Tesis sobre el tema "General practice"
Siga este enlace para ver otros tipos de publicaciones sobre el tema: General practice.
Crea una cita precisa en los estilos APA, MLA, Chicago, Harvard y otros
Consulte los 50 mejores tesis para su investigación sobre el tema "General practice".
Junto a cada fuente en la lista de referencias hay un botón "Agregar a la bibliografía". Pulsa este botón, y generaremos automáticamente la referencia bibliográfica para la obra elegida en el estilo de cita que necesites: APA, MLA, Harvard, Vancouver, Chicago, etc.
También puede descargar el texto completo de la publicación académica en formato pdf y leer en línea su resumen siempre que esté disponible en los metadatos.
Explore tesis sobre una amplia variedad de disciplinas y organice su bibliografía correctamente.
1
Rees, Sharon. "The role of nurses in general practice: general practitioners' and practice nurses' perceptions". University of Southern Queensland, Faculty of Sciences, 2004. http://eprints.usq.edu.au/archive/00001489/.
Texto completoResumen
The role of nurses in general practice: General Practitioners' and Practice Nurses' perceptions is a study that identifies the beliefs of Practice Nurses (PNs) and General Practitioners (GPs) of the PN role and how those roles impact on the general practice. Ethnographic techniquess were used for this study, with data collected through interviews, observation and questionnaires. Interviews were conducted with four PNs and four GPs in practices that employed nurses in an increased role similar to that described in the Nursing in General Practice Fact Sheets (Royal College of Nursing Australia, 2002). Two practices were observed to identify work practices and the nurses' interaction within the practice. The main finding of the study was the importance placed on the general practice team. Both GPs and PNs believed that working as a team was vital. They indicated that working together provided holistic care and enabled the practice to provide quality care. The role of the PN in this study was consistent with other studies in Australia. However, the nurses in this study appeared to have more autonomy in regard to care of people with chronic illness and the aged. Continuing education was considered important for the further development of the PN role. However, participants believed that the PN also needed to have considerable and varied experience together with good people skills. To further develop the PN role innovative ways of providing education to PNs should be investigated to ensure nurses have the necessary skills to undertake their role. Payment issues in general practice should also be examined and addressed to ensure that PNs are able to be employed, and receive remuneration appropriate for their experience and job description.
2
Gallagher, Morris. "Access to general practice : a qualitative study of appointment making in general practice". Thesis, University of Newcastle Upon Tyne, 2003. http://hdl.handle.net/10443/538.
Texto completoResumen
The aim of this thesis was to observe appointment negotiations in general practice, and investigate patients' and receptionists' experiences of appointment making. Improving access to health care is a National Health Service priority. These priorities are manifest when patients' request an appointment to see their GP. This study was conducted in three general practices on Tyneside: a singlehanded practice; a three doctor practice; and a seven-doctor practice. Two methods were used, participant observation, consisting of observing and recording practice activities and observations with informal interviews, and long interviews with patients and professionals. Activity recordings and observations were conducted in waiting rooms, behind reception counters, and in other settings. There were 35 activity recordings and 34 periods of observation. Thirty-eight patients and 15 professionals were interviewed. Participants were selected by theoretical sampling. These included 12 short interviews with patients attending an 'open access'surgery. Six groups of patients (23) and 15 professionals were selected for long interview. These included patients who complained about appointment making or who complimented the receptionists. Transcripts of observations and interviews were analysed by theoretical coding and data display to identify concepts and categories of data. Several methods were used to enhance the research's quality. Outcomes from appointment negotiations are influenced by patient's illness behaviour, the process of negotiation, and appointment availability. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Receptionists also work outside 'official' practice rules to manage limited appointment availability. These strategies include 'fitting patients in, ' reserving appointments, referring to other professionals and using advocates to support their actions. Patients volunteer information to provide evidence that their complaint is appropriate, and employ strategies, such as assertiveness, and threats, to try and obtain appointments. Receptionists have a crucial role in managing patient access that remains unacknowledged by policy makers.
3
Checkland, Katherine Harriet. "Understanding general practice : an exploration of bureaucratic initiatives in general practices in the UK". Thesis, University of Manchester, 2005. http://www.manchester.ac.uk/escholar/uk-ac-man-scw:67596.
Texto completoResumen
It is the argument of this thesis that there has been a move in the UK away from a model of medical practice based upon individual clinical experience towards one based upon the distillation of scientific evidence into bureaucratic guidelines that practitioners are expected to follow (scientific-bureaucratic medicine). National Service Frameworks and the quality framework of the new General Medical Services Contract introduced in general practice in the UK in 2004 are both exemplars of this, and this study set out to investigate the impact of these changes in general practices. The literature relating to the implementation of changes such as these suggests that the success or failure of implementation depends to a large extent upon the context involved, and this study was designed to investigate in detail the context that is UK general practice. A decision was made to take a theoretical view of general practices as small organisations, and the organisational studies literature was used to derive a theoretical framework to underpin the work. This framework uses the work of Weick, Vickers, Katz and Kahn and Checkland to understand the nature of organisations, taking a view that activity within organisations emerges from the (often unconscious) "sensemaking" undertaken by the organisation members. Using this theoretical framework, an iterative programme of qualitative case study research was undertaken, revisiting and elaborating upon the theoretical framework in the light of the results from each case. Data was collected by observation as well as at interview, and focused upon the roles that were occupied by the practice members, the nature of their decision making processes and their reactions (both practical and theoretical) to the initiatives being studied. The cases were analysed thematically, guided by the theoretical framework. These case studies demonstrated that the ideal of rationality that underpins the move towards scientific bureaucratic medicine is not one that has resonance for these practices. Behaviour in response to the initiatives studied could be best understood in terms of the collective sensemaking of those involved. The factors underpinning this sensemaking in the practices studied were explored, and out of this a conceptual model of the processes that take place within general practices in response to external change was developed. In addition, it was found that rather than responding as professionals whose autonomy was threatened by these "top down" initiatives, participants' behaviour could be more clearly understood as the response of "workers" who are seeking to make sense of their working lives. Finally, these detailed case studies demonstrated that the idea that general practitioners, as independent contractors to the NHS, hold all the power in their practices is not sustainable in all cases. These findings suggest that the implementation of change in general practice will only be successful if those seeking to bring about this change are aware of and take into account the micro-context involved. If this is the case, then not only should local implementation teams be prepared to work with practices in ways that are congruent with their internal realities, but also those making national policy should be aware that top-down initiatives will be interpreted by those on the ground in the light of these internal realities and as a result it is unlikely that "rational" implementation will occur.
4
Beilby, Justin J. "Fundholding in Australian general practice /". Title page, table of contents and abstract only, 1998. http://web4.library.adelaide.edu.au/theses/09MD/09mdb422.pdf.
Texto completo
5
Senore, Carlo. "Smoking cessation in general practice". Thesis, McGill University, 1994. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=22803.
Texto completoResumen
Available evidence from RCTs shows that GPs' counselling can be effective in reducing smoking prevalence and that some specific features of the intervention (for example the offer of follow-up visits) may enhance its effectiveness. The impact of such preventive activity, however, is dependent not only on intervention characteristics, but also on factors related to the recipients (smokers) and the providers (physicians). Paper 1 explores the role of pre-treatment factors in predicting quitting following GPs' counselling among 861 smokers enrolled in the Turin smoking cessation trial. Social support and smoke free environment reinforce the impact of GPs' counselling, which is less effective for more addicted smokers and for women. Counselling might be more effective, if GPs would take advantage of information on individuals' experience of behavioral change to tailor their message. Paper 2 compares a group of smokers (N = 965), who were invited to participate in the Turin smoking 1 cessation trial, to a matched sample of smokers (N = 277), listed in the files of 42 GPs collaborating in the trial. The patients in the second set were potentially eligible for recruitment, but were not invited to participate. Estimates of the effect of individual characteristics on patient recruitment indicate that GPs focused their efforts on heavier and diseased smokers. As this tendency may dilute the impact of their anti-smoking action, more effective educational strategies should be implemented when planning preventive interventions.
6
Jelley, Diana Mary. "Peer appraisal in general practice". Thesis, University of Newcastle Upon Tyne, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.366581.
Texto completo
7
McEwen, Andy. "Smoking cessation in general practice". Thesis, St George's, University of London, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.422431.
Texto completo
8
Havelock, Christine Margaret. "Cervical screening in general practice". Thesis, Imperial College London, 1991. http://hdl.handle.net/10044/1/46809.
Texto completo
9
Frese, Thomas, Jarmila Mahlmeister, Maximilian Heitzer y Hagen Sandholzer. "Chest pain in general practice". Universitätsbibliothek Leipzig, 2016. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-206317.
Texto completoResumen
Objective: Chest pain is a common reason for an encounter in general practice. The present investigation was set out to characterize the consultation rate of chest pain, accompanying symptoms, frequency of diagnostic and therapeutic interventions, and results of the encounter. Materials and Methods: Cross‑sectional data were collected from randomly selected patients in the German Sächsische Epidemiologische Studie in der Allgemeinmedizin 2 (SESAM 2) and analyzed from the Dutch Transition Project. Results: Overall, 270 patients from the SESAM 2 study consulted a general practitioner due to chest pain (3% of all consultations). Chest pain was more frequent in people aged over 45 years. The most common diagnostic interventions were physical examination, electrocardiogram at rest and analysis of blood parameters. For the majority of cases, the physicians arranged a follow‑up consultation or prescribed drugs. The transition project documented 8117 patients reporting chest pain with a frequency of 44.5/1000 patient years (1.7% of all consultations). Physical examination was also the most common diagnostic intervention, and physician’s advice the most relevant therapeutic one. Conclusion: The most common causes for chest pain were musculoskeletal problems followed by cardiovascular diseases. Ischemic heart disease, psychogenic problems, and respiratory diseases each account for about 10% of the cases. However, acutely dangerous causes are rare in general practice.
10
Frese, Thomas, Jarmila Mahlmeister, Maximilian Heitzer y Hagen Sandholzer. "Chest pain in general practice". Medknow, 2015. https://ul.qucosa.de/id/qucosa%3A14826.
Texto completoResumen
Objective: Chest pain is a common reason for an encounter in general practice. The present investigation was set out to characterize the consultation rate of chest pain, accompanying symptoms, frequency of diagnostic and therapeutic interventions, and results of the encounter. Materials and Methods: Cross‑sectional data were collected from randomly selected patients in the German Sächsische Epidemiologische Studie in der Allgemeinmedizin 2 (SESAM 2) and analyzed from the Dutch Transition Project. Results: Overall, 270 patients from the SESAM 2 study consulted a general practitioner due to chest pain (3% of all consultations). Chest pain was more frequent in people aged over 45 years. The most common diagnostic interventions were physical examination, electrocardiogram at rest and analysis of blood parameters. For the majority of cases, the physicians arranged a follow‑up consultation or prescribed drugs. The transition project documented 8117 patients reporting chest pain with a frequency of 44.5/1000 patient years (1.7% of all consultations). Physical examination was also the most common diagnostic intervention, and physician’s advice the most relevant therapeutic one. Conclusion: The most common causes for chest pain were musculoskeletal problems followed by cardiovascular diseases. Ischemic heart disease, psychogenic problems, and respiratory diseases each account for about 10% of the cases. However, acutely dangerous causes are rare in general practice.
11
Wiener-Ogilvie, Sharon. "Training environment in General Practice and preparedness for practice". Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/9447.
Texto completoResumen
This thesis explores the way General Practice trainees and early career General Practitioners describe their training environment in General Practice, the meaning they attach to the notion of preparedness and their perceptions of the impact of the training environment on their preparedness. The study was informed by the interpretivist paradigm. I conducted 27 in-depth semi-structured interviews with 15 early career General Practitioners and 12 General Practice trainees at the end of their training. Interview data were transcribed and analysed thematically, drawing partially on the grounded theory approach of data analysis. Interviewees described their training environment in terms of their sense of being included in the Practice, the Practice ethos, the importance of training within the Practice, the trainer and their relationship with the trainer. There was no unanimous way in which interviewees talked about preparedness, however the meanings attributed to preparedness centred around two central elements ‘confidence’ and ‘adaptability’ and included: working independently and being self directed; knowledge of business and partnership issues; ability to manage patients and workload; good consultation skills and effective time management; and adequate knowledge and passing the RCGP CSA examination. The way the training Practice can impact on trainees’ preparedness was explained drawing on Bandura’s theory of ‘self efficacy’ and Lave and Wenger’s theory of ‘situated learning’. Inclusive training Practices, characterised by less hierarchical relationships between the doctors, particularly vis-à-vis trainees, were better at preparing trainees for their future role by affording them greater opportunities to take part in a wider range of General Practice work. The role of the trainer was also pivotal in preparing trainees through effective teaching. Supervision tailored to trainees’ needs, and guided decision making enhanced confidence of trainees in their ability to work independently.
12
Jabareen, Hussein Mohammad. "Skill mix development in general practice : a mixed method study of practice nurses and general practitioners". Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/632/.
Texto completoResumen
General practice has undergone considerable change in the last two decades. New roles for nurses working in general practice have extended to include tasks that were previously delivered by general practitioners, in particular chronic disease management, and the development of new, advanced roles such as independent nurse prescribing. There have been few research studies investigating the impact of these changes, especially after the introduction of the new General Medical Services contract in April 2004. The overall aim of the work presented in this thesis was to examine the emerging roles of practice nurses, the forces influencing that development, and the effects of these changes on doctor-nurse skill mix in general practice within NHS Scotland. The work employed a mixed methods approach, with three inter-linked studies. The first study was a quantitative, desk-based analysis of workload and clinical activities of doctors and nurses working in 37 practices across Scotland for the year 2002. The second study was a postal questionnaire to all practice nurses working within NHS Greater Glasgow (n=329), conducted in autumn 2005 and achieving a 61% response rate. The third study was a qualitative study, consisting of eighteen interviews with a doctor and nurse inform each of nine general practices. The interviews were conducted between January and July 2006 and practices were selected according to the number of partners and the deprivation status of the practice population. Analysis of workload data showed that practice nurses and general practitioners dealt with 27.5% and 72.5% of total face-to-face encounters, respectively. Many of the encounters with nurses involved chronic disease management, with 20% of such encounters appearing similar in content to the work of GPs. The postal survey found that one third of practice nurses were aged over 50, and will be approaching retirement within 10 years. The majority worked in small teams of nurses, although 31% worked alone. This may have contributed to the finding that 52% (n=103) reported feeling isolated in their workplace. Many had attended CPD training on chronic conditions, but identified minor illness treatment as an area for future training. The qualitative study showed that the Quality and Outcomes Framework of the 2004 contract had been a key driver of changes in general practice service delivery. This has led to an increasing shift in routine care from doctors to nurses. As new roles for practice nurses have evolved, GPs have been able to focus on treating complex morbidities that need medical diagnosis and intervention. The incentivised targets of the new contract have made chronic disease management a predominant activity for practice nurses, with treatment room and non-incentivised activities featuring less and increasingly being provided by new, lower grade nurses or nurse replacements such as Health Care Support Workers (HCSW). There was no consensus between interview participants in terms of the most appropriate use of doctor-nurse skill mix in general practice. Nor did they agree on the merit of advanced roles for practice nurses. However, respondents did emphasise that nurses who wanted to have an independent/advanced role in the practice would need to combine three competencies (independent nurse prescribing, triaging, and minor illness treatment). Most practice nurses interviewed were concerned with obtaining a fair financial return to match their increasing responsibilities, especially after the introduction of the nGMS contract. GPs, however, tended to believe that nurses were appropriately remunerated for the level of responsibility they had within the practice. The continuing role of the GP as the employer of practice nurses was problematic for some nurses and many felt there would be advantages to being employed on Agenda for Change terms and conditions. However, the majority of nurses interviewed preferred being employed by a GP rather than the Health Board. There was little support amongst either nurses or GPs for the notion of nurse partners within practices. Overall, these studies provide lessons which will be of value in planning the future training and development of practice nurses. It suggests that practice nurses should obtain proper training and support in order to meet their individual needs and to carry out new responsibilities and roles. In addition, the impending shortage of practice nurses due to retirement, lack of retention and potential recruitment difficulties needs to be addressed urgently at the level of primary care policy and manpower planning.
13
Lawrence, Barbara. "Gender and general practice: the single-handed woman General Practitioner". Thesis, Aston University, 1987. http://publications.aston.ac.uk/12186/.
Texto completoResumen
This research examines women GPs' careers, how they run their practices and how they reconcile professional and domestic lives. It looks at the particular experiences of women GPs who practise alone, and at the pressures in past practice experience which have led them to do so. It is argued that many of the problems of group practice which can be identified are attributable to gender. For example, one reason given for entering general practice is a desire to be able to provide the full range of medical care and not to specialise. Women GPs, however, may find themselves seeing more women patients for "women's problems" and children than they would freely choose. Women have not entered general practice in order to specialise in these areas of medicine. Indeed, if they had wanted to specialise in obstetrics, gynaecology or paediatrics they would have had difficulty advancing very far in these male-dominated areas of hospital hierarchy. Other gender related problems exist for women in general practice and practising single-handedly is one strategy that women GPs have used to counter the problems of working in male-dominated practices and partnerships. However, the twenty-four hour commitment of single-handed practice may bring further pressures in reconciling this with responsibility for home life. Out-of-hours cover, which can be viewed as the link between professional and domestic life, where the one intrudes into the other, is also examined in terms of the gender issues it raises. The interaction of gender and ethnicity is also considered for the 11 Asian women GPs in the study. Interviews were conducted with 29 single-handed women GPs in the Midlands. In addition, some cases were studied in greater depth by being observed in their surgeries and on home visits for a day each. A qualitative/feminist approach to analysis has been employed.
14
Hays, Richard B. "Improving standards in rural general practice /". St. Lucia, Qld, 2003. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17837.pdf.
Texto completo
15
Proude, Elizabeth Marjorie. "HIV/STD Prevention in General Practice". University of Sydney. Public Health, 2002. http://hdl.handle.net/2123/838.
Texto completoResumen
This thesis examines aspects of the prevention of sexually transmitted diseases (STDs) in the Australian community, with a particular emphasis on HIV/AIDS in the context of general practice (or primary care settings). The work has four broad aims: i) To describe the primary prevention of sexually transmitted diseases, following from the arrival of the HIV/AIDS pandemic in Australia ii) To describe HIV/STD risk behaviour iii) To summarise previously known evidence of interventions to reduce risk and to raise awareness of HIV and other sexually transmitted diseases iv) To contribute new evidence addressing the potential of the general practitioners' role in HIV/STD prevention The first chapter gives a brief review of the history of HIV/AIDS from its discovery in the United States of America to its appearance in Australia and New Zealand, and discusses the Australian response strategies, both initial and continuing, to confine the epidemic. Specifically, the arrival of HIV/AIDS gave rise to increasing awareness of sexually transmitted diseases, which hitherto, although sometimes chronic, were rarely fatal. The public health risk of HIV necessitated swift government action and led to wider acceptance of publicity about sexual behaviour. Although the thesis does not concentrate solely on HIV, this is still an emphasis. This chapter provides useful background to ensuing chapters. Chapter Two provides an overview of behavioural risk in sexually transmitted diseases. It gives a review of risk factor prevalence studies, and introduces risk behaviour and cognitive models of behaviour change, as applied to STD risk. Sexual behaviour is a complex social interaction, usually involving more than one person, and relying on the personality and behaviour patterns intrinsic to the individuals taking part. It is therefore perhaps more challenging to alter than behaviour which is undertaken alone, being dependent on the behaviour and intentions of both parties. Moreover, comprehensive assessment of sexual risk behaviour requires very detailed information about each incident. Its private nature makes accurate data difficult to obtain, and sexual risk behaviour is, correspondingly, difficult to measure. Chapter Three reviews the effectiveness of interventions tested in primary health care settings to reduce sexual risk behaviour. The candidate uses a replicable method to retrieve and critique studies, comparable with standards now required by the Cochrane Collaboration. From 22 studies discussed, nine health interventions were short, 'one-shot', efforts owing to limited time, resources and other practical constraints. This review demonstrates the scarcity of interventions with people who may be perceived as 'low-risk'. Only four interventions were carried out in community health centres and two in university health clinics. One of the university interventions showed no change in sexual behaviour in any of three arms of the intervention (Wenger, Greenberg et al 1992) while the other showed an increase in condom use in both groups, although the intervention group's self-efficacy and assertiveness also improved (Sikkema, Winett & Lombard 1995). The rationale for the intervention, where given, is described. Chapter Four analyses the content, format and quality of sexual health information brochures available in New South Wales at the time of the candidate's own planning for an interventional study. One of the most effective ways to disseminate information widely is by the use of educational literature, especially when the subject material is potentially sensitive or embarrassing to discuss in person. In this chapter, the candidate reviews the literature available at the time of designing the intervention used in Chapter Five. Readability, attractiveness, clarity and the accurate presentation of facts about sexually transmitted disease risk are examined for each pamphlet. Forty-seven pamphlets were scored according to the Flesch formula, and twenty-four of these scored in the 'fairly' to 'very difficult' range. There was, therefore, a paucity of easy-to-read material on these subjects. Chapter Five evaluates a general practitioner-based counselling intervention to raise awareness of sexually transmitted diseases and to modify HIV/STD risk behaviour. While adults aged 18-25 are less likely than older cohorts to have a regular general practitioner or to visit often, most people visit a general practitioner at least once a year. This could provide an opportunity for the general practitioner to raise preventive health issues, especially with infrequent attendees. As the effectiveness of an opportunistic intervention about sexual risk behaviour was yet to be tested, the candidate designed an innovative randomised controlled trial to raise awareness of risk and increase preventive behaviour. The participation rate was 90% and 76% consented to followup; however the attrition rate meant that overall only 52% of the original participants completed the follow-up questionnaire. The intervention proved easy and acceptable both to GPs and to patients, and risk perception had increased at three months' follow-up; however this occurred in both the control (odds ratio 2.6) and the intervention group, whose risk perception at baseline was higher (odds ratio 1.3). In order to establish some markers of risk in the general population, Chapter Six analyses data resulting from questions on sexual behaviour asked in the Central Sydney section of the NSW Health Survey. The candidate advocated for inclusion of relevant questions to determine some benchmarks of sexual risk behaviour and to provide an indication of condom use among heterosexuals. Although limited in scope as a result of competing priorities for questions in the survey, results demonstrate that, while a small percentage of people were at risk, those with higher levels of partner change or of alcohol use were the most likely to always use condoms. Specifically, 100% of those with more than four new partners in the last 12 months had used condoms with every new partner. In addition, 'heavy' alcohol users were more likely to report condom use every time with new partners (odds ratio 0.34). To furnish data to inform future planning of educational activities for general practitioners, Chapter Seven presents the results of a survey of Central Sydney general practitioners' opinions and current practices in HIV risk reduction with in the broader context of sexually transmitted disease prevention. The general practitioner is in an ideal position to provide information and advice, especially if future research affirms the impact of such advice on STD risk behaviour. General practitioners in this study said they would be slightly more likely to discuss sexual health matters with young patients than with older ones (p=0.091), but this was not significant. The most cited barrier to discussing sexual health was inadequate remuneration for taking time to do so (over 50% gave this reason). The next most cited obstacle was difficulty in raising the subject of STDs or HIV in routine consultations, but this reason was given by less than half the sample. Forty-six percent had participated in continuing medical education programs in STDs, HIV/AIDS, or hepatitis diagnosis or management; 32% of GPs had patients with HIV, and 55% of all GPs indicated they would like more training in management and continuity of care of HIV patients. Approximately half (51%) wanted more training in sexuality issues, including sexual dysfunction. Chapter Eight reviews the whole thesis and discusses future directions for the research agenda.
16
Gregory, John. "Factors influencing learning in general practice". Thesis, University of Liverpool, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.260211.
Texto completo
17
McDonald, Paul Stephen. "The heartsink problem in general practice". Thesis, University of Nottingham, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.385121.
Texto completo
18
Scott, Anthony. "Agency and incentives in general practice". Thesis, University of Aberdeen, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.430052.
Texto completoResumen
The agency relationship in health care, and the resulting potential for supplier induced demand, has led to much research in health economics. The focus of this research has been on designing and evaluating financial incentive schemes for doctors. The aim of this thesis is to broaden this research by focusing more on the utility functions of patients and doctors, in the context of General Practice. The first half of the thesis concentrates on patients’ utility functions. Empirical work is conducted on patients’ preferences for aspects of the doctor-patient relationship using a discrete choice experiment. The results have implications for the training of doctors in communication skills. As well as broadening the nature of the utility function, this work examines empirically the source of asymmetry of information (i.e. the doctor-patient relationship), rather than its symptoms (i.e. supplier induced demand and the role of financial incentives). The second half of the thesis examines GPs’ utility functions. GPs’ preferences for pecuniary and non-pecuniary job characteristics are elicited, in the context of choosing a General Practice in which to work. Monetary valuations of non-pecuniary job characteristics are presented. This study broadens the nature of the GPs’ utility function and shifts the focus away from the role of financial incentives in influencing behaviour, towards altering non-pecuniary job characteristics. The results have policy implications for encouraging GPs to work in General Practices in under served areas. Patients and doctors make many other decisions in health care that should be the focus of future research. More information on patients’ and doctors’ utility functions is essential if optimal incentives and regulation are to be designed for doctors.
19
Lee, Anne M. "Management of conflict in general practice". Thesis, University of Surrey, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.334306.
Texto completo
20
Carthy, Patricia Ann. "Variation in prescribing in general practice". Thesis, University of Bristol, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325908.
Texto completo
21
Freeman, George Kenneth. "Continuity of care in general practice". Thesis, University of Cambridge, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.397947.
Texto completo
22
Moorhead, Robert George. "Communication skills training for general practice". Title page, contents and abstract only, 2000. http://web4.library.adelaide.edu.au/theses/09MD/09mdm825.pdf.
Texto completoResumen
Bibliography: leaves 554-636. Examines aspects of teaching medical students communication skills at a time when they are entering their clinical years. Integrates reports of 12 data-gathering exercises centred on medical student communication skills with the international literature, and with the author's reflections as an experienced educator and G.P. Recommends that communication skills training in a general practice setting should be a crucial factor in all future training of medical students.
23
Abdo, Ragheb. "Islamist moderation in practice: democratic practices and their shifting meanings". Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=107854.
Texto completoResumen
The purpose of this thesis is to examine the causes of Islamist ideological moderation. It focuses on the role of discursive structures and social practices in bringing about this ideational change. Through an in-depth case study of the Muslim Brotherhood in Jordan, a discourse and practice analysis is conducted to provide a theory that traces this group's moderation as a process. The thesis presents the argument that the group's increasing moderation was a result of practicing politics in a structural environment that challenged them strategically and ideologically. Under these environmental conditions, significant contestation arose within the movement. Resolving these debates internally by providing ideological justifications for controversial political practices, and doing so through deliberative democratic processes, provided the legitimacy needed to alter, and moderate, the movement's ideology.L'objectif du présent mémoire est d'examiner les causes qui sous-tendent la modération du discours idéologique des groupes Islamistes. À cet égard, ce mémoire se concentre sur le rôle des structures discursives et des pratiques sociales qui constituent la condition de possibilité de ce changement idéationnel. Grâce à une étude de cas approfondie des Frères Musulmans en Jordanie, ce mémoire mène une analyse du discours et des pratiques sociales pour formuler une théorie qui trace le processus de modération idéologique du dit groupe. Ainsi, ce mémoire présente la thèse que la croissante modération idéologique des Frères Musulmans en Jordanie est le résultat d'une façon de pratiquer la politique dans un environnement structurel qui les défit stratégiquement et idéologiquement. Sous ces conditions structurelles, un important courant de contestation est né au sein du groupe. Le fait de résoudre cette contestation à l'interne en ayant recours à des explications idéologiques pour justifier des pratiques politiques controversées, en plus de le faire en ayant recours à des processus démocratiques délibératifs, a fourni la légitimité nécessaire pour altérer et modérer l'idéologie du groupe.
24
Holt, Jackie. "Psychological distress amongst general practitioners /". [St. Lucia, Qld.], 2002. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17113.pdf.
Texto completo
25
Weijden, Trudy van der. "Evaluation of cholesterol guidelines in general practice". [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 1997. http://arno.unimaas.nl/show.cgi?fid=5829.
Texto completo
26
Cornel, Michiel. "Detection of problem drinkers in general practice". [Amsterdam : Maastricht : Thesis] ; University Library, Maastricht University [Host], 1994. http://arno.unimaas.nl/show.cgi?fid=6856.
Texto completo
27
Vægter, Keld. "Promoting Rational Drug Prescribing in General Practice". Doctoral thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-192315.
Texto completoResumen
Aims: To introduce the concepts “quality assurance”, “rational drug prescribing” and “outreach visits” in general practice in Storstrøm County, Denmark and study the effect of unsolicited mailed feedback and outreach visits on drug prescribing. Methods: The first step was to generate standardised charts displaying the county variations of drug volume prescribing within 13 major drug groups at the second ATC-level. The charts were mailed unsolicited to the 94 general practices in the county. Each practice could identify its position within the county prescribing variation. This procedure was repeated every six months from 1992 to 1998. In 1998 annual outreach visit were offered to general practice and 88 of 94 practices accepted. The awareness of prescribing profiles was monitored during the visits in 1998 and 1999. In 2000 a randomised controlled trial allocating practices into two parallel arms was launched. Effects of two desk guides on rational drug prescribing promoted during outreach visits were evaluated. Results: During the period of mailed feedback, there was a large variation in drug prescribing volumes between practices but little within-practice variation over time. No significant change was detected. Practitioners’ assessment of their own prescribing profiles improved significantly through the outreach visits. The prescribing of antibiotics was significantly affected by the desk guide whereas no effect was detected on the prescribing of non-steroid anti-inflammatory drugs. Conclusions: Semi-annually mailed feedback over a seven-year period had no significant effect on prescribing volumes or variations in prescribing volumes, but some effect on the practitioners’ awareness of their own prescribing profiles. Outreach visits significantly improved the awareness. A randomised controlled trial using outreach visits combined with a simple desk guide affected the prescribing of some antibacterial drugs as intended whereas the similar intervention had no detectable effect on the prescribing of non-steroid anti-inflammatory drugs.
28
Roland, Martin. "Back pain - two studies from general practice". Thesis, University of Oxford, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.235902.
Texto completo
29
Connolly, John Paul. "Perceived morbidity and prescribing in general practice". Thesis, Queen's University Belfast, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387870.
Texto completo
30
Neal, Richard David. "Patterns of frequent attendance to general practice". Thesis, University of Leeds, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.440361.
Texto completo
31
Pockney, Peter Graham. "Aspects of minor surgery in general practice". Thesis, University of Southampton, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.403822.
Texto completo
32
Angell, Emma Louise. "Responsiveness : perspectives on policy in general practice". Thesis, University of Leicester, 2017. http://hdl.handle.net/2381/40660.
Texto completoResumen
Meeting the needs of patients in general practice is complex, and responsiveness is seen as a way to meet these needs and preferences. Policies have been published advocating responsiveness, but its meaning is multi‐faceted. Little is known about how initiatives to improve responsiveness to patients interact with the values of the people and organisations trying to implement them. This qualitative study aimed to explore how responsiveness has been espoused in policy and it has been viewed and responded to in practice, with a focus on whether or not it is a useful concept in supporting quality management and improvement in primary care. The research design includes analysis of English national policies about responsiveness in primary care, and interviews with elite policy‐makers, and strategic and frontline staff. Analysis of policies took a thematic and longitudinal approach to investigate how responsiveness emerged as an aspiration in general practice and changed over time. Thematic analysis of interviews examined how the meaning of and response to responsiveness at the macro‐, meso‐ and micro‐levels has changed with the shifting political and social climate. Findings indicate that responsiveness is considered a way to attain goals aligned with the core values of general practice but that there are tensions when balancing the needs of the many and the needs of the few, especially in times of financial austerity. For responsiveness to become successfully enacted, the goals of responsiveness need to be ‘amplified’ such that they become a priority, and these goals need to be aligned with the values of those attempting to prioritise them. Findings suggest that value amplification and values alignment can be helpful when making difficult choices between competing priorities in a context of restricted finances and prolific targets.
33
Guthrie, Bruce. "Continuity of care in UK general practice". Thesis, University of Edinburgh, 2003. http://hdl.handle.net/1842/24660.
Texto completoResumen
'Continuity' is frequently cited as a core value for UK general practice, and in this context usually appears conceptualised in terms of personal continuity or ongoing relationships between patients and general practitioners (GPs). Formal definitions include other dimensions such as continuity of information, and the co-ordination of care, and these are more promoted in recent UK policy documents and by organisational change. Two studies were conducted for this thesis. The first used multilevel regression analysis of survey data from over 25,000 patients in 53 general practices to explore the distribution of 'continuity' in the sense of whether or not patients were seeing their 'usual or regular' GP. The key findings were that measured 'continuity' was lower in larger practices and those with shared lists where patients can see any GP. Younger patients and those without chronic disease were less likely to be seeing their usual or regular GP, although whether the age association represents a cohort or lifecycle effect cannot be addressed with cross sectional data. In the second study, thirty-two patients and sixteen GPs were interviewed about what they valued about general practice. Interviews were semi-structured, and the data were analysed qualitatively. A thematic analysis of which dimensions of 'continuity' were valued by patients and GPs, and how these related to other valued processes and outcomes of general practice care was developed. Further analysis focused on the ways that GPs used 'continuity' to construct a particular kind of professional identity, and whether patients accepted or rejected the claims to a particular identity made by GPs. Both GPs and the majority of patients emphasised the importance of personal continuity. A key difference was that patients talked about routinely balancing personal continuity against access, with their preference varying with the nature of the problem to be discussed. The majority of patients said that they usually preferred to wait to see 'their' GP, but a few solely prioritised speed or convenience of access. GPs and patients ascribed a similar range of advantages to personal continuity, but GPs focused on benefits in terms of better diagnosis and management of problems, whereas patients emphasised feeling more at ease, being able to be more active in consultations, and increased trust and legitimacy. In formal definitions, the different dimensions of'continuity' are made conceptually distinct. But for these GPs and patients, different dimensions of continuity were interwoven. Personal continuity (an ongoing relationship) and longitudinal continuity (seeing the same GP) were routinely conflated, and GPs described complex interactions between the different ways of knowing the patient associated with personal continuity and with continuity of information embodied in the medical record. Personal continuity was frequently deployed by GPs to distinguish themselves from hospital doctors. This boundary was repeatedly constructed without prompting throughout the GP interviews, suggesting that it was a problematic area. This appeared to be because of hospital doctors' greater expertise in diagnosis and management of particular diseases or problems, something acknowledged by GPs and taken for granted by patients. In contrast, GPs appeared to assume that their control of medical knowledge made their identity with regard to nurses unproblematic. Supporting this, patients talked about nurses' work largely in terms of the tasks done, and said they did not greatly value ongoing, personal relationships with nurses. Underpinning both of these boundaries was a shared assumption of medical work as primarily being the diagnosis and management of problems, with a stronger biomedical emphasis than was immediately apparent in talk about 'personal continuity'. The data are used to discuss the ways in which personal continuity appeared central to patients' and GPs' experience of general practice, and to the construction of a stable professional identity for GPs. The usefulness of 'continuity' as a research or policy concept is then explored. Although formal definitions of'continuity' are conceptually helpful, different dimensions of'continuity' are likely to be interdependent within an individual health care system. Understanding 'continuity' therefore requires a sensitivity to this wider context. Finally, possible implications of current organisational change for the experience of 'continuity' by patients and the professional identity of GPs and general practice are examined.
34
Patel, N., G. Messmer y John B. Bossaer. "Encounters with Immunologic Agents in General Practice". Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/2348.
Texto completo
35
Owen, Gwyneth. "Becoming a practice profession : a genealogy of physiotheraphy's moving/touching practices". Thesis, Cardiff University, 2014. http://orca.cf.ac.uk/68522/.
Texto completoResumen
This research responds to gaps in the literature about the evolution of physiotherapy practice and to uncertainties emerging from within physiotherapy about its professionalism and practice. It aimed to generate a theoretically informed understanding of the tensions present in contemporary physiotherapy practice by producing an embodied account of the process of becoming a practice profession. The research aim was achieved by a genealogical study of existing literature, documentary data from physiotherapy’s qualifying curricula and oral accounts of practice generated by depth interviews with physiotherapists who qualified during the 1940/60s. These data were subject to a Foucauldian discourse analysis and a phenomenological analysis to explore the events, discourses and actions shaping physiotherapy practice over time. Unlike existing historic accounts that trace the evolution of physiotherapy’s professional identity, this research prioritises the bodies doing physiotherapy over time so offers a fresh perspective on physiotherapy as a practice and as a profession. From a ‘doing’ perspective, professionalism ceases to be an acquisition that is externally bestowed and becomes a dynamic process of experiencing/producing autonomous problem-solving in practice. Physiotherapy’s professional practice can be traced back to the 1945 curriculum. It was enacted through the integration of physiotherapy movement/touch and by the discipline of movement, which generated autonomous problem-solving practices that cut across ward/disease boundaries established by medicine from the 1950s onwards. While still subject to medical supervision, physiotherapy’s movement/touch crossed the division of labour to develop capacity to produce diagnosis-inference-treatment once its technical autonomy was recognised in 1977. Once free of medicine, physiotherapy’s professional practices multiplied to provide moving/touching solutions for an increasing variety of movement disorders. My research complements the existing (disembodied) critical histories of physiotherapy as a profession and demonstrates the value of embodiment as a lens for tracing movement in physiotherapy’s professional identities and practices over time. It adds to sociological understanding of the organisation of healthcare occupations and practices by offering an account of a body that is a moving part of a division of labour organised around the dominant profession of medicine.
36
Paxton, Fiona M. "Practice nursing : a time of change : a study of nursing in general practice". Thesis, University of Edinburgh, 1998. http://hdl.handle.net/1842/22550.
Texto completoResumen
The view is offered within this thesis that nursing is essentially a practice-based discipline and therefore any theory of nursing must reflect what happens in practice. By analysing research material from a study of practice employed and attached nurses, the nurses' pattern of work was described within the context of the primary health care. Both delegated and more autonomous roles were examined, and the implications of these and their relationship with holistic care and experiential learning were described in view of the continued expansion of the role. The objectives were: a) to examine the process of care and identify any changes in workload or differences in working patterns of practice employed and attached nurses as a result of the introduction of the New GP Contract in April 1999; b) to measure patient satisfaction with nurse consultations and ascertain their views on the changing role of community nurses; and c) to determine the opinions and attitudes of community nurses and general practitioners to future developments and educational opportunities for primary care nursing. Thirty four nurses participated in 1990 with a total of 6675 consultations; 33 nurses in 1991 with a total of 6050 consultations. The largest proportion of patients seen by both groups of nurses during both periods of recording was by general practitioner referral. Practice employed nurses initiated more of their own appointments in the second year and saw fewer general practitioner referrals. This tend was reversed for attached nurses. By the second recording period both attached and practice employed nurses had experienced a reduction in the time spent on routine treatment room work and an increase in clinic activity. Practice employed nurses reported a higher level of therapeutic listening than the attached nurses both years. It was found that 39% of all nurse consultations in 1990 and 27% in 1991 had an interruption either before or during surgery sessions.
37
Varnam, Robert. "Patient perspectives on medical errors in general practice". Thesis, University of Manchester, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.514434.
Texto completoResumen
Patient safety is as an increasingly active field of research and policy in the UK and around the world. The prevailing academic model for understanding the cause of patient safety incidents considers failures in cognitive and system aspects of care to playa role, with an emphasis on system factors in preventing harm. General practitioners (GPs) are the first port of call for a wide range of undifferentiated medical, psychological and social problems, presented by patients with whom they may form lasting relationships. The priorities and processes of care in general practice are consequently less clearly defined, more individualised and more strongly influenced by the people involved than in the hospital settings where the existing model was developed. Research in general practice has thus far been conducted from a professional standpoint, using doctors' reports to detect and understand safety incidents. Patients may bring a valuable new perspective to understanding the nature, incidence and cause of adverse events in general practice, allowing the existing model to be refined. This study aimed to provide a detailed description and analysis of patients' perspective on episodes of care they regarded as regrettable. A qualitative approach was used, conducting in-depth interviews with 34 patients whose healthcare experiences made them likely to be good key informants regarding patient safety issues in general practice. An adaptive theorising approach was used, to allow grounded insights arising from the empirical data to be interpreted in the light of, and to add to the development of, theories about the causation of adverse events. The results showed respondents' evaluations of GPs' medical performance to be contingent on their expectations, prior experiences and the doctor-patient relationship. They understood the quality and safety of GPs' care to be determined by their knowledge, skills and an attitude of professional commitment, using this understanding to inform the attribution of responsibility or blame for their experiences of care. This approach differed from the prevailing academic model in that it focussed on errors more than adverse outcomes, placed a strong emphasis on the importance of personal and relational factors in error causation and paid relatively little attention to the role of system factors. It identified diagnostic error as a significant issue in general practice, highlighting the dependence of technical aspects of care upon the GP's personal and interpersonal performance. Having sufficient professional commitment to choose to perform well was seen as a prerequisite for the safe application of knowledge and skills. Even where little or no physical harm was sustained, errors attributed to a failing in professional commitment could result in Significant psychological distress, loss of trust, and changes in future help-seeking behaviour. Interpersonal aspects of care and personal factors in GP performance appear to be key influences on safety in this context. This has implications for the focus of safety improvement efforts, which may need to take more account of the role of the individual professional, alongside issues of human factors and system design. A renewed emphasis is recommended on traditional values of altruistic professionalism and personal responsibility. Patients may make good partners in improving safety, provided it is acknowledged that their perspective is subject to socially patterned biases, and that they are sometimes hesitant to challenge medical authority.
38
Pirie, Zoe. "The impact of delivering shiatsu in general practice". Thesis, University of Sheffield, 2003. http://etheses.whiterose.ac.uk/4214/.
Texto completo
39
Wilson, Robert Petrie Hay. "The effects of General Practice fundholding on prescribing". Thesis, University of Liverpool, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263875.
Texto completo
40
Marshall, Keith Francis. "Standards and quality assessment in general dental practice". Thesis, King's College London (University of London), 1995. https://kclpure.kcl.ac.uk/portal/en/theses/standards-and-quality-assessment-in-general-dental-practice(8481398c-b8bf-438d-b96b-ab3d5f8d4083).html.
Texto completo
41
Menachem, Meir. "The role of counselling psychology in general practice". Thesis, Manchester Metropolitan University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.409161.
Texto completo
42
Cape, John Donald. "General practice consultations with patients with psychological problems". Thesis, King's College London (University of London), 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.309361.
Texto completo
43
Howe, Robert William. "A study of sore throats in general practice". Thesis, University of Southampton, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.242420.
Texto completo
44
Gill, Peter John. "Developing paediatric quality indicators for UK general practice". Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:1837f24f-e501-4e56-906d-6080191f09cb.
Texto completoResumen
The overall aim of this thesis is to define a candidate set of quality indicators that are evidence-based, feasible to implement, and have the potential to improve the quality of care provided for children in UK general practice. The indicators were developed using a three-stage process. First, the areas and aspects of care of highest priority for quality indicator development were identified. This was achieved by seeking the views of primary care clinicians and by undertaking a formal analysis of unplanned hospital admissions for ambulatory care sensitive conditions. Then, the evidence-base to underpin indicator development was identified through an overview of Cochrane systematic reviews of interventions relevant to the primary care of children. A search of SIGN and NICE national guidelines was also conducted to inform the evidence-base. Lastly, an expert panel determined the formulation and selection of indicators by applying the RAND appropriateness methodology. This process created a final set of 26 quality indicators in six priority areas: early recognition of potentially serious illness (n=7); child protection and safeguarding (n=4); mental health (n=4); health promotion (n=1); routinely managed conditions (n=6); and general practice management (n=4). The main strength of these indicators is that they reflect a strong professional consensus on their validity and feasibility. The main weakness is that the indicators are underpinned by evidence mainly derived from expert opinion rather than formal research; the requirement for professional consensus means that they do not challenge existing models of care delivery.
45
Zhu, Jiming. "Assessing the viability of general practice in China". Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:b33cb439-3f72-44ec-b628-5e0d893bc1f1.
Texto completoResumen
Background: China has had a well-known tradition of primary care, particularly its barefoot doctors in the 1960s and 1970s, and it contributed to the Declaration of Alma-Ata. In 2011 China formally launched a new, ambitious plan of establishing a system of general practitioner (GP) care by 2020; and aims to train 300,000 GPs. My thesis assesses whether this new strategy for general practice is viable. Methods: I used a systematic approach with a rigorous pre-set protocol to review the government documents at national level in relation to GPs. I undertook a policy implementation study, in Henan Province, using a mixed methods approach. The qualitative element was a thematic analysis of focus group discussions (FGDs) and semi-structured interviews. The quantitative element comprised structured questionnaires. Two rounds of fieldwork generated eight FGDs, seven semistructured interviews, and 1,887 quantitative questionnaires covering medical students, grassroots doctors and GP residents (together called the policy implementation targets [PITs]). Main findings: The document analysis shows that the Chinese government has made great efforts in GP capacity building. However, the government definition of GPs, based on an idealistic primary care framework, is too broad to be a practical guide to the training and work of GPs. The PITs have some intuitive awareness of the attributes of general practice (comprehensiveness, first contact, continuity and coordination), but often misinterpret what GPs actually do, or base their understanding on their knowledge of the existing hospital-dominated system. Eight factors (such as low income) are identified as deterrents to medical students opting to be GPs. Understandings of what being a GP entails is more likely than the deterrents to influence the students' decision to become a GP. Conclusions: China is unlikely to have a GP system by 2020. Pursuing the quantity of GPs on its own is meaningless, as the number depends on how to define GPs. Top priority is to establish clarity about the GP role, which requires rigorously regulating China's medical pluralism, reversing the dominance of hospital and specialist practice model, and reforming the wider political and social environment in respect of health care.
46
Herasym, L. M. "Reasonability of general anesthesia in pediatric dental practice". Thesis, БДМУ, 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/17311.
Texto completo
47
Lau, Wing Kin Rosa. "Implementation of complex interventions in UK General Practice". Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10047560/.
Texto completoResumen
The pace of change in UK healthcare continues to be rapid with a drive to implement more clinically and cost-effective interventions in order to improve practice/care. Literature suggests that the take-up of these interventions is often slow. This delay in translation of evidence-based interventions into routine clinical practice is known as the ‘Evidence-to-Practice Gap’. Almost all changes to practice involve ‘complex interventions’. Such interventions can be particularly hard to implement as they are likely to require change at multiple levels. Initially a systematic review of reviews was conducted to synthesise the literature on a) explanation(s) as to why complex interventions are not implemented and b)the effectiveness of strategies in facilitating implementation. A key insight was that despite an increasing recognition of the role of context in implementation there is a lack of empirical evidence. None of the reviews addressed context and the contextual influences were largely reported as perceived barriers and facilitators. Studies tended to focus on one intervention when in reality more than one intervention is likely to be implemented simultaneously in any given setting. The systematic review led to a qualitative case study to investigate the implementation of multiple complex interventions in three GP practices, focusing on the role of context as an explanation. Initial practice meetings indicated all three practices were implementing various changes to improve patient access. The decision was taken to focus on online and telephone access and the Named GP scheme. Data from observation, interviews and documentations were analysed using thematic analysis. This study enhances understanding of the process in which multiple complex interventions are implemented into general practice. Paying particular attention to the ‘shifts’ of context and how changes in the ‘fit’ between the intervention and the context over time, may increase the likelihood of implementation success. The study reveals the importance of relative intervention prioritisation particularly when practices face competing intervention options, as a novel explanation of why some interventions get implemented/prioritised first before others.
48
Meechan, Kenneth Alastair. "The regulation of British medical practice". Thesis, University of Glasgow, 2002. http://theses.gla.ac.uk/1587/.
Texto completoResumen
This thesis begins by considering that modern medicine as a profession has tremendous scope for both good and ill, and as an enterprise consumes a vast amount of the national wealth. Against this background, the thesis considers how and why medicine is regulated, and what the effects of this regulation are. The study aims to assess the regulation of the medical profession against the interests of the state, the profession, and the consumers of health care, to see whether the regulatory mechanisms adopted adequately safeguard the interests of all parties concerned with the practice of medicine. The methodology chapter spells out the analytical techniques which the bulk of the thesis utilises and delimits the scope of the research to cover only bodies having a legal genesis and which are universal in application. A series of "core evaluation criteria" are identified against which the four regulatory mechanisms are assessed. Chapters 3 to 6 contain the bulk of the actual research into the four main areas of regulatory endeavour which the study considers; each is analysed in turn in terms of the purpose, mechanism and effect of the regulatory machinery being considered and then assessed against the core evaluation criteria. Finally, the conclusions chapter draws together the different threads which the sector-specific analyses have identified as being points of concern, and the system as a whole is evaluated to see whether the interests of the relevant stakeholders are adequately safeguarded, to identify any regulatory gaps which exist in the present system, and to point out the direction which anyone seeking to improve the system should consider
49
Clark, Sheila. "Loss and grief in general practice : the development and evaluation of two instruments to detect and measure grief in general practice patients /". Title page, contents and abstract only, 2002. http://thesis.library.adelaide.edu.au/public/adt-SUA20041217.150143.
Texto completo
50
Rao, Mala. "Assessing the quality of care in general practice : is the general practice assessment survey an adequate summary measure for a practical approach to clinical governance in primary care organisations?" Thesis, London School of Hygiene and Tropical Medicine (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.536757.
Texto completo