Section A: Policy Issue
Self-Medication/Over the Counter Drugs
Healthcare policy entails actions, plans, and decisions which are enacted to achieve healthcare principle objectives within the community. Public healthcare policies resolve numerous issues; defining the goals of healthcare future that further help in establishing primary targets for both long and short term. At the same time, public policies outline the most significant roles and priorities of diverse groupings, thus building information and consensus amongst the people. For example, the National Health Council has established a substantial momentum in the United States for both policy-makers and stakeholders intending to recognize pertinent issues facing healthcare. At the central heart of everything within the public domain is the welfare of patients in the central part of policymaking and discussions. Without the patient, public healthcare policies serve little or no purpose. People, no doubt, want to have the environment and communities that promote and secure their health.
Section 1a: Why Self-Medication/Over the Counter Drugs?
Health care policies such as patient-centered care have focused on improving patient care, diagnosis, treatment, and general care to achieve a holistic approach to the standard of care. Self-medication, for example, over the counter drugs have stood as a challenge to attaining several public health objectives that include pharmaceutical goals and objectives towards availing the right medications to the public. According to Tesfamariam et al., (2019), nursing professionals have also faced the problem of having to counter the threat posed by self-prescriptions. Snyder, Bennett, Oller, and Ge (2017) maintained that s elf-prescription has been identified as self-medication that entails identifying common health challenges and treating oneself with drugs that are effective and safe. Medications that do require self-prescriptions are known as prescription products.
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Section 1b: Relevance
Nursing professional see no danger or risk in self-prescription, especially for emergency purposes or joint ailments. If correctly used, self-prescription is an effective way of countering health emergencies or complications. However, Tesfamariam et al., (2019) further argue that self-prescription have given rise to high rates of dependence on over the counter drugs, raising much concern on the right use of the same in the market. With the dangers of wrong use of over the counter drugs, self-prescription in addition to over-dependence on over the counter drugs may pose a severe threat to numerous healthcare reforms and policies in place.
According to Rather et al., (2017) self-medication and over-dependence on over the counter drugs affect a wide array of stakeholders and departments within the healthcare sector ( Tesfamariam et al., 2019). Besides endangering users lives, illegal use and over-dependence on over the counter drugs may derail many healthcare objectives as outlined in various healthcare policy papers. It affects individuals, the sick, healthcare facilities, pharmaceutical companies, and multiple stakeholders having a particular interest in upholding productive performing healthcare sector. For example, Snyder et al., (2017) maintain that a large section of the community depending on over the counter drugs will increase research costs for the production of these drugs by pharmaceutical companies.
Section 1c: Financial Impact
While the use of over the counter drugs is legal with various medicines outlined as safe, over-dependence is risky. Firstly, it increases the cost of healthcare services with increased costs of drugs. As healthcare costs rise, a large number of people depend on self-medication and over the counter drugs. According to Snyder et al., 2017) the situation is unsafe and may endanger the lives of many while also driving pharmaceutical companies to invest more on the same, thus increasing the production cost. Enacting a policy that will guide and regulate the two issues; self-medication and over the counter drugs is critical towards achieving a host of public health policies such as affordable healthcare. .
Educating and creating awareness among the public on the two issues is critical towards achieving healthcare objectives and helping the community maintain a positive attitude towards seeking professional healthcare. Such will help the community understand the basics of healthcare, such as diagnosis in addition to understanding the importance of using professionally analyzed situations within the healthcare docket ( Tesfamariam et al., 2019). An appropriate policy for regulating and guiding the community on the two issues will help patients invest wisely on healthcare financial schemes. Such will guide people to get adequate healthcare service.
Section 2a: Ethical Principle
Lack of healthcare insurance or care remains the number one factor pushing individuals to self-medication and reliance on over the counter drugs. A duly enacted regulation will help individuals focus on healthy living and proper healthcare. It will also help in elevating the significance of healthcare facilities towards providing effective and efficient healthcare services. Passing and enacting an appropriate health care policy regarding self-medication and the use of over the counter drugs will no doubt assist healthcare professionals such as nurses in upholding ethical values such as justice, non-maleficence, and beneficence ( Rather et al., 2017). For example, nurses will ensure that the service they offer is measured in regards to equality and fairness. It will also help nurses provide equitable treatment to all patients. Fair treatment, focus on doing good to patients, seeking out for the best results, and committing to best practice, patients and community will be fully satisfied in seeking for professional healthcare services. It will help them refrain from over-dependence on over the counter drugs and self-medication.
It is thus vital to enhance and add stringent measures, especially towards over the counter drugs/ self-prescription and self-medication. Lack of relevant policies on the same will deny the professional community medication, diagnosis, treatment, and care. A poorly diagnosed and treated health complication is a threat to the individual and the entire society, especially towards achieving a universal healthcare practice and standard of care. Rather et al., (2017) portend that an outlined framework upon which individuals can seek for over the counter drugs in addition to self-medication will help individuals and the community at large understands the essence of healthy living, health insurance, and drug usage in the face of a health complication. The policy will also establish shared responsibility, universal coverage in addition to setting the standard of care for pharmacists, pharmaceutical companies and health practitioners.
Section B: Policy Brief
Section 1:
The primary stakeholders within the healthcare sector include the insurance companies, government, physicians, patients, and pharmaceutical companies. The best-placed stakeholder or decision-maker to handle and formulate the above-discussed policy is the government. The government upholds that healthcare is a fundamental human right as stipulated in the Constitution.
Section 1a: Decision Maker: Secretary of Health and Human Services
Jacobs and Skocpol (2015) maintain that wit hout considering the differences in political ideologies in regards to healthcare, the government has the sole responsibility of enacting and upholding stipulated laws. It also has the role of regulations, and policies that advance quality care within the healthcare sector. With the legislated "shared responsibility" that exists between individuals, employers, and the government, all citizens are guaranteed proper quality health insurance and affordable schemes. The government also oversees various public policies, the safety of pharmaceutical products, and medical devices. Under health, the docket is the Secretary of Health and Human Services who will receive the above-stated policy. The Secretary is best placed to approve relevant health programs in addition to creating awareness among the public on the government's healthcare objectives ( Jacobs & Skocpol 2015) . The Secretary will thus be better placed to handle the challenges facing the healthcare sector following self-medication and over-the-counter drugs.
The Secretary will be better placed to handle legal challenges that may arise from enacting such a policy due to vested interest from social groupings, especially pharmaceutical companies. Pharmaceutical companies may attempt to derail or prevent the enactment of such a system if it comes from a junior health official. The Secretary is highly positioned with the Federal government and as a close advisor to the present on matter health, stands a better chance of upholding the policy.
Section b2: Challenges
The primary challenge may arise majorly from vested interest groups such as pharmaceutical companies and interest groups who benefit directly from patients who prefer self-medication. Due to their vast financial resources and impact within the healthcare sector, a policy that may reduce their revenue collection may be derailed before being realized. Another major challenge is resistance from the public, especially those who depend solely on over the counter drugs. Jacobs and Skocpol (2015) posit that a lthough political opposition may be encountered, these can be overcome through a way of advocacy and strategic measures. These groups may find it challenging to accept the policy due to personal reasons and interests. If advocated and sponsored from the Secretaries office, the impact and significance will no doubt be felt, and awareness created effectively.
B3: Primary Option
The best strategy to enacting the policy will be to include it as a public health policy within the healthcare Affordable Care Act. Making it law will give it relevance and significance amongst pharmaceutical companies, small scale drug retailers, and among patients. The policy will strengthen other healthcare-related policies, especially those on drugs and standard of care if passed on as an act. It will also enhance existing healthcare coverage, specifically those that promote and safeguard the use of drugs by medical practitioners.
Firstly, the Secretary of health and human services will get official authorization from the President to implement the policy as part of the broader Affordable Care Act. After getting the authority from the President, the Secretary will engage with all the healthcare stakeholders ( Jacobs & Skocpol 2015) . They will include pharmaceutical companies, health practitioners, interest groups, and selected patients to come up with a framework of the policy concerning the current existing situation in the country. The Secretary may create a committee to structure the policy in the best way possible that fulfill all the necessary frameworks that may have been raised by the stakeholders.
B4: Course of Action
Through direct engagement, discussion, and barnstorming, the Secretary will find the best balancing act to navigate through the enactment process. Other parties who will make up the process of enactment include Federal and State Agencies, Legislators, Public officials and Administrators, and State and Local board members. By involving a more significant segment of the community, some challenges such as resistance or legal challenges can effectively be reduced. The policy may face numerous amendments and rejections. However, with concerted efforts and lobbying, the policy can be passed and agreed upon by all the relevant stakeholders. After the parties agree on the framework, the Secretary informs the President who will sponsor t bill the in Congress. From here, the bill will follow on all the prescribed stages of making it a law and enacted alongside or within the healthcare Act. The policy will entail frameworks and guidelines on how over the counter drugs are accessed, used, sold, labeled, and their pricing in the market. The primary objective of the bill will be to provide guidelines on the above issues to safeguard the gains made in healthcare service delivery and particularly the standard of care. It will give pharmacist the instructions of selling drugs over the counter, measures to consider, pricing, and conditions under the sale.
B5: Top-Down Approach
As described above, the top-down approach entails relying on higher authorities in determining the objectives of the policy. For example, in the above case, the Secretary of Health and Human Sciences will take the initiative to involve stakeholders in the policy enactment. The Secretary will then ask the President to or Federal government to sponsor a bill that will eventually be the law after passing through all the sue stages in Congress. The success of the entire policy brief will be determined by the response and reaction of the stakeholders who will be engaged with the Secretary towards having a joint policy paper on the same. The policy's success will also be evaluated from the response of the President and Congress during the process of enactment.
Five essential items will be used to evaluate the success of the policy. They will include: Keeping to the schedule in which the policy enactment kept to its time frame. For example, if the policy enactment was scheduled to take two years, the evaluation will focus if it took the recommended time. The second strategy will focus on the quality of the policy concerning how it is meeting its set standards. It will involve checking all the policy practices that include deliverables and their variables. The cost will also form a critical part of the evaluation in which the overall cost will be compared with the estimated cost. It will give a forecast on its relevance. Stakeholder satisfaction will form a critical aspect of the evaluation. It will involve finding out if the relevant stakeholders such as the pharmaceutical companies, the President and consumers are satisfied with the overall result of the policy. The last evaluation strategy will entail on the policy’s performance in the business environment. If it aligns to the business environment, then it is a success, but in case it fails to align with the business situation, it has still not yet achieved its overall objective.
Section C: The Plan
C1: Organization: American Medical Association
Since its establishment and incorporation, the American Medical Association has endeavored to enhance and create awareness on better public health and medication. The association has shown remarkable interest in the policy due to its promotion of healthy medical initiatives and public health. The association has often taken bold steps in pursing relevant policies that promote public health and medication. It has also made an aggressive attitude towards increasing or funding medical costs to improve healthcare services and accessibility to care. For example, AMA formed a coalition with other stakeholders, aiming at advancing the best healthcare policies and practices, towards defeating the United States National Health care Act. Thus, it stands as the best organization to partner with towards advancing the courses of the policy under discussion.
C2: CBPR Principles
Community-Based Participatory Research entails a partnership strategy that involves, for instance, researchers, organizational representative, and community members. The basic principles of CBPR are aimed at forming a strategic approach towards achieving a common goal with the community. In working with AMA, the best principles to use to address a policy change will include the recognition of the community as a unit of identity. It entails emotional identification and connection, establishing common goals, and setting shared needs. Another critical CBPR to use is building on resources and strengths within the community by way of identification of individual assets and skills, helpful contacts ad networks in addition to establishing faith-based structures. Thirdly, action, and research for the good of the partners in which it will seek to develop awareness on well-being and health.
2b: Alignment
The partnership will blend on intervention structures, research findings, and intervention strategies towards the policy change. AMA is the best to engage in this scenario as it will help in the promotion of appropriate healthcare practices that involves correct health practices and guidelines. Since its primary purpose is to promote the betterment of Medicare and public health, the plan will be aligned with communal health policies to achieve its primary purpose.
2c: Steps
Appropriate measures will be undertaken to formulate a single strategic objective towards accomplishing the goal of the policy to achieve the above mission in aligning the policy's goal to the organization's goal. It will entail, creating a draft of measures from both sides that will align with the policy change. After that, a common approach to unifying the objectives to get a common goal will be enacted. The two objectives aimed at the betterment of Medicare will be harmonized and agreed upon by the members. A final draft of the common purpose will then be sent to Congress.
2d: Roles and Responsibilities of AMA
The primary function of AMA in the policy change will be to research self-medication and over-reliance on over the counter drugs. The research will be carried out to understand the prevalence of the practice among the community members. The stud will also attempt to understand the common self-prescription drugs most used by the community members. AMA will, in after that, outline a draft of measures towards finding a lasting solution to the practice among the community members.
2e: Key Elements
Some of the critical elements to establishing a collaborative evaluation plan will entail capacity building. The partners will formulate measures of education the public on its roles and responsibilities ( Chambers, Feero & Khoury 2016) . Capacity building will involve meetings, study groups, and evaluation exercises towards understanding the part of the collaboration. It will also strike a balance between mutual benefit and action with the view of benefiting all the members.
2f: The Success of the Plan
Fleiszer et al., (2015) clarify that engaging members of the community will evaluate the progress of the arrangement on their understanding of the research project and policy change initiative. During the awareness engagement exercise, the public will be interviewed to determine their level of knowledge following the effort to enact a policy change. According to Fleiszer et al., (2015) the community members will be engaged directly at a personal level. Another group that will be involved will be medical practitioners and personnel on their understanding of the policy.
Section D: Analysis
Challenges and Benefits of Bottom up and Top-down approach
D1: Challenges
One of the most significant drawbacks and challenges of the top-down approach is minimal participation from those at the lower ranks. Thus decision making is mostly left to the leading personnel within the group. Bishop (2016) articulates that i n case the leading figure understands less, the entire team is disadvantaged in formulating a proper solution since participation from the other member is curtailed. It is difficult to understand another’s point of view, and at the same time, there will not enough conflict that will inspire problem-solving approach. The scenario will thus not argue well for constructive engagement.
D2: Strengths
However, according to Bishop (2016) authority wielded by the topmost personnel will positively influence the enactment of the policy since they will have sufficient resources, and influence to sway public and political forces. On the other hand, the community will have greater confidence in the policy if it is enacted and influenced by persons at a higher authority.
D3: Effective Approach
The bottom-up approach offers clarity and lessens conflict as it originates from the community members first. Thus, the chances of adoption are high. At the same time, less time will be taken in research and collaborations. Bishop (2016) further observes that It will find an excellent definite appeal from among the public in addition to garnering enough support from the grassroots. It thus means that the period of enactment is reduced significantly. However, one of the most significant challenges to the bottom-up approach is the policy may face various changes in later implementation phases ( Bishop 2016) . The community members may also feel the impact of the policy much earlier than intended. It may give rise to opposition if the policy is changed on later stages.
References
Bishop, W. (2016). Integrating IPE into an Academic Health Sciences Center: A Bottom-Up and Top-Down Approach. International Journal of Health Sciences Education , 3 (2), 2. https://dc.etsu.edu/cgi/viewcontent.cgi?article=1027&context=ijhse
Cairney, P. (2016). The politics of evidence-based policy making . Springer.
Chambers, D. A., Feero, W. G., & Khoury, M. J. (2016). Convergence of implementation science, precision medicine, and the learning health care system: a new model for biomedical research. Jama , 315 (18), 1941-1942. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624312/
Fleiszer, A. R., Semenic, S. E., Ritchie, J. A., Richer, M. C., & Denis, J. L. (2015). The sustainability of healthcare innovations: a concept analysis. Journal of advanced nursing , 71 (7), 1484-1498. https://s3.amazonaws.com/academia.edu.documents/43887305/The_sustainability_of_healthcare_innovat20160319-28543-1u12ih6.pdf?response-content-disposition=inline%3B%20filename%3DThe_sustainability_of_healthcare_innovat.pdf&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIAIWOWYYGZ2Y53UL3A%2F20190724%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20190724T001305Z&X-Amz-Expires=3600&X-Amz-SignedHeaders=host&X-Amz-Signature=9f5e7c5b8720e5cb4bf63bab53789142c78a5f996b8b8132ad5bcf13d5ba322a
Jacobs, L., & Skocpol, T. (2015). Health care reform and American politics: What everyone needs to know . Oxford University Press.
Rather, I. A., Kim, B. C., Bajpai, V. K., & Park, Y. H. (2017). Self-medication and antibiotic resistance: Crisis, current challenges, and prevention. Saudi journal of biological sciences , 24 (4), 808-812. https://www.sciencedirect.com/science/article/pii/S1319562X17300049
Snyder, D. D., Bennett, T. K., Oller, J. C., & Ge, W. (2017). Controversial Issues in Healthcare Policy: A Survey of Doctor of Physical Therapy Students in a Public University. Journal of allied health , 46 (4), 255-262.
Tesfamariam, S., Anand, I. S., Kaleab, G., Berhane, S., Woldai, B., Habte, E., & Russom, M. (2019). Self-medication with over the counter drugs, prevalence of risky practice and its associated factors in pharmacy outlets of Asmara, Eritrea. BMC public health , 19 (1), 159. http://www.jddtonline.info/index.php/jddt/article/view/2538
