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2.
Health Promot Int ; 37(6)2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36300698

RESUMO

Complex social issues such as population health mean that no one person, organization or sector can resolve these problems alone and instead require a collaborative approach. This study applied the Collective Impact framework to evaluate the alliance responsible for delivering a large-scale health promotion initiative. Committee meeting minutes for a 4-year period and qualitative interviews with key stakeholders (N = 14) involved in the design and implementation of the initiative explored the factors that contributed to collaborative efforts and initiative outcomes. Major strengths of the Healthier Queensland Alliance (the Alliance) stemmed from identifying a common agenda and using frequent communication to develop trust among Alliance partners. These processes were important, particularly in improving key relationships to ensure inclusivity and equity. Reinforcing activities helped to support individual organizational efforts, while shared measurement systems promoted data-driven decision-making and learning, which contributed to continuous improvement and innovation. Current findings support the use of the Collective Impact framework as a scaffold to assist collaborative alliances in working effectively and efficiently when implementing large-scale initiatives aiming to create positive social impact. This study has identified the foundations of practice to establish a successful Collective Impact alliance.


Collective action to achieve social impact requires collaboration allowing organizations to expand their resources and abilities to enhance their collective capabilities. This paper reports on the use of the Collective Impact framework to show how a collaboration of partner organizations was developed to achieve social impact in a large health promotion initiative. The study identified six foundations for practice to enable successful collective partnerships that will be useful for practitioners and policy-makers when developing health promotion initiatives targeting a range of priority groups. The Collective Impact framework offers a strategic approach for building capacity in a range of communities to navigate power dynamics and find new ways of collaboration to achieve positive social impacts for their communities.


Assuntos
Fundos de Seguro , Saúde da População , Humanos , Austrália , Promoção da Saúde , Avaliação de Resultados em Cuidados de Saúde
3.
Nutrients ; 14(14)2022 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-35889954

RESUMO

The Mediterranean diet is a plant-based, antioxidant-rich, unsaturated fat dietary pattern that has been consistently associated with lower rates of noncommunicable diseases and total mortality, so that it is considered one of the healthiest dietary patterns. Clinical trials and mechanistic studies have demonstrated that the Mediterranean diet and its peculiar foods and nutrients exert beneficial effects against inflammation, oxidative stress, dysmetabolism, vascular dysfunction, adiposity, senescence, cognitive decline, neurodegeneration, and tumorigenesis, thus preventing age-associated chronic diseases and improving wellbeing and health. Nocturnal sleep is an essential physiological function, whose alteration is associated with health outcomes and chronic diseases. Scientific evidence suggests that diet and sleep are related in a bidirectional relationship, and the understanding of this association is important given their role in disease prevention. In this review, we surveyed the literature concerning the current state of evidence from epidemiological studies on the impact of the Mediterranean diet on nighttime sleep quantity and quality. The available studies indicate that greater adherence to the Mediterranean diet is associated with adequate sleep duration and with several indicators of better sleep quality. Potential mechanisms mediating the effect of the Mediterranean diet and its foods and nutrients on sleep are described, and gap-in-knowledge and new research agenda to corroborate findings are discussed.


Assuntos
Disfunção Cognitiva , Dieta Mediterrânea , Dieta , Ingestão de Alimentos , Humanos , Fundos de Seguro , Sono
4.
BMC Prim Care ; 23(1): 102, 2022 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-35501712

RESUMO

BACKGROUND: Excessive and inappropriate use of antibiotics is the most important driver of antimicrobial resistance. The aim of the HAPPY PATIENT project is to evaluate the adaptation of European Union (EU) recommendations on the prudent use of antimicrobials in human health by evaluating the impact of a multifaceted intervention targeting different categories of healthcare professionals (HCPs) on common community-acquired infectious diseases, especially respiratory and urinary tract infections. METHODS/DESIGN: HAPPY PATIENT was initiated in January 2021 and is planned to end in December 2023. The partners of this project include 15 organizations from 9 countries. Diverse HCPs (doctors, nurses, pharmacists, and pharmacy technicians) will be audited by the Audit Project Odense (APO) method before and after an intervention in four different settings: general practice, out of hours services, nursing homes and community pharmacies in four high antibiotic prescribing countries (France, Poland, Greece, and Spain) and one low prescribing country (Lithuania). About 25 individuals from each professional group will be recruited in each country, who will register at least 25 patients with community-acquired infections during each audit period. Shortly before the second registration participants will undertake a multifaceted intervention and will receive the results from the first registration to allow the identification of possible quality problems. At these meetings participants will receive training courses on enhancement of communication skills, dissemination of clinical guidelines with recommendations for diagnosis and treatment, posters for the waiting rooms, and leaflets for patients. The results of the second registration will be compared with those obtained in the first audit. DISCUSSION: HAPPY PATIENT is an EU-funded project aimed at contributing to the battle against antibiotic resistance through improvement of the quality of management of common community-acquired infections based on interventions by different types of HCPs. It is hypothesized that the use of multifaceted strategies combining active intervention will be effective in reducing inappropriate prescribing and dispensing of antibiotics. STUDY REGISTRATION: EU Health programmes project database https://webgate.ec.europa.eu/chafea_pdb/health/projects/900024/summary ; date of registration: 1 January 2021.


Assuntos
Infecções Comunitárias Adquiridas , Infecções Respiratórias , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Resistência Microbiana a Medicamentos , Humanos , Fundos de Seguro , Infecções Respiratórias/tratamento farmacológico
6.
East Mediterr Health J ; 28(1): 3-4, 2022 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-35165872

RESUMO

The United Nations launched the Sustainable Development Agenda 2030 and its 17 Sustainable Development Goals (SDGs) in 2015, as a more detailed and ambitious follow-up to the Millennium Developments Goals (MDGs). Health and wellbeing of all, at all ages, is addressed by the third SDG (SDG3) and health-related targets of other SDGs. However, progress to date on the health-related SDGs in the Eastern Mediterranean Region (EMR) is not on track. Although there was progress in over half of the 50 health-related SDG targets and indicators between 2015 and 2019, there is still a long way to go. Progress is required, among others, in reducing maternal, child and neonatal mortality; increasing vaccination coverage; reducing the number of cases of malaria and HIV; and in tackling the increase in mortality rates due to noncommunicable diseases. Much progress is needed in many health-related SDGs considered as important social, economic and environmental determinants of health.


Assuntos
Fundos de Seguro , Desenvolvimento Sustentável , Criança , Saúde Global , Humanos , Recém-Nascido , Região do Mediterrâneo/epidemiologia , Nações Unidas
7.
Health Policy Plan ; 37(3): 322-336, 2022 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-34919688

RESUMO

Partnerships have become increasingly important in addressing complex global health challenges, a reality exemplified by the COVID-19 pandemic and previous infectious disease epidemics. Partnerships offer opportunities to create synergistic outcomes by capitalizing on complimentary skills, knowledge and resources. Despite the importance of understanding partnership functioning, research on collaboration is sparse and fragmented, with few conceptual frameworks applied to evaluate real-life partnerships in global health. In this study, we aimed to adapt and apply the Bergan Model of Collaborative Functioning (BMCF) to analyse partnership functioning in the UK Public Health Rapid Support Team (UK-PHRST), a government-academic partnership, dedicated to outbreak response and research in low- and middle-income countries. We conducted a literature review identifying important elements to adapt the framework, followed by a qualitative case study to characterize how each element, and the dynamics between them, influenced functioning in the UK-PHRST, exploring emerging themes to further refine the framework. Elements of the BMCF that our study reinforced as important included the partnership's mission, partner resources (skills, expertise and networks), leadership, the external environment, management systems and communication. Additional elements identified in the literature and critical to partnership functioning of the UK-PHRST included governance and financial structures adopted, trust and power balance, organizational culture, strategy and evaluation and knowledge management. Because of the way the UK-PHRST was structured, fostering team cohesion was an important indicator of synergy, alongside collaborative advantage. Dividing the funding and governance equally between organizations was considered crucial for maintaining institutional balance; however, diverse organizational cultures, weak communication practices and perceived power imbalances compromised team cohesion. Our analysis allowed us to make recommendations to improve partnership functioning at a critical time in the evolution of the UK-PHRST. The analysis approach and framework presented here can be used to evaluate and strengthen the management of global health partnerships to realize synergy.


Assuntos
COVID-19 , Saúde Global , COVID-19/epidemiologia , Comportamento Cooperativo , Humanos , Fundos de Seguro , Pandemias , Saúde Pública , SARS-CoV-2 , Reino Unido
8.
AMA J Ethics ; 23(6): E499-500, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34212852

RESUMO

This graphic narrative explores struggles with underinsurance, compromised access to indicated care, and intergenerational health inequity.


Assuntos
Afogamento , Humanos , Fundos de Seguro , Seguro Saúde , Narração
9.
J Healthc Manag ; 66(2): 141-154, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33692319

RESUMO

EXECUTIVE SUMMARY: The formation of regional strategic alliances continues to be a well-evidenced response to a varying array of market forces that are challenging the ability of healthcare institutions to realize their missions. Organizations that serve rural communities especially feel pressure to initiate the formation of these collaborative arrangements.In response to concerns of Pennsylvania legislators regarding the impact of these alliances on rural healthcare entities, the Center for Rural Pennsylvania funded a study of outcomes of regional strategic alliances involving rural healthcare institutions. Although the research focused on outcomes, the data also revealed organizational characteristics and patterns of decisions and actions that separated rural healthcare institutions with greater alliance outcome success from their peers serving other rural communities. Strategic leadership and interorganizational management expertise serve as the foundation for decisions and actions beginning before an active search for an alliance and culminating with the achievement of alliance goals. Commitments to collaborative leadership, purposeful partnership, coordination, and progress thematically represent the series of critical decisions and actions collectively required to achieve strategic alliance success. The case of the Laurel Health System illustrates these commitments.Although the findings are based on an intensive review of regional strategic alliances involving rural healthcare institutions, the lessons presented here are transferable to community healthcare organizations regardless of location.


Assuntos
Fundos de Seguro , População Rural , Atenção à Saúde , Humanos , Liderança , Pennsylvania
15.
Risk Anal ; 39(4): 906-925, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30261117

RESUMO

The preservation of perishable food via refrigeration in the supply chain is essential to extend shelf life and provide consumers with safe food. However, electricity consumed in refrigeration processes has an economical and an environmental impact. This study focuses on the cold chain of cooked ham, including transport, cold room in supermarket, display cabinet, transport by consumer, and domestic refrigerator, and aims to predict the risk for human health associated with Listeria monocytogenes, the amount of food wasted due to the growth of spoilage bacteria, and the electrical consumption to maintain product temperature through the cold chain. A set of eight intervention actions were tested to evaluate their impact on the three criteria. Results show that the modification of the thermostat of the domestic refrigerator has a high impact on food safety and food waste and a limited impact on the electrical consumption. Inversely, the modification of the airflow rate in the display cabinet has a high impact on electrical consumption and a limited impact on food safety and food waste. A cost-benefit analysis approach and two multicriteria decision analysis methods were used to rank the intervention actions. These three methodologies show that setting the thermostat of the domestic refrigerator to 4 °C presents the best compromise between the three criteria. The impact of decisionmaker preferences (criteria weight) and limitations of these three approaches are discussed. The approaches proposed by this study may be useful in decision making to evaluate global impact of intervention actions in issues involving conflicting outputs.


Assuntos
Medição de Risco , Economia , Alimentos , Inocuidade dos Alimentos , Humanos , Fundos de Seguro
16.
Milbank Q ; 96(4): 755-781, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30537369

RESUMO

Policy Points Accountable care organizations (ACOs) form alliances with management partners to access financial, technical, and managerial support. Alliances between ACOs and management partners are subject to destabilizing tension around decision-making authority, distribution of shared savings, and conflicting goals and values. Management partners may serve either as trainers, ultimately breaking off from the ACO, or as central drivers of the ACO. Management partner participation in ACOs is currently unregulated, and management partners may receive a significant portion (in some cases, majority) of shared savings. CONTEXT: Accountable care organizations (ACOs) are a prominent payment and delivery model. Though ACOs are often described as groups of health care providers, nearly 4 in 10 ACOs partner with a management company for services such as financial investment, contracting, data analytics, and care management, according to recent research. However, we know little about how and why these partnerships form. This article aims to understand the reasons providers seek partners, the nature of these relationships, and factors critical to the success or failure of these alliances. METHODS: We used qualitative data collected longitudinally from 2012 to 2017 at 2 ACOs to understand relationships between management partners and ACO providers. The data include 115 semistructured interviews and observational data from 7 site visits. Two coders applied 48 codes to the data. We reviewed coded data for emergent themes in the context of alliance life cycle theory. FINDINGS: Qualitative data revealed that management partners brought specific skills and services and also gave providers confidence in pursuing an ACO. Over time, tension between providers and management partners arose around decision-making authority, distribution of shared savings, and conflicting goals and values. We observed 2 outcomes of partnerships: cemented partnerships and dissolution. Key factors distinguishing alliance outcome in these 2 cases include degree of trust between organizations in the alliance; approach to conflict resolution; distribution of power in the alliance; skills and confidence acquired by the ACO over the life of the alliance; continuity of management partner delivery on promised resources; and proportion of savings going to the management partner. CONCLUSIONS: The diverging paths for ACOs with management partners suggest 2 different roles that management partners may play in ACO development. In some cases, management partners may serve as trainers, with the partnership dissolving once the ACO gains skills and confidence to work alone. In other cases, the management partner is a central driver of the ACO and unlikely to break off.


Assuntos
Organizações de Assistência Responsáveis/organização & administração , Organizações de Assistência Responsáveis/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Fundos de Seguro/organização & administração , Medicare/organização & administração , Medicare/estatística & dados numéricos , Humanos , Estados Unidos
17.
J Law Med Ethics ; 46(3): 766-772, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30336081

RESUMO

Despite a significant amount of literature debating the efficiency of high-risk pools in health insurance, dramatically less has been written about their normative implications. The present article takes the route less traveled by setting aside the question of efficiency to argue that the use of high-risk pools creates some serious normative concerns. The article explores these concerns by dividing them on two fronts. First, as regards the social-recognitional status of those who are forced into the high-risk pool. Second, as regards a general concern of distributive justice, namely fairness in access to resources. The author argues that regardless of the veracity of arguments which laud the efficiency of high-risk pools, their use in health insurance is unjust because of the herein explained implications for social recognition and distributive justice.


Assuntos
Cobertura do Seguro , Fundos de Seguro/ética , Seguro Saúde , Pessoas sem Cobertura de Seguro de Saúde , Humanos , Planos Governamentais de Saúde , Estados Unidos
20.
Issue Brief (Commonw Fund) ; 2018: 1-12, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30091863

RESUMO

Issue: Health care sharing ministries (HCSMs) are a form of health coverage in which members--who typically share a religious belief--make monthly payments to cover expenses of other members. HCSMs do not have to comply with the consumer protections of the Affordable Care Act and may provide value for some individuals, but pose risks for others. Although HCSMs are not insurance and do not guarantee payment of claims, their features closely mimic traditional insurance products, possibly confusing consumers. Because they are largely unregulated and provide limited benefits, HCSMs may be disproportionately attractive to healthy individuals, causing the broader insurance market to become smaller, sicker, and more expensive. Goal: To understand state regulator perspectives on regulation of HCSMs and the impact of these arrangements on consumers and markets. Methods: Analysis of state laws governing HCSMs in all states; interviews with officials in 13 states; and review of the membership requirements and benefits of five HCSMs. Findings and Conclusions: State regulators voiced concerns regarding the potential risks of HCSMs to consumers and their individual markets. However, in the absence of reliable data describing HCSM enrollment, regulators cannot adequately assess harm. Though limited resources and political constraints have made oversight difficult, all states, regardless of their regulatory approach to HCSMs, should obtain data to better understand the role of HCSMs in their markets.


Assuntos
Custo Compartilhado de Seguro , Fundos de Seguro/economia , Seleção Tendenciosa de Seguro , Seguro Saúde , Religião , Regulamentação Governamental , Trocas de Seguro de Saúde , Humanos , Benefícios do Seguro , Cobertura do Seguro , Marketing de Serviços de Saúde , Patient Protection and Affordable Care Act , Governo Estadual , Estados Unidos
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