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1
Smeds, Magdalena. „Managing care pathways for patients with complex care needs“. Licentiate thesis, Linköpings universitet, Logistik- och kvalitetsutveckling, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-156836.
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One of the central challenges for the healthcare system today is how to manage care for patients with complex needs. This patient group is not well-defined but covers patients with serious diseases and comorbidities, or with a limited ability to perform basic daily functions due to physical, mental or psychosocial challenges. This group has a high service and resource utilisation resulting in high costs for the healthcare system and, typically, poor health outcomes. To improve care for these patients, it is necessary to implement strategies to manage the differentiated care needs, the additional support needs, the uncertainty in care delivery, and the coordination needs of the involved providers and the patient. Care pathways are increasingly used internationally to make care more patient-centred and to structure and design care processes for individual patient groups. Important elements in care pathways include structuring care activities, by defining their content and sequence; coordinating between providers and professionals; and involving patients in their care process. In this thesis, care pathways are proposed as the overall strategy for managing care for patients with complex care needs. The purpose of this thesis is thus to contribute with knowledge on how care pathways can be managed for patients with complex care needs. This is achieved by analysing how the practices coordination, standardisation, customisation and personalisation can support management of care pathways and by discussing how these practices influence quality of care. The quality of care dimensions discussed are accessible, timely, equitable, and patient-centred care. The empirical context in this thesis is the Standardised Cancer Care Pathways (CCPs) which were implemented in Sweden from 2015 to 2018. CCPs is the umbrella term for the national initiative to shorten waiting times, decrease regional differences and reduce fragmentation in care processes. CCPs include elements such as diagnosis-specific pathways and guidelines, introduction of CPP coordinators, and mandatory reporting of waiting times. Focus has been on implementing care pathways for 31 cancer diagnoses in all Swedish healthcare regions. Both qualitative and quantitative research methods have been used. A case study was conducted to examine standardised and customised care pathways, and coordination and multidisciplinary work in care pathways. A document study of regional reports on CCPs was analysed to study effects of care pathways on accessibility, timeliness and equitability. Finally, a national survey was conducted to deepen the understanding of the role of coordination, as performed by coordinators, in care pathways. This thesis argues that standardised and customised care pathways should be combined to manage care for patients with complex care needs. The customised pathway in particular benefits patients with serious unspecific symptoms, unknown primary tumour or more complex care needs, while patients with care needs that can be treated independently of the main diagnosis benefit from following a standardised care pathway. Coordinators are an important means to manage coordination, customisation and personalisation in the care pathway. The coordinators’ role is twofold: the first role is to manage care pathways by customising the care pathway and coordinating involved providers; the second role is to support and guide patients through the care pathway. This can be achieved by adapting interpersonal communication with patients through personalisation. This thesis further argues that care pathways have most potential to positively influence accessibility, timeliness, equitability, and patient-centredness. Accessibility has been positively influenced, especially for patients with ambiguous symptoms where symptoms indicating cancer have improved their chances of accessing cancer diagnostics. A negative aspect of prioritising patients who follow CCPs has been the potentially longer waiting times for other patient groups in equal need of urgent care. Notwithstanding, prioritised access to care is perceived to positively influence timeliness for patients following CCPs. Care pathways are perceived to have positively influenced patient-centredness by shifting the focus from what to deliver to how to deliver it.
2
Bekele, Yilma Yitayew. „Pathways to psychiatric care in Ethiopia“. Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/10132.
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Includes bibliographical references.It is recognized that the pathways patients take en route to psychiatric services vary between countries and socio-cultural groups. Delay along the pathway to care is not a mere reflection of organization of health care and referral systems but also of availability and accessibilty of services. Studies have shown associations between delay and various sociodemographic, clinical and service related factors. Understanding the pathway to psychiatric care, and recognition od delay points along the pathway, is a crucial step for the development of intervention programs geared at improving the provision of mental health care.
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Brown, Christine S. H. „Pathways into High Security Psychiatric Care“. Thesis, University of Exeter, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.486662.
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Alsalamah, Hessah. „Supporting integrated care pathways with workflow technology“. Thesis, Cardiff University, 2012. http://orca.cf.ac.uk/28816/.
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Modern healthcare has moved to a focus on providing patient centric care rather than disease centred care. This new approach is provided by a unique care team which is formed to treat a patient. At the start of the treatment, the care team decide on the treatment pathway for the patient. This is a series of treatment stages where at the end of each stage, the care team use the patient’s current condition to decide whether the treatment moves to the next stage, continues in the treatment stage, or moves to an unanticipated stage. The initial treatment pathway for each patient is based on the clinical guidelines in an Integrated Care Pathway (ICP) [1] modified to suit the patient state. This research mapped a patient ICP decided by the healthcare providers into a Workflow Management System (WFMS) [2]. The clinical guidelines reflect the patient-centric flow to create an IT system supporting the care team. In the initial stage of the research the IT development team at Velindre Hospital identified that team communication and care coordination were obstacles hindering the implementation of a patient-centric delivery model. This was investigated to determine the causes, which were identified as difficulty in accessing the medical information held in dispersed legacy systems. Moreover, a major constraint in the domain is the need to keep legacy systems in operation and so there is a need to investigate approaches to enhance their functionalities. These information systems cannot be changed across all healthcare organisations and their complete autonomy needs to be retained as they are in constant use at the sites. Using workflow technology, an independent application representing an ICP was implemented. This was used to construct an independent layer in the software architecture to interact with legacy Clinical Information Systems (CISs) and so evolve their offered functionalities to support the teams. This was used to build a Virtual Organisation (VO) [3, 4] around a patient which facilitates patient-centric care. Moreover, the VO virtually integrates the data from legacy systems and ensures its availability (as needed) at the different treatment stages along the care pathway. Implications of the proposal include: formalising the treatment process, filtering and gathering the patient’s information, ensuring care continuity, and pro-acting to change. Evaluation of the proposal involved three stages; First, usefulness evaluation by the healthcare providers representing the users; Second, setup evaluation by developers of CISs; and Finally, technical evaluation by the community of the technology. The evaluation proved; the healthcare providers’ need for an adaptive and a proactive system, the possibility of adopting the proposed system, and the novelty and innovation of the proposed approach. The research proposes a patient-centric system achieved by creating a version of an ICP in the system for each patient. It also provides focussed support for team communication and care coordination, by identifying the treatment stages and providing the care team requirements at each stage. It utilises the data within the legacy system to be proactive. Moreover, it makes these required data for the actions available from the running legacy system which is required for patient-centred care. In the future the worth could be extended by mapping other ICPs into the system. This work has been published in four full papers. It found acceptance in the health informatics community [5, 6, 7] as well as the BPM community [8, 9]. It is also the winner of the 2011 “Global Award of Excellence in Adaptive Case Management (ACM)” in “Medical and Healthcare” [10] of the Workflow Management Coalition (WFMC) [11].
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Debbage, Samantha D. „Do integrated care pathways improve patient outcomes?“ Thesis, University of Sheffield, 2009. http://etheses.whiterose.ac.uk/14949/.
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The purpose of the study was to determine if the use of an Integrated Care Pathway (ICP) was associated with more positive outcomes than traditional methods of care. The effectiveness of the ICP had not previously been tested (in relation to traditional methods of care) to determine if it made any difference, at a patient, staff or system (healthcare organisation) level. In February 2001 (as part of the NHS modernisation agenda) the gynaecology services within one UK city were re-organised and two separate units were merged into one new larger unit. Prior to the reorganisation, the two units offered similar treatments and were managed collectively; however, one site had developed and implemented ICPs and the other site had continued to use traditional methods of care delivery. ICPs are multidisciplinary plans for organising and delivering patient care. The plan of care is outlined in a sequential manner including all interventions with expected patient outcomes. The literature suggests that ICPs result in improved patient outcomes and lower hospital costs by decreasing length of stay and improving observations i.e. detecting signs of infection in a timelier manner. ICPs are recognised to facilitate the multidisciplinary partnerships in planning of patient care. However the literature was primarily anecdotal or non generalisable, and therefore additional local research was deemed essential. To ensure the research problem could be answered, three specific research questions were developed for testing: (1) What effect does an /~ / ICP have on the outcomes of gynaecological patients attending for major abdominal surgery? (2) What factors, including the use of an ICP contribute to the variance in length of stay for gynaecological patients? (3) What are the opinions of the staff who have used the ICP, of the ICP itself? Relevant directional hypothesis were derived from each research question. A quasi-experimental design was used to answer the first research question. Subjects were attached to one of two groups, a treatment group, which used the ICP, and a comparison group, which continued to deliver care based on traditional methods. Descriptive correlation was used to answer research question two and for the third research question descriptive exploration was used. Variables of interest from a patient, staff and system (health care organisational) level were collected to determine the effectiveness of the ICP compared with traditional methods. One of the difficulties faced with ICP research is the number of variables that can potentially influence patient care. Holzemer's model (1994, based on the work of Donabedian, 1966) was used to conceptualise the variables (and therefore the data collection instruments) into the category of structure, process or outcome at either a patient, provider or systems (health care organisation) level. This in turn helped to theorise the linkage between the variables within this study, identifying conceptual and functional relationships. The abdominal surgery ICP supported improvements in cost and efficiency through a reduction in length of stay (treatment site = 5.29 days, comparison site = 6.16 days) and a positive return to patients' perception of health. However, there was a reduction in patient satisfaction with nursing care with the introduction of the ICP and this needs further study. Involving patients in future developments and evaluations could promote long-term patient satisfaction.
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Hall, Julie. „Using integrated care pathways in mental health care : a case study“. Thesis, University of Nottingham, 2010. http://eprints.nottingham.ac.uk/12749/.
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Background: Integrated Care Pathways (ICPs) are prearranged processes of care which are being increasingly used to deliver mental health services. The literature reveals difficulties in their development and implementation, and a lack of empirical evidence to support their use. Aims: The aim of this research was to investigate how an ICP has been used to manage mental health care in one selected mental health Trust in England. Methods: A case study approach was adopted with several units of analysis. The views of healthcare professionals using semi structured interviews; the experiences of service users and carers using focus groups; contrasting hospital episode and performance statistics with a comparison Trust and documentary analysis of the ICP. Findings & Discussion: Of the healthcare professions, only nurses used the ICP. No professionals used the ICP to support clinical decision making and risk management. However, just over two-thirds (67.2%) of the interventions described in the pathway were delivered. There was no statistically significant difference when comparing performance indicators for an equivalent episode of care between the ICP Trust and non ICP Trust. Service user and carers' experiences revealed that peopled did not feel that their care was individualised to them, although amongst them they had different perceptions of the care process. Conclusions: Mental health ICPs need to reflect the relationships between stakeholders, variability of illness and individual ways of living if they are to provide a framework for managing care in the future that accords with the needs of people using mental health services.
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O'Brien, Sarah Victoria. „Impact of care pathways on the care of people with diabetes mellitus“. Thesis, University of Liverpool, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.428994.
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This thesis aimed to develop care pathways for the management of in-patients and outpatients with diabetes in an acute NHS Trust, to review the evidence-base for existing care pathways and to evaluate the impact of care pathways on the management of in-patients with diabetes and patients with Diabetic Nephropathy. A comprehensive literature review (using the principles of a systematic review) was completed to determine whether care pathways improved the management and or outcome of hospital in-patients with a medical or surgical condition. From this review it appears that the main potential benefits associated with the introduction of a care pathway are a reduction in length of stay, reduced costs and possible improvements in the quality of patient care. However, these findings are limited because of the poor methodology used in all of the papers reviewed and there is a need for more robust research concerning care pathways. This work has provided a systematic process for developing diabetes care pathways and examples of diabetes care pathways that could be used and adapted by other clinicians managing patients with diabetes. A randomised controlled trial examined the impact of the in-patient diabetes care pathway on HbA1c, length of stay, re-admissions within 12 months, nurse knowledge and the quality of in-patient care. In terms of the primary endpoint of HbA 1c, the null hypothesis cannot be rejected as there was no difference between the study groups. In the main, secondary endpoints improved, but limitations in the design and execution of the study preclude excessive weight being attached to these findings. Furthermore, completion of the care pathway was poor and sustaining its ongoing use outside of a research study may be difficult, further work is needed to assess the cost of wider implementation of this care pathway. A care pathway-driven Diabetic Nephropathy service was developed, implemented and evaluated to examine whether it resulted in improvements in the management of Diabetic Kidney Disease (DKD). The results demonstrated successful implementation of six key evidence-based interventions for DKD and more importantly both surrogate and hard endpoints were comparable to those achieved in recent large clinical trials, in particular, the rate of doubling of serum creatinine, progression to End Stage Renal Failure and Death. This thesis demonstrates that in some circumstances care pathways can improve implementation of evidence-based diabetes care and lead to improvements in patient outcomes. Care pathways appear to be particularly useful when used by a dedicated, appropriately trained team dealing primarily with one condition, and can be an effective tool for the implementation of evidence-based diabetes care. Further work examining the impact of care pathways in all areas of health care would be useful.
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Seaton, Sarah Emma. „Modelling neonatal care pathways for babies born very preterm“. Thesis, University of Leicester, 2018. http://hdl.handle.net/2381/41212.
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Predicting length of stay in neonatal care is important for resource planning and the counselling of parents. However, it has received limited attention and two issues are: 1. Babies who die in neonatal care are not included appropriately and research should consider all babies simultaneously, irrespective of whether they live or die 2. The different levels of neonatal care (intensive, high dependency and special care) and how they contribute towards overall length of stay have not been considered This thesis contains four inter-connected studies to investigate how statistical approaches can help to address these issues. Firstly, a systematic review was conducted to identify factors commonly used to predict length of stay and mortality. Factors measurable at or around birth, such as gestational age and birthweight, were found to be important. Secondly, competing risks methods were used to predict median length of stay in neonatal care for two competing events: babies who survive to discharge and babies who die before discharge. These estimates can be used by clinicians, with their clinical judgement, to counsel parents about the risk of mortality and about potential length of stay. The third study develops this approach to account for the different levels of care received by the baby, using multistate modelling as a natural extension of the more limited competing risks approach. Mean lengths of stay at each level of care were estimated in order to facilitate commissioning of neonatal services. Finally, the differences in length of stay between Operational Delivery Networks, (groups of neonatal units that work together) were investigated to determine if differences existed. These were examined to understand whether differences were due to varying levels of intensity of specific levels of care within a network or a difference in total length of stay.
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Chiu, Chim-keung, und 趙漸強. „Pathways to care: help seeking pattern of thepeople with early psychosis“. Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B43895244.
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Horne, David. „Pathways into psychiatric care : user characteristics, settings and the referral process“. Thesis, London South Bank University, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.305150.
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The thesis grew out of the recognition that there is a dearth of information on the users of mental health services. It set out to describe the characteristics of users across a range of health settings and to consider the role of such characteristics in the mental health referral process. The early phases of this research project were strongly influenced by a model of the referral process developed by Goldberg & Huxley (1980). They conceptualized users of health care existing on 5 levels ranging from people living in the community to users in hospital. Hypothetical filters are said to operate between each level to govern who is referred on to the next level of services. This research project borrowed the notion of filters and their arrangement of services in a referral sequence. However, the focus of this research is on the characteristics of users, and not the detail of the filters per se. What is described is the effect of the referral process not the mechanism. This thesis also moves substantially beyond the five settings in the Goldberg & Huxley model to produce a uniquely comprehensive analysis of the users of all the main mental health care providers in one health district. The research project uses a wholly quantitative methodology. The challenge has been to design a range of compatible survey forms to collect data in seven separate study settings, to collate information on over one thousand one hundred users, to describe the user profiles in each study and to develop a comparative analysis of users across a range of settings. The emphasis throughout has been to align the research with contemporary developments in health care policy, and as the project has progressed, to make a practical contribution to the important debate about information systems in mental health service planning. The thesis has been divided into four parts. Part I introduces and sets the context of the research, and describes the methodology. In seven chapters, Part II of the thesis reports the .findings of each of the seven study settings. Part III of the thesis reports the demographic and utilization characteristics comparatively across all the study settings. The conclusions of the thesis are reported in Part IV of the thesis, where the theoretical, research and policy implications are discussed.The research project makes a contribution to knowledge on 4levels. Firstly, it identifies and describes the characteristics and the typical profiles of mental health service users in a range of study settings, in one area. Secondly, it identifies the differences between users in each study setting. Thirdly, it identifies the overlap in use of one service and another. It is argued that the findings have profound implications for both developing a clearer picture of the referral processes and for highlighting for planners, producers, and providers possible complementary or inefficient service utilization patterns. On the fourth and macro level, this research project has developed a revised model of mental health service referral routes. This model provides a framework for further investigation, and has potential as a planning tool in and beyond the geographical boundaries of the current study area.
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Bergquist, Adam. „Evaluation of the pathways palliative care program at the Denver hospice“. [Denver, Colo.] : Regis University, 2008. http://165.236.235.140/lib/ABergquist2008.pdf.
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Hines, Dana D. „Social patterns and pathways of HIV care among HIV-positive transgender women“. Thesis, Indiana University - Purdue University Indianapolis, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3730539.
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Transgender women have the highest HIV prevalence rates of all gender and sexual minorities, yet are less likely to enter and be retained in HIV care. As a result, they are at high risk for HIV-related morbidity and mortality. This study aimed to describe the illness career of transgender women living with HIV and to describe how interactions with health care providers and important others influenced their illness trajectory. The findings are a theoretical model that includes four stages: Having the world come crashing down, shutting out the world, living in a dark world, and reconstructing the world. Relationships within the social network (family, friends, and romantic partners) and the network of health care providers provided the context of the women’s illness careers. Pivotal moments marked movement from one phase to the next. Having the World Crashing Down was the first stage that occurred when the participants were diagnosed with HIV. They felt that their lives as they knew them had been destroyed. They indicated that the “whole world just shattered” the moment they found out they had HIV. Shutting Out the World occurred next. During this stage, many participants experienced withdrawal, denial, social isolation and loneliness. As they struggled with their diagnosis, they often avoided HIV care and avoided contact with important others. During the third stage, Living in a Dark World, participants descended into a dark phase of self-destructive life and health-threatening behaviors following their diagnosis. During the fourth stage, Reconstructing the World, participants began to reestablish themselves in the world and found new ways to reengage with important others and resume meaningful life activities. Findings confirm that the illness careers of HIV-positive transgender women are influenced by the social context of the health care setting and interactions with health care providers and important others.
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Sayal, Kapil Sen. „Pathways to care in children at risk of attention deficit / hyperactivity disorder“. Thesis, King's College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.412339.
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Cuevas, Penelope H. (Penelope Huggins). „Visualizing the conversation pathways of telephone linked care in a directed graph“. Thesis, Massachusetts Institute of Technology, 2009. http://hdl.handle.net/1721.1/54458.
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Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2009.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 12).
Telephone linked care (TLC) is a telehealth intervention that has been shown to be effective in a variety of clinical settings. TLC is an interactive computerized telephone system. The system 'speaks' to patients, asking them questions and understanding their responses. There is logic built into the calls, so that a patient's response to a question will dictate the next question that is asked. This serves to personalize the call for each patient, and makes the conversation more realistic. All of the patients' responses are stored in a database. This database provides much opportunity for analysis because a single phone call contains many responses. Visualization is an important way of gaining insight into data. Visualization can make data easier to understand and process. Different aspects of data can be encoded in a visualization. The TLC data lends itself to visualization. By viewing each of the questions that the system asks as nodes, and connecting the nodes by the chronological order in which these questions are asked, a tree structure will reveal the conversational paths that are taken in the calls. By combining data from multiple calls and encoding them in this tree structure, new insights can be gained into the TLC data. For example, the frequency with which questions are answered in a particular way can be encoded to reveal the most common pathways through the tree. This paper describes a visualization application of TLC data which will allow researchers to gain new insights into the TLC conversations and into medical interviews in general.
by Penelope H. Cuevas.
S.M.
15
Chiu, Chim-keung. „Pathways to care : help seeking pattern of the people with early psychosis /“. Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B43895244.
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Shelmerdine, Sarah. „Pathways to inhumane care : medical culture in a South African emergency unit“. Doctoral thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11385.
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Includes bibliographical references (leaves 268-287).While a comprehensive set of laws and ethical guidelines legally protects patients and promotes their access to good quality health care, inhumane and abusive medical practices have, nevertheless, been documented internationally. A large and varied body of work documents multiple aspects of medical culture.
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Zulkepli, Jafri. „A theoretical framework for hybrid simulation in modelling complex patient pathways“. Thesis, Brunel University, 2012. http://bura.brunel.ac.uk/handle/2438/6448.
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Providing care services across several departments and care givers creates the complexity of the patient pathways, as it deals with different departments, policies, professionals, regulations and many more. One example of complex patient pathways (CPP) is one that exists in integrated care, which most literature relates to health and social care integration. The world population and demand for care services have increased. Therefore, necessary actions need to be taken in order to improve the services given to patients in maintaining their quality of life. As the complexity arises due to different needs of stakeholders, it creates many problems especially when it involves complex patient pathways (CPP). To reduce the problems, many researchers tried using several decision tools such as Discrete Event Simulation (DES), System Dynamic (SD), Markov Model and Tree Diagram. This also includes Direct Experimentation, one of techniques in Lean Thinking/Techniques, in their efforts to help simplify the system complexity and provide decision support tools. However, the CPP models were developed using a single tools which makes the models have some limitations and not capable in covering the entire needs and features of the CPP system. For example, lack of individual analysis, feedback loop as well as lack of experimentation prior to the real implementation. As a result, ineffective and inefficient decision making was made. The researcher also argues that by combining the DES and SD techniques, named the hybrid simulation, the CPP model would be enhanced and in turn will help to provide decision support tools and consequently, will reduce the problems in CPP to the minimum level. As there is no standard framework, a framework of a hybrid simulation for modelling the CPP system is proposed in this research. The researcher is much concerned with the framework development rather than the CPP model itself, as there is no standard model that can represent any type of CPP since it is different in term of its regulations, policies, governance and many more. The framework is developed based on several literatures, selected among developed framework/models that have used combinations of DES and SD techniques simultaneously, applied in a large system or in healthcare sectors. This is due to the condition of the CPP system which is a large healthcare system. The proposed framework is divided into three phases, which are Conceptual, Modelling and Models Communication Phase, and each phase is decomposed into several steps. To validate the suitability of the proposed framework that provides guidance in developing CPP models using hybrid simulation, the inductive research methodology will be used with the help of case studies as a research strategy. Two approaches are used to test the suitability of the framework – practical and theoretical. The practical approach involves developing a CPP model (within health and social care settings) assisted by the SD and DES simulation software which was based on several case studies in health and social care systems that used single modelling techniques. The theoretical approach involves applying several case studies within different care settings without developing the model. Four case studies with different areas and care settings have been selected and applied towards the framework. Based on suitability tests, the framework will be modified accordingly. As this framework provides guidance on how to develop CPP models using hybrid simulation, it is argued that it will be a benchmark to researchers and academicians, as well as decision and policy makers to develop a CPP model using hybrid simulation.
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Counihan, Kate. „Analysis of care pathways of children who present with an avulsed permanent tooth“. Thesis, University of Leeds, 2013. http://etheses.whiterose.ac.uk/5515/.
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This thesis, examining care pathways of children who present with an avulsed permanent tooth, is divided into four parts. Chapter 1 presents a literature review, which looks specifically at the aetiology and treatment of tooth avulsion injuries. There is also a short review on the costs, both direct and indirect, associated with treating tooth avulsion injuries Chapter 2 investigates data sources for the prevalence of tooth avulsion injuries in the Yorkshire region. Two major sources of epidemiological data on child dental health are available in the UK, decennial and annual surveys. Decennial surveys have been run in England and Wales since 1973 and in the whole of the UK since 1983 whilst the annual NHS Dental Epidemiology Programme was started in 1985 and is now run by Local Authorities. It surveys five-year-olds every other year, and older children in intervening years. The 2003 Child Dental Health Survey reported data on accidental damage to teeth but only unpublished data on traumatic damage to teeth is available from the 2008/2009 NHS Dental Epidemiology Programme surveys of 12-year-olds. This was obtained from The Dental Observatory for the purpose of this thesis. On examining the data neither survey was able to provide accurate information on the prevalence of tooth avulsion injuries in our child population. This lack of information potentially complicates the local commissioning of healthcare services, if this is to be based on the available epidemiological data. Chapter 3 investigates the experience of Yorkshire dentists’ in relation to the management of avulsed permanent incisors. The study was designed as a selfcompletion postal questionnaire of a random sample of dentists working in primary care in the Yorkshire region. A response rate of 59.7% was achieved. Thirty nine per cent of respondents had replanted an avulsed permanent tooth. The replantations took place most often in the primary dental care services. Almost forty per cent of all respondents currently have a child who has sustained an avulsion injury on review. Many dentists in the Yorkshire region have limited experience of treating children with avulsed permanent teeth. A significant percentage currently has children with avulsion injuries under their care. Current guidance advises an early specialist multi-disciplinary team consultation for children following an avulsion injury. Chapter 4 investigates parents’ experiences of accessing emergency and follow-up care for their child following a tooth avulsion injury. This study used a qualitative approach and semi-structured interviews were undertaken to explore on how parents access emergency and follow-up care. Eight parents attending the Leeds Dental Institute were recruited to the study using purposive sampling. The framework analysis approach was used to analyse the data. Two core concepts of knowledge and access were inferred from the analysis. Parents found it difficult to access emergency dental care for their child. The knowledge of the parents, laypeople at the site of the accident and health care professionals involved in providing the emergency care had a direct impact on how emergency care was accessed. Accessing follow-up care proved more straightforward in our sample as could be expected from a cohort attending a tertiary service. A further core concept of emotion was also evident – parents were distressed by what happened to their child and also frustrated and disappointed with the difficulty in accessing emergency care. The final chapter presents the conclusions of this research, together with some recommendations for further work.
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Schofield, Gillian. „The experience of growing up in foster care : pathways from childhood to adulthood“. Thesis, University of East Anglia, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.247202.
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This study is an investigation of long-term foster care, which focuses on the reflections of 40 adults, aged 18-30, who grew up in foster families. The theoretical approach taken is developmental and the study draws on theories of attachment and resilience. The research method was qualitative. In-depth interviews were conducted, transcribed and analysed in order to generate a picture of the pathways taken through childhood and into adult life. The primary focus of the interviews was on family relationships and the development of the self, but relationships with peers, school experiences and practice relevant issues, such as what it meant to be `in care', the experience of stigma and the role of social workers, were also discussed. The analysis used the dimensions of placement continuity, the quality of family relationships and the nature of family membership to identify seven different pathways. The data suggests that although the development of secure emotional relationships is an important part of successful placement experiences, the development of a sense of family membership is also highly significant, particularly in adult life. In a psychosocial model of long-term foster care, a `secure base' can therefore be understood in attachment terms as an emotional resource, but can also be understood in a more social context, as providing a family identity and a place in society. The study concludes that foster families where there are no biological or legal ties can still be a form of permanent family placement. This has important implications for social work practice, both in the way in which placements are planned and in the importance of promoting continuity into adult life of relationships which officially end when a child leaves care. It requires a change in attitudes, so that long-term foster families are no longer treated as placements for childhood only, but are recognised as offering a home and a family for life
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Kwan, Joseph Shiu Kwong. „Integrated care pathways for acute stroke : an evaluation of their effects using multiple approaches“. Thesis, University of Edinburgh, 2003. http://hdl.handle.net/1842/24798.
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Methods and results: I sought to evaluate the effects of ICPs for acute stroke using four approaches: 1) Assessment of the evidence from previous studies of ICPs for non-stroke conditions: I performed a review of the recent literature and found that there were a large number of randomised and non-randomised studies of ICPs for non-stroke conditions. Positive, neutral and negative findings have been reported. 2) Assessment of the evidence from previous studies of ICPs for acute stroke: I performed a Cochrane systematic review and found three randomised trials and seven non-randomised studies. There were substantial heterogeneity between the studies and most of the evidence came from non-randomised studies. I found that ICP care may significantly improve the process of care and reduce in-hospital complications, but patient satisfaction and quality of life may be lower. 3) Undertaking of a non-randomised study of the ICP introduced for acute stroke at the Western General Hospital (WGH): I performed a before-and-after study (total of 351 patients) to assess the effects of introducing an ICP in a stroke unit. I found that, after its introduction, there were significant improvements in the quality of documentation and certain aspects of patient care, and the risk of urinary tract infection was reduced. However, there was no significant difference in death or discharge destination. I also assessed in the process of care and outcomes between stroke unit care after the introduction of the ICP and general medical ward care (total of 285 patients). The results were consistent with those of the before-and-after study. 4) Undertaking of a questionnaire survey to assess the experience of the stroke unit staff regarding the use of the ICP for acute stroke at the WGH: I found that, when the ICP was first introduced, the staff expected the ICP to improve the process and quality of care, communication and the general working environment. I repeated the survey at seven months after its introduction and found that, although certain aspects of care were felt to have improved, many of the staff’s expectations were not realised.
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Easton, Phyllis. „Exploring the pathways to poor health in the 'hidden population' with low literacy“. Thesis, University of Dundee, 2011. https://discovery.dundee.ac.uk/en/studentTheses/b87ea302-9fdb-4cdf-9243-4d70b1991a4d.
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Low literacy remains a problem across the developed world. Health literacy has emerged as a specialist literacy, although its conceptualisation and measurement overlap with those of functional literacy. The social practice view, which conceptualises literacy as an activity rather than a skill, is useful in examining literacy-related practices and demands in healthcare contexts. Associations between low functional or health literacy and poorer health outcomes have been established in the research literature but studies have included participants whose low literacy may be obvious to healthcare providers and others. This thesis presents first a systematic review that focuses on literacy and health outcomes in the ‘hidden population’ with low literacy, defined as those of working age whose first language is that of their resident country but who score low on literacy measures. The review concludes that there is a link between low literacy and poorer health in this ‘hidden population’ but that potential pathways have not been explored to any extent. The thesis then presents a primary research study which sought to explore links between low literacy and poor health from the perspectives of people with low literacy; and how the health service might respond to address the issues raised. The findings from 25 in-depth interviews and 2 focus groups with adult learners highlighted the various ways that people with low literacy struggle with written and spoken communication in clinical encounters and in self-care activities. They further revealed that stigma frequently plays a central role in the social practices of those with low literacy, affecting their mental wellbeing and social relationships, including those with healthcare staff. The potential solutions identified for service providers would benefit from piloting and evaluation to help create a literacy-sensitive health service, which could improve engagement; enable self-care and enhance capabilities for health in those with low literacy.
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Greeson, Johanna K. P. Usher Charles L. „Natural mentor relationships among young adults with foster care experience pathways to emerging adulthood outcomes /“. Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2009. http://dc.lib.unc.edu/u?/etd,2613.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2009.Title from electronic title page (viewed Oct. 5, 2009). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the School of Social Work." Discipline: Social Work; Department/School: Social Work.
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Hassiotis, Angela. „Prevalence of psychopathology and pathways to care in adolescents with intellectual disabilities : a population study“. Thesis, University College London (University of London), 2004. http://discovery.ucl.ac.uk/1446638/.
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Background: Adolescents with intellectual disability (ID) and mental health problems are a distinct group with particular difficulties, which need to be addressed. Despite the many studies available on the prevalence of mental health problems in children with intellectual disabilities, very few studies have investigated the prevalence of such disorders in adolescents with ID. Furthermore, there is little information about service provision for this specific age group. Aim: To investigate the prevalence and presentation of mental health problems in adolescents with intellectual disability in a geographically defined catchment area (West Essex) and to explore the pathways to care available to these adolescents and to their parents. Method: A cross sectional survey of adolescents aged 12-19 years old was undertaken. The participants were recruited from a wide range of specialist and community services. Structured interviews were conducted with adolescents and their carers and where possible their teachers. A social and health care proforma was also completed. Results: 75 adolescents were seen in total. The majority (42) had severe/profound intellectual disability. 24% had a history of epilepsy/seizures and 10% cerebral palsy. 50.7% (38/75) had a mental health problem as reported by parents but that increased to 66.7% (50/75) following a clinical assessment. The commonest ICD 10 diagnoses were conduct disorder (21.4%), atypical autism (16% ) and hyperkinetic disorder (14.7%). There was moderate agreement between parental reports and clinical diagnoses (kappa=0.51). Caseness was predicted by low levels of adaptive functioning, diagnosis of autism and family history of mental illness. Significant negative correlations were found between subdomain scores of the Vineland Adaptive Behaviour Scale and the Developmental Behaviour Checklist. In terms of service utilisation, the majority of the participants (94.7% of total sample) were in receipt of health and social care. Almost halt of all visits to General Practitioners in the past year were due to the parent seeking help for the young person's behavioural problem. 15% of the adolescents seen were receiving psychiatric medication. Conclusion: Prevalence rates for mental health problems in adolescents with intellectual disability are high. Adolescents with a diagnosis of autism and low level of adaptive skills appear to be more vulnerable in developing such disorders. Parents and primary health care providers will need targeted mental health promotion and education to recognise problems early and to seek specialist help. Services should co-ordinate their referral and assessment processes in order to meet current and future needs, particularly at the time of transition.
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Bhattacharya, Abhik. „Development of a framework to identify patient pathways through a segment of the health care cycle“. [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0002866.
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Duarte, Anette. „Standardvårdplaner – till vilken nytta?“ Thesis, Halmstad University, School of Social and Health Sciences (HOS), 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-5836.
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Standardvårdplaner är vanligt förekommande inom hälso- och sjukvård och är under ständig utveckling. Standardvårdplaner är i olika grad evidensbaserade och framtagna med skiftande kvalitet. Standardvårdplaner används som ett hjälpmedel för effektivisering och kvalitetshöjning av vården för en specifik patientgrupp och är en på förhand formulerad vårdplan. Behov av ytterligare forskning efterfrågas om standardvårdplaner faktiskt minskar mängden dubbeldokumentation, leder till ökad tidsvinst och ökad vårdkvalitet. Syftet med föreliggande litteraturstudie var att göra en beskrivning av de effekter som användande av standardvårdplaner leder till. I litteraturstudien bearbetades 10 vetenskapliga artiklar som grund för resultatredovisningen. Resultatet visar att standardvårdplaner kan höja vårdkvaliteten, minska mängden dubbeldokumentation och leda till att tid frigörs till patientnära arbete. Det finns emellertid studier som visar på det motsatta. Standardvårdplanen kan ses som ett verktyg som underlättar en jämlik, högkvalitativ vård till alla patienter oavsett vem som vårdar. Utveckling av standardvårdplaner i vården bör ske på ett strukturerat och vetenskapligt sätt och tid till detta bör prioriteras. Litteraturstudien redovisar motstridiga resultat vilket indikerar behovet av fortsatt forskning av vilka effekter standardvårdplaner har för vården, både sett ur patientperspektiv, personalperspektiv samt ur ett organisatoriskt perspektiv.
Standardized care plans are commonly used in health care and are under constant development. Standardized care plans are to varying degrees evidence-based and designed with varying quality. Standardized care plans are used as a tool for improving the quality of care and are seen as a pre-formulated treatment plan. Research is needed into whether standardized care plans reduce the amount of redundant documentation, save time and increase quality of care. The aim of this literature study was to describe the situation regarding effects of using standardized care plans. In this study 10 scientific articles were analyzed. Results show that standardized care plans can improve quality of care, reduce redundant documentation and decrease time spent on documentation. However, there are studies that demonstrate the opposite. Standardized care plans can be seen as a tool for providing high-quality basic care for all patients. Scientific evidence should be used for development of standardized care plans and therefore priority should be given to making resources for this work available. There is a need for further research to validate the effects of standardized care plans as the results from this literature study are ambiguous. It would also be interesting to compare the views from patients, staff and management on the effects of using standardized care plans.
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Sampson, Anna. „Ethnic variations in pathways to care, treatment delay and short-term outcome in early onset psychosis“. Thesis, University of Sheffield, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.489092.
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This review seeks to clarify issues and review evidence on ethnicity and mental health care access as shown in studies over the last five years. The results indicate that access to specialist mental health services remains largely negative and aversive for minority ethnic groups. Barriers to service access are high levels of socio-economic disadvantage, cultural and institutional exclusion as well as cultural attitudes and beliefs towards mental health problems. Methodological limitations, clinical implications are discussed and recommendations for future research are made.
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Brunet, Katerine F. „Treatment delay in first-episode psychosis : service configuration, pathways to care and the psychology of help-seeking“. Thesis, University of Birmingham, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.410883.
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Wieteck, Pia. „Validierung von Pflegediagnosen der Pflegeklassifikation ENP (European Nursing care Pathways) : crossmappings von ENP mit ICNP und NANDA /“. Bad Emstal : RECOM, 2008. http://d-nb.info/990746658/04.
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Champion, Susan. „Exploring the pathways into care for young people ages 14 - 35 years with a first episode psychosis“. Thesis, University of Essex, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.437663.
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Melluish, Stephen. „Masculinity and psychological help-seeking : a qualitative study of men's pathways into psychological help in primary care“. Thesis, University of Leicester, 2002. http://hdl.handle.net/2381/31340.
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The research describes a qualitative investigation of men's pathways to seeking psychological help. A total of seven men were interviewed using a semi-structured interview schedule. Qualitative data was analysed using grounded theory. One core category 'distancing' emerged from the analysis. This theme reflects the way in which men distance themselves from their distress and attempt to preserve a public appearance of coping. This general theme is reflected in five higher order categories that were also identified. These include: preserving a public identity; separating problems from self; crisis as disconnection; use of lay networks and self in psychological help. These themes are discussed in relation to men's pathways into psychological help and the network-episode model of help-seeking is revised to take account of these themes. Findings are discussed in relation to the relevant literature on help-seeking and masculinity. Recommendations for further research are made.
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Chiyaka, Edward Tafumaneyi. „Effectiveness of the Pathways Community Hub Model in Reducing Low Birth Weight Among High-Risk Pregnant Women“. Kent State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=kent1564765507539083.
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Grubnic, Suzana. „The social construction of care pathways : a nursing management initiative towards operationalising continuous quality improvement in a children's hospital“. Thesis, University of Derby, 2000. http://hdl.handle.net/10545/227118.
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The literature is dominated by prescriptive accounts of the application of Continuous Quality Improvement and care pathways in the acute hospital services sector. The authors assume that the organisation is a designed artefact (Scapens, Otley and Lister, 1984): goals can be achieved. This thesisr eports on the nature, processa nd consequenceso f a Nurse Manager introducing care pathways in a Children's Hospital It believes, in opposition to the conventional view, that the organisation is a culture. The actions and interactions of individuals and groups shape initiatives. This is within context and within time. The research investigation was conducted over a twenty-five month period, from February 1996 to April 1998. It was ethnographic in nature. Interviews were conducted with managers, nurses and doctors, formal meetings and activity in the Children's Emergency Department observed, and documentation collected. The findings are, however, presented from the nurses' perspective using their words. Files for newspaper clippings were created and maintained. The thesis contributes to the literature in three ways. In the main, it represents the first contextual and critical account of the implementation of care pathways than that believed to be contained in the literature. Further, it purposefully utilises for the first time two conceptualf rameworks in order to explicate the changep rocessesin the Children's Hospital. These are Watson's (1994) Strategic Exchange Perspective and Dawson's (1994) Processual Framework. It presents the descriptive part of the findings in the form of a narrative. The Nurse Manager established a project to multiskill experienced nurses in the diagnosis and treatment of minor conditions using care pathways as the vehicle. Her role changed during the process of implementation, but the project had little, if no, impact on power structures between and decision making of doctors and nurses
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Balfour, Liezl. „Implementation and evaluation of a clinical pathway for non-invasive ventilation in critical care : a person-centred practice development approach“. Thesis, University of Pretoria, 2020. http://hdl.handle.net/2263/79586.
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Introduction: Non-invasive ventilation (NIV) is an alternative method for
providing safe mechanical ventilatory assistance to adult patients
presenting with acute respiratory failure. Internationally the utilisation of
NIV has increased by 400% during the past decade. The clinical pathway
for NIV was collaboratively developed by the multidisciplinary team in the
critical care unit in 2012, but implementation into practice did not realise
as anticipated. As the burden of chronic disease rises in South Africa, the
healthcare system is under pressure to provide evidence-based and costeffective
care to more patients. Avoiding endotracheal intubation reduces
the patient’s risk of complications which lengthens the hospitalisation
period and the cost of hospitalisation. The utilisation of clinical pathways
in the South African context is limited.
Aim: The overall aim of the study was implementation and evaluation of
the outcomes of a person-centred clinical pathway for non-invasive
ventilation in the critical care unit.
Research methodology: Mixed method design through a personcentred
practice development approach utilising emancipatory action
research. Several data collection methods are used throughout the
phases of the study. A critical realist worldview was held which
incorporated the principles of a person-centred approach through
collaboration, inclusion and participation. The study was conducted in
three interdependent and interrelated phases. During Phase 1, the
culture of the critical care units was assessed using a validated 37-item
questionnaire to establish the perceptions of the critical care nurses
related to evidence implementation. A total of twenty-three registered
nurses participated. Additionally, the content of the clinical pathway was
adapted following a rigorous literature review in collaboration with the
internal facilitators and validated via a Delphi with critical care experts.
Phase 2 was dedicated to the collaborative development of an implementation strategy for the implementation of the clinical pathway in
the critical care unit. During Phase 3, the outcomes of the implementation
of the clinical pathway for NIV was evaluated.
Findings: The collaborative utilisation of a person-centred practice
development approach for the implementation and evaluation of the
clinical pathway for NIV, aided the researcher in identifying moral injury
amongst critical care nurses, which inhibits the implementation of
research evidence into practice.Thesis (PhD)--University of Pretoria, 2020.
Nursing Science
PhD
Unrestricted
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Kucharski, Zuzanna. „Pathways of Women’s Empowerment: Global Struggle, Local Experience, A Case Study of CARE-International’s Women’s Empowerment Project in Zanzibar“. Thèse, Université d'Ottawa / University of Ottawa, 2014. http://hdl.handle.net/10393/31032.
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In the field of International Development, increased attention has been given to the concept of women’s empowerment as it has been recognized as a potential driver for change. Classified as a global struggle, commitments to this concept have been at the core of many development interventions, whether they be a small NGOs working in a single community or large-scale international aid agencies with presence all around the world. Despite its international recognition, women’s empowerment has been largely left unquestioned within development practices and especially with regards to the impact it may have on local beneficiary communities. This thesis will address how universal ideas such as this one become meaningful in the local setting through a case study of CARE-International’s Women’s Empowerment in Zanzibar project that was implemented from the years 2008-2011. In applying Sally Merry’s (2006) concept of vernacularization, as a theoretical framework, it will be shown that international aid organizations do not simply adapt women’s empowerment to the local arena. Instead, various local actors are involved in a dynamic process of translating, negotiating, and making the concept more meaningful to the beneficiaries and, thus, cause a new hybrid understanding of women’s empowerment to emerge. This new concept draws more extensively on local institutions, knowledge and practices that have been inter-weaved with Islamic practices which play an important role in the lives of Zanzibaris. This thesis will illustrate how NGO culture converges with and diverges from the local communities and expose the realities that exist within the greater development discourse.
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Morgan, Craig. „Beliefs about mental illness and pathways to care in African Caribbeans and whites with a first episode of psychosis“. Thesis, King's College London (University of London), 2003. https://kclpure.kcl.ac.uk/portal/en/theses/beliefs-about-mental-illness-and-pathways-to-care-in-african-caribbeans-and-whites-with-a-first-episode-of-psychosis(9c81a034-3619-4531-b4d3-06144e8ecd8b).html.
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Hutson, Malo. „Politics, jobs and workforce development : the role of workforce intermediaries in building career pathways within Boston's health care industry“. Thesis, Massachusetts Institute of Technology, 2006. http://hdl.handle.net/1721.1/37874.
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Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 2006.Includes bibliographical references (leaves 201-204).
This research study examines the role that workforce intermediaries within Boston play in creating career pathways for economically disadvantaged, under-skilled residents in the local health care industry. Using a case study analysis, this study compares the outcomes of two workforce intermediaries-one which is employer-led and the other which is led by a community development corporation. Despite the proliferation of new workforce intermediaries around the country and the increased amount of funding to support them from the private and public sectors, these institutions are limited in their ability to increase the supply of a skilled workforce and to change the demand-side of the labor market. However, given the current structural holes in the publicly funded workforce development system, workforce intermediaries play a critical role in serving populations who otherwise would have a difficult time entering into the regional labor market.
by Malo André Hutson.
Ph.D.
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Shai, Matlou Stephina. „An exploration of help-seeking pathways followed by patients seeking mental health care services in Polokwane-Mankweng Hospital Complex“. Thesis, University of Limpopo (Turfloop Campus), 2012. http://hdl.handle.net/10386/891.
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Thesis (M.A. (Clinical psychology)) --University of Limpopo, 2012A number of studies have indicated that help-seeking pathways followed by individuals suffering from mental disorders and other conditions of ill-health are not random, but are structured by a range of psychosocial and cultural factors. The quality and seriousness of the distress provide the impetus to the pathway, but its direction and duration is shaped by the convergence of psychosocial and cultural factors. This study explored the help-seeking pathways followed by patients receiving mental health care services in Polokwane-Mankweng Hospital Complex (PMHC) in Limpopo Province (South Africa). A qualitative approach was followed and participants were selected through purposive sampling. Ten participants (5 males and 5 females) who are receiving mental health care services at PMHC and were apsychotic at the time were recruited to the study. Data were collected using semi-structured interviews and analyzed using content analysis. The following psychological themes emerged from the study: participants’ subjective notions of the events or factors that could have led to their mental illness; their explanations of mental illness; the reasons for entering the mental health care system; the pathways they followed before receiving mental health services in the hospital; concurrent use of hospital mental health services and other services; their experiences of living with mental illness; and, the role of significant others in this regard. The study revealed that various agencies and providers of health care are visited by individuals suffering from mental illness and that there is also some evidence of concurrent use of these services, i.e., Western and African. The findings emphasize that help-seeking pathways are mainly determined by the perceived causes of the illness, which are derived from cultural ideologies.
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Humphrys, Elka Suzanne. „Understanding the pathways to oesophageal and stomach cancer diagnosis : a multi-methods approach“. Thesis, University of Cambridge, 2019. https://www.repository.cam.ac.uk/handle/1810/289397.
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Increasing symptom awareness, encouraging help-seeking, and facilitating timely referral are key for improving cancer outcomes, particularly for cancers such as oesophageal and gastric (stomach), where five-year survival is less than 20%. In this research, I used multiple methods to explore factors that influence timely diagnosis of these cancers from a patient's perspective, with a particular focus on health literacy (accessing, understanding and using health information, and navigating healthcare systems). I started by exploring current knowledge in this field before conducting a systematic review investigating health literacy in the timely diagnosis of symptomatic cancer. Literature was searched from January 1990-May 2017 using six bibliographic databases. I screened 2304 titles/abstracts, assessed 26 full-text papers and included three, although they were methodologically weak, therefore limiting the conclusions. To examine pathways to diagnosis for oesophageal and gastric cancer, I conducted a questionnaire study of newly diagnosed patients across two hospitals in the East and North East of England. 127 participants were recruited (39.6% recruitment rate), aged 44-96 (median 71); 102 male (80%). Most had oesophageal cancer (n=102, 80%); 64 (50%) of the total cohort were late-stage at diagnosis. Common pre-diagnostic symptoms varied between cancers (oesophageal: difficulty swallowing (n=66, 65%), painful swallowing (n=55, 54%); gastric: fatigue/tiredness (n=20, 80%), weight loss (n=13, 52%)). The questionnaire included two domains (engagement, understanding) of the Health Literacy Questionnaire with participants demonstrating high health literacy (mean 4.18 and 4.28, score 1-5). The median time from noticing the trigger symptom (prompting help-seeking) to diagnosis was 81 days (IQR 45-137.5, n=107). Twenty-six participants were purposively sampled, from questionnaire respondents, for face-to-face interviews (aged 55-88, 18 male, 15 with oesophageal cancer). I undertook thematic analysis to explore participant accounts of their pathways to diagnosis, identifying that the symptom nature was important for appraisal, while health literacy ability influenced the health system interval. Descriptions of 'heartburn', 'reflux' and 'indigestion' differed between participants, suggesting these terms may introduce uncertainty in relation to symptom experience. This is the first study to explore the role of health literacy in the timely diagnosis of symptomatic cancer, and pathways to diagnosis for oesophageal and gastric cancers, from a patient's perspective. Findings provide important insights for the development of targeted awareness campaigns and strategies enhancing GP symptom exploration.
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Åmlid, Håkon Olav. „We Need to Talk: A Qualitative Inquiry into Pathways to Care for Young Men at Ultra-High Risk for Psychosis“. Thesis, Örebro universitet, Institutionen för juridik, psykologi och socialt arbete, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-92706.
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A modern conceptualization of psychotic disorders is as neurodevelopmental disorders, with different stages characterized by discrete clusters of symptoms. This conceptualization includes a stage of pre-psychotic prodrome, a target of contemporary research as an attempt to intervene before the development of psychosis. However, these at-risk individuals rarely present to the mental health services before transitioning into psychosis, even more so for male patients. In this study, a method of inductive thematic analysis has been employed to inquire into the pathways to care for young men at Ultra-High Risk (UHR) for psychosis to gain knowledge of- and generate hypotheses about pathways to care for this group. Data was collected using semi-structured interviews (n = 9) over video conference or telephone. Three core-themes were developed as “Willingness to Disclose Distress”, “The Gatekeeping Confidant”, and “The Boiler”, with “Openness” as a core organizing category permeating the core-themes. Together, the themes represent findings on both the importance of relations in help-seeking, as well as how the young men commonly employ non-disclosure, and how this lack of openness delays pathways to care, often resulting in adversities for the participants. Findings provide implications for further inquiry into how to increase the likelihood of young men to disclose distress, as well as providing additional rationale for the development of Mental Health Literacy in the public to make peers as well as participants more able to recognize symptoms of the pre-psychotic prodrome, when, where and how to seek help.
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Pelletier, Lori Rebecca. „Information-Enabled Decision-Making in Health Care: EHR-Enabled Standardization, Physician Profiling and Medical Home“. Digital WPI, 2010. https://digitalcommons.wpi.edu/etd-dissertations/166.
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Health care today harms too frequently and routinely fails to deliver its potential benefits. Significant evidence suggests that high quality primary care can positively affect health outcomes. I explored three related topics mentioned frequently in current United States health reform €“ Electronic Health Records (EHR), physician profiling and Medical Home. An investment in these areas is expected to significantly improve quality of care and efficiency; however, there is only a patchwork of evidence supporting such claims. To achieve EHR promises, my research employed a standardization lens to study the dynamics between EHR embedded structures and primary care processes. Using grounded theory, a standardization dynamics model was created describing the influencers, conditions and consequences of the process state. A matrix of two conditions, information exchange and patient complexity, identified four distinct pathways that require a different balance between standardization and flexibility. The value of such pathways is that they frame choices about how to use embedded IT structures to support effective delivery processes. Physician profiling is an emerging methodology used in health care quality improvement programs. Efforts to measure performance at the individual physician level face a number of challenges, including the need for sufficient sample size to support reliable measurement. A process for creating a physician profiling model was developed, and a model designed for a case study site. Results indicate that reliable physician profiling is possible across care domains using a hierarchical composite model. Patient-Centered Medical Home (PCMH) is a new care delivery approach for providing comprehensive primary care that seeks to strengthen the physician-patient relationship. This exploratory study utilizes Pearson correlation coefficients to test four hypotheses about relationships between two sources of data: (1) PPC-PCMH Survey results that measure adoption of PCMH structures and (2) patient experience data from Massachusetts Health Quality Partners (MHQP). The results showed that the PPC-PCMH structures of access and communication were negatively correlated with the related patient experience measure. This study contributes to the literature by addressing deficiencies in how EHR-enabled processes, physician profiling models and Medical Home constructs are measured, to support improved outcomes.
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Amechi, Mauriell H. „Refusing To Settle for Less: Narratives of Self-Authorship among Foster Care Youth in College“. The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1367315599.
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Hajdarevic, Senada. „Patient and health care delays in malignant melanoma“. Doctoral thesis, Umeå universitet, Dermatologi och venereologi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-54392.
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Background: Unlike other cancers, malignant melanoma (MM) is generally visible and can be easily and effectively cured if treated in time. Optimal cure of MM requires early detection, diagnosis, and treatment, which improves prognosis. However, patients as well as the health care organization and its professionals contribute to delayed treatment in various ways. Aims and objectives: The general aim of this PhD thesis was to explore reasons for delay in care seeking, diagnosis, and treatment of malignant melanoma. The specific objectives to be addressed were To explore patients’ decision making about seeking care for malignant melanoma To identify specific patterns in the decision-making process to seek care for suspect melanoma, as narrated by women and men To compare self-reported decision making coping styles between men and women in various ages, who live with or without a partner and are diagnosed with various stages of malignant melanoma in northern Sweden. To describe and compare patients diagnosed with MM, depending on their initial contact with care, and with regard to age, sex, and MM type and thickness, and to explore pathways and time intervals between clinics from the initial contact to diagnosis and treatment. Methods: In studies I and II, 21 and 30 patients, respectively, were interviewed about their decision making to seek care for MM. Study II focused on gender patterns in this decision making. The interviews were analysed using Grounded Theory (I) and qualitative content analysis (II). Study III included 270 people with MM who completed a translated questionnaire (Melbourne Decision Making Questionnaire) about coping styles in decision making. In study IV the pathways and time delay in health care for 71 people with MM were explored. Studies I and II were qualitative, whereas studies III and IV were quantitative. Results: In study I, the insights into severity and feelings of fear and existential threat were identified as key motivators for patients to decide to seek care for a suspected melanoma. Results in study II showed that gender constructions influenced the care-seeking behaviour. Women acknowledged the skin changes and attempted self-care first. They delayed care seeking due to family responsibilities. Men seldom acknowledged the suspicious skin change, but sought care immediately after prompting, and most often complied with relatives’ advice to seek care. Study III showed that men generally scored higher in buck-passing, while women and those living without a partner scored higher in hypervigilance. Participants with nodular melanoma (NM), a rapid-growing form of MM, scored higher in vigilance than those diagnosed as in situ melanoma. No correlation was found between tumour thickness and coping styles. Some differences concerning treatment of MM were found in study IV between people who initially had sought care at primary health care centres (PHC) and those who had sought care at dermatological and specialist clinics (Derm). Thicker tumours as well as NM were more common in the PHC group. A larger proportion of patients from PHCs were primarily excided within the primary health care; however, almost all of them were later referred to surgical clinics for wide excision. Patients within the PHC group also had to wait longer for the registered results of histopathological assessments. In general, women waited a shorter time for primary excision, and older people waited longer for wide excision. Conclusions: Time delay of diagnosis and treatment of MM is still common, and crucial to decrease. Future interventions should include gender aspects to influence people to seek care earlier. In health care, time delay could be decreased by facilitating access for patients with suspected skin melanomas, but also by reducing unnecessary referrals. Moreover, organizational changes whereby general practitioners and primary health care nurses are supported in using new technology for faster diagnoses and management of MM in collaboration with specialist clinics should be considered. Easy access and frequently used guidelines for MM could further decrease delay. Lastly, more efficient transfer and registration of laboratory results and referrals could decrease delay and improve patient safety.Bakgrund: Malignt melanom (MM) är till skillnad från andra cancerformer ofta synlig och kan enkelt och kostnadseffektivt botas om det behandlas i tid. En optimal prognos av MM förutsätter tidig upptäckt, diagnos och behandling. Patienter, samt hälso- och sjukvården, dess organisation och dess personal kan på olika sätt bidra till fördröjning av behandlingen av MM. Syfte: Det övergripande syftet med denna avhandling var att undersöka orsaker till fördröjning att söka vård, diagnosticera och behandla malignt melanom. Specifika delsyften var: Att utforska patienternas beslutsfattande process att söka vård för MM Att identifiera specifika mönster i beslutsfattande-processen att söka vård för misstänkt MM utifrån kvinnors och mäns egna berättelser Att jämföra självrapporterade coping-stilar i den beslutsfattande processen mellan män och kvinnor i olika åldrar, boende med eller utan partner, och diagnosticerade med MM i olika stadier från norra Sverige Att beskriva och jämföra patienter med MM utifrån deras primära vårdkontakt samt utifrån ålder, kön, MM-typ och tjocklek. Ytterligare att utforska vård- och remissvägar samt tidsintervaller mellan olika kliniker från första kontakt till diagnos och behandling. Metod: I studie I och II, intervjuades 21 respektive 30 patienter om den beslutsfattande processen att söka vård för MM. Genuskonstruktioner i relation till den beslutsfattande processen var i fokus i studie II. Intervjuerna analyserades med hjälp av Grounded Theory (I) och kvalitativ innehållsanalys (II). I studie III inkluderades 270 patienter med MM som besvarade ett instrument (MDMQ) avseende coping-stilar i beslutsfattande processen. I studie IV undersöktes övergångar mellan olika kliniker och remissvägar för 71 patienter med MM samt eventuell tidsfördröjning inom hälso- och sjukvården. Resultat: I studie I, identifierades insikt i allvarlighetsgrad samt rädsla och existentiellt hot till följd av tillståndet vara nyckel-motivatorer för att bestämma sig för att söka vård för misstänkt hudmelanom. Resultat från studie II påvisade att genuskonstruktioner påverkar hur personer söker vård för MM. Kvinnor upptäckte själv sina melanom och försökte tillämpa egenvård i början. De kunde dröja att söka vård pga. ansvar för familjen. Män upptäckte sällan suspekta melanom själva men följde oftast anhörigas råd att söka vård och sökte vård omedelbart efter påstötning. Resultaten från studie III visade att män i högre grad använde en avvaktande startegi (buck-passing) medan kvinnor och de som bodde utan partner var överdrivet vaksamma (hypervigilance). Deltagare med nodulärt melanom (NM), en snabbt växande form av MM, var mer vaksamma (vigilance) jämfört med de med melanom in situ, en mycket tidig form av melanom. Några korrelationer mellan tumörtjocklek och coping-stilar hittades ej. Vissa skillnader avseende typer av MM samt vårdens handläggning beroende på var patienter initialt sökt vård identifierades i studie IV. Bland patienter som initialt sökt vård på hälsocentralerna var tjockare tumörer vanligare jämfört med dem som hade sökt vård på hud- och andra specialistklinker. Dessa patienter hade också som regel genomgått den primära excisionen på hälsocentralerna och en majoritet blev senare remitterade till kirurgisk klinik för utvidgad excision. Hälsocentralernas patienter fick vänta längre på att det histopatologiska svaret registrerades i journalen än sjukhusklinikernas patienter. Kvinnor fick generellt vänta kortare tid på primär excision och äldre patienter fick vänta längre för utvidgad excision. Slutsatser: Tidsfördröjning av diagnos och behandling av MM är fortfarande vanlig och därför viktig att minska. Framtida interventioner för att påverka människor att söka vård tidigare bör inkludera genusaspekter. Inom hälso- och sjukvården kan tidsfördröjning minskas genom förbättrad tillgänglighet för patienter med misstänkta hudmelanom, men också genom minskning av onödig remittering. En förändrad organisation där sjuksköterskor och primärvårdsläkare i samarbete med specialistkliniker stöttas att använda ny teknologi för snabbare diagnosticering och omhändertagande av MM bör övervägas. Ökad kännedom bland hälso- och sjukvårdspersonal om riktlinjer for MM-vård kan vidare minska fördröjning. Till sist, mer effektiva och förbättrade arbetssätt kring registrering och överföring av laboratoriska svar och remisser skulle kunna minska fördröjning och därmed öka patientsäkerheten.
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McKenzie, Elizabeth. „A qualitative study exploring the experiences of access and pathways to health care among BME community groups residing in Ayrshire“. Thesis, Queen Margaret University, 2017. https://eresearch.qmu.ac.uk/handle/20.500.12289/7731.
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A review of the literature showed that Black and minority ethnic (BME) communities carry a disproportionately higher burden of illness than the general population and experience greater inequalities in health and health care provision. A growing body of research confirms that BME groups are under-represented in research. The main objective of the present study was to gain insights into the perspectives of BME community groups' experiences of accessing general and sexual health care services in Ayrshire. Semi-structured interviews were conducted with 11 participants, n = 5 men (age range: 32-65; mean age = 52.4 years), and n = 6 women (age range: 27-60; mean age = 47.67 years). Data were analysed employing Interpretative Phenomenological Analysis (IPA). The analysis is illustrated through the use of four super-ordinate themes: ‘It’s a Trust Thing’, ‘Minding the Gap(s)’, ‘Sexual Health: a Culture of Silence’, and ‘Personal Perception of Risk’. The findings both support and add to the existing trust literature by presenting a heuristic model of trust, and by showing that participants trust is dynamic in character, has a role, and serves various roles and functions that impact decisions about accessing health services. Significant gaps in knowledge about available health services and unique communication challenges that prevent full access to health care and health promotion information were found, resulting in unmet needs. Analysis charted culturally driven factors that prohibit discussions about sexual health concerns and found complex cognitions involved in the personal perception of risk that was meaningfully understood by participants that direct towards understanding risk in terms of a heuristic model. The implications for clinical practice, health promotion, health service development, and the direction of future research will be discussed.
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Hurrissa, Birke Anbesse. „Pathways to child and adolescent psychiatric care in the division of child and adolescent psychiatry at Red Cross Children's Hospital“. Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11328.
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Objective: To document the routes taken by patients to reach the Division of Child and Adolescent Psychiatry (DCAP) at Red Cross Children’s Hospital and to identify the factors that are associated with delay in gaining access to care.
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Eriksson, Miia, und Sören Skogvold. „Effekter av Tvärprofessionella standardvårdplaner för palliativ vård“. Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-1181.
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Bartlett, Colleen Kay. „Exploring the Impact of Wyoming's Pathways to Professional Development Program on Childcare Providers and Quality Early Childcare“. ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1434.
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Childcare programs that provide high quality care can strengthen children's early development. One component of a quality program is having providers who are knowledgeable in child development; however, despite the understanding of these known predictors of child development, Wyoming does not require childcare providers to complete any training before beginning to work with children. Guided by the constructivist theories of Piaget, Vygotsky, Dewey, and Bruner, this objectives-based program evaluation investigated the Pathways to Professional Development program to determine participants' perceptions of the strengths and weaknesses of the program. A researcher-produced survey was created based on the objectives of the program and consisted of open-ended and Likert scale questions. This survey was completed by 35 childcare providers who completed the 3 modules of the Pathways program. Data analysis began by identifying potential categories, comparing and contrasting emerging themes, and looking for emerging patterns in participant responses. Key results indicated that the participants of this program gained knowledge about child development and developmentally appropriate practice. The implications for social change from this research are directly related to the early childcare providers, children, and ultimately the communities of Wyoming. By increasing the knowledge of childcare providers, higher quality care can be provided, leading to positive relationships, stimulating learning experiences, and to a greater likelihood of children reaching their full potential.
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Ferreira, Paulo Ribeiro Matos. „Estudo das vias de acesso aos cuidados psiquiátricos na equipa de Sintra“. Master's thesis, Faculdade de Ciências Médicas. Universidade Nova de Lisboa, 2012. http://hdl.handle.net/10362/8169.
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Resumo: O estudo das vias de acesso à consulta de Psiquiatria permite identificar os parceiros mais importantes no acesso dos utentes aos serviços psiquiátricos. O modelo de Goldberg-Huxley considera que o acesso às
consultas de Psiquiatria se faz principalmente através dos cuidados de
saúde primários.
Material e Métodos: Para estudar as vias de acesso aos cuidados psiquiátricos utilizamos a Encounter Form, questionário desenvolvido por Gater. Foi também avaliada a classe social dos utentes utilizando a Escala
de Graffar.
Este inquérito foi passado na Consulta de Psiquiatria de Sintra a utentes de
primeira consulta. A amostra estudada foi de 93 utentes. O objectivo do estudo foi conhecer a trajectória do utente desde que teve necessidade de ser consultado até chegar à consulta de Psiquiatria, os sintomas que determinaram a decisão de procurar ajuda e a influência da classe social no tempo de percurso.
Resultados: Observa-se que os utentes passam pela Medicina Geral e Familiar em 71 % dos casos, pela Urgência Psiquiátrica em 16,1 % dos casos, pela Medicina Especializada Hospitalar em 10,7 % dos casos e pela
Urgência Geral em 1,1 % dos casos. Na escala de Graffar a classe social prevalente é a média (Classe III). O tempo de percurso foi maior que em estudo similar realizado em 1991. A classe Social III foi a que teve tempo de percurso maior.
Conclusões: O estudo conclui que o acesso a esta consulta de Psiquiatria se faz principalmente através da Medicina Geral e Familiar. O tempo de percurso é maior que o desejável por falta de recursos humanos.------- ABSTRACT: Introduction: The study of the Pathways to Psychiatric Care identifies the most important partners in accessing psychiatric services. The Goldberg-
Huxley model believes that access to Psychiatric consultation is done preferably through the primary health care.
Material and Methods: This survey included 93 first-time users of the Psychiatric Consultation of Sintra. The aim was to study the trajectory of the user since he had felt a need to be consulted until the consultation of Psychiatry, the symptoms that led to the decision to seek help and influence of social class in time spent in pathways. This study used the Encounter
Form, a questionnaire developed by Gater. Social class of users was also assessed using the Scale of Graffar.
Results: We observed that users have contact with General Practitionaires in 71% of cases, the Psychiatric Urgency in 16.1% of cases, the Hospital Medical Specialist in 10.7% of cases and the General Urgency in 1,1% of cases. On the Graffar scale middle class (Class III) was the most prevalent.
The travel time spend in pathways was reater than that obtained in a similar study carried out in 1991. Social Class III group had a greater time spent on pathways.
Conclusions: The study concludes that access to this Psychiatric consultation is principally through general practice. The time spent in pathways is greater than desirable due to lack of resources.
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Jerndahl, Fineide Mona. „Controlled by Knowledge : A Study of two Clinical pathways in Mental Healthcare“. Doctoral thesis, Karlstads universitet, Fakulteten för ekonomi, kommunikation och IT, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-12937.
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Standardisation of professional work is a major policy concern to ensure quality and efficiency of services and a number of hospitals are now focusing on the use of clinical pathways as an important tool to standardise their work. This study sheds light on the processes set in motion when notions of standardisation meet local practice. In order to gain insight into what clinical pathways mean for professional work in mental health care, the focus of the study was to explore the contexts in which standardisation by “rule production” takes place. Two empirical cases from Norwegian mental health care show how dedicated professionals are in charge of carrying out the standardisation work, strongly influenced by a steering framework of defined governmental policies where employee involvement and responsibility ensured loyalty to the idea. Along with a “package” of ideas, new bodies and techniques, clinical pathways contribute to the institutionalisation of prima facie knowledge in demonstrating that evidence basing is linked to steering and control of employees. Thus, professional autonomy is threatened in an insidious way: through the institutionalisation of evidence-based knowledge as ‘prima facie’ knowledge in combination with professionals who standardise and control their own work. The thesis therefore concludes that the control of professional work has now become a complex and sophisticated process where professional work is “controlled by knowledge”.
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Petkova, Hristina. „How gene tests travel : bi-national comparison of the institutional pathways taken by diagnostic genetic testing for Maturity Onset Diabetes of the Young (MODY) through the British and the German health care system“. Thesis, University of Exeter, 2008. http://hdl.handle.net/10036/47558.
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Scientific developments in genetics receive great public and political attention. However, genetic tests as medical innovations need to travel from the laboratory to the individual patient in order to fulfil the goal that makes the science so attractive. A medical innovation has to pass through the institutions of diverse health care systems. This thesis compares how the structures of two very different health care systems in Europe (Germany and the UK) foster or hinder the diffusion of genetic technologies. It presents a detailed analysis of the institutional pathways involved in order to discuss whether and in which way the kind of medical innovation that genetic testing represents is accommodated. The case study used for analysing the passage of a genetic test in both countries is diagnostic testing for Maturity Onset Diabetes of the Young (MODY). This example has the idiosyncratic dimension that it had strong support by scientists and government when the UK Government prioritized genetics in health policy. However, MODY testing was chosen for this study because MODY is a ‘simple’ monogenetic test, and it is one of the few at present that are both reliable and lead to altered treatment with a better quality of life for the patient. MODY represents, according to the current state of genomic knowledge, a prime example of what genetics is likely to deliver at best over the coming decades. In brief, the comparison of the pathways MODY travelled and the degree to which it reached patients successfully shows that both systems are not optimally set up to exploit what MODY genetic testing has to offer, but that the vertical structure and centralization in the UK system fit the needs of genetic medical innovations better than the horizontal, diversified and market oriented structures dominating the German health care system.
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Aicken, Catherine Rhiannon Helen. „Remote self-testing for sexually transmitted infections, within online care pathways : how could this intervention deliver public health benefit? : formative research using chlamydia as an exemplar“. Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10047215/.
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Sexually transmitted infections (STIs) remain a public health challenge in England, despite free, confidential testing/treatment services. The eSTI2 Research Consortium is developing a diagnostic self-test for STIs, to be deployed within online care-pathways. Should this intervention lead to increased STI detection and prompt effective treatment, it could reduce transmission and morbidity. Through a scoping review and three studies I explored its potential to benefit public health, thus informing the intervention’s ongoing development. The review (2013) found diverse uses of internet/electronic communications in STI care-pathways, but little research was transferable to remote self-testing or management. Current internet-use for sexual health may predict use of the proposed intervention, so I estimated its prevalence, and identified associated factors, using British probability survey data (2010-12). Among sexually-experienced 16-44-year-olds (n=8926), internet-use for STI testing/treatment was rare (< 0.5%), but available services were limited. 4.5% women and 4.6% men reported internet-use for information/support with their sex-lives, elevated among the better-educated and some STI risk-groups including young people. In qualitative interviews, 25 young people at risk of STI expressed enthusiasm for a (hypothetical) STI self-test within online care-pathways. Findings informed colleagues’ development of eSTI2’s Online Chlamydia Pathway (OCP). For people requiring chlamydia treatment, this included: online automated medical assessment, a helpline, and community pharmacy treatment collection or facilitated clinic access. I undertook and thematically-analysed 40 qualitative interviews with OCP users, within pilot studies. Participants valued the rapid, convenient and discreet treatment access, increased control over their healthcare, and optional professional support by telephone, enabled by the OCP. Offline parts of the pathway (pharmacy/clinic attendance) risked compromising its perceived advantages, and require further development. Recommendations derived from an iteratively-developed understanding of this complex intervention’s use and appeal, can enhance its potential to enable STI detection and treatment, promptly, effectively and acceptably. Future evaluation must consider impacts on health inequalities.