Collaborative health service planning: A stakeholder analysis with social network analysis to develop a community pharmacy service.

BACKGROUND: Stakeholder participation optimizes health planning, fostering the acceptability and integration of new health services. Collaborative approaches may help overcome existing challenges in the development, implementation and evaluation of community pharmacy services (CPSs). Stakeholder analyses lay the foundation for building collaboration in the integrated delivery of health care. OBJECTIVES: This stakeholder analysis was performed to organize a collaborative initiative to develop a CPS aimed at preventing cardiovascular diseases in Andalucía (Spain). It aimed to identify stakeholders, differentiate/categorize them, and analyze stakeholder relationships. METHOD: Stakeholders were identified using the snowballing technique. To differentiate/categorize stakeholders and analyze the relationships (i.e., collaboration) an online web-based questionnaire was sent to 186 stakeholders. Stakeholders were asked for: (1) their influence, interest and attitude toward the initiative; (2) stakes/interests; (3) capacity to contribute to the initiative; (4) desire for involvement; (5) concerns; (6) whom they considered a key stakeholder; and (7) the level of collaboration they had with other stakeholders. Data analysis combined descriptive qualitative content analysis, descriptive quantitative analysis and social network analysis. RESULTS: Of the 186 stakeholders approached, 96 (51.6%) participated. The identification process yielded 217 stakeholders (individuals, organizations or collectives), classified into 10 groups. Fifty-seven stakeholders were considered critical to the intended initiative. Most participant stakeholders supported the initiative and were willing to collaborate in the development of the CPS. Public health and science were the main driving interests. A collaboration network existed between the 96 stakeholders. CONCLUSION: This study revealed the magnitude of the social system surrounding the development of a CPS aimed at preventing cardiovascular disease. A large array of stakeholders was identified and analyzed, and a group of critical stakeholders selected. Stakeholder characteristics such as attitude toward the initiative, potential contribution, desire for involvement, and the existing collaboration network, provided complementary information that was helpful for planning the process and stakeholder engagement.

Rehabilitation in Malaysia.

This article reviews the epidemiology, rehabilitation intervention strategies, and rehabilitation resources for persons with disabilities (PWD) in Malaysia. Currently, the registered number of PWD is 409,269 individuals, 1.3% of the total population, which is far less than the World Health Organization estimation of 10%. The rehabilitation implementation strategies include health policies, health promotion, and prevention programs. Health-related services for PWD are provided by many government agencies, including health, welfare, education, manpower, housing, and the private sector and nongovernment organizations. It is hoped national health programs can ensure special care and rehabilitation for PWD, optimizing self-reliance and social integration.

The evolution of New Zealand's health workforce policy and planning system: a study of workforce governance and health reform.

INTRODUCTION: While considerable attention has been given to improving health workforce planning practice, few articles focus on the relationship between health workforce governance and health reform. By outlining a sequence of health reforms, we reveal how New Zealand's health workforce governance and practices came under pressure, leading to a rethink and the introduction of innovative approaches and initiatives. CASE DESCRIPTION: New Zealand's health system was quite stable up to the late 1980s, after which 30 years of structural and system reform was undertaken. This had the effect of replacing the centralised medically led health workforce policy and planning system with a market-driven and short-run employer-led planning approach. The increasing pressures and inconsistencies this approach produced ultimately led to the re-centralisation of some governance functions and brought with it a new vision of how to better prepare for future health needs. While significant gain has been made implementing this new vision, issues remain for achieving more effective innovation diffusion and improved integrated care orientations. DISCUSSION AND EVALUATION: The case reveals that there was a failure to consider the health workforce in almost all of the reforms. Health and workforce policy became increasingly disconnected at the central and regional levels, leading to fragmentation, duplication and widening gaps. New Zealand's more recent workforce policy and planning approach has adopted new tools and techniques to overcome these weaknesses that have implications for the workforce and service delivery, workforce governance and planning methodologies. However, further strengthening of workforce governance is required to embed the changes in policy and planning and to improve organisational capabilities to diffuse innovation and respond to evolving roles and team-based models of care. CONCLUSION: The case reveals that disconnecting the workforce from reform policy leads to a range of debilitating effects. By addressing how it approaches workforce planning and policy, New Zealand is now better placed to plan for a future of integrated and team-based health care. The case provides cues for other countries considering reform agendas, the most important being to include and consider the health workforce in health reform processes.

[Health Planning and Evaluation: antagonism versus collaboration]. / Planejamento e Avaliação em Saúde: entre antagonismo e colaboração.

The authors analyze the relations between two subareas of Collective Health - Planning and Evaluation - through a bibliometric study of articles, theses, and dissertations published from 1980 to 2016. The overall production on Evaluation exceeds that of Planning, particularly since the 2000s. The capacity to influence health sector administration appears to drive the dispute between the two subareas. Both have theoretical and methodological resources to overcome their reductions under the instrumental logic of so-called managerialism, as well as to consolidate themselves as devices for reflection and change.

Analisamos as relações entre duas subáreas da Saúde Coletiva - Planejamento e Avaliação - por meio de estudo bibliométrico de artigos, teses e dissertações, no período entre 1980 e 2016. A produção global relativa à Avaliação supera aquela do Planejamento, com predomínio acentuado a partir de meados da década de 2000. A capacidade de influenciar a gestão do setor Saúde parece impelir a disputa entre as duas subáreas. Considera-se que ambas têm recursos teóricos e metodológicos para superar suas reduções pela lógica instrumental do chamado gerencialismo, e se firmarem como dispositivos de reflexão e mudança.

Analizamos las relaciones entre dos subáreas de la Salud Colectiva -Planificación y Evaluación- mediante un estudio bibliométrico de artículos, tesis y disertaciones, durante el período entre 1980 y 2016. La producción global relativa a la Evaluación supera a la de la Planificación, con un predominio acentuado a partir de mediados de la década del 2000. La capacidad de influenciar en la gestión del sector salud parece impulsar la disputa entre las dos subáreas. Se considera que ambas tienen recursos teóricos y metodológicos para superar sus reducciones por la lógica instrumental del denominado gerencialismo, y se afianzan como dispositivos de reflexión y cambio.

Evolving Federal and State Health Care Policy: Toward a More Integrated and Comprehensive Care-Delivery System for Children With Medical Complexity.

Irrespective of any future changes in federal health policy, the momentum to shift from fee-for-service to value-based payment systems is likely to persist. Public and private payers continue to move toward alternative payment models that promote novel care-delivery systems and greater accountability for health outcomes. With a focus on population health, patient-centered medical homes, and care coordination, alternative payment models hold the potential to promote care-delivery systems that address the unique needs of children with medical complexity (CMC), including nonmedical needs and the social determinants of health. Notwithstanding, the implementation of care systems with meaningful quality measures for CMC poses unique and substantive challenges. Stakeholders must view policy options for CMC in the context of transformation within the overall health system to understand how broader health system changes impact care delivery for CMC.

Building Professionalism Through Management Training: New England Public Health Training Center's Low-Cost, High-Impact Model.

CONTEXT: Evolving practices, accreditation, and priorities established in Public Health 3.0 are adding to the long-identified need for management training among public health practitioners. PROGRAM: The New England Public Health Training Center is addressing this need with a flexible, open-source, 16-topic training program. The program is designed to build competencies for current and future managers, preparing them for their day-to-day tasks and for the kinds of adaptation suggested by Public Health 3.0 advocates. IMPLEMENTATION: The training program uses live expert instructors for 10 webinars and 2 in-person trainings. Experts have also created the content for multiple self-paced E-Learnings that trainees undertake in addition to the instructor-led sessions. A webinar platform with breakout rooms and an advanced learning management system allows for online discussion and mentor interaction. The course has now been offered, evaluated, and modified 3 times, and the materials are available for noncommercial use by the public health community. EVALUATION: Using the Kirkpatrick training evaluation model, the recent cohort was satisfied (87.5%) with the training, reported identifying actions to apply information learned to their work (85.8%), and experienced statistically significant knowledge gains. Earlier trainees reported work-related behavior change. DISCUSSION: Management training offers the hope of increasing professionalism; creating better, more effective workplaces and programs; and preparing practitioners for an evolving public health landscape. Early results indicate that NEPHTC's program, Managing Effectively in Today's Public Health Environment, is a useful tool in realizing that hope.

Planejamento e Avaliação em Saúde: entre antagonismo e colaboração / Health Planning and Evaluation: antagonism versus collaboration / Planificación y Evaluación en Salud: entre el antagonismo y la colaboración

Resumo: Analisamos as relações entre duas subáreas da Saúde Coletiva - Planejamento e Avaliação - por meio de estudo bibliométrico de artigos, teses e dissertações, no período entre 1980 e 2016. A produção global relativa à Avaliação supera aquela do Planejamento, com predomínio acentuado a partir de meados da década de 2000. A capacidade de influenciar a gestão do setor Saúde parece impelir a disputa entre as duas subáreas. Considera-se que ambas têm recursos teóricos e metodológicos para superar suas reduções pela lógica instrumental do chamado gerencialismo, e se firmarem como dispositivos de reflexão e mudança.

Abstract: The authors analyze the relations between two subareas of Collective Health - Planning and Evaluation - through a bibliometric study of articles, theses, and dissertations published from 1980 to 2016. The overall production on Evaluation exceeds that of Planning, particularly since the 2000s. The capacity to influence health sector administration appears to drive the dispute between the two subareas. Both have theoretical and methodological resources to overcome their reductions under the instrumental logic of so-called managerialism, as well as to consolidate themselves as devices for reflection and change.

Resumen: Analizamos las relaciones entre dos subáreas de la Salud Colectiva -Planificación y Evaluación- mediante un estudio bibliométrico de artículos, tesis y disertaciones, durante el período entre 1980 y 2016. La producción global relativa a la Evaluación supera a la de la Planificación, con un predominio acentuado a partir de mediados de la década del 2000. La capacidad de influenciar en la gestión del sector salud parece impulsar la disputa entre las dos subáreas. Se considera que ambas tienen recursos teóricos y metodológicos para superar sus reducciones por la lógica instrumental del denominado gerencialismo, y se afianzan como dispositivos de reflexión y cambio.

Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis.

BACKGROUND: The 2012 Health and Social Care Act (HSCA) in England led to among the largest healthcare reforms in the history of the National Health Service (NHS). It gave control of £67 billion of the NHS budget for secondary care to general practitioner (GP) led Clinical Commissioning Groups (CCGs). An expected outcome was that patient care would shift away from expensive hospital and specialist settings, towards less expensive community-based models. However, there is little evidence for the effectiveness of this approach. In this study, we aimed to assess the association between the NHS reforms and hospital admissions and outpatient specialist visits. METHODS AND FINDINGS: We conducted a controlled interrupted time series analysis to examine rates of outpatient specialist visits and inpatient hospitalisations before and after the implementation of the HSCA. We used national routine hospital administrative data (Hospital Episode Statistics) on all NHS outpatient specialist visits and inpatient hospital admissions in England between 2007 and 2015 (with a mean of 26.8 million new outpatient visits and 14.9 million inpatient admissions per year). As a control series, we used equivalent data on hospital attendances in Scotland. Primary outcomes were: total, elective, and emergency hospitalisations, and total and GP-referred specialist visits. Both countries had stable trends in all outcomes at baseline. In England, after the policy, there was a 1.1% (95% CI 0.7%-1.5%; p < 0.001) increase in total specialist visits per quarter and a 1.6% increase in GP-referred specialist visits (95% CI 1.2%-2.0%; p < 0.001) per quarter, equivalent to 12.7% (647,000 over the 5,105,000 expected) and 19.1% (507,000 over the 2,658,000 expected) more visits per quarter by the end of 2015, respectively. In Scotland, there was no change in specialist visits. Neither country experienced a change in trends in hospitalisations: change in slope for total, elective, and emergency hospitalisations were -0.2% (95% CI -0.6%-0.2%; p = 0.257), -0.2% (95% CI -0.6%-0.1%; p = 0.235), and 0.0% (95% CI -0.5%-0.4%; p = 0.866) per quarter in England. We are unable to exclude confounding due to other events occurring around the time of the policy. However, we limited the likelihood of such confounding by including relevant control series, in which no changes were seen. CONCLUSIONS: Our findings suggest that giving control of healthcare budgets to GP-led CCGs was not associated with a reduction in overall hospitalisations and was associated with an increase in specialist visits.

Expanding state laws and a growing role for pharmacists in vaccination services.

OBJECTIVES: Gaps in vaccination coverage leave populations vulnerable to illnesses. Since the 1990s, there has been a growing movement to improve vaccination access by giving pharmacists the authority to administer vaccines according to state laws. Understanding the variation of pharmacist vaccination laws over time is critical to understanding the effect of improving access to vaccination services. METHODS: We identified relevant statutes and regulations with the use of Westlaw legal databases. A 4-stage coding process identified 220 legal variables of pharmacist vaccination authority. Each jurisdiction's laws were coded against these 220 legal variables. The resulting legal dataset was then evaluated to determine whether jurisdictions expanded or restricted pharmacist vaccination authorities over time. RESULTS: From 1971 to 2016, jurisdictions made 627 changes to statutes and regulations relating to pharmacist vaccination authority. There were 85 expansions, 3 restrictions, and 22 regulatory clarifications. Eight changes were deemed to be unclear, and 479 changes did not substantively alter the scope of pharmacist vaccination authority. CONCLUSION: Collectively, the laws in 50 states and DC paint a clear picture: the scope of pharmacists' vaccination authority is expanding. Jurisdictions are allowing pharmacists to administer more vaccines to younger patients with less direct prescriber oversight. This clear expansion of pharmacist vaccination authority stands in contrast to the reservations expressed by some physician groups for pharmacists as vaccination providers. However, laws in some states still do not permit pharmacists to vaccinate according to the Advisory Committee on Immunization Practices recommendations.

[Small Area Variation in Demographic Aging - Informal and Formal Nursing Care Ratios and Care Preferences of Senior Citizens Inform Health Care Planners]. / Regionale Unterschiede bei demografischer Alterung.

Objective Demographic aging affects the number of older individuals potentially in need of care and age groups of younger individuals potentially providing formal and informal care. This study examines the current and future demographic aging and care preferences on a county level in Saxony. Methods To analyze demographic aging, formal (FISR) and informal intergenerational support ratios (IISR) based on population data from the Federal Institute for Research on Building, Urban Affairs and Spatial Development (BBSR) were used. Ratios were calculated for every county in Saxony from 2012 to 2035. Care preferences for care settings of senior German citizens in Saxony were determined by a representative telephone survey (n = 101; 65+). Results FISR and IISR tend to progress in similar ways and are reduced by 50 % by 2035. Regarding nursing care preferences, the majority preferred being cared for at home. Implications Upcoming care ratios may inform community health care planners and decision makers on critical constellations in advance. Strategies to ensure the future elderly care are to be developed and implemented.

Planning and priority setting for vaccine development and immunization.

We review a sequence of strategic planning efforts over time in the United States, all involving processes to prioritize new vaccine candidates. The Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine has been involved in three priority setting processes, each using different metrics and methodologies: infant mortality equivalents (1985-1986), cost-effectiveness (2000), and more recently, the implementation of a software system based on a broader multi-criteria systems approach that can include either of the earlier metrics among other various considerations (2015). The systems approach offers users the flexibility to select, combine, rank, weigh and evaluate different attributes representing their perspectives, assumptions, and particular needs. This approach also overcomes concerns relating to the previous single-metric ranking approaches that yielded lists that, once published, were static, and could not readily accommodate new information about emerging pathogens, new scientific advances, or changes in the costs and performance features of interventions. We discuss the rationale and reasoning behind the design of this multi-criteria decision support approach, stakeholder feedback about the tool, and highlight the potential advantages from using this expanded approach to better inform and support vaccine policies.