Network influences on policy implementation: Evidence from a global health treaty

Influence of physician networks on the implementation of pharmaceutical alternatives to a toxic drug supply in British Columbia

BACKGROUND

Characterizing the diffusion of adopted changes in policy and clinical practice can inform enhanced implementation strategies to ensure prompt uptake in public health emergencies and other rapidly evolving disease areas. A novel guidance document was introduced at the onset of the COVID-19 pandemic in British Columbia (BC), Canada, which supported clinicians to prescribe opioids, stimulants, and benzodiazepines. We aimed to determine the extent to which uptake and discontinuation of an initial attempt at a prescribed safer supply (PSS) program were influenced through networks of prescribers.

METHODS

We executed a retrospective population-based study using linked health administrative data that captured all clinicians who prescribed to at least one client with a substance use disorder from March 27, 2020, to August 31, 2021. Our main exposure was the prescribing patterns of an individuals' peers, defined as the proportion of a prescribers' professional network (based on shared clients), which had previously prescribed PSS, updated monthly. The primary outcome measured whether a clinician had prescribed their initial PSS prescription during a given calendar month. The secondary outcome was the discontinuation of PSS prescribing, defined as an absence for PSS prescriptions for at least 3 months. We estimated logistic regression models using generalized estimated equations on monthly repeated measurements to determine and characterize the extent to which peer networks influenced the initiation and discontinuation of PSS prescribing, controlling for network, clinician, and caseload characteristics. Innovators were defined as individuals initiating PSS prior to May 2020, and early adopters were individuals initiating PSS after.

RESULTS

Among 14,137 prescribers treating clients with substance use disorder, there were 228 innovators of prescribed safer supply and 1062 early adopters through the end of study follow-up, but 653 (50.6%) were no longer prescribing by August 2021. Prescribers with over 20% of peers whom had adopted PSS had a nearly fourfold higher adjusted odds of PSS prescribing themselves (aOR: 3.79, 95% CI: (3.15, 4.56)), compared to those with no connected safer supply prescribers.

CONCLUSIONS

The uptake of PSS in BC was highly dependent on the behavior of prescribers' peer networks. Future implementation strategies to support PSS or other policies would benefit from leveraging networks of prescribers.

Systems Thinking and Complexity Science Methods and the Policy Process in Non-communicable Disease Prevention: A Systematic Scoping Review

BACKGROUND

Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-informed methods in NCD prevention policy.

METHODS

Systematic scoping review: We searched academic databases (Medline, Scopus, Web of Science, EMBASE) for all publications indexed by 13 October 2020, screening titles, abstracts and full texts and extracting data according to published guidelines. We summarised key data from each study, mapping applications of methods informed by STCS to policy process domains. We conducted a thematic analysis to identify advantages, limitations, barriers and facilitators to using STCS.

RESULTS

4681 papers were screened and 112 papers were included in this review. The most common policy areas were tobacco control, obesity prevention and physical activity promotion. Methods applied included system dynamics modelling, agent-based modelling and concept mapping. Advantages included supporting evidence-informed decision-making; modelling complex systems and addressing multi-sectoral problems. Limitations included the abstraction of reality by STCS methods, despite aims of encompassing greater complexity. Challenges included resource-intensiveness; lack of stakeholder trust in models; and results that were too complex to be comprehensible to stakeholders. Ensuring stakeholder ownership and presenting findings in a user-friendly way facilitated STCS use.

CONCLUSION

This review maps the proliferating applications of STCS methods in NCD prevention policy. STCS methods have the potential to generate tailored and dynamic evidence, adding robustness to evidence-informed policymaking, but must be accessible to policy stakeholders and have strong stakeholder ownership to build consensus and change stakeholder perspectives. Evaluations of whether, and under what circumstances, STCS methods lead to more effective policies compared to conventional methods are lacking, and would enable more targeted and constructive use of these methods.

New Network Models for the Analysis of Social Contagion in Organizations: An Introduction to Autologistic Actor Attribute Models

Autologistic actor attribute models (ALAAMs) provide new analytical opportunities to advance research on how individual attitudes, cognitions, behaviors, and outcomes diffuse through networks of social relations in which individuals in organizations are embedded. ALAAMs add to available statistical models of social contagion the possibility of formulating and testing competing hypotheses about the specific mechanisms that shape patterns of adoption/diffusion. The main objective of this article is to provide an introduction and a guide to the specification, estimation, interpretation and evaluation of ALAAMs. Using original data, we demonstrate the value of ALAAMs in an analysis of academic performance and social networks in a class of graduate management students. We find evidence that both high and low performance are contagious, that is, diffuse through social contact. However, the contagion mechanisms that contribute to the diffusion of high performance and low performance differ subtly and systematically. Our results help us identify new questions that ALAAMs allow us to ask, new answers they may be able to provide, and the constraints that need to be relaxed to facilitate their more general adoption in organizational research.

Evaluation of the Indonesia national strategic policy of science and technology development

Purpose

The purpose of this study is to outline the improvement of framing in Indonesia science and technology policy content, policy formulation model, policy strategy implementation and policy performance indicators.

Design/methodology/approach

This study is conducted by implementing action research model to generate new knowledge as a research interest, through the search for solutions or improvements to problematical situation, applying Soft Systems Methodology. Thus, this research model is regarded as Soft Systems Methodology-based Action Research (SSM-based AR).

Findings

Policy formulation is not evidence based in which policy documents remain theoretical and are impractical or not detailed in engaging real conditions and strategic issues, yet the targets are measurable despite predictive results. Change and strengthening are required in the national science and technology policy for the next period, on the basis that future research policies are encouraged to address problems and solutions to build a country based on science and technology. Indonesia requires policies involving both effective and efficient national research; therefore, the need for an integrated policy direction conveying science and technology and other related sectors, such as the health sector and food, remains vital.

Originality/value

Previously, science and technology policy planning in Indonesia was not equipped with data and indicators of success, having no target to achieve within a five-year period. In the coming periods, science and technology policy documents in Indonesia are issued in the form of government regulations/presidential decrees, including indicators of science and technology achievements (quantitatively) for five years.

Ending TB in Australia: Organizational challenges for regional tuberculosis programs

The World Health Organization's End TB Strategy aims to eliminate tuberculosis (TB) by 2050. Low-burden countries such as Australia are targeted for early elimination (2035), which will require an increase in the intensity and scope of case finding and treatment of people with latent TB infection (LTBI). Because 80 % of TB disease in Australia occurs in metropolitan Sydney (New South Wales) and Melbourne (Victoria), the commitment to move towards elimination has major implications for TB programs in these jurisdictions. We report on a case study analysis that compares and contrasts key attributes of each of these healthcare organizations. Such analysis has important implications for all countries seeking to implement international agreements within local health structures. Differences in the organizational structure, culture and systems of care in NSW and Victoria may facilitate or create barriers to changes in organizational system functions, especially the way in which TB prevention and LTBI treatment is delivered. Ratification of global health treaties and the development of national strategies, alone, is insufficient for realizing the promised outcomes. Even in high income countries, global health agendas such as TB elimination can be complicated by differences in local system structure and funding. As the timelines tighten towards 2035, more work must be done to identify the organizational conditions and service models that will facilitate progress towards TB elimination.