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Criteria for priority setting of HIV/AIDS interventions in Thailand: a discrete choice experiment
Sitaporn Youngkong, Rob Baltussen, Sripen Tantivess, Xander Koolman, Yot Teerawattananon
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-197
Abstract: Criteria for priority setting of HIV/AIDS interventions in Thailand were identified in group discussions with policy makers, people living with HIV/AIDS (PLWHA), and community members (i.e. village health volunteers (VHVs)). On the basis of these, discrete choice experiments were designed and administered among 28 policy makers, 74 PLWHA, and 50 VHVs.In order of importance, policy makers expressed a preference for interventions that are highly effective, that are preventive of nature (as compared to care and treatment), that are based on strong scientific evidence, that target high risk groups (as compared to teenagers, adults, or children), and that target both genders (rather than only men or women). PLWHA and VHVs had similar preferences but the former group expressed a strong preference for care and treatment for AIDS patients.The study has identified criteria for priority setting of HIV/AIDS interventions in Thailand, and revealed that different stakeholders have different preferences vis-à-vis these criteria. This could be used for a broad ranking of interventions, and as such as a basis for more detailed priority setting, taking into account also qualitative criteria.While the number of new HIV positive cases in Thailand decreases [1-3], HIV/AIDS continues to take a large toll in the country with 610,000 prevalent cases and approximately 30,000 deaths in 2007 [2]. A wide array of HIV/AIDS control programmes has been implemented to confront the epidemic since the first wave of infections in the mid-1980s [1,4]. Thailand's current national plan for HIV/AIDS prevention and alleviation, 2007-2011 [3] aims to: (i) integrate AIDS prevention, care, treatment, and impact reduction implementation into service provision at all levels; (ii) strengthen community's education about AIDS; (iii) enhance capacity of local administration in taking responsibility on local HIV/AIDS interventions; and (iv) prevent HIV transmission among children in schools and high-risk populatio
Usefulness of Self- Help Interventions in Behavioural Research
Shweta Verma,Anita Sharma
Indian Streams Research Journal , 2012,
Abstract: Interventions to alleviate job stress have multiplied rapidly over the last two decades, paralleling the increasing recognition and acceptance of the adverse impacts of job stress on individuals and organizations. This development has been reflected in the rapid growth of the job-stress intervention literature, which has been reviewed in various ways and from a range of perspectives over the last decade. The goal of the present study was to identify models of international best practice through a comprehensive review of the job-stress intervention literature.
Priority setting of health interventions: the need for multi-criteria decision analysis
Rob Baltussen, Louis Niessen
Cost Effectiveness and Resource Allocation , 2006, DOI: 10.1186/1478-7547-4-14
Abstract: This indicates the need for rational and transparent approaches to priority setting. Over the past decades, a number of approaches have been developed, including evidence-based medicine, burden of disease analyses, cost-effectiveness analyses, and equity analyses. However, these approaches concentrate on single criteria only, whereas in reality, policy makers need to make choices taking into account multiple criteria simultaneously. Moreover, they do not cover all criteria that are relevant to policy makers.Therefore, the development of a multi-criteria approach to priority setting is necessary, and this has indeed recently been identified as one of the most important issues in health system research. In other scientific disciplines, multi-criteria decision analysis is well developed, has gained widespread acceptance and is routinely used. This paper presents the main principles of multi-criteria decision analysis. There are only a very few applications to guide resource allocation decisions in health. We call for a shift away from present priority setting tools in health – that tend to focus on single criteria – towards transparent and systematic approaches that take into account all relevant criteria simultaneously.Pertaining health needs and accelerating technological development put an ever-increasing demand on limited health budgets. Policy makers need to make important decisions on the use of public funds – to target which disease areas, which populations, and with which interventions. However, these choices may not be based on a rational and transparent process, and resources may not be used to an optimal extent [1,2]. For example, despite evidence that investing in primary health care is more effective than investing in specialized health care, allocations to primary care in Ghana have remained behind those allocated to tertiary care [3]. The underlying problem is that decisions on the choice of health interventions are complex and multifaceted [4,5], and th
Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers  [cached]
Tromp Noor,Baltussen Rob
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-454
Abstract: Background In rationing decisions in health, many criteria like costs, effectiveness, equity and feasibility concerns play a role. These criteria stem from different disciplines that all aim to inform health care rationing decisions, but a single underlying concept that incorporates all criteria does not yet exist. Therefore, we aim to develop a conceptual mapping of criteria, based on the World Health Organization’s Health Systems Performance and Health Systems Building Blocks frameworks. This map can be an aid to decision makers to identify the relevant criteria for priority setting in their specific context. Methods We made an inventory of all possible criteria for priority setting on the basis of literature review. We categorized the criteria according to both health system frameworks that spell out a country’s health system goals and input. We reason that the criteria that decision makers use in priority setting exercises are a direct manifestation of this. Results Our map includes thirty-one criteria that are distributed among five categories that reflect the goals of a health system (i.e. to improve level of health, fair distribution of health, responsiveness, social & financial risk protection and efficiency) and leadership/governance one category that reflects feasibiliy based on the health system building blocks (i.e. service delivery, health care workforce , information, medical products, vaccines & technologies, financing and). Conclusions This conceptual mapping of criteria, based on well-established health system frameworks, will further develop the field of priority setting by assisting decision makers in the identification of multiple criteria for selection of health interventions.
Integration of priority population, health and nutrition interventions into health systems: systematic review
Rifat Atun, Thyra E de Jongh, Federica V Secci, Kelechi Ohiri, Olusoji Adeyi, Josip Car
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-780
Abstract: Systematic review using Cochrane methodology of analysing randomised trials, controlled before-and-after and interrupted time series studies. We defined specific strategies to search PubMed, CENTRAL and the Cochrane Effective Practice and Organisation of Care Group register, considered studies published from January 1998 until September 2008, and tracked references and citations. Two reviewers independently agreed on eligibility, with an additional arbiter as needed, and extracted information on outcomes: primary (improved health, financial protection, and user satisfaction) and secondary (improved population coverage, access to health services, efficiency, and quality) using standardised, pre-piloted forms. Two reviewers in the final stage of selection jointly assessed quality of all selected studies using the GRADE criteria.Of 8,274 citations identified 12 studies met inclusion criteria. Four studies compared the benefits of Integrated Management of Childhood Illnesses in Tanzania and Bangladesh, showing improved care management and higher utilisation of health facilities at no additional cost. Eight studies focused on integrated delivery of mental health and substance abuse services in the United Kingdom and United States of America. Integrated service delivery resulted in better clinical outcomes and greater reduction of substance abuse in specific sub-groups of patients, with no significant difference found overall. Quality of care, patient satisfaction, and treatment engagement were higher in integrated delivery models.Targeted priority population health interventions we identified led to improved health outcomes, quality of care, patient satisfaction and access to care. Limited evidence with inconsistent findings across varied interventions in different settings means no general conclusions can be drawn on the benefits or disadvantages of integrated service delivery.Benefits of integrating targeted priority population, health and nutrition programmes into mai
Evidence-based interventions in dementia: A pragmatic cluster-randomised trial of an educational intervention to promote earlier recognition and response to dementia in primary care (EVIDEM-ED)
Steve Iliffe, Jane Wilcock, Mark Griffin, Priya Jain, Ingela Thuné-Boyle, Tamar Koch, Frances Lefford
Trials , 2010, DOI: 10.1186/1745-6215-11-13
Abstract: The customised educational intervention combines practice-based workshops and electronic support material. Its effectiveness will be tested in an unblinded cluster randomised controlled trial with a pre-post intervention design, with two arms; normal care versus the educational intervention. Twenty primary care practices have been recruited with the aim of gaining 200 patient participants. We will examine whether the intervention is effective, pragmatic and feasible within the primary care setting. Our primary outcome measure is an increase in the proportion of patients with dementia who receive at least two dementia-specific management reviews per year. We will also examine important secondary outcomes such as practice concordance with management guidelines and benefits to patients and carers in terms of quality of life and carer strain.The EVIDEM-ED trial builds on the earlier study but the intervention is different in that it is specifically customised to the educational needs of each practice. If this trial is successful it could have implications for the implementation of the National Dementia Strategy.NCT00866099Dementia presents many challenges for primary care. Early diagnosis is important as this allows those with dementia and their family care networks to engage with support services and plan for the future. These actions can relieve the significant psychological distress that people with dementia and close supporters may experience [1] and can also provide knowledge about the availability of medical and psycho-social support that can improved functioning and morale.The main efforts to improve the identification and diagnosis of dementia should logically be targeted at primary care as this is the first point of contact in the health service for most individuals and their carers. There is, however, evidence that dementia remains under-detected and sub-optimally managed in general practice [2]. An educational intervention that could enhance clinical practice
From papers to practices: district level priority setting processes and criteria for family planning, maternal, newborn and child health interventions in Tanzania
Dereck Chitama, Rob Baltussen, Evert Ketting, Switbert Kamazima, Anna Nswilla, Phares GM Mujinja
BMC Women's Health , 2011, DOI: 10.1186/1472-6874-11-46
Abstract: We conducted an exploratory study mixing both qualitative and quantitative methods to capture and analyse the priority setting for FMNCH at district level, and identify the criteria for priority setting. We purposively sampled the participants to be included in the study. We collected the data using the nominal group technique (NGT), in-depth interviews (IDIs) with key informants and documentary review. We analysed the collected data using both content analysis for qualitative data and correlation analysis for quantitative data.We found a number of shortfalls in the district's priority setting processes and criteria which may lead to inefficient and unfair priority setting decisions in FMNCH. In addition, participants identified the priority setting criteria and established the perceived relative importance of the identified criteria. However, we noted differences exist in judging the relative importance attached to the criteria by different stakeholders in the districts.In Tanzania, FMNCH contents in both general development policies and sector policies are well articulated. However, the current priority setting process for FMNCH at district levels are wanting in several aspects rendering the priority setting process for FMNCH inefficient and unfair (or unsuccessful). To improve district level priority setting process for the FMNCH interventions, we recommend a fundamental revision of the current FMNCH interventions priority setting process. The improvement strategy should utilize rigorous research methods combining both normative and empirical methods to further analyze and correct past problems at the same time use the good practices to improve the current priority setting process for FMNCH interventions. The suggested improvements might give room for efficient and fair (or successful) priority setting process for FMNCH interventions.The importance of reproductive health (RH- see appendix, footnote 1) is well recognized [1-3] and articulated in the Programme of A
Assessing research activity on priority interventions for non-communicable disease prevention in low- and middle-income countries: a bibliometric analysis
Amanda C. Jones,Robert Geneau
Global Health Action , 2012, DOI: 10.3402/gha.v5i0.18847
Abstract: Introduction: Action is urgently needed to curb the rising rates of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) and reduce the resulting social and economic burdens. There is global evidence about the most cost-effective interventions for addressing the main NCD risk factors such as tobacco use, unhealthy diets, physical inactivity, and alcohol misuse. However, it is unknown how much research is focused on informing the local adoption and implementation of these interventions. Objective: To assess the degree of research activity on NCD priority interventions in LMICs by using bibliometric analysis to quantify the number of relevant peer-reviewed scientific publications. Methods: A multidisciplinary, multi-lingual journal database was searched for articles on NCD priority interventions. The interventions examined emphasise population-wide, policy, regulation, and legislation approaches. The publication timeframe searched was the year 2000–2011. Of the 11,211 articles yielded, 525 met the inclusion criteria. Results: Over the 12-year period, the number of articles published increased overall but differed substantially between regions: Latin America & Caribbean had the highest (127) and Middle East & North Africa had the lowest (11). Of the risk factor groups, ‘tobacco control’ led in publications, with ‘healthy diets and physical activity’ and ‘reducing harmful alcohol use’ in second and third place. Though half the publications had a first author from a high-income country institutional affiliation, developing country authorship had increased in recent years. Conclusions: While rising global attention to NCDs has likely produced an increase in peer-reviewed publications on NCDs in LMICs, publication rates directly related to cost-effective interventions are still very low, suggesting either limited local research activity or limited opportunities for LMIC researchers to publish on these issues. More research is needed on high-priority interventions and research funders should re-examine if intervention research is enough of a funding priority.
A Detailed Analysis of Prehospital Interventions in Common Medical Priority Dispatch System Determinants  [cached]
Sporer, Karl A,Johnson, Nicholas J
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2011,
Abstract: Background: Medical Priority Dispatch System (MPDS) is a type of Emergency Medical Dispatch (EMD) system used to prioritize 9-1-1 calls and optimize resource allocation. Dispatchers use a series of scripted questions to assign determinants to calls based on chief complaint and acuity.Objective: We analyzed the prehospital interventions performed on patients with MPDS determinants for breathing problems, chest pain, unknown problem (man down), seizures, fainting (unconscious) and falls for transport status and interventions.Methods: We matched all prehospital patients in complaint-based categories for breathing problems, chest pain, unknown problem (man down), seizures, fainting (unconscious) and falls from January 1, 2004, to December 31, 2006, with their prehospital record. Calls were queried for the following prehospital interventions: Basic Life Support care only, intravenous line placement only, medication given, procedures or non-transport. We defined Advanced Life Support (ALS) interventions as the administration of a medication or a procedure.Results: Of the 77,394 MPDS calls during this period, 31,318 (40%) patients met inclusion criteria. Breathing problems made up 12.2%, chest pain 6%, unknown problem 1.4%, seizures 3%, falls 9% and unconscious/fainting 9% of the total number of MPDS calls. Patients with breathing problem had a low rate of procedures (0.7%) and cardiac arrest medications (1.6%) with 38% receiving some medication. Chest pain patients had a similar distribution; procedures (0.5%), cardiac arrest medication (1.5%) and any medication (64%). Unknown problem: procedures (1%), cardiac arrest medication (1.3%), any medication (18%). Patients with Seizures had a low rate of procedures (1.1%) and cardiac arrest medications (0.6%) with 20% receiving some medication. Fall patients had a lower rate of severe illness with more medication, mostly morphine: procedures (0.2%), cardiac arrest medication (0.2%), all medications (28%). Unconscious/fainting patients received the following interventions: procedures (0.3%), cardiac arrest medication (1.9%), all medications (32%). Few stepwise increases in the rate of procedures or medications were seen as determinants increased in acuity.Conclusion: Among these common MPDS complaint-based categories, the rates of advanced procedures and cardiac arrest medications were low. ALS medications were common in all categories and most determinants. Multiple determinants were rarely used and did not show higher rates of interventions with increasing acuity. Many MPDS determinants are of modest use to predict
Testing experiences of HIV positive refugees in Nakivale refugee settlement in Uganda: informing interventions to encourage priority shifting
Kelli N O?Laughlin, Shada A Rouhani, Zikama M Faustin, Norma C Ware
Conflict and Health , 2013, DOI: 10.1186/1752-1505-7-2
Abstract: Open-ended interviews were conducted with HIV-infected refugees (N=73) who had tested for HIV and with HIV clinic staff (N=4) in Nakivale Refugee Settlement in southwest Uganda. Interviews focused on accessibility of HIV/AIDS-related testing and care and perspectives on how to improve utilization of testing services. Data collection took place at the Nakivale HIV/AIDS Clinic from March to July of 2011. Observations of clinical activities were also carried out. An inductive approach to data analysis was used to identify factors related to utilization.In general, interviewees report focusing daily effort on tasks aimed at meeting survival needs. HIV testing is not prioritized over these responsibilities. Under some circumstances, however, HIV testing occurs. This happens when: (a) circumstances realign to trigger a temporary shift in priorities away from daily survival-related tasks; (b) survival needs are temporarily met; and/or (c) conditions shift to alleviate barriers to HIV testing.HIV testing services provided for refugees must be not just available, but also utilized. Understanding what makes HIV testing possible for refugees who have tested can inform interventions to increase testing in this population. Intervening by encouraging priority shifts toward HIV testing, by helping ensure survival needs are met, and by eliminating barriers to testing, may result in refugees making better use of existing testing services.
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