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Soto-Perez-de-Celis E, Dale W, Katheria V, Kim H, Fakih M, Chung VM, Lim D, Mortimer J, Cabrera Chien L, Charles K, Roberts E, Vazquez J, Moreno J, Lee T, Fernandes Dos Santos Hughes S, Sedrak MS, Sun CL, Li D. Outcome prioritization and preferences among older adults with cancer starting chemotherapy in a randomized clinical trial. Cancer 2024. [PMID: 38630903 DOI: 10.1002/cncr.35333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Older adults with cancer facing competing treatments must prioritize between various outcomes. This study assessed health outcome prioritization among older adults with cancer starting chemotherapy. METHODS Secondary analysis of a randomized trial addressing vulnerabilities in older adults with cancer. Patients completed three validated outcome prioritization tools: 1) Health Outcomes Tool: prioritizes outcomes (survival, independence, symptoms) using a visual analog scale; 2) Now vs. Later Tool: rates the importance of quality of life at three times-today versus 1 or 5 years in the future; and 3) Attitude Scale: rates agreement with outcome-related statements. The authors measured the proportion of patients prioritizing various outcomes and evaluated their characteristics. RESULTS A total of 219 patients (median [range] age 71 [65-88], 68% with metastatic disease) were included. On the Health Outcomes Tool, 60.7% prioritized survival over other outcomes. Having localized disease was associated with choosing survival as top priority. On the Now vs. Later Tool, 50% gave equal importance to current versus future quality of life. On the Attitude Scale, 53.4% disagreed with the statement "the most important thing to me is living as long as I can, no matter what my quality of life is"; and 82.2% agreed with the statement "it is more important to me to maintain my thinking ability than to live as long as possible". CONCLUSION Although survival was the top priority for most participants, some older individuals with cancer prioritize other outcomes, such as cognition and function. Clinicians should elicit patient-defined priorities and include them in decision-making.
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Affiliation(s)
- Enrique Soto-Perez-de-Celis
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - William Dale
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Vani Katheria
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Heeyoung Kim
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Marwan Fakih
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Vincent M Chung
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Dean Lim
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Joanne Mortimer
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | | | | | - Elsa Roberts
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Jessica Vazquez
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Jeanine Moreno
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Ty Lee
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | | | - Mina S Sedrak
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Can-Lan Sun
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Daneng Li
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
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Herlitz A. Global health impact, priority and time. Dev World Bioeth 2024; 24:15-20. [PMID: 37823400 DOI: 10.1111/dewb.12428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
This paper addresses normative issues that arise in relation to indicators and measures of health impact. With inspiration from Nicole Hassoun's recent proposal, the paper argues and illustrates that those interested in measuring global health impact face questions about how to prioritize among those with ill-health, how to weigh benefits to those who cannot lead minimally good lives against benefits to the better off, and how to think about whether someone is badly off.
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San Diego ERN, West NT, Pichon LC, Jiang Y, Powell TW, Rugless F, Lewis J, Campbell B, McCann L, McNeals S, Harmon BE. Associations Between Sociodemographic Variables, Social Determinants of Health, and Diabetes: Findings From a Congregational Health Needs Assessment. Am J Health Promot 2024:8901171241234662. [PMID: 38395415 DOI: 10.1177/08901171241234662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
PURPOSE To examine associations between sociodemographic variables, social determinants of health (SDOHs) and diabetes using health needs assessment data. DESIGN Cross-sectional study. SETTING Faith-based communities in the Mid-South U.S. SAMPLE Of the 378 churches, 92 participated in the study (24% response rate); N = 828 church leaders and members completed the survey. MEASURE The Mid-South Congregational Health Survey assessed perceived health-related needs of congregations and the communities they serve. ANALYSIS Generalized linear mixed modeling examined the associations between sociodemographic variables (age, sex, race/ethnicity, educational level), SDOHs (affordable healthcare, healthy food, employment), and diabetes. RESULTS Individuals with less education had lower odds of reporting all SDOHs as health needs compared to individuals with more education (ORrange = .59-.63). Men had lower odds of reporting diabetes as a health need or concern compared to women (OR = .70; 95% CI = .50, .97). African Americans had greater odds of reporting diabetes as a health need compared to individuals in the 'Other' race/ethnicity category (OR = 3.91; 95% CI = 2.20, 6.94). Individuals who reported affordable healthcare (OR = 2.54; 95% CI = 1.73, 3.72), healthy food (OR = 2.24; 95% CI = 1.55, 3.24), and employment (OR = 3.33; 95% CI = 2.29, 4.84) as health needs had greater odds of reporting diabetes as a health need compared to those who did not report these SDOHs as needs. CONCLUSIONS Future studies should evaluate strategies to merge healthcare and faith-based organizations' efforts to address SDOHs impacting diabetes.
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Affiliation(s)
- Emily Rose N San Diego
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA
| | - Nathan T West
- Institute of Social and Economic Research, University of Alaska, Anchorage, AK, USA
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, University of Memphis School of Public Health, Memphis, TN, USA
| | - Yu Jiang
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis School of Public Health, Memphis, TN, USA
| | - Terrinieka W Powell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fedoria Rugless
- Population Health Department, Amerigroup, Nashville, TN, USA
| | - Jonathan Lewis
- Community Partnerships, Methodist Le Bonheur Healthcare, Memphis, TN, USA
| | - Bettina Campbell
- Oak Hill Regional Community Development Center, Hernando, MS, USA
| | - Lauren McCann
- Le Bonheur Pediatrics, Le Bonheur Children's Hospital, Memphis, TN, USA
| | | | - Brook E Harmon
- Department of Nutrition and Healthcare Management, Appalachian State University, Boone, NC, USA
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Espinoza MA, Cabieses B, Goic C, Andrade A. The legal path for priority setting in Chile: a critical analysis to improve health planning and stewardship. Front Public Health 2024; 11:1302640. [PMID: 38259787 PMCID: PMC10801194 DOI: 10.3389/fpubh.2023.1302640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Health systems have committed their path to universal health coverage using health planning to accomplish their goals of efficiency, equity and sustainability. Chile, a high-income country with a public-private mix health system, has made significant progress through several successive health policies implemented in the last 20 years which have been consistent with this approach. However, in the last 5 years, the national congress has produced several disease-specific laws, which have been mainly promoted by the civil society. These laws indicate the actions the health authority must perform to tackle the needs of the affected population, which ultimately determine the priorities of the health system. We argue that this legal pattern has become an alternative path to priority-setting, as opposed to health planning. We claim this "legal path" is a mechanism used by civil society in a context where the health authority fails to implement a robust and legitimate prioritization process. Although these laws have brought benefits to patients suffering the corresponding conditions, we highlight this approach does not guarantee improvements in equity, efficiency and health system performance. Instead, we advocate for taking back the control of the priority-setting based on health planning, through a new institutionalization of health technology assessment and quality of care.
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Affiliation(s)
- Manuel Antonio Espinoza
- Departamento de Salud Pública, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Centro para la Prevención y Control del Cancer (CECAN) & Departamento de Hemotaologia y Oncología, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Baltica Cabieses
- Centro para la Prevención y Control del Cancer (CECAN) & Departamento de Hemotaologia y Oncología, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Center for Global Intercultural Health, University for Development, Santiago, Chile
| | - Carolina Goic
- Centro para la Prevención y Control del Cancer (CECAN) & Departamento de Hemotaologia y Oncología, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Lee WK, Ock M, Park JO, Kim C, Seo BS, Pyo J, Park HJ, Kim UJ, Choi EJ, Woo S, Park H. Prioritization of Injury Prevention and Management Programs and Research and Development (R&D) Projects: Survey Using the Delphi Technique and Analytic Hierarchy Process. Asia Pac J Public Health 2024; 36:78-86. [PMID: 38014835 DOI: 10.1177/10105395231213171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
We prioritized injury prevention and management programs, and research and development (R&D) projects using the Delphi method and analytic hierarchy process (AHP) for national plan. We summarized 21 programs and 31 R&D projects based on opinions collected in the opinion survey and brainstorming. Expert panel evaluated program and project relevance in the two Delphi rounds to make consensus. Total scores were calculated by adding criterion weights calculated through the AHP multiplied by the average of scores for each program and project. The top three programs were "Integrated Management System for Injury Data," "Comprehensive Injury Surveillance System," and "Transport System Improvement Program for Major Trauma." The top three R&D projects were researches on "Identification of Vulnerable Workers Injuries to Strengthen Protections," "Data Integration on Injury and Disability," and "Using Public Health Big Data to Identify Injury Status and Risk Factors." Experts highly rated the programs to improve injury surveillance system.
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Affiliation(s)
- Won Kyung Lee
- Department of Prevention and Management, Inha University Hospital, School of Medicine, Inha University, Incheon, Republic of Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ju Ok Park
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Changsoo Kim
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Beom Sok Seo
- Department of Emergency Medicine, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jeehee Pyo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyun Jin Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
| | - Ui Jeong Kim
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
| | - Eun Jeong Choi
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Shinyoung Woo
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hyesook Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
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Brownie S, Ackers L, Murphy G, Shumba C. Editorial: Transforming health and social education to include a greater focus on public health education in the curriculum. Front Public Health 2023; 11:1306124. [PMID: 38074725 PMCID: PMC10704497 DOI: 10.3389/fpubh.2023.1306124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Sharon Brownie
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
- Centre for Health and Social Practice, Te Pukenga: Wintec, Hamilton, New Zealand
| | - Louise Ackers
- Global Social Justice, University of Salford, Salford, United Kingdom
| | | | - Constance Shumba
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya
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Rosenthal EM, Tesoriero JM. Development of a Mission-Driven Research Agenda to Support Efforts to End Epidemics. J Public Health Manag Pract 2023; 29:838-844. [PMID: 37499111 PMCID: PMC10549879 DOI: 10.1097/phh.0000000000001787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
CONTEXT New York State continues efforts to end the AIDS and hepatitis C epidemics and reduce new infections of sexually transmitted infections. PROGRAM In 2022, the New York State Department of Health AIDS Institute released its first-ever Research Agenda. This Research Agenda was systematically developed following input from internal and external research and community stakeholders. We used a participatory and iterative process to prioritize research knowledge gaps related to HIV/AIDS; sexual health and sexually transmitted infections; hepatitis C; lesbian, gay, bisexual, transgender health; drug user health; health equity; and emerging issues such as COVID-19. Questions were prioritized on the basis of the alignment with the following 5 criteria: magnitude of impact; funding and resources; feasibility of conducting research; translatability; and addresses an internal priority area. Findings are anticipated to generate actionable results that can be readily translatable into programs, policies, and practices. IMPLEMENTATION This Research Agenda includes 79 research and program evaluation questions prioritized for internally led and collaborative research. Efforts on 35 of the 61 internally led questions and funding of 11 collaborative research projects related to Research Agenda priorities began in 2022. EVALUATION An evaluation survey was conducted among all stakeholders involved in the prioritization process. All were satisfied or very satisfied with the process, and results yielded recommendations for future processes including weighting of questions relative to one another within each focus area and other suggestions to streamline the process. In year 1, 10 of the 35 questions were completed. DISCUSSION Lessons learned include use of a participatory process to facilitate support and completion of Research Agenda, prioritize research questions to maximize impact and translatability, streamline the prioritization process by restricting proposed questions to those with clear potential for innovative research, emphasize anticipated resources necessary to implement the Research Agenda to set a realistic and actionable plan, and adaptability toward shifting priorities.
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Affiliation(s)
- Elizabeth M. Rosenthal
- AIDS Institute, New York State Department of Health, Albany, New York (Ms Rosenthal and Dr Tesoriero); and University at Albany School of Public Health, State University at New York, Albany, New York (Ms Rosenthal and Dr Tesoriero)
| | - James M. Tesoriero
- AIDS Institute, New York State Department of Health, Albany, New York (Ms Rosenthal and Dr Tesoriero); and University at Albany School of Public Health, State University at New York, Albany, New York (Ms Rosenthal and Dr Tesoriero)
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Burgmann S, Paier-Abuzahra M, Sprenger M, Avian A, Siebenhofer A. Identifying key policy objectives for strong primary care: a cross-sectional study. Prim Health Care Res Dev 2023; 24:e52. [PMID: 37577950 PMCID: PMC10466205 DOI: 10.1017/s1463423623000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 08/15/2023] Open
Abstract
AIM The aim of this study was to identify key policy objectives by investigating the perception of important stakeholders and affected professionals concerning relevance and feasibility of a successful primary care (PC) reform. BACKGROUND Since 2013, the Austrian PC system has been undergoing a reform process to establish multiprofessional primary care units. The reforms have various defined objectives and lack clear priorities. METHODS After the definition and consensus-based selection of 12 policy objectives, a cross-sectional online survey on their relevance and feasibility was distributed via email and social media to PC and public health networks. The survey was conducted in the period from January to February 2020. Results were analyzed descriptively, and further, Pearson Chi-Square Test or Fisher's Exact Test was performed for group comparison regarding respondents' characteristics. Open-ended responses were analyzed using qualitative content analysis. FINDINGS In total, 169 questionnaires were completed. A total of 46.3% of the responders had more than 20 years of professional experience (female: 60.5%). A mandatory internship in general practice, vocational training for general practice, and a modern remuneration system were the three top-rated policy objectives regarding relevance. A mandatory internship in general practice, specialization in general practice, and coding of services and diagnosis were assessed as the most feasible objectives. The group comparisons regarding working field, years of professional experience, age, and sex did not show any meaningful results in the evaluation of relevance and feasibility. DISCUSSION In the view of the study participants, easily obtainable objectives include adapting the duration and setting of internships for medical students, as well as mandatory vocational training for GP trainees. Further efforts are necessary to achieve complex objectives such as the adoption of a modern remuneration scheme and a comprehensive quality assurance program. Building capacity and creating team-oriented environments are also important aspects of a successful PC reform.
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Affiliation(s)
- Sarah Burgmann
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Muna Paier-Abuzahra
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Martin Sprenger
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Andrea Siebenhofer
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt60590, Germany
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Sánchez Colón YM, Acosta Pérez E, Roubert Rivera ML, Sánchez Cesáreo M, Miranda Diaz C, Ortiz GL, Meléndez González JC, Schleier Albino VM, Mora Lemus L. Community Forums as Amplifiers of Communities' Voices: Isolated Communities in Puerto Rico. Int J Environ Res Public Health 2023; 20:6335. [PMID: 37510568 PMCID: PMC10379210 DOI: 10.3390/ijerph20146335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
Social determinants of health contribute to health disparities and inequities. We conducted a community forum on the topic of isolation with the objectives of (1) identifying and prioritizing key health-related issues needing attention in isolated communities in Puerto Rico; (2) developing strategies in terms of Policies, Programs, and Practices to address the community priorities we identified. We used the triangulation method for qualitative data, integrating the Colorado State University's Tri-ethnic Center Model and the Delphi Technique for a better understanding of community health needs and priorities. The five community health-related priorities identified in the community forum were: (1) access to health services (physical and mental); (2) older adults; (3) access to basic services; (4) preparedness for future disasters/emergencies; and (5) COVID-19 and access to vaccination. The Alliance Leaders and Advisory Boards understand that we will work with the priorities of preparedness for future natural disasters/emergencies and COVID-19 and access to vaccination. Fifteen strategies were developed for these priorities and were grouped into five areas that require more attention in order to reduce health disparities. Isolated communities in Puerto Rico present an intersectionality of factors that affect a wide range of health-related risks and outcomes.
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Affiliation(s)
- Yashira M. Sánchez Colón
- Public Health Program, Ponce Health Sciences University, Ponce Research Institute-Ponce Medical School Foundation, Inc., Hispanic Alliance for Clinical and Translational Research, Ponce 00716, Puerto Rico;
| | - Edna Acosta Pérez
- Center for Sociomedical Research and Evaluation, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, Hispanic Alliance for Clinical and Translational Research, San Juan 00936, Puerto Rico; (E.A.P.); (M.S.C.)
| | - Mayra L. Roubert Rivera
- Public Health Program, Ponce Health Sciences University, Ponce Research Institute-Ponce Medical School Foundation, Inc., Hispanic Alliance for Clinical and Translational Research, Ponce 00716, Puerto Rico;
| | - Marizaida Sánchez Cesáreo
- Center for Sociomedical Research and Evaluation, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, Hispanic Alliance for Clinical and Translational Research, San Juan 00936, Puerto Rico; (E.A.P.); (M.S.C.)
- Grupo Nexos, Inc., San Juan 00936, Puerto Rico;
| | - Christine Miranda Diaz
- Institute of Research, Education, and Services in Addiction (IRESA), Internal Medicine Department, Universidad Central del Caribe, Hispanic Alliance for Clinical and Translational Research, Bayamón 00956, Puerto Rico;
| | - Glenda L. Ortiz
- Institute of Research, Education, and Services in Addiction (IRESA), Internal Medicine Department, Universidad Central del Caribe, Hispanic Alliance for Clinical and Translational Research, Bayamón 00956, Puerto Rico;
| | | | - Valeria M. Schleier Albino
- Center for Sociomedical Research and Evaluation, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, Hispanic Alliance for Clinical and Translational Research, San Juan 00936, Puerto Rico; (E.A.P.); (M.S.C.)
| | - Laura Mora Lemus
- Clinical Research Center, Universidad Central del Caribe, Hispanic Alliance for Clinical and Translational Research, Bayamón 00956, Puerto Rico
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Yevoo LL, Amarteyfio KA, Ansah-Antwi JA, Wallace L, Menka E, Ofori-Ansah G, Nyampong I, Mayeden S, Agyepong IA. The "No bed syndrome" in Ghana - what, how and why? A literature, electronic and print media review. Front Health Serv 2023; 3:1012014. [PMID: 37234197 PMCID: PMC10207332 DOI: 10.3389/frhs.2023.1012014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/03/2023] [Indexed: 05/27/2023]
Abstract
Objectives "No bed syndrome" has become a familiar phrase in Ghana. Yet, there is very little in medical texts or the peer reviewed literature about it. This review aimed to document what the phrase means in the Ghanaian context, how and why it occurs, and potential solutions. Design A qualitative desk review using a thematic synthesis of grey and published literature, print and electronic media content covering the period January 2014 to February 2021. Text was coded line by line to identify themes and sub-themes related to the research questions. Analysis was manual and with Microsoft Excel to sort themes. Setting Ghana. Participants and Intervention Not applicable. Results "No bed syndrome" describes the turning away by hospitals and clinics of people seeking walk in or referral emergency care with the stated reasons "no bed available" or "all beds are full". There are reported cases of people dying while going round multiple hospitals seeking help and being repeatedly turned away because there is "no bed". The situation appears to be most acute in the highly urbanized and densely populated Greater Accra region. It is driven by a complex of factors related to context, health system functions, values, and priorities. The solutions that have been tried are fragmented rather than well-coordinated whole system reform. Discussions and recommendations The "no bed syndrome" describes the challenge of a poorly functioning emergency health care system rather than just the absence of a bed on which to place an emergency case. Many low and middle income countries have similar challenges with their emergency health care systems and this analysis from Ghana is potentially valuable in attracting global attention and thinking about emergency health systems capacity and reform in low and middle income countries. The solution to the "no bed syndrome" in Ghana requires reform of Ghana's emergency healthcare system that takes a whole system and integrated approach. All the components of the health system such as human resource, information systems, financing, equipment tools and supplies, management and leadership need to be examined and addressed together alongside health system values such as accountability, equity or fairness in the formulation, implementation, continuous monitoring and evaluation of policies and programs for system reform to expand and strengthen emergency healthcare system capacity and responsiveness. Despite the temptation to fall back on them as low hanging fruit, piecemeal and ad-hoc solutions cannot solve the problem.
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Affiliation(s)
- Linda Lucy Yevoo
- Research and Development Division, Dodowa Health Research Center, Ghana Health Service, Dodowa, Ghana
| | | | | | - Lauren Wallace
- Research and Development Division, Dodowa Health Research Center, Ghana Health Service, Dodowa, Ghana
| | | | - Gifty Ofori-Ansah
- Greater Accra Region, Ningo Prampram District, Ghana Health Service, Accra, Ghana
| | | | - Samuel Mayeden
- Policy, Planning, Monitoring and Evaluation Division, Ghana Health Service, Accra, Ghana
| | - Irene Akua Agyepong
- Faculty of Public Health, Ghana College of Physicians and Surgeons (GCPS), Accra, Ghana
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Levin A, Okpechi IG, Caskey FJ, Yang CW, Tonelli M, Jha V. Perspectives on early detection of chronic kidney disease: the facts, the questions, and a proposed framework for 2023 and beyond. Kidney Int 2023; 103:1004-1008. [PMID: 37125982 DOI: 10.1016/j.kint.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chih-Wei Yang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
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12
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Vuong NX, Woods NK. On the Relationship Between Stakeholder Affiliation and Attitudes Toward Behavioral Health Reform in Kansas. Kans J Med 2023; 16:28-34. [PMID: 36845265 PMCID: PMC9957591 DOI: 10.17161/kjm.vol16.18542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/05/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction The lack of access to behavioral health care, trends in behavioral health issues, and the impact of social determinants of health underlie the need for behavioral health reform in Kansas. However, stakeholders may affect progress toward behavioral health reform. This study examined stakeholders' attitudes toward behavioral health reform. Methods The authors analyzed data from a survey administered to elected officials, members of health advocacy groups, state employees, and payers in Kansas. Main outcome measures included attitudes toward the perceived benefit of certain behavioral health and social determinants of health policies and the perceived performance of the primary care and behavioral health care systems in Kansas. Results Payers perceived legislation to improve insurance coverage for behavioral health issues as less beneficial than state employees and members of health advocacy groups. Elected officials perceived legislation to address various social determinants of health as less beneficial than health advocates. Members of health advocacy groups rated the behavioral health care system more poorly than elected officials did. Conclusions Preliminary findings reflected both the barriers and facilitators to behavioral health reform in Kansas. However, several limitations undermined the generalizability of these findings. Future studies should consider more representative sample sizes, additional variables in behavioral health and social determinants of health policies, and more comprehensive, validated measures.
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Affiliation(s)
- Ngoc X. Vuong
- Dorothy and Bill Cohen Honors College, Wichita State University, Wichita, KS
| | - Nikki K. Woods
- Department of Public Health Sciences, Wichita, KS,Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
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13
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Ramani VK, Jayanna K, Naik R. A commentary on cancer prevention and control in India: Priorities for realizing SDGs. Health Sci Rep 2023; 6:e1126. [PMID: 36824617 PMCID: PMC9941912 DOI: 10.1002/hsr2.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/02/2023] [Accepted: 02/12/2023] [Indexed: 02/25/2023] Open
Abstract
In India, cancers along with cardiovascular diseases contribute to significant mortality and morbidity. With less than 10 years remaining towards achieving Sustainable development Goals (SDGs), public health systems in India need to be critically assessed and strengthened, for addressing non-communicable diseases (NCDs) in general and cancers in particular. Our Commentary address the public health response to cancer prevention and control, with specific pointers based on emerging evidence. The relevant issues are stratified as: emphasis on the critical appraisal of national programs, strengthening primary health care (PHC) systems, enhancing focus on client and community centricity, exploring integrative approaches to cancer management and stepping up implementation and multidisciplinary research. Ongoing surveillance is essential to assess the current and future trends of cancer as well as the outcomes of prevention and treatment measures. For revitalizing comprehensive PHC, much depends on our epidemiological capacity and surveillance systems which impart information for local planning. It is imperative to address the cultural barriers and societal norms, which limit the acceptability and participation in screening programs. SDG 3 has ushered the wellbeing agenda at an opportune time. There is a compelling need to conduct research on an integrated approach (ayurveda complimenting allopathic medication) for the treatment of cancer. The unique challenges posed by the rise in NCD morbidity in LMIC, requires horizontal integration of the health systems with new services focused on cancer control.
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Affiliation(s)
- Vinod K. Ramani
- Preventive OncologyHealthcare Global Enterprise Ltd.BangaloreIndia
| | - Krishnamurthy Jayanna
- Department of Public Health, Faculty of Life and Allied Health SciencesM. S. Ramaiah University of Applied SciencesBangaloreIndia
| | - Radheshyam Naik
- Medical OncologyHealthcare Global Enterprise Ltd.BangaloreIndia
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14
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Macniven R, McKay CD, Graham S, Gubhaju L, Williams R, Williamson A, Joshy G, Evans JR, Roseby R, Porykali B, Yashadhana A, Ivers R, Eades S. Social and Behavioural Correlates of High Physical Activity Levels among Aboriginal Adolescent Participants of the Next Generation: Youth Wellbeing Study. Int J Environ Res Public Health 2023; 20:3738. [PMID: 36834433 PMCID: PMC9962528 DOI: 10.3390/ijerph20043738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Physical activity typically decreases during teenage years and has been identified as a health priority by Aboriginal adolescents. We examined associations between physical activity levels and sociodemographic, movement and health variables in the Aboriginal led 'Next Generation: Youth Well-being (NextGen) Study' of Aboriginal people aged 10-24 years from Central Australia, Western Australia and New South Wales. Baseline survey data collected by Aboriginal researchers and Aboriginal youth peer recruiters from 2018 to 2020 examined demographics and health-related behaviours. Logistic regression was used to estimate odds ratios (OR) for engaging in high levels of physical activity in the past week (3-7 days; 0-2 days (ref), or 'don't remember') associated with demographic and behavioural factors. Of 1170 adolescents, 524 (41.9%) had high levels of physical activity; 455 (36.4%) had low levels; 191 (15.3%) did not remember. Factors independently associated with higher odds of physical activity 3-7 days/week were low weekday recreational screen time [55.3% vs. 44.0%, OR 1.79 (1.16-2.76)], having non-smoking friends [50.4% vs. 25.0%, OR 2.27 (1.03-5.00)] and having fewer friends that drink alcohol [48.1% vs. 35.2%, OR 2.08 (1.05-4.14)]. Lower odds of high physical activity were independently associated with being female [40.2% vs. 50.9%, OR 0.57 (0.40-0.80)] and some findings differed by sex. The NextGen study provides evidence to inform the co-design and implementation of strategies to increase Aboriginal adolescent physical activity such as focusing on peer influences and co-occurring behaviours such as screen time.
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Affiliation(s)
- Rona Macniven
- School of Population Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Christopher D. McKay
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Simon Graham
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Lina Gubhaju
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Robyn Williams
- Curtin Medical School, Curtin University, Perth, WA 6102, Australia
| | - Anna Williamson
- School of Population Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, College of Health & Medicine, Australian National University, Canberra, ACT 2601, Australia
| | - John Robert Evans
- Moondani Toombadool Centre, Swinburne University of Technology, Melbourne, VIC 3122, Australia
| | - Robert Roseby
- Department of Respiratory Medicine, Monash Children’s Hospital, Clayton, VIC 3168, Australia
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, VIC 3800, Australia
| | - Bobby Porykali
- Guuna-Maana (Heal) Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Heath, Sydney, NSW 2042, Australia
| | - Aryati Yashadhana
- School of Population Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Centre for Primary Health Care & Equity, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Rebecca Ivers
- School of Population Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Sandra Eades
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
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15
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Modanloo S, Correll Q, Correll R, Major N, Quinlan M, Reszel J, Wilding J, Lin Zhou Z, Franck LS, Harrison D. Identifying research priorities with children, youth, and families: A scoping review. J Child Health Care 2023:13674935231151748. [PMID: 36647285 DOI: 10.1177/13674935231151748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Increased patient advocacy has resulted in a shift toward more active patient engagement in the research. A scoping review was conducted to explore the literature on healthcare research priority settings wherein children, youths, or their families were involved in the priority-setting process. Six databases including MEDLINE, CINAHL, PsycINFO, Embase, Web of Science, and Global Health and the James Lind Alliance website were searched up until September 2019. All primary studies involving children (<18 years of age) or families in developing research priorities in health care were included. All retrieved references were uploaded into Covidence, and two independent reviewers screened the search results. Descriptive thematic analysis was used to identify common themes. A total of 30 studies with 4247 participants were included. Less than half of the participants (n = 1237, (33%) were pediatric patients and their families. A total of 455 research priorities were identified. Three common themes emerged: (i) quality of care delivery, (ii) self-efficacy in health behaviors, and (iii) community engagement in care. This scoping review revealed priority research health topics from the perspectives of children, youths, or their families. The findings may be used as a foundation for future research to improve the health outcomes of children, youths, or their families according to their identified priorities.
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Affiliation(s)
- Shokoufeh Modanloo
- Arthur Labatt School of Nursing, Faculty of Health Sciences, 70383Western University, London, ON, Canada
| | - Quinn Correll
- Rankin School of Nursing, St Francis Xavier University, Antigonish, NS, Canada
| | - Rhonda Correll
- Children's Hospital of Eastern Ontario 274065(CHEO) Research Institute, Ottawa, ON, Canada
| | - Nathalie Major
- Children's Hospital of Eastern Ontario 274065(CHEO) Research Institute, Ottawa, ON, Canada
| | - Michelle Quinlan
- Children's Hospital of Eastern Ontario 274065(CHEO) Research Institute, Ottawa, ON, Canada
| | - Jessica Reszel
- Children's Hospital of Eastern Ontario 274065(CHEO) Research Institute, Ottawa, ON, Canada
| | - Jodi Wilding
- Children's Hospital of Eastern Ontario 274065(CHEO) Research Institute, Ottawa, ON, Canada
| | - Zhi Lin Zhou
- Children's Hospital of Eastern Ontario 274065(CHEO) Research Institute, Ottawa, ON, Canada
| | - Linda S Franck
- School of Nursing, 8783University of California, San Francisco, CA, USA
| | - Denise Harrison
- Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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16
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Askari A, Poursadeqiyan M, Sahl Abadi AS, Mahdinasab L, Farhadi AR. Semi-quantitative risk assessment for workers exposed to occupational harmful agents in an oilfield in Iran. Work 2023; 76:147-157. [PMID: 36872822 DOI: 10.3233/wor-220077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Workers are exposed to occupational health hazards from physical, chemical, biological, ergonomic, and psychological agents. Assessing occupational health risks is vital for executing control measures to protect employees' health against harmful occupational agents. OBJECTIVE The present study aimed to identify, evaluate, and prioritize occupational health risks to assist senior management in determining where to allocate the budget to carry out the required corrective actions in the oilfields project. METHODS This descriptive-analytical cross-sectional study was performed in 2021 among Iran's Sarvak Azar oil field job groups. The occupational health risk was assessed using the Harmful Agents Risk Priority Index (HARPI) as a semi-quantitative method. Then, to simplify decision-making and budget allocation, we reported HARPI final score in the Pareto principle format. RESULTS The results show that in this oil field, controlling exposure to adverse lighting, improving the thermal conditions and ergonomics, and preventing noise exposure has the highest priority, with scores of 6342, 5269, 5629, and 5050, respectively. Production, HSE, laboratory, and commissioning need the most health care measures with scores of 8683, 5815, 5394, and 4060, respectively. CONCLUSION HARPI could be used to prioritize occupational health hazards, and this method can simplify managers' decisions to allocate resources to implement control measures.
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Affiliation(s)
- Ali Askari
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Health, Safety, and Environment, OICO Occupational Health Division, Azar Oilfield, Ilam, Iran
| | - Mohsen Poursadeqiyan
- Department of Occupational Health Engineering, School of Public Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ali Salehi Sahl Abadi
- Workplace Health Promotion Research Center, Department of Occupational Health and Safety at Work, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Laila Mahdinasab
- Department of Work and Knowledge, Work and Education School, Mehran Education Office, Ilam, Iran
| | - Ali Reza Farhadi
- Department of Medical Education, Kermanshah University of Medical Sciences. Kermanshah, Iran
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17
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Bartling T, Oedingen C, Schrem H, Kohlmann T, Krauth C. Setting Organ Allocation Priorities: A Discrete Choice Experiment with German Patients and Their Relatives. Patient Prefer Adherence 2023; 17:827-838. [PMID: 36999164 PMCID: PMC10044066 DOI: 10.2147/ppa.s402203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/09/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE Organ transplantation systems benefit from guidelines that are harmonious with the preferences of the people involved. Discrete choice experiments are useful tools for eliciting preferences. PATIENTS AND METHODS This study evaluated the preferences of patients and their relatives (n=285) to identify their priorities in organ allocation using a discrete choice experiment. In eight hypothetical allocation decisions, the participants were asked to select the candidate they considered the most suitable The candidates differed in years of life gained after transplantation, quality of life after transplantation, waiting time until transplantation, age, compliance and social support. RESULTS The most important aspects for setting priority in organ allocation were lack of compliance (β= -2.5, p<0.001) and good quality of life after transplantation (β = +1.4, p<0.001). The lack of social support (ß = -0.8, p<0.05) and the more years of life gained after transplantation (β = +0.5, p<0.001) had less but still a significant amount of influence on this decision, while the waiting list was not considered significantly important (β = 0.1, p>0.05). The comparison of the different relations to transplantation showed that life years gained after transplantation was of high relevance to posttransplant patients (+10 years: β = +0.709, p<0.001 / +15 years: β = +0.700, p<0.001) and of no importance to waitlisted patients (+10 years: β = +0.345, p>0.05 / + 15 years: β = +0.173, p>0.05) and relatives (+ 10 years: β = +0.063, p>0.05 / +15 years: β = +0.304, p>0.05). CONCLUSION This study provides useful insights into the unique perspective of patients and their relatives on priority-setting in the allocation of donor organs that should be reflected in improved donor organ allocation rules.
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Affiliation(s)
- Tim Bartling
- Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
- Center for Health Economics Research Hannover, Hannover, Germany
- Correspondence: Tim Bartling, Medizinische Hochschule Hannover / Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str, 1, Hannover, Lower Saxony, 30625, Germany, Tel +49 511 532 9462, Fax +49 511 532 5376, Email
| | - Carina Oedingen
- Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
- Center for Health Economics Research Hannover, Hannover, Germany
| | - Harald Schrem
- Center for Health Economics Research Hannover, Hannover, Germany
- General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
| | - Thomas Kohlmann
- Department of Methods of Community Medicine, Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Christian Krauth
- Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
- Center for Health Economics Research Hannover, Hannover, Germany
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18
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Sarrafzadegan N, Bagherikholenjani F, Noohi F, Alikhasi H, Mohammadifard N, Ghaffari S, Hassan Adel SM, Assareh AR, Zibaee Nezhad MJ, Tabandeh M, Farshidi H, Khosravi A, Nematipour E, Kermani-Alghoraishi M, Hassannejad R, Sadeghi M, Najafian J, Shafie D, Shabestari MM, Mansouri A, Roohafza H, Shahidi S, Yarmohammadian MH, Moeeni M. Priority setting in cardiovascular research in Iran using standard indigenous methods. J Res Med Sci 2022; 27:91. [PMID: 36685027 PMCID: PMC9854914 DOI: 10.4103/jrms.jrms_343_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/26/2022] [Accepted: 07/27/2022] [Indexed: 12/24/2022]
Abstract
Background Determining cardiovascular disease (CVD) research priorities is essential given the high burden of these diseases, limited financial resources, and competing priorities. This study aimed to determine the research priorities in CVD field in Iran using standard indigenous methods. Materials and Methods An extensive search was done in relevant international and national studies. Then, an indigenous standard multistage approach based on multicriteria decision analysis steps was adapted to local situation and implemented. This process included forming a working group of experts in priority setting methodology, identifying the context and prioritization framework, discussing the methodology with the National Network of CVD Research (NCVDR) members who ultimately determined the priority research topics, weighted topics criteria, ranked topics, and reviewed all determined research priorities for final report. Results Thirteen cardiovascular research priorities were determined by the NCVDR members. The first five priorities based on their scores include studies in hypertension, prevention and control of ischemic heart disease (IHD) and its risk factors, burden of IHD, Registration of CVDs, and COVID-19 and CVDs. Conclusion Cardiovascular research priorities were determined using a standard indigenous approach by national experts who are the NCVDR members. These priorities can be used by researchers and health decision makers.
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Affiliation(s)
- Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,Iranian Network of Cardiovascular Research, Tehran, Iran
| | - Fahimeh Bagherikholenjani
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Fahimeh Bagherikholenjani, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Fereidoun Noohi
- Iranian Network of Cardiovascular Research, Tehran, Iran,Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Alikhasi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samad Ghaffari
- Iranian Network of Cardiovascular Research, Tehran, Iran,Cardiovascular Research Center, Tabriz University of Medical sciences, Tabriz, Iran
| | - Seyed Mohammad Hassan Adel
- Iranian Network of Cardiovascular Research, Tehran, Iran,Department of Cardiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Reza Assareh
- Iranian Network of Cardiovascular Research, Tehran, Iran,Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Javad Zibaee Nezhad
- Iranian Network of Cardiovascular Research, Tehran, Iran,Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Tabandeh
- Iranian Network of Cardiovascular Research, Tehran, Iran,Kowsar Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Farshidi
- Iranian Network of Cardiovascular Research, Tehran, Iran,Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Alireza Khosravi
- Iranian Network of Cardiovascular Research, Tehran, Iran,Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ebrahim Nematipour
- Iranian Network of Cardiovascular Research, Tehran, Iran,Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kermani-Alghoraishi
- Iranian Network of Cardiovascular Research, Tehran, Iran,Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Hassannejad
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Iranian Network of Cardiovascular Research, Tehran, Iran,Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamshid Najafian
- Iranian Network of Cardiovascular Research, Tehran, Iran,Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Iranian Network of Cardiovascular Research, Tehran, Iran,Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahmood Mohammadzadeh Shabestari
- Iranian Network of Cardiovascular Research, Tehran, Iran,Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asieh Mansouri
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahla Shahidi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Yarmohammadian
- Health Management and Economic Research Center, School of Medical Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Moeeni
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Schuttner L, Hockett Sherlock S, Simons CE, Johnson NL, Wirtz E, Ralston JD, Rosland AM, Nelson K, Sayre G. My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity. J Gen Intern Med 2022; 37:4189-4196. [PMID: 35606644 PMCID: PMC9126696 DOI: 10.1007/s11606-022-07533-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patient-centered care reflecting patient preferences and needs is integral to high-quality care. Individualized care is important for psychosocially complex or high-risk patients with multiple chronic conditions (i.e., multimorbidity), given greater potential risks of interventions and reduced benefits. These patients are increasingly prevalent in primary care. Few studies have examined provision of patient-centered care from the clinician perspective, particularly from primary care physicians serving in integrated, patient-centered medical home settings within the US Veterans Health Administration. OBJECTIVE We sought to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity. DESIGN We conducted semi-structured telephone interviews from April to July 2020 among physicians across 20 clinical sites. Findings were analyzed with deductive content analysis based on conceptual models of patient-centeredness and hierarchical factors affecting care delivery. PARTICIPANTS Of 23 physicians interviewed, most were female (n = 14/23, 61%), serving in hospital-affiliated outpatient clinics (n = 14/23, 61%). Participants had a mean of 21 (SD = 11.3) years of experience. KEY RESULTS Facilitators included the following: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients' psychosocial contexts. Barriers included the following: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care. CONCLUSIONS Physicians perceived individual physician-patient interactions were the greatest facilitators or barriers to patient-centered care. Efforts to increase primary care patient-centeredness for complex or high-risk patients with multimorbidity could focus on targeting physician-patient communication and reducing interpersonal conflict.
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Affiliation(s)
- Linnaea Schuttner
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA. .,Department of Medicine, University of Washington School of Medicine, Seattle, USA.
| | - Stacey Hockett Sherlock
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Health Care System, Iowa City, USA.,Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Carol E Simons
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Nicole L Johnson
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Health Care System, Iowa City, USA
| | - Elizabeth Wirtz
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Health Care System, Iowa City, USA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle, USA.,Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
| | - Ann-Marie Rosland
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Karin Nelson
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - George Sayre
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
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20
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Hilts KE, Yeager VA, Kooreman H, Smith R, Busching B, Spitznagle M. Public Health and Health Care Partnerships for Improved Tobacco Cessation. J Public Health Manag Pract 2022; 28:E404-E412. [PMID: 34347652 PMCID: PMC8807793 DOI: 10.1097/phh.0000000000001406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT Tobacco use remains a leading cause of preventable death and disease. While most tobacco users are interested in quitting, few receive professional assistance. PROGRAM This state health department-led project leveraged partnerships to build capacity and support 9 health care organizations in implementing system-level initiatives to improve delivery of tobacco cessation. IMPLEMENTATION Participating organizations' initiatives targeted 3 focus areas: implementing best practices for tobacco cessation; quality improvement; and utilization of the electronic health record. EVALUATION A qualitative study was conducted to examine facilitators and barriers to tobacco cession systems change among participating health care organizations. Common barriers included time constraints, staffing issues, and organizational structure. These factors often differed by organization type (eg, large vs small). Facilitators included leadership buy-in, organizational priority, technical assistance, teams/teamwork, and IT support. DISCUSSION Initial findings suggest that this type of partnership model can be leveraged to gain organizational support, build capacity, address key barriers, and ensure that systems change strategies align with best practices for tobacco cessation across a diverse set of health care organizations. Findings presented in this report provide insights for other public health and health care organizations looking to implement similar initiatives.
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Affiliation(s)
- Katy Ellis Hilts
- Center for Health Policy, Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Drs Hilts and Yeager and Mr Kooreman); and Tobacco Prevention and Cessation Commission, Indiana Department of Health, Indianapolis, Indiana (Mss Smith and Spitznagle and Mr Busching)
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21
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Abstract
Stroke exerts a tremendous burden on individuals, families, communities, and health systems globally. Even more troublesome are the striking disparities faced across diverse populations. These disparities are further exacerbated by the COVID-19 pandemic. Despite efforts to advance stroke research, substantial gaps remain in understanding factors that contribute to stroke disparities, including the Social Determinants of Health. Strategically designed studies and tailored interventions are needed to bridge the inequities high-risk populations face and to meet their specific needs. Community-based participatory research offers an approach to equitably partner with community members to understand and work collaboratively to address community-specific health priorities. In this focused update, we highlight the main processes of community-based participatory research studies and share exemplars from our team's work in stroke research and from the literature. As we continue to face an increasing prevalence of stroke, compounded by the COVID-19 pandemic and ongoing implications of the Social Determinants of Health, partnering with communities to address community-driven health priorities can inform interventions targeted to overcome the disparities faced by certain populations.
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Affiliation(s)
- Michelle Nichols
- College of Nursing, Medical University of South Carolina,
Charleston, SC, USA,South Carolina Clinical and Translational Research
Institute, Charleston, SC, USA
| | - Gayenell Magwood
- College of Nursing, Medical University of South Carolina,
Charleston, SC, USA
| | - Michelle Woodbury
- College of Health Professions, Medical University of South
Carolina, Charleston, SC USA
| | - Kimberly Brown
- South Carolina Clinical and Translational Research
Institute, Charleston, SC, USA
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina,
Charleston, SC, USA
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Ibadan,
Nigeria
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22
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Johnson SE, Jayasekar Zurn S, Anderson BO, Vetter BN, Katz ZB, Milner DA. International perspectives on the development, application, and evaluation of a multicancer early detection strategy. Cancer 2022; 128 Suppl 4:875-882. [PMID: 35133661 DOI: 10.1002/cncr.33927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 11/11/2022]
Abstract
The development and implementation of a multicancer early detection (MCED) test that is effective and affordable has the potential to change cancer care systems around the world. However, careful consideration is needed within the context of different health care settings (both low- and middle-income countries and high-income countries) to roll out an MCED test and promote equity in access.
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Affiliation(s)
| | | | - Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Danny A Milner
- American Society for Clinical Pathology, Chicago, Illinois
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23
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Cai M, Cui M, Nong Y, Qin J, Mo S. Health Priorities in Chronic Obstructive Pulmonary Disease Patients with Multimorbidity: A Qualitative Study. Patient Prefer Adherence 2022; 16:2521-2531. [PMID: 36124126 PMCID: PMC9482456 DOI: 10.2147/ppa.s377832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To explore the health priorities of patients with multimorbidity in COPD and the factors as to why their condition is prioritized. METHODS This qualitative study was conducted from February to April 2022 at a hospital in China. A specially selected sample of 18 patients completed a general information sheet and face-to-face interviews. The Colaizzi method was used to analyze the data. RESULTS Participants reported their experience which fell into three themes: disease burden, health perception and views of others. In addition, participants explained that health knowledge from short videos on mobile apps influenced them, which in turn influenced their ranking. CONCLUSION Our findings suggested that health priorities of patients with multimorbidity in COPD manifest differently. Specifically, our findings suggested that patients' health priorities are most influenced by disease burden, health perception, and the opinions of those around them. Nursing staff should fully understand each patients'own perspectives and provide them with personalized support.
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Affiliation(s)
- Mengqian Cai
- Department of Nursing, the First Hospital Affiliated of Guangxi Medical University, Nanning, People’s Republic of China
| | - Miaoling Cui
- Department of Nursing, the First Hospital Affiliated of Guangxi Medical University, Nanning, People’s Republic of China
- Correspondence: Miaoling Cui, Tel + 86 138 7813 4966, Email
| | - Ying Nong
- Respiratory Medicine, the First Hospital Affiliated of Guangxi Medical University, Nanning, People’s Republic of China
| | - Jinlian Qin
- Department of Nursing, the First Hospital Affiliated of Guangxi Medical University, Nanning, People’s Republic of China
| | - Sucai Mo
- Department of Nursing, the First Hospital Affiliated of Guangxi Medical University, Nanning, People’s Republic of China
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24
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Tuzzio L, Berry AL, Gleason K, Barrow J, Bayliss EA, Gray MF, Delate T, Bermet Z, Uratsu CS, Grant RW, Ralston JD. Aligning care with the personal values of patients with complex care needs. Health Serv Res 2021; 56 Suppl 1:1037-1044. [PMID: 34363205 PMCID: PMC8515216 DOI: 10.1111/1475-6773.13862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To identify opportunities to align care with the personal values of patients from three distinct groups with complex medical, behavioral, and social needs. DATA SOURCES/STUDY SETTING Between June and August 2019, we conducted semi-structured interviews with individuals with complex care needs in two integrated health care delivery systems. STUDY DESIGN Qualitative study using semi-structured interviews. DATA COLLECTION METHODS We interviewed three groups of patients at Kaiser Permanente Washington and Kaiser Permanente Colorado representing three distinct profiles of complex care needs: Group A ("obesity, opioid prescription, and low-resourced neighborhood"), Group B ("older, high medical morbidity, emergency department, and hospital use"), and Group C ("older, mental and physical health concerns, and low-resourced neighborhood"). These profiles were identified based on prior work and prioritized by internal primary care stakeholders. Interview transcripts were analyzed using thematic analysis. PRINCIPAL FINDINGS Twenty-four patients participated; eight from each complex needs profile. Mean age across groups was 71 (range 48-86) years. We identified five themes common across the three groups that captured patients' views regarding values-aligned care. These themes focused on the importance of care teams exploring and acknowledging a patient's values, providing access to nonphysician providers who have different perspectives on care delivery, offering values-aligned mental health care, ensuring connection to community-based resources that support values and address needs, and providing care that supports the patient plus their family and caregivers. CONCLUSIONS Our results suggest several opportunities to improve how care is delivered to patients with different complex medical, behavioral, and social needs. Future research is needed to better understand how to incorporate these opportunities into health care.
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Affiliation(s)
- Leah Tuzzio
- Kaiser Permanente Washington Health Research InstituteSeattleWAUSA
| | - Andrew L. Berry
- Department of Biomedical Informatics & Medical EducationUniversity of WashingtonSeattleWashingtonUSA
| | - Kathy Gleason
- Kaiser Permanente Colorado Institute for Health ResearchAuroraColoradoUSA
| | - Jennifer Barrow
- Kaiser Permanente Colorado Institute for Health ResearchAuroraColoradoUSA
| | | | | | - Thomas Delate
- Pharmacy Outcomes Research Group, Kaiser Permanente National PharmacyAuroraColoradoUSA
| | - Zoe Bermet
- Kaiser Permanente Washington Health Research InstituteSeattleWAUSA
| | - Connie S. Uratsu
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Richard W. Grant
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - James D. Ralston
- Kaiser Permanente Washington Health Research InstituteSeattleWAUSA
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25
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Björk J, Stenfors T, Juth N, Gunnarsson AB. Personal responsibility for health? A phenomenographic analysis of general practitioners' conceptions. Scand J Prim Health Care 2021; 39:322-331. [PMID: 34128751 PMCID: PMC8475098 DOI: 10.1080/02813432.2021.1935048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To analyse and describe general practitioners' perceptions of the notion of a 'personal responsibility for health'. DESIGN Interview study, phenomenographic analysis. SETTING Swedish primary health care. SUBJECTS General Practitioners (GPs). MAIN OUTCOME MEASURES Using the phenomenographic method, the different views of the phenomenon (here: personal responsibility for health) were presented in an outcome space to illustrate the range of perceptions. RESULTS The participants found the notion of personal responsibility for health relevant to their practice. There was a wide range of perceptions regarding the origins of this responsibility, which was seen as coming from within yourself; from your relationships to specific others; and/or from your relationship with the generalized other. Furthermore, the expressions of this responsibility were perceived as including owning your health problem; not offloading all responsibility onto the GP; taking active measures to keep and improve health; and/or accepting help in health. The GP was described as playing a key role in shaping and defining the patient's responsibility for his/her health. Some aspects of personal responsibility for health roused strong emotions in the participants, especially situations where the patient was seen as offloading all responsibility onto the GP. CONCLUSION The notion of personal responsibility for health is relevant to GPs. However, it is open to a broad range of interpretations and modulated by the patient-physician interaction. This may make it unsuitable for usage in health care priority settings. More research is mandated to further investigate how physicians work with patient responsibility, and how this affects the patient-physician relationship and the physician's own well-being.Key PointsThe notion of personal responsibility for health has relevance for discussions about priority setting and person-centred care.This study, using a phenomenographic approach, investigated the views of Swedish GPs about the notion of personal responsibility for health.The participants found the notion relevant to their practice. They expressed a broad range of views of what a personal responsibility for health entails and how it arises. The GP was described as playing a key role in shaping and defining the patient's responsibilities for his/her health.The notion was emotionally charged to the participants, and when patients were seen as offloading all responsibility onto the GP this gave rise to frustration.
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Affiliation(s)
- Joar Björk
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Stockholm, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- CONTACT Joar Björk Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Tomtebodavägen 18 A, Stockholm, 171 77, Sweden
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Niklas Juth
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Stockholm, Sweden
| | - A. Birgitta Gunnarsson
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- Institute of Neuroscience and Physiology, Section for Health and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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26
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Sobngwi-Tambekou JL, Jones CM, Wenham C, Ratsimbason M, Ratsimbazafy MR, Andriamizarasoa FA, Juma P, Mijumbi-Deve R, Parkhurst J. [Health research in Madagascar: state-of-the-art, challenges and perspectives]. Pan Afr Med J 2021; 39:36. [PMID: 34422159 PMCID: PMC8356933 DOI: 10.11604/pamj.2021.39.36.27462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/23/2021] [Indexed: 11/11/2022] Open
Abstract
The evolution and contemporary challenges of health research (HR) in Madagascar are poorly documented. We aim to gain insights on the factors that shape Madagascar's National Health Research System (NHRS) to better understand their influence. We conducted a qualitative case study, which included a documentary review and semi-structured interviews with 38 key informants. We carried out a thematic analysis and used the WHO/AFRO NHRS Barometer to structure the presentation of the results. There is no legislative framework to support HR activities and institutions. There is, however, a policy document outlining national priorities for HS. Human resources for HR are insufficient, due to challenges in training and retaining researchers. International collaboration is almost the only source of HR funding. Collaborations contribute to developing human and institutional capacity, but they are not always aligned with research carried out locally and the country's priority health needs. Incomplete efforts to improve regulation and low public investment in research training and research implementation reflect an insufficient commitment to HR by the government. Negotiating equitable international partnerships, the availability of public funding, and aligning HR with national health priorities would constitute a solid basis for the development of the NHRS in Madagascar.
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Affiliation(s)
- Joëlle Laure Sobngwi-Tambekou
- London School of Economics (LSE) and Political Science, LSE Health, London, United Kingdom.,Recherche Santé et Développement (RSD Institut), Yaoundé, Cameroun
| | - Catherine Marie Jones
- London School of Economics (LSE) and Political Science, LSE Health, London, United Kingdom
| | - Clare Wenham
- London School of Economics and Political Science, Department of Health Policy, London, United Kingdom
| | - Michel Ratsimbason
- Centre National d´Application de Recherches Pharmaceutiques, Antananarivo, Madagascar
| | - Marie-Rolland Ratsimbazafy
- Service d´Appui à la Recherche et à la Gestion des Connaissances, Direction de la formation et de la Recherche, Institut National de Santé Publique et Communautaire, Antananarivo, Madagascar
| | - Fidelis Adolphe Andriamizarasoa
- Direction des Études, de la Planification et du Système d'Information, Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Pamela Juma
- London School of Economics (LSE) and Political Science, LSE Health, London, United Kingdom
| | - Rhona Mijumbi-Deve
- London School of Economics (LSE) and Political Science, LSE Health, London, United Kingdom.,Centre for Rapid Evidence Synthesis, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Justin Parkhurst
- London School of Economics and Political Science, Department of Health Policy, London, United Kingdom
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27
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Ayman G, Strachan JA, McLennan N, Malouf R, Lowe‐Zinola J, Magdi F, Roberts N, Alderdice F, Berneantu I, Breslin N, Byrne C, Carnell S, Churchill D, Grisoni J, Hirst JE, Morris A, Murphy HR, O’Brien J, Schmutz C, Shah K, Singal AS, Strachan MWJ, Cowan K, Knight M. The top 10 research priorities in diabetes and pregnancy according to women, support networks and healthcare professionals. Diabet Med 2021; 38:e14588. [PMID: 33949704 PMCID: PMC8359941 DOI: 10.1111/dme.14588] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022]
Abstract
AIMS To undertake a Priority Setting Partnership (PSP) to establish priorities for future research in diabetes and pregnancy, according to women with experience of pregnancy, and planning pregnancy, with any type of diabetes, their support networks and healthcare professionals. METHODS The PSP used established James Lind Alliance (JLA) methodology working with women and their support networks and healthcare professionals UK-wide. Unanswered questions about the time before, during or after pregnancy with any type of diabetes were identified using an online survey and broad-level literature search. A second survey identified a shortlist of questions for final prioritisation at an online consensus development workshop. RESULTS There were 466 responses (32% healthcare professionals) to the initial survey, with 1161 questions, which were aggregated into 60 unanswered questions. There were 614 responses (20% healthcare professionals) to the second survey and 18 questions shortlisted for ranking at the workshop. The top 10 questions were: diabetes technology, the best test for diabetes during pregnancy, diet and lifestyle interventions for diabetes management during pregnancy, emotional and well-being needs of women with diabetes pre- to post-pregnancy, safe full-term birth, post-natal care and support needs of women, diagnosis and management late in pregnancy, prevention of other types of diabetes in women with gestational diabetes, women's labour and birth experiences and choices and improving planning pregnancy. CONCLUSIONS These research priorities provide guidance for research funders and researchers to target research in diabetes and pregnancy that will achieve greatest value and impact.
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Affiliation(s)
- Göher Ayman
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - James A. Strachan
- Medical Sciences DivisionUniversity of OxfordJohn Radcliffe HospitalOxfordUK
| | - Niamh McLennan
- MRC Centre for Reproductive HealthUniversity of EdinburghQueen's Medical Research InstituteEdinburghUK
| | - Reem Malouf
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Jack Lowe‐Zinola
- The Royal Wolverhampton Hospital NHS TrustNew Cross HospitalWolverhamptonUK
| | - Fida Magdi
- The Royal Wolverhampton Hospital NHS TrustNew Cross HospitalWolverhamptonUK
| | - Nia Roberts
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | - Fiona Alderdice
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
- School of Nursing and MidwiferyQueen’s University BelfastBelfastUK
| | - Iuliana Berneantu
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Niki Breslin
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Caroline Byrne
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Sonya Carnell
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - David Churchill
- The Royal Wolverhampton Hospital NHS TrustNew Cross HospitalWolverhamptonUK
- University of WolverhamptonWolverhamptonUK
| | - Jeannie Grisoni
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Jane E. Hirst
- Nuffield Department of Women’s and Reproductive HealthUniversity of OxfordOxfordUK
- John Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | | | - Helen R. Murphy
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- Division of Women's HealthSt Thomas’ CampusKing's College LondonLondonUK
- Elsie Bertram Diabetes CentreNorfolk and Norwich University HospitalNorwichUK
| | - Jane O’Brien
- Stockport NHS Foundation TrustStepping Hill HospitalStockportUK
| | | | | | - Ankita S. Singal
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | | | - Katherine Cowan
- James Lind AllianceNational Institute for Health Research EvaluationTrials and Studies Coordinating CentreUniversity of SouthamptonSouthamptonUK
| | - Marian Knight
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
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28
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Arize I, Ogbuabor D, Mbachu C, Etiaba E, Uzochukwu B, Onwujekwe O. Stakeholders' Perspectives on the Unmet Needs and Health Priorities of the Urban Poor in South-East Nigeria. Int Q Community Health Educ 2021:272684X211033441. [PMID: 34264139 DOI: 10.1177/0272684x211033441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Relatively little is known about readiness of urban health systems to address health needs of the poor. This study explored stakeholders' perception of health needs and strategies for improving health of the urban poor using qualitative analysis. Focus group discussions (n = 5) were held with 26 stakeholders drawn from two Nigerian states during a workshop. Urban areas are characterised by double burden of diseases. Poor housing, lack of basic amenities, poverty, and poor access to information are determinants of health of the urban poor. Shortage of health workers, stock-out of medicines, high cost of care, lack of clinical practice guidelines, and dual practice constrain access to primary health services. An overarching strategy, that prioritises community-driven urban planning, health-in-all policies, structured linkages between informal and formal providers, financial protection schemes, and strengthening of primary health care system, is required to address health needs of the urban poor.
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Affiliation(s)
- Ifeyinwa Arize
- Department of Health Administration and Management, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Nigeria.,Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - Daniel Ogbuabor
- Department of Health Administration and Management, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Nigeria.,Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - Chinyere Mbachu
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria.,Department of Community Medicine, Institute of Public Health, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Nigeria
| | - Enyi Etiaba
- Department of Health Administration and Management, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Nigeria.,Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - Benjamin Uzochukwu
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria.,Department of Community Medicine, Institute of Public Health, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Nigeria
| | - Obinna Onwujekwe
- Department of Health Administration and Management, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Nigeria.,Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
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29
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Rijken M, Stüssgen R, Leemrijse C, Bogerd MJL, Korevaar JC. Priorities and preferences for care of people with multiple chronic conditions. Health Expect 2021; 24:1300-1311. [PMID: 33938597 PMCID: PMC8369115 DOI: 10.1111/hex.13262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/15/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background To guide the development of high‐quality care for people with multiple chronic conditions, partners of the European Joint Action CHRODIS developed the Integrated Multimorbidity Care Model. To assess its suitability for improving care for people with multimorbidity in the Netherlands, the model was piloted in a primary care setting with both patients and care providers. Aim This paper reports on the patient perspective, and aims to explore the priorities, underlying values and preferences for care of people with multimorbidity. Participants and methods Twenty persons with multimorbidity (selected from general practice registries) participated in a focus group or telephone interview. Subsequently, a questionnaire was completed by 863 persons with multimorbidity registered with 14 general practices. Qualitative data were thematically analysed and quantitative data by means of descriptive statistics. Results Frequently prioritized elements of care were the use of shared electronic health records, regular comprehensive assessments, self‐management support and shared decision making, and care coordination. Preferences for how these elements should be specifically addressed differed according to individual values (eg weighing safety against privacy) and needs (eg ways of coping with multimorbidity). Conclusion The JA‐CHRODIS Integrated Multimorbidity Care Model reflects the priorities and preferences for care of people with multimorbidity in the Netherlands, which supports its relevance to guide the development of person‐centred integrated care for people with multiple chronic conditions in the Netherlands. Patient contribution European patient experts contributed to the development and applicability assessment of the JA‐CHRODIS Integrated Multimorbidity Care Model; Dutch patients participated in focus groups, interviews and a survey.
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Affiliation(s)
- Mieke Rijken
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - René Stüssgen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Zorginstituut Nederland, (National Health Care Institute), Diemen, The Netherlands
| | - Chantal Leemrijse
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Mieke J L Bogerd
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Joke C Korevaar
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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30
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Chirico I, Chattat R, Dostálová V, Povolná P, Holmerová I, de Vugt ME, Janssen N, Dassen F, Sánchez-Gómez MC, García-Peñalvo FJ, Franco-Martín MA, Ottoboni G. The Integration of Psychosocial Care into National Dementia Strategies across Europe: Evidence from the Skills in DEmentia Care (SiDECar) Project. Int J Environ Res Public Health 2021; 18:ijerph18073422. [PMID: 33806158 PMCID: PMC8036745 DOI: 10.3390/ijerph18073422] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022]
Abstract
There is evidence supporting the use of psychosocial interventions in dementia care. Due to the role of policy in clinical practice, the present study investigates whether and how the issue of psychosocial care and interventions has been addressed in the national dementia plans and strategies across Europe. A total of 26 national documents were found. They were analyzed by content analysis to identify the main pillars associated with the topic of psychosocial care and interventions. Specifically, three categories emerged: (1) Treatment, (2) Education, and (3) Research. The first one was further divided into three subcategories: (1) Person-centred conceptual framework, (2) Psychosocial interventions, and (3) Health and social services networks. Overall, the topic of psychosocial care and interventions has been addressed in all the country policies. However, the amount of information provided differs across the documents, with only the category of ‘Treatment’ covering all of them. Furthermore, on the basis of the existing policies, how the provision of psychosocial care and interventions would be enabled, and how it would be assessed are not fully apparent yet. Findings highlight the importance of policies based on a comprehensive and well-integrated system of care, where the issue of psychosocial care and interventions is fully embedded.
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Affiliation(s)
- Ilaria Chirico
- Department of Psychology, University of Bologna, 40126 Bologna, Italy; (R.C.); (G.O.)
- Correspondence:
| | - Rabih Chattat
- Department of Psychology, University of Bologna, 40126 Bologna, Italy; (R.C.); (G.O.)
| | - Vladimíra Dostálová
- Faculty of Humanities, Charles University, 182 00 Prague, Czech Republic; (V.D.); (P.P.); (I.H.)
- Institute for Postgraduate Medical Education, Charles University, 100 00 Prague, Czech Republic
| | - Pavla Povolná
- Faculty of Humanities, Charles University, 182 00 Prague, Czech Republic; (V.D.); (P.P.); (I.H.)
- Institute for Postgraduate Medical Education, Charles University, 100 00 Prague, Czech Republic
| | - Iva Holmerová
- Faculty of Humanities, Charles University, 182 00 Prague, Czech Republic; (V.D.); (P.P.); (I.H.)
- Institute for Postgraduate Medical Education, Charles University, 100 00 Prague, Czech Republic
| | - Marjolein E. de Vugt
- Alzheimer Centrum Limburg, Maastricht University, 6229 MD Maastricht, The Netherlands; (M.E.d.V.); (N.J.); (F.D.)
| | - Niels Janssen
- Alzheimer Centrum Limburg, Maastricht University, 6229 MD Maastricht, The Netherlands; (M.E.d.V.); (N.J.); (F.D.)
| | - Fania Dassen
- Alzheimer Centrum Limburg, Maastricht University, 6229 MD Maastricht, The Netherlands; (M.E.d.V.); (N.J.); (F.D.)
| | - María Cruz Sánchez-Gómez
- Psycho-Sciences Research Group of IBSAL, Salamanca University, 37007 Salamanca, Spain; (M.C.S.-G.); (F.J.G.-P.); (M.A.F.-M.)
| | - Francisco José García-Peñalvo
- Psycho-Sciences Research Group of IBSAL, Salamanca University, 37007 Salamanca, Spain; (M.C.S.-G.); (F.J.G.-P.); (M.A.F.-M.)
| | - Manuel A. Franco-Martín
- Psycho-Sciences Research Group of IBSAL, Salamanca University, 37007 Salamanca, Spain; (M.C.S.-G.); (F.J.G.-P.); (M.A.F.-M.)
| | - Giovanni Ottoboni
- Department of Psychology, University of Bologna, 40126 Bologna, Italy; (R.C.); (G.O.)
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Rybarczyk-Szwajkowska A, Rydlewska-Liszkowska I. Priority Setting in the Polish Health Care System According to Patients' Perspective. Int J Environ Res Public Health 2021; 18:ijerph18031178. [PMID: 33525746 PMCID: PMC7908543 DOI: 10.3390/ijerph18031178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/12/2021] [Accepted: 01/25/2021] [Indexed: 12/03/2022]
Abstract
Identification of health priorities is concerned with equitable distribution of resources and is an important part of strategic planning in the health care system. The aim of this article is to describe health priorities in the Polish health care system from the patients’ perspective. The study included 533 patients hospitalized in the Lodz region. The average age of the respondents was 48.5 years and one third (36.6%) had university education. Most of the respondents (64.9%) negatively assessed the functioning of the health care system in Poland. Most of them claimed the following aspects require improvements: financing health services (85.8%), determining priorities in health care (80.3%), the role of health insurance (80.3%), and medical education (70.8%). Over 70% of the respondents agreed the role of politicians in designing and implementing health system reforms should be limited. The fact that the respondents so negatively assessed the Polish health care system implies there is a need for full discussion on redefining health priorities.
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Abstract
The COVID-19 pandemic continues, now disproportionately affecting the richest and best-resourced country in the world. Although the death rates per affected individual have decreased from the initial wave in New York City, the United States is in the unfathomable situation of having more than 50,000 new cases per day, and the case numbers are increasing. The pandemic is now expected to remain a vexing health problem for months and perhaps years to come, and the implications for health promotion and disease prevention have taken on new importance given the need for ongoing attention to acute and long-term issues. However, the health-promoting behaviors of many Americans have changed during the pandemic, setting up risk for additional collateral losses, such as from an increase in cancer diagnoses.
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de Almeida JR, Noel CW, Forner D, Zhang H, Nichols AC, Cohen MA, Wong RJ, McMullen C, Graboyes EM, Divi V, Shuman AG, Rosko AJ, Lewis CM, Hanna EY, Myers J, Paleri V, Miles B, Genden E, Eskander A, Enepekides DJ, Higgins KM, Brown D, Chepeha DB, Witterick IJ, Gullane PJ, Irish JC, Monteiro E, Goldstein DP, Gilbert R. Development and validation of a Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN-HN) in a scarce resource setting: Response to the COVID-19 pandemic. Cancer 2020; 126:4895-4904. [PMID: 32780426 PMCID: PMC7436362 DOI: 10.1002/cncr.33114] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/22/2022]
Abstract
Background In the wake of the coronavirus disease 2019 (COVID‐19) pandemic, access to surgical care for patients with head and neck cancer (HNC) is limited and unpredictable. Determining which patients should be prioritized is inherently subjective and difficult to assess. The authors have proposed an algorithm to fairly and consistently triage patients and mitigate the risk of adverse outcomes. Methods Two separate expert panels, a consensus panel (11 participants) and a validation panel (15 participants), were constructed among international HNC surgeons. Using a modified Delphi process and RAND Corporation/University of California at Los Angeles methodology with 4 consensus rounds and 2 meetings, groupings of high‐priority, intermediate‐priority, and low‐priority indications for surgery were established and subdivided. A point‐based scoring algorithm was developed, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN‐HN). Agreement was measured during consensus and for algorithm scoring using the Krippendorff alpha. Rankings from the algorithm were compared with expert rankings of 12 case vignettes using the Spearman rank correlation coefficient. Results A total of 62 indications for surgical priority were rated. Weights for each indication ranged from −4 to +4 (scale range; −17 to 20). The response rate for the validation exercise was 100%. The SPARTAN‐HN demonstrated excellent agreement and correlation with expert rankings (Krippendorff alpha, .91 [95% CI, 0.88‐0.93]; and rho, 0.81 [95% CI, 0.45‐0.95]). Conclusions The SPARTAN‐HN surgical prioritization algorithm consistently stratifies patients requiring HNC surgical care in the COVID‐19 era. Formal evaluation and implementation are required. Lay Summary Many countries have enacted strict rules regarding the use of hospital resources during the coronavirus disease 2019 (COVID‐19) pandemic. Facing delays in surgery, patients may experience worse functional outcomes, stage migration, and eventual inoperability. Treatment prioritization tools have shown benefit in helping to triage patients equitably with minimal provider cognitive burden. The current study sought to develop what to the authors' knowledge is the first cancer–specific surgical prioritization tool for use in the COVID‐19 era, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN‐HN). This algorithm consistently stratifies patients requiring head and neck cancer surgery in the COVID‐19 era and provides evidence for the initial uptake of the SPARTAN‐HN.
To the authors' knowledge, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN‐HN) is the first cancer surgery–specific prioritization tool for use during the coronavirus disease 2019 (COVID‐19) pandemic. The SPARTAN‐HN algorithm is reliable and valid for the stratification of patients with head and neck cancer who require urgent cancer care in resource‐restricted practice environments.
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Affiliation(s)
- John R de Almeida
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Han Zhang
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Marc A Cohen
- Department of Otolaryngology-Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J Wong
- Department of Otolaryngology-Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Caitlin McMullen
- Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Vasu Divi
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Carol M Lewis
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey Myers
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Danny J Enepekides
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kevin M Higgins
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dale Brown
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Douglas B Chepeha
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Patrick J Gullane
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Dean E, Jones A, Yu HPM, Gosselink R, Skinner M. Translating COVID-19 Evidence to Maximize Physical Therapists' Impact and Public Health Response. Phys Ther 2020; 100:1458-1464. [PMID: 32589718 PMCID: PMC7337734 DOI: 10.1093/ptj/pzaa115] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2020] [Indexed: 02/05/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has sounded alarm bells throughout global health systems. As of late May, 2020, over 100,000 COVID-19-related deaths were reported in the United States, which is the highest number of any country. This article describes COVID-19 as the next historical turning point in the physical therapy profession's growth and development. The profession has had over a 100-year tradition of responding to epidemics, including poliomyelitis; 2 world wars and geographical regions experiencing conflicts and natural disasters; and, the epidemic of noncommunicable diseases (NCDs). The evidence-based role of noninvasive interventions (nonpharmacological/nonsurgical) that hallmark physical therapist practice has emerged as being highly relevant today in addressing COVID-19 in 2 primary ways. First, despite some unique features, COVID-19 presents as acute respiratory distress syndrome in its severe acute stage. Acute respiratory distress syndrome is very familiar to physical therapists in intensive care units. Body positioning and mobilization, prescribed based on comprehensive assessments/examinations, counter the negative sequelae of recumbency and bedrest; augment gas exchange and reduce airway closure, deconditioning, and critical illness complications; and maximize long-term functional outcomes. Physical therapists have an indisputable role across the contiuum of COVID-19 care. Second, over 90% of individuals who die from COVID-19 have comorbidities, most notably cardiovascular disease, hypertension, chronic lung disease, type 2 diabetes mellitus, and obesity. Physical therapists need to redouble their efforts to address NCDs by assessing patients for risk factors and manifestations and institute evidence-based health education (smoking cessation, whole-food plant-based nutrition, weight control, physical activity/exercise), and/or support patients' efforts when these are managed by other professionals. Effective health education is a core competency for addressing risk of death by COVID-19 as well as NCDs. COVID-19 is a wake-up call to the profession, an opportunity to assert its role throughout the COVID-19 care continuum, and augment public health initiatives by reducing the impact of the current pandemic.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 Friedman Bldg, 2177 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada,Address all correspondence to Dr. Dean at:
| | - Alice Jones
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Homer Peng-Ming Yu
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Sichuan, China; and Faculty of Physical Therapy, Rehabilitation Medicine College, Sichuan University
| | - Rik Gosselink
- Department Rehabilitation Sciences, Faculty Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Margot Skinner
- School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Pagedar NA, Kendell N, Christensen AJ, Thomsen TA, Gist M, Seaman AT. Head and neck cancer survivorship from the patient perspective. Head Neck 2020; 42:2431-2439. [PMID: 32445236 DOI: 10.1002/hed.26265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/26/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Survivorship is a critical part of head and neck cancer (HNC) care. In order to design better processes, we assessed care provided to long-term HNC survivors and their priorities for ongoing care. METHODS A survey was provided to HNC survivors at clinic appointments, including our HNC survivorship clinic. Questions focused on priorities for care in the otolaryngology clinic, types of care provided, and opioid use. RESULTS Of 168 respondents, the most common priority for survivors was surveillance for recurrence (first priority in 75%), with general health the next most common (8%). Few respondents reported active primary care involvement in survivorship. About 10% of patients reported current opioid use. CONCLUSION Survivors face a large burden of symptoms and deficits, but our data show that most survivors focus on recurrence. Few survivors reported recall of survivorship care plan delivery or discussing cancer care needs with primary care providers.
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Affiliation(s)
- Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Nicholas Kendell
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Alan J Christensen
- Department of Psychology and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Timothy A Thomsen
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Michaela Gist
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Aaron T Seaman
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
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Marg LZ, Ruiz G, Chagolla F, Cabral A, Taylor J, Christensen C, Martin M, Picou B, Brown B. "We are becoming older women and then we have two stigmas": voicing women's biopsychosocial health issues as they age with HIV. J Women Aging 2020; 32:365-388. [PMID: 32310730 DOI: 10.1080/08952841.2020.1751566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In April 2019, nine older women (age 50+) living with HIV in Palm Springs, California, participated in a 90-minute focus group to identify their major health issues, strengths, and HIV and aging-related health priorities. Using the rigorous and accelerated data reduction (RADaR) technique, we identified four major themes: (1) mental health, (2) HIV comorbidities, (3) social determinants of health, and (4) resiliencies. These results reinforce the need to conduct additional research focused on women aging with HIV, an understudied population that requires more effective, tailored interventions to promote better quality of life and healthy aging.
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Affiliation(s)
- Logan Z Marg
- Department of Sociology, University of California, Riverside , Riverside, California, USA
| | - Griselda Ruiz
- Department of Public Health, University of California, San Diego , San Diego, California, USA
| | - Fidel Chagolla
- Department of Sociology, University of California, Riverside , Riverside, California, USA
| | - Alejandra Cabral
- Department of Community Health Sciences, UCLA Fielding School of Public Health , Los Angeles, California, USA
| | - Jeff Taylor
- HIV and Aging Research Project-Palm Springs , Palm Springs, California, USA
| | - Chris Christensen
- HIV and Aging Research Project-Palm Springs , Palm Springs, California, USA
| | - Marjorie Martin
- HIV and Aging Research Project-Palm Springs , Palm Springs, California, USA
| | - Bridgette Picou
- HIV and Aging Research Project-Palm Springs , Palm Springs, California, USA.,Desert AIDS Project , Palm Springs, California, USA
| | - Brandon Brown
- Center for Healthy Communities, School of Medicine, University of California, Riverside , Riverside, California, USA
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Milstein B, Homer J. Which Priorities for Health and Well-Being Stand Out After Accounting for Tangled Threats and Costs? Simulating Potential Intervention Portfolios in Large Urban Counties. Milbank Q 2020; 98:372-398. [PMID: 32027060 PMCID: PMC7296431 DOI: 10.1111/1468-0009.12448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Policy Points Interventions in a regional system with intertwined threats and costs should address those threats that have the strongest, quickest, and most pervasive cross-impacts. Instead of focusing on an individual county's apparent shortcomings, a regional intervention portfolio can yield greater results when it is designed to counter those systemic threats, especially poverty and inadequate social support, that most undermine health and well-being virtually everywhere. Likewise, efforts to reduce smoking, addiction, and violent crime and to improve routine care, health insurance, and youth education are important for most counties to unlock both short- and long-term potential. CONTEXT Counties across the United States must contend with multiple, intertwined threats and costs that defy simple solutions. Decision makers face the necessary but difficult task of prioritizing those interventions with the greatest potential to produce equitable health and well-being. METHODS Using County Health Rankings data for a predefined peer group of 39 urban US counties, we performed statistical regressions to identify 37 cross-impacts among 15 threats to health and well-being. Adding appropriate time delays, we then developed a dynamic model of these cross-impacts and simulated each of the counties over 20 years to assess the likely impact of 12 potential interventions-individually and in a combined portfolio-for three outcomes: (1) years of potential life lost, (2) fraction of adults in fair or poor health, and (3) total spending on urgent services. FINDINGS The combined portfolio yielded improvements by year 20 that are considerably greater than those at year 5, indicating that the time delays have a major effect. Despite the wide variation in threat levels across counties, the list of top-ranked interventions is strikingly similar. Poverty reduction and social support were the most highly ranked interventions, even in the shorter term, for all outcomes in all counties. Interventions affecting smoking, addiction, routine care, health insurance, violent crime, and youth education also were important contributors to some outcomes. CONCLUSIONS To safeguard health and well-being in a system dominated by tangled threats and costs, the most important priorities for a county cannot be simply inferred from a profile of its relative strengths and weaknesses. Two interventions stood out as the top priorities for almost all the counties in this study, and six others also were important contributors. Interventions directed toward these priority areas are likely to yield the greatest impact, irrespective of the county's specifics. A significant concentration of resources in a regional portfolio therefore ought to go to these strongest contributors for equitable health and well-being.
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Affiliation(s)
- Bobby Milstein
- ReThink Health / Rippel Foundation.,MIT Sloan School of Management
| | - Jack Homer
- MIT Sloan School of Management.,Homer Consulting
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McKeown A, Turner A, Angehrn Z, Gove D, Ly A, Nordon C, Nelson M, Tochel C, Mittelstadt B, Keenan A, Smith M, Singh I. Health Outcome Prioritization in Alzheimer's Disease: Understanding the Ethical Landscape. J Alzheimers Dis 2020; 77:339-353. [PMID: 32716354 PMCID: PMC7592677 DOI: 10.3233/jad-191300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dementia has been described as the greatest global health challenge in the 21st Century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, and political challenges about healthcare resource allocation, what health improvements matter to patients, and how they are measured. This study highlights the complexity of the ethical landscape, relating particularly to the balances that need to be struck when allocating resources; when measuring and prioritizing outcomes; and when individual preferences are sought. OBJECTIVE Health outcome prioritization is the ranking in order of desirability or importance of a set of disease-related objectives and their associated cost or risk. We analyze the complex ethical landscape in which this takes place in the most common dementia, Alzheimer's disease. METHODS Narrative review of literature published since 2007, incorporating snowball sampling where necessary. We identified, thematized, and discussed key issues of ethical salience. RESULTS Eight areas of ethical salience for outcome prioritization emerged: 1) Public health and distributive justice, 2) Scarcity of resources, 3) Heterogeneity and changing circumstances, 4) Knowledge of treatment, 5) Values and circumstances, 6) Conflicting priorities, 7) Communication, autonomy and caregiver issues, and 8) Disclosure of risk. CONCLUSION These areas highlight the difficult balance to be struck when allocating resources, when measuring and prioritizing outcomes, and when individual preferences are sought. We conclude by reflecting on how tools in social sciences and ethics can help address challenges posed by resource allocation, measuring and prioritizing outcomes, and eliciting stakeholder preferences.
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Affiliation(s)
- Alex McKeown
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Andrew Turner
- The National Institute for Health Research Applied Research Collaboration West [NIHR ARC West] at University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | | | | | - Amanda Ly
- MRC Integrative Epidemiology Unit & Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | | | - Mia Nelson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Claire Tochel
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Alex Keenan
- Janssen Pharmaceutica NV, Titusville, NJ, USA
| | - Michael Smith
- Alzheimer Scotland Centre for Policy and Practice, University of the West of Scotland, Paisley, Scotland, UK
| | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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Goold SD, Danis M, Abelson J, Gornick M, Szymecko L, Myers CD, Rowe Z, Kim HM, Salman C. Evaluating community deliberations about health research priorities. Health Expect 2019; 22:772-784. [PMID: 31251446 PMCID: PMC6737773 DOI: 10.1111/hex.12931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/05/2019] [Accepted: 05/21/2019] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Engaging underrepresented communities in health research priority setting could make the scientific agenda more equitable and more responsive to their needs. OBJECTIVE Evaluate democratic deliberations engaging minority and underserved communities in setting health research priorities. METHODS Participants from underrepresented communities throughout Michigan (47 groups, n = 519) engaged in structured deliberations about health research priorities in professionally facilitated groups. We evaluated some aspects of the structure, process, and outcomes of deliberations, including representation, equality of participation, participants' views of deliberations, and the impact of group deliberations on individual participants' knowledge, attitudes, and points of view. Follow-up interviews elicited richer descriptions of these and also explored later effects on deliberators. RESULTS Deliberators (age 18-88 years) overrepresented minority groups. Participation in discussions was well distributed. Deliberators improved their knowledge about disparities, but not about health research. Participants, on average, supported using their group's decision to inform decision makers and would trust a process like this to inform funding decisions. Views of deliberations were the strongest predictor of these outcomes. Follow-up interviews revealed deliberators were particularly struck by their experience hearing and understanding other points of view, sometimes surprised at the group's ability to reach agreement, and occasionally activated to volunteer or advocate. CONCLUSIONS Deliberations using a structured group exercise to engage minority and underserved community members in setting health research priorities met some important criteria for a fair, credible process that could inform policy. Deliberations appeared to change some opinions, improved some knowledge, and were judged by participants worth using to inform policymakers.
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Affiliation(s)
- Susan Dorr Goold
- Department of Internal Medicine, Division of General Medicine, Institute for Healthcare Policy and InnovationCenter for Bioethics and Social Sciences in MedicineAnn ArborMichigan
| | - Marion Danis
- Warren Magnuson Clinical CenterNational Institutes of HealthBethesdaMaryland
| | - Julia Abelson
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonOntarioCanada
| | - Michelle Gornick
- Center for Bioethics and Social Sciences in MedicineUniversity of MichiganAnn ArborMichigan
| | - Lisa Szymecko
- Center for Bioethics and Social Sciences in MedicineUniversity of MichiganAnn ArborMichigan
| | - C. Daniel Myers
- Department of Political ScienceUniversity of MinnesotaMinneapolisMinnesota
| | | | - Hyungjin Myra Kim
- Center for Statistical Computation and ResearchUniversity of MichiganAnn ArborMichigan
| | - Cengiz Salman
- Center for Bioethics and Social Sciences in MedicineUniversity of MichiganAnn ArborMichigan
- Present address:
Department of American Culture, College of Literature, Science and the ArtsUniversity of MichiganAnn ArborMichigan
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Synnot AJ, Tong A, Bragge P, Lowe D, Nunn JS, O’Sullivan M, Horvat L, Kay D, Ghersi D, McDonald S, Poole N, Bourke N, Lannin NA, Vadasz D, Oliver S, Carey K, Hill SJ. Selecting, refining and identifying priority Cochrane Reviews in health communication and participation in partnership with consumers and other stakeholders. Health Res Policy Syst 2019; 17:45. [PMID: 31036016 PMCID: PMC6489310 DOI: 10.1186/s12961-019-0444-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 03/27/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Priority-setting partnerships between researchers and stakeholders (meaning consumers, health professionals and health decision-makers) may improve research relevance and value. The Cochrane Consumers and Communication Group (CCCG) publishes systematic reviews in 'health communication and participation', which includes concepts such as shared decision-making, patient-centred care and health literacy. We aimed to select and refine priority topics for systematic reviews in health communication and participation, and use these to identify five priority CCCG Cochrane Reviews. METHODS Twenty-eight participants (14 consumers, 14 health professionals/decision-makers) attended a 1-day workshop in Australia. Using large-group activities and voting, participants discussed, revised and then selected 12 priority topics from a list of 21 previously identified topics. In mixed small groups, participants refined these topics, exploring underlying problems, who they affect and potential solutions. Thematic analysis identified cross-cutting themes, in addition to key populations and potential interventions for future Cochrane Reviews. We mapped these against CCCG's existing review portfolio to identify five priority reviews. RESULTS Priority topics included poor understanding and implementation of patient-centred care by health services, the fact that health information can be a low priority for health professionals, communication and coordination breakdowns in health services, and inadequate consumer involvement in health service design. The four themes underpinning the topics were culture and organisational structures, health professional attitudes and assumptions, inconsistent experiences of care, and lack of shared understanding in the sector. Key populations for future reviews were described in terms of social health characteristics (e.g. people from indigenous or culturally and linguistically diverse backgrounds, elderly people, and people experiencing socioeconomic disadvantage) more than individual health characteristics. Potential interventions included health professional education, interventions to change health service/health professional culture and attitudes, and health service policies and standards. The resulting five priority Cochrane Reviews identified were improving end-of-life care communication, patient/family involvement in patient safety, improving future doctors' communication skills, consumer engagement strategies, and promoting patient-centred care. CONCLUSIONS Stakeholders identified priority topics for systematic reviews associated with structural and cultural challenges underlying health communication and participation, and were concerned that issues of equity be addressed. Priority-setting with stakeholders presents opportunities and challenges for review producers.
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Affiliation(s)
- Anneliese J. Synnot
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Australia
| | - Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jack S. Nunn
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | | | - Debra Kay
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Davina Ghersi
- NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Sydney, NSW Australia
- National Health and Medical Research Council, Canberra, Australia
| | - Steve McDonald
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Naomi Poole
- Australian Commission on Safety and Quality in Healthcare, Sydney, Australia
| | | | - Natasha A. Lannin
- Alfred Health, Melbourne, Australia
- School of Allied Health (Occupational Therapy), La Trobe University, Melbourne, Australia
| | | | - Sandy Oliver
- University College London, London, United Kingdom
- University of Johannesburg, Johannesburg, South Africa
| | - Karen Carey
- National Health and Medical Research Council, Canberra, Australia
| | - Sophie J. Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Abstract
The 2016 outbreak of the Zika arbovirus was associated with large numbers of cases of the newly‐recognised Congenital Zika Syndrome (CZS). This novel teratogenic epidemic raises significant ethical and practical issues. Many of these arise from strategies used to avoid cases of CZS, with contraception in particular being one proposed strategy that is atypical in epidemic control. Using contraception to reduce the burden of CZS has an ethical complication: interventions that impact the timing of conception alter which people will exist in the future. This so‐called ‘non‐identity problem’ potentially has significant social justice implications for evaluating contraception, that may affect our prioritisation of interventions to tackle Zika. This paper combines ethical analysis of the non‐identity problem with empirical data from a novel survey about the general public's moral intuitions. The ethical analysis examines different perspectives on the non‐identity problem, and their implications for using contraception in response to Zika. The empirical section reports the results of an online survey of 93 members of the US general public exploring their intuitions about the non‐identity problem in the context of the Zika epidemic. Respondents indicated a general preference for a person‐affecting intervention (mosquito control) over an impersonal intervention (contraception). However, their responses did not appear to be strongly influenced by the non‐identity problem. Despite its potential philosophical significance, we conclude from both theoretical considerations and analysis of the attitudes of the community that the non‐identity problem should not affect how we prioritise contraception relative to other interventions to avoid CZS.
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Vernazza CR, Taylor G, Donaldson C, Gray J, Holmes R, Carr K, Exley C. How does priority setting for resource allocation happen in commissioning dental services in a nationally led, regionally delivered system: a qualitative study using semistructured interviews with NHS England dental commissioners. BMJ Open 2019; 9:e024995. [PMID: 30904857 PMCID: PMC6475363 DOI: 10.1136/bmjopen-2018-024995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To understand approaches to priority setting for healthcare service resource allocation at an operational level in a nationally commissioned but regionally delivered service. DESIGN Qualitative study using semistructured interviews and a Framework analysis. SETTING National Health Service dentistry commissioning teams within subregional offices in England. PARTICIPANTS All 31 individuals holding the relevant role (dental lead commissioner in subregional offices) were approached directly and from this 14 participants were recruited, with 12 interviews completed. Both male and female genders and all regions were represented in the final sample. RESULTS Three major themes arose. First, 'Methods of priority setting and barriers to explicit approaches' was a common theme, specifically identifying the main methods as: perpetuating historical allocations, pressure from politicians and clinicians and use of needs assessments while barriers were time and skill deficits, a lack of national guidance and an inflexible contracting arrangements stopping resource allocation. Second, 'Relationships with key stakeholders and advisors' were discussed, showing the important nature of relationships with clinical advisors but variation in the quality of these relationships was noted. Finally, 'Tensions between national and local responsibilities' were illustrated, where there was confusion about where power and autonomy lay. CONCLUSIONS Commissioners recognised a need for resource allocation but relied on clinical advice and needs assessment in order to set priorities. More explicit priority setting was prevented by structure of the commissioning system and standard national contracts with providers. Further research is required to embed and simplify adoption of tools to aid priority setting.
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Affiliation(s)
- Christopher Robert Vernazza
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
- Child Dental Health, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Greig Taylor
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
- Child Dental Health, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Cam Donaldson
- Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Joanne Gray
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Richard Holmes
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Carr
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Exley
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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Ouellet GM, Ouellet JA, Tinetti ME. Principle of rational prescribing and deprescribing in older adults with multiple chronic conditions. Ther Adv Drug Saf 2018; 9:639-652. [PMID: 30479739 PMCID: PMC6243421 DOI: 10.1177/2042098618791371] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/27/2018] [Indexed: 12/12/2022] Open
Abstract
Although the majority of older adults in the developed world live with multiple chronic conditions (MCCs), the task of selecting optimal treatment regimens is still fraught with difficulty. Older adults with MCCs may derive less benefit from prescribed medications than healthier patients as a result of the competing risk of several possible outcomes including, but not limited to, death before a benefit can be accrued. In addition, these patients may be at increased risk of medication-related harms in the form of adverse effects and significant burdens of treatment. At present, the balance of these benefits and harms is often uncertain, given that older adults with MCCs are often excluded from clinical trials. In this review, we propose a framework to consider patients' own priorities to achieve optimal treatment regimens. To begin, the practicing clinician needs information on the patient's goals, what the patient is willing and able to do to achieve these goals, an estimate of the patient's clinical trajectory, and what the patient is actually taking. We then describe how to integrate this information to understand what matters most to the patient in the context of an array of potential tradeoffs. Finally, we propose conducting serial therapeutic trials of prescribing and deprescribing, with success measured as progress towards the patient's own health outcome goals. The process described in this manuscript is truly an iterative process, which should be repeated regularly to account for changes in the patient's priorities and clinical status. With this process, we aim to achieve optimal prescribing, that is, treatment regimens that maximize benefits that matter to the patient and minimize burdens and potential harms.
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Affiliation(s)
- Gregory M. Ouellet
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, Harkness A, Room 308-A, New Haven, CT 06520-8093, USA
| | - Jennifer A. Ouellet
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Mary E. Tinetti
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Abstract
OBJECTIVES To identify the shared priorities for future research of women affected by and clinicians involved with pessary use for the management of prolapse. DESIGN A priority setting project using a consensus method. SETTING A James Lind Alliance Pessary use for prolapse Priority Setting Partnership (JLA Pessary PSP) conducted from May 2016 to September 2017 in the UK. PARTICIPANTS The PSP was run by a Steering Group of three women with experience of pessary use, three experienced clinicians involved with management of prolapse, two researchers with relevant experience, a JLA adviser and a PSP leader. Two surveys were conducted in 2016 and 2017. The first gathered questions about pessaries, and the second asked respondents to prioritise a list of questions. A final workshop was held on 8 September 2017 involving 10 women and 13 clinician representatives with prolapse and pessary experience. RESULTS A top 10 list of priorities for future research in pessary use for prolapse was agreed by consensus. CONCLUSIONS Women with experience of pessary use and clinicians involved with prolapse management have worked together to determine shared priorities for future research. Aligning the top 10 results with existing research findings will highlight the gaps in current evidence and signpost future research to areas of priority. Effective dissemination of the results will enable research funding bodies to focus on gathering the evidence to answer the questions that matter most to those who will be affected.
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Affiliation(s)
- Kate Lough
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Lambert R, Carter D, Burgess N, Haji Ali Afzali H. The development of funding recommendations for health technologies at the state level: A South Australian case study. Int J Health Plann Manage 2018; 33:806-822. [PMID: 29676055 DOI: 10.1002/hpm.2529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 03/14/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES State governments often face capped budgets that can restrict expenditure on health technologies and their evaluation, yet many technologies are introduced to practice through state-funded institutions such as hospitals, rather than through national evaluation mechanisms. This research aimed to identify the criteria, evidence, and standards used by South Australian committee members to recommend funding for high-cost health technologies. METHODS We undertook 8 semi-structured interviews and 2 meeting observations with members of state-wide committees that have a mandate to consider the safety, effectiveness, and cost-effectiveness of high-cost health technologies. RESULTS Safety and effectiveness were fundamental criteria for decision makers, who were also concerned with increasing consistency in care and equitable access to technologies. Committee members often consider evidence that is limited in quantity and quality; however, they perceive evaluations to be rigorous and sufficient for decision making. Precise standards for safety, effective, and cost-effectiveness could not be identified. CONCLUSIONS Consideration of new technologies at the state level is grounded in the desire to improve health outcomes and equity of access for patients. High quality evidence is often limited. The impact funding decisions have on population health is unclear due to limited use of cost-effectiveness analysis and unclear cost-effectiveness standards.
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Affiliation(s)
| | - Drew Carter
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, Australia
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Reveiz L, Pinzón-Flórez C, Glujovsky D, Elias V, Ordunez P. [Establishing research priorities for chronic kidney disease of non-traditional causes in Central AmericaDeterminação de prioridades em pesquisa da doença renal crônica associada a causas não tradicionais na América Central]. Rev Panam Salud Publica 2018; 42:e13. [PMID: 31093042 PMCID: PMC6385632 DOI: 10.26633/rpsp.2018.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 11/07/2017] [Indexed: 12/24/2022] Open
Abstract
Introducción En 2013, los Estados Miembros de la OPS reconocieron la epidemia de enfermedad renal crónica de causas no tradicionales (ERCnT) como un grave problema de salud pública. Este artículo describe el establecimiento de prioridades de investigación para abordar de manera integral la ERCnT en Centroamérica. Métodos Se estructuró una encuesta virtual utilizando la metodología Delphi mediante una búsqueda de estudios de investigación efectuados en Centroamérica y de agendas de investigación previas sobre la ERC. Los encuestados se identificaron en diversas fuentes. La primera ronda buscó refinar y añadir tópicos de investigación y priorizar los más relevantes. La segunda ronda priorizó los tópicos más relevantes. Se realizó un análisis por fuzzy sets para estimar umbrales de decisión y puntajes por tópico. Resultados La encuesta se envió a 83 personas de habla hispana y 38 de habla inglesa y respondió 46,2%. Para la segunda ronda, se envió la encuesta a 56 personas en español y 16 en inglés que habían contestado a la la primera. Se priorizaron 18 tópicos de investigación enmarcados en 10 áreas: políticas públicas, determinantes, etiología, diagnóstico y tratamiento de la ERC, prevención primaria, prestación de servicios, recursos humanos, sistemas de información y financiamiento. Se comprobó que la investigación en ERCnT es escasa y está restringida a ciertos tópicos. Conclusiones Además de los factores etiológicos, se dio gran relevancia a aspectos relacionados con la respuesta de los sistemas de salud, incluidos el abordaje de la prestación de servicios, los recursos humanos, el financiamiento y aspectos ocupacionales y ambientales.
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Affiliation(s)
- Ludovic Reveiz
- Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Carlos Pinzón-Flórez
- Grupo de Investigación en Salud, Facultad de Medicina, Universidad de La Sabana, Chía, Colombia
| | - Demián Glujovsky
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Vanessa Elias
- Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Pedro Ordunez
- Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
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Pichon-Riviere A, Soto NC, Augustovski FA, García Martí S, Sampietro-Colom L. [Health technology assessment for decision-making in Latin America: good practice principles]. Rev Panam Salud Publica 2018; 41:e138. [PMID: 29466522 PMCID: PMC6660880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/31/2017] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Identify the most relevant, applicable, and priority good practice principles in health technology assessment (HTA) in Latin America, and potential barriers to implementing them in the region. METHODS HTA good practice principles postulated worldwide were identified and then explored through a deliberative process in a forum of evaluators, funders, and technology producers. RESULTS Forty-two representatives from ten Latin American countries participated in the forum. The good practice principles postulated at the international level were considered valid and potentially applicable in Latin America. Five principles were identified as priorities and as having greater potential to be expanded at this time: transparency in carrying out HTA; involvement of stakeholders in the HTA process; existence of mechanisms to appeal decisions; existence of clear mechanisms for HTA priority-setting; and existence of a clear link between assessment and decision-making. The main challenge identified was to find a balance between application of these principles and available resources, to prevent the planned improvements from jeopardizing report production times and failing to meet decision-makers' needs. CONCLUSIONS The main recommendation was to gradually advance in improving HTA and its link to decision-making by developing appropriate processes for each country, without attempting to impose, in the short term, standards taken from examples at the international level without adequate adaptation to the local context.
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Affiliation(s)
- Andrés Pichon-Riviere
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
| | - Natalie C Soto
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
| | - Federico Ariel Augustovski
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
| | - Sebastián García Martí
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
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Baker AL, Robson D, Lawn S, Steinberg ML, Bucci S, McNeill A, Castle DJ, Bonevski B. Reducing Smoking Among People With Schizophrenia: Perspectives on Priorities for Advancing Research. Front Psychiatry 2018; 9:711. [PMID: 30618881 PMCID: PMC6305594 DOI: 10.3389/fpsyt.2018.00711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/04/2018] [Indexed: 01/31/2023] Open
Abstract
Although tobacco smoking is very common among people with schizophrenia and has devastating effects on health, strategies to ameliorate the risk are lacking. Some studies have reported promising results yet quit rates are much lower than in the general population. There is a need to advance research into smoking cessation efforts among people with schizophrenia. We posed the following question to five leading international experts in the field: "What are the top three research ideas we need to prioritize in order to advance the field of reducing smoking amongst people with schizophrenia?" They identified three broad priorities: (i) deeper understanding about the relationship between smoking, smoking cessation and symptomatology; (ii) targeted, adaptive and responsive behavioral interventions evaluated with smarter methodologies; and (iii) improvements in delivery of interventions. Efforts should be made to establish a collaborative international research agenda.
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Affiliation(s)
- Amanda L Baker
- School of Medicine and Public Health, University of Newcastle Newcastle, NSW, Australia
| | - Debbie Robson
- Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Margaret Tobin Centre, College of Medicine & Public Health, Flinders University Adelaide, SA, Australia
| | - Marc L Steinberg
- Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School New Brunswick, NJ, United States
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust Manchester, United Kingdom
| | - Ann McNeill
- Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
| | - David J Castle
- Department of Psychiatry, University of Melbourne Melbourne, VIC, Australia.,Department of Psychiatry, St Vincent's Hospital Melbourne Fitzroy, VIC, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle Newcastle, NSW, Australia
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Lessa F, Caccavo F, Curtis S, Ouimet-Rathé S, Lemgruber A. Strengthening and implementing health technology assessment and the decision-making process in the Region of the Americas. Rev Panam Salud Publica 2017; 41:e165. [PMID: 31384277 PMCID: PMC6650625 DOI: 10.26633/rpsp.2017.165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 08/01/2017] [Indexed: 01/18/2023] Open
Abstract
Objective. Health technology assessment (HTA) has been adopted by countries in order to
improve allocative efficiency in their health systems. This study aimed to
describe and analyze the HTA decision-making process in the Region of the
Americas. Methods. A literature review was done to better understand the HTA situation in the
Region. Also, in 2014 and 2015, individuals responsible for conducting HTA
in countries of the Americas were identified and received a questionnaire on
HTA and the decision-making process. Results. A total of 46 questionnaire responses were obtained, from 30 countries. The
respondents were similar in terms of their institutions, main funding
sources, and technology types assessed. Of the 46 respondents, 23 (50%) work
for their respective ministry of health. Also, 36 (78%) undertake and/or
coordinate HTA through coverage and reimbursement/pricing decisions and
other HTA-related activities, while 24 (52%) use HTA for emerging
technologies. While some countries in the Region have created formal HTA
units, there is a weak link between the HTA process and decision-making.
Most of the countries with recognized HTA institutions are members of the
Health Technology Assessment Network of the Americas (RedETSA). Despite the
advances in the Region overall, most countries in Central America and the
Caribbean are still at the early stages of implementing HTA to support
decision-making. Conclusions. Many countries in the Americas have benefited from the exchange and
capacity-building opportunities within RedETSA. However, there are still
many challenges to overcome in the Region in terms of the discussion and
creation of HTA-related policies.
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Affiliation(s)
- Fernanda Lessa
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Francisco Caccavo
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Stephanie Curtis
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Stéphanie Ouimet-Rathé
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Alexandre Lemgruber
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
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Camilo Fuentes J, Andrea Cañón L, Viviana Pérez Á, E Pinzón C, María Pérez A, Avellaneda PA, Enrique Morales Á, Enrique Fernández YJ. Metodologías para la priorización en investigación en salud: una revisión sistemática de la literatura. Rev Panam Salud Publica 2017; 41:e122. [PMID: 31384258 PMCID: PMC6645202 DOI: 10.26633/rpsp.2017.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/17/2017] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Identificar elementos metodológicos clave para la priorización en investigación en salud, a partir de las metodologías reportadas en la literatura científica. Métodos. Se realizó una búsqueda sistemática en Medline, Embase, LILACS, y fuentes complementarias de literatura gris. Se utilizaron las palabras clave: research, methods y health priorities, en combinación con términos libres. Dos revisores independientes, de acuerdo con criterios previamente definidos, seleccionaron revisiones de la literatura o documentos metodológicos que presentaran metodologías para priorización en investigación en salud. Se extrajeron las principales características de las metodologías reportadas y se identificaron elementos comunes. Resultados. Se incluyeron siete revisiones y cinco documentos metodológicos, que reportaron cuatro metodologías estructuradas específicas y múltiples aproximaciones metodológicas que combinan elementos diversos. En general, estas metodologías integran la perspectiva de actores clave con información objetiva, mediante la aplicación de técnicas estandarizadas de participación, para establecer un ranking de prioridades, con base en criterios previamente definidos. Se identificaron elementos metodológicos comunes relacionados con pasos del proceso, mecanismos de participación, criterios para priorizar y análisis de resultados. Conclusión. La priorización en investigación en salud requiere el empleo de una metodología definida a priori, que debe contener como mínimo cuatro elementos clave: pasos claros del proceso, criterios para priorizar, técnicas formales de participación y métodos de análisis de resultados. Estos elementos deben ajustarse a las condiciones y necesidades del contexto de aplicación.
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Affiliation(s)
- Juan Camilo Fuentes
- Instituto de Evaluación Tecnológica en Salud Instituto de Evaluación Tecnológica en Salud Bogotá Colombia Instituto de Evaluación Tecnológica en Salud, Bogotá, Colombia
| | - Lorena Andrea Cañón
- Instituto de Evaluación Tecnológica en Salud Instituto de Evaluación Tecnológica en Salud Bogotá Colombia Instituto de Evaluación Tecnológica en Salud, Bogotá, Colombia
| | - Ángela Viviana Pérez
- Instituto de Evaluación Tecnológica en Salud Instituto de Evaluación Tecnológica en Salud Bogotá Colombia Instituto de Evaluación Tecnológica en Salud, Bogotá, Colombia
| | - Carlos E Pinzón
- Instituto de Evaluación Tecnológica en Salud Instituto de Evaluación Tecnológica en Salud Bogotá Colombia Instituto de Evaluación Tecnológica en Salud, Bogotá, Colombia
| | - Angélica María Pérez
- Instituto Nacional de Salud Instituto Nacional de Salud Bogotá Colombia Instituto Nacional de Salud, Bogotá, Colombia
| | - Paola Astrid Avellaneda
- Instituto de Evaluación Tecnológica en Salud Instituto de Evaluación Tecnológica en Salud Bogotá Colombia Instituto de Evaluación Tecnológica en Salud, Bogotá, Colombia
| | - Álvaro Enrique Morales
- Instituto Nacional de Salud Instituto Nacional de Salud Bogotá Colombia Instituto Nacional de Salud, Bogotá, Colombia
| | - Y Jorge Enrique Fernández
- Ministerio del Trabajo Ministerio del Trabajo Bogotá Colombia Ministerio del Trabajo, Bogotá, Colombia
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