Seventy-seventh session of the WHO Executive Board. Highlights of the Executive Board.
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Acquired Immunodeficiency Syndrome↗
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Results for “Health Plan Implementation”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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The integration of public health in hospitals: the case of community health departments in Quebec.
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Community Health Centers↗
Impediments to policy implementation: the offer of free installation of central heating to an elderly community has limited uptake.
OBJECTIVES: Increasing the warmth of homes in the UK to combat excess winter mortality has become an important part of public policy. This study examined the success of a local initiative to provide free installation of central heating for a group of elderly people. STUDY DESIGN: Cohort study. METHODS: The uptake of the offer of central heating was monitored through its different stages. Where possible, comments were invited from the elderly tenants to whom the offer was made; a sub-sample was interviewed about their views. RESULTS: Of 1181 tenants approached, only around one-quarter finally received central heating within the year. Reasons for the low uptake included inaccuracies in estimating those eligible as well as tenants' worries over upheaval and mess, health concerns and fear of increased heating costs. CONCLUSION: Successful policy implementation requires not only command of appropriate financial resources and the backing of local 'implementers', but also the local resources with which the policy will engage, especially local knowledge, and the 'targets' of the policy initiative, in this case the elderly tenants.
Aged↗
The conception of community children's nursing services in Northern Ireland.
This report is an exploration of the implications of establishing a community children's nursing service in Northern Ireland. It provides a description of the backdrop to the development of the service in the United Kingdom, and the experiences of children's nurses in attempting to upgrade the quality of care offered to sick children in this province. The frustrations that have characterized this development are explored in detail within the context of broader changes in health care on the national scene. The article ends with recommendations for implementing an effective service, following our experiences in Northern Ireland.
Adolescent↗
Nationwide implementation of guided supermarket tours in The Netherlands: a dissemination study.
The purpose of this study was to assess adoption, implementation and maintenance of a guided supermarket tour program of nutrition education by Dutch Public Health Services (PHSs), and the factors associated with program dissemination. A first questionnaire was sent to all 60 PHSs, and measured program adoption, perceived program attributes, and characteristics of the adopting organization and person. A second questionnaire was only sent to adopting PHSs, and measured extent and success of implementation, intentions to continue the program, and characteristics of the main implementing person. Of the 59 PHSs who responded, 30 adopted the program and 17 implemented it sufficiently. Perceived program complexity, social influence within the PHS toward program participation and existence of a separate health education department were predictors of adoption. Perceived program complexity was also a predictor of extent of implementation. The number of health educators within each PHS was a predictor of sufficient implementation. It was concluded that adoption and implementation of the program was reasonable, considering the limited dissemination strategy. Dissemination might have been more successful if the program had been less complex and required less effort, if positive social influence had been generated, and if specific attention had been given to PHSs without a separate health education department.
Attitude of Health Personnel↗
Problems and perspectives of managing an onchocerciasis control programme: a case study from Plateau state, Nigeria.
The onchocerciasis control programme in Plateau state (now Plateau and Nasarawa states), Nigeria, was one of the pioneering Mectizan-distribution projects in Nigeria. Although initiated under the River Blindness Foundation (RBF) in 1991, in collaboration with the Ministry of Health, it was absorbed into the Carter Center's Global 2000 River Blindness Programme (GRBP) in 1996. The objectives of the programme were to support the delivery of Mectizan (ivermectin, MSD) to at least 80% of those living in communities where onchocerciasis was highly endemic, within the first 3 years of the project's inception, and to maintain this coverage for a period of 10-15 years. The programme has so far been successful, and much of this success is attributed to problem identification and problem-solving through continuous review and evaluation of programme activities, and implementation of strategies, when required, to ensure those programme objectives are met. The implementation steps of the programme, and some of the managerial problems identified during the course of the effort, are reviewed. The challenge now is to learn how to transform this functional, programme-designed and programme-directed effort into the new community-directed treatment being promoted by the African Programme for Onchocerciasis Control. The new challenges of the transition require middle-level managers and implementors with effective, efficient and indeed state-of-the-art management skills.
Filaricides↗
[Participatory action-research in the development of health policies for Izumo City, Japan].
The method of participatory action-research has been introduced in planning and implementing health and welfare projects for the elderly in Izumo City since 1993. Public health researchers have participated in the projects with other related administrative sectors, citizen and non-profit organizations. This study analyzes the establishment and implementation of health policies of Izumo from the following five aspects: policy-making, priority, education, intersectoral cooperation and community development. The participatory action-research method was useful for developing the ability of health-staff to work with citizens; for integrating community care and community development; for using community resources effectively for primary health care; and for developing community-based education of citizens, medical students and health staff. This method can be and should be adopted for strengthening the policy-making ability of public health researchers who learn through cooperation with citizens and non-profit organizations.
Community Participation↗
The future is now: implementation of a tele-intensivist program.
Based on overwhelming scientific evidence, The Leapfrog Group focused on 3 practices that have tremendous potential to save lives by reducing preventable mistakes in hospitals. The authors describe these practices and how they served as a driving force to create a "virtual ICU" within a Magnet hospital network. The effort combined services of a board-certified intensivist and technological advancements in telemedicine to ensure the delivery of high-quality care to all critically ill patients throughout the network. A computerized physician-order entry system, an electronic medication administration record, an electronic documentation system, and a remote ICU were the 4 programmatic phases necessary to realize the concept. The purpose of this article is to describe the process of planning and implementing the tele-intensivist program.
Critical Care↗
Difficulties in moving routine medical checks from the specialist level to the general practitioner level.
We began a project to move routine medical checks for appropriate patients from the specialist level to the patient's normal general practitioner (GP). The GP's analysis and conclusions would be checked by the specialist, using electronic messaging. The idea for the project came from the top level of the regional health authority. Despite that, the project was closed down before pilot testing began. We used stakeholder theory as a post-project evaluation to analyse what happened and where it went wrong. A common mistake in project planning is to focus the planning effort on system tasks and not to pay attention to a well-thought-out handling of the project's stakeholders. This was what happened in our project. Ideal objectives and good political intentions are not enough to implement a new e-health service.
Delivery of Health Care↗
Implementing research findings into practice: improving and developing services for women with serious and enduring mental health problems.
This paper discusses the process that is currently being undertaken to improve and develop services for women with serious and enduring mental health problems in one specialist psychiatric service. The paper begins by highlighting the particular service needs of this group of women. The process of translating the research evidence into practice is then explored by highlighting the comprehensive preparatory work that was required, how a women's special interest group was established, the choice of a model to guide change and development, and a review of progress to date. The paper concludes by arguing that one of the means of maintaining the current momentum for change will be the celebration and acknowledgement of success.
Clinical Nursing Research↗
[Medical guidelines. Definitions, goals, implementation].
Medical guidelines are an important part of quality control programs. They may act on knowledge, attitude, and behaviour of physicians as well as of medical laymen and, therefore, on the quality of medical care. As guidelines have been developed and distributed in the U.S. and in other countries for decades, recommendations for the medical practice termed "guidelines" or "consensus reports" are more and more distributed in Germany, as well. However, the internationally accepted quality criteria are only rarely taken into account for such independent guidelines. This review aims to impart such quality criteria. Additionally, a structure for a standardized review and organization of guidelines is proposed.
Forecasting↗
PONV/PDNV: implementing the ASPAN Clinical Guideline.
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Guideline Adherence↗
Strategies for the introduction and implementation of a guideline for the treatment of type 2 diabetics by general practitioners (GPs) of the Lazio region of Italy (IMPLEMEG study): protocol for a cluster randomised controlled trial [ISRCTN80116232].
BACKGROUND: Despite broad agreement on the necessity to improve quality of diabetic care through implementation of clinical guidelines, in Italy many people with diabetes still lack adequate care in general practice. In addition there is little evidence to support the choice of implementation strategies, especially in the Lazio region (central Italy), where comparative studies among general practitioners (GPs) are uncommon. The primary objective of the study is to assess the effectiveness of different strategies for the implementation of an evidence-based guideline for the management of non-complicated type 2 diabetes mellitus (DM) among GPs of the Lazio region. METHODS/DESIGN: Three-arm cluster-randomised trial (C-RCT). 252 GPs were randomised either to arm 1 (comprising a training module and administration of the guideline), or to arm 2 (administration of guideline without training), or to arm 3 (control arm), continuing current practice. Arm 1 participants attended a two-day course with CME credits. Data collection will be performed using current information systems. Patients' health data was also collected to describe diabetic populations cared for by GP participants. Process outcomes will be measured at the patient level and at the cluster level one year after the intervention. We will assess GPs' adherence to guideline recommendations for diabetes management relative to: 1) pharmacological management of diabetes; 2) pharmacological management of cardiovascular risk factors (hypertension and dislypidaemia); 3) measurement of glycosilated haemoglobin as the principal indicator of glycaemic control; 4) micro- and macrovascular complications assessment tests. Outcomes will be expressed as proportions of patients cared for by GPs who will have prescriptions of drugs, requests for tests and for outpatient appointment visits. To estimate the efficiency of resource use associated with the intervention a cost-effectiveness analysis will be carried out. The design of the study is based on three Cochrane and one Health Technology Assessment systematic reviews of guideline dissemination and implementation strategies.
Age Factors↗
Implementation of an aggressive random drug-testing policy in a rural school district: Student attitudes regarding program fairness and effectiveness.
School districts are increasingly initiating random drug-testing (RDT) programs in an effort to curb substance-use rates among students, yet little is known about student attitudes toward RDT and potential obstacles to program acceptance and effectiveness. The authors surveyed 1011 9th through 11th grade students in 2 rural high schools in North Florida regarding the pending implementation of one of the most aggressive RDT programs in the nation. A significant majority of students predicted that RDT would be effective, yet students were more clearly divided in their perceptions of the fairness and the accuracy of testing. Student perceptions of whether there is a drug problem at their school proved to be a robust predictor of perceptions of policy fairness. Student substance-use rates were more limited predictors of policy effectiveness and fairness. These results may prove useful to school administrators, health professionals, and policy makers seeking to build acceptance for RDT in their schools.
Adolescent↗
Mortality from lung cancer and tobacco smoking in Ohio (U.S.): will increasing smoking prevalence reverse current decreases in mortality?
BACKGROUND: Despite significant changes in smoking patterns within the past few decades, lung cancer remains a major cause of cancer deaths in many developed countries in people of each sex, and one of the most important public health issues. The study aims to analyze the possible impact of changes in tobacco smoking practices in the state of Ohio (U.S.) on current and future trends and patterns of lung cancer mortality. MATERIALS AND METHODS: Mortality rates from lung cancer were calculated for the period 1970 to 2001 on the basis of data from the National Center for Health Statistics. The Joinpoint regression approach was used to evaluate changes in time trends by sex, age, and race. Data on smoking prevalence in Ohio were retrieved from the Centers for Disease Control and Prevention website. RESULTS: Lung cancer mortality rates in Ohio have declined among men of all ages as well as in specific age groups in the 1990s, and the rate of increase among middle-aged and elderly women has dropped over time. The mortality rate among young women (ages 20-44) began to increase during the early 1990s. The prevalence of smoking in Ohio has increased since the early 1990s, especially among young persons. CONCLUSIONS: Recent trends in tobacco smoking in Ohio indicate that the declining trends in lung cancer mortality might be reversed in the future. An early indicator of possible change is the recent increase in mortality among young women. Implementation of the Ohio Comprehensive Tobacco Use Prevention Strategic Plan might help to disseminate proven prevention strategies among the inhabitants of Ohio and might thus prevent future increases in lung cancer mortality rates in the state.
Adult↗
The development of a model and implementation process for clinical governance in primary dental care.
A model and an assessment tool have been developed to support clinical governance within the primary care sector. These bring together quality assurance and governance components to create a unified standard providing a single working model for service development. The model consists of 14 components that define structure, control the process and assure the outcome. Each consists of a number of indicators, which are scored in turn. The results are then weighted to emphasise those that are more critical. The model has been tested and found to be helpful in identifying weak areas to support action planning. Re-scoring will help to demonstrate that improvements have taken place. Other services and practices can now carry out baseline assessments, and demonstrate and measure improvements. General dental practitioners are provided with a scoring system, which identifies clinical governance areas in their practices that require attention and which facilitates prioritisation.
General Practice, Dental↗
Success factors of hospital information system implementation: what must go right?
Health care institutions are considering a variety of information technologies in the hope of increasing efficiency, reducing cost, re-engineering work processes, and improving quality of care. When we talk about any information system implementation, we need to keep in mind that there are actually three phases to such a project: pre-implementation, implementation and post-implementation. The aim of our contribution is to present the realities of successful implementation and our experience with such project.
Health Plan Implementation↗
Stroke Active Guideline Evaluation (STAGE) project.
In 2005 the American Stroke Association's task force on the development of stroke systems established that providers and policymakers at the local, state and national levels can make significant contributions to reducing the devastating effects of stroke by working to promote coordinated systems that improve patient care. In the last few years in North America and Canada several quality stroke registers have been implemented with the aim of improving the processes of care by the diffusion and implementation of national guidelines and by the identification and correction of critical points of stroke care provided in the hospitals participating in the register. The Italian guidelines for stroke, SPREAD, have been developed with the aim of generating a tool applicable to the Italian clinical setting, able to promote the planning and linking of the assistant interventions between the different phases of the stroke care process, from the hyper-acute to the rehabilitation phase, and from primary to secondary prevention in order to harmonise and streamline the actions of the various health-care providers involved in the different phases of the diagnostic and therapeutic path of patients with stroke. The primary end-point of the Stroke Active Guideline Evaluation (STAGE) project, founded by the Italian Ministry of Health in 2003, is the diffusion, implementation and validation of the Italian Guideline for Stroke, SPREAD, in 15 acute care and 3 rehabilitative institutions across Italy. Secondary end-points are the evaluation of impact of the implementation of a workflow management in the processes of care and the identification of a national, streamlined diagnostic and therapeutic path for ischaemic stroke patients. An existing electronic patient record (EPR) has been shared with the referents of the Centres participating in the study and adapted to SPREAD's indicators. This EPR has been augmented with the decision support system. The STAGE project represents the first Italian effort in this direction. A lot of work has to be done before this goal will be achieved, but as Albert Einstein said "Imagination is more important than intelligence".
Database Management Systems↗