Journal of Health Services Research & Policy

Successful partnership working has theoretically been linked to improvements in service delivery and is dependent on the strength of the partnership, trust, communication, professional roles and resource sharing. Empirical evidence to confirm the relationships between these factors and improved service provision, however, is lacking. Our aim was to assess the views of staff as to the conditions required for partnership working.

This study was a cross-sectional survey of 687 staff offering sexual health education, information or support to young people in the Healthy Respect intervention area in Scotland. Views of each variable were scored and structural equation modelling was used to assess the theoretical model.

Responses were received from 284 (41%) staff. Greater strength of partnership was directly associated with increasing the number of referrals. Establishing professional roles between organizations was also associated with increasing the number of referrals. Strength of partnership was indirectly associated with working more effectively with young people and this relationship depended on clear communication, trust, established professional roles and shared resources. Effective partnership working depends on a number of interdependent relationships between organizations, which act synergistically to improve organizational outcomes.

Effective partnership working leads to improved service delivery though there is a need for better controlled studies which demonstrate the effect on health outcomes.

To analyse the current and potential utilization of generic drugs in Japan, to examine the maximum possible cost savings from generic drug use and to develop a fairer measure to assess the level of generic drug substitution.

We conducted a cross-sectional retrospective analysis of nine million dispensing records during January to March 2010 in Kyoto Prefecture. Maximum potential quantity-based shares were defined as the quantity of generic drugs used plus the quantity of branded drugs that could have been replaced by generic drugs divided by the quantity of all drugs dispensed. We developed a ‘substitution index’, defined as the proportion of generic drugs out of the total drugs substitutable with generic drugs (based on quantity rather than cost).

Generic drugs had a quantity-based share of 17.9%, a cost-based share of 8.9% and a maximum potential quantity-based share of 50.1%, which is lower than the actual generic drug shares of some other countries. The maximum possible cost savings as a result of generic drug substitution was 16.5%. We also observed wide variations in maximum potential quantity-based shares between health care sectors and health care institutions.

Simple comparisons based on quantity-based shares may misrepresent the actual generic drug use. A substitution index that takes into account the maximum potential quantity-based share of generic drugs as a fairer measure may promote more realistic goals and encourage generic drug usage.

To explore current arrangements for identifying and managing performance concerns in community pharmacists in the UK.

Semi-structured qualitative telephone interviews were conducted with 20 senior managers from community pharmacies and locum agencies.

A strong emphasis was placed on business performance alongside other aspects of professional performance in the identification of performance concerns in pharmacists. The majority of concerns were identified reactively, through customer complaints, peer- or self-referral, or following a dispensing error. Community pharmacies sought to manage performance concerns internally where possible, but only the larger organizations had the infrastructure to provide their own training or other remedial support. Several challenges to identifying and managing performance concerns were identified. There were few mechanisms for identifying and supporting locum pharmacists with performance issues.

Being ‘for-profit’ organizations, community pharmacies may prioritize business performance over ensuring the professional performance of pharmacists, the responsibility for which would be left to the individual pharmacist. This may be detrimental to the quality of care provided. With the growth of independent sector providers more widely, these findings may have implications for the regulation of other health care professionals’ performance.

To explore the effectiveness of four different policy mechanisms in achieving a more equitable geographical distribution of general practitioners (GPs) in European countries. The following mechanisms were analysed: (1) interventions during medical training; (2) financial incentives; (3) quotas to allocate GPs to regions and (4) capitation-based remuneration.

A macro-comparative method, namely, fuzzy set qualitative comparative analysis, was employed to explore the distributional effectiveness of the four mechanisms. A literature review yielded information on the use of these mechanisms in the 21 European countries included, while country-specific equity in the geographic GP distribution served as the outcome variable.

Quotas determining the number of GPs per region proved to be highly effective in producing an equitable GP distribution if calculated based on health care needs. Remunerating GPs largely through capitation payments also proved to be an effective policy mechanism. Financial bonuses to GPs practising in under-served areas and interventions during medical training had little or no impact.

Several high income countries have a maldistribution of primary care physicians to the detriment of rural or socially deprived areas. Policy makers have instituted a variety of policies to counter this. This study helps to identify mechanisms which are likely to be more and less effective.

To examine the challenges to using systematic review evidence to develop guidance for decommissioning ineffective health services, and the problems experienced by clinicians and commissioners when they attempt to implement the evidence from this guidance.

Interviews with 23 clinicians and 15 commissioners from nine commissioning organizations (Primary Care Trusts) in the south of England.

Participants identified generic and intervention-specific barriers to using systematic review evidence to develop and implement decommissioning. Generic barriers included: contradictions within the health care system arising from policy; managing a high volume of evidence; difficulty in applying the evidence to the local context; and patient or parent expectations. Intervention-specific factors included: the influence of industry; an absence of systems for monitoring local implementation of guidance; and the availability of different codes for the same procedure which made monitoring some practices unreliable.

The micro practices of commissioners are shaped by the wider system of health policy, the knowledge producing and delivery agencies associated with health care, and power dynamics within the health care system. If decommissioning is to be guided by evidence, then adequate resources to support the process are necessary. This includes long-term engagement of clinicians, providing alternatives to the decommissioned activity and tackling perverse incentives. An important precursor to decommissioning is obtaining data on the nature and extent of current clinical practice and using these data to monitor variation in the implementation of guidance.

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.

Interviews with 27 people with cognitive impairment (13 with confirmed dementia) and 26 carers (20 matched pairs). Interviews continued until theoretical saturation was reached. Interview transcripts were subject to constant comparative analysis; data interpretation occurred in ‘data clinics’.

People with memory problems undergoing assessment often have unmet information needs, especially patients with a diagnosis other than Alzheimer's disease and those who do not receive a diagnosis. Patients wish to be kept informed about both the assessment and its outcomes. Some have unrealistic expectations of the process (expecting assessment and diagnosis to be complete in two weeks) and some experience what appear to be long delays (over 12 months) in receiving results. Most appreciated clear and honest communication about any diagnosis. Post-diagnostic groups, organized by local memory services, afford opportunities to learn practical strategies and gain informal peer support. Voluntary organizations may be an essential source of information.

Communication and information need improvement for patients undergoing assessment for possible dementia, especially for those considered unlikely to benefit from medication and those with mild cognitive impairment.

The design of the first Australian public nurse-led primary care walk-in centre was modelled on those established in the English National Health Service (NHS). An independent evaluation of the first 12 months of operation of the Australian Capital Territory (ACT) Health walk-in centre, in 2011, analysed the translation of evidence from the national evaluation of the NHS walk-in centres to the policy development and implementation of the ACT walk-in centre. Whilst in a number of ways the evidence was used well, our interest for this paper was to examine three areas identified as problematic and to identify the points at which the evidence was lost or diluted.

In addition to data obtained through nurse and key stakeholder interviews for the evaluation, an analysis was undertaken of documents on the planning and establishment of the ACT walk-in centre, either provided to the evaluation team or made publicly available.

Three areas were identified as problematic in the way that evidence from the NHS evaluation was translated: the use of clinical decision support software (CDSS); the marketing of the walk-in centre; and its location.

Our examination indicates that despite seeking evidence to inform the development of the ACT walk-in centre, the evidence was not fully used and some clear lessons ignored, resulting in much of the evidence being lost in translation.