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PubMed1998

Uses of oral health related quality of life measures in Public Health.

OBJECTIVE: The purpose of this paper was to review the current status of oral health related quality of life (OHRQoL) measures from a dental public health perspective. METHOD: Three questions are posed. (1) What additional work is needed in the development or application of quality of life measures? (2) How can existing quality of life measures be used most effectively now? (3) Can existing data be used for secondary analyses of 'generic questions' concerning the relationships between oral health care and quality of life outcomes? In answering these questions, methodological issues are discussed, existing sources of data are described, and recommendations are suggested for future directions. CONCLUSIONS: Current measures can be used for assessment of oral health impacts in adults, and to a lesser extent, for policy development. Other measures need to be developed that are relevant for children and their families, and for disease prevention and health promotion programmes. Continued psychometric analyses are needed to provide short, valid and reliable instruments that can be easily administered in public health settings. Longitudinal studies are needed to determine if the OHRQoL measures are responsive to access to dental care, different types of care including early diagnosis and treatment, and completion of care. The extensive array of existing measures need to be compared, equivalency of scores determined, and recommendations made for the appropriateness of their use in different circumstances and for different purposes.

Adult↗
PubMed2001

Preventing and resolving ethical conflicts: more help for policy makers.

Institutional policy makers have a useful resource in the "Joint Statement on Preventing and Resolving Ethical Conflicts Involving Healthcare Providers and Persons Receiving Care". Yet, some aspects of the joint statement pose challenges for institutional policy development and merit further reflection. With the aim of clarifying and augmenting the recommendations in the joint statement, this paper gives additional guidance on the issues of benefit, power imbalance, and legitimate decisional authority.

Canada↗
PubMed1988

Implications of an aging population.

The aging of the New Zealand population means there will be a continuing need for research into all aspects of gerontology. The Medical Research Council of New Zealand has recognised this need and for a number of years aging and health care of the elderly have been priority areas. Research workers are now recognising the attractiveness of the field. Many of the developments in the basic sciences have particular application in the study of aging. Knowledge is increasing rapidly with the development of world wide research programmes. The emphasis in research is no longer on the documentation of decremental change with age but on the teasing out of those external factors contributing to decline in function and which may be amenable to intervention. There is a need to coordinate the research efforts in gerontology. A national foundation or trust concerned with the health of elderly people would be of considerable benefit in this coordination, in linking research and policy development and in education, advocacy and fund raising.

Aged↗
PubMedDate not supplied

Workplace violence and corporate policy for health care settings.

Incidents of workplace violence have been of significant concern to health care employers and the public at large. Many employers now find themselves confronted with sentinel events in the workplace, such as assault; property damage; racially, ethnically, or religiously motivated violence; sexual assault; employee suicide; or homicide. Regardless of a health care agency's size or mission, when employees are unexpectedly confronted with workplace violence, they are typically overwhelmed with shock and multiple questions surrounding how the event could have occurred in the safety of the workplace. It is difficult to imagine returning to work only minutes after hearing such news and, yet, in this modern era of corporate health care, this is what usually happens. Awareness of the dynamics and issues related to workplace violence can guide policy development and related interventions to promote safety, stability, and provide a platform for adapting to the devastation of such a disturbing event.

Adaptation, Psychological↗
PubMed1993

Consequences of rapid fertility decline in the Republic of Korea: issues and solutions.

During the last 3 decades, efforts to deal with population problems in Korea have focused largely on reducing population growth. The national population control program has been a major means of achieving this goal. Between the early 1960s and 1990, evidence from a national survey indicates that the percent of current use of contraception rose from about 12% to 80% and the total fertility rate fell to 1.6. representing 1 of the most rapid fertility transitions in the developing world. In conjunction with this rapid reduction in fertility, mortality also improved significantly during this period. Thus, Korea has virtually completed the demographic transition from high birth and death rates to low birth and death rates during the same period. It is widely recognized that Korea has reached demographic maturity and has also achieved remarkable economic development at the same time. The world's demographic history shows that the demographic transition which almost every industrialized country has gone through from a predominantly rural, illiterate society with high birth and death rates, to a predominantly rural, illiterate society with high birth and death rates, to a predominantly urban, educated society with low birth and death rates usually takes well over a century, but in Korea, that process has taken only a few decades. On the other hand, the consequences of a rapid fertility decline bring about various demographic and social issues which we have to take into consideration for future socioeconomic development policy concerning the well-being of the Korean people. Some of issues for policy consideration can be broadly summarized as follows: 1) gradual imbalance of sex ratio at birth due to traditional son preference behavior; 2) latent effect of inevitable population aging and increasing dependency burden on behalf of the elderly for the public sector; 3) changes in family life cycle and rapid transformation form a large to a small family; 4) increasing demand for now social roles for women, supported by easing of child care burdens within households.

Asia↗
PubMed1985

Health policy and the emerging tobacco reality.

Public policy is part of and a creator of modern environments. By intent or neglect, it affects our socially-created and natural worlds. It sets the odds for what organizations and individuals are likely to produce and consume in the form of goods, services and information, and assures how equitably these options for choice-making--and thus for life styles--are dispersed among social and economic groups. Policy is also created by environments: it is influenced by the reality of changing conditions and by the perceptions of those changes by groups who are organized to influence policymakers' views of 'reality'. The direction, humaneness and healthfulness of societal changes--to the extent that they can be guided--depend on whether new and old things are seen by policymakers in new or old ways. Creating environments conducive to health thus requires a two-pronged effort. It means: (1) developing policies that provide incentives to producers and consumers to make more healthful choices than they do today; and (2) creating a social and political climate that will encourage policymakers to choose more healthful policy options. This view point is illustrated here through an analysis of the smoking and health issue, in which changing conditions can potentially be healthfully guided, or alternatively, left to the vagaries of political and economic events. This article outlines the changing economics of tobacco, mainly as seen in its largest form in the U.S.A., its policy implications, and a political strategy to move policy in more healthful directions. Economic data reveal the tobacco sector in affluent nations as one that has been slowly declining, but now at an accelerating rate. At the same time, the tobacco economy is a growing sector in less-industrialized nations. Policy issues involve how to deal with the economic changes in health-promoting ways. Strategically this requires two simultaneous efforts. One is education/informational: posing the smoking/health issue in light of changing conditions, and addressing policy-relevant data (both economic and value-oriented) to the gatekeepers of public action and information (e.g. policymakers and media). The second is environmental/organizational, to improve the feasibility of policy changes by establishing means for transition planning in the tobacco economy.

Cross-Cultural Comparison↗
PubMedDate not supplied

Turning point and public health institutes: vehicles for systems change.

Public Health Institutes are free-standing multisector entities able to function as conveners to improve health status and foster innovations in health systems. Turning Point is a program funded by The Robert Wood Johnson Foundation, involving 21 statewide initiatives and 2 "linked" states that formed multisector collaborative partnerships for public health systems change. In 18 of the Turning Point states, there are also Public Health Institutes, some formed by Turning Point partnerships and some established independently. Both Turning Point and Public Health Institutes represent efforts to reform and enhance public health systems. What has been the relationship between these two organizational forms? This descriptive, qualitative study examined the relationships between state-level Turning Point partnerships and Public Health Institutes in states that have both. Key participants in both institutions were interviewed, and models were developed to represent those relationships. Principal findings suggest that the relationships of Turning Point state partnerships with Public Health Institutes have taken many shapes. Factors that influence the choices and sequencing of these options are largely related to the political and economic resources of each state. Turning Point participants perceived Public Health Institutes to be a useful organizational form for sustaining public health systems change. Public Health Institutes have more administrative and fiscal flexibility than state government and greater opportunities for policy development and advocacy. However, free-standing institutes also have greater financial uncertainty.

Academies and Institutes↗
PubMed1993

Managed care for preventive services: a review of policy options.

In summary, the managed care system we propose for preventive services is designed to limit the potential for overcare under FFS payment and for undercare under capitation and comprehensive fixed fees. It bases payment on the provision of a complete set of preventive services, thus limiting the tendency of physicians to provide only the relatively high-profit services, such as screening tests, while neglecting the lower-profit services, such as counseling. It also allows primary care providers to outsource selected services to lower-cost providers, such as laboratories, health educators, and counselors, and community-based health promotion programs, thus encouraging greater efficiency. In addition, the proposed system funds both primary and high-risk preventive case management to ensure that individuals receive preventive services appropriate to their age, sex, and risk factors. Finally, the proposed system monitors the use of preventive services, relying on physician reminders to stimulate the appropriate provision of preventive care and denying payment for unauthorized care. Existing research suggests that none of the individual strategies for managed care can be expected to achieve all of the goals of managing and promoting the appropriate use of preventive services as defined by the U.S. Preventive Services Task Force (1989). To be most effective, we conclude that the strategies need to be coordinated and integrated into the current health care delivery practices of HMOs, PPOs, and point-of-service plans. In addition, the strategies require additional provider training in preventive care. With this support, the proposed model has the potential to improve quality, control costs, and increase the appropriate use of preventive care. While many of the individual components of the proposed managed care model have been evaluated for preventive services, a great deal more research is needed to evaluate the effect of combining these elements into a coordinated and comprehensive approach to managing preventive care. Research is also needed on workable ways to invite people not currently receiving medical care into the health care system to receive preventive care. To inform policy development, the impact of the proposed managed care model--both on preventive services utilization for specific screening, immunization, and counseling services, and on total health care costs and patient health status outcomes--needs to be evaluated.

Cost Sharing↗
PubMed1996

Clinical mycobacteriology. Activities and recommendations by the association of state and territorial public health laboratory directors.

By using the assessment, policy development, and assurance model to describe the functions of public health, the Association of State and Territorial Public Health Laboratory Directors (ASTPHLD) is shown to be responding to the laboratory aspects of tuberculosis detection, prevention, and control. The many activities described illustrate the value of public-private partnerships in addressing population-based, public health threats. The network of state and territorial public health laboratories, through voluntary involvement in ASTPHLD, provides an important resource to the scientific, educational, and policy-making community.

Bacteriology↗
PubMed2005

Recent developments in targeting access to high cost medicines in Australia.

BACKGROUND: In Australia, the Pharmaceutical Benefits Scheme (PBS) has developed a set of arrangements to control access to high-cost medicines to ensure their use is cost-effective. These medicines include the tumour necrosis factor-alpha inhibitors (TNFIs) for the treatment of rheumatoid arthritis. The aim of this first phase of a qualitative study was to explore basic views on the restricted access to TNFIs in order to confirm where further investigation should take place in the next phase. METHODS: Semi-structured interviews were conducted in 2004 with a member of the four relevant stakeholder groups. Participants were asked their opinions about features of the establishment, process and effects of the system of restricted access to TNFIs. Views on the collaboration between stakeholder groups in the decision-making process were also collected. RESULTS: The principle of 'controlled access' to TNFIs was supported in general. There were concerns regarding some of the specific eligibility criteria. Wider and more transparent stakeholder consultation was judged desirable. Some flexibility around prescribing of TNFIs by physicians, and regular review of the arrangements were proposed. These themes will inform the next phase of the study. CONCLUSION: This first phase highlighted a range of issues associated with the PBS arrangements restricting access to TNFIs. Timely review and report of issues and concerns associated with such policy developments that arose in practice are essential. There is a need for a more comprehensive exploration across a wide range of stakeholders with different perspectives that will in turn be helpful in guiding policy and practice around national arrangements to manage access to high-cost medicines.

Journal Article↗
PubMed2000

Development of a pharmacy residency program in home care.

A residency training program developed by a college of pharmacy in conjunction with a home care company is described. The 12-month program is based on the ASHP Residency Learning System and the goal statements and educational objectives of ASHP's accreditation standard for pharmacy practice residency training with emphasis in home care. Establishing the program involved identifying goals, objectives, and learning experiences consistent with the expected outcomes. Specific objectives for meeting goals in four categories--practice foundation skills, direct patient care, drug information and drug policy development, and practice management--were linked to expected program outcomes. Learning experiences that would lead to achievement of the program objectives and outcomes were selected and organized into one- to eight-week rotations (e.g., in acute care, care of pediatric patients, pain management, nutrition, patient education and counseling, and administration and practice management). Throughout the program, residents gain experience in pharmaceutical services and research. Skills in care planning and monitoring are emphasized, as is practicing pharmaceutical care in an interdisciplinary environment. Residents who have completed the program have found employment immediately as pharmacy managers of home infusion centers. Pharmacy residency training in home care provides the experience needed to function as a competent clinician and manager who can identify and solve problems to improve patient care.

Education, Pharmacy↗
PubMedDate not supplied

Must consent always be obtained for a do-not-resuscitate order?

Using cardiopulmonary resuscitation for cardiac or respiratory arrest unless there is an explicit do-not-resuscitate order is a policy adopted by all hospitals. Such a policy usually requires the patient's (or surrogate's) consent for a do-not-resuscitate order to be instituted. This article, however, presents the argument that consent need not always be obtained. In the case discussed, the well-being of the patient, other patients, and the health care providers all support a unilateral decision by the physician not to attempt resuscitation at the time of death. The medical community and society need to acknowledge that such cases exist and to develop policies that respect not only the interests of patients but also those of health care providers and society.

Adult↗
PubMed2000

Genetic technologies and achieving health for populations.

The remarkable progress in genetics over the last 50 years has led to the development of genetic technologies to identify or alter genes in living organisms, and these technologies can be applied to people. This article presents background information on the role of genetics in human disease, outlines the technologies, and discusses the sources of the strong push for a genetic approach to ill-health and some implications and harmful consequences of using these genetic technologies. The determinants of most diseases are complex and are embedded in a social context. To focus on only one strand of this web--the genetic strand--because it is one that may be amenable to biological/pharmaceutical treatment, although profitable for industry, does not address other important determinants of health and may lead to a harmful overemphasis on genetic approaches. The author outlines some limitations to the potential contribution of genetic technologies to population health across the globe and the need for policy development if these technologies are to have an appropriate place in health care.

Adult↗
PubMed1999

Knowledge of laws regulating issues related to HIV and AIDS: development of the HIV/AIDS and the law scale.

42 middle-aged and older adults, ranging in age from 51 to 85 years, completed 10 items dealing with the assessment of knowledge regarding laws regulating issues related to HIV and AIDS. Participants also completed 40 items involving knowledge of risks for HIV infection. The Cronbach coefficient alpha and test-retest reliability coefficient on the HIV/AIDS and the Law Scale were .74 and .83, respectively. Over-all, the grand mean for correct answers was 46.9%, whereas the grand means for incorrect answers and "don't know" responses were 13.6% and 39.5%, suggesting substantial lack of knowledge of laws regulating issues related to HIV and AIDS. Women (50%) and younger participants (51 to 66 years old; 48.2%) showed more of this knowledge (50%) than men (43.0%) and older participants (46.2%). The sample reported a substantial amount of knowledge regarding HIV transmission assessed with factual (92.2% correct) and misconception (87.5% correct) items. The correlation between this knowledge and knowledge of laws regulating issues related to HIV and AIDS was .42 (p < .01). Research with this scale using adolescents and young adults as well as the utility of the scale in areas of clinical, legal, and policy development are discussed.

AIDS Serodiagnosis↗
PubMed1984

Training of personnel for infection control.

The overall objectives for implementing an infection control program are to make hospital personnel aware of nosocomial infections and to educate these persons in their role in decreasing the risk of these infections. The infection control practitioner (ICP) implements these objectives by performing surveillance to determine problem areas and by developing policies and procedures that prevent and control nosocomial infections. Appropriate qualities for an ICP include initiative, leadership, communication skills, commitment, and charisma. Expertise in patient care practices, aseptic principles, sterilization practices, education, research, epidemiology, microbiology, infectious diseases, and psychology are acquired skills. Local, state, and national organizations, as well as universities, are responsible for ICP training, In the US the Centers for Disease Control have established a training program for the beginning ICP and the Association of Practitioners in Infection Control (APIC) has developed a study guide for developing infection control skills. The ultimate responsibility for education is an individual obligation, however. Certification of the ICP would insure a minimum level of knowledge, thereby standardizing and upgrading the practice of infection control.

Asepsis↗
PubMed1998

Remote area health service delivery in central Australia: primary health care and participatory management.

This paper provides a description of initiatives and changes made in remote primary healthcare service delivery in Central Australia. These changes included the introduction of an orientation and Aboriginal cultural awareness program, revising the recruitment process to include communities in staff selection, developing policies and protocols to support practice, and increasing support for remote area staff through managers being out and about in remote areas. The change from centralised management to an increasingly decentralised participatory management model, and involving local communities and local staff in decision making, was initiated early in the change process and continues to be of prime importance. After 5 years of intensive effort, it is clear that despite these initiatives sustainable change has been elusive and some problems remain. Further change and development is necessary. A number of new initiatives are described, including a Menzies School of Health Research project that examines structural issues, which will provide direction for the future by providing better support for remote area staff and facilitating greater community participation.

Community Participation↗
PubMed1995

The role of research in systems reform.

Knowledge concerning the care of people with severe and persistent mental illness has grown dramatically, but that knowledge is seldom translated into improvements in care. The authors describe their involvement in three service delivery projects in Ontario and discuss how, by assuming multiple roles, they were able to ensure that planning and policy development were informed by current knowledge. In addition to being an investigator, such roles may include being an administrator, planner, consultant and advocate. The redevelopment of Whitby Psychiatric Hospital resulted in an innovative plan for a comprehensive, integrated service delivery system based upon community support services research. Implementation of the Graham Report in Ontario provided an array of district mental health plans which incorporate current knowledge with regard to service delivery. Ontario's mental health reform strategy represents a close connection between public policy and scientific information. The authors recommend that researchers be prepared to assume multiple roles in the service delivery field so as to reduce the gap between science and practice.

Comprehensive Health Care↗