Implementation Of Healthcare Policies Research Articles

Key concepts in clinical epidemiology: research integrity definitions and challenges

Research integrity is guided by a set of principles to ensure research reliability and rigor. It serves as a pillar to uphold society's trust in science and foster scientific progress. However, over the past 2 decades, a surge in research integrity concerns, including fraudulent research, reproducibility challenges, and questionable practices, has raised critical questions about the reliability of scientific outputs, particularly in biomedical research. In the biomedical sciences, any breaches in research integrity could potentially lead to a domino effect impacting patient care, medical interventions, and the broader implementation of healthcare policies. Addressing these breaches requires measures such as rigorous research methods, transparent reporting, and changing the research culture. Institutional support through clear guidelines, robust training, and mentorship is crucial to fostering a culture of research integrity. However, structural and institutional factors, including research incentives and recognition systems, play an important role in research behavior. Therefore, promoting research integrity demands a collective effort from all stakeholders to maintain public trust in the scientific community and ensure the reliability of science. Here we discuss some definitions and principles, the implications for biomedical sciences, and propose actionable steps to foster research integrity.

Regulatory and legal regulation of the healtcare sector in Ukraine and Hungary: general and special

This article conducts a comparative analysis of the current state of legal regulation in the healthcare sector in Ukraine and Hungary. The significance of healthcare issues has elevated them to the level of one of the most important state tasks and an internal function of the modern state. This necessitates not only the execution of effective state governance but also the formation and implementation of state policy in this sphere. The article is dedicated to the formation and implementation of state policy concerning the legal regulation of the healthcare sector in Ukraine and Hungary, which underscores its relevance.
 During the writing process, the author researched the system of legal relations and state bodies responsible for performing relevant functions and tasks in the formation and implementation of healthcare policy. It analyzes the legislative system regulating these areas and the practice of its application in both countries. The article identifies the roles and places of the Verkhovna Rada (Supreme Council) of Ukraine and the Hungarian National Assembly, as well as the Cabinets of Ministers and the executive branch systems in both countries in the realization of healthcare policy.
 Like most contemporary scientific developments in this field, the article covers problems of three scientific disciplines – medicine, management, and law. In preparing this article, the author reviewed a considerable amount of medical literature, particularly in social medicine and healthcare organization, thoroughly exploring their scientific issues in both Ukraine and Hungary. However, it aims to illuminate the issues and problems arising in this context, specifically from the legal standpoint, particularly administrative law. Therefore, the focus of this work is primarily on legal categories and concepts – the legal mechanisms for implementing state medical and health improvement programs, ensuring the constitutionally guaranteed right of individuals in Ukraine and the Fundamental Law of Hungary to medical care, healthcare, and medical insurance, particularly the guaranteed level of free qualified medical aid.

Identifying key factors for successful formulation and implementation of healthcare policies on non-communicable diseases: a multinational analysis.

Non-communicable diseases (NCDs) are a major public health concern that accounts for 74% of global deaths each year. The increasing burden of NCDs exhausts public health resources and threatens the achievement of the 2030 agenda for sustainable development. The purpose of this study is to thematically analyze the contributory factors in the health policy process and reforms to strengthen the prevention of NCDs across borders, as well as the milestones achieved through the process of policy-making, change, and implementation. This study informs and draws on the findings of contributory factors in the health policy process for preventing NCDs across borders: United States, England, Sweden, Bangladesh, Singapore, South Korea, and Thailand. Ten experts from the seven countries were recruited purposively for a semi-structured interview (e-Interview) on the NCD policy-making process in their countries, either through health ministries or the authors' network. This descriptive qualitative study design is guided by the "Three I's" framework of public policy (institutions, ideas, and interests). In addition to the information obtained from the interviewee, data were also sourced from relevant documents and homepages suggested by the interviewee, as well as health homepages of the countries. The following themes were generated: (1) environmental policies and social determinants, (2) multistakeholder involvement, (3) interministerial collaboration, (4) independent evidence and review institution, (5) integrated health data, and (6) primary care system. There was a shift from individual-targeted policies to environmental policies and social determinants. Notably, national campaigns were developed through non-governmental organizations (NGOs) for the primary prevention of NCDs. The shift from behavioral modification and treatment to social determinants is important. NCDs are broad and require a multisector and multilevel approach. Establishing an organization or hierarchical body to overlook NCDs could result in increased awareness, focus, and surveillance and enhance the policy process.

EUROPEAN ASSOCIATION OF PERINATAL MEDICINE (EAPM) EUROPEAN MIDWIVES ASSOCIATION (EMA) Joint position statement: Caesarean delivery rates at a country level should be in the 15-20 % range

While cesarean deliveries performed for health indications can save lives, unnecessary cesareans cause unjustifiable health risks for the mother, newborn, and for future pregnancies. Previous recommendations for cesarean delivery rates at a country level in the 10–15% range are currently unrealistic, and the proposed concept that striving to achieve specific rates is not important has resulted in a confusing message reaching healthcare professionals and the public. It is important to have a clear understanding of when cesarean delivery rates are deviating from internationally acceptable ranges, to trigger the implementation of healthcare policies needed to correct this problem. Based on currently existing scientific evidence, we recommend that cesarean delivery rates at a country level should be in the 15–20% range. This advice is based on the demonstration of decreased maternal and neonatal mortalities when national cesarean delivery rates rise to circa 15%, but values exceeding 20% are not associated with further benefits. It is also based on real-world experiences from northern European countries, where cesarean delivery rates in the 15–20% range are associated with some of the best maternal and perinatal quality indicators in the world. With the increase in cesarean delivery rates projected for the coming years, experience in provision of intrapartum care may come under threat in many hospitals, and recovering from this situation is likely to be a major challenge. Professional and scientific societies, together with healthcare authorities and governments need to prioritize actions to reverse the upward trend in cesarean delivery rates observed in many countries, and to strive to achieve values as close as possible to the recommended range.

"Research ends with publication": a qualitative study on the use of health policy and systems research in Ethiopia.

Decision-making about the design and implementation of health care policies should be supported by research evidence. This article reports on a qualitative study on the experiences of both research institutes and policymakers in Ethiopia in generating and using research evidence to inform health policy decision-making. Semi-structured interviews were conducted from January through March 2020, with representatives of research institutes and with policymakers in Ethiopia. The data collected during the interviews were analyzed thematically. Half of the institutions represented had engaged in health policy and systems research (HPSR). These institutes' capacities were limited by multiple factors, including unsupportive research environments; the limited number of researchers with extensive experience; high turnover among senior researchers; lack of staff motivation mechanisms; underdeveloped research culture; limited technical and analytical capacity among researchers; lack of core funding for HPSR; ineffective financial management; and, lack of connections with health policy platforms. Research institutes also lacked the capacity in strategic packaging of findings to influence policy decision-making, although some programs have recently improved in this area. Meanwhile, there lacked a culture of using evidence in policymaking settings. In general, we found that policymakers had poor attitudes towards the quality or value of the evidence, and had little capacity to interpret evidence and apply findings to policy options. As a result, much of the research produced by the institutes have only been relevant academically, with little impact on policy. However, respondents reported that the environment is slowly changing, and the recent creation of a Research Advisory Council at the Ministry of Health offers a promising model. Despite some recent changes, in Ethiopia researchers and policymakers alike often tend to consider health policy and systems research (HPSR) to be not very valuable since the findings generated are rarely used for evidence-informed policy development. Research institutes and researchers need to strengthen their technical, analytical, and administrative capacities (through, among other efforts, seeking more funding for research, and better incentives to attract, retain and build skills among qualified researchers); they also need to improve their understanding of the evidence-to-policy cycle and how to engage effectively with policymakers.

Variations in pediatric dental coverage and visits following the implementation of healthcare policies in Pakistan

Background: In Pakistan, healthcare policies have been implemented to improve children's oral health, including the provision of dental services at primary healthcare centers, the inclusion of dental care services in health insurance schemes, and the promotion of oral health education among the public. However, it is unclear whether these policies have resulted in uniform changes in pediatric dental coverage and visits across different regions and socioeconomic groups. Objective: This study aimed to investigate variations in pediatric dental coverage and visits following the implementation of healthcare policies in Pakistan. Methods: A cross-sectional survey design was used, with a sample size of 200 children aged 0-18 years. Data on pediatric dental coverage and visits were collected through structured interviews with the children and their parents or guardians. The data were analyzed using descriptive statistics and chi-square tests to identify any significant variations in the pediatric dental coverage and visits across different regions and socioeconomic groups. Results: The study found that there were significant variations in pediatric dental coverage and visits across different regions and socioeconomic groups.

General healthcare policy and its influence on management practices: A review

This review paper explores the intricate relationship between healthcare policy and management practices within the healthcare sector, highlighting how policies shape management strategies and impact the operational realities of healthcare organizations. It delves into the challenges of aligning management practices with evolving healthcare policies and the vital role of healthcare managers in policy advocacy and implementation. Through a comprehensive analysis, the paper discusses emerging trends in healthcare policy, including the shift towards value-based care, digital health expansion, and the emphasis on health equity and their implications for management practices. Recommendations for healthcare managers and policy-makers are provided, emphasizing the importance of strategic alignment, innovation, and stakeholder engagement in enhancing healthcare delivery and outcomes. This paper offers insights into navigating the dynamic healthcare environment, leveraging policy changes as opportunities for improvement, and ensuring the effective implementation of healthcare policies.

Itinéraires thérapeutiques des patients dans un contexte de défaillances du marché de soins au Togo

Introduction : Improving access to and the use of health services remains a challenge for the health system in Togo, given the confidence and quality of care perceived by Togolese citizens.Purpose of research : This study aims to analyze the determinants of the therapeutic itinerary of patients in Togo, with a particular focus on the institutions that regulate the health care market.Results : This is an empirical study, based on data from the Unified Survey of Basic Welfare Indicators (QUIBB, 2015) covering 2400 households. Issues of care market failures are addressed in terms of perceived quality of care and organizational quality. The patients’ care pathway includes self-medication, and the use of public or private health services. Within the framework of a multinomial probit model, the results show that improving the perceived quality of health services increases the probability of using public and private health services with a much higher marginal effect for the use of public services. Organizational quality of health services was also found to increase the probability of using private health services.Conclusions : In view of the results found, it is necessary to improve the regulatory institutions of the health care market in Togo. This improvement requires the implementation of health care policies aimed at improving the professionalism of health care personnel.

Emergence and Development of Health Risk Communication Networks Among Street-Level Health Bureaucrats During the COVID-19 Pandemic Crisis in Myanmar

Street-level health bureaucrats have actively contributed to implementing the COVID-19 prevention, control, and treatment policies of the Myanmar government. However, the need for bureaucrats on the frontlines of policy implementation to maintain a safe distance from others to prevent the spread of COVID-19 has posed challenges for the sharing and exchange of information related to health risks. In this context, this study examined what health risk communication patterns have emerged and developed among street-level health bureaucrats during the COVID-19 pandemic, and how this risk communication has been affected by street-level health bureaucrats’ perceptions of client meaningfulness and willingness to implement COVID-19 policies. The results reveal that street-level health bureaucrats in the health risk communication network are embedded in reciprocally or transitively connected discussion relationships that sustain their health risk communication over time. Moreover, when specific healthcare staff members perceive more benefits of COVID-19 policies for their patients and are more willing to care for patients, other healthcare staff avoid them to protect themselves from COVID-19 infection. Due to their higher level of understanding of the adopted measures, healthcare staff members who are highly willing to implement COVID-19 policies are frequently approached by other staff members to communicate about COVID-19 issues. This study empirically contributes to the literature on street-level bureaucrats in times of pandemic crisis by examining the formation of health risk communications in the context of street-level health bureaucrats’ responses to and participation in public healthcare policy implementation processes.

Coordination of health and rehabilitation services for person with disabilities in Sierra Leone – a stakeholders’ perspective

Purpose To explore stakeholders’ perceptions of the coordination of health and rehabilitation services for persons with disabilities in Sierra Leone. Materials and methods A qualitative study including seven focus group discussions with health, rehabilitation, and disability organisations stakeholders in Sierra Leone. Content analysis was used for data analysis. Results One theme emerged; poor governance in implementing disability policies, healthcare, and rehabilitation services, which included seven subthemes: insufficient implementation of healthcare policies for persons with disabilities; changes, lack of coordination and communication between ministries governing disability policies and rehabilitation services; need for accurate disability data and clinical record keeping; absence of funds and poor political priority to healthcare and rehabilitation services; continuous support for non-governmental organisations (NGOs) to provide healthcare and rehabilitation service delivery; lack of coordination between different healthcare and rehabilitation service providers and calling for increasing persons with disabilities capacity for greater inclusion in society. Conclusions Increasing governmental prioritisation, and ensuring coordination and trust between donors, NGOs, and governmental programmes were keys for sustainable health and rehabilitation services. Stakeholders need to ensure national coverage and equally distributed health and rehabilitation services. Including rehabilitation services and assistive technology in the Free Healthcare Initiative would contribute to implementing the Disability Act. Implications for rehabilitation Political prioritisation of persons with disability (PWD) need to increase to provide national coverage and equally distributed health and rehabilitation services for PWD. To ensure access to rehabilitation services and access to basic assistive technology for PWD, the government of Sierra Leone could agree on basic rehabilitation services and a priority list of assistive devices to be distributed through rehabilitation centres and funded by the Free Health Care Initiative programme or the Sierra Leone health insurance scheme. To increase access to health services for PWD, the government of Sierra Leone could ensure inclusion of PWD in the Free Health Care Initiative programme. The government, donors, and organisations providing or funding health and rehabilitation services for PWD need to mobilise and coordinate resources better and be mutually held accountable to maximise the benefits of PWD resources.

Medical Law and Rhetorical Modes of its Presentation in an Institutional Discourse: An Issue Statement

As a result of rhetoric studies development in a specific medicine and healthcare field of interaction, scholars determined the grounds based on which rhetoric of law and medicine is singled out as a subfield of rhetoric. While medicine rhetoric is more focused on the rhetoric of science, the rhetoric analysis of substantive areas of medical law and healthcare prove that application of medicine rhetoric methodology to the areas of medical law results in dehumanization of the subjects of medical law; state healthcare policy implementation is perceived by affected communities as marketization of a national healthcare system; changes in medical law doctrines result in ethical shifts. The authors conclude that development of technologies in general and medical technologies in particular, public access to medical investigations’ results and inception of bioethics have resulted in the situation when the subjects of medical law are required to develop new approaches to communication with the audiences (or affected communities) based on rhetorical concepts.

IMPLEMENTASI KEBIJAKAN PENINGKATAN PELAYANAN KESEHATAN (Tentang Pelaksanaan Program Jaminan Mutu Pelayanan Kesehatan Dasar Di Puskesmas Ngronggot Kabupaten Nganjuk)

Implementation of Quality Assurance and the Public Health Service especially basic health care is a must. Quality assurance is not only a humanitarian obligation, ethical, administrative solely, but it has been a legal obligation as what has been stipulated in Law no. 23 of 1992 on Health in the Ministry of Health Decree No. 125/Menkes/SK/II/2008. This study examines how to increase health care policy implementation in Ngronggot health center, Nganjuk . This study concluded that actors involved in the implementation of cross-cutting health services to perform its role in different way. Efforts to increase public awareness in order to create a healthy living behaviors are difficult to achieve, because it is not supported by socio-economic factors, which is still low. Contributing factor in the implementation of this policy is the availability of regulation as law. while the inhibiting factor is the lack of resources in policy implementation.

IMPLEMENTASI KEBIJAKAN PENINGKATAN PELAYANAN KESEHATAN (Tentang Pelaksanaan Program Jaminan Mutu Pelayanan Kesehatan Dasar Di Puskesmas Ngronggot Kabupaten Nganjuk)

Implementation of Quality Assurance and the Public Health Service especially basic health care is a must. Quality assurance is not only a humanitarian obligation, ethical, administrative solely, but it has been a legal obligation as what has been stipulated in Law no. 23 of 1992 on Health in the Ministry of Health Decree No. 125/Menkes/SK/II/2008. This study examines how to increase health care policy implementation in Ngronggot health center, Nganjuk . This study concluded that actors involved in the implementation of cross-cutting health services to perform its role in different way. Efforts to increase public awareness in order to create a healthy living behaviors are difficult to achieve, because it is not supported by socio-economic factors, which is still low. Contributing factor in the implementation of this policy is the availability of regulation as law. while the inhibiting factor is the lack of resources in policy implementation.

Assessing the Integrative Framework for the Implementation of Change in Nursing Practice: Comparative Case Studies in French Hospitals.

The implementation of healthcare policies in healthcare organizations is a pivotal issue for managers. They generally require a change in professional practices. In previous work, we developed the Integrative Framework for Implementation of change in Nursing Practices (IFINP) to support implementation initiatives for such change in nursing practices. We aimed to assess the generalizability of IFINP in other organizational settings and explore links between strategic and socio-material factors during implementation. We used a comparative qualitative case study at three French hospitals to assess the implementation of certification procedures. Data were collected from 33 semi-structured interviews with managers and nurses. Narratives reflecting actions and interactions were extracted and deductively analyzed using IFINP components. The results showed that the framework was flexible and captured the different aspects of implementation actions and interactions at the three hospitals. Strong interferences were identified between mobilization mechanisms and strategic elements. Interferences were observed mostly between ‘reflexive monitoring and work articulation’, and ‘reflexive monitoring and sense-making’ mechanisms. Leadership was integrated into the different mechanisms, especially the ‘translation’ mechanism. The IFINP facilitated a greater understanding of strategic elements and associated relationships with social and material factors during implementation. It helps to provide a clear definition of the managers’ role when implementing new nurse practices.

To determine the effect of healthcare policy implementation on the COVID-19 pandemic.

As the Delta variant of SARS-CoV-2 has spread across the USA, some states have been impacted in different ways than others. This is due to factors such as the implementation of public health guidelines, primarily mask usage, and vaccination rates. With the Delta variant already causing much damage and with newer variants mutating, it is imperative to understand the spread of the Delta variant of SARS-CoV-2.
 The study examined five states - Minnesota, Iowa, Missouri, Arkansas, and Louisiana - and their respective COVID-19 cases. Data on these states were collected from the US Census Bureau and the CDC. The data was then compared between each state as well as to the USA. Finally, the data were analyzed and visualized using statistics software.
 First, COVID-19 cases were normalized by dividing by population in millions to get a standard measure, Daily Cases Per Million (DPCM), to compare the five states. Next, we used the CDC data to create a timeline, which was used to compare case data between states. Additionally, the CDC data was used to compare states concerning non-communicable disorders.
 Our analysis showed that the vaccination rate reduced while the masking mandates were interrupted for more than two months, with a rapid rise in delta variant of COVID-19 virus. Thus, from the study, it can be concluded that vaccines and mask usage are the most critical factors in preventing COVID-19 transmission.

United States Healthcare Burden of Pediatric Functional Gastrointestinal Pain Disorder Hospitalizations from 2002 to 2018.

The healthcare burden of pediatric functional gastrointestinal pain disorders (FGIDs) is unclear. Our study aimed to characterize the burden of these hospitalizations in the United States (US). We utilized the US National Inpatient Sample from 2002 to 2018 to capture pediatric hospitalizations (ages 4 to 18years old) with a primary discharge diagnosis of abdominal pain, constipation, irritable bowel syndrome, dyspepsia, abdominal migraine, cyclic vomiting syndrome, or fecal incontinence. We calculated the FGID hospitalization prevalence rate, length of stay (LOS), and inflation-adjusted costs annually and assessed for statistically significant trend changes using joinpoint analyses. 22.3million pediatric hospitalizations were captured, and 1 in 64 pediatric hospitalizations were attributed to a primary FGID hospitalization. The overall FGID hospitalization prevalence rate initially remained stable but decreased significantly from 2013 to 2018. Constipation and abdominal pain hospitalization rates, respectively, increased and decreased significantly over time. Constipation hospitalizations were more prevalent for younger non-Hispanic Blacks and Hispanics. FGID hospitalization rates stratified by sex were similar. Mean LOS was 2.3days; average LOS increased significantly from 2002 to 2013 and then stabilized. FGID hospitalization costs averaged $6,216 per admission and increased significantly for all FGIDs except dyspepsia. Endoscopic procedures were the most common interventions. FGID hospitalization prevalence rates decreased recently, possibly due to national healthcare policy implementation. Nonetheless, constipation admissions increased. LOS was stable in recent years but associated costs-per-hospitalization were increasing over time, probably due to endoscopic procedures. More studies are needed to explain these prevalence and cost trends.

Policy Implementation Science to Advance Population Health: The Potential for Learning Health Policy Systems.

Many health policies are designed with the intention of improving health outcomes for all. Yet implementation of policies are variable across contexts, potentially limiting its impact on population health outcomes. The potential impact of a policy to advance health equity depends both on the design and its implementation, requiring ongoing evaluation and stakeholder engagement. Despite the importance of health policies in shaping public health, health care policy implementation science remains underrepresented in research. We argue that enhanced integration of policy questions within implementation science could reduce the time lag from policy to practice and improve population health outcomes to build a body of evidence on effective policy implementation. In this commentary, we argue that approaches to studying policy implementation science should reflect the dynamic and evolving policy context, analogous to the “learning healthcare system,” to better understand and respond to systematic and multilevel impacts of policy. Several example opportunities for a learning health policy system are posed in building a broader agenda toward research and practice in policy implementation science in public health.

Divergent notions of “quality” in healthcare policy implementation: a framing perspective

PurposeThis paper examines how “quality” was framed in the design and implementation of a policy to reform hospital funding and associated care delivery. The aims of the study were: (1) To describe how government policy-makers who designed the policy and managers and clinicians who implemented the policy framed the concept of “quality” and (2) To explore how frames of quality and the framing process may have influenced policy implementation.Design/methodology/approachThe authors conducted a secondary analysis of data from a qualitative case study involving semi-structured interviews with 45 purposefully selected key informants involved in the design and implementation of the quality-based procedures policy in Ontario, Canada. The authors used framing theory to inform coding and analysis.FindingsThe authors found that policy designers perpetuated a broader frame of quality than implementers who held more narrow frames of quality. Frame divergence was further characterized by how informants framed the relationship between clinical and financial domains of quality. Several environmental and organizational factors influenced how quality was framed by implementers.Originality/valueAs health systems around the world increasingly implement new models of governance and financing to strengthen quality of care, there is a need to consider how “quality” is framed in the context of these policies and with what effect. This is the first framing analysis of “quality” in health policy.

Citizens Participation and Primary Healthcare Policy Implementation in Ogun State, Nigeria: An Empirical and Systems Enquiry

Health in its complete state of wellbeing is of utmost importance in the achievement, development and sustainability of societal goals, as envisioned in the United Nations Sustainable Development Goal (SDG) 3, and joint efforts are required for its attainment. Studies have focused on the importance of citizen participation in diverse fields, including health care, but little attention has been paid to this in developing countries’ primary healthcare (PHC) systems, such as Nigeria. Thus, this paper seeks to ascertain the relationship between citizens’ participation and primary healthcare policy implementation challenges in Nigeria. A cross-sectional survey research design was adopted with a multi-stage sampling technique used to select 500 Ogun State citizens. Primary data were analyzed using the Pearson Product Moment Correlation to ascertain the relationship between the variables. Findings show that there is a significant positive and strong relationship between citizens’ participation and policy implementation (R-value: 0.696; p-value: 0.000), but there is no significant relationship between citizens’ participation challenges and PHC policy implementation (R-value: -0.105; p-value: 0.120). The study is premised on the political system theory that explains citizens’ participation with a holistic and integrated approach of involvement, empowerment and accountability in the healthcare system. The study, therefore, recommends an integrated decision-making process that is bottom-up, which would support a sustainable healthcare system with enlightened citizens’ input towards the actualization of an effective PHC system.

Knowledge, Attitudes, and Practices (KAP) about COVID-19 among Indian Population: A Cross-sectional Study

Coronavirus Disease 2019 (COVID-19) is a global health emergency. Beliefs and behaviors of a target population about COVID-19 pose unique challenges to effective implementation of healthcare policies in densely populated and socio-geographically diverse nations like India. An online descriptive cross-sectional study was conducted among Indian population during the early phase of the COVID19 outbreak in the country to assess their knowledge, attitude and practices about the pandemic. A multinomial logistic regression (Z-test statistics with p<=0.05) was used to analyze the impact of demographic variables on knowledge and to test whether knowledge positively impacts the attitude and practices of an individual. It was found that a higher knowledge score influenced compliance with precautionary behaviors among the participants who were females, educated, and senior citizens. The findings suggest that health education intervention programs targeting males, the working age population and those belonging to lower income groups will be effective.