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Fuerst MF, Schrote K, Garg B, Rodriguez MI. Association of 12-month contraceptive supply policy and months of oral contraception prescribed by obstetrics and gynecology resident physicians: an exploratory cross-sectional study. BMC Womens Health 2022; 22:287. [PMID: 35820853 PMCID: PMC9275067 DOI: 10.1186/s12905-022-01869-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/05/2022] [Indexed: 11/02/2022] Open
Abstract
Abstract
Objective
This study sought to determine if there was a difference in the months of oral contraception prescribed by resident physicians living in U.S. states with a 12-month supply policy compared to resident physicians in states without a policy.
Methods
We conducted an exploratory descriptive study using a convenience sample of Obstetrics and Gynecology resident physicians (n = 275) in the United States. Standard bivariate analyses were used to compare the difference between groups.
Results
Few resident physicians in both groups (3.8% with a policy and 1.4% without a policy) routinely prescribed a 12-month supply of contraception. The mean coverage prescribed by providers in states with and without a policy was 2.81 and 2.07 months (p < 0.05).
Conclusions
The majority of resident physicians were unaware of 12-month contraceptive supply policies and unable to correctly write a prescription for 12-months of contraception, regardless of whether they lived in a state with a 12-month contraceptive supply policy. Physician education may be needed to effectively implement 12-month contraceptive supply policies.
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Nayak R, Manning L, Waterson P. Exploration of the fipronil in egg contamination incident in the Netherlands using the Functional Resonance Analysis Method. Food Control 2022. [DOI: 10.1016/j.foodcont.2021.108605] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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3
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Qasba N, Wallace KF, Sopko J, Czajka J, Capoccia KL, Shcherbakova N, Goff SL, Qasba N. Twelve-month supply of short-acting contraception methods: Pharmacists’ perspectives on implementation of new state law. J Am Pharm Assoc (2003) 2022; 62:1296-1303.e2. [DOI: 10.1016/j.japh.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/28/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
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Ashcroft R, Lam S, Kourgiantakis T, Begun S, Nelson MLA, Adamson K, Cadell S, Walsh B, Greenblatt A, Hussain A, Sur D, Sirotich F, Craig SL. Preparing social workers to address health inequities emerging during the COVID-19 pandemic by building capacity for health policy: a scoping review protocol. BMJ Open 2021; 11:e053959. [PMID: 34732499 PMCID: PMC8572402 DOI: 10.1136/bmjopen-2021-053959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has brought tremendous changes in healthcare delivery and exacerbated a wide range of inequities. Social workers across a broad range of healthcare settings bring an expertise in social, behavioural and mental healthcare needed to help address these health inequities. In addition, social workers integrate policy-directed interventions and solutions in clinical practice, which is a needed perspective for recovery from the COVID-19 pandemic. It remains unclear, however, what the most pressing policy issues are that have emerged during the COVID-19 pandemic. In addition, many social workers in health settings tend to underuse policy in their direct practice. The objectives of this scoping review are to: (1) systematically scope the literature on social work, COVID-19 pandemic and policy; and (2) describe the competencies required by social workers and the social work profession to address the policy issues emerging during the COVID-19 pandemic. METHODS AND ANALYSIS The scoping review follows Arksey and O'Malley's five-stage framework. Identification of literature published between 1 December 2019 and the search date, 31 March 2021, will take place in two stages: (1) title and abstract review, and (2) full-text review. In partnership with a health science librarian, the research team listed keywords related to social work and policy to search databases including Medline, Embase, PsycINFO, CINAHL, Social Services Abstract and Social Work Abstracts. Two graduate-level research assistants will conduct screening and full-text review. Data will then be extracted, charted, analysed and summarised to report on our results and implications on practice, policy and future research. ETHICS AND DISSEMINATION Results will help develop a policy practice competence framework to inform how social workers can influence policy. We will share our findings through peer-reviewed publications and conference presentations. This study does not require Research Ethics Board approval as it uses publicly available sources of data.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Michelle L A Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Susan Cadell
- Renison University College, Waterloo, Ontario, Canada
| | - Benjamin Walsh
- Robarts Library, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Greenblatt
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Amina Hussain
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Deepy Sur
- Ontario Association of Social Workers, Toronto, Ontario, Canada
| | - Frank Sirotich
- Canadian Mental Health Association, Toronto, Ontario, Canada
| | - Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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5
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Mueller J, Patterson L, Jakab M, Higgerson J, Steels S, Verma A. European-wide policymaking at the urban level: a qualitative study. Eur J Public Health 2021; 31:931-936. [PMID: 33724377 PMCID: PMC8546880 DOI: 10.1093/eurpub/ckab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Inter-urban area (UA) health inequalities can be as dramatic as those between high and low-income countries. Policies need to focus on the determinants of health specific to UAs to effect change. This study therefore aimed to determine the degree to which policymakers from different countries could make autonomous health and wellbeing policy decisions for their urban jurisdiction area. METHODS We conducted a cross-sectional, qualitative interview study with policymakers recruited from eight European countries (N = 37). RESULTS The reported autonomy among policymakers varied considerably between countries, from little or no autonomy and strict adherence to national directives (e.g. Slovak Republic) to a high degree of autonomy and ability to interpret national guidelines to local context (e.g. Norway). The main perceived barriers to implementation of local policies were political, and the importance of regular and effective communication with stakeholders, especially politicians, was emphasized. Having qualified health professionals in positions of influence within the UA was cited as a strong driver of the public health (PH) agenda at the UA level. CONCLUSION Local-level policy development and implementation depends strongly on the degree of autonomy and independence of policymakers, which in turn depends on the organization, structure and financial budget allocation of PH services. While high levels of centralization in small, relatively homogenous countries may enhance efficient use of resources, larger, more diverse countries may benefit from devolution to smaller geographical regions.
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Affiliation(s)
- Julia Mueller
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Lesley Patterson
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Matyas Jakab
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - James Higgerson
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Stephanie Steels
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
| | - Arpana Verma
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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6
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Noblet T, Heneghan NR, Hindle J, Rushton A. Accreditation of advanced clinical practice of musculoskeletal physiotherapy in England: a qualitative two-phase study to inform implementation. Physiotherapy 2021; 113:217-244. [PMID: 34579951 DOI: 10.1016/j.physio.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To establish whether international musculoskeletal physiotherapy educational standards and associated governance framework align with advanced clinical practice (ACP) frameworks in England; and to evaluate physiotherapy stakeholders' perceptions about potential accreditation and governance of ACP for musculoskeletal physiotherapists. DESIGN A qualitative two-phase study. 1] An explicit documentary mapping process of established international educational musculoskeletal standards to the ACP frameworks for England, in terms of domains, standards and competencies by two independent reviewers. Results were evaluated by a third reviewer and focus group participants. 2] Focus groups enabled maximal insight into perceptions of musculoskeletal stakeholders through the interactive process facilitated by a topic guide. Groups were recorded and transcribed verbatim; data were analysed using thematic coding. SETTING Three focus groups in London, Birmingham and Manchester facilitated recruitment from all regions of England. PARTICIPANTS Purposive sampling (n=26) ensured representation of stakeholders for ACP (e.g. Professional Networks, patients). RESULTS International educational standards fully mapped to both ACP frameworks, with 100% saturation of defined capabilities, and agreement across reviewers and focus groups. Four themes were identified from focus groups: musculoskeletal physiotherapy specific professional factors; fit for purpose, innovative educational opportunities; advocated recognition of musculoskeletal physiotherapy ACP as a discrete professional practice field; and advocating a potential vehicle for musculoskeletal physiotherapy ACP. CONCLUSIONS This study identifies the importance of musculoskeletal ACP specific to the physiotherapy profession. Fit-for-purpose innovative educational opportunities for musculoskeletal physiotherapists are required at Masters level to support preparation for ACP roles. The established national and international musculoskeletal frameworks afford an opportunity.
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Affiliation(s)
- Timothy Noblet
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Jacqueline Hindle
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; School of Physical Therapy, Western University, Elborn College, London, Ontario, N6G 1H1, Canada.
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7
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Collins R, Silarova B, Clare L. Dementia Primary Prevention Policies and Strategies and Their Local Implementation: A Scoping Review Using England as a Case Study. J Alzheimers Dis 2020; 70:S303-S318. [PMID: 30507574 PMCID: PMC6700624 DOI: 10.3233/jad-180608] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Understanding the policy context and how policy is implemented at the local and clinical level is an important precursor to developing preventive strategies focusing on dementia risk reduction in primary healthcare settings. Objective: Using England as a case study, we review policies and strategies relevant to dementia prevention from the national to local level and how these are translated into primary healthcare services. Methods: We conducted a scoping review covering: 1) identification of national, regional, and local policies and strategies that include dementia prevention; 2) identification of national guidelines for implementing dementia prevention at the clinical level; and 3) evaluation of the implementation of these at the clinical level. Results: Dementia prevention is addressed in national policy, and this filters through to regional and local levels. Focus on dementia prevention is limited and variable. Reference to modifiable risk factors is associated with other non-communicable diseases, placing less emphasis on factors more dementia specific. Evidence of implementation of dementia prevention policies at the clinical level is limited and inconsistent. Available evidence suggests messages about dementia prevention may best be delivered through primary healthcare services such as the National Health Service (NHS) Health Check. Conclusion: The limitations identified in this review could be addressed through development of a national policy focused specifically on dementia prevention. This could provide a platform for increasing knowledge and understanding among the general population and healthcare professionals. It would be important for such a policy to cover the full range of modifiable risk factors relevant to dementia.
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Affiliation(s)
- Rachel Collins
- Centre for Research in Ageing and Cognitive Health (REACH), University of Exeter, St Luke's Campus, Exeter, UK.,Centre for Research Excellence in Promoting Cognitive Health and Preventing Cognitive Decline, University of New South Wales and Neuroscience Research Australia, Barker Street, Randwick NSW, Australia
| | - Barbora Silarova
- Centre for Research in Ageing and Cognitive Health (REACH), University of Exeter, St Luke's Campus, Exeter, UK.,Centre for Research Excellence in Promoting Cognitive Health and Preventing Cognitive Decline, University of New South Wales and Neuroscience Research Australia, Barker Street, Randwick NSW, Australia
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health (REACH), University of Exeter, St Luke's Campus, Exeter, UK.,NIHR CLAHRC South West Peninsula, St Luke's Campus, Exeter, UK.,Centre for Research Excellence in Promoting Cognitive Health and Preventing Cognitive Decline, University of New South Wales and Neuroscience Research Australia, Barker Street, Randwick NSW, Australia
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Waterman AD, Rossi AP, Wood EH, Ranasinghe ON. Why Policy Changes May Be Necessary but Not Sufficient in Overcoming Disparities. Kidney Int Rep 2020; 5:1385-1386. [PMID: 32955517 PMCID: PMC7486334 DOI: 10.1016/j.ekir.2020.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Amy D. Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Terasaki Institute for Biomedical Innovation, Los Angeles, California, USA
| | - Ana P. Rossi
- Piedmont Transplant Institute, Atlanta, Georgia, USA
| | - Emily H. Wood
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Omesh N. Ranasinghe
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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9
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The challenges of implementing national policies to contain antibiotic resistance in Swedish healthcare-A qualitative study of perceptions among healthcare professionals. PLoS One 2020; 15:e0233236. [PMID: 32433688 PMCID: PMC7239472 DOI: 10.1371/journal.pone.0233236] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/30/2020] [Indexed: 12/22/2022] Open
Abstract
Objective To explore and describe how healthcare policymakers and healthcare practitioners from different levels of Swedish healthcare perceived the everyday practice of putting national policies to contain antibiotic resistance into effect. Method A strategic sample of four healthcare policymakers, three healthcare practitioners working in hospital care, and six working in primary care were recruited and interviewed in person. A manifest and latent content analysis was carried out on the transcribed interview data. Results Analysis revealed how the everyday practice of containing antibiotic resistance in different healthcare levels could be perceived as successful, difficult, or a dilemma. The informants’ perceptions are presented in three categories which describe first; informants’ perceptions of antibiotic use and antibiotic resistance in Sweden; secondly, informants’ perceptions of definable efforts in containing antibiotic resistance in Sweden, most notably responsible use of antibiotics, prevention of infection, improving public knowledge of antibiotic resistance, and international collaboration; and thirdly, informants’ perceptions of problem areas in containing antibiotic resistance in Sweden, such as behavior, attitudes and knowledge among healthcare practitioners and the public, work environment, and resources. Reflection on the underlying meaning of these perceptions led to identification of the latent theme, labelled “A sense of relative success, and many challenges yet to overcome”. Conclusion This study has given in-depth insight into how a group of healthcare policymakers and practitioners perceived the everyday practice of containing antibiotic resistance, and revealed their perceptions of successful efforts to combat antibiotic resistance so far. It has identified problem areas in different healthcare levels, bringing to light challenges yet to overcome, and areas to focus on in future policies, most notably more emphasis on attitude and behavior change, and increasing awareness of antibiotic resistance among both healthcare practitioners and patients.
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10
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Redvers N, Marianayagam J, Blondin B. Improving access to Indigenous medicine for patients in hospital-based settings: a challenge for health systems in northern Canada. Int J Circumpolar Health 2020; 78:1589208. [PMID: 31066651 PMCID: PMC6507818 DOI: 10.1080/22423982.2019.1589208] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this commentary, we argue that Indigenous patients in the Northwest Territories (NWT) have a right to access traditional medicine and related practitioners as a part of the continuum of medical care. Indigenous people make up over half of the NWT population, spread over vast geographic areas with representation from First Nations, Inuit and Métis (FNIM) people. Ensuring barrier-free access to traditional medicine and providers in a culturally respectful environment is a challenge that requires structural transformation in the territorial health system. The ongoing transmission of knowledge about Indigenous traditional medicine in Northern Canada and the collective survival of Northern peoples is a testament to the applicability of traditional medicines in a self-determined wellness system. Through a discussion of the barriers to policy development and implementation, this commentary aims to elevate Indigenous perspectives and offer recommendations for integrating traditional medicines into Northern health systems.
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Affiliation(s)
- Nicole Redvers
- a Arctic Indigenous Wellness Foundation , Yellowknife , NT , Canada
| | | | - Be'sha Blondin
- a Arctic Indigenous Wellness Foundation , Yellowknife , NT , Canada
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11
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Noblet TD, Marriott JF, Jones T, Dean C, Rushton AB. Perceptions about the implementation of physiotherapist prescribing in Australia: a national survey of Australian physiotherapists. BMJ Open 2019; 9:e024991. [PMID: 31110086 PMCID: PMC6530306 DOI: 10.1136/bmjopen-2018-024991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To explore: (1) the views of Australian physiotherapists regarding potential implementation of non-medical prescribing in Australia, (2) how the geographical location and health sector in which a clinician works may influence their perceptions and (3) the perceptions of Australian physiotherapists about how physiotherapist prescribing might impact the care that the profession can provide. DESIGN A cross-sectional descriptive survey using open and closed questions. SETTING Participants completed an online questionnaire. PARTICIPANTS 883 Australian Health Professionals Registration Authority (AHPRA)-registered physiotherapists, working across all states and territories. OUTCOME MEASURES An online questionnaire was developed by a panel of subject experts and pretested (n=10) for internal consistency. A hyperlink to the questionnaire was emailed to all members of the Australian Physiotherapy Association. A reminder email was sent 4 weeks later. Quantitative data were analysed descriptively, with use of absolute risk reductions (ARRs) and 95% CIs to determine the likelihood that health sector or geographical location were associated with specific views. Thematic analysis enabled synthesis of the qualitative data. RESULTS 79.0% participants felt that physiotherapist prescribing should be introduced in Australia, with 71.2% wanting to train as prescribers. Clinical governance, risk management, regulation of clinicians and the development of an education framework were identified as priorities for implementation. Participants working in the private sector were significantly more likely to train as prescribers than those in the public sector (ARR 9.9%; 95% CI 3.5 to 16.4) or educational/research institutions (ARR 23.3%; 95% CI 12.8 to 33.8), with city dwellers significantly more likely to train compared with physiotherapists in remote regions (ARR 19.8%; 95% CI 0.8 to 39.2). Physiotherapist prescribing was predicted to improve efficiency of healthcare delivery, access to medicines and reductions in healthcare costs. CONCLUSIONS AHPRA-registered physiotherapists perceive that the introduction of autonomous physiotherapist prescribing would be beneficial for the Australian population and should be introduced. Decision makers should consider the results of this survey in conjunction with cost-benefit and risk analysis when planning the introduction of physiotherapist prescribing.
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Affiliation(s)
- Timothy David Noblet
- CPR Spine, School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - John F Marriott
- CPR Spine, School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Taryn Jones
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Catherine Dean
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Alison B Rushton
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands, UK
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12
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Mwendera CA, de Jager C, Longwe H, Kumwenda S, Hongoro C, Phiri K, Mutero CM. Challenges to the implementation of malaria policies in Malawi. BMC Health Serv Res 2019; 19:194. [PMID: 30917823 PMCID: PMC6437884 DOI: 10.1186/s12913-019-4032-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite malaria prevention initiatives, malaria remains a major health problem in Malawi, especially for pregnant mothers and children under the age of five. To reduce the malaria burden, Malawi established its first National Malaria Control Programme in 1984. Implementation of evidence-based policies contributed to malaria prevalence dropping from 43% in 2010 to 22% in 2017. In this study, we explored challenges to implementing malaria policies in Malawi from the perspective of key stakeholders in the country. METHODS In this qualitative study, we conducted in-depth interviews with 27 key informants from April to July 2015. We stopped sampling new participants when themes became saturated. Purposive and snowballing sampling techniques were used to identify key informants including malaria researchers that were policy advisors, policy makers, programme managers, and other key stakeholders. Interviews were conducted in English, recorded and transcribed, and imported into QSR Nvivo 11 for coding and analysis. Data were analysed using the qualitative content analysis approach. RESULTS Participants identified three main categories of challenges to the implementation of malaria policies. First structural challenges include inadequate resources, unavailability of trained staff, poor supervision and mentorship of staff, and personnel turnover in government. The second challenge is unilateral implementation of policies. The third category is the inadequately informed policy development and includes lack of platforms to engage with communities, top-down approach in policy formulation and lack of understanding of socio-cultural factors affecting policy uptake by communities. CONCLUSIONS Policy makers should recognize that inadequate support of policy objectives leads to an implementation gap. Therefore, policy development and implementation should not be viewed as distinct, but rather as interactive processes shaping each other. Support for health policy and systems research should be mobilized to strengthen the health system. Detailed assessment of implementation challenges to specific malaria policies should also be conducted to address these challenges and support the shift from the paradigm of malaria prevention and control to elimination in Malawi.
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Affiliation(s)
- Chikondi A. Mwendera
- University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X363, Pretoria, 0001 South Africa
| | - Christiaan de Jager
- University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X363, Pretoria, 0001 South Africa
| | - Herbert Longwe
- ICAP at Columbia University, Mailman School of Public Health, Pretoria, South Africa
| | - Save Kumwenda
- Department of Environmental Health, the Polytechnic, University of Malawi, private bag 303, Blantyre, Malawi
| | - Charles Hongoro
- University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X363, Pretoria, 0001 South Africa
- Population Health, Health Systems and Innovation, Human Sciences Research Council (HSRC), Pretoria, South Africa
| | - Kamija Phiri
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Clifford M. Mutero
- University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X363, Pretoria, 0001 South Africa
- International Centre of Insect Physiology and Ecology (ICIPE), P.O. Box 30772, Nairobi, Kenya
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13
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Redvers N, Marianayagam J, Blondin B. Improving access to Indigenous medicine for patients in hospital-based settings: a challenge for health systems in northern Canada. Int J Circumpolar Health 2019; 78:1577093. [PMID: 30744519 PMCID: PMC6493304 DOI: 10.1080/22423982.2019.1577093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In this commentary, we argue that Indigenous patients in the Northwest Territories (NWT) have a right to access traditional medicine and related practitioners as a part of the continuum of medical care. Indigenous people make up over half of the NWT population, spread over vast geographic areas with representation from First Nations, Inuit and Métis (FNIM) people. Ensuring barrier-free access to traditional medicine and providers in a culturally respectful environment is a challenge that requires structural transformation in the territorial health system. The ongoing transmission of knowledge about Indigenous traditional medicine in Northern Canada and the collective survival of Northern peoples is a testament to the applicability of traditional medicines in a self-determined wellness system. Through a discussion of the barriers to policy development and implementation, this commentary aims to elevate Indigenous perspectives and offer recommendations for integrating traditional medicines into Northern health systems.
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Affiliation(s)
- Nicole Redvers
- a Arctic Indigenous Wellness Foundation , Yellowknife , NT , Canada
| | | | - Be'sha Blondin
- a Arctic Indigenous Wellness Foundation , Yellowknife , NT , Canada
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14
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Kuunders TJM, van Bon-Martens MJH, van de Goor IAM, Paulussen TGWM, van Oers HAM. Towards local implementation of Dutch health policy guidelines: a concept-mapping approach. Health Promot Int 2019; 33:635-647. [PMID: 28335022 PMCID: PMC6144776 DOI: 10.1093/heapro/dax003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
To develop a targeted implementation strategy for a municipal health policy guideline, implementation targets of two guideline users [Regional Health Services (RHSs)] and guideline developers of leading national health institutes were made explicit. Therefore, characteristics of successful implementation of the guideline were identified. Differences and similarities in perceptions of these characteristics between RHSs and developers were explored. Separate concept mapping procedures were executed in two RHSs, one with representatives from partner local health organizations and municipalities, the second with RHS members only. A third map was conducted with the developers of the guideline. All mapping procedures followed the same design of generating statements up to interpretation of results with participants. Concept mapping, as a practical implementation tool, will be discussed in the context of international research literature on guideline implementation in public health. Guideline developers consider implementation successful when substantive components (health issues) of the guidelines, content are visible in local policy practice. RHSs, local organizations and municipalities view the implementation process itself within and between organizations as more relevant, and state that usability of the guideline for municipal policy and commitment by officials and municipal managers are critical targets for successful implementation. Between the RHSs, differences in implementation targets were smaller than between RHSs and guideline developers. For successful implementation, RHSs tend to focus on process targets while developers focus more on the thematic contents of the guideline. Implications of these different orientations for implementation strategies are dealt with in the discussion.
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Affiliation(s)
- Theo J M Kuunders
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, LE Tilburg, The Netherlands.,Regional Health Service, 'GGD Hart voor Brabant', 's-Hertogenbosch, The Netherlands
| | - Marja J H van Bon-Martens
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, LE Tilburg, The Netherlands.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ien A M van de Goor
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, LE Tilburg, The Netherlands
| | - Theo G W M Paulussen
- TNO, Innovation for Life, Organization for Applied Scientific Research, Leiden, The Netherlands
| | - Hans A M van Oers
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, LE Tilburg, The Netherlands.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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15
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Behzadifar M, Bragazzi NL, Arab-Zozani M, Bakhtiari A, Behzadifar M, Beyranvand T, Yousefzadeh N, Azari S, Sajadi HS, Saki M, Saran M, Gorji HA. The challenges of implementation of clinical governance in Iran: a meta-synthesis of qualitative studies. Health Res Policy Syst 2019; 17:3. [PMID: 30626377 PMCID: PMC6327528 DOI: 10.1186/s12961-018-0399-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022] Open
Abstract
Background Policy- and decision-makers seek to improve the quality of care in the health sector and therefore aim to improve quality through appropriate policies. Higher quality of care will satisfy service providers and the public, reduce costs, increase productivity, and lead to better organisational performance. Clinical governance is a method through which management can be improved and made more accountable, and leads to the provision of better quality of care. In November 2009, the Iranian Ministry of Health and Medical Education implemented new clinical guidelines to standardise and improve clinical services as well as to increase efficiency and reduce costs. The purpose of this study was to assess the challenges of implementing clinical governance through a meta-synthesis of qualitative studies published in Iran. Methods Ten databases, including ISI/Web of Sciences, PubMed/MEDLINE, Embase, PsycINFO, the Cochrane Library, CINAHL, Scopus, Barakatns, MagIran and the Scientific Information Database, were searched between January 2009 and May 2018. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. This study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines. Thematic synthesis was used to analyse the data. Results Ten studies were selected and included based on the inclusion/exclusion criteria. In the first stage, 75 items emerged and were coded, and, following comparison and combination of the codes, 32 codes and 8 themes were finally extracted. These themes included health system structure, management, person-power, cultural factors, information and data, resources, education and evaluation. Conclusion The findings of the study showed that there exist a variety of challenges for the implementation of clinical governance in Iran. To successfully implement a health policy, its infrastructure needs to be created. Using the views and support of stakeholders can ensure that a policy is well implemented. Trial registration CRD42017079077. Dated October 10, 2017. Electronic supplementary material The online version of this article (10.1186/s12961-018-0399-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Nicola Luigi Bragazzi
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
| | - Morteza Arab-Zozani
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahad Bakhtiari
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Behzadifar
- Department of Epidemiology, Faculty of Health & Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Tina Beyranvand
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Negar Yousefzadeh
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Samad Azari
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Haniye Sadat Sajadi
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mandana Saki
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Maryam Saran
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hasan Abolghasem Gorji
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Noblet T, Marriot J, Jones T, Dean C, Rushton A. Views and perceptions of Australian physiotherapists and physiotherapy students about the potential implementation of physiotherapist prescribing in Australia: a survey protocol. BMC Health Serv Res 2018; 18:472. [PMID: 29921266 PMCID: PMC6006587 DOI: 10.1186/s12913-018-3300-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-medical prescribing (NMP) is acknowledged as an expanding area of clinical practice across the world. The physiotherapy profession is currently investigating the introduction of physiotherapist prescribing in Australia, with the case for reform centred around meeting the healthcare needs of the current and future Australian population. Conflict within a profession has been identified as a barrier to implementation of new clinical innovations. An online survey has been developed with the aim to collect and synthesise the views and perceptions of Australian physiotherapists and physiotherapy students about the potential use of NMP by physiotherapists in Australia. METHODS A cross-sectional descriptive survey design, using a pre-tested online questionnaire, including quantitative and qualitative components, will be utilised to explore the views and perceptions of Australian physiotherapists and physiotherapy students regarding NMP by physiotherapists in Australia. Quantitative data will be analysed descriptively and regression analysis will be utilised to identify associations between the specific question outcomes and demographic data. A thematic analytical approach will be utilised to synthesise qualitative data from open-questions. DISCUSSION The results from this survey will serve to inform decision-makers about the current views of the Australian physiotherapy profession with regards to the potential implementation of physiotherapist prescribing in Australia. Data will be used in conjunction with cost-benefit analyses, risk analysis as well as assessment of the health-requirements and consultation with key stakeholders including the Australian health consumer when contemplating change.
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Affiliation(s)
- T. Noblet
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Ground Floor, 75 Talavera Road, Sydney, NSW 2109 Australia
| | - J. Marriot
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - T. Jones
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Ground Floor, 75 Talavera Road, Sydney, NSW 2109 Australia
| | - C. Dean
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Ground Floor, 75 Talavera Road, Sydney, NSW 2109 Australia
| | - A. Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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17
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Gitobu CM, Gichangi PB, Mwanda WO. The effect of Kenya's free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities. BMC Pregnancy Childbirth 2018; 18:77. [PMID: 29580207 PMCID: PMC5870237 DOI: 10.1186/s12884-018-1708-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/16/2018] [Indexed: 11/16/2022] Open
Abstract
Background Kenya abolished delivery fees in all public health facilities through a presidential directive effective on June 1, 2013 with an aim of promoting health facility delivery service utilization and reducing pregnancy-related mortality in the country. This paper aims to provide a brief overview of this policy’s effect on health facility delivery service utilization and maternal mortality ratio and neonatal mortality rate in Kenyan public health facilities. Methods A time series analysis was conducted on health facility delivery services utilization, maternal and neonatal mortality 2 years before and after the policy intervention in 77 health facilities across 14 counties in Kenya. Results A statistically significant increase in the number of facility-based deliveries was identified with no significant changes in the ratio of maternal mortality and the rate of neonatal mortality. Conclusion The findings suggest that cost is a deterrent to health facility delivery service utilization in Kenya and thus free delivery services are an important strategy to promote utilization of health facility delivery services; however, there is a need to simultaneously address other factors that contribute to pregnancy-related and neonatal deaths. Electronic supplementary material The online version of this article (10.1186/s12884-018-1708-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C M Gitobu
- Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, Nairobi, Kenya.
| | - P B Gichangi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.,Department of Obstetrics and Gynecology, University of Ghent, Ghent, Belgium
| | - W O Mwanda
- Department of Human Pathology, University of Nairobi, Nairobi, Kenya
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18
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Pedersen AHM, Rasmussen K, Grytnes R, Nielsen KJ. Collaboration and patient safety at an emergency department - a qualitative case study. J Health Organ Manag 2018; 32:25-38. [PMID: 29508665 DOI: 10.1108/jhom-09-2016-0174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to examine how conflicts about collaboration between staff at different departments arose during the establishment of a new emergency department and how these conflicts affected the daily work and ultimately patient safety at the emergency department. Design/methodology/approach This qualitative single case study draws on qualitative semi-structured interviews and participant observation. The theoretical concepts "availability" and "receptiveness" as antecedents for collaboration will be applied in the analysis. Findings Close collaboration between departments was an essential precondition for the functioning of the new emergency department. The study shows how a lack of antecedents for collaboration affected the working relation and communication between employees and departments, which spurred negative feelings and reproduced conflicts. This situation was seen as a potential threat for the safety of the emergency patients. Research limitations/implications This study presents a single case study, at a specific point in time, and should be used as an illustrative example of how contextual and situational factors affect the working environment and through that patient safety. Originality/value Few studies provide an in-depth investigation of what actually takes place when collaboration between professional groups goes wrong and escalates, and how problems in collaboration may affect patient safety.
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Affiliation(s)
| | - Kurt Rasmussen
- Department of Occupational Medicine, Regional Hospital West Jutland University Research Clinic , Herning, Denmark
| | - Regine Grytnes
- Department of Occupational Medicine, Regional Hospital West Jutland University Research Clinic , Herning, Denmark
| | - Kent Jacob Nielsen
- Department of Occupational Medicine, Regional Hospital West Jutland University Research Clinic , Herning, Denmark
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19
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Noblet T, Marriott J, Graham-Clarke E, Rushton A. Barriers to and facilitators of independent non-medical prescribing in clinical practice: a mixed-methods systematic review. J Physiother 2017; 63:221-234. [PMID: 28986140 DOI: 10.1016/j.jphys.2017.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/01/2017] [Accepted: 09/08/2017] [Indexed: 01/06/2023] Open
Abstract
QUESTION What are the factors that affect the implementation or utilisation of independent non-medical prescribing (iNMP)? DESIGN Mixed-methods systematic review. Two reviewers independently completed searches, eligibility and quality assessments. DATA SOURCES Pre-defined search terms were utilised to search electronic databases. Reference lists, key journals and grey literature were searched alongside consultation with authors/experts. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES Qualitative and quantitative studies investigating independent prescribing by any non-medical professional group. Study participants included any stakeholders involved in actual or proposed iNMP. Measurements reported on data describing stakeholders' perceptions and experiences of the barriers to/facilitators of iNMP. RESULTS A total of 43 qualitative and seven quantitative studies from three countries (n=12, 117 participants) were included. Quality scores varied from 9 to 35 (Quality Assessment Tool for Studies with Diverse Designs, 0 to 48). Qualitative data were synthesised into four themes (and subthemes): systems (government and political, organisational, formulary); education and support (non-medical prescribing (NMP) courses/continuous professional development (CPD)); personal and professional (medical profession, NMP professions, service users); and financial factors. Quantitative data corroborated the qualitative themes. Integration of the qualitative themes and quantitative data enabled the development of a NMP implementation framework. CONCLUSION Barriers to and facilitators of the implementation and utilisation of iNMP are evident, demonstrating multifactorial and context-specific variables within four explicit themes. Professional bodies, politicians, policy and healthcare managers and clinicians could use the resulting NMP implementation framework to ensure the safe and successful implementation and utilisation of NMP. Clinical physiotherapists and other clinicians should consider whether these variables have been adequately addressed prior to adopting NMP into their clinical practice. REGISTRATION PROSPERO CRD42015017212. [Noblet T, Marriott J, Graham-Clarke E, Rushton A (2017) Barriers to and facilitators of independent non-medical prescribing in clinical practice: a mixed-methods systematic review. Journal of Physiotherapy 63: 221-234].
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Affiliation(s)
- Timothy Noblet
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Department of Health Professions, Macquarie University, Sydney, Australia
| | - John Marriott
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Emma Graham-Clarke
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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20
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Chahal K, Eldabi T, Young T. A conceptual framework for hybrid system dynamics and discrete event simulation for healthcare. JOURNAL OF ENTERPRISE INFORMATION MANAGEMENT 2013. [DOI: 10.1108/17410391311289541] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Watt S, Sword W, Sheehan D, Foster G, Thabane L, Krueger P, Landy CK. The effect of delivery method on breastfeeding initiation from the The Ontario Mother and Infant Study (TOMIS) III. J Obstet Gynecol Neonatal Nurs 2012; 41:728-37. [PMID: 22823063 DOI: 10.1111/j.1552-6909.2012.01394.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To report on the relationship between delivery method (cesarean vs. vaginal) and type (planned vs. unplanned) and breastfeeding initiation in hospital and continuation to 6 weeks postpartum as self-reported by study participants. DESIGN Quantitative sequential mixed methods design. SETTING Women were recruited from 11 hospital sites in Ontario, Canada. PARTICIPANTS Participants included 2,560 women age 16 years or older who delivered live, full-term, singleton infants. METHODS Data were collected from an in-hospital questionnaire, hospital records, and a 6-week postpartum interview. RESULTS Ninety-two percent of women reported initiating breastfeeding, and 74% continued to 6 weeks. The method of delivery, when defined as cesarean versus vaginal, was not a determining factor in breastfeeding initiation in hospital or in the early postdischarge period. An unexpected delivery method (i.e., unplanned cesarean or instrument-assisted vaginal deliveries) was associated, at a statistically significant level, with an increased likelihood of initiating breastfeeding and continuation to 6 weeks postdischarge. CONCLUSION Breastfeeding can be considered a coping strategy that serves to normalize an abnormal experience and allows the individual to once again assume control. These unexpected results warrant further investigation to understand why women make the decision to initiate breastfeeding, why they choose to continue breastfeeding, and how they can be supported to achieve exclusive breastfeeding as recommended for infants in the first 6 months.
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Affiliation(s)
- Susan Watt
- School of Social Work, McMaster University, Hamilton, ON, Canada.
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22
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Dauvrin M, Lorant V, Sandhu S, Devillé W, Dia H, Dias S, Gaddini A, Ioannidis E, Jensen NK, Kluge U, Mertaniemi R, Puigpinós i Riera R, Sárváry A, Straßmayr C, Stankunas M, Soares JJF, Welbel M, Priebe S. Health care for irregular migrants: pragmatism across Europe: a qualitative study. BMC Res Notes 2012; 5:99. [PMID: 22340424 PMCID: PMC3315408 DOI: 10.1186/1756-0500-5-99] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 02/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health services in Europe face the challenge of delivering care to a heterogeneous group of irregular migrants (IM). There is little empirical evidence on how health professionals cope with this challenge. This study explores the experiences of health professionals providing care to IM in three types of health care service across 16 European countries. RESULTS Semi-structured interviews were conducted with health professionals in 144 primary care services, 48 mental health services, and 48 Accident & Emergency departments (total n = 240). Although legal health care entitlement for IM varies across countries, health professionals reported facing similar issues when caring for IM. These issues include access problems, limited communication, and associated legal complications. Differences in the experiences with IM across the three types of services were also explored. Respondents from Accident & Emergency departments reported less of a difference between the care for IM patients and patients in a regular situation than did respondents from primary care and mental health services. Primary care services and mental health services were more concerned with language barriers than Accident & Emergency departments. Notifying the authorities was an uncommon practice, even in countries where health professionals are required to do this. CONCLUSIONS The needs of IM patients and the values of the staff appear to be as important as the national legal framework, with staff in different European countries adopting a similar pragmatic approach to delivering health care to IM. While legislation might help to improve health care for IM, more appropriate organisation and local flexibility are equally important, especially for improving access and care pathways.
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Affiliation(s)
- Marie Dauvrin
- Fonds de la Recherche Scientifique-FNRS, rue d'Egmont 5, 1000 Bruxelles, Belgium
- Institute of Health and Society IRSS, Université catholique de Louvain, Clos Chapelle aux Champs 30 B1.30.15, 1200 Bruxelles, Belgium
| | - Vincent Lorant
- Institute of Health and Society IRSS, Université catholique de Louvain, Clos Chapelle aux Champs 30 B1.30.15, 1200 Bruxelles, Belgium
| | - Sima Sandhu
- Unit for Social and Community Psychiatry, London and the Barts School of Medicine and Dentistry, Queen Mary University of London, Newham Centre for Mental Health, London E13 8SP, UK
| | - Walter Devillé
- International and Migrant Health, NIVEL (Netherlands Institute for Health Services Research), Otterstraat 118-124, PO Box 1568, 3500, BN Utrecht, The Netherlands
| | - Hamidou Dia
- Etablissement public de santé Maison Blanche, 3-5 rue Lespagnol, 75020 Paris, France
| | - Sónia Dias
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 96, 1349-008, Lisbon, Portugal
| | - Andrea Gaddini
- Laziosanità ASP Public Health Agency for the Lazio Region, Via S. Costanza 53, 00185 Rome, Italy
| | - Elisabeth Ioannidis
- Department of Sociology, National school of Public Health, 196 Alexandras avenue, Athens 11521, Greece
| | - Natasja K Jensen
- Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark
| | - Ulrike Kluge
- Clinic for Psychiatry and Psychotherapy, Charité - University Medicine Berlin, CCM, Charitéplatz 1, 10117 Berlin, Germany
| | - Ritva Mertaniemi
- Department for mental health and substance abuse services, National Institute for Health and Welfare (THL), P.O.B. 30, FIN-00271 Helsinki, Finland
| | | | - Attila Sárváry
- Faculty of Health, University of Debrecen, Sóstói út 2-4, 4400 Nyíregyháza, Hungary
| | - Christa Straßmayr
- Ludwig Boltzmann Institute for Social Psychiatry, Lazarettgasse 14A-912, 1090 Vienna, Austria
| | - Mindaugas Stankunas
- School of Public Health, Griffith University, Gold Coast Campus, Southport, Queensland 4222, Australia
- Department of Health Management, Lithuanian University of Health Sciences, A. Mickeviciaus 9, Kaunas 44307, Lithuania
| | - Joaquim JF Soares
- Department of Public Health Sciences, Section of Social Medicine, Karolinska Institutet, SE- 171 76 Stockholm, Sweden
- Department of Public Health Sciences, Mid Sweden University, SE-851 70 Sundsvall, Sweden
| | - Marta Welbel
- Institute of Psychiatry and Neurology, Ul. Sobieskiego 9, 02-957 Warsaw, Poland
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, London and the Barts School of Medicine and Dentistry, Queen Mary University of London, Newham Centre for Mental Health, London E13 8SP, UK
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Chahal K, Eldabi T. Hybrid simulation and modes of governance in UK healthcare. TRANSFORMING GOVERNMENT- PEOPLE PROCESS AND POLICY 2011. [DOI: 10.1108/17506161111131177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Comprehensive assessment of older people with complex care needs: the multi-disciplinarity of the Single Assessment Process in England. AGEING & SOCIETY 2010. [DOI: 10.1017/s0144686x10000395] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTThe quality of assessment of older people with health and social care needs has for some time been a concern of policy makers, practitioners, older people and carers in the United Kingdom and internationally. This article seeks to address a key aspect of these concerns, namely whether sufficient expertise is deployed when, as a basis for a care plan and service allocation, an older person's eligibility for local authority adult social-care services requires a comprehensive needs assessment of their usually complex and multiple problems. Is an adequate range of professionals engaged, and is a multi-disciplinary approach applied? The Single Assessment Process (SAP) was introduced in England in 2004 to promote a multi-disciplinary model of service delivery. After its introduction, a survey in 2005–06 was conducted to establish the prevalence and patterns of comprehensive assessment practice across England. The reported arrangements for multi-disciplinary working among local authority areas in England were categorised and reviewed. The findings suggest, first, that the provision of comprehensive assessments of older people that require the expertise of multiple professionals is limited, except where the possibility arose of placement in a care-home-with-nursing, and second that by and large a systematic multi-disciplinary approach was absent. Policy initiatives to address the difficulties in assessment need to be more prescriptive if they are to produce the intended outcomes.
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Hyder AA, Corluka A, Winch PJ, El-Shinnawy A, Ghassany H, Malekafzali H, Lim MK, Mfutso-Bengo J, Segura E, Ghaffar A. National policy-makers speak out: are researchers giving them what they need? Health Policy Plan 2010; 26:73-82. [PMID: 20547652 PMCID: PMC4031573 DOI: 10.1093/heapol/czq020] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The objective of this empirical study was to understand the perspectives and attitudes of policy-makers towards the use and impact of research in the health sector in low- and middle-income countries. The study used data from 83 semi-structured, in-depth interviews conducted with purposively selected policy-makers at the national level in Argentina, Egypt, Iran, Malawi, Oman and Singapore. The interviews were structured around an interview guide developed based on existing literature and in consultation with all six country investigators. Transcripts were processed using a thematic-analysis approach. Policy-makers interviewed for this study were unequivocal in their support for health research and the high value they attribute to it. However, they stated that there were structural and informal barriers to research contributing to policy processes, to the contribution research makes to knowledge generally, and to the use of research in health decision-making specifically. Major findings regarding barriers to evidence-based policy-making included poor communication and dissemination, lack of technical capacity in policy processes, as well as the influence of the political context. Policy-makers had a variable understanding of economic analysis, equity and burden of disease measures, and were vague in terms of their use in national decisions. Policy-maker recommendations regarding strategies for facilitating the uptake of research into policy included improving the technical capacity of policy-makers, better packaging of research results, use of social networks, and establishment of fora and clearinghouse functions to help assist in evidence-based policy-making.
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Affiliation(s)
- Adnan A Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Fostering participation of general practitioners in integrated health services networks: incentives, barriers, and guidelines. BMC Health Serv Res 2009; 9:48. [PMID: 19292905 PMCID: PMC2664801 DOI: 10.1186/1472-6963-9-48] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 03/17/2009] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND While the active participation of general practitioners (GPs) in integrated health services networks (IHSNs) plays a critical role in their success, little is known about the incentives and barriers to their actual participation. METHODS Data were gathered through semi-structured interviews and a mail survey with GPs enrolled in SIPA (system of integrated care for older persons) at 2 sites in Montreal. A total of 61 GPs completed the questionnaire, from which 22 were randomly selected for the qualitative study, with active and non-active participation in the IHSN. RESULTS The key themes associated with GP participation were clinician characteristics, consequences perceived at the outset, the SIPA implementation process, relationships with the SIPA team and professional consequences. The incentive factors reported were collaborative practices, high rates of elderly and SIPA patients in their clienteles, concerns about SIPA, the selection of frail elderly patients, close relationships with the case manager, the perceived efficacy of SIPA, and improved professional practices. Barriers to GP participation included high expectations, GP recruitment, lack of information on SIPA, difficult relationships with SIPA geriatricians and deterioration of physician-patient relationships. Four profiles of participation were identified: 2 groups of participants active in SIPA and 2 groups of participants not active in SIPA. The active GPs were familiar with collaborative practices, had higher IHSN patient rates, expressed more concerns than expectations, reported satisfactory relationships with case managers and perceived the efficacy of SIPA. Both active and non-active GPs reported quality care in the IHSN and improved professional practice. CONCLUSION Throughout the implementation process, the participation of GPs in an IHSN depends on numerous professional (clinician characteristics) and organizational factors (GP recruitment, relationships with case managers). Our study provides guiding principles for establishing future integrated models of care. It suggests practical guidelines to support the active participation of GPs in these networks such as physicians with collaborative practices, recruitment of significant number of patients per physicians, the information provided and the accompaniment by geriatricians.
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MacDougall C, Percival J, McGregor C. Integrating health information technology into clinical guidelines. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:4646-4649. [PMID: 19963615 DOI: 10.1109/iembs.2009.5332653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The current use of Health Information Technology (HIT) within healthcare practice is limited. Clinical guidelines have been developed to bring research based evidence into practice. However, there is no defining step during the development process that explores the use of HIT and how it can benefit the patient, staff and delivery of care process. This paper presents a review of current research on the integration of HIT into clinical guidelines, a methodology for updating and altering the clinical guideline development process to include exploration of HIT and an updated version of the Patient Journey Modeling Architecture (PaJMa) to include a technology layer to assist in visually depicting how HIT can benefit healthcare.
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Affiliation(s)
- Candice MacDougall
- Faculty of Health Science at the University of Ontario Institute of Technology (UOIT), Oshawa, Ontario, Canada L1L 7K 4.
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