Please read the discussion board post and complete a full 1-page peer review (response). Also, please elaborate on the discussion and follow the grading rubric. I do not need a title page. I have attached the discussion board post and grading rubric as a file.
The process of evidence-informed health policy (EIHP) implementation involves several stages. First, the World Health Organization (WHO) produces and disseminates guidelines to inform public health policy (Loversidge & Zurmehly, 2019). The guidelines developed by WHO provide stepwise guidance and include aspects of equity, human rights, gender, and social determinants of health considerations. Furthermore, these guidelines are based on scientific evidence (Loversidge & Zurmehly, 2019).
The WHO Handbook for Guideline Development provides instructions for informing public health policy (WHO, 2014). Topics included in the guidelines consist of the application of high-quality methodology using systematic search strategies and synthesis of the quality assessment of the best available evidence to support the recommendations. The handbook also provides the standards for a transparent decision-making process, developing plans for implementing and adapting guidelines, and expert group composition, including content experts and policymakers with gender and geographical balance.
The WHO strives to improve population health and decrease health inequities. Therefore, attention must be focused on equity, human rights principles, gender, and social determinants of health. The development of policy should center around the realization of the right to health. The respect of equity involves a concerted and sustained effort to improve health across all populations and decrease inequities in the distribution of health.
Inequities are nothing more than inequalities that are judged to be unfair (WHO, 2014). Human rights encompass the availability, accessibility, acceptability, and quality of information and services. It also includes privacy and confidentiality, as well as informed decision-making. For example, the right to health allows for entitlement to a health protection system that helps everyone enjoy the highest attainable level of health (WHO, 2014).
According to WHO, gender norms, roles, and relations influence people’s risk of contracting disease (WHO, 2014). Gender norms also affect one’s susceptibility to different health conditions. Therefore, gender can have a bearing on access to and uptake on health services and health outcomes. In addition, social determinants of health contribute to the inequity in health due to differences in physical and social environments, access to services and products, ability to benefit from services, and ability to cope with ill health and disability (WHO, 2014).
The assignment for this week’s discussion is to investigate an example of evidence-improved policy making (EIPM) on the global stage and evaluate how the policy was implemented. Therefore, it was essential to understand the guidelines developed by WHO and consider those throughout this evaluation process. There are two types of questions used in the WHO evaluation process to address the final recommendations for policy implementation: background and foreground questions. The context and rationale for the guideline are provided in the background question. The foreground questions inform and support the recommendations (WHO, 2014). The format utilizing these two types of questions will evaluate the policy chosen for this assignment.
The policy chosen for this review is entitled “A Call for Evidence-Based Medical Treatment of Opioid Dependence in the United States and Canada” (Bohdan et al., 2013). Bohdan et al. provided background information from 2004 to 2013 on the prevalence, burden, and distribution of the opioid problem. The authors emphasized that approximately 2.3 million people in the United States (U.S.) were dependent on opioids, including heroin and oxycodone. This prevalence was compared to Canada, in which approximately 75,000 to 125,000 were injection drug users of opioids, and another 200,000 were individuals with prescription opioid dependence. The information substantiated the increase in prevalence and the harms of opioid use being reported by both countries.
Opioid use was shown to be the second leading cause of accidental death in the U.S. and had been declared a national epidemic (WHO, 2014). Comparison to Canada revealed that prescription opioid deaths increased approximately 14% per million people, with oxycodone playing a significant part in this increase. As a result of this data, the authors highlighted the effectiveness of effective treatment that was not being utilized to its most important potential. The benefits of substitution treatment with methadone or buprenorphine had been through randomized trials, meta-analyses, and large-scale longitudinal studies in several countries. Methadone was shown to be effective in retaining individuals in treatment and was more cost-effective. Buprenorphine had a lower risk of abuse and was less likely to be diverted for nonprescription use.
Other benefits of substitution treatment included synergies with infectious disease treatment and prevention. For example, it showed how substance use treatment could reduce the sharing of needles in IV drug injection, facilitate access to HIV testing, increase access and adherence to antiretroviral therapy for HIV, and enhance treatment options for Hepatitis C. Studies also showed how the use of substitution treatment could result in improvement in health-related quality of life (WHO, 2014). Economic benefits such as increased workplace productivity were also mentioned.
The article listed the benefits, but it also listed the concerns surrounding the use of substitution treatment. The problems included the restrictions on office-based opioid substitution treatment, financial barriers to treatment, the use of opioid detoxification, and the consideration of new and emerging treatment approaches. After weighing the pros and cons of each concern, it was determined that restricting access to substitution treatment in the U.S. needed to be reversed. Office-based methadone treatment and education and certification programs in addiction medicine for healthcare practitioners could meet the increased demand for substitution treatment. All relevant evidence was identified, synthesized, and presented in a comprehensive and unbiased manner.
Recommendations were made based on the evidence presented for policy implementation. The recommended policy changes were as follows: (1) methadone maintenance treatment must be adopted in office-based settings in the U.S., (2) policies are needed in mandating addiction education in medical schools, (3) Buprenorphine should be on the drug formularies of all Canadian provinces and made available in approved treatment contexts, and (4) public and private insurers should provide universal coverage for opioid substitution treatment in both Canada and the U.S. (Bohdan et al., 2013). Other recommendations included reducing reliance on opioid detoxification treatment, especially in the U.S., due to the scientific evidence that proves it is ineffective and potentially harmful. Finally, there was a recommendation for assessing new and emerging medication options by all institutions utilizing opioid substitution treatment to optimize care.
The following factors determined the strength of the recommendations: the importance of the problem being addressed, equity and human rights, acceptability, and feasibility (WHO, 2014). The evidence of the burden of the substance use problem, along with the prevalence of the problem, was delineated in the literature. Additionally, the balance of benefit and harms of the opioid epidemic were addressed. The evidence supports lifting the restrictions on office-based methadone treatment in the U.S., reducing reliance on opioid detoxification, which has proven ineffective, and reducing financial barriers to treatment.
Evidence-based policy is a crucial component of policy development and implementation. It provides evidence of program effectiveness and is a valuable tool in policymaking (Collaborative, 2016). The information provided through this approach can improve existing programs, identify ineffective programs, and test new strategies. Incorporating evidence-based principles of policymaking into decision-making can improve the effectiveness of government programs and help solve social problems from a national and global perspective.
References
Bohdan, N., Anglin, M., Brissette, S., Kerr, T., Marsh, D., Schackman, B., Montaner, J. (2013). A call for evidence-based medical treatment of opioid dependence in the United States and Canada. Health Affairs, 1462-1469.
Collaborative, E.-b. P. (2016, September). Principles of evidence-based policymaking. Retrieved from https://www.urban.org/sites/default/files/publication/99739/principles_of_evidence-based_policymaking.pdf
Loversidge, J., & Zurmehly, J. (2019). Evidence-informed health policy: using EBP to transform policy in nursing and healthcare. Indianapolis: Sigma Theta Tau.
WHO. (2014). The WHO handbook for guideline development, 2nd ed. Retrieved from https://www.who.int/publications/guidelines/guidelines_review_committee/en/
| Discussion Board Responses Rubric | |||||
| Criteria | Ratings | Pts | |||
| This criterion is linked to a Learning OutcomeNumber of Responses
Students are expected to respond to at least 2 of their peers. |
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30 pts | |||
| This criterion is linked to a Learning OutcomeSubstance of Responses |
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45 pts | |||
| This criterion is linked to a Learning OutcomeGrammar, Punctuation & APA |
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25 pts | |||
Peer Response: Evaluation of an Evidence Informed Health Policy Program/Change
Today’s nurses are constantly involved in the creation and implementation of policies that are aimed at improving population health. According to Loversidge and Zurmehly (2019), health policy programs should be supported by research-based evidence. Evidence that supports a given policy program often directs the implementation of that particular policy. According to Collaborative (2016), evidence obtained through research is highly valuable because it communicates the effectiveness of a health policy in addressing specific issues faced by the community. The article by Bohdan et al. (2013) has incorporated the best principles into the implementation of an evidence-informed health policy program.
The implementation of a health policy that is informed by evidence normally starts from the identification of an issue or a problem that has an effect on population health. This is usually followed by the development of a population-based question which helps to direct the process of evidence collection. As you clearly put it in your discussion, Bohdan et al. (2013) have identified the problem of opioid dependence and have used data to explain its severity and impact on population health. Their goal is to determine whether evidence-based substitution treatment can address the health problem caused by opioid use. Published evidence supports the benefits of substitution treatment with methadone or buprenorphine. The researchers have used the evidence to recommend a number of policy changes that will see the utilization of opioid substitution treatment by all institutions to optimize care (Bohdan et al., 2013). I agree with your idea that incorporating evidence-based principles of policymaking into decision-making can improve the effectiveness of government programs and help solve social problems from a national and global perspective. Therefore, as nurses, we should always recommend policy changes with research-based evidence.
References
Bohdan, N., Anglin, M., Brissette, S., Kerr, T., Marsh, D., Schackman, B., Montaner, J. (2013). A call for evidence-based medical treatment of opioid dependence in the United States and Canada. Health Affairs, 1462-1469.
Collaborative, E.-b. P. (2016, September). Principles of evidence-based policymaking. Retrieved from https://www.urban.org/sites/default/files/publication/99739/principles_of_evidence-based_policymaking.pdf
Loversidge, J., & Zurmehly, J. (2019). Evidence-informed health policy: using EBP to transform policy in nursing and healthcare. Indianapolis: Sigma Theta Tau.