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Atun RA Kyratsis I Jelic G Rados-Malicbegovic D Gurol-Urganci I 《Health policy and planning》2007,22(1):28-39
Most transition countries in Central and Eastern Europe and Central Asia are engaged in health reform initiatives aimed at introducing primary health care (PHC) centred on family medicine to enhance performance of their health systems. But, in these countries the introduction of PHC reforms has been particularly challenging; while some have managed to introduce pilots, many have failed to these scale up. Using an innovation lens, we examine the introduction and diffusion of family-medicine-centred PHC reforms in Bosnia and Herzegovina (BiH), which experienced bitter ethnic conflicts that destroyed much of the health systems infrastructure. The study was conducted in 2004-05 over a 18-month period and involved both qualitative and quantitative methods of inquiry. In this study we report the findings of the qualitative research, which involved in-depth interviews in three stages with key informants that were purposively sampled. In our research, we applied a proprietary analytical framework which enables simultaneous and holistic analysis of the context, the innovation, the adopters and the interactions between them over time. While many transition countries have struggled with the introduction of family-medicine-centred PHC reforms, in spite of considerable resource constraints and a challenging post-war context, within a few years, BiH has managed to scale up multifaceted reforms to cover over 25% of the country. Our analysis reveals a complex setting and bidirectional interaction between the innovation, adopters and the context, which have collectively influenced the diffusion process. Family-medicine-centred PHC reform is a complex innovation-involving organizational, financial, clinical and relational changes-within a complex adaptive system. An important factor influencing the adoption of this complex innovation in BiH was the perceived benefits of the innovation: benefits which accrue to the users, family physicians, nurses and policy makers. In the case of BiH, policies or the innovation are not simply disseminated, but rather assimilated into the health system. The assimilation and implementation of the new PHC model relied on the consensus of a diverse group of adopters; the changes brought by the reforms were aligned with the expectations of the adopters: this created a 'receptive context' for adoption and diffusion of the innovation. The new family-medicine-centred PHC service model had a major impact on professional identity, inter-professional relationships and organizational routines. The post-conflict context was perceived as an opportunity to introduce the new model and implement transformational change, while the complex government structure meant the process of diffusion was as important as the innovation itself. In BiH, a holistic approach-comprising multifaceted and simultaneous interventions at multiple levels of the health system-reduced 'policy resistance' and enhanced the adoption and diffusion of the PHC reforms. 相似文献
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Frano Vu
kovi Jasminka Kriti Ivan Gudelj Maria Teruel Toma Keser Marija Pezer Maja Pu
i‐Bakovi Jerko tambuk Irena Trbojevi‐Akma
i Clara Barrios Tamara Pavi Cristina Menni Youxin Wang Yong Zhou Liufu Cui Haicheng Song Qiang Zeng Xiuhua Guo Bernardo A. Pons‐Estel Paul McKeigue Alan Leslie Patrick Olga Gornik Tim D. Spector Miroslav Harja
ek Marta Alarcon‐Riquelme Mariam Molokhia Wei Wang Gordan Lauc 《Arthritis \u0026amp; Rheumatology》2015,67(11):2978-2989
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Sonia K. Makhija Daniel A. Shugars Gregg H. Gilbert Mark S. Litaker James D. Bader Rebecca Schaffer Valeria V. Gordan D. Brad Rindal Daniel J. Pihlstrom Rahma Mungia Cyril Meyerowitz 《Journal of the American Dental Association (1939)》2017,148(12):922-929
Background
A lesion on an occlusal tooth surface with no cavitation and no radiographic radiolucency but in which caries is suspected owing to surface roughness, opacities, or staining can be defined as a suspicious occlusal carious lesion (SOCL). The authors' objective was to quantify the characteristics of SOCLs and their relationship to lesion depth and activity after these lesions were opened surgically.Methods
Ninety-three dentists participated in the study. When a consenting patient had an SOCL, information was recorded about the tooth, lesion, treatment provided, and, if the SOCL was opened surgically, its lesion depth. The Rao-Scott cluster-adjusted χ2 test was used to evaluate associations between lesion depth and color, roughness, patient risk, and luster.Results
The authors analyzed 1,593 SOCLs. Lesion color varied from yellow/light brown (40%) to dark brown/black (47%), with 13% other colors. Most (69%) of SOCLs had a rough surface when examined with an explorer. Over one-third of the SOCLs (39%) were treated surgically. Of the 585 surgically treated SOCLs, 61% had dentinal caries. There were statistically significant associations between lesion depth and color (P = .03), luster (P = .04), and roughness (P = .01). The authors classified 52% of the patients as being at elevated caries risk. The authors found no significant associations between lesion depth and patient risk (P = .07).Conclusions
Although statistically significant, the clinical characteristics studied do not provide accurate guidance for making definitive treatment decisions and result in high rates of false positives.Practical Implications
Given that 39% of the opened lesions did not have dentinal caries or were inactive, evidence-based preventive management is an appropriate alternative to surgical intervention. 相似文献107.
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Response to the letter to the editor: 1q gain is a frequent finding in preoperatively treated Wilms tumors,but of limited prognostic value for risk satisfaction in the SIOP2009/Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) trial 下载免费PDF全文