Suchergebnisse

In May 2005, preliminary trial results pronouncing the effectiveness of Herceptin (trastuzumab) for treatment of early-stage breast cancer were disseminated at a high-profile scientific meeting. Herceptin was subsequently approved for use in the public healthcare systems of Canada and the United Kingdom, although the differences between the two decision timelines were stark. The authors compared UK and Canadian newspaper coverage of the Herceptin story to assess how it may have been "hyped" in each country. They analyzed a diverse sample of newspapers and coded clippings for reporters' framing of the drug's efficacy, costs and funding approval process. Canadian news coverage preceded formal publication of the trial results, while UK coverage mirrored major national events. Reporters in both countries used predominantly individualistic perspectives and framed Herceptin's efficacy in salutary terms. Framing of costs was more neutral in Canadian than in UK newspapers. Funding approval framing focused on inequitable access in the UK and timeliness in Canada. News coverage of drug access stories varies across jurisdictions in terms of intensity and some aspects of framing. Such variations likely reflect different journalistic practices and dominant political rhetoric. Greater attention should be given to the role that news coverage of drug access plays in shaping public opinion and policy action, especially when this coverage precedes scientific debate.

BACKGROUND: Open Minds, Healthy Minds, Ontario's Comprehensive Mental Health and Addictions Strategy commits to the transformation of mental health and addictions services for all Ontarians. OBJECTIVE: We analyzed the formulation and implementation of this Strategy to address the question: What are the prospects for transformative change in Ontario's current approach to mental health and addictions? METHODS: Qualitative policy analysis using interpretive description of key documents of the policy process, drawing on policy network and horizontal governance theory. RESULTS: Three features set this policy process apart from previous reform efforts: (1) expansion of the state pluralist network to those outside of health, (2) extension of the policy network approach into the Strategy's implementation stage and (3) the combined presence of political and policy leadership. CONCLUSIONS: There is reason for optimism that the approach of the Strategy has increased the prospects for the transformation of Ontario's mental health and addictions system.

PURPOSE: In this paper, we contribute to the theorizing of patient involvement in organizational improvement by exploring concepts of "learning from patients" as mechanisms of organizational change. Using the concept of metaphor as a theoretical bridge, we analyse interview data ( n = 20) from participants in patient engagement activities from two case study organizations in Ontario, Canada. Inspired by classic organizational scholars, we ask "what is the organization that it might learn from patients?" DESIGN/METHODOLOGY/APPROACH: Patient involvement activities are used as part of quality improvement efforts in healthcare organizations worldwide. One fundamental assumption underpinning this activity is the notion that organizations must "learn from patients" in order to enact positive organizational change. Despite this emphasis on learning, there is a paucity of research that theorizes learning or connects concepts of learning to organizational change within the domain of patient involvement. FINDINGS: Through our analysis, we interpret a range of metaphors of the organization, including organizations as (1) power and politics, (2) systems and (3) narratives. Through these metaphors, we display a range of possibilities for interpreting how organizations might learn from patients and associated implications for organizational change. ORIGINALITY/VALUE: This analysis has implications for how the framing of the organization matters for concepts of learning in patient engagement activities and how misalignments might stymie engagement efforts. We argue that the concept and commitment to "learning from patients" would be enriched by further engagement with the sociology of knowledge and critical concepts from theories of organizational learning.

A summary of what was learned from a citizen panel that addressed problems related to end-of-life communication and decision-making options for addressing these problems, key implementation considerations, and next steps for improving end-of-life communication and decision-making in Ontario. ; McMaster University's Labarge Optimal Aging Initiative; Government of Ontario (through a Ministry of Health and Long-Term Care Health System Research Fund grant entitled Harnessing Evidence and Values for Health System Excellence)

This paper analyzes the debates surrounding the privatization of health services financing in Quebec. The objective is to clarify policy-making processes with regard to this important issue and, more generally, to provide a realistic understanding of health-related policy processes in Canada. The analysis is based on a large and continuous sample of mass media and National Assembly debates on the question during the four-and-a-half years following the Chaoulli ruling of the Supreme Court of Canada. These data are used to test four hypotheses about relationships among the types of political actors involved, their policy preferences, the rhetoric they use and the anticipated policy effects they assert. The results are applied to a discussion of questions about the factors that influence the effectiveness of political communication.

Background: Allusions to the uniqueness and value of childhood abound in academic, lay, and policy discourse. However, little clarity exists on the values that guide child health and social policy-making. We review extant academic literature on the normative dimensions of child health and social policy to provide foundations for the development of child-focused public policies. Methods: We conducted a critical interpretive synthesis of academic literature on the normative dimensions of child health and social policy-making. We employed a social constructivist lens to interpret emergent themes. Political theory on the social construction of target populations served as a bridge between sociologies of childhood and public policy analysis. Results: Our database searches returned 14,658 unique articles; full text review yielded 72 relevant articles. Purposive sampling of relevant literature complemented our electronic searches, adding 51 original articles, for a total of 123 articles. Our analysis of the literature reveals three central themes: potential, rights, and risk. These themes retain relevance in diverse policy domains. A core set of foundational concepts also cuts across disciplines: well-being, participation, and best interests of the child inform debate on the moral and legal dimensions of a gamut of child social policies. Finally, a meta-theme of embedding encompasses the pervasive issue of a child's place, in the family and in society, which is at the heart of much social theory and applied analysis on children and childhood. Conclusions: Foundational understanding of the moral language and dominant policy frames applied to children can enrich analyses of social policies for children. Most societies paint children as potent, vulnerable, entitled, and embedded. It is the admixture of these elements in particular policy spheres, across distinct places and times, that often determines the form of a given policy and societal reactions to it. Subsequent work in this area will need to detail the degree and ...

BACKGROUND: Public policy approaches to funding paediatric medicines in developed public health systems remain understudied. Current approaches to HTA present a variety of conceptual, methodological and practical problems in the context of child health. This study explores the technical and sociopolitical determinants of public funding decisions on paediatric drugs, through the analysis of interviews with stakeholders involved in or impacted by HTA for child health technologies at the provincial and national levels in Canada. METHODS: We undertook in-depth interviews with a purposive sample (n = 22) of stakeholders involved with or affected by drug funding decisions for children at the provincial (Ontario) and national levels in Canada. Grounded theory methods were employed to guide data collection and analysis. Theory on 'technology-as-policy' and the sociopolitics of health technologies served as sensitizing concepts for inductive data coding and analysis. Emergent themes informed the development of conceptual and practical insights on social values and system dynamics related to child HTA, of relevance to public policymaking on the coverage of health technologies for children in Canada. RESULTS: Participant reflection on the normative and systems dimensions of drug funding for children formed two broad categories: HTA paradigms and sociopolitical context. Our analysis revealed notable differences of context and substance related to child health technology production, evaluation and use. These differences spanned the major phases of HTA (from assembly to assessment to integration) and the surrounding sociopolitical milieu (from markets to governance to politics). Careful analysis of these differences sets in relief a number of substantive and procedural shortcomings of current HTA paradigms in respect of child health. Our findings suggest a need to rethink how HTA is structured and operationalized for child health technologies. CONCLUSIONS: Current approaches to health technology assessment are not well ...

The development of refugee health policies is significant, given the increased volume of displaced persons seeking refuge in Canada and around the world. Changes to the Canadian refugee health policy, known as the Interim Federal Health Program (IFHP), limited healthcare access for refugees and refugee claimants from 2012 to 2016. In this article, we present a policy analysis using the case of the IFHP retrenchments to examine how political actors on opposing sides of the issue defined the problem using different causal story mechanisms. This analysis reveals that organized interests dramatically changed the problem definition of the IFHP reforms. Following their use of causal stories in redefining the problem, the courts declared that the reforms to refugee healthcare were a form of cruel and unusual treatment. Understanding policy strategies used by proponents of refugee healthcare coverage expansion is important for countries responding to the current, enduring refugee crisis.

Decision makers are pressed to involve the public in priority setting. However, public input is only one form of evidence. So, how can information from the public be combined with other knowledge? The authors qualitatively analysed articles that explicitly address this question. We identified the other forms of information that tend to be used in conjunction with public input, the degree to which members of the public are asked to be the integrators of data, and techniques that recur in several settings. Three factors must be balanced when integrating public opinion into priority setting: first, balancing problem-solving and sense-making objectives; second, choosing between consensus-building and structured-conflict approaches; third, addressing many broad factors or a smaller set of focused alternatives.

The application of social network analysis to policy networks continues to grow, including the application of social network analysis tools and concepts in order to explain policy outcomes. Gaps in this field of study persist in terms of both policy issues studied, as well as types of polities or networks analysed. This study extends previous research on the role of network structure in shaping policy outcomes by analysing network structure's effect on the use of research evidence by three health policy networks in Burkina Faso, a low-income West African country, and the resulting innovativeness of the policies made. This comparative case study confirms certain hypotheses related to the effect of network closure and heterogeneity on evidence use and innovation; namely, that heterogeneous networks are more likely to be exposed to new ideas, and thus to use research evidence and adopt innovative policies. High levels of centralised control and power may support innovation when the new ideas are consistent with the dominant network paradigms; otherwise, new ideas may receive less traction. These findings confirm previous research and point to opportunities to shape networks to achieve innovation and policy change based on the best evidence.

English
We investigated researchers' experiences of, and views on, interacting with policy makers, using children's mental health as an example. Qualitative methods were used to interview university researchers, policy researchers, and research funders. Participants spoke of contributions to policy that went beyond interaction with policy makers. We describe how participants became motivated, developed approaches, and created new environments to contribute to policy. Our findings suggest that university researchers should challenge their peers to better recognise and support policy interaction and public engagement. Both university and policy researchers must balance academic rigour and policy relevance to make meaningful contributions to policy.

Les méthodes de consultation publique qui favorisent la délibération et le dialogue entre citoyens et décideurs ont donné lieu à un grand nombre d'études dans les dernières années. L'expérience de participation analysée dans cet article s'inscrit dans ce courant. Des citoyens de la région de Charlevoix ont été invités à examiner et à débattre du financement des programmes locaux de santé et de services sociaux à l'occasion d'une série de « panels » organisés avec le concours des autorités régionales responsables de l'allocation des budgets dans ces domaines. La recherche visait à évaluer la qualité du processus et des résultats, en fonction de trois critères : la valeur épistémique de la délibération, sa valeur « transformatrice » et sa valeur légitimante. Les données de l'expérience de Charlevoix conduisent notamment à conclure qu'il est possible d'envisager dans l'avenir une réduction de l'écart entre les préférences exprimées par les citoyens et les orientations qui sont arrêtées par les autorités publiques, à condition de respecter un certain nombre de principes dans le choix de la technique participative et dans son utilisation.