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Over the last few decades, medical and surgical advances have led to a growing population of individuals living with congenital heart disease. The challenges of this condition can reach beyond physical limitations to include anxiety, depression and post-traumatic stress disorder. To date, these psychological outcomes have been neglected; yet, they need not be inevitable. The factors contributing to these difficulties are considered here, drawing on current evidence and neuropsychological theories including the novel application of polyvagal theory. Suggestions for developing psychologically informed medical and social care to improve mental health, wellbeing and recovery and influence policy and training are proposed (See supplemental material for video abstract). [ABSTRACT FROM AUTHOR]

Based upon research in the state of Bihar, India, this article argues that informal access to medicines in Northern India is a core element of the government of healthcare. Informal providers such as unlicensed village doctors and unlicensed drug sellers play a major role in access to medicines in Bihar, in the particular context of the dismantling of public procurement services. Building on recent works in the socio-anthropology of pharmaceuticals, the article shows the importance of taking into account the political economy of drugs in India, in order to understand local problems of access more fully. If informal providers occupy such an important position in the government of healthcare in India, this is partly due to the shaping of healthcare as access to drugs on health markets. Elaborating the argument from interviews with health professionals and patients, the article first shows the situation of public healthcare and public procurement in Bihar; then it presents the role of informal medicine providers; lastly, it shows how patients deal with the fact that they live in a ‘pharmaceutical world’ where access to health equates with access to medicines. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the author discusses articles in the issue on topics including mental health services in Colombia, the distribution of COVID-19 vaccines in the Gulf countries and universal health care in the U.S.

Mitigating the impacts of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and substance use requires comprehensive and systematic thinking in designing interventions and developing policies. This study describes the growth of research publications from 1991 to 2021 in the Web of Science database and points out current research landscapes in the fields of HIV/AIDS and substance use. Latent Dirichlet Allocation was used for classifying 21 359 papers into corresponding topics. The most common topics were HIV transmission, HIV infection, quality of life and mental health of substance users, and the biomedical effect of substance use. Emerging research landscapes include vulnerabilities of people who inject drugs to HIV transmission and related health problems. This study found a lack of research on health services, interdisciplinary and inter-sectoral in combination with clinical evaluation and treatment services. Future investment and implementation of HIV/AIDS and substance use programs should focus on research of health services and clinical evaluation, especially context-specific interventions. [ABSTRACT FROM AUTHOR]

The coronavirus pandemic has impacted health care, economies and societies in ways that are still being measured across the world. To control the spread of the virus, governments continue to appeal to citizens to alter their behaviours and act in the interests of the collective public good so as to protect the vulnerable. Demonstrations of collective solidarity are being consistently sought to control the spread of the virus. Catchphrases, soundbites and hashtags such as 'we're all in this together', 'stronger together' and other messages of unity are employed, invoking the sense of a collective struggle. However, this approach is fundamentally challenged as collectivist attitudes run contrary to the individualism of neoliberal ideology, to which citizens have been subjected. This paper argues that attempting to employ the concept of solidarity is inherently challenged by the deep impact of neoliberalism in health policies and draws on the work of Durkheim to examine the concept in a context in which health care has become established as an individual responsibility. The paper will argue that a dominant private-responsibility model and an underfunded public system have eroded solidarity weakening its effectiveness in generating concerns for the collective. [ABSTRACT FROM AUTHOR]

The majority of U.S. states have legalized marijuana for medical use and some states have legalized marijuana for recreational use; yet, marijuana remains illegal federally. Given the misalignment between state and federal policies, this paper seeks to explore how hospitals handle inpatients' medical marijuana use in states where medical marijuana is legal. To examine this phenomenon, we conducted an anonymous, online, cross-sectional survey of nurse leaders working in acute care inpatient settings in states that had legalized medical marijuana. Using descriptive statistics, we report on these nurse leaders' experiences. There were 811 survey responses—291 who worked in an acute care inpatient setting in a state that had legalized medical marijuana. Among those respondents, only a small percentage reported that inpatients had some access to their medical marijuana: 5.8% reported that the drug was kept in the pharmacy and dispensed like other prescriptions; another 3.4% indicated that patients kept the medical marijuana in their rooms and took it, as needed. Most respondents (55.6%) reported that patients were switched to an alternative medication during their inpatient hospital stays. Almost half (49.4%) of the nurse leaders who reported that alternative medications were used, reported that opioids were substituted, and the majority reported that the marijuana was safer than the opioids. These findings are concerning given the increase in opioid overdose deaths. [ABSTRACT FROM AUTHOR]

Nursing knowledge is housed in its paradigms, philosophies, models, and theories. This knowledge must be utilized to demark nursing's unique contributions within healthcare, regardless of the setting. The purpose of this paper is to explore the ways in which Parse's community model may serve as a way to think about health policies and the unique ways policies may connect to nursing knowledge. Within this paper, there is a discussion about health policy, Parse's humanbecoming paradigm, and policy development reflected upon with change concepts within the humanbecoming community model. This exploration is important because "disciplinary knowledge is the foundation for transforming health policy and health care delivery systems" (American Academy of Nursing, 2020, para. 1). [ABSTRACT FROM AUTHOR]

Sexual and gender-based violence (SGBV) is a leading cause of physical, emotional, and psychosocial problems around the world, with many countries in East Africa having rates above the global average. Despite the high prevalence in the region, service provision for post-SGBV care is often poorly funded, difficult to access, or simply nonexistent. This review reports the findings of a scoping review of literature from East Africa. The goals of this research were to evaluate existing service provision practices throughout the region, understand how provider bias may affect service provision, and compare existing practices to national policies and internationally agreed human rights treaties. This review identified 54 academic papers and reports through a search of electronic databases and grey literature sources, and four main themes emerged: (1) current models of service provision are inadequate to address the medical and psychosocial needs of survivors; (2) countries are not providing sufficient funding for services; (3) further research is needed into how to incorporate SGBV care into existing health systems and align with international human rights treaties; and (4) there is limited research in many countries in East Africa. The findings are likely to be of use to policy makers, nongovernmental organizations, and service providers working in the medical, legal, and justice systems. [ABSTRACT FROM AUTHOR]

COVID-19 poses serious challenges to the health and safety of childcare providers, and these challenges were particularly acute in early 2022 during the first Omicron wave when vaccines were not available for children. Childcare providers work in environments where the recommended methods to minimize COVID-19 infection were often not possible to implement: children could not wear masks for extended periods and were not able to maintain physical distance. Under these pressures, Canada's already-fragile childcare sector was strained, caregivers struggled, and existing deficiencies were exacerbated. As part of a larger quality assurance and improvement project examining the impacts of the pandemic on childcare in the Canadian prairie province of Manitoba, this paper reports on qualitative findings to make public health and policy recommendations for the childcare sector. Data were voluntarily provided by a sample of childcare providers between January 6–13, 2022. A thematic analysis of open-text responses was performed, finding: an urgent need for health and safety resources; a need for sustained support and guidelines; and an absence of value and respect. We also identified an emergent theme of gratitude, which was reflected by an overwhelming number of thanks to the project team for listening to the voices of childcare providers. We draw on our qualitative analysis to propose measures to improve public health and safety, funding, and infrastructure, as well as to underscore the importance of systematic data collection and evaluation to protect and support the essential childcare workforce through the COVID-19 pandemic and into the future. [ABSTRACT FROM AUTHOR]

Introduction: Prior to the COVID-19 pandemic, telehealth utilization was growing slowly and steadily, although differentially across medical specialties in the United States. The pandemic dramatically expanded physician use of telehealth, but our understanding of how much telehealth use has changed in primary care in the United States, the correlates of physician telehealth uptake, and the frequency with which primary care physicians intend to use telehealth after the pandemic are unknown. This paper is designed to assess these important questions. Methods: Using data from an original national survey of 625 primary care physicians conducted from May 14 to May 25, 2021, we investigate the frequency of physician telehealth use before and during the pandemic and intended use after the pandemic. We also assess the correlates of changes in telehealth use by physicians, comparing telehealth use before the pandemic to use during and after the pandemic. Results: The proportion of primary care physicians using telehealth often, jumped from 5.3% (95% CI 3.5, 7.0) before the pandemic to 46.2% (95% CI 42.3, 50.2) during the pandemic. More importantly, over 70% of physicians intended to use telehealth at least occasionally after the pandemic compared to just 18.7% before, with younger physicians, physicians without telehealth training in medical school, and Asian physicians most likely to increase their telehealth use long-term. Discussion: The COVID-19 pandemic has spurred expansion in telehealth use by primary care physicians that will continue to shape care delivery well beyond the pandemic. Policy change could be needed to facilitate this growth of telehealth long-term. [ABSTRACT FROM AUTHOR]

Introduction: To support the expansion of a successful regional electronic consultation (eConsult) service, we hosted a full-day national eConsult Policy Think Tank, connecting health-services researchers, clinicians, patients and policymakers to discuss policy considerations related to eConsult. In this paper, we assess the discussion arising from the Think Tank to identify and understand the policy enablers and barriers to the national spread and scale of eConsult services across Canada.Methods: We conducted a constant comparative thematic analysis of stakeholder discussions captured during the Think Tank held in Ottawa, Canada, on 5 December 2016. Forty-seven participants attended and debated the following topic areas: (a) delivery of services and standards; (b) payment considerations; and (c) equitable access. The meeting was recorded, and verbatim transcripts were analysed using qualitative approaches.Results: We identified four themes affecting spread and scale of eConsult innovation from a policy perspective: (a) patient-centredness; (b) value; (c) regulation; and (d) considerations for spread and scale. Patient-centredness was viewed as a foundational principle upon which policy shifts should be guided. Active participation of patient partners transitioned the discussions and resulting recommendations from provider-centred to patient-centred thinking around the relevant policy issues, explicitly demonstrating the importance of patient involvement in healthcare policy decision making.Discussion: eConsult was viewed as a high-value, disruptive innovation with great potential to transform access to specialists in Canada. A patient-centred approach to policy change (and not just healthcare delivery) was identified as a novel yet critical enabler to the scale and spread of eConsult across Canada. [ABSTRACT FROM AUTHOR]

Objective: This review aims at gaining a broad overview of national approaches about Palliative care (PC) implementation into health care systems in countries that have PC identified within their national policies and strategies. Methods: Paper searching was conducted using both peer-reviewed databases and gray literature sources covering governmental reports with PC strategies from 2000 onward. Articles published in English that cited at least 1 category of the WHO's public health PC model were included. Qualitative content analysis was used for data analysis and synthesis of findings. Results: Thirteen reports met the inclusion criteria. Education and appropriate policies were the most frequent strategies covered by all countries included. Under education; information about training health care providers was needed for the effective introduction of a PC program. Reviewing standards of care required to deliver PC effectively, and financial support for PC service development were considered the central policies needed. Furthermore, partnerships and collaborations across the health systems as well as providing care based on patients' needs were required for the provision of a PC program. Conclusion: It is of the essence to learn from countries demonstrating enhanced PC practices before the implementation of a new PC program in a given country. Such practices could be used as a guide and to address barriers that may hinder the development of PC at a national level. Best practices can be achieved by focusing on educational and policy-based strategies through identifying patients' needs, assessing general public awareness, health care providers' knowledge and training as well as incorporating stakeholders' perspectives. [ABSTRACT FROM AUTHOR]

The utilization of nursing theories should serve as the foundation of policies that guide care for patients and those they love. The author of this paper explores linking conceptual elements within nursing theories to high-quality patient-centered care examples and policies. These linkages make clear how nursing knowledge may be utilized within healthcare systems that value patient-centered care. These patient-centered care policies need to be explicit about the contributions of nurses to healthcare, regardless of setting. [ABSTRACT FROM AUTHOR]

This paper examines how the British managed the 1918–1919 influenza epidemic in Lagos, the reactions of the local population to new sanitary and medical policies enforced during the period, and its social and political implications for future epidemic management in the colony. Unlike several studies which approach the history of the pandemic from global and national perspectives, a focus on Lagos, the colonial capital of Nigeria, one of Britain’s most important colonies provides this paper with a rare opportunity to engage with how local peculiarities informed decisions about the resolution of a global problem. Lagos is chosen as the terrain for discussion because of the ample data generated about it in the course of the 19th and 20th centuries (not just between European missionaries and the indigenous Lagosians, but also for other influential cultural and ethnic groups such as the Saro and Amaro (migrants from Brazil), and the Indian influence on medical policies in Lagos). [ABSTRACT FROM AUTHOR]

A trauma-informed, thematic analysis that identified stress-related themes evident in 39 personal abortion narratives from the Tennessee Stories Project in the United States is presented in this paper. Using the Braun and Clarke model of thematic analysis, guided by the trauma-informed social work framework, researchers examined these narratives to identify stress related themes. Findings: An overall theme of stress and traumatic stress was found to be present throughout the abortion narratives. These themes were categorized into subthemes, including: (a) existing life stressors preceding the abortion experience, (b) stressors while trying to access abortion services, (c) stressors while obtaining abortion services, and (d) stressors arising after the procedure. Applications: These results suggest that stress and traumatic stress were reflected in these abortion narratives throughout the abortion seeking experience. This finding supports the need for social work practice responses that are designed to address and eliminate stress during the process of seeking and obtaining an abortion in the United States. A trauma-informed framework is recommended for guiding social work education about abortion, social worker interactions with clients who are seeking abortions, and the development of abortion policy in the United States in order to better align the abortion seeking experience with the principles of trauma-informed care. [ABSTRACT FROM AUTHOR]

Austerity measures have become a contentious topic, shaping the landscape of health care systems around the world. As governments grapple with economic challenges, the impact of austerity on health care has emerged as a critical concern. This study focuses on the consequences of austerity actions adopted by the Zimbabwean government under the Transitional Stabilization Program (TSP) from August 2018 to December 2025. This research examines the impact of austerity measures on Zimbabwe's health care sector, exploring its connections with health infrastructure and resources, accessibility and affordability of health care, health funding, health care inequalities, and the health care workforce. Using a quantitative approach and data from 970 participants, including the general populace, health care providers, and government officials, significant positive correlations between austerity measures and these health care variables were identified. The findings indicated a noteworthy positive correlation between the independent variable "austerity measures" and five dependent variables: health care accessibility and affordability, health care inequalities, infrastructure and resources, health care funding, and health care workforce. The t -statistics values exceeded the threshold of 1.96, with values of 5.085, 3.120, 6.459, 8.517, and 3.830, respectively. These findings highlight the importance of considering the effects of austerity on health care access, health funding, health care inequalities, health workforce, health infrastructure and resources development. Policymakers should prioritize equitable resource allocation and targeted investments to strengthen the resilience of the health care system during economic challenges. Understanding these associations is crucial for evidence-based policy decisions and fostering a more equitable and resilient health care system in Zimbabwe. [ABSTRACT FROM AUTHOR]

Background: Public health midwives (PHMs) play a frontline role in the Sri Lankan public healthcare system, ensuring the health of children and women at the community level. However, cultural differences in diverse social contexts necessitate PHMs for customised interventions to ensure optimum child and maternal health, particularly in most vulnerable communities. Purpose: The objective of the present study is to explore how PHMs have adapted their roles as community change agents to facilitate community mobilisation before implementing healthcare interventions for children and mothers in the estate sector (a marginalised and vulnerable community) of Sri Lanka. Research Design and methods: Using an exploratory qualitative research design, data were collected through in-depth interviews with 16 participants. The thematic analysis revealed two main themes that describe how PHMs engage in community mobilisation in addition to their designated role as healthcare officials in the estate sector of Sri Lanka. Results: The first theme highlights PHMs' involvement in community mobilisation through context-relevant advocacy for effective service implementation. The second theme illustrates how PHMs' role has been reshaped as advocates to intervene in making the family a supportive institution for child and maternal health. PHMs who work in the estate sector in the country are morally committed to engaging in community mobilisation and advocacy. However, this obligation can be neglected due to the lack of formal arrangements and training in sociocultural determinants of health and working with vulnerable communities. Conclusions: The role of a PHM in the estate sector differs significantly from that in the urban and rural sectors, given the significance of their interventions in family health. Also, community mobilisation is a prerequisite for implementing health policies for child and maternal health in vulnerable communities. Both community-level and family-level advocacy interventions and mobilisation efforts are equally important to establishing a supportive environment, without which any child and maternal healthcare interventions are difficult to implement. [ABSTRACT FROM AUTHOR]

To mitigate COVID-19 exposure risks in methadone clinics, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary modification of regulations in March 2020 to permit, with state concurrence, extended take-home methadone doses. The modification allowed for up to 28 days of take-home methadone for stable patients and 14 days for those less stable. Using both interrupted time series and difference-in-differences methods, this study examined the association between the policy change and fatal methadone overdoses, comparing states that permitted the expansion of take-home doses with states that did not. The findings suggest the pandemic emergency take-home policy did not increase methadone-involved mortality. [ABSTRACT FROM AUTHOR]

On 30 June 2021, Ohio state Governor, Mike DeWine, signed a Bill which would enact the state's budget for the next two years. In addition to its core funding imperatives, the Bill also contained an amendment significantly expanding entitlements of health care providers to conscientiously object to professional duties to provide controversial health care services. This amendment has been heavily criticised as providing the means to allow health care providers to discriminate against a wide range of persons by denying them access to often contested services such as abortion and contraception. In this paper, we examine the implications of this amendment and situate it in relation to other legislative actions intended to guarantee absolute rights to conscientious objection. In doing so, we argue that the entitlements extended to health care providers by these Bills are overly broad and ignore their potential to allow significant harm to be caused to clients. We then argue that if health care providers should have rights to conscientiously object (a question we do not try an answer here), then any legislation intended to protect such rights should be limited, specific, and parsimonious. Where it is not, the ideological liberty of HCPs treads dangerously on the physical freedom of their clients. [ABSTRACT FROM AUTHOR]

It is important to develop and implement policies that are unique to nursing practice situations. To do so, nurses must participate in policy development that connects disciplinary knowledge with policy formulation. The purpose of this paper is to explore connections between nursing knowledge and transitional care. This is done with a discussion of transitional care definitions and models, along with connections to concepts and principles within extant nursing theories and models. [ABSTRACT FROM AUTHOR]

There is a growing human immunodeficiency virus (HIV) epidemic in Tajikistan. This paper presents factors associated with linkage to HIV care among people aged 15 years and older in Tajikistan. This retrospective cross-sectional study used the Tajikistan Ministry of Health HIV registry data from patients diagnosed with HIV at age 15 years or older from 2000 to 2016. Chi squared tests and logistic regression models tested factors associated with linkage to care. A multivariable logistic regression model examined effect modifications. While linkage to care had an overall increase from 2000 to 2016, the odds of linkage were lower among certain sub-groups including among people in Dushanbe, men, people engaging in sex work, injection drug users, and older people. Regional differences exist with linkage to care, occurring least frequently in Dushanbe. While access to care and quality of care have increased significantly over time, findings suggest that linkage to care is low, especially in the capital city where many services are provided. Evaluation focusing on acceptability of HIV services should be undertaken to understand why certain people do not link with services. Additional research about the types of barriers to linking with HIV care is needed to increase linkage to HIV care. [ABSTRACT FROM AUTHOR]

The Canadian health care system can be characterized as a mix of public and private participation, although it is often described as a publicly funded system. In Canada, “medically necessary” services are covered with public funds; however, the Canada Health Act provides no formal definition of medical necessity. The provincial and territorial health care insurance plans decide which services are medically necessary. As a result, coverage of hospital and medical services differs among provinces. Outpatient prescription drugs are not covered by public plans. The coverage for diagnostics and medications for rare diseases is also limited. Private insurance plans, often provided by employers, are an expensive solution, although coverage is not sufficient. Those who are unemployed, self-employed, or informally employed and those with rare diseases that require expensive treatments and drugs frequently are not covered by any plan and face financial difficulty paying for their prescriptions and treatments. As a result, many Canadians are struggling and facing inequality in acquiring medical services for rare diseases and outpatient prescription drugs due to an unfair Canadian health care system. This paper proposes some recommendation to make medical services more accessible and affordable to every Canadian. [ABSTRACT FROM AUTHOR]

This study examines the health care utilization pattern, associated financial catastrophes, and inequality across Indian states to understand the subnational variations and aid the policy makers in this regard. Data from recent National Sample Survey (2017–2018), titled, "Household Social Consumption: Health," covering 113,823 households, was employed in the study. Descriptive statistics, Erreygers concentration index (CI), and recentered influence function decomposition were applied in the study. We found that, in India, 7 percent of households experienced catastrophic health expenditure (CHE) and 1.9 percent of households were pushed below poverty line due to out-of-pocket expenditure on hospitalization. Notably, outpatient care was more burdensome (CHE: 12.1%; impoverishment: 4%). Substantial interstate variations were observed, with high financial burden in poorer states. Utilization of health care services from private health care providers was pro-rich (hospitalization CI 0.31; outpatient CI 0.10), while the occurrence of CHE incidence was pro-poor (hospitalization CI −0.10; outpatient CI −0.14). Education level, economic status, health insurance, and area of residence contributed significantly to inequalities in utilization of health care services from private providers and financial burden. The high financial burden of seeking health care necessitates the need to increase public health spending and strengthen public health infrastructure. Also, concerted efforts directed towards increasing awareness about health insurance and introducing comprehensive health insurance products (covering both inpatient and outpatient services) are imperative to augment financial risk protection in India. [ABSTRACT FROM AUTHOR]

Preventive policies have been devised with the aim of curbing health-related violence, and their efficacy is believed to furnish evidence for their continued implementation, thereby enhancing their effectiveness. This study undertakes a retrospective analysis of these policies in the context of Türkiye. A comprehensive examination involved the review of 26 documents, employing a progressive scanning approach for data collection. This methodology encompassed the utilization of gray literature databases (OECD iLibrary and WHO Iris), extensive Google searches, thorough website scans, and consultations with subject-matter experts. Data analysis was meticulously conducted within the framework of the Health Policy Triangle. The findings reveal active participation from diverse stakeholders, including governmental bodies, political entities, professional organizations, and trade unions, in various preventive initiatives aimed at mitigating health-related violence. Notably, the adoption of legislation for health violence prevention, perceived as a paramount achievement, can be attributed to persistent efforts by both the media and other influential actors and stakeholders. These endeavors have sustained the topic's prominence on the policy agenda, positioning it as a promising source for the development of novel violence prevention and management strategies. This study underscores the necessity for a comprehensive investigation into the working conditions, personal rights, and wage policies of healthcare workers, in light of documented factors that frequently precipitate violence. Concomitantly, it advocates for the development of effective mechanisms to address these issues. [ABSTRACT FROM AUTHOR]

This study examines caregiver networks, including size, composition, and stability, and their associations with the likelihood of hospitalization and skilled-nursing facility (SNF) admissions. Data from the National Health and Aging Trends Study linked to Center for Medicare and Medicaid Services data were analyzed for 3855 older adults across five survey waves. Generalized estimating equation models assessed the associations. The findings indicate each additional paid caregiver was associated with higher adjusted risk ratios (aRR) for hospitalization (aRR = 1.24, 95% CI 1.10–1.41) and SNF admission (aRR = 1.28, 95% CI 1.06–1.54) among care recipients, a pattern that is also observed with the addition of unpaid caregivers (hospitalization: aRR = 1.13, 95% CI 1.06–1.20; SNF: aRR = 1.12, 95% CI 1.02–1.23). These results suggest that policies and approaches to enhance the quality and coordination of caregivers may be warranted to support improved outcomes for care recipients. [ABSTRACT FROM AUTHOR]

The Press Ganey (PG) Outpatient Medical Practice Survey measures patients' experiences of healthcare access in the U.S. We aimed to identify differences in experiences of access to care by patient race, ethnicity, and other sociodemographic characteristics, an important first step in informing health policy and ensuring equitable healthcare delivery. We performed a cross-sectional analysis of PG surveys for adult outpatient visits within the University of Pennsylvania Health System from 2014–2017, including 119,373 unique patients. Compared with White patients, Black (odds ratio [OR] 0.84; 95% confidence interval [CI] 0.80–0.87), Asian (OR 0.62; 95% CI 0.58–0.66), and other/unknown race patients (OR 0.83; 95% CI 0.72–0.94) were each less likely to report the maximum score for timely access to care. Patients of all minoritized groups, as well as those whose primary language was not English, reported lower scores in secondary access measures related to communication and respect, compared to White and primarily English-speaking patients, respectively. Efforts to improve the experience of access to care among racial and ethnic minoritized patients are imperative to achieve equity in healthcare delivery. [ABSTRACT FROM AUTHOR]

School-based health centers (SBHCs) are associated with numerous positive aspects of student health services. Many schools in the United States (US) do not have transparent policies on chronic health condition (CHC) management. Of particular concern is the underreporting of the delivery of health services in U.S. schools concerning CHC management and its relationship with the presence or absence of a SBHC. Data from the 2020 School Health Profiles (SHP) Survey were examined in New York public secondary schools. Specific health services were reviewed, together with the presence or absence of a SBHC, including daily medication administration, stock rescue medication, case management services, community partners, chronic disease-specific education, and assurance that students with CHCs were enrolled in an insurance program. A significantly greater proportion of schools with a SBHC compared with schools without a SBHC provided: (1) daily medication administration (92.9% vs. 86.5%; p <.001), (2) stock or rescue medication (84.9% vs. 77.4%; p <.001), (3) case management services (83.1% vs. 67.2%; p <.001), (4) disease-specific education for families (63.1% vs. 57.2%; p =.022), (5) student and family connection to community health services (84.2% vs. 76.5%; p <.001), and (6) ensured that a protocol existed whereby students with a CHC were enrolled in an insurance plan if eligible (79.6% vs. 66.8%; p <.001). Findings suggest that data on a national scale include essential facts for states to consider concerning school health policies and practices. Additional research should examine the intricacy of elements connected with school-based health care to understand better the care provided to children with CHCs. [ABSTRACT FROM AUTHOR]

The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit is a key component of Medicaid policy intended to define an essential set of services provided to patients younger than age 21. Given increasing attention to social determinants of health in pediatric health care, this qualitative review examines the extent to which EPSDT might be used to implement structured screening to identify environmental and social factors affecting children's health. Themes derived from semistructured interviews conducted in 2017 were triangulated with a review of the recent literature to describe how states currently consider the EPSDT benefit with respect to social determinants of health screening. Our findings suggest that, with sufficient stakeholder advocacy given the evidence supporting social determinants of health screening as "medically necessary," EPSDT benefits could be considered as a funding source to incentivize the incorporation of social determinants of health screening into the basic package of well-child care. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has profoundly impacted the country's health systems and diminished its capability to provide safe and effective healthcare. This article attempts to review patient safety issues during COVID-19 pandemic in India, and derive lessons from national and international experiences to inform policy actions for building a 'resilient health system'. Methods: Systematic review of existing published articles, government and media reports was undertaken. Online databases were searched using key terms related to patient safety during COVID-19 and health systems resilience. Seventy-three papers were included dependent on their relevance to research objectives. Findings: Patient safety was impacted during COVID-19, owing to sub-optimal infection prevention and control measures coupled with reduced access to essential health services. This was largely due to inadequate infrastructure, human and material resources resulting from chronic underinvestment in public health systems, paucity of reliable data for evidence-based actions and limited leadership and regulatory capacity. Conclusions: India's health systems were found ill prepared to tackle large-scale pandemic, which has major implications for patient safety. The shortcomings observed in the COVID-19 response must be rectified and comprehensive health sector reforms should be initiated for building agile and resilient health systems that can withstand future pandemics. [ABSTRACT FROM AUTHOR]

Objectives: To explore the extent to which national policy in end of life care in England influences and guides local practice, to ensure that care for patients over the age 75 years is of a consistently good quality. Method: This paper reports on phase one of a larger study and focuses its discussion on the high-level (macro) determinants emerging from the analysis. Fifteen in-depth interviews were conducted with professionals involved in the development of English policy in end of life care. Results: Factors influencing the quality of end of life care were stratified into three system levels: meso, macro and micro. English national policy was reported to be an important macro-level determinant of effective outcomes, and examples were provided to demonstrate how policy was influencing practice. Yet, the complexity of the area and the range of interacting contributory factors mean the value of policy alone is hard to assess. At the macro-level, concern was voiced around: whether policy was effective in tackling rising inequity; lack of mandatory leverage to exert change relating to end of life outcomes; the impact of ongoing infrastructural change on statutory services; workforce pressures; over-reliance on acute services and continued abdication of responsibility for end of life care to medical professionals supported by the continued dominance of the medical model of care. Conclusions: The links between the existence of policy at the macro-level of the system and the effective enactment of good practice remain unclear, although strategies are suggested to help achieve greater national consistency in end of life care outcomes. Policymakers must pay attention to the following: controlling the rise in localism and its contribution to regional inequalities; the impact of continuous infrastructural change together with increasing workforce pressures; encouraging broader professional and public responsibility for recognition and care of those at the end of life. [ABSTRACT FROM AUTHOR]

To conduct a systematic review and develop a conceptual framework on the mechanisms linking loneliness, social isolation, health outcomes and mortality. Electronic databases were systematically searched (PubMed, MEDLINE, Scopus and EMBASE) from inception to October 2018 followed by manual searching to identify research on loneliness, social isolation and mortality in adults published in the English language. Articles were assessed for quality and synthesised into a conceptual framework using meta-ethnographical approaches. A total of 122 articles were included. These collated observational designs examining mediators and moderations of the association in addition to qualitative studies exploring potential mechanisms were included. A framework incorporating 18 discrete factors implicated in the association between loneliness, social isolation and mortality was developed. Factors were categorised into societal or individual, and sub-categorised into biological, behavioural and psychological. These findings emphasise the complex multidirectional relationship between loneliness, social isolation and mortality. Our conceptual framework may allow development of more holistic interventions, targeting many of the interdependent factors that contribute to poor outcomes for lonely and socially isolated people. [ABSTRACT FROM AUTHOR]

This study examines the goals of medical aid-in-dying (MAID) legislation introduced to the US Congress from 1994–2020 using a policy mapping analysis approach. Using congress.gov, we identified 98 bills, 23 bills were analyzed in this study. Most of the bills aimed to restrict the use of federal funds, to regulate the drugs commonly used for MAID, to prohibit the development of policies or practices supporting MAID, and to regulate practitioners' roles in MAID. In practice, these bills would limit patient access to MAID by restricting drugs, funds, health care services, legal assistance, policy, and research. These findings suggest there lacks congressional support for MAID, even though polls of the public are divided yet favorable. Policymakers who support MAID should consider affirmative policies that 1) prevent MAID policies from discriminating against vulnerable groups, 2) support funding to study the use of MAID, and 3) build avenues to allow all qualified people to access MAID in places where it is legal. [ABSTRACT FROM AUTHOR]

Background The development of new virtual care technologies (including telehealth and telemedicine) is growing rapidly, leading to a number of challenges related to health policy and planning for health systems around the world. Methods We brought together a diverse group of health system stakeholders, including patient representatives, to engage in policy dialogue to set health system priorities for the application of virtual care in the primary care sector in the Province of Ontario, Canada. We applied a nominal group technique (NGT) process to determine key priorities, and synthesized these priorities with group discussion to develop recommendations for virtual care policy. Methods included a structured priority ranking process, open-ended note-taking, and thematic analysis to identify priorities. Results Recommendations were summarized under the following themes: (a) identify clear health system leadership to embed virtual care strategies into all aspects of primary and community care; (b) make patients the focal point of health system decision-making; (c) leverage incentives to achieve meaningful health system improvements; and (d) building virtual care into streamlined workflows. Two key implications of our policy dialogue are especially relevant for an international audience. First, shifting the dialogue away from technology toward more meaningful patient engagement will enable policy planning for applications of technology that better meet patients' needs. Second, a strong conceptual framework on guiding the meaningful use of technology in health care settings is essential for intelligent planning of virtual care policy. Conclusions Policy planning for virtual care needs to shift toward a stronger focus on patient engagement to understand patients' needs. [ABSTRACT FROM AUTHOR]

Background: Despite an increase in methamphetamine use and subsequent hospitalizations, the majority of Canadian hospitals currently lack harm reduction strategies for substance use. This can mean that people with lived experience of methamphetamine use are faced with a number of difficult decisions to make when admitted to hospital. Caring for people with lived experience of methamphetamine use can also be problematic with zero tolerance policies requiring abstinence to be maintained. This analysis set out to understand potential health care issues due to a lack of harm reduction strategies from the prospective of people with lived experience of methamphetamine use as well as health care/service professionals. Methods: Based on a larger study, this secondary analysis explored issues discussed by people with lived experience of methamphetamine use and health care/service professionals regarding the challenges of providing harm reduction approaches in the hospital setting. A total of 108 individuals with lived experience of methamphetamine use completed a qualitative component of a mixed-method interview. In addition, 31 health care/service professionals participated in virtual focus groups and one-to-one interviews. Responses were analyzed using an ethnographic thematic approach. Results: People with lived experience of methamphetamine use reported 3 choices upon admission: leave or avoid the hospital, stay but experience unsupported withdrawal, or stay but hide their substance usage from health care professionals. Health care/service professionals described 2 options: uphold zero tolerance that can lead to stigma and a lack of knowledge regarding addiction, or accept harm reduction but be unable to implement such strategies. This could lead to health being compromised due to policy and practice that requires abstinence. Neither group of participants described a good choice for them. Conclusion: Current policy and education related to substance use needs to be revised. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe policies developed by English-speaking Canadian health authorities to guide multi-disciplinary healthcare practice in the context of MAID. Seventeen policies from 9 provinces and 3 territories were identified and analyzed thematically. Themes developed from these documents related to ensuring a team approach to care, supporting informed patient choice, creating region-specific guidance on eligibility criteria and safeguards, accommodating conscientious objection, and making explicit organizational responsibilities. Ethical language concerned vulnerability, non-judgmental care, dignity, non-abandonment, confidentiality, moral conscience, and diverse cultural values. Overall, these policies addressed important risk mitigation strategies, acknowledged important social contracts, and supported ethical practice. Collectively, these policies outline important considerations in the evolving Canadian context for other jurisdictions seeking to create policy around assisted death. [ABSTRACT FROM AUTHOR]

The increasing burden of chronic diseases is one of the greatest challenges healthcare systems globally are facing. Across the world, compelling demands can be found for a fundamental shift in the organisation of health and social care to meet the needs of chronic patients. Integrated care has gathered momentum to overcome fragmentation of care in order to create care systems which are demand-driven, client-centred and cost-conscious. Health information technology – often referred to as eHealth – is usually considered to be an essential building brick of integrated care. Moreover, health information technology is said to hold potential for improving patient safety in chronic care settings. The current perspective paper explores the role of health information technology in integrating and safeguarding care. We argue that health information technology – which supports integrated care – may create optimal conditions to improve patient safety, but only when well-implemented, state-of-the-art technologies are used. [ABSTRACT FROM AUTHOR]

Introduction To reduce the burden of chronic lung diseases, the Lung Alliance Netherlands has designed a National Action programme on Chronic Lung Diseases. It aims to improve healthcare coordination, thereby reducing the burden of chronic lung diseases, by focussing on five objectives to be achieved within five years: (1) a 25% reduction in hospitalisation days for asthma and chronic obstructive pulmonary disease; (2) a 15% reduction in working days lost due to respiratory diseases; (3) a 20% improved cost-effectiveness of inhalation medication; (4) a 25% reduction of adolescents taking up smoking; and (5) a 10% reduction of mortality due to asthma and chronic obstructive pulmonary disease. Methods/design Baseline data were collected from Dutch registries with the most recent available data from 2011, 2012 and 2013. To achieve the objectives, the Lung Alliance Netherlands presented various key activities and strategies that are described in this paper. Discussion The ambitious objectives are interconnected and their mutual reinforcement is expected to have a beneficial impact on the burden of chronic lung diseases. A strength of the Dutch national action programme is the extensive cooperation between the multiple healthcare parties that contribute to the coordination of the delivery of healthcare. A potential weakness is the relatively short time span of the programme, which may prevent observing its full potential. [ABSTRACT FROM AUTHOR]

A large share of countries is struggling to provide adequate care to their older populations. To deal with this challenge, philosopher Ingrid Robeyns has advocated legislation that requires (most) citizens to spend 1 year of their life providing dependency care. My aim of this contribution is to strengthen the case for this proposal, which I will refer to as a 'universal care conscription'. I do so by defending this type of conscription against various alternative ways of addressing care-deficits that have been proposed. As I show, not only is it doubtful whether pursuing these alternatives will always, or even generally, suffice to prevent and/or alleviate care-deficits at reasonable financial and moral cost, a universal care conscription has significant civic benefits in an age of polarization that count strongly in its favour. [ABSTRACT FROM AUTHOR]

This article examines the political economy of health inequalities and inequities in the public health care system in India and identifies potential areas for interventions to promote equal and equitable health care for marginalized people. Drawing on the Political Economy of Health Model of Research, this article reiterates the inadequacy of policy frameworks and programs in ensuring accessible, affordable, and quality public health care services to all. We argue that for policies to be successful, policymakers should consider the diverse social registries of class, caste, religion, gender, region, ethnicity, and age, as well as their intersections. We also argue that health care policies and programs need to be: (a) dynamic and flexible, (b) intersectional and backed up by sufficient grassroots research, and (c) equitable at every stage of policy formulation, implementation, and evaluation. [ABSTRACT FROM AUTHOR]

This article explores the impact of neoliberalism and biomedicalism on social work mental health care practice through presenting the results of a Canadian provincial study which illustrates the experiences of social work service users, providers, and supervisors. While Canada has a universal health care program, the intensification of the free-market approach is evident in the shifts from public sector support to growing rationalization and marked cutbacks to the provision of social welfare services. The specific impact of neoliberal economic restraint on social justice in mental health services has pressured practitioners to adopt medicalized, short-term strategies, under efficiency-based models. The participants in this study reported significant co-occurring concerns with the state of mental health service delivery, and results suggest social work is increasingly co-opted by the conservative individualizing, pathologizing, and contextualizing dominant biomedical framework in the provision of mental health social services and lack of professional practice autonomy. [ABSTRACT FROM AUTHOR]

Using the 2007 to 2016 Medical Expenditure Panel Survey-Household Component, this study analyzes trends in per capita health expenditures among nonelderly adults from the Great Recession to the period following full implementation of the Affordable Care Act. We find that the growth in total per capita spending-and specifically for prescription drug and emergency room spending-from 2007-2009 to 2014-2016 was largely driven by increases in expenditures per unit, that is, increases in per unit prices, quality, and/or intensity of treatment. We also find that changes in the health insurance distribution were the largest driver behind the increase in total per capita expenditures over this period, while changes in prevalence of chronic conditions explained a smaller portion of the increase. Identifying policies for containing health care spending growth requires a detailed understanding of the sources of that growth, particularly during periods of economic fluctuations, policy changes, and technological developments. [ABSTRACT FROM AUTHOR]

This article presents key results from a comparative qualitative Social Policy study of nine African regional economic communities' (RECs) regional health policies. The article asks to what extent has health been incorporated into RECs' public policy functions and actions, and what similarities and differences are evident among the RECs. Utilising a World Health Organization (WHO) framework for conceptualising health systems, the research evidence routes the article's arguments towards the following principal conclusions. First, the health sector is a key component of the public policy functions of most of the RECs. In these RECs, innovations in health sector organisation are notable; there is considerable regulatory, organisational, resourcing and programmatic diversity among the RECs alongside under-resourcing and fragmentation within each of them. Second, there are indications of important tangible benefits of regional cooperation and coordination in health, and growing interest by international donors in regional mechanisms through which to disburse health and -related Official Development Assistance (ODA). Third, content analysis of RECs' regional health strategies suggests fairly minimal strategic ambitions as well as significant limitations of current approaches to advancing effective and progressive health reform. The lack of emphasis on universal health care and reliance on piecemeal donor funding are out of step with approaches and recommendations increasingly emphasising health systems development, sector-wide approaches (SWAPs) and primary health care as the bedrock of health services expansion. Overall, the health component of RECs' development priorities is consistent with an instrumentalist social policy approach. The development of a more comprehensive sustainable world-regional health policy is unlikely to come from the African Continental Free-Trade Area, which lacks requisite social and health clauses to underpin 'positive' forms of regional integration. [ABSTRACT FROM AUTHOR]

This article discusses the results of a content and critical discourse analysis of Canadian federal policy documentation relating to the development of a national Canadian dementia strategy. These documents span from 2013 and focus upon Canadian federal policy directives and directions up to the release, and including the release, of a national strategy in June 2019. The analyses, supplemented by a subtextual examination of these documents guided by Bacchi's (2012) "What's the Problem Represented to be?" framework, focuses upon the treatment of gender in policy documentation and the specific gender related policy framework, known as GBA+ (gender-based analysis and intersectionality), which is intended to bring about health equity to disadvantaged groups. As women, particularly, working class women and their carers, as well as women with additional intersecting factors, such as being lesbian or bisexual, are less likely to receive the dementia related care and services they need, precipitating a premature move to residential care, GBA+ is an essential policy framework in the attempt to address these inequities. However, findings point to a superficial treatment of gender, GBA and GBA+ in federal policy documents and lack a meaningful invocation of women's gendered and intersectional lived experiences of dementia. Additionally, the Canadian federal government's Dementia Strategy for Canada: Together We Aspire (2019) is grounded in a rendition of citizenship that do not work to unearth the complex relationships between citizenship, old age, gender and intersectional factors. As a result, the Dementia Strategy for Canada: Together We Aspire (2019) presents a version of citizenship that homogenizes older adults and prevents representations of older adults as diverse, complex and continually changing groupings. Therefore, inspired by Bartlett et al. (2018), I advocate for the application of a feminist and intersectional citizenship lens in Canadian federal dementia-related policymaking documentation going forward. [ABSTRACT FROM AUTHOR]

Introduction: From the onset of the COVID-19 pandemic, public health officials have sought to develop evidence-based messages to reduce COVID-19 transmission by communicating key information to media outlets and the public. We describe the development of an interdisciplinary rapid message testing model to quickly create, test, and share messages with public health officials for use in health campaigns and policy briefings. Methods: An interdisciplinary research team from the University of North Carolina at Chapel Hill assembled in March 2020 to assist the state health department in developing evidence-based messages to influence social distancing behaviors in the state. We developed and iteratively executed a rapid message testing model; the components of the 4-step model were message creation, survey development, survey administration, and analysis and presentation to health department officials. The model was executed 4 times, each during a 7-day period in April and May, and each subsequent survey included new phrasing and/or messaging informed by the previous week's survey. A total of 917 adults from North Carolina participated in the 4 surveys. Results: Survey participants rated messages focused on protecting oneself and others higher than messages focused on norms and fear-based approaches. Pairing behaviors with motivations increased participants' desire to social distance across all themes and subgroups. For example, adding "Protect your grandmother, your neighbor with cancer, and your best friend with asthma," to messaging received a 0.9-point higher score than the base message, "Stay 6 feet apart from others when out in public." Practice Implications: Our model to promote social distancing in North Carolina during the COVID-19 pandemic can be used for rapid, iterative message testing during public health emergencies. [ABSTRACT FROM AUTHOR]

Introduction: Telemental health (TMH) is a promising approach to increase access to mental healthcare. This study examined the TMH adoption rates and associations with facility- and state-level factors among US mental health (MH) facilities.Methods: This retrospective, cross-sectional study used linked data for 2016 from the National Mental Health Services Survey (N = 11,833), Area Health Resources File, and national reports for broadband access and telehealth policies. The associations of facility and state-level characteristics with TMH adoption were examined with multi-level logistic regressions.Results: Overall, 25.9% had used TMH. Having veteran affiliation [Adjusted Odds Ratio (AOR) = 18.53, 95% Confidence Interval (95%CI): 10.66-32.21] and greater Information Technology (IT) capacity [AOR(95%CI): 2.89(2.10-3.98)] were the strongest correlates of TMH adoption. Other facility characteristics associated with higher likelihood of TMH adoption were: public ownership, high patient volumes, having comprehensive MH treatments or Quality Improvement practices, having private or non-Medicaid public payers, and treating elderly patients (AORs: 1.16-2.41). TMH adoption was less likely among facilities treating more African Americans or patients with substance abuse disorders. TMH adoption varied substantially across states, with adoption more likely in states issuing special telehealth licences and those with more rural counties.Discussion: One in four MH facilities adopted TMH in 2016. TMH adoption varied by multiple facility- and state-level factors. Our findings suggest that: legal/regulatory burden and lower facility IT capacity may discourage TMH adoption; significant racial disparities exist in TMH adoption; and there is a need to increase TMH use for substance abuse disorders. [ABSTRACT FROM AUTHOR]

The authors discuss the challenges in translating national and state reopening plans into local reopening policies during the COVID-19 pandemic. Topics mentioned include the reason why linear plans are easy to communicate, a plan confirmed in Indiana on April 29, 2020 to hire 500 contact tracers, and the U.S. Centers for Disease Control and Prevention's Public Health Associates Program.

The implementation of the nurse practitioner (NP) workforce in primary health care (PHC) in New Zealand has been slow, despite ongoing concerns over persisting health inequalities and a crisis in the primary care physician workforce. This article, as part of a wider institutional ethnography, draws on the experiences of one NP and two NP candidates, as they struggle to establish and deliver PHC services in areas of high need, rural, and Indigenous Māori communities in New Zealand. Using information gathered initially by interview, we develop an analysis of how the institutional and policy context is shaping their experiences and limiting opportunities for the informants to provide meaningful comprehensive PHC. Their work (time and effort), with various health organizations, was halted with little rationale, and seemingly contrary to New Zealand's strategic direction for PHC stipulated in the Primary Health Care Strategy 2001. The tension between the extant biomedical model, known as primary care, and the broader principles of PHC was evident. Our analysis explored how the perpetuation of the neoliberal health policy environment through a "hands-off" approach from central government and district health boards resulted in a highly fragmented and complex health sector. Ongoing policy and sector perseverance to support privately owned physician-led general practice; a competitive contractual environment; and significant structural health sector changes, all restricted the establishment of NP services. Instead, commitment across the health sector is needed to ensure implementation of the NP workforce as autonomous mainstream providers of comprehensive PHC services. [ABSTRACT FROM AUTHOR]

Background: There is a growing body of qualitative studies examining parents' experiences of caring for a child with a life-limiting condition, coinciding with recent evidence that indicates an increasing incidence of paediatric life-limiting conditions. However, research focusing on fathers' needs remains sparse and is often diluted among a predominant 'mother's voice', raising questions about whether practices in clinical settings meet fathers' needs. Aim: To provide an in-depth assembly of the current state of knowledge around fathers' experiences of caring for their children diagnosed with life-limiting conditions and understand the implications for healthcare services and policies. Design: A meta-ethnography was conducted to synthesise findings from existing qualitative studies exploring fathers' experiences of caring. Data sources: Four electronic databases (PubMed, PsycINFO, CINAHL and Science Direct) were searched up until April 2020. Qualitative studies exploring fathers' care experience and published in English language were included. The Critical Appraisal Skills Programme (CASP) checklist was employed for study quality appraisal. No temporal limits were used. Results: Sixty-three studies met the inclusion criteria. Thirty life-limiting conditions were included. Based on responses from 496 fathers, a conceptual model was developed which translates key experiences within the fathers' caregiving journeys. The overarching concepts identified were: the paradox of support, challenges in the caring process, 'nobody thinks of men', impact on family life and the fall of the curtain: an irrevocably altered world. These and associated sub-concepts are discussed, with recommendations for future research and practice provided. Conclusion: The findings indicate the value of a family-oriented approach to develop psychosocial interventions and support channels for fathers, thus empowering them whilst reducing the care-giving burden on the family unit. [ABSTRACT FROM AUTHOR]

For-profit hospitals' market share has increased in many nations over recent decades. Previous studies suggest that their growth is not attributable to superior performance on access, quality of care, or efficiency. We analyzed other factors that we hypothesized may contribute to the increasing role of for-profit hospitals. We studied the historical development of the for-profit hospital sector across 4 nations with contrasting trends in for-profit hospital market share: the United States, the United Kingdom, Germany, and the Netherlands. We focused on 3 factors that we believed might help explain why the role of for-profits grew in some nations but not in others: (1) the treatment of for-profits by public reimbursement plans, (2) physicians' financial interests, and (3) the effect of the political environment. We conclude that access to subsidies and reimbursement under favorable terms from public health care payors is an important factor in the rise of for-profit hospitals. Arrangements that aligned financial incentives of physicians with the interests of for-profit hospitals were important in stimulating for-profit growth in an earlier era, but they play little role at present. Remarkably, the environment for for-profit ownership seems to have been largely immune to political shifts. [ABSTRACT FROM AUTHOR]