Dissertations / Theses on the topic 'Service utilisation'
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Johnston, Janice Mary. "Ambulatory care: a comparison of event and episode utilisation patterns." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1998. http://hub.hku.hk/bib/B31237125.
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Rouvrais, Siegfried. "Utilisation d'agents mobiles pour la construction de services distribués." Rennes 1, 2002. http://www.theses.fr/2002REN10035.
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Roberts, Nicola. "Using attachment theory within mental health community services to improve patient outcomes and reduce service utilisation costs." Thesis, University of Manchester, 2012. https://www.research.manchester.ac.uk/portal/en/theses/using-attachment-theory-within-mental-health-community-services-to-improve-patient-outcomes-and-reduce-service-utilisation-costs(78a9832e-0e8f-4d2b-a6a4-8d7ffdf5aa6d).html.
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This thesis follows the paper-based format and papers one and two have been prepared for submission to Attachment and Human Development and the British Journal of Clinical Psychology, respectively. The relevant submission guidelines are included in the appendices (Appendix A and B).Attachment theory (Bowlby, 1977a) has prompted a wealth of empirical research in its contribution to adult attachment patterns and subsequent psychopathology in mental health (Holmes, 2001; Wallin, 2007). More recently, attachment theory has been proposed as a suitable framework by which to inform the organisation, design and delivery of mental health services (Goodwin, 2003; Seager et al., 2007) but it is unclear what this would look like in practice. Adopting an attachment-informed service model has key implications for individual and service outcomes and the two papers presented in this thesis aim to contribute to research in this area, followed by a critical review of the research, its relevance and future implications. Paper one is a narrative overview of the literature discussing the practice implications of services adopting an attachment-informed framework, and describes how this might be conceptualised in front-line service delivery. Articles reviewed described the influence of attachment theory in predominantly inpatient, secure forensic and/or psychiatric rehabilitation services, and its application within more generic community mental health services was explored. Paper two aimed to investigate the importance of individual attachment and service attachment to client psychopathology, quality of life, service utilisation and service costs in community-based mental health services. The final section, the Critical Review, critiqued the literature review and aimed to place the research within a wider context. This section considers the findings from the research and the limitations of the study, while also highlighting important issues for services, with implications for clinical practice and future research.
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Monnot, Elisa Marie. "L’expérience d’apprentissage du client : la première utilisation d’un produit-service." Paris 9, 2010. https://portail.bu.dauphine.fr/fileviewer/index.php?doc=2010PA090014.
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Alors que la connaissance est un construit souvent évoqué dans les recherches en comportement du consommateur, le développement des compétences a reçu peu d’attention dans la littérature en marketing, et en particulier dans le cadre de l’utilisation de produits-services. Cette thèse explore la dynamique de l’expérience d’apprentissage du client et son hétérogénéité dans le cas de la première utilisation d’un produit-service. Elle vise à comprendre comment les clients développent leurs compétences et apprennent à se servir des produits-services après l’achat. Sur le plan conceptuel, elle s’appuie sur des travaux pluridisciplinaires sur les compétences, l’apprentissage et les usages des produits. Sur le plan empirique (1) l’étude 1 par entretiens rétrospectifs analyse la façon dont les clients perçoivent leurs expériences de première utilisation de produits-services, (2) l’étude 2, une enquête expérientielle par observations filmées et entretiens, détermine les trajectoires qu’ils suivent pour apprendre à s’en servir. Des recommandations sont également formulées pour améliorer les stratégies de formation et d’assistance à l’usage des entreprisesWhile consumer knowledge is seen as a fundamental construct in consumer behaviour research, customer competencies development received very little attention in marketing literature. Academic researchers have also shown less concern with service-product usage. This dissertation investigates the dynamics and heterogeneity of customer learning experience during first service-product use. This doctoral study aims at having a better understanding of how customers develop their competencies and learn how to use services-products after purchase. It relies on multidisciplinary research works about competencies, learning and product usage. This research examines the customer learning experience during first service-product use through two qualitative studies: (1) via in-depth retrospective interviews to explain how customers perceive their first service-product use experiences; (2) via an experiential study, with video recorded observations and interviews, to determine different learning trajectories for first service-product use. Managerial implications are also discussed to improve usage assistance and customer education strategies
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CHAGNAUD, MAURICE. "Utilisation pratique d'un micro-ordinateur au sein d'un service hospitalier." Aix-Marseille 2, 1990. http://www.theses.fr/1990AIX20227.
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Fernandez, Plotka Jose-Luis. "Utilisation and service productivities in community social care for older people." Thesis, London School of Economics and Political Science (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.423140.
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Macey, Steven Michael. "Assessing the excess health service utilisation and direct medical costs of injuries." Thesis, Swansea University, 2010. https://cronfa.swan.ac.uk/Record/cronfa42913.
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This study was undertaken with the aim to develop improved measures of health service utilisation (HSU) and direct medical costs following an index injury, utilising large scale datasets linked via anonymous patient identifiers. A cohort of anonymous injury patients resident in Swansea and attending an emergency department (ED) or admitted to hospital between 01/04/2005 and 31/03/2007 were identified and tracked as they progressed through various treatment stages following their index injury, incorporating ED attendances, inpatient stay and outpatient contacts. To determine the extent of the subsequent HSU and direct medical costs associated with the index injury a unique model was developed whereby the numbers, lengths and treatment costs of health service contacts observed amongst the cohort of injured individuals during the follow-up period were compared with the equivalent figures expected in the absence of an injury. On average each index injury was found to lead to an excess of 0.12 (95% Cl 0.11, 0.13) ED attendances, 0.07 (95% Cl 0.06, 0.08) inpatient admissions, 1.00 (95% Cl 0.78, 1.23) inpatient bed days and 0.55 (95% Cl 0.52, 0.58) outpatient contacts being estimated over the follow-up period. Moreover, every index injury resulted in mean excess ED, inpatient and outpatient treatment costs of £12.05 (95% Cl £11.05, £13.05), £492.43 (95% Cl £415.66, £569.21) and £73.30 (95% Cl £68.44, £78.17), respectively, equating to a combined figure of £577.79 (95% Cl £500.32, £655.26). Across the entire injured cohort this amounts to an overall excess direct medical cost total of £17.6 million being incurred, with the equivalent figure for the whole of Wales potentially being as high as £306.4 million. Together with signifying the magnitude of the HSU and direct medical costs resulting from injury, this study has introduced and implemented improved methods for estimating these outcome measures based on the use of anonymous patient record linkage.
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Nätti, S. (Satu). "Customer-related knowledge utilisation in the collaborative relationships of professional service organisation." Doctoral thesis, University of Oulu, 2005. http://urn.fi/urn:isbn:9514279123.
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The purpose of this study is to describe customer-related knowledge utilisation in the collaborative relationships of professional service organisations. Within this specific context, knowledge transfer capabilities are emphasised as an important prerequisite in the utilisation process.
Effective organisation-level knowledge utilisation is crucial in collaborative relationships of professional service organisations. In order to formulate a coherent service offering across different areas of expertise, for instance, it is beneficial to transfer customer knowledge between professionals, business units and functions. Knowledge utilisation across different expertise areas may also be an important prerequisite for an organisation's innovativeness and proactiveness in customer cooperation.
Customer-related knowledge utilisation and related knowledge transfer processes are in this study approached from a relationship management perspective, and literature from organisation research, resource-based view and knowledge management is used as a theoretical basis. Empirically this study is based on a descriptive case study of two professional service firms in the field of business-to-business education and consultancy services. In the first case, an in-depth analysis of an organisation developing a collaborative relationship in the outsourcing situation is described. In the second case, additional views are given on organisational practices potentially facilitating customer-related knowledge transfer.
Empirical results show that internal fragmentation in the professional service organisation seems to be, to a large extent, inherent in this type of organisation, and may cause many problems in customer-related knowledge transfer and thus in effective utilisation of that knowledge. These knowledge transfer inhibitors rise from an organisation's characteristics; its dominant logic, culture, structure and systems. These organisational characteristics are bound to the characteristics of knowledge itself: its tacitness, non-observability and complexity, and can have an inhibiting influence on knowledge transfer.
However, in spite of the inherent forces causing internal fragmentation and inhibiting knowledge transfer, moderating practices of a well-planned relationship coordination system, customer knowledge and expertise codification, and cooperative working practices among the experts seem to help to maintain customer knowledge transfer and utilisation, and thus also continuity and value creation in the long-term relationships. This value creation can be seen to be based on accessing and integrating a wide variety of knowledge resources in order to create innovative, flexible and multifaceted service offerings. Value creation can also be based on organisational ability for generative learning in order to change prevailing organisational assumptions and to develop the operations model needed in collaborative relationship.
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Xu, Fang, and 徐方. "Self-rated health, chronic diseases and health service utilisation in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2015. http://hdl.handle.net/10722/212607.
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Introduction Self-rated health (SRH) is a widely used indicator of health service utilisation and reflects self-perceived objective health condition. Poorer non-comparative SRH was shown to be related to higher inpatient and outpatient utilisation in Western and elderly populations. Little is known about how healthcare utilisation relates to SRH in non-Western settings, such as Hong Kong and in adult populations. The association of age- and time- comparative SRH with healthcare utilisation is also unclear. This study aimed to assess the association of three types of SRH (non-, age- and time- comparative SRH) with inpatient and outpatient utilisation in Hong Kong‟s general populaion.
Methods Data were derived from 2011 Thematic Household Survey (THS), covering 23,892 non-institutional residents aged 20 and above. The study adopts Andersen‟s Behavioral Model of Health Service Use for the analytical framework. Healthcare utilisation was measured by inpatient use during the past year and outpatient use (including General Outpatient Clinic (GOPC) and Specialist Outpatient Clinic (SOPC)) during the past month, in terms of ever-use and the amount of use (bed-days and number of outpatient visits). SRH was measured with a 5-point Likert Scale: non-comparative SRH from “Excellent” to “Poor”; age- and time- comparative from “much worse” to “much better”. Logistic regression and zero-truncated negative binomial/ Poisson regression were applied to examine the association of SRH and chronic diseases with healthcare utilisation in the public and private sector separately as per the Andersen behavioral model.
Results “Fair/ poor” non-comparative SRH was associated with higher inpatient and outpatient utilisation. The association was not significant for hospital bed-days. Similarly, age-comparative SRH was associated with inpatient (except private bed-days) and outpatient utilisation (except the number of SOPC visits). “Worse/ much worse” time-comparative SRH was associated with higher healthcare utilisation, but the relationship was less clear for private hospitalisation. The presence of cancer, cardiovascular diseases, diabetes, lower respiratory diseases, and musculoskeletal diseases were associated with higher healthcare utilisation, with stronger association observed for ever-use than the amount of use. The relationships between musculoskeletal diseases and inpatient utilisation, between cardiovascular diseases and diabetes and the number of private outpatient visits, and between lower respiratory diseases and GOPC utillisation were not significant.
Conclusions The present study suggests SRH to be a useful health indicator of health service utilisation. All three SRH measures were associated with health service utilisation and no marked differences were observed between different measures. Poorer SRH were strongly related to higher public inpatient utilisation, with stronger association observed for ever hospitalisation than bed-days. Poorer SRH measures were also related to higher outpatient uilisation in both sectors during the past month. All the selected chronic conditions were related to increased healthcare use. The associations were less clear for hospital bed-days and the private sector. Future studies should focus on the predictive validity of SRH on future healthcare utilisation.published_or_final_version
Public Health
Master
Master of Philosophy
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Williams, Jonathan Mark. "Energy utilisation and combined heat & power sizing in the health service." Thesis, Cardiff University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273836.
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Bhatti, J. V. "Acculturation, shame, & self-compassion : an examination of mental health service utilisation." Thesis, University of Liverpool, 2018. http://livrepository.liverpool.ac.uk/3027481/.
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Marriott, Paul James. "Does the process of implementing service line management affect the theatre utilisation?" Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5247/.
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Introduction: The English National Health Service (NHS) is rationalising services to ensure healthcare remains sustainable. Implementation of Service Line Management (SLM) is recommended, as it is believed to empower clinical leaders to improve resource use and make cost efficiency savings in areas such as operating theatres (OT). The aim of this study was to examine if, how and why, SLM affects theatre utilisation. Methods: A mixed methods multiphase process evaluation design was used. Three years of theatre utilisation quantitative data, 35 semi-structured interviews and focussed observations were undertaken. The study focussed on elective colorectal surgery in two English NHS hospitals. Results: OTs were found to be inefficient. SLM implementation was minimal. Theatre data was not valued or used to affect performance and interviewees felt, in part, due to organisational structures, unable to control processes. Consequently, minimal impact on the cost effectiveness and efficiency of OTs was identified. Conclusion: To improve the cost effectiveness of OT, NHS hospitals need to invest in data systems and develop organisational structures that devolve control to clinical leaders and promote staff collaboration. Without these elements, SLM cannot be implemented and its potential impact will not be established.
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VIGUIER, PATRICK. "Utilisation du midazolam intra-nasal dans l'agitation psychomotrice dans un service d'urgence." Angers, 1994. http://www.theses.fr/1994ANGE1038.
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Paineau, Virginie. "Prescription et utilisation de médicaments dans un service de long séjour de gériatrie." Paris 5, 1997. http://www.theses.fr/1997PA05P104.
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Cheung, Chui Wah Edwin. "Survey of dental service utilisation by year six students in Western Sydney Area." Thesis, The University of Sydney, 1993. http://hdl.handle.net/2123/4718.
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MacRae, Jayden. "Using a natural experiment to assess the effect of spatial barriers on health service utilization." Thesis, University of Canterbury. Geography, 2014. http://hdl.handle.net/10092/9346.
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The closure of the Manawatu Gorge in August 2011 caused a change in the travel time for patients living in the eastern area of the MidCentral Health District to their main hospital and health services located in Palmerston North. This presented an opportunity to study the effect a change in travel time and spatial access had on a population before and after such an event. This study used a retrospective cohort design, using routinely collected data from general practice, emergency department, hospital admissions and outpatient services. The investigation was completed using novel geospatial information systems methods to produce high fidelity data for analysis with free and open source software by developing and validating two new methods of improving geocoding data quality and a new travel time prediction model. Potential and realised spatial accessibility measures were calculated for 101,456 patients over 3.5 years while the gorge was both open and closed. Catchment sensitivity analysis and two-step floating catchment area using distance decays presented complimentary evidence of accessibility change during the Manawatu Gorge closure. Analysis of utilisation measures in both primary and secondary care were correlated with travel time. Utilisation of general practice services appeared to be negatively impacted by increased travel time when comparing realised accessibility in a control and intervention group during the gorge closure. It appeared as though other factors affected access to health services to a greater degree than an increase of up to fifteen minutes travel time.
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Romero-Prada, Jaime-Ricardo. "An appraisal of cattle production service utilisation in Colombia using the stakeholder analysis approach." Thesis, University of Reading, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269645.
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Saignac, Pierre-Alain. "Utilisation et utilité du dépôt de sang du service des urgences de l'hôpital Pellegrin." Bordeaux 2, 2000. http://www.theses.fr/2000BOR23094.
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Olsson, Lena. "Children with mild intellectual disability and their families – needs for support, service utilisation and experiences of support." Doctoral thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. CHILD, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-29604.
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This thesis focuses on service utilisation among children with mild ID and their families, their needs for support and their experiences of support. Aims The overall aim of the thesis was to explore and describe service utilisation patterns among families of children with mild ID from a systems perspective. Methods A cross-sectional, descriptive and comparative quantitative design was used to describe the extent of service utilisation among 84 children with mild ID and their families (paper I and II). The types and number of services utilised were investigated in relation to the child’s age, gender and school setting. Data concerning the services utilised were collected from the organisational records of social services and paediatric habilitation units. In paper III, a descriptive questionnaire design was used to describe the support needs of families of 38 children with mild ID. A confirmatory design was used to examine the relation between family needs for support and (a) parental self-efficacy and (b) parents’ control over services. A confirmatory design was also used to examine the relation between parents’ experiences of the helpfulness of the support and (a) parental self-efficacy and (b) parents’ control over services. In paper IV a longitudinal, comparative and confirmatory design was used to investigate whether social service utilisation patterns differ over time when children with mild ID in self-contained classes are compared with those integrated into mainstream classes (n=405). Results In total, 60% of the families utilised paediatric habilitation services, and 40% of the families used disability-related services provided by social services. The most commonly utilised services were services concerned support outside of the home, such as respite care and services to improve children’s participation in society. Approximately 25% of the families utilised social problems-related services provided by social services. The most commonly utilised services concerned those to support parents in their parenting roles and financial assistance. In contrast to older children, younger children were more likely to utilise paediatric habilitation services. Older children utilised a higher number of disability-related service types provided by social services. Few differences were found between males and females. The majority of families did not utilise such services that are provided by social services. It was rare for families to use both disability-related services and those that address social problems during the same year. Commonly reported family needs concerned information about what services are available for their child, their child's impairment, how to respond to their child's behaviour and how to teach their child skills. Other common needs included access to parent support networks, to find suitable leisure activities for the child, and more alone time for parents. In contrast to families with mothers who did not participate in paid work, families with mothers who were employed expressed a lower requirement for support such as counselling, contact with other parents of children with impairments, more friends and more alone time for parents. Similar results werefound for families with mothers with higher levels of education. Parents with higher levels of perceived self-efficacy reported a lower need for information, as did also parents with higher levels of control over services. Parents with higher levels of control over services experienced the support as being more helpful. Children with mild ID who attended self-contained classes were more likely to utilise paediatric habilitation services than children integrated in mainstream classes. The same pattern was found for utilisation of disability-related services provided by social services. Integrated children who changed school setting to attend self-contained classes were more likely to begin to utilise disability-related services in comparison with those children who continued to be integrated. The former also had a higher likelihood of increasing the number of disability-related service types utilised. Conclusions In addition to disability-related problems, families of children with mild ID may also be at a higher risk of experiencing social problems when compared with the general population. Furthermore, very few families utilised both disability-related services and services addressing social problems. This implies that collaboration flaws exist between those professionals concerned with child welfare services and those concerned with disability-related services. A strong predictor of service utilisation was the type of school setting: children attending self-contained classes had a higher rate of service utilisation than those attending mainstream classes. This indicates that service systems outside of school are designed to collaborate with groups of pupils in special classes rather than individual children in mainstream classes. The strong need for information by families indicates that an ecological framework should be used to identify those factors that affect information availability and effectiveness. To increase parents’ perceived level of control over services, HSO professionals need to work in a capacity building manner with the explicit goal to enhance parental self-efficacy.
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Anskär, Eva. "Time flies in primary care : a study on time utilisation and perceived psychosocial work environment." Licentiate thesis, Linköpings universitet, Institutionen för medicin och hälsa, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-156119.
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Background: Time utilisation among primary care professionals has been affected by structural changes and reorganisation performed in Swedish primary care over several decades. The work situation is complex with a heavy administrative work load. The overall aim with this thesis was to describe time utilisation among staff in Swedish primary care and to investigate associations with perceived psychosocial work environment and legitimacy of work tasks. Methods: A multicentre, descriptive, cross-sectional study design was used including all staff categories in primary care i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals (physiotherapists, occupational therapists, psychologists, counsellors, dieticians and chiropodists) at eleven primary care centres located in southeast Sweden. The data collection consisted of a questionnaire including a subjective estimate of workload, the Bern Illegitimate Tasks Scale (BITS) and the Copenhagen Psychosocial Questionnaire (COPSOQ). Also, a time study was performed, where the participants reported their work time based on three main categories; direct patient work tasks, indirect patient work tasks and other work tasks, each with a number of subcategories. The participants reported time spent on different work tasks, day by day during two separate weeks. Response rates were 75% for the questionnaire and 79% for the time study. Results: In paper I the time study revealed that health professionals at the primary care centres spent 37% of their work time with direct patient work tasks. All professions estimated a higher proportion of time spent directly with patients than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress and role conflicts. The proportion of administrative work tasks was associated with role conflicts, the more administration the more role conflicts. Findings in paper II were that more than a quarter of physicians scored above the cut-off value for BITS regarding unnecessary work tasks, which was significantly more than the proportion observed in all other professions in the survey. Across all staff groups, a perception of having to perform illegitimate work tasks was associated with experiencing negative psychosocial work environment and with high proportion of administrative-related work tasks. Conclusions: Swedish primary care staff spend a limited proportion of their work time directly with patients and primary care physicians perceive the psychosocial work environment in negative terms to a greater extent than all other staff members. Allocation of work tasks has an influence on the perceived psychosocial work environment. The perception of having a large number of illegitimate work tasks affects the psychosocial work environment negatively, which might influence the perception the staff have of their professional roles. Perception of high proportion of unreasonable work tasks is associated with a high proportion of non-patient-related administration. This thesis illuminates the importance of decision makers thoroughly considering the distribution and allocation of non-patient related work tasks among staff in primary care, in order to achieve efficient use of personnel resources and favourable working conditions. Hopefully, the results of this study will contribute to further development of primary care so that medical competence will benefit patients as much as possible.Bakgrund: Under de senaste decennierna har det i svensk primärvård varit omfattande omorganisationer, vilket har påverkat arbetstidens innehåll. Arbetssituationen är komplex och omfattningen av administration har ökat. Det övergripande syftet med föreliggande studie var att beskriva arbetstidens innehåll bland personal i svensk primärvård och att undersöka samband mellan upplevd psykosocial arbetsmiljö och arbetsuppgifternas legitimitet. Metod: Studien har genomförts som en deskriptiv multicenterstudie med tvärsnittsdesign och inkluderade sjuksköterskor, läkare, vårdadministratörer, undersköterskor och övriga professioner (fysioterapeuter, arbetsterapeuter, psykologer, kuratorer, dietister och fotvårdsspecialister) vid elva vårdcentraler i sydöstra Sverige. Studien inleddes med att deltagarna ombads att besvara ett frågeformulär vars första del bestod av en skattning av hur arbetsuppgifterna var fördelade. Frågeformuläret innehöll också frågor om illegitima arbetsuppgifter; Bern Illegitimate Tasks Scale (BITS) och psykosocial arbetsmiljö; Copenhagen Psychosocial Questionnaire (COPSOQ). Därefter gjordes en tidsstudie där deltagarna fick registrera tidsåtgången för olika arbetsuppgifter, varje dag under två separata veckor. Arbetsuppgifterna delades upp i tre huvudkategorier; direkt patientarbete, indirekt patientarbete och övrigt arbete. Varje huvudkategori hade flera underkategorier. Svarsfrekvensen var 75% för frågeformuläret och 79% för tidsstudien. Resultat: Resultatet från delarbete I visar att personal i primärvård ägnade 37% av arbetstiden direkt med patienter. Alla professioner skattade den direkta patienttiden till större andel än vad tidsstudien visade. Läkare upplevde sämst psykosocial arbetsmiljö avseende kvantitativa krav, stress och rollkonflikter. Det förelåg ett samband mellan andelen administrativa arbetsuppgifter och rollkonflikter, ju mer administration desto mer rollkonflikter. I delstudie II visade resultatet att mer än en fjärdedel av läkarna upplevde en hög nivå av illegitima arbetsuppgifter avseende onödiga arbetsuppgifter, vilket var signifikant mer jämfört med andra professioner. För personalgruppen som helhet framträdde ett samband mellan upplevelsen av att ha mycket illegitima arbetsuppgifter och upplevelse av negativ psykosocial arbetsmiljö samt med hög andel administrationsrelaterade arbetsuppgifter. Konklusion: Personal i primärvård ägnar en begränsad andel av arbetstiden åt direkt patientarbete och läkare upplever sämre psykosocial arbetsmiljö än övriga professioner. Arbetstidens fördelning mellan olika arbetsuppgifter påverkar den psykosociala arbetsmiljön. Upplevelsen av att utföra en stor andel illegitima arbetsuppgifter påverkar den psykosociala arbetsmiljön negativt, vilket kan ha inverkan på hur personalen uppfattar sin professionella roll. Upplevelsen av att ha mycket oskäliga arbetsuppgifter har samband med hög andel icke patientrelaterad administration. Avhandlingen belyser vikten av att beslutsfattare noga överväger fördelningen av icke patientrelaterade arbetsuppgifter bland personal i primärvård, för att möjliggöra effektiv användning av personalresurserna och för att främja goda arbetsförhållanden. Förhoppningen är också att studiens resultat ska bidra till fortsatt utveckling av primärvården så att den medicinska kompetensen kommer patienterna till nytta i så stor omfattning som möjligt.
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Schlecht, Nicolas F. "Physiological and psychosocial determinants of health-care service utilisation in chronic obstructive pulmonary disease patients." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0024/MQ50872.pdf.
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Perera, Annie M. "Psychological factors associated with service utilisation in clients fulfilling diagnostic criteria for borderline personality disorder." Thesis, Coventry University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368835.
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Noor, Abdisalan Mohamed. "Developing spatial models of health service access and utilisation to define health equity in Kenya." Thesis, Open University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417576.
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Fernandez, Jose-Luis. "Utilisation and service productivities in community social care for older people : patterns and policy implications." Thesis, London School of Economics and Political Science (University of London), 2005. http://etheses.lse.ac.uk/135/.
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The study seeks to make two contributions. One is to participate in the development of theories and methods for the analysis of equity and efficiency in community care. The second is to yield evidence which assists policy-makers and managers to improve the effectiveness of their policies. The broad context is the évolution of the policy discourse about issues of equity and efficiency in community care of elderly people. More narrowly, the context is the implementation of the 1989 community care reforms, set out in Care in the Community: Policy Guidance (Department of Health 1990) and the government's commitment to commission research to evaluate their impact on equity and efficiency in social care. The more recent White Paper, Modernising Social Services (Department of Health 1998), is also an important element of the context. The detailed analysis in the thesis will therefore focus around two main foci: (1) the extent to which care brokered by social services departments has achieved the equity- and efficiency-related goals stated by the 1989 White Paper and developed in the 1998 White Paper; and (2) the extent to which current policies need to be adjusted in the light of understanding about how the new system produces equity and efficiency effects. 1.1 Public policy and the Holy Grail: improving efficiency in the use of public funds The Conservative administration which produced the 1989 White Paper attached a higher priority to efficiency in the use of public funds than its predecessors. However, the origins of its concerns could be traced back to the 1970s.
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RODRIGUEZ, LUC. "Utilisation des indices pronostiques et therapeutiques dans un service de reanimation polyvalente au centre hospitalier." Aix-Marseille 2, 1988. http://www.theses.fr/1988AIX20120.
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Sooful, Prasha. "The maintenance and utilisation of government fitted hearing aids." Diss., Pretoria : [s.n.], 2006. http://upetd.up.ac.za/thesis/available/etd-11132006-091720.
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Yélémou, Tiguiane. "Utilisation du taux d'erreur binaire pour améliorer la qualité de service dans les réseaux ad hoc." Thesis, Poitiers, 2012. http://www.theses.fr/2012POIT2317/document.
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Dans les réseaux sans fil ad hoc, les liens de communication sont sujets à un taux d'erreurimportant. Dans ce contexte, le routage joue un rôle stratégique pour augmenter les performancesdans les transmissions. Dans nos études, par une approche cross-layer, nous prenons en compte lafiabilité des liens dans le choix des routes. Pour cela, dans un premier temps, nous construisonsdeux nouvelles métriques, l'une basée sur le taux d'erreur binaire (au niveau couche physique) etl'autre, plus adaptée à la mesure, sur le nombre de retransmissions (au niveau couche MAC).Ensuite, pour exploiter ces métriques lors du calcul de routes, nous adaptons les algorithmes à labase des protocoles de routage.Les trois familles de protocoles de routage ont été traitées : les protocoles pro-actifs où chaquenoeud a une vision globale du réseau grâce aux échanges périodiques de messages de contrôle detopologie ; les protocoles réactifs où, avant de commencer ses transmissions de données, chaquenoeud doit initier un processus de recherche de route ; les protocoles hybrides qui mixent les deuxapproches.Pour tester l'effectivité de nos améliorations, nous utilisons le simulateur NS2 enrichi par unmodèle de propagation et un modèle de mobilité réalistes. Les paramètres de performance tels quele délai, le taux de livraison de paquets et la charge de routage sont mesurés dans plusieursscénarios représentatifs des conditions d'utilisation. Les résultats obtenus montrent une améliorationsignificative des protocoles standards dans un contexte de qualité de serviceIn ad hoc wireless networks, links are error-prone. In this context, routing plays a decisive role inimproving transmission performances. In our studies, by a cross-layer approach, we take intoaccount the reliability of links in route choice. For this, first, we concept two new metrics, onebased on bit error rate (at physical layer) and the other, more suitable for the measurement, onnumber of retransmissions (at MAC layer). Then, to exploit these metrics when determining routes,we adapt the algorithms based routing protocols.The three families of routing protocols have been addressed: proactive protocols where eachnode has a global view of the network through periodic exchanges of topology control messages;reactive protocols where, before starting data transmission, each node must initiate a routediscovery process; hybrid protocols which mix the two approaches.To test the effectiveness of our enhancements, we use the simulator NS.2 enhanced by arealistic propagation model and a realistic mobility model. Performance parameters such as delay,packets delivery ratio and routing load are measured in several scenarios including mobility andmulti-communication. The results show a significant improvement of standard protocols in thequality of service context
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Chateau, Thierry Michel de. "Utilisation clinique des dermocorticoi͏̈des : étude réalisée dans un service de dermatologie, son intérêt et ses dangers." Paris 5, 1989. http://www.theses.fr/1989PA05P022.
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BATAILLON, YVES. "Utilisation des morphinomimetiques au service d'aide medicale urgente de saint-etienne : etude de 384 interventions primaires." Saint-Etienne, 1994. http://www.theses.fr/1994STET6206.
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Maddams, Jacob. "Cancer prevalence in the United Kingdom : current estimates, future projections and health service utilisation among cancer survivors." Thesis, King's College London (University of London), 2012. https://kclpure.kcl.ac.uk/portal/en/theses/cancer-prevalence-in-the-united-kingdom(774b2620-4501-4ea4-bcf9-fc2309986c7f).html.
Full textAbstract:
Cancer prevalence is an important epidemiological measure of the disease burden. It is defined as the number of people in a given population who are alive at a specified point in time (the index date) and who have previously been diagnosed with cancer. It may be expressed as either a count or as a proportion of the population. Members of the prevalent population are known as 'cancer survivors' and the time spent as such is known as 'cancer survivorship'. Complete prevalence includes all survivors regardless of when they were diagnosed, whereas N-year limited duration prevalence includes only those who have received at least one cancer diagnosis in the N years prior to the index date. In the United Kingdom (UK), addressing the needs of cancer survivors is a high priority for the Department of Health, as well as for voluntary sector organisations, and the need for further research into cancer survivorship has been highlighted. Despite this, in recent years little study has focused on cancer prevalence in the UK. The aims in preparing this thesis were to provide up-to-date estimates of cancer prevalence in the UK, to describe levels of acute health service utilisation among cancer survivors in different temporal phases of survivorship and to provide projections of future cancer prevalence. National cancer registry data for the UK were analysed, together with National Health Service hospital activity data for England. It was found that there are currently around two million cancer survivors in the UK, a figure far higher than previously thought. Levels of acute in-patient health service utilisation were, however, generally low among cancer survivors who had survived at least five years and who were not in the final year of their life. A discrete time model for projecting cancer prevalence was derived and used to project cancer prevalence in the UK from 2009 to 2040 under various different scenarios of future cancer incidence and survival. It was shown that in the coming decades cancer prevalence is likely to increase substantially. This thesis contains a detailed description of cancer prevalence and aspects of cancer survivorship in the UK which highlights the need for adequate planning to meet the many and varied needs of those diagnosed with cancer.
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DANG-VAN, CAO AN HOA. "Utilisation du propofol dans le cadre d'un service d'urgences chirurgicales et dans l'optique d'une anesthesie ambulatoire eventuelle." Toulouse 3, 1988. http://www.theses.fr/1988TOU31182.
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CAZALAS, YVAN. "Utilisation de l'etomidate dans le cadre d'un service d'urgences chirurgicales et dans l'optique d'une anesthesie ambulatoire eventuelle." Toulouse 3, 1989. http://www.theses.fr/1989TOU31137.
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Siboni, Didier. "La gestion de service sur les réseaux hétérogènes interconnectes : utilisation des techniques d'intelligence artificielle et architectures hybrides." Versailles-St Quentin en Yvelines, 1997. http://www.theses.fr/1997VERS0005.
Full textAbstract:
La complexité toujours croissante des réseaux de communication interconnectes rend leur gestion de plus en plus complexe. Les systèmes experts ont été largement utilises pour résoudre ce type de problèmes mais ont montré leur limite pour prendre en compte les évolutions des configurations des réseaux et l'expertise souvent trop pauvre caractérisant ce domaine d'application. Nous proposons, dans cette thèse, un système intelligent et intègré de gestion des fautes utilisant de façon coopérative, les techniques d'apprentissages que sont les réseaux de neurones et le raisonnement est partir de cas et les systèmes experts. Nous proposons une articulation globale du processus de gestion des fautes en trois grandes étapes, regroupants des fonctions de gestions spécialisées: la détection de problèmes nécessitant les fonctions de filtrage et de diagnostic de problèmes de type fautes ou performances. La mesure de l'impact des problèmes sur la qualité de service nécessitant une modélisation de la qualité de service au niveau des différents services rendus par les éléments constitutifs des chaînes de liaison. La résolution des problèmes au moyen de fonctions de reconfigurations et reallocations de ressources, de maintenance curative et préventive, et de gestion d'historique de problème ou gestion de tickets d'incidents. Nous étudions les différentes techniques de l'intelligence artificielle intervenant dans le processus de gestion des fautes, comme les systèmes experts à base de modèles, les réseaux de neurones, le raisonnement est partir de cas. Nous établissons une correspondance entre les différentes étapes et les techniques d'intelligence artificielle, afin de proposer une architecture modulaire, bâtie au-dessus d'une plate-forme ouverte de gestion de réseaux. Un prototype opérationnel de corrélation d'alarmes utilisant la technique de système expert à base de modèles a été développé et intégré à la plate-forme hp openview. Un prototype correspondant au module de filtrage utilisant la technique de réseau de neurone a été développé et expérimenté de manière positive sur des données réelles. Un module de qualification et de correction de problème utilisant la technique d'apprentissage de raisonnement à partir de cas sur une base de tickets d'incident a été étudié
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Nhokwara, Primrose Tinashe. "Factors that influence the utilisation of ototoxicity monitoring services for patients on treatment for drug-resistant tuberculosis." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15683.
Full textAbstract:
Multi-drug resistance is increasingly becoming a challenge to tuberculosis control programmes globally. Treatment of multi-drug resistance tuberculosis (MDR-TB) includes aminoglycoside antibiotics which are known to cause hearing loss. Ototoxicity monitoring services are often provided to patients undergoing treatment for MDR-TB for early detection of ototoxic hearing loss to facilitate alerting the patients and relevant medical staff about the presence and progression of any hearing loss. Previously, models of managing patients with MDR-TB required mandatory hospitalization for at least 6 months. This made it relatively easy to monitor the hearing status of patients during their stay in the hospital. However, with recent introduction of policy guidelines that support management of patients with MDR-TB on an outpatients basis, ototoxicity monitoring for these patients will need to be reorganized to align with the new policy guidelines. The extent of the uptake of these services when patients are accessing them as outpatients is however, unknown. This study therefore aimed to describe the patterns of utilisation and explore the barriers and factors that facilitate the use of ototoxicity monitoring services when provided on an outpatient basis in the Cape Town Metropolitan area, Western Cape, South Africa.
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Matondolo, Siyamthanda Luthando. "Utilisation of ICT in healthcare centre to support HIV/AIDS flow of information and service delivery In Khayelitsha." Thesis, Cape Peninsula University of Technology, 2012. http://hdl.handle.net/20.500.11838/2477.
Full textAbstract:
Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2012.This research is an attempt to investigate the utilisation of Information Communication Technology (ICT) in Healthcare to support the flow of HIV/AIDS patient’s general information in public and private sector. Furthermore, the research examines the detail flow of database information for healthcare service delivery to patients, in particular HIV/AIDS patients, in Khayelitsha Township. Finally, the research will detail the types of technologies currently being utilised to transfer this information, technology utilised for capturing or data collection profile of the patient. The research study data collecting was done in 2009 in mostly private and public healthcare centre in Khayelitsha township. First, the study will concentrate on general utilisation of ICT in healthcare service delivery and flow of information for public and private sector healthcare centres. Additionally, the research also looks at NGOs such as HIV/AIDS Unit in Cape Peninsula University of Technology (CPUT) and Treament Action Campaign (TAC) to find out what ICT equipment is being utilised to transfer this information to adult people to inform and make them to be aware of HIV/AIDS and improve healthcare service delivery to patients and particularly to HIV/AIDS patients. Taking NGO’s such as TAC and CPUT HIV/AIDS Unit that are well informed about HIV/AIDS, nationally and internationally will make our research results to be more precise. The research will also look at the utilisation of ICT in flow of information at healthcare centre such as communication between healthcare providers such as receptionist/clerk, nurses, doctors and medical researchers since they are the first people who deal with HIV/AIDS patient cases when they come for healthcare provision.
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ALLEGRE, JEAN. "Etude comparative des pathologies des malades hospitalises dans les services d'urgences medicales de l'hopital edouard herriot : utilisation des resumes de sejour informatises de l'annee 1987." Lyon 1, 1989. http://www.theses.fr/1989LYO1M063.
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Overland, Jane Elizabeth. "Factors that affect the delivery of diabetes care." Thesis, The University of Sydney, 2000. http://hdl.handle.net/2123/365.
Full textAbstract:
Diabetes is emerging as a major threat to health, with global economic and social implications. Recent research has shown that the morbidity and mortality associated with diabetes can be reduced by timely and effective treatment. However, unless people with diabetes have access to this treatment, the impact of diabetes will continue to rise. This thesis therefore explores the current standards of care which people with diabetes receive. It also looks at factors likely to impact on delivery of diabetes care. Studies were conducted at two levels. In the studies described in Chapters 2 and 3, general data applicable to all or nearly all patients with diabetes were collected. This approach substantially eliminates selection bias but precludes the ability to examine clinical outcomes. In the other studies, detailed in Chapters 4, 5 and 6, specific aspects of diabetes care pertaining to more select groups of diabetic subjects were examined. This approach allows clinical parameters to be examined in more detail but is more subject to selection bias. It is hoped that the combination of these two approaches provides a more balanced view of the topic under examination. In Australia, the Medicare Program, a single government controlled universal health insurance fund, provides access to medical services for all residents. Medicare occasions of service data therefore represent the most comprehensive source of information regarding health service utilisation in Australia. The data does not account for people receiving diabetes care through public hospital based services. However, a survey of public hospitals within NSW (n=198), described in Chapter 2, showed that the number of individuals in this category is relatively small and represents only 5.2% of the diabetic population. Using Medicare item codes, and with the permission and assistance of the Commonwealth Department of Health and Aged Care, data were extracted on attendance to medical practitioners and utilisation of diabetes related procedures for people living in New South Wales (NSW) for the individual years between 1993 to 1997. All data were stratified by the presence of diabetes, gender and age group. Individuals were deemed to have diabetes if an HbA1c, which can only be ordered for a person with known diabetes, had been performed over the 5-year period and the sample size adjusted for the incidence of diabetes. Once adjusted, the number of people with diabetes in NSW for the individual years 1993 to 1997 were 143,920, 156,234, 168,216, 177,280 and 185,780. Comparison with 1996 census data confirmed a 91.7% capture of the total NSW population (5,495,900/5,995,545 individuals). The data were retrieved for NSW as a whole and for individual postcodes. Postcodes were then classified by population density as either major urban, urban or rural. On average over the study period, persons with diabetes accounted for 3.1% of the population but they used 5.5% of general practitioner services. As seen in Chapter 2, a large proportion of people with diabetes were also under the care of specialists and consultant physicians, up to 51.2% and 41.8% respectively, a 3 to 4 fold increase when compared with their non-diabetic counterparts. In regard to geographical location, once adjusted for age and gender, the odds ratio of attending a specialist was only slightly higher for people with diabetes living in areas of high population density when compared to people with diabetes living in rural areas. This ratio reached as high as 1.85 in regard to attendance to consultant physicians (Chapter 3). The odds ratio for the non-diabetic population was similar indicating that the difference in access to consultant physicians was not disease specific. Analysis of results showed that despite the increase in service utilisation, large proportions of people with diabetes were not routinely monitored in regard to diabetes and its complications across the State. By 1997, HbA1c was still not performed in over 40% of people with diabetes each year and only 11.6% of the diabetic population had undergone microalbuminuria estimation. Interestingly, the differences in levels of monitoring between rural and urban areas were surprisingly small. Monitoring of diabetes and its complications did improve in all parts of the State over the study period. However, the greatest improvement was seen in rural areas, despite rural patients having fewer attendances to general practitioners and fewer patients attending specialist care. In the face of finite resources and the rising prevalence of diabetes, an increasing number of patients will need to rely on general practitioners to provide diabetes care regardless of where they live. A 'shared care' approach which encourages and supports general practitioners to manage patients with diabetes, while giving them access to specialist services for those patients that require them, is increasingly being advocated as a way of maximising efficacy while minimising costs. Yet if health care professionals leave undone what they think is done by others, shared care can become neglected care. Chapter 4 reports a detailed audit of 200 randomly selected shared care patients who were assessed on two or more occasions. This study showed that the majority of specialist treatment recommendations are implemented by general practitioners. Doctors formally registered with the Diabetes Shared Care Programme and those who write longer referral letters were more likely to implement recommendations than their counterparts. Moreover, the average HbA1c and the complication profile of these patients were similar to those found in various studies around the world. This suggests that diabetes can be well managed by a shared care approach that is adequately integrated. To overcome the problem that data is lacking on those patients that did not return for specialist review, a further 200 shared care patients who were lost to follow up from the shared care system were traced. Information regarding whether treatment recommendations had been implemented was sought from both the referring doctor and the patient. Overall, information on 182 of the 200 patients could be obtained. As discussed in Chapter 5, comparison of the returned and non returned patients' demographic and clinical profiles at time of their initial specialist review showed that general practitioners differentiated between the 'more complicated' patients, choosing to re-refer those with macrovascular disease, while maintaining the care of 'less complicated' patients. Re-referral for specialist review was also dependent on the patient remaining under the care of their original doctor. Encouragingly, general practitioners seemed to take a more active role in the non-returned group. They included more details regarding type and duration of diabetes in the referral letters of patients who were not re-referred for specialist review. They also implemented more treatment recommendations in the non-returned group, with the difference in implementation rate for metabolic recommendations reaching statistical significance. This study also showed that movement of patients between doctors raises concern regarding continuity of care. The multi-factorial nature of diabetes means that best practice is not easily accommodated within a single appointment. Thus continuity of care becomes an important issue. To assess the current status, 479 consecutive patients referred to the Royal Prince Alfred Hospital Diabetes Centre in a 6-month period were recruited and underwent a detailed clinical assessment. They were also questioned regarding the number of general practitioners they attended and the length of time they had been under the care of the referring doctor. The results outlined in Chapter 6 showed that the majority of people with diabetes (87.7%) attended only one general practitioner and had been under the care of that doctor medium to long term. Younger patients, who were relatively healthy apart from the presence of diabetes, were more likely to attend several general practitioners or have changed their general practitioner within the last year. This lack of continuity had little difference on acute outcomes such as glycaemic and blood pressure control. Appropriately, continuity of care increased with increasing age and the increasing prevalence of diabetes complications, mainly macrovascular disease. These studies indicate that further efforts are required to improve the overall standard of diabetes care within Australia. At present there is a heavy dependency on specialist services. As the population ages and the number of people with diabetes increases, much of this burden will fall on general practitioners, as is already evident in rural areas. When provided with appropriate support and infrastructure, general practitioners are able to maintain standards of care through referral of patients with more complex medical problems and by maintaining the degree of continuity appropriate to the patient's needs. However, the collection of relevant information to monitor future trends in diabetes services provision is important. As shown in this thesis, Medicare data represents an easy and cost effective method with which to do so.
38
Overland, Jane Elizabeth. "Factors that affect the delivery of diabetes care." University of Sydney. Medicine, 2000. http://hdl.handle.net/2123/365.
Full textAbstract:
Diabetes is emerging as a major threat to health, with global economic and social implications. Recent research has shown that the morbidity and mortality associated with diabetes can be reduced by timely and effective treatment. However, unless people with diabetes have access to this treatment, the impact of diabetes will continue to rise. This thesis therefore explores the current standards of care which people with diabetes receive. It also looks at factors likely to impact on delivery of diabetes care. Studies were conducted at two levels. In the studies described in Chapters 2 and 3, general data applicable to all or nearly all patients with diabetes were collected. This approach substantially eliminates selection bias but precludes the ability to examine clinical outcomes. In the other studies, detailed in Chapters 4, 5 and 6, specific aspects of diabetes care pertaining to more select groups of diabetic subjects were examined. This approach allows clinical parameters to be examined in more detail but is more subject to selection bias. It is hoped that the combination of these two approaches provides a more balanced view of the topic under examination. In Australia, the Medicare Program, a single government controlled universal health insurance fund, provides access to medical services for all residents. Medicare occasions of service data therefore represent the most comprehensive source of information regarding health service utilisation in Australia. The data does not account for people receiving diabetes care through public hospital based services. However, a survey of public hospitals within NSW (n=198), described in Chapter 2, showed that the number of individuals in this category is relatively small and represents only 5.2% of the diabetic population. Using Medicare item codes, and with the permission and assistance of the Commonwealth Department of Health and Aged Care, data were extracted on attendance to medical practitioners and utilisation of diabetes related procedures for people living in New South Wales (NSW) for the individual years between 1993 to 1997. All data were stratified by the presence of diabetes, gender and age group. Individuals were deemed to have diabetes if an HbA1c, which can only be ordered for a person with known diabetes, had been performed over the 5-year period and the sample size adjusted for the incidence of diabetes. Once adjusted, the number of people with diabetes in NSW for the individual years 1993 to 1997 were 143,920, 156,234, 168,216, 177,280 and 185,780. Comparison with 1996 census data confirmed a 91.7% capture of the total NSW population (5,495,900/5,995,545 individuals). The data were retrieved for NSW as a whole and for individual postcodes. Postcodes were then classified by population density as either major urban, urban or rural. On average over the study period, persons with diabetes accounted for 3.1% of the population but they used 5.5% of general practitioner services. As seen in Chapter 2, a large proportion of people with diabetes were also under the care of specialists and consultant physicians, up to 51.2% and 41.8% respectively, a 3 to 4 fold increase when compared with their non-diabetic counterparts. In regard to geographical location, once adjusted for age and gender, the odds ratio of attending a specialist was only slightly higher for people with diabetes living in areas of high population density when compared to people with diabetes living in rural areas. This ratio reached as high as 1.85 in regard to attendance to consultant physicians (Chapter 3). The odds ratio for the non-diabetic population was similar indicating that the difference in access to consultant physicians was not disease specific. Analysis of results showed that despite the increase in service utilisation, large proportions of people with diabetes were not routinely monitored in regard to diabetes and its complications across the State. By 1997, HbA1c was still not performed in over 40% of people with diabetes each year and only 11.6% of the diabetic population had undergone microalbuminuria estimation. Interestingly, the differences in levels of monitoring between rural and urban areas were surprisingly small. Monitoring of diabetes and its complications did improve in all parts of the State over the study period. However, the greatest improvement was seen in rural areas, despite rural patients having fewer attendances to general practitioners and fewer patients attending specialist care. In the face of finite resources and the rising prevalence of diabetes, an increasing number of patients will need to rely on general practitioners to provide diabetes care regardless of where they live. A 'shared care' approach which encourages and supports general practitioners to manage patients with diabetes, while giving them access to specialist services for those patients that require them, is increasingly being advocated as a way of maximising efficacy while minimising costs. Yet if health care professionals leave undone what they think is done by others, shared care can become neglected care. Chapter 4 reports a detailed audit of 200 randomly selected shared care patients who were assessed on two or more occasions. This study showed that the majority of specialist treatment recommendations are implemented by general practitioners. Doctors formally registered with the Diabetes Shared Care Programme and those who write longer referral letters were more likely to implement recommendations than their counterparts. Moreover, the average HbA1c and the complication profile of these patients were similar to those found in various studies around the world. This suggests that diabetes can be well managed by a shared care approach that is adequately integrated. To overcome the problem that data is lacking on those patients that did not return for specialist review, a further 200 shared care patients who were lost to follow up from the shared care system were traced. Information regarding whether treatment recommendations had been implemented was sought from both the referring doctor and the patient. Overall, information on 182 of the 200 patients could be obtained. As discussed in Chapter 5, comparison of the returned and non returned patients' demographic and clinical profiles at time of their initial specialist review showed that general practitioners differentiated between the 'more complicated' patients, choosing to re-refer those with macrovascular disease, while maintaining the care of 'less complicated' patients. Re-referral for specialist review was also dependent on the patient remaining under the care of their original doctor. Encouragingly, general practitioners seemed to take a more active role in the non-returned group. They included more details regarding type and duration of diabetes in the referral letters of patients who were not re-referred for specialist review. They also implemented more treatment recommendations in the non-returned group, with the difference in implementation rate for metabolic recommendations reaching statistical significance. This study also showed that movement of patients between doctors raises concern regarding continuity of care. The multi-factorial nature of diabetes means that best practice is not easily accommodated within a single appointment. Thus continuity of care becomes an important issue. To assess the current status, 479 consecutive patients referred to the Royal Prince Alfred Hospital Diabetes Centre in a 6-month period were recruited and underwent a detailed clinical assessment. They were also questioned regarding the number of general practitioners they attended and the length of time they had been under the care of the referring doctor. The results outlined in Chapter 6 showed that the majority of people with diabetes (87.7%) attended only one general practitioner and had been under the care of that doctor medium to long term. Younger patients, who were relatively healthy apart from the presence of diabetes, were more likely to attend several general practitioners or have changed their general practitioner within the last year. This lack of continuity had little difference on acute outcomes such as glycaemic and blood pressure control. Appropriately, continuity of care increased with increasing age and the increasing prevalence of diabetes complications, mainly macrovascular disease. These studies indicate that further efforts are required to improve the overall standard of diabetes care within Australia. At present there is a heavy dependency on specialist services. As the population ages and the number of people with diabetes increases, much of this burden will fall on general practitioners, as is already evident in rural areas. When provided with appropriate support and infrastructure, general practitioners are able to maintain standards of care through referral of patients with more complex medical problems and by maintaining the degree of continuity appropriate to the patient's needs. However, the collection of relevant information to monitor future trends in diabetes services provision is important. As shown in this thesis, Medicare data represents an easy and cost effective method with which to do so.
39
Nguyen, Mai Phuong. "Contribution of private healthcare to universal health coverage: an investigation of private over public health service utilisation in Vietnam." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/225903/1/Mai%20Phuong_Nguyen_Thesis.pdf.
Full textAbstract:
Achievement of Universal Health Coverage (UHC) is a desirable goal for all countries. Complementary public and private services are essential. This study examined factors that influence consumer choice for private and public health care services in Vietnam. Thirty senior healthcare professionals were interviewed and secondary data on over 35,000 episodes of healthcare gathered during national health surveys in households were analyzed. For Vietnam and similar low and middle-income countries to achieve UHC, it is necessary to overcome incomplete social health insurance coverage, variable quality of private and public health services, unregulated quality in advertising and inefficient competition between sectors.
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Devaux, Caroline. "Résilience des services écosystémiques à l’échelle du paysage : un cadre conceptuel et une analyse pour un socio-écosystème de montagne." Thesis, Université Grenoble Alpes (ComUE), 2016. http://www.theses.fr/2016GREAV002/document.
Full textAbstract:
L’intérêt que porte la communauté scientifique ainsi que politique aux les services écosystémiques et à leur résilience face aux changements globaux (environnementaux ou sociétaux) en cours est grandissant, ce qui se reflète par le nombre d’études à ce sujet, le rapport d’évaluation des écosystèmes pour le millénaire et la mise en place d’un groupe de travail sur la résilience (« Resilience Alliance »). Les définitions de la résilience sont elles aussi très variées, avec des concepts tels que la résistance, la résilience spécifique (« de quoi à quoi ? »), la résilience générale, l’adaptabilité et la transformabilité, que nous nous sommes appropriés dans le but de développer un cadre conceptuel et méthodologique pour étudier la résilience de la fourniture de services écosystémiques, en particulier dans le but de comparer les potentiels de résilience des différents types de prairies subalpines du col du Lautaret (Hautes-Alpes, France) pour un ensemble de services sélectionnés. Nous avons proposé deux approches pour évaluer les potentiels de résilience des différents états dans lequel peut se trouver un socio-écosystème, en considérant la résilience comme la capacité d’un système à maintenir une fourniture stable de services écosystémiques (composante résistance) mais aussi sa capacité à l’adapter (différentes composantes selon le degré d’adaptation : résilience, transition, transformation). Une première étape d’évaluation d’un ensemble de services d’intérêt sur la zone d’étude est suivie d’une première analyse de la résilience de chacun de ces services spécifiquement, basée sur l’évaluation de « gammes opérationnelles » pour chaque service, définies comme les gammes de valeurs que peut prendre le dit service dans un état donné du socio-écosystème. L’échelle organisationnelle à laquelle ces gammes sont évaluées les relie aux différentes composantes de la résilience. Les résultats confirment l’intérêt de s’intéresser à la résilience spécifique de chaque service, car leur profil de résilience sont différents, c’est-à-dire que les prairies aux plus forts potentiels ne sont pas les même d’un site à l’autre, bien que dans tous les cas les potentiels de résilience soient plutôt forts, au contraire des autres potentiels.La deuxième analyse part de l’hypothèse théorique que la diversité des traits de réponse (hétérogénéité et redondance) améliore la résilience. Nous avons fait l’hypothèse que, lorsque les traits de réponse sont ceux utilisés pour modéliser les services écosystémiques, la diversité fonctionnelle d’une communauté végétale peut-être reliée à sa résilience générale en termes de services écosystémiques. Nous avons relié plusieurs mesures de la diversité fonctionnelle aux potentiels de résilience (entropie et diversité fonctionnelle dans leur dimension α et β, redondance et complémentarité des groupes fonctionnels). Cependant, les résultats obtenus par l’analyse des prairies du Lautaret nous amènent à réfuter l’hypothèse proposant que la diversité fonctionnelle des communautés végétales permet d’expliquer le profil de résilience des services écosystémiques analysés, car ils ne concordent pas avec les profils de résilience trouvés par l’approche des gammes opérationnelles. Au final, nous préconisons d’utiliser l’approche des gammes opérationnelles, qui permet de connaître le profil de résilience de chaque service, dans le cadre d’étude portant sur la capacité d’un socio-écosystème à maintenir la fourniture de ses services écosystémiques. Cette approche peut de plus être enrichie d’une approche de scénarisation qui permettrait de déterminer « à quoi » la fourniture de chaque service est résilienteAs evidenced by the number of studies on the subject, the recent millennium ecosystem assessment and the establishment of a working group on resilience (« Resilience Alliance »), the interest of the scientific community in ecosystem services and their resilience in the face of global change (environmental or social) is steadily increasing. Definitions of resilience are highly varied, and we used concepts such as resistance, specific resilience (« of what to what ? »), generalised resilience, adaptability and transformability to develop a conceptual and methodological framework to study the resilience of ecosystem service provision. This conceptual framework was applied to compare the potential resilience of differing sub-alpine grasslands types in three local government areas in the area of the Col du Lautaret (Hautes-Alpes, France) for a number of locally and regionally important ecosystem services. We proposed two approaches for evaluating the potential resilience of the different states in which a socio-ecosystem can exist, by considering resilience as the capacity of a system to maintain a stable provision of an ecosystem service (resistance component), as well as its capacity to adapt this provision if needed (components of resilience, transition, transformation depending on the degree of adaptation). A first stage of the quantification of ecosystem services was followed by an initial analysis of each of these services via the evaluation of their « operating ranges », defined as the range of values that a service can take given a particular state of the socio-ecosystem. The organizational scale at which these ranges are evaluated links them to other components of resilience. Our results confirm the utility of considering the specific resilience of each service, as the profiles of their resistance are different. In particular, the types of grasslands with the highest resilience component potential are not the same from one site to another, even though in all cases these resilience component potentials are rather high as compared to other components potentials. The second analysis is based on the theoretical hypothesis that it is the increasing diversity of response traits (heterogeneity and redundancy) which increases resistance. We hypothesised that, when it is response traits that have been used to model ecosystem services, the functional diversity of a plant community can be linked to its overall resistance in terms of ecosystem services. We linked a number of measures of functional diversity to resilience potential, including the α and β dimensions of entropy and functional diversity, and the redundancy and complementarity of functional groups. The obtained results for the grasslands at Lautaret lead us to reject the hypothesis which proposes that the functional diversity of plant communities can be used to predict the patterns of resilience of the analysed ecosystem services, as these do not correspond to the patterns of resistance obtained from the approach using operating ranges. Finally, we suggest that to assess the capacity of a socio-ecosystem to maintain the provision of ecosystem services, our approach using operating ranges is preferable as it allows for the quantification of the resistance profile of each service. This approach could be further developed using scenario building so as to determine « to what » the provision of each service is resistant
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Plamping, Diane. "Increasing access and utilisation : a study of a school-based mobile dental service in a sample of primary schools." Thesis, King's College London (University of London), 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339950.
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Mercier-Méthé, Laurence. "Motifs de non-utilisation des services et programmes par les proches aidants de personnes atteintes de démence." Thesis, Université Laval, 2012. http://www.theses.ulaval.ca/2012/29218/29218.pdf.
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Visser, Elizna. "Die benutting van lewenskaarte as hulpmiddel in pleegsorg dienslewering / E. Visser." Thesis, North-West University, 2008. http://hdl.handle.net/10394/4446.
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THE UTILISATION OF LIFE MAPS AS AN AID IN FOSTER CARE SERVICE DELIVERY.
During the past few years there has been a significant increase in foster care
service delivery, partially due to the HIV and AIDS pandemic. More children
need to be placed in foster care, and family placements become an only option in
many cases. Due to this shift in foster care placements permanency planning
has become an important part of foster care services.
Thus, this study has focused on the development of guidelines by using a concept
model with the focus on life maps in order to facilitate and structure the foster care process.Thesis (M.A. (MW))--North-West University, Potchefstroom Campus, 2009.
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Rosier, Bruno. "Utilisation des immunoglobulines polyvalentes intraveineuses dans un service de médecine interne de 1982 à 1992 : à propos de 60 cas." Bordeaux 2, 1994. http://www.theses.fr/1994BOR2M138.
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Awal, Mohammad abdul. "Efficient cqi feedback resource utilisation for multi-user multi-carrier wireless systems." Thesis, Paris 11, 2011. http://www.theses.fr/2011PA112223/document.
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La technologie OFDMA (Orthogonal frequency division multiple access) a été adoptée par les systèmes de télécommunications de 4ème génération (4G) comme technique de transmission et d'accès multiple pour ses performances supérieures en termes d'efficacité spectrale. Dans ce type de systèmes, l'adaptation dynamique du débit en fonction de la qualité du canal CQI (Channel Quality Indicator) constitue une problématique de recherche d'actualité qui attire l'attention de plusieurs acteurs académiques et industriels. Ce problème d'adaptation dynamique est encore plus complexe à gérer dans des environnements multi-utilisateurs hétérogènes et à ressources limitées tels que les systèmes OFDMA comme WiMAX Mobile et Long-term Evolution (LTE). Dans cette thèse, nous nous intéressons au problème d'allocation de ressources de l'information de feedback relative au CQI dans le cadre de systèmes OFDMA multi-porteuses multi-utilisateurs. Dans le but de réduire la charge (overhead) du feedback, nous proposons une méthode de prédiction du CQI basée sur l'exploitation de la corrélation temporelle de ce dernier et d'une solution inter-couches. L'objectif est de trouver des schémas d'allocation de ressources adaptatifs respectant les contraintes de qualité de service (QoS) applicatives.Nous proposons en premier lieu un algorithme de réduction de feedback PBF (Prediction Based Feedack) qui permet à la station de base (BS) à prédire certaines occurrences du CQI en se basant sur l'algorithme des moindres carrés récursif RLS (Recursive least-square). Les résultats de simulation montrent que l'outil de prédiction du CQI réduit sensiblement l'overhead du feedback et améliore par conséquent le débit de la liaison montante. Nous proposons, par la suite, une version opportuniste de PBF pour atténuer les éventuels effets de sur et sous estimations liées à l'algorithme de prédiction. Dans ce mécanisme, nous exploitons les informations inter-couches pour améliorer les performances des mécanismes de feedbacks périodiques dont PBF fait partie. L'approche opportuniste améliore sensiblement les performances du système pour les cas de mobilité élevée comparés aux cas de faible mobilité.Dans un second temps, nous proposons une plateforme (FEREP : feedback resource allocation and prediction) basée sur une approche inter-couches. Implémentée au niveau de la station BS, FEREP intègre les fonctionnalités de prédiction, d'adaptation dynamique du CQI et d'ordonnancement des demandes de feedback. Elle comporte trois modules. Le module FWA (feedback window adaptation) gère dynamiquement la fenêtre de feedbacks de chaque station mobile (MS) en se basant sur les messages ARQ (Automatic Repeat Request) reçus qui reflètent l'état actuel des canaux respectifs. Le module PBFS (priority-based feedback scheduling) effectue ensuite l'ordonnancement des feedbacks en tenant compte de la taille de la fenêtre de feedback, du profil de l'utilisateur sous la contrainte de la limitation des ressources globales du systèmes réservées au feedback. Afin de choisir les paramètres de transmission MCS (modulation and coding schemes), le module PBF (prediction based feedback) est utilisé pour les utilisateurs dont le feedabck n'a pas pu être ordonnancé dans la trame courante. Les résultats de simulation ont montré un gain significatif des performances de FREREP en comparaison à un mécanisme de référence, en particulier, sous de fortes contraintes de limitation des ressources du feedback.Le protocole ARQ génère un accusé de réception uniquement si l'utilisateur est sélectionné par l'ordonnanceur pour envoyer des données sur la liaison descendante. Dans le cas où la fréquence d'ordonnancement des utilisateurs sur le lien descendant est réduite, les messages ARQ s'en trouvent également réduits, dégradant par conséquent les performances de la plateforme FEREP proposée ci-dessus. En effet, dans ce cas la signalisation ARQ devient insuffisante pour adapter efficacement la fenêtre de feedback de chaque utilisateur. Pour pallier à ce problème, nous proposons l'algorithme DCRA (dynamic CQI resource allocation) qui utilise deux modes d'estimation de la fenêtre de feedback. Le premier est un mode hors-ligne basé sur des études empiriques permettant d'estimer la fenêtre moyenne optimale de feedback en utilisant les profils applicatif et de mobilité de l'utilisateur. Notre analyse de performance par simulation montre que la fenêtre de feedback peut être estimée en fonction de la classe de service des utilisateurs et de leurs profils de mobilité pour un environnement cellulaire donné. Le second mode de fonctionnement de DCRA effectue une adaptation dynamique de la fenêtre en temps réel dans le cas où la signalisation ARQ est suffisante. Une étude comparative avec les mécanismes DFS (deterministic feedback scheduling) et OFS (opportunistic feedback scheduling), a montré que DCRA arrive à réaliser un meilleur gain en ressources montantes grâce à la réduction de l'overhead des feedbacks, sans pour autant trop dégrader le débit descendant des utilisateurs. Du point de vue des utilisateurs, DCRA améliore les contraintes de QoS tels que le taux de perte de paquets et réduit la consommation énergétique des terminaux grâce à la réduction de feedbackOrthogonal frequency division multiple access (OFDMA) technology has been adopted by 4th generation (a.k.a. 4G) telecommunication systems to achieve high system spectral efficiency. A crucial research issue is how to design adaptive channel quality indicator (CQI) feedback mechanisms so that the base station can use adaptive modulation and coding (AMC) techniques to adjust its data rate based on the channel condition. This problem is even more challenging in resource-limited and heterogeneous multiuser environments such as Mobile WiMAX, Long-term Evolution (LTE) networks. In this thesis, we consider CQI feedback resource allocation issue for multiuser multicarrier OFDMA systems. We exploit time-domain correlation for CQI prediction and cross-layer information to reduce feedback overhead for OFDMA systems. Our aim is find resource allocation schemes respecting the users QoS constraints.Our study begins with proposing prediction based feedback (PBF) which allows the base station to predict the CQI feedbacks based on recursive least-square (RLS) algorithm. We showed that it is useful to use channel prediction as a tool to reduce the feedback overhead and improve the uplink throughput. Then, we propose an opportunistic periodic feedback mechanism to mitigate the possible under and over estimation effects of CQI prediction. In this mechanism, we exploited the cross-layer information to enhance the performance of periodic feedback mechanisms. The opportunistic mechanism improves the system performance for high mobility cases compared to low mobility cases.For OFDMA systems with limited feedback resource, we propose an integrated cross-layer framework of feedback resource allocation and prediction (FEREP). The proposed framework, implemented at the BS side, is composed of three modules. The feedback window adaptation (FWA) module dynamically tunes the feedback window size for each mobile station based on the received ARQ (Automatic Repeat Request) messages that reflect the current channel condition. The priority-based feedback scheduling (PBFS) module then performs feedback allocation by taking into account the feedback window size, the user profile and the total system feedback budget. To choose adapted modulation and coding schemes (MCS), the prediction based feedback (PBF) module performs channel prediction by using recursive least square (RLS) algorithm for the user whose channel feedback has not been granted for schedule in current frame. Through extensive simulations, the proposed framework shows significant performance gain especially under stringent feedback budget constraint.ARQ protocol receives users acknowledgement only if the user is scheduled in the downlink. The reduction in users scheduling frequency also reduces the rate of ARQ hints and degrades the performance of above contributions. In this case, it is difficult to exploit the ARQ signal to adapt the feedback window for that user. To address this issue, we propose a cross-layer dynamic CQI resource allocation (DCRA) algorithm for multiuser multicarrier OFDMA systems. DCRA uses two modes for feedback window estimation. The first one is an off-line mode based on empirical studies to derive optimal average feedback window based on user application and mobility profile. Our experimental analysis shows that the feedback window can be averaged according to users service class and their mobility profile for a given cell environment. DCRA performs a realtime dynamic window adaptation if sufficient cross-layer hints are available from ARQ signaling. DCRA increases uplink resource by reducing feedback overhead without degrading downlink throughout significantly compared to deterministic feedback scheduling (DFS) and opportunistic feedback scheduling (OFS). From the users perspective, DCRA improves QoS constraints like packet loss rate and saves users power due to feedback reduction
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Rentsch, C. T. "Point-of-contact interactive record linkage between demographic surveillance and health facilities to measure patterns of HIV service utilisation in Tanzania." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2018. http://researchonline.lshtm.ac.uk/4650292/.
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As significant investments and efforts have been made to strengthen HIV prevention and care service provisions throughout sub-Saharan Africa, approaches to monitoring uptake of these services have grown in importance. Global HIV/AIDS organisations use routinely updated estimates of the UNAIDS 90-90-90 targets, which state by 2020, 90% of all people living with HIV (PLHIV) should be diagnosed, 90% of diagnosed PLHIV should be receiving treatment, and 90% of PLHIV receiving treatment should achieve viral suppression. Currently, estimates of these targets in sub-Saharan Africa use population based demographic and HIV serological surveillance systems, which comprehensively measure vital events and HIV status but rely on self-reports of health service use. In contrast, most analyses of health service use are limited to patients already diagnosed and enrolled into clinical care and lack a population perspective. This thesis aims to augment existing computer software towards a novel approach to record linkage - termed point-of-contact interactive record linkage (PIRL) - and produce an infrastructure of linked surveillance data and medical records from clinics located within a surveillance area in northwest Tanzania. The linked data are then used to investigate methodological and substantive research questions. Paper A details the PIRL software that was used to collect the data for this thesis. Paper B reviews the data created by PIRL and reports record linkage statistics, including match percentages and attributes associated with (un)successful linkage. A subset of personal identifiers was found to drive the success of the probabilistic linkage algorithm, and PIRL was shown to outperform a fully automated linkage approach. Paper C provides original evidence measuring bias and precision in analyses of linked data with substantial linkage errors. Paper D critiques the estimation of the first 90-90-90 target and shows that current guidelines may underestimate the percentage diagnosed by a relative factor of between 10% and 20%. Finally, Paper E determines that while HIV serological surveillance has increased testing coverage, PLHIV who were diagnosed for HIV in a facility-based clinic were statistically significantly more likely to register for HIV care than those diagnosed at village-level temporary clinics during a surveillance round. Once individuals were in care, there was no evidence of any further delays to treatment initiation by testing modality. The collective findings of this thesis demonstrate the feasibility of PIRL to link community and medical records and use the linked data to measure patterns of HIV service use in a population.
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Mouhamed, Souad. "Dévelopement et évaluation d'un logiciel d'imagerie médicale, implante sur une station de travail, pour une utilisation dans un service de pneumologie." Lyon, INSA, 1994. http://www.theses.fr/1994ISAL0090.
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Les opérations, de manipulation d'images et d'accès aux informations, telles qu'elles sont pratiquées dans un hôpital sont d'une nature manuelle. Les médecins consacrent ainsi une part non négligeable de leur travail à la recherche et à la manipulation des informations médicales. L'intégration et l'adaptation d'une station de travail aux différentes tâches du clinicien se présentent comme des solutions d'avenir. L'informatisation des, tâches médicales offre des nouvelles perspectives, comme le traitement d'images. Cette étude concerne la conception et la réalisation d'un logiciel médical permettant la visualisation et le traitement interactif d'images médicales multi-modalités. Ce logiciel est implanté sur une station de travail chimique destinée à être intégrée au sein d'un PACS. Nos objectifs dans la conception ont été dirigés de sorte que la méthodologie de travail et les besoins du clinicien soient en priorité respectés. Ainsi, le logiciel dispose de fonctionnalités pour sélectionner, visualiser, traiter les images dans le but d'aider le clinicien à établir son diagnostic. Nous avons utilisé une méthode de conception s'appuyant sur une décomposition fonctionnelle qui conduit à un découpage du logiciel en modules. Ces modules coïncident avec les différentes étapes de travail du clinicien et réalisent chacun une unité fonctionnelle séparée. L'interface homme-machine qui constitue le lien privilégié entre l'utilisateur et le système a été développée avec une grande attention. De ce fait, le logiciel de par sa convivialité et son ergonomie est utilisable par des usagers non-informaticiens. L'évaluation du logiciel en site hospitalier et avec des experts médicaux a confirmé la demande des médecins pour ce type de logiciel, et a souligné leur motivation à travailler avec un tel logicielIn a hospital, the tasks of information retrieval and image manipulations are generally manual. Physicians spend an important part of their work to search and handle of medical information. The integration and the adaptation of a workstation to different tasks of the clinician appear as a good. Solution. The automatisation of these tasks open new perspectives to physicians such as image processing. This study is devoted to the design and the realization of a software allowing interactive visualization and processing of multi modalities medical images. This software is implemented on a workstation which is intended to be integrated in a PACS. Ours goals in the conception have primarily been to respect the methodology and the needs of the clinicians. Thus, the software provides functionalities for selection, visualization, and processing the images in order to help the clinician to establish his diagnosis. We used a functional decomposition method which lead to a division of the software in modules. This modules are defined from the decomposition of the working method of the clinician, and are independent from each others. The user interface which constitutes a privileged connection between the user and the system has been developed with particular attention. Due to his conviviality and its ergonomy, the software is us able by non-computer-oriented users. The evaluation of the software by medical experts on the hospital site has confirmed the call of the physicians for this type of tool, and has emphasized their motivation for working with such a software
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Nguyen, Bich Lien. "Expérience de soins de patients aînés atteints de cancer à l’urgence." Mémoire, Université de Sherbrooke, 2016. http://hdl.handle.net/11143/8182.
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Résumé: Introduction: Cette étude s’intéresse à l’expérience de soins de patients aînés de 70 ans et plus atteints de cancer entourant une visite à l’urgence. Elle repose sur plusieurs résultats d’études démontrant que ces personnes présentent des besoins spécifiques non comblés, les amenant à utiliser les services d’urgence pour y répondre. Peu d’études se sont intéressées à leur expérience de soins et encore plus rarement dans le contexte d’une visite à l’urgence. But : Mieux comprendre l’expérience de soins des patients aînés atteints de cancer entourant une visite à l’urgence. Cette étude comprend quatre objectifs soit : 1) établir le profil des patients de 70 ans et plus ayant consulté l’urgence pour un problème lié à leur cancer dans les 12 mois précédant l’étude; 2) identifier les raisons et les facteurs amenant ces patients à consulter les services d’urgence; 3) identifier les stratégies de coping utilisées avant d’aller à l’urgence et 4) décrire l’expérience de soins de ces patients à l’urgence. Méthode: Une étude à devis mixte simultané a été entreprise. Une analyse descriptive des bases de données administratives a été réalisée pour documenter le profil sociodémographique, clinique et l'utilisation des services des patients aînés atteints de cancer de 70 ans et plus qui ont visité l'urgence d'un centre hospitalier au Québec, le Canada (n = 792, Objectifs 1-2). Ensuite, des entrevues semi-structurées ont suivi (n = 11) et ont été analysées par une analyse de contenu en profondeur (Objectifs 2, 3, & 4). Résultats: Un total de 792 patients aînés atteints de cancer ont visité l'urgence pour un total de 1572 visites. Les raisons de consultation les plus fréquentes étaient de nature respiratoire (15,8%), digestive (13,4%) et les troubles cardiovasculaires (8,2%). Plus de la moitié des visites était réalisée de jour. L’anxiété, les problèmes d’accessibilité et la détérioration importante de la santé étaient des facteurs qui influençaient le recours aux services d’urgence. Les patients ont été en mesure de déployer une multitude de stratégies de coping pour faire face à leurs problèmes de santé. Par ailleurs, l’expérience de soins est un processus unique, vécu de manière très individuelle. Conclusion: Cette étude décrit l’expérience de soins de patients aînés atteints de cancer à l’urgence et souligne plusieurs domaines d’amélioration des services en périphérie de l’urgence, mais aussi au sein même du service d’urgence.Abstract: Introduction: Older cancer patients are known to have specific unmet needs due to the complexity of their health care, leading them to use emergency services. However, it is known that emergency rooms are not well-suited to the needs of the elderly. Few studies have focused on the health care experience of older cancer patients and even less so in the context of emergency room (ER) visits. Purpose: This study aims to better understand the experience of older cancer patients in the context of ER visits for unexpected health deterioration related to cancer. We sought to: 1) establish the profile of patients aged 70 years and older who made ER visits for problems related to their cancer in the 12 months preceding the study; 2) identify the reasons and factors that motivate older patients with cancer to make ER visits; 3) identify coping strategies used by older cancer patients prior to ER visits; and 4) describe the health care experience of older cancer patients in the context of ER visits. Methods: A concurrent mixed-method design was used. Descriptive analysis of administrative databases was first conducted to document the socio-demographic, clinical, and service utilization profile of elderly cancer patients aged 70 years and older who visited the ER of a hospital in Québec, Canada (n = 792, Objectives 1-2). Semi-structured interviews were subsequently conducted (n = 11) and then analysed using in-depth content analysis (Objectives 2, 3, & 4). Results: The sample of 792 older cancer patients made a total of 1,572 ER visits. The most frequent medical reasons for ER visits were respiratory (15.8%) and digestive (13.4%) concerns, and cardiovascular conditions (8.2%). Content analysis of the qualitative data suggested that older cancer patients made most of the ER visits when experiencing high levels of anxiety, when other cancer care services were unavailable, or because of a serious life-threatening health condition. Patients were able to use a variety of coping strategies to deal with health issues. Furthermore, the care process is experienced uniquely for each individual. Conclusion: This study describes the health care experience of older cancer patients in the context of ER visits and suggests areas of improvement both outside of and within emergency services.
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Koopu, Pauline Irihaere, and n/a. "Kia pakari mai nga niho : oral health outcomes, self-report oral health measures and oral health service utilisation among Maori and non-Maori." University of Otago. School of Dentistry, 2005. http://adt.otago.ac.nz./public/adt-NZDU20070502.152634.
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Health is determined by the past as well as the present; the health status of indigenous peoples has been strongly influnced by the experience of colonisation and their subsequent efforts to participate as minorities in contemporary society while retaining their own ethnic and cultural identities. Colonial journays may have led to innovation and adaptation for Maori, but they have also created pain and suffering from which full recovery has yet to be felt (Durie, 2001).
The oral health area can be described as having considerable and unacceptable disparities between Maori and non-Maori (Broughton 1995; Thomson, Ayers and Broughton 2003). Few reports have been conducted concerning Maori and patterns of oral health service utilisation, however a lower service utilisation among Maori than non-Maori has been noted (TPK 1996; Broughton and Koopu 1996). Overall, Maori oral health is largely unknown due to a paucity of appropriate research.
This research aims to provide new information by describing Maori oral health outcomes over the life course, within a Kaupapa Maori Research (KMR) methodology. In general, the basic tenets presented for KMR are: (1) to prioritise Maori - from the margin to the centre; (2) to be Maori controlled - by Maori, for Maori; (3) to reject �victim-blame� theories; and (4) to be a step towards action and change in order to improve Maori oral health outcomes.
The aims of this research are to:
1. Describe the occurrence of caris at ages 5, 15, 18 and 26 and periodontal disease at age 26 years for Maori.
2. Describe self-reported oral health, self-reported dental aesthetics and oral health service utilisation among Maori at ages 5, 15, 18 and 26.
3. Compare the above oral health characteristics between Maori and non-Maori .
4. Investigate the determinants of any differences in oral health outcomes between Māori and non-Maori using a KMR methodology.
The investigation involves a secondary analysis of data from the Dunedin multidisciplinary Health and Development study (DMHDS). The existing data-set was statistically analysed using SPSS (SPSS Inc, Chicago, USA). Descriptive statistics were generated. The levels of statistical significance were set at P< 0.05. Chi-square tests were used to compare proportions and independent sample t-tests or ANOVA were used for comparing means.
A summary of the Maori/non-Maori analysis shows that, for a cohort of New Zealanders followed over their life-course, the oral health features of caries prevalence, caries severity, and periodonal disease prevalence are higher among Maori compared to non-Maori. In particular, it appears that while Maori females did not always have the highest prevalence of dental caries, this group most often had a higher dmfs/DMFS for dental caries, compared to non-Maori. As adolescents and adults, self-reported results of oral health and dental appearance indicate that Maori males were more likely to report below average oral health and below average dental appearance, when compared to non-Maori. However, at age 26, non-Maori males made up the highest proportion of episodic users of oral health services.
This study has a number of health implications: these relate specifically to the management of dental caries, the access to oral health services, and Maori oral health and the elimination of disparities. These are multi-levelled and have implications for health services across the continuum of care from child to adult services; they also have public health implications that involve preventive measures and the broader determinants of health; and involve KMR principles than can be applied to oral health interventions and dental health research in general.
Dental diseases and oral health outcomes, such as dental anxiety and episodic use of services, are a common problem in a cohort of New Zealanders with results demonstrating ethnic disparities between Maori and on-Maori. As an area of dentistry that has had very little research in New Zealand, the findings of this study provide important information with which to help plan for population needs.
The KMR approach prioritises Maori and specifically seeks to address Maori oral health needs and the elimination of disparities in oral health outcomes. While the issues that are raised may be seen as the more difficult to address, they are also more likely to achieve oral health gains for Maori and contribute to the elimination of disparities.
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Lefebvre-Poirette, Armelle. "Utilisation des herbes médicinales dans les hépatopathies chroniques : étude prospective chez 411 patients vus consécutivement en consultation dans le service d'Hépatogastroentérologie de Montpellier." Montpellier 1, 2000. http://www.theses.fr/2000MON11141.
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