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At least 631 records · Page 35Linked to original sources
PubMed1998

Factors affecting patient-physician communication for abused Latina and Asian immigrant women.

BACKGROUND: Domestic violence is one of today's most serious health issues. Abused Latina and Asian immigrant women face unique barriers to the discussion of abuse with health care providers. This research was undertaken to identify any provider-related factors that may affect patient-provider communication for these women. METHODS: Qualitative data were collected using semistructured focus group interviews with abused Latina and Asian immigrant women. Participants were recruited through urban community-based organizations. Twenty-eight immigrant women with histories of domestic violence participated in four focus groups: two groups of Latina women and two groups of Asian women. Iterative readings by independent researchers identified provider-related factors affecting patient-provider communication. RESULTS: The study participants identified the provider behaviors that demonstrate trust, compassion, and understanding as elements that improve patient-provider communication. In addition, participants wanted providers to initiate discussions about partner abuse. CONCLUSIONS: Improved understanding of factors that may affect abused immigrant patients' communication may assist health care providers in offering meaningful support and assistance to these patients. Providers, administrators, policy makers, and educators should consider these factors when developing policy, protocols, and educational curricula for a variety of health care settings.

Adolescent↗
PubMedDate not supplied

Prehospital do-not-resuscitate orders: a survey of state policies in the United States.

INTRODUCTION: Many states in the United States have developed policies that enable prehospital emergency medical services (EMS) providers to withhold cardiopulmonary resuscitation (CPR) in the terminally ill. Several states also have policies that enable the implementation of do-not-resuscitate (DNR) orders. OBJECTIVES: 1) assess which states have statutes governing DNR orders for the prehospital setting; 2) determine which states authorize DNR orders in ways other than by specific state statue; and 3) define those states that had regional protocols which address prehospital DNR orders. METHODS: Survey of the state EMS directors in each of the 50 U.S. states, the District of Columbia, and Puerto Rico. RESULTS: As of 1992, specific legislation authorizing the implementation of DNR orders was in place in 11 states. In addition, six others have a legal opinion or policy allowing the implementation of DNR orders. Fourteen additional states have either working groups or legislation pending that address prehospital DNR orders. In only five were there no existing regional protocols for implementation of DNR orders in the prehospital setting. CONCLUSIONS: There exists great variation in legal authorization by states for implementation of DNR orders in the prehospital setting. Despite the existence of enabling legislation, many state, regional, or local EMS systems have implemented policies dealing with DNR orders.

Emergency Medical Services↗
PubMed2004

An algorithmic computerised order entry approach to assist in the prescribing of new therapeutic agents: case study of activated protein C at an academic medical centre.

BACKGROUND: Academic medical centres face the need to care for patients with complex medical conditions, educate physicians-in-training and conduct research, all with increasingly constrained budgets. The adoption of new therapeutic technology presents challenges and opportunities in each of these areas. Severe sepsis remains a major cause of morbidity and mortality, especially in tertiary-care facilities. Recombinant human activated protein C reduces mortality in patients with severe sepsis, but trial data indicate that the benefit of the drug is confined to the more seriously ill patients, while the risk of bleeding complications can be considerable. The cost of the drug is approximately USD 6000-8000 per treated patient. Integration of this product into routine care has produced unique challenges concerning clinical decision making, safety and cost. OBJECTIVES: To describe one hospital's multidisciplinary approach to the adoption of this new medication. METHODS: Before activated protein C was approved for use, Brigham and Women's Hospital (BWH) convened a working group to formulate clinical guidelines proactively. This new agent did not fit into an obvious therapeutic category but cut across multiple clinical disciplines requiring the involvement of several hospital departments in developing policy. As new data on efficacy emerged during the US FDA review of the drug, the working group had to devise a method for using the available information to assist clinical decision making while placing appropriate restrictions on the use of activated protein C. The goal was to make accurate information available to guide ordering physicians' decision making interactively, 24 hours a day. RESULTS: The committee developed a utilisation policy for activated protein C that provided guidance on patient selection, contraindications and risk stratification. Interactive computer-based order entry screens were developed to guide physicians through a complex set of clinical criteria to ensure appropriate evidence-based use. A careful review of contraindications is required as a second step. To risk stratify patients in accordance with the trial subset analyses and the FDA labelling guidelines, ordering physicians are guided in calculating an APACHE II (Acute Physiology and Chronic Health Evaluation) score for the patient. Physicians from several specialties are available for advice and consultation on patients with difficult or controversial conditions. Approximately two-thirds of completed orders passed the clinical algorithm; an additional 35% of patients did not meet the medication criteria but received the drug after the attending physician requested an override of the guidelines. CONCLUSION: The BWH approach to activated protein C used an innovative multidisciplinary approach and computer-assisted order entry to guide clinical use of a new agent with substantial clinical efficacy, risks and costs. This approach provides a model for strategies to deal with other new and complex medical technologies.

Academic Medical Centers↗
PubMed2003

Policy decision options during the first 5 years following certification of polio eradication.

Policy makers face a number of difficult choices as they develop policies to ensure maintenance of a polio-free world following global eradication and certification. These policy decisions include choices about immunization, outbreak response (including whether to create a vaccine stockpile), surveillance, containment, management of chronic excretors, and investment in future research. This paper focuses on identifying the categories of decisions and characterizing the actual factors that country-level policy makers must weigh to manage polio risks during the first 5 years after certification. Building on a comprehensive literature review, we report the results of the first qualitative analysis to: (1) systematically characterize each type of decision and the relevant options during the first 5 years after certification, (2) clearly identify critical factors that influence the choices, and (3) specifically demonstrate the interdependence among the decisions to produce a reduced set of decision options. This paper explicitly focuses on the different perspectives of developed and developing countries in characterizing the options. While the management of polio risk in the postcertification period presents important challenges, this comprehensive approach helps simplify the process by focusing on critical decisions.

Developed Countries↗
PubMed1984

A proposed method for the analysis of public health policy in less developed countries.

The study of public health policy in the less developed countries (LDCs) is handicapped by both lack of adequate data and gaps in conceptual apparatus. A new conceptual model is proposed that would be used for future policy analyses to assess what changes in health status of populations in LDCs can be expected as direct functions of increased health service resources, and of improved environmental and econosociocultural conditions. While direct policy analysis is ill-advised at this time due to data inadequacy, the model is illustrated using data presently available for twenty-five relatively homogeneous sub-Sahara African countries. Within the limitations of available data, the findings suggest that reductions in mortality in the region might best be achieved by making appropriate health resources available to the populations. Study findings also suggest that physicians contributed more during the study period to the variance in physical health status than did medical assistants.

Africa↗
PubMed2006

Participation of children with dyslexia in compulsory education: current public policy issues.

The assessment and placement of children with dyslexia at appropriate schools has been regulated in the UK by a series of laws since 1944. Recent public policy developments such as the introduction of new duties and rights, and the development of law regarding educational negligence have sharpened the public policy debate on the effectiveness of these policies. This paper explores policy-related issues from an interdisciplinary perspective by outlining and discussing a sample of appellate legal cases regarding children with dyslexia. The provisions of these laws have shaped the actions of key stakeholders such as parents and councils. Similarly, the law on educational negligence has had a similar impact. Procedural rules of courts and tribunals have been equally important in restricting access to the courts by parents. Learning difficulty tests have further restricted their access. It is essential that provisions of the relevant Acts should be designed to enable these children to develop their academic and social skills in the same way as their non-dyslexic peers and to make the transition into employment and/or higher education successfully.

Child↗
PubMed1989

What drives British drug policies?

This paper identifies four broad types of influence which have contributed to the dynamics of British drug policy development over many decades: international influences, varieties of fear, professional entrepreneurship, and the perceived tension between treatment and control. A follow-through of these same themes to current policy concerns is traced. The need to develop a comparative and international framework for policy analysis is stressed. Policy research, it is argued, deserves to be given greater attention as the necessary means toward a more informed sense of feasibilities and policy options.

Health Policy↗
PubMed2004

A framework for the integration of ecosystem and human health in public policy: two case studies with infectious agents.

Despite that a significant body of published literature exists in the complex area of interconnection among the environment, ecosystems, and human activity, relatively little attention has been paid to the integration and analysis of ecological and human health data in the form of a conceptual model. Human and ecological health protection generally have been treated as separate domains of policy, with significant differences in both the analytic methods used to characterize risks and the policies developed for risk reduction. Understanding the relationships among population growth, development, natural resource use, the environment, human health, and ecosystems is an important area of both scientific inquiry and environmental policy. The present paper focuses on the development of a conceptual model for understanding disease causation, particularly infectious disease, and the implications of such a model for public policy. The conceptual model incorporates ecological and human health risk assessment information applied to case studies of two infectious diseases. This article takes an initial step toward formalizing the conceptual model so that research and assessment procedures can be developed.

Agriculture↗
PubMed1998

Emergency departments and abuse: policy issues, practice barriers, and recommendations.

The abuse of women has reached epidemic proportions. There are an estimated 12 million abused women in the United States. Reported cases of abuse, however, range from 2 to 4 million. Less than 15% of these women ever seek medical care. Of women who do seek care, an estimated 75% use the emergency department, often presenting with complaints not readily suggestive of abuse. Reports indicate, however, that emergency departments consistently identify less than 10% of all abuse cases. In 1991 and 1992, the Joint Commission on Accreditation of Healthcare Organizations established standards for emergency departments to develop policies and procedures for the identification, treatment, and referral of female and elderly victims of abuse. Virtually all emergency medicine professional societies have official policies to encourage development of protocols for abuse identification and management. The American Medical Association and the Department of Health and Human Services have likewise developed guidelines to help emergency departments achieve these national health care objectives. Currently, less than 50% of all emergency departments have established algorithms to address abused women who present to the emergency department for treatment. This article reviews current health policy, examines the impediments to the detection of abuse in the emergency department, and recommends mechanisms to enhance the awareness of abuse among emergency department personnel.

Emergency Service, Hospital↗
PubMed2000

From kidnapping to corruption: some trials and tribulations in the implementation of rapid assessment studies.

In between the description of the methodology and the discussion of assessment results, lies a crucial area, namely that of implementation. If assessment methods cannot be implemented, there will be no assessment report, and no recommendations for intervention or policy development. Implementation is a critical, yet neglected, area of drug policy delivery. This paper describes some of the problems associated with the implementation of rapid assessment studies commissioned by the United Nations International Drug Control Programme (UNDCP) over the last 5 years. Drawing on the author's experience of commissioning rapid assessments on the extent and nature of drug use in a variety of international settings and political contexts, the paper draws eight main lessons for rapid assessments commissioned within the context of international development programmes. These are: (1) the need to get high level political support; (2) the need to employ competent social scientists to run the assessment; (3) the need to define exactly the object of the assessment; (4) the necessity of spelling out the methodology and the time scale; (5) the careful establishment of the financial framework; (6) the importance of cultivating contacts; (7) the necessity of actually getting a report; and (8) the danger of accepting an unseen or unread consultant's report as the basis for programme implementation. The paper emphasises the critical importance of planning prior to implementation and flexibility during it.

Journal Article↗
PubMed1990

Avoiding negligent release: contemporary clinical and risk management strategies.

Mental health professionals often must decide whether to release a psychiatric patient who has been committed for treatment on the basis of being mentally ill and dangerous. This decision involves liability risks if the patient becomes violent after release. The author draws together several recommendations made in the literature regarding the careful development and implementation of hospital release procedures, including 1) special consultation at the policy development stage, 2) preemptive judgments regarding the adequacy of hospital policies in relation to the professional standard of care, and 3) the use of videotaped exit interviews with patients at the time of their release.

Commitment of Persons with Psychiatric Disorders↗
PubMed2002

Primary care groups and trusts: a threat or an opportunity for the development of community-based nursing in England.

AIMS OF THE STUDY: To examine the role of Primary Care Groups and Trusts (PCG/T) in relation to nurses working in general practice and community health services. BACKGROUND: Over the past two decades there have been rapid changes in the numbers and roles of nurses working in primary care and community based settings. The establishment of Primary Care Groups offers health care professionals, including nurses, the chance to develop local primary care services and to integrate community and primary care nursing. These developments may offer opportunities or pose threats to nursing staff. RESEARCH METHODS: Data are drawn from a longitudinal study of a randomly selected sample of Primary Care Groups in England (n = 72). In a second survey of Groups carried out in autumn/winter 2000, Primary Care Group chairs and chief officers were interviewed by telephone. RESULTS: Response rates were 97% for both chairs and chief officers (69 of each). Chairs indicated that in most areas Primary Care Groups were consulting with local nurses to develop policy. Fifty-seven (85%) reported that investment in nursing staff and nursing services was a high priority in their area. Twenty-eight (41%) indicated that nurse-led services designed to increase patient access had already been established in their area, and 20 (29%) were planning new nurse-led services. Many developments had been initiated by Primary Care Groups. Initiatives to integrate community and general practice based staff were underway in most areas. CONCLUSIONS: Primary Care Groups and Trusts are initiating changes in general practice and community based services which are likely to have long-term and important implications for nurses in terms of their roles, conditions of work and future careers. It is important that nurses are consulted and are involved in developing and implementing policy change.

Community Health Nursing↗
PubMed2005

A rapid assessment of community-wide HIV/STI intervention in China.

BACKGROUND/OBJECTIVES: The key to HIV/STI control is community-wide intervention (CWI) which depends heavily on continuous monitoring and evaluation. Unfortunately, comprehensive CWI assessment methodology and reports are generally lacking. This study developed, applied, and evaluated a rapid tool for assessing CWI in China. METHODS: A total of 120 county level respondents in charge of county-wide responses to HIV/STI throughout China were selected randomly and surveyed using a structured inventory consisting of three tiers of indicators developed via consensus group techniques. The respondents were asked to rate each of the indicators against a five grade (1-5) scale. 30 pairs of the same staff from within Anhui Province were surveyed to gauge inter-rater reliability. RESULTS: Response rate for the nationwide survey was 85% and for inter-rater reliability survey, 90%. Correlation coefficients between the inter-rater ratings ranged from 0.68 to 0.95. The overall average rating of CWI in China was 2.85. Average ratings for the six first tier indicators, organisation and policy development, goals and objectives setting, project and action planning, resource exploitation, project and task implementation, and CWI evaluation were 2.87, 2.83, 2.67, 2.77, 3.26, and 2.71 respectively. Ratings derived for the 24 second tier indicators ranged from 2.1 to 3.86; while for the 96 third tier indicators, 1.90 to 4.40 CONCLUSIONS: The instrument developed proved to be reliable, useful, and easily applicable in common communities. Application of it in China revealed that a large gap exists between desired and actual CWI, and areas meriting particular attention include policy and incentives development, intervention planning and evaluation, and fund raising and utilisation.

China↗
PubMedDate not supplied

International developments in health policy: forces driving change.

A conference entitled "International Developments in Health Policy: Forces Driving Change' was held at the Royal College of Physicians, London on 12 July 1996. The aim of this conference was to examine factors currently making an impact upon health care delivery in the United Kingdom and the USA, in the light of the common need for cost containment within each of these health care systems. This meeting was organised as a follow-on to a conference held at the College in 1994 entitled "International Developments in Health Care: A Review of Health Systems in the 1990s', which has been previously reported in the Journal and published as proceedings by the Royal College of Physicians.

Cost Control↗
PubMed2001

Ethical research issues: going beyond the Declaration of Helsinki.

La Vaque and Rossiter made a strong, supported argument that it is unethical to use a "no treatment" control group in a research study if a known, effective treatment is available. Their argument is based on the supposition that the Declaration of Helsinki is the ethical world standard for research with humans. Their argument appears to be straightforward, but is not simple to apply. The issues are very complex, include issues not discussed in their argument, and can lead to a different conclusion as pointed out in this paper. The World Medical Association developed the Declaration of Helsinki as one of their official policies. The Declaration of Helsinki, however, is not accepted as the world ethical standard, as demonstrated by its lack of adoption by many professional associations or even by the United States Federal Government. Perhaps it is not mentioned because its ethical provisions are aspirational rather than mandatory as implied by La Vaque and Rossiter. Researchers and clinicians should also be aware of other ethical issues not directly discussed in the La Vaque and Rossiter paper. The Belmont Report is the basis for the ethical protection of human research subjects for at least 17 federal agencies and does not mention the Declaration of Helsinki. The Belmont Report mentions several ethical principles that form the basis for informed consent, risk/benefit assessment, confidentiality of data, subject selection, Institutional Review Boards, and other protections needed when doing research with human subjects. At least 2 of these core principles have direct implications to the discussion related to the use of placebo controls. The ethical principle of fidelity is also important in guiding research activities with human subjects. Researchers should be familiar with the La Vaque and Rossiter argument, the Belmont Report, and the federal policies developed to implement the provisions of that report, for example, Regulation 45 CFR 46.

Ethics↗
PubMed1991

Limiting resuscitation: emerging policy in the emergency medical system.

Patients, families, and physicians frequently decide that a hospitalized patient will forgo cardiopulmonary resuscitation and document this decision with a do-not-resuscitate (DNR) order. In community settings (home, nursing home, hospice), these orders may conflict with paramedics' standing orders to provide cardiopulmonary resuscitation whenever it is medically indicated. We did a nationwide telephone survey of state offices for coordination of emergency medical services (EMS) to see how the states deal with this potential conflict. We identified eight states that have specific policies enabling EMS personnel to accept DNR orders for patients being transported by ambulance. State officials identified administrative complexities and legal concerns as the primary barriers to enacting prehospitalization DNR policies. We also identified 21 local EMS systems that have developed policies for accepting orders to withhold life-sustaining treatment. Four types of policy models, characterized according to procedure for validating DNR orders and telephone accessing the EMS system, show that regulatory reform can address policy barriers in the absence of enabling legislation.

Attitude of Health Personnel↗
PubMedDate not supplied

The qualities and skills of practice developers.

AIM: To explore and describe the activities and approaches that constitute practice development by providing an insight into the qualities and skills exhibited by staff in practice development roles. METHOD: This involved examining 177 articles, plus data collected during focus group interviews with 60 staff around the UK and telephone interviews with 25 clinical staff. The focus groups and telephone interviews formed part of an earlier published study Garbett and McCormack (2002). RESULTS: A range of skills and qualities were highlighted. These include being effective, having vision, being motivated, empathic, experiential, cognitive political, communicative, facilitative and possessing clinical skills. CONCLUSION: The work of practice developers is of central importance in the light of NHS policy developments, such as the NHS Plan or the response to the Bristol inquiry.

Focus Groups↗
PubMedDate not supplied

The shape of public health policy: the Australian experience.

Public health policy is shaped by many factors. A brief historical reflection is given on policy development in Australia to illustrate the various influences on health policy. Medical technology; ethical trade-offs; environmental, social, and political imperatives; popular movements; and changing patterns of disease; as well as market forces have helped to shape Australian contemporary public health policy. These multiple and often competing forces, however, can work against individual consumer choice in health care decisions. This article demonstrates through the eyes of history the factors that shape public health policy. As Australia has a short history compared to most industrialized democratic societies and can be viewed as a microcosm, it is used as the exemplar.

Australia↗