Abstract:
OBJECTIVES:The National Service Framework (NSF) for Coronary Heart Disease--published by the English Department of Health in 2000--sets out how those within the health service should seek to prevent and treat coronary heart disease and care for people with the disease. Its prescriptions are partly based on what is known about coronary heart disease and partly on its underlying 'values'. This paper seeks to identify those values. METHODS:An analysis of the discourses within the text of the NSF based on critical discourse analysis. RESULTS:Three different discourses can be identified: the managerial, the clinical and the political. The managerial discourse is dominant. Each discourse has its own values. The main 'aspirational' values within the NSF are efficiency, effectiveness, autonomy (choice), universalism and equity. Some aspirational values--particularly equity--appear to be largely rhetorical and lead to few recommendations or prescriptions. Some values that might have been expected to underlie the framework, such as compassion and democracy, are largely absent. CONCLUSIONS:Discourse analysis provides a more systematic and transparent method of describing the values behind health care policy than the methods that have been used previously.
journal_name
J Health Serv Res Policyjournal_title
Journal of health services research & policyauthors
Rayner M,Scarborough P,Allender Sdoi
10.1258/135581906776318956subject
Has Abstractpub_date
2006-04-01 00:00:00pages
67-73issue
2eissn
1355-8196issn
1758-1060journal_volume
11pub_type
杂志文章abstract:OBJECTIVE:The effects of demographic, locational and socio-economic disadvantage, and the influence of private health care on five-year mortality rates in patients with lung cancer or after breast cancer surgery in Western Australia were examined. METHODS:The Western Australian Record Linkage Project was used to extra...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/1355819042248116
更新日期:2004-10-01 00:00:00
abstract::Research can contribute to resolving some of the workforce challenges that all heath care systems face. In an attempt to identify the research agenda, key stakeholders in the UK were brought together and background papers were presented by academics with expertise in seven related but distinct areas: global issues; pr...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581904322724158
更新日期:2004-01-01 00:00:00
abstract::In most jurisdictions, public policy regarding assisted death has not advanced beyond simple prohibition. However, this issue is increasingly likely to reach the policy agenda. Policy-makers may be tempted to turn for guidance to the three places in the world with developed policy or legislation: the Netherlands; the ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969900400409
更新日期:1999-10-01 00:00:00
abstract::'Integrated care' is pitched as the solution to current health system challenges. In the literature, what integrated care actually involves is complex and contested. Multi-disciplinary team case management is frequently the primary focus of integrated care when implemented internationally. We examine the practical app...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819616660581
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVES:To explore patients' and carers' views on what constitutes high-quality communication and information provision during diagnostic assessment in memory clinic services in three areas of England. METHODS:Interviews with 27 people with cognitive impairment (13 with confirmed dementia) and 26 carers (20 matched...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819613479945
更新日期:2013-07-01 00:00:00
abstract::Health services research must continually address the question: Under what conditions may data not collected specifically for research, such as primary medical data, be re-used for research without compromising the privacy of the data-subjects? For secondary use of data in research there are basically three options. O...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581903766468800
更新日期:2003-07-01 00:00:00
abstract:OBJECTIVES:In developed countries, community pharmacists are increasingly involved in clinical care. This study aimed to explore the acceptability to users of pharmaceutical care (drug therapy monitoring and management) provided in Portuguese community pharmacies, thereby informing future practice, policy and research....
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2010.009121
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVE:Our aim was to evaluate whether the involvement of health care managers in research projects improves the quality and relevance of research, and whether collaboration builds capacity in the managerial community. METHODS:The NIHR Service Delivery and Organization Management Fellowship programme supports the d...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2011.011099
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVE:To review the impact of payment systems on the behaviour of primary care physicians. METHODS:All randomised trials, controlled before and after studies, and interrupted time series studies that compared capitation, salary, fee-for-service or target payments (mixed or separately) that were identified by compu...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1258/1355819011927198
更新日期:2001-01-01 00:00:00
abstract:OBJECTIVES:To understand the challenges and opportunities associated with the introduction of assistant practitioner (AP) roles supporting the work of ward-based registered nurses (RNs) in National Health Service (NHS) acute hospital trusts in England. METHODS:Three case studies of NHS acute hospital trusts. This pape...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2011.010106
更新日期:2011-04-01 00:00:00
abstract::We review the foundations of resource allocation rules based on cost-effectiveness information. Comprehensive approaches, where a total budget is allocated in one go, require estimation of the costs and effects of all available health care programmes, which is unlikely to be practical. A common alternative is to asses...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1258/1355819042250177
更新日期:2004-10-01 00:00:00
abstract:OBJECTIVES:To determine whether geographical areas with relatively low overall hospitalization rates have higher population-based rates of admission of patients with advanced stages of disease. METHODS:Age- and sex-standardized hospital admission rate were calculated for the residents of the 80 Local Health Units in L...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969700200406
更新日期:1997-10-01 00:00:00
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journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1258/135581904322716111
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVES:To evaluate the effect of a risk factor checklist and training video for general practitioners in reducing inter-practice variation and improving the appropriateness of referrals (assessed by their positive predictive value or PPV) of patients with suspected otitis media with effusion (OME or 'glue ear') to ...
journal_title:Journal of health services research & policy
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1258/1355819011927387
更新日期:2001-07-01 00:00:00
abstract:OBJECTIVES:To compare the cost-effectiveness of four third molar guideline implementation strategies. METHODS:Fifty-one dental practices in Scotland were randomized to one of four implementation strategies. The effectiveness of the strategies was measured by general dental practitioners' compliance with the guideline....
journal_title:Journal of health services research & policy
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1258/1355819054339031
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVE:To explore the tensions across the primary-secondary interface when referral from primary care is to a team and to inform service developments in other specialties. METHODS:A nested qualitative study within a randomized controlled trial of primary care and Community Mental Health Teams (CMHTs) in Croydon and...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1258/jhsrp.2007.006053
更新日期:2008-01-01 00:00:00
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journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581906775094280
更新日期:2006-01-01 00:00:00
abstract:OBJECTIVES:To investigate the organisational factors that impede or facilitate transition of young people from child and adolescent (CAMHS) to adult mental health services (AMHS). METHODS:Thirty-four semi-structured interviews were conducted with health and social care professionals working in child and adult services...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819614527439
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Scholarship cites health care managers (HCMs) as not using research evidence in their management practice. The purpose of this review was to evaluate the effectiveness of interventions to enhance HCMs use of research evidence in practice. METHODS:We carried out a systematic review and focus groups to valida...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1177/1355819618786764
更新日期:2019-01-01 00:00:00
abstract::Moral hazard in public insurance for long-term care may be counteracted by strategies influencing supply or demand. Demand-side strategies may target the patient or the insurer. Various demand-side strategies and how they are implemented in four European countries (Germany, Belgium, Switzerland and the Netherlands) ar...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819615575080
更新日期:2015-07-01 00:00:00
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journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819613499903
更新日期:2013-10-01 00:00:00
abstract::The way that public involvement in research has been evaluated as a complex intervention has derailed the development of an evidence base. Two alternative approaches are available for constructing and evaluating patient involvement, each of which requires us to revisit the purposes and values that underpin it in each ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819615612510
更新日期:2016-07-01 00:00:00
abstract:INTRODUCTION:Levels of management staffing in the UK National Health Service (NHS) have received considerable political and media attention in the last four years or so. Both the previous and current governments committed themselves to reducing management expenditure in the health service, and significant cuts appear t...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969900400104
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Automated pharmacy data have been used to develop a measure of chronic disease status in the general population. The objectives of this project were to refine and apply a model of chronic disease identification using Italian automated pharmacy data; to describe how this model may identify patt...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581905774414259
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVES:To determine the extent to which reports of Cochrane reviews recommend the need for further research and, if so, the extent to which they make suggestions regarding that research. METHODS:We examined all 2535 reviews in Issue 4, 2005 of The Cochrane Library. Each review was categorized on the basis of wheth...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581907780279648
更新日期:2007-04-01 00:00:00
abstract::Diagnosis-related groups are widespread across Europe and they are meant to be a central instrument to improve the activity and efficiency of hospitals. However, there are many examples of diagnosis-related groups having adverse effects which are difficult to control and which endanger the goals of health care systems...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819615586444
更新日期:2016-01-01 00:00:00
abstract::Evidence-based medicine (EBM) and evidence-based decision-making (EBDM) were intended to revolutionize health care and health policy. Thus far they have not. A great deal of research has demonstrated the persistent ubiquity of error in health care, wide and unjustifiable variations in practice and the minimal impact o...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581907781543094
更新日期:2007-07-01 00:00:00
abstract::Patients are increasingly using the internet to access information on health care and services, as well as writing reviews of their own experiences. With patient choice increasing in many health systems, payers, purchasers and providers are attempting to take control of this trend by designing and managing their own p...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2010.010010
更新日期:2011-04-01 00:00:00
abstract::We summarise and evaluate Harris' criticisms of cost-effectiveness analysis (CEA) and the alternative processes he commends to health care decision makers. In contrast to CEA, Harris' asserts that individuals have a right to life-saving treatment that cannot be denied on the basis of their capacity to benefit. We conc...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2012.011057
更新日期:2013-01-01 00:00:00
abstract::It is important to include non English speakers in health services research to ensure not only the generalisability of findings but also to address health inequalities and promote social justice. One approach is to use interpreters but there is little guidance for working with an interpreter in interviews. Involving a...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/JHSRP.2012.012003
更新日期:2012-07-01 00:00:00