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Onookome-Okome T, Hsu A, Kilpatrick DG, Moreland A, Reuben A. Association of Public Works Disasters with Substance Use Difficulties: Evidence from Flint, Michigan, Five Years after the Water Crisis Onset. Int J Environ Res Public Health 2023; 20:7090. [PMID: 38063520 PMCID: PMC10706393 DOI: 10.3390/ijerph20237090] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023]
Abstract
Public works environmental disasters such as the Flint water crisis typically occur in disenfranchised communities with municipal disinvestment and co-occurring risks for poor mental health (poverty, social disconnection). We evaluated the long-term interplay of the crisis and these factors with substance use difficulties five years after the crisis onset. A household probability sample of 1970 adults living in Flint during the crisis was surveyed about their crisis experiences, use of substances since the crisis, and risk/resilience factors, including prior potentially traumatic event exposure and current social support. Analyses were weighted to produce population-representative estimates. Of the survey respondents, 17.0% reported that substance use since the crisis contributed to problems with their home, work, or social lives, including 11.2% who used despite a doctor's warnings that it would harm their health, 12.3% who used while working or going to school, and 10.7% who experienced blackouts after heavy use. A total of 61.6% of respondents reported using alcohol since the crisis, 32.4% using cannabis, and 5.2% using heroin, methamphetamine, or non-prescribed prescription opioids. Respondents who believed that exposure to contaminated water harmed their physical health were more likely to use substances to the detriment of their daily lives (RR = 1.32, 95%CI: 1.03-1.70), as were respondents with prior potentially traumatic exposure (RR = 2.99, 95%CI: 1.90-4.71), low social support (RR = 1.94, 95%CI: 1.41-2.66), and PTSD and depression (RR's of 1.78 and 1.49, respectively, p-values < 0.01). Public works disasters occurring in disenfranchised communities may have complex, long-term associations with substance use difficulties.
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Affiliation(s)
- Tuviere Onookome-Okome
- Institute for the Environment, University of North Carolina Chapel Hill, Chapel Hill, NC 27517, USA
- Samuel Centre for Social Connectedness, Montréal, QC H3A 0G4, Canada
| | - Angel Hsu
- Institute for the Environment, University of North Carolina Chapel Hill, Chapel Hill, NC 27517, USA
| | - Dean G. Kilpatrick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (D.G.K.); (A.M.)
| | - Angela Moreland
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (D.G.K.); (A.M.)
| | - Aaron Reuben
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (D.G.K.); (A.M.)
- Department of Psychology & Neuroscience, Duke University, Durham, NC 27708, USA
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2
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Pu D, Bonnici R, Haines T. Engaging the consumer in disinvestment in public healthcare: Concerns, perspectives and attitudes of older adults. J Eval Clin Pract 2023; 29:320-328. [PMID: 36165636 DOI: 10.1111/jep.13769] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022]
Abstract
RATIONALE Low-value care in public health can be addressed via disinvestment with the support of disinvestment research generated evidence. Consumers' views of disinvestment have rarely been explored despite the potential effects of this process on the care they will receive and the importance of consumer participation in decision-making in public healthcare. AIMS AND OBJECTIVES This study aimed to understand consumer concerns, perceptions and attitudes towards disinvestment processes, with the goal of providing recommendations to health service researchers and managers to more effectively engage consumers in shared decision-making in public healthcare. METHOD We conducted semistructured interviews using four scenarios describing the principles of disinvestment, how and why it could be undertaken, and a fifth scenario that described a real-life application of these principles. These scenarios were presented to participants in a written word document or a digital story during semistructured interviews. Participants were 18 community-dwelling older adults who were recruited via convenience sampling. Questions were addressed to the participants regarding their feelings and concerns towards disinvestment, their participation as consumers in disinvestment processes, as well as their preference for communicating information about disinvestment to patients and families. RESULTS Four major themes emerged around the negative perception of disinvestment and positive perception of research. Participants were concerned that the removal of a clinical activity was mainly the result of financial constraints in hospital systems. At times, participants indicated that disinvestment and its justifications were not easily understood. Participants expressed a need for consumer advocacy not always through themselves, but via others with more expertize; a single consumer is insufficient in representing the broader consumer perspective. Participants stressed the importance of transparency in relation to research evidence and decision-making outcomes. Face-to-face dissemination of information by expert staff was preferred, which could be supplemented with clear and concise written materials. CONCLUSION Consumers' main perception of disinvestment processes was that the removal of a clinical care activity depended on financial imperatives from hospital administration and political agendas. This tended to cause suspicion about reasons behind the removal of care, which overshadowed comprehension of the ineffective/inconclusive evidence that were key to disinvestment.
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Affiliation(s)
- Dai Pu
- National Centre for Healthy Ageing and School of Primary and Allied Healthcare, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Rachel Bonnici
- National Centre for Healthy Ageing and School of Primary and Allied Healthcare, Monash University Peninsula Campus, Frankston, Victoria, Australia.,Better Place Australia, Cheltenham, Australia
| | - Terry Haines
- National Centre for Healthy Ageing and School of Primary and Allied Healthcare, Monash University Peninsula Campus, Frankston, Victoria, Australia
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Roscoe S, Pryce R, Buykx P, Gavens L, Meier PS. Is disinvestment from alcohol and drug treatment services associated with treatment access, completions and related harm? An analysis of English expenditure and outcomes data. Drug Alcohol Rev 2021; 41:54-61. [PMID: 33960031 DOI: 10.1111/dar.13307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/11/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The positive impact of substance use treatment is well-evidenced but there has been substantial disinvestment from publicly funded treatment services in England since 2013/2014. This paper examines whether this disinvestment from adult alcohol and drug treatment provision was associated with changes in treatment and health outcomes, including: treatment access, successful completions from treatment, alcohol-specific hospital admissions, alcohol-specific mortality and drug-related deaths. METHODS Annual administrative data from 2013/2014 to 2018/2019 was matched at local government level and multi-level time series analysis using linear mixed-effect modelling conducted for 151 upper-tier local authorities in England. RESULTS Between 2013/2014 and 2018/2019, £212.2 million was disinvested from alcohol and drug treatment services, representing a 27% decrease. Concurrently, 11% fewer people accessed, and 21% fewer successfully completed, treatment. On average, controlling for other potential explanatory factors, a £10 000 disinvestment from alcohol and drug treatment services was associated with reductions in all treatment outcomes, including 0.3 fewer adults in treatment (95% confidence interval 0.16-0.45) and 0.21 fewer adults successfully completing treatment (95% % confidence interval 0.12-0.29). A £10 000 disinvestment from alcohol treatment was not significantly associated with changes in alcohol-specific hospital admissions or mortality, nor was disinvestment from drug treatment associated with the rate of drug-related deaths. DISCUSSION AND CONCLUSIONS Local authority spending cuts to alcohol and drug treatment services in England were associated with fewer people accessing and successfully completing alcohol and drug treatment but were not associated with changes in related hospital admissions and deaths.
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Affiliation(s)
- Suzie Roscoe
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert Pryce
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Penny Buykx
- School of Humanities and Social Science, University of Newcastle, Newcastle, Australia
| | - Lucy Gavens
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Petra S Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Morris ME, Haines T, Hill AM, Cameron ID, Jones C, Jazayeri D, Mitra B, Kiegaldie D, Shorr RI, McPhail SM. Divesting from a Scored Hospital Fall Risk Assessment Tool (FRAT): A Cluster Randomized Non-Inferiority Trial. J Am Geriatr Soc 2021; 69:2598-2604. [PMID: 33834490 PMCID: PMC8518986 DOI: 10.1111/jgs.17125] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 11/16/2020] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 12/26/2022]
Abstract
Background/Objectives We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation strategies. Design Two‐group, multi‐site cluster‐randomized active‐control non‐inferiority trial. Setting Hospital wards. Participants Adult inpatients admitted to participating hospitals (n = 10 hospitals, 123,176 bed days). Intervention Hospitals were randomly assigned (1:1) to a usual care control group that continued to use a historical FRAT to assign falls risk scores and accompanying mitigation strategies, or an experimental group whereby clinicians did not assign risk scores and instead used clinical reasoning to select fall mitigation strategies using a decision support list. Measurements The primary measure was between‐group difference in mean fall rates (falls/1000 bed days). Falls were identified from incident reports supplemented by hand searches of medical records over three consecutive months at each hospital. The incidence rate ratio (IRR) of monthly falls rates in control versus experimental hospitals was also estimated. Results The experimental clinical reasoning approach was non‐inferior to the usual care FRAT that assigned fall risk ratings when compared to a‐priori stakeholder derived and sensitivity non‐inferiority margins. The mean fall rates were 3.84 falls/1000 bed days for the FRAT continuing sites and 3.11 falls/1000 bed days for experimental sites. After adjusting for historical fall rates at each hospital, the IRR (95%CI) was 0.78 (0.64, 0.95), where IRR < 1.00 indicated fewer falls among the experimental group. There were 4 and 3 serious events in the control and experimental groups, respectively. Conclusion Replacing a FRAT scoring system with clinical reasoning did not lead to inferior fall outcomes in the short term and may even reduce fall incidence.
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Affiliation(s)
- Meg E Morris
- Healthscope ARCH, Victorian Rehabilitation Centre, Glen Waverley, Victoria, Australia.,La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Melbourne, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Anne Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, Kolling Institute, University of Sydney, St. Leonards, New South Wales, Australia
| | | | - Dana Jazayeri
- Healthscope ARCH, Victorian Rehabilitation Centre, Glen Waverley, Victoria, Australia.,La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Melbourne, Australia
| | - Biswadev Mitra
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Debra Kiegaldie
- Holmesglen Institute, Melbourne, Victoria, Australia.,Eastern Clinical School, Monash University, Melbourne, Australia
| | - Ronald I Shorr
- Geriatric Research Education and Clinical Center (GRECC), Malcom Randall VAMC, Gainesville, Florida, USA and Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
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Hofmann B. Internal barriers to efficiency: why disinvestments are so difficult. Identifying and addressing internal barriers to disinvestment of health technologies. Health Econ Policy Law 2021; 16:473-88. [PMID: 33563362 DOI: 10.1017/S1744133121000037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although efficiency is a core concept in health economics, its impact on health care practice still is modest. Despite an increased pressure on resource allocation, a widespread use of low-value care is identified. Nonetheless, disinvestments are rare. Why is this so? This is the key question of this paper: why are disinvestments not more prevalent and improving the efficiency of the health care system, given their sound foundation in health economics, their morally important rationale, the significant evidence for a long list of low-value care and available alternatives? Although several external barriers to disinvestments have been identified, this paper looks inside us for mental mechanisms that hamper rational assessment, implementation, use and disinvestment of health technologies. Critically identifying and assessing internal inclinations, such as cognitive biases, affective biases and imperatives, is the first step toward a more rational handling of health technologies. In order to provide accountable and efficient care we must engage in the quest against the figments of our minds; to disinvest in low-value care in order to provide high-value health care.
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6
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Williams I, Harlock J, Robert G, Kimberly J, Mannion R. Is the end in sight? A study of how and why services are decommissioned in the English National Health Service. Sociol Health Illn 2021; 43:441-458. [PMID: 33636017 DOI: 10.1111/1467-9566.13234] [Citation(s) in RCA: 6] [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: 04/08/2020] [Revised: 10/23/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
The decommissioning of a health-care service is invariably a highly complex and contentious process which faces many implementation challenges. There has been little specific theorisation of this phenomena, although insights can be transferred from wider literatures on policy implementation and change processes. In this paper, we present findings from empirical case studies of three decommissioning processes initiated in the English National Health Service. We apply Levine's (1979, Public Administration Review, 39(2), 179-183) typology of decommissioning drivers and insights from the empirical literature on pluralistic health-care contexts, complex change processes and institutional constraints. Data include interviews, non-participant observation and documents analysis. Alongside familiar patterns of pluralism and political partisanship, our results suggest the important role played by institutional factors in determining the outcome of decommissioning processes and in particular the prior requirement of political vulnerability for services to be successfully closed. Factors linked to the extent of such vulnerability include the scale of the proposed changes and extent to which they are supported at the macrolevel.
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Affiliation(s)
- Iestyn Williams
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Jenny Harlock
- Warwick Medical School, University of Warwick, Warwick, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing & Midwifery & Palliative Care, King's College London, London, UK
| | - John Kimberly
- Wharton Business School, University of Pennsylvania, Philadelphia, PA, USA
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
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Mitchell D, O'Brien L, Bardoel A, Haines T. Moving Past the Loss: A Longitudinal Qualitative Study of Health Care Staff Experiences of Disinvestment. Med Care Res Rev 2020; 79:78-89. [PMID: 33203314 DOI: 10.1177/1077558720972588] [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] [Indexed: 11/16/2022]
Abstract
This longitudinal qualitative study examines staff experience of disinvestment from a service they are accustomed to providing to their patients. It took place alongside a disinvestment trial that measured the impact of the removal of weekend allied health services from acute wards at two hospitals. Data were gathered from repeated interviews and focus groups with 450 health care staff. We developed a grounded theory, which explains changes in staff perceptions over time and the key modifying factors. Staff appeared to experience disinvestment as loss; a key difference to other operational changes. Early staff experiences of disinvestment were primarily negative, but evolved with time and change-management strategies such as the provision of data, clear and persistent communication approaches, and forums where the big picture context of the disinvestment was robustly discussed. These allowed the disinvestment trial to be successfully implemented at two health services, with high compliance with the research protocol.
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Affiliation(s)
- Deb Mitchell
- Allied Health, Monash Health, Dandenong, Victoria, Australia
| | - Lisa O'Brien
- Monash University, Frankston, Victoria, Australia
| | - Anne Bardoel
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Terry Haines
- Monash University, Frankston, Victoria, Australia
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8
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Porter J, Hanna L. Evidence-Based Analysis of Protected Mealtime Policies on Patient Nutrition and Care. Risk Manag Healthc Policy 2020; 13:713-721. [PMID: 32753984 PMCID: PMC7352007 DOI: 10.2147/rmhp.s224901] [Citation(s) in RCA: 2] [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: 02/13/2020] [Accepted: 06/16/2020] [Indexed: 01/07/2023] Open
Abstract
Malnutrition in hospitalized patients remains a significant problem. Protected Mealtimes is a complex, inter-professional ward-based intervention that was first introduced in the United Kingdom to address this issue. Now implemented internationally, the approach still remains in key policy documents including the National Health Service Essence of Care. This review aims to synthesize the nutrition, satisfaction and quality of life patient/resident outcomes that arise from the implementation of Protected Mealtimes in hospitals and residential aged care facilities and to consider fidelity issues that have been reported in previous research. A defined search strategy was implemented in seven databases to identify full text papers of original research that evaluated Protected Mealtimes implementation. After screening, data were extracted from eight studies (7 quantitative and 1 qualitative study) that were conducted in hospitals. There was no research identified from the aged care sector. There were few positive outcomes that resulted from Protected Mealtimes implementation, many fidelity issues with the intervention were reported. It is apparent that Protected Mealtimes provide few, if any, benefits for hospitalized patients. It is a complex, multi-pronged initiative that has limited fidelity and limited outcomes. As such, we recommend that disinvestment by policy makers for hospitals should be considered, with the implementation of other evidence based mealtime initiatives. We provide no recommendation for disinvestment in the aged care sector, since the approach has not been evaluated against any of the eligible outcomes of this review.
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Affiliation(s)
- Judi Porter
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia.,Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria 3168, Australia
| | - Lauren Hanna
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria 3168, Australia.,Department of Nutrition and Dietetics, Monash Health, Clayton, Victoria, Australia
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9
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Buchbinder R, Busija L. Why we should stop performing vertebroplasties for osteoporotic spinal fractures. Intern Med J 2020; 49:1367-1371. [PMID: 31713338 DOI: 10.1111/imj.14628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/23/2019] [Revised: 06/17/2019] [Accepted: 06/23/2019] [Indexed: 11/29/2022]
Abstract
While vertebroplasty enjoys continued use in some settings, there is now high-moderate quality evidence based on systematic review that includes five placebo-controlled trials that it provides no benefits over placebo and these results do not differ according to pain duration (≤6 vs >6 weeks). A clinically important increased risk of incident symptomatic vertebral fractures or other serious adverse events cannot be excluded due to small event numbers. Serious harms including cord compression, ventricular perforation, pulmonary embolism, infection and death have been reported. This unfavourable risk-benefit ratio should be convincing doctors and patients to stop the use of vertebroplasty. At the very least, clinicians should fully inform their patients about the evidence including the likelihood of improving without vertebroplasty and the potential harms, so that patients can make evidence-informed decisions about their treatment. They should also warn patients about the pitfalls of relying on information sourced from the internet or from 'awareness raising' campaigns.
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Affiliation(s)
- Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lucy Busija
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia.,Biostatistics Consulting Platform, Research Methodology Division, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
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Ibargoyen-Roteta N, Mateos Del Pino M, Gutiérrez-Ibarluzea I, Benguria-Arrate G, Rada-Fernández de Jauregui D, Domingo-Rico C, Regidor Fuentes I, González Santisteban R, Armendáriz Cuñado M, Jaio Atela N. Variability in the prescription of drugs with uncertain effectiveness. The case of SYSADOA in the Basque Country. GMS Health Technol Assess 2019; 14:Doc01. [PMID: 31015866 PMCID: PMC6460939 DOI: 10.3205/hta000130] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The majority of clinical practice guidelines do not recommend the use of SYSADOA (Symptomatic Slow Action Drugs for Osteoarthritis) for the treatment of osteoarthritis because of the lack of evidence or uncertainty around their efficacy. Nevertheless, the Spanish Public Health Service continues funding these drugs. Aim: The aim of this study is to describe the prescription status of SYSADOA in the primary care units of the Basque Country during 2011; to determine if variability exists among them; and to examine if the variability could be explained by the health care region each PC unit belongs to. Methods: Prescription data for SYSADOA during 2011 was obtained from the Basque Ministry for Health. In the Basque Country, primary care is divided into seven regions, each region consisting of several primary care units, which were used as the unit of analysis. Defined daily doses (DDD) per 1,000 inhabitant-days (DHD) were calculated. Data were standardized by sex and age using the total population of the Basque Country as the reference population. Small area statistics were calculated (extremal quotient, coefficient of variation and systematic component of variation). The influence of the region to which primary care units belonged was also analysed. R software (version R-2.15.0) was used for the analysis. Results: SYSADOA prescription during 2011 accounted for an expense of 4.5 million euros for the Basque Health Service. The crude rate of consumption of SYSADOA was 7.81 DDD per 1,000 inhabitant-days. The obtained external quotient was 13.67. The prescription of SYSADOA of the primary care units located in the 95th percentile was six times higher than the ones located in the 5th percentile. The region to which units belonged accounted for 57% of the observed variability. Discussion: The uncertainty around these drugs could be reflected in the existing variability of their prescription level. The analysis of the variability in the prescription of drugs with no demonstrated efficacy could help in allocating resources into other services or health technologies supported by evidence, thereby contributing to the improvement of health outcomes.
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Affiliation(s)
- Nora Ibargoyen-Roteta
- Osteba (Basque Office for Health Technology Assessment), Ministry for Health, Basque Government, Vitoria-Gasteiz, Spain
| | - Maider Mateos Del Pino
- Health Research and Studies Unit, Ministry for Health, Basque Government, Vitoria-Gasteiz, Spain
| | - Iñaki Gutiérrez-Ibarluzea
- Osteba (Basque Office for Health Technology Assessment), Ministry for Health, Basque Government, Vitoria-Gasteiz, Spain
| | - Gaizka Benguria-Arrate
- Osteba (Basque Office for Health Technology Assessment), Ministry for Health, Basque Government, Vitoria-Gasteiz, Spain
| | - Diego Rada-Fernández de Jauregui
- Department of Preventive Medicine and Public Health, University of the Basque Country/Euskal Herriko Unibertsitatea (UPV/EHU), Vitoria-Gasteiz, Spain
| | - Cristina Domingo-Rico
- Medical Directorate of the Interior Care Setting, Osakidetza, Basque Health Service, Amorebieta, Spain
| | - Iratxe Regidor Fuentes
- Quality and Research Unit, Interior Care Setting, Osakidetza, Basque Health Service, Amorebieta, Spain
| | | | - María Armendáriz Cuñado
- Pharmaceutical Unit, Barrualde-Galdakao Integrated Health Services Setting, Osakidetza, Basque Health Service, Amorebieta, Spain
| | - Nekane Jaio Atela
- Pharmaceutical Unit, Barrualde-Galdakao Integrated Health Services Setting, Osakidetza, Basque Health Service, Amorebieta, Spain
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11
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Sampson NR, Price CE, Kassem J, Doan J, Hussein J. "We're Just Sitting Ducks": Recurrent Household Flooding as An Underreported Environmental Health Threat in Detroit's Changing Climate. Int J Environ Res Public Health 2018; 16:ijerph16010006. [PMID: 30577470 PMCID: PMC6338881 DOI: 10.3390/ijerph16010006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 11/22/2022]
Abstract
Recurrent inland urban flooding is an understudied phenomenon that warrants greater attention, particularly in post-industrial cities where aging infrastructure, disinvestment, and climate change threaten public health. We conducted semi-structured interviews in 2017–2018 with 18 Detroit residents experiencing recurrent household flooding. We used standard qualitative coding analysis to generate 30 theoretically- and in vivo- derived themes related to flood experience, socioeconomic and health factors, and household, community, and policy interventions for reducing environmental exposures before, during, and after flood events. Snowball sampling yielded interviewees across both high- and low-risk areas for flood events, indicating vulnerability may be widespread and undocumented in formal ways. Residents described exposure to diverse risk factors for chronic and infectious diseases, particularly for seniors and young children, and emphasized stressors associated with repeated economic loss and uncertainty. Opinions varied on the adequacy, responsibility, and equity of local and federal relief funding and programs. We expand knowledge of flood-related vulnerability, offer innovative suggestions for risk communication based on residents’ experiences, and recommend additional research for documenting patterns of recurrent flooding and response, even for precipitation events that are not characterized as extreme or disaster-level in the media or by agencies. These findings should guide local public health, emergency preparedness, sustainability, water and sewage, and community leaders in post-industrial cities.
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Affiliation(s)
- Natalie R Sampson
- College of Education, Health, & Human Services, 19000 Hubbard Dr., Dearborn, MI 48126, USA.
| | - Carmel E Price
- College of Arts, Sciences, & Letters, 4901 Evergreen Rd, Dearborn, MI 48128, USA.
| | - Julia Kassem
- College of Arts, Sciences, & Letters, 4901 Evergreen Rd, Dearborn, MI 48128, USA.
| | - Jessica Doan
- College of Education, Health, & Human Services, 19000 Hubbard Dr., Dearborn, MI 48126, USA.
| | - Janine Hussein
- College of Education, Health, & Human Services, 19000 Hubbard Dr., Dearborn, MI 48126, USA.
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12
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Chambers JD, Salem MN, D'Cruz BN, Subedi P, Kamal-Bahl SJ, Neumann PJ. A Review of Empirical Analyses of Disinvestment Initiatives. Value Health 2017; 20:909-918. [PMID: 28712620 DOI: 10.1016/j.jval.2017.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 10/17/2016] [Revised: 03/18/2017] [Accepted: 03/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Disinvesting in low-value health care services provides opportunities for investment in higher value care and thus an increase in health care efficiency. OBJECTIVES To identify international experience with disinvestment initiatives and to review empirical analyses of disinvestment initiatives. METHODS We performed a literature search using the PubMed database to identify international experience with disinvestment initiatives. We also reviewed empirical analyses of disinvestment initiatives. RESULTS We identified 26 unique disinvestment initiatives implemented across 11 countries. Nineteen addressed multiple intervention types, six addressed only drugs, and one addressed only devices. We reviewed 18 empirical analyses of disinvestment initiatives: 7 reported that the initiative was successful, 8 reported that the initiative was unsuccessful, and 3 reported that findings were mixed; that is, the study considered multiple services and reported a decrease in the use of some but not others. Thirty-seven low-value services were evaluated across the 18 empirical analyses, for 14 (38%) of which the disinvestment initiative led to a decline in use. Six of the seven studies that reported the disinvestment initiative to be successful included an attempt to promote the disinvestment initiative among participating clinicians. CONCLUSIONS The success of disinvestment initiatives has been mixed, with fewer than half the identified empirical studies reporting that use of the low-value service was reduced. Our findings suggest that promotion of the disinvestment initiative among clinicians is a key component to the success of the disinvestment initiative.
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Affiliation(s)
- James D Chambers
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
| | - Mark N Salem
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Brittany N D'Cruz
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Prasun Subedi
- Global Health and Value, Innovation Center, Pfizer Inc., New York, NY, USA
| | | | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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13
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Soril LJ, MacKean G, Noseworthy TW, Leggett LE, Clement FM. Achieving optimal technology use: A proposed model for health technology reassessment. SAGE Open Med 2017; 5:2050312117704861. [PMID: 28491310 PMCID: PMC5406119 DOI: 10.1177/2050312117704861] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 10/07/2016] [Accepted: 03/21/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Healthcare providers, managers and policy-makers in many jurisdictions are focused on a common goal: optimizing value and quality of care provided to their citizens within a resource envelope. Health technology reassessment is a structured, evidence-based assessment of the clinical, social, ethical and economic effects of a technology currently used in the healthcare system to inform optimal use of that technology in comparison with its alternatives. There are, however, few practical experiences with health technology reassessment and, as such, a nascent theoretical and methodological base. Health technology reassessment is a key strategy to achieve optimal healthcare resource utilization, and establishing a model for health technology reassessment is a required methodological step. METHODS AND RESULTS The purpose of this article is to answer three formative questions: (1) What is health technology reassessment? (2) When should a health technology reassessment be implemented? (3) What is the role of health technology reassessment in evidence-informed health policy? Finally, we propose a conceptual framework for health technology reassessment, which others can modify, adapt, or adopt in their own context. The model consists of three broad phases and six iterative stages: (1) identification, (2) prioritization, (3) evidence synthesis, (4) determine policy/practice recommendation, (5) policy/practice implementation and (6) monitoring and evaluation. Two foundational components (meaningful stakeholder engagement and ongoing knowledge exchange and utilization) are represented across all stages. CONCLUSION This description of health technology reassessment and the proposed model can be used by healthcare policy-makers and researchers to advance the field of technology management, with the goal of achieving optimal use throughout a technology's lifecycle.
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Affiliation(s)
- Lesley Jj Soril
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Gail MacKean
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Tom W Noseworthy
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Laura E Leggett
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Fiona M Clement
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
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14
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Gutiérrez-Ibarluzea I, Chiumente M, Dauben HP. The Life Cycle of Health Technologies. Challenges and Ways Forward. Front Pharmacol 2017; 8:14. [PMID: 28174538 PMCID: PMC5258694 DOI: 10.3389/fphar.2017.00014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Received: 12/18/2016] [Accepted: 01/09/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Iñaki Gutiérrez-Ibarluzea
- Osteba, Basque Office for Health Technology Assessment (HTA), Ministry for Health, Basque Government Vitoria-Gasteiz, Spain
| | - Marco Chiumente
- Societá Italiana di Farmacia Clinica e Terapia (SIFaCT) - Italian Society of Clinical Pharmacy and Therapeutics Milan, Italy
| | - Hans-Peter Dauben
- German Agency for Health Technology Assessment (DAHTA), Deutsches Institut für Medizinische Dokumentation und Information (DIMDI) Cologne, Germany
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15
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Charles JM, Brown G, Thomas K, Johnstone F, Vandenblink V, Pethers B, Jones A, Edwards RT. Use of programme budgeting and marginal analysis as a framework for resource reallocation in respiratory care in North Wales, UK. J Public Health (Oxf) 2016; 38:e352-e361. [PMID: 26377991 PMCID: PMC5072164 DOI: 10.1093/pubmed/fdv128] [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] [Indexed: 11/15/2022] Open
Abstract
Background Since the global financial crisis, UK NHS spending has reduced considerably. Respiratory care is a large cost driver for Betsi Cadwaladr University Health Board, the largest health board in Wales. Under the remit of ‘prudent healthcare’ championed by the Welsh Health Minister, a Programme Budgeting Marginal Analysis (PBMA) of the North Wales respiratory care pathway was conducted. Methods A PBMA panel of directors of medicines management, therapies finance, planning, public health and healthcare professionals used electronic voting to establish criteria for decision-making and vote on candidate interventions in which to disinvest and invest. Results A sum of £86.9 million was spent on respiratory care in 2012–13. Following extensive discussion of 13 proposed candidate interventions facilitated by a chairperson, 4 candidates received recommendations to disinvest, 7 to invest and 2 to maintain current activity. Marginal analysis prioritized mucolytics and high antibiotic prescribing as areas for disinvestment, and medicines waste management and pulmonary rehabilitation for investment. Conclusions This exercise demonstrates the potential for health boards to use evidence-based approaches to reach potentially controversial disinvestment and investment decisions. Initial progress has begun with communication from the Medical Director in relation to the disinvestment in mucolytics prescribing and possible redirection of funding options being explored.
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Affiliation(s)
- J M Charles
- Centre for Health Economics & Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Bangor, Gwynedd LL57 2PZ, UK
| | - G Brown
- Public Health Wales, Preswylfa. Hendy Road, Mold, Flintshire CH7 1PZ, UK
| | - K Thomas
- Public Health Wales, Unit 10, Llys Castan, Parc Menai, Bangor, Gwynedd LL57 4DF, UK
| | - F Johnstone
- Betsi Cadwaladr University Health Board, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd LL57 2PW, UK
| | - V Vandenblink
- Betsi Cadwaladr University Health Board, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd LL57 2PW, UK
| | - B Pethers
- Betsi Cadwaladr University Health Board, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd LL57 2PW, UK
| | - A Jones
- Betsi Cadwaladr University Health Board, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd LL57 2PW, UK
| | - R T Edwards
- Centre for Health Economics & Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Bangor, Gwynedd LL57 2PZ, UK
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16
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Street JM, Callaghan P, Braunack-Mayer AJ, Hiller JE. Citizens' Perspectives on Disinvestment from Publicly Funded Pathology Tests: A Deliberative Forum. Value Health 2015; 18:1050-1056. [PMID: 26686790 DOI: 10.1016/j.jval.2015.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 12/12/2014] [Revised: 05/09/2015] [Accepted: 05/29/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Deliberative forums can be useful tools in policy decision making for balancing citizen voice and community values against dominant interests. OBJECTIVE To describe the use of a deliberative forum to explore community perspectives on a complex health problem-disinvestment. METHODS A deliberative forum of citizens was convened in Adelaide, South Australia, to develop criteria to support disinvestment from public funding of ineffective pathology tests. The case study of potential disinvestment from vitamin B12/folate pathology testing was used to shape the debate. The forum was informed by a systematic review of B12/folate pathology test effectiveness and expert testimony. RESULTS The citizens identified seven criteria: cost of the test, potential impact on individual health/capacity to benefit, potential cost to society, public good, alternatives to testing, severity of the condition, and accuracy of the test. The participants not only saw these criteria as an interdependent network but also questioned "the authority" of policymakers to make these decisions. CONCLUSIONS Coherence between the criteria devised by the forum and those described by an expert group was considerable, the major differences being that the citizens did not consider equity issues and the experts neglected the "cost" of social and emotional impact of disinvestment on users and the society.
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Affiliation(s)
- Jackie M Street
- School of Public Health, University of Adelaide, Adelaide, Australia.
| | - Peta Callaghan
- School of Public Health, University of Adelaide, Adelaide, Australia
| | | | - Janet E Hiller
- School of Public Health, University of Adelaide, Adelaide, Australia; Swinburne University of Technology, Hawthorn, Australia
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17
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Niven DJ, Mrklas KJ, Holodinsky JK, Straus SE, Hemmelgarn BR, Jeffs LP, Stelfox HT. Towards understanding the de-adoption of low-value clinical practices: a scoping review. BMC Med 2015; 13:255. [PMID: 26444862 PMCID: PMC4596285 DOI: 10.1186/s12916-015-0488-z] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/15/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Low-value clinical practices are common in healthcare, yet the optimal approach to de-adopting these practices is unknown. The objective of this study was to systematically review the literature on de-adoption, document current terminology and frameworks, map the literature to a proposed framework, identify gaps in our understanding of de-adoption, and identify opportunities for additional research. METHODS MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts and Reviews of Effects, and CINAHL Plus were searched from 1 January 1990 to 5 March 2014. Additional citations were identified from bibliographies of included citations, relevant websites, the PubMed 'related articles' function, and contacting experts in implementation science. English-language citations that referred to de-adoption of clinical practices in adults with medical, surgical, or psychiatric illnesses were included. Citation selection and data extraction were performed independently and in duplicate. RESULTS From 26,608 citations, 109 were included in the final review. Most citations (65%) were original research with the majority (59%) published since 2010. There were 43 unique terms referring to the process of de-adoption-the most frequently cited was "disinvest" (39% of citations). The focus of most citations was evaluating the outcomes of de-adoption (50%), followed by identifying low-value practices (47%), and/or facilitating de-adoption (40%). The prevalence of low-value practices ranged from 16% to 46%, with two studies each identifying more than 100 low-value practices. Most articles cited randomized clinical trials (41%) that demonstrate harm (73%) and/or lack of efficacy (63%) as the reason to de-adopt an existing clinical practice. Eleven citations described 13 frameworks to guide the de-adoption process, from which we developed a model for facilitating de-adoption. Active change interventions were associated with the greatest likelihood of de-adoption. CONCLUSIONS This review identified a large body of literature that describes current approaches and challenges to de-adoption of low-value clinical practices. Additional research is needed to determine an ideal strategy for identifying low-value practices, and facilitating and sustaining de-adoption. In the meantime, this study proposes a model that providers and decision-makers can use to guide efforts to de-adopt ineffective and harmful practices.
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Affiliation(s)
- Daniel J Niven
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, T1Y 6J4, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada.
| | - Kelly J Mrklas
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada.
| | - Jessalyn K Holodinsky
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada.
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, M5B 1T8, Canada.
| | - Brenda R Hemmelgarn
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. .,Department of Medicine, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada.
| | - Lianne P Jeffs
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, M5B 1T8, Canada.
| | - Henry Thomas Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, T1Y 6J4, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. .,Department of Medicine, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada.
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18
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Robinson S, Glasby J, Allen K. 'It ain't what you do it's the way that you do it': lessons for health care from decommissioning of older people's services. Health Soc Care Community 2013; 21:614-622. [PMID: 23647622 DOI: 10.1111/hsc.12046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/18/2013] [Indexed: 06/02/2023]
Abstract
Public sector organisations are facing one of the most difficult financial periods in history and local decision-makers are tasked with making tough rationing decisions. Withdrawing or limiting services is an emotive and complex task and something the National Health Service has always found difficult. Over time, local authorities have gained significant experience in the closure of care homes - an equally complex and controversial issue. Drawing on local knowledge and best practice examples, this article highlights lessons and themes identified by those decommissioning care home services. We believe that such lessons are relevant to those making disinvestment decisions across public sector services, including health-care. The study employed semi-structured interviews with 12 Directors of Adult Social Services who had been highlighted nationally as having extensive experience of home closures. Interviews were conducted over a 2-week period in March 2011. Results from the study found that having local policy guidance that is perceived as fair and reasonable was advocated by those involved in home closures. Many local policies had evolved over time and had often been developed following experiences of home closures (both good and bad). Decisions to close care home services require a combination of strong leadership, clear strategic goals, a fair decision-making process, strong evidence of the need for change and good communication, alongside wider stakeholder engagement and support. The current financial challenge means that public sector organisations need to make tough choices on investment and disinvestment decisions. Any such decisions need to be influenced by what we know constitutes best practice. Sharing lessons and experiences within and between sectors could well inform and develop decision-making practices.
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