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PubMed1977

[Priorities in health activities in refugee camps (author's transl)].

In times of natural or man-made disasters, settlements of refugees in temporary camps face the health authorities with new public health problems. The allocation of priorities and resources among Medical Care, Prevention and Sanitation, and Nutrition are usually not based on objective assessment of the situation. The potential role of epidemiological techniques and particularly of the surveillance is illustrated by the case studies of the Bengladesh civil war and the Niger drought. A rational priority order will usually rank nutrition at the top and individual medical care at the bottom.

Bangladesh↗
PubMed2003

Identifying nurse and health visitor priorities in a PCT using the Delphi technique.

A three-stage Delphi investigation was undertaken over a 4-month period in a primary care trust to identify the perceived clinical needs of nurses. Practice nurses, district nurses, health visitors and community hospital nurses all participated. In round 1, there were 28 replies from these groups of nurses, in round 2 there were 31, and in round 3 there were 25 replies. In round 1, 77 issues (excluding duplications) were identified. These were separated into three themes according to the most appropriate method for addressing the issue: education (29 issues), research (16 issues) and management (32). In round 2, the issues were redistributed in the three areas and staff were asked to choose the ten most important issues from education, research and management. Finally, in round 3 the ten issues in education, research and management were prioritized in terms of the "most pressing". The most pressing education need was recognizing accountability; the most pressing research need was caseload/dependency scoring--matching staff levels to workload, and the most pressing management need was risk management, e.g. staff safety. The results have identified locally that there is a gap between the modernization agenda and what nursing staff consider to be the issues that need addressing locally. If measures are not put in place to address these local issues, there is a danger that nurses will not take a full and active role in the modernization of the NHS.

Community Health Nursing↗
PubMed1993

Explorations in consultation of the public and health professionals on priority setting in an inner London health district.

The methodology for eliciting the public's priorities for health services is in its infancy. This paper presents the results from a series of exploratory exercises on priorities in City and Hackney. The authors surveyed the opinions of members of community groups and tenants' associations, and compared their responses with those of a random sample of the public as well as general practitioners, consultants and public health doctors. This revealed some disagreement on priorities between these groups. The public, in consistency with the results from other studies, prioritised perceived life saving technologies as high, in contrast to community services and services for people with mental illnesses, which they prioritised as medium to low, in contrast to all the samples of doctors; the public also prioritised health education and family planning as fairly low, as did the GPs and consultants, in contrast to the public health doctors who prioritised them as high. Before DHAs embark on these studies as part of priority setting, they must answer the question: "what will they do if they disagree with the results?"

Attitude of Health Personnel↗
PubMed1998

An approach to setting priorities in health planning.

This paper describes work undertaken in Pakistan within a project to strengthen the health planning system, aimed at improving the capacity of the planning cells to identify priorities and develop broad strategic guidelines. The work starts from the premise that identification of priorities requires two stages. In the first stage, problems must be structured and defined in a way that is accepted by all major stakeholders in the planning process. In the second stage, a transparent process of decision making must exist which will provide the means for the planning group to establish priorities and time-scales. The tools chosen in this instance were selected in relation to the characteristics of the local environment, and the paper describes these.

Decision Making, Organizational↗
PubMed2000

Role of academia and professional associations in support of health for all.

Health for all is facing many challenges at present, such as increasing global population, the widening gap between the rich and poor and the inequitable distribution of health services. The World Health Organization has always recognized that the achievement of health for all required the input of many partners, not simply the ministries of health. This paper outlines the role academia and professional associations can play in supporting health for all. It discusses, in particular, the areas of intervention, such as training human resources, planning and setting health priorities and strategies and conducting health systems research.

Ethics, Professional↗
PubMedDate not supplied

Health care priorities as a problem of local resource allocation.

The aim of this study was to examine attitudes to prioritization in health care among the general public, politicians, doctors and nurses. The focus in this paper is on the types of services from a perspective that is 'policy analytical'. This study forms part of the wider 'Prioritization in Health Care Project' carried out at the University of Kuopio exploring patient treatment level prioritizations. Data were collected by a postal questionnaire in 1995. Four groups were established for the study: (1) a general public sample of 2000 subjects, (2) a random sample of 1000 nurses, (3) a random sample of 1500 medical doctors and (4) a sample of 2200 politicians involved in social and health care administration. Respondents were asked to make value choices between specialized and primary health care services in a real budget situation. One of the most salient findings in this study was that attitudes towards priorities are context-dependent. Certain differences were observed between the groups studied. The attitudes of the general public and nurses were quite similar, while similar views were shared by politicians and doctors. The attitudes of the respondents reflect well what has actually happened in Finnish health care, with the exception of psychiatric services which have undergone drastic cuts.

Adult↗
PubMed1986

Research priorities in mental health.

Setting research priorities becomes necessary when the demand for research funds outstrips the supply; because it is impossible to do everything some topics must be chosen as more promising and pertinent than others. This paper proposes a scheme for estimating the relative merits of different branches of research within the whole field of mental health. The scheme for assessing the claims of each area is based upon three factors: the need for research in a particular topic (using data about prevalence of disorders; the costs attributable to disorders; and the like); the possibilities of doing good science; the estimated time to a clinical payoff. It is argued that reasonable assessments of these three factors can be combined to give a relative weight to any particular research area. The judgements of relative weight can be progressively improved as more data becomes available. The argument is put that one way to obtain more funds for mental health research overall is to improve the ordering of the different areas within the field of mental health. Once mental health has its house in order it will be better equipped to make the case for mental health research.

Canada↗
PubMed1999

Research needs and priorities in health informatics--early results of a Delphi study.

A four-phased Delphi study has been performed on the topic of "research needs and priorities to implement the Information Society within Healthcare". This contribution presents the outcome of the first three phases. The biggest surprises are that 'Telemedicine' is relatively lower ranked than expected, and that 'Business Process Re-engineering' is the highest ranking topic, as judged from the number of issues and barriers raised by the expert panel.

Delphi Technique↗
PubMed2005

Antiretroviral treatment in resource-poor settings: public health research priorities.

Many countries in Africa are planning to provide highly active antiretroviral therapy (HAART) to millions of people with acquired immune deficiency syndrome. This will be a highly complex therapy programme. Physician-based models of care adapted from industrialized countries will not succeed in providing treatment to the majority of those who need it in resource-constrained settings. A high priority is to identify care models for Africa that will increase coverage of HAART safely and effectively: key issues are (i) whether nursing staff or non-clinically qualified staff can take the major role in the treatment programme and reduce the workload of physicians, (ii) whether treatment and monitoring can be delivered through peripheral health centres or through home visits and achieve better adherence and be more cost-effective than delivery at hospitals and (iii) which clinical algorithms used by nursing or non-clinically qualified staff will be effective for screening, diagnosing and managing treatment-related side-effects and medical problems being incurred. Many current ART support programmes are making little or no investment in research, but answering important questions on delivery of HAART will be essential if HAART programmes are to be successful in African nations with a high burden of human immunodeficiency virus infection.

Africa↗
PubMed2002

Health care priorities for menopausal women with a history of breast cancer.

BACKGROUND: The opinion of breast cancer survivors and their physicians about long-term health, especially menopause, is not well understood. METHODS: Seventy-three patients and 22 physicians answered questions regarding medical follow-up and menopause. RESULTS: One third of specialists preferred follow-up of 5 years or less, while 59% preferred 10 years or longer; 46% of patients preferred follow-up for 10 years or longer. Physicians preferred that primary care physicians supervise menopausal health (55%), but patients disagreed (30%). Physicians cited heart health most important, followed by skeletal health and climacteric symptoms. Physicians believed that climacteric symptoms were patients' leading concern, but patients cited heart health, followed by skeletal health and cognitive dysfunction. Neither patients nor physicians advocated estrogen use. CONCLUSIONS: Differences of opinion exist between breast cancer patients and specialists regarding follow-up and management of menopause. However, both patients and physicians prefer prolonged surveillance by a cancer specialist, with attention to heart and skeletal health issues.

Attitude of Health Personnel↗
PubMed2005

Comparing the preferences of health professionals and members of the public for setting health care priorities : experiences from Australia.

INTRODUCTION: This article reports on a priority-setting exercise involving members of the general public and health professionals. The aim is to compare the healthcare priorities of these two groups, as well as their attitudes towards public involvement in priority setting. METHODS: A convenience sample of 373 members of the public attending two central Sydney, Australia, medical clinics were asked to complete a structured, interviewer-administered questionnaire. Forty-four purposively sampled healthcare professionals working in central Sydney completed the same questionnaire. Both groups were asked whether the preferences of the public should inform priority-setting decisions. They then had to allocate an additional (but fixed) amount of healthcare resources across competing programmes, medical procedures and population groups and their preferences were compared. RESULTS: The health professionals and members of the public strongly supported using public preferences to inform priorities in healthcare. Both groups expressed a slightly stronger preference for using public preferences to inform priorities across healthcare programmes and population groups than for medical interventions. DISCUSSION/CONCLUSION: Considerable uniformity of preferences was revealed between the health professionals and the members of the public. However, it is argued that, even where the preferences of health professionals are consistent with and representative of those of the wider community, public involvement is important in terms of procedural justice, as it helps to legitimise both the process and the resultant priorities.

Adult↗
PubMed2006

[International health research: priorities and commitment].

Of the global budget for health research, only 10% is spent on the disease burden of 90% of the world's population. Investments for international health research are lacking, hampering health for the poor. Effective vaccines against the world killers HIV, malaria and tuberculosis still do not exist. However, in order to understand the obstacles to implementing existing effective interventions, scaling up research for new drugs and vaccines must be accompanied by research in health systems, to understand the obstacles to implement existing effective interventions. The task demands political and private sector commitment.

Biomedical Research↗
PubMed2000

Research needs and priorities in health informatics.

A Delphi study was accomplished on the topic "what is needed to implement the information society within healthcare? and which research topics should be given higher priority than other topics to achieve the desired evolution?", involving 29 international experts. The study comprised of four phases, (I) a brainstorming phase based on a open question; (II) an evaluation phase for mutual commenting; (III) a feedback phase allowing corrections/extensions; and (IV) a phase collecting the ratings of individual issues within a questionnaire synthesised from the previous phases. A total of 110 research items and 58 supplementary barriers were raised, divided into 14 topics grouped according to homogeneity. The emphasised research topics are business process re-engineering, the electronic patient record and connected inter-operating systems, (support for) evidence-based medicine and clinical guidelines, and education. Issues inherent to the healthcare domain often are the kernel of the research recommended. Similarly, methods and 'people'-issues are strongly emphasised among the research issues in general and among those for which the experts' joint opinion was rated as statistically significant. In contrast, only a minority of the research issues emphasised was related to technical issues.

Delphi Technique↗