Thèses : « National health services – Sweden »

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Nordenfelt, Patrik. « Hereditary Angioedema in Sweden : a National Project ». Doctoral thesis, Linköpings universitet, Institutionen för klinisk och experimentell medicin, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-142207.

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Background: Hereditary angioedema (HAE) due to C1-inhibitor deficiency, type I and II, is a rare disease with an estimated prevalence of 1/50,000. Angioedema in the larynx can be life threatening and angioedema in the abdomen and skin can give severe and disabling pain. Data on patients with HAE in Sweden were scarce before our study. Aim: To study the prevalence of HAE, and to investigate clinical manifestations, treatments, and Health-Related Quality of Life (HR-QoL) in adults and children in Sweden. Method: In studies, I and II, all patients received a written questionnaire followed by a phone interview with questions about clinical manifestations, medication, sick leave and QoL. In study III the patients completed EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) questionnaires for both the attack-free state (EQ5D today), and the last HAE attack (EQ5D attack). Questions were also asked about sick-leave. In study IV all adults received questionnaires with EQ-5D-5L and RAND-36, Angioedema Quality of Life instrument (AE-QoL), and Angioedema Activity Score (AAS) form, and questionnaires on sick leave and prophylactic medication. Results: We identified 146 patients, 110 adults and 36 children with HAE, type I (n=136) or II (n=10), giving a minimal HAE prevalence of 1.54/100,000. For adults, the median age at onset of symptoms was 12 years and median age at diagnosis was 22 years. Median age at onset of symptoms for children was 4 years and at diagnosis 3 years. During the previous year, 47% of adults experienced at least 12 attacks, 21% 4-11 attacks, 11% 1-3 attacks, while 22% were asymptomatic. For children, the corresponding figures were about the same. The median number of attacks in those having attacks was 14 in adults and 6 in children last year. Adult females reported on average 19 attacks the previous year versus nine for males. Irrespective of location nine out of 10 reported pain. Trigger factors were experienced in 95 % of adults and 74 % of children. Plasma-derived C1-inhibitor concentrate (pdC1INH) had a very good effect on acute attacks. Long-term prophylaxis with androgens and pdC1INH reduced the annual attack frequency by more than 50 %. Of the children’s parents, 73% had been on parental leave to care for the child due to HAE symptoms. Health and QoL were generally rated as good. In study III 103 of 139 responded and reported an EQ5D today score that was significantly higher than the EQ5D attack score. Attack frequency had a negative effect on EQ5D today. Children had significantly higher EQ-5D-5L than adults. Forty four percent had been absent from work or school during the latest attack. In study IV 64 of 133 adults responded. The most affected HR-QoL dimensions in EQ-5D-5L were pain/discomfort and anxiety/depression, in RAND-36 energy/fatigue, general health, health transition, pain, and in AE-QoL fears/shame and fatigue/mood. Females had significantly lower HR-QoL in RAND-36 for general health and energy/fatigue. There was an association between AAS and EQ-5D-5L/RAND-36 (except physical function) /AEQoL. There was no significant difference in HR-QoL in patients with and without prophylactic medication. Conclusion: The minimal prevalence of HAE type I and II in Sweden is 1.54/100,000. Median age at onset was 12 years. Adult females had twice as many attacks as males, adults had also twice as many attacks as children. For acute treatment, pdC1INH had a very good effect. For long term prophylaxis, androgens and pdC1INH had good effect. The most affected HR-QoL dimensions in EQ-5D-5L were pain/discomfort and anxiety/ depression, in RAND-36 energy/fatigue, general health, health transition and pain, and in AE-QoL fears/shame and fatigue/mood. Children reported better HR-QoL than adults. AE-QoL is more disease-specific in HAE than the generic instruments EQ-5D-5L and RAND-36. However, the latter highlights the pain aspect, whereas AE-QoL does not. Patients with high disease activity should thus be considered for more intensive treatment to improve their HR-QoL.

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Nadowska, Agnieszka. « Services Marketing in the Health Care Industry- Elekta in Sweden ». Thesis, Högskolan i Gävle, Avdelningen för ekonomi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-15674.

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During the nineteenth and the twentieth centuries, the world has moved from a manufacturing to service-based economy, where the twentieth first century, will be the” century of services”, and will transform into the century of “international services” (Clark and Rajaratnam, 1999).

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Button, Catherine. « WTO review of national health regulations ». Thesis, University of Oxford, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273098.

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Atueyi, Kene Chukwu. « Implementing management information systems in the National Health Service ». Thesis, Sheffield Hallam University, 1991. http://shura.shu.ac.uk/4990/.

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As a discipline Management Information System (MIS) is relatively new. Its short history has been characterised with epistemological dialectism. The current conflict and debate about MIS inquiry is broadly between the advocates of the social systems and technical systems perspectives. Few authors have made positive contributions toward clarifying the meaning and nature of MIS, and the appropriate design framework for MIS development. This thesis adds to their effort by using a MIS designed and implemented through action research at the North Western Regional Health Authority. There are seven Chapters in this thesis. Chapters One and Two examine the nature of the problem addressed by this research; the project history, ontological assumptions and research strategy. Chapter Three examines the debate, nature and conflicting views about MIS. It defines the theoretical problem addressed by this thesis and proposes a new concept of MIS. The theoretical problems are dealt with in Chapter Four. In Chapter Five the application of the theoretical concepts developed in Chapter Four is demonstrated in the design of MIS. Chapter Six relates some of the findings of this thesis to the work of other authors. It also examines the problem of human inquiry and the suitability of action research for MIS research. The main findings of this research summarised in Chapter Seven provide a new perspective of MIS as a purposeful system; the taxonomy of purposeful systems; primary context and secondary context of MIS; context analysis and context evaluation of MIS.

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Marco, Mariano. « “Italy and Sweden : a comparative analysis of financing and health services provision” ». Thesis, University West, Department of Economics and Informatics, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-2558.

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The present study focuses on the financing and provision of health services in Italy and in Sweden. The purpose is to compare Italian and Swedish health system with respect to these aspects. The intention is to provide new insights to how the financing and provision health care system in Italy and Sweden are organized and make a comparison analyzing different quantitative data. The study is organized in two part: one “qualitative, based on literature review, and one “statistical” based on critical analysis of data. In the theoretical part the financing flow of Italian and Sweden public health care system, which incentives are awarded to providers and which health services are provided, are reviewed. The statistical part shows how many resources (human and technological) are involved in the delivery process. The main findings, discussed in the conclusion section, suggest the need to improve the fairness in the financial contribution for the Sweden and the need for Italy to undertake cost-control and rationalization measures. Further research and especially greater availability of data remains to be done in order to make more complete the comparison.

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Mariano, Marco. « Italy and Sweden : a comparative analysis of financing and health services provision ». Thesis, Högskolan Väst, Institutionen för ekonomi och informatik, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-3453.

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The present study focuses on the financing and provision of health services in Italy and in Sweden. The purpose is to compare Italian and Swedish health system with respect to theseaspects. The intention is to provide new insights to how the financing and provision health care system in Italy and Sweden are organized and make a comparison analyzing different quantitative data. The study is organized in two part: one " qualitative, based on literature review, and one" statistical" based on critical analysis of data. In the theoretical part the financing flow of Italianand Sweden public health care system, which incentives are awarded to providers and which health services are provided, are reviewed. The statistical part shows how many resources (human and technological) are involved in the delivery process. The main findings, discussed in the conclusion section, suggest the need to improve the fairness in the financial contribution for the Sweden and the need for Italy to undertake cost-control and rationalization measures. Further research and especially greater availability of data remains to be done in order to make more complete the comparison.

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Hopkins, Jan. « From National Lottery to national screening : improving cervical screening coverage and quality in South Lancashire ». Thesis, Lancaster University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.301823.

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Sexton, Jonathan. « The maximisation of strategic health care objectives through the commissioning of health services ». Thesis, University of Kent, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.365209.

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Domapielle, Maximillian K. « Extending health services to rural residents in Jirapa District : analyses of national health insurance enrolment and access to health care services ». Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14803.

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This thesis sheds light on differences in health insurance enrolment determinants and uptake barriers between urban and rural areas in the Jirapa district of Ghana. The National Health Insurance Scheme in Ghana has made significant progress in terms of enrolment, which has had a commensurate increase in utilization of health care services. However, there are challenges that pose a threat to the scheme’s transition to universal coverage; enrolment in the scheme has not progressed according to plan, and there are many barriers known to impede uptake of health care. Interestingly, these barriers vary in relation to locality, and rural residents appear to carry a disproportionate portion of the burden. A mixed method approach was employed to collect and analyse the data. On the basis of the primary qualitative and quantitative results, the thesis argues that the costs of enrolling and accessing health care is disproportionately higher for rural residents than it is their urban counterparts. It also highlights that the distribution of service benefits both in terms of the NHIS and health care in the Jirapa district favours urban residents. Lastly, the thesis found that whereas rural residents prefer health care provision to be social in nature, urban residents were more interested in the technical quality aspects of care. These findings suggest that rural residents are not benefitting from, or may not be accessing health services to the extent as their urban counterparts. Affordability, long distance to health facilities, availability and acceptability barriers were found to influence the resultant pro-urban distribution of the overall health care benefit.

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Rawabdeh, Ali Ahmad Awad. « An integrated national health insurance system for Jordan : costs, consequences and viability ». Thesis, Keele University, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337091.

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Arguably, in common with many other nation states, Jordan could be said to have drifted into different ways of paying for health services without always foreseeing the long run consequences of taking the strategic direction necessary. In part, of course, as in many developing countries, the financing of Jordan's health care services has been influenced by its colonial past. This partly explains why, historically, Jordan has attempted not only to provide wholly free services, but to provide privileged access to medical services, not only to the military personnel but also to public servants in general. With world economic instability and recent economic difficulties, notwithstanding the opportunities created by Jordan signing the peace treaty with Israel, and the unclear but likely stark future conditions facing the Jordanian economy, it is highly improbable that Jordan will continue to be in a position to sustain, from central government monies, a health system which currently consumes about7percent of the GDP. Financing strategies will, therefore, have to address the heightened expectations for rising health expenditures. Options under active consideration at this time include: introducing or extending the present system of user charges; community financing (participation ); (increased) use of the private sector; public or private health insurance; and, improving efficiency in the use of hospital and community resources. These are all financing options open to the Jordanian government to adopt, whether singly or in combination, to generate more resources for the health system and to make better use of existing resources. Examining the range of different modalities of health services' financing reveals, not surprisingly, that there are advantages and disadvantages in each financing scheme. Nevertheless, depending on Jordan 's circumstances, some of the approaches may be more appreciated than others: that is from a political, cultural, socio-economic, or strictly fiscal point of view. This thesis focuses upon one particular health financing approach, "National Health Insurance (NU)", and is aimed to lead the government of Jordan to rigorously explore the concept, consider the options, and develop an implementation strategy benefiting, where appropriate, from other countries' experiences with systems of NHI. Specifically, the thesis first provides an overview (or situation analysis) of the healthiness of the Jordanian economy, its key demographic and epidemiological characteristics, and salient features of the Jordanian health sector. This is followed by a largely theoretical discussion of the principles of insurance, and its potential relevance to the unpredictability and uncertainty of health and disease. Methodological problems inherent in public or private health insurance schemes are highlighted, and then considered in a comparative context, drawing on lessons and experience around the globe. The thesis considers as its basic premise that a system of national health insurance is both desirable and feasible for Jordan as it faces the next millennium. To test that premise, the study is conducted by means of a series of investigations emphasising both secondary and primary sources of data, and a range of quantitative and qualitative research methods including: content and document analysis; experimental and survey methods; interviews; and questionnaires. The conclusions drawn from the evidence supports the contention that the introduction of NM is potentially both desirable and feasible in Jordan but subject to meeting very strict conditionalities, not least government ownership of the scheme, and the willingness to address the present choice and diversity in health service provision through health sector reform. These matters are as much political as technical matters. On the more technical front, nonetheless, the design of an appropriate NHI is shown to raise critical issues regarding: coverage; benefits; organisation and management; costing and financing; and, provider payment mechanisms. Various technical options are discussed in the thesis, and were consulted upon with key decision makers in Jordan. Further directions of research and development are also identified, which likely have applicability beyond the specifics of Jordan itself.

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Mowbray, Derek. « Decision making in the Management Advisory Service to the National Health Service ». Thesis, University of Bath, 1991. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.306735.

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Holloway, Jacqueline Anne. « Performance evaluation in the National Health Service : a systems approach ». Thesis, Open University, 1990. http://oro.open.ac.uk/57302/.

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This research explores the contribution which systems theories, methodologies and models can make in the design and application of effective performance-evaluation processes. Approaches to performance assessment of organisations are reviewed, and the history and structure of the NHS, its objectives, and dimensions for evaluation are described. Drawing on questionnaire and interview data from health service and civil service staff, and secondary data, current performance evaluation and planning processes in the NHS are described and some problems identified. To test the hypothesis that attention to systemic factors could improve performance evaluation, eight topics are analysed by the application of systems methodologies or models. Four of the topic and methodology or model combinations have received detailed analysis: 1. Making and implementing strategic plans; the Open University's Hard Systems Methodology. 2. Controlling NHS performance through structure and process, e. g. the use of annual reviews, performance indicators; double-loop learning and cybernetic control model. 3. Improving the quality of NHS care; Stafford Beer's Viable System Model. 4. Assessing performance through the outcomes of care; Peter Checkland's Soft Systems Methodology. The areas studied in less detail are: 5. Planning for uncertainty and complexity; 6. Issues related to the politics of health; 7. Reducing the length of waiting lists and times; 8. Planning for health (health promotion and the prevention of ill health).

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Thomas, Karen Anne. « The National Health Service contract for pharmaceutical services 1995 to 1998 ». Thesis, University of Portsmouth, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368471.

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McNulty, Terence H. « Organization, cultures and the management of change in the National Health Service : case studies in one District Health Authority ». Thesis, Nottingham Trent University, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.245382.

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This thesis is concerned with the issues of managerial effectiveness, organizational change and cultures in the National Health Service. Using the micropolitical and cultural perspectives it is concerned to offer an approach which builds on existing organization, management and change theory in order to further an understanding of these issues in relation to National Health Service organizations as well as other contexts. The focus of attention is on the relationship between structure and culture at both the official and unofficial levels of the organization. The three case studies of organizations undergoing organizational change have allowed the opportunity to understand the complexity of the relationship between the official and unofficial arrangements in the organization and the impact of this on managerial effectiveness and organizational change. The main finding of the thesis is that within organizations, structure and culture are inextricably bound and their consonance at both official and unofficial levels of the organization is a necessary condition for managerial effectiveness. The types of organizational culture developed during the investigation indicate how the plurality of interests, beliefs and cultures within an organization make it difficult to achieve this condition. Concerning National Health Service organizations, the researcher argues that the recommendations contained within the Griffiths Report (1983) have offered a model of management which is based on cultural assumptions which are different to those which have traditionally underpinned the managerial process in the NHS. Following this, the researcher demonstrates via the cases, that the introduction of these recommendations has served to offer greater scope for a diversity of managerial style and philosophy at Unit level. They have also served to raise conflict between cultures, in particular the medical and managerial, to the point that the conditions needed for achieving managerial effectiveness do not exist.

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Surender, Rebecca Miriam. « Managed competition and the National Health Service : an evaluation of General Practice fundholding ». Thesis, University of Oxford, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285536.

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Allen, Pauline Wanda Louise. « Legal and economic aspects of contracts in the National Health Service internal market ». Thesis, London School of Hygiene and Tropical Medicine (University of London), 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312841.

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Stanley, Michael J. « The effect of change on the National Health Service general managers' information needs ». Thesis, Sheffield Hallam University, 2001. http://shura.shu.ac.uk/20820/.

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The research enquiry using a sample of 20 NHS organisations with similar revenue and population characteristic profiles sets out to identify the information needs of the NHS General Managers and in doing so highlight the information that they need to meet their organisations' key success factors. The research identifies through the enquiry process the General Managers' information needs and describes the categories of those needs, the pressures and influences of the General Managers' working environment on those needs and the links to the influences that have been reflected in their information needs. In particular the external influence of the Department of Health and the business environment has not only changed the General Managers' information needs but affected the balance of power between the stakeholders, which in turn has affected those information needs. These organisational and environmental changes, health policies, stakeholder demands, and changes in the balance of power between the stakeholders has resulted in a change in the way in which the General Managers work with information, which has in turn increased the need for more accurate, timely and complex information. The research analyses the General Managers' understanding of their roles in the General Manager/patient/doctor relationship and analyses the potential areas of conflict arising when the patients' interests clash with the market-led (business) interests of the healthcare organisations and the diverse needs of the Provider, Purchaser and Regional Executive General Managers. These problems together with the effects of organisational resistance, organisational culture clash and system requirements and its effect on the information needs of the General Managers were examined for associated links with the difficulties that the General Managers experience in defining their information requirements. The research provides an understanding of the links between a market-led healthcare environment, the General Managers' information needs, and their attitude towards information as well as an understanding as to whether the patient, a key stakeholder, has benefited in the healthcare empowerment stakes as a result of the re-delineation of the General Managers' information needs and the impact upon their decision making. The information needs identified as a result of the research have shown them to have become business orientated with financial targets as a key measure and clinical performance (outcomes) increasingly being seen as the other key factor as an indication of success for the organisation. The hypothesis (Null Hypothesis) of the research asserts that it is not possible to link a market-led healthcare environment, the General Managers' information needs, their attitudes and behaviour towards information, and patient empowerment in such a way as to develop a model of information needs that is common across the Purchaser, Provider and the NHS Executive organisations. However, the research has developed as a first step, a series of outline models of information needs that will lead to a more complex and common model of information needs across the General Managers' organisational groups that will allow, when assessed against key success factors, a judgmental view of the ability of both the General Managers and their organisations to deliver their aims and objectives.

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Gremu, Chikumbutso David. « Building an E-health system for health awareness campaigns in poor areas ». Thesis, Rhodes University, 2015. http://hdl.handle.net/10962/d1017930.

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Appropriate e-services as well as revenue generation capabilities are key to the deployment and the sustainability for ICT installations in poor areas, particularly common in developing country. The area of e-Health is a promising area for e-services that are both important to the population in those areas and potentially of direct interest to National Health Organizations, which already spend money for Health campaigns there. This thesis focuses on the design, implementation, and full functional testing of HealthAware, an application that allows health organization to set up targeted awareness campaigns for poor areas. Requirements for such application are very specific, starting from the fact that the preparation of the campaign and its execution/consumption happen in two different environments from a technological and social point of view. Part of the research work done for this thesis was to make the above requirements explicit and then use them in the design. This phase of the research was facilitated by the fact that the thesis' work was executed within the context of the Siyakhula Living Lab (SLL; www.siyakhulaLL.org), which has accumulated multi-year experience of ICT deployment in such areas. As a result of the found requirements, HealthAware comprises two components, which are web-based, Java applications that run in a peer-to-peer fashion. The first component, the Dashboard, is used to create, manage, and publish information for conducting awareness campaigns or surveys. The second component, HealthMessenger, facilitates users' access to the campaigns or surveys that were created using the Dashboard. The HealthMessenger was designed to be hosted on TeleWeaver while the Dashboard is hosted independently of TeleWeaver and simply communicates with the HealthMessenger through webservices. TeleWeaver is an application integration platform developed within the SLL to host software applications for poor areas. Using a core service of TeleWeaver, the profile service, where all the users' defining elements are contained, campaigns and surveys can be easily and effectively targeted, for example to match specific demographics or geographic locations. Revenue generation is attained via the logging of the interactions of the target users in the communities with the applications in TeleWeaver, from which billing data is generated according to the specific contractual agreements with the National Health Organization. From a general point of view, HealthAware contributes to the concrete realizations of a bidirectional access channel between Health Organizations and users in poor communities, which not only allows the communication of appropriate content in both directions, but get 'monetized' and in so doing becomes a revenue generator.

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Han, Ik-Hee. « Health care policy, equity and the welfare state : the case of national health insurance programme in the Republic of Korea ». Thesis, University of Bristol, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.302096.

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Cotter, Siobhan Maire. « The clinical role of the hospital pharmacist in the United Kingdom National Health Service ». Thesis, London School of Hygiene and Tropical Medicine (University of London), 1995. http://researchonline.lshtm.ac.uk/682295/.

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This thesis examines the roles adopted by clinical pharmacists in the United Kingdom (UK), the evidence for the effectiveness of the interventions arising from these roles, and the challenges to and opportunities for future developments in clinical pharmacy. The research was undertaken in four phases: problem definition; national survey of services currently provided; in-depth interviews on roles; and a review of literature on effectiveness. A literature search provided background information on the evolution of pharmacy and of clinical pharmacy, particularly in the UK. These developments in have been set in the context of changes in health care provision and in the roles of the other health care professions and occupational groups. Preliminary interviews, meetings and group work were carried out to facilitate clarification of the research questions and to assist in the choice of methods. Two nationwide postal questionnaire surveys were conducted. One inquired about the provision of clinical pharmacy services to the primary care sector and the other about service provision within secondary care facilities in the National Health Service (NHS). The response rates were 91% and 90% respectively. The results show some diversity in the provision of clinical pharmacy services and provide possible explanations for this variation. Subsequently, semi-structured interviews were conducted with pharmacists, pharmacy technicians, doctors, nurses and managers at eight sites selected to represent different characteristics of hospitals. These qualitative data were analyzed by constant comparison. The results provide a picture of the clinical roles that hospital pharmacists are, and should be, providing. In addition, they indicate the potential barriers to, and opportunities for, future role development. An assessment of the evaluative literature on clinical pharmacy services was undertaken. Most literature is descriptive and much of the evaluative literature has shortcomings. The results present the evidence for the effectiveness of clinical pharmacy services in improving patient care and financial outcomes in the UK NHS. Finally, quantitative information gathered in the questionnaire survey, qualitative information from the interviews and the literature evidence were combined to create models of the future role of the hospital clinical pharmacist in the UK.

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Lu, Jyh-Cherng 1959. « The national survey of hospital pharmaceutical services in the Republic of China ». Thesis, The University of Arizona, 1990. http://hdl.handle.net/10150/277927.

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A study of hospital pharmacy practice in the Republic of China was conducted in the Summer of 1987. The status of selected innovative pharmaceutical services and the attitudes of pharmacy directors toward developing and implementing those services were assessed. The innovative services were unit dose drug distribution, pharmacy-prepared i.v. admixtures, pharmacy computerization, drug information and clinical pharmacy services. A questionnaire was used to obtain data and information from a random sample of hospitals in Taiwan, R.O.C.. Most of selected services were performed in about 25% of the surveyed hospitals. The i.v. admixture program was performed by the lowest percent of general hospitals as compared to the other services in this study. Pharmacy directors indicated that their attitudes toward selected innovative pharmaceutical services in terms of seven possible effects or outcomes were positive, but the scores relating to the other professionals and operating expenses were neutral or negative.

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Goodall, Andrew K. « Comparing management development in the National Health Services of Britain and France ». Thesis, Cardiff University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.342311.

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Al-umaran, Saleh. « Culture dimensions of information systems security in Saudi Arabia national health services ». Thesis, De Montfort University, 2015. http://hdl.handle.net/2086/11393.

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The study of organisations’ information security cultures has attracted scholars as well as healthcare services industry to research the topic and find appropriate tools and approaches to develop a positive culture. The vast majority of studies in Saudi national health services are on the use of technology to protect and secure health services information. On the other hand, there is a lack of research on the role and impact of an organisation’s cultural dimensions on information security. This research investigated and analysed the role and impact of cultural dimensions on information security in Saudi Arabia health service. Hypotheses were tested and two surveys were carried out in order to collect data and information from three major hospitals in Saudi Arabia (SA). The first survey identified the main cultural-dimension problems in SA health services and developed an initial information security culture framework model. The second survey evaluated and tested the developed framework model to test its usefulness, reliability and applicability. The model is based on human behaviour theory, where the individual’s attitude is the key element of the individual’s intention to behave as well as of his or her actual behaviour. The research identified a set of cultural and sub-cultural dimensions in SA health information security and services.

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Witter, Sophie. « Making delivery care free : evidence from Ghana and Senegal on implementation, costs and effectiveness of national delivery exemption policies ». Thesis, Available from the University of Aberdeen Library and Historic Collections Digital Resources, 2009. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?application=DIGITOOL-3&owner=resourcediscovery&custom_att_2=simple_viewer&pid=25753.

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Poppi, M. K. « A cross-national study of childhood autism ». Thesis, City, University of London, 2016. http://openaccess.city.ac.uk/16174/.

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Autism is considered to be a chronic developmental disability that affects communication, relationships, emotional development and imagination (NAS, 2010). Prevalence rates for autism spectrum disorder (ASD) suggest that the rates have increased over time and recent research shows that 1 in 68 children are diagnosed with the disorder (Baio, 2014). These children’s difficulties in the areas of communication, social skills and restricted/repetitive behaviours and interests lead to the need of therapeutic support (APA, 2013) and often it falls to parents to find an appropriate treatment for their child (Marcus et al, 2005). Among recommended services to these children are speech and language therapy, occupational therapy (Johnson and Myer, 2007) and psychotherapy (Alvarez et al, 1999). There are a number of intervention approaches for children with autism that have been developed, however none have been universally accepted as being the most effective (Farrell et al, 2005). As a result, parents often find it difficult to know which is the most appropriate approach for their child. This study aims to explore the development of children with autism over time in the areas of social skill and communication, regardless of the kind of treatment (speech and language therapy, psychoanalytic/psychodynamic psychotherapy and occupational therapy) they are receiving and to investigate the association between therapy context and the patterns of developmental change. This thesis is designed as a cross-national study in order to examine the aspects of the disorder that differ in the UK and Greece along with the differences (if any) in the developmental patterns across countries. The significance of doing a cross-national study is to explore autism from a wider international perspective and to identify any differences and similarities across the two countries. Twenty children with autism who had completed one of two differing types of treatment in the UK (psychotherapy, n=10 and speech and language therapy, n=10) were recruited to be monitored post-therapy twice over a two-year period. Twenty children with autism who had received one of two types of treatment in Greece (occupational therapy, n=10 and speech and language therapy, n=10) were also recruited to be monitored post-therapy twice over a two-year period. The research found that all children changed significantly over time on all aspects of measurement. Furthermore, no significant differences were found in the children from the two different countries at the start of the study and they developed in a very similar way as well. The results suggested though that based on the ADOS-Social (p=0.008) and ADOS-Imagination (p=0.008) children in the UK improve faster in the areas of social skill, imagination and the CDI-no of words understood and produced (p=0.015) showed an increase in their ability to understand and say words compared to the children in Greece. However, the CDI-no of words understood (p=0.027) showed that the children in Greece improved faster in the area of comprehension. The children who received SLT are also mainly developing in a very similar way across the two countries. Most measures showed change over time, except for the SCQ (p=0.081), ADOS-Ster (p=0.050) and CDI-U (p=0.141|). Also, only the ADOS-Social (p=0.021) and the Social Communication Questionnaire (p=0.021) showed a significant interaction effect. Thus, the SLT group from the UK seems to improve faster in the area of social skills compared to the SLT group from Greece. Additionally, in regards to the effect of the therapy context on the developmental pattern of children with autism, there were no differences across intervention contexts at the beginning and there were mainly non-significant interactions in the rate of change across the differing types of intervention. The findings suggested that all measures showed change over time. Only the SCQ (p=0.041) and the ADOS-imagination (p=0.033) showed a significant interaction effect before adjusting for age. Therefore, the SLT group in the UK seems to improve faster in the social communication area and the Psychotherapy group in the UK improved faster in the area of imagination. Conclusively, the SLT groups showed more change on language and communication measures, whilst the psychotherapy and occupational therapy groups saw changes in other areas of autistic symptomatology not achieved in the SLT groups, such as imagination and stereotypical behaviour. In summary, the current study helps parents gain better insight in different therapy choices and raises awareness of other types of therapy that are available in terms of intervention. The findings of this study can help professionals who work with children with autism further their understanding of the disorder and how it manifests through time in order to provide appropriate services based on each child’s needs. Additionally, the cross-national approach was intended to give some suggestions about the manifestation of autism across countries and about the way childhood autism is treated in each country. In regards to the more specific changes that the analysis revealed, they seem to fit well with the intervention targets of each type of therapy. Thus, the analysis suggested that certain characteristics tend to be associated with specific treatment types, which leads us to believe that sometimes the most effective course of treatment is a combination of therapies depending on the individual needs of each family. Finally, the results of this study offer original findings with respect to the outcomes of psychodynamic/psychoanalytic psychotherapy for children with autism since there is a lack of rigorous research in this field.

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Forbes, Thomas McCrone. « Strategic management and National Health Service hospital trusts : empirical evidence for the West of Scotland ». Thesis, University of Glasgow, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.247706.

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Lewis, Richard. « Improving London's primary care : centre-local relations in the implementation of national policy objectives ». Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.248237.

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Stamos, Peter Spiro. « The welfare state and the challenge of economic crises : the case of Sweden 1974-1987, with particular attention to the Swedish health care system ». Thesis, University of Oxford, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.385812.

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Högberg, Ulf. « Maternal mortality in Sweden ». Doctoral thesis, Umeå universitet, Obstetrik och gynekologi, 1985. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1866.

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Every year about half a million women die from complications of pregnancy, parturition and puerperium, most of which are preventable. The purpose of this thesis was to chart the distribution and decline in maternal mortality in Sweden between 1751 and 1980, and furthermore to characterize positive (predisposing) factors and negative (protective) factors of maternal mortality. Maternal mortality declined from 900 to 6.6 per 100,000 live births in these 230 years. Maternal deaths accounted for 10070 of all female deaths in the reproductive ages between 1781 and 1785, but only 0.2.0/0 between 1976 and 1980. However, in the 19th century 40-450/0 of the female deaths in the most active childbearing ages were maternal deaths. The children left motherless had an extremely high mortality. Indirect maternal deaths and puerperal sepsis accounted for the bulk of maternal deaths in the rural areas. Only a minority of maternal deaths occurred in lying-in hospitals. Midwifery services in rural areas and antiseptic techniques were most effective in preventing maternal deaths during the late 19th century. The changing distribution ofage and parity amongst the parturients had a definite impact on the mortality decline, enhanced by time, contributing to 500/0 of the mortality decline over the last 15 years. The expontential decline of cause-specific mortality and case fatality rates during the last 40 years is furthermore explained by the emergence ofmodern medicine - antibiotics, antenatal and obstetric care. The earlier serious problem of illegal abortions was eradicated by legislation and changes in hospital practice. The maternal mortality decline has levelled out during the 1970s, the relative importance of embolism as a cause of death is increasing. Advanced age and intercurrent disease are the most difficult risk factors to overcome. To conclude, this study indicates that the reason why maternal mortality has declined faster than otherhealth indices is that the major part of the maternal deaths can be prevented by medical technology, including family planning, antenatal and obstetric care. This experience should be of interest to developing countries where high rates of maternal mortality prevails.

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Read, Susan Margaret. « Management changes in the National Health Service : nursing and organisational theory in relation to the development of a new unit of health care ». Thesis, University of Sheffield, 1989. http://etheses.whiterose.ac.uk/2978/.

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This thesis gives an account of research into management changes in the English NHS following the implementation of the Griffiths' Report (1983). The research had three aims: 1. To describe and consider the effects of new management philosophies plans and practices by conducting a case study of one particular unit of health care. 2. To study theories of nursing and health care organisation. 3. To assess the relationship, if any, between experience and theory, suggesting ways to bring theory and practice closer together. The academic perspective is multidisciplinary, drawing on literature from nursing, organisational 'theory and behaviour, health service management, social science, philosophy, history, economics and policy studies. The thesis commences with a discussion of research methodology, arguing the appropriateness of an interpretive stance. An account of the development of the NHS and nursing's place within it is followed by a detailed case study of one unit, which lasted nine months and involved more than a hundred interviews. Particular characteristics of the case study are:- Data analysis utilising grounded theory methodology Inclusion of members of the organisational context A system for participants to validate data pertaining to themselves. The style is naturalistic, qualitative and processual. Presentation of the results recognises the existence of multiple interpretations of organisational reality; a metaphor likens the development of the Unit to the weaving of a tapestry, where the backing is the structure of the unit, and the pattern the perceptions, values and aspirations of its staff, patients and context members. Emerging themes in the thesis are:- the complexity of the NHS professional philosophies and their relationship to management organising as a process growth of a distinctive unit culture. A deliberate choice is made to expose the conflicts and difficulties of naturalistic inquiry, by reflecting on research method throughout the thesis, which is written in the first person.

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Maguire, Stuart. « The development of a methodology for the introduction of information systems within the National Health Service ». Thesis, Lancaster University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287250.

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This thesis represents over five years of research focusing on the development and implementation of information systems within the National Health SefV1ce. It aims to contribute towards a better understanding of the information systems development process from inception through to system evaluation and review. Five long-term interventions have been undertaken in a range of National Health Service sites, examining different aspects of information provision. The length of the interventions ranged from nine months to almost two years. The five sites were all at different stages of system development. The research has been carried out using a combination of participant observation and action research. This has meant working with National Health Service staff on a series of system projects. The aim of the research is to try and help National Health Service (NHS) organisations deal more successfully with their information provision. The research question asks, "how can NHS organisations think about, and hence go about their information provision in such a way that successful information systems are introduced'!". Information systems development has generally been regarded as a technical discipline. This has led to a narrow view being taken of a number of areas that may affect the success or otherwise of system projects. Historically, the system development process has been concentrated in the hands of a small number of experts even though the implementation of systems can have far-reaching consequences for the organIsation. The output of the research is a set of issues that should be addressed when introducing information systems within the NHS. These have been translated into the OASES materials which form the appendices. OASES is not a prescriptive methodology but a set of principles and guidelines to try and improve the way that information systems are developed within the NHS. It IS hoped that the outcome of the research will be a situation in which effective information systems are developed that take account of the behavioural, cultural, and organisational issues that are important within complex organisations.

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Desombre, Terence Robert. « The role and preparation of Executive Nurse Directors in the new National Health Service (post 1990) ». Thesis, University of Reading, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.388394.

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Powell, Alison. « Examining the implementation of acute pain services in the UK National Health Service ». Thesis, University of St Andrews, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.667194.

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Davies, Ian. « Emerging management education issues for the human services ». Thesis, University of Bristol, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343294.

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Wungchun, Kittipadakul Nonglak Pancharuniti. « Client satisfaction towards oral health services under universal health coverage project in Singburi province, Thailand / ». Abstract, 2004. http://mulinet3.li.mahidol.ac.th/thesis/2547/cd363/4637905.pdf.

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Wood, Aileen J. « Towards a national library and information services policy in public sector healthcare in the United Kingdom ». Thesis, University of Brighton, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275086.

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Thompson, Carl Anthony. « Quality : a multi-method exploration of the social construction of a contested concept in the National Health Service ». Thesis, University of York, 1998. http://etheses.whiterose.ac.uk/13991/.

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Bentley, Melissa. « A National Assessment of Ideal Cardiovascular Health among Emergency Medical Service Professionals ». The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1480456097279235.

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Matthews, Jean Isabel. « Power, management and complexity in the NHS : a Foucauldian perspective ». Thesis, University of South Wales, 2009. https://pure.southwales.ac.uk/en/studentthesis/power-management-and-complexity-in-the-nhs(bb92809f-944d-4bfd-8502-7ffd0791a35a).html.

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This thesis is a critical and post-structural exploration of the discourse of managerialism in the NHS secondary care sector in Wales. Its central intent is to destabilise the dominant thinking about NHS management practice and to evoke intellectual debate about alternative discourses of management that ontologically perceive the organisation as a complex adaptive human system. The emergent theoretical framework conjoins the discipline of Complexity with post-structural conjecture, posing a novel conceptualisation of a fractal self where relations of power are seen as essential for harmonising diverse influences and legitimising a local discourse that informs and regulates practice. Using Foucault’s insights on power and knowledge the thesis critiques the strategic nature of NHS discourse, exposing the discursive dominance of managerialism and its inherent relations of power and debates what this predicates for a local negotiation and a flexible, safe and innovative environment. The methodological approach employs a reflexive and micro-level interpretative strategy to emphasise the singularity of agents and to explore the way in which the discursive constitution of the self influences agent practice. My profound experience of the secondary care system requires I situate my self reflexively within the context where I explore and liberate my own voice in conjunction with my participants. The research adopts a biographical narrative method of data collection and uses Foucauldian discourse analysis as a framework for exploring the underlying discourse in agent stories. The findings demonstrate the polyphonic nature of the secondary care context and reveal the demonstrate the polyphonic nature of the secondary care context and reveal the diverse ways in which agents legitimise, negotiate or resist the conflicting truth claims of various discourse in order to strategically sustain an image of health care historically constituted in their self. The results portray a web of discourses that endorse conformity or complicity through oppressive mechanisms of disciplinary control and surveillance, perpetuating authoritative and dualist structures, dissipating relations of trust and removing intellectual thinking from the front-line. The conclusion asserts that this significantly jeopardises the ability of agents to legitimise local ‘discourse’, severely limiting their capacity for adaptive practice and the generation of new order.

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Friedrich, Allison. « School-Based Mental Health Services : A National Survey of School Psychologists’ Practices and Perceptions ». Scholar Commons, 2010. http://scholarcommons.usf.edu/etd/3549.

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This study explored the current role of school psychologists in the provision of school-based mental health services, including factors that relate to their provision of such services, by surveying a national sample of practicing school psychologists. Despite an extensive knowledge base regarding which professional services school psychologists provide in general, few studies have focused exclusively on specific modalities of mental health services. Previous lines of research also have not fully identified why school psychologists do not spend as much of their professional time in the provision of mental health services as they would desire. Therefore, a central purpose of this study was to determine the extent to which specific factors are perceived as facilitating or prohibiting practitioners from providing psychotherapeutic interventions, including content/knowledge areas and training experiences that are tied to high perceptions of competence to provide mental health services in the schools. Mail out survey methodology was utilized to allow for data collection from a large, national sample of school psychologists in a timely and cost efficient manner. In total, surveys were completed and returned by 226 out of a possible 600 respondents, representing a 37.7% response rate. School psychologists reported receiving referrals for a variety of student issues (although primarily externalizing student behaviors, academic problems, and interpersonal problems) and providing a wide array of mental health services (e.g., consultation, social-emotional-behavioral assessment, individual counseling). Factors identified as posing significant to moderate potential barriers included caseload constraints, role strain, school-level factors (e.g., inconsistent treatment), and systems-level factors (e.g., insufficient funds for services from district administration). The highest rated facilitators to school-based mental health service provision involved personal characteristics (e.g., personal desire to provide mental health services), having adequate training and confidence, and school-related factors (e.g., availability consult with other mental health professionals). Important training preparation included a variety of didactic content areas (e.g., social-emotional behavioral assessment, consultation with teachers and parents) and many of the applied graduate training activities and professional development activities included in the current survey. Implications for future research and practice are presented, specifically related to the training and professional development needs of school psychologists.

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De, Voe Jennifer. « New national approaches to community health : a comparative analysis of historical case studies from Australia and the United States ». Thesis, University of Oxford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367771.

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Algaman, Abrahim Hamad. « TQM implementation in a health care setting : a case study of a Saudi Arabia National Guard primary care setting ». Thesis, Manchester Metropolitan University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.311074.

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Pendaries, Claude. « The development of prototype health benefit groups and healthcare resource groups in learning disability services ». Thesis, University of Kent, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.342095.

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Rathwell, Thomas Arnold. « The effects of policy-making within the planning framework of the National Health Service : the relationship between theory and practice ». Thesis, Durham University, 1986. http://etheses.dur.ac.uk/6818/.

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The re-organisation of the National Health Service (NHS) in 1974 was intended to have a profound and fundamental effect upon the decision-making underpinning the development and delivery of health care services. Re-organisation was considered necessary on two grounds: first to unite the tripartite structure of health care which had existed since 1948; and second to instil the discipline of a corporate management and planning system into the health service. By the late 1970s it had become clear that the corporate management planning system was not working; certainly not as its procreators had envisaged. The system was judged a failure on four counts: 1) health planning became largely prescriptive;2) it remained essentially incrementalist; 3) very few plans and policies produced were evaluated; and4) an inability to achieve the change envisaged. Given the perceived failure of the corporate management planning system to effect change in the NHS, the study sought to investigate two pertinent issues: firstly, the extent to which the philosophy and rationale of health planning is a guiding force leading to better policies; and secondly, to understand those factors which influence and impinge on the planning process and the resulting policy decisions. It is clear from the investigation that health planning in the NHS has failed to live up to expectations. The study has demonstrated that the introduction of a formal planning system into an organisation, however well-intended, is of itself not enough without additional and continuing support. In the local case study, mechanisms and procedures were established and adhered to, and yet very little in the way of acceptable and implementable plans were produced. Nevertheless policy changes did occur and a number of factors can be cited as explanation for this phenomenon. Leadership emerged from the study as being a crucial ingredient in any recipe for planning and policy-making. Power was another dominant factor which was generally applied in a negative sense but when used in a positive way, dramatic results were possible. The third ingredient necessary for effective planning and policy-making was involvement not only of others in the organisation but also of the public. However having these attributes is not enough and the study has demonstrated the need for a more integrated style of planning, policy-making and management, and a concept of strategic management is proffered as an appropriate vehicle for creating within the NHS the desired future change consistent with the needs of the public.

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Woodbridge-Dodd, Kim. « A discursive study of how mental health social workers constructed their professional selves within the context of National Health Service mental health services ». Thesis, University of Northampton, 2017. http://nectar.northampton.ac.uk/9721/.

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Since the 1990s there have been continued drives in England to integrate National Health Services and Local Authorities’ social care within a single mental health service, with the aim of bringing about improvements in health and social care (Local Government Association et al., 2016). This is underpinned by the belief that through bringing the different professional health (such as psychiatrists and mental health nurses) and social care disciplines together, people in need will have a single point of access to a range of skills and knowledge, that no one system could deliver alone (Cooper, 2017). However, the very unique professional approaches that have been stated as the reason to place social workers in NHS Mental Health Services have been the ones that mental health social workers have struggled to hold onto in this setting (Allen et al., 2016). This is a thesis of how mental health social workers constructed a professional self within the context of the NHS mental health services. I used a Foucauldian approach and the notion that professional identity is a socially constructed sense of self, produced from discourses, subject positions and a process of subjectification. Twelve social workers were interviewed; seven mental health social workers and five social workers who held positions as managers or educationalists. I asked social workers questions about their professional identity, their answers provided a rich source of ‘talk’ that I could analyse using Parker’s steps to discourse analysis. The findings discuss the nature of social work as a profession, generic and specialist social work, and suggests a typology of subject positions drawn from the mental health social workers’ discourses. These findings provide a useful resource to support critical social work practice, both as an example of how Foucauldian theory and concepts can be a rich toolbox for understanding practice in complex settings, and through the use of the typology of subject positions as a source to prompt self-reflection for mental health social workers’ practice.

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Ellberg, Lotta. « Postnatal care - outcomes of various care options in Sweden ». Doctoral thesis, Umeå universitet, Obstetrik och gynekologi, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1818.

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Background: In high-income countries, hospital length of stay after a normal birth has gradually decreased correspondingly to length of stay in care of other patients. A short stay provides a greater opportunity for autonomy and an increased sense of participation, but it may involve great challenges satisfying parental guidance as well as on the possibility of preventing, discovering, and treating neonatal medical conditions. Aim: This study evaluates postnatal care based on cost calculations, risk assessments, and parents’ satisfaction with care. Methods: Questionnaires were sent to 1 122 new mothers and her partner during 1998-1999. For the summary of utilization of health care services during the first 28 days postdelivery, the participants were linked with registry data from the hospital administration system for mothers and newborns (n= 773). The answers were also used to describe new parents’ experiences with postnatal care (n = 1 479). The costs for five postnatal care models were estimated, including three care options: Maternity Ward, Family Suite, and Early Discharge. Data about neonatal readmissions and death within 28 days was retrieved from the Swedish Medical Birth Register, the Swedish Hospital Discharge Registry, and the Swedish Cause-of-Death Register between 1999 and 2002 (n = 197 898). This data was related to data about postnatal follow-up practices from all 48 Swedish delivery wards. Results: The readmission rate for the mothers was similar among the various care options, and there was no difference in utilization of health care or breastfeeding outcome due to type of maternity care. As a proxy for morbidity, the readmission rate for the newborns was influenced by postdelivery follow-up routines as routine neonatal examination timing. Depending on the proportion of mothers receiving care at the Maternity Ward, the costs differed significantly between the various care models, while parents’ preferences complied with the cost-minimizing option Family Suite. Most mothers and fathers (70%) were satisfied with the overall impression of the postnatal care, but 72% were dissatisfied with at least one particular topic. A main finding was that the parents experienced a close emotional attachment, an affinity that was not always supported by the staff. The father was not treated as a principal character even though the parents wanted the father’s to be involved and recognized. Conclusions: Since the postnatal care options are not always the most cost minimizing and postnatal routines influence neonatal morbidity and parental satisfaction, the postnatal services need to be improved. Without increasing risks or costs, every postnatal care option ought to meet the families’ need for support, security, autonomy, and attachment with each other.

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Karanika, Vassiliki Lekea. « Greek national perinatal survey : the associations between socioeconomic characteristics of the family, maternal obstetric history, antenatal care features and pregnancy outcome ». Thesis, University of Bristol, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.385731.

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Clark, Margaret Oswald. « The development of a theoretical framework for nursing manpower planning in the hospital sector of the National Health Service in Scotland ». Thesis, University of Edinburgh, 1987. http://hdl.handle.net/1842/18789.

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Kelman, Christopher William, et christopher kelman@cmis csiro au. « Monitoring Health Care Using National Administrative Data Collections ». The Australian National University. National Centre for Epidemiology and Population Health, 2001. http://thesis.anu.edu.au./public/adt-ANU20020620.151547.

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With the inevitable adoption of information technology into all areas of human pursuit, the potential benefits for health care should not be overlooked. In Australia, details of most health care encounters are currently recorded for administrative purposes. This results in an impressive electronic data-bank that could provide a national resource for health service evaluation. ¶ Evaluation of health services has become increasingly important to provide indicators of the benefits, risks and cost-effectiveness of treatments. However, if administrative data are to be used for this purpose, several questions must first be addressed: Are the current data collections accessible? What outcome measures can be derived from these data? Can privacy issues be managed? Could the quality of the data be improved? Is the existing infrastructure adequate to supply data for evaluation purposes? Could the existing system provide a basis for the development of an integrated health information system? ¶ The aims of the project were: · To examine the potential for using administrative data to generate outcome measures and surveillance indicators. · To investigate the logistics of gaining access to these data for the purpose of research. This to be achieved within the current ethical, political and financial framework. · To compare the Australian health-service data system with the current international state-of-the-art. · To develop suggestions for expansion of the present system as part of an integrated health record and information system. This system to manage patient records and provide data for quality management, treatment surveillance and cost-effectiveness evaluation as a routine activity. ¶ The thesis is presented in two parts. In the first part, a historical cohort study is described that involved patients with implantable medical devices. The potential to evaluate outcomes was investigated using all national health-service information currently available in electronic form. Record linkage techniques were used to combine and augment the existing data collections. Australias national health databases are to varying degrees, amenable to such linkage and cover doctor visits, pharmaceuticals, hospital admissions and deaths. The study focused on medical devices as an illustrative case but the results are applicable to the routine assessment of all medical and surgical interventions. ¶ For the Australian Medical Devices study, the records of 5,316 patients who had medical device implants in 1993-94 were selected from the archives of a major private health insurer. Five groups of medical implants were studied: heart valves, pacemakers, hips, vascular grafts and intra-optic lenses. Outcomes for these patients, including death, re-operation and health service utilisation, were compared and analysed. ¶ A comparison study was performed using data from the Manitoba Health database in Winnipeg, Canada. Manitoba provides a very similar demographic group to that found in Australia and is an example of a prototype integrated-health-information system. One of the principal advantages for research is that personally identified data about medical and hospital services are collected for all patients. Selection bias is eliminated because individual consent is not required for this type of research and all selected patients could be included in the study. ¶ The two studies revealed many barriers to the use of administrative data for health outcomes research. Service event data for the Australian cohort could be collected but only after long delays and hospital morbidity data were not available for the entire cohort. In contrast to the situation in Australia, the Manitoba data were both accessible and complete, but were lacking in detail in some areas. ¶ Analysis of the collected data demonstrated that without the addition of clinical data only general indications of trends could be deduced. However, with minimal supplementary clinical data, it was possible to examine differences in performance between brands of medical devices thus indicating one of the uses for this type of data collection. ¶ In the second part of the thesis, conclusions are presented about the potential uses and limitations of the existing system and its use as a basis for the development of a national Integrated Health Record and Information System (IHRIS). The need for the establishment of a systemic quality management system for health care is discussed. ¶ The study shows that linked administrative data can provide information about health outcomes which is not readily available from other sources. If expanded and integrated, the system that is currently used to collect and manage administrative data, could provide the basis for a national health information system. This system would provide many benefits for health care. Benefits would include the monitoring, surveillance and cost-effectiveness analysis of new and existing treatments involving medical devices, drugs and surgical procedures. An integrated health information system could thus provide for both clinical and administrative needs, while in addition providing data for research. ¶ Unfortunately, in Australia, the use of administrative data for this purpose is not currently feasible. The principal barrier is the existence of a culture within the Australian health care system which is not supportive of research and is deficient in quality and safety measures. ¶ Recent initiatives by both the Commonwealth and state governments have supported the introduction of measures to improve quality and safety in health care. It is argued here that an Integrated Health Record and Information System (IHRIS) would provide an essential component of any such scheme. The results of this study have important policy implications for health care management in both the administrative and clinical domains.

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Meinow, Bettina. « Capturing health in the elderly population : Complex health problems, mortality, and allocation of home-help services ». Doctoral thesis, Stockholm University, Department of Social Work, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-7683.

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This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sources are used: (1) The Tierp study of community-dwelling persons (n=421, ages 75+), (2) the SWEOLD nationally representative samples (n=537 in 1992 and n=561 in 2002, ages 77+), and 3) SNAC-K comprised of home-help recipients in a district of Stockholm (n=1108, ages 65+).

Study I suggests that the length of the follow-up period may explain some of the differences found in predictor strength when comparing mortality studies. Predictors that can change rapidly (e.g., health) were found to be strongest for the short term, with a lower average mortality risk for longer follow-ups. Stable variables (e.g., gender) were less affected by length of follow-up.

Studies II and III present a measure of complex health problems based on serious problems in at least two of three health domains. These were diseases/symptoms, mobility, and cognition/communication. Prevalence of complex health problems increased significantly between 1992 and 2002. Older age, female gender, and lower education increased the odds of having complex problems. Complex problems strongly predicted 4-year mortality. Controlled for age, gender, health, and education, mortality decreased by 20% between 1992 and 2002. Men with complex problems accounted for this decrease. Thus, in 2002 the gender difference in mortality risk was almost eliminated among the most vulnerable adults.

Study IV revealed that physical and cognitive limitations, higher age, and living alone were significantly related to home-help allocation, with physical and cognitive limitations dominating. Psychiatric symptoms did not affect the assessment.

The increased prevalence of complex health problems and increased survival among people with complex needs have important implications concerning the need for collaboration among service providers.

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Thèses sur le sujet « National health services – Sweden »

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