International Journal of Health Policy and Management最新文献

Background: Achieving universal health coverage for maternal health (MH) requires a health system that ensures the availability, accessibility, acceptability, and effective use of services. The study aimed to identify bottlenecks that hinder project outcomes of MH in the rural districts of Tanzania.

Methods: This study employed a convergent mixed-method approach to conduct the bottleneck analysis. Quantitative data were collected to identify indicators of MH utilization, with source including Tanzanian health statistics, health facilities and the women in reproductive age (WRA) survey. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with WRA, their families, community health workers (CHWs), and healthcare personnel (HP) to gain insight into factors influencing healthcare utilization from both a demand and an environmental perspective. Following the Tanahashi steps, the quantitative data were analyzed using descriptive statistics and the qualitative data were analyzed using a thematic approach. The findings from both were integrated to identify bottlenecks toward effective coverage and how bottlenecks affected the utilization of MH services.

Results: Community awareness and acceptance were observed to be high, however only a limited number of individuals had received MH services. Utilization rates for antenatal care (ANC) and postnatal care (PNC) were 17.4% and 22.0%, respectively. This suggests that efforts to enhance awareness may be inadequate to change social norms and lead to health behaviors. Furthermore, even when women utilize the service, they may not do so in a timely or consistent manner due to low service quality or unsatisfactory experiences.

Conclusion: To strengthen the logic model, contextual factors such as provider attitudes, service quality, supportive family, and community climate need to be considered to ensure that WRAs are satisfied with and continue to access services. With building supply-side infrastructure, ongoing efforts to change stakeholders' perceptions of MH services and utilization patterns will be needed to improve the coverage of MH services.

Background: The participatory approach in policy construction is a historical debt to communities. An example of the above is the definition that Colombian Indigenous communities give to mental health or spiritual harmony. Spiritual harmonies are a collective good that implies being in harmony with the spirit and with thought, which is why it is related to the community context, with the territory, identity, autonomy, spirituality, worldview, diverse cultural uses, practices, and customs. The objective of this study was to analyze the process of building a mental health recovery path with multiple community representatives in a Colombian territory.

Methods: Through a co-production method based on Participatory Action Research, focus groups were developed with representatives of children, youth, indigenous peoples, migrant populations, as well as government sectors such as health, education, and decision-makers in the territory. This study was carried out in 2023 in the District of Riohacha, Colombia, in the last quarter of 2023, within the framework of the construction of a mental health route, led by the District Mayor's Office. Fifty-nine people participated in the focus groups.

Results: The necessity of living in safe and supportive environments was emphasized. The route built with the community was based on the definition of the necessary steps to generate a real approach to the context and their perceptions of well-being, mental health and spiritual harmonies. Three main themes were identified: (1) Mental health: a construct of well-being, care and identity, (2) Barriers to an integral approach and ideals of joint construction, and (3) The proposal for a comprehensive mental health route.

Conclusion: Co-productive methodologies strengthen community autonomy and empowerment, and make the implementation of mental health programs more feasible. In public policies, it is increasingly necessary to have communities that are strengthened in the production of knowledge and in the proposals for implementation.

Background: Integrated care systems (ICSs) in England were formally established in July 2022 to coordinate the planning and delivery of health and care services. A key responsibility was to address the quality of these services. Our study aimed to examine how ICSs approach this responsibility and to identify opportunities and barriers experienced in their early establishment and development.

Methods: A sample of four ICSs were recruited to participate. Interviews and meeting observations were undertaken in two phases (before and after the inception of ICSs) around 12 months apart. A total of 112 interviews were carried out with senior figures in the four ICSs supplemented by observation of relevant meetings and analysis of relevant documents.

Results: Regarding quality, ICSs demonstrated several new ways of working. They set-up new structures for quality governance and created whole-system strategies for quality centred on major responsibilities regarding population health and health inequalities. These strategies required new and relevant metrics to assess quality and outcomes and a greater focus upon co-production in the development of services. They aimed to strike a fine balance between long-standing requirements for quality assurance and new responsibilities for quality improvement (QI). New approaches were underpinned by new collaborations between system partners extending beyond healthcare to include Local Authorities (responsible for social care and public health) and local communities.

Conclusion: To address the many challenges of quality, ICSs have created new ways of working cultivating different kinds of collaborative relationships compared to established hierarchical, siloed and top-down ways of working prior to their formation. A focus on improving population health and reducing inequalities has required a shift from "here and now" urgent problem-solving to working with longer timelines. Such changes require patience in the context of political pressure to devote efforts to more salient problems such as waiting lists.

There is a growing interest in complexity research. A recent systematic review by Loffreda et al attempted to study the barriers and opportunities for the adoption and implementation of the "best buys" for non-communicable diseases (NCDs) from a political economy perspective. In this commentary we take forward the discussion on the NCD best-buys by comparing the findings of the article with one of the risk factors of tobacco use and its control in India. We reflect on the challenges in actualizing the promise of research methods and approaches while studying such complex interventions like the NCD best buys. The balance of studying complexity while still keeping the findings translatable at country levels. Future research could potentially use a comparative lens focusing on either industry/government or actor behaviour across the different risk factors to facilitate cross learning, anticipate and pre-empt adverse policy decisions and implementation outcomes.

McDonald and colleagues' work "Achieving Diagnostic Excellence: Roadmaps to Develop and Use Patient-Reported Measures With an Equity Lens" emphasizes the critical role of patient-reported measures (PRMs) in achieving diagnostic excellence, with a focus on equity. PRMs capture patients' experiences, symptoms, and concerns throughout the diagnostic process, enhancing accuracy and addressing uncertainties. In contexts like maternity care, PRMs have been applied to reveal and reduce communication gaps and alleviate anxiety, offering crucial support for improving diagnostic experiences and outcomes. This commentary explores the application of McDonald and colleagues' visions and roadmaps to prenatal diagnosis, specifically focusing "prenatal screening and testing" (PreST), a complex process where diverse patient populations face challenges in understanding and responding to sequential test results. Tailored diagnosis-related PRMs can provide healthcare providers with tools to enhance shared decision-making, equitable communication, and patient satisfaction, leading to more inclusive and personalized diagnostic pathways.

This commentary commends Milsom et al for their critical and rigorous application of qualitative system dynamics to unpack corporate power in food policy-making. Their use of Critical Realism, best practice qualitative methods, and feedback loops exemplifies the maturation of system dynamics applications in public health research. We reflect on how their work aligns with broader debates about power and social theory in system dynamics and how it offers a blueprint for trustworthiness and reflexivity in qualitative modelling. Drawing on our team's work with Aboriginal communities in Australia, we highlight the value of culturally grounded, participatory modelling in amplifying the voices of communities experiencing historical and ongoing oppression. We support the authors' call to advance toward simulation modelling and stress the importance of engaging with both system dynamics and community-based knowledge to realise the transformative potential of systems-informed, community-led research in reshaping food policy and practice.

Operational effectiveness is about improving what is being done, reducing errors and harms, and improving efficiency, while strategy involves making decisions and choices. Implementing value-based healthcare (VBHC) also means matching previous strategies and performance literature to guide building sustainable organizations in healthcare businesses. This commentary paper explores answers for: What does it mean to have a high-performance, sustainable, and impactful health organization? By describing frameworks about leadership and social capital, this piece argues that the healthcare system's sustainability involves making choices that set as a strategy implementing VBHC principles, cause implications on regulatory, organizational, and individual levels, and result in structuring systems that contribute to achieving high performance on improving population health. The argumentation suggests that achieving a high-performance, sustainable, and impactful health organization can be translated into positively impacting population health with financial accountability, and systems internal processes may serve as roads to achieve that impact on society.

Background: Pharmacoeconomic evaluations are becoming more important in China, and their research quality directly impacts government decisions, deserving extra attention. To summarize the quality of pharmacoeconomic publications for China compared to internationally and to identify areas for improvement both from a China-specific and international perspective.

Methods: First, we conducted a systematic review of pharmacoeconomic publications for China, with subsequent reporting quality assessment based on the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Second, we conducted an umbrella review of pharmacoeconomic publications internationally which used a similar quality assessment. We extracted the CHEERS checklist scores for each study and converted them to percentages to facilitate comparison of results.

Results: CHEERS 2022 instrument was used to evaluate the quality of 154 pharmacoeconomic publications by Chinese scholars. Across these articles, the average quality score was 61.0%, indicating a moderate level of quality on average. There were 27 (17.5%) high-quality articles, 85 moderate quality articles (55.2%) and 42 low-quality (27.3%) articles. Out of 28 scoring items, those included in the methods section such as: health economic analysis plan, characterizing heterogeneity, characterizing distributional effects, approach to engagement with patients and others affected by the study, got low scores. In addition to the generally lower scores of international articles on items 9 (Time horizon), 18 (Characterizing heterogeneity) and 24 (Effect of uncertainty), Chinese articles also scored lower than international articles on items included in the methods and other relevant information section, eg, health economic analysis plan, perspective, discount rate, analytics and assumptions, characterizing distributional effects, approach to engagement with patients and others affected by the study, source of funding, and conflicts of interest.

Conclusion: The quality of China's pharmacoeconomic publications has been improving year by year since the establishment of the National Healthcare Security Administration (NHSA) in 2018, but there is still a quality gap with similar international publications which requires further focus and improvement in study conduct and reporting standards for the evidence-base to be sufficient for health technology assessment (HTA).

Quality metrics for improving care are deeply embedded in healthcare systems. Patient-reported measures (PRMs) have now been implemented for many conditions and are a high priority for the Centers for Medicare and Medicaid Services (CMS).¹ However, the development of PRMs specific to diagnostic quality remains largely exploratory. Early progress in acquiring and analyzing diagnostic PRMs reveals that patients offer a novel and valuable source of information about their diagnostic journeys. To fully understand and learn from patient experiences, work needs to include varied clinical settings, sites, and conditions. This work requires and deserves focused commitment and coordinated effort with a unifying strategic vision optimally facilitated by a national, or international, coordinating center.