scholarly journals Rhetoric, Evidence and Policymaking: a Case Study of Priority Setting in Primary Care*

2011 ◽  
Author(s):  
JILL RUSSELL ◽  
TRISHA GREENHALGH
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Social Interaction ◽  
Priority Setting ◽  
Meaning Making ◽  
Primary Care Trust ◽  
Rhetorical Theory ◽  
Micro Level ◽  
The Uk

This chapter describes a study undertaken as part of the UCL Evidence programme to explore how policymakers talk about and reason with evidence. Specifically, researchers were interested in the micro-processes of deliberation and meaning-making practices of a group of people charged with prioritising health care in an NHS Primary Care Trust in the UK. The chapter describes how the research study brought together ideas from rhetorical theory and methods of discourse analysis to develop an innovative approach to exploring how evidence is constituted at the micro-level of social interaction and communication. It presents empirical data to illuminate the representation and meaning of evidence within one particular policymaking forum, and to highlight contrasting constructions of the policymaking process.

Evaluation of a deliberative approach to citizen involvement in health care priority setting

2014 ◽  
Vol 27 (1) ◽  
pp. 5-19 ◽  
Author(s):  
Iestyn Williams ◽  
Daisy Phillips ◽  
Charles Nicholson ◽  
Heather Shearer
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Decision Making ◽  
Public Engagement ◽  
Priority Setting ◽  
Primary Care Trust ◽  
Content Type ◽  
The Public ◽  
Novel Approach ◽  
Health Care Priority Setting

Purpose – The purpose of this paper is to describe and evaluate a novel approach to citizen engagement in health priority setting carried out in the context of Primary Care Trust (PCT) commissioning in the English National Health Service. Design/methodology/approach – Four deliberative events were held with 139 citizens taking part in total. Events design incorporated elements of the Twenty-first Century Town Meeting and the World Café, and involved specially-designed dice games. Evaluation surveys reporting quantitative and qualitative participant responses were combined with follow-up interviews with both PCT staff and members of the public. An evaluation framework based on previous literature was employed. Findings – The evaluation demonstrates high levels of enjoyment, learning and deliberative engagement. However, concerns were expressed over the leading nature of the voting questions and, in a small minority of responses, the simplified scenarios used in dice games. The engagement exercises also appeared to have minimal impact on subsequent Primary Care Trust resource allocation, confirming a wider concern about the influence of public participation on policy decision making. The public engagement activities had considerable educative and political benefits and overall the evaluation indicates that the specific deliberative tools developed for the exercise facilitated a high level of discussion. Originality/value – This paper helps to fill the gap in empirical evaluations of deliberative approaches to citizen involvement in health care priority setting. It reports on a novel approach and considers a range of implications for future research and practice. The study raises important questions over the role of public engagement in driving priority setting decision making.

Racial Socialization and Racism

2021 ◽  
Author(s):  
Margaret A. Hagerman
Keyword(s):  
Social Interaction ◽  
Young People ◽  
Everyday Life ◽  
Racial Socialization ◽  
Symbolic Interactionism ◽  
Meaning Making ◽  
Theoretical Principle ◽  
Shared Meaning ◽  
Micro Level ◽  
Interpretive Process

This chapter illustrates key connections between the traditional field of symbolic interactionism and the study of racial socialization and racism. When researching and writing about racial socialization and racism from a micro-level perspective, it is important to not lose sight of the mutually sustaining relationship between the shared meaning making processes that unfold in everyday life and the big, broad structures that shape and reinforce those meanings. This is particularly true when thinking about theories of how the newest members of a society, through an interpretive process, come to understand the concept of race. Understanding how children learn about race requires taking into account how this learning process is shaped by both micro-level meaning making and macro-level structures. And this is a key theoretical principle of symbolic interactionism. The chapter then explores how race as a concept develops for young people through processes of social interaction within particular contexts.

PP97 Delineating Key Components Of Community Paramedicine Programs

2018 ◽  
Vol 34 (S1) ◽  
pp. 102-103
Author(s):  
Charles Yan ◽  
Bing Guo ◽  
Paula Corabian
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Target Population ◽  
The United States ◽  
Careful Consideration ◽  
Integration Model ◽  
Community Paramedicine ◽  
Primary Health ◽  
The Uk

Introduction:Population growth, epidemiological and demographic transition, and a shortage of healthcare workers are affecting health care systems in Australia, Canada, the United Kingdom (UK), and the United States (US). Community paramedicine (CP) programs provide a bridge between primary care and emergency care to address the needs of patients with low acuity but lack of access to primary care. However, how to capture the key characteristics of these programs and present them in a meaningful way is still a challenge. The objective of this presentation is to identify and describe the characteristics of currently existing CP programs in the four countries to inform policy-making on CP program development in Alberta.Methods:Information was obtained from systematic reviews, health technology assessments, general reviews, and government documents identified through a comprehensive literature search. The characteristics of the CP programs are described using a framework originally developed in Australia with three categories: (i) the primary health care model, (ii) the health integration model (in Australia, called the substitution model), and (iii) the community coordination model.Results:In general, Australia emphasizes rural/remote paramedics, whereas Canada, the UK, and the US implement expanded paramedic practice within different environments including rural, remote, regional, and metropolitan settings. Extended care provider programs have been intensively investigated and widely implemented in the UK. While the identified CP programs vary in terms of program components, designation of providers, skill mix, target population, and funding model, the majority of these CP programs fall under the primary health care category of the Australian framework.Conclusions:Transitioning from hospital-based to community-based health care requires careful consideration of all key factors that could contribute to future program success. Delineating key components of CP programs using the Australian framework will help Alberta decision-makers design, develop, and implement appropriate CP programs that adequately address local needs.

scholarly journals Healthcare utilization among migrants to the UK: cross-sectional analysis of two national surveys

2020 ◽  
Vol 26 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Catherine L Saunders ◽  
Adam Steventon ◽  
Barbara Janta ◽  
Mai Stafford ◽  
Carol Sinnott ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Dental Care ◽  
Odds Ratio ◽  
Service Planning ◽  
Care Utilization ◽  
Cross Sectional ◽  
Objective Evidence ◽  
The Uk

Objective To contribute objective evidence on health care utilization among migrants to the UK to inform policy and service planning. Methods We analysed data from Understanding Society, a household survey with fieldwork from 2015 to 2017, and the European Health Interview Survey with data collected between 2013 and 2014. We explored health service utilization among migrants to the UK across primary care, inpatient admissions and maternity care, outpatient care, mental health, dental care and physiotherapy. We adjusted for age, sex, long-term health conditions and time since moving to the UK. Results Health care utilization among migrants to the UK was lower than utilization among the UK-born population for all health care dimensions except inpatient admissions for childbirth; odds ratio (95%CI) range 0.58 (0.50–0.68) for dental care to 0.88 (0.78–0.98) for primary care). After adjusting for differences in age and self-reported health, these differences were no longer observed, except for dental care (odds ratio 0.57, 95%CI 0.49–0.66, P < 0.001). Across primary care, outpatient and inpatient care, utilization was lower among those who had recently migrated, increasing to the levels of the nonmigrant population after 10 years or more since migrating to the UK. Conclusions This study finds that newly arrived migrants tend to utilize less health care than the UK population and that this pattern was at least partly explained by better health, and younger age. Our findings contribute nationally representative evidence to inform public debate and decision-making on migration and health.

scholarly journals Primary care research – influencing and implementing into policy

2021 ◽  
Vol 60 (3) ◽  
pp. 138-144
Author(s):  
Sally Kendall
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Policy Implementation ◽  
Previous Literature ◽  
Policy And Practice ◽  
Primary Care Research ◽  
Care Research ◽  
Primary Health ◽  
The Uk

Abstract This editorial describes how research in primary health care can be used to influence policy. It draws on previous literature to give an example from the UK of how research in one part of primary care, the health-visiting service, has endeavoured to use evidence to influence policy and practice. The editorial considers frameworks for policy implementation such as Bardach’s eight phase approach and concepts that can inform policy implementation such as Lipsky’s Street-Level Bureaucrat approach.

scholarly journals Primary care consultations in the UK between 2006 and 2015: An analysis of electronic health records

2017 ◽  
Author(s):  
Benjamin Eaton
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Medical Science ◽  
Care Provision ◽  
Health Records ◽  
Healthcare Needs ◽  
Economic Recessions ◽  
The 2008 Financial Crisis ◽  
The Uk ◽  
The Impact

Primary care accounts for the majority of patient contact within the NHS. Over time medical science and healthcare needs change, which may lead to differences in how patients are treated in primary care for good or ill. In this study over 700 million consultations were analysed over a 10 year period between 2006 and 2015 inclusively to examine the trends in how people access primary care. The number of consultations per person per year initially increased in the first two years from 5.81 to 5.92, an increase of 0.11(0.10 to 0.12 95% CI) before declining to 3.7 by 2015, a decrease of 2.21 from the peak in 2008(2.20 to 2.23 95% CI). Consultations were increasingly handled by health care assistants instead of Nurses and GPs, and increased slightly in duration for all types of staff. This reduction in number of consultations is theorized to be a consequence of the 2008 financial crisis and its aftermath, further research is recommended on the impact of economic recessions and austerity policies on health care provision.

scholarly journals Exploring the implementation and delivery of primary care services for transgender individuals in Ontario: case study protocol

2020 ◽  
Vol 21 ◽  
Author(s):  
Erin Ziegler ◽  
Ruta Valaitis ◽  
Nancy Carter ◽  
Cathy Risdon ◽  
Jennifer Yost
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Access To Health Care ◽  
Care Providers ◽  
Case Study Methodology ◽  
Care Services ◽  
Services Delivery ◽  
Primary Care Services ◽  
Care Models

Abstract Background: Historically transgender adults have experienced barriers in accessing primary care services. In Ontario, Canada, health care for transgender adults is accessed through primary care; however, a limited number of practitioners provide care, and patients are often waiting and/or traveling great distances to receive care. The purpose of this protocol is to understand how primary care is implemented and delivered for transgender adults. The paper presents how the case study method can be applied to explore implementation of health services delivery for the transgender population in primary care. Methods: Case study methodology will be used to explore this phenomenon in different primary care contexts. Normalization Process Theory is used as a guide. Three cases known to provide transgender primary care and represent different Ontario primary care models have been identified. Comparing transgender care implementation and delivery across different models is vital to understanding how care provision to this population can be supported. Qualitative interviews will be conducted. Participants will also complete the NoMAD (NOrmalization MeAsure Development) survey, a tool measuring implementation processes. The tool will be modified to explore the implementation of primary care services for transgender individuals. Documentary evidence will be collected. Cross-case synthesis will be completed to compare the cases. Discussion: Findings will provide an Ontario perspective on the implementation and delivery of primary care for transgender adults in different primary care models. Results may be applicable to other primary care settings in Canada and other nations with similar systems. Barriers and facilitators in delivery and implementation will be identified. Providing an understanding and increasing awareness of the implementation and delivery of primary care may help to reduce the invisibility and disparities transgender individuals experience when accessing primary care services. Understanding delivery of care could allow care providers to implement primary care services for transgender individuals, improving access to health care for this vulnerable population.

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