Tesi: "Health services utilisation"

1

Treanor, Charlene Jennifer. "The health status and utilisation of health services by cancer survivors with late effects". Thesis, Queen's University Belfast, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.603428.

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The number of cancer survivors is increasing. Knowledge gaps exist regarding the health of survivors and their use of services, particularly survivors with long-term effects of the disease and treatment, including late effects. This PhD study comprised (i) a systematic review of health service utilisation by cancer survivors; (ii) a population-based comparative survey of the health status and service utilisation of cancer survivors and a matched General Practice population; (iii) an overview of reviews of late effects; (iv) a comparative analysis of cancer survivors with self-reported late effects and survivors without late effects in terms of their health status and services utilisation patterns and; (v) a qualitative study of the narrative of cancer survivors with late • effects. The health service utilisation review identified that increasing age was associated with less care and increased hospitalisations. Improved care receipt was dependent on type and frequency of physician contact which facilitated health service use. Survivors were generally higher service users and received more care than the general population- this finding concurs with results of the survey. Survivors also had significantly poorer health than the general population. The presence of co-morbidities was associated with less service receipt, though the survey found that survivors with late effects were high users of care and experienced poorer health than their counterparts without late effects. There was general I SUMMARY 2 - PAGE 3 - agreement that physical late effects tend to emerge some time post-treatment, but there was -- less agreement regarding the onset of psychological late effects. Late effects impacted on many aspects of survivors' lives and were managed in many ways. The main emergent themes from the qualitative analysis were: sense-making, social comparisons and psychology of the individual. Care recommendations and implementation of preventive care plans would facilitate receipt of appropriate care and improve health for survivors including those with late effects.

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2

Johansson, Birgitta. "Intensified primary health care for cancer patients : Utilisation of medical services". Doctoral thesis, Uppsala University, Department of Public Health and Caring Sciences, 2000. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-512.

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The aim of the present thesis is to evaluate the effects of an Intensified Primary Health Care (IPHC) intervention on GPs' and home care nurses' possibilities to monitor and support cancer patients, and on cancer patients utilisation of medical services. A further aim is to identify determinants of cancer patients' utilisation of such services. A total of 485 patients newly diagnosed with breast, colorectal, gastric or prostate cancer were randomised to the intervention or to a control group. The follow-up period was 24 months for all patients.

Patients randomised to the IPHC were referred to the home care nurse. The home care nurse and the GP received copies of the medical record each time the patient was discharged from hospital after a period of in-patient care, or had visited a specialist out-patient clinic. In addition to this, recurrent education and supervision in cancer care were arranged.

The IPHC resulted in a marked increase of home care nurse follow-up contacts. The majority of control patients (74%) reported no such contacts, while 89% of IPHC patients reported this. High age (=80 yr) was the strongest predictor within the IPHC group for reporting a continuing home care nurse contact. Furthermore, the IPHC increased GPs' knowledge about patients' disease and treatments, and appeared to facilitate their possibilities to support the patients. The IPHC reduced the utilisation of specialist care among elderly cancer patients. The number of days of hospitalisation for older patients (=70 yr) randomised to the IPHC were 393 less than for older control patients during the 3 first months after inclusion. Regression analyses defined diagnosis, extensive treatment, comorbidity, low functional status, pain and socio-economic factors as predictors of a high utilisation of medical services.

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3

Bayer, Jordana. "Critical factors contributing to under-utilisation of professional mental health services /". Title page, table of contents and abstract only, 1990. http://web4.library.adelaide.edu.au/theses/09ARPS/09arpsb357.pdf.

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4

Roberts, Nicola. "Using attachment theory within mental health community services to improve patient outcomes and reduce service utilisation costs". Thesis, University of Manchester, 2012. https://www.research.manchester.ac.uk/portal/en/theses/using-attachment-theory-within-mental-health-community-services-to-improve-patient-outcomes-and-reduce-service-utilisation-costs(78a9832e-0e8f-4d2b-a6a4-8d7ffdf5aa6d).html.

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This thesis follows the paper-based format and papers one and two have been prepared for submission to Attachment and Human Development and the British Journal of Clinical Psychology, respectively. The relevant submission guidelines are included in the appendices (Appendix A and B).Attachment theory (Bowlby, 1977a) has prompted a wealth of empirical research in its contribution to adult attachment patterns and subsequent psychopathology in mental health (Holmes, 2001; Wallin, 2007). More recently, attachment theory has been proposed as a suitable framework by which to inform the organisation, design and delivery of mental health services (Goodwin, 2003; Seager et al., 2007) but it is unclear what this would look like in practice. Adopting an attachment-informed service model has key implications for individual and service outcomes and the two papers presented in this thesis aim to contribute to research in this area, followed by a critical review of the research, its relevance and future implications. Paper one is a narrative overview of the literature discussing the practice implications of services adopting an attachment-informed framework, and describes how this might be conceptualised in front-line service delivery. Articles reviewed described the influence of attachment theory in predominantly inpatient, secure forensic and/or psychiatric rehabilitation services, and its application within more generic community mental health services was explored. Paper two aimed to investigate the importance of individual attachment and service attachment to client psychopathology, quality of life, service utilisation and service costs in community-based mental health services. The final section, the Critical Review, critiqued the literature review and aimed to place the research within a wider context. This section considers the findings from the research and the limitations of the study, while also highlighting important issues for services, with implications for clinical practice and future research.

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5

Rahman, Syed Azizur. "Utilisation of primary health care services in rural Bangladesh : the population and provider perspectives". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://researchonline.lshtm.ac.uk/682288/.

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This thesis is about the Utilisation of Maternal and Child Health Care Services (MCH) in Rural Bangladesh. Investigations have been made to identify the underlying causes of low use of the MCH services provided through the public sector health care facilities, which is a major concern for the government of Bangladesh. This thesis focuses on the factors that are affecting the use of MCH services both from population and provider perspectives. Socio-economic condition of people, their knowledge and attitudes towards the public sector health care services are considered as population factors, while different aspects of quality of public health services, access to the service facilities and provider's behaviour are explored as the providers' factors. Aims: The aim of this research was to provide policy recommendations for improving utilisation of the public health services at the primary health care level by redesigning more accessible, acceptable and quality health care services, especially for rural women and children. Scope: Maternal health services: antenatal care; tetanus vaccination; place of child delivery; and postnatal care are considered in this study. While two major killer diseases: diarrhoea and acute respiratory infections, and immunisation of children under five years of age are included as child health care services. Methods: A combination of qualitative and quantitative methods are used to collect data /information from 360 mothers, 28 formal and informal community leaders, 44 various types of health care providers and 22 public sector facilities in a rural area of Bangladesh. The World Health Organisation (WHO) recommended 30 cluster sampling method was used in sample design. Household survey, in-depth interview, informal and formal discussion, participant observation and document analysis have been carried out to obtain necessary information/data. Data analyses: The quantitative data have been analysed by using STATA and SPSS statistical computer programme, performing descriptive, bivariate and logistic regression analysis. The qualitative information has been analysed in a descriptive way. Results: The results show that the use of government health facilities: THC, FWC and VHCP is generally very low with an exception of the use of VHCP for TT vaccination to women and child immunisation. The use of VHCP is encouraging for the government policy makers and planners. THC is partially meeting the health care need of rural people and mainly serving the interest of people of relatively high socio-economic condition. FWC is the most unused health care facility at the rural areas of Bangladesh. The majority of people (86%) received health care from non - qualified health care providers. Among the socio-economic factors - family education and income were found to be significant both individually and jointly with the variations of use of MCH services. The majority of the sample population does not have knowledge about the MCH service availability and possessed negative attitudes towards the public sector MCH services. These are attributable to the under utilisation problem. Nine gaps have been identified between peoples' `reasonable expectation' and the `existing' MCH service delivery system. Peoples' involvement in the health service organisation at the thana and union level was found almost nil. However their involvement in the operation of VHCP was encouraging. Low (2-3 minutes) consultation time, lack of privacy in treatment, unregulated involvement of public sector provider in private practice, lack of accountability, supervision and improper behaviour of providers deteriorating the quality of services hence decreases the use of public sector facilities. Unavailability of drug was found to be the single most important reason that deters people from using public facilities. Difficulties in access to quality services were found to be a major problem than access to the service facilities. Conclusions: This thesis suggests that giving priority to improving the service qualities of the existing facilities rather than construction/development of additional facilities at PHC level. It also suggests the initiation of behaviour change programmes for public sector health care providers. Secondly an effective mechanism needs to be developed to ensure peoples' involvement in the management and operation of public health care facilities to enhance accountability of public sector provider to the population and reduce the gap between them. Initiatives could be taken to improve the quality of non-qualified health care providers, as they are the main source of health care for the majority of population. Finally, increasing the education level of rural population particularly for women could increase the use of health services.

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6

Manthalu, Gerald Herbert. "The impact of user fee exemption on maternal health care utilisation and health outcomes at mission health care facilities in Malawi". Thesis, University of Aberdeen, 2014. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=214843.

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The Government of Malawi has entered into agreements with Christian health association of Malawi (CHAM) health care facilities in order to exempt their catchment populations from paying user fees. These agreements are called service level agreements (SLAs). Government in turn reimburses the CHAM health care facilities for the health services that they provide. The agreements started in 2006 with 28 out of 166 CHAM health care facilities and increased to 68 in 2010. The aim of the exemption policy is to guarantee universal access to a basic package of health care services. Although the agreements were designed to cover every health service in the basic health care package, only maternal and neonatal health services are included due to limited resources. The main objective of this thesis was to evaluate the impact of the health care financing change on health care utilisation and health. The specific objectives were as follows: first, to examine whether health care facility visits for maternal health care changed due to user fee exemption; second, to evaluate whether user fee exemption affected the choice of the health care provider where women living in the catchment areas of CHAM health care facilities with user fee exemption sought maternal health care; third, to analyse the effect of user fee exemption on birth weight and; fourth, to explore and apply novel methods in the evaluation of user fee exemption. The gradual uptake of service level agreements by CHAM health care facilities provided a natural experiment with treated and control health care facilities. An additional control group comprised of other demographic groups apart from pregnant women and neonates at CHAM health care facilities with service level agreements. In household survey data, individuals were assigned to treatment and control groups based on their proximity to either a CHAM health care facility with SLA or a CHAM health care facility without SLA. This proffered the unique opportunity to estimate the effect of a single treatment on multiple outcomes. The difference-in-differences (DiD) approach was used to obtain causal effects of user fee exemption. It was implemented in the context of fixed effects, switching regression and multinomial logit models across different chapters. Health care facility level panel data for utmost 146 health care facilities for a maximum of 8 years, 2003-2010, were used. The data were obtained from the Malawi health management xiii information system (HMIS). Linked survey data were also used. Malawi demographic and survey data for 2004 and 2010 were linked to health care facility data and then merged. Analyses that utilised health care facility data showed that user fee exemption had led to increases in first antenatal care visits in the first trimester, first antenatal care visits in any trimester, average antenatal care visits and deliveries at CHAM health care facilities with SLAs. Results from survey data showed that the probability of using a CHAM health care facility with user fee exemption for antenatal care increased, the probability of using home antenatal care declined and the probability of not using antenatal care also declined due to user fee exemption. The probability of delivering at a CHAM health care facility with SLA also increased while the probability of delivering at home declined. User fee exemption did not affect the choice of where to go for postpartum care. Results of the effect of user fee exemption on birth weight were not reported because of potential endogeneity bias arising from lack of instrumental variables for antenatal care. The key policy messages from this thesis are that the user fee exemption policy is an important intervention for increasing the utilisation of maternal health care and needs to be extended to as many CHAM health care facilities as necessary. User fee exemption is not enough, however. Other factors such as education of the woman and her husband/partner, wealth status and cultural factors are also important. This thesis has contributed to the body of knowledge in the following ways. First, it has generated evidence on the impact of user fee exemption on maternal health care utilisation and birth weight in Malawi. Second, with respect to maternal health care utilisation, the thesis has looked at variables that capture the whole maternal health care process from early pregnancy to postpartum care and in a policy relevant way. Third, the thesis has evaluated the effect of user fee exemption on a variable that have not been looked at before, first antenatal care visits in the first trimester. Fourth, the thesis has examined the effect of a single treatment on multiple outcomes in a methodologically unique way. Treatment effects, which were the changes in the probabilities of using different alternatives summed up to zero, thus showing where any increase in the probability of using the outcome of interest came from. Fifth, this thesis is first to use disequilibrium theory of demand and supply in health economics. Application of this theory entailed using switching regression models with unknown sample separation, a seldom used estimation method in health economics. This was an important contribution to the methods xiv of analysing aggregate health care utilisation. Sixth, the STATA program that was written for the estimation of the disequilibrium models was itself a very important contribution to the methods for estimating aggregate supply and demand.

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7

Ibrahim, Ghada. "The role of the health system in women's utilisation of maternal health services in Sudan". Thesis, City, University of London, 2015. http://openaccess.city.ac.uk/17079/.

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Abstract (sommario):

Background: Maternal mortality and morbidity still pose a significant challenge in Sudan, where no significant improvements in maternal health have been achieved despite the focus on the Millennium Development Goals. Under-utilisation is a major public health concern even though Sudan is among the African countries that have registered poor maternal and child health. Health services in Sudan are generally limited and with poor quality and disparate access. Therefore, there is a need for better understanding of the barriers to the provision and utilisation of maternal health services in order to improve the health and survival of Sudanese mothers. Objectives: This study sought to assess the maternal health system functions and influences on utilisation as well as the social, cultural, and women’s characteristics that may constitute barriers to utilisation. Methodology: The study used an explanatory sequential mixed-methods design. A comprehensive analysis was conducted using several quantitative and qualitative data sets, guided by a new framework, the Maternal Health System Performance framework (MHSP) developed as part of this work in order to assess both the three objectives and four functions of the health system on both macro and micro levels. Findings: The study findings provide clear evidence that the Sudan health system is not currently capable of achieving an adequate level of attainment of the health goals or equitable distribution, due to dysfunction of the four health system functions. In addition, the findings draw attention to the important role of the stewardship function in health system performance. This function can play a key role in health system reform, as it influences management of the health system and should work across all elements of the system to ensure a well-functioning health system and efficient use of resources. The findings also underline the important role of health system related factors rather than simply population factors (such as individual, household, and community factors) in the low service utilisation among women in poor settings. While it shows that certain population characteristics such as household income and education do have a significant impact on the utilisation, the health system functions, and in particular the stewardship function, are also demonstrated to be of considerable importance. Implication: These findings have implications for policy and practice, indicating that simply blaming women for not using maternal health services is unhelpful and inappropriate and indicate that decision makers should focus more fully on improving the performance of the health system. According to the comprehensive assessment of the health system performance, the study proposes several recommendations for each health system function to enhance the performance in the context of limited resources, ultimately to improve women’s and community health in Sudan.

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Matizirofa, Lyness. "Perceived quality and utilisation of maternal health services in peri-urban, commercial farming, and rural areas in South Africa". Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&amp.

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This investigation aimed to determine factors that influence women's utilisation of maternal health services, with specific focus on the quality of care and services available to disadvantaged communities in South Africa. It used the women's perspectives to assess the quality of maternal healthcare services in peri-urban commercial farming and rural areas with the purpose of understanding why women utilise maternal services the way they do.

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9

Idris, Deeni Rudita. "Health help seeking behaviour and health care services utilisation of Bruneian men : a grounded theory study". Thesis, Durham University, 2017. http://etheses.dur.ac.uk/12438/.

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Despite the growth in research on masculinities and health help seeking behaviour we have little idea of how gender and ethnicity intersect to inform health help seeking behaviour among men in multi-ethnic cultures. This paper presents findings from a PhD research project investigating how being a man in Brunei Darussalam, a country with a strong religious and diverse cultural society; influences men’s perceptions of and attitudes towards their health and health help seeking behaviour. Using Grounded Theory, this thesis reports a study that utilised semi structured interviews and focus group discussions with a total of 47 men and women from diverse ethnic backgrounds in Brunei Darussalam. Three key themes emerged from the analysis of interviews with men: 1) The physicality of health and its importance to masculinity; 2) “Ikhtiar” as a way of ‘doing masculinity’ in the context of experiences of ill-health; and 3) masculinity and legitimation of health help seeking. A core concept found in this study relates to the process by which men operate and re-negotiate their masculinity in relation to their engagement with health care services, particularly when their ability to perform masculine responsibilities are potentially jeopardised by ill-health. Themes emerging from interviews with women focused on the relationship between wives and husbands, and daughters and fathers, and the way caring responsibilities reinforced bonds within the family. Women saw men’s reluctance to use healthcare as ‘normal for men’, while men acknowledged that pressure from wives was a factor in their decision to seek help. This study contributes to the development of knowledge about masculinities and health in a geographical region where to date there has been no empirical research, despite the existence of epidemiological evidence indicating that men’s health needs are serious and appear to be unmet.

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Toan, Ngo Van. "Utilisation of health services in a transitional society : studies in Vietnam 1991-1999 /". Stockholm, 2001. http://diss.kib.ki.se/2001/91-628-4812-7/.

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11

Saleh, Doha Mahmoud Ismail. "The utilisation of ambulatory health care services in Saudi Arabia : a quantitative analysis". Thesis, London School of Economics and Political Science (University of London), 2004. http://etheses.lse.ac.uk/1862/.

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The thesis aims to investigate whether need is the major determinant of ambulatory health care utilisation for Saudi nationals in Saudi Arabia. This is done by applying multivariate analysis on the utilisation of both curative and preventive services on the data provided by the 1996 Saudi Arabia Family Health Survey. The analysis is applied within the framework of Andersen's sociobehavioural model, categorizing the factors that affect health services utilisation into predisposing, enabling and need factors. It can be concluded from the results that although need seems to be an important determinant of ambulatory health care utilisation, some of the predisposing and enabling factors were also found to affect health services utilisation, although the degree of their effect differs according to the health condition and type of services tested for. Need is dominant with regards to the utilisation of health services in response to children's diarrhoea, infants' full immunisation and attending at least one prenatal care session. But since some of the predisposing and enabling factors were found to affect health services utilisation, this highlights the importance of addressing the factors that were found to impede the utilisation at the health care system level as well as at the society level in order to achieve a more equitable health care system.

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12

Archary, Paverson. "Trends of utilisation of reproductive health services by lesbian women in Cape Town". Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13150.

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Includes bibliographical references.
Background: The Lesbian, Gay, Bisexual and Transgender (LGBT) community has historically been marginalised. Increased international awareness of the LGBT profile has led to the recognition that the medical profession has overlooked the health needs of lesbian women, with a resultant paucity of data regarding lesbian women’s health risks. International literature has shown that lesbians remain at risk of sexually transmitted infections and HIV; are at significant risk of mental health disorders; exhibit a high-risk profile for cardiovascular disease, diabetes, as well as cancer, and underutilise health care services due to experiences of homophobia. South African data is almost non-existent. Objective: To explore Cape Town wsw’s (women who have sex with women) experiences with, and trends of utilisation of Reproductive Healthcare Services. Study Design: Cross Sectional Survey. Methods: A sample of self-identified wsw was recruited using a snowball sampling method to complete an anonymous, self-administered online questionnaire during February 2013. Outcome Measures: Predominantly descriptive, with an aim to validate the study questionnaire for the South African context. Results: A total of 116 responses were analysed. The mean age of the population was 37 years of age, with the majority identifying as lesbian. The population comprised predominantly of Caucasian, middle class suburban residents, with most having medical aid, and accessing private health care. A significant proportion of respondents reported previous intercourse with a male sexual partner. Barrier contraception was not always used during intercourse with men and almost never during sex with women. There were a significant number of sexually transmitted infections in women with no previous male sexual partners. Most respondents considered themselves to be at low risk of contracting HIV, and at intermediate risk of cervical and breast cancer, and showed higher than average utilization of cervical screening practices for 4 this population, despite a general perception that screening is unnecessary in lesbian women. A general trend towards disclosure of sexual orientation was noted; however users of private healthcare were significantly more likely to have disclosed their orientation to their physician than users of public and NGO services. Respondents held a preference for practitioners that were themselves gay/lesbian.The study tool was validated for use in the South African context; however redundancy could not be formally excluded from the questionnaire. Conclusions: Wsw from Cape Town experience internationally comparable exposures and risks of gynaecological problems. Further research is required to fully understand the healthcare needs of lesbian women living in lower socio-economic conditions.

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Salem, Salem F. "The geography of health in Libya : accessibility to, utilisation of, and satisfaction with public polyclinics in Benghazi". Thesis, Durham University, 1995. http://etheses.dur.ac.uk/1709/.

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Mbugua, Jason Karanja. "Impact of user charges on health care utilisation patterns in rural Kenya : the case of Kibwezi Division". Thesis, University of Sussex, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335506.

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15

Diop, Kine Bibi. "Factors associated with diabetes prevalence and utilisation of diabetes care services in Mauritius". Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/10383.

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Includes bibliographical references (leaves 149-176).
Diabetes is a growing problem worldwide. It is estimated that at least 171 million people have diabetes worldwide and this figure is projected to more than double by 2030. Mauritius has not been spared from diabetes. Indeed, it has one of the highest diabetes prevalence in the world. It is creating tremendous pressure not only on households but on the health care system.

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Evans, Stuart Wyn. "Investigation and evaluation of the utilisation of advice offered to the public by community pharmacists". Thesis, Cardiff University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337199.

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17

Greenaway, John Richard. "The utilisation of endoscopy services : strategies for patient management at the primary/secondary care interface". Thesis, University of Newcastle Upon Tyne, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.391398.

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18

Fritsche, Ntombikayise. "Utilisation of university health care services by employees of the University of Fort Hare". Thesis, University of Fort Hare, 2016. http://hdl.handle.net/10353/5950.

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Background: University of Fort Hare (UFH) provides health care services to its students and staff; however, whether the health care services are being utilised by the staff is only speculative. Hence, the aim of the study was to determine the level of employees’ awareness regarding availability of University Health Care Services (UHS) and factors responsible for their utilization. wildlife and thereby may constitute a serious risk to public health. Therefore, it is recommended that proper regulation of the use of the compounds and their safe disposal be ensured to protect aquatic resources and the well-being of humans. Methodology: This quantitative descriptive study involved conveniently selected 255 UFH employees who were either permanently employed or on contract employment for two years and above. A structured self-administered questionnaire was used for data collection. The questionnaire solicited information on demographics variables, awareness of employees regarding the existence of university health services, and factors affecting utilization of university health services (UHS) by employees. Data was analysed using descriptive statistics (frequency and percentages) and inferential statistics (logistic regression analysis). Results: -Two hundred and thirty three (91 percent) of sampled UFH employees in both campuses are aware of the UHS. The longer the duration of employment and the older the employee (above 50 years old) the more likely the employees are aware of UHS. However, the elderly employees displayed poor utilization of health care services. Accessibility of UHS (96 percent), satisfaction with UHS (95 percent), listening to others (word of mouth) (61.2 percent) and having a health concern (51 percent) encourage UHS utilization whereas being unaware (8.6 percent) of the UHS remains the barrier for utilisation. Having medical aid (81 percent) prevent those who are aware of UHS from utilising the university health care services. Operating hours (30 percent), staff attitudes (50 percent) and long waiting time (70 percent) with lack of essential medicines (38 percent) prohibit employees from revisiting. Conclusion: The University of Fort Hare’s health care services are well known by almost every employee through “word of the mouth” though they are not completely aware as to which health service programmes are being offered. The utilization of University of Fort Hare’s health care services is positively and adversely influenced by different factors.

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Zhang, Jianzhen (Jenny). "Socioeconomic position and utilisation of preventive health services among adults in the general population". Queensland University of Technology, 2007. http://eprints.qut.edu.au/16532/.

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Background: International research has shown that socioeconomically disadvantaged groups experience significantly higher mortality and morbidity rates than other groups. Both cardiovascular disease (CVD) and diabetes are major contributors to Australia's burden of disease, and individuals from lower socioeconomic groups are more likely to be affected by both, and to have worse prognoses and outcomes. There is substantial research evidence that a range of preventive activities can reduce the morbidity and mortality associated with these conditions. Research in countries with good access to primary health care services has demonstrated that socioeconomically disadvantaged groups tend to have higher levels of medical consultations, but make less use of preventive care and screening services. This fact contributes to their poorer health outcomes, as diagnosis will typically occur later than for more advantaged individuals, thus leading to a poorer prognosis. However, to date, there has been little research on the differential utilisation of preventive health services for CVD and diabetes by different socioeconomic groups in Australia. To understand socioeconomic influences on the use of preventive health services, a comprehensive review of the literature of determinants of health service utilisation was conducted and a number of explanations for this relationship considered. It was proposed that the following factors are likely to be important in this relationship: differences in the perception of the availability of, and accessibility to health care, attitudes and beliefs toward preventive health care, having a regular source of care, perception of interpersonal care from general practitioners, and social support. A number of theoretical models were also reviewed; in particular, the Andersen Behavioural Model of Health Service Research Utilisation. Aims: This doctoral research program has described the relationship between socioeconomic position (SEP) and utilisation of preventive health services in relation to CVD and diabetes. It aims to improve the understanding of the determinants of uptake and utilisation of preventive health services in general practice by different socioeconomic groups in Australia. Methods: The study was conducted in Brisbane Australia, in 2004, using a cross-sectional design and a self-administered mailed survey for data collection. A sample of adults aged 25-64 years was selected randomly from the Brisbane Electoral Roll. A conceptual model incorporating a range of relevant socio-demographic, risk-factor and behavioural variables in the relationship between SEP and GP-based use of preventive health services was used to develop a self-administered questionnaire. The questionnaire was pilot-tested and then reviewed by a panel of international experts. A new self-administered questionnaire, the Health Service Utilisation Questionnaire (HSUQ), was developed. It included 79 items: 12 socio-demographic items; 10 items assessing health status, disease conditions and smoking status; 20 items assessing use of health services; and 37 items assessing the factors that might affect use of health services utilisation. The HSUQ was then mailed to 800 randomly selected survey participants. The survey response rate was 65.6 per cent. After exclusion of those patients with cardiovascular diseases and diabetes, the final sample size was 381, consisting of 155 males and 226 females. Socioeconomic indicators were individual education level and family income. Blood pressure, blood cholesterol and blood glucose check-ups by general practitioners (GPs) were used as the major outcome variables. Nine scales and two dichotomous variables that measure those potential factors were derived following Principal Component Analysis and reliability testing. The data were analysed separately by gender, and adjusted for age and each of the socioeconomic indicators. Statistical description, bivariate analysis and multivariable modelling in SPSS were applied for the data analysis. Results: The survey results were suggestive of socioeconomically disadvantaged people being less likely than more advantaged people to utilise preventive health services for CVD and diabetes. For males, the low socioeconomic groups recorded the least use of preventive health services among the three education and income groups, including blood cholesterol and blood glucose check-ups, while the high socioeconomic group recorded the greatest use of preventive health services. There was no apparent relationship between education level and blood pressure check-up, while individuals from low-income families were less likely to go for a blood pressure check-up. For females, most of the results suggested that the low socioeconomic groups were less likely than the high socioeconomic groups to have blood cholesterol and blood glucose check-ups. However, this was not the case for blood pressure check-ups. The results showed that the low and middle socioeconomic groups were more likely than the high socioeconomic groups to have BP check-ups. However, the low socioeconomic groups were still less likely than the middle socioeconomic groups to have a blood pressure check-up. Overall, there was a similar pattern between education and income and the use of GP-based preventive health services among both males and females. The findings from the examination of the mediating factors between SEP and the GP-based use of preventive health services suggested that socioeconomically disadvantaged adults (both low level of education and low income) are more concerned about transport and travel time to health care, and accessibility to health care in terms of finding a GP who bulk bills, the cost of seeing a GP and having a choice of GP. They are also less likely to have a regular place of care and social support. These potential factors are likely to result in a lesser use of preventive health services than their high-SEP counterparts. In addition, the findings also suggested that respondents with a low level of education have less-positive attitudes towards health care, and that those from low-income families do not have a regular care provider and are less likely to visit their GP for a preventive check-up in relation to CVD and diabetes in Australia. Conclusions: Strategies for reducing socioeconomic health inequalities are partly associated with changing social and economic policies, empowering individuals, strengthening social and family networks, and improving the equity of the health care system. Strategies have been recommended for implementation in general practice that are directed at targeting the needs of disadvantaged groups; for example, providing longer consultation time and actively offering information on preventive care. Implementation of health promotion programs is needed in disadvantaged areas to keep the community informed about the availability of health services and to make health services more accessible. The health care system needs to be geographically accessible through improvements to the transport system. In addition, improving access to a regular source of primary health care is likely to be an important step in encouraging low-SEP individuals to use preventive health services.

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20

Beale, Norman. "Unemployment and family morbidity : a study of a factory closure in British general practice". Thesis, University of Cambridge, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387595.

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21

Alfaqeeh, Ghadah Ahmad. "Access and utilisation of primary health care services in Riyadh Province, Kingdom of Saudi Arabia". Thesis, University of Bedfordshire, 2015. http://hdl.handle.net/10547/603523.

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The Kingdom of Saudi Arabia (KSA) faces an increasing chronic disease burden. Despite the increase in numbers of primary health care centres (PHCCs) current evidence from the KSA, which is limited overall, suggests that access and utilisation of PHCCs, which are key to providing early intervention services, remain unequal with its rural populations having the poorest access and utilisation of PHCCs and health outcomes. There is a dearth (lack) of information from the KSA on the barriers and facilitators affecting access and utilisation of primary health care services (PHCS) and therefore this study aimed to examine the factors influencing the access and utilisation of primary health care centre (PHCC) in urban and rural areas of Riyadh province of the KSA. The behavioural model of health services use (Andersen’s model) provided the contextual and individual characteristics and predisposing, enabling and need factors which assist with an understanding of the barriers and facilitators to access and utilisation of PHCCs in Riyadh province. A mixed methods approach was used to answer the research questions and meet the objectives of the study. The converged qualitative and quantitative findings show that there are a number of predisposing (socio-demographic characteristics; language and communication and cultural competency) enabling barriers such as; distance from PHCCs to the rural residence, lack of services, new services, staff shortages, lack of training, PHC infrastructure, and poor equipment. Facilitators: service provider behaviour/communication, free PHCS, service provision and improvements, primary health care (PHC) infrastructure, manpower, opening hours, waiting time, and segregated spaces and need (increasing prevalence of chronic diseases, PHC developments in the KSA) factors influencing access and utilisation of PHCS. This study highlights important new knowledge on the barriers and facilitators to access and utilisation of PHCS in Riyadh province in the KSA. The findings have some important policy and planning implications for the MOH in the KSA. Specifically, the findings suggest: the need for clear documentation/guidance on minimum standards against which the PHCS can be measured; an audit of service availability at the PHCCs, regular patient satisfaction evaluations of PHCS, that the MOH take a parallel approach and continue to resource and improve buildings and equipment in existing PHCCs, the recruiting of more GPs, nurses, pharmacists, nutritionists and physiotherapists to meet patient demand and more Saudi health care staff, more targeted health education and interventions for the prevention of chronic diseases in the KSA and the need for an appointment system for attending the PHCCs. There is a need for further research into the barriers and enablers to accessing and utilising health care in Riyadh and the KSA overall. This research would be made easier with a clearer definition of rural and urban in the KSA context which would allow a greater comparability between urban and rural PHCS for future research, audit and evaluation as well as comparison with PHCS in other parts of the world. The Andersen model provided a useful conceptual model to frame this research and provided a structure for contrasting and comparing the findings with other studies that have used the Andersen model to understand the barriers and enablers to accessing and utilising health care services.

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22

Kachimanga, Chiyembekezo. "Improving utilisation of maternal health related services: the impact of a community health worker pilot programme in Neno Malawi". Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29196.

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Malawi has one of the highest maternal mortality ratio (MMR) in sub-Saharan Africa (SSA). Despite investments in family planning and emergency obstetric care (EmOC), Malawi’s Millennium Development Goal (MDG) target of reducing maternal deaths to 155 deaths per 100,000 live births was not met by the end of 2015. Between 2010 and 2015, Malawi was only able to reduce the MMR from 675 to 439 per 100,000 live births. Inadequate utilisation of perinatal services is the contributing factor to the MMR target not being achieved. One approach for improving the utilisation of perinatal services is to invest in community health workers (CHWs). CHWs can be trained to: identify women of child bearing age (WCBA) who need perinatal services; provide community education; encourage timely referral of clients to the nearest health facility; and undertake community follow up for WCBA who are pregnant and/or have recently given birth. We evaluated changes in utilisation of antenatal care (ANC), facility based births, and postnatal care (PNC) after CHW deployment to conduct monthly home visits to WCBA for pregnancy identification and escorting women to ANC, labour and facility birth and PNC clinics in Neno district, Malawi. The CHW programme was implemented in two catchment areas from March 2015 to June 2016. Methodology: We employed a retrospective quasi-experimental study design to evaluate the impact of CHWs on changes in the utilisation of ANC, facility based births, and PNC in Neno district, Malawi between March 2014 and June 2016 (pre-intervention period: March 2014 to February 2015, and post-intervention period: March 2015 to June 2016). Monthly outcomes were compared between a combined CHW intervention area and its synthetic control area using the synthetic control method. The synthetic control area (or synthetic counterfactual of the CHW) 14 was the control area that was created from multiple available control sites where the CHW programme was not implemented to allow the comparison of outcomes between the sites where CHWs were implemented and the sites where CHWs was not implemented. Two hundred and eleven CHWs (128 existing CHWs plus 83 new CHWs from the community) were trained in maternal health and deployed to cover an estimated 5,132 WCBA living in a catchment area of about 20,530 people. The primary focus of the CHWs was to conduct monthly household visits to identify pregnant women, and then escort pregnant women to their initial and subsequent ANC appointments, facility births, and to PNC check-ups. As part of package of care, community mobilisation and improvements in services to achieve a minimum package of services at the local health centres were also added. Using the synthetic control method, as developed by Abadie and Gardeazabal (2003) and Abadie, Diamond and Hainmueller (2010) and a Bayesian approach of synthetic control developed by Brodersen (2015), a synthetic counterfactual of the CHW intervention was created based on six available public control facilities. The synthetic counterfactual trend was created to have similar pre-intervention characteristics as the CHW intervention trend. The impact of the CHW intervention was the difference between the CHW intervention site and its synthetic counterfactual Results: CHWs in the intervention areas visited an average of 3,147 (range 3,036 – 3,218) of WCBA monthly, covering 61.0% of WCBA. During these visit 3.6% (97 women per month) of WCBA were suspected to be pregnant every month. Of those women suspected to be pregnant, 67.8% (66 women per month) were escorted to health facilities immediately every month. CHWs 15 visited an average of 254 pregnant women enrolled in ANC and 64 women in postpartum period monthly. ANC and facility births utilisation in the CHW intervention site increased in comparison to the control site. Firstly, the number of new pregnant women enrolled in ANC per month increased by 18.0 % (95% Credible Interval (CrI) 8.0%, 28.0%), from 83 to 98 per pregnant women. Secondly, the proportion of women starting ANC in first trimester increased by 200.0% (95% CrI 162.0%, 234.0%), from 9.5% to 29.0% per month. Thirdly, the number of women attending four or more ANC visits increased by 37.0% (95% CrI 31.0%, 43.0%), from to 28.0% to 39.0%. Lastly, the number of facility births increases by 20% (CrI 13.0%, 28.0%), from 85 women to 102 per month. However, there was no net difference on PNC visits between the CHW intervention site and its counterfactual unit (-37.0%, 95% CrI -224.0%, 170.0%). Conclusions: CHW intervention significantly increased the utilisation of ANC and facility based births in Neno, Malawi. However, CHWs had no net difference on PNC utilisation.

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23

Ghimire, Laxmi. "Health services utilisation for sexually transmitted infections including HIV by female sex workers in Nepal". Thesis, University of Aberdeen, 2010. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=158823.

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A total of 425 questionnaire-based interviews and 15 in-depth interviews with FSWs in Nepal including non-participant observation in the field were conducted in 2006. The age range of the FSWs participated was 15-46 years. FSWs (30.8%) reported having had STI symptoms in presences 12 month. The quantitative findings suggested that many reported having used condoms during their last sexual intercourse, but in-depth interviews suggested the opposite. One fifth (21%) had never visited health facilities. Of those who visited, 149 (50.3%) turned to a private clinic and pharmacy; 181 (61.1%) used Non-Governmental Organisation (NGO) clinics, 79 (26.6%) resorted to care in hospital and 30 (10.1%) treated themselves. The remainder 85 (28.7%) were found to seek help from primary health care centre, health posts, family planning clinic or other health institutions for treatment. The behaviour theories and models used in this study (i.e. health belief model, theory of reasoned action and planned behaviour) partly explain the decisions of FSW on use and non-use of available health services. The study identified that lack of confidentiality and privacy created distrust among FSWs and stopped them from accessing health services. Embarrassment, disregard by health care providers and poor communication with them, long waiting time and fear of exposure as a sex worker were major barriers to seeking health services. It is therefore necessary to provide specific training to service providers in all types of health care institutions in order to promote confidential and quality health services.

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24

Meer, Ayishah Z. "An investigation into the reasons for the under utilisation of mental health services amongst farmers". Thesis, University of Leicester, 2004. http://hdl.handle.net/2381/31194.

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Objectives: To contribute to the U.K. research literature on psychological morbidity and helpseeking in farmers, and to explore factors involved in their use of mental health care, using the constructs of alexithymia and somatisation.;Design: A within-subjects survey design employing retrospective self-report was utilised to examine relationships between alexithymia, somatisation, health care utilisation and helpseeking attitudes. Method: A total of 54 male owner/tenant farmers between 18 and 65 years were recruited via the National Farmers' Union and Young Farmers Clubs. Participants completed the Hospital Anxiety and Depression Scale, Toronto Alexithymia Scale, Use of Healthcare questionnaire, Farming Life questionnaire, Medical Problems and Complaints questionnaire and the Helpseeking questionnaire. Data was analysed using chi-square, correlations, and multiple regression.;Results: The sample demonstrated elevated levels of psychological morbidity compared to normative samples. Participants were not found to be significantly alexithymic, and no associations were found between alexithymia and health care utilisation. Farmers were no more likely to seek help from family members than external sources, and their reported reasons for helpseeking delay/avoidance were not associated without he use of G.P or outpatient psychotherapy. No significant predictors were found for G.P. utilisation, but isolation was found to be a significant predictor of psychological morbidity.;Conclusions: Participants' high levels of psychological morbidity corroborate previous findings in the U.S. and U.K. Other findings are discordant with existing research, posing more questions regarding farmers' use of rural primary healthcare and helpseeking behaviour. More research is required to examine systemic factors in healthcare use and to explain the relationship between alexithymia and somatisation, using more robust measures of somatisation. Recommendations are put forward to broaden future study to incorporate systemic factors within rural primary care.

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25

Anskär, Eva. "Time flies in primary care : a study on time utilisation and perceived psychosocial work environment". Licentiate thesis, Linköpings universitet, Institutionen för medicin och hälsa, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-156119.

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Background: Time utilisation among primary care professionals has been affected by structural changes and reorganisation performed in Swedish primary care over several decades. The work situation is complex with a heavy administrative work load. The overall aim with this thesis was to describe time utilisation among staff in Swedish primary care and to investigate associations with perceived psychosocial work environment and legitimacy of work tasks. Methods: A multicentre, descriptive, cross-sectional study design was used including all staff categories in primary care i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals (physiotherapists, occupational therapists, psychologists, counsellors, dieticians and chiropodists) at eleven primary care centres located in southeast Sweden. The data collection consisted of a questionnaire including a subjective estimate of workload, the Bern Illegitimate Tasks Scale (BITS) and the Copenhagen Psychosocial Questionnaire (COPSOQ). Also, a time study was performed, where the participants reported their work time based on three main categories; direct patient work tasks, indirect patient work tasks and other work tasks, each with a number of subcategories. The participants reported time spent on different work tasks, day by day during two separate weeks. Response rates were 75% for the questionnaire and 79% for the time study. Results: In paper I the time study revealed that health professionals at the primary care centres spent 37% of their work time with direct patient work tasks. All professions estimated a higher proportion of time spent directly with patients than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress and role conflicts. The proportion of administrative work tasks was associated with role conflicts, the more administration the more role conflicts. Findings in paper II were that more than a quarter of physicians scored above the cut-off value for BITS regarding unnecessary work tasks, which was significantly more than the proportion observed in all other professions in the survey. Across all staff groups, a perception of having to perform illegitimate work tasks was associated with experiencing negative psychosocial work environment and with high proportion of administrative-related work tasks. Conclusions: Swedish primary care staff spend a limited proportion of their work time directly with patients and primary care physicians perceive the psychosocial work environment in negative terms to a greater extent than all other staff members. Allocation of work tasks has an influence on the perceived psychosocial work environment. The perception of having a large number of illegitimate work tasks affects the psychosocial work environment negatively, which might influence the perception the staff have of their professional roles. Perception of high proportion of unreasonable work tasks is associated with a high proportion of non-patient-related administration. This thesis illuminates the importance of decision makers thoroughly considering the distribution and allocation of non-patient related work tasks among staff in primary care, in order to achieve efficient use of personnel resources and favourable working conditions. Hopefully, the results of this study will contribute to further development of primary care so that medical competence will benefit patients as much as possible.
Bakgrund: Under de senaste decennierna har det i svensk primärvård varit omfattande omorganisationer, vilket har påverkat arbetstidens innehåll. Arbetssituationen är komplex och omfattningen av administration har ökat. Det övergripande syftet med föreliggande studie var att beskriva arbetstidens innehåll bland personal i svensk primärvård och att undersöka samband mellan upplevd psykosocial arbetsmiljö och arbetsuppgifternas legitimitet. Metod: Studien har genomförts som en deskriptiv multicenterstudie med tvärsnittsdesign och inkluderade sjuksköterskor, läkare, vårdadministratörer, undersköterskor och övriga professioner (fysioterapeuter, arbetsterapeuter, psykologer, kuratorer, dietister och fotvårdsspecialister) vid elva vårdcentraler i sydöstra Sverige. Studien inleddes med att deltagarna ombads att besvara ett frågeformulär vars första del bestod av en skattning av hur arbetsuppgifterna var fördelade. Frågeformuläret innehöll också frågor om illegitima arbetsuppgifter; Bern Illegitimate Tasks Scale (BITS) och psykosocial arbetsmiljö; Copenhagen Psychosocial Questionnaire (COPSOQ). Därefter gjordes en tidsstudie där deltagarna fick registrera tidsåtgången för olika arbetsuppgifter, varje dag under två separata veckor. Arbetsuppgifterna delades upp i tre huvudkategorier; direkt patientarbete, indirekt patientarbete och övrigt arbete. Varje huvudkategori hade flera underkategorier. Svarsfrekvensen var 75% för frågeformuläret och 79% för tidsstudien. Resultat: Resultatet från delarbete I visar att personal i primärvård ägnade 37% av arbetstiden direkt med patienter. Alla professioner skattade den direkta patienttiden till större andel än vad tidsstudien visade. Läkare upplevde sämst psykosocial arbetsmiljö avseende kvantitativa krav, stress och rollkonflikter. Det förelåg ett samband mellan andelen administrativa arbetsuppgifter och rollkonflikter, ju mer administration desto mer rollkonflikter. I delstudie II visade resultatet att mer än en fjärdedel av läkarna upplevde en hög nivå av illegitima arbetsuppgifter avseende onödiga arbetsuppgifter, vilket var signifikant mer jämfört med andra professioner. För personalgruppen som helhet framträdde ett samband mellan upplevelsen av att ha mycket illegitima arbetsuppgifter och upplevelse av negativ psykosocial arbetsmiljö samt med hög andel administrationsrelaterade arbetsuppgifter. Konklusion: Personal i primärvård ägnar en begränsad andel av arbetstiden åt direkt patientarbete och läkare upplever sämre psykosocial arbetsmiljö än övriga professioner. Arbetstidens fördelning mellan olika arbetsuppgifter påverkar den psykosociala arbetsmiljön. Upplevelsen av att utföra en stor andel illegitima arbetsuppgifter påverkar den psykosociala arbetsmiljön negativt, vilket kan ha inverkan på hur personalen uppfattar sin professionella roll. Upplevelsen av att ha mycket oskäliga arbetsuppgifter har samband med hög andel icke patientrelaterad administration. Avhandlingen belyser vikten av att beslutsfattare noga överväger fördelningen av icke patientrelaterade arbetsuppgifter bland personal i primärvård, för att möjliggöra effektiv användning av personalresurserna och för att främja goda arbetsförhållanden. Förhoppningen är också att studiens resultat ska bidra till fortsatt utveckling av primärvården så att den medicinska kompetensen kommer patienterna till nytta i så stor omfattning som möjligt.

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Mensah, Daniel Kweku Adabo. "An investigation of the knowledge and attitudes of Adolescents towards the sexual and reproductive Health services in the Omaruru district, Namibia". University of the Western Cape, 2020. http://hdl.handle.net/11394/7625.

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Master of Public Health - MPH
Background- Sexual and Reproductive Health (SRH) problems continue to affect adolescents’ health and well-being even into their adulthood. Globally and especially within sub-Saharan Africa with a heavy burden of adolescent SRH problems, increased attention is being paid to these issues. This study looks at adolescents’ awareness, utilisation of and experiences of the available SRH services in Omaruru District, Namibia. Methodology- This analytical cross-sectional study used a two-stage cluster sampling method. Data from students aged 15-19 years in secondary schools were collected and analysed using a structured self-administered questionnaire and STATA statistical software respectively. Ethical approval was obtained from the Biomedical Research and Ethics Committee (University of the Western Cape) and the Namibian Health Ministry. Written parental/caregiver informed consent and written participant assent, as per the Namibian law were obtained. Results- While 87% of respondents had heard of SRH, 46% had ever used SRH services. Of these 44% were contraceptive services. Fifty-one percent had ever had sex (of which 17% had given birth to or fathered their first child), 56% of their first sexual experiences were between ages 15-17 years. Twelve percent had used illegal drugs three months prior to the survey. In multivariate analyses female sex, urban residence and reported sexual debut had significant independent relationships with contraception use. Use of SRH services was independently significantly associated with having had sexual debut. Among SRH services users: 71% would recommend these services to their friends, 51% and 56% found health providers welcoming, with good attitudes, and guaranteeing their privacy and confidentiality. Conclusion Greater effort is needed to curb teenage pregnancy in school-going adolescents by promoting the use of all SRH services especially contraception among sexually active adolescents. It is encouraging that respondents who had used SRH service reported that their privacy and, confidentiality were respected and that healthcare providers’ attitudes generally satisfactory. Lower SRH knowledge, service use and use of contraception and condoms needs further investigation in rural youth and then programmatic and service changes tailored to their needs. Gender norms that underpin adolescent females disadvantage in a number of SRH areas needs to be addressed

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Dunlop, Sheryl Lynn. "Socio-economic status and the utilisation of physicians' services, results from the national population health survey". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0001/MQ34024.pdf.

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28

Alizadeh, khoei Mahtab. "Assessing factors in utilisation of health services and community aged care services by the Iranian elderly living in the Sydney metropolitan area". University of Sydney, 2008. http://hdl.handle.net/2123/3986.

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Doctor of philosophy (PhD)
Abstract As one of the most culturally diverse countries in the world, Australia has a high proportion of minority communities. However, its ageing population, particularly within these ethnic minorities, faces a range of barriers or difficulties in gaining access to and using health and aged care services. This study aims to identify the acculturation factors that affect the health status of Iranian-born elderly immigrants to Australia and their utilisation of health and community aged care services. The results of this study will be of value to Iranian elders, their families, and Australian aged health care service providers. The findings could also contribute towards enriched multicultural policy and improved social fairness, access to services, and equity for the aged from different ethnic backgrounds. 302 Iranian migrants aged 65 years who had lived in the Sydney Metropolitan area for at least six months were surveyed via a written questionnaire, face-to-face interviews, and telephone interviews. The results were analysed using SPSS and then compared to the findings from a 1999 survey of NSW elderly. The results indicate that Iranian migrants suffer higher levels of psychological distress and are more limited in their physical functioning than the general population of older Australians. They are in greater need of assistance with activities of daily living, have a lower sense of wellbeing, and are far less likely to utilise aged care services. Iranian migrant who do not speak English at home experience these disadvantages to an even greater extent English language proficiency was the only acculturation factor found to affect whether Iranian elderly utilised health and community aged care services, while ability to engage in activities of daily living (ADL) was the only health variable associated with their utilisation of community supportive aged care services. This variable did not predict the use of community aged care services in the broader sample of NSW respondents. Since limited proficiency in English placed elderly Iranian migrants at greater health risk and impeded their access to necessary assistance, the findings suggest that they would clearly benefit from English classes and from access to health and community care services and information regarding these services in the Farsi language.

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Zulu, Tryphine. "The socio-economic status, sign language interpreter utilisation and the cost of providing South African sign language interpreter services in the Cape Metropole District health services". Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13268.

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Includes bibliographical references.
Deafness affects about 15- 26% of the world’s population with an estimated prevalence of 3.7% in South Africa. Although sign language Interpreters (SLIs) improve the communication challenges in health care they are unaffordable for many Deaf people. On the other hand, there are no legal provisions in place to ensure the provision of SLIs in the health sector in most countries including South Africa. However, to advocate for funding of such initiatives, reliable cost estimates are essential and such data is scarce. To bridge this gap, this study estimated the costs of providing such a service at the District health services level based on estimates obtained from a pilot-project that initiated the first South African Sign Language Interpreter (SASLI) service in health-care. The ingredients method was used to calculate the unit cost per visit at the SASLI Project level from a provider perspective. The average SASLI utilisation rate was calculated from the projects records for 2008-2013. Sensitivity analyses were carried out to determine the effect of changing the discount rate and personnel costs. The unit costs per SASLI-assisted visit were used in estimating the costs of scaling up this service to the District Health Services. Average utilisation rates increased from 1.66 to 3.58 per person per year from 2008 -2013 with unmet need falling from 38.8% in 2008 to 10.8% by 2013. The cost per visit was R2074.80 in 2013 whilst the estimated costs of scaling up this service ranged from R143.6million to R775million in the Cape Metropole District. These cost estimates represent 2.4%-12.8% of the budget for the Western Cape District Health Services. The results show that in the presence of SLIs, Deaf SL users utilise health care service to a similar extent as the average population, however this service would requires significant capital investment by government to enable access to healthcare for the Deaf.

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Stone, Nicole Clare. "The provision, and utilisation, of sexual health services and contraception by heterosexual young people in the UK". Thesis, University of Southampton, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.440970.

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31

Nankwanga, Annet. "Factors influencing utilisation of postnatal services in Mulago and Mengo Hospitals Kampala, Uganda". Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&amp.

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Maternal and child-health and health education are three major concerns of public health organisations and researchers throughout the world. Health education for mothers is a strategy many countries have adopted to improve maternal and child-health. The present study was carried out in Uganda with the objective of exploring the factors influencing the utilisation of postnatal services at Mulago and Mengo hospitals, a government and private hospital. Both hospitals are located in Kampala district in Uganda. The survey, was completed by 330 women who responded to a structured questionnaire that was given to them six to eight weeks after delivery. Questions that were asked generated demographic information about the mothers
mothers&rsquo
knowledge about postnatal services
mothers&rsquo
socio-economic status and barriers to utilisation of the postnatal services. The participants included all women who delivered in Mulago and Mengo hospitals in November 2003 except for those who had had a neonatal death. The data was analysed using descriptive and inferential statistics. Some of the key findings of the study were that most women lacked awareness about postnatal services and those who knew about these services only knew about immunisation and family planning services. The majority of the mothers did not know about other services, such as physiotherapy, counselling, growth monitoring, and physical examination. Lack of money for transport or service costs, distance from the health care facility, not being aware of the services, lack of somebody to take care of the child at home were some of the main barriers to utilisation of postnatal services. Others included, lack of education, lack of employment, lack of decision-making powers, and lack of time to go back for the service. The ministry of health should educate women and communities about the importance of postnatal care, its availability, and the importance of women having decision-making power over their own health. The health service organization should improve on the quality of care by ensuring that services are provided at convenient hours with privacy, confidentiality and respect and it should evaluate the services periodically from the users perspective to maintain the quality of service.

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Harris, Patricia Amanda. "Promoting research utilisation and evidence-based decision making amongst healthcare managers : utilising nonrecursive structural equation modelling to develop the theory of planned behaviour". n.p, 2005. http://ethos.bl.uk/.

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33

Rukundo, Emmanuel Nshakira [Verfasser]. "Effects of community-based health insurance on child health outcomes and utilisation of preventive health services : Evidence from rural south-western Uganda / Emmanuel Nshakira Rukundo". Bonn : Universitäts- und Landesbibliothek Bonn, 2018. http://d-nb.info/1173898611/34.

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34

Stoddart, Helen. "The health determinants of social networks, social support and the utilisation of home care services in the elderly". Thesis, University of London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.246738.

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35

Golo, Kossi Thomas. "Three essays on the impact of financial incentives, waiting times and home care on patients' health and utilization of health care services in Quebec". Doctoral thesis, Université Laval, 2020. http://hdl.handle.net/20.500.11794/66863.

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Cette thèse de doctorat est composée de trois chapitres distincts et indépendants qui ont pour objectif d’analyser certaines politiques de santé au Québec notamment les incitatifs financiers, les délais d’attente et les soins à domicile sur la santé des patients et l’utilisation de services hospitaliers. Le premier chapitre porte sur l’impact des incitatifs financiers sur la santé des patients, spécialement le cas des soins spécialisés. Il faut noter de prime abord que la demande de soins de santé a beaucoup augmenté au Québec ces dernières années pour certains types de chirurgies. Cette augmentation, dont les causes sont multiples notamment les changements démographiques, a entraîné des temps d’attente plus élevés que les temps médicalement requis pour ces chirurgies. Pour résorber ce problème, le gouvernement québécois a mis en place en 2004 le Programme d’Accès à la Chirurgie (PAC), afin d’inciter financièrement les hôpitaux à pratiquer plus de chirurgies pour lesquelles les délais d’attente étaient plus importants. Ce programme a permis de diminuer la durée moyenne d’attente pour ces chirurgies, mais a aussi entraîné une augmentation des dépenses liées à ces chirurgies. Ces dépenses accrues étaient également dûes à certaines lacunes du programme. Une réforme majeure, qui consistait essentiellement à la modification des incitatifs financiers, a eu lieu en avril 2011, afin que le financement vienne appuyer la bonne pratique et le choix du plateau technique le plus adéquat. Notre étude, constituant une première évaluation de cette réforme, a pour but d’analyser l’impact de cette réforme sur la santé des patients, notamment les durées de séjour à l’hôpital après l’opération chirurgicale et les réadmissions après la sortie de l’hôpital. Notre application porte sur les chirurgies thoraciques et cardiovasculaires. Les résultats montrent une diminution significative des durées de séjour après l’introduction de la réforme et un impact non significatif sur les réadmissions urgentes. Dans le premier chapitre, les différentes politiques mises en places ont été initialement motivées par des délais d’attente excessifs. Pourtant, peu d’études ont analysé les impacts des délais d’attente sur la santé des patients au Québec. Tel est l’objectif du deuxième chapitre de la thèse, analyser si un délai d’attente élevé est associé à un risque de détérioration de la santé des patients. Nous utilisons des modèles empiriques pour analyser cette problématique. Nous introduisons le différentiel de distance du domicile du patient à l’hôpital le plus proche relativement à l’hôpital le plus proche parmi les hôpitaux avec de faibles délais d’attente comme variable instrumentale pour tenir compte de l’endogénéité potentielle des temps d’attente. Dans ce chapitre, nous analysons les variables de santé en termes de probabilité de réadmission urgente et de durée de séjour excédentaire (durée de séjour supplémentaire après la durée de séjour maximal recommandée). Les résultats montrent que les longs temps d’attente augmentent la probabilité d’être réadmis en urgence pour les patients qui ont eu une chirurgie de l’arthrose du genou, une chirurgie thoracique ou cardiovasculaire, une neurochirurgie, ou une chirurgie pour une tumeur de l’utérus. Il n’y a pas d’effet significatif des temps d’attente sur la probabilité de réadmission pour les chirurgies de l’arthrose de la hanche et des tumeurs de la prostate. Les longs temps d’attente augmentent également la durée de séjour à l’hôpital et les coûts d’hospitalisation après une chirurgie de l’arthrose du genou ou de la hanche. Le vieillissement de la population québécoise entraîne plusieurs enjeux cruciaux pour les services de soins de santé notamment les soins à domicile pour les personnes âgées (OIIQ, 2017). Les soins à domicile sont composés de tous les soins de santé que les établissements publics ou privés offrent aux individus à leur domicile. Ces services sont souhaitables pour toute personne qui a besoin de soins pour maladies chroniques, de soins palliatifs, de soins de réadaptation, de soins de fin de vie, ou des soins pour perte d’autonomie liée au vieillissement. Les soins à domicile pourraient constituer une alternative sécuritaire, à moindres coûts, aux soins de santé dans les hôpitaux. Les soins à domicile contribuent donc au maintien à domicile des personnes en offrant des services paramédicaux des infirmières, des aide-soignantes, coordonnés avec ceux des autres intervenants à domicile comme les kinésithérapeutes, les aides-ménagères, les auxiliaires de vie. Nous analysons dans le troisième iv chapitre, dans quelles mesures les services hospitaliers et les soins à domicile pour les personnes âgées sont substituables. Nous analysons également l’impact des soins à domicile sur l’admission dans les centres d’hébergement de soins de longue durée (CHSLD). Notre analyse montre que l’augmentation des soins à domicile pour les personnes âgées réduit la probabilité d’admission et la durée de séjour en urgence. L’effet des soins à domicile est plus prononcé chez les personnes âgées avec des pertes d’autonomie plus légères. Les résultats montrent également qu’une augmentation des soins à domicile réduit la probabilité d’être admis en CHSLD.
This doctoral thesis is composed of three separate and independent chapters that aim to analyze certain health policies in Quebec, including financial incentives, waiting times and home care on patients’ health and the use of hospital services. The first chapter focuses on the impact of financial incentives on the health of patients in Quebec, especially the case of specialized care. It should be noted, first of all, that the demand for health care has increased significantly in Quebec in recent years for certain types of surgery. This increase, which has many causes, including demographic changes, resulted in higher waiting times than the medically required times for these surgeries. To solve this problem, the Quebec government implemented in 2004 the Access to Surgery Program (ASP) to financially encourage hospitals to perform more surgeries for which waiting times were longer. This program allowed to reduce the average waiting time for these surgeries, but has also led to an increase in expenses related to these surgeries. These increased expenditures were also due to some weaknesses in the program. A major reform, which consisted mainly of modifying the financial incentives, took place in April 2011, so that the funding would support good practice and the choice of the most appropriate technical platform. Our study, which is a first evaluation of this reform, aims to analyze the impact of this reform on the health of patients, including the length of stay in hospital after surgery and readmissions post-discharge. The results show a significant decrease in length of stay after the introduction of the reform and a non-significant impact on urgent readmissions post-discharge within 30 days. In the first chapter, the various policies were initially motivated by excessive waiting times. Yet, few studies have analyzed the impact of wait times on patient health in Quebec. This vi is the purpose of the second chapter, to analyze whether a high waiting time is associated with a risk of deterioration of the patients’ health. We use empirical models to analyze this problem. We introduce the differential distance from the patients’ home to the nearest hospital relative to the nearest hospital among hospitals with low wait times as an instrumental variable to account for the potential endogeneity of the waiting time. In this chapter, we analyze health variables in terms of the probability of urgent readmission post-discharge within 30 days and excess length of stay (additional length of stay after the maximum recommended length of stay). The results show that long waiting times increase the likelihood of emergency readmissions for patients who had a knee surgery, a thoracic or cardiovascular surgery, a neurosurgery or a surgery for a tumor of the uterus. There is no significant effect of waiting times on the probability of readmission for hip and prostate surgeries. Long waiting times also increase the hospital length of stay and costs of hospitalization for knee and hip surgeries. The aging of the Quebec population is leading to many crucial issues for health care services, particularly home care for the elderly (OIIQ, 2017). Home care is composed of all health care that public or private institutions provide to individuals in their homes. These services are desirable for anyone who needs care for chronic illnesses, palliative care, rehabilitation care, end-of-life care, or care for loss of autonomy linked to aging. Home care could be a safe, low-cost alternative to health care in hospital. Home care, thus contributes to people to stay at home and receive paramedical services from nurses and care assistants, coordinated with those received from other home care providers such as physiotherapists, housekeepers and carers. In the third chapter, we analyze the extent to which hospital services and home care for the elderly are substitutes. We also analyze the impact of home care on admission to long-term care facilities (LTCFs). Our analysis shows that increased home care for the elderly reduces the probability of admission and the length of stay in emergency. The effect of home care is greater for seniors with less disabilities. The results also show that an increase in home care reduces the probability of being admitted to LTCFs.

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Alizadeh-Khoei, Mahtab. "Assessing factors in utilisation of health services and community aged care services by the Iranian elderly living in the Sydney metropolitan area acculturation aged care /". Connect to full text, 2008. http://hdl.handle.net/2123/3986.

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Thesis (Ph. D.)--University of Sydney, 2008.
Title from title screen (viewed Jan. 19, 2009) Includes tables and questionnaires in English and Farsi. Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Behavioural and Community Health Sciences, Faculty of Health Sciences. Includes bibliography. Also available in print form.

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Edmund, Ampeire. "The utilisation of HIV services on campus by the students of the University of the Western Cape". Thesis, University of the Western Cape, 2009. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_7383_1299041199.

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This qualitative study was conducted from June to November 2009, using designed questionnaires for sixty three (63) registered students and five (5) HIV program staff .The main reason for this study was to understand the underlying factors for why students may utilize or may not utilize the available HIV services on campus. The willingness of students to express their views was a positive finding in this study. Majority students who answered the questionnaires were quite aware of these HIV services. They also agreed that services provided are good. The study also found out that females utilized these services more than males and majority of students learnt of the HIV services from the HIV programs pamphlets and website thus indicating that the HIV program at UWC is function. However the research study also found out that the though students are aware of these services few utilize them and majority are females thus leaves a question why males do not utilize.

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Matondolo, Siyamthanda Luthando. "Utilisation of ICT in healthcare centre to support HIV/AIDS flow of information and service delivery In Khayelitsha". Thesis, Cape Peninsula University of Technology, 2012. http://hdl.handle.net/20.500.11838/2477.

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Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2012.
This research is an attempt to investigate the utilisation of Information Communication Technology (ICT) in Healthcare to support the flow of HIV/AIDS patient’s general information in public and private sector. Furthermore, the research examines the detail flow of database information for healthcare service delivery to patients, in particular HIV/AIDS patients, in Khayelitsha Township. Finally, the research will detail the types of technologies currently being utilised to transfer this information, technology utilised for capturing or data collection profile of the patient. The research study data collecting was done in 2009 in mostly private and public healthcare centre in Khayelitsha township. First, the study will concentrate on general utilisation of ICT in healthcare service delivery and flow of information for public and private sector healthcare centres. Additionally, the research also looks at NGOs such as HIV/AIDS Unit in Cape Peninsula University of Technology (CPUT) and Treament Action Campaign (TAC) to find out what ICT equipment is being utilised to transfer this information to adult people to inform and make them to be aware of HIV/AIDS and improve healthcare service delivery to patients and particularly to HIV/AIDS patients. Taking NGO’s such as TAC and CPUT HIV/AIDS Unit that are well informed about HIV/AIDS, nationally and internationally will make our research results to be more precise. The research will also look at the utilisation of ICT in flow of information at healthcare centre such as communication between healthcare providers such as receptionist/clerk, nurses, doctors and medical researchers since they are the first people who deal with HIV/AIDS patient cases when they come for healthcare provision.

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39

Larkin, Shaun Maurice. "Quality-based benefit design in health insurance : the impact of a product benefit design change on the utilisation of oral health services by members of a private health insurance fund in regional and rural New South Wales, Australia". Queensland University of Technology, 2008. http://eprints.qut.edu.au/26735/.

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Objective: To examine the impact on dental utilisation following the introduction of a participating provider scheme (Regional and Rural Oral Health Program {RROHP)). In this model dentists receive higher third party payments from a private health insurance fund for delivering an agreed range of preventive and diagnostic benefits at no out-ofpocket cost to insured patients. Data source/Study setting: Hospitals Contribution Fund of Australia (HCF) dental claims for all members resident in New South Wales over the six financial years from l99811999 to 200312004. Study design: This cohort study involves before and after analyses of dental claims experience over a six year period for approximately 81,000 individuals in the intervention group (HCF members resident in regional and rural New South Wales, Australia) and 267,000 in the control group (HCF members resident in the Sydney area). Only claims for individuals who were members of HCF at 31 December 1997 were included. The analysis groups claims into the three years prior to the establishment of the RROHP and the three years subsequent to implementation. Data collection/Extraction methods: The analysis is based on all claims submitted by users of services for visits between 1 July 1988 and 30 June 2004. In these data approximately 1,000,000 services were provided to the intervention group and approximately 4,900,000 in the control group. Principal findings: Using Statistical Process Control (SPC) charts, special cause variation was identified in total utilisation rate of private dental services in the intervention group post implementation. No such variation was present in the control group. On average in the three years after implementation of the program the utilisation rate of dental services by regional and rural residents of New South Wales who where members of HCF grew by 12.6%, over eight times the growth rate of 1.5% observed in the control group (HCF members who were Sydney residents). The differences were even more pronounced in the areas of service that were the focus of the program: diagnostic and preventive services. Conclusion: The implementation of a benefit design change, a participating provider scheme, that involved the removal of CO-payments on a defined range of preventive and diagnostic dental services combined with the establishment and promotion of a network of dentists, appears to have had a marked impact on HCF members' utilisation of dental services in regional and rural New South Wales, Australia.

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40

Weeks, William Brinson. "Geographic variation in the supply and utilization of hospital services : Economic motives and policy implications". Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM2002/document.

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Dans l’ensemble de la thèse, nous avons appliqué des techniques de ‘mesure des variations spatiales’ pour l'étude des variations géographiques de taux d'hospitalisation en France. La thèse est composée de 4 études :Étude 1 : « Variation géographique des recours aux procédures chirurgicales en France en 2008-2010 et comparaison avec les États-Unis et la Grande-Bretagne ».Étude 2 : « Variation géographique des admissions pour les prothèses du genou, de la hanche et la fracture de la hanche en France : existence d’une demande induite dans le secteur des hôpitaux à but lucratif et dans les hôpitaux public et privés à but non-lucratif »Étude 3 : « Caractéristiques et tendances des admissions non urgentes à but lucratif et sans but lucratif hôpitaux en France en 2009 et 2010 ». Étude 4 : « Taux d'admission pour des ’hospitalisations évitables par le système ambulatoire’ (ACSC) en France en 2009-2010 : tendances, variation géographique, coûts et comparaison internationale »
For all of this work, we applied ‘small-area variation’ techniques to the study of geographic variations in hospitalization rates in France. We conducted four studies:Study 1: Geographic variation in rates of common surgical procedures in France in 2008-2010 and comparison to the US and BritainStudy 2: Geographic variation in admissions for knee replacement, hip replacement, and hip fracture in France: evidence of supplier-induced demand in for-profit and not-for profit hospitalsStudy 3: Characteristics and patterns of elective admissions to for-profit and not-for-profit hospitals in France in 2009 and 2010Study 4: Rates of admission for ambulatory care sensitive conditions in France in 2009-2010: trends, geographic variation, costs, and an international comparison

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Kimber, Joanne Public Health &amp Community Medicine Faculty of Medicine UNSW. "Role of the Sydney Medically Supervised Injecting Centre in reducing injecting drug use-related harm: evaluating accessibility, utilisation, coverage and selected health impacts". Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2005. http://handle.unsw.edu.au/1959.4/23038.

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Drug Consumption Rooms (DCRs), where injecting drug users (IDUs) can use pre-obtained drugs in a hygienic and professionally supervised low threshold setting, aim to engage high risk IDUs, reduce public drug use, injecting-related morbidity and mortality, and improve access to drug treatment. This thesis evaluates the service demand, accessibility, utilisation, and coverage of Australia???s first DCR, the Sydney Medically Supervised Injecting Centre (MSIC), located in an area with a history of illegal shooting gallery operation. MSIC impact on injecting practices and injecting related health, and referral to drug treatment were also examined. Methods included cross-sectional IDU surveys, key informant interviews, staff focus groups, analysis of client registration and surveillance data and routinely collected data on needles and syringes - including multiple indirect prevalence estimation, and prospective follow-up of MSIC referrals. Shooting gallery users expressed demand for and willingness to use the MSIC. Injecting episodes previously occurring in shooting galleries appear to have been transferred to the MSIC, although shooting galleries continued to operate at a reduced level. The MSIC service model was accessible, with few refusals of entry, high levels of client satisfaction and limited non-use for reasons relating to the model. MSIC engaged high risk IDUs - regular injectors, sex workers, and those injecting in public places and shooting galleries - who were also more likely to be frequent attendees. MSIC clients were more likely than other IDUs to inject in public places and shooting galleries, be HCV seropositive, have riskier injecting practices and more severe injecting related health problems. MSIC achieved good coverage of the local IDU population (70.7%, range 59.1%-86.7%) and modest coverage of their estimated total injecting episodes during its operating hours (8.8%, range 7.3%-10.8%). MSIC use was associated with improvements in injecting practices and health. Frequent MSIC use was also associated with higher rates of referral to drug treatment than less frequent use. Drug treatment referral uptake was positively associated with a recent history of daily injection and sex work and negatively associated with a lifetime history of psychiatric treatment and/or self harm. This research was confounded by substantial changes in heroin availability during the study period but provides new evidence on DCR coverage, impact on injecting practices and health, and referral to drug treatment. Implications for future research are discussed.

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Rob, Marilyn Isobel Public Health &amp Community Medicine Faculty of Medicine UNSW. "Ear, nose and throat surgery among young Australian children". Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2005. http://handle.unsw.edu.au/1959.4/20840.

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Tonsillectomy, adenoidectomy and myringotomy are the most common surgical procedures undergone by children. Medical opinion regarding the appropriateness of these procedures remains contentious, and considerable resources have been expended in the formulation and distribution of relevant practice guidelines. The impact of this surgery on the child, community and private and public health resources is considerable, yet there has been little examination of surgery rates and trends, or of the characteristics of children who undergo surgery. This thesis addressed five major questions regarding this surgery in New South Wales, Australia. The first three related to population rates: the level of surgery among NSW children, comparability with international rates, trends over time and the effect of guidelines. Comprehensive hospital data between 1981 and 1999 were analysed. Major findings were a higher myringotomy rate in NSW than reported internationally, the short-term effect of guidelines, and a major shift towards children having surgery at a younger age. The remaining questions asked whether children who had surgery differed from other children in their use of health services prior to surgery, and if so, whether their utilization reverted to the norm following surgery. Matched records of a population cohort of 6239 NSW children, born during January 1990, were extracted from Health Insurance Commission data, and their claims for medical services followed retrospectively from birth to 8 years. Children who had privately funded surgery were found to use more medical services than other children, and, most unexpectedly, this did not change following surgery. The results suggest potential non-clinical factors influencing this excess utilization. This is the first population study to examine health service utilisation by these children and it has identified an important new risk factor for surgery.

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43

Al-Shaya, Ali Saleh. "Maternal utilisation of health care services and its effect on the health status of delivery outcomes in Riyadh area : a study based on the attendence of pregnant women at ANC clinics in the Primary Health Care centres". Thesis, Swansea University, 2001. https://cronfa.swan.ac.uk/Record/cronfa42901.

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International Conference on Population and Development (ICPD ), Cairo, 1994 focussed the importance of reproductive health issues and since then a wide attention has been given in this area of research. Prior to that, the second half of the last century has shown a dramatic change in the technological advancement and thus improved the health situation of the population. Moreover, many of the underdeveloped and developing countries could reduce its infant and child mortality and such health hazards with the use of proper health measures. Thus many of the researches were given due priority to cope with such problems, particularly in the developing nations. Also attention has been given in particular areas of health care delivery system and many of the governments directed their large part of economy towards this direction. Health care services, particularly prenatal, antenatal and post-natal care services, draw attention widely, which in turn not only determine the families' health status, but also improves the expectancy of life at birth.

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44

Sombie, Issiaka. "Amélioration de l'utilisation des services de santé maternelle au Burkina Faso: Quelles stratégies adopter ?" Doctoral thesis, Universite Libre de Bruxelles, 2007. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210671.

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Introduction

La mortalité maternelle reste encore élevée dans les pays en développement notamment en Afrique où une femme parmi 16 en âge de reproduction sera touchée par cette mortalité contre 1 femme parmi 2400 dans les pays développés. Au Burkina Faso, ce risque de mortalité est de 1 parmi 12 pour une femme en âge de reproduction.

La littérature internationale montre qu’un meilleur accès aux soins qualifiés à l’accouchement et aux soins obstétricaux d’urgence est la solution majeure pour sauver la vie d’une femme au cours de la grossesse, de l’accouchement et dans le post partum. Elle montre que cet accès est limité en milieu rural par l’existence de barrières liées aux services de santé, de barrières économiques et sociales. Au milieu des années 1990, il a été montré qu’il serait possible d’améliorer l’accès des femmes aux soins qualifiés et aux soins d’urgence par des interventions locales visant à réduire ces barrières. Ces résultats ont entraîné la mise en place de plusieurs interventions en milieu rural burkinabè. L’objectif de cette thèse est d’examiner les activités mises en place au niveau du système de santé dans les districts ruraux de Houndé et d’Orodara au Burkina Faso afin de mieux comprendre ce qui a été à la base de l’évolution des indicateurs de santé maternelle.

Méthodologie

Le travail a combiné des méthodes quantitatives et qualitatives. Des études de cas, plusieurs sources d’informations (revue des documents, interview des populations, prise de notes, observation participante) ont été utilisées pour identifier au niveau du système de santé des districts les activités pouvant influencer l’utilisation des soins obstétricaux d’urgence et analyser la dynamique et la qualité de leur mise en œuvre. Des approches quantitatives (étude écologique, analyse transversale, étude avant et après) ont permis d’étudier l’évolution des indicateurs et de mettre celles-ci en parallèle avec la réalisation de certaines activités. Enfin, les résultats dans les deux districts ont été comparés avec ceux d’autres districts ayant aussi bénéficié d’une intervention en santé maternelle.

Résultats

L’analyse du système de santé a identifié l’existence d’activités d’éducation et de mobilisation des populations, d’amélioration de l’environnement de la prise en charge de la femme enceinte et de renforcement de compétence des agents de santé et des accoucheuses villageoises dans les deux districts. Dans le district de Houndé une intervention bien structurée (le projet SAREDO) avec analyse des besoins a été à la base d’une grande partie des activités de 2000 à 2003. Mais l’analyse de la mise en oeuvre des activités de ce projet a montré des écarts par rapport à ce qui avait été planifié, des retards et un manque de suivi des activités. Ces faiblesses du projet étaient liées à l’approche participative de mise en œuvre, à des faiblesses organisationnelles et à l’arrêt avant terme du financement. Dans le district d’Orodara, la mise en place des activités a démarré avec l’arrivée en 2001 d’un médecin chef en provenance du district de Houndé. Aucune intervention planifiée n’a existé. Les activités ont été mises en place à partir de décisions empiriques s’inspirant de l’expérience du projet SAREDO à Houndé. Dans les deux districts, la collaboration avec des intervenants dans et hors du district, le leadership de l’équipe de district et l’utilisation rationnelle des ressources ont été déterminants dans la mise en œuvre des activités.

L’évolution des indicateurs de soins maternels a montré une amélioration de l’utilisation des soins maternels en général de 1999 à 2006 dans les deux districts. En 2004, si l’utilisation des services de consultation prénatale et de maternité pour l’accouchement était meilleure à Houndé qu’à Orodara, il n’existait aucune différence pour ce qui était du taux des accouchements par césarienne. Pour ce dernier indicateur, on notait une croissance linéaire dans le district de Houndé, tandis qu’à Orodara, le taux était resté stable de 1999 à 2002 et à partir de 2003 on assistait à une amélioration avec un taux atteignant celui de Houndé en 2005. La mise en parallèle de l’évolution du taux d’accouchements par césarienne et du calendrier des activités dans les deux districts montre une amélioration après la mise en place du renforcement de la qualité des soins (formation des agents et équipement) et de la réduction du coût des soins d’urgence surtout dans le district d’Orodara. Ces observations suggèrent l’existence d’une relation entre l’évolution du taux des accouchements par césarienne et, d’une part, le renforcement de la qualité des soins et d’autre part, la mise en place de la réduction du coût des soins d’urgence.

Une évaluation a relevé dans le district de Houndé que l’offre de soins était meilleure après la formation des agents de santé et l’équipement des services. Elle a aussi montré une meilleure utilisation des services de base (consultation prénatale et accouchements institutionnels) et un taux plus élevé d’évacuations obstétricales dans le groupe des centres de santé avec un responsable de la maternité ayant bénéficié de la formation que dans le groupe des centres de santé avec un agent non formé responsable de la maternité. Les proportions d’accouchements par césarienne et d’interventions obstétricales majeures réalisées pour sauver la vie de la mère étaient plus élevées dans le groupe des centres de santé avec un agent formé responsable de la maternité mais les différences n’étaient pas statistiquement significatives. Les résultats de cette évaluation montrent qu’au niveau des centres de santé de base, former les agents et équiper les services permettent d’améliorer la qualité et l’utilisation des services de base mais ne suffisent pas pour améliorer l’utilisation des soins obstétricaux d’urgence.

Au niveau de l’hôpital du district d’Orodara, après la mise en place des kits opératoires, les proportions des évacuations obstétricales à l’admission, des évacuations obstétricales prises en charge et des accouchements par césarienne à l’hôpital du district se sont améliorés significativement tandis que les proportions des complications infectieuses post césarienne et des évacuations obstétricales à l’hôpital de référence, et le coût des soins d’urgence ont été réduits. Ceci montre qu’en réduisant le coût des soins via les kits opératoires et en plus d’une formation des agents de santé, on a pu améliorer l’accès et la qualité des soins obstétricaux d’urgence dans cet hôpital.

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Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished

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Makhloufi, Khaled. "Towards universal health coverage in Tunisia : theoretical analysis and empirical tests". Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0025/document.

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La présente thèse explore, à travers quatre papiers, la possibilité d’étendre le régime d’assurance maladie sociale (SHI) vers la couverture santé universelle (CSU) et ce en présence d’obstacles structurels économiques.Les effets moyens de deux traitements, les deux assurances MHI et MAS, sur l’utilisation des soins de santé (consultations externes et hospitalisations) sont estimés. L’actuel régime d’assurance sociale en Tunisie (SHI), malgré l’amélioration de l’utilisation des soins de santé procurée aux groupes couverts, reste incapable d’atteindre une couverture effective de tous les membres de la population vis-à-vis des services de soins dont ils ont besoin. L’atteinte de cet objectif requière une stratégie qui cible les ‘‘arbres’’ et non la ‘‘forêt’’.Le chapitre deux contourne les principaux obstacles à l’extension de la couverture par l’assurance maladie et propose une approche originale permettant de cibler les travailleurs informels et les individus en chômage. Une étude transversale d’évaluation contingente (CV) a été menée en Tunisie se proposant d’estimer les volontés d’adhésion et les consentements à payer (WTP) pour deux régimes obligatoires présentés hypothétiquement à l’adhésion. Les résultats confirment l’hypothèse selon laquelle la proposition d’une affiliation volontaire à un régime d’assurance obligatoire serait acceptée par la majorité des non couverts et que les WTP révélés pour cette affiliation seraient substantiels. Enfin, dans le chapitre trois, on insiste sur l'’importance de prendre en compte les attitudes protestataires en évaluant la progression vers la CSU
This thesis explores, in a four paper format, the possibility of extending social health insurance (SHI) schemes towards Universal Health Coverage (UHC) in presence of structural economic obstacles.The average treatment effects of two insurance schemes, MHI and MAS, on the utilization of outpatient and inpatient healthcare are estimated. The current Tunisian SHI schemes, despite improving utilization of healthcare services, are nevertheless incapable of achieving effective coverage of the whole population for needed services. Attaining the latter goal requires a strategy that targets the “trees” not the “forest”.Chapter two gets around major challenges to extending health insurance coverage and proposes an original approach by targeting informal workers and unemployed. A cross-sectional Contingent valuation (CV) study was carried out in Tunisia dealing with willingness-to-join and pay for two mandatory health and pension insurance schemes.Results support the hypotheses that the proposition of a voluntary affiliation to mandatory insurance schemes can be accepted by the majority of non-covered and that the WTP stated are substantial.Finally in chapter three we focus on methodological aspects that influence the value of the WTP. Our empirical results show that the voluntary affiliation to the formal health insurance scheme could be a step towards achieving UHC in Tunisia. Overall, we highlight the importance of taking into account protest positions for the evaluation of progress towards UHC

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46

Palència, Fernàndez Laia. "Socioeconomic inequalities in the use of health care services in Europe : the role of public coverage and population-based cancer screening programmes". Doctoral thesis, Universitat Pompeu Fabra, 2012. http://hdl.handle.net/10803/104154.

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The aim of this thesis was to describe inequalities in the use of different health care services according to socioeconomic position (SEP) in Catalonia, Spain and Europe. In addition, we intended to assess whether the public coverage of the services, in particular dental health care, has an influence on the magnitude of inequalities in the use of such services. Finally, we aimed to determine the influence of population-based female cancer screening programmes on the prevalence of screening and on the extent of inequality. To accomplish these objectives four studies were carried out. The sources of information of the four studies were, respectively: several editions of the Catalan Health general practitioner (GP) services are equitable or manual classes use them to a greater extent. However, there are marked SEP inequalities in the use of outpatient specialist services, especially in dental care. Socioeconomic inequalities in use of dental care services exist throughout Europe, but they are larger in countries in which dental care is not covered at all by the public health care system than in countries in which dental care is partially covered. In Europe, socioeconomic inequalities in breast and cervical cancer screening are not found in countries with population-based screening programmes but they are found in those countries with only regional or pilot programmes and in those countries with opportunistic screening.
L'objectiu d'aquesta tesi era descriure les desigualtats en l'ús de diferents serveis sanitaris segons la posició socioeconòmica a Catalunya, Espanya i a Europa. A més a més, es volia avaluar si la cobertura pública dels serveis, en particular la dels serveis dentals, infuencia la magnitud de les desigualtats socioeconòmiques en l'ús d'aquests serveis. Finalment, es va voler determinar la influència dels programes poblacionals de cribratge dels càncers de mama i cèrvix en la prevalença de cribratge i en la magnitud de les desigualtats. Per tal d'assolir aquests objectius es van dur a terme 4 estudis. Les fonts d'informació d'aquests estudis van ser, respectivament: diferents edicions de l'Enquesta de Salut de Catalunya (ESCA), diferents edicions de l'Enquesta Nacional de Salut d'Espanya (ENS), l'Enquesta de Salut, Envelliment i Jubilació a Europa (SHARE) 2006 i dades dels països europeus que van participar a l'Enquesta Mundial de la Salut de l'OMS l'any 2002. Els dos primers estudis eren estudis de tendències mentre que els dos últims van ser transversals. En tots els estudis les desigualtats socioeconòmiques es van mesurar mitjançant índexos relatius (RII) i absoluts (SII) de desigualtat. Els resultats d'aquests estudis mostren que a Catalunya i a Espanya els serveis d'atenció primària són equitatius o fins i tot les persones de classes manuals en presenten una major proporció d'ús. Tanmateix, hi ha marcades desigualtats en visites a l'especialista, en especial en les visites al dentista. Les desigualtats socioeconòmiques en la utilització dels serveis dentals existeixen a tota Europa, però són més grans en aquells països on l'atenció dental no està coberta pel sistema públic de salut que en aquells països on aquesta està parcialment coberta. A Europa, no es troben desigualtats socioeconòmiques en el cribratge dels càncers de mama i cèrvix en aquells països amb programes poblacionals de cribratge, però sí que es troben en aquells països amb programes pilot o regionals o amb només cribratge oportunista.

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47

Williams, Jonathan Mark. "Energy utilisation and combined heat & power sizing in the health service". Thesis, Cardiff University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273836.

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48

McMahon, Meghan. "Obesity and health services utilisation in Canada". 2007. http://link.library.utoronto.ca/eir/EIRdetail.cfm?Resources__ID=452864&T=F.

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49

Madzudzo, Nyasha. "Inequalities in utilisation of maternal health services in Zimbabwe". Thesis, 2018. https://hdl.handle.net/10539/25375.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the requirements for the degree of Degree of Master of Public Health Johannesburg, April 2018.
Background: Maternal mortality in developing countries like Zimbabwe is much higher amongst poorer, rural and less educated communities. Poorer or marginalised communities have the highest burden of disease and worst health status, but the least access to health care services. The distribution of health care resources and their use plays a key part in determining health and health outcomes. This study aims to measure inequalities in the utilisation of key maternal health care services in Zimbabwe using the PROGRESS-Plus framework, and to examine how the intersection of these factors create multidimensional advantage and disadvantage. Methodology: Using Data from the 2015 Zimbabwe Demographic and Health Survey (DHS), the Concentration Index, Slope Index of inequality and Relative Index of Inequality were computed for key maternal health care utilisation outcomes. Bivariate and Multiple Logistic Regressions were computed to determine the PROGRESS-Plus factors associated with utilisation of these services. Multiple Correspondence Analysis was used to investigate the interaction of multiple PROGRESS- Plus factors influencing social position. Results: The majority of women (93.3%) in the 2015 Zimbabwean DHS survey had a skilled ANC attendant although few of the women (38.5%) had their first ANC visit before four months gestation. Most women (78.1%) had a skilled birth attendant and delivered at a health facility (77.0%). Inequalities were higher in delivery care than antenatal care. The utilisation of maternal health service was higher amongst socially advantaged groups, although the magnitude of the inequality was small. Higher wealth index, educational attainment and health insurance coverage were significantly associated with higher maternal health service utilisation. These factors were closely inter-related with the same group of women having low wealth, low levels of education and no health insurance. Conclusion: Inequalities in utilisation of maternal health services favour socially advantaged groups. Wealth, education and health insurance where the strongest determinants of use of maternal health care and these factors were interlinked. There is need to consider social protection policies that reduce the vulnerability of disadvantaged groups of women to access education and work opportunities Keywords: Inequality, Maternal Health, Zimbabwe
LG2018

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50

Mogotsi, Bulelwa Rose. "Utilisation of the employee health and wellness services at Kimberley Hospital Complex". Thesis, 2012. http://hdl.handle.net/10539/11332.

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M.P.H., Faculty of Health Sciences, University of the Witwatersrand 2011
Background: The Employee Health and Wellness (EHW) Centre at the Kimberley Hospital Complex (KHC) started off as a staff clinic, rendering nursing services to staff members with occupational injuries and minor ailments such as influenza, colds and headaches. Since the EHW Programme was introduced in 2004 there has been no evaluation of the services provided. There is no information about referrals and current usage of the service, which compromises further planning. Study aim: The aim of the study was to describe the extent and patterns of utilization of the Employee Health and Wellness Services at the Kimberley Hospital Complex for the period 1 January 2008 to 31 December 2009. Methodology: This was a cross sectional descriptive study, involving a retrospective record review at the EHW Centre. Data extraction from various data sources was recorded on data collection tools using coding instead of names to protect the identity of the employees. The study setting was the EHW Centre at Kimberley Hospital Complex, which is the only hospital with a Centre for Employee Health and Wellness in the Northern Cape Province. Conclusion: The utilization rate of the EHW services at KHC is generally low (6.2% and 6.4%) in 2008 and 2009 respectively. There is a need for further research to determine the reasons for low utilisation through employee and employer interviews and focus group discussions. An interesting fact is the steep increase in the number of employees with multiple visits. It would be interesting to conduct a study that will determine the reasons for multiple visits in one month. There was no significant difference between the age and utilization of EHW services but there was a significant association between gender and components of services used, (chi-square test, p<0.001) for both PHC and OHS components. More males used the PHC component whilst more females used the OHS component of the services. While the reasons have not been established, it may possibly be related to a larger number of female employees in the professional category in the health sector. Thus there is a need for further research to explore the gender mismatch in utilising PHC and OHS components of the services. The Wellness programme was minimally used. There was no significant association between age and medical aid status and the usage of service components. The average length of employment for employees who visited the EHW centre was less than 10 years; there was no significant difference in usage of the service between more experienced and less experienced staff. There is a need for further studies to explore reasons for the low utilization rate of the EHW services as well as the perceptions of service providers and employees regarding the utilisation of these services at Kimberley Hospital Complex.

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Tesi sul tema "Health services utilisation"

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