NR 443 Healthcare Policies and Population Health DQ

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NR 443 Healthcare Policies and Population Health DQ

NR 443 Healthcare Policies and Population Health DQ

Discussion Question

Healthcare policies impact all populations. Now, with the use of social media, policies involvement and awareness are rising.

Take a moment to review the Twitter feed for compelling Tweets that are related to healthcare policy and are directly impacting your community or those you care for.

Give an overview of the policy or potential policy. Include how it could impact your community or those you care for positively negatively.

Next, discuss the importance that interdisciplinary collaboration would have related to the policy.

Then, identify any ethical concerns it raises for you and why.

Compose a 280-character or fewer Tweet that describes what you have shared with the class. Remember Twitter only allows 280 characters (this include spaces, etc.) so you will need to be concise. It should include a hashtag. Include a reference URL if applicable. Share this Tweet in the discussion. (Note: A Twitter account is not required).

Your discussion post should look like:

Paragraph one: overview of the policy or potential policy. Include how it could impact your community or those you care for positively negatively.

Paragraph two: Discuss the importance that interdisciplinary collaboration would have related to the policy.

Paragraph three: Identify any ethical concerns it raises for you and why

Paragraph four: Compose a Tweet that describes what you have shared with the class.

Resources: Where did you find your data?

Example Tweet: Medications should be affordable. #pharmaceuticaltransparency #nursesunit #advocate https://www.cms.gov/newsroom/press-releases/cms-takes-action-lower-prescription-drug-prices-and-increase-transparency

A systematic review methodology will be used to locate and evaluate published systematic review-level evidence on the effects of public health policy regulation on health and inequalities in health (‘umbrella review’) [172223]. Umbrella reviews are an established method of locating, appraising and synthesising systematic reviews [24]. Umbrella reviews are therefore able to present the overarching findings of such systematic reviews (usually considered to be the highest level of evidence) and can also extract data from the best quality studies within them [17]. In this way, they represent an effective way of rapidly reviewing a broad evidence base. An umbrella review methodology is an increasingly used technique in public health and medical research but is seldom used in the evaluation of institutional policies or the social determinants of health [2425]. Although umbrella reviews have been published on particular aspects of public health interventions (e.g. [13151722]), no comprehensive umbrella review has been reported detailing the full suite of public health policies which governments may use to influence public health and reduce health inequalities.

Inclusion criteria

Following standard evidence synthesis approaches [18], the inclusion criteria for the review are determined a priori in terms of PICOS (Population, Intervention, Comparison, Outcome and Setting; [26]).

  • Population: Children and adults (all ages) in any high-income country (defined as Organisation for Economic Co-operation Development (OECD) members) and additional EU-28 members not OECD members.Footnote1 The population is kept purposively broad to allow the widest range of literature to be identified.
  • Intervention: Upstream, population-level and public health policies defined as primary and secondary interventions. The inclusion criteria are purposely broad to allow for a range of different public health interventions to be located. Table 1 gives an indication of the type of interventions which this review may highlight. The domains listed and the specific intervention types are however illustrative of the variety of policy areas and interventions which public health spans and should not be considered exhaustive.
  • Comparison: We will include systematic reviews that include studies with and without controls. Acceptable controls include randomised or matched designs.
  • Outcomes: Health and health inequality outcomes. Primary outcome measures include (but are not limited to) morbidity, health behaviours, mortality, accidents and injuries. Secondary outcomes relate to health inequalities in terms of gender, ethnicity and socio-economic status (defined as individual income, wealth, education, employment or occupational status, benefit receipt; as well as area-level economic indicators). When available, cost-effectiveness data will also be collected.
  • Setting: Only systematic reviews will be included in the analysis.

Following the methods of previous umbrella reviews [1722], publications will need to meet the two mandatory criteria of Database of Abstracts of Reviews of Effects (DARE): (i) that there is a defined review question (with definition of at least two of the participants, interventions, outcomes or study designs) and (ii) that the search strategy included at least one named database, in conjunction with either reference checking, hand searching, citation searching or contact with authors in the field. When two reviews are identified with the same research question, only the most recent umbrella review will be synthesised as part of this study. A rigorous and inclusive literature search for existing systematic reviews will be conducted, incorporating a range of study designs (following [27]), including randomised and nonrandomised controlled trials, randomised and nonrandomised cluster trials, prospective and retrospective cohort studies (with and/or without control groups), prospective repeat cross-sectional studies (with and/or without control groups) and interrupted time series (with and/or without control groups).

Search strategy

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Twenty databases will be searched from their start until March 2016 (host sites given in parentheses): Medline (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCOhost), PsycINFO (EBSCOhost), Social Science Citation Index (Web of Science), Applied Social Sciences Index and Abstracts (ASSIA; ProQuest), International Bibliography of the Social Sciences (IBSS; ProQuest), Sociological Abstracts (ProQuest), Social Services Abstracts (ProQuest), PROSPERO (Centre for Reviews and Dissemination, University of York), Campbell Collaboration Library of Systematic Reviews (The Campbell Library), Cochrane Library (includes Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, DARE, Health Technology Assessment Database, NHS Economic Evaluation Database; Wiley), Database of Promoting Health Effectiveness Reviews (DoPHER; EPPI-Centre), Social Care Online (SCIE) and Health Systems Evidence. All searches will be tailored to the specific host site; an example search strategy is shown for Medline in Additional file 2. To complement these searches, citation follow-up from the bibliographies and reference lists of all included articles will be conducted. No language or publication date restrictions will be included. Searches will be limited to peer-reviewed publications only. Authors will be contacted to obtain any relevant information that is missing. If reviews do not have sufficient data, they will be excluded from further analysis.

The proposed search terms used in the search strategy are shown in Additional file 2. After careful consideration, and some initial searches, inequality terms were not included in the final search strategy. It was decided to screen the articles after the initial search to maximise ‘hits’ using the PROGRESS-Plus acronym recommended by the Cochrane/Campbell Health Equity Group [1819]. The framework includes socio-economic factors that may impact health equity including Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socio-economic status and Social capital [28]. The additional ‘Plus’ captures further variables of age, disability and sexual orientation that may indicate a disadvantage [18]. Due to the diverse nature of interventions this review will synthesise, a discrete list of health outcomes has not been generated either, but will be reviewed post screening.

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