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1.
Healthc Q ; 24(1): 28-35, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33864438

RESUMEN

Provincial health systems have been challenged by the surge in healthcare demands caused by the COVID-19 pandemic; the COVID-19 vaccine rollout across the country has further added to these challenges. A successful vaccination campaign is widely viewed as the only way to overcome the COVID-19 pandemic, placing greater urgency on the need for a rapid vaccination strategy. In this paper, we present emerging findings, from a national research study, that document the key challenges faced by current vaccine rollout strategies, which include procurement and leadership strategies, citizen engagement and limitations in supply chain capacity. These findings are used to inform a scalable vaccine strategy comprising collaborative leadership, mobilization of an integrated workforce and a digitally enabled supply chain strategy. The goal of vaccinating the entire Canadian population in the next few months can be achieved when supported by such a strategy.


Asunto(s)
/uso terapéutico , Práctica Clínica Basada en la Evidencia/métodos , Programas de Inmunización/organización & administración , Capacidad de Reacción/organización & administración , /provisión & distribución , Canadá , Humanos , Liderazgo , Gobierno Estatal
2.
Healthc Q ; 24(1): 36-43, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33864439

RESUMEN

The COVID-19 pandemic has highlighted the many challenges that provincial health systems have experienced while scaling health services to protect Canadians from viral transmission and support care for those who get infected. Supply chain capacity makes it possible for health systems to deliver care and implement public health initiatives safely. In this paper, we present emerging findings from a national research study that documents the key features of the fragility of the health supply chain evident across the seven Canadian provinces. Results suggest that the fragility of the health supply chain contributes to substantive challenges across health systems, thus limiting or precluding proactive and comprehensive responses to pandemic management. These findings inform strategies to strengthen supply chain capacity and performance in order to enable health systems to effectively respond to pandemic events.


Asunto(s)
/epidemiología , Prestación de Atención de Salud/organización & administración , /terapia , Canadá , Equipos y Suministros de Hospitales/provisión & distribución , Humanos , Administración de Materiales de Hospital/organización & administración , Política , Gobierno Estatal
4.
Appl Clin Inform ; 12(2): 208-221, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33853140

RESUMEN

BACKGROUND: In the United States, all 50 state governments deployed publicly viewable dashboards regarding the novel coronavirus disease 2019 (COVID-19) to track and respond to the pandemic. States dashboards, however, reflect idiosyncratic design practices based on their content, function, and visual design and platform. There has been little guidance for what state dashboards should look like or contain, leading to significant variation. OBJECTIVES: The primary objective of our study was to catalog how information, system function, and user interface were deployed across the COVID-19 state dashboards. Our secondary objective was to group and characterize the dashboards based on the information we collected using clustering analysis. METHODS: For preliminary data collection, we developed a framework to first analyze two dashboards as a group and reach agreement on coding. We subsequently doubled coded the remaining 48 dashboards using the framework and reviewed the coding to reach total consensus. RESULTS: All state dashboards included maps and graphs, most frequently line charts, bar charts, and histograms. The most represented metrics were total deaths, total cases, new cases, laboratory tests, and hospitalization. Decisions on how metrics were aggregated and stratified greatly varied across dashboards. Overall, the dashboards were very interactive with 96% having at least some functionality including tooltips, zooming, or exporting capabilities. For visual design and platform, we noted that the software was dominated by a few major organizations. Our cluster analysis yielded a six-cluster solution, and each cluster provided additional insights about how groups of states engaged in specific practices in dashboard design. CONCLUSION: Our study indicates that states engaged in dashboard practices that generally aligned with many of the goals set forth by the Centers for Disease Control and Prevention, Essential Public Health Services. We highlight areas where states fall short of these expectations and provide specific design recommendations to address these gaps.


Asunto(s)
/epidemiología , /fisiología , Gobierno Estatal , Análisis por Conglomerados , Humanos , Estados Unidos/epidemiología
5.
Kennedy Inst Ethics J ; 31(1): 1-15, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33716225

RESUMEN

One consequence of the lockdowns that many countries have introduced in response to the COVID-19 pandemic is that people have become more vulnerable to loneliness. In this contribution, I argue that even if this does not render lockdowns unjustified, it is morally incumbent upon states to make reasonable efforts to protect their residents from loneliness for as long as their social confinement measures remain in place. Without attempting to provide an exhaustive list of ways in which this might be done, I identify four broad measures that I believe many, if not most, states ought to take. These require states to (i) help ensure that people have affordable access to the internet, as well as opportunities for learning how to use this medium so as that they can digitally connect to others; (ii) help people to have harmonious and rewarding intimate relationships; and try to make (iii) non-human companionship as well as (iv) various non-social solutions to loneliness widely available.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles , Soledad , Cuarentena , Gobierno Estatal , Animales , Humanos , Acceso a Internet , Relaciones Interpersonales , Salud Mental , Pandemias , Mascotas , Aislamiento Social , Estados Unidos
7.
Artículo en Alemán | MEDLINE | ID: mdl-33666683

RESUMEN

The Robert Koch Institute (RKI) plays a central role in Germany in the management of health hazards of biological origin. The RKI's crisis management aims to contribute to protecting the health of the population in Germany in significant epidemic situations and to maintain the RKI's working ability over a long period of time even under high load. This article illustrates the crisis management of the RKI in general as well as during the COVID-19 pandemic. The generic RKI crisis management structures and the setup of the RKI emergency operations centre (EOC), their operationalisation in the context of the COVID-19 pandemic and the resulting challenges as of 31 October 2020 are described in this paper. The exchange between the federal and state governments during the pandemic is also described.The COVID-19 pandemic has led to extraordinary circumstances. During the epidemic situation, good communication and coordination has been essential, both within the RKI and with other federal or state authorities and expert groups. Under great pressure, the RKI produces and regularly updates recommendations, statements and assessments on various topics. To provide operational support for all COVID-19 related activities, an EOC was activated at the RKI. During the COVID-19 pandemic, there are various challenges regarding personnel and structures. It became apparent that good preparation (e.g. existing task descriptions and premises) has an important positive impact on crisis management.


Asunto(s)
Pandemias , Alemania , Humanos , Pandemias/prevención & control , Gobierno Estatal
8.
Cochrane Database Syst Rev ; 2: CD011512, 2021 02 22.
Artículo en Inglés | MEDLINE | ID: mdl-33617665

RESUMEN

BACKGROUND: The strain on public resources to meet the healthcare needs of populations through publicly-provided health insurance programmes is increasing and many governments turn to private health insurance (PHI) to ease the pressure on government budgets. With the goal of improving access to basic health care for citizens through PHI programmes, several high-income countries have developed strong regulations for PHI schemes. Low- and middle-income countries have the opportunity to learn from this experience to optimise PHI. If poorly regulated, PHI can hardly achieve an adequate quantity or quality of population coverage, as can be seen in the USA where a third of adults younger than 65 years of age have no insurance, sporadic coverage or coverage that exposes them to high out-of-pocket healthcare costs. OBJECTIVES: To assess the effects of policies that regulate private health insurance on utilisation, quality, and cost of health care provided. SEARCH METHODS: In November 2019 we searched CENTRAL; MEDLINE; Embase; Sociological Abstracts and Social Services Abstracts; ICTRP; ClinicalTrials.gov; and Web of Science Core Collection for papers that have cited the included studies. This complemented the search conducted in February 2017 in IBSS; EconLit; and Global Health. We also searched selected grey literature databases and web-sites.  SELECTION CRITERIA: Randomised trials, non-randomised trials, interrupted time series (ITS) studies, and controlled before-after (CBA) studies conducted in any population or setting that assessed one or more of the following interventions that governments use to regulate private health insurance: legislation and licensing, monitoring, auditing, and intelligence. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias and certainty of the evidence resolving discrepancies by consensus. We planned to summarise the results (using random-effects or fixed-effect meta-analysis) to produce an overall summary if an average intervention effect across studies was considered meaningful, and we would have discussed the implications of any differences in intervention effects across studies. However, due to the nature of the data obtained, we have provided a narrative synthesis of the findings. MAIN RESULTS: We included seven CBA studies, conducted in the USA, and that directly assessed state laws on cancer screening. Only for-profit PHI schemes were addressed in the included studies and no study addressed other types of PHI (community and not for-profit). The seven studies were assessed as having 'unclear risk' of bias. All seven studies reported on utilisation of healthcare services, and one study reported on costs. None of the included studies reported on quality of health care and patient health outcomes. We assessed the certainty of evidence for patient health outcomes, and utilisation and costs of healthcare services as very low. Therefore, we are uncertain of the effects of government mandates on for-profit PHI schemes. AUTHORS' CONCLUSIONS: Our review suggests that, from currently available evidence, it is uncertain whether policies that regulate private health insurance have an effect on utilisation of healthcare services, costs, quality of care, or patient health outcomes. The findings come from studies conducted in the USA and might therefore not be applicable to other countries; since the regulatory environment could be different. Studies are required in countries at different income levels because the effects of government regulation of PHI are likely to differ across these income and health system settings. Further studies should assess the different types of regulation (including regulation and licensing, monitoring, auditing, and intelligence). While regulatory research on PHI remains relatively scanty, future research can draw on the rich body of research on the regulation of other health financing interventions such as user fees and results-based provider payments.


Asunto(s)
Regulación Gubernamental , Seguro de Salud/legislación & jurisprudencia , Sector Privado/legislación & jurisprudencia , Gobierno Estatal , Sesgo , Neoplasias Colorrectales/diagnóstico , Estudios Controlados Antes y Después/estadística & datos numéricos , Femenino , Costos de la Atención en Salud , Necesidades y Demandas de Servicios de Salud/legislación & jurisprudencia , Humanos , Seguro de Salud/economía , Masculino , Sector Privado/economía , Neoplasias de la Próstata/diagnóstico , Estados Unidos , Neoplasias del Cuello Uterino/diagnóstico
9.
Health Place ; 68: 102537, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33636596

RESUMEN

The COVID-19 pandemic poses unprecedented risks to the health and well-being of the entire population in the U.S. To control the pandemic, it is imperative for individuals to take precautionary behaviors (e.g., wearing a mask, keeping social distance, washing hands frequently, etc.). The factors that influence individual behavioral response thus warrants a close examination. Using survey data for respondents from 10 states merged with state-level data, our study represents a pioneering effort to reveal contextual and individual social capital factors that explain public mask wearing in response to COVID-19. Findings of logistic multilevel regression show that the COVID-19 death rate and political control of government at the state level along with one's social capital at the individual level altogether influence whether people decide to wear face masks. These findings contribute to the rapidly growing literature and have policy implications for mitigating the pandemic's devastating impact on the American public.


Asunto(s)
Política de Salud , Equipo de Protección Personal , Capital Social , Adulto , /mortalidad , Femenino , Humanos , Masculino , Gobierno Estatal , Encuestas y Cuestionarios , Estados Unidos/epidemiología
11.
Tex Med ; 117(1): 20-27, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33641112

RESUMEN

The way the Texas Legislature conducts business during the 2021 session may look different due to the COVID-19 pandemic. But the Texas Medical Association's commitment to improving health care remains the same. Some of those goals are up against deep cuts to state agency budgets. At the same time, however, the pandemic has created opportunities for medicine to bend lawmakers' ear on some of its longstanding goals, including advancing access to care, vaccines, health coverage, and telemedicine.


Asunto(s)
/epidemiología , Legislación Médica , Gobierno Estatal , /prevención & control , Humanos , Texas
14.
JAMA Netw Open ; 4(2): e2036687, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33576816

RESUMEN

Importance: In response to the increase in opioid overdose deaths in the United States, many states recently have implemented supply-controlling and harm-reduction policy measures. To date, an updated policy evaluation that considers the full policy landscape has not been conducted. Objective: To evaluate 6 US state-level drug policies to ascertain whether they are associated with a reduction in indicators of prescription opioid abuse, the prevalence of opioid use disorder and overdose, the prescription of medication-assisted treatment (MAT), and drug overdose deaths. Design, Setting, and Participants: This cross-sectional study used drug overdose mortality data from 50 states obtained from the National Vital Statistics System and claims data from 23 million commercially insured patients in the US between 2007 and 2018. Difference-in-differences analysis using panel matching was conducted to evaluate the prevalence of indicators of prescription opioid abuse, opioid use disorder and overdose diagnosis, the prescription of MAT, and drug overdose deaths before and after implementation of 6 state-level policies targeting the opioid epidemic. A random-effects meta-analysis model was used to summarize associations over time for each policy and outcome pair. The data analysis was conducted July 12, 2020. Exposures: State-level drug policy changes to address the increase of opioid-related overdose deaths included prescription drug monitoring program (PDMP) access, mandatory PDMPs, pain clinic laws, prescription limit laws, naloxone access laws, and Good Samaritan laws. Main Outcomes and Measures: The outcomes of interests were quarterly state-level mortality from drug overdoses, known indicators for prescription opioid abuse and doctor shopping, MAT, and prevalence of drug overdose and opioid use disorder. Results: This cross-sectional study of drug overdose mortality data and insurance claims data from 23 million commercially insured patients (12 582 378 female patients [55.1%]; mean [SD] age, 45.9 [19.9] years) in the US between 2007 and 2018 found that mandatory PDMPs were associated with decreases in the proportion of patients taking opioids (-0.729%; 95% CI, -1.011% to -0.447%), with overlapping opioid claims (-0.027%; 95% CI, -0.038% to -0.017%), with daily morphine milligram equivalent greater than 90 (-0.095%; 95% CI, -0.150% to -0.041%), and who engaged in drug seeking (-0.002%; 95% CI, -0.003% to -0.001%). The proportion of patients receiving MAT increased after the enactment of mandatory PDMPs (0.015%; 95% CI, 0.002% to 0.028%), pain clinic laws (0.013%, 95% CI, 0.005%-0.021%), and prescription limit laws (0.034%, 95% CI, 0.020% to 0.049%). Mandatory PDMPs were associated with a decrease in the number of overdose deaths due to natural opioids (-518.5 [95% CI, -728.5 to -308.5] per 300 million people) and methadone (-122.7 [95% CI, -207.5 to -37.8] per 300 million people). Prescription drug monitoring program access policies showed similar results, although these policies were also associated with increases in overdose deaths due to synthetic opioids (380.3 [95% CI, 149.6-610.8] per 300 million people) and cocaine (103.7 [95% CI, 28.0-179.5] per 300 million people). Except for the negative association between prescription limit laws and synthetic opioid deaths (-723.9 [95% CI, -1419.7 to -28.1] per 300 million people), other policies were associated with increasing overdose deaths, especially those attributed to non-prescription opioids such as synthetic opioids and heroin. This includes a positive association between naloxone access laws and the number of deaths attributed to synthetic opioids (1338.2 [95% CI, 662.5 to 2014.0] per 300 million people). Conclusions and Relevance: Although this study found that existing state policies were associated with reduced misuse of prescription opioids, they may have the unintended consequence of motivating those with opioid use disorders to access the illicit drug market, potentially increasing overdose mortality. This finding suggests that there is no easy policy solution to reverse the epidemic of opioid dependence and mortality in the US.


Asunto(s)
/mortalidad , Tratamiento de Sustitución de Opiáceos/estadística & datos numéricos , Epidemia de Opioides , Trastornos Relacionados con Opioides/epidemiología , Política Pública , Gobierno Estatal , Analgésicos Opioides/uso terapéutico , Control de Medicamentos y Narcóticos , Reducción del Daño , Política de Salud , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Humanos , Naloxona , Antagonistas de Narcóticos , Clínicas de Dolor/legislación & jurisprudencia , Pautas de la Práctica en Medicina/legislación & jurisprudencia , Programas de Monitoreo de Medicamentos Recetados/legislación & jurisprudencia , Prevalencia , Estados Unidos/epidemiología
20.
Health Aff (Millwood) ; 40(1): 82-90, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33400570

RESUMEN

States' decisions to expand Medicaid may have important implications for their hospitals' financial ability to weather the coronavirus disease 2019 (COVID-19) pandemic. This study estimated the effects of the Affordable Care Act (ACA) Medicaid expansion on hospital finances in 2017 to update earlier findings. The analysis also explored how the ACA Medicaid expansion affects different types of hospitals by size, ownership, rurality, and safety-net status. We found that the early positive financial impact of Medicaid expansion was sustained in fiscal years 2016 and 2017 as hospitals in expansion states continued to experience decreased uncompensated care costs and increased Medicaid revenue and financial margins. The magnitude of these impacts varied by hospital type. As COVID-19 has brought hospitals to a time of great need, findings from this study provide important information on what hospitals in states that have yet to expand Medicaid could gain through expansion and what is at risk should any reversal of Medicaid expansions occur.


Asunto(s)
/epidemiología , Economía Hospitalaria , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitales , Medicaid , Pacientes no Asegurados , Humanos , Medicaid/economía , Medicaid/estadística & datos numéricos , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Gobierno Estatal , Estados Unidos
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