Report of the survey of poison control centres and related toxicological services 1984-1986.
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Developing Countries↗
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Results for “Interinstitutional Relations”
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.
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Networks for integrated care provision: an economic approach based on opportunism and trust.
In this paper, we provide the economic rationale for an important issue in the health care sector, namely the network formation, e.g., in The Netherlands. The presence of such cooperation structures is hard to explain using the basic concept of the economic organization (EO) theory, i.e., the dichotomy of hierarchy versus market. However, acknowledging the aspect of trust renders the clan concept to be a powerful tool in understanding the viability of intra- and inter-organizational cooperation in the health sector. The main reason for this is the manner in which the professionals involved perform, as well as the importance of the tacit knowledge of the actors employed in the various health institutions. First, we address the conversion from supply towards demand orientation and the resulting pressure on multi-professional cooperation between health care providers. Then, relevant EO concepts will be reviewed, while introducing theory on knowledge, learning, and trust. Moreover, we offer conclusions for the health care sector on a concept-by-concept basis. Finally, we propose the notion of interclan, a clan-inspired notion for inter-organizational cooperation, and analyse the observed network formation.
Community Networks↗
The rationale of interorganizational linkages to connect multiple sites of expertise, knowledge production, and knowledge transfer: an example from HIV/AIDS services for the inner city.
This paper presents the rationale for a long-running project in which various community-based and tertiary-based providers are being linked to each other in order to understand, reach, and engage high-risk, hard-to-reach inner-city residents for prevention, treatment, and management of HIV/AIDS. Not simply a program to link disparate actors, the work has developed into a more fundamental approach through which to build and maintain the infrastructure required to generate and sustain knowledge development and integration within and between systems. This work is grounded in the recognition that each type of provider, as well as patients and clients themselves, has a particular type of expertise. All forms of expertise are necessary to fight HIV/ AIDS. Different forms of expertise are necessary to diagnose, treat, prevent, and cure HIV/AIDS and its sequelae. This work suggests revisions in traditional approaches to expertise and to the content and geometry of dissemination networks, and ultimately challenges the very concepts of dissemination and the lay/scientific boundary.
Acquired Immunodeficiency Syndrome↗
Directly observed therapy in an inner city hospital.
SETTING: A directly observed therapy (DOT) tuberculosis (TB) program in a large urban teaching hospital in the East Harlem section of New York City. OBJECTIVE: In response to an emergent epidemic of TB, the State Department of Health mobilized a coalition of providers outside the public sector to provide DOT and medical care for people with TB, with the goal of treatment until cure. The results of the first 150 patients of one program are reviewed. DESIGN: A multidisciplinary DOT team coordinated treatment at several sites within and without the institution, according to established medical regimens. RESULTS: The program served a hard-to-reach population, 63% human immunodeficiency virus (HIV) positive, 64% substance users, 17% inadequately housed and 15% indigent. In the program's first three years there was 85% overall compliance with DOT visits. Using the completion of therapy index, 66% of patients completed therapy, 13% remained on treatment, 7% transferred to self medication and 1% were lost to follow up. No patient on DOT developed a drug resistant organism. There were no hospital readmissions for TB. CONCLUSION: The experience of this program demonstrates the efficacy of an intensive, personalized DOT program in ensuring treatment until cure.
AIDS-Related Opportunistic Infections↗
[Research and teaching in public health. History of the relations between the universities and the government].
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Academies and Institutes↗
Evaluation of the cost effectiveness of a collaborative liaison program.
In response to today's health care environment, a metropolitan area association of hospices developed a collaborative hospital liaison program to educate and maximize referral sources, improve patient access to services and assist in ensuring the long-term survival of hospice care. Five hospices participated in the study, analyzing data on the numbers, sources and appropriateness of referrals and admissions, liaison staff expense and hospice relations with hospital staff. Recommendations were made for further collaborative efforts.
Cost-Benefit Analysis↗
Workshop 7 (synthesis): integrating the water and energy sectors.
Integration of the water and energy sectors is a key issue for effective resource management. However, everything that seems to make sense cannot always be easily accomplished. Barriers are ultimately related to political will where a variety of "instruments" is needed to make such coordination effective.
Energy-Generating Resources↗
The American Dental Trade Association looks at dental reimbursement: responsible consumption of appropriate dental services. Managed Care Task Force of the American Dental Trade Association.
The American Dental Trade Association Managed Care Task Force has provided an extensive study of the effects of reimbursement on the dental profession and the dental trade industry. There is great variety among the needs of patients and in the reimbursement plans available. ADTA is urged to take a leadership position to ensure that programs do not restrict access, value, or quality. The key to this strategy will be communicating a consistent message to dentists, patients, benefit managers, and the research community. The message is: "Responsible consumption of appropriate dental services."
Decision Making↗
[National development of health targets in Germany--the health targets.de Forum].
Health targets.de is a co-operation between the German Federal Ministry of Health (BMG) and the Association for Social Security Policy and Research (GVG) and is funded by the Ministry. Health targets.de unites numerous players in the field of health care and establishes a round table to put the development and implementation of some exemplary health targets to the test by the players themselves. The players are required to reach consensus about health targets and strategies and propose them collectively to health policy makers. Herewith, health targets.de aims to establish this "health targets" tool in order to supplement existing instruments of German health policy. Furthermore, its aim is to strengthen the idea of target setting at all levels of the health care system. Health targets.de was started in December 2001 and will present results at the beginning of 2003. Interim results are made accessible on the Internet. Since December 2001 health targets.de has so far been developing five specific health targets concerning diabetes; breast cancer; reduction in tobacco consumption; nutrition, physical activities and stress reduction in children and adolescents; and the improvement of the patients' and citizens' competence in health-related issues. Further topics will be dealt with later. For additional information see www.health targets.de.
Delivery of Health Care↗
Healthy children ready to learn: an essential collaboration between health and education.
The "Healthy Children Ready to Learn" initiative starts with the underlying concept that health is a critical partner to optimum education. All children have a right to be healthy. At a minimum, this right assumes promoting optimum use of available and effective preventive measures, such as ensuring compliance with immunization recommendations; promoting measures to prevent injuries; ensuring opportunities to identify disease and disabilities early; and providing prompt treatment when needed. Families must receive the support and assistance they need to raise healthy and educated children. Activities directed toward National Education Goals and the related National Health Promotion and Disease Prevention Objectives can advance progress toward school readiness, focus attention and available resources on needed programs and services, and thus help the nation in achieving its goal of having all children arriving at school each day healthy, well nourished, and ready to learn. To realize these goals and objectives, the two critical systems of greatest importance to children, those providing health services and education, need to collaborate, not only among themselves, but also with social services. A range of critical health problems will require our attention if the goals are to be met, such as availability of prenatal care, infant mortality, inadequate nutrition during pregnancy or early childhood, or both, disease prevention by immunization, infants who have been exposed to drugs, fetal alcohol syndrome, and the emotional and mental disorders of early childhood, to name a few. At any one time, any family may be in need of appropriate services. To address the health and well-being of their young children, a continuum of appropriate, accessible services must be available in the community. The first steps toward successful achievement of the readiness goal will require the identification of health, education, and social service programs that serve young children and their families, and the creation of a climate that fosters innovative and effective collaboration between programs at the Federal and State levels, especially as it pertains to the community. Policies and programs should be built around the needs of families. In this regard, the critical role that parents play in shaping a healthy environment conducive to school readiness must be recognized as a key element in shaping the strategies that should help in achieving the readiness goal. Similarly important is the need to engage professional organizations and other private sector groups involved with health, education, and other children's issues to work with government and families to achieve the school readiness goal and its related health objectives.
Adolescent↗
Cops and Docs: St Clare Hospital's strategy for educating teens about the medical and legal consequences of violence.
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Adolescent↗
Monitoring long-term ecological changes through the Ecological Monitoring and Assessment Network: science-based and policy relevant.
Ecological monitoring and its associated research programs have often provided answers to various environmental management issues. In the face of changing environmental conditions, ecological monitoring provides decision-makers with reliable information as they grapple with maintaining a sustainable economy and healthy environment. The Ecological Monitoring and Assessment Network (EMAN) is a national ecological monitoring network consisting of (1) about 100 case study sites across the country characterized by long-term multi-disciplinary environmental work conducted by a multitude of agencies (142 partners and counting); (2) a variety of less comprehensive yet more extensive monitoring sites; (3) a network where core monitoring variables of ecosystem change are measured; and (4) geo-referenced environmental observations. Environment Canada is the co-ordinating partner for the network through the EMAN Co-ordinating Office. EMAN's mission is to focus a scientifically-sound, policy-relevant ecosystem monitoring and research network based on (a) stabilizing a network of case-study sites operated by a variety of partners, and (b) developing a number of cooperative dispersed monitoring initiatives in order to deliver unique and needed goods and services. These goods and services include: (1) an efficient and cost-effective early warning system which detects, describes and reports on changes in Canadian ecosystems at a national or ecozone scale; and (2) cross-disciplinary and cross-jurisdictional assessments of ecosystem status, trends and processes. The early warning system and assessments of ecosystem status, trends and processes provide Environment Canada and partner organizations with timely information that facilitates increasingly adaptive policies and priority setting. Canadians are also informed of changes and trends occurring in Canadian ecosystems and, as a result, are better able to make decisions related to conservation and sustainability.
Canada↗
Using interagency collaboration to serve older adults with chronic care needs: the Care Advocate Program.
This article describes the Care Advocate Program, an interagency collaborative effort that involved health care organizations, social service agencies, and an academic research center to improve chronic care service delivery to older adults. The article discusses existing barriers to effective chronic care delivery as well as concepts for successful collaboration. The article describes the multiple and often competing demands of stakeholders who undertake collaborative projects. It concludes with lessons learned when partners from different settings work together to design and implement a demonstration program.
Aged↗
An invisible barrier to integrating HIV primary care with harm reduction services: philosophical clashes between the harm reduction and medical models.
Overall AIDS mortality in the United States has declined in recent years, but declines have not been consistent across all populations. Due to an array of barriers to care, minorities and poor people who are active substance users have not benefited as others have from advances in the treatment of HIV disease. One way to address this problem is to integrate HIV primary care into harm reduction programs that already effectively serve this population. Such collaborations, however, are difficult to initiate and sustain. Philosophical differences between the medical model and the harm reduction model, which often remain invisible to the parties involved, underlie these difficulties. This article addresses the issue by describing a partnership in the Bronx, NY, between CitiWide Harm Reduction Inc. (CitiWideHR) and the Montefiore Medical Center. It focuses specifically on the sources of philosophical differences between models, and briefly assesses the potential for successful collaborations of this sort.
Community-Institutional Relations↗
Wiring the HIV/AIDS system: building interorganizational infrastructure to link people, sites, and networks.
This paper presents a case example of the new "geometry of care" (Rier and Indyk, this volume), by examining selected examples from five facets of a program developed by the lead author and in operation since 1989. This program is designed to understand, build, revise, and maintain the organizational infrastructure with which to link diverse players and sites, and combine these into a web for producing, assessing, and exchanging the information needed to combat HIV/AIDS. Each example demonstrates how opportunities were exploited for developing and linking resources within and between systems of care and prevention. The program began as an iterative and systems approach to improve access of high-risk, hard-to-reach inner city New York populations to HIV/AIDS services, treatment, and research. The approach is also currently being further elaborated and applied in Argentina and India (see Boylan et al., this volume), and is adaptable to other local and global public health challenges (see Indyk & Rier, this volume).
Acquired Immunodeficiency Syndrome↗
"How much do you get paid if I volunteer?" Suggested institutional policy on reward, consent, and research.
Pharmaceutical companies often ask practicing physicians to conduct phase IV or postmarketing research on new drugs. Companies pay physicians to enroll their patients and report dosage and side-effect information. Postmarketing research embraces a multibillion dollar effort at promotion and familiarization, but subjects' informed consent to it normally does not include physician reward. Improving investigators' financial status while increasing medical risks to phase IV subjects is ethically unsound, especially if subjects are unaware of investigators' rewards. We suggest a model policy and guidelines that affirm subjects' need for informed consent, investigators' need for recognition and support, and institutions' need to protect patients from undisclosed risk and relations.
Clinical Trials, Phase IV as Topic↗
Dentistry and medicine, then and now.
Two factors have, at times, pushed dentistry and medicine together and pulled them apart. The factor acting to create a symbiosis is the common biomedical or scientific foundation for these fields. The factor causing independence deals with socio-cultural matters impacting on the professions and the public. These two factors will be examined at three points in time when the relationship between the two professions was significantly important for the welfare of the public: the 1920s and '30s, the 1960s and '70s, and our own time. Contemporary major discussion about the alignment of dental education, scientific advances, and societal needs point to a need for a new look at how dentistry and medicine relate to one another.
Culture↗
PPP insights in South Africa.
After functioning for some time in an increasingly regulated and structured environment in dealing with the private sector in South Africa, it was important to Government, to carefully review the terminology used in this evolving playing field. As the definitions and mechanisms impacting on this form of interaction became clear, it was essential to find a broader definition to encompass all forms of commercial intervention between the two sectors. In preparation for the first South African National Health Summit during 2001, the term public private interaction became a general term used in this context. In the South African healthcare sectors this term is used specifically to indicate that all forms of interaction between the two sectors should be considered, rather than merely focussing on specific Public Private Partnerships (PPPs), that have a much more narrow definition. Recent health policy documents in South Africa all stress four key goals--equity, coherence, quality of care and efficiency--which provide a useful basis for decision-making about PPIs. The range of public-private interactions that may support or constrain the South African health system's development are set within the overall public/private mix of the country. In developing an equitable, efficient, coherent and high quality health system in South Africa, there is considerable potential for constructive engagement (collaboration and co-operation) between the public and the private health care sectors. Both sectors should embrace this opportunity and therefore it is useful to propose some basic guidelines for engagement based on the vision and goals of the national health system. In deciding whether or not to pursue any new PPI within the health sector, or in evaluating whether an existing PPI should continue or be revised, it is necessary to assess its merits in relation to the achievement of health system goals.
Community Health Services↗