Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis

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• 作者：Sheena M Mc Hugh ; Ivan J Perry ; Colin Bradley…
• 关键词：Health care reform ; Policy analysis ; Quality of care ; Type 2 diabetes mellitus
• 刊名：Health Research Policy and Systems
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：12
• 期：1
• 全文大小：850 KB
• 参考文献：Diabetes -The Policy Puzzle: Towards Benchmarking in the EU 25. International Diabetes Federation-Europe/Federation of European Nurses in Diabetes, Brussels
  A Strategy for Cancer Control in Ireland. Stationery Office, Dublin
  1. Wagner, EH, Austin, BT, Davis, C, Hindmarsh, M, Schaefer, J, Bonomi, A (2001) Improving chronic illness care: translating evidence into action. Health Aff 20: pp. 64 in new window">CrossRef
  2. Wild, S, Roglic, G, Green, A, Sicree, R, King, H (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27: pp. 1047-1053 in new window">CrossRef
  3. Jiang, HJ, Stryer, D, Friedman, B, Andrews, R (2003) Multiple hospitalizations for patients with diabetes. Diabetes Care 26: pp. 1421 in new window">CrossRef
  4. Zhang, P, Zhang, X, Brown, J, Vistisen, D, Sicree, R, Shaw, J, Nichols, G (2010) Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res Clin Pract 87: pp. 293-301 in new window">CrossRef
  The Saint Vincent Declaration. Diabet Med 7: pp. 360 in new window">CrossRef
  5. Firth, R (2000) Existing facilities for diabetes care in the Republic of Ireland and developments required. Ir J Med Sci 169: pp. 2-7
  6. Griffin, S (2001) The management of diabetes. Br Med J 323: pp. 946-947 in new window">CrossRef
  7. Maier, M, Knopp, A, Pusarnig, S, Rurik, I, Orozco-Beltran, D, Yaman, H, van Eygen, L (2008) Diabetes in Europe: role and contribution of primary care position paper of the European Forum for Primary Care. Qual Prim Care 16: pp. 197-207
  8. Mc Hugh, S, O’Keeffe, J, Fitzpatrick, A, de Siún, A, O’Mullane, M, Perry, I, Bradley, C (2009) Diabetes care in Ireland: a survey of general practitioners. Prim Care Diabetes 3: pp. 225-231 in new window">CrossRef
  9. O'Donnell, M, de Siún, A, O'Mullane, M, Smith, D, Bradley, C, Finucane, F, Dinneen, S (2013) Differences in the structure of outpatient diabetes care between endocrinologist-led and general physician-led services. BMC Health Serv Res 13: pp. 493 in new window">CrossRef
  10. Smith, S, Bury, G, O’Leary, M, Shannon, W, Tynan, A, Staines, A, Thompson, C (2004) The North Dublin randomized controlled trial of structured diabetes shared care. Fam Pract 21: pp. 39-45 in new window">CrossRef
  11. Brennan, C, Harkins, V, Perry, I (2008) Management of diabetes in primary care: a structured-care approach. Eur J Gen Pract 14: pp. 117-122 in new window">CrossRef
  12. Mc Hugh, S, Marsden, P, Brennan, C, Murphy, K, Croarkin, C, Moran, J, Harkins, V, Perry, IJ (2011) Counting on commitment; the quality of primary care-led diabetes management in a system with minimal incentives. BMC Health Serv Res 11: pp. 384-393 in new window">CrossRef
  Diabetes -The Policy Puzzle: Is Europe Making Progress?. International Diabetes Federation Europe, Federation of European Nurses in Diabetes, Brussels
  Expert Advisory Groups; An Introduction.
  Tackling Chronic Disease. A Policy Framework for the Management of Chronic Disease. Department of Health & Children, Dublin
  Framework for the Development of a Diabetic Retinopathy Screening Programme for Ireland. Health Service Executive, Dublin
  13. Harkins, V (2008) A Practical Guide to Integrated Type 2 Diabetes Care. Health Service Executive, Dublin
  14. Kingdon, J, Thurber, J (2003) Agendas, Alternatives, and Public Policies. Longman, New York
  15. Keegan, C, Thomas, S, Normand, C, Portela, C (2013) Measuring recession severity and its impact on healthcare expenditure. Int J Health Care Finance Econ 13: pp. 139-155 in new window">CrossRef
  16. Thomas, S, Burke, S, Barry, S (2014) The Irish health-care syste
• 刊物主题：Health Administration; Social Policy; Quality of Life Research;
• 出版者：BioMed Central
• ISSN：1478-4505

文摘

Background In 2006, the Health Service Executive (HSE) in Ireland established an Expert Advisory Group (EAG) for Diabetes, to act as its main source of operational policy and strategic advice for this chronic condition. The process was heralded as the starting point for the development of formal chronic disease management programmes. Although recommendations were published in 2008, implementation did not proceed as expected. Our aim was to examine the development of recommendations by the EAG as an instrumental case study of the policy formulation process, in the context of a health system undergoing organisational and financial upheaval. Methods This study uses Kingdon’s Multiple Streams Theory to examine the evolution of the EAG recommendations. Semi-structured interviews were conducted with a purposive sample of 15 stakeholders from the advisory group. Interview data were supplemented with documentary analysis of published and unpublished documents. Thematic analysis was guided by the propositions of the Kingdon model. Results In the problem stream, the prioritisation of diabetes within the policy arena was a gradual process resulting from an accumulation of evidence, international comparison, and experience. The policy stream was bolstered by group consensus rather than complete agreement on the best way to manage the condition. The EAG assumed the politics stream was also on course to converge with the other streams, as the group was established by the HSE, which had the remit for policy implementation. However, the politics stream did not converge due to waning support from health service management and changes to the organisational structure and financial capacity of the health system. These changes trumped the EAG process and the policy window remained closed, stalling implementation. Conclusions Our results reflect the dynamic nature of the policy process and the importance of timing. The results highlight the limits of rational policy making in the face of organisational and fiscal upheaval. Diabetes care is coming on to the agenda again in Ireland under the National Clinical Care Programme. This may represent the opening of a new policy window for diabetes services, the challenge will be maintaining momentum and interest in the absence of dedicated resources.