Journal of Health Services Research & Policy最新文献

{"title":"Age-varying effects of repeated emergency department presentations for children in Canada","authors":"R. Rosychuk, A. Chen, A. McRae, P. McLane, M. Ospina, X. Joan Hu","doi":"10.1177/13558196221094248","DOIUrl":"https://doi.org/10.1177/13558196221094248","url":null,"abstract":"Objectives Repeated presentations to emergency departments (EDs) may indicate a lack of access to other health care resources. Age is an important predictor of frequent ED use; however, age-varying effects are not generally investigated. This study examines the age-specific effects of predictors on ED presentation frequency for children in Alberta and Ontario, Canada. Methods This retrospective study used population-based data during April 2010 to March 2017. Data were extracted from the National Ambulatory Care Reporting System for children aged <18 who were members of the top 10% of ED users in any one of the fiscal years 2011/2012 to 2015/2016 along with a comparison sample from the bottom 90%. A marginal regression model studied the age-varying associations on the frequency of ED presentations with province, sex, access to primary health care provider (for Ontario only), area of residence and lowest neighbourhood income quintile. Results There were 2,481,172 patients who made 9,229,156 ED presentations. The effects of sex, lowest income quintile, rural residence, access to primary health care provider and province on the frequency of presentations varied by age. Notably, boys go from having more frequent presentations than girls when aged ≤5 (i.e. adjusted intensity ratio [IR]=1.04 at age 5, 95% confidence interval [CI] = 1.03,1.06) to less frequent for ages 8–11 years and beyond 14 (i.e. IR = 0.80 at age 15, 95% CI = 0.78,0.81). Adolescents aged ≥15 without access to a primary care provider had more frequent presentations compared to those with a primary care provider. Conclusions When examining the frequency of ED presentations in children, age-varying effects of predictors should be considered. Our more nuanced examination of age provides insights into how health services might better target programmes for different ages to potentially reduce unnecessary ED use by providing other health care alternatives.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"11 5 1","pages":"278 - 286"},"PeriodicalIF":2.4,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90373608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Processes supporting effective skill-mix implementation in general practice: A qualitative study","authors":"S. Spooner, Imelda McDermott, M. Goff, Damian Hodgson, A. Mcbride, K. Checkland","doi":"10.1177/13558196221091356","DOIUrl":"https://doi.org/10.1177/13558196221091356","url":null,"abstract":"Objectives Health policy and funding initiatives have addressed increasing workloads in general practice through the deployment of clinicians from different disciplinary backgrounds. This study examines how general practices in England operate with increasingly diverse groups of practitioners. Methods Five general practices were selected for maximum variation of the duration and diversity of skill-mix in their workforce. Individual interviews were recorded with management and administrative staff and different types of practitioner. Patient surveys and focus groups gathered patients’ perspectives of consulting with different practitioners. Researchers collaborated during coding and thematic analysis of transcripts of audio recordings. Results The introduction of a wide range of practitioners required significant changes in how practices dealt with patients requesting treatment, and these changes were not necessarily straightforward. The matching of patients with practitioners required effective categorization of health care patients’ reported problem(s) and an understanding of practitioners’ capabilities. We identified individual and organizational responses that could minimize the impact on patients, practitioners and practices of imperfections in the matching process. Conclusions The processes underpinning the redistribution of tasks from GPs to non-GP practitioners are complex. As practitioner employment under the Primary Care Network contracts continues to increase, it is not clear how the necessarily fine-grained adjustments will be made for practitioners working across multiple practices.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"43 1","pages":"269 - 277"},"PeriodicalIF":2.4,"publicationDate":"2022-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74432995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loss associated with subtractive health service change: The case of specialist cancer centralization in England","authors":"G. Black, Victoria J Wood, A. Ramsay, C. Vindrola‐Padros, C. Perry, C. Clarke, C. Levermore, K. Pritchard-Jones, A. Bex, M. Tran, D. Shackley, J. Hines, Muntzer M. Mughal, N. Fulop","doi":"10.1177/13558196221082585","DOIUrl":"https://doi.org/10.1177/13558196221082585","url":null,"abstract":"Objective Major system change can be stressful for staff involved and can result in ‘subtractive change’ – that is, when a part of the work environment is removed or ceases to exist. Little is known about the response to loss of activity resulting from such changes. Our aim was to understand perceptions of loss in response to centralization of cancer services in England, where 12 sites offering specialist surgery were reduced to four, and to understand the impact of leadership and management on enabling or hampering coping strategies associated with that loss. Methods We analysed 115 interviews with clinical, nursing and managerial staff from oesophago-gastric, prostate/bladder and renal cancer services in London and West Essex. In addition, we used 134 hours of observational data and analysis from over 100 documents to contextualize and to interpret the interview data. We performed a thematic analysis drawing on stress-coping theory and organizational change. Results Staff perceived that, during centralization, sites were devalued as the sites lost surgical activity, skills and experienced teams. Staff members believed that there were long-term implications for this loss, such as in retaining high-calibre staff, attracting trainees and maintaining autonomy. Emotional repercussions for staff included perceived loss of status and motivation. To mitigate these losses, leaders in the centralization process put in place some instrumental measures, such as joint contracting, surgical skill development opportunities and trainee rotation. However, these measures were undermined by patchy implementation and negative impacts on some individuals (e.g. increased workload or travel time). Relatively little emotional support was perceived to be offered. Leaders sometimes characterized adverse emotional reactions to the centralization as resistance, to be overcome through persuasion and appeals to the success of the new system. Conclusions Large-scale reorganizations are likely to provoke a high degree of emotion and perceptions of loss. Resources to foster coping and resilience should be made available to all organizations within the system as they go through major change.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"1 1","pages":"301 - 312"},"PeriodicalIF":2.4,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88396979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining organization and provider challenges with the adoption of virtual domestic violence and sexual assault interventions in Alberta, Canada, during the COVID-19 pandemic","authors":"S. Montesanti, Winta Ghidei, Peter H. Silverstone, Lana Wells, Suzanne Squires, Allan Bailey","doi":"10.1177/13558196221078796","DOIUrl":"https://doi.org/10.1177/13558196221078796","url":null,"abstract":"Objectives In Canada, calls to domestic violence and sexual assault hotlines increased during the COVID-19 pandemic as stricter public health restrictions took effect in parts of the country. Moreover, the public health measures introduced to limit the transmission of COVID-19 saw many health providers abruptly pivot to providing services virtually, with little to no opportunity to plan for this switch. We carried out a qualitative research study to understand the resulting challenges experienced by providers of domestic violence and sexual assault support services. Methods Twenty-four semi-structured interviews were conducted to gather in-depth information from service providers and organizational leaders in the Canadian province of Alberta about the challenges they experienced adopting virtual and remote-based domestic violence and sexual assault interventions during the COVID-19 outbreak. Interview transcripts and field notes were analysed using a thematic analysis approach. Results Our findings highlighted multiple challenges organizations, service providers and clients experienced. These included: (1) systemic (macro-level) challenges pertaining to policies, legislation and funding availability, (2) organization and provider (meso-level) challenges related to adapting services and programmes online or for remote delivery and (3) provider perceptions of client (micro-level) challenges related to accessing virtual interventions. Conclusions Equity-focused policy and intersectional and systemic action are needed to enhance delivery and access to virtual interventions and services for domestic violence and sexual assault clients.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"34 1","pages":"169 - 179"},"PeriodicalIF":2.4,"publicationDate":"2022-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81776790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are advanced clinical practice roles in England's National Health Service a remedy for workforce problems? A qualitative study of senior staff perspectives.","authors":"Vari M Drennan,&nbsp;Linda Collins,&nbsp;Helen Allan,&nbsp;Neil Brimblecombe,&nbsp;Mary Halter,&nbsp;Francesca Taylor","doi":"10.1177/13558196211036727","DOIUrl":"https://doi.org/10.1177/13558196211036727","url":null,"abstract":"<p><strong>Objective: </strong>A major issue facing all health systems is improving population health while at the same time responding to both growing patient numbers and needs and developing and retaining the health care workforce. One policy response to workforce shortages has been the development of advanced clinical practice roles. In the context of an English national policy promoting such roles in the health service, we explored senior managers' and senior clinicians' perceptions of factors at the organization level that support or inhibit the introduction of advanced clinical practice roles. The investigation was framed by theories of the diffusion of innovation and the system of professions.</p><p><strong>Methods: </strong>We conducted a qualitative interview study of 39 senior manager and clinicians in 19 National Health Service acute, community, mental health and ambulance organizations across a metropolitan area in 2019.</p><p><strong>Results: </strong>Small numbers of advanced clinical practice roles were reported, often in single services. Four main influences were identified in the development of advanced clinical practice roles: staff shortages (particularly of doctors in training grades) combined with rising patient demand, the desire to retain individual experienced staff, external commissioners or purchasers of services looking to shape services in line with national policy, and commissioner-funded new roles in new ambulatory care services and primary care. Three factors were reported as enabling the roles: finance for substantive posts, evidence of value of the posts, and structural support within the organization. Three factors were perceived as inhibiting developing the roles: confusion and lack of knowledge amongst clinicians and managers, the availability of finance for the roles, and a nervousness (sometimes resistance) to introducing the new roles.</p><p><strong>Conclusions: </strong>While the national policy was to promote advanced clinical practice roles, the evidence suggested there was and would continue to be limited implementation at the operational level. Development scenarios that introduced new monies for such roles reduced some of the inhibiting factors. However, where the introduction of roles required funding to move from one part of a service to another, and potentially from one staff group to another, the growth of these roles was and is likely to be contested. In such scenarios, research and business evidence of relative advantage will be important, as too will be supporters in powerful positions. The paucity of publicly available evidence on the effectiveness of advanced clinical practice roles across the specialties and professions in different contexts requires urgent attention.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"96-105"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39296900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities: A systematic literature review.","authors":"Frédérique Dupuis,&nbsp;Julien Déry,&nbsp;Fabio Carlos Lucas de Oliveira,&nbsp;Ana Tereza Pecora,&nbsp;Rose Gagnon,&nbsp;Katherine Harding,&nbsp;Chantal Camden,&nbsp;Jean-Sébastien Roy,&nbsp;Josiane Lettre,&nbsp;Anne Hudon,&nbsp;Marie Beauséjour,&nbsp;Anne-Marie Pinard,&nbsp;Brenna Bath,&nbsp;Simon Deslauriers,&nbsp;Marie-Ève Lamontagne,&nbsp;Debbie Feldman,&nbsp;François Routhier,&nbsp;François Desmeules,&nbsp;Luc J Hébert,&nbsp;Jordan Miller,&nbsp;Angel Ruiz,&nbsp;Kadija Perreault","doi":"10.1177/13558196211065707","DOIUrl":"https://doi.org/10.1177/13558196211065707","url":null,"abstract":"<p><strong>Objective: </strong>Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities.</p><p><strong>Methods: </strong>We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted.</p><p><strong>Results: </strong>Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy (<i>n</i> = 11), occupational therapy (<i>n</i> = 2), prosthetics (<i>n</i> = 1), exercise physiology (<i>n</i> = 1) and multidisciplinary (<i>n</i> = 4) services. The methodological quality varied (<i>n</i> = 10 high quality, <i>n</i> = 6 medium, <i>n</i> = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services.</p><p><strong>Conclusions: </strong>This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"157-167"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39778528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Person-centred care and measurement: The more one sees, the better one knows where to look.","authors":"Brendan McCormack","doi":"10.1177/13558196211071041","DOIUrl":"https://doi.org/10.1177/13558196211071041","url":null,"abstract":"Determining the quality of a health system is a complex and challenging endeavour. The variety of perspectives needed to determine quality means that increasingly complex measurement frameworks are often employed. Providing the best possible health care has always been a priority for health system leaders, individual professions and individual professionals. But the importance and significance of measuring quality has increased since the evolution of quality-improvement methodologies for health-care quality standardisation in the 1990s. Audit and feedback systems evolved into quality-control methods with the increased industrialisation of health systems. As the patient voice became increasingly important, with the rise in advocacy groups and patient-representative organisations, the focus on controlling the quality of services through a managerialist ideology was challenged. Broader, more inclusive, approaches to quality were embraced. Quality-improvement methodologies aim to adopt an inclusive approach to ongoing quality enhancement, ensuring that services are continuously developed and improved. This evolutionary context is important when considering the measurement methods that dominate health systems. To some extent, it could be argued that while health care cultures have shifted their focus from one of control to improvement, approaches to measurement continue to privilege standardised, quantifiable data and information that can be used for quality standardisation. Despite more than 30 years of developments in patient-centred and then person-centred care, the focus on quantitative measurement has continued to dominate, even though it does little to inform stakeholders about the person-centredness of a health system. The person-centred care movement is not new in health care and there are some who would argue that other approaches, such as relationship-centred care, have superseded person-centredness. The lack of concept clarification and theory-driven methodologies by researchers in the field has done little to help this situation. This failure has also been reflected in approaches to measurement and evaluation. The paper by Cribb in this issue of the Journal of Health Services Research & Policy highlights this problem precisely, that is, the interchangeable use of patientand person-centred care and a lack of definition of either! In 2017, Dewing and McCormack highlighted the problem of researchers evaluating person-centredness without defining what they mean. After more than 20 years of research in this field, including the publication of concepts, models, theories and frameworks, it is unacceptable not to present a clear definition as a basis of an evaluation methodology. This lack of precision carries on through the focus on person-centred care as an isolated activity associated with providing care to patients – as if somehow person-centred care practices can be isolated from the context in which they exist. Previously, Laird et al. argue","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"85-87"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39863423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An evaluation of five regional health information technology-based programmes to improve health and social care coordination: A quasi-experimental controlled before/after mixed design.","authors":"Louis-Rachid Salmi,&nbsp;Tamara Roberts,&nbsp;Thomas Renaud,&nbsp;Sophie Buffeteau,&nbsp;Sandrine Cueille,&nbsp;Emmanuelle Fourneyron,&nbsp;Aurélie Gaillard,&nbsp;Maelys Abraham,&nbsp;Nora Arditi,&nbsp;Mathieu Castry,&nbsp;Fabien Daniel,&nbsp;N'deye Fatou N'gom,&nbsp;Orlane Guéry,&nbsp;Yannick L'Horty,&nbsp;Stéphane Pincemail,&nbsp;Sonia Purgues,&nbsp;Franz Thiessard,&nbsp;Viviane Ramel,&nbsp;Emmanuel Langlois,&nbsp;Florence Saillour-Glénisson,&nbsp;Matthieu Sibé,&nbsp;Jérôme Wittwer","doi":"10.1177/13558196211065704","DOIUrl":"https://doi.org/10.1177/13558196211065704","url":null,"abstract":"<p><strong>Objectives: </strong>Health information technology (HIT) can help coordinate health and social actors involved in patients' pathways. We assess five regional HIT-based programmes ('<i>Territoires de Soins Numériques</i>' or TSN) introduced in France, covering the period 2012-2018.</p><p><strong>Methods: </strong>This was a quasi-experimental controlled before/after mixed design. We used data from the French National Health Insurance database, qualitative and quantitative surveys, and information extracted from project documents and databases. We assessed the impact of TSN using four main impact indicators: emergency room visits, unplanned hospitalizations, avoidable hospitalizations and rehospitalization within 30 days. We also collected qualitative and secondary quantitative data covering perceived needs, knowledge, use, satisfaction, adoption and understanding of projects, pathway experience, impact on professional practices and appropriateness of hospitalizations.</p><p><strong>Results: </strong>TSN implemented a heterogeneous mix of HIT. Implementation was slower than expected and was not well documented. Users perceived the HIT as having a positive but weak overall effect. There were no significant differences in trends for the main impact indicators, nor on the appropriateness of hospitalizations, but favourable trends on secondary polypharmacy indicators.</p><p><strong>Conclusions: </strong>If similar innovations take place in future, they should be based on a logical framework that defines causal, measurable links between services provided and expected impacts.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"122-132"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39916595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The contribution of professions to the governance of integrated care: Towards a conceptual framework based on case studies from Denmark.","authors":"Viola Burau,&nbsp;Ellen Kuhlmann,&nbsp;Loni Ledderer","doi":"10.1177/13558196211055652","DOIUrl":"https://doi.org/10.1177/13558196211055652","url":null,"abstract":"<p><strong>Objective: </strong>Good governance of integrated care is key to better health care, but we know little about how professions can help make this happen. Our aim is to introduce a conceptual framework to analyse how professions contribute to the governance of integrated care, and to apply the framework to a secondary analysis of selected case studies from Denmark.</p><p><strong>Methods: </strong>We developed a framework, which identified the <i>what</i>, <i>how</i> and <i>why</i> of the contribution professions make to the governance of integrated care. We included five qualitative Danish studies, using coordination as an indicator of integrated care. We adopted a thematic approach in our analysis, combining deductive and inductive elements.</p><p><strong>Results: </strong>Health professions engage in highly diverse activities, which fall into closely connected clusters of more formal or more informal coordination. Professions apply many different adaptive mechanisms at different levels to fit coordination into local contexts. Professions are driven by interlocking rationales, where a common focus on patients connects organizational and professional concerns.</p><p><strong>Conclusions: </strong>Our analytical framework emerges as a useful tool for analysis. The contribution of professions to the governance of integrated care needs greater attention in health policy implementation as it can promote more effective governance of integrated care.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"106-113"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39747557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to early detection and management of oral cancer in the Asia Pacific region.","authors":"Sin Wi Ng,&nbsp;Sharifah Nur Syamim Syed Mohd Sobri,&nbsp;Rosnah Binti Zain,&nbsp;Thomas George Kallarakkal,&nbsp;Rahmi Amtha,&nbsp;Felix A Wiranata Wong,&nbsp;Jyotsna Rimal,&nbsp;Callum Durward,&nbsp;Chanbora Chea,&nbsp;Ruwan Duminda Jayasinghe,&nbsp;Patravoot Vatanasapt,&nbsp;Nor Saleha Binti Ibrahim Tamin,&nbsp;Lai Choo Cheng,&nbsp;Siti Mazlipah Binti Ismail,&nbsp;Chher Tepirou,&nbsp;Zainal Ariff Bin Abdul Rahman,&nbsp;Senthilmani Rajendran,&nbsp;Jananezwary Kanapathy,&nbsp;Chee Sun Liew,&nbsp;Sok Ching Cheong","doi":"10.1177/13558196211053110","DOIUrl":"https://doi.org/10.1177/13558196211053110","url":null,"abstract":"<p><strong>Objective: </strong>Oral cancer is amenable to early detection but remains a prominent cause of mortality in the Asia Pacific region. This study aimed to identify barriers to early detection and management of oral cancer in the Asia Pacific region.</p><p><strong>Methods: </strong>A mixed-methods approach was employed triangulating findings from a survey and focus groups. The survey was conducted among seven representative members of the Asia Pacific Oral Cancer Network (APOCNET) across six countries. Focus groups were conducted to gain deeper insights into the findings of the survey.</p><p><strong>Results: </strong>The identified barriers were a lack of national cancer control strategies and cancer registries and the limited availability of trained health care professionals. Overcoming these challenges in the Asia Pacific region where resources are scarce will require collaborative partnerships in data collection and novel approaches for continuous professional training including eLearning. Further, to overcome the lack of trained health care professionals, innovative approaches to the management of oral potentially malignant lesions and oral cancer including telemedicine were suggested.</p><p><strong>Conclusion: </strong>The findings of this study should be taken into account when charting national cancer control plans for oral cancer and will form the basis for future collaborative studies in evaluating effective measures to improve oral cancer detection and management in low- and middle-income countries.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"133-140"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39713011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}