the needs of decision makers. CONCLUSIONS The main recommendation was to progress gradually in strengthening HTA and its link to decision making by developing appropriate processes for each country, without trying to impose, in the short-term, standards taken from examples at the international level without adequate adaptation of these to local contexts.
Collapse
|
28
|
Berkley-Patton J, Thompson CB, Bradley-Ewing A, Berman M, Bauer A, Catley D, Goggin K, Williams E, Wainright C, Petty T, Aduloju-Ajijola N. Identifying health conditions, priorities, and relevant multilevel health promotion intervention strategies in African American churches: A faith community health needs assessment. Eval Program Plann 2018; 67:19-28. [PMID: 29156312 PMCID: PMC6195353 DOI: 10.1016/j.evalprogplan.2017.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 09/09/2017] [Accepted: 10/28/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | - Carole Bowe Thompson
- University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA
| | - Andrea Bradley-Ewing
- Children's Mercy Hospitals and Clinics, 2405 Grand Blvd, Kansas City, MO 64108, USA
| | - Marcie Berman
- Institute of Community Research, 2 Hartford Square W, Hartford, CT 06106, USA
| | - Alexandria Bauer
- University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA
| | - Delwyn Catley
- Children's Mercy Hospitals and Clinics, 2405 Grand Blvd, Kansas City, MO 64108, USA
| | - Kathy Goggin
- Children's Mercy Hospitals and Clinics, 2405 Grand Blvd, Kansas City, MO 64108, USA
| | - Eric Williams
- Calvary Community Outreach Network, 2940 Holmes, Kansas City MO 64109, USA
| | | | - Therese Petty
- University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA
| | | |
Collapse
|
29
|
Lindemark F, Haaland ØA, Kvåle R, Flaatten H, Norheim OF, Johansson KA. Costs and expected gain in lifetime health from intensive care versus general ward care of 30,712 individual patients: a distribution-weighted cost-effectiveness analysis. Crit Care 2017; 21:220. [PMID: 28830479 PMCID: PMC5567919 DOI: 10.1186/s13054-017-1792-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 07/07/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Clinicians, hospital managers, policy makers, and researchers are concerned about high costs, increased demand, and variation in priorities in the intensive care unit (ICU). The objectives of this modelling study are to describe the extra costs and expected health gains associated with admission to the ICU versus the general ward for 30,712 patients and the variation in cost-effectiveness estimates among subgroups and individuals, and to perform a distribution-weighted economic evaluation incorporating extra weighting to patients with high severity of disease. METHODS We used a decision-analytic model that estimates the incremental cost per quality-adjusted life year (QALY) gained (ICER) from ICU admission compared with general ward care using Norwegian registry data from 2008 to 2010. We assigned increasing weights to health gains for those with higher severity of disease, defined as less expected lifetime health if not admitted. The study has inherent uncertainty of findings because a randomized clinical trial comparing patients admitted or rejected to the ICU has never been performed. Uncertainty is explored in probabilistic sensitivity analysis. RESULTS The mean cost-effectiveness of ICU admission versus ward care was €11,600/QALY, with 1.6 QALYs gained and an incremental cost of €18,700 per patient. The probability (p) of cost-effectiveness was 95% at a threshold of €22,000/QALY. The mean ICER for medical admissions was €10,700/QALY (p = 97%), €12,300/QALY (p = 93%) for admissions after acute surgery, and €14,700/QALY (p = 84%) after planned surgery. For individualized ICERs, there was a 50% probability that ICU admission was cost-effective for 85% of the patients at a threshold of €64,000/QALY, leaving 15% of the admissions not cost-effective. In the distributional evaluation, 8% of all patients had distribution-weighted ICERs (higher weights to gains for more severe conditions) above €64,000/QALY. High-severity admissions gained the most, and were more cost-effective. CONCLUSIONS On average, ICU admission versus general ward care was cost-effective at a threshold of €22,000/QALY (p = 95%). According to the individualized cost-effectiveness information, one in six ICU admissions was not cost-effective at a threshold of €64,000/QALY. Almost half of these admissions that were not cost-effective can be regarded as acceptable when weighted by severity of disease in terms of expected lifetime health. Overall, existing ICU services represent reasonable resource use, but considerable uncertainty becomes evident when disaggregating into individualized results.
Collapse
Affiliation(s)
- Frode Lindemark
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Øystein A Haaland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Reidar Kvåle
- Norwegian Intensive Care Registry, Helse Bergen HF, Bergen, Norway.,Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hans Flaatten
- Norwegian Intensive Care Registry, Helse Bergen HF, Bergen, Norway.,Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ole F Norheim
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kjell A Johansson
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| |
Collapse
|
30
|
Petricca K, Bekele A. Conceptualizations of fairness and legitimacy in the context of Ethiopian health priority setting: Reflections on the applicability of accountability for reasonableness. Dev World Bioeth 2017; 18:357-364. [PMID: 28544136 DOI: 10.1111/dewb.12153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A critical element in building stronger health systems involves strengthening good governance to build capacity for transparent and fair health planning and priority setting. Over the past 20 years, the ethical framework Accountability for Reasonableness (A4R) has been a prominent conceptual guide in strengthening fair and legitimate processes of health decision-making. While many of the principles embedded within the framework are congruent with Western conceptualizations of what constitutes procedural fairness, there is a paucity in the literature that captures the degree of resonance between these principles and the views of decision makers from non-Western settings; particularly in Africa, where many countries have only recently, within the last 20-30 years, become more democratic. This paper contributes to the ethics literature by examining how Ethiopian decision makers conceptualize fair and legitimate health decision-making, and reflects on the degree of conceptual resonance between these views and the principles embedded in A4R. A qualitative case study approach from three districts in Ethiopia was undertaken. Fifty-eight decision makers from district, regional, zonal, and national levels were interviewed to describe their conceptualization of fairness and legitimacy in the district health planning process. Findings revealed that Ethiopians have a broad conception of fairness and legitimacy that while congruent with procedural justice, also aligned with principles of distributive and organizational justice. Researchers and practitioners seeking to strengthen procedural fairness in health priority setting must therefore recognize the significance of other philosophical dimensions influencing how fairness and legitimacy of health decision-making are constructed within the Ethiopian setting.
Collapse
|
31
|
Eliadi I, Tsoumi G, Kampouropoulou O, Theofanis V, Mantzourani M, Samarkos M. Characterization of the medical admissions in a tertiary Greek hospital. Eur J Intern Med 2017; 40:e15-e16. [PMID: 28119030 DOI: 10.1016/j.ejim.2017.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Irene Eliadi
- 1st Department of Medicine, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Georgia Tsoumi
- 1st Department of Medicine, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Olga Kampouropoulou
- 1st Department of Medicine, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Vasileios Theofanis
- 1st Department of Medicine, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Marina Mantzourani
- 1st Department of Medicine, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Michael Samarkos
- 1st Department of Medicine, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece.
| |
Collapse
|
32
|
Aitken LM, Chaboyer W, Jeffrey C, Martin B, Whitty JA, Schuetz M, Richmond TS. Indicators of injury recovery identified by patients, family members and clinicians. Injury 2016; 47:2655-2663. [PMID: 27793327 DOI: 10.1016/j.injury.2016.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/11/2016] [Accepted: 10/13/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A focus on what is important to patients has been recognized as an essential pillar in care to ensure safe patient care that focuses on outcomes identified as important by patients. Despite this, asking trauma patients and their families what they consider should be the priorities of care and recovery has been neglected. METHODS Adult trauma patients admitted to two centers in Australia for ≥24h for the treatment of physical injury, and family members of injured patients and clinicians caring for injured patients were invited to participate. Individual interviews were conducted with the patient and family members prior to hospital discharge, and again one and three months post discharge. Individual interviews or focus groups were conducted with clinicians at one point in time. Content analysis of all transcripts was undertaken to determine the indicators of successful recovery over time. RESULTS Participants in the three stakeholder groups were enrolled (patients - 33; family members-22; clinicians-40). Indicators of recovery focused on five main categories including returning to work, resuming family roles, achieving independence, recapturing normality and achieving comfort. Other categories that were less frequently identified included maintaining one's household, restoring emotional stability, cosmetic considerations and appearance, realignment of life goals, psychological recovery and development of self. Indicators of recovery after physical injury were similar across the three stakeholder groups, although with greater detail identified by patients. In addition, indicators evolved over time with increasing recognition of the importance of the overall impact of the injury in general and on activities of daily living and an unfolding appreciation that life could not be taken for granted. CONCLUSIONS Description of the indicators of recovery after traumatic injury that matter to patients, family members and clinicians enable an understanding of similarities and differences. Further testing in a broader cohort of participants is essential to identify patient reported outcome measures that might be used in trauma care and associated research.
Collapse
Affiliation(s)
- Leanne M Aitken
- Nursing School of Health Sciences, City, University of London, United Kingdom; Menzies Health Institute Queensland & School of Nursing and Midwifery, Griffith University, Australia; Intensive Care Unit, Princess Alexandra Hospital, Australia.
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland & School of Nursing and Midwifery, Griffith University, Australia
| | - Carol Jeffrey
- Princess Alexandra Hospital, Australia & School of Nursing and Midwifery Griffith University, Australia
| | - Bronte Martin
- National Critical Care Trauma Response Centre, Royal Darwin Hospital, Australia
| | - Jennifer A Whitty
- Health Economics, Norwich Medical School, University of East Anglia, Norwich, UK; Menzies Health Institute Queensland & School of Medicine, Griffith University, Australia; School of Pharmacy, The University of Queensland, Australia
| | | | | |
Collapse
|
33
|
Rankin NM, McGregor D, Butow PN, White K, Phillips JL, Young JM, Pearson SA, York S, Shaw T. Adapting the nominal group technique for priority setting of evidence-practice gaps in implementation science. BMC Med Res Methodol 2016; 16:110. [PMID: 27566679 PMCID: PMC5002198 DOI: 10.1186/s12874-016-0210-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background There are a variety of methods for priority setting in health research but few studies have addressed how to prioritise the gaps that exist between research evidence and clinical practice. This study aimed to build a suite of robust, evidence based techniques and tools for use in implementation science projects. We applied the priority setting methodology in lung cancer care as an example. Methods We reviewed existing techniques and tools for priority setting in health research and the criteria used to prioritise items. An expert interdisciplinary consensus group comprised of health service, cancer and nursing researchers iteratively reviewed and adapted the techniques and tools. We tested these on evidence-practice gaps identified for lung cancer. The tools were pilot tested and finalised. A brief process evaluation was conducted. Results We based our priority setting on the Nominal Group Technique (NGT). The adapted tools included a matrix for individuals to privately rate priority gaps; the same matrix was used for group discussion and reaching consensus. An investment exercise was used to validate allocation of priorities across the gaps. We describe the NGT process, criteria and tool adaptations and process evaluation results. Conclusions The modified NGT process, criteria and tools contribute to building a suite of methods that can be applied in prioritising evidence-practice gaps. These methods could be adapted for other health settings within the broader context of implementation science projects. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0210-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nicole M Rankin
- Sydney Catalyst Translational Cancer Research Cente, The University of Sydney, Level 6, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Deborah McGregor
- Sydney Catalyst Translational Cancer Research Cente, The University of Sydney, Level 6, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia.,Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Phyllis N Butow
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia.,Centre for Medical Psychology & Evidence-based Decision-making, The University of Sydney, Sydney, Australia
| | - Kate White
- Cancer Nursing Research Unit (CNRU), Sydney Nursing School, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Jane M Young
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,RPA Institute of Academic Surgery, Sydney Local Health District, NSW Ministry of Health, Sydney, Australia
| | - Sallie A Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Sarah York
- Sydney Catalyst Translational Cancer Research Cente, The University of Sydney, Level 6, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia
| | - Tim Shaw
- Sydney Catalyst Translational Cancer Research Cente, The University of Sydney, Level 6, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia.,Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| |
Collapse
|
34
|
Kaplan G, Baron-Epel O. Decision-makers' acquaintance with the public's priorities in health services. Isr J Health Policy Res 2016; 5:32. [PMID: 27358725 PMCID: PMC4926295 DOI: 10.1186/s13584-016-0081-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 05/23/2016] [Indexed: 12/01/2022] Open
Abstract
Background Decision makers often assume they know the public’s standpoints and see themselves as capable of representing them. The aim of this study is to assess the level of acquaintance that senior decision-makers in the Israeli health system have concerning the priorities of the public in whose name they act. Methods A phone survey was conducted with a representative population sample and face-to-face interviews were conducted with senior decision-makers. Results The decision-makers did predict correctly the public’s desired level of government involvement in health care; but only some of them correctly predicted the public’s preferences on allocation of funds—to health versus other areas. They had difficulty foreseeing public priorities for allocating additional monies to health, and even greater difficulty ascertaining preferences of the public for their own health insurance. Conclusions Government decision-making processes should include evidence about public preferences. The findings of this study indicate that decision makers need to be provided with reliable, systematic information on public preferences.
Collapse
Affiliation(s)
- Giora Kaplan
- Psychosocial Aspects of Health, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, 52621 Israel
| | - Orna Baron-Epel
- School of Public Health, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
| |
Collapse
|
35
|
Berg Brigham K, Darlington M, Wright JSF, Lewison G, Kanavos P, Durand-Zaleski I. Mapping research activity on mental health disorders in Europe: study protocol for the Mapping_NCD project. Health Res Policy Syst 2016; 14:39. [PMID: 27230585 PMCID: PMC4894554 DOI: 10.1186/s12961-016-0111-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/12/2016] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Mental health disorders (MHDs) constitute a large and growing disease burden in Europe, although they typically receive less attention and research funding than other non-communicable diseases (NCDs). This study protocol describes a methodology for the mapping of MHD research in Europe as part of Mapping_NCD, a 2-year project funded by the European Commission which seeks to map European research funding and impact for five NCDs in order to identify potential gaps, overlaps, synergies and opportunities, and to develop evidence-based policies for future research. METHODS The project aims to develop a multi-focal view of the MHD research landscape across the 28 European Union Member States, plus Iceland, Norway and Switzerland, through a survey of European funding entities, analysis of research initiatives undertaken in the public, voluntary/not-for-profit and commercial sectors, and expert interviews to contextualize the gathered data. The impact of MHD research will be explored using bibliometric analyses of scientific publications, clinical guidelines and newspaper stories reporting on research initiatives. Finally, these research inputs and outputs will be considered in light of various metrics that have been proposed to inform priorities for the allocation of research funds, including burden of disease, treatment gaps and cost of illness. DISCUSSION Given the growing burden of MHDs, a clear and broad view of the current state of MHD research is needed to ensure that limited resources are directed to evidence-based priority areas. MHDs pose a particular challenge in mapping the research landscape due to their complex nature, high co-morbidity and varying diagnostic criteria. Undertaking such an effort across 31 countries is further challenged by differences in data collection, healthcare systems, reimbursement rates and clinical practices, as well as cultural and socioeconomic diversity. Using multiple methods to explore the spectrum of MHD research funding activity across Europe, this project aims to develop a broad, high-level perspective to inform priority setting for future research.
Collapse
Affiliation(s)
- Karen Berg Brigham
- URC Eco Ile-de-France (AP-HP), Hôtel Dieu, place du Parvis Notre-Dame, 75004, Paris, France. .,Université Paris Est Créteil Val de Marne (UPEC), 61 avenue du Général de Gaulle, 94010, Créteil, Cedex, France.
| | - Meryl Darlington
- URC Eco Ile-de-France (AP-HP), Hôtel Dieu, place du Parvis Notre-Dame, 75004, Paris, France.,Université Paris Est Créteil Val de Marne (UPEC), 61 avenue du Général de Gaulle, 94010, Créteil, Cedex, France
| | - John S F Wright
- Department of Social Policy, London School of Economics and Political Science (LSE), Houghton Street, London, WC2A 2AE, United Kingdom
| | - Grant Lewison
- Research Oncology, Bermondsey Wing, Guy's Hospital, King's College London (KCL), 3rd Floor, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Panos Kanavos
- Department of Social Policy, London School of Economics and Political Science (LSE), Houghton Street, London, WC2A 2AE, United Kingdom
| | - Isabelle Durand-Zaleski
- URC Eco Ile-de-France (AP-HP), Hôtel Dieu, place du Parvis Notre-Dame, 75004, Paris, France.,Université Paris Est Créteil Val de Marne (UPEC), 61 avenue du Général de Gaulle, 94010, Créteil, Cedex, France.,ECEVE UMRS 1123, UEC - Hôpital Robert Debré, 48, boulevard Serurier, 75019, Paris, France
| | | |
Collapse
|
36
|
Abstract
Background The state of the world is one with scarce medical resources where longevity is not equally distributed. Given such facts, setting priorities in health entails making difficult yet unavoidable decisions about which lives to save. The business of saving lives works on the assumption that longevity is valuable and that an early death is worse than a late death. There is a vast literature on health priorities and badness of death, separately. Surprisingly, there has been little cross-fertilisation between the academic fields of priority setting and badness of death. Our aim is to connect philosophical discussions on the badness of death to contemporary debates in health priorities. Discussion Two questions regarding death are especially relevant to health priorities. The first question is why death is bad. Death is clearly bad for others, such as family, friends and society. Many philosophers also argue that death can be bad for those who die. This distinction is important for health priorities, because it concerns our fundamental reasons for saving lives. The second question is, ‘When is the worst time to die?’ A premature death is commonly considered worse than a late death. Thus, the number of good life years lost seems to matter to the badness of death. Concerning young individuals, some think the death of infants is worse than the death of adolescents, while others have contrary intuitions. Our claim is that to prioritise between age groups, we must consider the question of when it is worst to die. Conclusions Deprivationism provides a more plausible approach to health priorities than Epicureanism. If Deprivationism is accepted, we will have a firmer basis for claiming that individuals, in addition to having a health loss caused by morbidity, will have a loss of good life years due to mortality. Additionally, Deprivationism highlights the importance of age and values for health priorities. Regarding age, both variants of Deprivationism imply that stillbirths are included in the Global Burden of Disease. Finally, we suggest that the Time-Relative Interest Account may serve as an alternative to the discounting and age weighting previously applied in the Global Burden of Disease.
Collapse
Affiliation(s)
- Carl Tollef Solberg
- Department of Global Public Health and Primary Care, University of Bergen, PB. 7804, 5018, Bergen, Norway.
| | - Espen Gamlund
- Department of Global Public Health and Primary Care, University of Bergen, PB. 7804, 5018, Bergen, Norway.,Department of Philosophy, University of Bergen, PB. 7805, 5020, Bergen, Norway
| |
Collapse
|
37
|
Nicholls W, Pilsbury L, Blake M, Devonport TJ. The attitudes of student nurses towards obese patients: A questionnaire study exploring the association between perceived causal factors and advice giving. Nurse Educ Today 2016; 37:33-37. [PMID: 26608388 DOI: 10.1016/j.nedt.2015.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/09/2015] [Accepted: 11/06/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Nurses acting in primary care roles are central in addressing obesity as a public health priority. Nurses with a lower Body Mass Index have been shown to have negative attitudes towards obesity. Additionally, where the patient is perceived as being responsible for their excess weight, a negative attitude may also be held. The extent to which negative attitudes may influence the advice provided by nurses to obese patients is unknown. OBJECTIVES The present paper sought to examine whether the level of advice offered to obese patients by student nurses is associated with (i) the perceived causal factors of obesity, (ii) attitudes towards obesity and (iii) body mass index of the nurse. METHOD Participants were 92 student nurses from a university in the Midlands, UK. Participants received one of four patient vignettes; three were affected by obesity, with reference to either a behavioural, social, or medical cause; and the fourth was normal weight. Student nurses elected advice they would offer from five staged options (from no active involvement in advising the patient, through to discussing dietary advice). Attitudes towards obesity and social desirability were measured using validated questionnaires. RESULTS No association was found between the level of advice offered and either the causal factor of obesity, the student nurses' attitude towards obesity, or the nurses' Body Mass Index. Most students endorsed the highest level of advice-a patient centred discussion. CONCLUSION Findings show that advice giving by student nurses was not associated with perceived cause of obesity, or attitude, but is in line with the current Nursing and Midwifery Council (2015) recommendations. That is, most students endorsed a patient centred discussion. This suggests that professional training guidelines for the non-judgemental treatment of obese patients are not only being recognised, but implemented.
Collapse
Affiliation(s)
- Wendy Nicholls
- Institute of Psychology, University of Wolverhampton, Mary Seacole Building, Nursery Street, Wolverhampton, WV1 1AD, United Kingdom.
| | - Linda Pilsbury
- Institute of Psychology, University of Wolverhampton, Mary Seacole Building, Nursery Street, Wolverhampton, WV1 1AD, United Kingdom.
| | - Marcia Blake
- Institute of Sport, University of Wolverhampton, Gorway Road, Walsall, WS1 3BD, United Kingdom.
| | - Tracey J Devonport
- Institute of Sport, University of Wolverhampton, Gorway Road, Walsall, WS1 3BD, United Kingdom.
| |
Collapse
|
38
|
Asiedu GB, Hayes SN, Williams KP, Bondaryk MR, Halyard MY, Parker MW, Balls-Berry JE, Pinn VW, Breitkopf CR. Prevalent Health Concerns Among African American Women Belonging to a National Volunteer Service Organization (The Links, Incorporated). J Racial Ethn Health Disparities 2017; 4:19-24. [PMID: 27294766 DOI: 10.1007/s40615-015-0195-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/25/2015] [Accepted: 11/27/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE African American women bear a disproportionate burden of cardiovascular disease (CVD) and cancer. The purpose of this study was to identify prevalent health concerns among African American women who are members of The Links, Incorporated (Links), a large national service organization with health programming for communities of color. METHODS Survey data (n = 391) were collected during the 2012 Links National Assembly. Twenty-six health issues were presented within five groups: cancer, CVD, pulmonary disease, chronic conditions, and behavioral health. For each issue, women indicated if it was a concern for "you/your family" or "the African American community" via check-boxes. Differences in the proportions for "you/your family" and "the African American community" were evaluated using the McNemar test. RESULTS Hypertension was the most frequently endorsed concern for you/your family (79 %); 73 % indicated this was a concern for the African American community. Sickle cell anemia was the most frequently endorsed concern for the African American community (77 %). Melanoma was the least endorsed health issue overall (15 % you/your family, 55 % community). Breast was the most frequently endorsed cancer concern, while lung was among the least. For 23 out of 26 health issues, the proportion concerned was greater for the "African American community" than for "you/your family" (all p < 0.05). CONCLUSION CVD and breast cancer were salient concerns; both are topics for which national awareness campaigns and Links health programming exist. Comparatively lower concern was observed for melanoma, a cancer with known survival disparities, and for lung cancer, a leading cause of death in women.
Collapse
|
39
|
Stebler N, Schuepbach-Regula G, Braam P, Falzon LC. Use of a modified Delphi panel to identify and weight criteria for prioritization of zoonotic diseases in Switzerland. Prev Vet Med 2015; 121:165-9. [PMID: 26036342 DOI: 10.1016/j.prevetmed.2015.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/10/2015] [Accepted: 05/20/2015] [Indexed: 11/19/2022]
Abstract
Zoonotic diseases have a significant impact on public health globally. To prevent or reduce future zoonotic outbreaks, there is a constant need to invest in research and surveillance programs while updating risk management strategies. However, given the limited resources available, disease prioritization based on the need for their control and surveillance is important. This study was performed to identify and weight disease criteria for the prioritization of zoonotic diseases in Switzerland using a semi-quantitative research method based on expert opinion. Twenty-eight criteria relevant for disease control and surveillance, classified under five domains, were selected following a thorough literature review, and these were evaluated and weighted by seven experts from the Swiss Federal Veterinary Office using a modified Delphi panel. The median scores assigned to each criterion were then used to rank 16 notifiable and/or emerging zoonoses in Switzerland. The experts weighted the majority of the criteria similarly, and the top three criteria were Severity of disease in humans, incidence and prevalence of the disease in humans and treatment in humans. Based on these weightings, the three highest ranked diseases were Avian Influenza, Bovine Spongiform Encephalitis, and Bovine Tuberculosis. Overall, this study provided a preliminary list of criteria relevant for disease prioritization in Switzerland. These were further evaluated in a companion study which involved a quantitative prioritization method and multiple stakeholders.
Collapse
Affiliation(s)
- N Stebler
- Veterinary Public Health Institute, University of Bern, Schwarzenburgstrasse 155, CH 3097 Liebefeld, Switzerland
| | - G Schuepbach-Regula
- Veterinary Public Health Institute, University of Bern, Schwarzenburgstrasse 155, CH 3097 Liebefeld, Switzerland
| | - P Braam
- Federal Food Safety and Veterinary Office, Schwarzenburgstrasse 155, CH 3097 Liebefeld, Switzerland
| | - L C Falzon
- Veterinary Public Health Institute, University of Bern, Schwarzenburgstrasse 155, CH 3097 Liebefeld, Switzerland.
| |
Collapse
|
40
|
Kaplan G, Baron-Epel O. Personal needs versus national needs: public attitudes regarding health care priorities at the personal and national levels. Isr J Health Policy Res 2015; 4:15. [PMID: 25984294 PMCID: PMC4432952 DOI: 10.1186/s13584-015-0010-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 02/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many stakeholders have little or no confidence in the ability of the public to express their opinions on health policy issues. The claim often arises that lay people prioritize according to their own personal experiences and may lack the broad perspective necessary to understand the needs of the population at large. In order to test this claim empirically, this study compares the public's priorities regarding personal insurance to their priorities regarding allocation of national health resources. Thus, the study should shed light on the extent to which the public's priorities at the national level are a reflection of their priorities at the personal level. METHODS A telephone survey was conducted with a representative sample of the Israeli adult population aged 18 and over (n = 1,225). The public's priorities were assessed by asking interviewees to assume that they were the Minister of Health and from this point of view allocate an additional budget among various health areas. Their priorities at the personal level were assessed by asking interviewees to choose preferred items for inclusion in their personal supplementary health insurance. RESULTS Over half of the respondents (54%) expressed different personal and national priorities. In multivariable logistic analysis, "population group" was the only variable found to be statistically significant; Jews were 1.8 times more likely than Arabs to give a similar response to both questions. Income level was of borderline significance. CONCLUSIONS At least half of the population was able to differentiate between their personal needs and national policy needs. We do not advocate a decision-making process based on polls or referendums. However, we believe that people should be allowed to express their priorities regarding national policy issues, and that decision-makers should consider these as one of the factors used to determine policy decisions.
Collapse
Affiliation(s)
- Giora Kaplan
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621 Israel
| | - Orna Baron-Epel
- School of Public Health, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
| |
Collapse
|
41
|
Wong EG, Ameh EA, Wren SM, Mulwafu W, Hardy MA, Nwomeh BC, Kushner AL, Price RR. Recommendations for including surgery on the public health agenda. J Surg Res 2015; 197:112-7. [PMID: 25940158 DOI: 10.1016/j.jss.2015.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/21/2015] [Accepted: 04/03/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgical care has made limited inroads on the public health and global health agendas despite increasing data showing the enormous need. The objective of this study was to survey interested members of a global surgery community to identify patterns of thought regarding barriers to political priority. MATERIALS AND METHODS All active members of the nongovernmental organization Surgeons OverSeas were surveyed and asked why surgical care is not receiving recognition and support on the public health and global health agenda. Responses were categorized using the Shiffman framework on determinants of political priority for global initiatives by two independent investigators, and the number of responses for each of the 11 factors was calculated. RESULTS Seventy-five Surgeons OverSeas members replied (75 of 176; 42.6% response rate). A total of 248 individual reasons were collected. The most common responses were related to external frame, defined as public portrayals of the issue (60 of 248; 24.2%), and lack of effective interventions (48 of 248; 19.4%). Least cited reasons related to global governance structure (4 of 248; 2.4%) and policy window (4 of 248; 1.6%). CONCLUSIONS This survey of a global surgery community identified a number of barriers to the recognition of surgical care on the global health agenda. Recommendations include improving the public portrayal of the problem; developing effective interventions and seeking strong and charismatic leadership.
Collapse
Affiliation(s)
- Evan G Wong
- Surgeons OverSeas (SOS), New York, New York; Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Emmanuel A Ameh
- Surgeons OverSeas (SOS), New York, New York; Division of Paediatric Surgery, Department of Surgery, Ahmadu Bello University & Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Sherry M Wren
- Surgeons OverSeas (SOS), New York, New York; Department of Surgery, Stanford University, Palo Alto, California
| | - Wakisa Mulwafu
- Surgeons OverSeas (SOS), New York, New York; Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Mark A Hardy
- Surgeons OverSeas (SOS), New York, New York; Department of Surgery, Columbia University, New York, New York
| | - Benedict C Nwomeh
- Surgeons OverSeas (SOS), New York, New York; Department of Pediatric Surgery, Nationwide Children's, Hospital, Columbus, Ohio
| | - Adam L Kushner
- Surgeons OverSeas (SOS), New York, New York; Department of Surgery, Columbia University, New York, New York; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Raymond R Price
- Surgeons OverSeas (SOS), New York, New York; Department of Surgery, Intermountain Health Care, Salt Lake City, Utah; Department of Surgery, University of Utah, Salt Lake City, Utah
| |
Collapse
|
42
|
Varela-Lema L, De La Fuente-Cid R, López-García M. Developing a prioritized list of innovative technologies: the Spanish experience. Int J Technol Assess Health Care 2014; 30:626-33. [PMID: 25816830 DOI: 10.1017/S0266462314000774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Selecting technologies for formal assessment poses a great challenge to health technology assessment agencies. This study aims to contribute to the creation of a reference framework for the identification, filtering, and prioritization of new and emerging technologies which could be demanded in clinical practice within the next 1-2 years. METHODS Technologies were identified using a prevalidated systematic Medline strategy. They were classified by medical specialty and then sent to selected professionals belonging to the medical units or areas responsible for their application, until there was a minimum of three participants per health care setting. A self-administered questionnaire was drawn up and health professionals were asked to: (1) assess the degree of innovation of the technologies, and (11) score their foreseeable clinical impact on the basis of predefined prioritization criteria (n = 4). Intra-rater reliability was analyzed using the intraclass correlation coefficient (ICC). RESULTS The Medline search yielded 246 potentially relevant technologies. When analyzed by health care area or unit, sixty-eight were deemed to be high-impact innovative technologies (median score >6), with ICCs ranging from 0.03 to 0.83. The final list resulting from the aggregate analysis comprised fifty-one technologies. CONCLUSIONS This study constitutes an innovative contribution to horizon scanning, providing a systematic and reproducible basis for the identification and selection of relevant new and emerging technologies based on the views and values of health professionals involved in their use. In our opinion, the current proposal could be helpful and useful to many other organizations worldwide, serving to complement already existing strategies.
Collapse
|
43
|
Abstract
This introduction to a special issue on the economics of breastfeeding draws attention to the lack of economic justice for women. Human milk is being bought and sold. Commodifying and marketing human milk and breastfeeding risk reinforcing social and gender economic inequities. Yet there are potential benefits for breastfeeding, and some of the world's poorest women might profit. How can we improve on the present situation where everyone except the woman who donates her milk benefits? Breastfeeding is a global food production system with unsurpassed capacity to promote children's food security and maternal and child health, but it is side-lined by trade negotiators who seek instead to expand world markets for cow's milk-based formula. Regulators focus on potential risks of feeding donated human milk, rather than on health risks of exposing infants and young children to highly processed bovine milk. Similarly, policymakers aspire to provide universal health care access that may be unaffordable when two thirds of the world's children are not optimally nourished in infancy, resulting in a global double burden of infectious and chronic disease. Universal breastfeeding requires greater commitment of resources, but such investment remains lacking despite the cost effectiveness of breastfeeding protection, support and promotion in and beyond health services. Women invest substantially in breastfeeding but current policy - epitomised by the G20 approach to the 'gender gap' - fails to acknowledge the economic value of this unpaid care work. Economic incentives for mothers to optimally breastfeed are dwarfed by health system and commercial incentives promoting formula feeding and by government fiscal policies which ignore the resulting economic costs. 'The market' fails to protect breastfeeding, because market prices give the wrong signals. An economic approach to the problem of premature weaning from optimal breastfeeding may help prioritise global maternity protection as the foundation for sustainable development of human capital and labour productivity. It would remove fiscal subsidies for breast milk substitutes, tax their sale to recoup health system costs, and penalise their free supply, promotion and distribution. By removing widespread incentives for premature weaning, the resources would be available for the world to invest more in breastfeeding.
Collapse
|
44
|
Palma E, Antonaci D, Colì A, Cicolini G. Analysis of emergency medical services triage and dispatch errors by registered nurses in Italy. J Emerg Nurs 2014; 40:476-83. [PMID: 24746868 DOI: 10.1016/j.jen.2014.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 12/31/2013] [Accepted: 02/25/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The major elements of an effective emergency medical services (EMS) system include a single telephone access number, accurate assessment of the urgency of the health problem, and timely dispatch of appropriate personnel and equipment. In Italy, EMS calls are managed by emergency operations centers by registered nurses who have received specialized education in this function. The nurses determine the criticality of the situations and assign an EMS response priority level identified by a color code, ranging from red (very critical) to green (not critical). At times, the severity of a situation may be underestimated, resulting in assignment of a lower EMS response priority and the potential for patient death (code black). The purpose of this study was to analyze factors associated with registered nurse under-triage of EMS calls subsequently found to be associated with deaths, termed "green-black code" cases. METHODS We carried out a retrospective qualitative analysis of EMS telephone conversations using Fele's conversation analysis method. The characteristics of green-black code calls were compared with the characteristics of the population of all EMS calls during the study period. RESULTS The study patients were older, with a mean age of 81.6 years. The callers were individuals calling on behalf of the patients, rather than the patients themselves. The callers reported symptoms that were not life-threatening. Nurse operators did not always inquire about the patients' vital signs as required by the Medical Priority Dispatch System protocol. The phone conversations were shorter than normal (54.26 seconds vs 65 seconds). DISCUSSION Although the importance of dispatch system protocols is wellknown, it is also important that nurse triage operators have proper training to ensure that major parameters such as vital signs and symptomatology are obtained and to reduce caller stress level.
Collapse
|