Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “policy frameworks”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 325 records · Page 18Linked to original sources
PubMed1987

An implementation model for health system reform.

Health system reform in post-industrial countries has become a dominant problem facing national governments. This problem is aggravated by the pace of social and technological changes and continued economic pressures. In order to accomplish health system reform, governments must develop new policies to redirect or change the present course of the system. Health system reform involves broad based change in behaviors of consumers, providers and the government itself. The direction of the change requires nothing less than shifting the focus of the system and its actors from its predominant emphasis on sickness treatment (negative-health focus) towards an emphasis on maintaining and promoting the highest possible standards of personal health (positive-health focus). This paper introduces an implementation model for health system reform. The model was developed based on major supports and constraints presently operating in the United States health policy context. Major support is provided by the existence of both theoretical and structural frameworks upon which the policy shift can be built. The structural framework includes four laws and their associated activities which outline national health goals and objectives. A major constraint is the implementation conundrum. Policy is government's primary tool to achieve system reform. However, while government is strong in creating policies, it is extremely weak in implementing the very policies it creates. This implementation conundrum consists of three barriers. These barriers are: a universal fear of change; early stage in development of the technology of social change; and the failure of government to plan for implementation of the very policies it creates. The implementation model for health system reform is introduced to aid policy makers and analysts in overcoming this implementation conundrum. The model recognizes policy as a process of change and provides two stages for use in translating theory and aims of policy into a formula for action. Stage one is used to identify the factors of change necessary in achieving policy reform. Stage two identifies the appropriate process of change to achieve successful outcomes. The model can be used in planning for both national and local levels of health system reform by both public and private sector players in the health arena.

Community Participation↗
PubMed2003

The role of nurses in the human immunodeficiency virus/acquired immune deficiency syndrome policy process in Botswana.

In Botswana, there is dearth of literature on the role of nursing in health-care policy and resource allocation and yet nurses constitute the majority (85%) of health manpower. The health-care delivery system depends mostly on nurses for service provision. There were two main purposes of this study: first, to gather descriptive data from major key players (with particular emphasis on nurses) concerning knowledge of the policy process and resource allocation for management and care of clients with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in Botswana; and, second, to identify nurse characteristics (e.g. position, education, experience, job category) associated with motivation to influence health-care policy in HIV/AIDS management and care in Botswana. A policy process conceptual framework was used to guide data collection and analysis. A case-study research method was used to conduct in-depth interviews from a purposive sample of 19 policy makers, and a survey questionnaire was used to collect data from a purposive sample of 95 registered nurses from six study sites in Botswana. The study findings indicate minimal participation of nurses in health-care policy process and resource allocation. The demographic variable of position was a predictor of the involvement of nurses in policy and in budgetary decisions. Both survey and interview data indicated that this minimal participation of nurses in the policy process resulted in implementation problems, thus compromising service provision. Implications of the findings for the nursing profession, nursing practice and policy, which address the importance of nurses' involvement, are discussed.

Botswana↗
PubMed2001

New data and tools for integrating discrete and continuous population modeling strategies.

Realistic population models have interactions between individuals. Such interactions cause populations to behave as systems with nonlinear dynamics. Much population data analysis is done using linear models assuming no interactions between individuals. Such analyses miss strong influences on population behavior and can lead to serious errors--especially for infectious diseases. To promote more effective population system analyses, we present a flexible and intuitive modeling framework for infection transmission systems. This framework will help population scientists gain insight into population dynamics, develop theory about population processes, better analyze and interpret population data, design more powerful and informative studies, and better inform policy decisions. Our framework uses a hierarchy of infection transmission system models. Four levels are presented here: deterministic compartmental models using ordinary differential equations (DE); stochastic compartmental (SC) models that relax assumptions about population size and include stochastic effects; individual event history models (IEH) that relax the SC compartmental structure assumptions by allowing each individual to be unique. IEH models also track each individual's history, and thus, allow the simulation of field studies. Finally, dynamic network (DNW) models relax the assumption of the previous models that contacts between individuals are instantaneous events that do not affect subsequent contacts. Eventually it should be possible to transit between these model forms at the click of a mouse. An example is presented dealing with Cryptosporidium. It illustrates how transiting model forms helps assess water contamination effects, evaluate control options, and design studies of infection transmission systems using nucleotide sequences of infectious agents.

Data Interpretation, Statistical↗
PubMedDate not supplied

The mental health policy template: domains and elements for mental health policy formulation.

Mental disorders are a major and rising cause of disease burden in all countries. Even when resources are available, many countries do not have the policy and planning frameworks in place to identify and deliver effective interventions. The World Health Organization (WHO) and the World Bank have emphasized the need for ready access to the basic tools for mental health policy formulation, implementation and sustained development. The Analytical Studies on Mental Health Policy and Service Project, undertaken in 1999-2001 by the International Consortium for Mental Health Services and funded by the Global Forum for Health Research aims to address this need through the development of a template for mental health policy formulation. A mental health policy template has been developed based on an inventory of the key elements of a successful mental health policy. These elements have been validated against a review of international literature, a study of existing mental health policies and the results of extensive consultations with experts in the six WHO regions of the world. The Mental Health Policy Template has been revised and its applicability will be tested in a number of developing countries during 2001-2002. The Mental Health Policy Template and the work of the Consortium for Mental Health Services will be presented and the future role of the template in mental health policy development and reform in developing countries will be discussed.

Developed Countries↗
PubMed2000

Health policy-making in central and eastern Europe: lessons from the inaction on injuries?

The burden of disease due to injuries has elicited virtually no public health response in the countries of central and eastern Europe, even though injuries have long been a much greater problem in the east of Europe than in the west, with children especially affected. This paper seeks to identify factors that have inhibited policy development on this topic and to draw lessons for health policy development in this region more generally. Several factors emerge. Deaths from injuries have had low visibility. Data have not been assembled in a way that would facilitate identification of the burden of disease that they constitute. Those organizations responsible for public health, whether within government or at local level, were typically very weak with little capacity either to identify the nature and scale of threats to the health of their populations or to develop strategies to address them. There was uncertainty about ownership, with fragmentation of responsibility but no tradition of intersectoral working. Non-governmental organizations, which have placed injuries on the health policy agenda in the west, are weak or non-existent. International donors, who could have had a role, have focused on issues such as health care reform. This analysis provides a potential framework for examining policy responses, or lack thereof, to other health challenges in this region. It highlights the need for a better understanding of the potential for using available data, which, in turn, requires a major strengthening of capacity. However, in many countries, there is a need for new ways of working, involving a broadening of the sense of ownership, with clearly designated responsibilities but designed in ways that encourage rather than inhibit intersectoral action. There is also a need to develop non-governmental organizations that have sufficient capacity to undertake their own analyses and to place issues on the agenda.

Child↗
PubMed1996

The practitioner-teacher: a study in the introduction of mentors in the preregistration nurse education programme in Wales: Part 1.

This study focused on the introduction of mentors in the Common Foundation Programme of Project 2000 schemes of preregistration nurse education. The research, which was commissioned by the Department of Health Research and Development Division on behalf of the Welsh Office Nursing Division, began in February 1992 and was undertaken on an all-Wales basis. The completed report aims to provide policy makers with information relating to important issues which are central to the teaching and learning of nursing in clinical locations. This first paper discusses some background issues and gives a brief conceptual framework for considering policy reform, summarizes the research questions which emerged and describes the methods used to address them. The second paper (to appear in the next issue of the journal) will describe the key findings from the study and discuss some ensuing potential implications and considerations for all those involved in the preparation of future practitioners of nursing.

Clinical Competence↗
PubMedDate not supplied

[Public sector and social and health policy reforms. An inventory on the eve of the new millennium].

This study reflects on reforms in health systems and social policies within the framework of the so-called public sector reforms. The point of departure is a review of various explanations for the crisis in the Welfare State, present in the literature from the 1990s. Social policies, at the heart of the crisis, are heavily challenged. What we intend to demonstrate is that this argument plays a specific role, that of introducing neoliberal changes into economic policy, in which the economic tools used generate abstention by the state from the social sphere, deregulation of national economies in favor of the free market, and the fundamentally oversized role of the international financial market. Within this context we analyze the social security and health system reforms. The final part of the article deals with current difficulties in social policies, focusing the debate on a mapping of possible alternatives for developing social and health policies.

Health Care Reform↗
PubMed1997

Setting the stage for health impact assessment.

Defining health impact assessment as any combination of procedures or methods by which a proposed policy or program may be judged as to the effect(s) it may have on the health of a population, we make recommendations about how to evaluate the health impact of all government-initiated policies. Such health impact cannot be assessed in the absence of a conceptual or organizing framework that provides the requisite guideposts--population health goals and targets. Health impact assessment offers an approach to ensuring that governments' program and policy initiatives align, or are congruent with, the agreed-upon health goals. It suggests that proposed national policies should be supported or resisted on the basis of their probable influence on the health of populations. In the current Canadian national policy framework, however, there are no underpinnings on which to situate such a process. The specification of consensus goals and objectives with measurable targets can provide the requisite guideposts and benchmarks for health impact assessment. Such an undertaking can set the stage and provide the necessary foundation for an effective health impact assessment process.

Canada↗
PubMed1997

Alcohol policy and aviation safety.

Aviation provides an environment which is almost uniquely unforgiving of mistakes. Accordingly, impairment of aircrew performance by alcohol can, and occasionally does, lead to catastrophic mistakes. That such disasters are rare, is a credit to the responsibility of aircrew themselves and to the effectiveness of aviation industry policies. Similarly, maintenance of this exemplary record depends upon continued attention to alcohol policy in the future. The aviation industry thus provides a useful model for the study of alcohol policies within a safety critical environment. Surprisingly, this model appears not to have been subjected to critical research and evaluation. Based upon previous research on alcohol and aviation, and in consideration of findings from the wider field of alcohol policy, suggestions are made here as to a promising framework for future alcohol policy formation in the aviation environment.

Aerospace Medicine↗
PubMed2002

A framework for the dissemination and utilization of research for health-care policy and practice.

PURPOSE: The purpose of this paper is to construct a comprehensive framework of research dissemination and utilization that is useful for both health policy and clinical decision-making. ORGANIZING CONSTRUCT: The framework illustrates that the process of the adoption of research evidence into health-care decision-making is influenced by a variety of characteristics related to the individual, organization, environment and innovation. The framework also demonstrates the complex inter-relationships among these characteristics as progression through the five stages of innovation namely, knowledge, persuasion, decision, implementation and confirmation occurs. Finally, the framework integrates the concepts of research dissemination, evidence-based decision-making and research utilization within the diffusion of innovations theory. METHODS: During the discussion of each stage of the innovation adoption process, relevant literature from the management field (i.e., diffusion of innovations, organizational management and decision-making) and health-care sector (i.e., research dissemination and utilization and evidence-based practice) is summarized. Studies providing empirical data contributing to the development of the framework were assessed for methodological quality. CONCLUSIONS: The process of research dissemination and utilization is complex and determined by numerous intervening variables related to the innovation (research evidence), organization, environment and individual.

Clinical Nursing Research↗
PubMed2002

Care of the frail elderly in developed and developing countries: the experience and the challenges.

Demographic and epidemiological changes will result in dramatic changes in the health needs of the world's populations. Everywhere there is a steep increase in the need for management of chronic diseases and for long-term care. Therefore, the search for effective policies to care for the frail elderly in general and long-term care (LTC) policies in particular, is one of the most pressing challenges facing modern society. There is no single converging paradigm and countries are experimenting with a number of different approaches. This section of the Monograph presents the experience in several developed and developing countries: Canada, United States, Italy, Germany, Sweden, Japan, Thailand and Chile. This effort is important because there is much to be learned from the experience of developed and developing countries in defining the range of policy options and in identifying successful and unsuccessful practices. In-depth understanding of the existing situations in developed and developing countries, and the nature of the variance among countries are important to provide insight for development of care policies by learning from what already exists. This article focuses on LTC, that is, on addressing the needs of the functionally disabled elderly. Our reflections are based on an international initiative to develop a decision-making framework for LTC policies launched by the World Health Organization (WHO) with the JDC-Brookdale Institute leading this effort.

Aged↗
PubMed2000

The relationship between external threats and smoking in central Harlem.

OBJECTIVES: This study assessed the relationship between external risks, such as personal and neighborhood danger, and smoking by using a new theoretical framework based on competing mortality risk models. METHODS: Regression analyses of self-reported data from residents of Central Harlem, New York, surveyed from 1992 through 1994 (n = 695, response rate = 72%) were used to assess the relationship between smoking and 2 measures of external health threats: levels of neighborhood danger and lifetime trauma. RESULTS: Support for the framework was mixed. At the 95% confidence level, exposure to lifetime trauma was positively related to current smoking status but was not related to the number of cigarettes smoked, conditional on being a smoker. Living in a "somewhat unsafe neighborhood" was also statistically significantly related to current smoking status. CONCLUSIONS: Although the framework implies that policies directed at improving the physical and social environment might improve health through their indirect effects on behaviors, little supporting evidence was found. Smoking rates may decrease if exposure to violence and neighborhood danger is reduced. This framework needs to be tested on larger and more information-rich data sets.

Humans↗
PubMed1986

Nitrates in ground and drinking water: analysis of policies and regulations.

On the societal level, risks are the result of collective processes of definition. Accepted risks are mainly the output and secondarily the (scientific) input of these processes. As a consequence, in this paper the question of risk management of the nitrate burden to ground and drinking water is analysed within the framework of comparative policy analysis. Various actors pursue their respective interests in different policy arenas within the given rules of the policy game. The impacts of the policy outputs on the policy addressees, namely farmers and water companies, (substantially) determine the level of actual risk. Different national regulatory styles and traditions towards nitrate regulation shape the policy outputs. Consequently, the assumption or normative postulate of a 'rational' (scientific) risk assessment and risk management appears to be utterly heroic and, in the end, misleading.

Germany, West↗
PubMed2001

Changes in drug economy in Israel's health maintenance organizations in the wake of the National Health Insurance Law.

BACKGROUND: It is not clear to what extent the drug economy in Israel's health maintenance organizations is responsive to major healthcare reforms. OBJECTIVE: To provide information on how drug expenditures, revenues, net costs and drug utilization have changed in the wake of the 1995 National Health Insurance Law in Israel. METHODS: This study compares trends in aggregate sick fund expenditures, revenues (patient co-payment) and net costs (expenditures less revenues) in Israel's four health maintenance organizations for the 3 year period 1992-1994 prior to the introduction in 1995 of the NHI Law, with that of the 4 year period 1995-1998 following its introduction. This analysis is similarly carried out for Israel's largest HMO, Clalit Health Services, and for the three smaller HMOs combined. RESULTS: The pace of growth in the pre-NHI era in drug expenditures and particularly in drug revenues was drastically reduced in the NHI era--whether measured as totals or as per insured person (age-adjusted) or in real terms at constant medicine prices. These trends were mirrored to a large extent in Clalit and in the other HMOs, with some important differences noted between the HMOs. Despite declining growth rates in drug expenditures and net costs, the proportion of these measures of the total HMO economy actually increased in the NHI era, reversing the trend seen in the pre-NHI era. CONCLUSIONS: The impact of the NHI Law on the HMO drug economy has been substantial. The evidence suggests a decline in both the qualitative (basket of drugs consumed) and quantitative (volume of drugs consumed) elements of growth. These changes in expenditure and revenue trends are discussed in the light of the evolving involvement of the Israel Ministry of Health in drug policy within the framework of the NHI, with emphasis on the basket of drugs reimbursed and co-payments for prescriptions.

Drug Costs↗
PubMed2002

Collateral biodiversity benefits associated with 'free-market' approaches to sustainable land use and forestry activities.

Concern over the ever more rapid and widespread losses of biodiversity has instigated various remedial actions: whether in situ conservation, such as the establishment of protected areas, or ex situ, such as the conservation of germplasm in gene banks. In the past, such activities were funded and managed by the public sector; however, in recent years, public support has declined and this has spawned a growing interest in conservation opportunities that might arise from 'free-market' approaches to sustainable land use and management. The UN Convention on Biological Diversity (CBD) is the key framework for articulating policies and actions on biodiversity; however, progress in developing suitable economic and market incentives for biodiversity conservation and its sustainable use has been slow, with activities such as bioprospecting and ecotourism making some, albeit limited, headway. Given the United Nations Framework for Climate Change or United Nations Framework Convention on Climate Change's (UNFCCC's) high profile within the public and private sectors, there is some potential for using it to help advance CBD objectives and provide the much-needed economic incentives for conservation, through some of the market-based mechanisms presented under the Kyoto Protocol. Significant potential lies in the fact that many 'natural' forests and certain other ecosystems are both major stores of carbon and areas of valuable biodiversity. Thus, any attempt at conserving these areas has the potential to yield both carbon and biodiversity benefits. So far, however, the conservation of natural forests is not included in the Kyoto Protocol's definition of sinks. Instead the creation of sinks - through the establishment of fast-growing monocultures - may well lead to biodiversity losses, especially if partly degraded lands are cleared for this purpose. If real progress is to be made, our understanding of the relationship between land use and biodiversity benefits needs to be improved, and more appropriate proxies for biodiversity need to be developed. At the same time, we need to have a clear understanding of the precise nature of the potential synergies and be more able to identify possible jointaction opportunities that exist between the UNFCCC, the CBD and the Convention on Combating Desertification and other international trade and economic agreements.

Agriculture↗
PubMed2000

Using a multihospital systems framework to evaluate and establish drug use policy.

PURPOSE: In order to develop rational drug purchasing and use policy for a class of pharmaceuticals used in a consortium system of 14 university based hospitals, the antiemetic use patterns of inpatients receiving cancer chemotherapy were evaluated to assess the comparative effectiveness of granisetron, ondansetron, and conventional antiemetics. PATIENTS AND METHODS: A prospective, observational study was conducted in 14 academic health centers linked under research and purchasing consortium arrangements from October to December 1994. The use of antiemetics was evaluated in hospitalized patients receiving cancer chemotherapy agents with a known propensity for causing, alone or in combination, varying degrees of nausea or vomiting. Clinical outcomes measured were the impact of chemotherapy administration on the functional status of patients, and the occurrence of post-treatment vomiting. RESULTS: The most often prescribed cancer chemotherapy regimens consisted of cisplatin, paclitaxel, etoposide and cyclophosphamide, and the most often prescribed antiemetics were the 5-hydroxytryptamine subtype-3 antagonists (5-HT3 antagonists, granisetron and ondansetron), dexamethasone and lorazepam. Of the 439 patients studied, 329 (75%) reported no episodes of emesis. Of the patients receiving highly emetogenic chemotherapy, those receiving 5-HT3 antagonists experienced better overall outcomes (as measured by functional health status and the absence of vomiting) than patients receiving conventional (non-5-HT3 antagonist) antiemetics. In contrast, patients receiving chemotherapy associated with moderate or low emetogenicity experienced similar outcomes, regardless of the antiemetic regimen selected. No statistical difference was seen between granisetron and ondansetron in achieving positive patient outcomes. CONCLUSION: The study results suggest that 5-HT3 antagonists are associated with better clinical outcomes than other antiemetics in patients receiving highly emetogenic chemotherapy. Less costly conventional antiemetic therapy (or, in some cases, no antiemetic therapy) provide comparable outcomes in patients receiving chemotherapy associated with moderate or low emetogenic potential. Granisetron and ondansetron were found to be clinically comparable.

Adult↗