Against the Odds: Syringe Exchange Policy Implementation in Indiana
Against the Odds: Syringe Exchange Policy Implementation in Indiana
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DOI：
10.1007/s10461-017-1688-7
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发表时间：
2017-04-01
影响因子：
4.4
通讯作者：
Shannon, D. J.
中科院分区：
文献类型：
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作者：
Meyerson, Beth E.;Lawrence, Carrie A.;Shannon, D. J.
印第安纳州最近通过立法，允许地方政府建立注射器交换。虽然确定了注射器交换规划的有效性，但缺乏关于相关政策采用和执行的研究。本研究记录了印第安纳州24个县在新的州法律下建立注射器交换项目的经验。2015年5月至2016年4月，采用混合方法、定性、探索性案例研究。我们观察到迅速而广泛的政策采纳兴趣，然而各国报告了显著的政策模糊性、流行病学和资源能力问题。涉及信息和有形资源共享网络的卫生公域的出现，使在资源匮乏的情况下进行机构重组成为可能；然而，鉴于国家的结构性障碍，这种重新安排似乎是政策采纳和执行的主要威胁。新出现的公地可能是一个关键的政策成功因素，因为它将实现在当前资源环境中不可能实现的效率，并有助于实现体制重新安排，以改善人口健康。提出了若干改进建议。
Indiana recently passed legislation allowing local governments to establish syringe exchanges. While the effectiveness of syringe exchange programming is established, there is a dearth of studies about associated policy adoption and implementation. This study documents the experiences of 24 Indiana counties engaged in the process of establishing syringe exchange programming under new state law. A mixed method, qualitative, exploratory case study was conducted from May 2015 to April 2016. We observed rapid and widespread policy adoption interest, and yet counties reported significant policy ambiguity, epidemiologic and resource capacity issues. The emergence of health commons involving information and tangible resource sharing networks allowed institutional rearrangement in the midst of resource scarcity; however, such rearrangement appeared to be a central threat to policy adoption and implementation given state structural barriers. The emerging commons could be a critical policy success factor, as it would achieve efficiencies not possible in the current resource environment, and can help achieve institutional rearrangement for the improvement of population health. Several recommendations for improvement are offered.