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41.
Patricia J. Martens 《Journal of urban health》2012,89(6):925-936
As health equity researchers, we need to produce research that is useful, policy-relevant, able to be understood and applied, and uses integrated knowledge translation (KT) approaches. The Manitoba Centre for Health Policy and its history of working with provincial government as well as regional health authorities is used as a case study of integrated KT. Whether or not health equity research “takes the day” around the decision-making table may be out of our realm, but as scientists, we need to ensure that it is around the table, and that it is understood and told in a narrative way. However, our conventional research metrics can sometimes get in the way of practicality and clear understanding. The use of relative rates, relative risks, or odds ratios can actually be detrimental to furthering political action. In the policy realm, showing the rates by socioeconomic group and trends in those rates, as well as incorporating information on absolute differences, may be better understood intuitively when discussing inequity. Health equity research matters, and it particularly matters to policy-makers and planners at the top levels of decision-making. We need to ensure that our messages are based on strong evidence, presented in ways that do not undermine the message itself, and incorporating integrated KT models to ensure rapid uptake and application in the real world. 相似文献
42.
Jin Yong Lee Sang Jun Eun Minsu Ock Hyun Joo Kim Hyeon-Jeong Lee Woo-Seung Son Min-Woo Jo 《Journal of Korean medical science》2015,30(5):523-532
Although primary care has been recognized as an essential element of the healthcare system, the primary healthcare of Korea has not been highly valued. Listening to the voices of physicians who are engaged in primary care should be the first step for improving the level of primary care in Korea. In this study, we conducted a questionnaire survey of general internists to investigate their perspectives regarding primary care, and which included the evaluation of current primary care, perception of the five, key attributes of primary care, and their opinions regarding the management system of chronic diseases. A total of 466 general internists'' responses were used in this analysis. The results showed that primary care is considered to have an important role, according to general internists, although their evaluation of the overall status of primary care in Korea indicated that it is poor. The respondents also indicated that the functions of coordination and comprehensiveness in primary care, which can be integral for treating patients with chronic diseases, are most vulnerable. Given the high level of agreement regarding the need for a new medical management system for chronic diseases, based on physicians'' autonomy and provided by clinics, establishing a policy encouraging the participation of general internists should be emphasized.
Graphical Abstract
相似文献43.
Rituparna Maiti Vikas Bhatia Biswa Mohan Padhy Debasish Hota 《Indian Journal of Community Medicine》2015,40(4):223-232
The concept of defining essential medicines and establishing a list of them was aimed to improve the availability of affordable medicines for the world''s poor. Access to essential medicines is a major determinant of health outcomes. Several countries have made substantial progress towards increasing access to essential medicines, but access to essential medicines in developing countries like India is not adequate. In this review we have tried to present the Indian scenario in respect to availability and accessibility of essential medicines over last one decade. To enhance the credibility of Indian healthcare system, procurement and delivery systems of essential medicines have to be strengthened through government commitment, careful selection, adequate public sector financing, efficient distribution systems, control on taxes and duties, and inculcating a culture of rational use of medicines in current and future prescribers. 相似文献
44.
45.
The Family Smoking Prevention and Tobacco Control Act (FSPTCA) give the U.S. Food and Drug Administration (FDA) unprecedented power to regulate tobacco products. One of the most significant provisions of the law allows state and local governments to adopt and enforce tobacco control legislation restricting the time, place, and manner (but not the content) of tobacco advertising. However, there is still reluctance among states and localities for mass adoption of laws due to challenges associated with legal feasibility and lack of U.S.-based evidence in effectiveness. The Center for Public Health Systems Science conducted interviews with key tobacco control contacts in 48 states at two time points (2012 and 2014) since the passage of the FSPTCA to assess the influence of the law on point-of-sale policy development in their state tobacco programs. Logistic regression results show that point-of-sale policy importance is growing post-FSPTCA, and that key influencers of this importance are states'' tobacco control histories and environments, including that related to excise taxes and smoke free air policies. The adoption of smokefree and tax policies has become commonplace across the U.S., and the quality and extent of these laws and prevailing political will increasingly impact the ability of states to work in emerging tobacco control policy areas including those directed at the point of sale. 相似文献
46.
Objectives
Since the Cabinet’s decision concerning the Basic Policies 2005, the Japanese government has implemented specific measures to suppress increases in national medical care expenditure. However, we believe that the economic significance of medical care should be quantified in terms of its economic impact on national medical care expenditure. No one has examined the economic impact of all medical institutions in Japan using data from a statement of profits and losses. We used an input–output analysis to quantitatively estimate economic impact of medical care and examined its estimation range with a probabilistic sensitivity analysis.Methods
To estimate the economic impact and economic impact multipliers of all medical institutions in Japan, an input–output analysis model was developed using an input–output table, statement of profits and losses, margin rates, employee income rates, consumption propensity and an equilibrium output model. Probabilistic sensitivity analysis was conducted using a Monte Carlo simulation.Results
Economic impact of medical care in all medical institutions was ¥72,107.4 billion ($661.5 billion). This impact yielded a 2.78-fold return of medical care expenditure with a 95 % confidence interval ranging from 2.74 to 2.90.Conclusion
Economic impact of medical care in Japan was two to three times the medical care expenditure (per unit). Production inducement of medical care is comparable to other industrial sectors that are highly influential toward the economy. The contribution to medical care should be evaluated more explicitly in national medical care expenditure policies. 相似文献47.
Background
China has made remarkable efforts and achievements since its health reform in 2009, yet there are substantial knowledge gaps in the quality of primary health care (PHC) in China. We aimed to assess the quality of PHC in China by analysing hospital admission rates among diabetics, a frequently used quality indicator for PHC.Methods
We obtained data from a nationwide longitudinal survey for 1006, 1472, and 1771 participants with diabetes who were surveyed as part of China Health and Retirement Longitudinal Study in 2011, 2013, and 2015, respectively. We described and analysed primary care coverage and hospital admission rates (proportion of patients with diabetes who were admitted to hospital) to assess the quality of PHC in eastern, central, and western China. Primary care coverage included proportion of patients who received diabetes-related health education, examinations, and treatments. We used logistic regressions to model the changes of primary care coverage and hospital admission rates in 2011–15 by adjusting for sociodemographic variables. Ethical approval is not applicable in this study as we use anonymised secondary data.Findings
Health education coverage decreased significantly in 2011–15 (76·17% in 2011, 73·15% in 2013, and 70·15% in 2015; OR 0·747 [95% CI 0·62–0·90]) whereas the proportion of patients who received diabetic-related examinations and medical treatments remained largely unchanged (78·88% in 2011, 78·35% in 2013, and 81·45% in 2015; OR 1·18 [95% CI 0·95–1·45]). Moreover, the proportion of patients who received diabetic-related examinations in the west was lower than that in the east (OR 0·52 [0·35–0·76]). Diabetes-related hospital admission rates increased from 4·01% in 2011 to 6·08% in 2013 (OR 1·47 [0·97–2·22]), and recurrent hospital admission rates increased from 18·87% in 2011 to 28·45% in 2015 (OR 1·78 [1·44–2·20]). Both diabetes-related admission rates (OR 1·80 [1·13–2·87]) and recurrent hospital admission rates (OR 1·92 [1·50–2·45]) were higher in the west than in the east.Interpretation
Judging by the patient-reported process and outcome indicators studied, quality of PHC has not improved in China between 2011–2015. Continuous evidence-based monitoring, evaluation and reporting of PHC quality are crucial for accomplishing the goals of health-care system reform in China.48.
Background
People with prehypertension are highly likely to develop hypertension and other cardiovascular diseases. Lifestyle modifications may prevent hypertension in patients with prehypertension, but evidence remains scarce in developing countries. This study aimed to investigate whether a community-based intervention could prevent hypertension through lifestyle modifications in people with prehypertension in the rural areas of China.Methods
A community-based quasi-experiment design was applied. Eighteen villages from six townships in Sheyang county, a rural area in eastern China, were randomly sampled. Of these local residents, patients with prehypertension—a systolic blood pressure (SBP) of 120–139 mm Hg or a diastolic blood pressure (DBP) of 80–89 mm Hg—and who were 30–60 years old were screened. Participants from three of the townships (n=206) were randomly assigned to the intervention group, and those from the other three townships (n=250) were assigned to the control group. At the outset, intervention group participants received individual consultations from a community health management team to assess their self-management ability, determine their lifestyle, set goals for a healthier lifestyle, and design individualised action plans. A guideline booklet was provided to intervention group participants, which contained detailed explanations of hypertension, prehypertension, healthy lifestyles and their impacts, and methods to lose weight, cease smoking, and deal with mental pressure. Intervention group participants also received quarterly follow-ups to assess the implementation of action plans, identify difficulties in changing unhealthy lifestyles, and find feasible solutions. In both intervention and control groups, usual care was provided to participants according to national guidelines, and the available resources were the same across the townships. Evaluations were conducted at baseline, and at the end of months 6, 12, 18, and 30. Between-group analyses were performed using repeated measures ANOVA. Written informed consent was obtained from the participants.Findings
At 30 months, 18 participants in the intervention group (n=188) showed progression to hypertension, whereas 47 in the control group (n=234) developed hypertension. This difference between intervention and control groups was statistically significant (9·6 vs 20·1%, p=0·007). Significant changes in DBP (–2·7 vs 0·7 mmHg, p<0·0001), weight (–0·79 vs ?0·66 kg, p=0·029), and daily walking steps (11?500 vs 8000 steps, p<0·0001) were observed between intervention and control groups. No differential effects were found for SBP, drinking, and smoking, with both groups showing substantial improvements.Interpretation
This intervention could prevent hypertension among patients with prehypertension by improving health-related behaviours. This study might be one of the first community-based experiments implemented among people with prehypertension in the rural areas of China. Further investigations are required to assess the sustainability of this intervention.Funding
This study was funded by the Postgraduates Innovation Project of Jiangsu Province (KYZZ15_0267). 相似文献49.
Min Joo Choi Won Suk Choi Hye Seong Jun Yong Choi Jong-Hyun Kim Yae-Jean Kim Eun Young Cho Dong-Hyun Kim Hyesook Park Heeyoung Lee Nam Joong Kim Joon Young Song Hee Jin Cheong Sang Il Kim Kyong Ran Peck 《Journal of Korean medical science》2021,36(23)
BackgroundThis study presents a framework for determining the allocation and distribution of the limited amount of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).MethodsAfter analyzing the pandemic strategies of the major organizations and countries and with a literature review conducted by a core panel, a modified Delphi survey was administered to 13 experts in the fields of vaccination, infectious disease, and public health in the Republic of Korea. The following topics were discussed: 1) identifying the objectives of the vaccination strategy, 2) identifying allocation criteria, and 3) establishing a step-by-step vaccination framework and prioritization strategy based on the allocation criteria. Two rounds of surveys were conducted for each topic, with a structured questionnaire provided via e-mail in the first round. After analyzing the responses, a meeting with the experts was held to obtain consensus on how to prioritize the population groups.ResultsThe first objective of the vaccination strategy was maintenance of the integrity of the healthcare system and critical infrastructure, followed by reduction of morbidity and mortality and reduction of community transmission. In the initial phase, older adult residents in care homes, high-risk health and social care workers, and personal support workers who work in direct contact with coronavirus disease 2019 (COVID-19) patients would be prioritized. Expansion of vaccine supply would allow immunization of older adults not included in phase 1, followed by healthcare workers not previously included and individuals with comorbidities. Further widespread vaccine supply would ensure availability to the extended adult age groups (50–64 years old), critical workers outside the health sector, residents who cannot socially distance, and, eventually, the remaining populations.ConclusionThis survey provides the much needed insight into the decision-making process for vaccine allocation at the national level. However, flexibility in adapting to strategies will be essential, as new information is constantly emerging. 相似文献
50.
ObjectiveTo investigate clinical stem cell research doctors to know their profe ssional training situation, cognition of related policy and satisfaction. MethodsSix grade A hospitals including 23 departments and 128 doctors were investigated by using self made questionnaire. ResultsOf 128 doctors, 53.1% did not participate in the stem cell technology professional training while 27.3% of them were familiar with stem cell management policies and regulations. Age, title, education, hospital, department, years of working in clinical stem cell research, whether participation in training, whether trained in the organization by their hospitals were the influence factors. 32.0% of doctors were satisfied with the current stem cell policy. ConclusionHospitals should encourage doctors to participate in stem cell professional training to increase their professional technology. Hospitals need to organize stem cell policy lectures, propagate the national stem cell policy, standardize physician’s behavior of stem cell clinical trials, and consider doctors’ advice and feedback as reference for relevant policy. 相似文献