Dissertations / Theses on the topic 'Medical care Research Australia'
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Leon, de la Barra Sophia. "Building research capacity for indigenous health : a case study of the National Health and Medical Research Council : the evolution and impact of policy and capacity building strategies for indigenous health research over a decade from 1996 to 2006." University of Sydney, 2007. http://hdl.handle.net/2123/3538.
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Master of PhilosophyAs Australia’s leading agency for funding health research (expending over $400 million in 2006), the National Health and Medical Research Council (NHMRC) has a major responsibility to improve the evidence base for health policy and practice. There is an urgent need for better evidence to guide policy and programs that improve the health of Indigenous peoples. In 2002, NHMRC endorsed a series of landmark policy changes to acknowledge its ongoing role and responsibilities in Indigenous health research—adopting a strategic Road Map for research, improving Indigenous representation across NHMRC Council and Principal Committees, and committing 5% of its annual budget to Indigenous health research. This thesis examines how these policies evolved, the extent to which they have been implemented, and their impact on agency expenditure in relation to People Support. Additionally, this thesis describes the impact of NHMRC policies in reshaping research practices among Indigenous populations.
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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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Mykhalovskiy, Eric. "Knowing health care / governing health care exploring health services research as social practice /." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0018/NQ56249.pdf.
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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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Wu, Chi-pang Sam. "Chinese medical convalescence and research centre." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25949871.
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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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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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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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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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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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Wu, Ning. "Measurement issues in evaluating provider performance in health services research /." View online version; access limited to Brown University users, 2005. http://wwwlib.umi.com/dissertations/fullcit/3174695.
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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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胡志鵬 and Chi-pang Sam Wu. "Chinese medical convalescence and research centre." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31986912.
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Menon, Prema Ramachandran. "Telemedicine Enhances Communication in the Intensive Care Unit." ScholarWorks @ UVM, 2016. http://scholarworks.uvm.edu/graddis/574.
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Patients admitted to the Intensive Care Unit (ICU) are critically ill and often at extremely high risk of death. These patients receive aggressive interventions to prolong their lives. Despite these measures, many patients still succumb to their illness. Although ICU physicians are good at predicting which patients have a high risk of mortality, they are still offering interventions that do not prolong life, but potentially cause more suffering at the end of life. This is because there is a lack of high quality and early communication to discuss prognosis and establish patients' goals of care. This gap in communication is even more profound when patients are transferring from rural hospitals to busy tertiary care centers.
This dissertation discusses the utilization of tele-video conferencing to enhance early communication with family members/loved ones of critically ill patients prior to their transfer from a rural hospital to a tertiary care center. It begins with a description of telemedicine and its uses in the ICU to date. Chapter 2 discusses the poor prognoses of patients receiving high intensity interventions such as cardiopulmonary resuscitation (CPR). The extremely dismal outcomes underscore the importance of early, thorough discussions regarding prognosis and goals of care in these patients. The next chapter describes a pilot study utilizing telemedicine to conduct formal unstructured telemedicine conferences with family members prior to transfer. This study demonstrated that palliative care consultations can be provided via telemedicine for critically ill patients and that adequate preparation and technical expertise are essential. Although this study is limited by the nature of the retrospective review, it is evident that more research is needed to further assess its applicability, utility and acceptability. Chapter 4 describes an investigation into the barriers and facilitators of conducting conferences via telemedicine and the perceptions of clinicians regarding the use of telemedicine for this purpose. This chapter identified unique barriers and facilitators to the use of telemedicine that will need to be addressed when designing a telemedicine intervention for conducting family conferences.
This thesis describes the importance and process of implementation of telemedicine for the novel purpose of enhancing early communication among physicians and family members of critically ill loved ones. Further studies are needed to refine and investigate patient and family centered clinical outcomes utilizing this intervention.
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Ho, Kenneth. "Improving the quality of the documentation system in a health care environment." [Denver, Colo.] : Regis University, 2006. http://165.236.235.140/lib/KHo2006.pdf.
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Sealey, Margaret Anne. "Developing a bereavement risk assessment model for palliative care in Western Australia: An action research study." Thesis, Curtin University, 2016. http://hdl.handle.net/20.500.11937/644.
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A minority of people at risk poor health related outcomes following bereavement require assessment using sensitive and reliable grief measures to provide appropriate support. This study aimed to develop a bereavement risk assessment model for use in palliative care using an Action Research methodology to work collaboratively with palliative care stakeholders across five phases. Existing grief measures were found unsuitable and a new brief grief measure was developed that was piloted and evaluated in three palliative care services.
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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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D'Andrea, Maureen. "A study investigating the health care support service training needs for Gloucester County and workforce development demand /." Full text available online, 2005. http://www.lib.rowan.edu/home/research/articles/rowan_theses.
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Delorme, Robert W. "Action research on transformation of rural health center to level 3 patient-centered medical home." Thesis, Central Michigan University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3732245.
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The Institute of Medicine evaluated the U.S. health system in the 1990s and found an extremely expensive system with clinical outcomes that were ranked lower than a number of other industrialized nations. (Institute of Medicine, 2001) In addition, the per capita spending was almost double that of other nations. The U.S. health care system was fragmented, highly technical, and specialty oriented. Even though the primary care system is the backbone of more efficient and less expensive systems in other countries (Landon, Gill, Antodelli, & Rich, 2010). The primary care system was in a downward spiral in terms of morale and number of U.S. medical students entering primary care specialties. To respond to the call of the Institute of Medicine and the ongoing decline of primary care residents, seven primary care organizations including the American Academy of Family Physicians and the American Board of Family Medicine, published a report called the “Future of Family Medicine” (Kahn, 2004). The report described a new model of family medicine called the patient-centered medical home (PCMH). The model needed to be standardized to evaluate outcomes. Three bodies provide certification: the Joint Commission, the Accreditation Commission for Health Care, and the National Committee for Quality Assurance (NCQA) (Klein,, Laugesen, & Liu, 2013). The NCQA is the organization that most of the practices use for recognition (Landon et al., 2010). Various organizations have conducted studies on the implementation PCMH and found the PCMH model took about two years to implement, consumed practice resources but led to improved quality and some indication of lower costs (AHRQ, 2012). To become the future landscape of primary care, the PCMH model depends on small practices adopting it because a large percentage of family practices have fewer than five providers (Scholle, et al., 2013). The Hamilton Family Health Center (HFHC) of Community Memorial Hospital (CMH) is a small center with the equivalent of three and a half full-time providers and two specialists. The CMH recently became a critical access rural hospital certified for 25 beds, whose average daily census is 15-16 patients. This project was a combination of participatory action research (PAR) and insider action research (IAR). The project can be classifed as PAR because the staff, providers, and patients were involved and had significant input. The project is considered IAR as well because the author was also a provider in the center. The project goal was threefold: (a) achieve level three PCMH status for a small health center with markedly limited resources, (b) identify the process taken to meet this goal and how it can be improved and (c) learn what the changes will mean for the center. The Hamilton Family Health Center has achieved level three, but the project is ongoing because achieving the NCQA standards is only a step to achieving an ideal practice.
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Glantz, Namino M. "Formative research on elder health and care in Comitan, Chiapas, Mexico." Diss., The University of Arizona, 2007. http://hdl.handle.net/10150/195879.
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This dissertation documents my active involvement in anthropological research on elder well-being in Comitan, Chiapas, Mexico, and how my research was a springboard for local dialogue on the need for primary health care for the elderly, an issue with global significance. I describe my work as part of a larger process, still unfolding, that I helped initiate and continue to trace as an ethnographer engaged in participant observation. My long-term residence and applied health research in Chiapas, graduate training in medical anthropology, and institutional backing from the Comitan Center for Health Research (an NGO where I have worked since 1994) equipped me to catalyze engagement around elder health in Comitan. To do so, I drew on formative research, a multi-stage participatory process that is iterative and draws upon multiple methods and actors to identify and define a problem, then develop, monitor, and assess locally-congruent interventions. Specifically, I conducted: 1) ethnographic research on middle and lower class elders living alone and with family; 2) an elder health needs and resources survey of 300 households; 3) interviews with elders, home-based caregivers, and formal care providers; 4) an interinstitutional elder health conference and 5) a strategic planning meeting, which spawned 6) an independent working group that is currently exploring potential elder care strategies, with 7) my ongoing facilitation. In detailing elders' lives, problems, and care, I at once address the specific issue of elder well-being in Chiapas as seen by elders, caregivers, and providers, and describe the social relations of community action to provide basic elder care. I take stock of historical factors that have altered family relations and elder care dynamics in Chiapas, including structural adjustment, epidemiological and demographic transitions, globalization, and migration, as well as resultant local and regional socio-political struggles. I give special consideration to the household production of health, gendered differences in elder health and care resources, and the social relations of health care-seeking and therapy management. My findings challenge popular misconceptions regarding elder entitlement and access to economic, cultural, and social capital, and indicate potential solutions. This dissertation, then, illuminates how anthropological research can facilitate community-based problem solving.
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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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Scott, Edward Sherman. "Digital research cycles how attitudes toward content, culture and technology affect web development /." Orlando, Fla. : University of Central Florida, 2009. http://purl.fcla.edu/fcla/etd/CFE0002637.
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Williamson, Graham Richard. "Developing lecturer practitioner roles in nursing using action research." Thesis, University of Plymouth, 2003. http://hdl.handle.net/10026.1/414.
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The lecturer practitioner role in nursing is widely seen as offering hope for the future of nurse education, by overcoming the 'theory-practice gap', and establishing and maintaining effective links at many different levels between education and practice. It is clear, however, that there are a number of issues of concern about the role. These can be summarised as: lack of role clarity about overcoming the theory-practice gap; varying conceptions of the role and unclear job descriptions; and role conflicts and overload, from the conflicting demands of service and education settings Despite current political support for strengthening the links between higher education institutions and practice settings, a new governmental emphasis on the support of students in practice, and a growing in-depth evaluative literature about the role, there is no research examining its systematic development, or measuring and addressing aspects of lecturer practitioners' occupational stress and burnout. Initial project planning work found that lecturer practitioners perceived themselves as 'adding value' to education provision, with personal and professional gains for postholders. However, their key concerns were: absence of role clarity; absence of effective joint review/appraisal;a bsenceo f formal support In, order to develop and address aspects of lecturer practitioners' work roles and their employment position, this action research project was established. Using a spiral methodological framework, and a multi-methods approach to data collection to triangulate the findings, new knowledge about lecturer practitioner roles was uncovered, and employment practices were developed as a result. The project established three new mechanisms, and these outcomes can be summarised as: joint appraisal policies and materials; orientation/induction policies and materials; group support network. In addition, previously validated measures of occupational stress and burnout were used to meas. ure those conceptsi n this group of lecturer practitioners, and the impact of the project. They were found to be generally no more stressed or burnt out than comparable workers, and the project was unable to demonstrate statistically significant differences in beforeand after-scores. Synthesis of quantitative and qualitative findings indicates that these LPs were 'thriving rather than just surviving'.
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Toomla, T., and A. Vain. "Diagnostical Informativity of The Myometrical Method in The Medical Research of Occupational Helth Care." Thesis, Sumy State University, 2016. http://essuir.sumdu.edu.ua/handle/123456789/49172.
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The purpose of current research was to study the diagnostic informativity of the
parameters of skeletal muscles (measured by myometric method) in the medical
research of occupational health care.
The research involved 1796 employees from different Estonian companies,
aged 19-74 (with body mass index (BMI) in the range of 16-46). The methods that
were used included: health study in accordance with international standards,
conducted by a therapist and a neurologist, ergonomic evaluation of the work
place, body mass and height were measured (for calculation of BMI).
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Glasson, Janet, University of Western Sydney, College of Social and Health Sciences, and of Nursing Family and Community Health School. "Improving aspects of quality of nursing care for older acutely ill hospitalised medical patients through an action research process." THESIS_CSHS_NFC_Glasson_J.xml, 2004. http://handle.uws.edu.au:8081/1959.7/481.
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The current literature suggests one of the challenges of nursing today is to meet the health care needs of the growing older population, people over the age of 65. Quality of nursing is important for acutely ill older people who are the largest group of patients in terms of hospital admissions. The ageing population is a major focus for social and economic planners and policy makers. There is an increasing need for health systems to change their focus to more closely assess strategies used to manage the acutely ill older hospital population. The main aim of this study was to improve the quality of nursing care for older, acutely ill, hospitalised medical patients. The study used a mixed method triangulated approach that utilised quantitative and qualitative methods to survey perceived needs of older patients, their family members/carers and the nursing staff, in the process of developing, implementing and evaluating a new model of care using a participatory action research (PAR) process. There were three specific objectives. The first was to evaluate which aspects of nursing care were considered most important for older patients during acute hospitalisation from the perspective of older patients, their family members/carers and their nurses. The second was to develop and implement a model of care that addressed the identified nursing care needs and priorities of older patients through the PAR process. The third was to determine whether employing a PAR process, the chosen model of care addressed the identified nursing care needs and priorities and resulted in increased patient satisfaction and improved health care for older patients. This study demonstrated the implementation of a PAR process to motivate nursing staff, utilising an evidence-based model of care approach, resulted in changes to clinical nursing practice that impacted positively on older patients’ and nursing staff’s satisfaction with care provided, patient knowledge and final health outcomes. It is recommended that the findings of this study be applied to develop guidelines for acutely hospitalised medical patients, particularly for issues relating to educational sessions to increase the patient’s functional activities and knowledge levels of their medication regimes prior to discharge.Master of Health Science (Hons)
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Crengle, Suzanne Marie. "The management of children's asthma in primary care : Are there ethnic differences in care?" Thesis, University of Auckland, 2008. http://hdl.handle.net/2292/4957.
Full textAbstract:
Whole document restricted until August 2010, see Access Instructions file below for details of how to access the print copy.Abstract Background Asthma is a common problem in New Zealand, and is associated with significant morbidity and costs to children, their families, and wider society. Previously published New Zealand literature suggested that Māori and Pacific children were less likely than NZ European children to receive asthma medications and elements of asthma education, had poorer knowledge of asthma, and experienced greater morbidity and hospitalisations. However, none of the previous literature had been specifically designed to assess the nature of asthma care in the community, or to specifically answer whether there were ethnic disparities in care. A systematic review of studies published in the international literature that compared asthma management among different ethnic groups drawn from community-based samples was undertaken. The results of this review suggested that minority ethnic group children were less likely to receive elements of asthma medication use, asthma education and self-management (action) plans. Objectives The primary objectives of the study were to: • describe the use of medications, medication delivery systems, asthma education, and self-management plans in primary care for Māori, Pacific, and Other ethnic group children • ascertain whether there were any ethnic disparities in the use of medications, medication delivery systems, asthma education, and self-management plans in primary care after controlling for differences in socio-economic position and other potential confounders. Secondary objectives were to: • describe the asthma-related utilisation of GP, after hours medical care, emergency departments, and hospital admissions among Māori, Pacific, and Other ethnic group children with asthma • ascertain whether differences in medication use, the provision of asthma education, and the provision of self-management plans explained ethnic differences in health service utilisation. Methods A cross-sectional survey was conducted in Auckland, New Zealand. The caregivers of 647 children who were aged 2–14 years, had a diagnosis of asthma or experienced ‘wheeze or whistling in the chest’, and had experienced symptoms in the previous 12 months were identified using random residential address start points and door knocking. Ethnically stratified sampling ratios were used to ensure that approximately equal numbers of children of Māori, Pacific and Other ethnicity were enrolled into the study. A face-to-face interview was conducted with the caregivers of these children. Data was collected about: socio-demographic factors; asthma morbidity; asthma medications and delivery devices; exposure to, and experiences of, asthma education and asthma action plans; and asthma-related health services utilisation. Results In this study, the caregivers of 647 eligible children were invited to participate and 583 completed the interview, giving an overall completion rate of 90.1%. There were no ethnic differences in completion rates. The overall use of inhaled corticosteroid medications had increased since previous New Zealand research was published. Multivariable modelling that adjusted for potential confounders did not identify ethnic differences in the use of inhaled corticosteroids or oral steroids. Some findings about medication delivery mechanisms indicated that care was not consistent with guidelines. About 15% of participants reported they had not received asthma education from a primary care health professional. After adjusting for potential confounders there were no ethnic differences in the likelihood of having received asthma education from a health professional. Among those participants who had received education from a primary care health professional, significantly fewer Māori and Pacific caregivers reported receiving education about asthma triggers, pathophysiology and action plans. Lower proportions of Pacific (77.7%; 95% confidence interval (95%CI) 70.3, 85.1) and Māori (79.8%; 95% CI 73.6, 85.9) caregivers were given information about asthma triggers compared to Other caregivers (89.2%; 95% CI 84.9, 93.6; p=0.01). Fewer Māori (63.6%; 95% CI 55.7, 71.4) and Pacific (68.1%; 95% CI 60.1, 76.1) caregivers reported receiving information about pathophysiology (Other 75.9%; 95% CI 69.5, 82.3; p=0.05). Information about asthma action plans had been given to 22.7% (95% CI 15.5, 29.9) of Pacific and 32.9% (95% CI 25.3, 40.6) of Māori compared to Other participants (36.5%; 95% CI 28.6, 44.3; p=0.04). In addition, fewer Māori (64.2%; 95% CI 56.1, 72.3) and Pacific (68.5%; 95% CI 60.1, 77.0) reported that the information they received was clear and easy to understand (Other 77.9%; 95% CI 71.8, 84.1; p=0.03). About half of those who had received education from a health professional reported receiving further education and, after adjustment for potential confounders, Pacific caregivers were less likely to have been given further education (odds ratio 0.57; 95% confidence interval 0.33, 0.96). A minority of participants (35.3%) had heard about action plans and, after adjustment for potential confounders, Pacific caregivers were less likely to have heard about these plans (odds ratio 0.54; 95% confidence interval 0.33, 0.96). About 10% of the sample was considered to have a current action plan. The mean number of visits to a GP for acute and routine asthma care (excluding after-hours doctors and medical services) in the previous twelve months were significantly higher for Pacific (3.89; CI 3.28, 4.60) and Māori (3.56; CI 3.03, 4.16) children than Other ethnic group children (2.47; CI 2.11, 2.85; p<0.0001). Multivariable modelling of health service utilization outcomes (‘number of GP visits for acute and routine asthma care in the previous twelve months’, ‘high use of hospital emergency departments’, and ‘hospital admissions’) showed that adjustment for potential confounding and asthma management variables reduced, but did not fully explain, ethnic differences in these outcomes. Māori children experienced 22% more GP visits and Pacific children 28% more visits than Other children (p=0.05). Other variables that were significantly associated with a higher number of GP visits were: regular source of care they always used (regression coefficient (RC) 0.24; p<0.01); lower household income (RC 0.31; p=0.004) and having a current action plan (RC 0.38; p=0.006). Increasing age (RC -0.04; p=0.003), a lay source of asthma education (RC -0.41; p=0.001), and higher scores on asthma management scenario (RC -0.03; p=0.05) were all associated with a lower number of GP visits. Pacific (odds ratio (OR) 6.93; 95% CI 2.40, 19.98) and Māori (OR 2.60; 95% CI 0.87, 8.32) children were more likely to have used an emergency department for asthma care in the previous twelve months (p=0.0007). Other variables that had a significant effect on the use of EDs in the multivariable model were: not speaking English in the home (OR 3.72; 95% CI 1.52, 9.09; p=0.004), male sex (OR 2.43; 95% CI 1.15, 5.15; p=0.02), and having a current action plan (OR 7.85; 95% CI 3.49, 17.66; p<0.0001). Increasing age was associated with a reduced likelihood of using EDs (OR 0.90; 95% CI 0.81, 1.00; p=0.05). Hospitalisations were more likely in the Pacific (OR 8.94; 95% CI 2.25, 35.62) and Māori (OR 5.40; 95% CI 1.28, 23.06) ethnic groups (p=0.007). Four other variables had a significant effect on hospital admissions in the multivariable model. Participants who had a low income (OR 3.70; 95% CI 1.49, 9.18; p=0.005), and those who had a current action plan (OR 8.39; 95% CI 3.85, 18.30; p<0.0001) were more likely to have been admitted to hospital in the previous 12 months. Increasing age (OR 0.88; 95% CI 0.80, 0.98; p=0.02) and parental history of asthma (OR 0.39; 95% CI 0.18, 0.85; p=0.02) were associated with reduced likelihood of admission. Conclusions The study is a robust example of cross-sectional design and has high internal validity. The study population is representative of the population of children with asthma in the community. The three ethnic groups are also considered to be representative of those ethnic groups in the community. The study, therefore, has good representativeness and the findings of the study can be generalised to the wider population of children with asthma in the Auckland region. The results suggested that some aspects of pharmacological management were more consistent with guideline recommendations than in the past. However, given the higher burden of disease experienced by Māori and Pacific children, the lack of observed ethnic differences in the use of preventative medications may reflect under treatment relative to need. There are important ethnic differences in the provision of asthma education and action plans. Future approaches to improving care should focus on interventions to assist health professionals to implement guideline recommendations and to monitor ethnic disparities in their practice. Asthma education that is comprehensive, structured and delivered in ways that are effective for the people concerned is needed.
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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.
Full textAbstract:
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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Stanton, Jennifer Margaret. "Health policy and medical research : hepatitis B in the UK since the 1940s." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1995. http://researchonline.lshtm.ac.uk/682243/.
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This thesis explores the way changing constructions of hepatitis B have mediated between science and policy during the past fifty years. Research-based 'facts' were filtered in the policy arena according to social, political and economic pressures. Central policy processes depended heavily on expert advisers, who emerged from networks of researchers. This account draws on scientific, clinical and epidemiological research, central policy documents, and interviews with people working with or suffering from the disease. Though epidemiologically close to AIDS, hepatitis B has rarely attracted public attention: there are an estimated 100,000 carriers in the UK, but few deaths due to the acute form. The disease was a major problem in the blood supply, and featured as a hospital infection, with notable outbreaks from 1965 in renal dialysis units. It was seen as an occupational hazard for laboratory workers, doctors, nurses and dentists. The introduction of a test for hepatitis B around 1970 opened up opportunities for epidemiological research. Hepatitis B was increasingly recognized as a sexually transmitted disease, widespread among gay men; also, because of needle sharing, prevalent among drug users. Another outcome of research in the 1970s was the development of a vaccine. However, availability of a vaccine in the UK from 1982 afforded no immediate resolution of public health issues raised by hepatitis B. The legacy of a restricted screening policy from the 1970s, emphasizing prevention via hygiene precautions among health care workers, facilitated a limited vaccine policy throughout the 1980s. While discussing negotiations over hepatitis B in the past five decades, this thesis aims to contribute to a broader analysis of interactions between science and policy, between centre and regions, and between interest groups.
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Shannon, Sarah Elizabeth. "Caring for the critically-ill patient receiving life-sustaining therapy : combining descriptive and normative research in ethics /." Thesis, Connect to this title online; UW restricted, 1992. http://hdl.handle.net/1773/7329.
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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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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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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.
Full textAbstract:
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.
Full textAbstract:
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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Kelly, Janet. "Moving forward together in Aboriginal women's health a participatory action research exploring knowledge sharing, working together and addressing issue collaboratively in urban primary health care settings /." 2008. http://catalogue.flinders.edu.au/local/adt/public/adt-SFU20090324.084222/index.html.
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McNair, Ruth Patricia. "Same-sex attracted women and their relationship with GPs: identity, risk and disclosure." 2009. http://repository.unimelb.edu.au/10187/8522.
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Patient-doctor relationships between same-sex attracted women and general practitioners (GPs) have been presented as problematic in the literature. The problems arise from women’s concerns about the potential for negative attitudes amongst GPs. They also relate to GPs’ concerns about offending patients if they ask about sexual orientation due to the stigmatised nature of minority sexual orientation. As a result, disclosure of sexual orientation can be difficult and the patient-doctor relationship can be compromised. The aim of this study was to explore the nature of patient-doctor relationships in this context and how optimal relationships can be achieved.Using a critical hermeneutic approach, I conducted in-depth interviews with 33 same-sex attracted women and 28 doctors. This included 24 pairs of people in a current patient-doctor relationship. I found that women commonly experienced silencing of their minority sexual orientation within general practice settings, but that this was occasionally desired and not problematic for some women and most GPs. For other women and for many GPs, the silence resulting from a lack of disclosure was a response to perceived risks to women’s personal identity and GPs’ professional identity. Few GPs asked directly about sexual orientation, placing the burden of responsibility for disclosure on same-sex attracted women. Building reciprocal trust could overcome the perceived risks inherent in revealing minority sexual orientation. I initially defined optimal patient-doctor relationships in terms of existing models of cultural competence and patient-centredness; however I found that such relationships were built on cultural sensitivity rather than cultural competence, and relationship-centredness rather than patient-centredness.
I developed a new model of sexual identity disclosure that demonstrated the key influences on disclosure of sexual orientation to GPs for same-sex attracted women. These influences were women’s sexual identity experience, risk perceptions, and the level of knowing within the patient-doctor relationship. The model depicts women’s range and fluidity of sexual identity experiences and challenges current assumptions that disclosure is essential for effective health care. The model has transformative potential for general practice education and research. It could assist GPs to understand that not all women desire disclosure, but that the majority of women are happy to disclose if asked. GPs would be encouraged to take note of the socio-political environment in which women live and its influence on women’s fears and actual experiences of discrimination. Finally, understanding the role of trust and reciprocal knowing in mitigating perceived risks would encourage GPs to focus more on relationship building. This could also assist GPs to overcome their own perceptions of risk and encourage them to broach the subject of sexual orientation, ultimately enhancing the patient-doctor relationship.
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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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Lin, Wan-yi, and 林萬壹. "Research on Doctors' Personal Medical-Care Seeking Behaviors." Thesis, 2003. http://ndltd.ncl.edu.tw/handle/86038457509116589582.
Full textAbstract:
碩士南華大學
生死學研究所
91
Medical-care seeking behavior is one of the inevitable life processes for human beings. A random sample of 700 doctors (dentists included) in Taiwan received a mailed, anonymous questionnaire focusing on their personal medical-care seeking behaviors. Probing the related behavior patterns from the perspective of doctors themselves is the main purpose of this research. The effective response rate was 34.6 % (242 copies). Data were analyzed by using SPSS for Windows (version 8.0). Bivariate associations were evaluated by performing frequency table and Chi-square tests. Level of significance was set in P≦0.05 (95 % confidence level). The conclusions are listed below： In general, it’s not difficult for doctors to acquire any medicament-related information or ask any other department doctors’ help. Instead of the doctors’ gender or age, “recognize the doctor or not” is the principal issue considered by doctors seeking medical help. But, if it is compared with “the doctor’s medical skill”, the latter is definitely more important. In the doctor-patient relationship, being a sick doctor rather than a therapeutic doctor was found to cause fewer communication problems. The results unveiled western medical doctors’ viewpoints on three different medical systems as well. They trust western medicine most, Chinese medicine second and alternative therapy lastly. The same utilization order among these different systems can also be seen in sick doctors. The attitude of sick doctors making use of Chinese medicine is based on “the lack of an effective therapy in western medicine” and “give it a try, there’s nothing to lose”. Basically, there is a positive correlation between faith and utilization of three different medical systems by sick doctors. The medical environment where doctors serve also plays an important role in the utilization of Chinese medicine by western medical doctors. This means that in fields that offer Chinese medical services, western medical doctors have a higher utilization of Chinese medicine than in fields that do not offer this service. The research points out that there is an obviously declining trend among Taiwanese doctors to utilize Chinese medicine and alternative therapy after practicing a clinical job. On the other hand, focusing on the treatment of malignant tumors, the utilization of Chinese medicine by sick doctors is going to double, and a triple rise is expected in the utilization of alternative therapy.
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Hsia, Tsu-I., and 夏祖怡. "Research of Emergency Medical Care Planning for Triathlon." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/75885004335865744170.
Full textAbstract:
碩士國立體育大學
運動保健學系
102
Purpose: To establish domestic standard operating procedure of emergency medical care planning for Triathlon Method: Using participant observation of qualitative research methods, the author not only collects frequently-seen sport injuries in triathlon and relevant information in researches, but participates in the emergency medical care planning and execution of triathlon. The necessary factors and procedures of emergency medical care planning for triathlon were derived from the analysis of current data set and the comparison of available foreign norms. Result: After data analysis and exploring material, we obtain the followings, 13 items, for the emergency medical care planning and execution of triathlon: basic information, site survey, emergency medical care deployment, capacity of lifeguard, and radio communication etc. According to these thirteen items, we make the reference examples for the standard operating procedure (checking list) and the deployment of emergency medical care of Taiwan triathlon. Conclusion: Every country has its standard norm of emergency medical care planning for their sport. Although there is no such norm can be followed in Taiwan, we could learn from the mistakes of others. However, it shouldn't duplicate completely. We hope that we could follow the norm developed by this research with better prevention for Taiwan triathlon and move toward the international standards gradually.
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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.
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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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Derrick, G. E. "Institutionalising the agora : investigating the evolution of public accountability in Australian medical research institutes." Phd thesis, 2009. http://hdl.handle.net/1885/149722.
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Chen, Yu-pei, and 陳俞沛. "The Research on Conferring Juridical Personalityto Medical Care Institutions." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/91506089112690753263.
Full textAbstract:
碩士東吳大學
法律學系
93
The Medical Care Act was greatly amended on April, 2004. One of the amendments to the Act is to the addition of the Chapter of Medical Juridical Persons in Medical Care. The Section of Medical Care Corporations was added to the Act. It has great and far-reaching influence on the system of medical care. It also alters the essence of medical care. This study is based on the effects of the Chapter of Medical Juridical Persons in Medical Care. Before the Act was amended, the private medical care institutions registered by natural persons caused several problems and defects in law. To resolve the problems and defects and prevent the disorder of the medical care institutions before the amendments to the Act, medical care corporations are allowed for establishment. So far, the system of medical care institutions will be more organized, and the quality of medical care will be promoted. Although the system of medical care corporations in our country was established based on the Medical Care Act of Japan, the limitation of "surplus shares should not given" has been cancelled after the amendments to the Act. The Act has some characteristics similar to "commercial corporations." But the central competent authority defines medical care corporations as "the special juridical persons", which are referred to as neither the completely public-interest juridical persons nor the completely commercial institutions. The central competent authority is opposed to the compliance of the juridical corporations in medical care with related provisions of the Company Law. In this way, the medical juridical persons in medical care will not be well managed and administered by the Medical Care Act and Civil Law. In addition, the central competent authority showed its great ambition to interfere in the management and administration of medical juridical persons in medical care. But it has made related administrative decrees without being legally authorized by related provisions of laws. These decrees not only ruin the independence of the medical juridical persons in medical care, but also result in the uncertainty of administering medical juridical persons. In this way, the private medical care institutions have looked on the policy of juridical persons in medical care from the sidelines. This study is based on the analyses of the Medical Care Act, the Civil Law, and the Company Law. It is thought that the medical care corporations with rights are defined as commercial juridical persons, and the medical care corporations without rights are defined as public-interest juridical persons, even cancelled from the Medical Care Act. In addition, the administration and management of medical juridical persons in medical care can be compliance with related provisions of the Company Law, without any conflict between the Medical Care Law and the Company Law. Also, the medical juridical persons in medical care should be under the less supervision of the central competent authority. The definite criteria for administering the medical juridical persons in medical care should be instituted to avoid the inappropriate interference. Moreover, in compliance with the trend of conferring juridical personality to public medical care institutions, the medical care corporation is maybe the optimal way of transforming public medical care institutions into juridical persons in accordance with the amendments to the Medical Care Act.
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齊燕駒. "The research of the family medical care expenditure's factors." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/23306182784354998074.
Full textAbstract:
碩士佛光大學
經濟學系
96
Recently,Taiwan and the most of the advanced countries has been faced with the increasing expenditure in health care. It has been assumed that is has occurred because of an increase income, According to increased spending on health care. However, over the last twenty years, real income growth has actually slowed down, while the ratio of health care expenditure has increase on average at 10％ per year. Based on the above situation, in this study, we analyzed health care data in Taiwan during the period from 2004-2006. We applied the mulitiple regression, T-test,intercept dummy variables and SAS to analyze the imformation. After the anaylysis,the results showed that the main factor leading to increased the health care expenditure, except increasing incomes, still including the expansion of health insurance system. We intended to explore causation among variables. However, traditional analysis variables can only measure variablesone by one. This approach cannot explore the causation that happened among variables simultaneously. Therefore,the study changed from a traditional research approach to the directed graphs approach. As a result, we don’t find any directed edges among each variable. As a consequence of this study, there are some keypoints. Firstly, the income elasticity is less than 1.Secondly, the main factor that has affected health care expenditure in Taiwan is the expansion of the health insurance system.
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Cochrane, Susan Frances. "The personal interest and decision-making about medical treatment." Phd thesis, 2006. http://hdl.handle.net/1885/150997.
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Yi, Lee Heng, and 李恆宜. "Medical Research of Urinary Tract Infection in Respiratory Care Ward." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/59582172023646450811.
Full textAbstract:
碩士輔仁大學
應用統計學研究所
93
The thesis survey certain Hospital in Taipei county by recalled memory. There are 35,200 patients in the Respiratory Care Ward in the past three years. Numbers of the infection cases are 278 and among that the Urinary Tract Infection (UTI) are152. The thesis is to research the effect of infection part in each medical system and the reason of urinary tract infection syndrome. The result of analysis revealed: 1. There are variant symptoms of UTI in different ages, sex, bacterial special, DM and heart disease patient.53.2%are female and 46.8%are male. Most of them are between 70-79 y/o, and the 2nd part are 80-89 y/o. The most symptom of UTI are voidiy difficulty and pyuria. Most voidiy difficulty are male patient and pyuria are female patient. 2. Chronic disease contrast urinary tract infection syndrome. Chronic diseases are DM and CVA. Female have DM, H/D and CVA is more than male. Male have H/T more than female. 3. Seasons, age, infection culture, Anti and foley is contrast in urinary tract infection part. Urinary tract infection come in the spring；Respiratory infection come in the summer, blood infection come in the fall. If control the culture growth environment, temperature and humidity, or control the hospital temperature and humidity, perhaps effect urinary tract infection and Infection part control.