HISTORICAL

DEVELOPMENTS OF
COMMUNITY HEALTH
NURSING IN THE WORLD

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HISTORICAL DEVELOPMENTS OF
COMMUNITY HEALTH NURSING IN THE
WORLD:-

ANCIENT PERIOD:- The history of public

health and public health nursing can be
traced far back in the past. In earliest
times people struggled for their survival
by devising their own methods to deal
with life events such as births, deaths
etc.
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HISTORICAL DEVELOPMENTS OF
COMMUNITY HEALTH NURSING IN THE
WORLD: people were concerned about diseases
and had some knowledge of its treatment.
Medical carte was given by religious
leaders or priests who were revered by the
society.
Record history of ancient civilization such
as Babylonian, Hebrew, greek and roman
reveals that they possessed knowledge of
personal hygiene, community
responsibility and medicine.
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HISTORICAL DEVELOPMENTS OF
COMMUNITY HEALTH NURSING IN THE
WORLD: They

had well developed system of

environmental sanitation such as
safe water supply, drainage and
sewage disposal system. They also
had understanding of contagious
nature of diseases.

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HISTORICAL DEVELOPMENTS OF
COMMUNITY HEALTH NURSING IN THE
WORLD: This

resulted in rigid public health

measures like isolation of the sick,
quarantine of the families and some
times of the communities.
The philosophy of the time was that
the individual should provide for the
basic needs for himself and his
family
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HISTORICAL DEVELOPMENTS OF
COMMUNITY HEALTH NURSING IN THE
WORLD: his

responsibility included the

provison of food,shelter and clothing
and care in case of illness. The
community responsibility was to
protect the individual and his family
against illness that might be due to
communal life.

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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
IN BRITAIN:NURSING
The development
of modern public
health and nursing took place from
the middle of 19th century both in
England and America and various
other countries as a result of
occurance of great epidemics of
bubonic plague, leprosy, small pox,
cholera etc.
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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
BRITAIN:NURSING
During 18th IN
century
and early 19th
century England faced industrial
revolution which created tremendous
social impacts in terms of socioeconomic imbalance, exploitation of
workers, slums, overcrowding, poor
sanitation, broken families, child
abuse, maternal and child health
problems.
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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
BRITAIN:NURSING
During 19th IN
century
inspite of the act
being passed and implemented to
improve the environmental
sanitation, these diseases continued
to occur time and again in the
western world. This was bcause of
the fact that epidemiology of the
diseases were not fully understood.
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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
BRITAIN:NURSING
Ms. FlorenceIN
Nightingle
has been
recognized as one of the foremest
pioneers in the public health and
public health nursing movements in
England. She is acclaimed as the
founder of modern nursing. She
began her work when nursing
services which were established by
religious order, had withered away
with the decline of church power and
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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
INwork
BRITAIN:NURSING
She began her
when nursing
services which were established by
religious order, had withered away
with the decline of church power and
influence.
Florence Nightingle created an
atmosphere of dignity and self
respect for nursing.
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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
IN AMERICA:NURSING
In America, similar
developments
took place in the field of public
health and public health movement
gained momentum in 1850, when
lemuel Shattuck, a publisher and
book seller, submitted a report on
sanitary conditions of Massachusetts
to its legislature and also published
the same.
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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
INheAMERICA:NURSING
In his report
put forward
specific recommendations
regarding a system of sanitary
inspection, collection of vital
statistics school health
programme.

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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
IN AMERICA:NURSING
In 1872, American
health
association, a national level
profession organization of community
health workers was established. This
association initiates various public
health campaigns and has
consistently worked for improving
standars of community health
services.
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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
IN AMERICA:NURSING
The field of public
health bradend
under the influence of scientific
advances in microbiology, social and
behavioral sciences. Thus in late
19th century and at the beginning of
20th century a new concept began to
take impetus that state has the
direct responsibility for the health of
people.
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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
AMERICA:NURSING
Public healthIN
activities
not only
included the activities of improved
sanitation and control of
communicable diseases but aalso
preventive and promotive services to
mothers,children,school
children,workers and elderly.

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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
NURSING
The need forIN
theAMERICA:application of
principles of personal hygiene, care
and health teaching was felt in all
these public health services for
controlling mortality and morbidity
among mothers, children and
workers etc. and improve and
promote their health.
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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
AMERICA:NURSING
This phase ofIN
public
health gave
origin to public health nursing.
During this period, the foundation of
district nursing through private,
voluntary efforts was laid.

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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
IN AMERICA:NURSING
By 1890, twenty
one such
organizations existed in USA. In
1893, Lillian wald, the pioneer in
public health nursing, founded the
hennery street settlement, which
grew in to a well organized health
centre with visiting nurse services for
the surrounding community.
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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
IN foundation
AMERICA:NURSING
The rockfellers
of new
york established in 1913, adepted
public health as one of its field of
interest. This foundation assisted in
establishment of schools of public
health in united states and other
countries.

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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
INred
AMERICA:NURSING
The American
cross society, the
common wealth fund and kelogg
foundation were the other volutary
and private bodies which were very
active in the development of public
health and public health nursing
services.

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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
IN AMERICA:NURSING
During the early
part of 20th century,
there were specialized nurses in the
field of public healthy like nurses in
maternal and chil;d health, veneral
diseases, other communicable
diseases, tuberculosis control etc.

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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
AMERICA:NURSING
public healthIN
had
entered a newera.
It was faced with new emergent
health problems which were more
serious but chronic and degenerative
such as cardiovascular diseases,
cancer, stroke, mental illness and
metasbolic disorders.

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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
IN AMERICA:NURSING
Thus public health
deal with wide
range of health problems and its
activities moved beyond the
traditional basic seven services
which included communicable
disease control, environmental
sanitation, maternal and child health,
health education, medical and
nursing care, nutrition, & vital
statistics.
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HISTORY OF PUBLIC HEALTH

AND PUBLIC HEALTH
IN AMERICA:NURSING
The field of public
health, broadend,
increasing emphasis was given on
primary health care and preventive
and promotive services, further as a
result of ALMA Ata declaration of the
goal of health for all through
primary health care by WHO and
UNICEF in 1975.
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HISTORICAL DEVELOPMENT
OF PUBLIC HEALTH NURSING
IN
INDIA:
ANCIENT
PERIOD:- The
development of public health nursing
in India started much later as
compared to developed countries of
the west. But public health in India
was in practice much before its
development in western countries.

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HISTORICAL DEVELOPMENT
OF PUBLIC HEALTH NURSING
IN
INDIA:
The
Indian history revealed its public
health practice as early as 5000BC.
The period can be classified as vedic
period and post vedic period. During
the vedic period the sacred books
Upanishads and Vedas- especially the
atharveda documented all the
knowledge about medicine,personal
hygiene,prevention of sickness etc.
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HISTORICAL DEVELOPMENT
OF PUBLIC HEALTH NURSING
IN
INDIA:
The
post vedic period (500BC to 700)
started with the rise of Buddhism,
Buddhism emboied the principles of
nonviolence, helping the sick,poor
and needy people, self discipline,self
education, charity towards all men
etc.

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HISTORICAL DEVELOPMENT
OF PUBLIC HEALTH NURSING
IN
INDIA:
BRITISH
PERIOD ( 18TH century
to 1947):- The british had
estabilished its rule in India in 1757
by establishing civil and military
services. In 1859, the administration
of India was taken over by the crown
from east India company.

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HISTORICAL DEVELOPMENT
OF PUBLIC HEALTH NURSING
IN
INDIA:In 1859,
a royal commission which
came to India to study the problem,
recommended to establish sanitary
commission of five persons each in
Bengal, Bombay and madras.

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HISTORICAL DEVELOPMENT
OF PUBLIC HEALTH NURSING
IN
INDIA:
In1896,
following the out break of
epidemic of plague, aplague
commission was set up to investigate
its
epidemiological aspects. As result of
investigation and suggestion,

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HISTORICAL DEVELOPMENT
OF PUBLIC HEALTH NURSING
IN
INDIA:
In1912,
the local government bodies
were made responcible to execute
various health services according to
over all plans and directions of
central government.

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HISTORICAL DEVELOPMENT
OF PUBLIC HEALTH NURSING
IN

In INDIA:1939 some very important

developments took place. The
madras public health act was passed
for the first time in the country. The
first rural health training centers was
established at singur near Calcutta
with the support of Rockfeller
Foundations.
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HISTORICAL DEVELOPMENT
OF PUBLIC HEALTH NURSING
IN

In INDIA:1943, health survey and

development committee existing
health conditions and health
organization in the country and to
make recommendations about the
developments in future.

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HISTORICAL DEVELOPMENT
OF PUBLIC HEALTH NURSING

IN
INDIA:DEVELOPMENT
SINCE
INDEPENDENCE( 1947ONWARDS)
:Before India attained independence
on 15th august 1947, some of the
provinces and princely states of India
were parted to constitute Pakistan.

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HISTORICAL DEVELOPMENT
OF PUBLIC HEALTH NURSING
IN
INDIA:
This
effected change in demographic,
Political and socio-economic aspects.
At the same time, a large number of
people from Pakistan migrated to
India.

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HISTORICAL DEVELOPMENT
OF PUBLIC HEALTH NURSING
IN
INDIA:
The
government of India at that time
faced a large number of socioeconomic and public health
problems. But because of new
constitutional policies and the
enthusiastic attitude of political
leaders, administrators and the
people in general, the government
could manage to overcome initial
difficulties,implement strict public
health measures to prevent
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HISTORICAL DEVELOPMENT
OF PUBLIC HEALTH NURSING
IN
INDIA:
planning
commission was
constituted top help government to
plan out integrated development
plan for the entire country with in the
available resourses for a defined
period of five years for its socoieconomic progress. The planning
commission has been responsible for
ten five year plans.
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COMMUNITY HEALTH
NURSING ISSUES: The

professional issues challenging

community health nursing . first of all
empowered community health
nurses need to be able to address
the following questions.

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COMMUNITY HEALTH
NURSING ISSUES:who is assessed by community
health nurses: the individual,
family, group, or community ?
what do community health nurses
assess ?
what nursing diagnosis do
community health nurses use ?

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COMMUNITY HEALTH
NURSING ISSUES:what types of nursing interventions
do community health nurses use in
practice ? differ with differences in
client focus ?
how do interventions differ with
differences in client focus

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COMMUNITY HEALTH
NURSING ISSUES:

how is community health nursing

evaluated for quality of care, cost,
effectiveness, and outcomes
assessment?

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COMMUNITY HEALTH
NURSING ISSUES: ASSESSMENT:-

the previously
listed questions, which challenge
community health nurses
suggest that there may be wide
variety of areas that are
considered appropriate and
necessary for assessment in
community health nursing.
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COMMUNITY HEALTH
NURSING ISSUES: DIAGNOSIS:-

with the lake of

clarity in terms of nursing
assessment in community health
nursing, it follows that nursing
diagnosis in community health
nursing is equally undeveloped

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COMMUNITY HEALTH
NURSING ISSUES:Muecke (1984) critiques the concept
of community health diagnosis and
proposes the following steps to
identify the community of concern
identification of the health risk of
the community.

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COMMUNITY HEALTH
NURSING ISSUES:specification of the characteristics
of the community and its
environment that are etiologically
associated with the risk
specification of the health indicators
that verify the risk.

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COMMUNITY HEALTH
NURSING ISSUES:GOALS:- goeppingere (1984) examines the
principles issues of community helth
nursing from the perspective of the
following questions
what are the goals of community health
nursing practice ?
what are the target system that
community health nurses intend to change
?
in what setting do community health
nurses practice
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COMMUNITY HEALTH
NURSING ISSUES: INTERVENTIONS:-

A major nursing
intervention issue is that of the
measurement of costs of community
health nursing in the home health
care setting. Kovner categorizes
alternatives in to four models. Per
visit, acuity of care, hourly, and by
diagnosis.
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COMMUNITY HEALTH
NURSING ISSUES: The

setting for community health

nursing practice leads to a question
of weather community health nursing
is setting specific. Is it communityoriented because it emphasizes the
collective need ? three newer and
related delopments in nursing
community setting have been the
nursing entrepreneurship, and parish
nursing.
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COMMUNITY HEALTH
NURSING ISSUES:EVALUATION:- measurement of the
outcomes of community health nursing
care leads to avariety of questions and
issues.
what are the consequences of organizing
care around reimbursement guidelines
rather than a theory- based approach?
what level of focus of community health
nursing is most cost-effective: individual,
families, group or communities?
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COMMUNITY HEALTH
NURSING ISSUES:what are the effects of changes in
referral patterns, level of illness of
clients referred,intensity of services
required, and quality of services
delivered ?
what measures of patient outcomes
in terms of behavioral or functional
changes can be used to evaluate
the interventions of community
health nurses ?

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COMMUNITY HEALTH
NURSING ISSUES:what are the effects of different
management procedures for
specific types of clients ?
what is the effect of various
management structures and types
of agencies on the way home care
is delivered ?

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CURRENT ISSUES
school

nurses have played a

significant part in school health
programs. They need to be flexible,
creative, and involved in revising
their role to fit with new directions,
otherwise, the role of the school
nurse may be jeopardized. Economic
justification for services is necessary
and therefore, the value of the school
nurse must be ascertained.
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CURRENT ISSUES
National

health objectives for the

year 2000 seek to increase schoolbased education to prevent human
immunodeficiency virus infection,
alcohol and other drug use, tobacco
use, injury, and sexually transmitted
diseases.

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CURRENT ISSUES
Health

education has proven to be

effective at reducing risk behaviors
associated with the leading causes of
death, that is heart diseases, cancer,
stroke, C.O.P.D. un intentional
injuries, AIDS.etc. responsibility
needs to be a fundamental
component of health care reform.
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TRENDS IN COMMUNITY
HEALTH NURSING
The major forces for shaping
nursing role in the health care
environment are considered to
be.
Shifting payment system.
increased proportion of the
aged population.
increased competition among
health care providers.
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TRENDS IN COMMUNITY
HEALTH NURSING
increased complexity of client
needs and severity of client
conditions.
government intervention in cost
containment.

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TRENDS IN COMMUNITY
HEALTH NURSING
TRENDS

IN HEALTH CARE
DELIVERY
CONSUMER TRENDS
NURSES AND PRACTICE
LEADERSHIP AND CHANGE

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SCOPE OF COMMUNITY
HEALTH NURSING
Areas of activities of community
health falls in to four catagories
described below.
those areas where activities must
be on a community basis

the supervision of food, water and milk

supply of a community basis.

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SCOPE OF COMMUNITY
HEALTH NURSING

those areas dealing with

preventable illness, disabilities or
premature death.

communicable diseases including

infestations, for example diphtheria,
pertusis, tetanus, TB, measles,
poliomyelitis, worm infestation etc.

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SCOPE OF COMMUNITY
HEALTH NURSING

nutritional deficiences for example the

conditions of mal-nutrition like
marasmus, kwashiorkor, nightblindness, goiter, nutritional anaemia
etc.
substance abuse, for example drug
abuse and other substances abuse like
alcohol.
Mental health and illness i.e. disorders
of emotion, personality, behaviour etc.
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SCOPE OF COMMUNITY
HEALTH NURSING

Occupational health includes

prevention and treatment of
occupational illness & hazards.
Non-communicable diseases and
conditions like cancer, cardio- vascular
diseases, diabetes and accidents.
Dental health

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SCOPE OF COMMUNITY
HEALTH NURSING

Maternal & child health

Rehabilitation of victims of accidents
and illness.
Problem of old age

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SCOPE OF COMMUNITY
HEALTH NURSING
Those areas of health , medical and
nursing which need organized
official leadership.
providing facilities for under
graduates, postgraduates and
continuing education programmes
in concerned fields
promoting of equitable distribution
of health man power and facilities

research.
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HEALTH TECHNOLOGY
DEFINITION:Health technologies are
evidence-based when they meet
well-defined specifications and
have been validated through
controlled clinical studies or rest
on a widely accepted consensus
by experts.
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HEALTH TECHNOLOGY
HEALTH TECHNOLOGY
ASSESSMENT (HTA)
Basic HTA Orientations
Technology-oriented
assessments
Problem-oriented assessments
Project-oriented assessments
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PURPOSES OF HTA

Regulatory agencies such as the

Food and Drug Administration (FDA)
about whether to permit the
commercial use (e.g. marketing) of
a drug, device or other technology

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PURPOSES OF HTA
Clinicians and patients about the
appropriate use of health care
interventions for a particular
patients clinical needs and
circumstances
Health professional associations
about the role of a technology in
clinical protocols or practice
guidelines

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PURPOSES OF HTA

Health care payers, providers, and

employers about whether
technologies should be included in
health benefits plans or disease
management programs, addressing
coverage (whether or not to pay)
and reimbursement (how much to
pay)
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PURPOSES OF HTA

Hospitals, health care networks,

group purchasing organizations,
and other health care organizations
about decisions regarding
technology acquisition and
management

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HEALTH TECHNOLOGY
ASSESSMENT PROGRAM
The(HTA)
primary goals are to make:
Health

care safer by relying on

scientific evidence and a committee
of practicing clinicians
Coverage decisions of state agencies
more consistent
State purchased health care more
cost effective
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OHTAC
CRITERIA : Technology must improve the
net health outcome and/or
safety for patients and/or
providers or improve health
systems efficiency.
Technology must be at least as
beneficial as any established
alternative
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OHTAC
1. Technology must be licensed by
Health Canada and have received
other applicable licensing or
approvals from appropriate
governmental or regulatory bodies
(e.g. the Canadian Nuclear Safety
Commission).

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HEALTH TECHNOLOGIES AND

DECISION MAKING:
How

evidence (particularly HTAbased evidence) is produced and

used in decision making.
How aspects of health-care systems
facilitate or impede the
implementation of decisions.

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Thank you

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