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Carpenter, Tyler, Kate E. Beatty, Ross Brownson, and Paul Erwin. "Accreditation Seeking Decisions in Local Health Departments." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6848.
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background: Accreditation of local health departments (LHDs) has been identified as a crucial strategy for strengthening the public health infrastructure. This study seeks to identify the role of organizational and structural factors on accreditation-seeking decisions of LHDs.
data sets and sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. . LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes. “Micropolitan” includes census tracts with towns of 10,000 - 49,999 population and census tracts tied to these towns through commuting. “Rural” includes census tracts with small towns of fewer than 10,000 population, tracts tied to small towns, and isolated census tracts.
analysis: Binary logistic regression analysis was conducted to predict PHAB accreditation decision. Predictors included variables related to rurality, governance, funding, and workforce.
findings: From a sample of 448, approximately 6% of LHDs surveyed had submitted their letter of intent or full accreditation application. Over two-thirds were not seeking accreditation or deferring to the state agency. LHDs located in urban communities were 30.6 times (95% CI: 10.1, 93.2) more likely to seek accreditation compared to rural LHDs. LHDs with a local board of health were 3.5 times (95% CI: 1.6, 7.7) more likely to seek accreditation (controlling for rurality). Additionally, employing an epidemiologist (aOR=2.4, 95% CI: 1.2, 4.9), having a strategic plan (aOR=14.7, 95% CI: 6.7, 32.2) were associated with higher likelihood of seeking PHAB accreditation.
conclusions: Rural LHDs are less likely to seek accreditation. This lower likelihood of seeking accreditation likely relates to a myriad of challenges. Simultaneously, rural populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural LHDs can become better equipped to meet the needs of their communities.
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Beatty, Kate, Tyler Carpenter, Ross Brownson, and Paul Erwin. "Accreditation Seeking Decisions in Local Health Departments." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6854.
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Background: Accreditation of local health departments (LHDs) has been identified as a crucial strategy for strengthening the public health infrastructure. Research Objective: To identify the role of organizational and structural factors on accreditation-seeking decisions of LHDs. Of particular interest is the effect of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB). Data Sets and Sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study (2013 Profile Study). The 2013 Profile Study includes a core questionnaire (core,) that was sent to all LHDs, and two modules, sent to a sample. Variables were selected from the core and module one for this project. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes for the zip code of the LHD address. “Micropolitan” includes census tracts with towns of between 10,000 and 49,999 population and census tracts tied to these towns through commuting. “Rural” includes census tracts with small towns of fewer than 10,000 population, tracts tied to small towns, and isolated census tracts. Both “micropolitan” and “rural” categories are considered rural by the Federal Office of Rural Health Policy. Study Design: Cross-sectional. Analysis: Binary logistic regression analysis was conducted to predict PHAB accreditation decision. The variable for PHAB accreditation decision was created from the 2013 Profile Study question, “Which of the following best describes your LHD with respect to participation in the PHAB’s accreditation program for LHDs?” LHDs that selected “My LHD has submitted an application for accreditation” or “My LHD has submitted a statement of Intent” were coded as “Seeking PHAB Accreditation.” LHDs that selected “My LHD has decided NOT to apply for accreditation” or “The state health agency is pursuing accreditation on behalf of my LHD” were coded as “Not Seeking PHAB Accreditation.” Predictors included variables related to rurality, governance, funding, and workforce. Findings: From a sample of 448, approximately 6% of LHDs surveyed had either submitted their letter of intent or full accreditation application. Over two-thirds were either not seeking accreditation or deferring to the state agency. LHDs located in urban communities were 30.6 times (95% CI: 10.1, 93.2) more likely to seek accreditation compared to rural LHDs. LHDs with a local board of health were 3.5 times (95% CI: 1.6, 7.7) more likely to seek accreditation (controlling for rurality). Additionally, employing an epidemiologist (aOR=2.4, 95% CI: 1.2, 4.9), having a strategic plan (aOR=14.7, 95% CI: 6.7, 32.2), and higher per capita revenue (aOR=1.02, 95% CI: 1.01, 1.02) were associated with higher likelihood of seeking PHAB accreditation. Conclusions: Specific geographic, governance, leadership, and workforce factors were associated with intention to seek accreditation. Implications: Rural LHDs are less likely to seek accreditation. This lower likelihood of seeking accreditation likely relates to a myriad of challenges (e.g., lower levels of staffing and funding). Simultaneously, rural populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural LHDs can become better equipped to meet the needs of their communities.
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Alsaid, Nimer, and Nimer Alsaid. "Ex Ante Economic Evaluations of Arg389 Genetic Testing and Bucindolol Treatment Decisions in Heart Failure Stage III/IV." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/626340.
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Introduction: Beta-Blocker Evaluation Survival Trial (BEST) sub-analyses indicated a likely interaction between bucindolol and race disadvantaging black heart failure (HF) patients (Domanski J Cardiac Fail 2003); Arg389 homozygotes having adjusted reductions of 38% in mortality and 34% in mortality/hospitalization over other genotypes (Liggett PNAS 2006). Bucindolol is being evaluated in Arg389 genotype patients in the GENETIC-AF trial (NCT01970501).
Objective: To conduct parallel (using Domanski et al and Liggett et al) ex ante economic evaluations of Arg389 genetic testing in stage III/IV HF to support bucindolol treatment decisions (if Arg389-positive) and carvedilol (if Arg389-negative) treatment versus no such testing and empirical bucindolol; using Domanski et al and Liggett et al BEST sub-analyses.
Methods: In both Domanski et al and Liggett et al analyses, we used a decision tree model with time horizon of 18 months divided into 3 six-month cycles to estimate the cost-effectiveness and cost-utility of Arg389 genetic testing, considering overall survival (OS) from Domanski et al and Liggett et al BEST sub-analyses. Costs and utilities were retrieved from literature except for
assumed cost for bucindolol treatment (1.5x cost of carvedilol) and genetic testing ($250). Discount rate was set at 3%/yr. Weibull distributions were fitted to OS data. Life-years (LY) and quality-adjusted life-years (QALY) were used to estimate incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR), and results were validated using probabilistic sensitivity analyses (PSA).
Results: In the Domanski et-based analysis, Arg389 genetic testing versus no testing was associated with incremental gains of 0.29LYs and 0.27QALYs at incremental cost of $726; yielding ICER of US$2,503/LY and ICUR of US$2,688/QALY gained. In the Liggett et al-based analysis, Arg-389 genetic testing versus no testing was associated with incremental gains of 0.35LYs and 0.32QALYs at savings of -$1.081; for ICER of -US$3,089/LY and ICUR of -US$3,378/QALY gained. Both analyses were confirmed in PSAs.
Conclusion: Arg389 genetic testing to support bucindolol treatment in stage III/IV HF patients prevails economically over bucindolol treatment without genetic testing due to superior OS. If bucindolol is priced at 1.5x the cost of carvedilol. this economic benefit is likely to disappear if bucindolol and/ or genetic testing are priced higher. The clinical and economic benefits of bucindolol treatment with versus without Arg389 genetic testing versus empiric carvedilol remains to be assessed.
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BIGOT, Ana Carina Jorge dos Santos Ferreira Borges. "Alcohol consumption in the African context: contributions to a public health approach to policy decisions." Doctoral thesis, Instituto de Higiene e Medicina Tropical, 2015. http://hdl.handle.net/10362/19307.
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A contribuição dos problemas ligados ao álcool para a carga de doenças em África tem sido amplamente negligenciada. Devido a rápidas mudanças no contexto de vários países e a novas evidências científicas relativas a doenças atribuíveis ao álcool, tais como HIV e a incidência de TB, os problemas e carga da doença em África relacionados com o consumo de álcool podem ser maiores do que o que foi previamente estimado. Ao mesmo tempo existe pouca informação sob a forma como os países estão a gerir o consumo de álcool e as consequências ligadas a esse consumo, o que sugere que uma avaliação das políticas nacionais é necessária nesta região.
O objetivo geral desta tese é o de rever as evidências relacionadas com o consumo de álcool em África e analisar as políticas do álcool existentes, contribuindo assim para a melhoria das decisões políticas relacionadas com esse consumo na região. Em particular, a tese concentra-se nos quatro objetivos específicos seguintes: I) estimar a mortalidade e morbilidade atribuídas ao álcool em África; II) identificar os fatores que podem afetar a magnitude e os padrões de consumo de álcool em África; III) avaliar as respostas políticas nacionais relacionadas com o consumo de álcool em 46 países e sua eficácia para reduzir os malefícios relacionados com esse consumo; IV) documentar as diferentes etapas e atores envolvidos no desenvolvimento de uma política relativa ao consumo de álcool num país Africano (Malawi).
A investigação utilizou diferentes tipos de métodos. Os resultados mostram que o consumo de álcool tem um grande impacto sobre a carga de doença e mortalidade nos países africanos, com o álcool sendo responsável, em 2012, por 6.4% de todas as mortes e 4.7% de todos os DALYs na Região (estudo I). A nossa análise identificou sete fatores que estão intimamente ligados a possíveis mudanças no consumo de álcool em África. Impulsionada em grande parte pela globalização, a convergência potencial desses fatores é suscetível de se associar a um crescimento contínuo no consumo de álcool bem como ao aumento da morbilidade e mortalidade relacionada ao álcool em todo o continente (estudo II). Os países têm vindo a utilizar diferentes tipos de medidas de política para controlar o consumo de álcool. A avaliação dos níveis atuais de restrição das políticas existentes, mostra que os países atingiram uma pontuação média de 44,1 de 100 pontos possíveis, variando entre 9,1 (São Tomé e Príncipe) e 75,0 pontos (Argélia). De acordo com nossos resultados, os níveis de restrição das políticas existentes estão negativamente correlacionados com o consumo de álcool em consumidores atuais (rs = -.353, p = 0,005) (Estudo III). O estudo IV reflete as dificuldades e complexidade dos processos políticos e sociais na elaboração de políticas de álcool no
Malawi. Apesar da influência da indústria do álcool no estabelecimento da agenda politica e no processo de consulta, o nosso estudo demonstra que as organizações da sociedade civil, quando devidamente financiadas e apoiadas, podem desempenhar um papel importante e decisivo na evolução da política do governo com vista a defesa do interesse público.
As frações de mortalidade e morbilidade atribuídas ao álcool em muitos países africanos são consideráveis e, portanto, o álcool não pode ser deixado de fora das agendas de saúde e desenvolvimento desses países. Os governos africanos precisam de ter um papel mais ativo na proteção da saúde da população. Embora os países tenham adotado algum tipo de medidas de políticas para controlar o consumo de álcool, os nossos resultados mostram que há uma necessidade de uma resposta política mais forte para reduzir a carga relacionada com o consumo de álcool no continente. Finalmente, devido às dificuldades inerentes ao desenvolvimento de políticas do álcool, os governos devem considerar fortemente o aumento da participação das organizações da sociedade civil para apoiar uma direção no sentido da defesa do interesse público.Alcohol-related problems and burden of disease in Africa has been largely neglected. Due to the rapidly changing context in several countries and new scientific evidences of alcohol-attributablediseases, such as HIV and TB incidence, alcohol-related problems and burden of disease in Africa might be higher than what has previously been estimated.At the same time there is little information on the extent to which African countries are addressing alcohol consumption and alcohol-related harm, which suggests that evaluations of national alcohol policies are needed in this region.The overall aim of this thesis is to reviewevidence about alcohol consumption and analyse alcohol-related policies in Africa, thus contributingto the improvement of alcohol-related policy decisions in this region. In particular the thesis concentrates on followingfour objectives: I) estimate alcohol-attributablemortality and morbidityin Africa; II) identifyfactors that might affect magnitude and patterns of alcohol consumption in Africa; III)evaluatenational alcohol policy responses in 46 countries and their effectiveness to reduce alcohol-related harm; IV) document the different stages and actors involved in the development of alcohol policy in one African country (Malawi).The research used different type of methods. Our results show thatalcohol consumption has a large impact on burden of disease and mortality in African countries, withalcohol being responsible, in 2012, for 6.4% of all deaths and 4.7% of all DALYs in the Region(study I). Our analysis identified seven factors which are closely tied to potential changes in alcohol consumption in Africa. Driven largely by globalization, a potential convergence of these factors is likely to be associated with continued growth in alcohol consumption and alcohol-related morbidity and mortality across the continent(study II).Countries have been using different types of policy measuresto control alcohol consumption. When evaluating current policy restrictiveness, countries attained a mean score of 44.1 of 100 points possible, ranging from 9.1 (Sao Tomé and Principe) to 75.0 (Algeria). According to our results, actual policy restrictiveness scores were negatively correlated with and APC among drinkers (rs = -.353, p = 0.005) (Study III). Study IV reflects the difficulties and complexityof alcohol policy development in Malawi. Despite the influence of the alcohol industry in the agenda-settingand consultative process, when adequately resourced and supported, civil society organizations were found toplay an ximportant and decisiverole in steering policy developments in a sound public-interest direction. Alcohol-attributable fractions of mortality and morbidity in many African countries are considerable and therefore alcohol cannot be left out of countries health and development agendas. African governments need to take a more active role in protecting the public’s health. Although countries have adopted some type of policy measures to control alcohol consumption, our results show that there is a need for a strongerpolicy response to reduce alcohol-related burden in the continent. Finally, due to the inherent difficulties in alcohol policydevelopment, governments should strongly consider increasing the involvement of civil society organisations to support sound public-interest direction.
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Carter, Mary Frances. "Beliefs, Costs, and Policies Influencing African American Men's Decisions on PSA Screening." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4605.
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Despite the growing concerns about routine prostate-specific antigen (PSA) screening in men, little is known about the societal and economic impact of screening among the African American population. The purpose of this qualitative case study was to explore beliefs among African American men about PSA screening, funding for screening, and the role of the United States Preventive Service Task Force in addressing the problem. Guided by rational choice theory, data collection consisted of completion of a health beliefs survey, face-to-face interviews, field notes taken during interview, and interview audio recording. The population for the study included African American men residing in a large metropolitan Midwestern city, who are between the ages of 45 and 65, and who have not been diagnosed with prostate cancer disease. Data were analyzed using NVivo10-© to identify themes and patterns. Results from the study show that the decision to participate in prostate screening for African American men is hindered due to concerns about access, cost, and affordability. These three factors should be further evaluated in a larger setting for a greater understanding of their roles in more effective screening programs and policies. Insights gained from this study may positively impact future policy by providing a deeper understanding of the beliefs held by African American men on the issue of prostate cancer screening that may eventually lead to developing and successfully implementing policies that can be cost effective.
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Ayaebene, Francess Uju. "Maintaining Confidentiality among HIV Infected Couples: Physicians' Patterns of Decision in Nigeria." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7784.
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Policies mandating HIV status disclosure to decrease incidence create ethical challenges for physicians on whether to breach or maintain infected patients' confidentiality. In Sub-Saharan Africa where HIV incidence is high, there is a need for clear guidelines/policies on making confidentiality decisions. The purpose of this quantitative quasi experiment was to determine whether the gender, gender orientation, and sexual relationship of an infected patient and physicians' demographics predicted physicians' decisions to breach confidentiality. In Plateau State, Nigeria, 222 physicians were given vignette questionnaires containing 6 different descriptions of gender, gender orientation, and sexual relationships of a hypothetical patient. Each physician decided to maintain or breach a patient's confidentiality in a variant. The utilitarian framework was applied, and data were analyzed using logistic regression models. A majority of the participants (70%) indicated a breach by directly informing sex partners or informing or referring to the health department. Only physicians' feature of previous confidentiality breach significantly predicted the decision to breach [p =.028, Exp (B) =.1.345, 95%CI (1.032, 1.753)]. The results suggested that regardless of patients' characteristics, physicians will breach confidentiality to protect sex partners potentially at risk of HIV infection. These findings may bring about positive social change by clarifying reasons for physicians' breach decisions, by informing the development of physicians' decision guidelines that would enhance physicians' practices in managing discordant couples, which could reduce HIV transmission among discordant couples leading to better and longer lives.
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Ramos, Raquel de Souza. "As representações sociais da judicialização da saúde para profissionais de saúde." Universidade do Estado do Rio de Janeiro, 2015. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=8601.
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A judicialização da saúde é uma expressão cada vez mais presente nos cenários de assistência à saúde no Brasil materializada, principalmente, pelos mandados judiciais para a realização de procedimentos diagnósticos e terapêuticos, consultas, internações e dispensação de insumos médico-cirúrgicos. Como objetivo geral o estudo visa analisar o processo de judicialização da saúde no Brasil, no âmbito do SUS, a partir dos profissionais de saúde envolvidos nesse processo. Foram definidos como objetivos específicos descrever a estrutura e os conteúdos das representações sociais da judicialização da saúde no âmbito do SUS para gestores, reguladores e profissionais de saúde envolvidos no processo de atendimento às demandas geradas pela prática da ação judicial; comparar as Representações Sociais sobre a judicialização da saúde destes grupos sociais; discutir os conteúdos dessas representações no processo de judicialização da saúde compreendendo o campo social no qual esta questão se insere, as relações de poder que as perpassam e as construções simbólicas que as especificam. Trata-se de um estudo qualitativo, desenvolvido à luz da Teoria das Representações Sociais, realizado com 152 profissionais, em um hospital universitário e na central de regulação de procedimentos e leitos na cidade do Rio de Janeiro. Aplicou-se a Técnica de Evocação Livre através do termo indutor judicialização da saúde, sendo essas analisadas com a técnica de quadro de quatro casas e 40 entrevistas semiestruturadas analisadas através da análise de conteúdo temático-categorial instrumentalizada pelo software NVivo. Na análise estrutural foram evocadas 761 palavras, com média das ordens médias de evocação de três, com frequência máxima de 17 e mínima de 10, já a análise processual resultou em seis categorias, com 2257 unidades de registro, distribuídas em 85 temas. Identificou-se que os profissionais de saúde apresentam um posicionamento negativo diante da realidade imposta pela judicialização, entretanto reconhecem esse recurso como necessário mediante a crise da saúde pública brasileira. Os profissionais de saúde trabalham sob a pressão do poder judiciário, com a ameaça de prisão levando a um cotidiano estressante de suas práticas profissionais decorrente de uma ação ineficaz do Estado na execução da política de saúde. Conclui-se que a representação social encontra-se em fase final de consolidação. Considerando a representação social como determinante de práticas, concluímos também que as representações que emergiram deste estudo podem contribuir para a mudança das práticas dos profissionais de saúde que operacionalizam esse sistema. Espera-se desta forma, que ocorra a promoção de melhorias no resultado final da assistência direta aos usuários que buscam as instituições públicas de saúde para serem atendidos em suas necessidades de saúde, caracterizando-se dessa forma um desafio maior que caminha no sentido de fazer avançar a democracia e a cidadania.The health litigation is an expression increasingly present in the public institutions of health care in Brazil materialized mainly by warrants for performing diagnostic and therapeutic procedures, consultations, hospitalizations and dispensation of medical and surgical supplies. The study aims to analyze the process of legalization of health in Brazil, under the Unified Health System, from the health professionals involved in this process. Were defined as specific goals the description of the structure and content of the social representations of litigation of health activities and services within the managers, regulators and health professionals involved in the process of legalization of health; the comparison of the social representations about the legalization of that social group and the discussion of the contents of these representations in the legalization of health process. This is a qualitative study, based on the Theory of Social Representations, conducted with 152 subjects in a university hospital and the central of regulation of procedures and beds in the city of Rio de Janeiro. We applied the free word association technique by the inducing term "health litigation", that were analyzed with the technique of four-digit chart and also 40 semi-structured interviews that were analyzed through thematic content analysis, instrumentalized by NVivo software. 761 words were evoked with average sized orders recall of 3, with maximum and minimum frequency of 17 and 10. The procedural analysis resulted in six categories, with 2257 units of analysis, distributed in 85 themes. It was identified that health professionals have a negative position towards the reality imposed by the l health litigation, however they recognize this feature as required by the Brazilian public health crisis. Health professionals are working under the pressure of the judiciary, with the threat of arrest leading to a stressful routine of their professional practices due to an ineffective action of the State in the implementation of health policy. It is concluded that social representation is in the final stages of consolidation. Considering the social representation as a determinant of practices, we also concluded that the representations that have emerged from this study may contribute to the changing practices of health professionals that operationalize this system. It is expected therefore, that the promotion of improvements occur on the outcome of direct assistance to users seeking the public health institutions to be cared for in their health needs, characterizing thereby a greater challenge that goes towards making advancing democracy and citizenship.
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Sankaramoorthy, Saravana Kumar. "Distributed Policy Decision Points for Electronic Health Records." Thesis, KTH, Skolan för informations- och kommunikationsteknik (ICT), 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-90810.
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The advancement in technology mandates the extensive use of computerized healthcare devices making Electronic Health Records (EHRs) the way to store the patient details. The EHR systems have high availability and security requirements for the storage database. DIGHT is a distributed key-value store architecture being developed at SICS addressing the problems of high availability and scalability, data integrity and confidentiality, accountability, EHR versioning and extensibility. This Master thesis addresses the authorization requirements of the EHR systems. eXtensible Access Control Markup Language (XACML) is a OASIS standard for general purpose access control policy language designed for managing the access for resources. All of the available open source implementation of Policy Decision Point(PDP) conforms to XACML version 2.0 and retrieves the policies from the traditional file systems. Sun open source implementation of PDP conforming to XACML 2.0 was evaluated. It was upgraded to conform with XACML 3.0 standards. The XACML Admin Profile for delegation was also implemented. The testing was carried out with a prototype application which accepts text sms from registered doctors through an sms gateway. The application was designed for adding new patient record, medical record to an existing patient and retrieving existing patient and medical records. The application generates the XACML Request and send it to the PDP for evaluation. The XACML policies for authorizing the doctors were stored in MySQL database clusters. The PDP evaluates the request and send the XACML Response back to the application. The application processes the response and send appropriate reply to the sender. Performance evaluation was carried out with policies stored in database clusters. The thesis also discusses about the possible future enhancements like implementing XACML profile for SAML assertions, implementing the Policy Information Point to fetch attributes.
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Saffore, Lateef Yusef PhD. "What Factors Influence Medicare Reimbursement Payments for Healthcare Providers that Admit Diabetic Patients?" University of Akron / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=akron1303145384.
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Wirtz, Veronika. "Medicine and choices : health policy and individual decision making." Thesis, University College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.404891.
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Chieffi, Ana Luiza. "Análise das demandas judiciais de medicamentos junto a Secretaria de Estado da Saúde de São Paulo à luz da política de assistência farmacêutica." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-31072017-130420/.
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Introdução: No Brasil, a saúde é um direito fundamental do cidadão garantido pela Constituição Federal de 1988 que propiciou a criação do Sistema Único de Saúde (SUS). O SUS, dentro de seus princípios de igualdade, universalidade, integralidade e equidade, disponibiliza medicamentos à população por meio de programas da Assistência Farmacêutica. Apesar dos avanços da Política de Assistência Farmacêutica e da ampliação do acesso aos medicamentos, observa-se um aumento significativo da busca por medicamentos/tratamentos de saúde pela via judicial, o que vem se constituindo um desafio aos gestores e prestadores de saúde. Objetivo: Caracterização geral das demandas judiciais de solicitação de medicamentos/tratamentos de saúde impetradas contra a Secretaria de Estado da Saúde de São Paulo (SES/SP) no período de 2010 a 2014, com ênfase nos medicamentos solicitados para tratamento da diabetes mellitus, à luz da política de incorporação de novas tecnologias no SUS. Metodologia: Trabalho descritivo com dados secundários referentes aos processos judiciais de solicitação de medicamentos impetrados contra a SES/SP. A fonte de dados foi o sistema informatizado S-Codes. Ao lado da descrição, calculou-se os coeficientes de Gini em relação à quantidade de ações judiciais por patrono e por prescritor nos processos totais e nos processos dos pacientes diabéticos. Foi utilizada a regressão de Poisson com variância robusta para avaliar as associações entre as características das ações nos dois grupos de demandantes, os diabéticos e não diabéticos. Resultados e discussão: No período analisado, houve crescimento de aproximadamente 63% das demandas judiciais para fornecimento de produtos de interesse à saúde, destacando-se os medicamentos. Praticamente 30% dos itens de medicamentos solicitados nos processos judiciais pertenciam aos Programas de AF. Em relação aos medicamentos ajuizados presentes no componente especializado, 77,3% foram prescritos em desacordo com os Protocolos publicados pelo Mistério da Saúde. Dos processos jurídicos deferidos no período, 14,4% indicavam como doença principal nos relatórios médicos a diabetes mellittus. As insulinas análogas glargina (6,3%) e asparte (3,3%) foram os medicamentos mais demandados, ambos não aprovados pela Comissão Nacional de Incorporação de Tecnologia para incorporação no SUS, em razão da não comprovação de sua superioridade em relação ao tratamento disponível para diabetes. Observou-se que as ações judiciais dos pacientes diabéticos têm menor chance de serem impetradas por defensores públicos e promotores que por advogados privados. Em relação ao tipo de ação, observou-se maior chance de serem impetradas via mandado de segurança do que via rito ordinário, e menor chance de serem impetradas via ação civil pública em relação ao rito ordinário. A análise do local onde ocorreu a prescrição médica dos itens judicializados mostrou menor chance desta ser elaborada em UBS/centro de saúde, hospitais e clínica especializada/ambulatório de especialidade/policlínica, quando comparadas com a clínica privada. Os dados demonstraram que as ações judiciais dos pacientes diabéticos acentuam as características de natureza privada e individual da demanda. O índice de Gini elaborado sugere concentração de advogados e médicos nas demandas judiciais estudadas, para o total de pacientes e pacientes diabéticos. Conclusão: Houve aumento das ações judiciais mostrando não conformidade destas demandas com os protocolos, diretrizes e regras do SUS, observável tanto no conjunto de demandas quanto nas de solicitação de medicamentos/tratamentos para diabéticos. A judicialização da saúde no estado de São Paulo, com as características apresentadas neste estudo, sugere uma ameaça à sustentabilidade do Sistema Único de SaúdeIntroduction: In Brazil, healthcare is a fundamental right that is guaranteed to the citizen by the Federal Constitution of 1988 which allowed for the creation of the Brazilian Universal Health System (Sistema Único de Saúde - SUS). According to its principles of equality, universality, integrality and equity, the SUS provides medication to the population through Pharmaceutical Assistance (PA) programs. Despite the advances in PA policies which include the improvement in access to medications, there has been a significant increase in lawsuits related to health products and services, increasingly constituting a challenge to healthcare managers and providers. Objective: To characterize medication lawsuits filed between 2010 and 2014 against the State Health Secretary of São Paulo (Secretaria de Estado de Saúde de São Paulo - SES/SP), during the period between 2010 and 2014, with emphasis on solicited medication for treating diabetes mellitus, in the light of the policy for incorporation of new technologies in the SUS. Methodology: A descriptive work with secondary data referring to legal proceedings of medicine solicitation filed against the State Health Secretary of São Paulo. The data source was the the S-Codes computerized system. Beside the description, Gini coefficients were calculated in relation to the total processes and in the processes of diabetic pacientes. Poisson regression with robust variance was used to evaluate the associations between the characteristics of actions in the two applicant groups, the diabetics and nondiabetics. Results and discussion: During the analysed period there was an increase of approximately 63% in the judicial demands for the supply of products of healthcare interest, highlighting medicines. Practically 30% of the solicited medicinal items in the judicial proceedings belong to the Pharmaceutical Assistance Programs. In relation to the judged medicines present in the specialized component, 77.3% were prescribed in disagreement with the Protocols published by the Ministry of Health. Out of the granted judicial proceedings in this period, 14.4% indicated diabetes mellitus as the main illness in medical reports. The analogous insulins, glargins (6.3%) and asparte (3.3%), where the most demanded medications, both not approved by the National Commission for Incorporation of Technology for incorporation in the SUS due to the lack of evidence proving superiority in the available treatment for diabetes. It was observed that the judicial proceedings of diabetic patients have less chance of being filed by public defenders and district attorneys than private lawyers. In relation to the kind of lawsuit, one observes that there is a bigger chance of filling a lawsuit through an injunction than through ordinary rite, and less chance of filling a lawsuit through public Civil action in relation to ordinary rite. The analysis of the location in which occurred the medical prescription of the judicialized items, demonstrated a smaller chance of it being elaborated in primary health care units/ medical centre, hospitals and specialized clinics/ speciality environments/polyclinics, when compared to private clinic. The data shows that the judicial proceedings of diabetic patients highlight the private and individual nature of the characteristics of the demand. The Gini Index that was elaborated suggests a concentration of lawyers and doctors in the judicial demands that were studied, for the total of patients and diabetic patients. Conclusion: There was an increase in the judicial actions showing nonconformity of these demands with the protocols, guidelines and rules of the SUS, which is observed both in the collection of demands, and also in the solicitation of medication/treatments for diabetics. The judicialization of health in the state of São Paulo with the presented characteristics in this study suggest a threat to the sustainability of the Unified Healthcare System (SUS). Descriptors: Rigth to health; judicial decisions; National Drug Policy on Pharmaceutical Care; Brazilian National Health System
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Wagner, Steven M. "Public Sponsored Health Insurance to Improve Health Outcomes with Implications for Government Health Policy, Design, and Decision Making." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1002.
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This research sought to ascertain the extent to which providing public sponsored health insurance (PSHI) to previously uninsured Mexican-American Hispanics improves health outcomes among those requiring ongoing treatment to control diabetes. Prior research utilizing insurance access theory; access, equity, and health outcome interrelationship theory; health affordability theory; and financial and resource burden theory suggests the uninsured receive less care than the insured, with delayed treatment, leading to chronic conditions. This research tested each of those major theoretical constructs into a blended conceptual framework based on the notion that providing health insurance helps alleviate the disabling effects of diabetes among this population. This study used an unobtrusive, longitudinal, one group pretest-posttest design. Research questions were designed to measure the strength of the relationship between PSHI and patient health outcomes using physical examination data, laboratory results, and diagnosis of 712 diabetic patients with 5,300 medical visits over 3 years before and after enrolling for PSHI. Logistic regression was used to analyze data related to age, gender, time enrolled in PSHI, and service location relative to health outcomes. Findings support the theories that accessibility increases with the provision of health insurance but also show that health outcomes do not improve after enrollment in a PSHI. This study contributes to the body of knowledge in public health policy and administration by quantifying the strength and significance of the relationship between health insurance and health outcomes and effects positive social change by measuring the effectiveness of legislation providing the uninsured with health insurance in order to improve health outcomes.
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Lewis, Bryan L. "in silico Public Health: The Essential Role of Highly Detailed Simulations in Support of Public Health Decision-Making." Diss., Virginia Tech, 2011. http://hdl.handle.net/10919/26058.
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Public Health requires a trans-disciplinary approach to tackle the breadth and depth of the issues it faces. Public health decisions are reached through the compilation of multiple data sources and their thoughtful synthesis. The complexity and importance of these decisions necessitates a variety of approaches, with simulations increasingly being relied upon. This dissertation describes several research efforts that demonstrate the utility of highly detailed simulations in public health decision-making.
Simulations are frequently used to represent dynamic processes and to synthesize data to predict future outcomes, which can be used in cost-benefit and course of action analyses. The threat of pandemic influenza and its subsequent arrival prompted many simulation-based studies. This dissertation details several such studies conducted at the federal policy level. Their use for planning and the rapid response to the unfolding crisis demonstrates the integration of highly detailed simulations into the public health decision-making process.
Most analytic methods developed by public health practitioners rely on historical data sources, but are intended to be broadly applicable. Oftentimes this data is limited or incomplete. This dissertation describes the use of highly detailed simulations to evaluate the performance of outbreak detection algorithms. By creating methods that generate realistic and configurable synthetic data, the reliance on these historical samples can be reduced, thus facilitating the development and improvement of methods for public health practice.
The process of decision-making itself can significantly influence the decisions reached. Many fields use simulations to train and evaluate, however, public health has yet to fully adopt these approaches. This dissertation details the construction of highly detailed synthetic data that was used to build an interactive environment designed to evaluate the decision-making processes for pertussis control. The realistic data sets provide sufficient face validity to experienced public health practitioners, creating a natural and effective medium for training and evaluation purposes.
Advances in high-performance computing, information sciences, computer science, and epidemiology are enabling increasing innovation in the application of simulations. This dissertation illustrates several applications of simulations to relevant public health practices and strongly argues that highly detailed simulations have an essential role to play in Public Health decision-making.Ph. D.
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Dana-Sacco, Gail. "Applying Passamaquoddy wisdom to contemporary tribal health decision-making." Restricted access (UM), 2008. http://libraries.maine.edu/gateway/oroauth.asp?file=orono/etheses/37803141.pdf.
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Thesis (Ph. D.)--Johns Hopkins University, 2009.Includes Vita. Title from PDF title page (viewed on May 21, 2010) Available through UMI ProQuest Digital Dissertations. Includes bibliographical references (leaves 144-152). Also issued in print.
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Smith, Kane. "A Multi-Objective Framework for Information Security Public Policy: The Case of Health Informatics." VCU Scholars Compass, 2018. https://scholarscompass.vcu.edu/etd/5320.
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Detailed holistic patient data is critical for healthcare organizations to better serve their patient populations. This information allows healthcare organizations to create a detailed and holistic record of a patient’s health. However, this large aggregation of personally identifiable patient data raises serious privacy and security concerns amongst patients. For this reason, patient concerns around the privacy and security of information retained by healthcare organizations must be addressed through the development of effective public policy. This research, therefore argues that any decision making process aimed at developing public policy dealing with patient data privacy and security concerns should not only address regulatory concerns, but also patient-centric values. To accomplish this task, multi-objective decision analytic techniques, with Nissenbaum’s (2004) contextual integrity as a normative framework are used. This is done to elicit patient-centric preferences to assist organizations and governmental institutions alike in dealing with their privacy and security concerns around patient data stored by Healthcare Systems.
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Fridkin, Alycia Jayne. "First Nations involvement in health policy decision-making : the paradox of meaningful involvement." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/57073.
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Alongside consistent reporting on health inequities affecting Indigenous peoples in Canada, Indigenous people have been routinely excluded from health policy decision-making. This pattern of exclusion perpetuates health policy decisions that are often ineffective at addressing the root causes of persistent health inequities. Despite Indigenous peoples’ repeated calls to be meaningfully involved, and the emergence of health policy initiatives that include Indigenous peoples, the influence of neoliberalism and neocolonialism in the Canadian policy sphere continues to undermine self-determination and limit Indigenous peoples’ involvement in health policy processes. Those advocating for Indigenous health equity are left wrestling with the question: What constitutes, and what can foster, meaningful involvement in the contemporary health policy climate? This exploratory qualitative research aims to provide a window of insight into this urgent social justice question by exploring the perspectives of twenty leaders and decision-makers in First Nations health and other areas of health policy, with a view to understanding what constitutes meaningful involvement of First Nations peoples in health policy decision-making in BC and Canada. A critical analysis of these data reveals that meaningful involvement is often experienced as a paradox where Indigenous people are excluded via processes of inclusion, and that fostering meaningful involvement requires attuning to the underlying power dynamics inherent in policymaking and taking action to decolonize and transform the policy system itself. Based on this analysis, I articulate a new conceptualization of and framework for meaningful involvement, which is rooted in seven key elements: Recognizing and Representing Indigenous Peoples; Interrupting and Re-imagining Relationships; Preparing Agreements; Practicing Protocols; Leveraging Power; Exerting Community Authority; and Shifting Social Structures. This dissertation concludes with a discussion on the significance and implications of these findings and strategic directions and recommendations for meaningfully involving urban First Nations people in health policy decision-making in BC and beyond.Graduate and Postdoctoral Studies
Graduate
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Eckard, Nathalie. "The matter of economic evaluations in health policy decision-making : The case of the Swedish national guidelines for heart diseases." Doctoral thesis, Linköpings universitet, Avdelningen för hälso- och sjukvårdsanalys, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-121282.
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Economic evaluations are used to inform decision makers about the efficient allocation of scarce healthcare resources and are generated with the direct intent to support decisions in healthcare. Producing guidelines is a complex process and the inclusion of health-economic aspects in the formulation of the Swedish national guidelines as a basis for the written recommendations (priority gradings), distinguishes them from their European counterparts. Despite the increased use of cost-effectiveness data in decision-making, little is known about the actual use of such data. This thesis covers issues concerning how economic evaluations matter in health policy decision-making. The thesis includes four papers based on the Swedish national guidelines for heart diseases, one of the most prominent examples in Sweden of following the notion of evidence-based policy (EBP), in order to inform explicit priority setting. Both Papers I and II followed a qualitative case study design, based on the same data set. Paper I explored how a specific working group, the Priority Setting Group (PSG), handled the various forms of evidence and values when producing the national guidelines. Two themes were identified in reaching collective agreement in priority gradings; group facilitation activities and avoiding deadlock in the discussion. The work process involved disagreement and negotiation as part of that task. Paper I contributes to the theoretical and practical debate on EBP. Paper II focused on the use of cost-effectiveness data as decision support in the PSG work process. The paper addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. Three themes were identified. The paper contributes to knowledge on how cost-effectiveness evidence was used in actual decision-making. The use of cost-effectiveness evidence was one of many tools employed to avoid deadlock in discussion and to reach a priority grading, when the overall evidence base was weak, in times of uncertainty and on the introduction of new expensive medical technologies. Quantitative research methods were used for both Papers III and IV. Paper III explored how the PSG was presented with cost-effectiveness evidence as decision support and as a basis for their priority gradings. Cost-effectiveness ratios (ICERs) were provided, based on a systematic literature review, as well as how the results may be conveyed and communicated, for the treatment of heart diseases using a cost-effectiveness ranking or league and providing valid information within a limited space, aiding decision makers on the allocation of healthcare resources. The thesis also includes decision support in the form of cost-effectiveness analysis on catheter ablation treatment. Paper IV provides an example of presenting evidence in the form of a decision-analytic model. The modelling approach provides an analytic framework for decision-making, specifically under conditions of uncertainty as in the introduction of new medical technology. Catheter ablation was associated with reduced cost and an incremental gain in quality adjusted life years (QALYs), and was considered a cost-effective treatment strategy compared to the medical treatment strategy in a lifetime perspective.
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Gillies, Clare Louise. "Development of evidence synthesis methods for health policy decision making - A chain of evidence approach." Thesis, University of Leicester, 2007. http://hdl.handle.net/2381/7462.
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This project comprises a critical exploration and development of methods for the synthesis of evidence, using a chain of evidence approach, from diverse, yet inter-related, sources. The methodologies were explored through the development of a comprehensive decision model to assess different health policies in respect to screening for type 2 diabetes mellitus (T2DM). Four strategies were compared which were, no screening (current policy), screening for T2DM alone allowing for early diagnosis and treatment of the condition, and two strategies whereby both impaired glucose tolerance (IGT) and T2DM were screened for, allowing for early treatment of T2DM and for either lifestyle or pharmacological interventions to be applied to those with IGT in an attempt to delay the onset of T2DM. The comprehensive decision model developed here was innovative when compared to current published models in a number of ways. Firstly the entire model was encompassed within a single flexible framework, which has a number of advantages, and secondly as much of the available data as was feasible to use, was incorporated into the model inputs. A number of methodological issues and techniques were explored during the development of the comprehensive decision model. These included mixed treatment comparison analyses, assessment of baseline risk on intervention effects and the use of individual patient data. A number of sensitivity analyses and model extensions were carried out to assess the parameters with most influence on model results, and to adapt the model to different screening scenarios. The results of the model provide evidence that a screening strategy for IGT and T2DM, followed by appropriate treatment and interventions appears to be a cost-effective screening strategy. Uncertainty still surrounds the cost-effectiveness of screening for T2DM alone and further research is required. Running decision models within a Bayesian, comprehensive decision modelling framework, allows for model flexibility and has advantages over more conventional modelling techniques.
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Halton, Kate Amanda. "Setting hospital infection control policy : a decision-making framework incorporating health economics and healthcare epidemiology." Thesis, Queensland University of Technology, 2009. https://eprints.qut.edu.au/31145/1/Kate_Halton_Thesis.pdf.
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Background:
Reducing rates of healthcare acquired infection has been identified by the Australian Commission on Safety and Quality in Health Care as a national priority. One of the goals is the prevention of central venous catheter-related bloodstream infection (CR-BSI). At least 3,500 cases of CR-BSI occur annually in Australian hospitals, resulting in unnecessary deaths and costs to the healthcare system between $25.7 and $95.3 million. Two approaches to preventing these infections have been proposed: use of antimicrobial catheters (A-CVCs); or a catheter care and management ‘bundle’. Given finite healthcare budgets, decisions about the optimal infection control policy require consideration of the effectiveness and value for money of each approach.
Objectives:
The aim of this research is to use a rational economic framework to inform efficient infection control policy relating to the prevention of CR-BSI in the intensive care unit. It addresses three questions relating to decision-making in this area:
1. Is additional investment in activities aimed at preventing CR-BSI an efficient use of healthcare resources?
2. What is the optimal infection control strategy from amongst the two major approaches that have been proposed to prevent CR-BSI?
3. What uncertainty is there in this decision and can a research agenda to improve decision-making in this area be identified?
Methods:
A decision analytic model-based economic evaluation was undertaken to identify an efficient approach to preventing CR-BSI in Queensland Health intensive care units. A Markov model was developed in conjunction with a panel of clinical experts which described the epidemiology and prognosis of CR-BSI. The model was parameterised using data systematically identified from the published literature and extracted from routine databases. The quality of data used in the model and its validity to clinical experts and sensitivity to modelling assumptions was assessed.
Two separate economic evaluations were conducted. The first evaluation compared all commercially available A-CVCs alongside uncoated catheters to identify which was cost-effective for routine use. The uncertainty in this decision was estimated along with the value of collecting further information to inform the decision. The second evaluation compared the use of A-CVCs to a catheter care bundle. We were unable to estimate the cost of the bundle because it is unclear what the full resource requirements are for its implementation, and what the value of these would be in an Australian context. As such we undertook a threshold analysis to identify the cost and effectiveness thresholds at which a hypothetical bundle would dominate the use of A-CVCs under various clinical scenarios.
Results:
In the first evaluation of A-CVCs, the findings from the baseline analysis, in which uncertainty is not considered, show that the use of any of the four A-CVCs will result in health gains accompanied by cost-savings. The MR catheters dominate the baseline analysis generating 1.64 QALYs and cost-savings of $130,289 per 1.000 catheters. With uncertainty, and based on current information, the MR catheters remain the optimal decision and return the highest average net monetary benefits ($948 per catheter) relative to all other catheter types. This conclusion was robust to all scenarios tested, however, the probability of error in this conclusion is high, 62% in the baseline scenario.
Using a value of $40,000 per QALY, the expected value of perfect information associated with this decision is $7.3 million. An analysis of the expected value of perfect information for individual parameters suggests that it may be worthwhile for future research to focus on providing better estimates of the mortality attributable to CR-BSI and the effectiveness of both SPC and CH/SSD (int/ext) catheters.
In the second evaluation of the catheter care bundle relative to A-CVCs, the results which do not consider uncertainty indicate that a bundle must achieve a relative risk of CR-BSI of at least 0.45 to be cost-effective relative to MR catheters. If the bundle can reduce rates of infection from 2.5% to effectively zero, it is cost-effective relative to MR catheters if national implementation costs are less than $2.6 million ($56,610 per ICU). If the bundle can achieve a relative risk of 0.34 (comparable to that reported in the literature) it is cost-effective, relative to MR catheters, if costs over an 18 month period are below $613,795 nationally ($13,343 per ICU).
Once uncertainty in the decision is considered, the cost threshold for the bundle increases to $2.2 million. Therefore, if each of the 46 Level III ICUs could implement an 18 month catheter care bundle for less than $47,826 each, this approach would be cost effective relative to A-CVCs. However, the uncertainty is substantial and the probability of error in concluding that the bundle is the cost-effective approach at a cost of $2.2 million is 89%.
Conclusions:
This work highlights that infection control to prevent CR-BSI is an efficient use of healthcare resources in the Australian context. If there is no further investment in infection control, an opportunity cost is incurred, which is the potential for a more efficient healthcare system. Minocycline/rifampicin catheters are the optimal choice of antimicrobial catheter for routine use in Australian Level III ICUs, however, if a catheter care bundle implemented in Australia was as effective as those used in the large studies in the United States it would be preferred over the catheters if it was able to be implemented for less than $47,826 per Level III ICU.
Uncertainty is very high in this decision and arises from multiple sources. There are likely greater costs to this uncertainty for A-CVCs, which may carry hidden costs, than there are for a catheter care bundle, which is more likely to provide indirect benefits to clinical practice and patient safety. Research into the mortality attributable to CR-BSI, the effectiveness of SPC and CH/SSD (int/ext) catheters and the cost and effectiveness of a catheter care bundle in Australia should be prioritised to reduce uncertainty in this decision.
This thesis provides the economic evidence to inform one area of infection control, but there are many other infection control decisions for which information about the cost-effectiveness of competing interventions does not exist. This work highlights some of the challenges and benefits to generating and using economic evidence for infection control decision-making and provides support for commissioning more research into the cost-effectiveness of infection control.
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Gauld, Robin David Charles. "Policy processing in theory and practice : health reform in Hong Kong and New Zealand /." Thesis, Hong Kong : University of Hong Kong, 1996. http://sunzi.lib.hku.hk/hkuto/record.jsp?B17311664.
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Baldeh, Yero H. J. "Information support for district health care planning and decision making in The Gambia : a holistic approach." Thesis, University of Central Lancashire, 1997. http://clok.uclan.ac.uk/21604/.
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This research builds upon a body of previous research on health informatics in developing countries. Early research on this area was motivated by a desire to understand the role of different health informatics applications for an effective and efficient health care delivery in developing countries. These applications range from the use of medical expert systems for clinical diagnosis to epidemiological systems at the central level. None of these looked at health information systems at the district level, especially in relation to the information needs of district health staff. Therefore, this research differs from earlier studies in three aspects. First, it looks at the planning and decision-making processes at the district level and how information support could play a crucial role in these processes. Second, it provides a critical evaluation of the existing vertical reporting systems, and through action-research demonstrates the use of an integrated health information system at the district level. Third, it applies multiple perspectives to analyse the research findings in relation to information support for district health care planning and decision making. These three perspectives are the functional perspective, organisational perspective, and the political perspective. To achieve this, the research: • uses a systemic approach to examine the health care system in The Gambia; • uses action-research to design, develop and implement an integrated district health information system in The Gambia; • uses an interpretive evaluation framework to evaluate the impact of the system development efforts in this research; • uses the theory of contextualism to reflect on the research findings over the three year period. Various themes emerged during the research. These themes would be introduced here as the contributions to knowledge arising from the completion of this research project. These include: • a demonstration of the suitability of using a systemic approach for the design, development and implementation of an integrated information system for district health care planning and decision making; • the development of a conceptual implementation framework suitable for the unique characteristics of developing countries; • a manifestation of the implications of an integrated information system for management development, decentralisation, intersectoral coordination and community participation at the district level; • suggestions for further work especially on the need to evaluate the socio-political impact of this research on the existing political and cultural structures in The Gambia.
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Kiatpongsan, Sorapop. "Decision Making for Medical Innovations." Thesis, Harvard University, 2014. http://dissertations.umi.com/gsas.harvard:11386.
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Heffner, Michael D. "Informing Decision-Making for Derailments Involving Hazmat| An Analysis of Phmsa Train Accident Data." Thesis, California State University, Long Beach, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10604290.
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A review of literature suggests that train derailments are a statistically relevant concern. While not all train derailments involve hazardous materials, those that do release chemicals pose a public health threat. This study challenges the decision-making mainstay tool of the hazardous materials response community – the Emergency Response Guidebook (ERG) – and its default strategy of evacuation through quantitative research that evaluates data from train derailments involving the release of hazardous materials. It explores whether there are correlations between a derailment’s variables and evacuation, as well as correlations between the number evacuated and the number of those injured or killed. Secondary data on train derailments from the Pipeline Hazardous Material Safety Administration revealed 358 incidents involving the release of 876 substances between October 12, 1989 through August 10, 2016. The resulting data analysis confirms a certain level of predictability between causal factors and worsening outcomes supporting expansion of decision-making tools in the ERG.
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Bryan, Lona. "A Limited Rational Choice Theory in Local Public Health Decision Making." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5542.
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The threat and occurrence of terrorist attacks have increased in the United States since September 2011, heightening concerns for weaponized anthrax, other biological pathogens, and epidemics and pandemics. Early decisions and funding levels in local public health agencies can be the first line of defense or first point of failure; yet little is understood about how decisions are made when there are budget cuts before a biological event happens. Using Lindblom's conceptualization of limited rational choice theory, the purpose of this single case study was to understand how a local public health official made decisions after budget cuts in a single public health entity in the mid-Atlantic area of the United States. Data were collected through an interview with 1 public health official and publicly available plans, procedures, and funding documents. These data were inductively coded and then subjected to Braun and Clarke's thematic analysis procedure. Findings indicated that the public health agency's ability to make the best decisions were negatively impacted by limited resources, though adequate planning before a catastrophic event, active and continual communication with stakeholders, and clarity about financial and resource needs can partially offset the impact of budgetary reductions. The implications for social change include recommendations to anticipate and address the needs of the public health system through decision making to protect the health care community and the reduction or elimination of the spread of disease in the wake of a biological incident.
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Navaneelan, Tanya. "Normalization and Informed Decision-making in Public Health Programs: A Case Study of HPV Vaccination in Canada." Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/23517.
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This thesis examined the evidence, policy decision-making, and implementation of HPV vaccination in Canada as a case study to explore normalization versus individualized decision making in public health programs. Mixed methods were used: a systematic review, content analyses and policy document analysis.
Overall, the scientific evidence supported an effect of vaccination against HPV infection and precancerous cervical lesions, but evidence regarding cervical cancer incidence or mortality is lacking. Scientific and medical communities appeared optimistic about the vaccine, but cautious about its readiness for routine implementation. Policy decision-making was initially cautious, but shifted towards active program implementation, possibly related to the availability of federal funding. The educational materials and media coverage both sent clearly normalizing messages about HPV vaccination.
The discussion suggests that HPV vaccination might be more suited to an individualized than population approach, but many factors coincided to promote its implementation, in Canada, within a traditional public health model.
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Mehter, Hashim Moosa. "Physician approaches to provider-family conflict associated with end-of-life decision-making in the ICU: a qualitative study." Thesis, Boston University, 2014. https://hdl.handle.net/2144/21217.
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Thesis (M.S.P.H.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.BACKGROUND: As critically ill patients approach the end of life in an intensive care unit (ICU), their families are often asked to make difficult decisions surrounding the withholding or withdrawal of aggressive care or resuscitative measures. Families are asked to exercise “substituted judgment” by making decisions from the imagined standpoint of the patient. ICU physicians work with families to support them through the decision-making process, but conflict commonly arises between physicians and family members regarding the optimal course of care for a critically ill patient. Existing qualitative data regarding physician perspectives and practical approaches to negotiating and managing these conflicts is limited. OBJECTIVE: To investigate and characterize how critical care physicians approach and manage conflict with surrogates with respect to decisions on withdrawing or withholding aggressive care in the ICU. METHODS: Semi-structured interviews were conducted with eighteen critical care physicians, recruited from two large academic medical centers in Boston. Interview transcripts were analyzed using methods of grounded theory to identify emergent themes and concepts, along with illustrative quotes. RESULTS: Physicians described an initial process of gauging surrogate receptiveness to provider input and recommendations. When faced with resistance to their recommendations for less aggressive care, provider approaches ranged from deference to family wishes to various negotiation strategies designed to change families’ minds. The likelihood of deferring to family in the event of conflict was associated with the perceived sincerity of the family’s “substituted judgment” approach and the ability of the provider to manage patient pain and suffering. Providers described a common theme of concern for the family’s emotional needs; manifestations of this concern included efforts to alleviate guilt and stress associated with end-of-life decision-making by assuming some of the decision-making burden and strategies to repair damage to the provider-family relationship in the aftermath of conflict or disagreement. Providers also described personal stress and anxiety associated with contentious end-of-life decision-making, and the effect of career experience on their approach to conflict with families. CONCLUSIONS: Critical care physicians describe a multi-layered approach to physician-family conflict surrounding end-of-life decision-making in the ICU, including adaptive strategies to achieve optimal outcomes for both patient and family. These findings may help to inform future research and quality-improvement initiatives.
2031-01-01
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Boxenbaum, Eva. "The partnership metaphor in Quebec health care policy : the decision-making process with cognitively impaired elderly clients in home care." Thesis, McGill University, 2001. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=33063.
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This research evaluates Quebec's health care policy by analyzing how the partnership metaphor is implemented in policy and practice. The partnership construction is identified in 4 interpretive communities within long-term community services to the elderly population. This analysis focuses on the placement decision for cognitively impaired clients in home care. Interpretive policy analysis is employed to examine 3 policy documents and 3 client files, while grounded theory serves to analyze 13 semi-structured interviews with 2 administrators and 3 open triads of client, caregiver, and case manager. The findings show partnership to be an egalitarian, collaborative ideal widely adopted but with little consensus on the pertinent objects and actors. Important differences emerge in how partnership is applied to the placement decision, indicating a too flexible application. Specific restrictions are recommended on the application of the partnership metaphor in order to improve community services and organizational structures in health care.
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Waldau, Susanne. "Creating organisational capacity for priority setting in health care : using a bottom-up approach to implement a top-down policy decision." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-36316.
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In this thesis, priority setting to the form of the Swedish parliamental decision on priority setting, 1997, is considered an innovation for implementation in health care. The features of this innovation are investigated. The practical implications of implementation are identified by investigating the user organisation, ie, Swedish health care organisations and management systems. Also, a case of a three-stage process for macro-level priority setting that engaged the entire organisation in the Västerbotten County Council (VCC) is presented. This is done against a background of preceding implementation efforts in the VCC. Four specific research efforts and papers are presented. In Paper I, priority setting is operationalised into a multi-dimensional resource allocation task. On that basis, with the help of interviews (1998) and surveys (2002 and 2005) primarily of VCC health care managers, the impact of implementation is measured by prioritisation structures, processes and decisions. Survey response rates were low. Results were used as qualitative data, internally compared, and interpreted as: a) responses reflected mainly “early adopters’” opinions; b) priority setting is an ambiguous concept; c) indicating limited overall implementation; d) reinterpretation of the prioritisation task occurred over time among respondents; and, e) this group took increasingly personal responsibility as stakeholders in priority setting. Paper II reports a case study intervention of explicit, departmental level priority setting with the aim of improving cost-effectiveness in in vitro fertilization resource use and a rationing of services perceived legitimate by all stakeholders. The intervention combined priority setting and structured quality improvement techniques. Results were: a) improved operational efficiency of diagnostic procedures that allowed resources to be reallocated to treatment; and b) patients were prioritized and treatment resources were rationed based on evidence of treatment effect among subgroups. Evaluation showed that the procedure met stated criteria for legitimacy. In Paper III, a full-format test of the macro level prioritisation process is described and evaluated by participants with the help of surveys after each completed stage. Participants report the need for improvement of elements in the overall process and of procedural specifics. However, overall there was a strong commitment to the initiative and satisfaction with the process and the resulting decisions. In Paper IV, procedural specifics of the prioritisation process are evaluated. They are also compared to the Program Budgeting and Marginal Analysis (PBMA) framework when used for macro level purposes. Procedures provided intended results such as vertical and horizontal priority setting and a consistent process. However, economic targets were not fully achieved in any of the stages. Conclusions include that health care management systems are not prepared for priority setting and need profound restructuring and that the prioritisation process described in Papers III and IV was successful because: a) the process satisfied politicians’ directives; b) participants were satisfied with the procedures and perceived the subsequent reallocation decisions as legitimate; and, c) methods resulted in the intended outcome. Factors suggested as the basis of success include: long-term overall preparations; broad and deep participation; a readiness for change among participants; a stage for horizontal priority setting that added to the quality, feasibility and perceived validity of the knowledge base; a strong process leadership; and politicians determined to protect the process from opportunistic disturbances.
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Khalil, Doris Deedei. "A study of four international donor agencies : their role and influence in decision-making and health policy in Ghana from 1983-1995." Thesis, University of Liverpool, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343997.
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Davis, Millicent Amanda. "Decision Making of Environmental Engineers on Project Selection." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2808.
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Some environmental engineers do not understand how to perceive profitable opportunities in redeveloping the large number of contaminated brownfield sites in New Jersey. The purpose of this qualitative exploratory case study was to find effective decision-making strategies that help environmental engineers acquire profitable environmental redevelopment projects. The target population consisted of 4 environmental engineers in an environmental organization in Camden County, New Jersey who possessed proven decision-making strategies that helped them acquire profitable environmental redevelopment projects in the past 5 years. The conceptual framework for this study was the multiple criteria decision method (MCDM). Semistructured interviews were conducted with the engineers, and company documents were additional sources of data gathered. Triangulation and member checking were used to ensure the trustworthiness of interpretations. Five themes emerged from the analyses relating to strategies for an MCDM assessment in project management, a go/no-go assessment in project selections, education and training, ethics as an organizational value, and project management. These findings may lead to social change in Camden County, New Jersey community organizations, such as schools, daycare centers, and local businesses, which may benefit from the knowledge and safety recommendations of remediation decision making. Furthermore, these findings may provide opportunities for environment organizations to teach and train stakeholders on environmental processes while providing profitable opportunities to shareholders through sustainable practices.
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Sullivan, Shannon. "Knowledge Translation of Economic Evaluations and Network Meta-Analyses." Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/32109.
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Economic evaluations and network meta-analyses (NMAs) are complex methodologies. Increasing their transparency and accessibility could enhance confidence in the legitimacy of policy decisions informed by these analyses.
Four systematic reviews were conducted to understand policymakers’ informational needs and to determine what guidance researchers have on how to present economic evaluations and NMAs. Qualitative interviews were conducted with Canadian policymakers, i.e., knowledge users, to understand barriers and facilitators to using and communicating economic evaluations and NMAs and with individuals in international health technology assessment organizations, i.e. knowledge producers, to explore current approaches to communicating economic evaluations and NMAs. A toolkit for NMAs and economic evaluations was proposed based on an integrated review of these findings and guided by the Knowledge-to-Action framework. Examples of tools were developed and applied to an economic evaluation and NMA of osteoporosis therapies.
Systematic reviews and qualitative interviews found that communication approaches that provide robust content, identify contextual factors relevant to policy decisions and enhance clarity were valued. Twelve tools were proposed that enhance communication, education and access to resources for policymakers. Two of these tools were developed: Economic Guidance for Researchers and NMA Guidance for Researchers.
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Darnell, Whittney H. "NAVIGATING THE MICHELLE P. WAIVER: A NARRATIVE EXAMINATION OF THE IMPACT OF PARENT CAREGIVER-RELATED UNCERTAINTY AND DECISION MAKING FOR CHILDREN WITH DISABILITIES." UKnowledge, 2019. https://uknowledge.uky.edu/comm_etds/82.
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The Michelle P. Waiver (MPW) is the primary means of health insurance for more than 10,000 people in the state of Kentucky. The waiver is especially popular among families with young children with disabilities because it is robust in its benefit offerings and also one of the few Medicaid resources that does not include parental income as a qualifying factor in eligibility. Through the waiver, children receive a medical card as well as additional coverage for medical expenses that fall beyond the scope of traditional health insurance. For these young children to gain access to the comprehensive offerings of the MPW, their parents must apply for the waiver, negotiate the terms of service, and make critical health care decisions on their behalf, or at least until they reach adulthood—although this responsibility often extends throughout the child’s life. The present study builds upon recent research on parental uncertainty in caregiving for children with complex care needs. By combining two ecological approaches to health communication research, Brashers’s (2001) uncertainty management theory (UMT) and Ball-Rokeach, Kim, and Matai’s (2001) communication infrastructure theory (CIT), my aim in this dissertation was to explain how meso-level (e.g., community organization) interactions influenced parental caregivers’ experiences of uncertainty. I collected data through narrative interviews with 31 parents of children who are currently receiving services through the MPW and analyzed them using narrative thematic analysis. The analysis focused on the community-level communication that contributes to parent caregivers’ ability to successfully access and negotiate care within the MPW system. Findings show that parents experience unique personal, social, and medical uncertainties related to the MPW. In addition, the findings demonstrate that MPW-related uncertainty and decision making are managed with a variety of strategies aimed to decrease, increase, or maintain desired levels of uncertainty. Finally, findings showcase how one’s connectedness to community storytelling at the meso level, particularly within online communities and disability network communities supports their adaptive management of MPW-related uncertainty. This project contributes to the health communication literature theoretically by (a) expanding the conceptualization of the uncertainty in illness framework to include the means of health care (i.e., Medicaid) as a consequential element of an individual’s illness experience, (b) identifying two additional strategies of uncertainty management (i.e. advocacy and vigilance), and by (c) extending existing notions of residency, connectedness, and belongingness within the CIT framework to include membership in online and disability-specific networks. Practically, this project offers important insights that can guide future research exploring the role of meso-level communication in parent caregivers’ management of waiver-based care, such as in identifying the need for a systematic communication process that introduces potentially eligible families to the MPW.
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Gonçalves, Maria de Lourdes. "Participação social no sistema único de saúde: a experiência do conselho municipal de saúde de Ribeirão Preto - SP." Universidade de São Paulo, 1999. http://www.teses.usp.br/teses/disponiveis/83/83131/tde-14022003-102526/.
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Este estudo analisou a experiência de construção da participação social no Sistema Único de Saúde, tendo como objeto de estudo o Conselho Municipal de Saúde de Ribeirão Preto, no período de 1991-1998. Construiu-se o referencial teórico a partir da redemocratização do país e da Reforma Sanitária, abordando o objeto de estudo nas dimensões: Direito à Saúde, Participação, Controle Social e Cidadania. A metodologia foi o Estudo de Caso, na abordagem qualitativa da pesquisa em saúde. Procurou-se, a partir de Análise documental e de Entrevistas com Conselheiros e ex-Secretários Municipais de Saúde, através da técnica de Análise Temática, identificar relações estabelecidas entre os sujeitos sociais que compõem o Conselho, projetos de interesse e concepção de Direito à Saúde; buscou-se apontar limites e potencialidades do espaço de participação para a construção da cidadania. Principais limites: os temas são levados ao Conselho, apenas para aprovação, não oportunizando discussões prévias; a vinculação do Fundo Municipal de Saúde à Secretaria da Fazenda, impede Gestor e Conselho de terem autonomia na decisão do uso dos recursos; alguns segmentos não levam para o Conselho suas demandas, utilizando outros canais; o corporativismo de alguns segmentos, impede a publicização de projetos de interesse. Como potencialidade, verificou-se que os entrevistados têm no Conselho, o fórum político legítimo, para discutir e deliberar as diretrizes políticas para a saúde no município, legitimando-o, enquanto espaço público de construção do Direito e da Cidadania. Isto permitiu o funcionamento, nestes 8 anos, sem solução de continuidade.This study analysed the experience of building social participation in the Unique Health System (Sistema Único de Saúde), having as its study object the Municipal Health Council of Ribeirão Preto, during the period of 1991 - 1998. The theoretical reference was built from the countys redemocratization and the Sanitary Reform, broaching the study object in the dimensions: the Right to Health, Participation, Social Control and Citizenship. The methodology was Case Study, in the qualitative aspect of health research. We sought, from document analysis and interviews with Counsellors and former Municipal Healt Secretaries, through the technique of Thematic Analysis, to identify relations established among the social subjects which compose the Council, projects of interest and the conception on the Right to Health; we sought to point out limits and potencialities of the space of participation for the construction of citizenship. Main limits: the themes are sent to the Council for aprovement only, not allowing previous discussions; the bond between the Municipal Health Fund and the Secretary of Treasure, obstructs Manager and Council of having autonomy in the decision on the use of resources; some segments dont take their pleas to the Council, using other channels; the corporativism of some segments dont allow publicizing projects of interest. As potentiality, we observed that those interviewed have in the Council, the legitimate political forum to discuss and deliberate on the political directions for health in the Municipality, legitimating it as a public space for the construction of Rights and Citizenship. This allowed its functioning, during 8 years, without interruption.
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Hansson, Jonas. "Mind the blues : Swedish police officers' mental health and forced deportation of unaccompanied refugee children." Doctoral thesis, Umeå universitet, Enheten för polisutbildning vid Umeå universitet, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-138923.
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Introduction: Policing is a public health issue. The police often encounter vulnerable populations. Police officers have wide discretionary powers, which could impact on how they support vulnerable populations. In encountering vulnerable populations the police officers are required to be professional; maintaining mental health in the face of challenges is part of professionalism. Their encounters with vulnerable populations might influence their mental health which in turn might influence the way they use their discretion when making decisions. Background/context: Sweden receives more unaccompanied, asylum-seeking refugee children than any other country in Europe. The number of asylum applications for such children increased from 400 in 2004 to 7000 in 2014 to over 35,000 in 2015. These children come to Sweden and apply for asylum without being under the care of their parents or other legal guardian. Some are denied asylum. If they do not return to their country of origin voluntarily the police are responsible for their deportation. The Swedish government wants an increasing number of deportations and wants them carried out with dignity. This thesis is about the police officers’ perceptions of how to interpret the seemingly contradictory demands for more deportations, that is, efficiency; and concerns for human rights during the deportation process, that is, dignity. This is conceptualized using three theoretical frameworks: a) street-level bureaucracy, b) job demand-control-social support model and c) coping. These theoretical frameworks indicate the complexity of the issue and function as constructions by means of which understanding can be brought to the police officers’ perceptions of deportation work involving unaccompanied, asylum-seeking refugee children and how such work is associated to their mental health. Aim: The current research aims to investigate and analyse Swedish police officers’ mental health in the context of deportations of unaccompanied, asylum-seeking refugee children. Methods: This thesis uses both qualitative and quantitative methodology. The qualitative approach comprised interviews conducted to achieve a deeper understanding of the phenomenon of police officers’ perceptions of deportations of unaccompanied, asylum-seeking refugee children. The quantitative method involved the use of validated questionnaires to investigate the association between police officers’ mental health and psychosocial job characteristics and coping. This approach made it possible to study a complex issue in a complex environment and to present relevant recommendations. A total of 14 border police officers were interviewed and 714 police officers responded to a survey. Results: The police officers utilize their wide discretionary powers and perceive that they are doing what is best in the situation, trying to listen to the child and to be aware of the child’s needs. Police officers with experience of deportations of unaccompanied, asylum-seeking refugee children were not found to have poorer mental health than police officers with no such experience. Furthermore, high job demand, low decision latitude, low levels of work-related social support, shift work and being single are associated with poor mental health. Coping moderates the association between mental health and the experience of carrying out deportations of unaccompanied, asylum-seeking, refugee children, and the police officers seem to utilize both emotional and problem-solving coping during the same complex deportation process. Implications / conclusions: The general conclusion reached in this thesis is that if police officers are subject to reasonable demands, have high decision latitude, access to work-related social support, and utilize adaptable coping, the deportation work does not seem to affect their mental health. When police officers meet vulnerable people, they utilize their discretionary powers to deal with seemingly contradictory demands, that is, efficiency and dignity. The executive role in the deportations of unaccompanied, asylum-seeking refugee children and the awareness of dealing with a child threatened with deportation might give rise to activation of a sense of protection, safety and security. Discretion might make it possible to act on this sense of protection, safety and security and to combine efficiency and dignity. Further studies, which integrate cognitive and emotional discretion with coping, need to be undertaken.Introduktion: Polisarbete är i mångt och mycket en folkhälsofråga, något som inte minst blir tydligt i polisers möte med utsatta människor. Poliser har ett stort handlingsutrymme, vilket kan påverka hur de bemöter utsatta människor. I mötet med dessa människor behöver poliserna vara professionella; att ta hand om sin psykiska hälsa när man möts av utmaningar är en del av professionalismen. Att möta utsatta människor kan påverka polisernas psykiska hälsa, som i sin tur kan påverka hur de använder sitt handlingsutrymme när de fattar beslut. Bakgrund: Sverige tar emot fler ensamkommande asylsökande flyktingbarn än något annat land i Europa. Antalet asylansökningar för sådana barn ökade från 400 år 2004 till 7000 år 2014 till över 35 000 år 2015. Dessa barn kommer till Sverige och ansöker om asyl utan sina föräldrar eller annan vårdnadshavare. Somliga av dem nekas asyl. Om de inte återvänder till sitt ursprungsland frivilligt är polisen ansvariga för utvisningen. Den svenska regeringen kräver ett ökande antal verkställigheter av av- och utvisningar samt fastlår att verkställigheterna ska genomföras med respekt för människors värdighet. Denna avhandling handlar om polisers uppfattningar och tolkningar av de till synes motsägelsefulla kraven på att verkställa fler av- och utvisningar, det vill säga effektivitet; och hur man hanterar de mänskliga rättigheterna under utvisningsprocessen, det vill säga värdighet. Detta beskrivs och analyseras med hjälp av tre teoretiska ramverk: a) gräsrotsbyråkrati, b) jobb-krav-kontroll-socialt stödmodellen och c) coping. Dessa teoretiska ramverk visar på arbetsuppgiftens komplexitet och fungerar som utgångspunkt för att skapa förståelse för polisernas uppfattningar av arbetet med att verkställa av- och utvisningar av ensamkommande asylsökande flyktingbarn och hur sådant arbete är associerat med polisernas psykiska hälsa. Syfte: Denna avhandling syftar till att undersöka och analysera svenska polisers psykiska hälsa i relation till av- och utvisningar av ensamkommande asylsökande flyktingbarn. Metod: Både kvalitativ och kvantitativ metod användes i denna avhandling. Det kvalitativa tillvägagångssättet innefattade intervjuer för att uppnå en djupare förståelse för hur poliser uppfattar av- och utvisningar av ensamkommande asylsökande flyktingbarn. Den kvantitativa metoden innebar tillämpning av validerade frågeformulär för att undersöka sambandet mellan polisernas psykiska hälsa och psykosociala jobbkarakteristika samt coping. Detta tillvägagångssätt gjorde det möjligt att studera en komplex fråga i en komplex miljö och att presentera relevanta rekommendationer. Totalt intervjuades 14 gränspoliser och 714 poliser svarade på en enkätundersökning. Resultat: Resultatet visar att poliserna utnyttjar sitt stora handlingsutrymme och uppfattar att de gör det som är bäst i situationen, att de försöker lyssna på barnet och vara medvetna om barnets behov. Poliser med erfarenhet av av- och utvisningar av ensamkommande asylsökande flyktingbarn har inte visat sig ha en sämre psykisk hälsa än poliser utan sådan erfarenhet. Vidare är höga krav och lågt beslutsutrymme på arbetet, låga nivåer av arbetsrelaterat socialt stöd, skiftarbete och singelliv associerat med dålig psykisk hälsa. Coping mildrar effekten på den psykiska hälsan hos de som har erfarenhet av att utföra av- och utvisningar av ensamkommande asylsökande flyktingbarn. Poliserna verkar utnyttja både emotionell och problemlösande coping under en och samma komplexa utvisningsprocess. Slutsats: Den viktigaste slutsatsen i denna avhandling är att om poliser utsätts för rimliga krav, har stort beslutsutrymme, tillgång till arbetsrelaterat socialt stöd och använder sig av anpassningsbar coping, verkar det som att arbetet med av- och utvisningar inte påverkar deras psykiska hälsa. När poliser möter utsatta människor utnyttjar de sitt handlingsutrymme för att hantera de till synes motsägelsefulla kraven, det vill säga effektivitet och värdighet. Den verkställande rollen i av- och utvisningar av ensamkommande asylsökande flyktingbarn och medvetenheten om att hantera ett barn som hotas av utvisning kan ge upphov till en aktivering av känslan att ge skydd, trygghet och säkerhet. Handlingsutrymmet kan göra det möjligt att agera på denna känsla av skydd, trygghet och säkerhet samt att kunna kombinera effektivitet och värdighet. Ytterligare studier, som integrerar kognitivt och känslomässigt handlingsutrymme med coping, behöver emellertid genomföras.
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Nembhard, Kimberly T. "Knowledge of Overdiagnosis and the Decision To Participate in Breast Cancer Screening." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/467.
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In 2014, breast cancer was the second leading cause of death among Canadian women, with women over age 50 years making up 82% of the identified cases. To address this issue, the Ontario Breast Screening Program developed a media campaign that promoted the benefits of mammogram screening, but not the associated risks (i.e., false-positive, false-negative, radiation exposure, and overdiagnosis). This study was designed to determine whether there was a statistically significant relationship between knowledge of overdiagnosis and participation in mammogram screening. This cross-sectional, correlational study used schema theory supported by the effective health communication model. Forty-one women were invited to listen to a brief presentation on the benefits and risks of screening mammograms and then completed a modified Champion Health Belief Model Scale survey. Two sample t tests and logistic regression analyses of the survey scores showed that the data did not support any correlations with education and screening, but did indicate a correlation between overdiagnosis and participation. The less a participant felt that overdiagnosis was a negative consequence, the more likely they were to participate in breast screening. Survey participants also stated that promotions of mammograms should present balanced information about the benefits and risks of screening. The positive social change and policy implications of this study include providing women aged 50-69 years more information on overdiagnosis in mammograms so they are more informed participants in the decision-making process, and educating Ontario government policymakers with information about the barriers that women aged 50-69 years face in getting balanced information on mammography programs.
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Botkins, Elizbeth R. "Three Essays on the Economics of Food and Health Behavior." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu149208205990797.
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Sá, Maria Célia Delduque Nogueira Pires de. "Controle judicial da política pública de vigilância sanitária: a proteção da saúde no Judiciário." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-08122010-140717/.
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A Constituição da República Federativa do Brasil de 1988 elevou a saúde como direito social fundamental e constituiu o Sistema Único de Saúde com competência para as ações e serviços de saúde, incluídas as de vigilância sanitária. As ações e serviços da área formulam-se e implementam-se por intermédio de políticas públicas adotadas pelo Poder Público. As referidas políticas são programas de ação governamental que se valem de normas jurídicas e têm estimulado a reflexão dos juristas, em vista, especialmente, de frequentes decisões judiciais sobre políticas públicas, mais notadamente, nas de caráter social. Em vigilância sanitária há o estabelecimento de políticas públicas, por parte da União, que tem na Agência Nacional de Vigilância Sanitária (Anvisa) seu órgão executor, em nível federal. A Anvisa, para executar a política pública de vigilância sanitária, formula atos que regulam essa atividade. Tais atos, muitas vezes, são questionados judicialmente. Esta pesquisa analisou as decisões judiciais federais, entre os anos de 1999 e 2007, em que a Anvisa figurou no pólo passivo da relação processual, com o intuito de observar se o Poder Judiciário, ao decidir sobre essa importante matéria, leva em conta o código binário Direito Sanitário/Não Direito Sanitário da Teoria dos Sistemas Sociais de Niklas Luhmann ou o ignora, formulando sentenças baseadas em outras fontes que não o Direito Sanitário e a política pública de vigilância sanitária. Concluiu-se que o Poder Judiciário federal, embora pouco versado em matéria de saúde pública, deixa-se influenciar pela compreensão de vigilância sanitária e de risco sanitário e tem julgado, em maioria, a favor da saúdeThe 1988 Constitution of the Federative Republic of Brazil has given health a fundamental social right status and also has created a centralized health system called SUS which is responsible, among other subjects, for health surveillance services. In Brazil, actions and health services are created and implemented as public policies. Those are government actions and programs supported by laws that have been stimulating lawyers to speculate about the subject, notably because of numerous court decisions in public policies, especially those with a social character. In Brazil, health surveillance is jurisdiction of federal government through the National Health Surveillance Agency (Anvisa). This agency in order to implement public policies in health surveillance enforces acts to regulate such activities. However, such acts are often challenged in court. In order to determine if Judiciary decisions takes into account Health Law / Not Health law Niklas Luhmann\'s binary system or simply ignores the subject resulting in sentences based on other sources but Health Law and health surveillance public policy. The conclusion was that Federal Judiciary has decided mostly in favor of health, although not much experienced in public health matters they are influenced by health surveillance and health hazard notions
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Mohamed, Marwa Awad. "“YOU DO IT WITHOUT THEIR KNOWLEDGE”: IS NONCONSENSUAL COMDOM REMOVAL THE NEW PUBLIC HEALTH EMERGENCY?" CSUSB ScholarWorks, 2019. https://scholarworks.lib.csusb.edu/etd/897.
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Background: Sexual consent is often defined as the voluntary agreement to participate in a sexual act, though the differing definitions across and within countries make legal consensus difficult. In recent years, due to popularization through social media, nonconsensual condom removal, termed stealthing, is becoming common, especially among young adults. Yet, little to no empirical evidence exists on this sexual behavior.
Methods: In this exploratory sequential mixed methods approach, we aimed to address the current perception of stealthing among young adults. College students were recruited from general education courses at a medium-sized four- year public university. Focus groups were conducted to understand the current perception of stealthing, including knowledge, perceived influence, and outcome, followed by quantitative assessment of knowledge, attitude, and self-efficacy of sexual consent.
Results: Results demonstrated central theme of health-decision making with associated themes of consent, which further included subthemes of privacy, trust, and violation, followed by consideration of stealthing as sexual assault and social norm and acceptance of stealthing. Quantitative assessment showed that knowledge and awareness of stealthing remains low, though sex differences exist on the perception of stealthing being considered sexual assault; with higher rates among males as compared to females.
Conclusion: The act of stealthing has been popularized in social media. Our results demonstrate that there is a need for health educators to assess the prevalence of such a behavior among young adults and policy makers to assess the legal implications of nonconsensual condom removal.
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Astbury, Ruth A. "What processes will support effective shared decision making when health visitors and parent are planning to improve the wellbeing of babies and children within the context of the Getting It Right For Every Child (GIRFEC) policy framework?" Thesis, University of Stirling, 2014. http://hdl.handle.net/1893/22356.
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Two key policy documents are having an impact on health visiting practice in Scotland: Getting It Right for Every Child (GIRFEC) (2013), which seeks to promote all children’s wellbeing, and The Healthcare Quality Strategy for NHS Scotland (2010) which promotes person-centred care. ‘Shared decision making’ is integral to ‘person-centred care’; however no research studies to date have linked shared decision making with health visitor practice. This thesis reports on a descriptive, qualitative research study, which was conducted in two health board areas in Scotland, in order to explore the processes that support effective shared decision making in health visiting practice within the context of implementing GIRFEC. The design was in three phases and used Elwyn’s Framework, of ‘Choice, Options and Decision Talk’ as a structure (2012). Phase 1 consisted of audio recordings of 2 x health visitor: parent encounters when decisions were being made; Phase 2 consisted of semi-structured interviews with 9 x health visitors and 9 x parents who had made decisions within the last 6 months; Phase 3 involved 3 x focus groups reviewing the findings to date and reflecting on current issues when implementing GIRFEC. The framework method was used for analysis and two additional themes were identified: ‘Issues’ and ‘Relationships’. The health visitors demonstrated that they built up trusting relationships with parents; however there was lack of understanding and application of decision making theory which supports analysis, and an outcome focused approach to person-centred planning. This thesis identifies areas for health visitor practice development.
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Backteman-Erlanson, Susann. "Burnout, work, stress of conscience and coping among female and male patrolling police officers." Doctoral thesis, Umeå universitet, Institutionen för omvårdnad, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-71206.
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Background. Police work is a stressful occupation with frequent exposure to traumatic events and psychological strain from work might increase the risk of burnout. This thesis focuses on patrolling police officers (PPO), who work most of their time in the community and have daily contact with the public. Since police work traditionally is a male coded occupation we assume that there are differences between women and men in burnout as well as experiences from psychosocial work environment. Aim. The overall aim of this thesis is to explore burnout, psychosocial and physical work environment, coping strategies, and stress of conscience when taking gender into consideration among patrolling police officers. Methods. This thesis employs both qualitative and quantitative methods. In Paper I a qualitative approach with narrative interviews was used where male PPO described experiences of traumatic situations when caring for victims of traffic accidents. A convenience sample of nine male PPO from a mid-sized police authority was recruited. Interviews were analyzed using qualitative content analysis. Papers II, III, and IV were based on a cross-sectional survey from a randomly selected sample stratified for gender from all 21 local police authorities in Sweden. In the final sample, 1554 PPOs were invited (778 women, 776 men), response rate was 55% (n=856) in total, 56% for women (n=437) and 53% for men (n=419). The survey included a self-administered questionnaire based on instruments measuring burnout, stress of conscience, psychosocial and physical work environment, and coping. Results. Findings from Paper I were presented in three themes; “being secure with the support system,” “being confident about prior successful actions,” and “being burdened with uncertainty.” Results from Paper II showed high levels of emotional exhaustion (EE), 30% for female PPOs and 26% for male PPOs. High levels of depersonalization (DP) were reported for 52 % of female PPO, corresponding proportions for male were 60%. Multiple logistic regression showed that stress of conscience (SCQ-A), high demand, and organizational climate increased the risk of EE for female PPO. For male PPO stress of conscience (SCQ-A), low control and high demand increased the risk of EE. Independent of gender, stress of conscience (SCQ-A) increased the risk of DP. Psychometric properties of the WOCQ were investigated with exploratory factor analysis and confirmatory factor analysis, a six-factor solution was confirmed. DIF analysis was detected for a third of the items in relation to gender. In Paper IV a block wise hierarchical multiple regression analysis was performed investigating the predictive impact of psychological demand, decision latitude, social support, coping strategies, and stress of conscience on EE as well as DP. Findings revealed that, regardless of gender, risk of EE and DP increased with a troubled conscience amongst the PPO. Conclusion. “Being burdened with uncertainty” in this male-dominated context indicate that the PPO did not feel confident talking about traumatic situations, which might influence their coping strategies when arriving to a similar situation. This finding can be related to Paper II and IV showing that stress of conscience increased the risk of both EE and DP. The associations between troubled conscience and the risk of experiencing both emotional exhaustion and depersonalization indicate that stress of conscience should be considered when studying the influence of the psychosocial work environment on burnout. Results from this study show that the psychosocial work environment is not satisfying and needs improvement for patrolling police officers in Sweden. Further studies including both qualitative and quantitative (longitudinal) methods should be used to improve knowledge in this area to increase conditions for preventive and rehabilitative actions.
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Korchagina, Daria. "Development of a Multi-Criteria Procedure to Inform the Decision on Price and Reimbursement of Orphan Drugs." Thesis, Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLS288.
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Dans le but d’améliorer l’accès au traitement pour les patients souffrant des maladies rares, les gouvernements de certains pays ont mis en place une législation ‘orpheline’ dont le but est d’aider à promouvoir la recherche dans ce secteur. En conséquence, le nombre de médicaments orphelins approuvés a significativement augmenté et continue de croître. Cependant, beaucoup de questions restent encore sans réponses. Les coûts par patients élevés, le manque de connaissance sur les maladies, et d’autres spécificités des médicaments orphelins font obstacle à l’utilisation de méthodes d’évaluations standards. L’objectif de cette étude est d’identifier les critères qui permettraient de déterminer la valeur des médicaments orphelins et les préférences de la société vis-à-vis de ces critères.Dans la première phase de l’étude, un état de l’art du marché des médicaments orphelins a été mené. Les défis associés tant à la recherche & développement qu’à l’évaluation des médicaments pour les maladies rares ont été décrits et classifiés. Une revue de toutes les autorisations de mise sur le marché pour les médicaments orphelins en Europe, ainsi que du marché des médicaments orphelins en France, en Italie, en Angleterre et au Pays de Galles a été réalisée. La disponibilité des médicaments orphelins, leur prix et leur remboursement, ainsi que les détails de l’évaluation par les autorités de santé ont été analysés.Dans la seconde phase de l’étude, une revue de littérature a été effectuée afin d’identifier les déterminants potentiels de la valeur des médicaments orphelins. L’impact de certains de ces attributs - dont le choix a été fait en fonction de la disponibilité des données - sur les prix des médicaments orphelins en France, en Italie, en Angleterre et au Pays de Galles a été exploré à l’aide d’une analyse de régression.Enfin, une enquête en ligne a été menée auprès d’un échantillon représentatif de la population française, afin d’étudier ses préférences relatives à certains attributs, sélectionnés au préalable. La liste de déterminants a été développée en se fondant sur un groupe de discussion et des interviews avec des experts. La méthode de l’enquête a suivi la structure d’un questionnaire à choix discrets et a permis d’estimer les poids relatifs des déterminants étudiés.L’étude a permis d’identifier les caractéristiques des médicaments orphelins qui sont le plus appréciées par la société. Ces résultats pourraient être pris en considération dans la méthode d’évaluation des médicaments orphelins, afin de la rendre plus transparente et robusteIn order to improve the access to treatment for patients suffering from rare diseases, the governments of several countries put in place specific ‘orphan’ legislation aiming at promoting research in the field. In response to these measures, the number of approved orphan drugs has dramatically increased and continues to grow. Nevertheless, a number of issues remain unresolved. Thus, high per-patient costs, poor knowledge of the diseases and other specificities of medicines for rare diseases make it impossible to apply standard methods of health technology assessment to orphan drugs. The objective of the present research was to identify the criteria that determine the value of orphan drugs and study public preferences regarding these criteria.In the first phase of the research, a detailed review was conducted of the current situation on orphan drug market. Challenges related to the development and appraisal of orphan drugs were described and catalogued. A review was carried out of all approvals of orphan drugs in Europe, as well as of orphan drug markets in France, Italy and England and Wales. Orphan drug availability, price and reimbursement status, as well as the details of assessment were analysed.In the second phase, a literature review was conducted to identify potential determinants of orphan drug value. The impact of some of these determinants (choice was based on the availability of data) on orphan drug prices in France, Italy and England and Wales was then explored in a regression analysis.Finally, preferences of French general population in relation to the most relevant determinants of orphan drug value were analysed using an online survey. The list of determinants was developed based on a focus group and expert interviews. The survey was designed as a discrete choice experiment and allowed estimating relative weights of the included determinants.The study allowed identification of orphan drug characteristics that are most valued by the society. Its results may be taken into consideration in drug appraisal process in order to enable a fair assessment and pricing of orphan drugs
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Pathak, Amit. "Forecasting Models to Predict EQ-5D Model Indicators for Population Health Improvement." Ohio University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1480959312370497.
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McFerran, Ethna. "Health economic evaluation of alternatives to current surveillance in colorectal adenoma at risk of colorectal cancer." Thesis, Queen's University Belfast, 2018. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.766286.
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The thesis provides a comprehensive overview of key issues affecting practice, policy and patients, in current efforts for colorectal cancer (CRC) disease control. The global burden of CRC is expected to increase by 60% to more than 2.2 million new cases and 1.1 million deaths by 2030. CRC incidence and mortality rates vary up to 10-fold worldwide, which is thought to reflect variation in lifestyles, especially diet. Better primary prevention, and more effective early detection, in screening and surveillance, are needed to reduce the number of patients with CRC in future1. The risk factors for CRC development include genetic, behavioural, environmental and socio-economic factors. Changes to surveillance, which offer non-invasive testing and provide primary prevention interventions represent promising opportunities to improve outcomes and personalise care in those at risk of CRC. By systematic review of the literature, I highlight the gaps in comparative effectiveness analyses of post-polypectomy surveillance. Using micro-simulation methods I assess the role of non-invasive, faecal immunochemical testing in surveillance programmes, to optimise post-polypectomy surveillance programmes, and in an accompanying sub-study, I explore the value of adding an adjunct diet and lifestyle intervention. The acceptability of such revisions is exposed to patient preference evaluation by discrete choice experiment methods. These preferences are accompanied by evidence generated from the prospective evaluation of the health literacy, numeracy, sedentary behaviour levels, body mass index (BMI) and information provision about cancer risk factors, to highlight the potential opportunities for personalisation and optimisation of surveillance. Additional analysis examines the optimisation of a screening programme facing colonoscopy constraints, highlighting the attendant potential to reduce costs and save lives within current capacity.
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Jabot, Françoise. "L'évaluation des politiques publiques : cadres conceptuel et étude de son utilisation par les décideurs des institutions régionales de santé en France." Thesis, Université de Lorraine, 2014. http://www.theses.fr/2014LORR0201/document.
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Contexte : Malgré une volonté affichée traduite dans des textes et procédures, l’évaluation en France n’est que peu intégrée dans le processus de décision. Pourtant, dans le secteur de la santé confronté à de multiples défis, l’évaluation pourrait être une approche utile à la détermination des choix. L’utilisation de l’évaluation dépend d’une pluralité de facteurs, dont les connaissances produites et leur mode de production, les caractéristiques des décideurs et autres utilisateurs et le contexte sociopolitique et institutionnel de l’évaluation. Objectifs : Les objectifs de ce travail sont d’apprécier l’utilisation de l’évaluation dans les politiques de santé, d’identifier les leviers associés à cette utilisation et d’apprécier la capacité de l’évaluation à satisfaire les attentes et favoriser l’utilisation de ses productions. Méthode : Une revue de littérature a permis d’enrichir la compréhension du concept d’utilisation, d’identifier les facteurs influents et de faire émerger les problématiques associées. Considérant l’évaluation comme un système d’action complexe, un modèle basé sur une approche systémique a été construit et mis à l’épreuve à travers quatre étapes d’analyse des évaluations des plans régionaux de santé publique (PRSP) : (1) analyse globale de 16 évaluations ; (2) lien processus/utilisation dans une région ; (3) résultats à court/moyen terme dans 9 régions ; (4) études de cas approfondies et analyse multicritères dans 5 régions. Résultats : Une première analyse a éclairé les enjeux du contexte et la contribution des PRSP à la cohérence des politiques régionales de santé. L’examen du processus d’évaluation dans une région a montré la relation entre finalités, démarche et utilisations de l’évaluation. L’observation des suites de l’évaluation dans neuf régions a identifié différentes formes d’utilisation et les principaux facteurs intervenant. La dynamique de changement a été appréhendée dans la globalité des interactions entre le contexte, les acteurs et l’évaluation dans cinq régions. Discussion : Les retombées de l’évaluation sont plus à chercher du côté des savoirs accumulés et des évolutions des pratiques que dans des décisions formelles transformant de façon radicale les politiques. Le contexte, la crédibilité de l’évaluation, l’engagement et la motivation des acteurs sont des facteurs déterminants. Des pistes de recherche sont envisagées en vue d’approfondir les conditions du développement des capacités et de la culture d’évaluation, elles-mêmes indispensables à une meilleure exploitation de l’évaluationContext: Despite the willingness showed in texts and procedures, evaluation in France is little integrated in the decision making process. However, in the health sector which faces multiple challenges, evaluation should be a useful approach to select choices. The use of evaluation depends on multiple factors such as, knowledge and its production process, characteristics of decision makers and others users, and the political and institutional context of the evaluation Objective: The objectives were: to assess the use of evaluation on health policies; to identify levers associated with use; to assess the capacity of evaluation to fit with decision-makers needs and to enhance usability. Method: Literature review allowed to enrich the understanding of the concept of use and to identify the main influent factors as well as the related issues. Regarding evaluation as a complex system, a model based on a systemic approach was built and tested in evaluations of regional public health plans (PRSP) in 4 steps: (1) global analysis of 16 evaluations; (2) relation process/use in on region; (3) use at short/medium term in 9 regions; (4) case studies and multicriteria analysis in 5 regions. Results: A first analysis enlighted the context and the contribution of the PRSP to the coherence of regional policies. A deeper process analysis carried out in one region pointed out the relation between final aims, management and evaluation use. The examination of evaluation consequences conducted in nine regions identified different forms of use and the major factors associated with them. The dynamic of change has been apprehended as a whole through the interactions between context, users and evaluation in five regions. Discussion: The effects of evaluation are more obvious in terms of knowledge building and evolution of practice than in radical change of policies. Context, evaluation credibility, actors’ commitment and motivation are key factors. Future research should help to better understand how to foster the culture and the capacities of evaluation. These are important prerequisites to a wider use of evaluation
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Brain, David C. "An economic evaluation of healthcare interventions designed to reduce Clostridium difficile infection." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/100099/1/David_Brain_Thesis.pdf.
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This thesis is a cost-effectiveness analysis of multiple healthcare interventions that are designed to reduce the debilitating hospital acquired infection, Clostridium difficile. In doing so, new evidence that is of use to healthcare decision-makers has been generated and will be used to guide the rational allocation of scarce healthcare dollars.
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Laokri, Samia. "Assessing cost-of-illness in a user's perspective: two bottom-up micro-costing studies towards evidence informed policy-making for tuberculosis control in Sub-saharan Africa." Doctoral thesis, Universite Libre de Bruxelles, 2014. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209273.
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Health economists, national decision-makers and global health specialists have been interested in calculating the cost of a disease for many years. Only more recently they started to generate more comprehensive frameworks and tools to estimate the full range of healthcare related costs of illness in a user’s perspective in resource-poor settings. There is now an ongoing trend to guide health policy, and identify the most effective ways to achieve universal health coverage. The user fee exemptions health financing schemes, which grounded the tuberculosis control strategy, have been designed to improve access to essential care for ill individuals with a low capacity to pay. After decades of functioning and substantial progress in tuberculosis detection rate and treatment success, this thesis analyses the extent of the coverage (financial and social protection) of two disease control programs in West Africa. Learning from the concept of the medical poverty trap (Whitehead, Dahlgren, et Evans 2001) and available framework related to the economic consequences of illness (McIntyre et al. 2006), a conceptual framework and a data collection tool have been developed to incorporate the direct, indirect and intangible costs and consequences of illness incurred by chronic patients. In several ways, we have sought to provide baseline for comprehensive analysis and standardized methodology to allow comparison across settings, and to contribute to the development of evidence-based knowledge.To begin, filling a knowledge gap (Russell 2004), we have performed microeconomic research on the households’ costs-and-consequences-of-tuberculosis in Burkina Faso and Benin. The two case studies have been conducted both in rural and urban resource-poor settings between 2007 and 2009. This thesis provides new empirical findings on the remaining financial, social and ‘healthcare delivery related organizational’ barriers to access diagnosis and treatment services that are delivered free-of-charge to the population. The direct costs associated with illness incurred by the tuberculosis pulmonary smear-positive patients have constituted a severe economic burden for these households living in permanent budget constraints. Most of these people have spent catastrophic health expenditure to cure tuberculosis and, at the same time, have faced income loss caused by the care-seeking. To cope with the substantial direct and indirect costs of tuberculosis, the patients have shipped their families in impoverishing strategies to mobilize funds for health such as depleting savings, being indebted and even selling livestock and property. Damaging asset portfolios of the disease-affected households on the long run, the coping strategies result in a public health threat. In resource-poor settings, the lack of financial protection for health may impose inability to meet basic needs such as the rights to education, housing, food, social capital and access to primary healthcare. Special feature of our work lies in the breakdown of the information gathered. We have been able to demonstrate significant differences in the volume and nature of the amounts spent across the successive stages of the care-seeking pathway. Notably, pre-diagnosis spending has been proved critical both in the rural and urban contexts. Moreover, disaggregated cost data across income quintiles have highlighted inequities in relation to the direct costs and to the risk of incurring catastrophic health expenditure because of tuberculosis. As part of the case studies, the tuberculosis control strategies have failed to protect the most vulnerable care users from delayed diagnosis and treatment, from important spending even during treatment – including significant medical costs, and from hidden costs that might have been exacerbated by poor health systems. To such devastating situations, the tuberculosis patients have had to endure other difficulties; we mean intangible costs such as pain and suffering including stigmatization and social exclusion as a result of being ill or attending tuberculosis care facilities. The analysis of all the social and economic consequences for tuberculosis-affected households over the entire care-seeking pathway has been identified as an essential element of future cost-of-illness evaluations, as well as the need to conduct benefit incidence assessment to measure equity.
This work has allowed identifying a series of policy weaknesses related to the three dimensions of the universal health coverage for tuberculosis (healthcare services, population and financial protection coverage). The findings have highlighted a gap between the standard costs foreseen by the national programs and the costs in real life. This has suggested that the current strategies lack of patient-centered care, context-oriented approaches and systemic vision resulting in a quality issue in healthcare delivery system (e.g. hidden healthcare related costs). Besides, various adverse effects on households have been raised as potential consequences of illness; such as illness poverty trap, social stigma, possible exclusion from services and participation, and overburdened individuals. These effects have disclosed the lack of social protection at the country level and call for the inclusion of tuberculosis patients in national social schemes. A last policy gap refers to the lack of financial protection and remaining inequities with regards to catastrophic health expenditure still occurring under use fee exemptions strategies. Thereby, one year before 2015 – the deadline set for the Millennium Development Goals – it is a matter of priority for Benin and Burkina Faso and many other countries to tackle adverse effects of the remaining social, economic and health policy and system related barriers to tuberculosis control. These factors have led us to emphasize the need for countries to develop sustainable knowledge.
National decision-makers urgently need to document the failures and bottlenecks. Drawing on the findings, we have considered different ways to strengthen local capacity and generate bottom-up decision-making. To get there, we have shaped a decision framework intended to produce local evidence on the root causes of the lack of policy responsiveness, synthesize available evidence, develop data-driven policies, and translate them into actions.
Beyond this, we have demonstrated that controlling tuberculosis was much more complex than providing free services. The socio-economic context in which people affected by this disease live cannot be dissociated from health policy. The implications of microeconomic research on the households’ costs and responses to tuberculosis may have a larger scope than informing implementation and adaptation of national disease-specific strategies. They can be of great interest to support the definition of guiding principles for further research on social protection schemes, and to produce evidence-based targets and indicators for the reduction and the monitoring of economic burden of illness. In this thesis, we have build on prevailing debates in the field and formulated different assumptions and proposals to inform the WHO Global Strategy and Targets for Tuberculosis Prevention, Care and Control After 2015. For us, to reflect poor populations’ needs and experiences, global stakeholders should endorse bottom-up and systemic policy-making approaches towards sustainable people-centered health systems.
The findings of the thesis and the various global and national challenges that have emerged from case studies are crucial as the problems we have seen for tuberculosis in West Africa are not limited to this illness, and far outweigh the geographical context of developing countries.
Keywords: Catastrophic health expenditure, Coping strategies, Cost-of-illness studies, Direct, indirect and intangible costs, Evidence-based Public health, Financial and Social protection for health, Health Economics, Health Policy and Systems, Informed Decision-making, Knowledge translation, People-centered policy-making, Systemic approach, Universal Health Coverage
Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished
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Telemo, Nilsson Sara, and Laurinda Rexha. "When the physical patient becomes digital : A study of the innovation “digital health care center” on the Swedish market." Thesis, Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-32145.
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Object of study: The innovation “Digital health care center” from a multi-level stakeholder’s perspective. Problem: A new technology era has opened up for new kind of innovations. Digital health care centers are a service that recently has been introduced on the Swedish market, which needs further investigation. To be able to better understand, explain and predict future behavior of an innovation the innovation could be theoretical conceptualized and classified. In the specific area of health care, new innovation should preferable be investigated in from a multilevel perspective, including different stakeholders opinions. One if the stakeholders are the customers. If new innovative products and services want to be successful, it required consumers to adopt the product or service, but relatively few studies have focused on the adoption of technology services among customers. Purpose: The purpose of this thesis is to gain a better understanding of the innovation “digital health care center” in Sweden. Research question: How can the innovation “digital health care center” be described through a stakeholder perspective? Method: The empirical data were collected through qualitative semi-structured interviews and a structured quantitative questionnaire. Conclusions: The innovation digital health care center can from a multi-level perspective be described as an innovation that contributes and have an impact on the market and the healthcare industry in many ways. The innovation could be described as a complement to traditional health care. The innovation has influences from different theoretical classes of innovation which means that the innovation cannot be categorized in a specific class. The innovation can be considered successful because it facilitates for the patient.. According to the stakeholder group potential patients, a majority of the respondents thinks that increased availability and time-efficiency would be facilitating factors and reasons for using the service. The innovation is described by the various stakeholders as contributing to a better society. The care becomes more productive, cost effective, more available, and in the broader perspective, the innovation contributes to increased digitalization of the healthcare sector as a whole. There are many new possible fields of application which in the healthcare industry which could develop the innovation further. Strengths and opportunities with the innovation can be considering outweighing weaknesses with the innovation and potential threats of the innovation.
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Castro, Regina Célia Figueiredo. "Comunicação científica na área de Saúde Pública: perspectivas para a tomada de decisão em saúde baseada em conhecimento." Universidade de São Paulo, 2003. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-29082014-152052/.
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Objetivos. Reflexos das transformações sociais promovidas pela Sociedade do Conhecimento são percebidos no contexto da gestão em saúde no Brasil. Apresentam-se referencial teórico sobre essas mudanças, gestão do SUS, sistemas de informação em saúde, produção científica e uso da informação na gestão. Foi analisada a produção científica brasileira em saúde pública como fonte de apoio à tomada de decisão em saúde. Metodologia. Foram feitos estudo exploratório qualitativo e análise documental em três áreas: bases de dados bibliográficas disponíveis na Biblioteca Virtual em Saúde, agendas estaduais de saúde e sites das Secretarias Estaduais de Saúde. Resultados. Os principais resultados foram: as bases de dados LILACS e MEDLINE foram as fontes de apoio mais abrangentes para localizar produção brasileira publicada no país e no exterior, respectivamente; a produção científica brasileira destaca-se nessa área, correspondendo a 39 por cento dos registros da LILACS-SP; as principais instituições produtoras são universidades e organismos governamentais; a produção de saúde pública encontra-se distribuída em revistas de outras áreas da saúde; a internet, já utilizada pelo ministério e pelas secretarias de saúde, seria favorável para disseminação de conhecimento científico para a gestão em saúde. Conclusões e recomendações. A informação científica e técnica disponível poderia apoiar os processos de tomada de decisão, mas o caminho entre sua produção e uso não é linear e precisa ser estimulado. São apresentadas sugestões para promover integração e articulação entre pesquisa científica e decisão política.Objectives. Social changes introduced by Knowledge Society are perceptible in the health management context in Brazil. Literature on these social changes, on National Health System - SUS legislation, on health information systems, on the health scientific production and on its use for decision making was reviewed. Brazilian public health scientific literature as support to health decision making was analyzed. Methods. Qualitative exploratory methods and document analysis were used to study bibliographic databases available at the Virtual Health Library, health agendas and sites of the State Secretaries of Health. Results. The main results were: LILACS and MEDLINE databases were the most comprehensive sources for searching Brazilian public health literature; 39 per cent of LILACS-SP records corresponds to Brazilian public health literature; universities and government institutions are the main producers of public health scientific literature; public health journal articles are published also in journals from other health fields; Internet, which is already being used by Ministry and State Secretaries of Health for communication, could be a favorable environment for dissemination of scientific information for health decision making. Conclusions and recommendations. Available health scientific and technical information could support health decision making processes but the channels between its production and use are not linear and need to be strengthened. Recommendations to improve relationship and interaction between health research and policy were presented.
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Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.
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Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.
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Peixoto, Neto João. "A intervenção sanitária moderna e a quebra da confiança social sobre o risco: atores e pressupostos técnicos e políticos envolvidos na experiência de criação do modelo regulatório paraibano." Universidade Federal da Paraíba, 2011. http://tede.biblioteca.ufpb.br:8080/handle/tede/7265.
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Previous issue date: 2011-06-08Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
This monograph is a overview discussion of the political situation of Paraíba s brazilian state in which the first Paraíba s State Health Surveillance Agency (in portuguese Agência Estadual de Vigilância Sanitária - AGEVISA-PB) was created in 2002, specially all the decision process involved in the implementation of it s Public Health. The main points studied were the decisions, the governors agents, politicians and others interested persons involved on this process. Were highlighted during this study the participation of all agents involved in the early negociation, their interests, as well as their conflicting and cooperanting relationship, the strategies to induce the decisions and the rules that had effect on the action to be made, including the relation among the Executive and Legislative powers, on the State and Federal scope. This study was conducted between the year 2001 e 2002 and followed the influence of the first State Conference of Health Surveilance related to the changes that turned the State Coordination Health Surveillance to Paraíba s State Health Surveillance Agency, besides all the Public Health problems in that age. In this context, we emphasize the discussion about the Health Surveillance and contemporary risk society, as well all the alternatives that could be possible to the State Coordination Health Surveillance to become a agency and meet the demands of the healthcare and economic scenario and political situation of the state. As a consequence, we report the technical and political ways that were followed in the institutional transformation, whose design will be defined by complex processes of negotiation and consensus. The research was funded in large documentary material and interviews with key actors, which allowed empirically unravel the power relations that in a short time, led to the creation of the Paraíba s State Health Surveillance Agency (AGEVISA-PB). As such, it constituted itself as a political-institutional improvement, the first steps toward the discussions and reflections on its implementation, that this work proposes to introduce.
O presente projeto enfoca o estudo sobre o panorama político estadual que permeou a criação da primeira Agência Estadual de Vigilância Sanitária do país, a AGEVISA-PB, em especial todo o processo decisório envolvido na fase de formulação de sua política pública, na Paraíba, quando de sua instituição, no ano de 2002. Priorizaram-se, como terreno de pesquisa, as arenas decisórias, os agentes públicos, os atores políticos e os interesses organizados envolvidos no processo. Foram ressaltados, na abordagem realizada, os registros descritivos quanto à participação dos atores envolvidos nas negociações, seus interesses, bem como as relações conflituosas e de cooperação, as estratégias para influenciar a tomada de decisão e as regras do jogo que influenciaram as alternativas de ação, incluindo as relações entre os Poderes Executivo e Legislativo, em âmbito estadual e federal. O estudo abrange o período entre 2001 e 2002, e destaca os principais aspectos referentes à influência estratégica da I Conferência Estadual de Vigilância Sanitária na trajetória de mudança da então Coordenadoria Estadual para o modelo de agência reguladora de Vigilância Sanitária da Paraíba, além dos graves problemas sanitários estaduais e nacionais que permearam a época. Nesse contexto, ressalta-se a discussão sobre a Vigilância Sanitária contemporânea e a sociedade do risco, bem como sobre as diversas alternativas que possibilitassem à coordenadoria assumir um novo formato institucional, face às exigências do cenário sanitário-econômico e da conjuntura política estadual. Como conseqüência, relata-se os caminhos técnicos e políticos que foram percorridos na transformação institucional, cujo desenho vai ser definido por complexos processos de negociação e consenso. A pesquisa foi subsidiada em amplo material documental e entrevistas com atores privilegiados, o que possibilitou desvendar empiricamente as relações de força que, em um curto espaço de tempo, levaram à criação da Agência Estadual de Vigilância Sanitária da Paraíba, a AGEVISA-PB. Como tal, constituiu-se em um processo político-institucional em aperfeiçoamento, cujos primeiros passos em direção às discussões e reflexões sobre sua implementação, o presente trabalho se propõe a introduzir.