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Policy PointsLow‐value care is common in clinical practice, leading to patient harm and wasted spending. Much of this low‐value care stems from the use of medical device‐based procedures.We describe here a novel academic‐policymaker collaboration in which evidence‐based clinical coverage for device‐based procedures is implemented through prior authorization‐based policies for Louisiana's Medicaid beneficiary population.This process involves eight steps: 1) identifying low‐value medical device‐based procedures based on clinical evidence review, 2) quantifying utilization and reimbursement, 3) reviewing clinical coverage policies to identify opportunities to align coverage with evidence, 4) using a low‐value device selection index, 5) developing an evidence synthesis and policy proposal, 6) stakeholder engagement and input, 7) policy implementation, and 8) policy evaluation. This strategy holds significant potential to reduce low‐value device‐based care. [ABSTRACT FROM AUTHOR]

Policy PointsPatients and families can identify clinically relevant errors, including "blindspots"—safety hazards that are difficult for clinicians or organizations to see.Health information transparency, including patient access to electronic visit notes, now federally mandated in the US and the subject of policy debate worldwide, creates a new opportunity to engage patients in diagnostic safety. However, not all patients access notes.Patient identification of blindspots in their notes underscores the need to systematically and equitably engage willing patients in safety, promote patient "good catches," and establish routine systems for patient feedback to help avoid preventable diagnostic errors and delays. Context: Policy shifts toward health information transparency provide a new opportunity for patients to contribute to diagnostic safety. We investigated whether sharing clinical notes with patients can support identification of "diagnostic safety blindspots"—potentially consequential breakdowns in the diagnostic process that may be difficult for clinical staff to observe. Method: We used mixed methods to analyze patient‐reported ambulatory documentation errors among 22,889 patients at three US health care centers who read ≥ 1 visit note(s). We identified blindspots by tailoring a previously established taxonomy. We used multiple regression analysis to identify factors associated with blindspot identification. Findings: 774 patients reported a total of 962 blindspots in 4 categories: (1) diagnostic misalignments (n = 421, 43.8%), including inaccurate symptoms or histories and failures or delay in diagnosis; (2) errors of omission (38.1%) including missed main concerns or next steps, and failure to listen to patients; (3) problems occurring outside visits (14.3%) such as tests, referrals, or appointment access; and (4) multiple low‐level problems (3.7%) cascading into diagnostic breakdowns. Many patients acted on the blindspots they identified, resulting in "good catches" that may prevent potential negative consequences. Older, female, sicker, unemployed or disabled patients, or those who work in health care were more likely to identify a blindspot. Individuals reporting less formal education; those self‐identifying as Black, Asian, other, or multiple races; and participants who deferred decision‐making to providers were less likely to report a blindspot. Conclusion: Patients who read notes have unique insight about potential errors in their medical records that could impact diagnostic reasoning but may not be known to clinicians—underscoring a critical role for patients in diagnostic safety and organizational learning. From a policy standpoint, organizations should encourage patient review of visit notes, build systems to track patient‐reported blindspots, and promote equity in note access and blindspot reporting. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 pandemic is persisting for more than a year and it's still far from being controlled. It is making a big impact not only on physical illness but also on mental and social aspects. In this situation, we need to reflect on current medical society's view of disease and health. The dominant paradigm in contemporary medicine is the reductionist view of disease and the biomedical model of health. As a result, the healthcare system seems to be more focused on virus eradication than on patient care. We need to look back on this position in view of humanities and ethics and broaden our perspective to an ecological view of disease and the sociomedical model of health. The quarantine and health care policy also needs to be re‐built with more focus on patient care. [ABSTRACT FROM AUTHOR]

In Canada, as elsewhere, it has been agreed that primary health care (PUC) is needed, particularly for the underserved population. But the debate continues over which approach, what measures and who should be involved. To help find the answers, the Canadian Nurses Association presented a working paper already in 1980 to the Canadian Government recommending changes in the health system and proposing various roles that nurses could play in formulating and implementing its national primary health policy and in November this year organized a two-day PHC workshop involving representatives from provincial councils and government as well as nurses. Below, two nurses teaching at the University of Ottawa's School of Nursing give their view on what should and could be done in Canada. [ABSTRACT FROM AUTHOR]

The American Academy of Nursing introduces a panel on alternative care models. The session was the first in a series of explorations by the academy of the influence, real and potential of the nursing profession on health policy for the next decade. In addition to those addressing alternative care models , papers by academy fellows included in a new publication are about payment for the services of nurses and women and power. Also included in the publication is the keynote paper of the session delivered by Anne J. Davis, a fellow of the academy and Professor, School of Nursing, University of California.

Aims: To describe and compare the health system responses for type 1 diabetes in Kyrgyzstan, Mali, Peru and Tanzania. Methods: The Rapid Assessment Protocol for Insulin Access, a multi‐level assessment of the health system, was implemented in Kyrgyzstan, Mali, Peru and Tanzania using document reviews, site visits and interviews to assess the delivery of care and access to insulin. Results: Despite the existence of noncommunicable or diabetes strategies and Universal Health Coverage policies including diabetes‐related supplies, this has not necessarily translated into access to insulin or diabetes care for all. Insulin and related supplies were often unavailable and unaffordable. Across the four countries test strips and insulin, when paid for by the individual, represented respectively 48–82% and 25–36% of total costs. Care was mainly delivered at tertiary‐level hospitals by specialists. Only Kyrgyzstan had data collection systems integrated into the Ministry of Health structure. In addition, issues with healthcare worker training and education and empowerment of people with diabetes were present in these health systems. Conclusions: People with type 1 diabetes in these countries face different barriers, including the cost of insulin and care. Given the renewed attention to diabetes on the global health agenda tailored health system responses for type 1 diabetes are needed. Insulin should be prioritized as it is the foundation of type 1 diabetes care, but other elements of care and support need to be fostered by different actors. [ABSTRACT FROM AUTHOR]

One of the unintended effects of China's health care reforms is the emergence of unregistered practitioners. We discuss reasons for their development and their role in the urban health care provision system under consideration of general developments in health care provision and health governance - thereby drawing scientific attention to a by far under-researched topic. We analyse the basic characteristics and strategies of clinic-based unregistered practitioners in Guangzhou and examine their perception and utilisation by rural-to-urban migrants. The research design followed a qualitative dominant mixed methods research approach, which included expert interviews with representatives of administration, indepth interviews with practitioners and migrants, a quantitative survey with 450 migrants and field observations. According to our results, gaps in the formal health care system - especially lack of access of marginalised population groups and inadequate responsiveness - poor enforcement of regulation and corrupt executive personnel are responsible for their emergence and prevalence. [ABSTRACT FROM AUTHOR]

The article presents comments of the author on the paper "Whither Dermatology?" by John Cotterill. In this paper Cotterill laments that a new "management culture" has resulted in medicine being "increasingly driven by market forces." As explained in the accompanying presentation "The Golden Rule of Health Care," health care reform is being driven totally by economic factors. As physicians we have been trained to care for the sick and injured. The major concern is the welfare of the patients. This is in stark contrast to the primary concern of private industry and governments worldwide that the cost of medicine be reduced period. The increased longevity of our patients, the advent of new technologies and other factors are forcing the rate of medical inflation to exceed that of the general economy.

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Aim: To emphasize that nurses need to be fully protected to carry out their vital role, particularly during pandemics, yet the lack of a standardized and systematic collection of high‐quality disaggregated data on nurses health inhibits our ability to assess this within and across countries. Background: Nurses are the largest workforce group in the health sector, yet only 59 countries worldwide report on nurse COVID‐19 infections and related deaths, and the standardized, systematic collection of disaggregated health data is not yet in place. Sources of evidence: Medline, International Council of Nurses, World Health Organization, Centers of Disease Control and Prevention and the experiences of the authors. Discussion: Inconsistent recording and definitions of nurses, precarious and informal employment conditions, limited transparent and reliable data, lack of mass testing and long‐standing structural issues and biases have affected nursing for too long. Conclusions: These issues are reflected in the limited capacity of many national public health information systems to collect, monitor and report on the health of the largest group of health workers. Political will, accountability and public data transparency at different levels are essential to adequately protect nurses at work. Implications for nursing practice, and nursing and health policy: Building on current momentum in the nursing field, immediate political action is required to strengthen existing nursing and midwifery policies, standards and regulatory capacity, as well as existing public health services and information and surveillance systems. The generation of up‐to‐date, context‐specific knowledge is needed to inform and monitor political decisions related to the protection of nurses, and the improvement of their employment conditions, as well as to strengthen accountability for these areas at various levels. [ABSTRACT FROM AUTHOR]

Public health initiatives aim to improve health outcomes for populations by preventing disease and ill‐health consequences of environmental hazards and natural or human‐made disasters. Whilst public health initiatives have been used successfully to modify behaviours for chronic diseases, many initiatives targeting reduced dementia risk in older adults suffer from conceptual and statistical flaws that greatly limit their usefulness. The limited success in modifying lifestyle dementia risk factors has led us to fall short in building a successful roadmap to dementia risk reduction. Here we argue for adopting a population‐level, holistic approach to dementia risk reduction strategies across the lifespan. This approach is supplemented by 10 strategies that focus on improving social policies, harnessing existing policy, legislature and incentive schemes, and identifying feasible approaches to increase recreational and transport‐related physical activity to creating best practice health care that supports healthy brain ageing for all. [ABSTRACT FROM AUTHOR]

Objective: The Severe Behaviour Response Team (SBRT) program, which was established in 2015 to support aged care residents with dementia experiencing very severe and extreme responsive behaviours received far fewer referrals than projected during its first year. This article describes the outcomes of a brief survey to identify potential barriers to referrals and identify opportunities to improve the uptake of the service. Methods: A pragmatic, quasi‐experimental study was conducted involving clinical leads working in a representative sample of care homes that had not used the SBRT. The study was part of the formative evaluation activities of an ongoing program evaluation. Results: Of the 53 clinical leads that participated in the survey, one‐third had not heard of the SBRT prior to being contacted. The remaining two‐thirds (n = 36) had not used the service due to the availability of existing resources and concerns regarding responsiveness of, and access to, the new service. Conclusions: Three themes emerged from the study relating to awareness of the service, responsiveness and the interface between local aged care and health services. Referrals increased following interventions to address the first two themes; however, they continue to remain well below the number projected. This indicates a fundamental disconnection between the policy design process and the day‐to‐day experience of residential aged care. The study highlights the importance of aged care clinical leads being engaged in dementia policy and program development processes to support improved targeting of resources. [ABSTRACT FROM AUTHOR]

Existing calls to implement learning health care systems have tended to stipulate a minimal or near‐minimal risk limit for compulsory learning activities. I argue to the contrary that such a limit cannot be defended. So long as the way in which patients are compelled to participate in learning activities is solely through the withholding of nonresearch options for receiving care, compelling participation does not violate any individual's rights and can be both efficient and adequately fair. Because the decision to compel participation in this way is relevantly similar to the decision to ration care, theories of justice in cost‐effectiveness rationing can be used to further specify when it is appropriate to use this method to compel research participation. When applied, these theories will not support a minimal risk limit for compulsory research. [ABSTRACT FROM AUTHOR]

European competition policy's first interactions with national healthcare systems emerged after 2000 without much controversy as only those healthcare regimes with clear market‐orientated elements were subject to EU competition rules. After 2010 however, this began to be challenged as a result of pressures from the private sector, various marketization reforms in Europe as well as pressures from within the EU itself. The question therefore re‐emerged: would EU competition law, and its 'state aid law' part especially, now be pushed into social solidarity‐orientated healthcare, including those that were subject to some degree of marketisation? This article examines this question through two important recent competition law cases from Belgium and Slovakia, but with a focus on the latter. Despite the apparent limits placed on European competition law's place in healthcare in the 2000s, European Commission and the Court of Justice were called upon to reassert some limits on its role in healthcare and social solidarity‐based regimes in particular. Together, the Iris‐H and Dôvera cases resolve those political and institutional problems that such a competition policy‐based intrusion into healthcare would have created. [ABSTRACT FROM AUTHOR]

In the two decades between Oral Health in America: A Report of the Surgeon General and Oral Health in America: Advances and Challenges much good happened but intractable challenges persist. Inequity in oral health status, utilization, and access to care continue to negatively affect the health and economic wellbeing of Americans and their families, local, state, and federal health care systems, and American society overall. To move the nation forward, we argue that: more emphasis is needed in prevention; access to care must be improved to mitigate inequity; newer understandings of oral disease must be leveraged in the service of health and health care; the value that oral health brings to economic wellbeing must be elucidated; better policy choices must be made in all of the above; and more effective oral health care leaders in driving policy change must be trained. [ABSTRACT FROM AUTHOR]

Sturmberg and Martin make a compelling case for primary healthcare (PHC) to be the foundation for universal healthcare (UHC). They state that a system should have necessary resources, but what does that mean? Basic economic theory postulates that all resources are limited and that choices must be made between competing options. For a UHC system to be successful and resilient, it must accept that healthcare is a limited right, there will always be inequalities in healthcare delivery and outcomes, primary care physicians and their teams must accept the added burden of balancing the needs of their personal patients with the greater system, leaders and observers of healthcare systems must accept that moderation and balance will often be the best outcome even though they are difficult to measure, and leaders of healthcare systems must accept that they cannot control the system, but contribute by providing context and limited constraints, information, and resources. A deeper understanding of complex adaptive systems will best guide these necessary changes. [ABSTRACT FROM AUTHOR]

An analysis of the financing of Nigeria's health‐care system in response to coronavirus disease 2019 (COVID‐19) pandemic was conducted. Nigeria projected that it would need US$330 million to control its COVID‐19 pandemic. However, it raised more than US$560.52 million, of which more than 90% came from the private sector and the donor/philanthropist community. The pooled COVID‐19 fund is mainly being expended on temporary public health and clinical care measures, with little invested to strengthen the health system beyond the pandemic. The poor turn‐around time for COVID‐19 test results and the stigma associated with the disease results in most persons with mild to moderate symptoms seeking care from alternatives to the health‐care institutions designated for COVID‐19 health care. The huge out‐of‐pocket expenses, and the inability of most Nigerians to earn money because of measures instituted to contain the pandemic, will likely cause many Nigerians to become economically impoverished by the COVID‐19 pandemic. COVID‐19‐related commodity procurement was least responsive to the needs of those most in need of care and support. The government needs to institute several fiscal policies. Immediate response to ease the financial impact of COVID‐19 require inclusion of COVID‐19 management in health insurance packages and an increase in domestic government health spending. Key points: Nigeria projected that it would need US$330 million to control its COVID‐19 pandemic.However, it raised more than US$560.52 million, of which more than 90% came from the private sector and the donor/philanthropist community.The pooled COVID‐19 fund is mainly being expended on temporary public health and clinical care measures, with little invested to strengthen the health system beyond the pandemic.Immediate response to ease the financial impact of COVID‐19 require inclusion of COVID‐19 management in health insurance packages and an increase in domestic government health spending. [ABSTRACT FROM AUTHOR]

The increase in cancer incidence and mortality is challenging current cancer care delivery globally, disproportionally affecting low‐ and middle‐income countries (LMICs) when it comes to receiving evidence‐based cancer prevention, treatment, and palliative and survivorship care. Patients in LMICs often rely on traditional, complementary, and integrative medicine (TCIM) that is more familiar, less costly, and widely available. However, spheres of influence and tensions between conventional medicine and TCIM can further disrupt efforts in evidence‐based cancer care. Integrative oncology provides a framework to research and integrate safe, effective TCIM alongside conventional cancer treatment and can help bridge health care gaps in delivering evidence‐informed, patient‐centered care. This growing field uses lifestyle modifications, mind and body therapies (eg, acupuncture, massage, meditation, and yoga), and natural products to improve symptom management and quality of life among patients with cancer. On the basis of this review of the global challenges of cancer control and the current status of integrative oncology, the authors recommend: 1) educating and integrating TCIM providers into the cancer control workforce to promote risk reduction and culturally salient healthy life styles; 2) developing and testing TCIM interventions to address cancer symptoms or treatment‐related adverse effects (eg, pain, insomnia, fatigue); and 3) disseminating and implementing evidence‐based TCIM interventions as part of comprehensive palliative and survivorship care so patients from all cultures can live with or beyond cancer with respect, dignity, and vitality. With conventional medicine and TCIM united under a cohesive framework, integrative oncology may provide citizens of the world with access to safe, effective, evidence‐informed, and culturally sensitive cancer care. [ABSTRACT FROM AUTHOR]

Aim: Following the establishment of paediatric palliative care services over recent decades, this study sought to identify information to inform future policy and practice.Methods: A rapid review using thematic synthesis was conducted to synthesise existing information about improving paediatric palliative care. Information was extracted in relation to key areas for investment and change: quality, access, advance care planning, skills, research, collaboration and community awareness.Results: A total of 2228 literature sources were screened, with 369 included. Synthesised information identified clear ways to improve quality of care, access to care, advance care planning, and research and data collection. The synthesis identified knowledge gaps in understanding how to improve skills in paediatric palliative care, collaboration across Australian jurisdictions and community awareness.Conclusions: The findings of this review bring together information from a vast range of sources to provide action-oriented information to target investment and change in paediatric palliative care over the coming decades. [ABSTRACT FROM AUTHOR]

Increasingly, palliative care is being referred to as an essential programme and in some cases as a human right. Once it is recognized as such, it becomes part of the lexicon of social justice in that it can be argued that all members of society should have access to such care. However, this begs the question of how that care should be enacted, particularly in rural and remote areas. This question illustrates some of Friedrich Hayek's critiques of social justice. Hayek has likened social justice to a 'moral stone' arguing that social justice is meaningless to the extent that society is impersonal and as such cannot be just, only those individuals who make up that society can be just. When responsibility for justice is assigned to an impersonal society, ideas of social justice can become a clarion call for whom no one is directly accountable. This opens the door for questionable macro-level political agendas that have no capacity to enact the ideal, and worse, may suppress individual moral acts towards the desired end. Further, acts of interference at the macro level with the ideal of equal opportunity run the risk of disadvantaging other members of society. Instead, he has argued that a better approach lies in finding ways to induce and support individual moral acts that promote the human good. Hayek's arguments are particularly compelling for rural palliative care. In this paper we draw upon data from an ethnographic study in rural palliative care to illustrate the potential misfit between the ethical ideal of palliative care as expressed by rural participants and the narratives of social justice. [ABSTRACT FROM AUTHOR]

This study investigates health professionals' reactions to patients' perceptions of health issues - a little-researched topic vital to the reform of the care of chronic illness. Focus groups were undertaken with doctors, nurses, allied health staff and pharmacists ( n = 88) in two Australian urban regions. The focus groups explored responses to patient experiences of chronic illness (COPD, Diabetes, CHF) obtained in an earlier qualitative study. Content analysis was undertaken of the transcripts assisted by NVivo7 software. Health professionals and patients agreed on general themes: that competing demands in self-management, financial pressure and co-morbidity were problems for people with chronic illness. However where patients and carers focused on their personal challenges, health professionals often saw the patient experience as a series of failures relating to compliance or service fragmentation. Some saw this as a result of individual shortcomings. Most identified structural and attitudinal issues. All saw the prime solution as additional resources for their own activities. Fee for service providers (mainly doctors) sought increased remuneration; salaried professionals (mainly nurses and allied health professionals) sought to increase capacity within their professional group. Professionals focus on their own resources and the behaviour of other professionals to improve management of chronic illness. They did not factor information from patient experience into their views about systems improvement. This inability to identify solutions beyond their professional sphere highlights the limitations of an over-reliance on the perspectives of health professionals. The views of patients and carers must find a stronger voice in health policy. [ABSTRACT FROM AUTHOR]

The article focuses on the influence of the Milbank Memorial Fund on the health policy in the U.S. The Fund has been consistent in its goals, and in how its board and staff implemented them. The Fund sought improvement in the general level of public welfare and public health. The chronological history of the Fund's programs is presented.

There is a dearth of literature exposing the systems, processes and roles involved in practice development activity. This paper addresses this deficit by proposing a framework derived from research to facilitate setting the aim and enabling the process of practice development. Based on the theories of change approach, the context of the development is a key component of the process. The method of articulating the rationale guiding the activity ensures that it is Kith 'plausible' and 'doable' thereby enhancing the likelihood of a successful outcome. [ABSTRACT FROM AUTHOR]

Policy PointsPolicymakers at federal and state agencies, health systems, payers, and providers need rigorous evidence for strategies to improve health care delivery and population health. This is all the more urgent now, during the COVID‐19 pandemic and its aftermath, especially among low‐income communities and communities of color.Randomized controlled trials (RCTs) are known for their ability to produce credible causal impact estimates, which is why they are used to evaluate the safety and efficacy of drugs and, increasingly, to evaluate health care delivery and policy. But RCTs provide other benefits, allowing policymakers and researchers to: 1) design studies to answer the question they want to answer, 2) test theory and mechanisms to help enrich understanding beyond the results of a single study, 3) examine potentially subtle, indirect effects of a program or policy, and 4) collaborate closely to generate policy‐relevant findings.Illustrating each of these points with examples of recent RCTs in health care, we demonstrate how policymakers can utilize RCTs to solve pressing challenges. [ABSTRACT FROM AUTHOR]

The apportionment of responsibility for health policy within multi‐level states should be sensitive to a number of conflicting normative pressures, some of which militate for placing decision‐making authority at the higher reaches of policy‐making structures, while others would seem to require placing them lower down this structure. The principle of subsidiarity is a structural principle that addresses in a manner that is neutral with respect to these values a way of addressing the conflicting claims of these values. Standard accounts of federalism fare poorly with respect to the criterion of subsidiarity. While central governments are at first glance better equipped to apply such a principle to the issue of the distribution of authority, there are strong empirical grounds for thinking that centralized governments will non‐neutrally privilege central authorities in applying the principle. Federal structures that admit of overlapping jurisdictions, and that therefore require that deliberation among federal parties occur as a condition of the problem of the distribution of powers over health care being solved, are most amenable to solving problems of distribution of authority. [ABSTRACT FROM AUTHOR]

Universal health care (UHC) is primarily a financing concern, whereas primary health care (PHC) is primarily concerned with providing the right care at the right time to achieve the best possible health outcomes for individuals and communities. A recent call for contributions by the WHO emphasized that UHC can only be achieved through PHC, and that to achieve this goal will require the strengthening of the three pillars of PHC ‐ (a) enabling primary care and public health to integrate health services, (b) empowering people and communities to create healthy living conditions, and (c) integrating multisectoral policy decisions to ensure UHC that achieves the goal of "health for all." "Pillars" ‐ as a static metaphor ‐ sends the wrong signal to the research and policy‐making community. It, in fact, contradicts the WHO's own view, namely that there is "the need to strengthen comprehensive primary health care systems based on local priorities, needs and contexts ... [that are] co‐developed by people who are engaged in their own health." What we really need to develop PHC as the basis to achieve the goal of UHC is a dynamic agency to drive a "system‐as‐a‐whole framework" that simultaneously takes into account finance, individual, and local needs. Health systems are socially constructed organizational systems that are "functionally layered" in a hierarchical fashion ‐ governments and/or funders at the top‐level not only promote the goals of the system (policies) but also constrain the system (rules, regulations, resources) in its ability to deliver. Hence, there is a need to focus on two key system features ‐ political leadership and dynamic bottom‐up agency that maintains everyone's focus on the goal to be achieved, and a limitation of system constraints so that communities can shape best adapted primary care services that truly meet the needs of their individuals, families, and community. [ABSTRACT FROM AUTHOR]

Abstract This paper compares the health policies of Hong Kong, South Korea, Singapore and Taiwan with the purpose of drawing policy lessons. The study finds two distinct policy clusters: Hong Kong and Singapore on the one hand, and Korea and Taiwan on the other. With respect to provision of health care, the former rely largely on public hospitals for delivering inpatient care while the latter rely on private hospitals. In matters of financing, they are similar in that out-of-pocket is a major source of financing in all four countries. However, they are also different because Korea and Taiwan have universal health insurance while the city states do not. The study concludes that public provision of hospital care, as in Hong Kong and Singapore, yields more favourable outcomes than many mainstream economists would have us believe. Conversely, private provision in combination with social insurance, as found in Korea and Taiwan, severely undermines efforts to contain health care costs. [ABSTRACT FROM AUTHOR]

Presents a critical examination of the progress of evidence-based health care debate. Arguments on the practice of evidence-based medicine; Significance of reasoning and explanation in clinical practice; Description of qualitative approaches to the synthesis of evidence for clinical practice; Guidelines for clinical practices; Effect of guidelines on knowledge and practice pattern.

The task of examining just how the concept of ‘organisations’ has fared in Sociology of Health and Illness in its first 25 years is in some ways unrewarding. The answer has to be – ‘not at all well’. But why is this and does it matter? Part one of this paper considers what research on health care organisations was being conducted in the early years of the Journal and why that work was not viewed with favour by sociologists. Part two examines the growing gulf between those who saw themselves principally as responding to the call for a sociology of health and illness informed by broader sociological theory, and those who regarded themselves more as analysts of health policy and practice. Postmodernism, curiously, has begun to open up something of a route back. Just what might be done to create a closer rapprochement between those calling for theory and those wanting to address some of the day to day challenges of the delivery and experience of health care in the 21[sup st] century are topics for the final section. [ABSTRACT FROM AUTHOR]

Abstract This article draws attention to an absurd feature of contemporary political life that significantly affects health service policy and calls for an urgent explanation. Policies are formed by a process that privileges rhetoric over reality, producing policies that are ‘operationalized’ first and only ‘conceptualized’ at a later date. Two influential articles on clinical governance illustrate this phenomenon perfectly. Lack of clarity about its true meaning and nature is a key feature of clinical governance. The lack of clarity allows policy-makers to shift responsibility for the problems of the health service onto the workforce, who are required to interpret the deliberately vague and platitudinous statements of management in order to implement the policy. But management, through the creation of monitoring agencies, reserves the right to determine whether the policy has been correctly interpreted, thus retaining power without responsibility. Government and senior management have abandoned the communicative function of language, eschewing reasoned debate (as characterized by the use of evidence and structured argument), instead employing language exclusively for the purposes of control and manipulation. Those of us still concerned that the future of our essential services should be determined by open and reasonable debate need to discuss urgently how to explain and respond to this appalling situation. [ABSTRACT FROM AUTHOR]

Discusses articles on critical advances in the evaluation and development of clinical care, published in the 'Journal of Evaluation in Clinical Practice'. Articles on evidence-based medicine (EBM); 'Advancing the Evidence-based Healthcare Debate'; 'Recent Progress in Health Services Research'.

This article provides a summary of manuscript activity during the period September 1, 1999 through August 31, 2000, published in June 2001 issue of the journal "Health Services Research." Several significant new events in the Journal's evolution are also highlighted. Beginning with the January/February 2002 issue, Health Services Research (HSR) will be published by Blackwell Publishers. HSR will expand its page content from the current 160 pages per issue to 288 pages per issue beginning with the January/February 2002 issue.

Background: Evidence‐based guidelines are often cited as a means of ensuring high‐quality care for all patients. Our objective was to assess whether emergency department (ED) adherence to core evidence‐based guidelines differed by patient sex and race/ethnicity and to assess the effect of ED guideline adherence on patient outcomes by sex and race/ethnicity. Methods: We conducted a preplanned secondary analysis of data from a multicenter retrospective observational study evaluating variation in ED adherence to five core evidence‐based treatment guidelines including aspirin for acute coronary syndrome, door‐to‐balloon time for acute ST‐elevation myocardial infarction, systemic thrombolysis for acute ischemic stroke, antibiotic selection for inpatient pneumonia, and early management of severe sepsis/septic shock. This study was performed at six hospitals in Colorado with heterogeneous and diverse practice environments. Hierarchical generalized linear modeling was used to estimate adjusted associations between ED adherence and patient sex and race/ethnicity while controlling for other patient, physician, and environmental factors that could confound this association. Results: A total of 1,880 patients were included in the study with a median (IQR) age of 62 (51–74) years. Males and non‐Hispanic whites comprised 59% and 71% of the cohort, respectively. While unadjusted differences were identified, our adjusted analyses found no significant association between ED guideline adherence and sex or race/ethnicity. Patients who did not receive guideline adherent care in the ED were significantly more likely to die while in the hospital (odds ratio = 2.0, 95% confidence interval = 1.3 to 3.2). Conclusions: Longstanding, nationally reported evidence‐based guidelines can help eliminate sex and race/ethnicity disparities in quality of care. When providers know their care is being monitored and reported, their implicit biases may be less likely to impact care. [ABSTRACT FROM AUTHOR]

Distress management (DM) (screening and response) is an essential component of cancer care across the treatment trajectory. Effective DM has many benefits, including improving patients' quality of life; reducing distress, anxiety, and depression; contributing to medical cost offsets; and reducing emergency department visits and hospitalizations. Unfortunately, many distressed patients do not receive needed services. There are several multilevel barriers that represent key challenges to DM and affect its implementation. The Consolidated Framework for Implementation Research was used as an organizational structure to outline the barriers and facilitators to implementation of DM, including: 1) individual characteristics (individual patient characteristics with a focus on groups who may face unique barriers to distress screening and linkage to services), 2) intervention (unique aspects of DM intervention, including specific challenges in screening and psychosocial intervention, with recommendations for resolving these challenges), 3) processes for implementation of DM (modality and timing of screening, the challenge of triage for urgent needs, and incorporation of patient‐reported outcomes and quality measures), 4) organization—inner setting (the context of the clinic, hospital, or health care system); and 5) organization—outer setting (including reimbursement strategies and health‐care policy). Specific recommendations for evidence‐based strategies and interventions for each of the domains of the Consolidated Framework for Implementation Research are also included to address barriers and challenges. [ABSTRACT FROM AUTHOR]

Adults are capable of self‐assessment of their health status and are at the rudimentary level, able to determine if they need to consume more of health services or not. This, however, lacks in children below the age of 5 years, and as such they rely on their parents and or guardians for healthcare utilization. The study acknowledges the mismatch between utilization and prevalence of illness across the country and the attendant inequality in healthcare utilization across regions. The study adopts the NDHS 2013, the Grossman Framework on the demand for health and the Logistic Regression Analysis, and found that higher maternal educational levels increase child healthcare utilization. Other factors include increased wealth, frequency of older mothers, vaccination and exclusive breastfeeding. Frequency of older children and larger household sizes were, however, found to reduce the probability of child healthcare utilization. The study finds strong regional variations across the country with utilization more enabled in some regions than others, under the same conditions, and recommends that households maintain a size they can cater for health‐wise. The study recommends an all‐inclusive health policy to cater for disparities across regions and the retraining of mothers since secondary education alone is requisite for child healthcare utilization. [ABSTRACT FROM AUTHOR]

Universal health coverage (UHC) has been elevated to the status of a global policy target, but this was at the expense of losing its aspirational meaning. As a case in point, Turkey has been one of the countries that has achieved UHC, according to the technocratic definition. This article employs a combination of deductive and inductive thematic analysis methods to explore patient organisation (PO) perspectives on the Turkish health‐care system based on 26 respondent interviews from 19 POs in Istanbul. Highlighting the inadequacy of the technocratic definition of UHC, the article maintains that an analysis of PO perspectives opens the way for a nuanced and bottom‐up assessment of essential service coverage and financial protection by identifying elusive gaps in both dimensions that would otherwise be lost in generalist evaluations. The findings also underline the importance of keeping intact the UHC's aspirational element to enable POs to participate in the politics of priority setting in health care. [ABSTRACT FROM AUTHOR]

Reflects on the perception of people on health policy as a product. How it affects the outcome of the policymaking process; Implications on the delivery of health care services; Insights on the role of health care providers in the policymaking issue.

Objective: To document dementia-relevant state assisted living regulations and their changes over time as they pertain to licensed care settings.Data Sources: For all states, current directories of licensed assisted living communities and state regulations for each year, 2007-2018, were obtained from state agency websites and Nexis Uni, respectively.Study Design: We identified multiple types of regulatory classifications for each state and documented the presence or absence of specific dementia care provisions in the regulations for each type by study year. Maps and summary statistics were used to compare results to previous research and document change longitudinally.Data Collection/extraction Methods: We used a policy analysis approach to connect communities listed in directories to applicable regulatory text. Then, we employed policy surveillance and question-based coding to record the presence or absence of specific policies for each classification and study year.Principal Findings: Our team empirically documented provisions requiring dementia-specific training for administrators and direct care staff, and cognitive impairment screening for each study year. We found that 23 states added one or more of these requirements for one or more license types, but the states that had these provisions for all types of licensed assisted living declined from four to two.Conclusions: We identified significant, previously undocumented, within-state policy variation for assisted living licensed settings between 2007 and 2018. Using the regulatory classification instead of the state as the unit of analysis revealed that many policy adoptions were limited to dementia-designated settings. This suggests that people living with dementia in general assisted living are not afforded the same protections. We call our approach health services regulatory analysis and argue that it has the potential to identify gaps in existing policies, an important endeavor for health services research in assisted living and other care settings. [ABSTRACT FROM AUTHOR]

Almost exactly 10 years after the publication of 'Call for a national plan for rare diseases' in this journal, the Federal Government launched the National Strategic Action Plan for Rare Diseases (the Action Plan) on the 26th of February 2020, in the lead up to Rare Disease Day on the 29th of February - a rare day for rare diseases. The Action Plan is the culmination of effective advocacy by Rare Voices Australia (RVA) and other stakeholders in the rare disease (RD) sector. RVA is the peak body for Australians living with a RD. The organisation works collaboratively with RD organisations, researchers and clinicians. Since the initial call for a RD plan, a number of health-care initiatives and policy changes have gathered apace including expanded antenatal and newborn screening, the increasing application of next generation sequencing and advances in gene and cell therapeutics. The development of new models of care, diagnostic and treatment pathways, and communities of practice have started to ease the considerable burden and inequitable access to care experienced by RD patients and their families. However, much work remains to be done. The Action Plan outlines the actions to bring about the best possible health and well-being outcomes for Australians living with RD. It is centred around three pillars - awareness and education, care and support, research and data - and will be delivered against the principles of person centredness, equity, and sustainable systems and workforce. [ABSTRACT FROM AUTHOR]

The article presents the standard of practice in intensive care for pharmacy services in 2021. Topics discussed include the purpose and definitions, evidence of pharmacist impact in intensive care unit (ICU) and paediatric ICU (PICU) services, objectives of the pharmacy service, and the scope of standard of practice. Also noted are the policies, procedures and governance in pharmacist practice.

Rationale, aims and objective: Primary Care Plus (PC+) focuses on the substitution of hospital‐based medical care to the primary care setting without moving hospital facilities. The aim of this study was to examine whether population health and experience of care in PC+ could be maintained. Therefore, health‐related quality of life (HRQoL) and experienced quality of care from a patient perspective were compared between patients referred to PC+ and to hospital‐based outpatient care (HBOC). Methods: This cohort study included patients from a Dutch region, visiting PC+ or HBOC between December 2014 and April 2018. With patient questionnaires (T0, T1 and T2), the HRQoL and experience of care were measured. One‐to‐two nearest neighbour calliper propensity score matching (PSM) was used to control for potential selection bias. Outcomes were compared using marginal linear models and Pearson chi‐square tests. Results: One thousand one hundred thirteen PC+ patients were matched to 606 HBOC patients with well‐balanced baseline characteristics (SMDs <0.1). Regarding HRQoL outcomes, no significant interaction terms between time and group were found (P >.05), indicating no difference in HRQoL development between the groups over time. Regarding experienced quality of care, no differences were found between PC+ and HBOC patients. Only travel time was significantly shorter in the HBOC group (P ≤.001). Conclusion: Results show equal effects on HRQoL outcomes over time between the groups. Regarding experienced quality of care, only differences in travel time were found. Taken as a whole, population health and quality of care were maintained with PC+ and future research should focus more on cost‐related outcomes. [ABSTRACT FROM AUTHOR]

Rational, aims, and objectives: Qualitative research has been promoted as an important component of the evaluation of complex interventions to support the scale up and spread of health service interventions, but is currently not being maximized in practice. We aim to identify and explore the sociocultural and structural factors that impact the uses (and misuses) of qualitative research in the evaluation of complex health services interventions. Methods: We conducted a qualitative analysis of data collected in a multiple case study of the evaluation and scale up and spread of three health service intervention. Results: Our findings demonstrate the challenges of meaningfully integrating qualitative research in evaluation programmes lead by clinicians with limited qualitative expertise and operating within an environment dominated by biomedical research, even with methodological support. Conclusions: Based on these findings we encourage ongoing engagement of qualitative researchers in evaluation programmes to begin to refine our methodological understanding, while also suggesting changes to medical education and evaluation funding models to create fertile environments for interdisciplinary collaborations. [ABSTRACT FROM AUTHOR]

This paper addresses the relevance of research to practice under two headings using a policy analysis perspective. Firstly, the relationship of knowledge to action is considered within the context of a piece of longitudinal research into the welfare of children in hospital. The general difficulties of research application are discussed in terms of the different problem perceptions and time scales held by the policy makers who commission research, and the researchers themselves. The example cited demonstrates a useful compromise. The practical consequences arising from the distinct epistemological premises which underpin research into the natural and social worlds of nursing care are considered. Secondly, the constraints on achieving research-based action are described briefly in terms of the resources of time, manpower and funding. It is concluded that an awareness of both conceptual and practical issues is essential in order to comprehend fully the complexity of, and the necessity for, a range of research approaches to nursing issues. [ABSTRACT FROM AUTHOR]

This second adult oral health survey was conducted with the following main aims: 1) to describe the oral health conditions and to analyse the oral health care needs and demands of 65-74-yr-olds in Hong Kong. and to propose appropri- ate strategies for meeting their needs in the light of societal obligations; 2) to describe the oral health conditions and to analyse the oral health care needs and demands of 35-44-yr-olds in Hong Kong with special emphasis on assessment of changes in this age group since 1984 (when the first adult oral health survey was conducted); 3) to assess the impact of sociodemographic and dental care system factors on the oral health status of selected adult age groups: and 4) to utilize survey data to refine curriculum development and research strategies in the Fa- culty of Dentistry. as well as in the proposal of appropriate action to governmental committees on dental health policy. For enhanced comparability with the previous study, the 35 44-yr-olds were selected from the same geographic areas of Hong Kong Island. Multistage cluster sampling was used to recruit the study popula- tion, defined geographic units and addresses being used as the starting-point. A sample of 398 subjects was selected, of whom 9 3d/u were both interviewed and clinical- ly examined. The 65-74-yr-olds were recruited from housing estates in all principal areas of Hong Kong, yielding a sample of 559 subjects, of whom 96% were both interviewed and clinically examined. The analysis of the data was based on the model used by the International Collaborative Study H. from which other meth- odologic guidance had been sought. The definitions of selected sociodemographic variables such as occupation, income, Family Material Possession Index, family support, and dental anxiety, which are relevant to the whole study, are given here. [ABSTRACT FROM AUTHOR]

Government policy in the UK has been to provide comprehensive personalized health care to the whole population free at the point of delivery. However, the first major attempt to unify and regionalize the service in 1974 left a number of problems, and a further restructuring of the, NHS was required. This article reports on the results of research into the 1982 restructuring. The main feature of this second reorganization was the formation of territorial entities called "Districts "', and their organizational subdivision into "Units ". The kind and level of work and authority assigned to Districts and Units is discussed. An important finding, seemingly counter to official policy, is the existence of small Districts which operate at the same level as Units of the larger Districts. [ABSTRACT FROM AUTHOR]

This paper seeks to analyze the political factors involved in health care delivery in a modern industrial welfare state and to illustrate how the transformation of the French state has affected the policymaking environment surrounding this particular issue. Cultural traditions rooted in the nineteenth century seriously circumscribed the role of the state in defining the conditions of medical practice. Nonetheless, pressures emerging since 1945 for the provision of a wide array of social services have drawn the state into ever closer regulation of the health sector. The economic constraints of the past decade resulted in state-imposed cost-containment policies which accentuated the trend toward politicization of health care. In consequence, and despite the rear-guard defensive tactics of the medical profession, the French state has succeeded in firmly establishing its primacy in this major area of public policy. [ABSTRACT FROM AUTHOR]

The paper examines some inter-relationships between dentistry and the national health service, particularly the way in which it was slotted into the management arrangements in 1974. The aspirations of dentists during the pre-1974 period are compared with government intent and the management structure achieved. Analysis of the managerial or officer structure at each level of the service highlights the ways in which the patterns laid down for dentistry varied from the norm. Dentists' expectations and the officially declared intent were seldom synonymous; both were very different from the final system. In some ways dentists lost out in relation to the management arrangements. Their major organization was at area level rather than in the health districts. Whether or not this unusual structure was to the disadvantage of the profession and of dental care, time alone would have told. However, no such assessment is now possible. In April 1982 area health authorities disappeared: area dental officers have therefore been abolished. [ABSTRACT FROM AUTHOR]

The author focuses on the quality of nursing care and discusses the major problems inherent in control of the quality of nursing care. The concept of quality is analysed and the approaches of health care professionals to the concept are discussed. An overview of the American contribution to the relevant research is presented together with ongoing developments in Europe. [ABSTRACT FROM AUTHOR]

Countries reforming their health systems need an understanding of the extent of transferability of reform experience from one country to another. Ideally, a typology or a system of categorization which groups countries according to some of their key features, would be available as a guide. Before such a typology can be developed, an appropriate comparative framework or a hierarchically organized list of key features across which health systems can be compared, would need to be available. Those comparative frameworks and typologies which are available have been driven by the understanding of industrialised country health systems. The best known is that of Roemer (1991). These give inadequate attention to the informal dimension of health systems (unregulated and illegal activities, and the traditional sector) for application to developing countries, and they often supply a political dimension which does not take account of the importance of the stability and strength of government in developing country contexts. Two-dimensional, tabular typologies are static and cannot incorporate the implications of change. The literature offers some promising approaches to development of a more useful comparative framework including more dynamic ways of grouping system characteristics, and the idea of a modular approach which can accommodate the problem of information shortage. Two types of research will be particularly useful in further development of this framework: cross country comparisons of experience with specific reforms, and comprehensive country case studies of reform programmes which enable the full context to be understood. © 1997 by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper presents a theoretical model to be used for comparative studies of lay and medically defined need for medical care. The model is based on an analysis of the concept of need and need statements, lay and medical concepts of ill health and the relationships between need, ill health and utilization of medical care. It is concluded, on both theoretical and empirical grounds, that need is relative to time, place and assessor. The most important determinants of assessments of for what and when one should seek medical attention are assumed to be the assessor's perception and valuation of the health status and his expectations of the probable out-come of medical care use. Assessment of need is seen as a process in which past experiences and expectations of the future course of the health status affect decision-making. It is emphasized that the points of view of both client and provider should be taken into consideration in medical practice, as well as in health care planning, because the two perspectives tend to be only partially congruent. The nature and extent of these incongruences could be studied by the application of the proposed model. [ABSTRACT FROM AUTHOR]