Bruni Rebecca A, Laupacis Andreas, Levinson Wendy, Martin Douglas K
Joint Centre for Bioethics, University of Toronto, Toronto, Canada.
BMC Health Serv Res. 2007 Nov 16;7:186. doi: 10.1186/1472-6963-7-186.
As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement.
This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation.
The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy.
We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public engagement, and provided a concrete plan to operationalize a strategy for improving public involvement in this, and other, wait time initiatives.
由于没有任何卫生系统能够负担得起为其服务对象提供所有可能的服务和治疗，每个系统都必须确定优先事项。确定优先事项的决策者越来越多地让公众参与政策制定。本研究聚焦于公众参与一个困扰全球每个卫生系统的关键优先事项确定背景：等候名单管理。本研究的目的是描述和评估安大略省等候时间策略的优先事项确定情况，特别关注公众参与。
本研究在加拿大安大略省的安大略省等候时间策略中进行，该策略是联邦 - 地区 - 省级倡议的一部分，旨在改善五个领域的就医机会并减少等候时间：癌症、心脏疾病、视力恢复、关节置换和诊断成像。有两个数据来源：（1）超过25份文件（如战略规划报告、公众更新），以及（2）对信息提供者进行的28次一对一访谈（如安大略省等候时间策略参与者、安大略省卫生和长期护理部代表、临床医生、患者权益倡导者）。分析采用改进的主题技术，分三个阶段进行：开放编码、轴心编码和评估。
安大略省等候时间策略部分符合“合理问责”的四个条件。公众未直接参与安大略省等候时间策略的优先事项确定活动。研究参与者确定了公众参与安大略省等候时间策略的益处（支持该倡议、有实际生活经验的专家、公共资助系统以及医疗保健系统的可持续性）和担忧（个人偏见、缺乏参与兴趣、时间限制以及技术水平）。此外，参与者还确定了对安大略省等候时间策略所产生后果（可持续性、自相残杀和等级制度）的担忧。
我们描述和评估了一项等候时间管理倡议（安大略省等候时间策略），特别关注公众参与，并提供了一个具体计划，以实施一项提高公众参与此等候时间倡议及其他等候时间倡议的策略。
