Publications by authors named "Claudia B Maier"

21 Publications

  • Page 1 of 1

European countries' responses in ensuring sufficient physical infrastructure and workforce capacity during the first COVID-19 wave.

Health Policy 2021 Jul 9. Epub 2021 Jul 9.

European Observatory on Health Systems and Policies, Eurostation, Place Victor Horta/Victor Hortaplein, 40/30, 1060 Brussels, Belgium.

The COVID-19 pandemic has placed unprecedented pressure on health systems' capacities. These capacities include physical infrastructure, such as bed capacities and medical equipment, and healthcare professionals. Based on information extracted from the COVID-19 Health System Reform Monitor, this paper analyses the strategies that 45 countries in Europe have taken to secure sufficient health care infrastructure and workforce capacities to tackle the crisis, focusing on the hospital sector. While pre-crisis capacities differed across countries, some strategies to boost surge capacity were very similar. All countries designated COVID-19 units and expanded hospital and ICU capacities. Additional staff were mobilised and the existing health workforce was redeployed to respond to the surge in demand for care. While procurement of personal protective equipment at the international and national levels proved difficult at the beginning due to global shortages, countries found innovative solutions to increase internal production and enacted temporary measures to mitigate shortages. The pandemic has shown that coordination mechanisms informed by real-time monitoring of available health care resources are a prerequisite for adaptive surge capacity in public health crises, and that closer cooperation between countries is essential to build resilient responses to COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healthpol.2021.06.015DOI Listing
July 2021

Regulating the health workforce in Europe: implications of the COVID-19 pandemic.

Hum Resour Health 2021 07 10;19(1):80. Epub 2021 Jul 10.

Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni 135, 10623, Berlin, Germany.

In the European free movement zone, various mechanisms aim to harmonize how the competence of physicians and nurses is developed and maintained to facilitate the cross-country movement of professionals. This commentary addresses these mechanisms and discusses their implications during the COVID-19 pandemic, drawing lessons for future policy. It argues that EU-wide regulatory mechanisms should be reviewed to ensure that they provide an adequate foundation for determining competence and enabling health workforce flexibility during health system shocks. Currently, EU regulation focuses on the automatic recognition of the primary education of physicians and nurses. New, flexible mechanisms should be developed for specializations, such as intensive or emergency care. Documenting new skills, such as the ones acquired during rapid training in the pandemic, in a manner that is comparable across countries should be explored, both for usual practice and in light of outbreak preparedness. Initiatives to strengthen continuing education and professional development should be supported further. Funding under the EU4Health programme should be dedicated to this endeavour, along with revisiting the scope of necessary skills following the experience of COVID-19. Mechanisms for cross-country sharing of information on violations of good practice standards should be maintained and strengthened to enable agile reactions when the need for professional mobility becomes urgent.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12960-021-00624-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8271310PMC
July 2021

Health workforce response to Covid-19: What pandemic preparedness planning and action at the federal and state levels in Germany?: Germany's health workforce responses to Covid-19.

Int J Health Plann Manage 2021 May 18;36(S1):71-91. Epub 2021 Mar 18.

Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.

Introduction: The Covid-19 pandemic has required countries to prepare their health workforce for a rapid increase of patients. This research aims to analyse the planning and health workforce policies in Germany, a country with a largely decentralised workforce governance mechanism.

Methods: Systematic search between 18 and 31 May 2020 at federal and 16 states on health workforce action and planning (websites of ministries of health, public health authorities), including pandemic preparedness plans and policies. The search followed World Health Organisation (WHO) Europe's health workforce guidance on Covid-19. Content analysis was performed, informed by the themes of WHO.

Results: The pandemic preparedness plans consisted of no or limited information on how to expand and prepare the health workforce during pandemics. The 16 states varied considerably regarding implementing strategies to expand health workforce capacities. Only one state adopted a policy on task-shifting despite a federal law on task-shifting during pandemics.

Conclusions: Planning on the health workforce, its capacity and skill-mix during pandemics was limited in the pandemic response plans. Actions during the peak of the pandemic varied considerably across states, were implemented ad hoc and with limited planning. Future action should focus on integrated planning and evaluation of workforce policies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hpm.3146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250947PMC
May 2021

The COVID-19 pandemic presents an opportunity to develop more sustainable health workforces.

Hum Resour Health 2020 10 31;18(1):83. Epub 2020 Oct 31.

University Eduardo Mondlane, Mondlane, Mozambique.

This commentary addresses the critically important role of health workers in their countries' more immediate responses to COVID-19 outbreaks and provides policy recommendations for more sustainable health workforces. Paradoxically, pandemic response plans in country after country, often fail to explicitly address health workforce requirements and considerations. We recommend that policy and decision-makers at the facility, regional and country-levels need to: integrate explicit health workforce requirements in pandemic response plans, appropriate to its differentiated levels of care, for the short, medium and longer term; ensure safe working conditions with personal protective equipment (PPE) for all deployed health workers including sufficient training to ensure high hygienic and safety standards; recognise the importance of protecting and promoting the psychological health and safety of all health professionals, with a special focus on workers at the point of care; take an explicit gender and social equity lens, when addressing physical and psychological health and safety, recognising that the health workforce is largely made up of women, and that limited resources lead to priority setting and unequitable access to protection; take a whole of the health workforce approach-using the full skill sets of all health workers-across public health and clinical care roles-including those along the training and retirement pipeline-and ensure adequate supervisory structures and operating procedures are in place to ensure inclusive care of high quality; react with solidarity to support regions and countries requiring more surge capacity, especially those with weak health systems and more severe HRH shortages; and acknowledge the need for transparent, flexible and situational leadership styles building on a different set of management skills.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12960-020-00529-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602762PMC
October 2020

Time trends in the regional distribution of physicians, nurses and midwives in Europe.

BMC Health Serv Res 2020 Oct 12;20(1):937. Epub 2020 Oct 12.

Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623, Berlin, Germany.

Background: Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends.

Methods: We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005-2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 14 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR).

Results: There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.4-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tended to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives.

Conclusions: The study shows for the first time the large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data in sub-national geographic areas to develop integrated health workforce policies for health professionals at regional levels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12913-020-05760-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549210PMC
October 2020

Nurse prescribing of medicines in 13 European countries.

Authors:
Claudia B Maier

Hum Resour Health 2019 12 9;17(1):95. Epub 2019 Dec 9.

Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623, Berlin, Germany.

Background: Nurse prescribing of medicines is increasing worldwide, but there is limited research in Europe. The objective of this study was to analyse which countries in Europe have adopted laws on nurse prescribing.

Methods: Cross-country comparative analysis of reforms on nurse prescribing, based on an expert survey (TaskShift2Nurses Survey) and an OECD study. Country experts provided country-specific information, which was complemented with the peer-reviewed and grey literature. The analysis was based on policy and thematic analyses.

Results: In Europe, as of 2019, a total of 13 countries have adopted laws on nurse prescribing, of which 12 apply nationwide (Cyprus, Denmark, Estonia, Finland, France, Ireland, Netherlands, Norway, Poland, Spain, Sweden, United Kingdom (UK)) and one regionally, to the Canton Vaud (Switzerland). Eight countries adopted laws since 2010. The extent of prescribing rights ranged from nearly all medicines within nurses' specialisations (Ireland for nurse prescribers, Netherlands for nurse specialists, UK for independent nurse prescribers) to a limited set of medicines (Cyprus, Denmark, Estonia, Finland, France, Norway, Poland, Spain, Sweden). All countries have regulatory and minimum educational requirements in place to ensure patient safety; the majority require some form of physician oversight.

Conclusions: The role of nurses has expanded in Europe over the last decade, as demonstrated by the adoption of new laws on prescribing rights.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12960-019-0429-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902591PMC
December 2019

Nurses in expanded roles to strengthen community-based health promotion and chronic care: policy implications from an international perspective; A commentary.

Isr J Health Policy Res 2018 10 12;7(1):64. Epub 2018 Oct 12.

WHO Collaborating Centre for Nursing, Midwifery and Health Development, Faculty of Health, University of Technology, PO BOX 123, Broadway NSW, Sydney, 2007, Australia.

Chronic conditions and health inequalities are increasing worldwide. Against this backdrop, several countries, including Israel, have expanded the roles of nurses as one measure to strengthen the primary care workforce. In Israel, community nurses work in expanded roles with increased responsibilities for patients with chronic conditions. They also work increasingly in the field of health promotion and disease prevention. Common barriers to role change in Israel are mirrored by other countries. Barriers include legal and financial restrictions, resistance by professional associations, inflexible labor markets and lack of resources. Policies should be revisited and aligned across education, financing and labor markets, to enable nurses to practice in the expanded roles. Financial incentives can accelerate the uptake of new, expanded roles so that all patients including vulnerable population groups, benefit from equitable and patient-centered service delivery in the communities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13584-018-0257-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182781PMC
October 2018

Health workforce planning: which countries include nurse practitioners and physician assistants and to what effect?

Health Policy 2018 Oct 11;122(10):1085-1092. Epub 2018 Aug 11.

Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623 Berlin, Germany. Electronic address:

Background: An increasing number of countries are introducing new health professions, such as Nurse Practitioners (NPs) and Physician Assistants (PAs). There is however limited evidence, on whether these new professions are included in countries' workforce planning.

Methods: A cross-country comparison of workforce planning methods. Countries with NPs and/or PAs were identified, workforce planning projections reviewed and differences in outcomes were analysed, based on a review of workforce planning models and a scoping review. Data on multi-professional (physicians/NPs/PAs) vs. physician-only models were extracted and compared descriptively. Analysis of policy implications was based on policy documents and grey literature.

Results: Of eight countries with NPs/PAs, three (Canada, the Netherlands, United States) included these professions in their workforce planning. In Canada, NPs were partially included in Ontario's needs-based projection, yet only as one parameter to enhance efficiency. In the United States and the Netherlands, NPs/PAs were covered as one of several scenarios. Compared with physician-only models, multi-professional models resulted in lower physician manpower projections, primarily in primary care. A weakness of the multi-professional models was the accuracy of data on substitution. Impacts on policy were limited, except for the Netherlands.

Conclusions: Few countries have integrated NPs/PAs into workforce planning. Yet, those with multi-professional models reveal considerable differences in projected workforce outcomes. Countries should develop several scenarios with and without NPs/PAs to inform policy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healthpol.2018.07.016DOI Listing
October 2018

What are the motivating and hindering factors for health professionals to undertake new roles in hospitals? A study among physicians, nurses and managers looking at breast cancer and acute myocardial infarction care in nine countries.

Health Policy 2018 Oct 26;122(10):1118-1125. Epub 2018 Jul 26.

Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623 Berlin, Germany.

Background: Many European countries experience health workforce skill-mix changes due to population ageing, multimorbidity and medical technology. Yet, there is limited cross-country research in hospitals.

Methods: Cross-sectional, observational study on staff role changes and contributing factors in nine European countries. Survey of physicians, nurses and managers (n = 1524) in 112 hospitals treating patients with breast cancer or acute myocardial infarction. Group differences were analysed across country clusters (skill-mix reform countries [England, Scotland and the Netherlands] versus no reform countries [Czech Republic, Germany, Italy, Norway, Poland and Turkey]) and stratified by physicians, nurses and managers, using Chi-squared, Mann-Whitney U and Kruskal Wallis tests.

Results: Nurses in countries with major skill-mix reforms reported more frequently being motivated to undertake a new role (66.5%) and having the opportunity to do so (52.4%), compared to nurses in countries with no reforms (39.2%; 24.8%; p < .001 each). Physicians and nurses considered intrinsic motivating factors (personal satisfaction, use of qualifications) more motivating than extrinsic factors (salary, career opportunities). Reported barriers were workforce shortages, facilitators were professional and management support. Managers' recruitment decisions on choice of staff were mainly influenced by skills, competences and experience of staff.

Conclusion: Managers need to know the motivational factors of their employees and enabling versus hindering factors within their organisations to govern change effectively.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healthpol.2018.07.018DOI Listing
October 2018

A call for action to establish a research agenda for building a future health workforce in Europe.

Health Res Policy Syst 2018 Jun 20;16(1):52. Epub 2018 Jun 20.

Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, 7 Pandurilor Street, 400376, Cluj-Napoca, Romania.

The importance of a sustainable health workforce is increasingly recognised. However, the building of a future health workforce that is responsive to diverse population needs and demographic and economic change remains insufficiently understood. There is a compelling argument to be made for a comprehensive research agenda to address the questions. With a focus on Europe and taking a health systems approach, we introduce an agenda linked to the 'Health Workforce Research' section of the European Public Health Association. Six major objectives for health workforce policy were identified: (1) to develop frameworks that align health systems/governance and health workforce policy/planning, (2) to explore the effects of changing skill mixes and competencies across sectors and occupational groups, (3) to map how education and health workforce governance can be better integrated, (4) to analyse the impact of health workforce mobility on health systems, (5) to optimise the use of international/EU, national and regional health workforce data and monitoring and (6) to build capacity for policy implementation. This article highlights critical knowledge gaps that currently hamper the opportunities of effectively responding to these challenges and advising policy-makers in different health systems. Closing these knowledge gaps is therefore an important step towards future health workforce governance and policy implementation. There is an urgent need for building health workforce research as an independent, interdisciplinary and multi-professional field. This requires dedicated research funding, new academic education programmes, comparative methodology and knowledge transfer and leadership that can help countries to build a people-centred health workforce.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12961-018-0333-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6011393PMC
June 2018

Task shifting between physicians and nurses in acute care hospitals: cross-sectional study in nine countries.

Hum Resour Health 2018 05 25;16(1):24. Epub 2018 May 25.

Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623, Berlin, Germany.

Background: Countries vary in the extent to which reforms have been implemented expanding nurses' Scopes-of-Practice (SoP). There is limited cross-country research if and how reforms affect clinical practice, particularly in hospitals. This study analyses health professionals' perceptions of role change and of task shifting between the medical and nursing professions in nine European countries.

Methods: Cross-sectional design with surveys completed by 1716 health professionals treating patients with breast cancer (BC) and acute myocardial infarction (AMI) in 161 hospitals across nine countries. Descriptive and bivariate analysis on self-reported staff role changes and levels of independence (with/without physician oversight) by two country groups, with major SoP reforms implemented between 2010 and 2015 (Netherlands, England, Scotland) and without (Czech Republic, Germany, Italy, Norway, Poland, Turkey). Participation in 'medical tasks' was identified using two methods, a data-driven and a conceptual approach. Individual task-related analyses were performed for the medical and nursing professions, and Advanced Practice Nurses/Specialist Nurses (APN/SN).

Results: Health professionals from the Netherlands, England and Scotland more frequently reported changes to staff roles over this time period vs. the other six countries (BC 74.0% vs. 38.7%, p < .001; AMI 61.7% vs. 37.3%, p < .001), and higher independence in new roles (BC 58.6% vs. 24.0%, p < .001; AMI 48.9% vs. 29.2%, p < .001). A higher proportion of nurses and APN/SN from these three countries reported to undertake tasks related to BC diagnosis, therapy, prescribing of medicines and information to patients compared to the six countries. Similar cross-country differences existed for AMI on prescribing medications and follow-up care. Tasks related to diagnosis and therapy, however, remained largely within the medical profession's domain. Most tasks were reported to be performed by both professions rather than carried out by one profession only.

Conclusions: Higher levels of changes to staff roles and task shifting were reported in the Netherlands, England and Scotland, suggesting that professional boundaries have shifted, for instance on chemotherapy or prescribing medicines. For most tasks, however, a partial instead of full task shifting is practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12960-018-0285-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5970499PMC
May 2018

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care.

BMJ Qual Saf 2017 Jul 15;26(7):559-568. Epub 2016 Nov 15.

University of Leuven, Leuven Institute for Healthcare Policy, Leuven, Belgium.

Objectives: To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care.

Design: Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models.

Setting: Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland.

Participants: Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals.

Main Outcome Measures: Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction.

Results: Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80
Conclusions: A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjqs-2016-005567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477662PMC
July 2017

Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: size, growth, physician substitution potential.

BMJ Open 2016 09 6;6(9):e011901. Epub 2016 Sep 6.

Department of Healthcare Management, Head of the Berlin Hub of the European Health Observatory on Health Systems and Policies, Technische Universität Berlin, Berlin, Germany.

Objectives: Many countries are facing provider shortages and imbalances in primary care or are projecting shortfalls for the future, triggered by the rise in chronic diseases and multimorbidity. In order to assess the potential of nurse practitioners (NPs) in expanding access, we analysed the size, annual growth (2005-2015) and the extent of advanced practice of NPs in 6 Organisation for Economic Cooperation and Development (OECD) countries.

Design: Cross-country data analysis of national nursing registries, regulatory bodies, statistical offices data as well as OECD health workforce and population data, plus literature scoping review.

Setting/participants: NP and physician workforces in 6 OECD countries (Australia, Canada, Ireland, the Netherlands, New Zealand and USA).

Primary And Secondary Outcome Measures: The main outcomes were the absolute and relative number of NPs per 100 000 population compared with the nursing and physician workforces, the compound annual growth rates, annual and median percentage changes from 2005 to 2015 and a synthesis of the literature on the extent of advanced clinical practice measured by physician substitution effect.

Results: The USA showed the highest absolute number of NPs and rate per population (40.5 per 100 000 population), followed by the Netherlands (12.6), Canada (9.8), Australia (4.4), and Ireland and New Zealand (3.1, respectively). Annual growth rates were high in all countries, ranging from annual compound rates of 6.1% in the USA to 27.8% in the Netherlands. Growth rates were between three and nine times higher compared with physicians. Finally, the empirical studies emanating from the literature scoping review suggested that NPs are able to provide 67-93% of all primary care services, yet, based on limited evidence.

Conclusions: NPs are a rapidly growing workforce with high levels of advanced practice potential in primary care. Workforce monitoring based on accurate data is critical to inform educational capacity and workforce planning.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2016-011901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020757PMC
September 2016

Task shifting from physicians to nurses in primary care in 39 countries: a cross-country comparative study.

Eur J Public Health 2016 12 2;26(6):927-934. Epub 2016 Aug 2.

Claire M Fagin Professor and Director, Center for Health Outcomes and Policy Research, School of Nursing, Senior Fellow, Leonard Davis Institute for Health Economics, University of Pennsylvania, 418 Curie Blvd, Claire M. Fagin Hall, 387R, Philadelphia, PA 19104-4217, USA.

Background: Primary care is in short supply in many countries. Task shifting from physicians to nurses is one strategy to improve access, but international research is scarce. We analysed the extent of task shifting in primary care and policy reforms in 39 countries.

Methods: Cross-country comparative research, based on an international expert survey, plus literature scoping review. A total of 93 country experts participated, covering Europe, USA, Canada, Australia and New Zealand (response rate: 85.3%). Experts were selected according to pre-defined criteria. Survey responses were triangulated with the literature and analysed using policy, thematic and descriptive methods to assess developments in country-specific contexts.

Results: Task shifting, where nurses take up advanced roles from physicians, was implemented in two-thirds of countries (N = 27, 69%), yet its extent varied. Three clusters emerged: 11 countries with extensive (Australia, Canada, England, Northern Ireland, Scotland, Wales, Finland, Ireland, Netherlands, New Zealand and USA), 16 countries with limited and 12 countries with no task shifting. The high number of policy, regulatory and educational reforms, such as on nurse prescribing, demonstrate an evolving trend internationally toward expanding nurses' scope-of-practice in primary care.

Conclusions: Many countries have implemented task-shifting reforms to maximise workforce capacity. Reforms have focused on removing regulatory and to a lower extent, financial barriers, yet were often lengthy and controversial. Countries early on in the process are primarily reforming their education. From an international and particularly European Union perspective, developing standardised definitions, minimum educational and practice requirements would facilitate recognition procedures in increasingly connected labour markets.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurpub/ckw098DOI Listing
December 2016

Expanding clinical roles for nurses to realign the global health workforce with population needs: a commentary.

Isr J Health Policy Res 2016 7;5:21. Epub 2016 Jun 7.

Claire M Fagin Professor and Director, Center for Health Outcomes and Policy Research, University of Pennsylvania, 418 Curie Blvd, Claire M. Fagin Hall, 387R, Philadelphia, PA 19104-4217 USA.

Many countries, including Israel, face health workforce challenges to meet the needs of their citizens, as chronic conditions increase. Provider shortages and geographical maldistribution are common. Increasing the contribution of nurse practitioners and other advanced practice nursing roles through task-shifting and expansion of scope-of-practice can improve access to care and result in greater workforce efficiency. Israel and many other countries are introducing reforms to expand nurses' scope-of-practice. Recent international research offers three policy lessons for how countries just beginning to implement reforms could bypass policy barriers to implementation. First, there is substantial evidence on the equivalence in quality of care, patient safety and high consumer acceptance which should move policy debates from if to how to effectively implement new roles in practice. Second, regulatory and finance policies as well as accessible advanced education are essential to facilitate realignment of roles. Third, country experience suggests that advanced practice roles for nurses improve the attractiveness of nursing as a career thus contributing to solving nursing shortages rather than exacerbating them. Designing enabling policy environments and removing barriers will gain in relevance in the future as the demand for high-quality, patient-centered care is increasing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13584-016-0079-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4897947PMC
June 2016

Effects of Regulation and Payment Policies on Nurse Practitioners' Clinical Practices.

Med Care Res Rev 2017 08 13;74(4):431-451. Epub 2016 May 13.

1 University of Pennsylvania, Philadelphia, PA, USA.

Increasing patient demand following health care reform has led to concerns about provider shortages, particularly in primary care and for Medicaid patients. Nurse practitioners (NPs) represent a potential solution to meeting demand. However, varying state scope of practice regulations and Medicaid reimbursement rates may limit efficient distribution of NPs. Using a national sample of 252,657 ambulatory practices, we examined the effect of state policies on NP employment in primary care and practice Medicaid acceptance. NPs had 13% higher odds of working in primary care in states with full scope of practice; those odds increased to 20% if the state also reimbursed NPs at 100% of the physician Medicaid fee-for-service rate. Furthermore, in states with 100% Medicaid reimbursement, practices with NPs had 23% higher odds of accepting Medicaid than practices without NPs. Removing scope of practice restrictions and increasing Medicaid reimbursement may increase NP participation in primary care and practice Medicaid acceptance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1077558716649109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114168PMC
August 2017

The role of governance in implementing task-shifting from physicians to nurses in advanced roles in Europe, U.S., Canada, New Zealand and Australia.

Authors:
Claudia B Maier

Health Policy 2015 Dec 25;119(12):1627-35. Epub 2015 Sep 25.

2014-15 Harkness & Braun Fellow in Healthcare Policy and Practice, Center for Health Outcomes and Policy Research, University of Pennsylvania, School of nursing, Claire Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19104, United States; Technische Universität (TU) Berlin, Germany. Electronic address:

Task-shifting from physicians to nurses is increasing worldwide; however, research on how it is governed is scarce. This international study assessed task-shifting governance models and implications on practice, based on a literature scoping review; and a survey with 93 country experts in 39 countries (response rate: 85.3%). Governance was assessed by several indicators, regulation of titles, scope of practice, prescriptive authority, and registration policies. This policy analysis focused on eleven countries with task-shifting at the Advanced Practice Nursing/Nurse Practitioner (APN/NP) level. Governance models ranged from national, decentralized to no regulation, but at the discretion of employers and settings. In countries with national or decentralized regulation, restrictive scope of practice laws were shown as barrier, up-to-date laws as enablers to advanced practice. Countries with decentralized regulation resulted in uneven levels of practice. In countries leaving governance to individual settings, practice variations existed, moreover data availability and role clarity was limited. Policy options include periodic reviews to ensure laws are up to date, minimum harmonization in decentralized contexts, harmonized educational and practice-level requirements to reduce practice variation and ensure quality. From a European Union (EU) perspective, regulation is preferred over non-regulation as a first step toward the recognition of qualifications in countries with similar levels of advanced practice. Countries early on in the process need to be aware that different governance models can influence practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healthpol.2015.09.002DOI Listing
December 2015

Is there scope for cost savings and efficiency gains in HIV services? A systematic review of the evidence from low- and middle-income countries.

Bull World Health Organ 2014 Jul 1;92(7):499-511AD. Epub 2014 Apr 1.

SaME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, England .

Objective: To synthesize the data available--on costs, efficiency and economies of scale and scope--for the six basic programmes of the UNAIDS Strategic Investment Framework, to inform those planning the scale-up of human immunodeficiency virus (HIV) services in low- and middle-income countries.

Methods: The relevant peer-reviewed and "grey" literature from low- and middle-income countries was systematically reviewed. Search and analysis followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Findings: Of the 82 empirical costing and efficiency studies identified, nine provided data on economies of scale. Scale explained much of the variation in the costs of several HIV services, particularly those of targeted HIV prevention for key populations and HIV testing and treatment. There is some evidence of economies of scope from integrating HIV counselling and testing services with several other services. Cost efficiency may also be improved by reducing input prices, task shifting and improving client adherence.

Conclusion: HIV programmes need to optimize the scale of service provision to achieve efficiency. Interventions that may enhance the potential for economies of scale include intensifying demand-creation activities, reducing the costs for service users, expanding existing programmes rather than creating new structures, and reducing attrition of existing service users. Models for integrated service delivery--which is, potentially, more efficient than the implementation of stand-alone services--should be investigated further. Further experimental evidence is required to understand how to best achieve efficiency gains in HIV programmes and assess the cost-effectiveness of each service-delivery model.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2471/BLT.13.127639DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121865PMC
July 2014

Mobility of health professionals pre and post 2004 and 2007 EU enlargements: evidence from the EU project PROMeTHEUS.

Health Policy 2012 Dec 13;108(2-3):122-32. Epub 2012 Nov 13.

Berlin University of Technology, Germany.

Background: EU enlargement has facilitated the mobility of EU citizens, including health professionals, from the 2004 and 2007 EU accession states. Fears have been raised about a mass exodus of health professionals and the consequences for the operation of health systems. However, to date a systematic analysis of the EU enlargement's effects on the mobility of health professionals has been lacking. The aim of this article is to shed light on the changes in the scale of movement, trends and directions of flows pre and post 2004 and 2007 EU enlargements.

Methods: The study follows a pan-European secondary data analysis to (i) quantitatively and (ii) qualitatively analyse mobility before and after the EU enlargement. (i) The secondary data analysis covers 34 countries (including all EU Member States). (ii) Data were triangulated with the findings of 17 country case studies to qualitatively assess the effects of enlargement on health workforce mobility.

Results: The stock of health professionals from the new (EU-12) into the old EU Member States (EU-15) have increased following EU accession. The stock of medical doctors from the EU-12 in the EU-15 countries has more than doubled between 2003 and 2007. The available data suggest the same trend for dentists. The extremely limited data for nurses show that the stock of nurses has, in contrast, only slightly increased. However, while no reliable data is available evidence suggests that the number of undocumented or self-employed migrant nurses in the home-care sector has significantly increased. Health professionals trained in the EU-12 are becoming increasingly important in providing sufficient health care in some destination countries and regions facing staff shortages.

Conclusion: A mass exodus of health professionals has not taken place after the 2004 and 2007 EU enlargements. The estimated annual outflows from the EU-12 countries have rarely exceeded 3% of the domestic workforce. This is partly due to labour market restrictions in the destination countries, but also to improvements in salaries and working conditions in some source countries. The overall mobility of health professionals is hence relatively moderate and in line with the overall movement of citizens within the EU. However, for some countries even losing small numbers of health professionals can have impacts in underserved regions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healthpol.2012.10.006DOI Listing
December 2012

Costs and efficiency of integrating HIV/AIDS services with other health services: a systematic review of evidence and experience.

Sex Transm Infect 2012 Mar 8;88(2):85-99. Epub 2011 Dec 8.

Department of Global Health and Development, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK.

Objectives: To review the literature on the potential efficiency gains of integrating HIV services with other health services.

Design: Systematic literature review. Search of electronic databases, manual searching and snowball sampling. Studies that presented results on cost, efficiency or cost-effectiveness of integrated HIV services were included, focusing on low- and middle-income countries. Evidence was analysed and synthesised through a narrative approach and the quality of studies assessed.

Results: Of 666 citations retrieved, 46 were included (35 peer reviewed and 11 from grey literature). A range of integrated HIV services were found to be cost-effective compared with 'do-nothing' alternatives, including HIV services integrated into sexual and reproductive health services, integrated tuberculosis/HIV services and HIV services integrated into primary healthcare. The cost of integrated HIV counselling and testing is likely to be lower than that of stand-alone counselling and testing provision; however, evidence is limited on the comparative costs of other services, particularly HIV care and treatment. There is also little known about the most efficient model of integration, the efficiency gain from integration beyond the service level and any economic benefit to HIV service users.

Conclusions: In the context of increasing political commitment and previous reviews suggesting a strong public health argument for the integration of HIV services, the authors found the evidence on efficiency broadly supports further efforts to integrate HIV services. However, key evidence gaps remain, and there is an urgent need for further research in this area.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/sextrans-2011-050199DOI Listing
March 2012

Quo vadis SANEPID? A cross-country analysis of public health reforms in 10 post-Soviet states.

Health Policy 2011 Sep 22;102(1):18-25. Epub 2010 Sep 22.

European Observatory on Health Systems and Policies, Rue de l'Autonomie 4 B-1070 Brussels, Belgium.

Background: The public health systems of the post-Soviet states have evolved from the san-epid system, which dominated public health practice throughout the former Soviet Union. Since independence, reforms have taken different directions. This article provides a cross-country comparison of public health reform processes and contents in 10 post-Soviet states.

Methods: The study is descriptive and comparative, based on a literature review of the major health databases, the Health Systems in Transition (HiT) volumes and grey literature. Search terms included terms on public health, the san-epid services and organizational reforms in one or several post-Soviet states.

Results: Public health reforms have varied greatly: some countries have preserved the san-epid structure, some have built structures in addition to the san-epid system, and others have set up a new public health infrastructure. Traditional "functions" of the former san-epid system, such as vaccination, are still more advanced, while health promotion and intersectoral collaboration are less developed.

Conclusion: Critical self-evaluation, implementation of performance measurement and rigorous external research will prove essential in identifying strengths and weaknesses of past reforms and learning for the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healthpol.2010.08.025DOI Listing
September 2011
-->