To see the other types of publications on this topic, follow the link: Health services regulation.
Dissertations / Theses on the topic 'Health services regulation'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Health services regulation.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Hamid, Mir Ajmal. "Regulation of private health care in Pakistan." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://researchonline.lshtm.ac.uk/682255/.
Full textAbstract:
The private health sector in Pakistan has been expanding rapidly, largely unregulated and partly at the expense of the public sector. While there have been previous attempts at formulating policies for the regulation of this sector, these have not always been based on ground realities, with the result that they never reached the stage of implementation. The objectives of the thesis were: 1) to describe and evaluate the existing regulatory framework governing health care provision in general and private health care provision in particular both at federal & provincial levels; 2) to explore the views and perceptions of key stakeholders regarding existing regulations and the reasons for their effectiveness/non-effectiveness; 3) to identify whether and how regulatory mechanisms can be made to work effectively; and 4) to explore the views of stakeholders regarding the potential for alternative mechanisms for ensuring the quality of formal private medical services, including the role of information dissemination to service users/the public. The methods adopted to achieve the stated objective were mapping of the existing legislations and a stakeholder analysis. The results showed that the existing legislations on regulation of health care provision were scanty, weak and inadequate and required radical re-structuring. The stakeholder analysis demonstrated the conflicting interests of the state and the private providers, the role of the powerful medical community and the views of the service users, who were shown to be the ultimate victims. Avenues for alternative regulatory mechanisms, including one based on information dissemination were explored and their feasibility discussed. It is hoped that the information gained from this study, by reflecting the views of the various actors in this process, will contribute towards the formulation of a policy for regulation of private health care provision in Pakistan, which is realistic, feasible and sustainable.
2
Hemingway, C. A. "The regulation of women detained under mental health legislation." Thesis, University of Oxford, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.264817.
Full text
3
Button, Catherine. "WTO review of national health regulations." Thesis, University of Oxford, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273098.
Full text
4
Ross, Gabrielle Catherine. "Sustaining menstrual regulation policy : a case study of the policy process in Bangladesh." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2002. http://researchonline.lshtm.ac.uk/1742272/.
Full textAbstract:
Bangladesh introduced menstrual regulation (early abortion) into its national family planning program in 1979, and for more than 20 years women with unwanted pregnancies have been able to avail themselves of a relatively safe and accessible service. Over the years, however, concern has been expressed about deficiencies in the implementation of the policy, and by the mid-1990s, the menstrual regulation (MR) policy was approaching a critical juncture. The introduction of health sector reforms and the waning of international and domestic support raised questions regarding the sustainability of the policy. This study was conducted to determine the factors that influenced the development of and support for the MR policy in Bangladesh, in order to explore how far those factors might influence future sustainability. The study used an analytic framework based on literature from the policy field to test what factors were important in the policy process in Bangladesh. Qualitative data was gathered from interviews and documents in an inductive approach to determine the development of the MR policy, which was then subjected to a retrospective analysis of the entire life cycle of the MR policy-how it came to be placed on the policy agenda, how and why it was formulated the way it was, and why it was not implemented as well as it could have been. Data gathered from interviews and document reviews were then used in a political mapping exercise undertaken in a prospective analysis for the policy, providing insights in relation to the future sustainability of the MR policy. The research suggested that the analytic framework used was helpful in providing a systematic analysis of contextual conditions, agenda-setting circumstances, and policy characteristics that could explain much of the variability in the policy process. The role of international donors and attitudes toward religion were found to be particularly relevant to explaining the policy process. The study concluded that the MR policy would likely not be sustained in the future unless purposeful action were taken to mobilise additional bureaucratic and political resources in support of the policy.
5
Dell'Aera, Anthony D. "Prescription drug regulation and the art of the possible : reconciling private interest and public good in American health care policy." View abstract/electronic edition; access limited to Brown University users, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3318305.
Full text
6
Farquharson, Barbara. "How people present symptoms of Acute Coronary Syndrome to health services : an analysis using the Commonsense Model of Self-Regulation." Thesis, University of Stirling, 2007. http://hdl.handle.net/1893/244.
Full textAbstract:
Acute Coronary Syndrome (ACS) is common and associated with high mortality. Effective treatments are available but require prompt administration. Studies have consistently demonstrated that delays to treatment are common, with patient decision time accounting for most delay. Interventions aimed at reducing delay have had little success. Evidence suggests that psychological factors, in particular illness representations (Leventhal’s Commonsense Model of Self-Regulation (CS-SRM)) might be important in relation to patient decision time. This thesis describes a two-stage investigation, undertaken within NHS 24, exploring the content and timing of people’s initial presentations with possible symptoms of ACS. The first stage comprised a CS-SRM-guided content analysis of peoples’ initial symptom presentations. The second stage utilised the Illness Perception Questionnaire-revised (IPQ-R) to explore how illness representations relate to patient decision time. Results show that the components of illness representations accounted for 95% of participants’ initial presentations. The components most related to behaviour and outcome were volunteered least (cause, consequences, cure/control and coherence). Decision time for most participants (89%) was out-with the ideal and appraisal time accounted for most of the delay. Appraisal delay was shorter for those with fewer symptoms and high emotion. Illness delay was longer where the person making the call reported high treatment control. Interventions may need to raise awareness of the range of possible presentations and of the consequences associated with delay. Interventions should also provide guidance as to an appropriate time-limit for self-care. Individuals may benefit from being informed about how to respond to strong emotional responses. Interventions aimed at bystanders may need to differ from those for patients. People at high risk of ACS should be informed about how and when to access healthcare out-of-hours.
7
Germundsson, Frida, and Nicole Kvist. "MDR 2017/745 - New EU Regulation for Medical Devices: A Process Description for EHR Manufacturers on How to Fulfill the Regulation." Thesis, KTH, Medicinteknik och hälsosystem, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-279137.
Full textAbstract:
On the 26th of May 2021 the new regulation for medical devices, MDR 2017/745, will come into force. The underlying incentives to go from the medical device directive (MDD 93/42/EEC) to MDR are a series of adverse events involving medical devices. The main goal of MDR is to strengthen and improve the already existing legislation and thus will entail large changes for manufactures, one of them being manufacturers of Electronic Health Record (EHR) systems. For medical software, such as EHR systems, the new regulation will imply an upgrade in risk classification. This upgrade will bring additional requirements for EHR manufacturers. Furthermore, the released guidelines have been insufficient regarding the specific requirements for medical device software and thus EHR manufacturers are in need of tools and guidance to fulfill MDR. This thesis examines the new regulation for medical devices and thus identifies main requirements for EHR manufacturers. A qualitative approach was conducted comprising a literature study as well as a document study of the medical device regulation along with interviews with experts within the field of medtech regulatory affairs and quality assurance. The information gathered was analyzed to create a process description on how EHR manufacturers are to fulfill MDR. The process description is a general outline and presents the main steps on the route to be compliant with MDR in a recommended order of execution. The main steps are: divide the system into modules, qualify the modules, classify the modules, implement a quality management system, compile a technical documentation, compile the declaration of conformity, undergo a conformity assessment and finally, obtain the CE-mark. To each of the main steps additional documentation provides further information and clarification. The process description functions as a useful tool for EHR manufacturers towards regulatory fulfillment. Even though the process description is created for EHR manufacturers, it can be useful for other medical device software manufacturers. The process description provides an overview of the path to a CE mark and functions as a guidance. It can be used in educational purposes as well as to serve as a checklist for the experienced manufacturer to make sure everything is covered. However, it is not sufficient to rely solely on the process description in order to be in full compliance with MDR. Moreover, there is still a need for further clarifications from the European Commission regarding specific requirements on medical device software.
8
Barcelos, Gabriela Miron. "Aproveitamento de vagas de consultas eletivas em um hospital universitário." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/17/17157/tde-29032017-155338/.
Full textAbstract:
A garantia do acesso dos usuários do Sistema Único de Saúde (SUS) em todos os níveis de atenção em tempo adequado e a criação de fluxos de assistência à saúde que opere de forma sincronizada são uns dos grandes desafios do SUS. O HCFMRP-USP oferta serviços de nível terciário dentro do sistema, sendo referência dentro de sua Regional de Saúde trabalha para otimizar suas vagas ofertadas aos Departamentos Regionais de Saúde e absorver o maior número possível de pacientes que necessitam de atendimento terciário. Objetivo: Avaliar o aproveitamento das vagas de consultas para novos pacientes ofertadas pelo HCFMRP - USP aos Departamentos Regionais de Saúde de sua região de abrangência, no período de 2006 a 2014. Metodologia: Foi realizado um estudo descritivo com dados secundários do banco de dados do HCFMRP-USP, a partir das informações do Serviço de Agendamento e Controle de Pacientes Ambulatoriais. Foram calculadas no período de 2006 até 2014, a Taxa de Agendamento, Taxa de Falta, Taxa de adequação da Referência e Taxa de Aproveitamento Global. Resultados: A taxa geral de agendamento foi 76%, a taxa de falta de pacientes novos teve a média de 17%, a Taxa média de Adequação da Referência foi de 92%. A taxa de aproveitamento global foi 57%, ano de 2014 das 37.830 vagas disponibilizadas pelo HCRP apenas 21.170 foram efetivamente aproveitadas. CONCLUSÕES: As iniciativas para o HCFMRP-USP se consolidar como um hospital terciário vem sendo gradativamente concretizadas, todas as taxas avaliadas tiveram uma melhora significativa se compararmos com o estudo anteriormente realizado que avaliou os anos de 2000-2005, mas ainda existem muitos desafios. Os gestores precisam avaliar os dados e buscarem mudanças em suas práticas de gestão, sendo necessários investimentos na formação recursos humanos e na integração entre gestores para que seja possível o integral aproveitamentos das vagas disponibilizadas.Ensuring access of users of the Unified Health System (UHS) at all levels of care in a timely manner and the creation of health care flows that operate synchronously are one of the great challenges of UHS. The HCFMRP-USP offers tertiary services within the system, being a reference within its Regional Health activity to optimize their vacancies offered to the Regional Health Departments and the largest possible number of patients who need tertiary care. Objective: Evaluate the use of vacancies consultations for new patients offered by HCFMRP - USP to Regional Departments of Health within the respective coverage area in the period 2006-2014. Methodology: A descriptive study of secondary data from HCFMRP- USP database was conducted from information of the Scheduling and Ambulatory Patient Control Service. There were calculated in the period of 2006 until 2014: the Schedule Rate, Lack Rate, Adequacy Rate Reference and Global Utilization Rate. Results: The overall Schedule Rate was 76%, the Lack Rate of new patients had an average of 17%, the average Reference Adequacy Rate 92%. The Global Utilization Rate was 57%, in the year of 2014 37,830 vacancies provided by HCFMRP-USP only 21,170 were actually utilized. Conclusions: The initiatives for HCFMRP-USP consolidate as a tertiary hospital has been gradually implemented, all measured rates had a significant improvement when compared to the previously conducted study that evaluated the years 2000-2005, but there are still many challenges. Managers need to evaluate the data and seek changes in their management practices and the necessary investments in training human resources and integration of managers for the full exploitations of available vacancies is possible.
9
Sitonio, Fabianny Tomaz. "Acesso ao tratamento oncológico no município de São Paulo: o câncer de mama como condição traçadora." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-10032016-144758/.
Full textAbstract:
Acompanhando a tendência mundial, o Brasil apresenta um processo de envelhecimento de sua população, caracterizado pelo aumento das condições crônicas, inclusive do câncer. O quadro convoca mudanças profundas nos sistemas de saúde, demandando a implantação de Redes de Atenção, a fim de garantir acesso a todos os níveis de atenção, superando a fragmentação do cuidado. Com o intuito de conhecer os avanços no que se refere à atenção oncológica em rede, analisou-se o acesso ao tratamento do câncer em São Paulo, especialmente a partir do surgimento da Lei dos sessenta dias. Foram considerados os sistemas de monitoramento da atenção oncológica no município, além de analisados os itinerários assistenciais de usuárias, utilizando o câncer de mama como condição traçadora. Não foi possível identificar uma redução do tempo de espera para iniciar o tratamento, a partir do banco do Registro Hospitalar de Câncer de são Paulo, considerando que não há completude na base a partir de 2013, sendo observado que o tempo indicado na lei foi ultrapassado nos dois anos anteriores. Da mesma forma, notou-se um aumento da proporção de estádios avançados nesse período. Ainda com relação à variável tempo, as informações no SIGA demonstraram que, em 2013, o tempo médio para uma consulta em Onco-mastologia nos serviços de gestão municipal que estão sob regulação foi de apenas 4 dias. Por meio dos Sistemas de Informação Ambulatorial e Hospitalar, observou-se um aumento estatisticamente significativo na produção de radioterapia e de cirurgias oncológicas entre os anos 2011 e 2014, e uma tendência de redução dos procedimentos quimioterápicos. O Sistema de Informação sobre Câncer de Mama demonstrou aumento no percentual de mamografias alteradas, aspecto que, ao ser analisado em conjunto com o aumento da proporção de estadiamentos avançados, pode ser indicativo de maior dificuldade no acesso ao diagnóstico precoce do câncer de mama. Observou-se que a judicialização esteve muito relacionada a acesso a medicamentos quimioterápicos, de prescrição após a entrada nos serviços especializados, o que confirma que o acesso ao tratamento de câncer de mama no município não apresenta grandes barreiras. Um importante efeito visualizado com o surgimento da Lei foi a padronização dos protocolos de acesso aos serviços de gestão municipal e estadual. Entretanto, a rede de oncologia em São Paulo continua fragmentada dentre seus componentes estruturais, as ações permanecem no plano da construção de fluxos de encaminhamento, ficando restrita à atenção especializada. A atenção oncológica na cidade é atravessada pelo setor privado, o que deixa na dependência dos prestadores a disponibilização de vagas para acesso e o fluxo interno de cada serviço. O poder ainda continua com os grandes prestadores, não sendo bem conhecidos os caminhos para o acesso a algumas instituições, nem publicizadas as informações sobre fila e tempo de espera. A legislação sozinha não é indutora de melhoria de acesso, nem muito menos de garantia de integralidade. Um importante desafio para o SUS é a integração dos serviços e a construção de redes de atenção com centralidade na APS, garantindo, acima de tudo, o diagnóstico em tempo oportuno e a efetiva gestão sobre os serviços privados contratados de média e alta complexidade.Following the global trend, Brazil has an aging process of the population, characterized by an increase in chronic conditions, including cancer. The framework calls for changes in health care systems, demanding the implementation of Healthcare Networks to ensure access to all levels of healthcare, overcoming the fragmentation of health care delivery. In order to know the progress in relation to cancer care network, because of the urgent need for integrated access to cancer treatment, it was analyzed the access to cancer treatment in Sao Paulo, particularly since the advent of Law \"of sixty days. Thus, it was considered the monitoring system of cancer care, as well as analyzed the assistance itineraries of the patients, using breast cancer as a tracer. From the São Paulos database Hospital Cancer Registry, it was not possible to identify a reduction in the waiting time to start the treatment, considering that the data base is not complete from 2013, and observed that the time specified in the law was passed in the previous two years. Likewise, it was noted an increase in the proportion of advanced stages during this period. Through the Outpatient clinical and hospital Information Systems Database, there was a statistically significant increase in the production of radiotherapy and cancer surgery between the years 2011 and 2014 and a trend of reduced chemotherapy procedures. Breast Cancer Information Systems Database demonstrated an increase in the percentage of abnormal mammograms, aspect which can be indicative of greater difficulty in access to diagnosis of breast cancer, when it is analyzed with the increase in the proportion of advanced stages of tumors. It was observed that the Litigation was closely related to access to chemotherapeutic drugs, from prescription after entry into the specialized services, which confirms that the access to breast cancer treatment in the municipality does not present major barriers. It was observed that the law organized the access to cancer treatments flows, standardizing the protocols between the state and the municipality in health management. However, Oncology care network in São Paulo is disjointed from its structural components and away from other healthcare networks, besides it is very strongly crossed by the private health assistance and dedicated to specialized healthcare sector. We understand that the law might be dispositif\" of changing for improving access to oncology services, because it built parameters to the society. However, only the law by itself is not an inducer of improving health services accessibility, and it doesnt guarantee of an integrative care. Finally, the emergence of the law is still very recent, it is not possible to visualize many related effects, which necessitates the continuation of observations in order to associate if the kind of strategy results benefit to public policies in the country.
10
Sugarman, Philip A. "A model of integrated healthcare governance." Thesis, University of Northampton, 2009. http://nectar.northampton.ac.uk/2716/.
Full textAbstract:
The history of psychiatry is littered with serious failures of governance, to the detriment of mentally disordered people, especially those resident in psychiatric hospitals. Current mental health providers, increasingly focussed on community care, have also struggled to develop effective internal governance systems. Nine peer-reviewed research papers, published by the author (mostly with others) and the wider literature, reveal deficits in mental health governance at a jurisdictional, professional, and corporate level. In this thesis new governance solutions are developed against this background, built on contemporary principles in mental health and healthcare management. A new model of mental health governance is presented, based on the key demands of the strategic and regulatory environment, articulated as rights, risks and recovery. This integrated healthcare governance approach, covering provider policy, staff training and service audit, can monitor and ensure the protection of patients’ rights, as well as those of others; it also promotes the management of clinical risks, and of patients’ recovery outcomes. Rights-based risk-reduction training is the core interventional element of the model, whilst the monitoring element can be formalised as part of a Balanced Scorecard reporting system. This thesis makes a contribution to research methodology, theory and practice in mental health, human rights, healthcare management and governance. The model generates specific propositions for testing in mental health governance, with the potential for application in wider settings of service provision.
11
Magalhães, Maria Conceição Benigno. "Comissões de regulação, controle e avaliação dos leitos hospitalares em uma capital do nordeste: desafios da sua implementação." Programa de pós-graduação em saúde coletiva, 2010. http://www.repositorio.ufba.br/ri/handle/ri/10353.
Full textAbstract:
p. 1-125Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-23T17:34:46Z No. of bitstreams: 1 2222.pdf: 2507518 bytes, checksum: 8106c62d2cb88f8f99606dfdd7859301 (MD5)
Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:28:22Z (GMT) No. of bitstreams: 1 2222.pdf: 2507518 bytes, checksum: 8106c62d2cb88f8f99606dfdd7859301 (MD5)
Made available in DSpace on 2013-05-04T17:28:22Z (GMT). No. of bitstreams: 1 2222.pdf: 2507518 bytes, checksum: 8106c62d2cb88f8f99606dfdd7859301 (MD5) Previous issue date: 2010
A regulação dos leitos hospitalares do SUS no Brasil vem sendo realizada por Centrais Estaduais e ou Municipais de Regulação. O Estado da Bahia, desde 2003, vem tentando regular os leitos hospitalares do SUS no município de Salvador. No entanto, os usuários que acessavam o sistema pelas portas de entrada das emergências tinham dificuldade em conseguir vagas em outras unidades, muitas vezes iam a óbito sem acesso a um leito hospitalar. O projeto de implantação das comissões permanentes de regulação, controle e avaliação de leitos em alguns hospitais visa melhorar a resolutividade da Central Estadual de Regulação. Esse estudo foi uma pré-avaliação do tipo avaliabilidade desse projeto. Para isso, foi realizada a análise documental, entrevistas com informantes-chave, a observação das práticas destas comissões e a elaboração de um modelo lógico. O estudo foi realizado em Salvador, na comissão do Hospital Geral do Estado (HGE). Observou-se que a intervenção aumentou a saída dos pacientes dos corredores do HGE e qualificou as transferências desses pacientes. Contudo, não há governabilidade da CER sobre os leitos da rede hospitalar conveniada, o que reduz o êxito desse projeto. Sugere-se a instalação de comissões dessa natureza nos hospitais fora da rede própria. O estudo aponta ainda outros focos para avaliação futura, como a relação entre o número de leitos existentes hoje no município de Salvador e a necessidade real de internação para população própria e referenciada, o grau de utilização dos leitos existentes de acordo com a necessidade do sistema, a relação entre o público e o privado na oferta de leitos para o sistema, e o mesmo, considerou que é necessário a implantação de comissões permanentes de regulação, controle e avaliação em todos os grandes hospitais de leito retaguarda em Salvador.
Salvador
12
Freire, Mariana Prado. "Regulação em saúde produtora de cuidado: cartografia de novos arranjos." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-09062017-132238/.
Full textAbstract:
A regulação em saúde exercida no Sistema Único de Saúde tem origem em um emaranhado de conceitos e foi sendo construída historicamente no Brasil acompanhando os diferentes contornos da Saúde Pública e a necessidade de regular os sistemas de saúde. Esta regulação se constituiu em um terreno de disputas entre a oferta e a demanda, produzindo efeitos no acesso dos usuários aos serviços e procedimentos. Mais recentemente a nova aposta para a regulação, é a possibilidade de que ela ocupe um papel central na produção do cuidado do usuário, juntamente com outros movimentos com este mesmo fim. Esta é uma pesquisa qualitativa de abordagem cartográfica, que contou com um usuário guia para conduzir a caminhada do pesquisador pelo território. Além do usuário guia, foram utilizados outros informantes, consulta documental, entrevistas transcritas e registro em diário de campo. O estudo teve por objetivo mapear os arranjos regulatórios presentes nas relações de produção do cuidado entre usuários, trabalhadores e gestores no cotidiano do trabalho em saúde de São Bernardo do Campo. Foram construídos analisadores a partir das cenas vivenciadas no campo e dos processamentos, que auxiliaram a dar visibilidade e dizibilidade aos arranjos do cuidado que estavam sendo produzidos. Distintas ações de regulação foram observadas, desde as que envolviam diretamente o complexo regulador até outras produzidas em ato pela rede de forma capilarizada. A aposta em novos arranjos regulatórios capazes de produzir cuidado trouxe possibilidades de empregar tecnologias mais relacionais no lugar da dureza dos protocolos e fluxos assistenciais. Estas ações foram observadas em diferentes cenários do sistema de saúde de São Bernardo do CampoThe health regulation made at Brazilian public health system originates from a set of concepts and was historically constructed in Brazil, following the different contours of Public Health and the task of regulating health systems. Regulation has become a field of disputes between supply and demand, producing effects on users\' access to services and procedures. More recently, the new focus on regulation is the possibility that it may play a central role in the production of user care, along with other movements for the same purpose. This is a qualitative research of cartographic approach with the participation of user guide to lead the walk of the researcher by the territory. In addition to the user guide, other informants were used, documentary consultation, transcribed interviews and field journaling. The purpose of this study was to map out the regulatory arrangements present in the relations of care production among users, workers and managers in the daily work of health care in São Bernardo do Campo. Analyzers were constructed from the scenes experienced in the field and from the processing, which helped to give visibility and readability to the care arrangements that were being produced. Different regulatory actions were observed, from those that directly involved the regulatory complex to others produced in act by the capillary network. The bet on new regulatory arrangements capable of producing care has brought possibilities of using more relational technologies instead of the hardness of protocols and care flows. These actions were observed in different scenarios of the health system of São Bernardo do Campo
13
Meyer-Wolfarth, Friederike [Verfasser], and Roland [Akademischer Betreuer] Klein. "Biological control of plant pathogenic fungi and the regulation of mycotoxins by soil fauna communities in a conservation tillage system as ecosystem services for soil health / Friederike Meyer-Wolfarth ; Betreuer: Roland Klein." Trier : Universität Trier, 2017. http://d-nb.info/1197703071/34.
Full text
14
Stefanova, Deyana. "Le rôle de la notion de service public dans l'organisation du système de santé en droit français." Thesis, Bordeaux, 2020. http://www.theses.fr/2020BORD0273.
Full textAbstract:
Depuis les années 1970, la notion de service public a été conçue comme le fondement du système de santé en droit français. Cependant, cette notion ne s’est pas imposée comme un élément d’intégration des services de soins de ville dans le champ du système de santé. Parallèlement, le concept de système hospitalier, qui renvoie à la coordination de l’ensemble de l’offre de soins hospitaliers par l’Etat, a été construit en dehors du spectre de la notion de service public. Cela amène au constat de l’échec de la notion de service public comme fondement du système de santé en droit français. Depuis les années 2000, l’émergence du concept du système de santé en droit interne de la santé, ainsi que l’influence du droit de l’Union Européen sur la conception de service public dans le champ des services sociaux et sanitaires, ont conduit à un renouveau du rôle du service public dans le domaine de la santé. Le service public s’est alors progressivement transformé en instrument d’organisation du système de santé au travers de son régime juridique. En ce sens, la réintroduction de la notion de service public hospitalier, opérée par la loi Touraine de 26 janvier 2016, apparaît comme paradoxale. Le passage à une approche exclusivement fonctionnelle de service public en matière de santé implique désormais de procéder à la définition et à l’aménagement des missions de « service au public » au sein du système de santéSince the 1970s, the notion of public service has been conceived as the basis of the health system in French law. However, this notion has not become an integral part of city care services within the scope of the health system. At the same time, the concept of the hospital system, which refers to the coordination of the entire supply of hospital care by the state, was constructed outside the spectrum of the concept of public service. This leads us the to observe the failure of the notion of public service as the basis of the health system in French law. Since the 2000s, the emergence of the concept of the health system in domestic health law, as well as the influence of European Union law on the design of public service in the field of social and health services, have led to the renewal of the role of the public service in the domain of health. Public service then gradually became an instrument for organizing the health system through its legal regime. In this sense, the reintroduction of the concept of public health service, operated by the Touraine law of January 26, 2016, appears paradoxical. The shift to an exclusively functional public service approach in health involves defining and building "service to the public" missions within the health system
15
Ferreira, Janise Braga Barros. "Avaliação do complexo regulador do sistema público municipal de serviços de saúde." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/22/22133/tde-13112007-161607/.
Full textAbstract:
Este estudo avaliou a repercussão da implantação Complexo Regulador (CR) do Sistema Público Municipal de Serviços de Saúde para a rede de atenção de Ribeirão Preto-SP. Teve por aporte teórico a avaliação em saúde e como objetivos específicos: avaliar o alcance do CR, de acordo com a dimensão cobertura, nos anos de 2004, 2005 e 2006; avaliar o efeito do CR de acordo com a dimensão efetividade social. Estudo de avaliação normativa e pesquisa avaliativa, sendo adotada abordagem quanti-qualitativa. O cenário foi o CR, em RP/SP, em seu espaço funcional e organizacional de operação das ações regulatórias do sistema de atenção, implantado na Secretaria Municipal da Saúde. As fontes primárias, produzidas junto aos trabalhadores de diferentes categorias profissionais que atuavam na gestão e no nível operacional do CR, foram coletadas por meio de entrevista estruturada tendo como eixo temático: implantação do CR, sua função de ferramenta operacional para atenção básica e a relação entre a intervenção proposta e os resultados alcançados. As fontes secundárias foram: documentos oficiais existentes sobre o CR, Atas do Conselho Municipal de Saúde; artigos de jornais locais, Sistema de Informação Ambulatorial e Hospitalar do DATASUS. Para organização dos indicadores de análise, elaborou-se planilha específica, com dados relativos aos indicadores de cobertura: Indicador de Consultas Básicas; Indicador de Consultas Especializadas, Indicador de Internações de Baixa e Média Complexidade; Indicador de Internações de Alta Complexidade. Na análise dos dados primários, foi realizada a análise temática, sendo articulada à análise dos indicadores produzidos. O estudo mostrou que: o CR provocou alterações na acessibilidade organizacional e eqüidade da rede de saúde, tanto na atenção ambulatorial quanto hospitalar; destacou necessidade de constituição de rede solidária de atenção e apresentou a potência da estratégia em ser ferramenta profícua de avaliação e de gestão. A implantação do CR alterou significativamente o processo de trabalho dos sujeitos. A avaliação ainda apontou que, apesar do pouco tempo de implantação, a estratégia do CR é potencialmente capaz de colaborar na sustentabilidade do SUS, mas se fazem necessários: investimento, divulgação e aperfeiçoamento.This study aimed to evaluate the publicity of the implementation of the Regulator Complex (CR) of the Municipal Public System of Health Services for the care network of Ribeirão Preto, SP, Brazil. The health evaluation provided the theoretical framework and the specific objectives were: evaluate the CR scope according to the coverage dimension in 2004, 2005 and 2006; evaluate the CR effect in terms of social effectiveness. This is a normative evaluation and an evaluative research with a quantitative qualitative approach. The scenario was the CR in RP/SP in its functional and organizational space of regulatory actions operation of the care system implemented in the Municipal Secretary of Health. The primary sources produced with workers of different professional categories who acted in the CR management and in its operational level were collected through structured interview according to the following thematic axis: implementation of the CR, its function as operational tool for the primary care and the relation between the proposed intervention and the results accomplished. The secondary sources were: CR official documents, Minutes of the Municipal Council of Health; local newspapers, outpatient and hospital DATASUS Information System. For the organization of the analysis indexes, a specific data sheet was elaborated, with data related to the coverage indexes: Primary Consultation index; Specialized Consultation Index, Low and Medium Complexity Hospitalizations Index; High Complexity Hospitalization Index. The thematic analysis was used for the primary data which was coordinated with the indexes produced. The study showed that: the CR caused alterations on the organizational accessibility and equity in the health network, both in the outpatient and the hospital care; highlighted the need of creating a comprehensive care network and presented the power of the strategy as a proficient evaluation and management tool. The CR implementation changed significantly the subjects\' work process. The evaluation also pointed that despite the little time of implementation, the CR strategy has potential to benefit the SUS sustainability, though investment, publicity and improvement are necessary.
16
Ferreira, Gabriela Souza Assis. "O fluxo de usuários no SUS coordenado pela regulação assistencial: um estudo dos processos para acesso a organizações de saúde de média complexidade." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/96/96132/tde-02122015-165628/.
Full textAbstract:
A regulação assistencial é um importante instrumento de gestão pública que tem como objetivo viabilizar o acesso dos usuários aos serviços de saúde. No entanto, há estudos que apontam que não há um equilíbrio entre a oferta e a demanda por serviços da atenção secundária no SUS. Na presente pesquisa questiona-se como está efetivamente estruturado o acesso a esse nível de atenção e quais os principais entraves para a efetividade do acesso. O objetivo consistiu em analisar o processo de acesso à atenção secundária da saúde buscando identificar oportunidades de melhoria. O foco desse estudo foi o acesso à especialidade médica de gastrocirurgia dos dois hospitais secundários integrantes do complexo do Hospital das Clínicas de Ribeirão Preto. Foram realizadas entrevistas com gestores, médicos e demais profissionais envolvidos no processo. A partir das informações coletadas foi construído um mapa dos processos utilizando o software Bizagi e a notação de modelagem de processos de negócios (BPMN). A partir da descrição e análise, foi verificado como os processos descritos poderiam ser otimizados. Foi possível identificar que os dois processos estudados, apesar de terem o mesmo objetivo: prover acesso a atenção secundária de saúde, possuem diferenças marcantes. As vagas são distribuídas aos municípios na forma de cotas no processo de acesso ao HEAB enquanto que no acesso ao HERP há uma regulação compartilhada entre o DRSXIII e o próprio hospital. Os principais problemas identificados foram: absenteísmo dos usuários nas consultas; guias de referência incompletas ou ilegíveis; dificuldades de relacionamento entre os profissionais e organizações de saúde; demora para agendar consulta, entre outros. Concluiu-se que existem pontos no processo que não estão coerentes com as normas que o regulam e que há dados que podem ser utilizados para medir o desempenho do processo, como a proporção de casos novos e de pedidos de interconsulta; distribuição de vagas por município e situação após primeira consulta. Concluiu-se ainda que os problemas identificados podem ser solucionados a partir da implantação de melhorias sugeridas como: melhorar a comunicação e a triagem nos municípios, realizar treinamento dos funcionários e divulgar protocolos aos envolvidos.The assistance regulation is an important public management tool that aims to facilitate users\' access to health services. However, studies show that there is not a balance between supply and demand for services in secondary care in the Unified Health System (SUS). In the present study it casts doubt on how the access is effectively structured to this level of care and what the main obstacles to the effectiveness of access are. The aim was analyze the process of access to secondary health care seeking to identify opportunities for improvement. The focus of this study was the access to medical specialty Gastrosurgery of the two hospitals that are members of the complex of the General Hospital of Ribeirão Preto Medical School (University of São Paulo). Interviews were conducted with managers, doctors and other stakeholders. From the information collected, a map of the processes using the Bizagi software and the notation for business process modeling (BPMN) was constructed. From the description and analysis, it was verified how the described processes could be optimized. It was possible to identify that the two processes studied have the same goal: provide access to secondary health care, have marked differences, such as how the distribution of vacancies. The vacancies are distributed to municipalities for quotas in the process of access to HEAB while access to HERP there is a shared regulation between the DRSXIII and the hospital. The main problems identified were outpatient non-attendance (absenteeism), incomplete or illegible reference guides, relationship difficulties between professionals and health organizations, long wait for schedule consultation, among others. It was concluded that there are points in the process that are not consistent with the rules that regulate, there is data that can be used to measure the performance process, as the proportion of new cases and requests for referral; distribution of vacancies for municipality and situation after first appointment. It was possible concluded also that the problems found can be solved through the implementation of suggested improvements; such as how improve communication and sorting in the municipalities, conduct employee training and disseminate the protocols involved.
17
Souza, Danielle Cristina Campos de. "Agendamento eletrônico ambulatorial: análise de melhorias após a implantação." Universidade Nove de Julho, 2017. http://bibliotecatede.uninove.br/handle/tede/1717.
Full textAbstract:
Submitted by Nadir Basilio (nadirsb@uninove.br) on 2017-09-19T20:56:23Z
No. of bitstreams: 1
Danielle Cristina Campos de Souza.pdf: 1576989 bytes, checksum: da92792bd527aad6147656d031525bac (MD5)Made available in DSpace on 2017-09-19T20:56:23Z (GMT). No. of bitstreams: 1 Danielle Cristina Campos de Souza.pdf: 1576989 bytes, checksum: da92792bd527aad6147656d031525bac (MD5) Previous issue date: 2017-02-06
With the objective of analyzing the results of the implantation of electronic systems and tools, used to perform the regulation of high complexity access, that is, consultation schedules and specialized outpatient exams, this research starts from an exploratory descriptive analysis, promoting a greater knowledge on the history of the Regulation of Access to Assistance (Also called regulation of access or care regulation) and the implementation of a computerized system that acts in this practice. With the 1988 Constitution, the Unified Health System was defined as the right of all, and the State should guarantee equal access. At the outset, it found difficulties in broadening access to citizens and decentralize health actions, dividing the responsibility between States and Municipalities. The approach used was qualitative and quantitative, because it intends to describe and interpret the phenomena, besides analyzing the information collected. The regulation of access to care had its mark with publication of NOA / SUS 2001(Health Care Operational Standard), and has intensified over the years, even with the challenges encountered in achieving the quality required by SUS users and meet the needs that vary according to your individual profile. Since its inception in 2008 through ordinance no. 1,559, presented advances related to the improvement of the quality of care flows making this dimension of regulation can be considered the user's access door to public health services. That is why the main objective of the research consists of analyzing the indicators of satisfaction and absenteeism, because, these are the ones that reveal how the image of the institution is and their use in relation to supply and demand. In August 2010, the Central of Regulation of the Health Services Offering - CROSS, and was implanted in the Hospital of this work with its various functions, allowing a more practical and organized flow to promote access to SUS users, so in this work will be evaluated the impact of the schedules made through the CROSS system allowing outpatient access and evaluating the indicators that effectively present the impact of its implementation. The obtained results indicate positive changes and improvements in the quality of care, since it adopts more adequate protocols in the practice of health care regulation.
Com o objetivo de analisar os resultados da implantação de sistemas e ferramentas eletrônicas, utilizados para executar a regulação do acesso de alta complexidade, ou seja, agendamentos de consultas e exames ambulatoriais especializados, esta pesquisa parte de uma análise exploratória descritiva, promovendo um maior conhecimento sobre a história da Regulação do Acesso à Assistência (também denominada regulação do acesso ou regulação assistencial) e a implantação de um sistema informatizado que atua nessa prática. Com a Constituição de 1988, o Sistema Único de Saúde foi definido como sendo direito de todos, devendo o Estado, garantir o acesso igualitário. Em seu início, encontrou dificuldades em ampliar os acessos aos cidadãos e descentralizar as ações de saúde, dividindo a responsabilidade entre Estados e Municípios. A abordagem utilizada foi qualitativa e quantitativa, pois tem a intenção de descrever e interpretar os fenômenos, além de analisar as informações coletadas. A regulação do acesso à assistência teve seu marco com a publicação da NOA/SUS 2001 (Norma Operacional de Assistência à Saúde), e tem se intensificado no decorrer dos anos, mesmo com os desafios encontrados em atingir a qualidade exigida pelos usuários do SUS e atender as necessidades que variam de acordo com seu perfil individual. Desde sua instituição, em 2008 através da portaria nº 1.559, apresentou avanços relacionados à melhoria da qualidade dos fluxos assistenciais, fazendo com que essa dimensão da regulação possa ser considerada a porta de acesso do usuário aos serviços públicos de saúde. Por isso, o objetivo principal da pesquisa consiste em analisar os indicadores de satisfação e absenteísmo, pois, estes são os que revelam como está a imagem da instituição e seu aproveitamento com relação à oferta e demanda. Em agosto de 2010, surgiu a Central de Regulação de Oferta de Serviços de Saúde – CROSS, e foi implantada no Hospital alvo deste trabalho com suas diversas funções, permitindo um fluxo mais prático e organizado de promover o acesso aos usuários do SUS, por isso, neste trabalho será avaliado o impacto dos agendamentos realizados por meio do sistema CROSS, permitindo o acesso ambulatorial e avaliando os indicadores que apresentem efetivamente o impacto de sua implantação. Os resultados obtidos apontam mudanças positivas e melhorias na qualidade assistencial, pois passa a seguir protocolos mais adequados na prática da regulação assistencial.
18
Feitosa, Paulo Egidio dos Santos. "AÃÃes de urgÃncia e emergÃncia no Estado do CearÃ: uma proposta de organizaÃÃo a partir da implantaÃÃo do atendimento prÃ-hospitalar." Universidade Federal do CearÃ, 2008. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=2559.
Full textAbstract:
CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel SuperiorEste estudo, descritivo, teve como objetivo elaborar uma proposta para organizaÃÃo do Sistema Estadual de UrgÃncia e EmergÃncia no estado do CearÃ-Brasil, baseado na implantaÃÃo de serviÃos de atendimento prÃ-hospitalar de urgÃncia e emergÃncia. PropÃe o desenho de regionalizaÃÃo dos serviÃos na Ãtica do atendimento prÃ-hospitalar com Ãnfase na integralidade da atenÃÃo e integraÃÃo dos serviÃos, da qualificaÃÃo e da humanizaÃÃo da atenÃÃo. Com base nos dados do Datasus, e IBGE, ano 2003 e de acordo com o estabelecido pela Portaria GM-MS 2048/2003, foram definidos 12 pÃlos regionais de urgÃncia e emergÃncia com o mesmo nÃmero de centrais de regulaÃÃo (11 a serem implantadas). SÃo necessÃrias 133 ambulÃncias de suporte bÃsico (USB) e 28 ambulÃncias de suporte avanÃado (USA). O pessoal necessÃrio serÃ: 396 mÃdicos, 396 enfermeiros, 737 auxiliares/tÃcnico de enfermagem, 660 condutores socorristas, 11 farmacÃuticos, 110 telefonistas, entre outros. Foi analisado o quantitativo de internaÃÃes realizadas nos 20 hospitais pÃlos em relaÃÃo a intervalos de distÃncia do local da residÃncia. A ocupaÃÃo dos leitos à em sua maioria feita pelos residentes dos municÃpios onde o hospital està localizado. Com base nos parÃmetros do Ato Portaria n 1101/GM-MS e de acordo com o agrupamento pÃlo-regional sugerido foi analisado o quantitativo de leitos disponÃveis, verificou-se que o nÃmero de leitos à insuficiente, sendo mais preocupante a situaÃÃo dos leitos de UTI. Quanto aos tipos de procedimentos de urgÃncia e emergÃncia, na comparaÃÃo entre os pÃlos, por freqÃÃncia, existe maior concentraÃÃo nas internaÃÃes para realizaÃÃo de partos, cesarianas e curetagem pÃs-aborto. Sugere-se que a implantaÃÃo seja feita de forma gradual com prioridade para as regiÃes mais desassistidas. Na repactuaÃÃo da ocupaÃÃo dos leitos dos hospitais pÃlo-regionais deverà haver definiÃÃo clara de um percentual eqÃitativo para os tipos de procedimentos por internaÃÃo a serem utilizados pelos moradores dos municÃpios da Ãrea de cobertura regional, com definiÃÃo de um âportfÃlioâ padronizado de serviÃos hospitalares, almejando auto-suficiÃncia do atendimento de urgÃncia e emergÃncia a nÃvel micro e macrorregional de saÃde no estado do CearÃ.
This study, descriptive, aimed to develop a proposal for organizing the State System of Urgency and Emergency in the state of CearÃ-Brazil, based on the deployment of the prehospital emergency care. Proposes the design of regional services in the optics of prehospital care with emphasis on the completeness of care and integration of services, qualification and the humanization of attention. Based on data from DATASUS and IBGE, year 2003, in conformity with a Minister of Health Order n 2048/2003-GM-MS, were defined 12 regional clusters of urgency/emergency, with the same number of centrals regulation (11 to be implanted), 133 ambulances are needed for basic support (USB in portuguese) and 28 ambulances for advanced support (USA in portuguese). The necessary staff will be: 396 physicians, 396 nurses, 737 assistant/technical nursing, 660 ambulance drivers, 11 pharmacists, 110 telephone operators, among others. It was analyzed the admissions quantitative made in 20 poles hospitals in relation to the intervals of distance from the place of domicile. The occupation of beds is, in its majority, made by people of the municipality where the hospital is located. Based on the features of the Act Order of a Minister of Health n 1101/GM-MS and according to the pole-regional grouping suggested, an analysis was made to verify the amount of beds available. It was obeyed that the number of beds is insufficient, more worrying is the situation of the ICU beds. As for the types of procedures of emergency, in the comparison between the poles, by frequency, there is greater focus on admissions for carrying out deliveries, cesarean sections and curettage post-abortion. It is suggested that the implementation of services should be done gradually with priority to the most underprivileged regions. In the re agreement of occupation of the beds in poleregional hospitals there should be clear a fair percentage for the types of procedures to be used by residents of the municipalities in regional coverage area, with definition of a standardized portfolio of hospital services, targeting self-sufficiency of emergency care at micro and macrorregional health in the state of Ceara.
19
Court, Alex J. "They're NICE and neat, but are they useful? : a grounded theory of clinical psychologists' beliefs about, and use of, NICE guidelines." Thesis, Canterbury Christ Church University, 2014. http://create.canterbury.ac.uk/12832/.
Full textAbstract:
There is a growing research interest into investigating why NICE (National Institute for Health and Care Excellence) guidelines are not consistently followed in UK mental health services. The current study utilised grounded theory methodology to investigate clinical psychologists’ use of NICE guidelines. Eleven clinical psychologists working in routine practice in the NHS were interviewed. A theoretical framework was produced conceptualising the participants’ beliefs, decision making processes and clinical practices. The overall emerging theme was “considering NICE guidelines to have benefits but to be fraught with dangers”. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, as a result of pressure, and also the rewards that follow from being seen to comply with NICE guidelines, they tended to practice in ways that prevent these skills from being recognised. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. This is the first theoretical framework that attempts to explain why NICE guidelines are not consistently utilised in UK mental health services. Attention is drawn to the proposed benefits and limitations of guidelines and how these are managed. This study highlights the importance of clinical psychologists articulating and advertising their specialist skills. The findings are integrated with existing theory and research, and clinical and research implications are presented.
20
Hanna, Elizabeth Gayle (Liz), and lizhanna@netc net au. "Environmental health and primary health care: towards a new workforce model." La Trobe University. School of Public Health, 2005. http://www.lib.latrobe.edu.au./thesis/public/adt-LTU20061110.152550.
Full textAbstract:
Public health was once synonymous with environmental health. However, as living conditions improved the two fields diverged. Environmental factors are again re-emerging as hazards human health. Increasing global reliance on agricultural and veterinary chemicals (AgVets) over recent decades has is now a serious public health concern. Evidence of their toxicity has prompted international efforts to minimize, monitor and manage exposure risks. Direct involvement of the primary health care workforce is seen as critical to this process, yet little data exists on the health burden on Australian rural communities imposed by these chemicals.
The study presented here attempts to explore the impact of these chemicals on two rural communities in Victoria, and ascertain the how the existing primary heath care system responds to AgVet exposure issues. Health determinants are complex, and inter-related, and the client �provider interface is not an entity acting in isolation from other frameworks. The provider-client service relationship has evolved against a background of legislation and provider training. Many external factors also impinge, such as the structure and focus of the health sector, and Australia�s systematic approach to environmental and chemical management. Examination of this underlying infrastructure in Australia provided the background against which the issue of exposure to agricultural and veterinary chemicals was explored. A brief summary of international developments in this area served to provide insight as to what interventions may be introduced to address the issue of chemical exposure.
A CATI (Computer Assisted Telephone Interview) survey of 1050 households sought the perspectives from two Victorian agricultural communities to gather self-reported AgVet exposure patterns and health data, and whether respondents perceived their health problems were linked to exposure. Respondents were also asked to comment on the primary health care service experiences from local providers, and which services they preferred to seek for health advice. Perspectives were then sought from all primary health care providers servicing these communities. Information was sought on their level of expertise in diagnosing, and managing exposure related illness, via face-to-face interviews, focus groups and paper surveys.
The study revealed rural communities have a long history of hazardous exposure to toxic AgVets. Awareness of toxicity risks is growing, yet further scope exists to improve safe handling of chemicals. High levels of illnesses known be associated with AgVet exposure exist among rural populations. Many believe their own ill-health is linked to exposure, and express strong dissatisfaction with the apparent lack of environmental health expertise especially among their GPs. Health providers demonstrated limited understanding of the health impacts of AgVet exposure.
The lack of environmental health expertise among the existing primary health care workforce means that health conditions associated with exposure to AgVets are not being identified, and the absence of health intelligence hampers health planning. In Australia, the health, environment and primary industries sectors function in effect, as distinct silos, with little cross-fertilisation. The United States has combined its agricultural chemical legislative authority to develop a focus on human health, establish direct links, and biomonitoring programs to protect human heath. The U.S. has also developed environmental health expertise at the primary health care level to address community needs as they arise. Strategies are required in Australia to connect the environment, chemical management and health portfolios, with respect to the emerging environmental issues of chemical exposure. There is a need also in Australia to inject environmental health capacity into the primary health care practice.
21
Mathekgane, Justice Mpho. "The laws regulating National Health Insurance scheme :prospects and challenges." Thesis, University of Limpopo, 2013. http://hdl.handle.net/10386/2542.
Full text
22
Kale, Hrishikesh P. "Economic Burden of Renal Cell Carcinoma (RCC) and Treatment Patterns, Overall Survival and Healthcare Costs among Older Metastatic RCC Patients." VCU Scholars Compass, 2018. https://scholarscompass.vcu.edu/etd/5555.
Full textAbstract:
Background
Renal cell carcinoma (RCC) is the most common type of kidney cancer. Patients diagnosed with metastatic RCC (mRCC) have shorter overall survival compared to those diagnosed at earlier stages. Several targeted therapies, which cost from $7,000 - $16,000 per month have been approved since 2005 to treat mRCC. In addition, there is a growing interest in the use of cytoreductive nephrectomy (CN) with targeted therapies among mRCC patients. However, little is known regarding the economic burden of RCC and role of CN and prescribing patterns of targeted therapies among older mRCC patients.
Objectives
1) To assess the economic burden of RCC among older adults in the targeted therapy era 2) To compare the overall survival (OS) and total healthcare cost (THC) among older mRCC patients receiving CN and targeted therapy versus patients receiving targeted therapy alone 3) To describe prescribing patterns of targeted therapies and associated OS and THC among older mRCC patients.
Methods
This dissertation was conducted using the Surveillance Epidemiology and End Results (SEER) - Medicare linked data. For the first objective, the study included a prevalent cohort of RCC patients from 2013, diagnosed during 2005 - 2013 and continuously enrolled in Medicare. RCC patients were matched to non-cancer beneficiaries using propensity score matching. Generalized linear models estimated the incremental healthcare costs. Incremental total healthcare cost (THC) was multiplied by the estimated number of RCC patients on Medicare to calculate the total economic burden of RCC. For the second objective, we included patients diagnosed with mRCC between 2007-2014 and compared overall survival (OS), and THC between patients who received CN + targeted therapy and targeted therapy alone. A propensity score based inverse probability of treatment weighting (IPTW) method was used to balance the two treatment groups. A Cox proportional hazard model assessed the risk for death and a GLM compared healthcare costs between the groups. For the third objective, patients with mRCC were defined as patients who were diagnosed at stage-IV or at earlier stages but were currently using targeted therapies. Further, we restricted our sample to patients who initiated targeted therapy. We described the frequencies of the most common first and second line targeted therapies. We also described OS and THC per month for clear-cell and non-clear cell mRCC for each therapy and line of therapy.
Results
The first study included 10,392 each of RCC and control patients. The average THC associated with RCC was $7,419. The average THC was $4,584 for patients diagnosed at stage-I, $4,727 for stage-II, $9,331 for stage-III, and $31,637 for stage-IV. The annual economic burden of RCC on Medicare was estimated to be $1.5 billion. The second study included 471 mRCC patients that received CN + targeted therapy or targeted therapy alone. The median OS from the adjusted survival curves was significantly higher (p
Conclusions
The economic burden of RCC varied substantially between early stage and metastatic patients. Among mRCC patients, use of CN among targeted therapy users was associated with a higher median OS and similar monthly THC over a lifetime. Sunitinib and everolimus were the most common first and second line targeted therapies among mRCC patients. The descriptive analysis suggested that OS and THC were similar across types of targeted therapy sequences.
23
Njoumemi, Zakariaou. "Enabling and regulating private sector provision of malaria services in three districts of Western Cameroon." Doctoral thesis, University of Cape Town, 2007. http://hdl.handle.net/11427/7442.
Full textAbstract:
Includes bibliographical references (leaves 369-414).This study aims to examine the existing enabling and regulatory interventions in Cameroon, and to explore their impact on the performance of private providers of malaria services. It makes recommendations to decision-makers on the best strategies for influencing the performance of private providers of public health services in low income countries. The study’s framework involves the Ministry of Health as a principal who authorises the private sector as an agent to provide malaria services to populations, in exchange for mutually agreed rewards and in the context of specified rules. Data were collected using both qualitative and quantitative research methods. This study found that the private sector provides a substantial portion of malaria services in Cameroon. There is evidence that enabling and regulatory interventions can enhance the private sector's quantity and quality of inputs which are used for expanding coverage, improving quality of care and affordability of malaria services. These interventions can approximate the objectives of multiple stakeholders including the Ministry of Health, Medical Council, managers, clinical staff and patients, thereby addressing the principal- agent problems in the health sector. Areas of private sector activity that are particularly difficult, but critical to influence are those of overcharging, unnecessary self-referral and issues of informal providers. Enabling interventions neither compete with nor negate traditional regulations in the health sector but seek to complement regulatory mechanisms by adding value from the perspective of influencing private sector providers’ behaviour. Government needs to invest in its ability - improving capacities and governance, providing resources and logistics - to oversee the ongoing development, implementation, monitoring and revision of enabling and regulatory interventions for the private health sector. The performance of private providers appears to be more positively influenced by enabling interventions than by regulatory mechanisms. In the absence of enabling interventions it may be inappropriate to try to influence the performance of private providers through regulatory mechanisms alone. While the resources needed for enforcement of regulations are limited, enabling and regulatory interventions can be integrated in such a way that it is in the interests of the private sector to comply with regulation of health service delivery. This can reduce the level of resources needed for effective enforcement of regulation amongst private providers. This study concludes that the integration of enabling and regulatory interventions appear to be a strategic policy option for influencing the performance of private providers of malaria services in low income countries.
24
Patterson, Andrea M. "Evaluating The Effects of an Educational Lifestyle Modification Intervention on Blood Pressure in Adults With Prehypertension." UNF Digital Commons, 2014. http://digitalcommons.unf.edu/etd/496.
Full textAbstract:
The purpose of this project was to evaluate the effectiveness of an educational lifestyle modification (LM) intervention on blood pressure (BP) among adults with prehypertension. Prehypertension is a precursor to hypertension (HTN) and is a public epidemic in the United States. Approximately 68 million (31%) U.S. adult’s aged ≥18 years have hypertension. Hypertension can cause significant target organ damage, lead to coronary heart disease, heart failure, stroke, and kidney failure. Early identification and the primary treatment of persons with prehypertension with LM have the potential to minimize the progression and delay the onset of comorbidities associated with hypertension. This quality improvement project retrospectively reviewed changes in blood pressure for a small sample (n=5) of patients diagnosed with prehypertension who received education about modifying lifestyle behaviors according to nationally accepted clinical practice guidelines. Blood pressure measurements were extracted from the medical record beginning at the time of the education through a three month period. Descriptive data indicates that all five patients had a decrease in systolic and diastolic blood pressure. The median systolic blood pressure at baseline was 129 mmHg decreasing to 121 mmHg at end of study period. The median diastolic blood pressure was 86 mmHg decreasing to 76 mmHg. Integration of lifestyle modification education and subsequent blood pressure monitoring during a routine primary care visit is feasible and may help motivate patients to implement changes and subsequently reduce blood pressure. Future studies should include identifying strategies for improving patient participation.
25
Buckell, John A. S. "Empirical essays on the cost efficiency and economic regulation of hospitals in the National Health Service in England." Thesis, University of Leeds, 2015. http://etheses.whiterose.ac.uk/9675/.
Full textAbstract:
Rising global healthcare expenditures, the fallout from the global financial crisis and a commitment to improving patient outcomes have increased pressure on the budget of the National Health Service (NHS) in England to unprecedented levels. Therefore, ensuring services are delivered efficiently is key both politically and economically. In the context of the NHS, the large share of spending in secondary care means that this area is well analysed in the literature. However, the scale of the savings needed requires that both (a) more research is needed to identify further possible gains; and (b) the potential for improvement that has been identified by these studies is captured. To these ends, there are two specific aims of this thesis. The first is to examine the regulation of NHS hospital efficiency. Drawing from health care and other sectors of the economy, a number of lessons for regulators to promote hospital efficiency in the NHS and beyond are proposed. The second is to look to areas of hospital activity for which empirical evidence on efficiency is limited to identify further available gains. Many studies in the UK and beyond have sought to measure efficiency in health: the so-called “supply” of efficiency analysis is booming. However, despite their potential, the use of these studies has been limited in the NHS. In response to this, this thesis seeks to answer some of the methodological and practical issues raised around efficiency measurement and its application to the setting of NHS hospital efficiency targets. How these findings are useful more widely to health care systems around the world is also discussed.
26
Reynolds, Lisa Marie. "Risk and the regulation of communication in relation to service users' and providers' experiences of forensic mental health care." Thesis, City University London, 2010. http://openaccess.city.ac.uk/7783/.
Full textAbstract:
This thesis presents a qualitative study of service users’ and providers’ experiences of one UK inner city medium secure forensic mental health service. The study focused on the processes through which service users and providers attempted to manage their risk status. Aims The study had three main aims: 1. To develop a greater understanding of the complex formal and informal risk assessment and management processes operating in medium secure forensic mental health services. 2. To investigate the processes through which providers and users of medium secure services attempt to manage risk by balancing safety with the promotion of service user autonomy. 3. To generate recommendations derived from the study findings for the development of forensic mental health services. Methodology and methods A qualitative grounded theory methodology was used to explore forensic mental health care from the perspectives of service users and providers. Data were collected through lightly structured interviews and participant observation. Participant observation occurred over a period of eighteen month. Activities that took place within the service were observed and spontaneous informal conversations between the researcher and participants recorded. A theoretical sampling approach was adopted. Design, data collection and analysis were done in cycles so that the direction of inquiry could be grounded in participants’ concerns. Eventually, data collection and analysis were organised around the core category of the regulation of communication. Findings The regulation of communication was analysed in relation to three other important categories: the management of own risk status; the dynamics of self-forming groups; and external role expectations. It is hypothesized that the regulation of communication provided a means of attempting to meet competing role expectations and thus manage risk status. Conclusions The study provides an insight into how service users and providers situated within a complex and conflicted system may attempt to manage their risk status through regulating their communication. This strategy enables service users and providers to attempt to achieve the highly problematic mission of the forensic mental health service; to provide mental health care and public protection. However, organisational learning and risk management may be hampered by the regulation of communication as information regarding clinical and organisational risks may be silenced within official organisational systems. Furthermore underlying problems may remain unresolved for users and providers who feel unable to express dissent.
27
McAllister, Steve Randolph. "Implementation of Food Safety Regulations in Food Service Establishments." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5902.
Full textAbstract:
Food service businesses in the United States have experienced millions of dollars in losses caused by foodborne illness outbreaks, which can lead to bankruptcy and business closures. More than 68% of all foodborne illness outbreaks occur in food service establishments. The purpose of this descriptive case study was to explore the strategies leaders of food service establishments use to implement food safety regulations. Force field analysis was the conceptual framework for this study. The population for the study consisted of 3 leaders of food service establishments located in the southeastern region of the United States. Data were collected using semistructured interviews and a review of the business policies and procedures that support compliance with critical food safety regulations. The methodological triangulation approach was used to assist in correlating the interview responses with company policies and procedures during the data analysis process. Yin's 5-step data analysis approach resulted in 3 themes: (a) organizational performance analysis for improvements in food safety, (b) strategies applied to improve food safety, and (c) stability of new strategies for food safety. The key strategies identified included adhering to the guidelines of food code and regulation, conducting employee training and awareness building, and working closely with food safety inspectors. The implications for positive social change include the potential to add knowledge to businesses, employees, and communities on the use of effective food safety strategies to minimize foodborne illnesses. Such results may lead to the improvement of service performance and long-term growth and sustainability of food service establishments.
28
Ozkan, Ozlem. "Attitudes And Opinions Of People Who Use Medical Services About Privacy And Confidentiality Of Health Information In Electronic Environment." Master's thesis, METU, 2011. http://etd.lib.metu.edu.tr/upload/12612974/index.pdf.
Full textAbstract:
In health services, it is a necessity to keep the records of the patients. Although paper-based records are commonly used for this aim, they are not as convenient as computerized records. Therefore, many of the health facilities have recently started keeping patients&rsquohealth records in electronic databases. However, new questions about confidentiality and privacy of these records were raised with this new system.This study aims to investigate the opinions and attitudes of the people who use the health services of Turkey about the privacy and confidentiality of health information in electronic environment. In the survey, there are 596 participants from 64 different cities in six geographical regions of Turkey. The findings show that people feel comfortable about computer usage in health-care but they are concerned about the privacy and confidentiality of their information and also they are not sure if their medical information is safe and secure now. Moreover, they are mostly unaware about current regulations related to information privacy in Turkey. The study also shows that people trust in their doctors, health researchers in universities, pharmacist, nurses and other hospital staff but do not trust in insurance companies, government, private sector health researchers, information technology specialists and government health researchers for the privacy of their medical records.
29
Salako, Abiodun. "The impact of state nurse practitioner scope-of-practice regulations on access to primary care in health professional shortage areas." Diss., University of Iowa, 2019. https://ir.uiowa.edu/etd/7025.
Full textAbstract:
Primary care physician (PCP) shortages have been a barrier to accessing care for millions of Americans, particularly those living in areas facing the worst shortages - primary care health professional shortage areas (HPSAs). Increased use of nurse practitioners (NPs) has been proposed as a solution to the shortages as NPs can effectively substitute for PCPs. However, this proposal has been hampered by regulatory restrictions on NP scope-of-practice (SOP) that exist in many states. While some states permit NPs to practice and prescribe medications independent of physicians (NP independence), others require extensive physician supervision that limit NPs ability to provide care and substitute for PCPs. Despite the limitations that restrictive regulations pose to improving access to primary care, research evidence of their effect on access in primary care HPSAs is limited. This dissertation fills this gap in the literature.
Using individual-level data from the Medical Expenditure Panel Surveys (1996-2015) and a difference-in-differences approach, I exploit variation in NP independence across states and over time to evaluate the impact of NP independence on access to primary care in HPSAs Further, I examined for heterogeneity in the effect of NP independence between HPSAs and non-HPSAs as well as effect heterogeneity in HPSAs based on individual (age, insurance status, and insurance type) and health system characteristics (availability of primary care facilities and NP Medicaid reimbursement rate)
I find that NP independence led to a 5% increase in the number of individuals with a primary care provider and a 2% increase in the use of non-physicians (relative to physicians) as the primary care provider in HPSAs. However, non-HPSAs experienced no significant changes in access to care. Further, I find evidence of heterogeneity in the effect of NP independence in HPSAs for all three individual characteristics but find no significant effect heterogeneity for any of the health system characteristics. Non-elderly individuals experienced greater improvements in access following NP independence compared to their elderly counterparts, and while both insured and uninsured individuals experienced improvements in access to care, uninsured individuals benefitted more from NP independence. Further, I find evidence of greater improvements in access to care among Medicaid beneficiaries relative to their privately insured and Medicare counterparts.
These findings imply that removing regulatory restrictions on NP SOP could be an effective policy strategy for mitigating the effects of PCP shortages and improving access to care in HPSAs. Further, they demonstrate that NP independence could be a viable tool for addressing access to care issues in two traditionally underserved populations – the uninsured and Medicaid beneficiaries. Beyond addressing access issues, NP independence could also mitigate rising health care costs. The finding of increased use of lower-cost non-physicians rather than their more costly physician counterparts after NP independence indicates that this policy change could also bring about cost savings for society.
30
Bamyr, Hanssen Soziar, and Rosemarie Ohanyan. "Konsekvenserna av (EU) 2017/746- förordningen på tillverkning och användning av medicintekniska produkter för in vitro-diagnostik inom Karolinska Universitetssjukhuset." Thesis, KTH, Medicinteknik och hälsosystem, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-297857.
Full textAbstract:
In collaboration with the Karolinska University Hospital, this research was carried out with the aim of executing a consequence analysis of the new regulation (EU) 2017/746. The consequences of the regulation regarding access, distribution, manufacturing and in-house production of in vitro diagnostic products were examined for various departments at the Karolinska University Hospital. This was investigated through an extensive literature study and interviews that were conducted digitally and through email. Of the departments examined, attention was drawn to the fact that only Lab & Primary Health Care and the Karolinska University Laboratory were affected by the new regulation. The availability of products may be affected as a consequence of the new requirements for risk classification and the notified bodies. If the manufacturer does not meet the new requirements, this may lead to a shortage of materials and products, which can affect Lab & Primary Care and the Karolinska University Laboratory. Lab & Primary Health Care will be affected by the requirements for distribution in the new regulation if they decide to distribute new in vitro diagnostic products to other businesses. The Karolinska University Laboratory has a production that they currently CE mark according to the old directive and an in-house production. In order for the Karolinska University Laboratory to continue its own production, it is required that they meet the requirements imposed on in-house production in the new regulation. With continued CE marking of the products, they will be classified as manufacturers and need to meet its requirements. In summary, it can be stated that both Lab & Primary Health Care and the Karolinska University Laboratory have three paths to go; distribute, produce in-house or manufacture in vitro diagnostic products. Depending on the decision they make, they are classified differently according to the new regulation (distributors, in-house manufacturers or manufacturers) and thus have different requirements to follow.I samarbete med Karolinska Universitetssjukhuset utfördes denna studie med målet att genomföra en konsekvensanalys av det nya regelverket (EU) 2017/746. Regelverkets konsekvenser gällande tillgång, distribution, tillverkning och egentillverkning av in vitro-diagnostik produkter undersöktes för olika enheter inom Karolinska Universitetssjukhuset. Detta undersöktes genom en omfattande litteraturstudie och intervjuer som utfördes digitalt och via mail. Av de enheter som granskades uppmärksammades att endast Lab & Primärvård och Karolinska Universitetslaboratoriet påverkades av den nya lagstiftningen. Tillgången på produkter kan komma att påverkas som en konsekvens av de nya kraven på riskklassificering och på de anmälda organen. Om tillverkaren inte uppfyller de nya kraven kan detta leda til brist på material och produkter, vilken kan påverka Lab & Primärvård samt Karolinska Universitetslaboratoriet. Lab & Primärvård kommer beröras av kraven för distribution i den nya förordningen om de beslutar att distribuera nya in vitro-diagnostik produkter till andra verksamheter. Karolinska Universitetslaboratoriet har en tillverkning som de i dagsläget CE-märker enligt det gamla direktivet samt en egentillverkning. För att Karolinska Universitetslaboratoriet ska fortsätta sin egentillverkning krävs det att de uppfyller kraven som ställs på egentillverkare i nya regelverket. Vid fortsatt CE-märkning av produkterna kommer de att klassas som tillverkare och behöver uppfylla dess krav. Sammanfattningsvis kan det konstateras att både Lab & Primärvård och Karolinska Universitetslaboratoriet har tre vägar att gå; distribuera, egentillverka eller tillverka in vitro-diagnostik produkter. Beroende på beslutet de fattar klassas de olika enligt det nya regelverket (distributörer, egentillverkare eller tillverkare) och har därmed olika krav att följa.
31
Pimentel, Camilla B. "Use of Opioids for Pain Management in Nursing Homes: A Dissertation." eScholarship@UMMS, 2015. https://escholarship.umassmed.edu/gsbs_diss/773.
Full textAbstract:
Nursing homes are an essential yet understudied provider of cancer-related care for those with complex health needs. Nine percent of nursing home residents have a cancer diagnosis at admission, and it is estimated that one-third of them experience pain on a daily basis. Although pain management is an essential component of disease treatment, few studies have evaluated analgesic medication use among adults with cancer in this setting. Use of opioids, which are the mainstay of pain management in older adults because of their effectiveness in controlling moderate to severe pain, may be significantly related to coverage by the Medicare Part D prescription drug benefit. However, little is known about Medicare Part D’s effects on opioid use in this patient population. A limited body of evidence also suggests that despite known risks of overdose and respiratory depression in opioid-naïve patients treated with long-acting opioids, use of these agents may be common in nursing homes.
This dissertation examined access to appropriate and effective pain-related health care services among US nursing home residents, with a special focus on those with cancer. Objectives of this dissertation were to: 1) estimate the prevalence, and identify resident-level correlates, of pain and receipt of analgesic medications; 2) use a quasi-experimental research design to examine the relationship between implementation of Medicare Part D and changes in the use of fentanyl patches and other opioids; and 3) to estimate the prevalence, and identify resident-level correlates, of naïve initiation of long-acting opioids. Data on residents’ health status from the Resident Assessment Instrument/Minimum Data Set (versions 2.0 and 3.0) were linked with prescription drug transaction data from a nationwide long-term care pharmacy (January 2005–June 2007) and the Centers for Medicare and Medicaid Services (January–December 2011).
From 2006 to 2007, more than 65% of residents of nursing homes throughout the US with cancer experienced pain (28.3% on a daily basis), among whom 13.5% reported severe pain. More than 17% of these residents who experienced daily pain received no analgesics (95% confidence interval [CI]: 16.0–19.1%), and treatment was negatively associated among those with advanced age, cognitive impairment, feeding tubes, and restraints. These findings coincided with changing patterns in opioid use among residents with cancer, including relatively abrupt 10% and 21% decreases in use of fentanyl patches and other strong opioids, respectively, after the 2006 implementation of Medicare Part D. In the years since Medicare Part D was introduced, some treatment practices in nursing homes have not been concordant with clinical guidelines for pain management among older adults. Among a contemporary population of long-stay nursing home residents with and without cancer, 10.0% (95% CI: 9.4–10.6%) of those who began receiving a long-acting opioid after nursing home admission had not previously received opioid therapy. Odds of naïve initiation of these potent opioids were increased among residents with terminal prognosis, functional impairment, feeding tubes, and cancer.
This dissertation provides new evidence on pharmaceutical management of pain and on Medicare Part D’s impact on opioid use in nursing home residents. Results from this dissertation shed light on nursing home residents’ access to pain-related health care services and provide initial directions for targeted efforts to improve the quality of pain treatment in nursing homes.
32
Pimentel, Camilla B. "Use of Opioids for Pain Management in Nursing Homes: A Dissertation." eScholarship@UMMS, 2004. http://escholarship.umassmed.edu/gsbs_diss/773.
Full textAbstract:
Nursing homes are an essential yet understudied provider of cancer-related care for those with complex health needs. Nine percent of nursing home residents have a cancer diagnosis at admission, and it is estimated that one-third of them experience pain on a daily basis. Although pain management is an essential component of disease treatment, few studies have evaluated analgesic medication use among adults with cancer in this setting. Use of opioids, which are the mainstay of pain management in older adults because of their effectiveness in controlling moderate to severe pain, may be significantly related to coverage by the Medicare Part D prescription drug benefit. However, little is known about Medicare Part D’s effects on opioid use in this patient population. A limited body of evidence also suggests that despite known risks of overdose and respiratory depression in opioid-naïve patients treated with long-acting opioids, use of these agents may be common in nursing homes.
This dissertation examined access to appropriate and effective pain-related health care services among US nursing home residents, with a special focus on those with cancer. Objectives of this dissertation were to: 1) estimate the prevalence, and identify resident-level correlates, of pain and receipt of analgesic medications; 2) use a quasi-experimental research design to examine the relationship between implementation of Medicare Part D and changes in the use of fentanyl patches and other opioids; and 3) to estimate the prevalence, and identify resident-level correlates, of naïve initiation of long-acting opioids. Data on residents’ health status from the Resident Assessment Instrument/Minimum Data Set (versions 2.0 and 3.0) were linked with prescription drug transaction data from a nationwide long-term care pharmacy (January 2005–June 2007) and the Centers for Medicare and Medicaid Services (January–December 2011).
From 2006 to 2007, more than 65% of residents of nursing homes throughout the US with cancer experienced pain (28.3% on a daily basis), among whom 13.5% reported severe pain. More than 17% of these residents who experienced daily pain received no analgesics (95% confidence interval [CI]: 16.0–19.1%), and treatment was negatively associated among those with advanced age, cognitive impairment, feeding tubes, and restraints. These findings coincided with changing patterns in opioid use among residents with cancer, including relatively abrupt 10% and 21% decreases in use of fentanyl patches and other strong opioids, respectively, after the 2006 implementation of Medicare Part D. In the years since Medicare Part D was introduced, some treatment practices in nursing homes have not been concordant with clinical guidelines for pain management among older adults. Among a contemporary population of long-stay nursing home residents with and without cancer, 10.0% (95% CI: 9.4–10.6%) of those who began receiving a long-acting opioid after nursing home admission had not previously received opioid therapy. Odds of naïve initiation of these potent opioids were increased among residents with terminal prognosis, functional impairment, feeding tubes, and cancer.
This dissertation provides new evidence on pharmaceutical management of pain and on Medicare Part D’s impact on opioid use in nursing home residents. Results from this dissertation shed light on nursing home residents’ access to pain-related health care services and provide initial directions for targeted efforts to improve the quality of pain treatment in nursing homes.
33
Bundgaard, Henning. "Potassium regulation in heart and skeletal muscles : relation to level of K intake, disease mechanisms and pharmacotherapy /." København : Lægeforeningen, 2005. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=013175180&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
Full text
34
Henriksson, Otto. "Protection against cold in prehospital trauma care." Doctoral thesis, Umeå universitet, Kirurgi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-54372.
Full textAbstract:
Background: Protection against cold is vitally important in prehospital trauma care to reduce heat loss and prevent body core cooling. Objectives: Evaluate the effect on cold stress and thermoregulation in volunteer subjects byutilising additional insulation on a spineboard (I). Determine thermal insulation properties of blankets and rescue bags in different wind conditions (II). Establish the utility of wet clothing removal or the addition of a vapour barrier by determining the effect on heat loss within different levels of insulation in cold and warm ambient temperatures (III) and evaluating the effect on cold stress and thermoregulation in volunteer subjects (IV). Methods: Aural canal temperature, sensation of shivering and cold discomfort was evaluated in volunteer subjects, immobilised on non-insulated (n=10) or insulated (n=9) spineboards in cold outdoor conditions (I). A thermal manikin was setup inside a climatic chamber and total resultant thermal insulation for the selected ensembles was determined in low, moderate and high wind conditions (II). Dry and wet heat loss and the effect of wet clothing removal or the addition of a vapour barrier was determined with the thermal manikin dressed in either dry, wet or no clothing; with or without a vapour barrier; and with three different levels of insulation in warm and cold ambient conditions (III). The effect on metabolic rate, oesophageal temperature, skin temperature, body heat storage, heart rate, and cold discomfort by wet clothing removal or the addition of a vapour barrier was evaluated in volunteer subjects (n=8), wearing wet clothing in a cold climatic chamber during four different insulation protocols in a cross-over design (IV). Results: Additional insulation on a spine board rendered a significant reduction of estimated shivering but there was no significant difference in aural canal temperature or cold discomfort (I). In low wind conditions, thermal insulation correlated to thickness of the insulation ensemble. In greater air velocities, thermal insulation was better preserved for ensembles that were windproof and resistant to the compressive effect of the wind (II). Wet clothing removal or the use of a vapour barrier reduced total heat loss by about one fourth in the cold environment and about one third in the warm environment (III). In cold stressed wet subjects, with limited insulation applied, wet clothing removal or the addition of a vapour barrier significantly reduced metabolic rate, increased skin rewarming rate, and improved total body heat storage but there was no significant difference in heart rate or oesophageal temperature cooling rate (IV). Similar effects on heat loss and cold stress was also achieved by increasing the insulation. Cold discomfort was significantly reduced with the addition of a vapour barrier and with an increased insulation but not with wet clothing removal. Conclusions: Additional insulation on a spine board might aid in reducing cold stress inprolonged transportations in a cold environment. In extended on scene durations, the use of a windproof and compression resistant outer cover is crucial to maintain adequate thermal insulation. In a sustained cold environment in which sufficient insulation is not available, wet clothing removal or the use of a vapour barrier might be considerably important reducing heat loss and relieving cold stress.
35
Benda, Vladislav. "Problém rovnosti a efektivnosti při realizaci vládních programů." Master's thesis, Vysoká škola ekonomická v Praze, 2011. http://www.nusl.cz/ntk/nusl-136306.
Full textAbstract:
The goal of this work is to show particular conditions and problems according to Equality and Effecciency of Government Progammes and offer possibilities how to solve them, improve them or alternatives to those problems on particular examples. Theoretical part of this work is at first about the role of Public Sector in the National Economy, reasons why is this sector involved in some parts of economy, especially in Healthcare Services. This part is followed by concepts of Efficiency evaluation of particular Government Programmes and theoretical concepts about Equality. Practical part is then aimed on Regulative charges introduced in the Healthcare Services in the Czech Republic.
36
Farzanehfar, Forogh. "Samverkan mellan aktörer som arbetar med personer med funktionsnedsättning inom LSS." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-55390.
Full textAbstract:
En person som har insatser enligt LSS (Lagen om stöd och service till vissa funktionshindrade) kan möta många olika aktörer i sin vardag. Studien avsåg att undersöka hur samverkan fungerar mellan aktörerna inom LSS. Frågeställningar behandlade två frågor som handlade om främjande faktorer och hämmande faktorer för samverkan. Urvalet begränsades till personer som arbetar nära brukare och mer eller mindre på daglig basis ser dennes behov av stöd. Verksamhetschef, boendestödjare och platsansvarigchef är de aktörer som har en övergripande bild av samverkan. Utifrån semistrukturerade intervjuer och en tematisk analys genererades 7 teman. Främjande faktorer var gemensam värdegrund, tydlighet och strukturerade rutiner, verksamhetsmål, ömsesidigt samförstånd och förtroende. Hämmande faktorer var lagar och förordningar, brist på kommunikation samt brist på kunskap. Resultatet av undersökningen visar att för en välfungerande samverkan, behövs det samsyn kring aktörernas olikheter. Goda relationer och respekt för varandras uppdrag och regelverk är central i samverkan.
37
Zajac, Tomáš. "Využití velkokapacitních baterií v provozu Červený Mlýn k rozšíření podpůrných služeb vůči ČEPS." Master's thesis, Vysoké učení technické v Brně. Fakulta elektrotechniky a komunikačních technologií, 2018. http://www.nusl.cz/ntk/nusl-377045.
Full textAbstract:
The aim of master´s thesis is analysis of utilization of large-capacity battery energy storage systems, used in cooperation with facility Červený mlýn to supply ancillary services to ČEPS, a.s.. In the first part, categorisation of ancillary services is presented. Within the categorisation technical and legislative requirements on subjects providing individual services are defined, the overview of ancillary services providers is listed and the mechanisms of ancillary services procurement are elucidated. The thesis continues with an overview of accumulation technologies used in high-capacity application around the world and in Czech republic. Subsequently three technologies are presented – Li-Ion, NaS and VRB, which are considered as suitable technological solutions for given application. The last part of thesis deals with specification of parameters of the accumulation system, with selection of installation site within the facility and with description of operating modes while providing ancillary services. In order to evaluate the investment from an economic point of view, a model of sensitivity analysis is created and described and its outputs are presented and discussed at the end of the thesis.
38
Mascarenhas, Neil Patrick. "Análise de um processo em construção: a regulação da saúde suplementar no Brasil." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-24102007-133803/.
Full textAbstract:
Trata-se de uma pesquisa qualitativa composta por análise bibliográfica categorial com foco em reforma do Estado e regulação, por um levantamento da estrutura do mercado e das atas de reunião da Câmara de Saúde Suplementar (CSS) e por entrevistas semi-estruturadas com os principais atores desta câmara, buscando entender posicionamentos e principais pontos em debate, construindo um quadro de referência do setor, visando identificar sucessos e lacunas do processo. A pergunta central é até que ponto a regulação, a partir do modelo de agência adotado no Brasil para o setor de saúde suplementar, não estaria atingindo os objetivos propostos quando da sua criação, ou seja, de defender o interesse público na assistência suplementar à saúde. O mercado de saúde suplementar é composto por 36,9 milhões de beneficiários de planos de saúde em 2006 representando 19,6% da população brasileira. Apesar do seu tamanho e da relação público-privada que permitiu seu desenvolvimento ao longo do século passado ocorreu à margem de um regramento oficial até 1998, com a promulgação das Leis 9.656/98 e 9.961/00, esta última criando a ANS, estendendo o processo de reconfiguração do papel do Estado para o setor de saúde. Entre 01/2000 e 12/2006 a ANS realizou 25 consultas públicas (4,2 consultas ao ano em média), destas 11 trataram de temas financeiros; enquanto questões cadastrais, de definição de produtos e de contratualização foram temas de três consultas cada. Neste mesmo período a ANS emitiu 790 normativos, uma média de 113 normativos por ano. A comparação entre consultas públicas e normativos sugere uma pequena participação externa à agência no processo de regulação. Desde sua criação em 1998 até 09/2006 a CSS se reuniu 44 vezes, considerando presença relativa (ponderada pelo número de convocações) as representações mais presentes foram: prestadores de serviço, medicinas de grupo, seguradoras, reguladores (ANS) e consumidores com 100%. No pólo inverso foram identificados: trabalhadores, governo e gestores com menos de 55% de presença relativa, sugerindo o grau de importância que cada grupo de representação confere à CSS, seja como fórum de debate ou espaço para disseminação de suas posições. Nestas reuniões foram pautados 129 temas, com predominância daqueles ligados a característica e estrutura da regulamentação (35% dos temas), apresentações da ANS (13% das pautas) e programas da ANS (9% dos temas). Temas como a avaliação da ANS pelos atores e discussão quanto a lacunas no processo de regulação, embora pareçam cruciais para a adequação do modelo, foram tratados apenas uma vez cada. Adicionalmente, a elaboração por parte dos atores da CSS de documentos para discussão foi tema em apenas duas das 129 pautas. As entrevistas com os atores da CSS revelam que há consenso quanto a Reforma do Estado ser a origem da regulação via agência, porém discute-se sua autonomia, distanciamento do controle social do SUS, falta de integração com políticas do Ministério da Saúde, interfaces entre os sistemas público e privado, renúncia fiscal, subordinação entre SUS e sistema suplementar, efetividade dos contratos préregulação e participação (ou interferência) do Judiciário no processo. A maioria das xv representações discute saúde suplementar desde o inicio dos anos 90, sofrendo o desgaste em função do longo período de participação e dos resultados aquém dos esperados. A composição heterogênea, não paritária e o caráter consultivo da CSS dificulta a construção do entendimento. A baixa participação de governo, trabalhadores e gestores e a discussão prévia entre ANS e MS dos assuntos relevantes corroboram com a avaliação de baixa produtividade dada à CSS. Há consenso pela busca de sustentabilidade do mercado, mas com divergências quanto às alternativas para atingi-la, com posicionamentos antagônicos quanto a incentivos fiscais, ressarcimento ao SUS, volume de lucro aceitável e metodologia de apuração dos reajustes de preços. Os gargalos apontados pelos atores foram sistemas e recursos humanos, falta de integração entre as diretorias da agência e o volume de normativos, que são apontados como fatores de lentidão e incremento de custos no processo regulatório. Ressaltam ainda a necessidade de maior participação da sociedade e transparência. São reconhecidos poucos sucessos (definição de produtos, direitos e cobertura, saneamento do mercado e programas de qualificação e troca de informação) e diversas lacunas (adequação do marco regulatório, integração interna da ANS, incorporação do prestador de serviços no campo regulado e integração com o SUS). Conclui-se que a regulação em saúde suplementar atingiu uma fase em que nenhum ator está satisfeito, mesmo entendendo ser este um processo em construção e dadas as divergências de interesses e limitações do fórum de discussão, a construção de consensos via CSS é complexa podendo não ocorrer. Adicionalmente, os posicionamentos e lacunas da agência no processo não permitem enxergá-la como efetiva defensora do interesse público em saúde suplementar.This qualitative research is composed by a bibliographical analysis focused on state reform and regulation, the market structure analysis, the Câmara de Saúde Suplementar (CSS) meeting minutes analysis and by semi-structured interviews with CSS actors understanding positioning, discussion points, identifying successes and lacking points of the process. The objectives of this thesis are build a frame of reference for the supplementary health market, through a statistical analysis including analysis of the CSS meeting minutes, of the public consultations and rules issued by ANS; as well as analyzing the impacts of regulation on the several groups of interest represented in the CSS, discussing amplitude and range of regulation and questioning ANS mission achievement, as public interest defender in this market. The Brazilian supplementary health market assists 36.9 million beneficiaries, according to 2006 s data, which represents 19.6% of the population. Despite its size and the public-private relationship which allowed its growth since the beginning of last century, it remained unregulated until 1998. Regulatory activity was undertaken by ANS in 2000, extending State role reconfiguration concept to health field. Between 01/2000 and 12/2006 ANS called 25 public consultations (4.2 per year), from which 11 dealt with financial subjects, while masterfile, product definitions and contractualization were subject of 3 consultations each. During this period ANS issued 790 rules, an average of 113 per year. The comparison between the number of public consultations and of rules issued suggests small external participation. Since its creation in 1998 until 09/2006, CSS held 44 meetings. Considering relative participation, the most present representations were service providers, health maintenance groups, insurers, regulators and consumers with 100% of presence. On the other hand health workers, government and public health managers were present to less than 55% of the meetings, suggesting the relative importance given to CSS by each representation. During these meetings 129 different subjects were discussed. Main topics covered were regulation characteristics and structure (35%), ANS presentations (13%) e ANS programs (9%). Subjects as ANS evaluation and lacking points discussion, despite seeming crucial were dealt only once each. Additionally discussion of documents prepared by CSS actors took place only twice. Interviews seeked for actor s positioning on regulation model, were consensus resides on agency origin from state reform process, but autonomy, distance from SUS social control, lack of integration with Health Ministry policies, public and private systems interfaces, tax relieves, subordination of private system to SUS, effectiveness of preregulation contracts and Justice interference in the process are still points of discussion. The majority of representants have being discussing private health issues since the beginning of the 90s, suffering from the stress of long participation with limited results. The uneven composition and consulting status of the CSS are obstacles towards build understanding. Government s, health workers and public health managers low participation in CSS and pre-meeting discussions of relevant xvii subjects between ANS and MS, induce to a low productivity appraisal of CSS. Pursue sustainability seems to be a consensus, although ways to achieve this are discrepant, varying from definition of new fiscal incentives and reimbursement to SUS policy to definition of admited profit margins. ANS s evaluation by actors indicate botlenecks in IT and human resources, lack of integration within the agency s directorships and the amount of rules issued all of with contribute to increase costs and delay the regulatory process. Transparency and participation on decision processes are also claimed for. Few success examples are identified (product, rights and coverage definition, market clearing and implementation of quality programs) and several lacking points are indicated (adequacy of the regulatory base, internal integration, inclusion of the service providers in the regulated field and integration with SUS). Conclusions indicate that regulation has achieved a stage were none of the actors are satisfied, even recognizing that this is still a process in construction, and given the interest discrepancies between actors and limitations of the discussion arena, build consensus via CSS is complex and may not happen. At the same time, the number of lacking points in the regulation process show the distance for ANS to achieve its mission, and therefore do not allow see ANS as effective public interest defender in this market.
39
Lievaut, Jeanne. "Le "maillon faible" de la régulation des dépenses de santé en France : les comportements inattendus des médecins libéraux : quatre approches micrométriques longitudinales." Thesis, Paris 10, 2010. http://www.theses.fr/2010PA100140.
Full textAbstract:
L’objectif central de cette thèse est d’appréhender « le maillon faible » du système français de régulation et de contrôle des dépenses de santé, entendu comme un élément résiduel, « caché », qui empêche le système de parvenir aux objectifs ciblés. Nous mettons en œuvre les outils économiques et économétriques pour tester l’hypothèse selon laquelle les comportements dépensiers et inattendus des médecins sont liés aux politiques publiques. Pour appréhender le phénomène recherché nous menons quatre études micro–économétriques (qui sont économiques, quantitatives et sociologiques) de l’évolution du comportement du médecin omnipraticien libéral français. Nous nous sommes intéressés aux choix volontaires des praticiens portant sur les pratiques tarifaires et sur l’organisation du travail. Dans le cadre de l’approche économétrique, nous utilisons les données d’un panel non-cylindré de 8131 médecins libéraux différents observés durant la période 1979-2000 et représentatifs de la population concernée, ainsi que les méthodes économétriques appropriées à chaque cas étudié selon sa nature. Outre la validité de l’hypothèse, les résultats obtenus apportent des éléments de compréhension du type de rationalité du médecin, de ses motivations, des facteurs qui guident ses choix et des pistes d’explication de l’inefficacité des dispositifs politiques mis en œuvre. Ils fournissent également des réflexions sur les recommandations à faire en matière de mesures politiques et suggèrent de nouvelles pistes de rechercheThe main aim of that doctoral dissertation is to comprehend "the weak link" in the French system of regulation and control of health expenditure, understood us a residual, "hidden" element, which prevents the system from reaching the targets. We use the economic and econometric methods to prove the hypothesis that unexpected and wasteful medical behaviour can be caused by the public policy. There are four micro-econometric studies (which are economic, sociological and quantitative) of the French general self-employed practitioner’s behavioural evolution. We focus on the practitioner’s voluntary choices of the pricing practices and on the medical practice organisation. In the econometric studies, we use an unbalanced panel data comprising 8131 self-employed physicians who were observed over the 1979-2000 period and who are representative of the medical population, and different econometric methods depending on the analysis. Our results offer an empirical understanding of an unexpected medical behaviour phenomenon; they offer information about the practitioner’s rationality kind, the practitioner’s motivations, the factors exerting influence on their choices; and they offer clarification of the public policy’s inefficiency. Also, our results propose observations about a recommendation for policy measures and new approaches for the future research
40
Monier, Hélène. "Les régulations individuelles et collectives des émotions dans des métiers sujets à incidents émotionnels : quels enjeux pour la GRH ?" Thesis, Lyon, 2017. http://www.theses.fr/2017LYSE3027/document.
Full textAbstract:
Tant au niveau de la littérature que des pratiques, ce n’est que récemment que la GRH considère la composante émotionnelle au travail (Allouche, 2012). Pourtant, le courant des Relations Humaines, et diverses disciplines distinctes de la GRH, ont intégré cette dimension depuis les années 1930. À partir des travaux de Weiss et Cropanzano (1996) en comportements organisationnels, de Salovey et Mayer (1990 et 1997) et de Gross (Gross 1998 et 2014 ; Gross & John, 2003) en psychologie, d’Hochschild (1998, 2003a et 2003b) et de Goffman (1959, 1969 et 1973) en sociologie, de recherches en GRH et sociologie du travail à propos du soutien social et des régulations sociales (Reynaud, 1988, 1997 et 2003 ; Ruiller, 2010), notre thèse exploite et combine une diversité de cadres théoriques, afin d’explorer les fonctions et les régulations des émotions au travail dans quatre métiers sujets à incidents émotionnels : policiers, urgentistes, enseignants en REP+ et téléconseillers en centre d’appels. À travers une étude de cas multiple au sein de ces secteurs, nous avons triangulé les données issues d’ethnographies, de 107 entretiens, et de documentations, afin d’analyser les cas de ces professionnels en primo contact avec un public, dans une optique comparative. D’une part, nous faisons émerger un modèle d’application managériale revisitant l’analyse des facteurs de RPS, et des préconisations managériales opérationnelles, ces apports intéressant la préservation de la santé de l’individu, et la qualité de service. D’autre part, nous introduisons un modèle théorique général de structuration du processus émotionnel au travail, intégrant le concept de « régulation émotionnelle collective ». Cet apport principal de la thèse, à la GRH, envisage les émotions à la fois comme des objets, des outils et des effets du travail, retentissant sur la santé de l’individu et sur la qualité du serviceAt a theoretical as well as practical level, it is only recently that the emotional component of work has been taken into account by the HRM (Allouche, 2012). However, since the 1930s, the Human Relations movement and various disciplines distinct from HRM, have included this dimension. In order to examine the emotional functions and regulations of work through four different lines of work most prone to emotional incidents, such as police officers, emergency room staff, teachers in priority education zone, and call center operators, this PhD dissertation exploits and combines various theoretical frameworks. The latter are based on the research conducted by Weiss and Cropanzano (1996) in organizational behaviors, by Salovey and Mayer (1990, 1997) and Gross (Gross, 1998, 2014 ; Gross & John 2003) in psychology, by Hochschild (1998, 2003a, 2003b) and Goffman (1959, 1969, 1973) in sociology, and on studies about social support and social regulations in HRM and sociology of work (Reynaud, 1988, 1997, 2003 ; Ruiller, 2010).To analyze the cases of these professions that involve direct contact with the public from a comparative perspective, we have triangulated data from ethnographies, 107 interviews, and documentation, through a multiple case study within these sectors. On the one hand, we offer a managerial application model revisiting the analysis of the psychosocial factors, as well as operational managerial recommendations, as they help preserve both the professional’s health, and quality of service. On the other hand, we introduce a general theoretical model structuring the emotional process at work, that integrates the concept of "collective emotional regulation". This main contribution of the PhD dissertation to HRM, is that it views emotions as objects, tools and effects of work, which impact the individual’s health and the quality of service
41
Santos, Joacira Mota Matos. "Avaliação da integração entre a atenção primária à saúde e a atenção especializada, no cuidado do paciente hipertenso, no distrito de saúde do Campo Limpo do município de São Paulo." reponame:Repositório Institucional do FGV, 2018. http://hdl.handle.net/10438/24187.
Full textAbstract:
Submitted by JOACIRA MOTA MATOS SANTOS (joaciramms@gmail.com) on 2018-06-25T17:48:30Z
No. of bitstreams: 1
JOACIRA_TA_FINAL_22_06_2018_3.pdf: 969948 bytes, checksum: b466871c53b44e27219e6cfeab1bbb46 (MD5)Approved for entry into archive by Simone de Andrade Lopes Pires (simone.lopes@fgv.br) on 2018-06-25T20:11:40Z (GMT) No. of bitstreams: 1 JOACIRA_TA_FINAL_22_06_2018_3.pdf: 969948 bytes, checksum: b466871c53b44e27219e6cfeab1bbb46 (MD5)
Approved for entry into archive by Suzane Guimarães (suzane.guimaraes@fgv.br) on 2018-06-26T12:33:20Z (GMT) No. of bitstreams: 1 JOACIRA_TA_FINAL_22_06_2018_3.pdf: 969948 bytes, checksum: b466871c53b44e27219e6cfeab1bbb46 (MD5)
Made available in DSpace on 2018-06-26T12:33:20Z (GMT). No. of bitstreams: 1 JOACIRA_TA_FINAL_22_06_2018_3.pdf: 969948 bytes, checksum: b466871c53b44e27219e6cfeab1bbb46 (MD5) Previous issue date: 2018-05-25
Estudo quanti-qualitativo que objetivou avaliar a articulação entre serviços de atenção primária à Saúde e da atenção especializada no cuidado de pacientes hipertensos, na rede de atenção à saúde, no Distrito de Saúde do Campo Limpo do município de São Paulo. Participaram do estudo cento e trinta médicos que atuam em vinte e cinco Unidades Básicas de Saúde, sob a lógica da Estratégia de Saúde da Família. A coleta de dados foi feita por meio de questionário autoaplicado e os dados submetidos à análise quantitativa e de conteúdo temática. Ao analisar os dados, concluiu-se que há uma acentuada fragilidade na integração entre as equipes de saúde da família e os serviços de atenção secundária que atendem os pacientes hipertensos. Os achados permitiram analisar que há ausência de contrarreferência frente às demandas encaminhadas, pressão do paciente para ser encaminhado ao especialista; insegurança do médico generalista, envolvendo problemas na formação ou estratégias de educação continuada; falta de comprometimento, responsabilização das equipes de saúde da família, que ser relacionam a vinculação comprometida; total ausência de pactuação entre os serviços no território que corroboram para escassez de integração entre os serviços e ainda questões culturais relacionadas à desvalorização do médico generalista ou da atenção básica. Foi possível observar um grande interesse dos profissionais da atenção básica em melhorarem a relação com os profissionais da atenção especializada. Foram apresentadas propostas voltadas para criação de espaços coletivos de discussão, revisão de protocolos, alinhamento de fluxos e até mesmo, a incorporação entre os serviços e profissionais de mecanismos tecnológicos para favorecer essa integração no cotidiano dos serviços. A partir da análise dos aspectos limitantes e favorecedores para a articulação entre a atenção primária e a atenção especializada, no cuidado do paciente hipertenso, no território estudado foi possível elencar alguns problemas que devem ser superados, na perspectiva de fortalecer o desempenho da Rede de Atenção à Saúde, como também propor o desenvolvimento de um projeto local para fortalecimento do cuidado do paciente hipertenso em rede.
Quantitative-qualitative study aimed at evaluating the articulation between primary health care services and specialized care in the care of hypertensive patients in the health care network in the Campo Limpo Health District of the city of São Paulo. One hundred and thirty physicians working in twenty-five Basic Health Units participated in the study, under the logic of the Family Health Strategy. The data were collected through a self-administered questionnaire and the data submitted to the quantitative analysis and thematic content. When analyzing the data, it was concluded that there is a marked fragility in the integration between the family health teams and the secondary care services that serve hypertensive patients. The findings allowed us to analyze that there is no counter-referral to the demands submitted, the patient's pressure to be referred to the specialist; general practitioner insecurity, involving training problems or continuing education strategies; lack of commitment, accountability of family health teams, to be related to committed commitment; total lack of agreement between the services in the territory that corroborate to the lack of integration between services and also cultural issues related to the devaluation of the general practitioner or primary care. It was possible to observe a great interest of the professionals of the basic attention in improving the relation with the professionals of the specialized attention. Proposals aimed at creating collective spaces for discussion, protocol revision, alignment of flows and even the incorporation among services and professionals of technological mechanisms were proposed to favor this integration in the daily services. From the analysis of the limiting and favorable aspects for the articulation between the primary care and the specialized attention, in the care of the hypertensive patient, in the territory studied it was possible to list some problems that must be overcome, with a view to strengthening the performance of the Attention Network to Health, as well as to propose the development of a local project to strengthen the care of hypertensive patients in a network.
42
Mogaji, Emmanuel. "Emotional appeals in UK banks' print advertisement." Thesis, University of Bedfordshire, 2016. http://hdl.handle.net/10547/622103.
Full textAbstract:
The unprecedented turbulence and uncertainty experienced in global economic and financial markets because of the 'credit crunch' has had a damaging impact on consumer confidence. Trust and credibility have been eroded as many customers feel let down by the banks suggesting the need for banks to rebuild constructive dialogue and long-term, meaningful relationships with their customers again. Though financial service, in this case, is considered a utilitarian service, based on the fact that money is needed to support people‘s daily activities, the present state of financial service has suggested the need for banks to appeal to consumers‘ emotions with the aim of improving their reputation. Also, the competition within the industry also could suggest the need to adopt an emotionally appealing advertisement strategy as emotions are known to play an influential role in building robust brand preference. This study builds on the communication theory, meaning transfer theory and consumer involvement theory, to understand the messages the banks are sending out and to elicit consumers‘ emotional reaction. One thousand, two hundred and seventy-four UK bank advertisements in nine national newspapers were content-analysed to identify the emotional appeals presented by the banks. The perception of these appeals and their associated meanings were sought through semi-structured interviews with 33 participants in London and Luton. The results of the analysis indicated that UK Banks are utilising emotional appeal in their advertisements to reach out to the consumers to convince them to upgrade their account, to open an additional account or switch their account. The most predominantly used appeals were relief and relaxation followed by excitement and happiness or satisfaction with the bank, and finally, security and adventure. However, variations were found in different financial products that employed emotional appeals. It was found that high-involvement products such as mortgages and loans used fewer emotional appeals. Both bank groups - high street banks, including the big four (Barclays, HSBC, Lloyds and RBS) and non-high street banks, such as the new entrants, supermarket brands, and online banks were using emotional appeals. However, it is acknowledged that the communication strategies between these banks could be different as the non-high street banks are more likely to repeat and publish the same messages across many newspapers, instead of publishing different emotionally appealing advertisements. Though consumers acknowledged these emotional appeals in the advertisements, they were more concerned about their relationship with the banks as they don‘t rely on advertisements to make a financial decision. Rather, recommendations from families, friends and associates and also branch location are more important when deciding on which bank to choose. The lack of congruency between financial services and emotional appeals in advertisements is also observed as customers are more likely to be persuaded by rational appeals however this study has not completely ruled out emotional appeals in bank advertisements as the use of both types of appeals is recommended. The study provides important theoretical and managerial contributions to understanding how the consumers understand meaning-embedded advertisements produced by the banks. Managers will be able to consider the implications of advertisements in enhancing their brand equity and building relationships with customers in anticipation that, by word of the mouth and established relationship, their bank‘s reputation will be enhanced. Limitations of the study and opportunities for future research are identified.
43
Hu, Che-Hsin, and 胡哲馨. "The study of the Correlation among Emotional Labor, Emotion Regulation, Psychological Flexibility and Mental Health in Public Service Workers." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/68501654179808798946.
Full textAbstract:
碩士國立臺灣師範大學
教育心理與輔導學系
104
Aim: When front-line public service workers earned quality of service, they have to exhibit particular affection and emotion, so-called emotional labor. The present study focused on if the emotion regulation strategies and psychological flexibility can mediate the effects between the emotional labor and mental health. The purposes of the present study were: (1) To explore the relationships among emotional labor, emotion regulation, psychological flexibility, and negative mental health of public service workers. (2) To test the predictability weight of emotional labor, cognition reappraisal, expression suppression and psychological flexibility to negative mental health. (3) To find the role of the cognition reappraisal, expression suppression or psychological flexibility variables between emotional labor and negative mental health. Method: The present study surveyed a total of 428 civil servants of Household registration office of Taipei City. Participants were required to complete 5 questionnaires, including general information, emotional labor questionnaire, emotion regulation questionnaire (ERQ), acceptance and action questionnaire-II (AAQ-II) and general health questionnaire (GHQ-28). According to the study purposes, statistical methods were included independent sample t-test, MANOVA, Pearson product-moment correlation and hierarchical multiple regression analysis. Results: (1) The more emotional labor public service workers had, the less psychological flexibility and the more negative mental health symptoms they had. (2) Psychological flexibility was the main factor to negatively predict negative mental health, including somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. (3) The mediating effect of psychological flexibility was showed between emotional labor and negative mental health, also same relations found in other negative mental health sub-scales including somatic symptoms, anxiety and insomnia, social dysfunction, or severe depression separately. Discussion: (1) The psychological flexibility gave full play for emotional labor workers to promote their health. (2) Cognitive reappraisal need through psychological flexibility influenced negative mental health. (3) Suppression only with emotional labor moderated the negative mental health. Our study suggested a mental health improving model for our emotional labor public service workers as well as some actual practices and policy can include in the on-the-job training program.
44
"Testing an integrated emotional regulation strategies model among Chinese service employees: an investigation of the role of service culture and emotional expressivity." Thesis, 2006. http://library.cuhk.edu.hk/record=b6074255.
Full textAbstract:
In this study, an integrated model was proposed to examine the impact of emotional labor on quality of work life and psychological health among Chinese employees. Compared to other emotional labor models, this model considered the influence of perceived service culture as an antecedent of perceived organizational emotion control (i.e., display rules and performance monitoring). Apart from surface acting and deep acting, it also incorporated an alternative emotional regulation strategy, namely authentic self, to cope with the organizational emotion control. The integrated model included emotional expressivity as an individual factor that might influence the emotional regulation process. Two studies were conducted to examine the validity of the model. In Study 1, 486 Chinese service employees, including call center representatives, retail shop managers, human service workers, and local registered nurses were recruited. Path analysis was used to examine if the integrated model fit the cross-sectional data and results showed satisfactory model fit. A series of hierarchal regression analyses were conducted to examine the moderating effect of emotional expressivity. Instead of the hypothesized moderating effect, there were significant main effects of emotional expressivity on emotional regulation strategies. Considering the significant association between these variables, the integrated model was further revised by incorporating the emotional expressivity as an individual factor of emotional regulation strategies. Multi-sample path model analyses showed that the model was equally applicable in both gender groups for job and health outcomes. Result of the cross-sectional model showed that perceived service culture was directly related to both perceived display rules and performance monitoring. While perceived performance monitoring and authentic self were associated with surface acting, perceived display rule was in turn related to deep acting. Emotional expressivity was related to authentic self. Quality of work life was associated with surface acting and deep acting. This model could also be applied to understand psychological distress.Study 2 was conducted to provide additional support to the integrated model, including an emotional expressivity training program and a longitudinal validation on the emotional regulation strategies model. In the emotional expressivity training program, 155 participants who had completed the questionnaire survey in Study 1 were recruited. Among them, 131 participants had joined a half-day emotional expressivity training program while 24 participants were assigned into the control group. The objective of the program was to enhance participants' positive expressivity and reduce negative expressivity and impulse strength. Results showed that the training was effective in maintaining participants' authentic self. In particular, authentic self did not change across time among training group. However, authentic self in the control group decreased significantly 3 months after the training program (T2) when it was compared to the pre-training period. In the longitudinal validation study, a longitudinal model was devised to measure changes on emotional expressivity at T1 and T2 and its relations to emotional regulation strategies among the training group (n = 131). The significant associations between perception of service culture, organizational emotion control, and emotional regulation strategies in Study 1 were also found in Study 2. Quality of work life at T2 was related to surface acting at T2 and quality of work life at TI. The longitudinal model was also applied to predict psychological distress. Deep acting, surface acting, and emotional expressivity at T2 as well as psychological distress at TI were significantly related to psychological distress at T2. Limitations, suggestions for future research, and practical implication to organizations are discussed in Chapter 6.
Cheung Yue Lok.
"July 2006."
Adviser: Catherine S. K. Tang.
Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1970.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2006.
Includes bibliographical references (p. 172-189).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts in English and Chinese.
School code: 1307.
45
Smit, Michèl Maria. "Exploring barriers to the implementation of hazard analysis critical control point regulations in small foodservice establishments in South Africa." 2012. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1000267.
Full textAbstract:
M.Tech. Business Administration. Business School.The purpose of this study is to investigate the internal behavioural barriers to the implementation of hazard analysis and critical control point (HACCP). This investigation aims to assist the hospitality industry in implementing best practice in food hygiene to maximise public food safety and profitability. It also aims to investigate and possibly generate creative initiatives to control and monitor the long-term implementation of hazard analysis and critical control point principles in the sector so as to render it competitive on an international level.
46
Seiça, Maria Beatriz de Ascensão Silva Medina de. "A (des)regulação da publicidade no âmbito da prestação de cuidados de saúde." Master's thesis, 2019. http://hdl.handle.net/10316/90403.
Full textAbstract:
Dissertação de Mestrado em Ciências Jurídico-Forenses apresentada à Faculdade de DireitoThe purpose of this dissertation is to study the regulation of advertising in the healthcare context. First, it focuses on consumers rights, freedom to advertise and. especially, the right to health. Additionally, the text explores the Unfair commercial practices’ regime. As the main objective, we analyse the different types of regulation in Portugal: advertising self-regulation; professional self-regulation, and State regulation. In particular, we will critically examine the Statute: «Decreto-Lei nº 238/2015». The purpose of this dissertation is to study the regulation of advertising in the healthcare context. First, it focuses on consumers rights, freedom to advertise and. especially, the right to health. Additionally, the text explores the Unfair commercial practices’ regime. As the main objective, we analyse the different types of regulation in Portugal: advertising self-regulation; professional self-regulation, and State regulation. In particular, we will critically examine the Statute: «Decreto-Lei nº 238/2015».The purpose of this dissertation is to study the regulation of advertising in the healthcare context. First, it focuses on consumers rights, freedom to advertise and. especially, the right to health. Additionally, the text explores the Unfair commercial practices’ regime. As the main objective, we analyse the different types of regulation in Portugal: advertising self-regulation; professional self-regulation, and State regulation. In particular, we will critically examine the Statute: «Decreto-Lei nº 238/2015».
A presente dissertação pretende contribuir para o estudo da regulação das práticas publicitárias em saúde. Primeiramente, tratamos dos direitos dos consumidores, das liberdades dos anunciantes, e em especial, da protecção da saúde. Depois, analisamos o regime vigente. Após um enquadramento comunitário, no qual destacamos o Regime das Práticas Comerciais Desleais, focamo-nos, no ordenamento interno e suas formas regulatórias: a Auto-regulação publicitária, a Auto-regulação Profissional e a Hetero-regulação. Nesta última, levada a cabo pela ERS, incidimos sobretudo no DL nº 238/2015, de 14 de Outubro e seu Regulamento complementar, propondo-se algumas vias de superação das dificuldades identificadas. A presente dissertação pretende contribuir para o estudo da regulação das práticas publicitárias em saúde. Primeiramente, tratamos dos direitos dos consumidores, das liberdades dos anunciantes, e em especial, da protecção da saúde. Depois, analisamos o regime vigente. Após um enquadramento comunitário, no qual destacamos o Regime das Práticas Comerciais Desleais, focamo-nos, no ordenamento interno e suas formas regulatórias: a Auto-regulação publicitária, a Auto-regulação Profissional e a Hetero-regulação. Nesta última, levada a cabo pela ERS, incidimos sobretudo no DL nº 238/2015, de 14 de Outubro e seu Regulamento complementar, propondo-se algumas vias de superação das dificuldades iden-tificadas.A presente dissertação pretende contribuir para o estudo da regulação das práticas publicitárias em saúde. Primeiramente, tratamos dos direitos dos consumidores, das liberdades dos anunciantes, e em especial, da protecção da saúde. Depois, analisamos o regime vigente. Após um enquadramento comunitário, no qual destacamos o Regime das Práticas Comerciais Desleais, focamo-nos, no ordenamento interno e suas formas regulatórias: a Auto-regulação publicitária, a Auto-regulação Profissional e a Hetero-regulação. Nesta última, levada a cabo pela ERS, incidimos sobretudo no DL nº 238/2015, de 14 de Outubro e seu Regulamento complementar, propondo-se algumas vias de superação das dificuldades identificadas.
47
Nghitanwa, Emma Maano. "Development of practical guidelines to promote occupational health and safety for workers in the construction industry in Windhoek, Namibia." Thesis, 2016. http://hdl.handle.net/10500/22684.
Full textAbstract:
Text in EnglishThe study, which considers that the construction industry is a high risk one due to the physical work demand and nature of the working environment, was conducted to develop practical guidelines for workers and employers that promote occupational health and safety (OHS) in the construction industry in Namibia. The study, conducted at 13 study sites in Windhoek, Namibia, used a quantitative descriptive study method to gather data regarding the OHS status of the construction industry. Data was collected from the 13 study sites using a site interviewer-led questionnaire for 549 construction workers. In addition, both a site inspection checklist and document review checklist were used to collect the data from ten construction sites. A review of documents concerning occupational accidents, diseases and injuries encountered at construction sites that were held by the Ministry of Labour, Industrial relations and Employment creation for the five-year period from April 2011 to March 2016 was carried out. Data was analysed using the Statistical Package for Social Sciences (SPSS) software version 23. The study findings show that most of the workers at the study sites were young and male, with most participants lacking awareness of OHS issues, which may hinder accidents and injuries prevention. It also emerged that occupational hazards are prevalent at the study sites and yet there were poor mechanisms for hazard prevention or mitigation measures. The study notes that there was a high rate of occupational accidents and injuries, as well as a few incidences of health hazards, as indicated by few participants, although there was no documented occupational disease. It is also noted that most study sites do not comply with OHS legislations, such as having OHS policies that indicate the employer’s commitment towards OHS, which placed workers at risk of hazard exposure, occupational accidents, injuries and diseases. Practical guidelines to promote OHS in the construction industry of Windhoek, Namibia are developed as the primary output of this project.
Health Studies
D. Litt. et Phil. (Health Studies)
48
Martins, Filipe Costa. "A regulação do preço dos medicamentos em Portugal." Master's thesis, 2020. http://hdl.handle.net/10362/111194.
Full textAbstract:
Medicines are a fundamental contribution to the health of citizens. However, as a result of scientific and technological advances in this field and the increase in the prevalence of chronic diseases, there is a constant growth in expenditure on medicines. The National Health Service, as a financing entity for the purchase of medicines, requires an efficient management in order to ensure its financial sustainability so that taxpayers do not see their taxes increased due to growing health care costs. In this context, regulation of the medicine sector proves to be essential not only to guarantee the quality and safety of medicines, but also to promote their accessibility through the application of price and reimbursement rules. In this study, it was also considered essential to be aware of models that may constitute valid alternatives to the current price system of medicines in Portugal, seeking its continuous improvement and increasing cost rationalization. Another important issue is the need for an efficient regulation of the sector to be able to find the necessary balance between cost control and the creation of incentives for research and development of new therapies. For this purpose we considered useful to make an economic analysis of the most relevant aspects of the pharmaceutical industry to grasp the impact of regulatory activity, both from a legal and economic point of view.Os medicamentos são um contributo fundamental para a saúde dos cidadãos. Porém, fruto dos avanços científicos e tecnológicos na área do medicamento bem como do aumento da prevalência de doenças crónicas, verifica-se um constante crescimento da despesa com medicamentos. O Serviço Nacional de Saúde, enquanto entidade financiadora da aquisição de medicamentos, requer uma gestão eficiente que garanta a sua sustentabilidade financeira para que os contribuintes não vejam os seus impostos agravados face ao aumento dos encargos com a saúde. Neste contexto, a regulação do sector do medicamento revela-se essencial não só para garantir a qualidade e segurança dos medicamentos como também para promover a acessibilidade aos mesmos mediante a aplicação de regras de formação de preços e da criação de regimes de comparticipação. Neste estudo, considerou-se ainda essencial estar atento a modelos de formação de preços de medicamentos que possam constituir alternativas válidas ao sistema vigente em Portugal, procurando a sua melhoria contínua e uma crescente racionalização de custos. Outro ponto importante é a necessidade de uma regulação eficiente do sector que permita encontrar o necessário equilíbrio entre o controlo de custos e a criação de incentivos para a investigação e desenvolvimento de novas terapêuticas. Para este efeito considerámos útil fazer uma análise económica dos aspectos mais relevantes da indústria farmacêutica para apreender o impacto da actividade regulatória quer do ponto de vista legal quer económico.
49
Rodrigues, Susana Isabel Ribeiro. "A re-regulação do emprego e das relações laborais dos médicos do Serviço Nacional de Saúde face às reformas do setor: o processo de contratação coletiva." Master's thesis, 2013. http://hdl.handle.net/10071/7743.
Full textAbstract:
Neste trabalho procura-se perceber os fatores que estiveram na base dos resultados da negociação coletiva efetuada entre os sindicatos médicos e os dois últimos governos. A análise centra-se no processo de contratação coletiva, que deu origem a dois acordos coletivos de trabalho de conteúdos semelhantes que procuram harmonizar as regras sobre emprego e relações laborias dos médicos em funções públicas e dos médicos com contrato individual de trabalho do Serviço Nacional de Saúde. Partindo-se da identificação dos aspetos desreguladores do emprego no setor público da saúde, analisa-se as fases do processo, as posições dos atores sobre a negociação e sobre os desafios, os objetivos e as estratégias para os alcançar. Da análise efetuada, concluiu-se que os sindicatos médicos conseguiram negociar a re-regulação de várias matérias laborais alargando o universo da sua aplicação aos médicos das entidades públicas empresariais da saúde. Isto numa negociação com governos que resistiram partilhar o espaço da regulação das condisções de emprego com o ator sindical. Na base deste resultado está uma abordagem não ideológica às matérias alvo de negociação, além da adoção de uma posição consertada por parte dos sindicatos na mesa negocial e do recurso ao poder profissional dos médicos.This study seeks to understand the factors that lead to results achieved through collective bargaining between medical labour unions and the last two governments. The analysis focuses on the process of collective agreement, which gave rise to two similar collective bargaining agreements, both of which seeked to harmonise the rules relating to the employment and labour relations of doctors in public service as well as doctors possessing individual labour contracts within the National Health Service. Based on the identification of deregulating aspects of employment in the public health sector, the analyses will focus on the different phases of the process, the actors’ positions in the negotiation and the challenges, objectives and strategies taken to achieve them. From this examination, it is revealed that the medical unions were able to negotiate the re-regulation of various labor issues, broadening the universe of their applications to medical public health enterprises through negotiations with governments that resisted sharing the regulation platform on labour conditions with union actors. On the basis of this result is a non-ideological approach to the issues subject to negotiation, and the adopting of a position fixed by the unions at the negotiating table as well as the use of the professional power possessed by physicians.
50
Van, Rooyen Bernadette. "Prevention mechanisms to minimise injuries on duty : perceptions of security officers in a private security company." Diss., 2017. http://hdl.handle.net/10500/24015.
Full textAbstract:
The aim of the study was to determine the causes of IODs in the workplace and to identify possible preventative measures to reduce IODs. A literature review was conducted as part of the study, involving assessment of all related articles and books on the subject of IODs in the workplace. A qualitative research methodology was utilised to conduct the study. The main research instruments were four focus group interviews and eight individual interviews. The study concluded that employees experienced IODs in different ways, with most
participants describing negative experiences such as physical pain, undue financial hardship, psychological trauma and lack of support from the employer. A minor percentage experienced IODs in a positive sense in that there is heightened safety awareness in the workplace after an IOD has occurred, and the adoption of a more cautious approach by employees when performing their duties. From a practical and organisational/managerial perspective, the adoption of effective
training of security officers and adherence to organisational standard operating procedures will assist in reducing IODs in the workplace.
Limitations of the study included the small sample size from the research population, perceived language barriers during the interview processes and non-participation and inputs from managers at the organisation. However, it is hoped that the study will form the basis for further research to broaden the field to include parastatal or public-service entitiesHuman Resource Management
M. Com. (Human Resource Management)