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At least 595 records · Page 33Linked to original sources
PubMed2006

Difficult commissioning choices: lessons from English primary care trusts.

OBJECTIVE: In England, primary care organizations (primary care trusts, PCTs) have scope to influence the provision of health care at the margin. However, when faced with difficult commissioning choices, restriction of services potentially leaves them vulnerable to legal challenge. PCTs are developing different approaches to priority setting but there is a need to develop processes that lead to more consistent, accountable and fair decision-making. Our objective was to describe recent local developments on prioritization decision-making. METHODS: Rationing policies in PCTs in West Yorkshire and North & East Yorkshire and North Lincolnshire (NEYNL) Strategic Health Authority areas in 2003 were examined. To evaluate priority setting, we compared the descriptive findings with an internationally recognized ethical framework for priority setting, 'accountability for reasonableness' (AFR). RESULTS: PCTs varied as regards the stage of policy development they had reached. Rationing by exclusion was the most common approach to prioritization, but in general PCTs failed to make the rationale for their decisions explicit and accessible. The importance of an appeals process was recognized by the majority of PCTs. Those that had developed a formal process to address difficult commissioning decisions were an exception. CONCLUSIONS: Adopting AFR as a prioritization framework can serve to improve the fairness and consistency of the decision-making process, reducing the vulnerability of PCTs to legal challenge. Characteristics of rationing policies already in place fulfil some of the AFR conditions but there remains scope for further improvements in their design and dissemination.

England↗
PubMed2006

Lessons from developing and running a clinical database for colorectal cancer.

BACKGROUND: Recent policy developments in the UK require the routine monitoring of the performance of cancer services. Developing and using clinical databases is one approach to meet this objective, but to date their implementation has been challenging. OBJECTIVE: To describe the development of the Thames Cancer Registry clinical database for colorectal cancer, and to present the lessons learnt in the first five years since its establishment. METHODS: Planning of this clinical database began in 1998. Detailed variables for the data set were derived by analysis of national standards and guidelines. Structured pro formas were designed to abstract data from clinical notes. A pilot study over 12 months collected 400 cases from seven hospital trusts in one cancer network. Data collection over the wider North Thames area began in 1999. RESULTS: The number of new records entered each year into the database rose from 747 in 1999 to 1107 in 2002. By 2004, it held a total of 8500. However, participation and completeness of data collection varied between trusts. Currently only 18 of 26 trusts in the area submit data and only 12 have done so every year. Overall completeness for key demographic and treatment variables has been between 80 and 100% but less so for more detailed diagnostic and treatment variables (40-60%). Barriers to implementation in trusts could be grouped as organizational, professional and data-related. Organizational barriers have included changes in the cancer networks, variability in trust commitment to different data sets and lack of personnel to enter data consistently. Professional barriers have included competing priorities and varying commitments within the multidisciplinary clinical teams. Data-related barriers include the wide range of database formats that are used in trusts, and a tendency for data to be collected at the end of the year rather than continuously. CONCLUSIONS: Creating and maintaining a clinical database is a time-consuming and complex undertaking. Completeness of ascertainment and quality are major issues of concern. Key lessons from this project have been that the commitment of clinicians and the ability of trusts to provide consistent support for data collection are crucial.

Colorectal Neoplasms↗
PubMedDate not supplied

Developing a hospital policy for clinical pathways.

Clinical pathways are used for planning, coordinating and facilitating the continuum of patient care from before admission to after discharge. They rapidly are changing the provision of healthcare services through improved patient care and cost containment, but they also have raised questions about possible legal ramifications. If sound policies and procedures for clinical pathways are developed and consistently adhered to by healthcare facilities, the potential for liability may be minimized while patient care is improved. This article describes a multidisciplinary task force's work to develop such policies and procedures.

Confidentiality↗
PubMed2005

Introduction of direct-to-consumer advertising of prescription drugs in Canada: an opinion survey on regulatory policy.

BACKGROUND: Canada is strongly influenced by US cross-border direct-to-consumer advertising (DTCA) and has held consultations to discuss introduction of DTCA since 1996. This article describes a survey of Canadian drug policy experts carried out in 2001, during one such legislative review. The survey results are compared to more recent DTCA policy developments. METHODS: We recruited key informants on pharmaceutical policy to complete a faxed questionnaire that queried their opinions on DTCA information quality, effects on drug and health care use, and regulatory issues. Respondents were asked about the evidence they had used to back their opinions. Analysis was descriptive. RESULTS AND DISCUSSION: Of 79 identified potential participants, 60 (76%) participated, 40% of whom were from federal and provincial government; 3% were private insurers; 18%, 15%, and 8% were from health professional groups, consumer groups, and patient groups, respectively; 8% and 7% were from pharmaceutical and advertising industries, respectively. Opinions were highly polarized on the effects of DTCA on drug and health care use. Advertising and pharmaceutical industry respondents were generally positive, public sector, health professional and consumer groups generally negative. Over 80% believed DTCA leads to higher private and public drug costs and more frequent physician visits. Fewer judged billboards or television to be appropriate media for DTCA than magazines or the Internet, and most believed that children and adolescents should not be targeted. CONCLUSION: Given the polarization observed within this survey, we examined how DTCA policy has evolved in Canada since 2001. The federal government has legislative authority over DTCA, but bears few of the additional costs potentially incurred through policy change. These fall to the provinces, which provide an eroding patchwork of public coverage for prescription drugs in the face of rapidly increasing costs. No new federal legislation has been tabled since 2001. However, considerable shifts in administrative policy have occurred, all supportive of expanded advertising. Thus, the law continues to be restrictive but its application less so.

Advertising↗
PubMed2002

Cancer-related health policy: beyond the smoke and mirrors.

OBJECTIVE: To review the process of cancer-related health policy in the US. DATA SOURCES: Professional journals, texts, government and organization newsletters, and Internet websites. CONCLUSIONS: Health care and cancer-related health policy has been fraught with contention and ambiguity. Special interest groups of all sizes and causes interface with the legislative process to influence outcome at every level of policy development, implementation, and evaluation. Cancer-related health policy is formulated and actualized being influenced by competing interests, needs, and resources, which is an inherently political process. IMPLICATIONS FOR NURSING PRACTICE: A more complete understanding of this process will aid oncology nurses to participate more fully and more effectively in helping reduce the burden of cancer.

Health Policy↗
PubMed2005

Regulation of alcohol marketing: a global view.

The marketing of alcohol produces a new challenge for policy development internationally, in part because of the increase in the use of new, unmeasured technologies. Many of these new developments are, as yet, relatively invisible in the policy arena. New approaches in branding, the utilization of marketing opportunities via branded events and new products provide additional complexity to attempts to monitor and to restrict the impact of marketing on young people and other vulnerable groups. Current attempts to restrict marketing globally, which rely primarily on voluntary codes and focus on traditional media, are inadequate to these challenges. A new statutory framework is required to enable the monitoring and control of the full marketing mix in ways which match the sophistication of the marketing efforts themselves.

Alcoholic Beverages↗
PubMed1999

Does it really care? The Harvard report on health care reform for Hong Kong.

This paper aims to provide a rendition of the care ethic in Confucian philosophy and to argue that social policy developments in Hong Kong society, including health care policy, have been significantly shaped and justified in terms of the ideal of care in the Confucian moral tradition. On the basis of this analysis, the paper raises a number of questions about a recent proposal for health care reform for Hong Kong put forth by the Harvard School of Public Health which argues for adopting the principle of equity as the overriding value for the moral foundation of Hong Kong's health care system. The paper examines how the over-emphasis on equity in the Harvard Report proposals can lead to the erosion of care and ultimately the eclipse of the vision of care in Hong Kong's health care system. It argues that the pursuit of equity, which is itself a valuable principle, should not displace the importance of the value of care or undermine the ideal of care and that health care decisions must be firmly embedded in local cultures and moral traditions.

Advisory Committees↗
PubMed1989

Public health policy: maternal substance use and child health.

Maternal substance use and abuse is a public health issue. Much of what researchers have discovered in this field has been achieved through support of funds appropriated by Congress to the Public Health Service agencies and institutes whose mandates include stimulating and supporting this research in the scientific community. In this same vein the research institutes have a responsibility for disseminating new knowledge and encouraging its application in real-life settings. Individual freedom, social justice and public health relationships need to be carefully weighed by the architects of public policy. We elect those architects through our system of citizen participation in government. However, how to effectively incorporate the relevance of what has been learned about harmful effects of substance abuse into policy that will enable society to deal with emerging maternal and child health issues remains unresolved. Health-policy-relevant issues, as they impact the lives and well-being of our children, including the increasing number who are children of drug-abusing parents, are too important for politicians to ignore and too complex for health professionals to resolve alone. Participation by the research community in policy development is critical. It is clear that a policy of preventive intervention will need widespread public support. It will need to be feasible, effective and affordable in relation to other public demands. Society will ultimately need to make choices among those options that can be implemented and sustained in a political climate characterized by conflicting values.

Child↗
PubMed2001

Ecology. Giant pandas in a changing landscape.

The giant panda has been restricted to several disjunct montane forest populations, and habitat loss and fragmentation are the primary threats to its survival. For pandas to survive, conservation efforts must focus on larger landscapes rather than individual nature reserves. China recently initiated several policies, including the Natural Forest Conservation Program and Grain-to-Green Policy, which provide a historic opportunity to integrate panda conservation into national policies. Simultaneously, China is promoting the Western China Development Program, which calls for substantial infrastructure and hydropower development and economic investments. Integrating panda conservation into these development policies will be a critical challenge.

Animals↗
PubMed2002

"Agriculture at risk: A report to the nation"--a historical review, critical analysis, and implications for future planning.

"Agricultural at Risk: A Report to the Nation" is a proceedings document of a three-year (1987-1990) policy development process entitled "Agricultural Occupational and Environmental Health: Policy Strategies for the Future." That process culminated in the emergence of occupational health and safety in agriculture as a public health policy issue in the U.S. Several agricultural health and safety programs evolved as direct or indirect consequences of this process, including, but not limited to, the NIOSH agricultural occupational health programs, The Kellogg Foundation agricultural health grants programs, and the prospective chronic health studies of pesticides (EPA-NlH funded). The Agriculture at Risk report resulted in 86 specific recommendations. The authors of this article reviewed each of these recommendations and rated them on a subjective scale as to their degree of attainment. They found that 44% of the recommendations had received moderate to substantial action. Most of the positive action was in the areas of research and coalition building. A noticeable lack of action was in the areas of standards and regulation, occupational health service delivery, and education categories. This article concludes with an analysis of the limitations of the AAR report, changes in exposed populations over the past decade, and specific recommendations on future actions to address the issues.

Agriculture↗
PubMedDate not supplied

Progress in dietary behavior change.

Nutrition has important influences on health and mortality. Public response to current dietary guidance is indicated by positive movement on some indicators, notably reductions in calories from fat and in blood cholesterol levels. Downstream case finding and intensive educational and behavioral interventions are often effective for high risk and motivated subjects and for persons with diet-related disease. Midstream environmental changes (e.g., in grocery stores, schools) proffer improved nutritional choices and supports. Individualized dietary counseling has yet to become the norm. Despite recent upstream success in developing broad dietary guidance and improving nutrition labeling policies, numerous avenues remain open for aggressive national policy developments. Emerging studies and continuing improvement in intervention methods, measurement, and research design will help realize the preventive effects of healthful diets.

Behavior Therapy↗
PubMed2004

Growing controversy over "wise international water governance".

This article takes the perspective that when political relationships are strained, there seem to be few examples of wise international water resources governance. The Middle East is a striking example. Much effort has been put into policy development and the design of international principles, but very little into the translation of those into concrete and lasting governance. One of the theses of the article is that politics--whether domestic or international--in most cases overrides these principles and standards. Moreover readymade regional co-operation models of water managements are not directly applicable to every geographical, political, economic and social setting. Certain factors are often under-estimated in international water negotiations, such as: the complexity of any hydro-political negotiations, and need to develop commonly accepted standards; the difficulty of translating policy--either politically or legally--into an operational and realistic negotiations strategy; the format of the procedures and meetings; recognition that third parties should have a long-term perspective on any conflict they get involved in. With reservations, the lessons learned indicate that the following factors have an impact on grid locked situations, such as: new substantive information; new trade-offs between the parties; and changed political climate or relationship with external power-brokers.

Conflict, Psychological↗
PubMed2006

[Combating infectious disease using mathematical modelling].

When determining interventions against threatening infectious diseases such as HIV-infection, severe acute respiratory syndrome (SARS), smallpox and pandemic influenza, the use of mathematical models of the spread of infectious diseases is becoming increasingly popular. These models contribute to the structuring of the knowledge already available in various disciplines, to finding epidemiological connnections, to demonstrating lacunas within the pool of knowledge and to the comparison of the expected effects and costs of preventative and intervention measures. The use of models leads to a 'made-to-measure' analysis ofthe effects and costs of preventative and intervention measures which takes account of the specific characteristics of infectious diseases. The integration of knowledge from various disciplines can be supported by more research into the theoretical epidemiology of infectious disease and by better integration of mathematical models into policy development. The resulting and better foundations of this policy that are achieved by means of infectious disease modelling translate into more effective combating of infectious disease.

Cost-Benefit Analysis↗
PubMed1993

[Medical research in Portugal: the geniuses and the structures, the myths and common sense].

There was recently a growth in the funds allocated directly to scientific programs and projects and in particular to infrastructures (buildings and large pieces of equipment). It is very likely that this investment will continue to grow as a result of the development policies of the EEC applied to its less developed members. The recent experience with the Science Program, the main factor in this evolution, has demonstrated that the bottleneck in our scientific development is at the level of the allocation of funds (management). Hence, the nonrealistic Regulations of the Program, the allocation of funds to ghost institutions and the inability to distribute the funds allocated to the Program. The Program was conceived based on problem oriented and not on research oriented strategies. In the case of medical research this choice is not supported by the recent history of research in this area or by the experience of countries such as the UK or the USA. Funding of medical research in this country should be based on the identification of a talented scientist with a good research program and on an inventory of the productivity, potentialities and needs of existing institutions. We should seek the support of foreign scientists and of Portuguese scientists living abroad for the technical evaluation of projects but they should not be asked to provide global strategies of investment in Portuguese science.

Portugal↗
PubMed1998

The evolving duty to disclose the presence of genetic disease to relatives.

Under the aegis of the Human Genome Project, research laboratories are identifying the genetic bases of human diseases almost daily. This explosion in molecular biology has raised many medical-legal issues about genetic information, such as privacy, discrimination, and insurability. Less appreciated is another issue that faces physicians who deal with genetic information in their practices--their duty to disclose a genetic disease to relatives of their patients who have the disease. Few cases have addressed the issue directly, and there has been little statutory and policy development in this area. However, because a physician's diagnosis of a genetic disease could have such a profound impact on the patient's relatives, there is a developing duty to consider disclosing genetic information to relatives. The case law and policy that support such disclosure reflect the evolution of medicine and the law away from paternalism toward an expanded concept of legal and moral duty. Since genetic information is presumed to be confidential by the law, as is essentially all medical information, guidelines need be developed regarding a physician's duty to disclose a genetic disease to a patient's relatives. These guidelines should consider the patient, the genetic test, the disease, and the third-party relative. Disclosure should be considered for a disease that is serious or fatal, treatable or curable, and transmitted dominantly with high penetrance. Specifics notwithstanding, these policies should be developed by physicians who care for patients and their families, not by lawyers and ethicists with no clinical training.

Ethics, Medical↗
PubMed2003

Promoting mental health through employment and developing healthy workplaces: the potential of natural supports at work.

In England, policy developments in the field of mental health are stimulating interest in employment for mental health service users as a means of mental health promotion. To date, research that might assist in increasing employment rates amongst this group has focused largely on the question of which service users are most likely to benefit from vocational interventions and, more recently, on models of vocational support. Less is known about how employers can assist people in their transition or return to work. In this article we draw on the accounts of 17 employment project clients to identify workplace factors that were associated with job retention. Specific adjustments such as flexibility about working hours, work schedules and job tasks emerged as crucial in enabling clients to deal with the effects of medication, and to regain stamina and confidence. Over and above these, however, 'natural supports' of a kind from which any employee would arguably benefit were equally important. In this respect the main themes revolved around training and support to learn the job, supportive interpersonal relationships at work, workplace culture, and approaches to staff management. These themes might equally provide a productive focus for workplace health promotion more generally, using organization development approaches.

Employment↗
PubMed1991

Population density and development potential in rural Zimbabwe: an assessment based on the 1969 and 1982 censuses.

"Based on 1969 and 1982 census data, this paper examines the spatial association between high rural population density and development potential in Zimbabwe and its significance for national development policy. A 1982 grid cell density map was compiled on the same geographical frame as an existing 1969 density map, yielding an intercensal density change map. A land classification map and a composite map of development constraints were rasterized on the same spatial framework and subjected to computer analysis. Areas of critically high (and generally increasing) densities showed strong spatial associations with areas of severe development constraints...."

Africa↗
PubMed1983

The population geography of Hong Kong, 1949-1981.

"This paper attempts a comprehensive account of the changes in population of Hong Kong in 1949-81. It has given detailed treatment to the two major factors: migration and natural growth, that underly such changes. The spatial process of population is also examined against the government's post-war urban development policies."

Asia↗