Objectives: There is widespread commitment--at least in principle--to "evidence-informed" clinical practice and policy development in health care. The intention is that only "appropriate" care ought to be delivered at public expense. Although the rationale for an appropriateness agenda is widely endorsed, and methods have been proposed for addressing it, few published studies exist of contemporary policy initiatives which have actually led to successful disinvestment. Our objective was to explore whether the direct involvement of policy stakeholders could advance appropriateness and disinvestment.
Methods: Several collaborative engagements with policy stakeholders were undertaken to adapt and combine conceptual and empirical material related to appropriateness and disinvestment from the literature to create tools and processes for use in Canada and the province of Ontario in particular.
Results: By combining inputs from the literature with colloquial evidence from policy stakeholders, a definition of appropriateness was developed and, importantly, endorsed by all the provincial and territorial ministers of health in Canada. Second, a reassessment framework was successfully implemented for identifying priorities for selective disinvestment.
Conclusions: When scientific evidence was combined with colloquial evidence from policy stakeholders, progress was made on the design and successful implementation of policies for appropriateness and disinvestment.
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http://dx.doi.org/10.1017/S0266462315000392 | DOI Listing |
JMIR Res Protoc
January 2025
Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany.
Background: Artificial intelligence (AI)-based clinical decision support systems (CDSS) have been developed for several diseases. However, despite the potential to improve the quality of care and thereby positively impact patient-relevant outcomes, the majority of AI-based CDSS have not been adopted in standard care. Possible reasons for this include barriers in the implementation and a nonuser-oriented development approach, resulting in reduced user acceptance.
View Article and Find Full Text PDFJ Health Serv Res Policy
January 2025
Associate Professor, Exeter Collaboration for Academic Primary Care, University of Exeter Medical School, Exeter, UK.
Objective: Digital services in primary care are becoming more common, yet access to and use of services can create inequities. Our aim was to explore the drivers, priorities, and evolving policy context influencing digital facilitation in primary care as reported by national, regional and local level stakeholders in England.
Methods: We conducted online semi-structured qualitative interviews with stakeholders, including those in NHS England organisations, local commissioners for health care, statutory and third sector organisations, those working within the research community, and digital platform providers.
PLoS One
January 2025
School of Health and Social Care, University of Essex, Colchester, United Kingdom.
Background: Non-governmental organisations (NGOs) have the potential to make a significant contribution to improving health system goals through the provision of resources, health services and community participation. Therefore, this paper examines the role of NGOs in achieving health system goals, based on the six building blocks of a health system framework, and identifies strategies to enhance NGO involvement in achieving health system goals.
Methods: A scoping systematic review methodology was used to map and synthesise the existing literature on the topic, following the latest JBI six-stage framework.
Dysphagia
January 2025
The Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark.
Prevalence of dysphagia is high in hospitalised geriatric patients, posing risks of complications including malnutrition, dehydration, aspiration, and pneumonia. These complications may lead to reduced daily functioning, frailty, prolonged hospital stays, readmissions, and mortality. Diagnosing dysphagia in geriatric patients is often challenging due to the complex health conditions of this patient group, and overall these patients are at risk of lack of continuity in patient pathways and unnecessary hospitalisations.
View Article and Find Full Text PDFF1000Res
January 2025
Industrial Engineering, Tshwane University of Technology, Pretoria, Gauteng, 0183, South Africa.
Background: This research investigated the dynamics of fee-free higher education in South Africa, analysing the interplay of socioeconomic, political, and institutional factors to elucidate the complexities surrounding its implementation and impact. Using a causal loop diagram approach (CLD), the study aims to identify key factors to effective implementation, how they interact to shape the outcome of the policy, and actionable strategies to address the challenges hindering the policy sustainability.
Method: A participatory approach was used to developing the CLD, integrating insights from an extensive literature review and stakeholder opinion.
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