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Sterpetti AV, Gabriele R, Sapienza P, Marzo LD, Borrelli V. Mortality and burden related with aortic aneurysms and dissections. The importance of information and education. Curr Probl Cardiol 2024; 49:102384. [PMID: 38184128 DOI: 10.1016/j.cpcardiol.2024.102384] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 01/08/2024]
Abstract
BACKGROUND In this study we correlated changes of risk factors for cardiovascular diseases with trends of age standardized mortality rates and burden for aortic aneurysms and dissections. METHODS We analyzed data from the Global Burden of Diseases and EUROSTAT. FINDINGS There was a significant increase of expenditure for health from 1980 and 2019. In the period 1980-2000, despite higher health spending, age standardized mortality rates increased in almost all European countries. During the period 2000-2019, in Western European Countries and in Poland, Estonia, Latvia, Slovenia there was a correlation between higher health expenditure and decrease of ASMR. The most important changes between the period 1980-2000 and the period 2000-2019 was the proportion of health expenditure devoted to preventive care and to the increased use of aspirin and statins. INTERPRETATION Information about risk factors for cardiovascular diseases have leads to decreased aortic aneurysm related mortality and burden.
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Affiliation(s)
- Antonio V Sterpetti
- Sapienza University Rome, Policlinico Umberto I- Viale del Policlinico 00167 Rome, Italy.
| | - Raimondo Gabriele
- Sapienza University Rome, Policlinico Umberto I- Viale del Policlinico 00167 Rome, Italy
| | - Paolo Sapienza
- Sapienza University Rome, Policlinico Umberto I- Viale del Policlinico 00167 Rome, Italy
| | - Luca Di Marzo
- Sapienza University Rome, Policlinico Umberto I- Viale del Policlinico 00167 Rome, Italy
| | - Valeria Borrelli
- Sapienza University Rome, Policlinico Umberto I- Viale del Policlinico 00167 Rome, Italy
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Bozzani A, Cutti S, Marzo LD, Gabriele R, Sterpetti AV. Spatio-temporal correlation between admissions for ruptured abdominal aortic aneurysms and levels of atmospheric pollution in Italy. Curr Probl Cardiol 2024; 49:102249. [PMID: 38040214 DOI: 10.1016/j.cpcardiol.2023.102249] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
AIMS The aim of our study was to determine a correlation between rates and number of patients admitted with ruptured abdominal aortic aneurysms (rAAA) in Italian regions with different levels of atmospheric pollution. METHODS We analyzed a possible correlation between the number and rate (ruptured versus not ruptured) of patients with rAAA admitted in eight Italian regions with different levels of atmospheric pollution. RESULTS Number and rates of patients with rAAA were statistically correlated with levels of air pollution and low air temperature (RR = 1.90, 95% CI: 1.42, 2.1.0) (p<0.01). Even if low temperatures amplified the correlation between admissions for rAAA and PMs exposure, also during Summer and Spring there were sudden increases of the number of admissions for rAAA patients in periods with higher air pollution. The regions with high levels of atmospheric pollution had higher rates of admissions of patients with rAAA in comparison with regions with low level of air pollution. However, there was no difference between regions with low and very low level of atmospheric pollution. Mean age, sex distribution, exposure to established risk factors were similar for the population of the eight analyzed Italian regions. CONCLUSIONS The findings of this study highlight the potential to reduce AAA related mortality and burden by addressing the negative effects of exposure to high levels of atmospheric pollution. The possibility of a dose-dependent effect of atmospheric pollution on the cardiovascular system opens research initiatives and discussions about when and how to modulate interventions to reduce atmospheric pollutants.
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Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Cutti
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Whitty JA, Littlejohns P, Ratcliffe J, Rixon K, Wilson A, Kendall E, Burton P, Chalkidou K, Scuffham PA. Impact of information and deliberation on the consistency of preferences for prioritization in health care - evidence from discrete choice experiments undertaken alongside citizens' juries. J Med Econ 2023; 26:1237-1249. [PMID: 37738383 DOI: 10.1080/13696998.2023.2262329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Public preferences are an important consideration for priority-setting. Critics suggest preferences of the public who are potentially naïve to the issue under consideration may lead to sub-optimal decisions. We assessed the impact of information and deliberation via a Citizens' Jury (CJ) or preference elicitation methods (Discrete Choice Experiment, DCE) on preferences for prioritizing access to bariatric surgery. METHODS Preferences for seven prioritization criteria (e.g. obesity level, obesity-related comorbidities) were elicited from three groups who completed a DCE: (i) participants from two CJs (n = 28); (ii) controls who did not participate in the jury (n = 21); (iii) population sample (n = 1,994). Participants in the jury and control groups completed the DCE pre- and post-jury. DCE data were analyzed using multinomial logit models to derive "priority weights" for criteria for access to surgery. The rank order of criteria was compared across groups, time points and CJ recommendations. RESULTS The extent to which the criteria were considered important were broadly consistent across groups and were similar to jury recommendations but with variation in the rank order. Preferences of jurors but not controls were more differentiated (that is, criteria were assigned a greater range of priority weights) after than before the jury. Juror preferences pre-jury were similar to that of the public but appeared to change during the course of the jury with greater priority given to a person with comorbidity. Conversely, controls appeared to give a lower priority to those with comorbidity and higher priority to treating very severe obesity after than before the jury. CONCLUSION Being informed and undertaking deliberation had little impact on the criteria that were considered to be relevant for prioritizing access to bariatric surgery but may have a small impact on the relative importance of criteria. CJs may clarify underlying rationale but may not provide substantially different prioritization recommendations compared to a DCE.
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Affiliation(s)
- Jennifer A Whitty
- Health Economics Group, Norwich Medical School, Faculty of Medicine and Health Sciences, The University of East Anglia, Norwich, UK
- NIHR Applied Research Collaboration (ARC), East of England, UK
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Patient Centered Research, Evidera, London, UK
| | | | - Julie Ratcliffe
- Menzies Centre for Health Policy and Economics, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Kylie Rixon
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Elizabeth Kendall
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Paul Burton
- Cities Research Institute, Griffith University, Queensland, Australia
| | - Kalipso Chalkidou
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Schoon R, Chi C. Integrating Citizens Juries and Discrete Choice Experiments: Methodological issues in the measurement of public values in healthcare priority setting. Soc Sci Med 2022; 309:115223. [DOI: 10.1016/j.socscimed.2022.115223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/02/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022]
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Tugendhaft A, Danis M, Christofides N, Kahn K, Erzse A, Gold M, Twine R, Khosa A, Hofman K. CHAT SA: Modification of a Public Engagement Tool for Priority Setting for a South African Rural Context. Int J Health Policy Manag 2022; 11:197-209. [PMID: 32654436 PMCID: PMC9278606 DOI: 10.34172/ijhpm.2020.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/21/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Globally, as countries move towards universal health coverage (UHC), public participation in decisionmaking is particularly valuable to inform difficult decisions about priority setting and resource allocation. In South Africa (SA), which is moving towards UHC, public participation in decision-making is entrenched in policy documents yet practical applications are lacking. Engagement methods that are deliberative could be useful in ensuring the public participates in the priority setting process that is evidence-based, ethical, legitimate, sustainable and inclusive. Methods modified for the country context may be more relevant and effective. To prepare for such a deliberative process in SA, we aimed to modify a specific deliberative engagement tool - the CHAT (Choosing All Together) tool for use in a rural setting. METHODS Desktop review of published literature and policy documents, as well as 3 focus groups and modified Delphi method were conducted to identify health topics/issues and related interventions appropriate for a rural setting in SA. Our approach involved a high degree of community and policy-maker/expert participation. Qualitative data were analysed thematically. Cost information was drawn from various national sources and an existing actuarial model used in previous CHAT exercises was employed to create the board. RESULTS Based on the outcomes, 7 health topics/issues and related interventions specific for a rural context were identified and costed for inclusion. These include maternal, new-born and reproductive health; child health; woman and child abuse; HIV/AIDS and tuberculosis (TB); lifestyle diseases; access; and malaria. There were variations in priorities between the 3 stakeholder groups, with community-based groups emphasizing issues of access. Violence against women and children and malaria were considered important in the rural context. CONCLUSION The CHAT SA board reflects health topics/issues specific for a rural setting in SA and demonstrates some of the context-specific coverage decisions that will need to be made. Methodologies that include participatory principles are useful for the modification of engagement tools like CHAT and can be applied in different country contexts in order to ensure these tools are relevant and acceptable. This could in turn impact the success of the implementation, ultimately ensuring more effective priority setting approaches.
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Affiliation(s)
- Aviva Tugendhaft
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, MD, USA
| | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit - Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Agnes Erzse
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Marthe Gold
- New York Academy of Medicine, New York City, NY, USA
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit - Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Khosa
- MRC/Wits Rural Public Health and Health Transitions Research Unit - Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Tugendhaft A, Hofman K, Danis M, Kahn K, Erzse A, Twine R, Gold M, Christofides N. Deliberative engagement methods on health care priority-setting in a rural South African community. Health Policy Plan 2021; 36:1279-1291. [PMID: 34051093 PMCID: PMC8428615 DOI: 10.1093/heapol/czab005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Public engagement in priority-setting for health is increasingly recognized as a means to ensure more ethical, inclusive and legitimate decision-making processes, especially in the context of Universal Health Coverage where demands outweigh the available resources and difficult decisions need to be made. Deliberative approaches are often viewed as especially useful in considering social values and balancing trade-offs, however, implementation of deliberative engagement tools for priority-setting is scant, especially in low- and middle-income settings. In order to address this gap, we implemented a context-specific public deliberation tool in a rural community in South Africa to determine priorities for a health services package. Qualitative data were analysed from seven group deliberations using the engagement tool. The analysis focused on understanding the deliberative process, what the participants prioritized, the reasons for these selections and how negotiations took place within the groups. The deliberations demonstrated that the groups often considered curative services to be more important than primary prevention which related to the perceived lack of efficacy of existing health education and prevention programmes in leading to behaviour change. The groups engaged deeply with trade-offs between costly treatment options for HIV/AIDS and those for non-communicable disease. Barriers to healthcare access were considered especially important by all groups and some priorities included investing in more mobile clinics. This study demonstrates that deliberative engagement methods can be successful in helping communities balance trade-offs and in eliciting social values around health priorities. The findings from such deliberations, alongside other evidence and broader ethical considerations, have the potential to inform decision-making with regard to health policy design and implementation.
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Affiliation(s)
- Aviva Tugendhaft
- SAMRC/Wits Centre for Health Economics and Decision Science- PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science- PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, MD, USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit -Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Agnes Erzse
- SAMRC/Wits Centre for Health Economics and Decision Science- PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit -Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marthe Gold
- New York Academy of Medicine, New York City, NY, USA
| | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Rosoff PM. Healthcare Rationing Cutoffs and Sorites Indeterminacy. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2020; 44:479-506. [PMID: 31356664 DOI: 10.1093/jmp/jhz012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Rationing is an unavoidable mechanism for reining in healthcare costs. It entails establishing cutoff points that distinguish between what is and is not offered or available to patients. When the resource to be distributed is defined by vague and indeterminate terms such as "beneficial," "effective," or even "futile," the ability to draw meaningful boundary lines that are both ethically and medically sound is problematic. In this article, I draw a parallel between the challenges posed by this problem and the ancient Greek philosophical conundrum known as the "sorites paradox." I argue, like the paradox, that the dilemma is unsolvable by conventional means of logical analysis. However, I propose another approach that may offer a practical solution that could be applicable to real-life situations in which cutoffs must be decided (such as rationing).
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Affiliation(s)
- Philip M Rosoff
- Duke University School of Medicine, Durham, North Carolina, USA
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Leopold C, Lu CY, Wagner AK. Integrating public preferences into national reimbursement decisions: a descriptive comparison of approaches in Belgium and New Zealand. BMC Health Serv Res 2020; 20:351. [PMID: 32334579 PMCID: PMC7183657 DOI: 10.1186/s12913-020-05152-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 03/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background Public health care payer organizations face increasing pressures to make transparent and sustainable coverage decisions about ever more expensive prescription drugs, suggesting a need for public engagement in coverage decisions. However, little is known about countries’ approaches to integrating public preferences in existing funding decisions. The aim of this study was to describe how Belgium and New Zealand used deliberative processes to engage the public and to identify lessons learned from these countries’ approaches. Methods To describe two countries’ deliberative processes, we first reviewed key country policy documents and then conducted semi-structured interviews with five leaders of the processes from Belgium and New Zealand. We assessed each country’s rationales for and approaches to engaging the public in pharmaceutical coverage decisions and identified lessons learned. We used qualitative content analysis of the interviews to describe key themes and subthemes. Results In both countries, the national public payer organization initiated and led the process of integrating public preferences into national coverage decision making. Reimbursement criteria considered outdated and changing societal expectations prompted the change. Both countries chose a deliberative process of public engagement with a multi-year commitment of many stakeholders to develop new reimbursement processes. Both countries’ new reimbursement processes put a stronger emphasis on quality of life, the separation of individual versus societal perspectives, and the importance of final reimbursement decisions being taken in context rather than based largely on cost-effectiveness thresholds. Conclusions To face the growing financial pressure of sustainable funding of medicines, Belgium’s and New Zealand’s public payers have developed processes to engage the public in defining the reimbursement system’s priorities. Although these countries differ in context and geographic location, they came up with overlapping lessons learnt which include the need for 1) political commitment to initiate change, 2) broad involvement of all stakeholders, and 3) commitment of all to engage in a long-term process. To evaluate these changes, further research is required to understand how coverage decisions in systems with and without public engagement differ.
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Affiliation(s)
- Christine Leopold
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive Suite 401, Boston, MA, 02215, USA.
| | - Christine Y Lu
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive Suite 401, Boston, MA, 02215, USA
| | - Anita K Wagner
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive Suite 401, Boston, MA, 02215, USA
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Thomas R, Scott AM, Sims R, Craig L, Claase LA, Lowe J, Heal C, Hardiman L, Glasziou P. Exploring women's priorities for the potential consequences of a gestational diabetes diagnosis: A pilot community jury. Health Expect 2020; 23:593-602. [PMID: 32090415 PMCID: PMC7321745 DOI: 10.1111/hex.13036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There is no international diagnostic agreement for gestational diabetes mellitus (GDM). In 2014, Australia adopted a new definition and testing procedure. Since then, significantly more women have been diagnosed with GDM but with little difference in health outcomes. We explored the priorities and preferences of women potentially impacted by a GDM diagnosis. METHOD We recruited 15 women from the Gold Coast, Australia, to participate in a pilot community jury (CJ). Over two days, the women deliberated on the following: (a) which important consequences of a diagnosis of GDM should be considered when defining GDM?; (b) what should Australian health practitioners call the condition known as GDM? RESULTS Eight women attended the pilot CJ, and their recommendations were a consensus. Women were surprised that the level of risk for physical harms was low but emotional harms were high. The final ranking of important consequences (high to low) was as follows: women's negative emotions; management burden of GDM; overmedicalized pregnancy; minimizing infant risks; improving lifestyle; and macrosomia. To describe the four different clinical states of GDM, the women chose three different labels. One was GDM. CONCLUSIONS The women from this pilot CJ prioritized the consequences of a diagnosis of GDM differently from clinicians. The current glucose threshold for GDM in Australia is set at a cut-point for adverse risks including macrosomia and neonatal hyperinsulinaemia. Definitions and guideline panels often fail to ask the affected public about their values and preferences. Community voices impacted by health policies should be embedded in the decision-making process.
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Affiliation(s)
- Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Qld, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Qld, Australia
| | - Rebecca Sims
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Qld, Australia
| | - Louise Craig
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Qld, Australia
| | | | - Julia Lowe
- University of Newcastle, Newcastle, NSW, Australia
| | - Clare Heal
- School of Medicine and Dentistry, James Cook University, Mackay, Qld, Australia
| | - Leah Hardiman
- Maternity Choices Australia, Brisbane, Qld, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Qld, Australia
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Krucien N, Heidenreich S, Gafni A, Pelletier-Fleury N. Measuring public preferences in France for potential consequences stemming from re-allocation of healthcare resources. Soc Sci Med 2019; 246:112775. [PMID: 31923838 DOI: 10.1016/j.socscimed.2019.112775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 11/25/2022]
Abstract
When deciding which new programme to implement and where the additional resources, if needed, will come from, the decision makers need to accommodate the uncertainty of the potential changes in population health and medical expenditures that can occur. They also need to determine the value of these potential changes. The objective of this study is to identify a public valuation function measuring how the public values changes in population health and medical expenditures when healthcare resources are re-allocated. We report the results of a choice experiment conducted in March 2016 in a representative sample of the population living in France (N = 1008). The main results indicate that the public is more sensitive to changes in population health than changes in the level of medical expenditures. There is a non-linear valuation of these changes with evidence of asymmetric preferences and non-constant marginal sensitivity. The public gives 1.4 times more weight to decrease in population health than for the same-size increase. The public becomes less sensitive to marginal changes in population health as the level of changes increases. In a simulation study of 5000 resource allocation decisions, we show that non-linearities in public valuation of population health and medical expenditures matters. The linear and non-linear public valuation functions were associated with respectively 50.1% and 28.1% of situations of acceptable outcome of the reallocation of resources. The level of agreement between these two functions was moderate with a Kappa coefficient of 0.56, and the probability of agreement was mainly driven by the distribution of net changes in population health. This study provides a method and an estimation of a public valuation function that describes the preferences (or values attributed) for every potential outcome stemming from the reallocation of healthcare resources. The results show the importance of measuring such function rather than assuming one.
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Affiliation(s)
- Nicolas Krucien
- Patient-Centered Research, Evidera Ltd, London, United Kingdom.
| | | | - Amiram Gafni
- Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Nathalie Pelletier-Fleury
- Centre de Recherche en Epidemiologie et Santé des Populations, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
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Abstract
BACKGROUND It is important that guidelines and criteria used to prioritise access to bariatric surgery are informed by the values of the tax-paying public in combination with the expertise of healthcare professionals. Citizens' juries are increasingly used around the world to engage the public in healthcare decision-making. This study investigated citizens' juries about prioritising patient access to bariatric surgery in two Australian cities. OBJECTIVES The objective of this study is to examine public priorities for government expenditure on the surgical management of obesity developed through either a one or three-day citizen jury. SUBJECTS/METHODS A three-day jury was held in Brisbane and a one-day jury in Adelaide. Jurors were selected in Brisbane (n = 18) and in Adelaide (n = 12) according to pre-specified criteria. Expert witnesses from various medical disciplines and consumers were cross-examined by jurors. RESULTS The verdicts of the juries were similar in that both juries agreed bariatric surgery was an important option in the management of obesity and related comorbidities. Recommendations about who should receive treatment differed slightly across the juries. Both juries rejected the use of age as a rationing tool, but managed their objections in different ways. Participants' experiences of the jury process were positive, but our observations suggested that many variables may influence the nature of the final verdict. CONCLUSIONS Citizen's juries, even when shorter in duration, can be an effective tool to guide the development of health policy and priorities. However, our study has identified a range of variables that should be considered when designing and running a jury and when interpreting the verdict.
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Zhu J, Li J, Zhang Z, Li H, Cai L. Exploring determinants of health provider choice and heterogeneity in preference among outpatients in Beijing: a labelled discrete choice experiment. BMJ Open 2019; 9:e023363. [PMID: 30948563 PMCID: PMC6500246 DOI: 10.1136/bmjopen-2018-023363] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE For a long time in China, public hospitals have been the most prominent provider of healthcare. However, recent policy reforms mean the private sector is experiencing rapid development. Thus, the purpose of this study is to detect whether the policies published by the government aimed to improve the quality of healthcare services were catering to patient's preferences. PARTICIPANTS AND METHODS Our work uses dental care as an example of services provided in outpatient setting and takes advantage of a labelled discrete choice experiment with a random sample of respondents from Beijing. Participants were asked to make a choice between four healthcare providers with different attributes. Mixed logit and latent class models were used for the analysis. RESULT Care provided by high-level private hospitals and community hospitals were valued RMB154 and 216 less, respectively, than care provided by class A tertiary hospitals, while the most disliked provider was private clinics. This was the most valued attribute of dental care. Respondents also value: lower waiting times, the option to choose their doctor, lower treatment costs, shorter travel times and a clean waiting room. However, when the level of provider was analysed, the prevailing notion that patients in China were always likely to choose public services than private services no longer holds. Four classes of patients with distinct preferences for dental care provider choice were identified, which can partly be explained by age, income, experience and Hukou status-a household registration permit. DISCUSSION The study to some extent challenged the overwhelming predominance of public healthcare providers in China. The preference heterogeneity we found was relatively large. Our findings are significant for providers in developing more specific services for patients and for policymakers in weighing the pros and cons of future initiatives in medical reform.
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Affiliation(s)
- Jingrong Zhu
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Jinlin Li
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Zengbo Zhang
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Hao Li
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Lingfei Cai
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
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Littlejohns P, Kieslich K, Weale A, Tumilty E, Richardson G, Stokes T, Gauld R, Scuffham P. Creating sustainable health care systems. J Health Organ Manag 2019; 33:18-34. [PMID: 30859907 PMCID: PMC7068726 DOI: 10.1108/jhom-02-2018-0065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/28/2018] [Accepted: 10/02/2018] [Indexed: 12/02/2022]
Abstract
PURPOSE In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgements, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritisation and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritisation process. DESIGN/METHODOLOGY/APPROACH Through a multidisciplinary collaboration involving a series of international workshops, ethical and political theory (including accountability for reasonableness) have been applied to develop a practical way forward through the creation of a values framework. The authors have tested this framework in England and in New Zealand using a mixed-methods approach. FINDINGS A social values framework that consists of content and process values has been developed and converted into an online decision-making audit tool. RESEARCH LIMITATIONS/IMPLICATIONS The authors have developed an easy to use method to help stakeholders (including the public) to understand the need for prioritisation of health services and to encourage their involvement. It provides a pragmatic way of harmonising different perspectives aimed at maximising health experience. PRACTICAL IMPLICATIONS All health care systems are facing increasing demands within finite resources. Although many countries are introducing ways to prioritise health services, the decisions often face legal, political, commercial and ethical challenge. The research will help health systems to respond to these challenges. SOCIAL IMPLICATIONS This study helps in increasing public involvement in complex health challenges. ORIGINALITY/VALUE No other groups have used this combination of approaches to address this issue.
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Affiliation(s)
- Peter Littlejohns
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | | | - Albert Weale
- School of Public Policy, University College London, London, UK
| | - Emma Tumilty
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Georgina Richardson
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- School of Business, University of Otago, Dunedin, New Zealand
| | - Paul Scuffham
- Centre for Applied Health Economics, Griffith University, Southport, Australia
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Krucien N, Pelletier-Fleury N, Gafni A. Measuring Public Preferences for Health Outcomes and Expenditures in a Context of Healthcare Resource Re-Allocation. PHARMACOECONOMICS 2019; 37:407-417. [PMID: 30499065 DOI: 10.1007/s40273-018-0751-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The final outcome of any resource allocation decision in healthcare cannot be determined in advance. Thus, decision makers, in deciding which new program to implement (or not), need to accommodate the uncertainty of different potential outcomes (i.e., change in both health and costs) that can occur, the size and nature (i.e., 'bad' or 'good') of these outcomes, and how they are being valued. Using the decision-making plane, which explicitly incorporates opportunity costs and relaxes the assumptions of perfect divisibility and constant returns to scale of the cost-effectiveness plane, all the potential outcomes of each resource allocation decision can be described. OBJECTIVE In this study, we describe the development and testing of an instrument, using a discrete choice experiment methodology, allowing the measurement of public preferences for potential outcomes falling in different quadrants of the decision-making plane. METHOD In a sample of 200 participants providing 4200 observations, we compared four versions of the preference-elicitation instrument using a range of indicators. RESULTS We identified one version that was well accepted by the participants and with good measurement properties. CONCLUSION This validated instrument can now be used in a larger representative sample to study the preferences of the public for potential outcomes stemming from re-allocation of healthcare resources.
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Affiliation(s)
- Nicolas Krucien
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2QN, Scotland, UK.
| | - Nathalie Pelletier-Fleury
- Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | - Amiram Gafni
- Department of Health Research Methods, Evaluation and Impact, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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15
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Thomas R, Sims R, Beller E, Scott AM, Doust J, Le Couteur D, Pond D, Loy C, Forlini C, Glasziou P. An Australian community jury to consider case-finding for dementia: Differences between informed community preferences and general practice guidelines. Health Expect 2019; 22:475-484. [PMID: 30714290 PMCID: PMC6543153 DOI: 10.1111/hex.12871] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 01/13/2023] Open
Abstract
Background Case‐finding for dementia is practised by general practitioners (GPs) in Australia but without an awareness of community preferences. We explored the values and preferences of informed community members around case‐finding for dementia in Australian general practice. Design, setting and participants A before and after, mixed‐methods study in Gold Coast, Australia, with ten community members aged 50‐70. Intervention A 2‐day citizen/community jury. Participants were informed by experts about dementia, the potential harms and benefits of case‐finding, and ethical considerations. Primary and secondary outcomes We asked participants, “Should the health system encourage GPs to practice ‘case‐finding’ of dementia in people older than 50?” Case‐finding was defined as a GP initiating testing for dementia when the patient is unaware of symptoms. We also assessed changes in participant comprehension/knowledge, attitudes towards dementia and participants’ own intentions to undergo case‐finding for dementia if it were suggested. Results Participants voted unanimously against case‐finding for dementia, citing a lack of effective treatments, potential for harm to patients and potential financial incentives. However, they recognized that case‐finding was currently practised by Australian GPs and recommended specific changes to the guidelines. Participants increased their comprehension/knowledge of dementia, their attitude towards case‐finding became less positive, and their intentions to be tested themselves decreased. Conclusion Once informed, community jury participants did not agree case‐finding for dementia should be conducted by GPs. Yet their personal intentions to accept case‐finding varied. If case‐finding for dementia is recommended in the guidelines, then shared decision making is essential.
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Affiliation(s)
- Rae Thomas
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Rebecca Sims
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Elaine Beller
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Anna Mae Scott
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Jenny Doust
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - David Le Couteur
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Dimity Pond
- School of Medicine and Public Health, The University of Newcastle, Sydney, New South Wales, Australia
| | - Clement Loy
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,The Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Cynthia Forlini
- Sydney Health Ethics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
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16
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Brazier J, Rowen D, Karimi M, Peasgood T, Tsuchiya A, Ratcliffe J. Experience-based utility and own health state valuation for a health state classification system: why and how to do it. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:881-891. [PMID: 29022120 PMCID: PMC6008352 DOI: 10.1007/s10198-017-0931-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 09/19/2017] [Indexed: 05/28/2023]
Abstract
In the estimation of population value sets for health state classification systems such as the EuroQOL five dimensions questionnaire (EQ-5D), there is increasing interest in asking respondents to value their own health state, sometimes referred to as "experience-based utility values" or, more correctly, own rather than hypothetical health states. Own health state values differ to hypothetical health state values, and this may be attributable to many reasons. This paper critically examines whose values matter; why there is a difference between own and hypothetical values; how to measure own health state values; and why to use own health state values. Finally, the paper examines other ways that own health state values can be taken into account, such as including the use of informed general population preferences that may better take into account experience-based values.
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Affiliation(s)
- John Brazier
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Donna Rowen
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
| | - Milad Karimi
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Tessa Peasgood
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Aki Tsuchiya
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Department of Economics, University of Sheffield, Sheffield, UK
| | - Julie Ratcliffe
- Institute for Choice, School of Business, University of South Australia, Adelaide, Australia
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17
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Darker CD, Donnelly-Swift E, Whiston L. Demographic factors and attitudes that influence the support of the general public for the introduction of universal healthcare in Ireland: A national survey. Health Policy 2017; 122:147-156. [PMID: 29198852 DOI: 10.1016/j.healthpol.2017.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/16/2017] [Accepted: 11/18/2017] [Indexed: 01/20/2023]
Abstract
Ireland is still struggling to end the inequitable two-tiered health system and introduce universal healthcare (UHC). Public opinion can influence health policy choice and implementation. However, the public are rarely asked for their views. This study describes the demographic and attitudinal factors that influence the support of the public for the introduction of UHC. It provides data on a nationally representative survey sample of n=972. There are high levels of support for the introduction of UHC (n=846 87.0%). Logistic regression analyses indicated that demographic factors, such as, the location of respondent, whether the respondent was in receipt of Government supported healthcare, a purchaser of private health insurance or neither; plus attitudinal factors, such as, opinions on the Government prioritising healthcare, healthcare being free at the point of access, taxes being increased to provide care free at the point of access and how well informed participants felt about UHC were associated with agreeing with the introduction of UHC in Ireland. This paper is timely for policy leaders both in Ireland and internationally as countries with UHC, such as the United Kingdom, are facing difficulties maintaining health services in the public realm.
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Affiliation(s)
- Catherine D Darker
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Russell Centre, Tallaght Cross, D24 DH 74, Ireland.
| | - Erica Donnelly-Swift
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Russell Centre, Tallaght Cross, D24 DH 74, Ireland.
| | - Lucy Whiston
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Russell Centre, Tallaght Cross, D24 DH 74, Ireland.
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18
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Harris P, Whitty JA, Kendall E, Ratcliffe J, Wilson A, Littlejohns P, Scuffham PA. The importance of population differences: Influence of individual characteristics on the Australian public's preferences for emergency care. Health Policy 2017; 122:115-125. [PMID: 29157994 DOI: 10.1016/j.healthpol.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/25/2017] [Accepted: 11/06/2017] [Indexed: 11/17/2022]
Abstract
A better understanding of the public's preferences and what factors influence them is required if they are to be used to drive decision-making in health. This is particularly the case for service areas undergoing continual reform such as emergency and primary care. Accordingly, this study sought to determine if attitudes, socio-demographic characteristics and healthcare experiences influence the public's intentions to access care and their preferences for hypothetical emergency care alternatives. A discrete choice experiment was used to elicit the preferences of Australian adults (n=1529). Mixed logit regression analyses revealed the influence of a range of individual characteristics on preferences and service uptake choices across three different presenting scenarios. Age was associated with service uptake choices in all contexts, whilst the impact of other sociodemographics, health experience and attitudinal factors varied by context. The improvements in explanatory power observed from including these factors in the models highlight the need to further clarify their influence with larger populations and other presenting contexts, and to identify other determinants of preference heterogeneity. The results suggest social marketing programs undertaken as part of demand management efforts need to be better targeted if decision-makers are seeking to increase community acceptance of emerging service models and alternatives. Other implications for health policy, service planning and research, including for workforce planning and the possible introduction of a system of co-payments are discussed.
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Affiliation(s)
- Paul Harris
- School of Medicine, School of Human Services and Social Work, The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Meadowbrook, Queensland 4131, Australia.
| | - Jennifer A Whitty
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - Elizabeth Kendall
- The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Meadowbrook, Australia.
| | - Julie Ratcliffe
- Institute for Choice, Business School, University of South Australia, Adelaide, South Australia, Australia.
| | - Andrew Wilson
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, NSW, Australia.
| | - Peter Littlejohns
- Division of Health and Social Care Research, King's College School of Medicine, London, United Kingdom.
| | - Paul A Scuffham
- Menzies Health Institute of Queensland, Griffith University, Logan Campus, Nathan, Queensland, Australia.
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19
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Heard C, Scuffham PA, Ratcliffe J, Whitty JA. The association between misperceptions around weight status and quality of life in adults in Australia. Health Qual Life Outcomes 2017; 15:53. [PMID: 28320413 PMCID: PMC5359799 DOI: 10.1186/s12955-017-0627-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Limited evidence supports a possible association between a person’s perception of their weight status and their quality of life (QoL). This study evaluates whether misperception around weight status is associated with QoL and the impact of gender on this association. Methods A cross-sectional survey of Australian adults (n = 1,905 analysed) collected self-reported height and weight (used to estimate BMI), gender and QoL (described using the AQoL-8D). Participants reported whether they perceived their weight status to be ‘underweight’, ‘healthy weight’, ‘overweight’ or ‘obese’. Misperception around weight status was categorised based on perceived weight status and self-reported BMI. Ordinary least squares regression was used to test associations between self-reported overall, physical and psychosocial QoL, misperception of weight status, and gender, across different BMI categories, after controlling for income, education, relationship status and health conditions. Results Compared to accurate perception, underestimation of weight status was associated with higher overall QoL for obese males and females and for overweight males. Overestimation of weight status was associated with higher overall QoL for underweight females and lower overall QoL for healthy weight males and females. The same pattern was seen for psychosocial QoL. Physical QoL was less sensitive to misperception than psychosocial QoL. Conclusions Self-reported misperception around weight status is associated with overall, psychosocial and to a lesser extent physical QoL in Australian adults, although its role depends on BMI category and gender. Generally misperception in the direction of “healthy weight” is associated with higher QoL and overestimation of weight status by those who are of healthy weight is associated with lower QoL. Findings should be confirmed in datasets that contain measured as opposed to self-report height and weight. Electronic supplementary material The online version of this article (doi:10.1186/s12955-017-0627-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher Heard
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Julie Ratcliffe
- Institute for Choice, Business School, University of South Australia, Adelaide, South Australia, Australia
| | - Jennifer A Whitty
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia. .,Menzies Health Institute Queensland, Griffith University, Queensland, Australia. .,Health Economics Group, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK, NR4 7JT.
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20
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Hollin IL, Hanson C, Bridges JFP, Peay H. Developing a Patient-Centered Benefit-Risk Survey: A Community-Engaged Process. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:751-757. [PMID: 27712702 DOI: 10.1016/j.jval.2016.02.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To provide a community-engaged process to inform the design of a stated-preferences experiment. The process involved integrating patients and caregivers of people with Duchenne/Becker muscular dystrophy, advocates, clinicians, and the sponsor in conceptualizing and developing a benefit-risk survey on the basis of phase III trial results. METHODS Our community-engagement process for the development of a stated-preference survey included a set of five guiding principles with a foundation in the principles of community-engaged research. Engagement efforts were carried out through an informal network of three committees. Members of the leadership, stakeholder, and review committees comprised patients, caregivers, clinicians, advocacy leadership, and industry representatives. RESULTS Committee members participated in 15 hours of formal engagement including interviews and conference calls that ranged from 45 to 90 minutes, plus additional less-formal ad hoc communication. Committees comprised 20 individuals across three committees including adults with DMD (n = 6), parents of children with DMD (n = 6), clinicians (n = 3), members of research and advocacy organizations (n = 4), and an industry representative (n = 1). Community engagement informed attribute selection, survey length, word choice, and eligibility criteria. Challenges in the process included managing diverse stakeholder perspectives, time requirements, and the inherent tension between outcomes used in clinical trials versus attributes that correspond to patient- and family-relevant outcomes. CONCLUSIONS We demonstrated how community engagement can successfully influence study design to support the design of a relevant survey instrument that is ethical, acceptable, meaningful to the community, and enhances patient-centered benefit-risk assessment for regulatory decision making.
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Affiliation(s)
- Ilene L Hollin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Caroline Hanson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John F P Bridges
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly Peay
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA; RTI International, Research Triangle Park, NC, USA
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21
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Scuffham PA, Moretto N, Krinks R, Burton P, Whitty JA, Wilson A, Fitzgerald G, Littlejohns P, Kendall E. Engaging the public in healthcare decision-making: results from a Citizens' Jury on emergency care services. Emerg Med J 2016; 33:782-788. [PMID: 27323789 DOI: 10.1136/emermed-2015-205663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/09/2016] [Accepted: 05/30/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Policies addressing ED crowding have failed to incorporate the public's perspectives; engaging the public in such policies is needed. OBJECTIVE This study aimed at determining the public's recommendations related to alternative models of care intended to reduce crowding, optimising access to and provision of emergency care. METHODS A Citizens' Jury was convened in Queensland, Australia, to consider priority setting and resource allocation to address ED crowding. Twenty-two jurors were recruited from the electoral roll, who were interested and available to attend the jury from 15 to 17 June 2012. Juror feedback was collected via a survey immediately following the end of the jury. RESULTS The jury considered that all patients attending the ED should be assessed with a minority of cases diverted for assistance elsewhere. Jurors strongly supported enabling ambulance staff to treat patients in their homes without transporting them to the ED, and allowing non-medical staff to treat some patients without seeing a doctor. Jurors supported (in principle) patient choice over aspects of their treatment (when, where and type of health professional) with some support for patients paying towards treatment but unanimous opposition for patients paying to be prioritised. Most of the jurors were satisfied with their experience of the Citizens' Jury process, but some jurors perceived the time allocated for deliberations as insufficient. CONCLUSIONS These findings suggest that the general public may be open to flexible models of emergency care. The jury provided clear recommendations for direct public input to guide health policy to tackle ED crowding.
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Affiliation(s)
- P A Scuffham
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - N Moretto
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - R Krinks
- Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - P Burton
- Urban Research Program, Griffith School of Environment, Griffith University, Southport, Queensland, Australia
| | - J A Whitty
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.,School of Pharmacy, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - A Wilson
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - G Fitzgerald
- School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - P Littlejohns
- Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - E Kendall
- Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
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22
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Parrella A, Braunack-Mayer A, Collins J, Clarke M, Tooher R, Ratcliffe J, Marshall H. Prioritizing government funding of adolescent vaccinations: recommendations from young people on a citizens' jury. Vaccine 2016; 34:3592-7. [PMID: 27195757 DOI: 10.1016/j.vaccine.2016.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/04/2016] [Accepted: 05/08/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adolescents' views, and preferences are often over-looked when public health policies that affect them are designed and implemented. The purpose of this study was to describe young people's views and preferences for determining government funding priorities for adolescent immunization programs. METHODS In 2015 we conducted a youth jury in metropolitan Adelaide, South Australia to deliberate on the question "What criteria should we use to decide which vaccines for young people in Australia should receive public funding?" Fifteen youth aged 15-19 years participated in the jury. Jury members were recruited from the general community through a market research company using a stratified sampling technique. RESULTS The jury's key priorities for determining publically funded vaccines were: Disease severity - whether the vaccine preventable disease (VPD) was life threatening and impacted on quality of life. Transmissibility - VPDs with high/fast transmission and high prevalence. Demonstration of cost-effectiveness, taking into account purchase price, program administration, economic and societal gain. The jury's recommendations for vaccine funding policy were strongly underpinned by the belief that it was critical to ensure that funding was targeted to not only population groups who would be medically at risk from vaccine preventable diseases, but also to socially and economically disadvantaged population groups. A novel recommendation proposed by the jury was that there should be a process for establishing criteria to remove vaccines from publically funded programs as a complement to the process for adding new vaccines. CONCLUSIONS Young people have valuable contributions to make in priority setting for health programs and their views should be incorporated into the framing of health policies that directly affect them.
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Affiliation(s)
- Adriana Parrella
- Discipline of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Annette Braunack-Mayer
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Joanne Collins
- Discipline of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Michelle Clarke
- Discipline of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Rebecca Tooher
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Julie Ratcliffe
- Flinders Health Economics Group, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, Adelaide, South Australia 5041, Australia.
| | - Helen Marshall
- Discipline of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia
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Wortley S, Tong A, Howard K. Preferences for engagement in health technology assessment decision-making: a nominal group technique with members of the public. BMJ Open 2016; 6:e010265. [PMID: 26832433 PMCID: PMC4746444 DOI: 10.1136/bmjopen-2015-010265] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To identify characteristics (factors) about health technology assessment (HTA) decisions that are important to the public in determining whether public engagement should be undertaken and the reasons for these choices. DESIGN Focus groups using a nominal group technique to identify and rank factors relevant to public engagement in HTA decision-making. Thematic analysis was also undertaken to describe reasons underpinning participants' choices and rankings. SETTING Members of the Australian general public. PARTICIPANTS 58 people, aged 19-71 years participated in 6 focus groups. RESULTS 24 factors were identified by participants that were considered important in determining whether public engagement should be undertaken. These factors were individually ranked and grouped into 4 themes to interpret preferences for engagement. Members of the public were more likely to think public engagement was needed when trade-offs between benefits and costs were required to determine 'value', uncertainties in the evidence were present, and family members and/or carers were impacted. The role of public engagement was also seen as important if the existent system lacked transparency and did not provide a voice for patients, particularly for conditions less known in the community. CONCLUSIONS Members of the public considered value, impact, uncertainty, equity and transparency in determining when engagement should be undertaken. This indicates that the public's preferences on when to undertake engagement relate to both the content of the HTA itself as well as the processes in place to support HTA decision-making. By understanding these preferences, decision-makers can work towards more effective, meaningful public engagement by involving the public in issues that are important to them and/or improving the processes around decision-making.
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Affiliation(s)
- Sally Wortley
- Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Corner Hawkesbury and Hainsworth Street, Westmead, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
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24
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Whitty JA, Ratcliffe J, Kendall E, Burton P, Wilson A, Littlejohns P, Harris P, Krinks R, Scuffham PA. Prioritising patients for bariatric surgery: building public preferences from a discrete choice experiment into public policy. BMJ Open 2015; 5:e008919. [PMID: 26474940 PMCID: PMC4611181 DOI: 10.1136/bmjopen-2015-008919] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To derive priority weights for access to bariatric surgery for obese adults, from the perspective of the public. SETTING Australian public hospital system. PARTICIPANTS Adults (N=1994), reflecting the age and gender distribution of Queensland and South Australia. PRIMARY AND SECONDARY OUTCOME MEASURES A discrete choice experiment in which respondents indicated which of two individuals with different characteristics should be prioritised for surgery in repeated hypothetical choices. Potential surgery recipients were described by seven key characteristics or attributes: body mass index (BMI), presence of comorbid conditions, age, family history, commitment to lifestyle change, time on the surgical wait list and chance of maintaining weight loss following surgery. A multinomial logit model was used to evaluate preferences and derive priority weights (primary analysis), with a latent class model used to explore respondent characteristics that were associated with variation in preference across the sample (see online supplementary analysis). RESULTS A preference was observed to prioritise individuals who demonstrated a strong commitment to maintaining a healthy lifestyle as well as individuals categorised with very severe (BMI≥50 kg/m2) or (to a lesser extent) severe (BMI≥40 kg/m2) obesity, those who already have obesity-related comorbidity, with a family history of obesity, with a greater chance of maintaining weight loss or who had spent a longer time on the wait list. Lifestyle commitment was considered to be more than twice as important as any other criterion. There was little tendency to prioritise according to the age of the recipient. Respondent preferences were dependent on their BMI, previous experience with weight management surgery, current health state and education level. CONCLUSIONS This study extends our understanding of the publics' preferences for priority setting to the context of bariatric surgery, and derives priority weights that could be used to assist bodies responsible for commissioning bariatric services.
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Affiliation(s)
- Jennifer A Whitty
- Faculty of Health and Behavioural Sciences, School of Pharmacy, The University of Queensland, St Lucia, Queensland, Australia
| | - Julie Ratcliffe
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Elizabeth Kendall
- Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Paul Burton
- Urban Research Program, Griffith School of Environment, Griffith University, Southport, Queensland, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, New South Wales, Australia
| | - Peter Littlejohns
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Paul Harris
- School of Human Services and Social Work, Menzies Health Institute Queensland, Griffith University,Meadowbrook, Queensland, Australia
| | - Rachael Krinks
- Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
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Wortley S, Tong A, Lancsar E, Salkeld G, Howard K. Public preferences for engagement in Health Technology Assessment decision-making: protocol of a mixed methods study. BMC Med Inform Decis Mak 2015; 15:52. [PMID: 26166149 PMCID: PMC4499948 DOI: 10.1186/s12911-015-0176-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 06/29/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Much attention in recent years has been given to the topic of public engagement in health technology assessment (HTA) decision-making. HTA organizations spend substantial resources and time on undertaking public engagement, and numerous studies have examined challenges and barriers to engagement in the decision-making process however uncertainty remains as to optimal methods to incorporate the views of the public in HTA decision-making. Little research has been done to ascertain whether current engagement processes align with public preferences and to what extent their desire for engagement is dependent on the question being asked by decision-makers or the characteristics of the decision. This study will examine public preferences for engagement in Australian HTA decision-making using an exploratory mixed methods design. METHODS/DESIGN The aims of this study are to: 1) identify characteristics about HTA decisions that are important to the public in determining whether public engagement should be undertaken on a particular topic, 2) determine which decision characteristics influence public preferences for the extent, or type of public engagement, and 3) describe reasons underpinning these preferences. Focus group participants from the general community, aged 18-70 years, will be purposively sampled from the Australian population to ensure a wide range of demographic groups. Each focus group will include a general discussion on public engagement as well as a ranking exercise using a modified nominal group technique (NGT). The NGT will inform the design of a discrete choice study to quantitatively assess public preferences for engagement in HTA decision-making. DISCUSSION The proposed research seeks to investigate under what circumstances and how the public would like their views and preferences to be considered in health technology assessments. HTA organizations regularly make decisions about when and how public engagement should occur but without consideration of the public's preferences on the method and extent of engagement. This information has the potential to assist decision-makers in tailoring engagement approaches, and may be particularly useful in decisions with potential for conflict where clarification of public values and preferences could strengthen the decision-making process.
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Affiliation(s)
- Sally Wortley
- Sydney School of Public Health, The University of Sydney, Camperdown, 2006, Australia.
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Camperdown, 2006, Australia.,Centre for Kidney Research The Children's Hospital, Westmead Corner Hawkesbury and Hainsworth Street, Westmead, 2145, Australia
| | - Emily Lancsar
- Centre for Health Economics, Monash University, Clayton, 3800, Australia
| | - Glenn Salkeld
- Sydney School of Public Health, The University of Sydney, Camperdown, 2006, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Camperdown, 2006, Australia
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Harris P, Whitty JA, Kendall E, Ratcliffe J, Wilson A, Littlejohns P, Scuffham PA. The Australian public's preferences for emergency care alternatives and the influence of the presenting context: a discrete choice experiment. BMJ Open 2015; 5:e006820. [PMID: 25841233 PMCID: PMC4390735 DOI: 10.1136/bmjopen-2014-006820] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The current study seeks to quantify the Australian public's preferences for emergency care alternatives and determine if preferences differ depending on presenting circumstances. SETTING Increasing presentations to emergency departments have led to overcrowding, long waiting times and suboptimal health system performance. Accordingly, new service models involving the provision of care in alternative settings and delivered by other practitioners continue to be developed. PARTICIPANTS A stratified sample of Australian adults (n=1838), 1382 from Queensland and 456 from South Australia, completed the survey. This included 951 females and 887 males from the 2045 people who met the screening criteria out of the 4354 people who accepted the survey invitation. INTERVENTIONS A discrete choice experiment was used to elicit preferences in the context of one of four hypothetical scenarios: a possible concussion, a rash/asthma-related problem involving oneself or one's child and an anxiety-related presentation. Mixed logit regression was used to analyse the dependent variable choice and identify the relative importance of care attributes and the propensity to access care in each context. RESULTS Results indicated a preference for treatment by an emergency physician in hospital for possible concussion and treatment by a doctor in ambulatory settings for rash/asthma-related and anxiety-related problems. Participants were consistently willing to wait longer before making trade-offs in the context of the rash/asthma-related scenario compared with when the same problem affected their child. Results suggest a clear preference for lower costs, shorter wait times and strong emphasis on quality care; however, significant preference heterogeneity was observed. CONCLUSIONS This study has increased awareness that the public's emergency care choices will differ depending on the presenting context. It has further demonstrated the importance of service quality as a determinant of healthcare choices. The findings have also provided insights into the Australian public's reactions to emergency care reforms.
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Affiliation(s)
- Paul Harris
- School of Medicine, Population and Social Health Research Program, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Jennifer A Whitty
- Faculty of Health and Behavioural Sciences, School of Pharmacy, The University of Queensland, St Lucia, Queensland, Australia
| | - Elizabeth Kendall
- Centre of National Research on Disability and Rehabilitation, Population and Social Health Research Program, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Julie Ratcliffe
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Littlejohns
- Division of Health and Social Care Research, King's College School of Medicine, London, UK
| | - Paul A Scuffham
- Centre for Applied Health Economics, Population and Social Health Research Program, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
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Burton P, Whitty JA, Kendall E, Ratcliffe J, Wilson A, Littlejohns P, Scuffham PA. Public participation: methods matter; a response to Boaz et al. Int J Health Policy Manag 2014; 3:355. [PMID: 25396214 DOI: 10.15171/ijhpm.2014.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/24/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Paul Burton
- Urban Research Program, Griffith School of Environment, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Jennifer A Whitty
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Kendall
- Griffith Health Institute, Griffith University, Logan Campus, University Drive, Meadowbrook, Queensland, Australia
| | - Julie Ratcliffe
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, New South Wales, Australia
| | - Peter Littlejohns
- Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, London, UK
| | - Paul A Scuffham
- Griffith Health Institute, Griffith University, Logan Campus, University Drive, Meadowbrook, Queensland, Australia
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Abstract
Health services research (HSR) is broadly focused on characterizing and improving the access, quality, delivery, and cost of health care. HSR is a multidisciplinary field, engaging experts in clinical medicine and surgery, policy, economics, implementation science, statistics, psychology, and education to improve the care of patients across all specialties. This article summarizes the evolution and distinctive attributes of HSR and present several real-world applications.
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Affiliation(s)
- Kate Nellans
- Hofstra North Shore Long Island Jewish School of Medicine, 611 Northern Boulevard, Suite 200, Great Neck, NY 11021, USA
| | - Jennifer F Waljee
- Section of Plastic Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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