Dissertations / Theses on the topic 'Healthcare utilisation'
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Wenig, Christina M. [Verfasser]. "Impact of Obesity on Healthcare Utilisation and Costs / Christina M. Wenig." München : Verlag Dr. Hut, 2011. http://d-nb.info/1018982507/34.
Full textOnyigbuo, Chineme. "Exploring health-seeking behaviours among Nigerians in the UK : towards improved healthcare utilisation." Thesis, Middlesex University, 2016. http://eprints.mdx.ac.uk/21324/.
Full textGale, Samantha Charlotte. "Healthcare utilisation amongst those with Down's syndrome in Hong Kong : a population-based, cross-sectional study." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193762.
Full textpublished_or_final_version
Public Health
Master
Master of Public Health
Wikehult, Björn. "Use of Healthcare, Perceived Health and Patient Satisfaction in Patients with Burns." Doctoral thesis, Uppsala University, Department of Surgical Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-9262.
Full textA severe burn is a trauma fraught with stress and pain and may change the entire course of life. This thesis focuses on care utilisation, care experiences and patient satisfaction after a severe burn.
The patients studied were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2006. Burn-related health was examined using the Burn Specific Health Scale-Brief (BSHS-B), personality traits with the Swedish universities Scales of Personality (SSP), psychological symptoms using the Hospital Anxiety and Depression scale (HADS), symptoms of posttraumatic stress with the Impact of Event Scale-Revised (IES-R) and satisfaction with care using the Patient Satisfaction-Results and Quality (PS-RESKVA) questionnaire.
Those utilising care years after injury reported poorer functioning on three of the BSHS-B subscales. Personality traits had a greater impact on care utilisation than injury severity.
Social desirability was lower among care utilisers and was associated with burn-related health aspects.
The participants reported a low level of negative care experiences, the most common of which was Powerlessness.
Most patients were satisfied with care, more with quality of contact with the nursing staff, and less with treatment information. Multiple regressions showed that the BSHS-B Interpersonal relationships subscale was an independent variable related to all measured aspects of patient satisfaction. The highest adjusted R2 was 0.25.
In a prospective assessment with multiple regression analyses, Age and Education, the personality traits of Stress susceptibility, Trait irritability, Detachment and Social desirability, in addition to the post-traumatic stress symptoms Intrusion and Hyperarousal, were predictors of satisfaction with care. The highest adjusted R2 was 0.19.
The thesis has pointed out that interpersonal factors are related to care utilisation as well as satisfaction with care. However, satisfaction with care was only moderately associated with health and individual characteristics, which may imply that the care itself is of major importance.
Cheruto, Sowon Karen. "How the healthcare-seeking socio-cultural context shapes maternal health clients' mHealth utilisation in a Kenyan context." Doctoral thesis, Faculty of Commerce, 2021. http://hdl.handle.net/11427/34016.
Full textEl-Atem, Nathan Abraham. "An investigation of ambulatory tertiary hospital resource utilisation by people with liver disease." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/180900/1/Nathan_El-Atem_Thesis.pdf.
Full textMatondolo, Siyamthanda Luthando. "Utilisation of ICT in healthcare centre to support HIV/AIDS flow of information and service delivery In Khayelitsha." Thesis, Cape Peninsula University of Technology, 2012. http://hdl.handle.net/20.500.11838/2477.
Full textThis research is an attempt to investigate the utilisation of Information Communication Technology (ICT) in Healthcare to support the flow of HIV/AIDS patient’s general information in public and private sector. Furthermore, the research examines the detail flow of database information for healthcare service delivery to patients, in particular HIV/AIDS patients, in Khayelitsha Township. Finally, the research will detail the types of technologies currently being utilised to transfer this information, technology utilised for capturing or data collection profile of the patient. The research study data collecting was done in 2009 in mostly private and public healthcare centre in Khayelitsha township. First, the study will concentrate on general utilisation of ICT in healthcare service delivery and flow of information for public and private sector healthcare centres. Additionally, the research also looks at NGOs such as HIV/AIDS Unit in Cape Peninsula University of Technology (CPUT) and Treament Action Campaign (TAC) to find out what ICT equipment is being utilised to transfer this information to adult people to inform and make them to be aware of HIV/AIDS and improve healthcare service delivery to patients and particularly to HIV/AIDS patients. Taking NGO’s such as TAC and CPUT HIV/AIDS Unit that are well informed about HIV/AIDS, nationally and internationally will make our research results to be more precise. The research will also look at the utilisation of ICT in flow of information at healthcare centre such as communication between healthcare providers such as receptionist/clerk, nurses, doctors and medical researchers since they are the first people who deal with HIV/AIDS patient cases when they come for healthcare provision.
Nguyen, Mai Phuong. "Contribution of private healthcare to universal health coverage: an investigation of private over public health service utilisation in Vietnam." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/225903/1/Mai%20Phuong_Nguyen_Thesis.pdf.
Full textPalmer, James Caldwell. "Qualities of personal interaction : the promotion of research utilisation for quality improvement in the US health care sector." Thesis, University of Hertfordshire, 2008. http://hdl.handle.net/2299/2323.
Full textNzute, Anastesia. "Utilisation of insecticide treated nets among women in rural Nigeria : themes, stories, and performance." Thesis, University of Wolverhampton, 2017. http://hdl.handle.net/2436/620391.
Full textHarris, Patricia A. "Promoting research utilisation and evidence-based decision making amongst healthcare managers : utilising nonrecursive structural equation modelling to develop the theory of planned behaviour." Thesis, Open University, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.424678.
Full textHarris, Patricia Amanda. "Promoting research utilisation and evidence-based decision making amongst healthcare managers : utilising nonrecursive structural equation modelling to develop the theory of planned behaviour." n.p, 2005. http://ethos.bl.uk/.
Full textGavidia, Tania Guadalupe. "Equity in utilisation of maternal healthcare services: a mixed methods investigation of antenatal, delivery, and postnatal care among squatter and non-squatter residents living in Ward 34, Kathmandu, Nepal." Thesis, Curtin University, 2015. http://hdl.handle.net/20.500.11937/1261.
Full textWeeks, William Brinson. "Geographic variation in the supply and utilization of hospital services : Economic motives and policy implications." Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM2002/document.
Full textFor all of this work, we applied ‘small-area variation’ techniques to the study of geographic variations in hospitalization rates in France. We conducted four studies:Study 1: Geographic variation in rates of common surgical procedures in France in 2008-2010 and comparison to the US and BritainStudy 2: Geographic variation in admissions for knee replacement, hip replacement, and hip fracture in France: evidence of supplier-induced demand in for-profit and not-for profit hospitalsStudy 3: Characteristics and patterns of elective admissions to for-profit and not-for-profit hospitals in France in 2009 and 2010Study 4: Rates of admission for ambulatory care sensitive conditions in France in 2009-2010: trends, geographic variation, costs, and an international comparison
Maura, Géric. "Utilisation des bases de l'Assurance Maladie pour l'analyse de l'utilisation et de la sécurité des anticoagulants oraux dans la fibrillation auriculaire." Thesis, Bordeaux, 2018. http://www.theses.fr/2018BORD0234.
Full textDirect oral anticoagulants (DOAC) were gradually introduced since 2012 in France for stroke and systemic embolism prevention in patients with nonvalvular atrial fibrillation (AF), as a more convenient alternative to vitamin K antagonists (VKA) for which underprescribing and high rates of discontinuation have been frequently reported. As part of the work programme of the Department of Studies in Public Health, French National Health Insurance, the aim of this dissertation was to assess the patterns of use and safety of oral anticoagulant (OAC) therapy in real-life setting using the French healthcare databases. First, an algorithm was developed to identify AF in outpatients initiating OAC and for whom no diagnosis of AF was found in the French claims data. Second, 1-year dabigatran and rivaroxaban adherence rates were estimated in nonvalvular AF patients and 1-year non-persistence rates were compared versus VKA. At least 1 in 3 dabigatran or rivaroxaban new users was found to be non-adherent to treatment. Treatment persistence among dabigatran or rivaroxaban new users was not found to be better versus VKA therapy. Third, OAC therapy use was found to have increased following in France between 2011 and 2016 but remained suboptimal with 1 in 3 patients with AF not treated by OAC therapy. Several situations of inappropriate use of DOAC were identified including potential undertreatment by inappropriate dosing. Finally, a sequence symmetry analysis suggested that DOAC therapy is associated with rare but severe liver injury and more frequent gastrointestinal disorders. A low risk of kidney injury with DOAC therapy can also not be excluded. These findings advocate further investigation of the potential risk of DOAC underdosing at initiation and the continuous monitoring of the non-bleeding adverse events of DOAC therapy
Nguyen, Bich Lien. "Expérience de soins de patients aînés atteints de cancer à l’urgence." Mémoire, Université de Sherbrooke, 2016. http://hdl.handle.net/11143/8182.
Full textAbstract: Introduction: Older cancer patients are known to have specific unmet needs due to the complexity of their health care, leading them to use emergency services. However, it is known that emergency rooms are not well-suited to the needs of the elderly. Few studies have focused on the health care experience of older cancer patients and even less so in the context of emergency room (ER) visits. Purpose: This study aims to better understand the experience of older cancer patients in the context of ER visits for unexpected health deterioration related to cancer. We sought to: 1) establish the profile of patients aged 70 years and older who made ER visits for problems related to their cancer in the 12 months preceding the study; 2) identify the reasons and factors that motivate older patients with cancer to make ER visits; 3) identify coping strategies used by older cancer patients prior to ER visits; and 4) describe the health care experience of older cancer patients in the context of ER visits. Methods: A concurrent mixed-method design was used. Descriptive analysis of administrative databases was first conducted to document the socio-demographic, clinical, and service utilization profile of elderly cancer patients aged 70 years and older who visited the ER of a hospital in Québec, Canada (n = 792, Objectives 1-2). Semi-structured interviews were subsequently conducted (n = 11) and then analysed using in-depth content analysis (Objectives 2, 3, & 4). Results: The sample of 792 older cancer patients made a total of 1,572 ER visits. The most frequent medical reasons for ER visits were respiratory (15.8%) and digestive (13.4%) concerns, and cardiovascular conditions (8.2%). Content analysis of the qualitative data suggested that older cancer patients made most of the ER visits when experiencing high levels of anxiety, when other cancer care services were unavailable, or because of a serious life-threatening health condition. Patients were able to use a variety of coping strategies to deal with health issues. Furthermore, the care process is experienced uniquely for each individual. Conclusion: This study describes the health care experience of older cancer patients in the context of ER visits and suggests areas of improvement both outside of and within emergency services.
Desmonde, Sophie. "Care of HIV-infected children before and after antiretroviral therapy initiation in West Africa : contribution towards the development of a multi-state model." Thesis, Bordeaux 2, 2013. http://www.theses.fr/2013BOR22112/document.
Full textAccess to prevention of mother-to-child transmission (PMTCT) interventions is limited in West Africa and mothers continue to transmit HIV disease to their children. Important questions on early HIV diagnosis and early antiretroviral therapy (ART) for children in resource-limited settings remain unanswered. Computer simulation models can provide helpful information to project long-term patient outcomes and inform health policy. Although simulation models are computationally sophisticated, the usefulness of the results of modelling studies depends on the quality and accuracy of the data on which they are based. The main objective of the following work was to provide accurate and up-to-date data on mortality, severe morbidity and healthcare resource utilisation in HIV-infected children enrolled in care, before and after ART initiation in the context of the access to ART roll-out since 2004 in West Africa. Our findings suggest mortality rates comparable to those of other studies, reaching 5.5% by 18 months of follow-up in children enrolled in cohorts at a median age of 5 years who had not yet initiated ART. Severe morbidity rates were high, in both ART-treated and untreated children. We found that one hospitalisation in three was caused by an infectious disease, avoidable by cotrimoxazole prophylaxis, a simple and efficient intervention that is still not accessible to all in West Africa. We also reported substantial rates of healthcare resource utilisations associated with this severe morbidity. However, in both untreated and ART-treated children, healthcare resource utilisation was lower in the sickest, most immunodeficient children. Access to healthcare remains limited and one of the explanations we put forward are the costs borne by the families. Finally, children on ART remain initiated at a too late stage to be able to restore normal immunity for age; this is even less likely in those who initiated ART after 5 years compared to younger children. Overall, this work underlines the need for an effective early HIV diagnosis and treatment. Optimising this requires interventions at multiple levels of the healthcare system and no single approach is likely to be effective. Furthermore, lifetime treatment costs will need to be assessed as HIV becomes a chronic disease leading to greater healthcare resource utilisation. Integrating these data in computer simulation models will assist healthcare providers and policy-makers to identify the most effective and cost-effective strategies for diagnosis, treatment and monitoring of paediatric HIV in low income countries
Giusti, Igor. "Changer d’angle de vue pour concevoir autrement l’action publique ? Le cas des déserts médicaux au prisme des parcours de soins." Thesis, Université Paris sciences et lettres, 2020. http://www.theses.fr/2020UPSLM054.
Full textThis dissertation deals with the concept of medical desert. Despite widespread use of the word by the media and political representatives, identifying medical deserts is far from easy for public authorities. Spotting inequalities in access to health services requires to identify users’ needs wherever they live. However, health needs are individualized. Besides, an individual does not fully know his needs. We must therefore understand how public authorities themselves appreciate this object and how they design actions accordingly to regulate care access. This is our purpose in this dissertation. We led an action research with the Regional Health Agency of Corsica in order to analyze how public actions are designed to regulate care access inequalities. We show in particular how the care pathway approach can highlight the diversity of inequalities in a medical desert thanks to a more global modeling of health needs. Fighting medical deserts is no longer limited to guaranteeing the presence of health professionals locally. It also relies on ensuring equality between citizens in the continuity of their care pathway. Yet, territories and individuals specificities suggest a strong heterogeneity between these pathways, which is difficult to manage at a national level. We then evaluate feasibility of a bottom-up innovative public action to reduce inequalities in care access. Through a slow, fragile and complex process, local actions can still address territorial specificities without ignoring a national regulatory and institutional framework. However, multiplying these proximity experiments requires new national-level criteria to select and rank projects. Hence, we recommend methods often used to manage the exploration of the unknown
Makhloufi, Khaled. "Towards universal health coverage in Tunisia : theoretical analysis and empirical tests." Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0025/document.
Full textThis thesis explores, in a four paper format, the possibility of extending social health insurance (SHI) schemes towards Universal Health Coverage (UHC) in presence of structural economic obstacles.The average treatment effects of two insurance schemes, MHI and MAS, on the utilization of outpatient and inpatient healthcare are estimated. The current Tunisian SHI schemes, despite improving utilization of healthcare services, are nevertheless incapable of achieving effective coverage of the whole population for needed services. Attaining the latter goal requires a strategy that targets the “trees” not the “forest”.Chapter two gets around major challenges to extending health insurance coverage and proposes an original approach by targeting informal workers and unemployed. A cross-sectional Contingent valuation (CV) study was carried out in Tunisia dealing with willingness-to-join and pay for two mandatory health and pension insurance schemes.Results support the hypotheses that the proposition of a voluntary affiliation to mandatory insurance schemes can be accepted by the majority of non-covered and that the WTP stated are substantial.Finally in chapter three we focus on methodological aspects that influence the value of the WTP. Our empirical results show that the voluntary affiliation to the formal health insurance scheme could be a step towards achieving UHC in Tunisia. Overall, we highlight the importance of taking into account protest positions for the evaluation of progress towards UHC
Jaffré, Marc-Olivier. "Connaissance et optimisation de la prise en charge des patients : la science des réseaux appliquée aux parcours de soins." Thesis, Compiègne, 2018. http://www.theses.fr/2018COMP2445/document.
Full textIn France, the streamlining of means assigned hospitals result in concentration of resources ana growing complexily of heallhcare facilities. Piloting and planning (them turn out to be all the more difficult, thus leading of optimjzation problems. The use of massive data produced by these systems in association with network science an alternative approach for analyzing and improving decision-making support jn healthcare. Method : Various preexisting optimisation are first highblighted based on observations in operating theaters chosen as experirnentai sites. An analysis of merger of two hospitlas also follows as an example of an optimization method by massification. These two steps make it possible to defend an alternative approach that combines the use of big data science of networks data visualization techniques. Two sets of patient data in orthopedic surgery in the ex-Midi-Pyrénées region in France are used to create a network of all sequences of care. The whole is displayed in a visual environment developed in JavaScript allowing a dynamic mining of the graph. Results: Visualizing healthcare sequences in the form of nodes and links graphs has been sel out. The graphs provide an additional perception of' the redundancies of he healthcare pathways. The dynamic character of the graphs also allows their direct rnining. The initial visual approach is supplernented by a series of objcctive measures from the science of networks. Conciusion: Healthcare facilities produce massive data valuable for their analysis and optimization. Data visualizalion together with a framework such as network science gives prelimiaary encouraging indicators uncovering redondant healthcare pathway patterns. Furthev experimentations with various and larger sets of data is required to validate and strengthen these observations and methods
Ali, Pungkas Bahjuri. "Healthcare utilisation in Indonesia : determinants and projections." Phd thesis, 2013. http://hdl.handle.net/1885/156025.
Full textHimmelreich, Tom. "Poverty, health status and healthcare utilisation: is wealth imperative for a healthy society?" Master's thesis, 2021. http://hdl.handle.net/10362/131518.
Full textDarkwah, Frank. "Health Insurance, Healthcare Utilisation and Labour Market Outcomes: a Micro Study of Ghana." Thesis, 2019. http://hdl.handle.net/2440/122300.
Full textThesis (Ph.D.) -- University of Adelaide, School of Economics, 2019
Asgedom, Mesghane Ghirmai. "The experience of Eritrean immigrants regarding utilisation of healthcare services in Indianapolis, Indiana, USA." Diss., 2015. http://hdl.handle.net/10500/20113.
Full textPublic Health
M.A. (Health Studies)
"Health of migrant factory workers in Shenzhen, China: mobility, self-reported health and healthcare utilisation." Thesis, 2010. http://library.cuhk.edu.hk/record=b6075061.
Full textInternal migration has become a more and more prominent societal and economic phenomenon in mainland China and Shenzhen is one of the most frequently selected locales for rural-urban migrants. This thesis aims 1) to assess health status and to describe patterns of healthcare utilisation amongst migrant factory workers, 2) to follow up the sample over 6 months to understand the impact of health insurance participation on health service utilisation and health expenditures, and 3) to assess the implications for health policies.
Our results suggest that health strategies should take into consideration the specific health needs of the highly mobile factory migrant workers. Through insurance coverage, local health authorities may be able to help improve rural-urban migrant workers' health by improving services at community level, and incorporating psychological care in the services provided by Community Health Centres.
Questionnaire surveys were used in a representative sample from factory workers in Shenzhen. The baseline and follow-up studies were conducted during April to December 2009 in Shenzhen, China.
Results show that migrant factory workers in Shenzhen represent a broad combination of geographic complexity and have special socio-demographic characteristics. The results have specified some association between self-rated health and SES, and major correlates of depressive symptoms amongst migrant factory workers. The seroprevalence of antibodies to rubella amongst female migrant workers is too low to provide immunity in the population. Sex, age, education, sleeping hours and internet use were associated with being a current smoker. The crude two-week illness rate was 21.6%. More than half and 11.6% of sick migrant workers chose self-treatment or neglected their sickness, respectively. Self-perception of disease being not severe, lack of time and economic difficulties were the major explanations for not utilizing professional care.
Mou, Jin.
Adviser: Sian Meryl Griffiths.
Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: .
Thesis (Ph.D.)--Chinese University of Hong Kong, 2010.
Includes bibliographical references (leaves 253-270).
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, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese.
Reilly, Siobhan, C. McCabe, N. Marchevsky, M. Green, L. Davies, N. Ives, H. Plappert, et al. "Status of primary and secondary mental healthcare of people with severe mental illness: an epidemiological study from the UK PARTNERS2 programme." 2001. http://hdl.handle.net/10454/18576.
Full textThere is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK. We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012-2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages. The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14-68) and 24% were from primary care (median, 10; IQR, 5-20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years. The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.
This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (grant reference no. RP-PG-0611-20004). Professors Siobhan Reilly, Richard Byng and Max Birchwood are partially supported by the NIHR Applied Research Collaboration (ARC) for North West Coast, Care South West Peninsula and West Midlands, respectively.
Reilly, Siobhan T., C. McCabe, N. Marchevsky, M. Green, L. Davies, N. Ives, H. Plappert, et al. "Status of primary and secondary mental healthcare of people with severe mental illness: an epidemiological study from the UK PARTNERS2 programme." 2021. http://hdl.handle.net/10454/18576.
Full textThere is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK. We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012-2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages. The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14-68) and 24% were from primary care (median, 10; IQR, 5-20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years. The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.
This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (grant reference no. RP-PG-0611-20004). Professors Siobhan Reilly, Richard Byng and Max Birchwood are partially supported by the NIHR Applied Research Collaboration (ARC) for North West Coast, Care South West Peninsula and West Midlands, respectively.
De, Wet Johannes Marthinus. "Prescribing patterns of asthma treatment in the private healthcare sector of South Africa / Johannes Marthinus de Wet." Thesis, 2013. http://hdl.handle.net/10394/10840.
Full textMPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014
Artenie, Andreea Adelina. "Examining the impact of healthcare and harm reduction services on drug use and hepatitis C virus infection risk among people who inject drugs." Thesis, 2019. http://hdl.handle.net/1866/24265.
Full textInfection with hepatitis C virus (HCV) is one of the main public health concerns affecting people who inject drugs (PWID). Although no effective prophylactic vaccine currently exists to prevent acquisition of HCV, a number of other tools are available to curb the HCV burden among PWID. These include harm-reduction programs, such as opioid agonist treatment (OAT), which can reduce the risk of HCV infection among those susceptible, and highly effective antiviral therapies to eradicate the virus among those who are infected. In recent years, there has been national and international interest in eliminating HCV as a public health threat by 2030, prioritising PWID in prevention and treatment efforts given that they are the population most affected. In parallel to this global effort, the high prevalence of injection-related harms among PWID that are unrelated to HCV, such as overdose, highlight a need to adopt a broader view on drug user health. Overall, this thesis is concerned with addressing some of the knowledge gaps and barriers that remain to achieving HCV elimination in PWID. First, because little is known about the importance of OAT dosage in influencing the risk of HCV acquisition, I examine this relationship in a sample of PWID followed in the Hepatitis Cohort (HEPCO) in Montreal. Findings indicate that the risk of HCV infection may not be systematically reduced for everyone receiving OAT and rather, that the risk of infection varies considerably according to the level of the prescribed OAT dosage and patient-perceived dosage adequacy. These findings suggest that simply scaling-up OAT access may not be sufficient to achieving the HCV elimination goals, and that the dosage of treatment should be considered as part of prevention efforts. Second, uptake of HCV treatment is low among PWID, partly due to concerns among providers and policymakers that drug use and injection risk behaviours may increase following treatment, thereby negating the benefits of therapy. Capitalising on two different studies - the IMPACT Cohort in Montreal and the SIMPLIFY/D3FEAT trials conducted in several countries - I illustrate that drug-related behaviours decrease or remain stable following HCV treatment. Together, these two studies suggest that concerns of escalating drug use or risk behaviours following HCV treatment are unfounded, further supporting the importance of expanding access to therapy among PWID. Third, moving beyond HCV as the primary focus of research, and capitalising once more on data collected in HEPCO, I examine the associations between three factors- OAT, housing and income, and patterns of injection frequency among PWID. Recognizing that injection patterns are dynamic over time, I examine the extent to which these three factors relate to injection frequencies among PWID with diverse trajectories of injection drug use, followed over a period of 7.5 years. Our findings indicate that socioeconomic stability and OAT are consistently associated with a lower injection frequency among all PWID, irrespective of their underlying injection trajectory and whether or not they are on a path to cessation. These findings suggest that there may be ways to support PWID in making small behavioral changes that could reduce their risks of injection-related harms, irrespective of whether or not they are in a position to stop injecting. In conclusion, at a time when many countries have embarked onto a global effort to eliminate HCV, efforts are needed to ensure that well-evidenced harm-reduction programs are optimised to reduce transmission of HCV, treatment for HCV infection is scaled-up among those who are infected ,and efforts do not overlook the basic needs and concerns of affected communities. This thesis provided data to help inform (i) optimisation of OAT provision for the prevention of HCV transmission, (ii) expanded access to HCV treatment, and (iii) access to stable housing and income to reduce the risk of injection-related harms among PWID. Ultimately, findings could contribute to reducing the HCV burden among PWID, helping move towards HCV elimination and, more broadly, improving the overall health of this marginalised group.
Croteau, Caroline. "Évaluation de l’utilisation et des coûts des soins de santé psychiatriques associés à l’autisme au Québec et impact de l’usage des médicaments psychoactifs dans la survenue de l’obésité chez les jeunes autistes." Thèse, 2018. http://hdl.handle.net/1866/21819.
Full textBirhanu, Bizuhan Gelaw. "The effectiveness of neonatal health care services in the primary health care units in the north-west of Ethiopia." Thesis, 2018. http://hdl.handle.net/10500/25802.
Full textHealth Studies
D. Litt. et Phil. (Health Studies)
Simard, Patrice. "Évaluation de l’adhésion et de la persistance aux antidiabétiques, et de l’effet de la non-adhésion à la metformine sur la mortalité de toutes causes, sur l’utilisation et les coûts directs des soins de santé." Thèse, 2018. http://hdl.handle.net/1866/19990.
Full textFaress, Ahmed. "L'utilisation des soins prénataux chez les migrants sans assurance maladie à Montréal." Thesis, 2020. http://hdl.handle.net/1866/25214.
Full textObjective: Previous research has identified poor prenatal care use among uninsured migrants in Canada, however, the factors influencing this usage remain largely unexplored. The study objective was to quantify the use of prenatal care among this group and to identify the barriers and facilitating factors to prenatal care use. Methods: A cross-sectional survey of uninsured migrants in Montreal, Canada was carried out between January 2016 and August 2017. Participants were recruited from a local volunteer clinic and from the community using venue-based and snowball sampling. Outcome measures included prenatal care use, prenatal care initiation, and prenatal care adequacy. Regression analysis identified barriers and facilitating factors to prenatal care use. Results: 125 previous pregnancies in Canada were identified among 101 women. 65.0% of pregnancies involved prenatal care use and 44.6% involved an early initiation of care. Among the 62 pregnancies carried to term, 29.5% received adequate prenatal care. Women ≥35 years of age (OR 0.13, 95% CI: 0.03-0.54, p=0.01), between the ages of 18-24 (OR 0.30, 95% CI: 0.09-0.99, p=0.049), and those who did not know where to consult (OR 0.25, 95% CI: 0.06-0.99, p=0.049) were significantly less likely (p<0.05) to use prenatal care. Women aged 30-34 (OR 0.27, 95% CI: 0.10-0.72, p=0.01) were significantly less likely (p<0.05) to initiate prenatal care early. In contrast, women who were married or in common-law relationships (OR 3.16, 95% CI: 1.04-9.62, p=0.04) were significantly more likely (p<0.05) to initiate prenatal care early. Conclusion: Our study found that prenatal care use among uninsured migrants was very poor. Factors influencing prenatal care use were varied and related to demographics, social network, and migration. Future policy should aim to improve access to prenatal care among this vulnerable population.
Duranceau, Marie-France. "Les processus de dissémination et de création des connaissances dans les organisations de santé : le cas du Bureau de transition du Centre universitaire de santé McGill." Thèse, 2016. http://hdl.handle.net/1866/18582.
Full textHealth organizations are characterized by the complexity of their activities and a high level of care fragmentation that inevitably result in service coordination stakes. Their main coordination mechanism, knowledge and expertise standardization is an essential, but limited, mechanism. Thus, the challenge still stands for a health organization to promote knowledge utilization at an organizational level. This project evaluates how an organizational structure aiming at mobilization and knowledge utilization in decision making helps to improve the coordination services in a health organization. This research relies on a specific case: the Transition Support Office (TSO) of the McGill University Health Center (MUHC). The analysis uses a conceptual framework of organizational knowledge creation inspired by the work of Nonaka et al. Data have been collected by observations, documentary and interview analyses. This theory driven evaluation explains how the conversion process of tacit knowledge to explicit knowledge allows the dissemination and creation of new organizational knowledge and contributes to the improvement of service coordination. The evaluation demonstrates the influence of contextual factors on the processes of knowledge creation/utilization. The research shows that it is necessary to otherwise conceptualize the use of empirical data in decision making by highlighting their specific role in the social process of knowledge creation. We propose a new knowledge use typology in decision making. We also show how an organizational structure like the TSO can contribute to the care and service coordination in a health organization. Results also enrich the scientific knowledge on governance and organization transformation.
Beauséjour, Marie. "Pertinence de la référence en orthopédie pédiatrique des cas suspectés de scoliose idiopathique : association avec la morbidité perçue et les itinéraires de soins des patients." Thèse, 2012. http://hdl.handle.net/1866/12179.
Full textAdolescent Idiopathic Scoliosis (AIS) is the type of musculoskeletal deformity most frequently encountered in the pediatric population with a prevalence of approximately 2.0%. Since the Canadian school screening programs were discontinued in the 1980s, data detailing health service utilization or typical reference patterns for patients with suspected AIS are no longer available. Without such programs, changes in the utilization patterns of pediatric orthopedic specialized services are anticipated. The thesis therefore aims to study the appropriateness of referral of youths with suspected AIS. It comprises three main objectives: 1) To validate a measurement tool based on perceived morbidity (perception of the symptoms) in the orthopedic pediatric patient population, 2) To study the relationships between morbidity perceived by lay persons (the young patient and his parent), and the objective morbidity determined by medical professionals, 3) To characterize the healthcare service pathways of suspected AIS cases upstream of their first orthopedic consultation in order to define a taxonomy of the pathways and analyse their relationships with the appropriateness of referral. In 2006-2007, an extensive survey conducted in the five clinics serving southwest Quebec recruited 831 patients. They were categorized using criteria for the appropriateness of referral (inappropriate, appropriate or late) based on the amplitude of the main spinal curve and skeletal maturity at the first visit. Lay perceived morbidity was operationalized according to the seriousness, urgency, pain, self-image and general perceived health. Medical and paramedical visits upstream of the pediatric orthopedic consultation were documented with questionnaires to the families. Based on Andersen’s Health Behavior Model, the individual (facilitating and enabling), professional and systemic factors were considered as control variables in the study of associations between perceived morbidity or healthcare trajectories, and appropriateness of referral. The main conclusions of the thesis are: i) Reliable (Cronbach alpha between 0.79 and 0.86) and valid (construct, concurrent and discriminant validity) measurement tools are available to evaluate the perceived morbidity in the French-speaking adolescent population that consults in pediatric orthopedics, ii) Lay stakeholders play an important role in the suspicion of scoliosis (53% of cases) with their perceived morbidity directly related to the objective morbidity, and therefore associated to the appropriateness of referral, iii) The current orthopedic casemix is considered suboptimal with regards to the appropriateness of referral, and the actual mechanisms for reference are in fact responsible for a large number of inappropriate (38%) and late (18%) referrals to specialized pediatric orthopedic services, iv) Adolescents with suspected AIS consult with a wide range of health specialists resulting in a large variety of healthcare pathways upstream of the orthopedic consultation, and v) Continuity of healthcare services, mainly through a regular source of care for the child, is favourable to a reduction in late referrals (OR=0.32 [0.17-0.59]). This thesis is intended to contribute to the advancement of conceptual, empirical and applied knowledge leading to a series of knowledge translation initiatives targeting primary health care providers. Such initiatives have the potential to increase awareness of the condition, to support decision-making as well as to improve the coordination of consultation requests, thus promoting appropriateness and timeliness of referrals.
Langlois, Étienne Vincent. "Déterminants et inégalités d’utilisation des services obstétricaux essentiels dans les pays à revenu faible et intermédiaire." Thèse, 2014. http://hdl.handle.net/1866/11805.
Full textBackground Each year, 289 000 women die from complications related to pregnancy, childbirth or the postnatal period, and 2.9 million newborns decease before reaching 28 days of life. The near totality (99%) of maternal and neonatal deaths occur in low- and middle-income countries (LMICs). Utilization of essential obstetric care services including skilled birth attendance (SBA) and postnatal care (PNC) largely contributes to the reduction of maternal and neonatal morbidity and mortality. There is a strong need to assess the determinants and inequalities in coverage of SBA and PNC services, to inform health policy planning. Objectives 1. Systematically assess the socioeconomic, geographic and demographic inequalities in PNC services utilization in LMICs. 2. Evaluate the effect of Burkina Faso’s 2007 user-fee subsidy policy on SBA rate across socioeconomic status (SES) strata. Methods 1. We conducted a systematic review of the association between PNC services utilization and key determinants, including a meta-analysis of PNC use across socioeconomic status quintiles, and place of residence (urban vs. rural). 2. We used a quasi-experimental design. The data sources were two representative surveys (n=1408 and n=1403) carried out in 2008 and 2010, respectively, of women from Houndé and Ziniaré health districts of Burkina Faso, and a survey of health centres assessing structural quality of care. Multilevel segmented Poisson regression models were used to assess the effect of subsidy on SBA rate. We estimated adjusted rate ratios and rate differences as a function of time and socioeconomic status level. Results 1. The pooled odds ratio (OR) (95% CI) estimates for highest SES women (quintile 5, Q5), Q4, Q3 and Q2 (reference: poorest quintile, Q1) were respectively: 2.27 (1.75 – 2.93); 1.60 (1.30-1.98); 1.32 (1.12-1.55); and 1.14 (0.96-1.34). Meta-analysis also showed a PNC utilization divide between urban and rural women: OR (95% CI) = 1.36 (1.01-1.81). Narrative assessment of studies identified a gradient in PNC coverage across education levels. 2. For low-SES women, immediately upon the introduction of the subsidy policy, the rate of SBA was 24% higher (95% CI: 4-46%) than expected in the absence of subsidy policy introduction. The magnitude of the apparent effect decreased over time, with the corresponding estimates (95% CI) being 22% (3-45%) at 6 months, 20% (1-43%) at 12 months, and 17% (-4-42%) at 24 months after the policy introduction. Furthermore, the magnitude of the association varied across SES strata, with the apparent effect being most pronounced in the low SES stratum. Conclusions 1. PNC utilization remains inequitable across socioeconomic status and geographic access to health facilities in LMICs. 2. Our study suggests that introduction of user fee subsidy in Burkina Faso resulted in sustained increase in the rate of SBA, especially among low-SES women. This evidence should inform maternal and child health programmes and guide health policies and health care systems in LMICs.