Home About us Contact
|
Home About us Contact | ||
|
|
||
Health Policy Makers (health + policy_maker)
Selected AbstractsFactors Associated with the Income Distribution of Full-Time Physicians: A Quantile Regression ApproachHEALTH SERVICES RESEARCH, Issue 5 2007Ya-Chen Tina Shih Objective. Physician income is generally high, but quite variable; hence, physicians have divergent perspectives regarding health policy initiatives and market reforms that could affect their incomes. We investigated factors underlying the distribution of income within the physician population. Data Sources. Full-time physicians (N=10,777) from the restricted version of the 1996,1997 Community Tracking Study Physician Survey (CTS-PS), 1996 Area Resource File, and 1996 health maintenance organization penetration data. Study Design. We conducted separate analyses for primary care physicians (PCPs) and specialists. We employed least square and quantile regression models to examine factors associated with physician incomes at the mean and at various points of the income distribution, respectively. We accounted for the complex survey design for the CTS-PS data using appropriate weighted procedures and explored endogeneity using an instrumental variables method. Principal Findings. We detected widespread and subtle effects of many variables on physician incomes at different points (10th, 25th, 75th, and 90th percentiles) in the distribution that were undetected when employing regression estimations focusing on only the means or medians. Our findings show that the effects of managed care penetration are demonstrable at the mean of specialist incomes, but are more pronounced at higher levels. Conversely, a gender gap in earnings occurs at all levels of income of both PCPs and specialists, but is more pronounced at lower income levels. Conclusions. The quantile regression technique offers an analytical tool to evaluate policy effects beyond the means. A longitudinal application of this approach may enable health policy makers to identify winners and losers among segments of the physician workforce and assess how market dynamics and health policy initiatives affect the overall physician income distribution over various time intervals. [source] Burden of stroke in Maori and Pacific peoples of New ZealandINTERNATIONAL JOURNAL OF STROKE, Issue 3 2007Valery L. Feigin Studying ethnic particularities of stroke epidemiology may not only provide a clue to the causes of the observed racial/ethnic differences in stroke mortality but is also important for appropriate, culturally specific health care planning, prevention in stroke and improved health outcomes. This overview of published population-based stroke incidence studies and other relevant research in the multi-ethnic New Zealand population demonstrates an obvious ethnic disparity in stroke in New Zealand, with the greatest and increasing burden of stroke being imposed on Maori, who are indigenous, and Pacific people, who have migrated and settled in this country. These data warrant urgent and effective measures to be undertaken by health policy makers and health care providers to reverse the unfavourable trends in stroke and improve Maori and Pacific people's health. [source] SARS , a perspective from a school of nursing in Hong KongJOURNAL OF CLINICAL NURSING, Issue 2 2004David R. Thompson PhD Background., Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS. Aims and objectives., This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications. Conclusions., The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario. Relevance to clinical practice., Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large. [source] GPs' perceptions of multiple-medicine use in older patientsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2010Janne Moen PhD Abstract Rationale, aim and objective, Multiple-medicine use (polypharmacy) is a growing problem for older patients, prescribers and health policy makers. The general practitioner (GP) is most often the main professional care provider; hence, improvements of treatment can only be carried out in concordance with GPs. The aim of this study was, therefore, to explore GPs' perspectives of treating older users of multiple medicines, using a qualitative approach. Method, Six focus groups, with four private GPs and 27 county-employed GPs, were analysed by using the framework method. Results, In contrast to definitions in most epidemiologic studies, the GPs gave a spontaneous definition of polypharmacy as ,the administration of more medicines than are clinically indicated'. They had problems stating both a cut-off number and which medicines should be included. Clinical practice guidelines were thought of as ,medicine generators', having an ambiguous effect on the GPs, who both trust them and find them difficult to apply. There was a perceived lack of communication between GPs and hospital specialists concerning their patients' medicines, which was further perceived to reduce treatment quality. The influence of patient pressure was acknowledged by the GPs as a factor contributing to the development of multiple-medicine use. Conclusions, The GPs felt insecure although surrounded by clinical practice guidelines. There is a need for policy makers to appreciate this paradox, as the problem is likely to grow in size and proportion. GPs must be empowered to handle the increasing proportion of older users of multiple medicines with individual agendas, receiving care from multiple specialists. [source] Asthma in Latin America: a public heath challenge and research opportunityALLERGY, Issue 1 2009P. J. Cooper ,Asthma has emerged as an important public health problem in many Latin American countries over the past decade. In Brazil and Costa Rica, the prevalence of asthma and associated morbidity is as great or greater as reported in traditional high prevalence countries such as the US, but remains neglected as a public health priority. Asthma in Latin America is associated particularly with underprivileged populations living in cities but remains relatively rare in many rural populations. The causes of asthma in Latin America are likely to be associated with urbanization, migration, and the adoption of a modern ,Westernized' lifestyle and environmental changes that follow these processes that include changes in diet, physical activity, hygiene, and exposures to allergens, irritants, and outdoor and indoor pollutants. Because of the enormous social, genetic, and environmental contrasts within and between Latin American countries, and the large differences in prevalence associated with these differences, the investigation of asthma in Latin America provides important research opportunities to identify the social and biological mechanisms that underlie asthma development. Asthma in Latin America poses enormous challenges for health policy makers, health services, and researchers to respond to and alleviate the growing burden of asthma disability, particularly among marginalized urban populations. [source] Barriers to the provision of evidence-based psychosocial care in oncologyPSYCHO-ONCOLOGY, Issue 10 2006Penelope Schofield Abstract Meeting the psychological, social and physical needs of people with cancer is a challenge for individual health practitioners, health administrators and health policy makers. However, there is a considerable gap between recommended best-evidence psychosocial and supportive care and actual practice. This paper provides a discussion of the reasons for this gap using the precede-proceed model as a theoretical framework. The model is a useful way of classifying potential barriers to the application of recommended best practice into three categories: predisposing factors which influence motivation to behave in a particular way, enabling factors which facilitate the enactment of the behaviour and reinforcing factors which increase the likelihood that the behaviour will be maintained over time. Ways of addressing these barriers are proposed and discussed. Copyright © 2005 John Wiley & Sons, Ltd. [source] Continuing education meets the learning organization: The challenge of a systems approach to patient safetyTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2000John M. Eisenberg MD Director Abstract Since the release of the report of the Institute of Medicine on medical errors and patient safety in November 1999, health policy makers and health care leaders in several nations have sought solutions that will improve the safety of health care. This attention to patient safety has highlighted the importance of a learning approach and a systems approach to quality measurement and improvement. Balanced with the need for public disclosure of performance, confidential reporting with feedback is one of the prime ways that nations such as the United States, Canada, the United Kingdom, and Australia have approached this challenge. In the United States, the Quality Interagency Coordination Task Force has convened federal agencies that are involved in health care quality improvement for a coordinated initiative. Based on an investment in a strong research foundation in health care quality measurement and improvement, there are eight key lessons for continuing education if it is to parlay the interest in patient safety into enhanced continuing education and quality improvement in learning health care systems. The themes for these lessons are (1) informatics for information, (2) guidelines as learning tools, (3) learning from opinion leaders, (4) learning from the patient, (5) decision support systems, (6) the team learning together, (7) learning organizations, and (8) just-in-time and point-of-care delivery. [source] On Estimating Medical Cost and Incremental Cost-Effectiveness Ratios with Censored DataBIOMETRICS, Issue 4 2001Hongwei Zhao Summary. Medical cost estimation is very important to health care organizations and health policy makers. We consider cost-effectiveness analysis for competing treatments in a staggered-entry, survival-analysis-based clinical trial. We propose a method for estimating mean medical cost over patients in such settings. The proposed estimator is shown to be consistent and asymptotically normal, and its asymptotic variance can be obtained. In addition, we propose a method for estimating the incremental cost-effectiveness ratio and for obtaining a confidence interval for it. Simulation experiments are conducted to evaluate our proposed methods. Finally, we apply our methods to a clinical trial comparing the cost effectiveness of implanted cardiac defibrillators with conventional therapy for individuals at high risk for ventricular arrhythmias. [source] Present and future role of Mental Illness Advocacy Associations in the management of the mentally ill: realities, needs and hopes at the edge of the third millenniumBIPOLAR DISORDERS, Issue 3p2 2000Paolo Lucio Morselli Objective: The purpose of the present review is the analysis of the development and current status of the Mental Illness Advocacy Movement in the USA and in Europe, as well as of the role such a movement is playing in the management of the mentally ill. Methods: Information on the issue has been collected via literature search and several personal inquiries and contacts with different Mental Illness Advocacy Groups in the USA and in Europe. Results: The findings indicate that the Mental Illness Advocacy Movement is very alive and in full growth. Its role in the management of the mentally ill has become more and more important over the years. In several countries, it makes it possible to overcome some of the deficiencies of the National or Private Health Services. Thanks to the actions of the various Mental Illness Advocacy Groups, today, patients and families are more and better informed of their conditions and their rights. In many cases, this results in earlier diagnosis, better compliance and better outcomes. However, despite significant improvement in the status of the mentally ill patient, much still remains to be done. Conclusions: We need an improved dialogue with mental heath providers, public administrators, mental health policy makers, mass media and politicians. The dialogue between primary care team and the specialist must also be improved. A global alliance for action is needed to ensure better and more available services to those who suffer from mental disorders. [source] Utility of Qualitative Research Findings in Evidence-Based Public Health PracticePUBLIC HEALTH NURSING, Issue 3 2006Ph.D., Susan M. Jack R.N. ABSTRACT Epidemiological data, derived from quantitative studies, provide important information about the causes, prevalence, risk correlates, treatment and prevention of diseases, and health issues at a population level. However, public health issues are complex in nature and quantitative research findings are insufficient to support practitioners and administrators in making evidence-informed decisions. Upshur's Synthetic Model of Evidence (2001) situates qualitative research findings as a credible source of evidence for public health practice. This article answers the following questions: (1) where does qualitative research fit within the paradigm of evidence-based practice and (2) how can qualitative research be used by public health professionals? Strategies for using qualitative research findings instrumentally, conceptually, and symbolically are identified by applying Estabrooks' (1999) conceptual structure of research utilization. Different research utilization strategies are illustrated through the use of research examples from the field of work on intimate partner violence against women. Recommendations for qualitative researchers disseminating findings and for public health practitioners/policy makers considering the use of qualitative findings as evidence to inform decisions are provided. [source] | ||||||||||