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1
McGuiness, Clare Frances. "Client perceptions : a useful measure of coordination of health care." View thesis entry in Australian Digital Theses Program, 2001. http://thesis.anu.edu.au/public/adt-ANU20020124.141250/index.html.
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McCreanor, Victoria Helen Rarity. "Identifying high-value care for coronary artery disease in Australia." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/130756/1/Victoria_McCreanor_Thesis.pdf.
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This project compared the cost-effectiveness of drug therapy, stents and surgery for Australian patients with heart disease, modelling their long-term treatment trajectories, costs and health outcomes. It showed that drug therapy is high-value and that the health system, and Australians, would benefit from targeted rather than routine use of stents. This research provides policy recommendations to reduce the use of low-value care and increase the use of high-value care for Australian patients with heart disease.
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Carter, Robert C. (Robert Charles) 1950. "The macro economic evaluation model (MEEM) : an approach to priority setting in the health sector." Monash University, Dept. of Management, 2001. http://arrow.monash.edu.au/hdl/1959.1/8672.
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Forsyth, Rowena Public Health & Community Medicine Faculty of Medicine UNSW. "Tricky technology, troubled tribes: a video ethnographic study of the impact of information technology on health care professionals??? practices and relationships." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/30175.
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Whilst technology use has always been a part of the practice of health care delivery, more recently, information technology has been applied to aspects of clinical work concerned with documentation. This thesis presents an analysis of the ways that two professional groups, one clinical and one ancillary, at a single hospital cooperatively engage in a work practice that has recently been computerised. It investigates the way that a clinical group???s approach to and actual use of the system creates problems for the ancillary group. It understands these problems to arise from the contrasting ways that the groups position their use of documentation technology in their local definitions of professional status. The data on which analysis of these practices is based includes 16 hours of video recordings of the work practices of the two groups as they engage with the technology in their local work settings as well as video recordings of a reflexive viewing session conducted with participants from the ancillary group. Also included in the analysis are observational field notes, interviews and documentary analysis. The analysis aimed to produce a set of themes grounded in the specifics of the data, and drew on TLSTranscription?? software for the management and classification of video data. This thesis seeks to contribute to three research fields: health informatics, sociology of professions and social science research methodology. In terms of health informatics, this thesis argues for the necessity for health care information technology design to understand and incorporate the work practices of all professional groups who will be involved in using the technology system or whose work will be affected by its introduction. In terms of the sociology of professions, this thesis finds doctors and scientists to belong to two distinct occupational communities that each utilise documentation technology to different extents in their displays of professional competence. Thirdly, in terms of social science research methodology, this thesis speculates about the possibility for viewing the engagement of the groups with the research process as indicative of their reactions to future sources of outside perturbance to their work.
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Brereton, John. "An evaluation of introducing advanced airway skills in the Western Australian Ambulance Service." University of Western Australia. Emergency Medicine Discipline Group, 2004. http://theses.library.uwa.edu.au/adt-WU2005.0065.
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[Truncated abstract] Objective: To investigate the demographics, success rate of application, nature and frequency of complication and the survival outcome of patients receiving advanced airway management in the pre-hospital setting. Design: Prospective observational cohort study. Participants: Patients who were attended to by St. John Ambulance Paramedics in the Perth Metropolitan area and selected regional areas within Western Australia. The patients were unconscious, unresponsive with no gag reflex and where application of an advanced airway would improve ventilation. Methods: Ambulance Paramedics received mannequin training within the classroom environment on the techniques for the application of the Endo-Tracheal Tube and the Laryngeal Mask Airway. The indication for the application of an advanced airway was any patient whose ventilation may be improved by intubation. These patients would be either deeply unconscious and areflexic, long term transport, severely injured (especially head injured) or cardiac arrest patients. Results: ... Paramedic assessment demonstrated that 14 (7.4%) 3 patients had an improvement in outcome. Of the 14 patients, 5 (2.7%) cardiac arrest patients survived to discharge from hospital compared to a 2.1 % survival rate for all cardiac arrest cases attended by the WAAS in 2002. Conclusion: Ambulance Paramedics can successfully apply an advanced airway apparatus in the pre-hospital environment. There was no statistical significance to demonstrate whether the introduction of advanced airway skills was beneficial or detrimental to patient survival outcome.
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Bennett, Paul J. "An investigation into the health related outcomes of surgery performed by Fellows of the Australian College of Podiatric Surgeons." Thesis, Queensland University of Technology, 1999. https://eprints.qut.edu.au/36746/1/36746_Digitised%20Thesis.pdf.
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Health care providers in the United States, United Kingdom and Australia debate the need for expanding the role of podiatrists' to include the surgical care of foot problems. Paradoxically, during a twelve month period from July 1995 to June 1996, Fellows of the Australian College of Podiatric Surgeons (FACPS) performed over 1,500 individual surgical operations on approximately 785 Australians.
Few prospective investigations of podiatric surgeon outcomes have been conducted, none of which have taken place in Australia. More particularly, no studies have used valid psychometric instruments to measure the effects of care provided on patients' "health related quality of life". The research contained in this thesis deals with the conceptualisation, development and validation of a new health status instrument: the Foot Health Status Questionnaire. This instrument has been developed with the specific intent of investigating the impact of FACPS on patients' health related quality of life.
One hundred and forty-two subjects treated by eleven Fellows for orthopaedic, neurological or integumentary systems diseases of the foot were recruited into a six month long quasi-experimental repeated measures (time series) study. The study identified that the vast majority of subjects (more than 92%) who underwent foot surgery experienced significant improvements' in a range of health related quality of life dimensions and indicated that they would undergo their procedure again. In particular, a MANCOVA analysis demonstrated that subjects' reported reduced levels of foot pain, increased levels of physical function, improved general foot health perception and footwear related quality of life, up to six months after their respective operations.
Adverse effects of surgery identified in this study include a significant short-term functional disability for subjects' undergoing orthopaedic correction of foot problems and, in the immediate post operative phase, a significant reduction in social function for all three groups of subjects'. Generic measures of General Health and Vitality, as captured by the Short Form 36 health status instrument, were unaffected by Fellows treatment. This study did not identify any significant short to medium term morbid outcomes.
Assessment of patients' satisfaction with surgery one, three and six months postoperatively reflected a general under-reporting of the beneficial effects of foot surgery. These findings support the premise that; specific health related quality of life measures provide significant explanatory power about the outcomes of care compared with the more traditional approach of evaluating patient satisfaction with surgery.
In summary, it has been recommended that podiatrists, like other health care professionals, use recognised methods to determine whether their care meets professional standards and to generate evidence to prove that it does. This research contributes to meeting this important public health need.
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Kelman, Christopher William, and christopher kelman@cmis csiro au. "Monitoring Health Care Using National Administrative Data Collections." The Australian National University. National Centre for Epidemiology and Population Health, 2001. http://thesis.anu.edu.au./public/adt-ANU20020620.151547.
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With the inevitable adoption of information technology into all areas of human pursuit, the potential benefits for health care should not be overlooked. In Australia, details of most health care encounters are currently recorded for administrative purposes. This results in an impressive electronic data-bank that could provide a national resource for health service evaluation.
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Evaluation of health services has become increasingly important to provide indicators of the benefits, risks and cost-effectiveness of treatments. However, if administrative data are to be used for this purpose, several questions must first be addressed: Are the current data collections accessible? What outcome measures can be derived from these data? Can privacy issues be managed? Could the quality of the data be improved? Is the existing infrastructure adequate to supply data for evaluation purposes? Could the existing system provide a basis for the development of an integrated health information system?
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The aims of the project were:
· To examine the potential for using administrative data to generate outcome measures and surveillance indicators.
· To investigate the logistics of gaining access to these data for the purpose of research. This to be achieved within the current ethical, political and financial framework.
· To compare the Australian health-service data system with the current international state-of-the-art.
· To develop suggestions for expansion of the present system as part of an integrated health record and information system. This system to manage patient records and provide data for quality management, treatment surveillance and cost-effectiveness evaluation as a routine activity.
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The thesis is presented in two parts. In the first part, a historical cohort study is described that involved patients with implantable medical devices. The potential to evaluate outcomes was investigated using all national health-service information currently available in electronic form. Record linkage techniques were used to combine and augment the existing data collections. Australias national health databases are to varying degrees, amenable to such linkage and cover doctor visits, pharmaceuticals, hospital admissions and deaths. The study focused on medical devices as an illustrative case but the results are applicable to the routine assessment of all medical and surgical interventions.
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For the Australian Medical Devices study, the records of 5,316 patients who had medical device implants in 1993-94 were selected from the archives of a major private health insurer. Five groups of medical implants were studied: heart valves, pacemakers, hips, vascular grafts and intra-optic lenses. Outcomes for these patients, including death, re-operation and health service utilisation, were compared and analysed.
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A comparison study was performed using data from the Manitoba Health database in Winnipeg, Canada. Manitoba provides a very similar demographic group to that found in Australia and is an example of a prototype integrated-health-information system. One of the principal advantages for research is that personally identified data about medical and hospital services are collected for all patients. Selection bias is eliminated because individual consent is not required for this type of research and all selected patients could be included in the study.
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The two studies revealed many barriers to the use of administrative data for health outcomes research. Service event data for the Australian cohort could be collected but only after long delays and hospital morbidity data were not available for the entire cohort. In contrast to the situation in Australia, the Manitoba data were both accessible and complete, but were lacking in detail in some areas.
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Analysis of the collected data demonstrated that without the addition of clinical data only general indications of trends could be deduced. However, with minimal supplementary clinical data, it was possible to examine differences in performance between brands of medical devices thus indicating one of the uses for this type of data collection.
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In the second part of the thesis, conclusions are presented about the potential uses and limitations of the existing system and its use as a basis for the development of a national Integrated Health Record and Information System (IHRIS). The need for the establishment of a systemic quality management system for health care is discussed.
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The study shows that linked administrative data can provide information about health outcomes which is not readily available from other sources. If expanded and integrated, the system that is currently used to collect and manage administrative data, could provide the basis for a national health information system. This system would provide many benefits for health care. Benefits would include the monitoring, surveillance and cost-effectiveness analysis of new and existing treatments involving medical devices, drugs and surgical procedures. An integrated health information system could thus provide for both clinical and administrative needs, while in addition providing data for research.
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Unfortunately, in Australia, the use of administrative data for this purpose is not currently feasible. The principal barrier is the existence of a culture within the Australian health care system which is not supportive of research and is deficient in quality and safety measures.
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Recent initiatives by both the Commonwealth and state governments have supported the introduction of measures to improve quality and safety in health care. It is argued here that an Integrated Health Record and Information System (IHRIS) would provide an essential component of any such scheme. The results of this study have important policy implications for health care management in both the administrative and clinical domains.
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Ho, Kwok Ming. "Use of prognostic scoring systems to predict outcomes of critically ill patients." University of Western Australia. School of Medicine and Pharmacology, 2008. http://theses.library.uwa.edu.au/adt-WU2009.0101.
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[Tuncated abstract] This research thesis consists of five sections. Section one provides the background information (chapter 1) and a description of characteristics of the cohort and the methods of analysis (chapter 2). The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system is one of commonly used severity of illness scoring systems in many intensive care units (ICUs). Section two of this thesis includes an assessment of the performance of the APACHE II scoring system in an Australian context. First, the performance of the APACHE II scoring system in predicting hospital mortality of critically ill patients in an ICU of a tertiary university teaching hospital in Western Australia was assessed (Chapter 3). Second, a simple modification of the traditional APACHE II scoring system, the 'admission APACHE II scoring system', generated by replacing the worst first 24-hour data by the ICU admission physiological and laboratory data was assessed (Chapter 3). Indigenous and Aboriginal Australians constitute a significant proportion of the population in Western Australia (3.2%) and have marked social disadvantage when compared to other Australians. The difference in the pattern of critical illness between indigenous and non-indigenous Australians and also whether the performance of the APACHE II scoring system was comparable between these two groups of critically ill patients in Western Australia was assessed (Chapter 4). Both discrimination and calibration are important indicators of the performance of a prognostic scoring system. ... The use of the APACHE II scoring system in patients readmitted to ICU during the same hospitalisation was evaluated and also whether incorporating events prior to the ICU readmission to the APACHE II scoring system would improve its ability to predict hospital mortality of ICU readmission was assessed in chapter 10. Whilst there have been a number of studies investigating predictors of post-ICU in-hospital mortality none have investigated whether unresolved or latent inflammation and sepsis may be an important predictor. Section four examines the role of inflammatory markers measured at ICU discharge on predicting ICU re- 4 admission (Chapter 11) and in-hospital mortality during the same hospitalisation (Chapter 12) and whether some of these inflammatory markers were more important than organ failure score and the APACHE II scoring system in predicting these outcomes. Section five describes the development of a new prognostic scoring system that can estimate median survival time and long term survival probabilities for critically ill patients (Chapter 13). An assessment of the effects of other factors such as socioeconomic status and Aboriginality on the long term survival of critically ill patients in an Australian ICU was assessed (Chapter 14). Section six provides the conclusions. Chapter 15 includes a summary and discussion of the findings of this thesis and outlines possible future directions for further research in this important aspect of intensive care medicine.
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Patterson, Jan. "Consumers and complaints systems in health care /." Title page, contents and summary only, 1996. http://web4.library.adelaide.edu.au/theses/09PH/09php3174.pdf.
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Sinclair, Andrew James, and n/a. "The primary health care experiences of gay men in Australia." Swinburne University of Technology, 2006. http://adt.lib.swin.edu.au./public/adt-VSWT20060713.084655.
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The present research, consisting of two studies, was designed to examine the
primary health care experiences of gay men in Australia and assess doctors? attitudes and
training with regard to gay men and their health care. In the first study, 195 gay men were
surveyed regarding their health issues and their primary health care experiences. The
most important health concerns of gay men were stress and depression followed by
HIV/AIDS, body image disorder and other sexually transmissible infections. Including
those participants who were unsure, approximately one-half reported experiencing
homophobia and almost one?quarter reported experiencing discrimination in the
provision of health care. Despite this, respondents were generally satisfied with their
primary health care, although respondents felt that all GPs should receive additional
undergraduate medical education regarding gay men?s health. In the second study, 25
doctors (13 gay specialists and 12 non-gay specialists) were surveyed regarding their
knowledge of gay men?s health and their comfort working with gay men. Non-gay
specialist GPs were less comfortable treating gay men, reported poorer communication
and were more homophobic than their gay specialist counterparts. Further, doctors
perceived their medical education regarding gay men?s health has been inadequate.
Together, the results of the two current studies suggest that disclosure of sexuality is an
important issue for both gay men and doctors, and has the potential to impact on the
quality of health care that gay men receive. In order to improve the level of disclosure,
the pervasiveness of homophobia and discrimination in primary health care must be
reduced. Finally, the results indicate that medical education must be updated to reflect
current knowledge regarding the health issues of gay men. Failure to address these issues
will condemn gay men to continued health inequality.
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Walker, Annette Clare, of Western Sydney Nepean University, and Faculty of Nursing and Health Studies. "Nurse and patient work: comfort and the medical-surgical patient." THESIS_FNHS_XXX_Walker_ A.xml, 1996. http://handle.uws.edu.au:8081/1959.7/286.
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This grounded theory study investigates the experiences and perceptions of comfort and discomfort of hospital patients admitted for medical-surgical conditions, with a focus on the post-accute stage of hospitalisation. In-depth post-discharge interviews were conducted with seventeen English speaking adults who had been admitted to nine Australian hospitals. A substantive theory of finding comfort and of managing discomfort was generated. Processes of self-talk (anticipating, interpreting, accepting, making allowances and maintaining perspective) and self-care (self-help and seeking help, which involved accommodating to the level and type of help available through deferring, avoiding, persisting or desisting) were used to find comfort and to manage discomfort. The study has implications for nursign practice, management, research and education. Existing practice in the areas of assessment, communication, individualised care planning and the management of discomfort need to be strengthened if nursing care is to make a difference for this category of patient. The study revealed that integrated caring by nurses perceived by informants as 'experts', contributed most to the experience of finding comfort and managing discomfort in this group of informantsDoctor of Philosophy (PhD)
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Fickel, Jacqueline Jean. "Quality of care assessment : state Medicaid administrators' use of quality information." Full text (PDF) from UMI/Dissertation Abstracts International Access restricted to users with UT Austin EID, 2002. http://wwwlib.umi.com/cr/utexas/fullcit?p3077639.
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Berthelsen, Donna. "An ecology of centre-based child care." Thesis, Queensland University of Technology, 1997. https://eprints.qut.edu.au/36555/6/36555_Digitised%20Thesis.pdf.
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The studies in the thesis were derived from a program of research focused on centre-based child care in Australia. The studies constituted an ecological analysis as they examined proximal and distal factors which have the potential to affect children's developmental opportunities (Bronfenbrenner, 1979). The project was conducted in thirty-two child care centres located in south-east Queensland. Participants in the research included staff members at the centres, families using the centres and their children. The first study described the personal and professional characteristics of one hundred and forty-four child care workers, as well as their job satisfaction and job
commitment. Factors impinging on the stability of care afforded to children were examined, specifically child care workers' intentions to leave their current position and actual staff turnover at a twelve month follow-up. This is an ecosystem analysis (Bronfenbrenner & Crouter, 1983), as it examined the world of work for carers; a setting not directly involving the developing child, but which has
implications for children's experiences. Staff job satisfaction was focused on working with children and other adults, including parents and colleagues. Involvement with children was reported as being the most rewarding aspect of the work. This intrinsic satisfaction was enough to sustain caregivers' efforts to maintain their employment in child care programs. It was found that, while improving working conditions may help to reduce turnover, it is likely that
moderate turnover rates will remain as child care staff work in relatively small centres and they leave in order to improve career prospects. Departure from a child care job appeared to be as much about improving career opportunities or changing personal circumstances, as it was about poor wages and working conditions. In the second study, factors that influence maternal satisfaction with child care
arrangements were examined. The focus included examination of the nature and qualities of parental interaction with staff. This was a mesosystem analysis
(Bronfenbrenner & Crouter, 1983), as it considered the links between family and child care settings. Two hundred and twenty-two questionnaires were returned from mothers whose children were enrolled in the participating centres. It was found that maternal satisfaction with child care encompassed the domains of child-centred and parent-centred satisfaction. The nature and range of responses in the quantitative and qualitative data indicated that these parents were genuinely satisfied with their children's care. In the prediction of maternal satisfaction with
child care, single parents, mothers with high role satisfaction, and mothers who were satisfied with the frequency of staff contact and degree of supportive
communication had higher levels of satisfaction with their child care arrangements. The third study described the structural and process variations within child care programs and examined program differences for compliance with regulations and differences by profit status of the centre, as a microsystem analysis (Bronfenbrenner, 1979). Observations were made in eighty-three programs which
served children from two to five years. The results of the study affirmed beliefs that nonprofit centres are superior in the quality of care provided, although this was not to a level which meant that the care in for-profit centres was inadequate. Regulation of structural features of child care programs, per se, did not guarantee higher quality child care as measured by global or process indicators.
The final study represented an integration of a range of influences in child care and family settings which may impact on development. Features of child care programs which predict children's social and cognitive development, while taking into account child and family characteristics, were identified. Results were consistent with other research findings which show that child and family
characteristics and child care quality predict children's development. Child care quality was more important to the prediction of social development, while family
factors appeared to be more predictive of cognitive/language development. An influential variable predictive of development was the period of time which the
child had been in the centre. This highlighted the importance of the stability of child care arrangements. Child care quality features which had most influence
were global ratings of the qualities of the program environment. However, results need to be interpreted cautiously as the explained variance in the predictive models developed was low. The results of these studies are discussed in terms of the implications for practice and future research. Considerations for an expanded view of ecological approaches to child care research are outlined. Issues discussed include the need to generate child care research which is relevant to social policy development, the
implications of market driven policies for child care services, professionalism and professionalisation of child care work, and the need to reconceptualise child care
research when the goal is to develop greater theoretical understanding about child care environments and developmental processes.
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Wollin, Judy A. "A comparative study of aspects of health care valued by residents with multiple sclerosis and staff at a residential setting." Thesis, Queensland University of Technology, 1993. https://eprints.qut.edu.au/36811/1/36811_Digitised%20Thesis.pdf.
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This research was undertaken in response to the implementation of a program of de-institutionalisation under the auspices of the Disability Services Act 1986, involving people with Multiple Sclerosis {MS) . The impact of de-institutionalisation on people with MS has not been researched before in Australia.
The aim of the research was to identify and compare aspects of health care valued by people with Multiple Sclerosis and staff at an assisted accommodation unit in suburban Australia.
The research participants included the residents and staff of a residential centre for people with MS. Elements of quantitative and qualitative research methods were used. Data were collected using unstructured interviews and sequential questionnaires. These data were analysed using recurrent theme identification technique.
The research shows that the current program of deinstitutionalisation has resulted in changes affecting both residents and staff. The findings of the research were similar for both groups, who wish to see the Centre remain as much as possible as it is, with in-house services continued. Changes resulting in the abolition or reduction of services are not supported by either group.
While the overall objectives of the Disability Services Act 1986 are supported by residents and staff, the major conclusion of the study is that its implementation should more closely reflect the needs of people with MS already living in an assisted accommodation unit.
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Sims, Hazel Jane. "A case study of pressure group activity in Western Australia: Medical care of the dying bill (1995)." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1999. https://ro.ecu.edu.au/theses/1220.
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When the Australian Labor Party member for Kalgoorlie, Ian Taylor, presented his Private Member's Bill - the Medical Care of the Dying Bill (1995), he laid the foundation for this thesis. Mr Taylor introduced his Bill to the Western Australian Legislative Assembly on 28 March 1995. The Bill codified the terminally ill patient's right to refuse medical treatment, which clarified common law. This thesis attempts to overcome the dearth of literature in Western Australian lobbying concerning conscience-vote issues. It also identifies the key issues in understanding political lobbying, the form of pressure group activity that takes place and why certain groups respond in different ways. The pressure groups selected for this case study are examined, classified and evaluated resulting in a prescription for lobby group activity for similar conscience-vote issues. According to the Bill's sponsor, Ian Taylor, the legislation was needed to deal with the inconsistencies in common law of the medical treatment of terminally ill people. The Law Reform Commission in its 1991 Report on Medical Treatment for the dying, stated that there was a need to deal with the issue in Western Australia. Due to the advances in medical treatment practices in the past 50 years, doctors can prolong the life of patients for whom there is no cure. The major problem, however, is the Criminal Code: doctors and care providers can be at risk of prosecution and conviction if the patient's wishes are respected and medical treatment is withdrawn, leading to the patient's death. At present there is a general common law right to refuse medical treatment. According to Mr Taylor, the difficulty lies in the fact that in Western Australia, the common law is overridden by the Criminal Code. The Bill also highlighted the role of palliative care and the treatment of the dying. The opinion of most pressure groups was that the rights of terminally ill patients should be protected and enhanced. Of the groups selected for this case study, only the Coalition for the Defence of Human Life objected to the Bill. Other groups supported the principles of the Bill, while some hoped for voluntary euthanasia legislation and others gave tacit approval. Of all the groups the L. J. Goody Bioethics Centre distinguished itself as a key organisation which tended to monopolise political influence. Media exposure of the issue was high, particularly in The West Australian. The "right to die" issue was canvassed and often was reported with references to euthanasia. At the same time the Northern Territory legislation, the Rights of the Terminally Ill Bill (1995), was receiving much media attention. The issue of euthanasia was necessarily discussed in the context of national and international arenas. The political masters of thought on citizen participation and group theory were introduced early in the thesis. John Locke, Jean -Jacques Rousseau, James Madison, Alexis de Tocqueville, Thomas Paine and John Stuart Mill provided valuable insight into the nature of modern political thought on this interesting aspect of political activity. Contemporary political writers such as Trevor Matthews. Dean Jaensch and Graham Maddox were also consulted. The eight pressure groups selected for the study were the: • West Australian Voluntary Euthanasia Society Inc. • Coalition for the Defence of Human life • Australian Medical Association (WA Branch) • Australian Nursing Federation (WA Branch) • L. J. Goody Bioethics Centre • Silver Chain Nursing Association Inc. • Uniting Church of Australia • Anglican Church of Australia Information from the groups formed a significant part of this thesis. An attempt was made in the conclusion to ascertain the effectiveness of the various strategies utilised by the pressure groups and provide an insight into lobbying practices. Ultimately, though, the contentious Bill was not given a third reading. Nor was it debated in the Legislative Council. At one stage it was considered likely that the Bill would be recommitted to parliament. The monitoring of the Medical Care of the Dying Bill (1995) undertaken in this thesis, indicates that this would have been a lengthy and divisive process.
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Chauvin, James Brodie. "An analysis of evaluative research : the case of primary health care." Thesis, University of British Columbia, 1985. http://hdl.handle.net/2429/24593.
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The primary health care (PHC) model is being actively promoted as an effective and lower-cost alternative to conventional health care delivery systems in many developing countries. Despite the fact that over 300 PHC projects of varying scale have been implemented and reported on throughout the Third World over the past two decades, there appears to be little evidence available to support the popular hypothesis that the availability and utilization of primary health care services necessarily results in significant improvements in health. The objective of this thesis is to identify alternative strategies for evaluating PHC projects which will establish credible and useful results. The thesis reviews the evolution of both the PHC model and evaluative research methodologies, and then presents a critical analysis of a set of PHC project evaluations. The aim of this exercise is to identify some of the major factors which have limited the validity, utility and significance of the evaluation results. The thesis suggests that less rigorous evaluative research designs and evaluative techniques which use a combination of quantitative and qualitative data be used to enhance the credibility and utility of evaluation results.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Haghshenas, Abbas Public Health & Community Medicine Faculty of Medicine UNSW. "Negotiating norms, navigating care: the practice of culturally competent care in cardiac rehabilitation." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/32280.
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BACKGROUND Increasingly, it is recognised that the unique needs of people from culturally and linguistically diverse backgrounds (CaLDB) should be addressed within a framework of cultural competence. To date, there are limited data on the issues facing CaLDB patients in the Cardiac Rehabilitation (CR) setting. Appreciation of an individual???s values, attitudes and beliefs underpins negotiation of behaviour change in the CR setting. Therefore an understanding of patient and professional interactions is of key importance. OBJECTIVES The focus of this study has been to undertake an exploration of CR service delivery to people from culturally and linguistically diverse backgrounds, using Arabic speaking people as an exemplar of a CaLDB group. More broadly, this research project has sought to identify factors, which influence the practice of health professionals towards CaLDB patients, and to develop a model for evaluation of culturally competent health care in the CR setting. The study sought to achieve these aims by addressing the following research questions: 1. In what way do health practitioners in CR adjust their treatment and support to accommodate the perceived needs of CaLDB communities? 2. In what way do factors (such as individual and organisation perspectives) influence the adjustment of clinical practice and service delivery of CR practitioners; and what are practitioners??? and patients??? perception of barriers and facilitators to service delivery? 3. To what level are CaLDB patients satisfied with CR services? This study design is comprised of the following elements: (1) interviews with health practitioners and Arabic speaking background patients as an exemplar of CaLDB patients; (2) review of policy and procedure documents and medical records; and (3) field observation. METHOD This thesis embraces a qualitative approach as the primary method of investigation to align with the exploratory and descriptive nature of the study. The main methods used in the study were: in depth interviews with health professionals and patients; field observations; appraisal of relevant documents and consultation with expert panels. Study samples were selected through a purposive sampling strategy.Data were analysed using the method of content analysis, guided by the research questions. FINDINGS In total, 25 health professionals (20 female and 5 male) and 32 patients (21 male and 11 female) were interviewed. The method of qualitative content analysis was used for data analysis. Data analysis revealed four major themes: 1) The challenging context; 2) Tuning practices; 3) Influencing factors; and 4) Goodness of fit. The study demonstrated a challenging context for CR delivery, both from the perspective of patients and health professionals. Data reveal a process of reflection, negotiation, and navigation of care by CR health professionals in an effort to understand and meet the diverse needs of CALDB patients. CONCLUSION On the basis of the study findings, a process-oriented model of tuning practice to achieve cultural competence in CR delivery is proposed to inform policy, research and clinical practice.
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McNamara, Laurence James. "Just health care for aged Australians : a Roman Catholic perspective /." Title page, contents and abstract only, 1997. http://web4.library.adelaide.edu.au/theses/09PH/09phm1682.pdf.
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MURPHY, CATHRYN LOUISE School of Health Services Management UNSW. "INFECTION CONTROL IN THE AUSTRALIAN HEALTH CARE SETTING." Awarded by:University of New South Wales. School of Health Services Management, 1999. http://handle.unsw.edu.au/1959.4/17600.
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1,708 members of the Australian Infection Control Association were surveyed to describe the practices of Australian infection control practitioners. The study details the methods infection control practitioners use to co-ordinate and measure nosocomial infections as clinical outcomes of Australian infection surveillance and control programs. Administrators' and clinicians' perceptions of the elements and infrastructure of infection surveillance and control programs and the role of the infection control were measured in 316 hospitals in New South Wales, Australia. A literature review found that the development of Australian infection surveillance and control programs is behind that of U.S.A and the United Kingdom. The survey of the infection control practitioners identified that their role and duties varied between facilities as did the time allocated to infection control tasks. The survey of infection control practitioners demonstrated variation in their levels of skill, education and experience. Infection control practitioners' use and application of evidence and associated skills was examined and found to be limited in relation to clinical decision making and policy development. The survey also examined the methods infection control practitioners use to undertake surveillance of nosocomial infections. The methods reported indicated non-standard approaches to surveillance activity. A survey of administrators and clinicians in NSW hospitals was undertaken to identify variation in administrator and clinician perceptions and to describe their level of support for recommended essential infrastructure and criteria for infection surveillance and control programs and the role of the infection control practitioner in accordance with Scheckler's model. The survey indicated divergent views regarding the role of the infection control practitioner and the essential elements of infection surveillance and control programs. The study identified that education of infection control practitioners is necessary to facilitate standard approaches to co-ordinating infection surveillance and control activity. The development of Australian infection surveillance and control programs require a strategic alliance between stakeholders. to define essential elements of infection surveillance and control programs. In addition, the role of the infection control practitioner must be defined before key stakeholders can agree on the minimum skills, qualifications and experience required by an infection control practitioner.
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Hocutt, Peggy Lynn, and Peggy Lynn Hocutt. "Transitional Care Coach Program Evaluation at a Southwest Urban Medical Center." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/625569.
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In an effort to reduce hospital 30-day readmissions a Transitional Care Coach Program (TCCP) was developed in 2014 at a Southwest Urban Medical Center. The CDC Framework for Program Evaluation (2012) applies insight and experience gained from past program experience to effect change in practice and improve patient outcomes. The evaluation seeks to determine TCCP utilization, to assess its impact on 30-day readmission rates for high-risk patients, to inform stakeholders of a viable follow-up program, and to determine evidence-based interventions for program improvement. This TCCP program evaluation describes characteristics of patients who participated in the program, assesses whether interventions were delivered as intended, and determines if interventions reduced hospital 30-day readmission rates compared to readmission rates prior to program implementation. Descriptive statistics are used to describe the patient population, health status, and program utilization. For the diagnoses of acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure (HF), and pneumonia (PNA), Chi-square test analyses were performed to compare 30-day readmission rates of the TCCP participants and readmission rates for this medical center for the time period prior to program implementation. The primary finding of this program evaluation is an overall numerical decrease in hospital readmission rate by 3% compared to the baseline data. Although the change (a decrease) was in the desired direction, the degree of change was not statistically significant based on pooled data. A statistically significant decrease was observed only for the AMI diagnosis. However, as any decrease in readmissions decreases the financial burden to both the organization and the patient, the TCCP appears to have had a positive impact. It is recommended that a renewed TCCP be conducted to allow for (1) an increased timespan for data collection, (2) an increased number of medical categories assessed to allow for more non-parametric statistical analysis (e.g. adding categories of Total Joint Replacement and Sepsis diagnoses), (3) tracking of number of days to readmittance to allow for improvement to be measured and analyzed beyond a single dichotomous category. Evidence-based recommendations have been made to continue and improve interventions that further reduce hospital readmissions.
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Cretikos, Michelle School of Anaesthetics Intensive Care & Emergency Medicine UNSW. "An evaluation of activation and implementation of the medical emergency team system." Awarded by:University of New South Wales. School of Anaesthetics, Intensive Care and Emergency Medicine, 2006. http://handle.unsw.edu.au/1959.4/25720.
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Problem investigated: The activation and implementation of the Medical Emergency Team (MET) system. Procedures followed: The ability of the objective activation criteria to accurately identify patients at risk of three serious adverse events (cardiac arrest, unexpected death and unplanned intensive care admission) was assessed using a nested, matched case-control study. Sensitivity, specificity and Receiver Operating Characteristic curve (ROC) analyses were performed. The MET implementation process was studied using two convenience sample surveys of the nursing staff from the general wards of twelve intervention hospitals. These surveys measured the awareness and understanding of the MET system, level of attendance at MET education sessions, knowledge of the activation criteria, level of intention to call the MET and overall attitude to the MET system, and the hospital level of support for change, hospital capability and hospital culture. The association of these measures with the intention to call the MET and the level of MET utilisation was assessed using nonparametric correlation. Results obtained: The respiratory rate was missing in 20% of subjects. Using listwise deletion, the set of objective activation criteria investigated predicted an adverse event within 24 hours with a sensitivity of 55.4% (50.6-60.0%) and specificity of 93.7% (91.2-95.6%). An analysis approach that assumed the missing values would not have resulted in MET activation provided a sensitivity of 50.4% (45.7- 55.2%) and specificity of 93.3% (90.8-95.3%). Alternative models with modified cut-off values provided different results. The MET system was implemented with variable success during the MERIT study. Knowledge and understanding of the system, hospital readiness, and a positive attitude were all significantly positively associated with MET system utilisation, while defensive hospital cultures were negatively associated with the level of MET system utilisation. Major conclusions: The objective activation criteria studied have acceptable accuracy, but modification of the criteria may be considered. A satisfactory trade-off between the identification of patients at risk and workload requirements may be difficult to achieve. Measures of effectiveness of the implementation process may be associated with the level of MET system utilisation. Trials of the MET system should ensure good knowledge and understanding of the system, particularly amongst nursing staff.
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Sinclair, Andrew. "The primary health care experiences of gay men in Australia." Connect to this title online, 2006. http://adt.lib.swin.edu.au/public/adt-VSWT20060713.084655/.
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Price, David C. "Evaluation of a Difficult Urinary Catheter Team in an Academic Medical Center." Thesis, Walden University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10793008.
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The placement of an indwelling urinary catheter (IUC) is a commonly performed clinical procedure which may become challenging for the clinician and painful for the patient. In response to urologic complications attributed to repeated failed IUC insertion attempts by nurses, a difficult urinary catheter (DUC) team program was launched in October 2012. The purpose of the doctoral project was to conduct a quality improvement evaluation of the effectiveness of the DUC team program using retrospective data from May 1, 2013 through May 31, 2017. Benner’s novice to expert model was chosen as the theoretical framework to guide the additional training, critical thinking, problem-solving, and skill acquisition necessary for team member inclusion. The practice-focused question for the project answered whether DUC team nurses, through advanced training and demonstrated procedural competence, have been effective with DUC insertions. Sources of evidence included primary and secondary articles in peer-reviewed journals, as well as clinical evidence collected from internal sources. During the project time-line, 463 DUC team consultations were recorded with an insertion success rate of 89.6%. Based on the DUC team concept, additional didactic content and simulation training may be developed for other cognitive and skill-based clinical procedures. The implications for positive social change include improved patient safety and comfort, as well as cost savings for the organization and overall healthcare system.
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Moodley, Vineshree Mischka. "Improving point-of-care diagnosis of tuberculosis: development and evaluation of novel technologies." Doctoral thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25439.
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With an estimated third of all tuberculosis (TB) cases being missed, the need to develop rapid, simple and accurate diagnostic tests is critical. The last five years has seen an unprecedented activity in the development of a range of new tests. However, a major concern is that not all marketed TB tests have been assessed rigorously, particularly in terms of diagnostic accuracy, robustness under operational conditions in the field, and practical usefulness. This dissertation comprises a compilation of diagnostic clinical studies of novel point-of-care tests, namely a chemiresistive "TB breath-analyser"; a lipoarabinomannan (LAM) urine dipstick, and an adaptation of the Xpert®MTB/RIF assay for use on blood. Lastly, there is a modification of the sputum collection device (SCD) to enable specimen processing without the requirement of a biosafety cabinet. The chemiresistive sensor, which detects volatile organic compounds released by Mycobacterium tuberculosis in a patient's breath, demonstrated a high sensitivity (100%) and specificity (92%) for distinguishing patients with active TB from healthy controls. However, sensitivity (74%) and specificity (63%) were lower when the culture-negative participant group was compared to the culture-positive participants. The test shows potential as a useful screening test for TB with further refinement of the sensor technology. The LAM dipstick was shown to be useful in hospitalised HIV-infected patients with CD4 T-cell counts <200 cells/μL reinforcing the data from other studies. Although the blood Xpert®MTB/RIF assay showed some utility in diagnosis of TB in hospitalised patients with very advanced HIV, given the poor sensitivity and specificity, and the requirement for specialised equipment as well as a large volume of blood for testing, it is unlikely that Xpert®MTB/RIF testing on blood will contribute much over other existing diagnostics in resource-limited settings. Finally, the redesigned SCD offers a solution to biosafety concerns with minimal impact on patient acceptability and clinical care.
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Kairouz, Joseph. "Patient data management system medical knowledge-base evaluation." Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=24060.
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The purpose of this thesis is to evaluate the medical data management expert system at the Pediatric Intensive Care Unit of the Montreal Children's Hospital. The objective of this study is to provide a systematic method to evaluate and, progressively improve the knowledge embedded in the medical expert system.Following a literature survey on evaluation techniques and architecture of existing expert systems, an overview of the Patient Data Management System hardware and software components is presented. The design of the Expert Monitoring System is elaborated. Following its installation in the intensive Care Unit, the performance of the Expert Monitoring System is evaluated, operating on real vital sign data and corrections were formulated. A progressive evaluation technique, new methodology for evaluating an expert system knowledge-base is proposed for subsequent corrections and evaluations of the Expert Monitoring System.
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Humphrey, Charlotte Miranda. "Promoting audit in primary care : a qualitative evaluation of medical audit advisory groups." Thesis, University College London (University of London), 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.338849.
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Webb, Janet Marie. "Information about primary care physicians considered most useful by managed health care consumers." CSUSB ScholarWorks, 1997. https://scholarworks.lib.csusb.edu/etd-project/1370.
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Cheng, Qinglu. "Cost-effectiveness of guideline-based care for venous leg ulcers in Australia." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/134462/1/Qinglu_Cheng_Thesis.pdf.
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This thesis investigated the cost-effectiveness of guideline-based care to manage patients with venous leg ulcers in the Australian setting. It showed that both the healthcare system and patients affected by venous leg ulcers would benefit from implementing and funding guideline-based care. This research provided important evidence to policy makers on the most efficient use of scarce health resources to manage venous leg ulcers. It is expected that these results will support changes to the reimbursement structure to increase access to guideline-based care for venous leg ulcers in Australia.
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Pleasant, Michelle L. "Improving Dementia Care through Online Training Programs: A Systematic Review and Evaluation." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/6745.
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Over the next thirty years, Alzheimer’s disease rates will increase alongside global aging. To handle the anticipated increase in demand, knowledgeable and skilled dementia caregivers are in need throughout the long-term care spectrum. Online training programs have emerged as a viable and convenient platform to educate both formal and informal caregivers. The first and second study systematically reviewed online dementia training programs and evaluated the CARES® Dementia Basics Training Program among formal and informal caregivers.
The first study is a systematic review of online dementia-based training programs for both formal and informal caregivers conducted using the Preferred Reporting Items for Systematic Reviews (PRISMA) method. Methodological quality of the final sample (N=15) was assessed by the Cochrane Collaboration Back Review Group criteria. Results of the systematic review suggests that online interventions improve the condition and preparedness of caregivers, but future evaluations should consider study designs with multiple time points, control groups, and content that is personalized and interactive.
In the second study, an evaluation of the online CARES® Dementia Basics Program among formal and informal caregivers was performed. The sample (N=233) included respondents from the states of OR, WA, CA and IL over three time points. Results indicate baseline differences in education, race, and caregiver type and a modest improvement in knowledge among both formal and informal caregivers. Recommendations are provided for future development and evaluation of online interventions.
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Sorensen, Ros Public Health & Community Medicine Faculty of Medicine UNSW. "The dilemma of health reform : managing the limits of policymaking, managerialism and professionalism in health care reform." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2002. http://handle.unsw.edu.au/1959.4/33194.
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Hospitals worldwide are under pressure to perform and models abound to remedy poor performance. Reform, however, is contested, uneven and slow. One reason is that few models address a core issue in reform: the management of clinical work. A further reason is that stakeholder groups, specifically policymakers, managers and clinicians, limit opportunities for collaborative problem solving as they seek to impose their own frame of reference in the struggle for control. I hypothesise that performance will be relatively better in hospitals that have in place strategies of agreement to set the objectives of reform, such as participative problem identification, problem solving and decision making, together with a method to manage clinical work. This hypothesis was tested in twelve public hospitals in three Australian states between 1999 and 2001 using both quantitative and qualitative research methods. Government and hospital policy documents were assessed and semi-structured interviews were conducted to gauge the attitudes and practices of managers and clinicians regarding health care reform. The results of the research show that hospitals with inclusive strategies for change, principally strategies of agreement, joint education and skills development, team-based incentives to direct and reward effort and a method of clinical work management, performed better than those without. Findings indicate that policy was developed and communicated as a rational top-down process that tended to exclude diverse views. Although the effect of different jurisdictional policy processes on hospital performance was not clear, they had considerable impact on the environment of reform. Cost containment and patient safety dominated as policy objectives. These alone did not engage clinician interest or address service quality. The connection between the quality of care and its cost did not appear to be understood. Organisational structures and processes necessary to support reform, that is communication forums for objective setting and performance review, integrated clinical and corporate accountability systems and organisational capacity building were not in place in the majority of hospitals studied. An organisational model of clinical work management was developed to improve cost-effectiveness by balancing clinical autonomy and clinical accountability based on the research results.
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Yamada, Go. "Input-output analysis on the economic impact of medical care in Japan." 京都大学 (Kyoto University), 2016. http://hdl.handle.net/2433/215218.
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Cheung, Yuk-fai, and 張煜暉. "Clinical and health-related quality of life evaluation of acute strokeunit care versus conventional medical care for minor stroke patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48422800.
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The efficacy of stroke units has been extensively investigated in clinical trials. However, little information is available to the health care providers and policy makers on the benefits of stroke unit care in Hong Kong. The quality of life of our local stroke patients is largely unknown.
The objective of this study was to compare the 2-month outcomes after stroke admitted to either a stroke unit or a non-stroke unit. Outcomes included mortality, dependency, institutional care and quality of life. This was a prospective observational study conducted in a regional, tertiary hospital in Hong Kong. Baseline demographic and clinical data were collected from the subjects. The 36-Item Short-Form health survey (SF-36) questionnaire was administered to them. Follow up assessment at two months were made for mortality, dependency, institutionalisation, length of hospital stay and SF-36.
Eligible subjects were Cantonese-speaking Chinese aged 18 years or over. They should provide written informed consent, and verbally and cognitively competent in completing the SF-36 questionnaire
162 patients with acute stroke were included in the analysis. 106 patients were solely managed in the stroke unit. 41 patients were managed in other wards (as the control group). There were no statistically significant differences found between the two groups for death alone, death or dependency, and death or institutionalisation.
Multivariate logistic regression analyses showed similar findings. Mean lengths of acute and total hospital stay were similar between the two groups. Quality of life was impaired during the acute phase of stroke as reflected by low Physical Functioning (PF) and Social Functioning (SF) dimensions of the SF-36. At two months, significant improvement was observed in five out of eight dimensions of the SF-36 as well as its two summary scores, Physical Component Summary (PCS) and Mental Component Summary (MCS). There were several limitations in our study, namely small number of patients, minor stroke severity and tertiary hospital setting.
In conclusion, no significant differences in the clinical outcomes were found between the stroke unit group and the control group. These findings were inconclusive in view of limitations in this study. Stroke affected quality of life. Future researches with larger sample size are warranted.published_or_final_version
Public Health
Master
Master of Public Health
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Hardy, Jennifer Lynette. "Healthcare providers communication mechanisms using a case management model of care implications for information systems development, implementation & evaluation /." Access electronically, 2006. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20060731.120940/index.html.
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Macfarlane, Chelsea E., University of Western Sydney, and School of Applied Social and Human Sciences. "A comparison of the predictors of hepatitis B vaccination acceptance amongst health care and public safety workers in Australia." THESIS_XXX_ASH_MacFarlane_C.xml, 2001. http://handle.uws.edu.au:8081/1959.7/784.
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This thesis examines the results of a hepatitis B vaccination questionnaire study that was completed by medical officers, nurses, carers of the developmentally disabled, and correctional officers in the Greater Western Sydney area of New South Wales, Australia. The main aim of the study was to contrast these four high risk occupational groups for their acceptance of hepatitis B vaccination, seroconversion status, and behavioural, attitudinal, motivational and institutional determinants of their vaccination status. The results of the thesis revealed that medical officers and nurses were the most likely to be tested and vaccinated for seroconversion, while DD carers and correctional officers had the largest number of Not Vaccinated respondents. The findings of the questionnaire are discussed in some detail. It is also suggested that groups differ in the degree of hepatitis risk anxiety they experience as well as the degree of control felt over their health status. A number of indications for personal, institutional and governmental interventions to increase vaccination levels are discussed.Doctor of Philosophy (PhD)
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Swanton, Amanda Rachel. "Evaluation of trauma response to agricultural injuries." Diss., University of Iowa, 2017. https://ir.uiowa.edu/etd/5654.
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Agriculture is a hazardous industry with high rates of occupational industry. Due to a variety of occupation-related factors, farmers may also be at risk for delays in reaching trauma services. Though the state of Iowa has a comprehensive trauma system implemented to provide an efficient response to traumatic injuries, it is unknown how farmers fare in this system. The aims of this study were to determine if the use of emergency medical services (EMS), the occurrence of interfacility transfers, the time to definitive care in severely injured patients, and the length of prehospital intervals for those using EMS differs between farmers and other workers.
A population-based, retrospective observational study was performed using data from the Iowa State Trauma Registry for the years 2005-2011. Eligible entries included adults (≥15 year old) sustaining an occupational injury within the state of Iowa and treated in an Iowa trauma center. Multiple imputation was performed to replace values for missing covariates. Logistic regression modeling was performed to examine the use of EMS and the occurrence of interfacility transfers among farmers compared to non-farmers. Survival analysis was performed to determine the time to definitive care for severely injured farmers compared to severely injured non-farmers; similarly, a survival-based multi-state model was performed to compare the prehospital time intervals for farmers to non-farmers among EMS users.
The study demonstrated that the likelihood of EMS use was dependent on injury severity. For lower severity injuries, farmers were less likely to use EMS, but there was no difference in EMS use for high severity injuries. The occurrence of interfacility transfers was also dependent on injury severity as well as rurality. Farmers tended to be less likely to receive an interfacility transfer in more rural areas; in large town and urban areas, farmers tended to be more likely to receive an interfacility transfer, particularly for moderate and severe injuries. These trends were slightly stronger for EMS non-users than EMS users; however, the results did not reach statistical significance for most levels. The median time to definitive care for farmers was nearly an hour longer for farmers compared to non-farmers (1h48m vs. 2h46m, respectively). In the survival analysis, time to definitive care for severely injured farmers compared to severely injured non-farmers was found to be time-dependent, and was only significant in the first hour after injury. When the prehospital time intervals for farmers using EMS (included all severities) were compared to non-farmers, farmers took longer to complete the discovery, response, and transport intervals; the scene interval was the only interval that did not reach statistical significance.
The results obtained from this study provide useful information about the operation of the Iowa State Trauma System. While EMS use was lower for minor injuries, farmers with severe injuries had no significant difference in EMS use compared to non-farmers, suggesting comparable access. Likewise, the probability of transfer was only higher in specific instances when the patient did not use EMS. However, the fact that both time to definitive care and several prehospital intervals were longer suggest that occupation-specific factors may contribute to delay. Further research is needed to identify these barriers and develop new strategies to improve the response to traumatic agricultural injury.
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Fleming, Brian James. "The social gradient in health : trends in C20th ideas, Australian Health Policy 1970-1998, and a health equity policy evaluation of Australian aged care planning /." Title page, abstract and table of contents only, 2003. http://web4.library.adelaide.edu.au/theses/09PH/09phf5971.pdf.
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Jerrom, David William Andrew. "A description and evaluation of the introduction of a primary care clinical psychology service in one health district." Thesis, University of Stirling, 1985. http://hdl.handle.net/1893/24393.
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The introduction of a primary care clinical psychology service into one Scottish Health District is described and evaluated. The service was widely used by G.P.s, and the volume of referrals increased each year. After 5 years of operation 83% of G.P.s had referred cases. The types of problems referred are described, two thirds of patients were suffering from generalised anxiety or phobias. The patients were a chronic population, the average length of problem being 6.9 years. G.P. and psychiatrist referred patients were compared, the latter had longer histories and there were differences in the types of problem referred. Outcome was evaluated using a number of measures. Consultation rate fell significantly post treatment and a significant proportion of patients stopped psychotropic medication. There were significant reductions in psychologist ratings of severity and in handicap, and in patient self-ratings of severity and General Health Questionnaire scores. Patient satisfaction with treatment 6 months post discharge was surveyed. The G.P.s satisfaction with the service was surveyed and found to be high. At follow up G.P.s rated 69% of patients as receiving "definite benefit" and 31% as "unchanged". A study of treatment of the commonest problem referred, generalised anxiety, was conducted using a waiting-list control group. Treatment group patients improved significantly on self rating questionnaires, controls did not change, but showed a similar order of treatment response when they did enter treatment. The costs of the service are compared to another report in the literature, and it is concluded that the service was cost-effective. A number of recommendations are made for further research in the field. It is concluded that primary care psychology services are feasible in terms of staffing levels, and also lead to significant patient benefit.
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Phahladira, Martha Thapelo. "A critical Evaluation of the Locality Rule regarding the rural health care service in Public Sector." Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/75388.
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The South African health sector encounters significant challenges of inequality in terms of access to health care services. A ‘quadruplet burden of disease’ does not make access to health any easier. Patient’s access to health care can be hindered by the patient’s residential area. Rural patients are faced with hospitals that do not have specialist care while urban areas are swamped with patient who need specialist care. Medical general practitioners’ scope of practice is limited and that creates challenges when patients need specialised care in a resource constrained environment. The time it takes for the patient in public health sector to access health services may be affected by their locality. The same challenges may be experienced by patient in private sector with medical Aids who are residing in the rural areas. The state’s impression is that demand is more than supply. On the other hand the court pursues justice for people who do not receive timeous access to healthcare. The study will be researching on locality issues that can jeopardise the standard of care. Although The Health Professions Council of South Africa is silent about the Locality Rule but it has unanimously adopted prerequisites and contraindications for using the Locality Rule as a defence. The Council has a duty in terms of Health Professional Act 56 of 1974 to uphold patient safety. The work seeks to understand the origin of the locality rule, its application in terms of the Constitution of the Republic Of South Africa, case law and relevant legislature. The work will also take into consideration the historical background of the South African health system and its responsibility in advancing socioeconomic rights for the citizens of South Africa. The prerequisite for using resource constrains and special circumstances will be discussed.Dissertation (MPhil)--University Of Pretoria, 2020.
Public Law
MPhil
Unrestricted
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Sprivulis, Peter Carl. "Evaluation of the prehospital utilisation of the Australasian Triage Scale." University of Western Australia. Emergency Medicine Discipline Group, 2004. http://theses.library.uwa.edu.au/adt-WU2004.0055.
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[Truncated abstract] Background : Triage systems have evolved from battlefield casualty prioritisation tools to integral components of civilian emergency care systems over the last 50 years. There is significant variation in prehospital triage practices in Australia and little research has been undertaken to validate the triage systems used. There is considerable evidence to support the use of the Australasian Triage Scale (ATS) for triage in the emergency department setting and the ATS is used ubiquitously for emergency department triage in Australasia ... Conclusions : The findings of this thesis support integrating prehospital ATS allocations with emergency department triage processes. It is concluded that Paramedics apply the ATS similarly to nurses ... Allocations to ATS 1, 2 and 3 and most ATS 4 allocations by paramedics are valid when compared to nurse ATS allocations. Australasian Triage Scale category 5 is used inappropriately by paramedics and should be used rarely, if at all, by paramedics. The reliability of paramedic and nurse ATS allocations is sufficient to warrant a trial of the omission of retriage of ambulance presentations at Perth metropolitan emergency departments. However, early nursing assessment of a small proportion of ATS 3 patients may be required to ensure timely assessment for some mistriaged bone fide ATS 2 patients. Paramedic ATS allocations appear sufficiently reliable and valid to warrant a trial of their use as part of a two-tier trauma team activation system ... The implementation of standardised training between paramedics and nurses based on current Australasian College for Emergency Medicine guidelines is recommended. The implementation of paramedic triage audit, including comparison of paramedic ATS allocations with nurse ATS allocations may improve reliability between paramedics and nurses, and particularly the reliability of ATS 4 and ATS 5 allocations. Prehospital ATS allocations may prove useful in prehospital casemix analysis, the evaluation of prehospital service delivery and for prehospital research. Research opportunities include actual trials of the integration of prehospital use of ATS with emergency department triage and trauma system activation, and the evaluation of the ATS as a prehospital casemix and performance evaluation tool. Research into alternative triage tools to the ATS for use in the prehospital environment and into the impact of standardised triage training is also suggested.
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Grech, Carol Margaret. "Coronial inquiries into fatal adverse events in South Australian hospitals : from inquest to practice / Carol Grech." 2004. http://hdl.handle.net/2440/22153.
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"October 2004"Includes bibliographical references (leaves 313-337)
x, 337 leaves : ill. (col.), maps (col.) ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2004
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Grech, Carol Margaret. "Coronial inquiries into fatal adverse events in South Australian hospitals : from inquest to practice / Carol Grech." Thesis, 2004. http://hdl.handle.net/2440/22153.
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Davies, Michael John. "The role of commonsense understandings in social inequalities in health : an investigation in the context of dental health / Michael Davies." 2000. http://hdl.handle.net/2440/19680.
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Bibliography: leaves 203-219.219 leaves : ill. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Concerned with the contribution of commonsense understandings of disease to social differentials in health outcomes. Argues that understandings in part reflect the social circumstances of an individual and mediate preventive activities and use of services, thereby influencing health outcomes. These are examined using the specific health outcomes of tooth loss and tooth decay.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2000
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Davies, Michael John. "The role of commonsense understandings in social inequalities in health : an investigation in the context of dental health / Michael Davies." Thesis, 2000. http://hdl.handle.net/2440/19680.
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Bibliography: leaves 203-219.219 leaves : ill. ; 30 cm.
Concerned with the contribution of commonsense understandings of disease to social differentials in health outcomes. Argues that understandings in part reflect the social circumstances of an individual and mediate preventive activities and use of services, thereby influencing health outcomes. These are examined using the specific health outcomes of tooth loss and tooth decay.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2000
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Kelman, Christopher William. "Monitoring Health Care Using National Administrative Data Collections." Phd thesis, 2000. http://hdl.handle.net/1885/47457.
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With the inevitable adoption of information technology into all areas of human pursuit,
the potential benefits for health care should not be overlooked. In Australia, details of most health care encounters are currently recorded for administrative purposes. This results in an impressive electronic data-bank that could provide a national resource for health service evaluation.
¶ ... ¶
The aims of the project were: · To examine the potential for using administrative data to generate outcome measures and surveillance indicators. · To investigate the logistics of gaining access to these data for the purpose of research. This to be achieved within the current ethical, political and financial framework. · To compare the Australian health-service data system with the current international state-of-the-art. · To develop suggestions for expansion of the present system as part of an integrated health record and information system. This system to manage patient records and provide data for quality management, treatment surveillance and cost-effectiveness evaluation as a routine activity. ¶ The thesis is presented in two parts. In the first part, a historical cohort study is described that involved patients with implantable medical devices. ... ¶ In the second part of the thesis, conclusions are presented about the potential uses and limitations of the existing system and its use as a basis for the development of a national Integrated Health Record and Information System (IHRIS). ...¶ ... Unfortunately, in Australia, the use of administrative data for this purpose is not currently feasible. The principal barrier is the existence of a culture within the Australian health care system which is not supportive of research and is deficient in quality and safety measures. ¶ Recent initiatives by both the Commonwealth and state governments have supported the introduction of measures to improve quality and safety in health care. It is argued here that an Integrated Health Record and Information System (IHRIS) would provide an essential component of any such scheme. The results of this study have important policy implications for health care management in both the administrative and clinical domains.
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Reddy, Libandra. "Strategic recommendations to improve South African healthcare based on the Australian health model." Thesis, 2005. http://hdl.handle.net/10413/9860.
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Although strategic planning is widely used in industry and has been adopted by many not-for-profit organisations, the Department of Health has been slow to realise the relevance of a strategic approach. This thesis uses a strategic planning approach to assess the Department of Health by examining the three interacting factors which influence organisational outcome, namely the external environment, the internal structure of the
organisation and the planning process itself. A composite model or template which incorporates several well-known strategic instruments is proposed as well as an overview of the Australian national health system and these are then used as part of the strategic assessment of the Department's vision and mission. The results and recommendations of the assessment are presented in the thesis.Thesis (MBA)-University of KwaZulu-Natal, 2005.
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Patterson, Jan. "Consumers and complaints systems in health care / Jan Patterson." Thesis, 1996. http://hdl.handle.net/2440/19008.
Full textAbstract:
Bibliography: leaves 463-496.ix, 497 leaves ; 30 cm.
This thesis explores the dimensions of the actions of consumers, governments and service providers influential in contributing to the climate of reform in the health care area in Australia and the subsequent developments. There are clearly defined consumer models of complaints-handling for the health area, ascertainable from examination of the broader context of the development of the consumer movement and consumer organisations ; and specifically drawing on the common elements from the contribution of the consumer movement in health. A consumer model for complaints-handling at the local level is proposed.
Thesis (Ph.D.)--University of Adelaide, Dept. of Community Medicine, 1997?
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Sidorenko, Alexandra A. "Health insurance and demand for medical care : theory and application to Australia." Phd thesis, 2001. http://hdl.handle.net/1885/109953.
Full textAbstract:
Private health insurance plays an important role in Australian health care
finance, complementing the universal health insurance system, Medicare,
established in 1984. The road to the current health insurance system was long and
winding, filled with political passions and debates. This study covers the major
historical steps leading to the introduction of Medicare, and analyses specific
features of the Australian private health insurance sector.
After the recent policy change, regulations of the private health insurance
industry were somewhat eased, and a new range of benefits permitted to be
provided. This thesis seeks to analyse the likely effects of the policies, and develops
a theoretical model which adds to the existing literature on the demand for health.
Studies of demand for medical care and health insurance constitute an
important part of the health economics literature. Grossman’s theory of demand for
health has become a major framework for the analysis. Generalisations of the
Grossman model to incorporate uncertainty about health status and insurance
against medical expenditure are major challenges for theoretical economists
working in this area. This thesis proposes a new dynamic continuous time
stochastic optimisation model of demand for medical care, in which uncertainty
about health and wealth is modelled by correlated Wiener processes. Consumption
and leisure decisions are included in the model. A health insurance contract with
coinsurance rate is introduced in this model, and a two-stage procedure of choosing
an optimal ex-ante coinsurance rate, and optimal ex-post amount of medical care,
consumption and leisure is discussed.
The theoretical model is then applied to the 1993-94 Household Expenditure
Survey, Australia. Even though the full structure of the model cannot be tested on
this dataset, some empirical evidence is found in support of the new theoretical
model. A two-part bivariate probit model and quantile regression analysis allowed
the estimation of the income elasticity of demand for medical care and health
insurance, which was shown to vary with income. To study the quantitative effect
of the recent policy change based on the new theoretical model, a finer level of data
is needed.
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Rogers, G. D. "Feeling queer : can a primary health care approach mitigate health inequity experienced by homosexually active South Australian men ?" 2005. http://hdl.handle.net/2440/37819.
Full textAbstract:
Health inequity refers to differences in health status between populations ( health inequalities ) that are unnecessary and avoidable and, additionally, are considered unfair or unjust. The history of the concept is reviewed and the mechanisms by which inequity affects health surveyed, with a focus on multi - level models of health production. The origins and development of the Primary Health Care approach is then considered with an emphasis on the Australian setting and on HIV / AIDS policy. The construct of homosexuality is then explored and concepts of sexual attraction, ' orientation ', identity and behaviour differentiated. What is known about the health characteristics of homosexually active men in the First World is then surveyed by means of a systematic literature review. It is concluded that there is evidence that they are affected by substantial health inequality in a range of areas including mortality, suicidality, depressive disorders, anxiety disorders, report of childhood sexual abuse and problematic substance use. Few of these inequalities have been confirmed in the Australian context, however, and almost none have been confirmed specifically in South Australia. The background to the development of a Primary Health Care programme focused on homosexually active men, is then described. The baseline health characteristics of the programme ' s cohort of 542 homosexually active South Australian men ( including their sexual behaviour in the context of HIV transmission ) are described and compared with other samples of men to identify inequalities. It is concluded that men in the cohort were subject to health inequality in a wide range of health parameters including mortality, suicidality, sexually transmitted infections, depressive and anxiety disorders, levels of substance use and self - rated health on the short - form 36 ( sf36 ) instrument. The relationships between these characteristics and factors indicative of disadvantage and victimisation are then explored. It is concluded that many of the health inequalities identified were related to sociohistorical factors such as emotional withdrawal by one ' s father, low income, unemployment, reduced educational attainment, and recent experience of violence and abuse from strangers. It is argued that some of these factors can be considered to be examples of unfairness and injustice and that, as a consequence, at least some of the health inequality experienced by this population is also health inequity. The elements of the Primary Health Care programme devised to meet the needs of homosexually active men is described and the trajectory of health characteristics of its participants over three time points is examined. 210 homosexually active men had reached Second Review, an average of thirty - six months after enrolment, by the time of analysis. Among this group, significant sustained improvement in a range of health outcomes, including prevalence of depressive disorders, sf36 scores and rate of recent suicidal ideation, is reported in association with involvement in the programme. Participant ' s subjective satisfaction with the programme is then described and their beliefs about the causes of their improved health explored using a qualitative methodology. It is concluded that the programme had largely met the needs of participants and they believed that it had been responsible for their improved health. Limitations of the study are considered and discussed. Limitations of the investigation to identify health inequality include questions of external validity arising from the absence of a perfect comparator group and concerns with construct validity related to the possibility of geographical and cultural variation in definitions of ' homosexually active men '. In the investigation to determine the extent to which health inequalities were also examples of inequity, issues of conclusion validity are discussed particularly in relation to multiple comparisons and the balance between Type I and Type II errors. In the evaluation of the impact of the Primary Health Care programme, there are concerns about internal validity resulting from the absence of randomisation and an uncontrolled design. The components of this issue are discussed and some support for internal validity is found in the reported subjective beliefs of participants about the cause of their health improvement and the outcomes of critical reflection by the programme team. The implications of the findings for policy, practice and further research are explored. It is argued that the health inequity experienced by people of sexual diversity will require profound social change for complete resolution. In the meantime, however, focused Primary Health Care with a community of sexual diversity has the potential to mitigate the health inequity its members experience and to help them to survive and function while they wait for a fairer and kinder society.Thesis (Ph.D.)--School of Population Health and Clinical Practice, 2005.
49
Rogers, Gary David. "Feeling queer : can a primary health care approach mitigate health inequity experienced by homosexually active South Australian men ?" Thesis, 2005. http://hdl.handle.net/2440/37819.
Full textAbstract:
Health inequity refers to differences in health status between populations ( health inequalities ) that are unnecessary and avoidable and, additionally, are considered unfair or unjust.
The history of the concept is reviewed and the mechanisms by which inequity affects health surveyed, with a focus on multi - level models of health production. The origins and development of the Primary Health Care approach is then considered with an emphasis on the Australian setting and on HIV / AIDS policy.
The construct of homosexuality is then explored and concepts of sexual attraction, ' orientation ', identity and behaviour differentiated. What is known about the health characteristics of homosexually active men in the First World is then surveyed by means of a systematic literature review. It is concluded that
there is evidence that they are affected by substantial health inequality in a range of areas including mortality, suicidality, depressive disorders, anxiety disorders, report of childhood sexual abuse and problematic substance use.
Few of these inequalities have been confirmed in the Australian context, however, and almost none have been confirmed specifically in South Australia.
The background to the development of a Primary Health Care programme focused on homosexually active men, is then described. The baseline health
characteristics of the programme ' s cohort of 542 homosexually active South Australian men ( including their sexual behaviour in the context of HIV transmission ) are described and compared with other samples of men to identify inequalities. It is concluded that men in the cohort were subject to health inequality in a wide range of health parameters including mortality, suicidality, sexually transmitted infections, depressive and anxiety disorders,
levels of substance use and self - rated health on the short - form 36 ( sf36 ) instrument.
The relationships between these characteristics and factors indicative of disadvantage and victimisation are then explored. It is concluded that many of the health inequalities identified were related to sociohistorical factors such as
emotional withdrawal by one ' s father, low income, unemployment, reduced educational attainment, and recent experience of violence and abuse from strangers. It is argued that some of these factors can be considered to be examples of unfairness and injustice and that, as a consequence, at least some of the health inequality experienced by this population is also health inequity.
The elements of the Primary Health Care programme devised to meet the needs of homosexually active men is described and the trajectory of health
characteristics of its participants over three time points is examined.
210 homosexually active men had reached Second Review, an average of thirty - six months after enrolment, by the time of analysis. Among this group, significant sustained improvement in a range of health outcomes, including prevalence of depressive disorders, sf36 scores and rate of recent suicidal ideation, is reported in association with involvement in the programme.
Participant ' s subjective satisfaction with the programme is then described and
their beliefs about the causes of their improved health explored using a qualitative methodology. It is concluded that the programme had largely met
the needs of participants and they believed that it had been responsible for their improved health.
Limitations of the study are considered and discussed. Limitations of the investigation to identify health inequality include questions of external validity arising from the absence of a perfect comparator group and concerns with
construct validity related to the possibility of geographical and cultural variation in definitions of ' homosexually active men '. In the investigation to determine the extent to which health inequalities were also examples of inequity, issues of conclusion validity are discussed particularly in relation to multiple comparisons and the balance between Type I and Type II errors.
In the evaluation of the impact of the Primary Health Care programme, there are concerns about internal validity resulting from the absence of randomisation and an uncontrolled design. The components of this issue are discussed and
some support for internal validity is found in the reported subjective beliefs of participants about the cause of their health improvement and the outcomes of critical reflection by the programme team.
The implications of the findings for policy, practice and further research are explored. It is argued that the health inequity experienced by people of sexual diversity will require profound social change for complete resolution. In the
meantime, however, focused Primary Health Care with a community of sexual diversity has the potential to mitigate the health inequity its members experience and to help them to survive and function while they wait for a fairer and kinder society.Thesis (Ph.D.)--University of Adelaide, School of Population Health and Clinical Practice, 2005.
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Kuo, Shui-Chuan, and 郭水泉. "STUDY ON THE EVALUATION ASPECTS FOR PATIENTS’ MEDICAL CARE." Thesis, 2004. http://ndltd.ncl.edu.tw/handle/75541829543642728459.
Full textAbstract:
碩士國立臺北大學
企業管理學系碩士在職專班
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The study on the evaluation aspects for patients’ medical care via medical grid will be using Asthma Grid as a case study. The discussing aspects will focus on the opinions and usage of using asthma grid as a internet medical care consultation tool and on the significations and satisfactions upon its visual as well as the service qualities. The questionnaires were conducted by doctors, or nurses through face to face interview and explanations with the asthma patients in medical center, area hospitals, and clinics throughout Taiwan. 146 completed questionnaires were to be collected during 50 days of survey period. The questionnaires results are as following: 53.4% male, 46.6% female. 50% of the patients are around their forties or above. There are 80.1% patients rated the service functions are significant, while the 53.5% patients regarded the service functions are satisfied. There are 86.1% patients rated the service qualities are significant, while only 49.6% regarded the service qualities are satisfied. 48.2% of the patients regarded the total resolutions of asthma grid are satisfactory. Over 70% of the patients answered that they would like to receive medical care response within 24 hours. 44% of the patients were worried about the security of person information, such as medical care record on the internet. Over 80% of the patients would comprehend that using asthma grid would be better taken care of their medical care. Based on the questionnaires’ result, the suggestions are: 1.The asthma improvement model, promoted by public health care center, could use asthma grad as a platform for interacting medical care between doctors and patients. This would better improve the ideal of disease management. 2.The statistics of patients’ input data, through asthma grid, could be output as useful medical evidence. The medical evidence would be used as one of the decision support system material to better support diagnoses and medical care suggestions. 3.There should be more promotion activities upon asthma grid to enhance the public awareness and disease care management.