Novel COVID-19 Intersections with Dentistry : approaches to protection

COVID-19 outbreak brought many challenges to the society and to health care systems. Health care professionals in dental practices are a high-risk population, due to close contact to saliva and aerosols. Specific guidance for those professionals is essen

Knowledge systems, health care teams, and clinical practice: a study of successful change

Clinical teams are of growing importance to healthcare delivery, but little is known about how teams learn and change their clinical practice. We examined how teams in three US hospitals succeeded in making significant practice improvements in the area of antimicrobial resistance. This was a qualitative cross-case study employing Soft Knowledge Systems as a conceptual framework. The purpose was to describe how teams produced, obtained, and used knowledge and information to bring about successful change. A purposeful sampling strategy was used to maximize variation between cases. Data were collected through interviews, archival document review, and direct observation. Individual case data were analyzed through a two-phase coding process followed by the cross-case analysis. Project teams varied in size and were multidisciplinary. Each project had more than one champion, only some of whom were physicians. Team members obtained relevant knowledge and information from multiple sources including the scientific literature, experts, external organizations, and their own experience. The success of these projects hinged on the teams' ability to blend scientific evidence, practical knowledge, and clinical data. Practice change was a longitudinal, iterative learning process during which teams continued to acquire, produce, and synthesize relevant knowledge and information and test different strategies until they found a workable solution to their problem. This study adds to our understanding of how teams learn and change, showing that innovation can take the form of an iterative, ongoing process in which bits of K&I are assembled from multiple sources into potential solutions that are then tested. It suggests that existing approaches to assessing the impact of continuing education activities may overlook significant contributions and more attention should be given to the role that practical knowledge plays in the change process in addition to scientific knowledge

Challenges for health care development in Croatia [Izazovi razvoja zdravstvenog sustava Republike Hrvatske]

The main aim of the research done in this paper was to establish key challenges and perspectives for health care development in the Republic of Croatia in the next two decades. Empirical research was conducted in the form of semi-structured interviews involving 49 subjects, representatives of health care professionals from both, public and private sectors, health insurance companies, pharmaceutical companies, drug wholesalers, and non-governmental organisations (patient associations). The results have shown that key challenges and problems of Croatian health care can be divided into three groups: functioning of health care systems, health care personnel, and external factors. Research has shown that key challenges related to the functioning of health care are inefficiency, financial unviability, inadequate infrastructure, and the lack of system transparency. Poor governance is another limiting factor. With regard to health care personnel, they face the problems of low salaries, which then lead to migration challenges and a potential shortage of health care personnel. The following external factors are deemed to be among the most significant challenges: ageing population, bad living habits, and an increase in the number of chronic diseases. However, problems caused by the global financial crisis and consequential macroeconomic situation must not be neglected. Guidelines for responding to challenges identified in this research are the backbone for developing a strategy for health care development in the Republic of Croatia. Long-term vision, strategy, policies, and a regulatory framework are all necessary preconditions for an efficient health care system and more quality health services

The International Right to Health: What Does It Mean in Legal Practice and How Can It Affect Priority Setting for Universal Health Coverage?

The international right to health is enshrined in national and international law. In a growing number of cases, individuals denied access to high-cost medicines and technologies under universal coverage systems have turned to the courts to challenge the denial of access as against their right to health. In some instances, patients seek access to medicines, services, or technologies that they would have access to under universal coverage if not for government, health system, or service delivery shortfalls. In others, patients seek access to medicines, services, or technologies that have not been included or that have been explicitly denied for coverage due to prioritization. In the former, judicialization of the right to health is critical to ensure patients access to the technologies or services to which they are entitled. In the latter, courts may grant patients access to medicines not covered as a result of explicit priority setting to allocate finite resources. By doing so, courts may give priority to those with the means and incentive to turn to the courts, at the expense of the maximization of equity- and population-based health. Evidence- based, informed decision-making processes could ensure that the most clinically and cost-effective products aligning with social value judgments are prioritized. Governments should be equipped to engage in and defend rational priority setting as a means to promote fair allocation of resources to maximize population health. Rational priority setting is an evidence-based form of explicit priority setting, where the priority setting process is deliberate and transparent, the decision makers are specified, relevant stakeholders are involved, and the best available evidence about clinical and cost-effectiveness and social values is considered. The most rational priority setting processes will also account for the benefit to patients, the cost, the ethicality and the fairness. The priority setting process and institutions involved should then be held accountable through an appeals process, allowing independent review by health systems, health care, and other relevant experts, and an opportunity for judicial review. While the implementation of a three-step (1) rational priority setting, (2) appeals, and (3) judicial review process will differ depending on a country’s resource constraints, political systems, and social values, the authors argue that the three stages together will promote the greatest accountability and fairness. As a result, the courts could place greater reliance on the government’s coverage choices, and the population’s health could be most equitably distributed

Economic impact of the public debt

Following the financial and economic crisis, there was a marked increase in the public debt of the euro area countries, the United States, the United Kingdom and Japan. In addition, without a change of policy, the public debt of those countries would maintain an upward trend, a key factor being the rising costs associated with population ageing. The article analyses the risks and implications of the expansion of the public debt currently evident in most of the advanced countries. The difficulties which certain euro area countries are experiencing in raising finance on the markets illustrate some of those risks. After outlining the movement in the public debt in the advanced countries in recent years, a simulation is produced in view of showing the future debt pattern in the absence of any change of policy. This exercise clearly highlights the potentially exponential growth of the public debt in most of the advanced countries. Next, the impact of the public debt on economic activity and inflation is examined. That impact appears to be very heavily dependent on the circumstances, which may vary greatly over time and between countries. When looking at the impact of the pattern and size of the public debt on economic activity, it is always important to distinguish between the short and the long term. Finally, the article sets out the need for fiscal consolidation and appropriate strategies for achieving that. The strategy focuses on three aspects: fiscal consolidation aimed at reducing the public debt, boosting the employment rate and productivity, and reform of the pension systems, health care and care of the elderly. For most of the advanced countries, large-scale reform programmes will be necessary in order to restore sustainable public finances. Some countries have already implemented consolidation measures, while others have yet to put most of the measures in place.public debt, deficit, economic growth, government expenditure and revenue, taxation, fiscal policies

Health literacy review: a guide

This guide shows how to carry out a health literacy review and build a health-literate organisation. Summary Individuals and whānau face a series of demands on their health literacy when navigating their way through the health system. These demands impact on consumers’ ability to access health information, care and services. Internationally, support is growing for a stronger focus on how health systems, health care providers and practitioners can support people to access care, manage and maintain their own health and wellbeing. A health literate organisation makes health literacy a priority and integral to quality service improvement. It makes health literacy part of all aspects of its service planning, design, delivery, and performance evaluation