Australia in 2030: what is our path to health for all?

CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.

COVID-19, oportunidad para la salud comunitaria. Barrioyincanas / No disponible

No disponible

PARC report: a health-systems focus on reimbursement and patient access to pharmacogenomics testing.

Pharmacogenomics test coverage and reimbursement are major obstacles to clinical uptake. Several early adopter programs have been successfully initiated through dedicated investments by federal and institutional research funding. As a result of research endeavors, evidence has grown sufficiently to support development of pharmacogenomics guidelines. However, clinical uptake is still limited. Third-party payer support plays an important role in increasing adoption, which to date has been limited to reactive single-gene testing. Access to and interest in direct-to-consumer genetic testing are driving demand for increasing healthcare providers and third-party awareness of this burgeoning field. Pharmacogenomics implementation models developed by early adopters promise to expand patient access and options, as testing continues to increase due to growing consumer interest and falling test prices.

Pharmacist-led transitions-of-care program reduces 30-day readmission rates for Medicare patients in a large health system.

PURPOSE: This report describes the growth and development of the Pharmacy Transitions of Care (PTOC) program at a Florida health system and examines its impact on 30-day readmission rates for Medicare core-measure patients. SUMMARY: BayCare Health System is a large not-for-profit community health system with 15 hospitals in central Florida. In 2015, the PTOC program was developed to integrate 2 pharmacists into the transitions-of-care space to reduce readmissions, enhance patient care, and improve medication safety. The PTOC program focuses on traditional Medicare beneficiaries 65 years of age or older with the goal of preventing 30-day readmissions. The service model includes integration of a pharmacist into the discharge medication reconciliation process, as well as postacute care telephonic follow-up. Data and outcomes have been carefully tracked since program inception and consistently demonstrate a reduction in 30-day readmissions, with a 63% relative risk reduction during the beginning phases of the program and a ratio of observed to expected readmissions of 0.77. As a result, in less than 3 years the PTOC program has grown from 2 to 23 pharmacists and is a key component of BayCare Health System's patient care strategy. CONCLUSION: Medication reconciliation, clinical interventions, and patient education by pharmacists after hospital discharge reduced 30-day readmission rates for Medicare core-measure patients across a large health system. The adaptability of this program to other health systems and hospitals of varying size to achieve similar outcomes is valuable to share with the profession.

COVID-19 Community Stabilization and Sustainability Framework: An Integration of the Maslow Hierarchy of Needs and Social Determinants of Health.

All levels of government are authorized to apply coronavirus disease 2019 (COVID-19) protection measures; however, they must consider how and when to ease lockdown restrictions to limit long-term societal harm and societal instability. Leaders that use a well-considered framework with an incremental approach will be able to gradually restart society while simultaneously maintaining the public health benefits achieved through lockdown measures. Economically vulnerable populations cannot endure long-term lockdown, and most countries lack the ability to maintain a full nationwide relief operation. Decision-makers need to understand this risk and how the Maslow hierarchy of needs and the social determinants of health can guide whole of society policies. Aligning decisions with societal needs will help ensure all segments of society are catered to and met while managing the crisis. This must inform the process of incremental easing of lockdowns to facilitate the resumption of community foundations, such as commerce, education, and employment in a manner that protects those most vulnerable to COVID-19. This study proposes a framework for identifying a path forward. It reflects on baseline requirements, regulations and recommendations, triggers, and implementation. Those desiring a successful recovery from the COVID-19 pandemic need to adopt an evidence-based framework now to ensure community stabilization and sustainability.

The impact of a new curriculum on medical students' interest in and knowledge of health systems science.

In this analysis, we describe medical student interest in and knowledge of health systems science (HSS) during the launching of a new curriculum. We surveyed first year students (MS1s) before and after exposure to a new HSS curriculum. MS1s demonstrated a 16% increase in HSS knowledge post-curriculum. Interest in HSS was high in MS1s before (90%) and after (88%) the curriculum when compared to MS3s (72%). The implementation of a longitudinal HSS curriculum may increase knowledge and maintain interest in the subject.

Todo está en el mapa: Atlas Integrales de Salud Mental para la planificación de servicios. Informe SESPAS 2020 / Everything is on the map: Integrated Mental Health Atlases as support tools for service planning. SESPAS Report 2020

OBJETIVO: Este artículo revisa y evalúa el uso de los Atlas Integrales de Salud Mental como herramientas de apoyo a la planificación de servicios dentro del modelo de investigación de ecosistemas de atención de salud. MÉTODO: Se describen los tipos de atlas y el procedimiento para su elaboración. Se presentan los realizados en España y se evalúa su impacto en la planificación de servicios de salud mental. Los atlas agregan información sobre las características locales del sistema de atención, la disponibilidad geográfica de recursos recogida mediante el instrumento DESDE-LTC, y su uso. Utilizan un sistema de información geográfica y otras herramientas visuales. Siguen una metodología de abajo arriba con colaboración de personas decisoras de agencias de planificación para su elaboración y validación externa. RESULTADOS: Desde 2005 se han realizado Atlas Integrales de Salud Mental en nueve comunidades autónomas que comprenden alrededor del 65% de la población de España. Los atlas han tenido un impacto desigual en la planificación de servicios, con un mayor impacto en Cataluña, Vizcaya y Guipúzcoa, y Andalucía, donde responsables sociales han participado activamente en su codiseño y su aplicación a la planificación de servicios sociosanitarios. CONCLUSIONES: Los atlas permiten detectar carencias o duplicidades en la atención, monitorizar cambios a lo largo del tiempo, realizar comparaciones nacionales e internacionales, modelar la eficiencia y hacer análisis benchmark. Este conocimiento puede incorporarse a los sistemas de apoyo a la decisión para una más eficaz planificación de los servicios de salud mental basada en evidencia informada

OBJECTIVE: This article reviews the usability of the Integrated Atlases of Mental Health as a decision support tool for service planning following a health ecosystem research approach. METHOD: This study describes the types of atlases and the procedure for their development. Atlases carried out in Spain are presented and their impact in mental health service planning is assessed. Atlases comprise information on the local characteristics of the health care system, geographical availability of resources collected with the DESDE-LTC instrument and their use. Atlases use geographic information systems and other visualisation tools. Atlases follow a bottom-up collaborative approach involving decision-makers from planning agencies for their development and external validation. RESULTS: Since 2005, Integrated Atlases of Mental Health have been developed for nine regions in Spain comprising over 65% of the Spanish inhabitants. The impact on service planning has been unequal for the different regions. Catalonia, Biscay and Gipuzkoa, and Andalusia reach the highest impact. In these areas, health advisors have been actively involved in their co-design and implementation in service planning. CONCLUSIONS: Atlases allow detecting care gaps and duplications in care provision; monitoring changes of the system over time, and carrying out national and international comparisons, efficiency modelling and benchmarking. The knowledge provided by atlases could be incorporated to decision support systems in order to support an efficient mental health service planning based on evidence-informed policy

What Else Is Needed in the Korean Government's Master Plan for People With Developmental Disabilities?

On September 12, 2018, President Jae-In Moon announced the Comprehensive Plan for Lifelong Care for People with Developmental Disabilities, with representatives from the associated government branches (Ministry of Health and Welfare, Ministry of Education, and Ministry of Employment and Labor) in attendance. The goals of this plan are to provide health, medical, rehabilitative, special education, and social welfare services according to the life-stages of the affected individuals; to reduce parental pressure; to promote social interventions; and to enhance community-level participation in order to create a 'welfare society in harmony.' However, in order for the plan to succeed, additional efforts must be made in the following areas. First, an epidemiological survey is needed to understand the scale, prevalence, and incidence of developmental disabilities and to establish an evidence base to support policy development. Second, accurate definitions of developmental disabilities must be established in order to avoid policy discrimination based on impairment type and age. Third, personal evaluations to assess disabled individuals' unmet needs and customized service designs to deliver those needs are required. Fourth, the plan must fulfill the goals of accessibility and fairness that the government intends to provide. Fifth, the government should consider an integrated financial support system and to propose a detailed plan for monetary distributions. Finally, an integrated system that links health, medical, employment, educational, and welfare services must be constructed.

New Educator Roles for Health Systems Science: Implications of New Physician Competencies for U.S. Medical School Faculty.

To address gaps in U.S. health care outcomes, medical education is evolving to incorporate new competencies, as well as to align with care delivery transformation and prepare systems-ready providers. These new health systems science (HSS) competencies-including value-based care, quality improvement, social determinants of health, population health, informatics, and systems thinking-require formal education and role modeling in both classroom and clinical settings. This is challenging because few faculty had formal training in how to practice or teach these concepts. Thus, these new competencies require both expanding current educators' skills and a new cohort of educators, especially interprofessional clinicians. Additionally, because interprofessional teams are the foundation of many clinical learning environments, medical schools are developing innovative experiential activities that include interprofessional clinicians as teachers. This combination of a relative "expertise vacuum" within the current cohort of medical educators and expanding need for workplace learning opportunities requires a reimagining of medical school teachers. Based on experiences implementing HSS curricula at two U.S. medical schools (Penn State College of Medicine and University of California, San Francisco, School of Medicine, starting in 2013), this Perspective explores the need for new educator competencies and the implications for medical education, including the need to identify and integrate "new" educators into the education mission, develop faculty educators' knowledge and skills in HSS, and acknowledge and reward new and emerging educators. These efforts have the potential to better align the clinical and education missions of academic health centers and cultivate the next generation of physician leaders.

The Refugee Health Partnership: A Longitudinal Experiential Medical Student Curriculum in Refugee/Asylee Health.

PROBLEM: In 2017, there were 25.4 million refugees worldwide, of whom 33,400 were resettled in the United States. In fiscal year 2016, 20,455 individuals were granted permanent asylum status in the United Sates. Both in the United States and overseas, refugees/asylees face significant disparities in accessing needed medical, mental health, and social support. APPROACH: The Refugee Health Partnership (RHP) was developed by Johns Hopkins University School of Medicine students and colleagues at a local refugee resettlement agency in 2011. The program pairs teams of preclinical medical students with recently resettled refugees/asylees who have special health care needs. After receiving training, students conducted monthly home visits and accompanied patients to appointments to assist them in navigating the health care system over one year. Students participated in monthly reflection exercises to process experiences and attended monthly seminars facilitated by expert faculty and guests. OUTCOMES: From 2012 to 2016, the RHP served 20 refugee families and engaged 60 students across four cohorts. Refugee participant retention was 20/22 (90.9%), and student retention was 57/60 (95.0%). In surveys completed at the end of their programs, students reported improvement in all measures, including understanding of different patient perspectives as well as comfort in communicating with patients across cultures and language barriers. NEXT STEPS: The authors plan to integrate more objective measures of students' progress into the evaluations. They are scaling this model up both locally and beyond and plan to gather data from refugee/asylee participants to more accurately assess how they benefit from the program.

Understanding the Collaborative Planning Process in Homeless Services: Networking, Advocacy, and Local Government Support May Reduce Service Gaps.

OBJECTIVE: The Continuum of Care (CoC) process-a nationwide system of regional collaborative planning networks addressing homelessness-is the chief administrative method utilized by the US Department of Housing and Urban Development to prevent and reduce homelessness in the United States. The objective of this study is to provide a benchmark comprehensive picture of the structure and practices of CoC networks, as well as information about which of those factors are associated with lower service gaps, a key goal of the initiative. DESIGN: A national survey of the complete population of CoCs in the United States was conducted in 2014 (n = 312, 75% response rate). This survey is the first to gather information on all available CoC networks. Ordinary least squares (OLS) regression was used to determine the relationship between internal networking, advocacy frequency, government investment, and degree of service gaps for CoCs of different sizes. SETTING: United States. PARTICIPANTS: Lead contacts for CoCs (n = 312) that responded to the 2014 survey. MAIN OUTCOME MEASURE: Severity of regional service gaps for people who are homeless. RESULTS: Descriptive statistics show that CoCs vary considerably in regard to size, leadership, membership, and other organizational characteristics. Several independent variables were associated with reduced regional service gaps: networking for small CoCs (ß = -.39, P < .05) and local government support for midsized CoCs (ß = -.10, P < .05). For large CoCs, local government support was again significantly associated with lower service gaps, but there was also a significant interaction effect between advocacy and networking (ß = .04, P < .05). CONCLUSIONS: To reduce service gaps and better serve the homeless, CoCs should consider taking steps to improve networking, particularly when advocacy is out of reach, and cultivate local government investment and support.

Exploring the role of social capital in urban citizens' initiatives in the Netherlands / Papel del capital social en las iniciativas de los ciudadanos de zonas urbanas en los Países Bajos

Objective: This research explores the role of social capital in urban citizens’ initiatives in the Netherlands, by using in-depth interviews. Method: Social capital was operationalized as shared norms and values, connectedness, trust and reciprocity. Results: The findings show that initiatives form around a shared idea or ambition (shared norms and values). An existing network of relationships (connectedness) is needed for an idea to emerge and take form. Connectedness can also increase as a result of an initiative. Some level of trust between people needs to be present from the start of the initiative. For the initiative to persist, strong in-group connections seem important, as well as a good balance between investments and returns. This reciprocity is mainly about intangible assets, such as energy and friendship. Conclusion: This study concludes that social capital within citizens’ initiatives is both a prerequisite for the formation of initiatives and a result of the existence of initiatives

Objetivo: Explorar, mediante la realización de entrevistas en profundidad, el papel del capital social en las iniciativas de los ciudadanos de zonas urbanas de los Países Bajos. Método: Se conceptualizó el capital social como normas y valores compartidos, conectividad, confianza y reciprocidad. Resultados: Las iniciativas se forman alrededor de una idea o ambición compartida (normas y valores compartidos). Es necesaria la existencia de una red de relaciones previa (conectividad) para que una idea surja y tome forma. La conectividad también puede incrementarse como resultado de la iniciativa. Desde el inicio de la iniciativa debe estar presente un nivel mínimo de confianza entre las personas. Para que la iniciativa persista, parecen importantes las conexiones fuertes dentro del grupo, así como un buen equilibrio entre los esfuerzos y los beneficios obtenidos. Esta reciprocidad se refiere principalmente a bienes inmateriales, como la energía y la amistad. Conclusión: Este estudio concluye que el papel del capital social en las iniciativas de los ciudadanos de zonas urbanas es tanto un requisito para la aparición de iniciativas como el resultado de la existencia de algunas iniciativas

Clinical outcomes in patients with advanced epidermal growth factor receptor-mutated non-small-cell lung cancer in South Western Sydney Local Health District.

BACKGROUND: Epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) is a subgroup of oncogene addicted lung cancer that predicts response to tyrosine kinase inhibitors (TKI). However, there is variability in response and survival outcomes in patients with EGFR mutation treated with TKI. AIM: To describe clinical characteristics, treatment patterns and factors influencing outcomes in patients with EGFR-mutated NSCLC in South Western Sydney Local Health District. METHODS: Retrospective review of patients with EGFR-mutated NSCLC diagnosed between January 2010 and June 2016. RESULTS: A total of 85 EGFR-mutated NSCLC patients was identified; 80 (94%) received first-line treatment with EGFR-TKI. The median follow-up was 10.7 months with a median duration of treatment of 9 months. On disease progression (n = 44), 37% had best supportive care only, 30% received chemotherapy, 23% participated in clinical trials, 7% continued on a first generation EGFR-TKI and 3% received afatinib. Overall response rate to first-line EGFR-TKI was 66%. Median progression-free survival (PFS) was 10.7 months (range 2.7-55.9 months) and median overall survival (OS) was 23 months (range 0.4-35.8 months). Multivariate Cox regression analysis showed that patients with lower disease burden (<4 sites) had longer PFS (hazard ratio (HR) 0.36, 95% confidence interval (CI) 0.18-0.72, P = 0.004) but not OS. Good performance status predicts longer OS (HR 0.33, CI 0.14-0.77, P = 0.01). Lower (<5) pre-treatment neutrophil-to-lymphocyte ratio (NLR) was associated with better PFS (HR 0.40, 95% CI 0.18-0.87, P = 0.02) and OS (HR 0.43, 95% CI 0.19-0.94, P = 0.04). There were no survival differences when patients were stratified by age, baseline albumin level and types of EGFR mutation. CONCLUSION: Results from this community-based cohort confirm known prognostic factors in patients with EGFR-mutated NSCLC receiving TKI and suggest the negative influence of a heightened host systemic inflammatory response on patient outcomes.

Strategy and technology to prevent hospital-acquired infections: Lessons from SARS, Ebola, and MERS in Asia and West Africa.

Hospital-acquired infections (HAIs) are serious problems for healthcare systems, especially in developing countries where public health infrastructure and technology for infection preventions remain undeveloped. Here, we characterized how strategy and technology could be mobilized to improve the effectiveness of infection prevention and control in hospitals during the outbreaks of Ebola, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS) in Asia and West Africa. Published literature on the hospital-borne outbreaks of SARS, Ebola, and MERS in Asia and West Africa was comprehensively reviewed. The results showed that healthcare systems and hospital management in affected healthcare facilities had poor strategies and inadequate technologies and human resources for the prevention and control of HAIs, which led to increased morbidity, mortality, and unnecessary costs. We recommend that governments worldwide enforce disaster risk management, even when no outbreaks are imminent. Quarantine and ventilation functions should be taken into consideration in architectural design of hospitals and healthcare facilities. We also recommend that health authorities invest in training healthcare workers for disease outbreak response, as their preparedness is essential to reducing disaster risk.

Implementation of a multidisciplinary pharmacogenomics clinic in a community health system.

PURPOSE: The development and implementation of a multidisciplinary pharmacogenomics clinic within the framework of an established community-based medical genetics program are described. SUMMARY: Pharmacogenomics is an important component of precision medicine that holds considerable promise for pharmacotherapy optimization. As part of the development of a health system-wide integrated pharmacogenomics program, in early 2015 Northshore University Health-System established a pharmacogenomics clinic run by a multidisciplinary team including a medical geneticist, a pharmacist, a nurse practitioner, and genetic counselors. The team identified five key program elements: (1) a billable-service provider, (2) a process for documentation of relevant medication and family histories, (3) personnel with the knowledge required to interpret pharmacogenomic results, (4) personnel to discuss risks, benefits, and limitations of pharmacogenomic testing, and (5) a mechanism for reporting results. The most important program component is expert interpretation of genetic test results to provide clinically useful information; pharmacists are well positioned to provide that expertise. At the Northshore University HealthSystem pharmacogenomics clinic, patient encounters typically entail two one-hour visits and follow a standardized workflow. At the first visit, pharmacogenomics-focused medication and family histories are obtained, risks and benefits of genetic testing are explained, and a test sample is collected; at the second visit, test results are provided along with evidence-based pharmacotherapy recommendations. CONCLUSION: A multidisciplinary clinic providing genotyping and related services can facilitate the integration of pharmacogenomics into clinical care and meet the needs of early adopters of precision medicine.

Measuring needs for priority setting in healthcare planning and policy.

Much research aimed at developing measures for normative criteria to guide the assessment of healthcare resource allocation decisions has focused on health maximization, equity concerns and more recently approaches based on health capabilities. However, a widely embraced idea is that health resources should be allocated to meet health needs. Little attention has been given to the principle of need which is often mentioned as an alternative independent criteria that could be used to guide healthcare evaluations. This paper develops a model and indicator of need satisfaction that aggregates the health needs of a population in a particular time period into a single measure that weights individual health needs by the severity of their ill health. The paper provides a first step towards formalizing the principle of need as a measurable objective for healthcare policy and we discuss some challenges for future research, including incorporating the duration of time into need-based health evaluations.

Implementation of a new dantrolene formulation across a multifacility health system.

PURPOSE: An initiative to optimize the treatment of malignant hyperthermia in surgical patients through a dantrolene product conversion program is described. SUMMARY: A large health system's formulary evaluation of a new dantrolene sodium product indicated that despite a higher cost per treatment course, the product could offer key advantages over older formulations of dantrolene in terms of preparation and administration time, product content, and storage requirements. A work group, consisting of pharmacy personnel, an anesthesiologist, a nurse anesthetist, and a representative of the health system's group purchasing organization, determined that a switch to the new dantrolene product would offer both patient care benefits and process benefits. With the approval of the health system's pharmacy and therapeutics committee, the new product was added to the formulary as the preferred dosage form of dantrolene, and existing dantrolene product stock was converted to the new formulation. Key implementation steps included (1) concurrent replacement of dantrolene stock on all "malignant hyperthermia carts" across the 15-hospital health system, (2) development of educational materials to raise awareness of the conversion and revised product preparation procedures, (3) anesthesiology provider and pharmacy staff education, (4) revision of dantrolene listings in each hospital's computerized prescriber-order-entry system, and (5) redistribution of returned dantrolene product stock. The dantrolene product conversion occurred over a four-month period. CONCLUSION: A multifacility health system was successful in converting an existing stock of dantrolene to a newly available formulation.