RESUMO
There is a plethora of meat-borne hazards - including parasites - for which there may be a need for surveillance. However, veterinary services worldwide need to decide how to use their scarce resources and prioritise among the perceived hazards. Moreover, to remain competitive, food business operators - irrespective of whether they are farmers or abattoir operators - are preoccupied with maintaining a profit and minimizing costs. Still, customers and trade partners expect that meat products placed on the market are safe to consume and should not bear any risks of causing disease. Risk-based surveillance systems may offer a solution to this challenge by applying risk analysis principles; first to set priorities, and secondly to allocate resources effectively and efficiently. The latter is done through a focus on the cost-effectiveness ratio in sampling and prioritisation. Risk-based surveillance was originally introduced into veterinary public health in 2006. Since then, experience has been gathered, and the methodology has been further developed. Guidelines and tools have been developed, which can be used to set up appropriate surveillance programmes. In this paper, the basic principles are described, and by use of a surveillance design tool called SURVTOOLS (https://survtools.org/), examples are given covering three meat-borne parasites for which risk-based surveillance is 1) either in place in the European Union (EU) (Trichinella spp.), 2) to be officially implemented in December 2019 (Taenia saginata) or 3) only carried out by one abattoir company in the EU as there is no official EU requirement (Toxoplasma gondii). Moreover, advantages, requirements and limitations of risk-based surveillance for meat-borne parasites are discussed.
Assuntos
Carne/parasitologia , Doenças Parasitárias/prevenção & controle , Gestão de Riscos/métodos , Animais , Prioridades em Saúde/classificação , Prioridades em Saúde/organização & administração , Humanos , Doenças Parasitárias/transmissão , Fatores de Risco , Gestão de Riscos/organização & administração , Gestão de Riscos/normas , Gestão de Riscos/tendências , Taenia saginata/isolamento & purificação , Teníase/prevenção & controle , Teníase/transmissão , Toxoplasma/isolamento & purificação , Toxoplasmose/prevenção & controle , Toxoplasmose/transmissão , Trichinella/isolamento & purificação , Triquinelose/prevenção & controle , Triquinelose/transmissãoRESUMO
Objectives: To prioritize Domains of SCI Rehabilitation Care (SCI-Care) based on clinical importance and feasibility to inform the development of indicators of quality SCI-Care for adults with SCI/D in Canada. Methods: A 17-member external advisory committee, comprised of key stakeholders, ranked 15/37 Domains of rehabilitation previously flagged by the E-scan project team for gaps between knowledge generation and clinical implementation. Priority scores (D) were calculated using the Hanlon formula: D=[A+(2×B)]×C , where A is prevalence, B is seriousness, and C is the effectiveness of available interventions. A modified "EAARS" (Economic, Acceptability, Accessibility, Resources, and Simplicity) criterion was used to rank feasibility on a scale of 0-4 (4 is high). The product of these two scores determined the initial Domain ranking. Following the consensus process, further changes were made to the Domain rankings. Results: Despite a low feasibility score, Sexual Health was ranked as high priority; and, the Community Participation and Employment Domains were merged. The 11 final prioritized Domains in alphabetic order were: Cardiometabolic Health; Community Participation and Employment; Emotional Well-Being; Reaching, Grasping, and Manipulation; Self-Management; Sexual Health; Tissue Integrity; Urinary Tract Infection; Urohealth; Walking, and Wheeled Mobility. Conclusions: The modified Hanlon method was used to facilitate prioritization of 11 of 37 Domains to advance the quality of SCI-care by 2020. In future, the Spinal Cord Injury Rehabilitation Care High Performance Indicators (SCI-High) Project Team will develop structure, process and outcome indicators for each prioritized Domain.
Assuntos
Comitês Consultivos , Prioridades em Saúde/classificação , Prioridades em Saúde/normas , Reabilitação Neurológica/normas , Traumatismos da Medula Espinal/reabilitação , Canadá , Humanos , Reabilitação Neurológica/métodos , Reabilitação Neurológica/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Participação dos InteressadosRESUMO
BACKGROUND: Shortage of corneas for transplantation has created long waiting lists in most countries. Transplant calculators are available for many organs. The purpose of this study is to describe a simple automatic scoring system for keratoplasty recipient candidates, based on several parameters that we consider most relevant for tissue allocation, and to compare the system's accuracy in predicting decisions made by a cornea specialist. METHODS: Twenty pairs of candidate data were randomly created on an electronic spreadsheet. A single priority score was computed from the data of each candidate. A cornea surgeon and the automated system then decided independently which candidate in each pair should have surgery if only a single cornea was available. RESULTS: The scoring system can calculate values between 0 (lowest priority) and 18 (highest priority) for each candidate. Average score value in our randomly created cohort was 6.35 ± 2.38 (mean ± SD), range 1.28 to 10.76. Average score difference between the candidates in each pair was 3.12 ± 2.10, range 0.08 to 8.45. The manual scoring process, although theoretical, was mentally and emotionally demanding for the surgeon. Agreement was achieved between the human decision and the calculated value in 19 of 20 pairs. Disagreement was reached in the pair with the lowest score difference (0.08). CONCLUSIONS: With worldwide donor cornea shortage, waiting for transplantation can be long. Manual sorting of priority for transplantation in a long waiting list is difficult, time-consuming and prone to error. The suggested system may help achieve a justified distribution of available tissue.
Assuntos
Doenças da Córnea/classificação , Transplante de Córnea/classificação , Prioridades em Saúde/classificação , Alocação de Recursos , Doenças da Córnea/cirurgia , Humanos , Reprodutibilidade dos Testes , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos , Listas de EsperaRESUMO
BACKGROUND: A wide range of preventive, treatment, and care programs for HIV/AIDS are currently available and some of them have been implemented in Thailand. Policy makers are now facing challenges on how the scarce resources for HIV/AIDS control can be spent more wisely. Although effectiveness and cost-effectiveness information is useful for guiding policy decisions, empirical evidence indicates the importance of other criteria, such as equity and the characteristics of the target population, also play important roles in priority setting. This study aims to experiment with the use of multi-criteria decision analysis (MCDA) to prioritise interventions in HIV/AIDS control in Thailand. METHODS: We used MCDA to rank 40 HIV/AIDS interventions on the basis of the priority setting criteria put forward by three groups of stakeholders including policy makers, people living with HIV/AIDs (PLWHA), and village health volunteers (VHVs). MCDA incorporated an explicit component of deliberation to let stakeholders reflect on the rank ordering, and adapt where necessary. RESULTS: Upon deliberation, policy makers expressed a preference for programs that target high risk groups such as men who have sex with men, injecting drug users, and female sex workers. The VHVs preferred interventions that target the youth or the general population, and gave lower priority to programs that target high risk groups. PLWHA gave all interventions the same priority. The rank order correlation between the priorities as expressed before and after deliberation was 37% among the policy makers and 46% among the VHVs. CONCLUSION: This study documented the feasibility of MCDA to prioritize HIV/AIDS interventions in Thailand, and has shown the usefulness of a deliberative process as an integrated component of MCDA. MCDA holds potential to contribute to a more transparent and accountable priority setting process, and further application of this approach in the prioritisation of health interventions is warranted.
Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Técnicas de Apoio para a Decisão , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Prioridades em Saúde/classificação , Síndrome da Imunodeficiência Adquirida/epidemiologia , Análise Custo-Benefício , Feminino , Infecções por HIV/epidemiologia , Soropositividade para HIV , Humanos , Masculino , TailândiaRESUMO
One of the main tasks of a scientific society is to define the theoretical bases and appropriate management strategies with the aim to maintain a high-quality diagnostic and therapeutic standard. As far as echocardiography is concerned, the task of the Italian Society of Cardiovascular Echography is to provide appropriate, complete, and useful echocardiographic tests for clinical application, as well as procedural, technological, organizational and economic indications to be adopted in clinical practice. In addition, there is an increasing need for regulating access to echocardiographic assessment according to clinical priority, because of the huge proportion of patients who should undergo a first or follow-up echocardiographic evaluation. The aim of this document is to implement appropriateness in echocardiography for the study and follow-up of cardiovascular diseases, and to optimize demand on the basis of clinical priority classification criteria outlined by the scientific societies and used by the National Health Service. Besides cardiovascular diseases, this document also addresses other diseases that often require echocardiographic investigation, such as liver diseases, connective tissue diseases, endocrine diseases, peripheral vascular and oncological diseases. Although not included in the previous guidelines, clinical priority and followup criteria are defined also for these groups of diseases according to the available literature. In conclusion, this document aims at guaranteeing access to the diagnostic echocardiographic procedures provided by the National Health Service to the general population, with practical indications on how to solve the problem of waiting lists.
Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Consenso , Ecocardiografia/estatística & dados numéricos , Prioridades em Saúde/classificação , Sociedades Médicas , Procedimentos Desnecessários , Assistência Ambulatorial , Primeiros Socorros , Acessibilidade aos Serviços de Saúde , Humanos , Unidades de Terapia Intensiva , Itália , Programas Nacionais de Saúde , Fatores de Risco , Listas de EsperaRESUMO
The aim of the National Health Priority Area (NHPA) initiative is to promote cooperation between government and non-government organisations to monitor, report on and develop strategies to improve health outcomes for Australians. The seven existing NHPAs (cancer control, injury prevention and control, cardiovascular health, mental health, diabetes mellitus, asthma and musculoskeletal conditions) were selected on the basis of their profound burden on the health of Australians. Up to eighty per cent of Australians will experience back pain at some point in their lives and 10% will experience significant disability as a result. Back pain disrupts individuals' quality of life and accounts for an enormous cost to the community. Integrating back pain into the NHPA framework has many potential benefits, including more systematic development and implementation of programs aimed at minimising back pain-related disability by providing a focus for policy, legislation and public awareness; and promotion of best-practice management of the condition. A disadvantage of making back pain an NHPA is the risk that back pain management could become further medicalised and ineffective interventions could become more accepted. Coordinated action on back pain is needed, and integrating back pain into the NHPA framework is one solution. Informed decision making through consultation with key stakeholders is a necessary first step towards ensuring that favourable outcomes are achieved.
Assuntos
Dor nas Costas/epidemiologia , Prioridades em Saúde/classificação , Austrália/epidemiologia , Planejamento em Saúde , Política de Saúde , Promoção da Saúde , Humanos , Prevalência , Qualidade de VidaAssuntos
Prioridades em Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde , Feminino , Prioridades em Saúde/classificação , Serviços de Saúde do Indígena/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Obesidade/epidemiologia , Prevalência , Fumar/epidemiologia , Prevenção do Hábito de FumarAssuntos
Prioridades em Saúde/classificação , Disparidades em Assistência à Saúde/economia , Alocação de Recursos/métodos , Medicina Estatal/economia , Comitês Consultivos , Área Programática de Saúde , Relações Comunidade-Instituição , Confidencialidade , Demografia , Humanos , Renda , Áreas de Pobreza , Alocação de Recursos/ética , Serviços de Saúde Rural/provisão & distribuição , Medicina Estatal/ética , Serviços Urbanos de Saúde/provisão & distribuiçãoRESUMO
BACKGROUND: Despite considerable investment in research priority setting within diverse fields of healthcare, little is known about the extent to which different stakeholder groups share research priorities. Conflicting priorities may jeopardize stakeholder engagement in research. OBJECTIVE: To identify the research priorities of different stakeholder groups within mental health care and examine the extent and nature of agreement between them. DESIGN: Using a Delphi technique, we conducted parallel consultation processes within four different stakeholder groups. Each group process consisted of three rounds. SETTING AND PARTICIPANTS: The study was carried out within a mental health and learning disabilities trust in southern England. Participants were recruited from the following groups: mental health service users (34), informal carers (26), mental health practitioners (35) and service managers (23). FINDINGS: There were striking differences between the four groups in respect of their ability and willingness to make priority decisions. These differences notwithstanding, there was considerable overlap in respect of their research interests. All groups identified and attached high importance to issues relating to the promotion of independence, self-esteem and recovery. The quality of in-patient care, the place of psychological therapies and the relationship between physical and mental health also emerged across the board. CONCLUSIONS: The confluence of four different stakeholder groups around a number of clear themes is highly encouraging, providing a framework within which to construct a research agenda and suggesting that mental health research can be built on solid partnerships.
Assuntos
Participação da Comunidade/estatística & dados numéricos , Pesquisa Participativa Baseada na Comunidade/organização & administração , Prioridades em Saúde/classificação , Serviços de Saúde Mental/normas , Pesquisa/classificação , Pessoal Administrativo , Atitude Frente a Saúde , Cuidadores , Planejamento em Saúde Comunitária , Técnica Delphi , Inglaterra , Processos Grupais , Humanos , Serviços de Saúde Mental/organização & administração , Pessoas Mentalmente Doentes , Cultura Organizacional , Objetivos Organizacionais , Pessoas com Deficiência Mental , Medicina Estatal , UniversidadesRESUMO
BACKGROUND: Involving members of the public in setting priorities for health research in becoming increasingly common practice. One method used in public involvement exercises is the citizens' jury. OBJECTIVE: This article examines some challenges and benefits of citizens' juries, including issues relating to process, public engagement and outcome. DESIGN: In Bristol, UK, a citizens' jury was held with the aim of identifying local priorities for research into health and social care. This jury is used as an example through which key issues in public involvement and jury processes are explored. SETTING AND PARTICIPANTS: The Bristol Citizens' Jury comprised 20 members of the public ('jurors'), an oversight panel and a steering group. The jurors met at 11 consecutive sessions during 2006 over a period of 16 weeks, which culminated in a written report. All the sessions were audio-recorded, five sessions were observed and video-recorded, and 16 jurors completed written feedback forms at the end of the jury process. FINDINGS AND CONCLUSION: In this article we discuss degree and timing of public involvement in the process of health research; the role of context; representation of communities; processes of deliberation and knowledge production; and how constraints of time and cost may affect public involvement. It was clear that jurors who took part in the Bristol Citizens' Jury were engaged and committed. This engagement may be related to jurors' belief in their ability to shape future research alongside concern about the relevance of the issues under discussion. Opposing emotions of tension and harmony are a crucial part of the deliberation process.
Assuntos
Atitude Frente a Saúde , Planejamento em Saúde Comunitária , Participação da Comunidade , Conselhos de Planejamento em Saúde/organização & administração , Prioridades em Saúde/classificação , Atenção Primária à Saúde , Pesquisa/classificação , Serviço Social , Pesquisa Comportamental , Consenso , Tomada de Decisões , Processos Grupais , Pesquisa sobre Serviços de Saúde , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Justiça Social , Reino UnidoRESUMO
OBJECTIVES: To assess the feasibility of using a citizens' jury to elicit public values on health technologies and to develop criteria for setting priorities for health technology assessment (HTA). METHODS: Sixteen individuals were selected from 1600 randomly sampled residents of the Capital Health Region in Alberta, Canada. They participated in a 2 (1/2) day jury which comprised presentations by 'expert witnesses', who represented innovators, patients, health-care policy-makers and clinicians, as well as a series of small and large group priority-setting exercises based on actual examples of technologies that had recently been considered for assessment by local and national HTA bodies. The session was audio-taped, and transcripts were independently reviewed by two researchers using content analytical techniques in order to ensure that no important concepts expressed by individual jurors were missed during group development of the final list of priority-setting criteria. Jurors evaluated the process by completing self-administered, semi-structured questionnaires at the end of the session. Responses were analysed using qualitative methods. RESULTS: The jury identified 13 criteria, which they subsequently ranked in order of importance. The top two criteria included 'potential to benefit a number of people' and 'extends life with quality'. Based on feedback from questionnaires, jurors valued the opportunity to become engaged in such a process, and expressed interest in participating in future juries. CONCLUSIONS: Citizens' juries offer a feasible approach to involving the public in priority-setting for HTA. Furthermore, technologies that may benefit a number of people and improve quality of life appear to be of greatest importance to the public.
Assuntos
Atitude Frente a Saúde , Planejamento em Saúde Comunitária , Participação da Comunidade , Processos Grupais , Conselhos de Planejamento em Saúde/organização & administração , Prioridades em Saúde/classificação , Pesquisa/classificação , Avaliação da Tecnologia Biomédica , Adulto , Idoso , Alberta , Participação da Comunidade/estatística & dados numéricos , Tomada de Decisões , Feminino , Diretrizes para o Planejamento em Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Programas , Avaliação de Programas e Projetos de SaúdeRESUMO
This study describes health care decision makers' perceptions about decision making processes for the introduction, diffusion and prioritisation of new health technologies at the regional and institutional level. The aim of the study was to aid the design of a new process of technology assessment and decision making for the Northern Sydney and Central Coast Area Health Service (NSCCAHS). Twelve in-depth, semi-structured interviews were conducted with senior health service managers, nurse managers and senior medical clinicians in the NSCCAHS. Interviewees described prioritisation and decision-making processes as "ad hoc". Safety and effectiveness were considered the most important criteria in decision making but budgetary consideration often drove decisions about the uptake and diffusion of new technologies. Current dissatisfaction with decision-making processes creates opportunities for reform, including the introduction of consistent local technology assessments.
Assuntos
Atitude do Pessoal de Saúde , Área Programática de Saúde , Tomada de Decisões Gerenciais , Difusão de Inovações , Administradores de Instituições de Saúde/psicologia , Avaliação da Tecnologia Biomédica/organização & administração , Administradores de Instituições de Saúde/educação , Prioridades em Saúde/classificação , Humanos , Entrevistas como Assunto , Conhecimento , New South Wales , Pesquisa Qualitativa , Avaliação da Tecnologia Biomédica/métodosRESUMO
Health inequities linked to poverty remain entrenched in certain subgroups in the United States, despite public health efforts to the contrary. My experiences in working with the poor in Nepal and Pakistan informed my later approach to addressing health and poverty in the Appalachians of eastern Tennessee. Three aspects of this approach include enhancing community power through participation in local decisionmaking about health, educating students within the actual context of poverty, and increasing local opportunity by employing people from the communities of concern to serve as a means to reach those communities. Empowerment, education, and opportunity can serve as ways to ameliorate poverty and may serve to modulate the persistent underlying conditions that create and sustain poverty.
Assuntos
Planejamento em Saúde Comunitária/organização & administração , Participação da Comunidade , Disparidades nos Níveis de Saúde , Pobreza , Administração em Saúde Pública , Saúde Pública , Populações Vulneráveis , Região dos Apalaches , Agentes Comunitários de Saúde , Conselhos de Planejamento em Saúde , Prioridades em Saúde/classificação , Humanos , Modelos Organizacionais , Saúde Pública/educação , Administração em Saúde Pública/educação , Faculdades de Saúde Pública , Tennessee , Estados UnidosRESUMO
The CDC provides funding for HIV prevention activities and state and local decision-makers must allocate these funds. The implementation of a resource allocation tool designed to facilitate this process that incorporates concepts of efficiency and equity as well as CDC mandates on the use of community planning groups is demonstrated, showing how information obtained from the resource allocation tool can be used to guide the policy analysis. The demonstration uses a simplified example based on data from Florida. The tool quantifies the inherent trade-offs associated with efficiency and equity and allows decision-makers to explore different ways of achieving equity. Given the underlying epidemiological model, results are not necessarily linear so common proportionality assumptions do not hold. However, a sense of equity can be provided by implementing various metrics allowing the policy maker flexibility in their decision process. By quantifying the impact of policy choices in terms of efficiency, cost, and distribution, the resource allocation tool makes the decision process more transparent and permits more informed choices.
Assuntos
Planejamento em Saúde Comunitária/organização & administração , Infecções por HIV/prevenção & controle , Prioridades em Saúde/classificação , Governo Local , Serviços Preventivos de Saúde/economia , Alocação de Recursos/métodos , Governo Estadual , Área Programática de Saúde , Proposta de Concorrência , Tomada de Decisões Gerenciais , Florida/epidemiologia , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Prioridades em Saúde/economia , Humanos , Modelos Organizacionais , Serviços Preventivos de Saúde/provisão & distribuição , Administração em Saúde Pública , Alocação de Recursos/economia , Alocação de Recursos/ética , Medição de Risco , Estados Unidos/epidemiologiaRESUMO
During the 1990s priority discussions were actualized in Sweden due to increased demands on health care and limited resources. In the county of Västerbotten in northern Sweden, with large rural areas, the decision makers faced special challenges due to distances and cost. Despite discussions striving for fairness in priorities, decision makers are still dealing with limited resources and difficult priority decisions regarding different diseases and treatments. In this study we aimed at describing views on priorities in public psoriasis care and visions of a future care among politicians, administrators and professionals in the county of Västerbottten in northern Sweden. Qualitative research interviews were performed with 23 key-persons. The findings revealed priority dilemmas about issues on organization, accessibility and ethics. Visions of a future care appeared as ambitions of a more effective care with good accessibility, continued research, information and a holistic approach in priorities. We conclude that dilemmas revealed in this study were a reflection of a gap between intentions and practice. In efforts to reduce these dilemmas we suggest methods with fairness in economic planning and priority setting, with concrete, official statements about the dominating views on which the priorities are based, and public information about these statements.
Assuntos
Atitude Frente a Saúde , Prioridades em Saúde/classificação , Acessibilidade aos Serviços de Saúde/normas , Psoríase/terapia , Regionalização da Saúde/ética , Alocação de Recursos/ética , Serviços de Saúde Rural/provisão & distribuição , Justiça Social , Previsões , Diretrizes para o Planejamento em Saúde , Prioridades em Saúde/ética , Acessibilidade aos Serviços de Saúde/ética , Humanos , Intenção , Entrevistas como Assunto , Formulação de Políticas , Psoríase/economia , Pesquisa Qualitativa , Responsabilidade Social , Medicina Estatal , SuéciaRESUMO
BACKGROUND: Priority setting in every health system is complex and difficult. In less wealthy countries the dominant approach to priority setting has been Burden of Disease (BOD) and cost-effectiveness analysis (CEA), which is helpful, but insufficient because it focuses on a narrow range of values - need and efficiency - and not the full range of relevant values, including legitimacy and fairness. 'Accountability for reasonableness' is a conceptual framework for legitimate and fair priority setting and is empirically based and ethically justified. It connects priority setting to broader, more fundamental, democratic deliberative processes that have an impact on social justice and equity. Can 'accountability for reasonableness' be helpful for improving priority setting in less wealthy countries? METHODS: In 2005, Tanzanian scholars from the Primary Health Care Institute (PHCI) conducted 6 capacity building workshops with senior health staff, district planners and managers, and representatives of the Tanzanian Ministry of Health to discussion improving priority setting in Tanzania using 'accountability for reasonableness'. The purpose of this paper is to describe this initiative and the participants' views about the approach. RESULTS: The approach to improving priority setting using 'accountability for reasonableness' was viewed by district decision makers with enthusiastic favour because it was the first framework that directly addressed their priority setting concerns. High level Ministry of Health participants were also very supportive of the approach. CONCLUSION: Both Tanzanian district and governmental health planners viewed the 'accountability for reasonableness' approach with enthusiastic favour because it was the first framework that directly addressed their concerns.
Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões Gerenciais , Prioridades em Saúde/ética , Administração em Saúde Pública/ética , Alocação de Recursos/ética , Justiça Social , Responsabilidade Social , Ética Institucional , Prioridades em Saúde/classificação , Humanos , Entrevistas como Assunto , Objetivos Organizacionais , Formulação de Políticas , Inquéritos e Questionários , TanzâniaRESUMO
BACKGROUND: Procedures for priority setting need to incorporate both scientific evidence and public values. The aim of this study was to test out a model for priority setting which incorporates both scientific evidence and public values, and to explore use of evidence by a selection of stakeholders and to study reasons for the relative ranking of health care interventions in a setting of extreme resource scarcity. METHODS: Systematic search for and assessment of relevant evidence for priority setting in a low-income country. Development of a balance sheet according to Eddy's explicit method. Eight group interviews (n-85), using a modified nominal group technique for eliciting individual and group rankings of a given set of health interventions. RESULTS: The study procedure made it possible to compare the groups' ranking before and after all the evidence was provided to participants. A rank deviation is significant if the rank order of the same intervention differed by two or more points on the ordinal scale. A comparison between the initial rank and the final rank (before deliberation) showed a rank deviation of 67%. The difference between the initial rank and the final rank after discussion and voting gave a rank deviation of 78%. CONCLUSION: Evidence-based and deliberative decision-making does change priorities significantly in an experimental setting. Our use of the balance sheet method was meant as a demonstration project, but could if properly developed be feasible for health planners, experts and health workers, although more work is needed before it can be used for laypersons.
Assuntos
Países em Desenvolvimento , Medicina Baseada em Evidências , Administração Financeira/métodos , Prioridades em Saúde/classificação , Humanos , Alocação de Recursos , Valores SociaisRESUMO
BACKGROUND: In recent years, decision makers in Canada and elsewhere have expressed a desire for more explicit, evidence-based approaches to priority setting. To achieve this aim within health care organizations, knowledge of both the organizational context and stakeholder attitudes towards priority setting are required. The current work adds to a limited yet growing body of international literature describing priority setting practices in health organizations. METHODS: A qualitative study was conducted using in-depth, face-to-face interviews with 25 key decision makers of the Provincial Health Services Authority (PHSA) of British Columbia. Major themes and sub-themes were identified through content analysis. RESULTS: Priorities were described by decision makers as being set in an ad hoc manner, with resources generally allocated along historical lines. Participants identified the Strategic Plan and a strong research base as strengths of the organization. The main areas for improvement were a desire to have a more transparent process for priority setting, a need to develop a culture which supports explicit priority setting, and a focus on fairness in decision making. Barriers to an explicit allocation process included the challenge of providing specialized services for disparate patient groups, and a lack of formal training in priority setting amongst decision makers. CONCLUSION: This study identified factors important to understanding organizational context and informed next steps for explicit priority setting for a provincial health authority. While the PHSA is unique in its organizational structure in Canada, lessons about priority setting should be transferable to other contexts.
Assuntos
Tomada de Decisões Gerenciais , Prioridades em Saúde/classificação , Regionalização da Saúde/organização & administração , Alocação de Recursos/organização & administração , Colúmbia Britânica , Medicina Baseada em Evidências , Pesquisa sobre Serviços de Saúde , Humanos , Entrevistas como Assunto , Cultura Organizacional , Pesquisa Qualitativa , Regionalização da Saúde/métodos , Alocação de Recursos/métodos , Justiça SocialRESUMO
ISSUE ADDRESSED: Health differentials related to the social position of people whose sexual attraction or gender identity differs from that of the majority may be the 'forgotten inequity' in contemporary Australian discourses on health inequalities and social inclusion. What sexually- and gender-diverse communities see as health priorities and the social determinants of their health have been little studied in Australia. This survey explored the experience and opinions of a convenience sample of gay, lesbian, bisexual, trangender and intersex (GLBTI) people in South Australia. METHOD: A pencil and paper survey was administered to people attending events associated with the Feast GLBTI festival in Adelaide in 2004 and good participation rates were obtained. Two hundred and fifty-three people completed the survey, of which 122 identified as female, 124 as male and seven as other genders. RESULTS: Depression, HIV, suicide, family relationship problems and alcohol problems were seen as the most important health issues for these communities, while discrimination under the law and in daily life were rated the most important health determinants. CONCLUSIONS: GLBTI South Australians surveyed identified priority health issues for their communities and identified legal and personal discrimination as significant determinants of their health.
Assuntos
Prioridades em Saúde/classificação , Promoção da Saúde/organização & administração , Sexualidade/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Identidade de Gênero , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Preconceito , Pesquisa Qualitativa , Meio Social , Austrália do SulRESUMO
BACKGROUND: In the English National Health Service (NHS), Primary Care Trusts (PCTs) are responsible for commissioning health-care services on behalf of their populations. As resources are finite, decisions are required as to which services best fulfil population needs. Evidence on effectiveness varies in quality and availability. Nevertheless, decisions still have to be made. METHODS: We report the development and pilot application of a multi-criteria prioritization mechanism in an English PCT, capable of accommodating a wide variety of evidence to rank six service developments. RESULTS: The mechanism proved valuable in assisting prioritization decisions and feedback was positive. Two community-based interventions were expected to save money in the long term and were ranked at the top of the list. Based on weighted benefit score and cost, two preventive programmes were ranked third and fourth. Finally, two National Institute for Health and Clinical Excellence (NICE)-approved interventions were ranked fifth and sixth. Sensitivity analysis revealed overlap in benefit scores for some of the interventions, representing diversity of opinion among the scoring panel. CONCLUSION: The method appears to be a practical approach to prioritization for commissioners of health care, but the pilot also revealed interesting divergences in relative priority between nationally mandated service developments and local health-care priorities.