Base de dados : MEDLINE
Pesquisa : SP1.001.002 [Categoria DeCS]
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  1 / 14132 MEDLINE  
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PMID:28207807
Autor:Klitzman R
Endereço:Masters of Bioethics Program, Columbia University, New York, New York, United States of America.
Título:How much is a child worth? Providers' and patients' views and responses concerning ethical and policy challenges in paying for ART.
Fonte:PLoS One; 12(2):e0171939, 2017.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:Infertility treatments remain expensive and in many countries are covered by little, if any, insurance, raising critical questions concerning how patients and providers view and make decisions regarding these challenges. In-depth semi-structured interviews of approximately 1 hour were conducted with 37 IVF providers and 10 patients (17 physicians, 10 other providers and 10 patients), and were systematically analyzed. These data suggest current insurance policies and legislation pose critical ethical and logistical challenges for both patients and providers. These individuals face multiple uncertainties about costs and insurance, related to unclear causes of fertility, treatment length, costs and outcomes, and odds that insurers will cover expenses. Insurers frequently decline to agree to reimbursement beforehand, and decide only afterwards, case-by-case, generating stress. Patients and providers thus may not be able to predict how best to allocate limited resources. Providers may advocate for patients, but are usually unsuccessful. Patients may adopt several strategies: e.g., moving/seeking treatment elsewhere, switching or feeling "stuck" in jobs because of insurance, seeking "free" medications, going into debt, or using funds intended for other purposes. Patients do not perceive and respond to resource limitations as fixed phenomena-i.e., patients do not see treatment simply as "affordable" or not. Rather, patients face quandaries of how much to keep spending-how much a child is worth-and are forced to make complex risk/benefit calculations. Couples can disagree, straining relationships. In sum, these data, the first to explore how providers and patients struggle, view, and make decisions regarding limited insurance and resources for infertility, raise several critical ethical and policy issues. These data suggest that individuals have difficulty translating profoundly life-altering, deeply personal quests for meaning and fulfillment into purely economic terms. These findings thus have important implications for future policy, practice, research, and patient and provider education.
Tipo de publicação: JOURNAL ARTICLE


  2 / 14132 MEDLINE  
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PMID:28742288
Autor:Wonder AH; Martin EK; Jackson K
Endereço:Assistant Professor, Indiana University School of Nursing, Bloomington, IN, USA.
Título:Supporting and Empowering Direct-Care Nurses to Promote EBP: An Example of Evidence-Based Policy Development, Education, and Practice Change.
Fonte:Worldviews Evid Based Nurs; 14(4):336-338, 2017 Aug.
ISSN:1741-6787
País de publicação:United States
Idioma:eng
Resumo:This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.
Tipo de publicação: JOURNAL ARTICLE


  3 / 14132 MEDLINE  
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PMID:28327123
Autor:Eboreime EA; Abimbola S; Obi FA; Ebirim O; Olubajo O; Eyles J; Nxumalo NL; Mambulu FN
Endereço:Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. ejemai.eboreime@wits.ac.za.
Título:Evaluating the sub-national fidelity of national Initiatives in decentralized health systems: Integrated Primary Health Care Governance in Nigeria.
Fonte:BMC Health Serv Res; 17(1):227, 2017 Mar 21.
ISSN:1472-6963
País de publicação:England
Idioma:eng
Resumo:BACKGROUND: Policy making, translation and implementation in politically and administratively decentralized systems can be challenging. Beyond the mere sub-national acceptance of national initiatives, adherence to policy implementation processes is often poor, particularly in low and middle-income countries. In this study, we explore the implementation fidelity of integrated PHC governance policy in Nigeria's decentralized governance system and its implications on closing implementation gaps with respect to other top-down health policies and initiatives. METHODS: Having engaged policy makers, we identified 9 core components of the policy (Governance, Legislation, Minimum Service Package, Repositioning, Systems Development, Operational Guidelines, Human Resources, Funding Structure, and Office Establishment). We evaluated the level and pattern of implementation at state level as compared to the national guidelines using a scorecard approach. RESULTS: Contrary to national government's assessment of level of compliance, we found that sub-national governments exercised significant discretion with respect to the implementation of core components of the policy. Whereas 35 and 32% of states fully met national criteria for the structural domains of "Office Establishment" and Legislation" respectively, no state was fully compliant to "Human Resource Management" and "Funding" requirements, which are more indicative of functionality. The pattern of implementation suggests that, rather than implementing to improve outcomes, state governments may be more interested in executing low hanging fruits in order to access national incentives. CONCLUSIONS: Our study highlights the importance of evaluating implementation fidelity in providing evidence of implementation gaps towards improving policy execution, particularly in decentralized health systems. This approach will help national policy makers identify more effective ways of supporting lower tiers of governance towards improvement of health systems and outcomes.
Tipo de publicação: JOURNAL ARTICLE


  4 / 14132 MEDLINE  
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PMID:28320374
Autor:Podolak I; Kisia C; Omosa-Manyonyi G; Cosby J
Endereço:Brock University, 213-2300 Upper Middle Road W., Oakville, ON, L6M 0T4, Canada. ipodolak@bell.net.
Título:Using a multimethod approach to develop implementation strategies for a cervical self-sampling program in Kenya.
Fonte:BMC Health Serv Res; 17(1):222, 2017 Mar 21.
ISSN:1472-6963
País de publicação:England
Idioma:eng
Resumo:BACKGROUND: Numerous health policy makers/researchers are concerned about the limitations of research being applied to support informed decision/policy making and the implementation of practical solutions. The aim of the Chaguo Letu project (which means our choice in Swahili) was to determine how local decision makers could apply a multimethod approach to make strategic decisions to effectively implement a Cervical Self-Sampling Program in Kenya. METHODS: A multimethod approach, involving participatory action research, scenario based planning, and phenomenology, was applied in conjunction with two tools to identify relevant factors (negative or positive) that could impact Cervical Self-Sampling Program implementation. A total of 107 stakeholders participated in interviews, focus groups, workshops, and informal interactions. Content analysis, an affinity exercise, and impact analysis were used to analyze data and develop robust strategic directions and supporting implementation strategies. RESULTS: A total of 57 factors thought to impact the implementation of the Cervical Self-Sampling Program were identified and grouped into 13 thematic categories. These themes were instrumental in developing 10 strategic directions and 22 implementation strategies deemed necessary to implement a technically viable, politically supported, affordable, logistically feasible, socially acceptable, and transformative Program. CONCLUSIONS: This study made three conclusions: 1) there is political will and a desire to improve cervical screening across Kenya, but in a period of dynamic change resources are constrained; 2) implementing the Program in urban/rural settings is logistically feasible, but the majority of Kenyan women could not afford screening without some form of a subsidy, and 3) self-sampling is perceived to be much more socially acceptable than the current Pap screening process. The Chaguo Letu study went beyond the traditional strategy development process of determining "what" needs to do done by describing in detail "how" the Program should be implemented to be relevant and accessible to all Kenyan women at risk of cervical cancer. This work could potentially facilitate communities of practice and knowledge sharing when addressing other types of health decisions in other low resource settings beyond Kenya.
Tipo de publicação: JOURNAL ARTICLE


  5 / 14132 MEDLINE  
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PMID:28056098
Autor:Houngbo PT; Coleman HL; Zweekhorst M; De Cock Buning T; Medenou D; Bunders JF
Endereço:Ministry of Health, Cotonou, Republic of Benin.
Título:A Model for Good Governance of Healthcare Technology Management in the Public Sector: Learning from Evidence-Informed Policy Development and Implementation in Benin.
Fonte:PLoS One; 12(1):e0168842, 2017.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:Good governance (GG) is an important concept that has evolved as a set of normative principles for low- and middle-income countries (LMICs) to strengthen the functional capacity of their public bodies, and as a conditional prerequisite to receive donor funding. Although much is written on good governance, very little is known on how to implement it. This paper documents the process of developing a strategy to implement a GG model for Health Technology Management (HTM) in the public health sector, based on lessons learned from twenty years of experience in policy development and implementation in Benin. The model comprises six phases: (i) preparatory analysis, assessing the effects of previous policies and characterizing the HTM system; (ii) stakeholder identification and problem analysis, making explicit the perceptions of problems by a diverse range of actors, and assessing their ability to solve these problems; (iii) shared analysis and visioning, delineating the root causes of problems and hypothesizing solutions; (iv) development of policy instruments for pilot testing, based on quick-win solutions to understand the system's responses to change; (v) policy development and validation, translating the consensus solutions identified by stakeholders into a policy; and (vi) policy implementation and evaluation, implementing the policy through a cycle of planning, action, observation and reflection. The policy development process can be characterized as bottom-up, with a central focus on the participation of diverse stakeholders groups. Interactive and analytical tools of action research were used to integrate knowledge amongst actor groups, identify consensus solutions and develop the policy in a way that satisfies criteria of GG. This model could be useful for other LMICs where resources are constrained and the majority of healthcare technologies are imported.
Tipo de publicação: JOURNAL ARTICLE


  6 / 14132 MEDLINE  
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PMID:28655372
Autor:Martin CM
Título:Antibiotic Stewardship: New Frontier, Familiar Journey.
Fonte:Consult Pharm; 32 Suppl A(5):27-32, 2017 May 01.
ISSN:0888-5109
País de publicação:United States
Idioma:eng
Resumo:Recent changes in regulations by the Centers for Medicare & Medicaid Services require long-term care facilities to meet specific requirements on antibiotic stewardship, promoting the appropriate use of antibiotics and antimicrobials. The goal is to improve patient outcomes and decrease the spread of infections caused by multi-drug-resistant organisms. Consultant pharmacists can help facility personnel implement policies and procedures for effective antibiotic stewardship, assist prescribers and facility staff in understanding how to use the facility's antibiogram, find appropriate resources, and provide facility personnel with feedback on their antimicrobial stewardship efforts.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (Anti-Bacterial Agents)


  7 / 14132 MEDLINE  
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PMID:28655371
Autor:Martin CM
Título:Implementing an Antimicrobial Stewardship Program.
Fonte:Consult Pharm; 32 Suppl A(5):18-25, 2017 May 01.
ISSN:0888-5109
País de publicação:United States
Idioma:eng
Resumo:The Centers for Medicare & Medicaid Services is expected to expand requirements for antimicrobial stewardship in nursing facilities during 2016. Many facilities are looking to pharmacists to help them take the initial steps toward developing these coordinated programs to promote the appropriate use of antimicrobials.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (Anti-Bacterial Agents)


  8 / 14132 MEDLINE  
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PMID:28655370
Autor:Martin CM
Título:Antibiotic Stewardship in Long-Term Care: A Call to Action.
Fonte:Consult Pharm; 32 Suppl A(5):10-16, 2017 May 01.
ISSN:0888-5109
País de publicação:United States
Idioma:eng
Resumo:The Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention are focused heavily on curbing the misuse of antibiotics in health care facilities. Regulations governing the management of antibiotics in the nursing facility will likely be changing in the near future, which will put the pharmacist at the forefront of a clinical team that is dedicated to proper antibiotic utilization. Savvy pharmacists are embracing this opportunity to engage long-term care facility staff to improve the care of their residents.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (Anti-Bacterial Agents)


  9 / 14132 MEDLINE  
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PMID:28492268
Título:Beware the anti-science label.
Fonte:Nature; 545(7653):133-134, 2017 05 10.
ISSN:1476-4687
País de publicação:England
Idioma:eng
Tipo de publicação: EDITORIAL


  10 / 14132 MEDLINE  
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PMID:28483011
Autor:Baldwin P
Título:Proposed Medicaid Changes Make Nursing Facilities Nervous.
Fonte:Consult Pharm; 32(5):312, 2017 May 01.
ISSN:0888-5109
País de publicação:United States
Idioma:eng
Tipo de publicação: JOURNAL ARTICLE



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