73 research outputs found
Interventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: a systematic review
Background
Implicit biases are present in the general population and among professionals in various domains, where they can lead to discrimination. Many interventions are used to reduce implicit bias. However, uncertainties remain as to their effectiveness.
Methods
We conducted a systematic review by searching ERIC, PUBMED and PSYCHINFO for peer-reviewed studies conducted on adults between May 2005 and April 2015, testing interventions designed to reduce implicit bias, with results measured using the Implicit Association Test (IAT) or sufficiently similar methods.
Results
30 articles were identified as eligible. Some techniques, such as engaging with others’ perspective, appear unfruitful, at least in short term implicit bias reduction, while other techniques, such as exposure to counterstereotypical exemplars, are more promising. Robust data is lacking for many of these interventions.
Conclusions
Caution is thus advised when it comes to programs aiming at reducing biases. This does not weaken the case for implementing widespread structural and institutional changes that are multiply justified
Solidarity and cost management: Swiss citizens’ reasons for priorities regarding health insurance coverage
ContextApproaches to priority‐setting for scarce resources have shifted to public deliberation as trade‐offs become more difficult. We report results of a qualitative analysis of public deliberation in Switzerland, a country with high health‐care costs, an individual health insurance mandate and a strong tradition of direct democracy with frequent votes related to health care.MethodsWe adapted the Choosing Healthplans All Together (CHAT) tool, an exercise developed to transform complex health‐care allocation decisions into easily understandable choices, for use in Switzerland. We conducted focus groups in twelve Swiss cities, recruiting from a range of socio‐economic backgrounds in the three language regions.FindingsParticipants developed strategic arguments based on the importance of basic coverage for all, and of cost‐benefit evaluation. They also expressed arguments relying on a principle of solidarity, in particular the importance of protection for vulnerable groups, and on the importance of medical care. They struggled with the place of personal responsibility in coverage decisions. In commenting on the exercise, participants found the degree of consensus despite differing opinions surprising and valuable.ConclusionThe Swiss population is particularly attentive to the costs of health care and means of reducing these costs. Swiss citizens are capable of making trade‐offs and setting priorities for complex health issues.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146495/1/hex12680.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146495/2/hex12680_am.pd
'Do not attempt resuscitation' and 'cardiopulmonary resuscitation' in an inpatient setting : factors influencing physicians' decisions in Switzerland
To determine the prevalence of cardiopulmonary resuscitation (CPR) and do-not-attempt-resuscitation (DNAR) orders, to define factors associated with CPR/DNAR orders and to explore how physicians make and document these decisions. We prospectively reviewed CPR/DNAR forms of 1,446 patients admitted to the General Internal Medicine Department of the Geneva University Hospitals, a tertiary-care teaching hospital in Switzerland. We additionally administered a face-to-face survey to residents in charge of 206 patients including DNAR and CPR orders, with or without patient inclusion.; 21.2% of the patients had a DNAR order, 61.7% a CPR order and 17.1% had neither. The two main factors associated with DNAR orders were a worse prognosis and/or a worse quality of life. Others factors were an older age, cancer and psychiatric diagnoses, and the absence of decision-making capacity. Residents gave four major justifications for DNAR orders: important comorbid conditions (34%), the patients' or their family's resuscitation preferences (18%), the patients' age (14.2%), and the absence of decision-making capacity (8%). Residents who wrote DNAR orders were more experienced. In many of the DNAR or CPR forms (19.8 and 16%, respectively), the order was written using a variety of formulations. For 24% of the residents, the distinction between the resuscitation order and the care objective was not clear. 38% of the residents found the resuscitation form useful.; Patients' prognosis and quality of life were the two main independent factors associated with CPR/DNAR orders. However, in the majority of cases, residents evaluated prognosis only intuitively, and quality of life without involving the patients. The distinction between CPR/DNAR orders and the care objectives was not always clear. Specific training regarding CPR/DNAR orders is necessary to improve the CPR/DNAR decision process used by physicians
Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians
Responding to critical shortages of physicians, most sub-Saharan countries have scaled up training of nonphysician
clinicians (NPCs), resulting in a gradual but decisive shift to NPCs as the cornerstone of healthcare
delivery. This development should unfold in parallel with strategic rethinking about the role of physicians
and with innovations in physician education and in-service training. In important ways, a growing number of
NPCs only renders physicians more necessary – for example, as specialized healthcare providers and as leaders,
managers, mentors, and public health administrators. Physicians in sub-Saharan Africa ought to be trained in
all of these capacities. This evolution in the role of physicians may also help address known challenges to the
successful integration of NPCs in the health syste
Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage
Abstract
Background: As universal health coverage becomes the norm in many countries, it is important to determine public
priorities regarding benefits to include in health insurance coverage. We report results of participation in a decision
exercise among residents of Switzerland, a high-income country with a long history of universal health insurance and
deliberative democracy.
Methods: We adapted the Choosing Healthplans All Together (CHAT) tool, an exercise developed to transform complex
healthcare allocation decisions into easily understandable choices, for use in Switzerland. We conducted CHAT exercises
in twelve Swiss cities with recruitment from a range of socio-economic backgrounds, taking into account differences in
language and culture.
Results: Compared to existing coverage, a majority of 175 participants accepted greater general practice gatekeeping
(94%), exclusion of invasive life-sustaining measures in dying patients (80%), longer waiting times for non-urgent
episodic care (78%), greater adherence to cost-effectiveness guidelines in chronic care (66%), and lower premium
subsidies (51%). Most initially chose greater coverage for dental care (59%), quality of life (57%), and long-term care
(90%). During group deliberations, participants increased coverage for out-of-pocket costs (58%) and mental health
to current levels (41%) and beyond current levels for rehabilitation (50%), and decreased coverage for quality of life to
current levels (74%). Following group deliberation, they tended to change their views back to below current coverage
for help with out-of-pocket costs, and back to current levels for rehabilitation. Most participants accepted the plan as
appropriate and fair. A significant number would have added nothing.
Conclusion: Swiss participants who have engaged in a priority setting exercise accept complex resource allocation tradeoffs in healthcare coverage. Moreover, in the context of a well-funded healthcare system with universal coverage centered
on individual choice, at least some of our participants believed a fully sufficient threshold of health insurance coverage
was achieve
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