This document discusses improving how non-drug technologies are appraised in Ontario by revising the decision-making framework. It summarizes work done by various committees and working groups since 2007 to operationalize ethics and social values in the appraisal process. This includes identifying core social values, developing evaluative questions related to equity, patient-centered care and other domains, and proposing a methodology for systematic, evidence-based analysis of ethics and social values issues. The goal is to fully integrate such analyses into the technology appraisal process to make recommendations more responsive to patient and societal considerations.
Community diagnosis involves analyzing the health status, resources, and services of a community to identify priorities and goals for improving community health. It examines mortality and morbidity rates, nutritional status, healthcare access, and other social and environmental health indicators. The process involves listening to community members, observing health problems, reviewing available data, conducting surveys, and holding monthly meetings. The results are used to plan and evaluate community health programs and services.
Suicide Care in Systems Framework (National Action Alliance for Suicide Preve...David Covington
Co-led with Dr. Mike Hogan, the Clinical Care & Intervention Task Force published this National Action Alliance for Suicide Prevention road map for the Zero Suicide in Healthcare initiative.
The document discusses the nursing process as it applies to community health nursing. It consists of five phases: assessment, diagnosis, planning, implementation, and evaluation. In the assessment phase, the community is examined based on its location, population, and social system. Key data is gathered about the community's boundaries, health services, demographics, economy, and other factors. This data is then analyzed to make a nursing diagnosis which identifies community health problems and strengths. Goals and objectives are established in the planning phase. The implementation phase involves carrying out planned interventions. Finally, the evaluation phase assesses whether the goals were achieved and the client's needs were met.
8 pharmacy track pharmacists working with local coalitions and pdm psOPUNITE
This document summarizes a presentation on pharmacists working with local coalitions and prescription drug monitoring programs (PDMPs). It discusses Nicole O'Kane presenting on how pharmacists can utilize PDMPs to screen for safety concerns and optimize patient care. It also discusses Kristina Clark and Christina Merino presenting on how a local coalition in Coffee County, TN engaged pharmacists and other stakeholders to reduce prescription drug abuse through education, monitoring, and evaluation.
The US health care system is characterized by high technology and research but also lacks standardization and coordination. It employs millions of professionals across thousands of facilities but access remains unequal and costs are rising faster than economic growth. The system has evolved from early traditions of home care provided by women and religious healers to the current complex arrangement involving private insurers, employers, and government programs. Ongoing debates center around whether health care should be viewed primarily as an economic good or a social right.
Engines of Success for U.S. Health Reform?
Eric B. Larson, MD, MPHVice President for Research, Group Health Executive Director, Group Health Research Institute
The document discusses essential components for transforming healthcare delivery systems. It identifies leadership, collaboration, balancing regulation and creativity, health information systems, and research as key elements. It provides examples of research studying the adoption of evidence-based practices and the impact of interventions on outcomes like costs, falls, and pain management.
This e-book focuses on Health Management Solutions the value it adds alongside other systems that are already in place throughout the care lifecycle...
Community diagnosis involves analyzing the health status, resources, and services of a community to identify priorities and goals for improving community health. It examines mortality and morbidity rates, nutritional status, healthcare access, and other social and environmental health indicators. The process involves listening to community members, observing health problems, reviewing available data, conducting surveys, and holding monthly meetings. The results are used to plan and evaluate community health programs and services.
Suicide Care in Systems Framework (National Action Alliance for Suicide Preve...David Covington
Co-led with Dr. Mike Hogan, the Clinical Care & Intervention Task Force published this National Action Alliance for Suicide Prevention road map for the Zero Suicide in Healthcare initiative.
The document discusses the nursing process as it applies to community health nursing. It consists of five phases: assessment, diagnosis, planning, implementation, and evaluation. In the assessment phase, the community is examined based on its location, population, and social system. Key data is gathered about the community's boundaries, health services, demographics, economy, and other factors. This data is then analyzed to make a nursing diagnosis which identifies community health problems and strengths. Goals and objectives are established in the planning phase. The implementation phase involves carrying out planned interventions. Finally, the evaluation phase assesses whether the goals were achieved and the client's needs were met.
8 pharmacy track pharmacists working with local coalitions and pdm psOPUNITE
This document summarizes a presentation on pharmacists working with local coalitions and prescription drug monitoring programs (PDMPs). It discusses Nicole O'Kane presenting on how pharmacists can utilize PDMPs to screen for safety concerns and optimize patient care. It also discusses Kristina Clark and Christina Merino presenting on how a local coalition in Coffee County, TN engaged pharmacists and other stakeholders to reduce prescription drug abuse through education, monitoring, and evaluation.
The US health care system is characterized by high technology and research but also lacks standardization and coordination. It employs millions of professionals across thousands of facilities but access remains unequal and costs are rising faster than economic growth. The system has evolved from early traditions of home care provided by women and religious healers to the current complex arrangement involving private insurers, employers, and government programs. Ongoing debates center around whether health care should be viewed primarily as an economic good or a social right.
Engines of Success for U.S. Health Reform?
Eric B. Larson, MD, MPHVice President for Research, Group Health Executive Director, Group Health Research Institute
The document discusses essential components for transforming healthcare delivery systems. It identifies leadership, collaboration, balancing regulation and creativity, health information systems, and research as key elements. It provides examples of research studying the adoption of evidence-based practices and the impact of interventions on outcomes like costs, falls, and pain management.
This e-book focuses on Health Management Solutions the value it adds alongside other systems that are already in place throughout the care lifecycle...
The document discusses the nursing process in community health nursing. It describes the steps of the nursing process - assessment, diagnosis, planning, implementation, and evaluation. It provides details on how community health nurses assess communities to identify health needs, formulate nursing diagnoses for communities and populations, plan interventions, implement plans through activities like health teaching, and evaluate the impact of nursing care. The nursing process provides structure for community health nurses to systematically address the health needs of communities.
This document discusses the ethical and legal issues in community health nursing. It begins by defining ethics and explaining that ethics deals with values relating to human conduct. It then discusses several client rights including informed consent, privacy, and the right to refuse treatment. The document outlines the nurse's professional responsibilities, which include upholding the code of ethics. It discusses key ethical principles like beneficence, autonomy, nonmaleficence, and justice. Finally, it examines some laws that affect nursing practice like scope of practice laws and malpractice.
Medical Governance, Health Policy, and Health Sector Reform in the PhilippinesAlbert Domingo
Suggested citation:
Domingo, Albert Francis E. "Medical Governance, Health Policy, and Health Sector Reform in the Philippines.” De La Salle Health Sciences Institute (DLSHSI). DLSHSI College of Medicine, Dasmarinas, Cavite. 27 Jun. 2014. Lecture.
The document defines key public health terminology used by the Oregon Health Authority, including definitions of public health concepts like access, assessment, assurance, behavioral risk factors, benchmarks, best practices, boards of health, cultural competence, determinants of health, environmental health, epidemiology, and essential public health services. It also describes several federal agencies that support public health work, such as the CDC, HRSA, FDA, and EPA.
Professinalism and legal issues in Community Health Nursing In Indiasthomas4u
1) Nursing requires devotion and preparation like the fine arts. It involves caring for the living body as the temple of God's spirit.
2) Professionalism in nursing includes various attributes like knowledge, spirit of inquiry, accountability, autonomy, advocacy, innovation, collaboration, and upholding ethics and values.
3) Nurses face challenges like lack of autonomy and leadership skills due to issues like short staffing, but professionalism helps them overcome such obstacles through commitment to lifelong learning and accountability.
This document describes a proposed randomized controlled trial to test the effectiveness of a health literacy and community health worker intervention for type 2 diabetes patients in community health centers. The study aims to address the gap in knowledge about how such interventions impact clinical outcomes like adherence, self-management, and communication. If shown to be effective, the intervention could help the millions of Americans with limited health literacy better manage their chronic conditions. The trial would involve community health centers in low-income neighborhoods of Boston serving predominantly minority populations disproportionately impacted by diabetes complications. Results could demonstrate cost-effective ways to incorporate health literacy and community health workers into standard care for medically underserved groups.
Nurs 710 CA and National Requirements for Nursing ProgramsNsarr
The document outlines the nine essentials that all nursing schools must fulfill according to the American Association of Colleges of Nursing to be eligible to teach a Baccalaureate Education for Professional Nursing Practice. Essential I discusses the importance of a liberal education foundation in sciences, arts, and humanities. Essential II covers organizational and systems leadership skills for quality care and patient safety. Essential III addresses the importance of scholarship and applying evidence-based practice.
The document discusses the nursing process used in community health settings. It defines community health nursing process as a systematic, ongoing process where nurses and clients work as a system to address health issues. The main steps of the nursing process are: 1) establishing relationships with the community, 2) assessing health needs and problems, 3) setting objectives, 4) planning and implementing interventions, and 5) evaluating interventions. Key principles for community health nurses include exploring the community, establishing relationships, providing education, and working collaboratively with other organizations and community members.
This document outlines concepts related to health care quality assessment. It describes key definitions, such as quality referring to services that increase health outcomes and are consistent with current knowledge. It also discusses perspectives on quality from practitioners, patients, and communities. Additionally, the document outlines different levels of quality analysis from national policies to individual care provision and lists examples of common quality indicators assessed in the US, such as patient satisfaction, mortality rates, and adherence to treatment protocols.
This document discusses key concepts in medical ethics including:
1. The four basic principles of medical ethics are autonomy, beneficence, non-maleficience, and justice.
2. Informed consent and respect for patient autonomy are fundamental, such as allowing patients to refuse blood transfusions based on their beliefs.
3. The principle of non-maleficience means "first, do no harm" and requires medical competence to avoid intentionally harming patients.
Harm reduction aims to reduce the harms associated with drug use without requiring abstinence. It is defined as a pragmatic, humane and non-judgmental approach that prioritizes harm reduction over moralistic judgments. Nurses play an important role in harm reduction through developing therapeutic relationships, health promotion, and overdose management while maintaining professional boundaries. There are ongoing debates around the ethics, policies and evidence regarding harm reduction strategies such as supervised consumption sites.
This document discusses patient-centered care and behavioral medicine in primary care. It covers several key points:
- Understanding diverse patient populations and how they perceive health and illness. This includes taking cultural factors like race, gender, socioeconomic status and health literacy into consideration.
- Developing skills like effective communication, providing culturally-sensitive assessments and interventions, and addressing barriers to patient adherence.
- Common factors that influence medication adherence such as health system challenges, patient health conditions and literacy, complexity of treatment regimens, and social/economic issues. Limited health literacy is strongly associated with lower levels of medication adherence and health knowledge.
- Strategies providers can use to improve adherence, including assessing literacy levels
The document discusses health literacy as it relates to medication and the use and delivery of healthcare. It analyzes reports from the National Academies of Sciences on these topics. For medication, it describes progress made in standardizing drug labels but notes more is needed. It also discusses using technology like apps and electronic records to promote health literacy. For healthcare delivery, it highlights the importance of health literacy in reducing complexity and disparities. While policies have helped, stronger communication skills are still required. The document proposes a case study on screening for low health literacy using the Newest Vital Sign assessment tool to test hypotheses about time and cost constraints.
The document discusses population health management and achieving healthy communities. It outlines major issues with the US healthcare system like uneven access to care. Real reform requires a focus on prevention, continuous care relationships, and evidence-based decisions. Population health management programs aim to maintain and improve people's health across different risk levels. Barriers to population health include fragmented care and misaligned incentives. Patient-centered medical homes and accountable care organizations show promise by emphasizing coordinated, team-based care. Automation and health information technology can help strengthen these models and drive effective population health management.
This document was produced for a Webinar for the Association of Directors of Public Health (ADHP www.adph.org.uk ) on 27th April 2017 in partnership with Public Health England (PHE www.gov.uk/phe) Hertfordshire County Council (www.hertfordshire.gov.uk) and the Health Psychology in Public Health Network (HPPHN www.hppn.org.uk ).
This document discusses several key ethical issues in public health, including disparities in health and access to care, responding to infectious diseases, international health cooperation, exploitation of individuals, health promotion, and ensuring participation, transparency and accountability. It also compares research activities and non-research public health practices, noting some common ethical tensions between individual and community interests as well as oversight mechanisms.
This document summarizes a presentation on advancing community health across the continuum of care from a health systems perspective. The presentation describes global trends driving more integrated and person-centered health services. It identifies challenges like intersectoral issues, medicalization, and accountability. Examples are provided on early childhood development programs, lessons from Ebola, and strengthening integrated community case management. The conclusion advocates for health systems that engage communities, challenge inequity, coordinate sectors, respond to illness causes, and adapt resiliently.
The document discusses the nursing process in community health nursing. It describes the steps of the nursing process - assessment, diagnosis, planning, implementation, and evaluation. It provides details on how community health nurses assess communities to identify health needs, formulate nursing diagnoses for communities and populations, plan interventions, implement plans through activities like health teaching, and evaluate the impact of nursing care. The nursing process provides structure for community health nurses to systematically address the health needs of communities.
This document discusses the ethical and legal issues in community health nursing. It begins by defining ethics and explaining that ethics deals with values relating to human conduct. It then discusses several client rights including informed consent, privacy, and the right to refuse treatment. The document outlines the nurse's professional responsibilities, which include upholding the code of ethics. It discusses key ethical principles like beneficence, autonomy, nonmaleficence, and justice. Finally, it examines some laws that affect nursing practice like scope of practice laws and malpractice.
Medical Governance, Health Policy, and Health Sector Reform in the PhilippinesAlbert Domingo
Suggested citation:
Domingo, Albert Francis E. "Medical Governance, Health Policy, and Health Sector Reform in the Philippines.” De La Salle Health Sciences Institute (DLSHSI). DLSHSI College of Medicine, Dasmarinas, Cavite. 27 Jun. 2014. Lecture.
The document defines key public health terminology used by the Oregon Health Authority, including definitions of public health concepts like access, assessment, assurance, behavioral risk factors, benchmarks, best practices, boards of health, cultural competence, determinants of health, environmental health, epidemiology, and essential public health services. It also describes several federal agencies that support public health work, such as the CDC, HRSA, FDA, and EPA.
Professinalism and legal issues in Community Health Nursing In Indiasthomas4u
1) Nursing requires devotion and preparation like the fine arts. It involves caring for the living body as the temple of God's spirit.
2) Professionalism in nursing includes various attributes like knowledge, spirit of inquiry, accountability, autonomy, advocacy, innovation, collaboration, and upholding ethics and values.
3) Nurses face challenges like lack of autonomy and leadership skills due to issues like short staffing, but professionalism helps them overcome such obstacles through commitment to lifelong learning and accountability.
This document describes a proposed randomized controlled trial to test the effectiveness of a health literacy and community health worker intervention for type 2 diabetes patients in community health centers. The study aims to address the gap in knowledge about how such interventions impact clinical outcomes like adherence, self-management, and communication. If shown to be effective, the intervention could help the millions of Americans with limited health literacy better manage their chronic conditions. The trial would involve community health centers in low-income neighborhoods of Boston serving predominantly minority populations disproportionately impacted by diabetes complications. Results could demonstrate cost-effective ways to incorporate health literacy and community health workers into standard care for medically underserved groups.
Nurs 710 CA and National Requirements for Nursing ProgramsNsarr
The document outlines the nine essentials that all nursing schools must fulfill according to the American Association of Colleges of Nursing to be eligible to teach a Baccalaureate Education for Professional Nursing Practice. Essential I discusses the importance of a liberal education foundation in sciences, arts, and humanities. Essential II covers organizational and systems leadership skills for quality care and patient safety. Essential III addresses the importance of scholarship and applying evidence-based practice.
The document discusses the nursing process used in community health settings. It defines community health nursing process as a systematic, ongoing process where nurses and clients work as a system to address health issues. The main steps of the nursing process are: 1) establishing relationships with the community, 2) assessing health needs and problems, 3) setting objectives, 4) planning and implementing interventions, and 5) evaluating interventions. Key principles for community health nurses include exploring the community, establishing relationships, providing education, and working collaboratively with other organizations and community members.
This document outlines concepts related to health care quality assessment. It describes key definitions, such as quality referring to services that increase health outcomes and are consistent with current knowledge. It also discusses perspectives on quality from practitioners, patients, and communities. Additionally, the document outlines different levels of quality analysis from national policies to individual care provision and lists examples of common quality indicators assessed in the US, such as patient satisfaction, mortality rates, and adherence to treatment protocols.
This document discusses key concepts in medical ethics including:
1. The four basic principles of medical ethics are autonomy, beneficence, non-maleficience, and justice.
2. Informed consent and respect for patient autonomy are fundamental, such as allowing patients to refuse blood transfusions based on their beliefs.
3. The principle of non-maleficience means "first, do no harm" and requires medical competence to avoid intentionally harming patients.
Harm reduction aims to reduce the harms associated with drug use without requiring abstinence. It is defined as a pragmatic, humane and non-judgmental approach that prioritizes harm reduction over moralistic judgments. Nurses play an important role in harm reduction through developing therapeutic relationships, health promotion, and overdose management while maintaining professional boundaries. There are ongoing debates around the ethics, policies and evidence regarding harm reduction strategies such as supervised consumption sites.
This document discusses patient-centered care and behavioral medicine in primary care. It covers several key points:
- Understanding diverse patient populations and how they perceive health and illness. This includes taking cultural factors like race, gender, socioeconomic status and health literacy into consideration.
- Developing skills like effective communication, providing culturally-sensitive assessments and interventions, and addressing barriers to patient adherence.
- Common factors that influence medication adherence such as health system challenges, patient health conditions and literacy, complexity of treatment regimens, and social/economic issues. Limited health literacy is strongly associated with lower levels of medication adherence and health knowledge.
- Strategies providers can use to improve adherence, including assessing literacy levels
The document discusses health literacy as it relates to medication and the use and delivery of healthcare. It analyzes reports from the National Academies of Sciences on these topics. For medication, it describes progress made in standardizing drug labels but notes more is needed. It also discusses using technology like apps and electronic records to promote health literacy. For healthcare delivery, it highlights the importance of health literacy in reducing complexity and disparities. While policies have helped, stronger communication skills are still required. The document proposes a case study on screening for low health literacy using the Newest Vital Sign assessment tool to test hypotheses about time and cost constraints.
The document discusses population health management and achieving healthy communities. It outlines major issues with the US healthcare system like uneven access to care. Real reform requires a focus on prevention, continuous care relationships, and evidence-based decisions. Population health management programs aim to maintain and improve people's health across different risk levels. Barriers to population health include fragmented care and misaligned incentives. Patient-centered medical homes and accountable care organizations show promise by emphasizing coordinated, team-based care. Automation and health information technology can help strengthen these models and drive effective population health management.
This document was produced for a Webinar for the Association of Directors of Public Health (ADHP www.adph.org.uk ) on 27th April 2017 in partnership with Public Health England (PHE www.gov.uk/phe) Hertfordshire County Council (www.hertfordshire.gov.uk) and the Health Psychology in Public Health Network (HPPHN www.hppn.org.uk ).
This document discusses several key ethical issues in public health, including disparities in health and access to care, responding to infectious diseases, international health cooperation, exploitation of individuals, health promotion, and ensuring participation, transparency and accountability. It also compares research activities and non-research public health practices, noting some common ethical tensions between individual and community interests as well as oversight mechanisms.
This document summarizes a presentation on advancing community health across the continuum of care from a health systems perspective. The presentation describes global trends driving more integrated and person-centered health services. It identifies challenges like intersectoral issues, medicalization, and accountability. Examples are provided on early childhood development programs, lessons from Ebola, and strengthening integrated community case management. The conclusion advocates for health systems that engage communities, challenge inequity, coordinate sectors, respond to illness causes, and adapt resiliently.
The document provides an overview of different frameworks for conceptualizing health systems. It describes the World Health Organization's definition of a health system as including all organizations, people, and actions aimed at promoting, restoring, or maintaining health. It also outlines WHO's six building blocks of a health system: service delivery, health workforce, information, medical products/vaccines/technology, financing, and governance. Additionally, it summarizes key components of health systems from the perspectives of the World Bank, including financing, payment, organization of service delivery, regulation, persuasion, politics, ethics, and values.
Current ethical issues in PH Final.pptxKeirelEdrin
Common ethical issues arise in public health activities related to surveillance, outbreak response, health promotion, and screening programs. Regarding surveillance and outbreak response, issues of privacy, confidentiality, and autonomy emerge when health information is collected and shared. For health promotion, ensuring voluntary participation while avoiding undue influence is important. Screening programs require informed consent, confidentiality to prevent stigma, and addressing potential harms of false results. These ethical issues could have severe consequences if not properly addressed, such as loss of trust and discrimination. Methods to prevent problems include strong legal protections, informed and voluntary participation, and minimizing risks of stigma or psychological harm.
Weitzman 2013: PCORI: Transforming Health CareCHC Connecticut
This document summarizes a presentation given by Joe Selby on the Patient-Centered Outcomes Research Institute (PCORI). It discusses PCORI's mission to fund comparative clinical effectiveness research that is guided by patients and other stakeholders. Key points include: PCORI's focus on research questions of interest to patients and providers; its criteria for funding proposals, including patient-centeredness and engagement; and its plans to significantly increase funding for such research over time. Examples are given of funded pilot projects involving community health centers.
This document introduces standards for social work practice in health care settings developed by the National Association of Social Workers (NASW). It provides background on the role of social workers in health care, outlines guiding principles for social work, and defines key terms. The standards are intended to enhance social workers' skills and knowledge when working with individuals, families, providers, and communities in health care.
The document discusses key issues in health system development and the Thai experience as an example. It summarizes that Thailand achieved early Millennium Development Goals through sustained action over time to address access barriers, including expanding infrastructure and human resources, gradually increasing financial risk protection, and strengthening community awareness of health programs. This sustained action was enabled by values-based leadership, support from elites, use of evidence, decentralized decision-making, and flexible implementation within a pro-poor, pro-rural ideology.
1. The document discusses the concept of culture and healthcare. It defines culture and explains how cultural norms can impact a person's health beliefs and behaviors.
2. Embracing cultural competence in healthcare can improve quality of care by helping providers understand patient values and beliefs. Awareness of cultural factors is important for developing effective health communication strategies.
3. Analyzing one's own cultural influences is a first step for healthcare providers to improve cultural sensitivity when working with diverse populations.
- The document discusses ensuring community care is provided in close collaboration with citizens and communities. It emphasizes the importance of patient empowerment, health literacy, digital health, patient involvement, and inclusiveness.
- Patient empowerment in community settings requires a shift towards seeing patients as equal partners in their care. This involves improving health literacy, self-management support, and shared decision-making between patients and healthcare professionals.
- Digital technologies can help facilitate chronic disease management and patient-centered care if designed and implemented in a way that strengthens patient empowerment and health literacy. Meaningful patient involvement in healthcare, research, and policy is also critical.
PowerPoint Presentation #1TOPIC- Mental health illness in adults w.docxIRESH3
This document outlines the key components of a powerpoint presentation on mental health issues among adults with substance abuse. It discusses conducting an epidemiological assessment of the target population that describes demographic information, identifies the health issue and risk factors, and explains how monitoring health and diagnosing/investigating diseases apply. It also covers analyzing existing policies around the issue, developing new potential policies, and identifying stakeholders. Finally, it discusses providing assurances around enforcing laws/regulations, linking people to services, ensuring a competent workforce, and evaluating programs. The conclusion examines legal/ethical considerations and how research/innovation can help address the issue through assessment, policy development, and assurance.
Patients' satisfaction towards doctors treatmentmustafa farooqi
This document provides an introduction, literature review, and proposed framework for a study on patient satisfaction towards doctor treatment at state hospitals in Multan, Pakistan. The study aims to examine if patients are satisfied with the healthcare process, doctor treatment and behavior, and information/communication. The conceptual framework identifies background variables, independent variables related to doctor treatment, and dependent variables of patient satisfaction. The literature review discusses several prior studies that examined factors influencing patient satisfaction like doctor competence, communication, and attitudes. The theoretical framework discusses social identity theory and satisfaction theory in understanding patient attitudes and expectations.
Patients' satisfaction towards doctors treatmentmustafa farooqi
The mood of the care recipient to see if the impression (expectations) of service are met by the patient may be defined as patient satisfaction. The current perspective on service efficiency tends to be that patient treatment meets public standards and requirements in terms of interpersonal support as well as professional assistance. (Hardy et al. 1996).
For various reasons, customer satisfactions in the healthcare industry have been investigated. First it was important to decide on the extent and the degree to which patient care seekers, the meeting of drugs criteria and the continuous use of these services have effect, satisfaction as a quality of service metric, as well as allowing doctors and health services to better appreciate and use the input of the patient. (Ong et al. 2000).
Consumer satisfaction with healthcare services is a multi-panel term that refers to the core facets of treatment and suppliers, while PS medical services with the quality enhancement systems from the patient context, full control of quality and the intended outcomes of services are considered to be of primary importance (Janicijevic et al. 2013).
The Pakistani health system is being changed somewhat and there are wonderful scope for applying standard of services to health care. Patients in Pakistan now have access to increased quality health care. Obviously, the staff and staff are the most important winners of a successful health care environment of every community sector framework (Bakari et al. 2019).
The medical clinic of today's study is the product of a long and complicated war of civilization to quantify produce and study and to give thought to the thoughtful (Fullman et al. 2017).
This research article examines the ethical dilemmas faced by palliative care physicians through surveys and interviews with 30 palliative care specialists in Mexico.
The study identified 113 common dilemmas, most frequently regarding sedation, home administration of opioids, and institutional regulations. It was observed that truth-telling and bidirectional trust between patients and providers are core to palliative medicine ethics. The most prominent virtues among participants were justice and professional humility. Physicians in palliative care see themselves most importantly as educators and advisers who provide medical assistance.
The research aims to better understand the values that guide decision-making in palliative care in order to improve care for patients at the end of life. It finds rediscovering virtues in clinical practice can
The assessment and identification of health need is a process that helps:
Inform planning of health care for individuals and their families, communities and the wider population.
It can be a powerful learning tool for local service providers, presenting them with the rationale for re-designing services to better target assessed needs of the local population.
ETHICAL AND LEGAL ISSUES IN CARDIOVASCULAR AND THORACIC NURSING.pptxEDWINjose43
Cardiovascular and thoracic nurses often face ethical and legal dilemmas that stem from advanced medical technologies. They must apply principles like autonomy, beneficence, and informed consent. Some common issues include promoting patient well-being, preventing harm, handling errors, withdrawal of life support, and allocating resources fairly. Evidence-based practice provides the best evidence to guide complex healthcare decisions and improve patient outcomes.
Management as a function of quality assurancesamehibrahim44
This document discusses health care delivery systems and primary health care. It defines primary health care as essential health care that is accessible to communities based on practical and scientifically sound methods. The key principles of primary health care are intersectoral collaboration, community participation, appropriate technology, equity, prevention and health promotion, and decentralization. The document also outlines the eight essential elements of primary health care: immunization, nutrition, water/sanitation, disease treatment, health education, maternal/child care including family planning, essential drugs, and additional elements like oral health and mental health. It defines key terms related to health care delivery systems.
This document summarizes the proceedings of an advisory panel meeting to discuss potential research topics for improving healthcare systems and patient outcomes. It provides an overview of the Patient-Centered Outcomes Research Institute's (PCORI) mission to fund research that discovers new information, allows for better decision making, and leads to better patient outcomes. Key areas of focus for potential research include care for chronic conditions, cancer, palliative care, pregnancy, and patients with multiple chronic conditions. The document discusses criteria for prioritizing research topics and provides brief summaries of 15 potential research topics for the advisory panel to review and rate.
A document prepared by Dr. Mustafa Salih, the former director of the Directorate General of Health Policy, planning and research at the Federal ministry of Health in Sudan.
This document provides an overview of community diagnosis and its framework. It defines community diagnosis as a quantitative and qualitative description of citizen health and influencing factors, including perceptions. The general framework involves 7 steps: 1) defining the community; 2) gathering health information; 3) measuring health conditions; 4) planning/organizing services; 5) integrating with the health system; 6) intersectoral coordination; and 7) community involvement. The goal is to estimate problem magnitude, analyze trends, and stimulate action to improve community health.
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Cadth symp breakfast 4 Update to Guidelines for the Economic Evaluation of He...CADTH Symposium
This document provides details about an update to the 3rd edition of CADTH's Guidelines for the Economic Evaluation of Health Technologies in Canada. It discusses that the methodology for economic evaluations is constantly evolving so it is important to provide up-to-date guidance. Key points include that CADTH and a working group are leading the update, topics from the 3rd edition will be reviewed and some identified for updates, new topics will be added, and stakeholders will provide feedback on gaps and challenges. Milestones include discussion sessions in 2015/2016 and posting a revised 4th edition for feedback in Spring 2016.
This document summarizes a workshop on developing clinical care guidelines for growth hormone treatment in Prader-Willi syndrome. The workshop brought together over 40 experts, including endocrinologists, geneticists, clinicians with an interest in growth hormone research, patient advocates, and methodologists. It utilized a multi-criteria decision analysis framework to develop the guidelines, taking into account scientific evidence, disease impact, safety, and other criteria. The goal was to produce consensus guidelines that integrated evidence, values, and ethics to guide policy and clinical practice around this complex treatment decision.
The document summarizes a literature review examining decision-making methodologies used in health technology appraisal processes. It describes common decision criteria identified in the literature, including efficacy, safety, disease burden, quality of evidence, ethics and cost-effectiveness. Decision-making methods reviewed integrate these criteria through approaches like assigning weights, ranking criteria or using decision rules. The literature search included publications from organizations in several countries.
This document describes a study that used a discrete choice experiment with duration (DCEtto) to value health states described by the EQ-5D-5L instrument in Canada. It notes limitations of the traditional time trade-off (TTO) method, such as many respondents not understanding or engaging with the task. The study found the DCEtto method led to fewer exclusions, increasing representativeness. Health state values from the DCEtto were generally lower than the TTO but allowed valuing all respondents. The document discusses differences in the distributions and average levels of values from the two methods and impact of exclusions. It acknowledges limitations to interpreting DCEtto values that require further investigation.
The document summarizes discussions from two roundtables on opportunities and barriers to using real-world evidence in Canada. Key points identified include the need to: 1) build a culture that recognizes real-world evidence can foster healthcare innovation; 2) increase understanding of real-world evidence's value to improve quality and efficiency; and 3) use common data structures and vocabularies to better link and analyze data. Next steps discussed building real-world evidence capacity in Canada through continued stakeholder discussions, leveraging existing data infrastructure, and balancing privacy concerns with the need for appropriate care.
Cadth 2015 e4 lourenco adaptive design april 2015 finalCADTH Symposium
Health Canada regulates clinical trials and drug approvals. Adaptive clinical trial designs are increasing and can modify aspects of ongoing trials using accumulating data. Health Canada's main concerns are appropriate scientific questions, error control, and avoiding bias. Examples seen include adaptive randomization, sample size changes, and seamless phase 2/3 designs. Case studies demonstrate increased complexity, new statistical methods, and more simulation use. Health Canada recommends early consultation and education on adaptive designs.
Cadth 2015 e4 fields slides for adaptive panel finalCADTH Symposium
This document discusses pCODR's experience with adaptive clinical trial designs and how they impact drug funding assessments. It provides examples of two clinical trials for chronic lymphocytic leukemia (CLL) and non-small cell lung cancer (NSCLC) that used adaptive designs. The CLL trial had early stopping rules and treatment switching based on interim analyses. The NSCLC trial allowed patients who progressed on chemotherapy to switch to the experimental drug crizotinib, introducing uncertainty into estimating the treatment's effectiveness and cost-effectiveness. pCODR will likely see more complex adaptive designs as cancer treatments increasingly target biomarker-defined subgroups and employ personalized medicine approaches, requiring continuous evolution of its assessment expertise.
This document discusses adaptive clinical trial designs used by Merck for oncology studies. It provides examples of different types of adaptive designs including:
1) Dose-finding designs like modified toxicity profile interval designs that allow for dose escalation and de-escalation in a table-driven manner.
2) Single-arm response rate studies that can provide early access for patients and allow early interim analyses to discontinue biomarker-negative patient populations if no responses are found.
3) Comparative studies with dual primary endpoints of overall survival and progression-free survival that can adapt based on biomarker-selected patient populations at interim analyses.
4) Bayesian adaptive studies like I-SPY 2 that
Cadth 2015 e4 thorlund innovative trial designs in medical decision makingCADTH Symposium
Adaptive clinical trial designs are increasingly used in commercial trials due to demands for faster evidence and more efficient trials. However, health technology assessment decision-making typically requires large parallel randomized controlled trials, creating a mismatch. Without long-term placebo/control data or trials that resemble approved treatment algorithms, innovative trial designs risk not providing sufficient evidence for reimbursement decisions. To address this, more education is needed on innovative designs for health technology assessors, and trials should apply these designs to further validate their ability to provide robust evidence for reimbursement.
This document summarizes a panel discussion on integrating evidence, values and ethics into healthcare decision-making using multicriteria decision analysis (MCDA). It discusses how MCDA can help address ethical dilemmas by explicitly considering multiple criteria, including efficacy, safety, costs, and other social values. It outlines the key steps in MCDA, including defining objectives and criteria, assigning weights to criteria, synthesizing evidence on the criteria, scoring performance on criteria, and aggregating scores to determine the overall value of interventions. The document emphasizes that MCDA supports making decisions in a way that is participatory, transparent, systematic and reflective of different stakeholder perspectives to arrive at decisions that optimize health in its widest sense.
Cadth 2015 e4 adaptive design april 2015 final lourencoCADTH Symposium
Health Canada regulates clinical trials and drug approvals. Adaptive clinical trial designs are increasing and can modify aspects of ongoing trials using accumulating data. Health Canada's main concerns are appropriate scientific questions, error control, and avoiding bias. Examples seen include adaptive randomization, sample size changes, and seamless phase 2/3 designs. Case studies demonstrate increased complexity, new statistical methods, and more simulation use. Health Canada recommends early consultation and education on adaptive designs.
Cadth symposium 2015 d3 pr os va. generic measures cadth 14th april 2015CADTH Symposium
This document discusses the use of generic and condition-specific patient-reported outcome measures (PROs) in value-based healthcare reimbursement decisions. It compares the EQ-5D-3L generic PRO to the PuQol_UI condition-specific PRO for pressure ulcers. The condition-specific measure was more sensitive to pressure ulcer severity levels compared to the generic measure. Using different PROs can lead to different assessments of treatment value and impact reimbursement decisions. The document concludes that using PROs in reimbursement requires care, as it can impede equitable decision-making and comparing "apples to oranges" treatments.
This document discusses methods for incorporating single-arm study data into network meta-analyses (NMAs). Currently, NMAs primarily use data from randomized controlled trials. The document presents two methods for including single-arm evidence: 1) Using single-arm results to create informative priors in Bayesian NMA models, and 2) Creating "virtual comparisons" based on patient characteristics to include single-arm studies directly in the NMA. It provides examples applying these methods in analyses of treatments for cryptococcal meningitis and hepatitis C. The results showed inclusion of single-arm evidence can improve model fit and precision of treatment effect estimates in NMAs.
The document discusses guidelines from different committees on oral anticoagulants for atrial fibrillation stroke prevention that show some discordance despite being based on the same three landmark trials. It suggests that values influence guideline committees and prescribing specialists differently, and that patient values through shared decision making should also be considered to tailor therapy to individual patients.
Cadth 2015 e5 noac ad symposium_panel_14apr2015CADTH Symposium
This document summarizes a symposium on promoting evidence-based use of anticoagulants across Canada. It discusses the prevalence of atrial fibrillation, options for anticoagulation including warfarin and newer oral anticoagulants, and initiatives for collaboration between provinces to educate health professionals and patients on appropriate anticoagulant therapy. Speakers from various provinces outlined academic detailing programs and a CADTH systematic review comparing benefits and harms of anticoagulants.
Cadth 2015 b1 slides allan grill-pcodr-cadth_symposium2015presentationfinalCADTH Symposium
The document discusses discordance between recommendations from the pan-Canadian Oncology Drug Review (pERC) and provincial funding decisions for cancer drugs in Canada. It presents results from a survey of provincial drug funding decision-makers that identified several potential reasons for discordance, including differences in priorities, clinical evidence, and budget constraints between the levels. Challenges to alignment included issues with clinical trial evidence as well as pressure to expand access, while suggested solutions centered on strengthening consensus around treatment pathways and priorities nationally.
The document provides an overview of CADTH Excel-based health technology assessment tools that have been developed or are in development. It summarizes NetMetaXL, an Excel-based tool for conducting network meta-analyses of dichotomous outcomes. The presentation includes a live demo of NetMetaXL and previews of three other CADTH Excel-based HTA tools.
This document discusses different forms of public engagement that could be appropriate for drug policy decisions. It notes that deliberative public engagement events can incorporate diverse perspectives but may not be fully representative. It advocates for participatory governance with advisory bodies that regularly refresh their engagement to better reflect the public. Experiments with different engagement methods should be assessed to help balance input with decision efficiency.
This document presents a framework for strengthening public and patient engagement in Health Quality Ontario's evidence review process. Key elements of the framework include articulating goals and principles, establishing a common language, describing a menu of engagement approaches matched to process stages, and identifying measures. The framework was developed through a review of literature and practices, expert consultation, and stakeholder dialogue. It recommends increasing transparency, incorporating diverse perspectives throughout stages, and evaluating engagement impacts. The framework provides guidance to enhance public and patient contributions to health technology decision-making in Ontario.
This document discusses challenges associated with going beyond health-related quality of life measures in cost-utility analysis. It notes that while economic evaluations often use quality-adjusted life years (QALYs) based on health-related quality of life instruments like EQ-5D, interventions can provide benefits beyond health alone. There are theoretical, normative, conceptual and methodological challenges to incorporating these broader outcomes. Measuring instruments have been developed to capture non-health domains, but valuing these outcomes poses challenges. Considering non-health outcomes increases complexity, but may provide a more comprehensive assessment.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Cadth 2015 e2 miller cadth-ohtac approach-april 14, 2015
1. Improving the Appraisal of Non-Drug Technologies:
Revising the Ontario Decision Framework
Ethics & Social Values: Patient Centred Care
Fiona A. Miller, PhD
Associate Professor, IHPME
Division of Health Policy & Ethics, THETA
CADTH, Saskatoon
April 14, 2015
2. Addressing Ethics & Social Values at OHTAC
2
Decision determinants Public engagement
PE #1
(2007-8)
PE #2
(2012-2014)
3. Addressing Ethics & Social Values at OHTAC
3
Decision determinants
DD #1
(2007-8)
• Johnson et al, Decision
Determinants Committee #1:
2007-2008/9
- Nancy Sikich, Gerald Evans,
William Evans, Mita
Giacomini, Les Levin,
Murray Krahn, Murray
Glendinning, Paul Oh,
Charmaine Perera
5. Addressing Ethics & Social Values at OHTAC
5
Decision determinants
DD #1
(2007-8)
Subcommittee on
social values & ethics
(2011-2012)
• Giacomini et al, Subcommittee on Social
Values & Ethics Evaluation: Identification
of core values relevant to OHTAC decision
making (2011-2012)
– Frank Wagner, Murray Krahn, Julia
Abelson, Nancy Sickich, Kellee
Kaulback
6. QualityEvidence-informed
policy
Effectiveness
Resource
stewardship
Resource
sufficiency
Equity
Solidarity
Collaboration
Patient-centred care
Shared responsibility
for health
Population health
OHTAC
• Mission Statement
• Terms of Reference
• Decision Determinants Framework
• Public Engagement Subcommittee, 2007
• External reviews, 2005, 2008
• Citizen’s Reference Panel, 2010
HTA (international ethics fwks)
• EUNetHTA Core Model
• INAHTA Working Group
• (“Hoffman’s list”, IJTAHC)
Canadian Health System
• Canada Health Act
• Romanow Commission
• First Ministers’ Accord on
Health Care Renewal
• Health Council of Canada
Ontario Health System
• (No MOHLTC strategic plan)
• Excellent Health Care for All
Act
• Ontario Health Plan for an
Infuenza Epidemic
• Ontario Health Quality
Council
Grounded in:
Established values frameworks
relevant to OHTAC’s jurisdiction
Human rights,
rule of law, etc.
Traditional
in HTA
Over-
arching
Economic
Clinical
Giacomini et al, 2012
NOT
Traditional
in HTA
7. Social values
7
Six domains of social value 20 social values statements
EQUITY#1: Access to health care should be universal among Canadians, and based on individual need.
EQUITY #2: Individuals should not face discrimination on the basis of factors other than need. These include but
are not limited to: ability to pay, wealth, province of residence, geographic location, origin, gender, or age.
COLLABORATION #1: Health care is complex. Success depends on
constructive collaboration between many providers, agencies,
organizations, professionals, patients, and their caregivers.
COLLABORATION #2: Mechanisms to support collaboration –
whether legal frameworks, economic incentives, organizational
structures, support technology, or others – should be regarded as
integral and important aspects of health services.
COLLABORATION #3: Health technologies should be analyzed in
context, including attention to both their integral components and how
they integrate with other aspects of health care.
COLLABORATION #4: Policy makers should understand and
consider health services’ (and technologies’) potential organizational,
economic, and social impacts, and how these affect constructive
collaborations.
SOLIDARITY #1: The principle of solidarity recognizes the importance of relationships and interdependence for
individual and societal flourishing.
SOLIDARITY #2 Solidarity is related to other values such as equity, justice, collaboration, and shared
responsibility for health. It also resonates with the familiar values of non-abandonment and compassion in clinical
bioethics.
SOLIDARITY #3: Solidarity entails sustaining strong, trusting, and compassionate relationships in the health
system. These include relationships between patients and providers, between citizens and their government
agencies, and others.
SOLIDARITY #4: Solidarity also implies that conflicts of interest and externalities should be transparent and
addressed.
8. Social values
8
Six domains of social value 20 social values statements
PATIENT-CENTRED CARE #1: Processes of care and positive patient experiences matter, in addition to health
outcomes.
PATIENT-CENTRED CARE #2: Patient burdens should be minimized and kept in proportion with benefits.
PATIENT-CENTRED CARE #3: Health care services should be responsive to patients’needs, values, and preferences.
PATIENT-CENTRED CARE #4: Diversity in patient values should be expected, and accommodated within legal and
pragmatic bounds
PATIENT-CENTRED CARE #5: The dignity, rights, liberty, autonomy, and privacy of patients must be respected
throughout the health care process.
PATIENT-CENTRED CARE #6: Patient-centred care also entails respect and support for the roles of family members
and other informal caregivers in generating the patient’s well-being.
POPULATION HEALTH #1: The health system should serve the health of the population as well as
the health of individuals.
POPULATION HEALTH #2: Policy makers should consider implications of decisions for
population health, prevention, and protection of the public from harm.
SHARED RESPONSIBILITY FOR HEALTH #1: The health system
holds partial responsibility for individual and population health.
Additional responsibility rests on social factors, the environment,
occupational settings, individual behaviours and lifestyle.
SHARED RESPONSIBILITY FOR HEALTH #2: Consideration should
be given to the role of not only the personal, but also the social
determinants of health.
9. Addressing Ethics & Social Values at OHTAC
9
Decision determinants
DD #1
(2007-8)
Subcommittee on
social values & ethics
(2011-2012)
DD #2
(2012-2014)
Clinical
Economic
E&SV
WorkingGroup
• Krahn et al, Decision Determinants
Committee #2: Revise decision
determinants framework (2012-2014)
- Mita Giacomini, Shawn Winsor, Frank
Wagner, Fiona Miller, Ahmed Bayoumi,
Ba Pham, Gabrielle Van Der Velde, Holger
Schunemann, Ron Goeree, Nancy Sikich
• Giacomini et al; Miller et al, Ethics &
Social Values Working Group:
Operationalize core values
- Frank Wagner, Shawn Winsor, Juliana
Yi, Celine Cressman (2014)
12. Evaluative questions
Evaluative category Evaluative questions
Equity Are there differences among equity-relevant groups* with regard to
disease burden or access to care?
Patient-centred care Describe patient experiences and preferences regarding the condition,
as well as processes and outcomes of care?
Have particular issues been identified relevant to ethical principles and
rights in health care: autonomy and independence, vulnerability and
dignity, privacy and confidentiality?
Context-sensitive care Describe, if warranted, the potential effects on other health services or
systems, in the short or long term - Setting precedents, establishing or
diminishing clinical or organizational capacity, requiring new standards
of practice for regulated health professionals, etc?
Are there social or cultural pressures that affect the use of the
technology - Tensions between the individual and their community,
social stigma, or judgments of personal or social responsibility for poor
or improved health?
* Groups identified by MOHLTC HEIA Tool for equity considerations: Aboriginal peoples, Age-related groups, Disability,
Ethno-racial communities, Francophone, Homeless, Linguistic communities, Low income, Religious/faith communities,
Rural/remote or inner-urban populations, Sex/gender, Sexual orientation, “Other” 12
13. Test case for evidence-based E&SV analysis
• Uterine fibroids
– Benign tumors of the smooth muscle cells of the myometrium
– Common
• prevalence of 70% among white women in late 40s; 80% for black
women, though are asymptomatic in most women.
13
– Prevalence of clinically relevant tumors
increases with age
• 10-15% of white women in their 30’s and
35% of white women in their late 40’s.
• 2-3 fold higher incidence rates for black
women; earlier age of onset, over a greater
age span; more severe disease at
presentation and at surgery
14. Test case for evidence-based E&SV analysis
• A range of treatment alternatives
– Invasive
• surgical interventions (myomectomy and hysterectomy)
– Minimally invasive
• various embolic and ablative therapies (embolization,
radiofrequency, laser, microwave and cryoblation)
– Non-invasive thermal ablation technology - MRgHIFU
• magnetic resonance imaging (MR) for targeting and monitoring
• high-intensity focused ultrasound (HIFU) for treatment
15. Test case for evidence-based E&SV analysis
• Research questions
– What are patient values, preferences and expressed needs related to
uterine fibroids and treatments for it?
– What challenges exist in the provision of patient-centred care for uterine
fibroids and how might these be affected by the availability of MRgHIFU?
• Evidence review
– Comprehensive review of relevant literature – systematic scoping review
– 47 studies included in evidence synthesis
• Primary studies of patients and providers – qualitative & quantitative
• Epidemiologic and service utilization data (e.g., billing data, chart
review, disease registry)
• Findings across 4 thematic areas
– The burden of uterine fibroids
– The importance of values and preferences in treatment selection
– Challenges in delivering patient-centred care
– Challenges for health equity
15
17. Patient-centred carePatient-CentredCare*
Patient &
public values
Equitable &
integrated
care systems
*Entwistle, V. A., & Watt, I. S. (2013). Treating patients as persons: A capabilities approach to support delivery of
person-centered care. The American Journal of Bioethics, 13(8), 29-39.
18. Patient-centred carePatient-CentredCare*
Patient &
public values
Treating patients as persons, recognizing the relational nature of our autonomy
• Not disease-centred
• Respectful and responsive to considered preferences, needs and values
• A positive and supportive respect, recognizing the social resources involved in
formulating and achieving valued ends
Equitable &
integrated
care systems
*Entwistle, V. A., & Watt, I. S. (2013). Treating patients as persons: A capabilities approach to support delivery of
person-centered care. The American Journal of Bioethics, 13(8), 29-39.
19. Patient-centred carePatient-CentredCare*
Patient &
public values
Treating patients as persons, recognizing the relational nature of our autonomy
• Not disease-centred
• Respectful and responsive to considered preferences, needs and values
• A positive and supportive respect, recognizing the social resources involved in
formulating and achieving valued ends
Equitable &
integrated
care systems
Ensuring that health systems work to fairly serve the needs of populations of patients
• Not staff or system-centred
• Integrated systems of responsive and respectful care
• Ensuring non-discrimination (not unfairly treating likes differently in the delivery of
healthcare services)
• Seeking to overcome health inequities (remediating, where possible, avoidable,
unfair and unjust differences in health outcomes)
*Entwistle, V. A., & Watt, I. S. (2013). Treating patients as persons: A capabilities approach to support delivery of
person-centered care. The American Journal of Bioethics, 13(8), 29-39.
22. The stages of an HTA
Vignette:
Topic selection
& scoping
Evidence based
analysis
Appraisal:
OHTAC
Recommendations
Ethics &
Social
Values
Ethics &
Social
Values
Ethics &
Social
Values
23. Priority setting for HTA – Approach to E&SV
Domain Criteria Ranking Unknown RANK
A B C
Patient-
centred
care
Patient & public
values
Consistent with
patient values
& preferences
Limited impact
related to
patient
values/preferen
ces
Contrary to
patient values
and
preferences
Equitable &
integrated care
systems
Has the
potential to
improve the
delivery of
equitable and
integrated care
Limited impact
on the delivery
of equitable
and integrated
care
May worsen
the delivery of
equitable and
integrated care
23
• Incorporate the 2 main criteria proposed for the patient-centred care
domain
• Set at highest rank those technologies that promise to significantly
improve patient-centred care
24. • All mega-analyses should be accompanied by an evidence-based
E&SV analysis
• Review of a network of technologies provides excellent
opportunity for considering patient-centred system of care
• Evidence-based E&SV analysis to be triggered for other HTAs
(e.g., single technology appraisals) on a case by case basis
• Informed by: Institute of Health Economics, Edmonton, AB
Report: Assessing the Need for and Quality of Ethics
Analyses in HTA, October 18-26, 2013: 1-38.
Scoping – Triggering evidence-based E&SV analysis
24c
25. Trigger checklist
• Where use of priority setting tool identifies opportunities or
challenges in addressing patient-centred care
• Where treatments or outcomes are sensitive to patient
preferences, values or needs
• Where the patient population is vulnerable or marginalized
– For example, ill children, individuals with impaired cognitive capacity,
institutionalized persons, etc.
– Marginalized by unfair or unjust health differences
• Where the technology is proposed for use in healthy populations
– Population screening; prophylactic interventions
• Where the technology is ‘disruptive’ of existing services or systems
– Changing health care delivery and disease management processes
– Changing job prospects for health care providers
– Requiring new capital equipment and infrastructure
• Where the technology challenges legal or ethical commitments to
patient autonomy, privacy or confidentiality
25
26. The stages of an HTA
Vignette:
Topic selection
& scoping
Evidence based
analysis
Appraisal:
OHTAC
Recommendations
Ethics &
Social
Values
Ethics &
Social
Values
Ethics &
Social
Values
27. Evidence-based E&SV analysis
27
• Evidence-based E&SV analysis should involve a systematic review
of research evidence
• A consistent evidence-based approach to all relevant
decision criteria
• As appropriate, primary data collection or public engagement
• PE Subcommittee
28. Suggested methodology
• Suggested methodology for evidence review
– Scoping review
• Comprehensive and systematic search and selection
• Not specific to any one research methodology (i.e., including qualitative studies but
not only qualitative studies)
• Quality assessment through assessment of relevance; use of quality prompts and
exclusion for studies deemed critically flawed
– Addressing multiple domains of interest to E&SV analysis - drawing on 3 non traditional
approaches to research synthesis
• Qualitative research – To illuminate social phenomena commonly captured by
studies using qualitative methodologies: Patient (and other stakeholder) values,
preferences and experiences; also social and cultural beliefs, perceptions of
treatments and outcomes, implementation-relevant considerations
• Health equity – To identify “differences in health outcomes that are avoidable,
unfair and unjust.” (Welch et al, 2013, p2)
• Health ethics – To identify the moral issues arising in technologies, technology
appraisal, or technology use
– Search strategy – PICo - intermediate level of sensitivity/specificity
• Population, the phenomena of Interest, and the Context
– Data extraction and analysis using criteria for E&SV appraisal
28
29. The stages of an HTA
Vignette:
Topic selection
& scoping
Evidence based
analysis
Appraisal:
OHTAC
Recommendations
Ethics &
Social
Values
Ethics &
Social
Values
Ethics &
Social
Values
30. Appraisal – Integrating E&SV
30
• “Patient centred care” domain
• Not to be completed unless evidence-based E&SV analysis
undertaken
• Summative judgment includes consideration of relevance and
consistency of the evidence
• Role of evaluative criteria
• Influence decisions
• Give reason for favouring/ disfavouring adoption
• Inform implementation
• Give guidance related to education, training, service design
31. Patient Centred Care
✓
Check mark ("✓") indicates formal analysis completed. X mark ("✗") indicates no formal analysis
completed.
Patient-CentredCare
Patients:
Values &
Preferences
Aligned with patient values &
preferences
Do patients have specific values, preferences or needs
related to the condition, treatment or life impact that are
relevant to this assessment? (NB. Values and preferences of
family, informal caregivers or the public to be considered,
as appropriate)
Consistent with commitments
to autonomy, privacy,
confidentiality
Are there concerns regarding accepted ethical or legal
standards related to patient autonomy, privacy or
confidentiality that are relevant to this assessment?
Populations:
Equity &
Coordinated
Care
Enhances equity in access or
outcomes
Are there disadvantaged populations or populations in
need whose access to care or health outcomes might be
improved (or not worsened) that are relevant to this
assessment?
Coordinates care
Are there challenges in the coordination of care for patients
that might be improved (or not worsened) that are relevant
to this assessment?
SUMMARY
Taking account of these
considerations, select the
degree to which the evidence
supports the use of the
technology(ies)/ intervention.
Strongly
supports
Somewhat
supports
Neutral/
Unknown
Does not
support
Strongly
discourages
32. Conclusion, 1
• At OHTAC, many efforts to to integrate ethics & social values
into HTA:
– Public engagement subcommittees
– Decision Determinants subcommittees
• Ethics & Social Values Working Group
• Proposed methodology
– Across stages of HTA
– Based in set of social values
– Involving clear conceptual framework & evidence review
32
33. Conclusion, 2
• Many questions remain
– Evidence review
• Have we asked the right questions?
• Have we fairly and appropriately called attention to both
– The preferences and values of individual patients?
– The needs of populations of patients?
– Evidence review relative to direct engagement
• What is the value add?
– Technology appraisal
• What role does/ should these considerations play in HTA
decisions?
– Conducting evidence-based ethics & social values analysis
• Is this the right methodology?
• When should these reviews be done?
33
34. Acknowledgements
• Decision Determinants Subcommittee
– Murray Krahn, Chair
– Ahmed Bayoumi
– Ba Pham
– Gabrielle Van Der Velde
– Holger Schunemann
– Ron Goeree
– Nancy Sikich
– Mita Giacomini
– Frank Wagner
– Shawn Windsor
• Key HQO supports
– Corinne Holubowich
– Caroline Higgins
– Gaylene Pron
– Stephen Petersen
E&SV Evidence review team
Juliana Yi
Celine Cressman
Carolyn Barg
Sarah Patton
E&SV Working Group of DD
Mita Giacomini (2012-
2013)
Shawn Windsor
Frank Wagner
Juliana Yi
Celine Cressman (2014)
Editor's Notes
Step 3: Develop process to integrate ‘other’ inputs
Step 3: Develop process to integrate ‘other’ inputs