International Journal of Health Policy and Management最新文献

{"title":"System-Based Interventions to Address Physician Burnout: A Qualitative Study of Canadian Family Physicians' Experiences During the COVID-19 Pandemic.","authors":"Maria Mathews, Samina Idrees, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Judith Belle Brown, Paul Gill, Madeleine McKay, Eric Wong, Leslie Meredith, Lauren Moritz, Sarah Spencer","doi":"10.34172/ijhpm.8166","DOIUrl":"10.34172/ijhpm.8166","url":null,"abstract":"<p><strong>Background: </strong>Medical professionals experienced high rates of burnout and moral distress during the COVID-19 pandemic. In Canada, burnout has been linked to a growing number of family physicians (FPs) leaving the workforce, increasing the number of patients without access to a regular doctor. This study explores the different factors that impacted FPs' experience with burnout and moral distress during the pandemic, with the goal of identifying system-based interventions aimed at supporting FP well-being and improving retention.</p><p><strong>Methods: </strong>We conducted semi-structured qualitative interviews with FPs across four health regions in Canada. Participants were asked about the roles they assumed during different stages of the pandemic, and they were also encouraged to describe their well-being, including relevant supports and barriers. We used thematic analysis to examine themes relating to FP mental health and well-being.</p><p><strong>Results: </strong>We interviewed 68 FPs across the four health regions. We identified two overarching themes related to moral distress and burnout: (1) inability to provide appropriate care, and (2) system-related stressors and buffers of burnout. FPs expressed concern about the quality of care their patients were able to receive during the pandemic, citing instances where pandemic restrictions limited their ability to access critical preventative and diagnostic services. Participants also described four factors that alleviated or exacerbated feelings of burnout, including: (1) workload, (2) payment model, (3) locum coverage, and (4) team and peer support.</p><p><strong>Conclusion: </strong>The COVID-19 pandemic limited FPs' ability to provide quality care to patients, and contributed to increased moral distress and burnout. These findings highlight the importance of implementing system-wide interventions to improve FP well-being during public health emergencies. These could include the expansion of interprofessional team-based models of care, alternate remuneration models for primary care (ie, non-fee-for-service), organized locum programs, and the availability of short-term insurance programs to cover fixed practice operating costs.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"13 ","pages":"8166"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Meso-Level in Quality Improvement: Perspectives From a Maternal-Neonatal Health Partnership in South Africa.","authors":"Helen Schneider, Solange Mianda","doi":"10.34172/ijhpm.2024.7948","DOIUrl":"10.34172/ijhpm.2024.7948","url":null,"abstract":"<p><strong>Background: </strong>Sustained implementation of facility-level quality improvement (QI) processes, such as plan-do-study-act cycles, requires enabling meso-level environments and supportive macro-level policies and strategies. Although this is well recognised, there is little systematic empirical evidence on roles and capacities, especially at the immediate meso-level of the system, that sustain QI strategies at the frontline.</p><p><strong>Methods: </strong>In this paper we report on qualitative research to characterize the elements of a quality and outcome-oriented meso-level, focused on sub/district health systems (DHSs), conducted within a multi-level initiative to improve maternal-newborn health (MNH) in three provinces of South Africa. Drawing on the embedded experience and tacit knowledge of core project partners, obtained through in-depth interviews (39) and project documentation, we analysed thematically the roles, capacities and systems required at the meso-level for sustained QI, and experiences with strengthening the meso-level.</p><p><strong>Results: </strong>Meso-level QI roles identified included establishing and supporting QI systems and strengthening delivery networks. We propose three elements of system capacity as enabling these meso-level roles: (1) leadership stability and capacity, (2) the presence of formal mechanisms to coordinate service delivery processes at sub-district and district levels (including governance, referral and outreach systems), and (3) responsive district support systems (including quality oriented human resource, information, and emergency medical services [EMS] management), embedded within supportive relational eco-systems and appropriate decision-space. While respondents reported successes with system strengthening, overall, the meso-level was regarded as poorly oriented to and even disabling of quality at the frontline.</p><p><strong>Conclusion: </strong>We argue for a more explicit orientation to quality and outcomes as an essential district and sub-district function (which we refer to as meso-level stewardship), requiring appropriate structures, processes, and capacities.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"13 ","pages":"7948"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We Need a Combination of Approaches to Evaluate Health System Resilience Comment on \"Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic\".","authors":"Julia Zimmermann, Marina Karanikolos, Jonathan Cylus, Martin McKee","doi":"10.34172/ijhpm.8564","DOIUrl":"10.34172/ijhpm.8564","url":null,"abstract":"<p><p>Health system resilience has become a desirable health system attribute in the current permacrisis environment. The article by Saulnier and colleagues reviews the literature on health system resilience and refines the concept, pinpointing dimensions of resilience governance that have not reached consensus, or that are missing from the literature. In this commentary we complement the findings by discussing different conceptual frameworks for understanding resilience and introducing resilience testing, a method to assess health system resilience using a hypothetical shock scenario. Resilience testing is a mixed-methods approach that combines a review of existing data with a structured workshop, where health system experts collaboratively assess the resilience of their health system. The new method is proposed as a tool for policy-making, as the results can identify attributes of the current health system that may hinder or boost a resilient response to the next crisis.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"13 ","pages":"8564"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Are African Researchers Left Behind in Global Scientific Publications? - A Viewpoint.","authors":"Juliet Nabyonga-Orem, James Avoka Asamani, Olushayo Olu","doi":"10.34172/ijhpm.2024.8149","DOIUrl":"10.34172/ijhpm.2024.8149","url":null,"abstract":"","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"13 ","pages":"8149"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Launch Price and Clinical Value With Reimbursement Decisions for Anticancer Drugs in China.","authors":"Jing Zhou, Hao Lu, Jay Pan","doi":"10.34172/ijhpm.2024.8150","DOIUrl":"10.34172/ijhpm.2024.8150","url":null,"abstract":"<p><strong>Background: </strong>The potential role played by launch price and clinical value in reimbursement decisions has not been sufficiently established in China. This study aimed to investigate the association of launch price and clinical value with reimbursement decisions for anticancer drugs after the implementation of reimbursement-linked price negotiation in China.</p><p><strong>Methods: </strong>Anticancer drugs approved by the National Medical Products Administration (NMPA) of China from January 2017 to June 2022 were eligible for inclusion. Approval and reimbursement dates of included drug indications were retrieved from publicly available resources. We collected measures of clinical value, including survival, quality of life (QoL), and overall response rate from pivotal clinical trials and calculated treatment price at launch. Univariate and multivariate Cox proportional hazards models were employed to estimate the association between launch price, clinical value, and reimbursement decisions of anticancer drugs in China.</p><p><strong>Results: </strong>The median reimbursement lag was 579 days (interquartile range [IQR]: 402-936) for 93 indications supported by randomized controlled trials and 637 days (IQR: 373-858) for 42 indications supported by single-arm clinical trials. Reimbursement was granted to 60 (65%) and 23 (55%) indications supported by randomized controlled and single-arm clinical trials, respectively. The launch price of anticancer drugs was not associated with reimbursement decisions in multivariate regression analyses. Indications supported by randomized controlled trials with higher clinical value were more likely to be reimbursed (hazard ratio [HR] for survival=1.07, 95% CI: 1.00-1.15, <i>P</i>=.037), while the overall response rate of indications supported by single-arm clinical trials was not associated with the likelihood of being reimbursed (HR=2.09, 95% CI: 0.14-32.28, <i>P</i>=.595).</p><p><strong>Conclusion: </strong>The launch price of anticancer drugs may not have a significant impact on reimbursement decisions, while the implementation of reimbursement-linked price negotiation in China has prioritized anticancer drugs with higher clinical value, but only for indications supported by randomized controlled trials. Efforts are needed to prioritize indications supported by single-arm clinical trials that have higher value during the process of price negotiation.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":" ","pages":"8150"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the County Level Mortality Pattern Variations in Rural Areas of Iran (2006-2016).","authors":"Mehrangiz Rezaee, Nader Tavakoli, Siamak Tahmasbi","doi":"10.34172/ijhpm.2024.8032","DOIUrl":"10.34172/ijhpm.2024.8032","url":null,"abstract":"<p><strong>Background: </strong>Mortality rate in rural areas is a useful measure of the health of the population and the function of the health system, which varies over space and time. The objective of this research is to explore the spatial and temporal variations in the rural mortality rate in Iran at the county level in 2006, 2011, and 2016.</p><p><strong>Methods: </strong>data were gathered from the rural population and mortality statistics published by the Statistical Centre of Iran (SCI) and the National Organization for Civil Registration (NOCR). Global spatial patterns were assessed using the global Moran's I and local clusters through the local Moran's I.</p><p><strong>Results: </strong>Spatial distribution of rural mortality rate shows that during the years under study the number of counties with a lower rate has increased. The counties with rate of less form continuous areas in the southwest, central and east regions. The excess risk map reveals significant variations in both value and extent. Also, the values of Moran's index increased from 0.1848 in 2006 to 0.4041 in 2016, which indicates the strengthening of the cluster spatial pattern of the overall rural mortality rate. Local patterns have undergone substantial changes over space and time.</p><p><strong>Conclusion: </strong>The findings indicate significant spatial and temporal variations in rural mortality rates in Iran. Policy-makers can use this information to plan and enhance healthcare infrastructure in specific counties. The findings serve for evaluating the effectiveness of health policies, enabling policy-makers to make informed decisions, allocate resources efficiently and design targeted interventions for improved public health outcomes.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":" ","pages":"8032"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Adaptation of Digital Health Solutions During the COVID-19 Pandemic in Hungary: A Scoping Review.","authors":"Bence Döbrössy, Edmond Girasek, Zsuzsa Győrffy","doi":"10.34172/ijhpm.7940","DOIUrl":"10.34172/ijhpm.7940","url":null,"abstract":"<p><strong>Background: </strong>Before the pandemic, digital health was merely a potential alternative to established systems of healthcare provision in Hungary. The technology was available but there was no governmental strategy regarding digital health use and development. The legal framework for digital solutions in healthcare was fragmented. COVID-19 created conditions in which digital solutions became the most feasible form of healthcare provision. We present the legislative and policy-making activities of the Hungarian government during the pandemic aimed at enhancing the organised and systematic use of these technologies.</p><p><strong>Methods: </strong>The core method used in our research is a review of legislation using the principles and methods of a systematic literature review. We searched the National Legislation Database for digital health related legislation for the period January 31, 2020 - June 1, 2022. To provide the context for the analysis, other relevant documents were identified through desk research.</p><p><strong>Results: </strong>Although established in 2017, the electronic health records (EHRs) were only widely used after the onset of the pandemic. Hungary used temporary state of emergency regulations to facilitate an increase in the number of teleconsultations. Our search identified 7 pieces of legislation that enabled healthcare providers to put digital solutions to instant use. They defined the conditions healthcare providers must meet for teleconsultations, set what interventions may be done, what can be reimbursed and dealt with security issues. The National Health Informatics Strategy of July 2021 is complex but mainly deals with technical issues. The three basic principles of the strategy are people centeredness, digital transformation and integrated care.</p><p><strong>Conclusion: </strong>Hungarian digital health solutions and policies fare well in international comparison. This is due to the intensive legislative activity of the pandemic period. The National Health Informatics Strategy ensures that the digital health solutions implemented during the pandemic outlive COVID-19.</p>","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"13 ","pages":"7940"},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stakeholders’ Perceived Barriers and Successes of Quality Improvement Programs for Patients With Diabetes Comment on \"Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China\"","authors":"Ana Neumann","doi":"10.34172/ijhpm.2023.7831","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.7831","url":null,"abstract":"Rasooly et al performed a qualitative evaluation to characterize the experiences of 26 stakeholders with the implementation of diabetes-related quality and performance measures delivered in primary healthcare to patients with diabetes in metropolitan China. Results from this cross-sectional investigation identified relevant gaps in primary care delivery for people with diabetes from one major center in China. As diabetes is a prevalent condition worldwide, lessons learned from this research can be useful to guide, refine, and improve quality measurement evaluations in primary care in China and other countries. In this commentary, we comment on the strengths and weaknesses of the study, suggest future directions, and discuss how lessons learned from this research can be helpful to guide, refine, and improve the quality measurement of diabetes care in other countries.","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"23 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139158514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Reformulation Still a Suitable Goal for Sugary Beverage Taxes? A Response to Recent Commentaries","authors":"H. Forde, Tarra L. Penney, Martin White, Jean Adams","doi":"10.34172/ijhpm.2023.8366","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.8366","url":null,"abstract":"","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"22 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139181628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Insights to Advance Political Economy Analysis: A Response to Recent Commentaries","authors":"M. Nannini, M. Biggeri, G. Putoto","doi":"10.34172/ijhpm.2023.8367","DOIUrl":"https://doi.org/10.34172/ijhpm.2023.8367","url":null,"abstract":"","PeriodicalId":14135,"journal":{"name":"International Journal of Health Policy and Management","volume":"365 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139181131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}