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PubMed2006

Utilization of the medical librarian in a state Medicaid program to provide information services geared to health policy and health disparities.

OBJECTIVE: The role of two solo medical librarians in supporting Medicaid programs by functioning as information specialists at regional and state levels is examined. SETTING: A solo librarian for the Massachusetts Medicaid (MassHealth) program and a solo librarian for the New England States Consortium Systems Organization (NESCSO) functioned as information specialists in context to support Medicaid policy development and clinical, administrative, and program staff for state Medicaid programs. BRIEF DESCRIPTION: The librarian for MassHealth initially focused on acquiring library materials and providing research support on culturally competent health care and outreach, as part of the United States Department of Health and Human Services Culturally and Linguistically Appropriate Services in Health Care Standards. The NESCSO librarian focused on state Medicaid system issues surrounding the implementation of the Health Insurance Portability and Accountability Act. The research focus expanded for both the librarians, shaping their roles to more directly support clinical and administrative policy development. Of note, the availability and dissemination of information to policy leaders facilitated efforts to reduce health disparities. In Massachusetts, this led to a state legislative special commission to eliminate health disparities, which released a report in November 2005. On a regional level, the NESCSO librarian provided opportunities for states in New England to share ideas and Medicaid program information. The Centers for Medicaid and Medicare are working with NESCSO to explore the potential for using the NESCSO model for collaboration for other regions of the United States. RESULTS/OUTCOMES: With the increased attention on evidence-based health care and reduction of health disparities, medical librarians are called on to support a variety of health care information needs. Nationally, state Medicaid programs are being called on to provide coverage and make complex medical decisions regarding the delivery of benefits. Increasing numbers of beneficiaries and shrinking Medicaid budgets demand effective and proactive decision making to provide quality care and to accomplish the missions of state Medicaid programs. In this environment, the opportunities for information professionals to provide value and knowledge management are increasing.

Health Policy↗
PubMed1995

Improving breastfeeding support: a community health improvement project.

BACKGROUND: Because of the brevity of the postpartum hospital stay, mothers and their newborns are discharged home before breastfeeding is well established. In 1992, feedback from patients who had given birth at Fletcher Allen Health Care (Burlington, VT) suggested a need for more consistent, expert, and timely assistance with breastfeeding in the hospital and better continuity of care during the first few weeks at home. QUALITY IMPROVEMENT TEAM: In 1993 a team developed objectives, analyzed the problem and possible solutions, and made eight recommendations on how the hospital could do more to promote breastfeeding. Implementation by team members and hospital staff included policy development, staff education, acquisition of funding, a visiting professorship, development of a lactation consultant coordinator and team, and patient surveys to evaluate the program. A late 1994 survey of 63 postpartum patients on their day of discharge indicated a high level of satisfaction with breastfeeding support in the hospital. CURRENT STATUS: Activities are being undertaken for lactation consultation coverage, further policy development, implementation of nurse competency validation, improved patient and family education materials, and continued evaluation of the breastfeeding support program through patient surveys. CONCLUSION: In the face of barriers such as the project's large scope, a paucity of internal team members, and a large number and variety of recommendations, some of the recommendations and follow-up plans have yet to be implemented. Yet the project has yielded improvements in care and provides a model of how hospitals can expand their traditional boundaries of care and quality improvement into community health issues.

Breast Feeding↗
PubMed2004

Perceptions on the standardization of psychiatric work: development of a care pathway.

Policy development and practice for hospital care has shifted towards a more deterministic approach. Crucial within this development is the assumption that interventions can be standardized to fit within the confines of a practice framework. A system to deliver standardized approaches to care is a care pathway. A research study was carried out to determine how care could be standardized to fit within a care pathway for people diagnosed with schizophrenia. A range of interviews with the multidisciplinary team and observations of the working group process was the data collection technique. Analysis was driven by emergent themes across the data set. Clinicians expressed divergent views on the nature of standardized care for people with schizophrenia. Respondents also offered a deeper understanding of standardized care by arguing for a sense of flexibility to be built into care systems. Findings from this study have implications for the introduction of NICE core standards for people with schizophrenia. For example, clinicians may be so opposed to such structures as to work against them. By understanding different views on standardized care, it may ultimately support their introduction into practice.

Attitude of Health Personnel↗
PubMed2005

Values in psychiatric diagnosis: developments in policy, training and research.

Diagnosis, although traditionally thought to be a value-free scientific process, incorporates values, for example in judgements of impaired functioning and clinical significance. Such judgements are particularly problematic in psychiatry because the values concerned are often diverse and hence potentially conflicting. Values-based practice is the theory and clinical skills-base for effective healthcare decision-making where, as in relation to psychiatric diagnosis, diverse and conflicting values are in play. The paper describes recent developments in values-based practice in the UK and with international partners, in policy (a national framework for values-based practice in mental health service provision), training (a training manual launched recently by the Minister responsible for mental health in the UK) and research (including an international research methods meeting on psychiatric diagnosis funded by the National Institute for Mental Health in England).

Diagnosis, Differential↗
PubMed1993

The negotiation of New Zealand alcohol policy in a decade of stabilized consumption and political change: the role of research.

Significant changes in the key alcohol policy areas of availability, advertising and taxation have taken place in New Zealand from 1985 to 1991. These changes are described in the context of the social climate which was one of extreme fiscal crisis and an unprecedented swing to the right. The very limited role played by public health research in the process of policy development is viewed in part as a consequence of this social climate. The political changes affected the strength and extent of the public health voices in the debate and the reception they received. In each of the policy areas in which change occurred, the policy-keeper was other than a public health agency and the utilization of research by public health advocates was, therefore, in response to already articulated positions. The dissemination of research relied too heavily on lengthy written submissions, and too little on media advocacy and interpersonal contact. There was also a lack of directly relevant local research to inform the policy debate. The case study illustrates the constraints on researchers' in the policy development process, but suggests that such involvement is important for the public's health.

Advertising↗
PubMed2004

Surveillance for disparities in maternal health-related behaviors--selected states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2001.

PROBLEM/CONDITION: Disparities in maternal and infant health have been observed among members of different racial and ethnic populations and persons of differing socioeconomic status. For the Healthy People 2010 objectives for maternal and child health to be achieved (US Department of Health and Human Services. Healthy People 2010. 2nd ed. With understanding and improving health and objectives for improving health [2 vols.]. Washington DC: US Department of Health and Human Services, 2000), the nature and extent of disparities in maternal behaviors that affect maternal or infant health should be understood. Identifying these disparities can assist public health authorities in developing policies and programs targeting persons at greatest risk for adverse health outcomes. REPORTING PERIOD COVERED: 2000-2001. DESCRIPTION OF THE SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver live-born infants. PRAMS employs a mixed mode data-collection methodology; up to three self-administered surveys are mailed to a sample of mothers, and nonresponders are followed up with telephone interviews. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets that can be used to produce statewide estimates of different perinatal health behaviors and experiences among women delivering live infants in 31 states and New York City. This report summarizes data for 2000-2001 from eight states (Alabama, Colorado, Florida, Hawaii, Illinois, Maine, Nebraska, and North Carolina) on four behaviors (smoking during pregnancy, alcohol use during pregnancy, breastfeeding initiation, and use of the infant back sleep position) for which substantial health disparities have been identified previously. RESULTS: Although the prevalence of each behavior varied by state, consistent patterns were observed among the eight states by age, race, ethnicity, education, and income level. Overall, the prevalence of smoking during pregnancy ranged from 9.0% to 17.4%. Younger (aged <25 years) women, white women, American Indian women, non-Hispanic women (except in Hawaii), women with a high school education or less, and women with low incomes consistently reported the highest rates of smoking. Overall, the prevalence of alcohol use during pregnancy ranged from 3.4% to 9.9%. In seven states, women aged >35 years, non-Hispanic women, women with more than a high school education, and women with higher incomes reported the highest prevalence of alcohol use during pregnancy. Overall, the prevalence of breastfeeding initiation ranged from 54.8% to 89.6%. Younger women, black women, women with a high school education or less, and women with low incomes reported the lowest rates of breastfeeding initiation. The size of the black-white disparity in breastfeeding varied among states. Overall, use of the back sleep position for infants ranged from 49.7% to 74.8%. Use of the back sleep position was lowest among younger women, black women, women with lower levels of education, and women with low incomes. Ethnic differences in sleep position varied substantially by state. INTERPRETATION: PRAMS data can be used to identify racial, ethnic, and socioeconomic disparities in critical maternal health-related behaviors. Although similar general patterns by age, education, and income were observed in at least seven states, certain racial and ethnic disparities varied by state. Prevalence of the four behaviors among each population often varied by state, indicating the potential impact of state-specific policies and programs. PUBLIC HEALTH ACTION: States can use PRAMS data to identify populations at greatest risk for maternal behaviors that have negative consequences for maternal and infant health and to develop policies and plan programs that target populations at high risk.sk. Although prevalence data cannot be used to identify causes or interventions to improve health outcomes, they do indicate the magnitude of disparities and identify populations that should be targeted for intervention. This report indicates a need for wider targeting than is often done. The results from this report can aid state and national agencies in creating more effective public health policies and programs. The data described in this report should serve as a baseline that states can use to measure the impact of policies and programs on eliminating these health disparities.

Female↗
PubMed1992

Planning mental health services: II. Current Canadian initiatives.

A brief overview of recent policy developments across Canada and a discussion of the common themes and challenges they address demonstrates the scope of activity in this field. The federal level of mental health planning and a summary of recent of policy developments in each province are described. Significant progress has been made in Canada in the development of mental health services since deinstitutionalization. Major challenges remain, however, which are being addressed to varying degrees across the country. The challenges related to the key issues of major mental illness, integration and consumerism are illustrated.

Canada↗
PubMedDate not supplied

The Canadian Heart Health Initiative: dissemination perspectives.

The Canadian Heart Health Initiative is a country-wide strategy for the prevention of cardiovascular disease. Initiated with a 15-year horizon, it has resulted in extensive networks and coalitions involving Health Canada, the 10 provincial departments of health and over 1,000 organizations. There are five phases: policy development through country-wide consultations (1986-88); provincial heart health surveys (1986-91); research demonstration programs (1989-97); and evaluation (1994-97). The dissemination research phase studies the adoption of interventions by communities and health systems. As a paradigm for dissemination of health policy, some key features of the Initiative are translation of the science base in prevention into community programs; consensual policy development; federal and provincial co-funding arrangements; key role played by the public health system; capacity building; organization and management model linking activities at the national, provincial and community levels. The methodologies and capacities developed are applicable to other health promotion and disease prevention areas.

Canada↗
PubMed1994

The social impact of aging populations: some major issues.

Demographic trends regarding the issue of aging underscore the fact that both current situations and future trends directly concerns all of us. Aging is the reality for the future world. The pace at which demographic transition develops varies among countries and regions of the world, but most of the developed and developing countries will be challenged by increasing numbers of dependent individuals. This is particularly critical in the less-developed countries where older populations will increase substantially faster. It is expected that by the year 2000, Latin America and the Caribbean will have 41 million elderly, 7.2% of the total population. By 2025 this percentage will increase to 10.8%. The stunning growth of the elderly demands special attention of policy and decision-makers. The total dependency ratio will decrease in the Americas between 1980 and 2025 due to a marked decrease in the fertility rate, whereas old age dependency ratios will show a marked increase in all countries except Haiti and Surinam. Most of the elderly populations, predominantly women, are living in urban centers. This fact is one of the most important characteristic of the socioeconomic picture in Latin American and Caribbean countries: urbanization with poverty. Women are bearing mainly the burden. It is obvious that, from a cultural perspective, the social impact of aging populations is a complex issue. The wide range of possible future programs will be the result of differences and similarities in social values, relationships, and dynamics within each society. It is important to recognize that since modern industrialized societies live in a culture emphasizing competition for economic wealth, that values economic over social productivity, and where inequities based on class, gender, and race are accepted, that these are the issues influencing the parameters of aging populations. Social policy development for the elderly needs to be critically examined in order for society to adapt to aging as well as for older populations to adapt to a charging society. The major political challenge is the need for redistributive policies. Developing countries must add new priorities to their scarce resources, for social programs for elderly, while still having to deal with the problems of their younger populations. Women issues are extremely important in considering social policies for elderly population. Feminization of poverty and ill-health during old age is a result of exacerbated risks for women across the life course. Appropriate care and support for this vulnerable group is a priority.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2004

A review of acid sulfate soil impacts, actions and policies that impact on water quality in Great Barrier Reef catchments, including a case study on remediation at East Trinity.

An estimated 666,000 ha of acid sulfate soils (ASS) occur within the Great Barrier Reef (GBR) catchments of Queensland, Australia. Extensive areas have been drained causing acidification, metal contamination, deoxygenation and iron precipitation in reef receiving waters. The close proximity of ASS to reef waters makes them a substantial threat to water quality. Another important issue linked with ASS is their release of soluble iron, which is known to stimulate nuisance marine algal blooms, in particular Lyngbya majuscula. Known blooms of the cyanobacteria in reef waters have been confirmed at Shoalwater Bay, Corio Bay, the Whitsunday area and Hinchinbrook Channel. Acid sulfate soils are intimately related to coastal wetland landscapes. Where landscapes containing ASS have been disturbed (such as for agriculture, aquaculture, marinas, etc.) the biodiversity of adjacent wetlands can be adversely affected. However, there is no clear knowledge of the real extent of the so-called "hotspot" ASS areas that occur within the GBR catchments. Management of ASS in reef catchments has benefited from the implementation of the Queensland Acid Sulfate Soils Management Strategy through policy development, mapping, training programs, an advisory service, research and community participation. However, major gaps remain in mapping the extent and nature of ASS. Areas of significant acidification (i.e. hotspots) need to be identified and policies developed for their remediation. Research has a critical role to play in understanding ASS risk and finding solutions, to prevent the adverse impacts that may be caused by ASS disturbance. A case study is presented of the East Trinity site near Cairns, a failed sugar cane development that episodically discharges large amounts of acid into Trinity Inlet, resulting in periodic fish kills. Details are presented of scientific investigations, and a lime-assisted tidal exchange strategy that are being undertaken to remediate a serious ASS problem.

Animals↗
PubMed2005

Promoting effective social work policy in end-of-life and palliative care.

Policy developments in the health care arena in general, and in end-of-life and palliative care in particular, strongly influence the practice environment for the delivery of hospice and palliative care services and the diverse roles of social work practitioners. This article analyzes policy developments in two crucial areas-ethics and law and disenfranchisement and health disparities. It focuses on the recent social work literature and other key sources and provides recommendations to promote the roles of social workers in ethics consultation, public policy, and advocacy and to integrate better the perspectives and concerns of diverse communities into palliative care practice, education, and policy.

Cultural Diversity↗
PubMed1996

Conscious sedation: a multidisciplinary team approach.

The administration of intravenous conscious sedation for patients undergoing minor procedures has increased in many settings throughout health care. Recognizing this, managers are challenged to develop policies to standardize the quality of patient care delivery. Consumer interest and knowledge in health care has increased dramatically in the last few years. Their demands for decreased cost, increased technology, and quality of care have compelled health care organizations to adopt quality management models. Quality improvement teams were developed to look at processes crossing departmental boundaries. Teams facilitate dialogue, understanding, and knowledge, and use the scientific method to design, streamline, and improve processes. The authors share strategies for policy development using a 7-step quality improvement process with a multidisciplinary team approach.

Clinical Competence↗
PubMed2005

Child well-being in an era of welfare reform: the sensitivity of transitions in development to policy change.

This study examined the age-specific pattern of effects of welfare policies on child achievement. Drawing from 7 random-assignment welfare and antipoverty evaluations that provided more than 30,000 observations of children's achievement, this study found that times of developmental transition are the only periods sensitive to the changes in families brought about by these policies. More specifically, small positive effects of welfare and antipoverty policies were found for children making the transition into middle childhood, and small negative effects of these same policies were found for children making the transition out of middle childhood and into early adolescence. Effects were robust across various program groupings and could not be attributed to family characteristics that differ for children of different ages. This research informs the understanding of how changes in employment and income for low-income parents affect development across childhood.

Adolescent↗
PubMed1994

Centralised versus decentralised funding of evaluative research: impact on medical technology policy in Italy.

Medical technology assessment in Italy is considered to have had scant impact on policy. Government has played a limited role in financing evaluative research and increased public funding might therefore be expected to have a positive effect on the contribution that this activity makes to policy. The choice of arrangements for such funding, however, must take account of the broader institutional context in which these operate. Intergovernmental relations in any country are inherently difficult due to the fact that the distribution of powers is in general poorly specified and to a tendency for central government to try to impose itself. Budgetary difficulties may exacerbate the problem. Italy has quite a decentralised system of government and there has been significant disagreement over how to interpret the intergovernmental distribution of powers, including those relating to health care. Central government has also had difficulty in that sector making lower governments accountable for how they spend their central grants and for budget deficits. This has created serious problems for the implementation of medical technology policy developed at the centre. This state of affairs counsels against adopting funding arrangements for evaluative research in which central government plays a dominant role. Probably the most appropriate solution is that of a partnership between the centre and the Regions with each party having an equal say on the medical technologies studied, the evaluative methodologies adopted and how the data produced are used in policy development.(ABSTRACT TRUNCATED AT 250 WORDS)

Budgets↗