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PubMed1995

Effects and effectiveness of telemedicine.

The use of telemedicine has recently undergone rapid growth and proliferation. Although the feasibility of many applications has been tested for nearly 30 years, data concerning the costs, effects, and effectiveness of telemedicine are limited. Consequently, the development of a strategy for coverage, payment, and utilization policy has been hindered. Telemedicine continues to expand, and pressure for policy development increases in the context of Federal budget cuts and major changes in health service financing. This article reviews the literature on the effects and medical effectiveness of telemedicine. It concludes with several recommendations for research, followed by a discussion of several specific questions, the answers to which might have a bearing on policy development.

Cost-Benefit Analysis↗
PubMed2003

Perceptions on the development of a care pathway for people diagnosed with schizophrenia on acute psychiatric units.

Policy development and practice for hospital mental health care has shifted towards a user-focused and evidence-based direction. Important within this policy development has been a guideline for inpatient care, particularly the establishment of an inpatient Acute Care Forum. A vehicle to both commission and develop this agenda is the Implementation of a care pathway. A research study was designed to explore how a care pathway could be developed for inpatients diagnosed with schizophrenia. Interviews with a range of health care professionals and observation of the process of care pathway development were the data-collection tools. Analysis was driven by emergent themes across the data set. Themes were then presented as one possible interpretation of the factors to be considered for the development of a care pathway for people diagnosed with schizophrenia. Clinicians experienced many difficulties in finding and including evidence-based practice (EBP) within a care pathway. Professions on the whole felt that there was a certain futility to psychiatric care given the paucity of evidence to support practice. This may contribute towards the poor use of hospital care as a therapeutic intervention as part of the wider spectrum of care. Difficulties arise when trying to develop a care pathway with EBP, given the paucity of knowledge on why certain interventions are only partially effective. The development of a care pathway may inform the priorities of the inpatient Acute Care Forum for people diagnosed with schizophrenia. A care pathway should not be constrained, however, to EBP and should incorporate therapeutic activities to improve the overall experience of service users. Limitations on the study and the collection of evidence supporting these conclusions conclude the paper.

Attitude of Health Personnel↗
PubMed1994

The influence of system factors upon the macro-economic efficiency of health care: implications for the health policies of developing and developed countries.

This paper aims to clarify the global association of system factors with the attainment of health policy goals, through economic analyses of cross-country data. In the case of OECD (the Organization for Economic Co-operation and Development) data for 1990, the variation in total expenditure on health among 24 countries can be explained by various factors including Gross Domestic Product (GDP). Among these, the variables representing the level of public sector involvement through social protection or public-private mix within a health care system, such as the Public-to-Total Expenditure Ratio, Coverage Rate and Public Cost Sharing, are significantly negative when factors such as GDP are controlled. This suggests that countries attaining higher equity or accessibility are in a better position to gain higher cost-containment or macro-economic efficiency. The results of this study may be helpful for developing countries searching for a long-term health care system as well as for developed countries facing health care system reforms.

Costs and Cost Analysis↗
PubMedDate not supplied

HIPAA. Health Insurance Portability and Accountability Act of 1996.

Organizations must obtain a copy of the final privacy rule. For those organizations that have acted in advance and developed policies it will be necessary for them to assess and revise these policies as indicated. Develop and post a notice of the organizations privacy practices and patient's privacy rights. Develop and implement a mechanism in which patients would be asked to sign an acknowledgment of receipt of the privacy notice, which would become part of the patient's treatment record. Offices will be required to provide evidence that staff has been trained on the organization's privacy policies procedures, patient's privacy rights and the consequence of violating established policies and procedures. This training should become part of the employee initial orientation. Develop a log to be kept in each patient's record to document release of information. This includes any element of the patient's medical record released to a third party (sexual abuse, substance abuse, health issues, etc.). This document should be reviewed with legal counsel. Develop a log to be kept in each patient's record to document patient authorization to leave messages on personal answering devices By ensuring consistency throughout the industry, these national standards will make it easier for health plans, doctors, dentists and hospitals to process claims and other electronic transactions efficiently and effectively.

Confidentiality↗
PubMed1996

The evolution of divergences in physician supply policy in Canada and the United States.

The size, geographic distribution, and specialty mix of the US physician workforce continue to interest American health policy analysts. Evidence suggests that the United States is on the verge of a serious oversupply of physicians, particularly nongeneralist physicians. Canada faces some of the same problems in physician supply, cost, and distribution as does the United States. Unlike the American states, however, the Canadian provinces, which have responsibility for financing health care, have in recent years made changes in their physician workforce policies that address these problems. Of particular note, Canadian provinces have developed policies that limit medical school enrollments, adjust the specialty training mix to better accord with needs, and establish physician practice location incentives. This article proceeds on the assumption that historical and contemporary similarities between medical care systems in Canada and the United States make comparisons between them potentially valuable. It offers a historical perspective on the evolution of workforce planning in the 2 countries and identifies 3 periods of policy development. It also compares and contrasts the relative size and specialty composition of the Canadian and US workforces and discusses how Canadian initiatives have diverged from American policy. Unless the United States devises its own coordinated workforce strategy, it will have considerable difficulty limiting physician workforce growth and influencing specialization and distribution in the future.

Canada↗
PubMedDate not supplied

Primary care in Canada: so much innovation, so little change.

The development of Canadian primary care has been shaped by a series of policy legacies that continue to affect the possibilities for change in primary care through their cumulative effects on the health care system and the process of health policy development. The pursuit of radical systemwide change in the face of unfavorable circumstances (created in large part by those legacies) has resulted in missed opportunities for cumulative incremental change. While major changes in primary care policy seem unlikely in the near future, significant incremental change is possible, but it will require a reorientation of the policy development process.

Canada↗
PubMed2000

Carotid artery reconstruction for Takayasu's arteritis the necessity of all-autogenous-vein graft policy and development of a new operation.

BACKGROUND: We have adopted an all-autogenous-vein-graft policy in carotid reconstruction for Takayasu arteritis, namely an ascendo-right carotid and right subclavian (axillary) arteries bypass using a pantaloon vein graft for patients all of whose arch branches are occluded, and an extra-anatomical bypass from the right subclavian artery for patients whose brachiocephalic artery is the only arch branch that remains patent. This report is to elaborate on these operations and to assess the long-term outcome. METHODS: Six patients were operated on according to this policy; (5 women, 1 man, age range: 14 to 59 years (mean: 30). The indications for surgery were severe cerebral ischaemia that significantly interfered with their daily lives. The pantaloon vein graft bypass was performed in four patients, and an extra-anatomical bypass in two. The specific management protocol to prevent the "postbypass hyperperfusion syndrome" and cerebral oedema included a shunt procedure to the internal carotid artery using one limb of the pantaloon vein graft, induced hypotension just before the completion of the carotid reconstruction and the administration of a glycerine-fructose solution. RESULTS: Cerebral ischaemic symptoms disappeared in all patients. All but one, who died of a ruptured thoraco-abdominal aneurysm on the 35th postoperative month, are living a normal life with a patent graft. No suture line complications have as yet been encountered (follow-up: 10 to 205 months, mean: 126 months). CONCLUSIONS: Carotid vein bypass for Takayasu arteritis, particularly, the pantaloon vein graft bypass is recommended for those of whom all aortic arch branches are occluded, resulting in severe brain ischaemia. Perioperative blood pressure control is important for prevention of the hyperperfusion syndrome.

Adolescent↗
PubMedDate not supplied

eHealth in Latin America and the Caribbean: development and policy issues.

This paper reviews trends and issues in health and in the information and communication technologies (ICT) market as they relate to the deployment of eHealth solutions in Latin America and the Caribbean. Heretofore designed for industrialized countries and large organizations, eHealth solutions are being proposed as an answer to a variety of health-system management problems and health care demands faced by all health organizations including those in developing societies. Particularly, eHealth is seen as especially useful in the operational support of the new health care models being implemented in many countries. The authors examine those developments vis-à-vis the characteristics of the Latin American and the Caribbean health-sector organizational preparedness and technological infrastructure, and propose policy and organizational actions to foster the development of eHealth solutions in the region.

Caribbean Region↗
PubMed1989

[The public health service as an instrument of health policy goal development].

Public Health service is an instrument that is absolutely essential in communal and national health policy. It cannot be replaced by independent doctors and institutions. Tasks of social and environmental hygiene will become increasingly important besides many other problems. This means adequate staff and equipment are an absolute must. Private enterprise cannot step in without causing irreparable damage. It is absolutely out of place and highly damaging to talk about subsidies. Doctors performing practice outside their Public Health duties can do so if that does not interfere with these duties and is not meant to cater to any alleled need for additional income. However, it is to be welcomed as a matter of principle since it is an effective and economic form of continuing education.

Germany, West↗
PubMed2002

Nutrition and brain development: social policy implications.

Undernutrition among young children is widespread in the United States and has a detrimental impact on brain development. This article explores the risks associated with undernutrition and the potential for recovery when diet and the environment improve. Three policy implications are discussed: (a) increasing access to federal food programs, (b) promoting breastfeeding, and (c) working toward reducing child poverty.

Anemia, Iron-Deficiency↗
PubMedDate not supplied

Development of immunization policy and its implementation in the United Kingdom.

The U.K. immunization program is managed through a tightly connected process that links the ways policy is developed, submitted to independent expert review and recommendation, adopted into strategy, and implemented into practice. There is one advisory body for immunization. Its recommendations, once accepted by government, are centrally funded, and vaccines are provided at no cost to recipients. Although the present system has worked well, changes in health care management at the peripheral level mean that the immunization program will need to adapt to retain the health gains achieved. Rates of vaccine-preventable disease are at historically low levels, although challenges related to costs and effectiveness remain.

Health Policy↗
PubMed2004

Ethical issues in fertility preservation for adolescent cancer survivors: oocyte and ovarian tissue cryopreservation.

UNLABELLED: Oocyte and ovarian tissue harvesting and implantation may one day restore fertility in adolescent cancer survivors. Discussion ensues regarding ways to respect patients and address ethical issues in future clinical trials. STUDY OBJECTIVE: To offer a normative analysis of ethical issues in oocyte and ovarian tissue cryopreservation and implantation for adolescent cancer survivors. DESIGN: Normative ethical analysis. RESULTS AND CONCLUSION: Oocyte and ovarian tissue harvesting and implantation hold promise in restoring fertility in adolescent cancer survivors; however, more research is required before adolescents can ethically be enrolled in clinical trials. As these methods advance, clinician investigators serve these patients best by (1). ensuring that the intervention does not harm the patient by delaying cancer treatment; (2). ensuring that no remnant cancer cells will be reintroduced in transplantation or fertilization; (3). preventing damaged cryopreserved oocytes from being fertilized and implanted; (4). seeking informed assent from adolescent patients and informed consent from their parents or guardians; (5). developing policies to protect the patient's future rights to her gametes; (6). developing policies addressing the disposition of gametes if the patient dies; and (7). respecting the patient by protecting her from harm while also honoring her right to self-determination.

Adolescent↗