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Hong, Wing-yee Veronica. "A comparative study of healthcare financing systems in US, UK and HK." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41709858.
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Campbell, John Lennox. "The accessibility of UK primary medical care : problems, practice and potential." Thesis, University of Edinburgh, 1998. http://hdl.handle.net/1842/21126.
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This thesis addresses issues relating to the accessibility of primary medical care within the context of the National Health Service. A review of the literature is undertaken which identifies access as a key issue for patients, doctors, and health care planners. A basic framework using the geographical, organisational, and psycho-social elements of access to care is adopted for a detailed consideration of these distinct elements of accessibility. Five studies are described. The first of these relates to the provision of out-of-hours care by five general practitioners in one practice in central Edinburgh. The association of reduced access (a completely booked appointment system) with an increase in subsequent out-of-hours workload is reported. A case study of upper respiratory illness presenting out-of-hours investigates the impact of doctors' choices made regarding the management of out-of-hours contacts on subsequent consultation patterns. While the first study considered the operation of the appointment system as a factor influencing out-ofhours workload, the operation of a practice appointment system was studied in more detail in the second study. This work investigated the consequences of increasing appointment length on clinical workload, appointment system operation, patient "flow" (waiting and consultation times), and consultation and doctor behaviour. Changing from booking eight patients per hour to six patients per hour was associated with an increased matching between supply and demand for appointments, increased numbers of patients requiring to be fitted in as "extras", and reduced waiting time for patients seen under the new arrangements. Surgeries in which an undergraduate medical student was present were observed to be different from non-teaching surgeries with respect to a number of measures. Variations in the operation of appointment systems have been judged by some to have important sequelae in the decisions made by patients as to where they might receive care. Such judgements form the basis for the central study of this thesis where the impact of varying doctor accessibility on the decision taken by patients to self refer to a hospital Accident and Emergency Department was investigated in nineteen of twenty six practices in the West Lothian district of Lothian Health Board, Scotland. Information was collected about practices and their appointment systems over an eight week period and a questionnaire survey of patients attending participating practices or the local Accident and Emergency Department was undertaken. This study highlighted the importance of distance from Accident and Emergency as a factor influencing the use of Accident and Emergency services, and also highlighted the importance of patients' perceptions of doctor availability as a contributing factor in patient's consulting behaviour. The relationship between patients' perceptions of doctor availability and practice list size was investigated using data obtained from the questionnaire survey of patients attending West Lothian practices during one week of 1994. Practices rather than patients formed the unit of analysis in this investigation where patients' perceptions of doctor availability were reported for urgent and non-urgent situations separately. A significant negative association between practice list size and the perceived availability of general practitioners is described and regression modelling used to investigate the association between patient satisfaction with doctor availability, patients' perceptions of doctor availability, and practice list size. The final two studies describe the potential for using geographical information systems (GIS) technology in investigating the accessibility of primary care. Some of the features of GIS technology (mapping of geo-referenced information, construction of polygons, buffers and convex hulls, contour plotting and construction of spider maps) are demonstrated using data obtained from West Lothian as a case study. Plotting of polygons representing practice areas is used in the final study, which investigated the accessibility of general practitioners as, reflected in the size of their practice catchment areas. Using this approach, an association between quality of primary care and the size of practice catchment area is described and questions are posed regarding the lack of available guidance for general practitioners in relation to defining the size of the area in which they provide services. Access to primary medical care requires a consideration of the quality of services to which access is being provided. Health service planners, doctors, and their patients must ensure that quality in relation to service delivery is matched by quality in relation to the arrangements by which that service is accessed. This work contributes to and informs that relationship.
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Horne, D. A. "Public policy making and private medical care in the United Kingdom since 1948." Thesis, University of Bath, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.381894.
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康詠儀 and Wing-yee Veronica Hong. "A comparative study of healthcare financing systems in US, UK and HK." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41709858.
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Stanton, Jennifer Margaret. "Health policy and medical research : hepatitis B in the UK since the 1940s." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1995. http://researchonline.lshtm.ac.uk/682243/.
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This thesis explores the way changing constructions of hepatitis B have mediated between science and policy during the past fifty years. Research-based 'facts' were filtered in the policy arena according to social, political and economic pressures. Central policy processes depended heavily on expert advisers, who emerged from networks of researchers. This account draws on scientific, clinical and epidemiological research, central policy documents, and interviews with people working with or suffering from the disease. Though epidemiologically close to AIDS, hepatitis B has rarely attracted public attention: there are an estimated 100,000 carriers in the UK, but few deaths due to the acute form. The disease was a major problem in the blood supply, and featured as a hospital infection, with notable outbreaks from 1965 in renal dialysis units. It was seen as an occupational hazard for laboratory workers, doctors, nurses and dentists. The introduction of a test for hepatitis B around 1970 opened up opportunities for epidemiological research. Hepatitis B was increasingly recognized as a sexually transmitted disease, widespread among gay men; also, because of needle sharing, prevalent among drug users. Another outcome of research in the 1970s was the development of a vaccine. However, availability of a vaccine in the UK from 1982 afforded no immediate resolution of public health issues raised by hepatitis B. The legacy of a restricted screening policy from the 1970s, emphasizing prevention via hygiene precautions among health care workers, facilitated a limited vaccine policy throughout the 1980s. While discussing negotiations over hepatitis B in the past five decades, this thesis aims to contribute to a broader analysis of interactions between science and policy, between centre and regions, and between interest groups.
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Gill, Peter John. "Developing paediatric quality indicators for UK general practice." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:1837f24f-e501-4e56-906d-6080191f09cb.
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The overall aim of this thesis is to define a candidate set of quality indicators that are evidence-based, feasible to implement, and have the potential to improve the quality of care provided for children in UK general practice. The indicators were developed using a three-stage process. First, the areas and aspects of care of highest priority for quality indicator development were identified. This was achieved by seeking the views of primary care clinicians and by undertaking a formal analysis of unplanned hospital admissions for ambulatory care sensitive conditions. Then, the evidence-base to underpin indicator development was identified through an overview of Cochrane systematic reviews of interventions relevant to the primary care of children. A search of SIGN and NICE national guidelines was also conducted to inform the evidence-base. Lastly, an expert panel determined the formulation and selection of indicators by applying the RAND appropriateness methodology. This process created a final set of 26 quality indicators in six priority areas: early recognition of potentially serious illness (n=7); child protection and safeguarding (n=4); mental health (n=4); health promotion (n=1); routinely managed conditions (n=6); and general practice management (n=4). The main strength of these indicators is that they reflect a strong professional consensus on their validity and feasibility. The main weakness is that the indicators are underpinned by evidence mainly derived from expert opinion rather than formal research; the requirement for professional consensus means that they do not challenge existing models of care delivery.
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Al-Nahdi, Abdullah Ahmed Waridan. "Computer deployment in the health services of developed and developing countries : a comparative case study of the UK and Oman." Thesis, University of Hull, 1998. http://hydra.hull.ac.uk/resources/hull:6972.
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Organisations are increasingly deploying and using computer technology in various ways, involving the allocation of large amounts of capital and human resources. However, in many cases, computer deployment has been accompanied by failure, particularly in health care services. Therefore, information technology has raised grave questions, misunderstanding, fears, and hostility. This study emphasises the importance of computer deployment and development in developed and developing countries' health care services with examples from advanced and less advanced nations. It describes strategy development for IT/ISs using information system methodologies and explores the development of ISs strategy in the NHS in the light of fundholding and the internal market. A number of problems that commonly influence the success or failure of computer deployment and development are identified. These issues are explained through two case studies: the Omani health system and General Practices (GPRs) in the UK, which have introduced computers. The research focuses on five main sets of issues related to computer deployment and utilisation in health care: strategic planning; computer utilisation; computer fears; computer impact; and computer technical problems and performance. Users' overall satisfaction with systems in use is also considered. Data collection was carried out using two surveys. One survey was conducted in GPRs in Humberside and the other conducted in Royal Hospital and Sultan Qaboos University Hospital in Oman. Data sources included observations, review of relevant documents, such as reports, research papers and manuals, structured and non-structured interviews with selected users and a questionnaire. A number of conclusions can been drawn from this study: firstly, computer deployment, utilisation and development still faces problems in both the systems studied, more especially the Omani system. Secondly, GPRs have carried out strategic planning for computer deployment and utilisation and are prepared to use information system methodology for IT/IS strategy and there is a plan to use this for competitive advantage but Omani hospitals did not set a constructive strategic plan for their systems. Thirdly, the main problems of computer failure are related to human issues rather technical issues. The most important of these human issues are the style of the leadership planning, poor utilisation of computer applications, lack of skills and poor training. Finally, the results of the survey suggested that though the respondents were aware of the potential of computer technology, the problems of computer fears, training and lack of skills were experienced, and often, few individuals possessed computing knowledge. The author suggests several points to be considered: 1) that any thinking about computer deployment and development should employ appropriate information system development methodologies; 2) the decisions on computer deployment, use and development should be made by a special committee that has expertise in IT matters; 3) good strategic planning for computer deployment, use and development; should be connected to the organisation's overall strategy and 4) there is a need of mandate review for such development and planning. With these points in mind the researcher presents a diagram to help improving strategic planning and development of IT/IS methods with particular emphasis on the Omani environment.
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Brisley, Adam Leon. "Accessing cancer care in the context of a changing English National Health Service." Thesis, University of Manchester, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.654877.
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This thesis is based on 18 months ethnographic fieldwork in and around the National Heath Service (NHS) in Greater Manchester, UK, between 2011 and 2012. The fieldwork focused on practices and experiences of cancer care and the care of other related diseases (e.g. brain tumour, post surgical pain and cancer related mental illnesses) and primarily involved in-depth interview-based case studies with patients, carers and clinicians, as well as participant observation at hospital outpatient clinics and a local cancer centre. Over the past thirty years, the English NHS has been through numerous market- based structural reorganisation programmes broadly aimed at increasing provider competition and patient choice within the health service. At the same time, various new ways of configuring medical knowledge and reforming the ‘traditional clinical interaction’ have grown in influence in NHS care practices. This thesis seeks to record the ways in which new managerial technologies, clinical tools and medical and healthcare rationalities (e.g. risk medicine, patient pathways, diagnostic categories and the logic of patient choice) introduce new ways to experience disease and treatment. Following Das (2015), among others (see Biehl and Moran- Thomas 2009), I do not treat these abstract forms as dominating forces that over-determine experience and practice. But instead, I attend to how broad structures and rationalities become embedded in practices, experiences and biographies of illness and care. In particular, I focus on what is required for care to be accessed (or ‘activated’) in a context permeated by these competing systems of value and meaning.
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Wu, Xiaotong, and Zhe Luo. "Analysis on Opportunities and Challenges of Chinese Medical Device Industry under New Health Care Reform : Reference of Sweden, USA and UK." Thesis, Karlstad University, Faculty of Economic Sciences, Communication and IT, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-6358.
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Purpose and Execution –The purpose of this paper is to seek feasible suggestions and recommendations to the Chinese medical device industry under the new current market situation—Chinese health care system reform. In order to achieve this aim, we will start with introducing the background of current status of related issues. The next part will be the preparation of further analysis, which contains the theory and descriptions of the health care system reform histories of China, Sweden, the USA and UK. We will consequent present the environmental potential influential aspects. The main discussion will take place around medical device market analysis, together with three representative company case studies. After identifying the opportunities and challenges of the industry, we will draw the conclusions which are the recommendations for Chinese health care industry and also some suggestions for the Chinese government.
Design/Methodology/Approach – To explore these issues, besides literature reviews on market analysis (five forces, SWOT analysis), this paper applies generic competitive strategy, value-based service and service innovation as well. In addition, it also illustrates with 3 mini cases. We acquired both secondary data from related databases and primary data through questionnaires.
Limitation – Due to the restricted access to the specific database, the acquired information is limited to analyze the paper. Furthermore, according to the fact that the data we obtained is mostly on the basis of the whole medical device industry and it is quite difficult to be classified into particular parts, we decided to limit our research to the medical device industry that caters to both medical equipments and disposable tools when doing the analysis. In addition, since the design of questionnaire includes open questions, the research quality is heavily dependent on the individual skills of the researcher.
Findings – The new health care system reform will definitely boost the growth of medical device industry, but also create fiercer competition. Chinese Medical device companies need to enhance abilities of marketing, research and development, and aim at meeting customer needs to exploit new profit alternatives.
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Thompson, Trevor David Barnes. "Homeopathy : exploring the popularity paradox : a multi-method study of the players, process and outcome of homeopathic care by UK medical doctors." Thesis, University of Bristol, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.432940.
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Stickley, Anna. "An exploration of occupational therapy practice in social enterprises in the UK." Thesis, University of Northampton, 2015. http://nectar.northampton.ac.uk/7482/.
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Introduction: Occupational therapy in the UK has been heavily shaped by the medical model, however developments within the occupational therapy profession that have led to a re-focussing on the centrality of occupation for health have resulted in the need for new areas for practice outside of traditional, medicalised settings. The recent changing landscape of health and social care provision in the UK provides occupational therapists with new and different environments for practice. This research explored the provision of occupational therapy within social enterprises in the UK, and the compatibility of the occupational therapy philosophy with a social enterprise model. Methods: This mixed methods exploratory study that was conducted within the pragmatic paradigm and had two phases. In Phase 1, twenty-one online questionnaires were completed by occupational therapists working in social enterprises in the UK and focused on their practice and the social enterprise they work for. Social enterprises that employed occupational therapists were also identified through desk based research. In Phase 2, eight of these social enterprises (which were identified in Phase 1) participated as case studies, using case study methodology to explore occupational therapists perceptions of their practice; service users’ experiences; and the social entrepreneur’s involvement in the provision of occupational therapy. The data collection in the case studies consisted of twenty-six semi-structured interviews with occupational therapists, social entrepreneurs and service users; unstructured observation and formal documentation was used for triangulation. The interviews were analysed using qualitative thematic analysis and the findings of the case studies were combined with findings from Phase 1. Findings: Social enterprise has been used as an effective model for implementing holistic occupational therapy services that promote health, wellbeing and occupational justice. Occupational therapists benefit social enterprises to achieve their social and business aims. Funding social enterprise start-ups and ensuring their sustainability continues to be a challenge and government policy needs to be supported with finance to implement it, without which there is a risk of private companies taking over public sector services. Conclusions: Social enterprises can provide an environment where occupational therapists have freedom to practise according to the principles of their profession without the limitations of the medical model and in a socially inclusive environment. Social enterprise can provide a rewarding and satisfying environment for occupational therapists to practise in client centred, holistic ways. The current health and social care climate provides many opportunities for occupational therapists to create and shape their own environments for practise. Alternatively, occupational therapists may need to promote the profession to existing social enterprises to gain employment in the new organisations that deliver public services.
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Raleigh, Mary. "Multiple perspectives of community nurse practitioners' use of medical physical assessment skills in primary care : a qualitative study of current practice in the UK." Thesis, University of Surrey, 2015. http://epubs.surrey.ac.uk/809067/.
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Aim: To explore the use of medical physical assessment skills (PAS) by community nurse practitioners in primary care in the UK. Background: Physical assessment skills are commonly practiced by community nurse practitioners in primary care. These skills are used to support GPs to deliver a wide range of services in primary care. There is no evidence on how physical assessment skills are used by community nurse practitioners in primary care. Methods: A qualitative interpretative embedded case study design. Results: Participants reported that community nurse practitioners used medical PAS in integrated ways, by bringing together their clinical expertise, leadership, education and liaison skills to work across professional boundaries, to deliver a range of services. Specialist nurses caring for patient with one or more chronic long-term condition use these skills within the constructs of a person-centred framework, which is relationship focussed, holistic and collaborative. Nurse practitioners use physical assessment skills to work as generalists and make independent diagnostic decisions. Competence, capability and performance are necessary to make complex decisions. Failure of community nurse practitioners to take responsibility for assessment decisions creates inter-professional tensions and conflict. Conclusions: Medical physical assessment skills are successfully being used by community nurse practitioners to deliver a wide range of services in primary care. These skills improve competence, capability and performance for advanced nursing practice roles. Physical assessment skills education and training at universities needs to be validated by allied health professional bodies for advanced practice roles. Relevance to clinical practice: • Physical assessment education and training prepares nurses with higher levels of theoretical assessment knowledge and skills that are fit for purpose. • GPs believe that education and training of physical assessment skills are vital for nurses to manage the burden of assessment work in primary care. • Common sets of assessment practices between disciplines have better outcomes for patients • Registered nurses require a standard of competence which allows them to perform physical assessment skills to the same level as doctors. • Competence and performance are best achieved when working with patients and experienced clinicians. Key words: medical physical assessment skills, community nurse practitioners, cross boundary working, diagnostic skills.
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Smith, Sarah. "Delivering optometric care in the UK." Thesis, Aston University, 2012. http://publications.aston.ac.uk/19137/.
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Optometrists play an important part in delivering eye care in the United Kingdom; however opportunities for practitioners to extend their role through co-management of patients with ophthalmologists vary across the country. Devolution in Scotland and Wales has led to greater emphasis on community based care in these regions. This thesis reviews the current situation and, by examining ophthalmic outpatient clinic data, discusses further opportunities to reduce demands on secondary care and the cost savings that can be made. To assess whether the profession is currently in a position to adopt an extended clinical role, changes in the availability of optometric instrumentation are assessed over a two year period. An increased prevalence of fundus cameras and contact tonometers places optometrists in a good position to take on further responsibilities in glaucoma management, however future investment could be impacted by the current economic climate as value for money became increasingly important to practitioners looking to purchase equipment. Methods of training optometrists in the necessary skills to utilise new technology to extend their role are evaluated in terms of both learning and cost effectiveness. Interactive distance learning is proposed as a convenient and effective method to deliver continuing professional development. Any changes to optometric practice must take account of the need for a sustainable business and the importance of attracting and retaining patients. The views of patients are assessed through a validated service quality questionnaire, SERVQUAL. The questionnaire is found to be valid for use in an optometry setting. Patients have a generally positive view of the service quality they receive from their optical practice and consider the intangible aspects, in particular responsiveness and empathy, most important. Optometrists are well placed to increase their role in patient management; however a viable business model must exist to enable investment in instrumentation and training.
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Guthrie, Bruce. "Continuity of care in UK general practice." Thesis, University of Edinburgh, 2003. http://hdl.handle.net/1842/24660.
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'Continuity' is frequently cited as a core value for UK general practice, and in this context usually appears conceptualised in terms of personal continuity or ongoing relationships between patients and general practitioners (GPs). Formal definitions include other dimensions such as continuity of information, and the co-ordination of care, and these are more promoted in recent UK policy documents and by organisational change. Two studies were conducted for this thesis. The first used multilevel regression analysis of survey data from over 25,000 patients in 53 general practices to explore the distribution of 'continuity' in the sense of whether or not patients were seeing their 'usual or regular' GP. The key findings were that measured 'continuity' was lower in larger practices and those with shared lists where patients can see any GP. Younger patients and those without chronic disease were less likely to be seeing their usual or regular GP, although whether the age association represents a cohort or lifecycle effect cannot be addressed with cross sectional data. In the second study, thirty-two patients and sixteen GPs were interviewed about what they valued about general practice. Interviews were semi-structured, and the data were analysed qualitatively. A thematic analysis of which dimensions of 'continuity' were valued by patients and GPs, and how these related to other valued processes and outcomes of general practice care was developed. Further analysis focused on the ways that GPs used 'continuity' to construct a particular kind of professional identity, and whether patients accepted or rejected the claims to a particular identity made by GPs. Both GPs and the majority of patients emphasised the importance of personal continuity. A key difference was that patients talked about routinely balancing personal continuity against access, with their preference varying with the nature of the problem to be discussed. The majority of patients said that they usually preferred to wait to see 'their' GP, but a few solely prioritised speed or convenience of access. GPs and patients ascribed a similar range of advantages to personal continuity, but GPs focused on benefits in terms of better diagnosis and management of problems, whereas patients emphasised feeling more at ease, being able to be more active in consultations, and increased trust and legitimacy. In formal definitions, the different dimensions of'continuity' are made conceptually distinct. But for these GPs and patients, different dimensions of continuity were interwoven. Personal continuity (an ongoing relationship) and longitudinal continuity (seeing the same GP) were routinely conflated, and GPs described complex interactions between the different ways of knowing the patient associated with personal continuity and with continuity of information embodied in the medical record. Personal continuity was frequently deployed by GPs to distinguish themselves from hospital doctors. This boundary was repeatedly constructed without prompting throughout the GP interviews, suggesting that it was a problematic area. This appeared to be because of hospital doctors' greater expertise in diagnosis and management of particular diseases or problems, something acknowledged by GPs and taken for granted by patients. In contrast, GPs appeared to assume that their control of medical knowledge made their identity with regard to nurses unproblematic. Supporting this, patients talked about nurses' work largely in terms of the tasks done, and said they did not greatly value ongoing, personal relationships with nurses. Underpinning both of these boundaries was a shared assumption of medical work as primarily being the diagnosis and management of problems, with a stronger biomedical emphasis than was immediately apparent in talk about 'personal continuity'. The data are used to discuss the ways in which personal continuity appeared central to patients' and GPs' experience of general practice, and to the construction of a stable professional identity for GPs. The usefulness of 'continuity' as a research or policy concept is then explored. Although formal definitions of'continuity' are conceptually helpful, different dimensions of'continuity' are likely to be interdependent within an individual health care system. Understanding 'continuity' therefore requires a sensitivity to this wider context. Finally, possible implications of current organisational change for the experience of 'continuity' by patients and the professional identity of GPs and general practice are examined.
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Al-Ghatam, Rana. "Cleft Care UK (CCUK) : analysis of photographs." Thesis, University of Bristol, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.681748.
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Design: Prospective retrolective study. Setting: 11 National Health Service cleft centres. Participants: The frontal facial photographs of239 five year old children with nonsyndromic UCLP from the 1998 CSAG survey were collected, along with the frontal and worm's eye view (WEV) photographs of252 five year old children with nonsyndromic UCLP from the current CCUK survey. The children in the CSAG group having been treated pre-centralisation and those in the CCUK cohort treated post centralisation. Main Outcome Measures: The main outcome measure was an aesthetic rating using a categorical five point Likert scale rating of the frontal and the WEV photographs. Methods: All photographs were cropped to include the nasolabial region only. The photographs were arranged randomly within a web-based aesthetic scoring tool. The aesthetic appearance of 742 photographs (239 CSAG frontals, 252 CCUK frontals and 251 CCUK WEVs) were assessed by 6 raters using a categorical 5-point Likert type scale over a 3 week period. Each rater repeated the scoring of 10% of the photographs 4 weeks after the initial assessment stage to allow analysis of inter- and intra-rater reliability . Results: The overall level of agreement between the members of the assessment panel when rating the frontal views in both the CSAG group and the CCUK group was fair. Assessment of facial appearance of the CCUK group using WEV s showed a poor agreement between the examiners. The results showed a good overall agreement within the examiners assessing both the pooled frontal views (CSAG and CCUK) and WEVs (CCUK). There was a poor agreement within the examiners assessing the same subjects using 2 different views i. e. frontal and WEV s in the CCUK group. Overall the odds ratio shows that there was evidence that outcomes had improved in CCUK group relative to the CSAG group. Conclusion: The impact of the new centralised cleft care showed a better facial appearance outcome compared to the original CSAG survey.
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Leck, Christopher. "The impact of care farming in the UK." Thesis, University of Worcester, 2013. http://eprints.worc.ac.uk/2733/.
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Care farms seek to support and empower people who are in some way vulnerable by enabling them to engage with agricultural places and farming activities. Their numbers have increased substantially in the UK and elsewhere over the past decade, but there is a paucity of evidence concerning that which takes place, associated outcomes and consequential change. This mixed methods study investigated care farming from multiple perspectives in order to provide an enhanced understanding of overall impact. It was informed primarily by qualitative and quantitative data provided by service users and providers but also incorporates input from representatives of other significant stakeholder groups. The evidence of sixty seven care farmers highlighted the challenges associated with the initiation and development of sustainable enterprises, but simultaneously demonstrated this to be an activity that can benefit farming people and places. Altruistic intent was identified as a common denominator and care farming was found to have enabled both new and established farmers to engage with activities that support the land and develop community. Productive and consumptive elements interlink to provide multifaceted value. Agricultural and familial connections were presented as having been enabled, on-farm employment as having increased and farms as having regained their position as a social hub. Multivariate statistical analysis of health and well-being measure scores provided by two hundred and sixteen care farm participants identified statistically significant positive relationships (p<.001) between the amount of time that people had been attending care farms and subjective happiness, satisfaction with life and more generic mental well-being. Analysis of qualitative data suggested that service users often received support initially from the animals, plants and wider natural environment, but that people and associated social interactions were increasingly enjoyed and influential as time progressed. An assessment of the overall impact associated with an individual care farm was provided through the application of Social Return on Investment. This took account of all elements of associated change and assigned justified financial proxies so that overall value could be conceptualised. The analysis suggested that, for every £1 that was invested, there was a return that exceeded £3.50. Value was presented as having emanated from the natural, social, learning and physical elements of the care farm space, but consequential positive outcomes were also demonstrated to impact outside this space. This study found care farming to be a cost effective vehicle for enabling the improved health and well-being of both individuals and wider society. Associated dividends are apparent and it is hoped that this will help policy makers and service commissioners to recognise and understand the value that care farms provide.
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Brown, Celia Alison. "Student medical school choice in the UK." Thesis, University of Birmingham, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.403890.
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Fletcher-Smith, Joanna C. "Occupational therapy for stroke survivors in UK care homes." Thesis, University of Nottingham, 2015. http://eprints.nottingham.ac.uk/29779/.
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Stroke is a major contributor to the global burden of disease. It is the third main cause of death and the largest cause of adult disability in the UK. Stroke is reported to be the second most common cause of disability after dementia in the UK care home population with an estimated 25% of residents living with the consequences of stroke. The aim of this PhD programme of research was to explore the current research evidence for the provision of occupational therapy to stroke survivors living in care homes; investigate current routine occupational therapy practice for this specific stroke population in UK care homes; and to contribute original new knowledge on the health outcomes of sub groups of the care home population with stroke. This study was divided into four distinct projects that were completed alongside a National Institute for Health Research funded phase III multi-centre cluster randomised controlled trial of occupational therapy for care home residents with stroke known as the ‘OTCH study’. The OTCH study evaluated the efficacy of delivering occupational therapy interventions targeted towards increasing and maintaining independent performance of personal self-care activities of daily living and mobility. The PhD student was a member of the OTCH study team with responsibility for delivering the intervention at the Nottingham site. A PhD studentship from the University of Nottingham enabled the development of this complimentary and integrated programme of research. Stage one (reported in chapter two) involved the completion of a Cochrane systematic review and meta-analysis as a means of systematically appraising published randomised controlled trials of occupational therapy interventions for care home residents with stroke to the highest gold standard. Systematic searching identified 1,436 unduplicated records however only 1 study met the inclusion criteria, with another trial ongoing. There was insufficient evidence from the reviewed randomised controlled trial to determine that occupational therapy improves outcomes for care home residents with stroke and therefore further high quality research in this area is needed. Stage two (reported in chapter three) involved a national online survey study to provide contextual demographic data, along with data on the aims, content, funding and provision of occupational therapy services currently being delivered to stroke survivors residing in UK care homes. Out of a total of 138 completed questionnaires, data were analysed from 114 respondents who met the eligibility criteria of providing assessment and treatment to residents in a care home setting. The survey findings confirmed that occupational therapy is being delivered in some care homes; however, interventions for residents with stroke are not routinely delivered by stroke specialist occupational therapists and are not routinely delivered using a systematic, evidence-based approach. Stage three (reported in chapter four) utilised the raw data from the 1,042 participants recruited to the OTCH study to perform subgroup analysis and predictive modelling (including regression modelling and generalised estimating equation (GEE) modelling) with the aim of further investigating the effect of occupational therapy on various subgroups of the participant sample. Subgroup analysis determined that age, time since stroke onset, cognitive status, mood and pain made no difference to the effect of a three month occupational therapy intervention aimed at improving or maintaining independence in basic ADLs (as measured by the Barthel Index (BI)). Predictive modelling found type of care home (residential or nursing) and cognitive status (dementia or normal cognition) to be a far greater predictor of ADL performance and mobility outcome than whether or not the resident had received the occupational therapy intervention. Stage four (reported in chapter five) involved analysis of the content of occupational therapy intervention delivered to the OTCH study participants and their performance in self-care ADLs to account for possible reasons why the trial produced neutral results by (1) exploring the content of the treatment that the intervention arm participants received from the study occupational therapists; and (2) investigating the performance of those participants who had received the allocated occupational therapy intervention, whilst accounting for possible predictor covariates. Binary logistic regression was used to model the relationship between the dependent outcome variable and the explanatory predictor variables. Results of the analyses demonstrated that the therapists did not allocate their time according to those with greater levels of disability and higher levels of need. Residents with dementia received less therapy input than those with mild cognitive impairment or normal cognition. Cognitive status was the strongest predictor of functional outcome. The thesis concludes by highlighting the implications of this new body of research evidence for occupational therapy clinical practice, policy, and future research.
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Hirst, Jennifer. "The optimisation of HbA1c testing in UK primary care." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:b2f07d75-32f4-4c41-a9ef-d614b91cb6d7.
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Background. HbA1c monitoring to guide diabetes management usually requires more than one clinic appointment. Point-of-care (POC) testing allows testing and treatment changes in a single appointment, but trials of POC HbA1c testing have not been shown to benefit patients and the healthcare system. This work explores how HbA1c testing in primary care could be streamlined using POC testing. It comprises four pieces of work and is guided by complex intervention and test-evaluation frameworks. Methods. Database analyses were used to describe current practice in HbA1c testing and identify factors associated with testing schedules not recommended by guidelines. Systematic review and meta-analysis was used to determine the most accurate POC device. A device was selected to use in a feasibility study to determine how POC HbA1c testing can be used in primary care consultations. Data on recruitment, care pathways, care delivery, satisfaction and behaviour were gathered using data collection forms and questionnaires. Qualitative interviews with patients and clinicians explored perceptions and barriers to POC testing. Results. Database analyses showed that high or low HbA1c testing rates are associated with previous HbA1c levels and use of incentive schemes. Most POC HbA1c devices have a mean negative bias and large variability compared to laboratory methods. When POC HbA1c testing was used in GP practices, nurses used the result to make clinical decisions during the consultation. Nurse consultations were longer than GP consultations (22mins versus 11mins) and POC results were successfully uploaded to patient records. Patients liked POC testing and found it convenient. It helped some link their HbA1c result to recent behaviour. Clinicians found the tests easy to use but were concerned about cost. Conclusion. POC testing can be effectively delivered in primary care but funding mechanisms are needed to encourage adoption. This work could inform the design of a randomised trial to test the effect on patient outcomes.
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Donato, Francis A. "Reforming health care through managed care." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1995. http://www.kutztown.edu/library/services/remote_access.asp.
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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1995.Source: Masters Abstracts International, Volume: 45-06, page: 2939. Abstract precedes thesis as [1] preliminary leaf. Typescript. Includes bibliographical references (leaves 91-92).
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Higgins, Peter McRorie. "Medical care in English prisons." Thesis, Open University, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.406489.
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Wright, Hollis G. "Means, ends and medical care /." view abstract or download file of text, 2002. http://wwwlib.umi.com/cr/uoregon/fullcit?p3055725.
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Thesis (Ph. D.)--University of Oregon, 2002.Typescript. Includes vita and abstract. Includes bibliographical references (leaves 272-280). Also available for download via the World Wide Web; free to University of Oregon users. Address: http://wwwlib.umi.com/cr/uoregon/fullcit?p3055725.
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Frank-Weinberger, Jessica. "Barriers to care following combat-related trauma in UK veterans." Thesis, University of London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.542326.
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Horton, Amy Eleanor. "Financialisation of care : investment and organising in the UK and US." Thesis, Queen Mary, University of London, 2017. http://qmro.qmul.ac.uk/xmlui/handle/123456789/31797.
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This research investigates the relationship between the crises of care and finance, and efforts to ensure that care is valued more highly. It explores why investment funds have acquired care homes, how they realise value, and the implications for workers and residents. It also examines the factors that have limited financialisation, including the activities of social and labour movements. These developments are studied through empirical case studies of three major UK care companies, and analysis of the strategies of selected movements in the UK and US. The research involved 64 interviews, observation and document analysis. A geographical perspective helps to illuminate uneven investment in real estate, the quality of the care homes produced, and the spatial dimensions of organising within globalised care systems. The research finds that financial ownership of care companies has been driven by their real estate assets, the availability of debt financing, and specific business models. Corporate debt has also enabled governments to displace and depoliticise responsibility for funding care. However, finance has not replaced labour as a source of value: care remains labour intensive and value can be extracted from low-status, poorly organised workers and clients. The thesis deploys feminist care ethics to analyse the effects of financial ownership and crisis on labour and residents, including evictions that result from care home closures and the production of new, 'hotel-like' facilities. Financialisation has, though, been limited by a lack of material resources in care and political opposition. In contesting financialised care, movements have used stories to locate economic agency; to address political, experiential and affective divides; and to promote alternative social relations of interdependence. Organising is crucial to creating space for such stories. Overall, financialisation has been enabled by the undervaluing of care, but it has also been limited by social values and relationships associated with care.
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Yeung, Yee-hung Stella. "Sustainable healthcare delivery in Hong Kong : organizational initiatives and strategic financing /." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk:8888/cgi-bin/hkuto%5Ftoc%5Fpdf?B23295776.
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Iyekekpolor, Maria E. "The antenatal care experiences of overweight pregnant women in the UK." Thesis, University of Huddersfield, 2016. http://eprints.hud.ac.uk/id/eprint/34176/.
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The current position of the World Health Organisation (WHO, 2014) is that there is a threat of a global “obesity epidemic” (Boero, 2007, p.1); and existing studies in the UK report that a 5th of pregnant women are overweight. This has created increased scrutiny of fatness and weight, especially in pregnant women. The concern about obesity and pregnancy outcomes also contributes to the National Institute for Health Care Excellence (NICE, 2010), recommending that the antenatal care delivered to overweight pregnant women should be within the guidelines of a high-risk pathway of antenatal care. This has increased the medicalisation of the care for overweight pregnant women. The aim of this study is to explore the experiences of overweight pregnant women in relation to their heightened medicalised antenatal care. Using a social constructionist approach and a Foucauldian interpretive lens, semi-structured face-to-face interviews were used to collect data from 12 women who were between 16 and 30 weeks pregnant, 6 midwives who provide antenatal care for them, and 3 obstetricians to whom women are referred. The data were analysed using thematic analysis. The findings show that pregnant women do not identify with being ‘obese’ and perceive themselves as being overweight but healthy. Key themes that emerged from the data describing women’s perception of heightened antenatal care are: their understanding of risk and risk perception, the power of science and how it constructs their maternal health and the power of obstetricians justifying medical interventions in pregnancy and childbirth. This study creates and contributes to the awareness of how overweight pregnant women who are healthy experience antenatal care. It explores the need of overweight pregnant women, and identifies changes that need to be made to positively enhance how these women experience pregnancy and childbirth. These findings need to be considered by policy makers, individuals in practice and those with a role in educating health care practitioners so that overweight pregnant women are provided the appropriate antenatal care.
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Penfold, Christopher M. "Patient copayments in primary medical care." Thesis, Cardiff University, 2011. http://orca.cf.ac.uk/54411/.
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This research was carried out to assess the feasibility of studying the effects of introducing copayments in primary medical care via studying the effects of copayments in primary dental care. Quantitative methods were used to investigate the impact of primary dental care copayments on patients and to compare predictors of primary medical and dental care uptake. Qualitative methods were used to investigate attitudes towards copayments for NHS primary health services and their extension to include primary medical consultations. Regression models, chi-square analyses and ANOVA were applied to the England and Wales sub-sample of nationally representative self-report data from the 1998 Adult Dental Health Survey (ADHS) (n=3628) to investigate the impact of copayments on primary dental care uptake. Regression models and chi-square analyses were applied to the England and Wales sub-sample of nationally representative self-report data from the 1997/98 British Household Panel Survey (BHPS) (n=8526) and the 1998 ADHS (n=3641) to compare predictors of primary medical and dental consultations. Semi- structured interviews were undertaken in Bristol and Somerset with purposively sampled frequent and infrequent primary medical care users (n=19). Predictors of primary medical and dental care utilisation differed across predisposing, enabling and illness level factors. Private and NHS dental copayments were perceived to be expensive and this perception was associated with lower preventive-led dental consultation rates, but not with treatment-led consultation rates. Copayments for services affected the nature of the patient-practitioner relationship. Findings were inconclusive regarding the effect of copayment exemption status on people's decisions to consult a dentist and on dental treatments received. It was not feasible to study the effects of introducing copayments in primary medical care via studying the effects of copayments in primary dental care.
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Chan, Yee-ying Michelle. "The formulation and implementation of healthcare reform in Hong Kong." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk:8888/cgi-bin/hkuto%5Ftoc%5Fpdf?B2329470x.
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Mykhalovskiy, Eric. "Knowing health care / governing health care exploring health services research as social practice /." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0018/NQ56249.pdf.
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Sorinola, Olanrewaju. "A realist evaluation of faculty development in UK medical schools." Thesis, University of Warwick, 2014. http://wrap.warwick.ac.uk/66192/.
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Background The central mission of every medical school is education, however most teachers have not received formal teacher training. Hence there is an expectation that faculty development (FD) with planned programmes to prepare faculty members for their role in teaching will be integral to medical school life. The widespread investment in FD is predicated on the belief that it enhances the effectiveness of teaching but the evidence is limited. Aim To carry out an in-depth exploration of FD in UK medical schools and evaluate the effectiveness of FD on teaching. The realist framework with its principle of explanatory causation was chosen to find out what works for whom in FD in what context, and why. This was an innovative use of the model in educational research. Methods A detailed literature review was carried out and combined with the researchers experience and insight of FD to develop eight realist hypotheses in the form of contexts, mechanisms and outcomes (CMO). Data that would support, modify or challenge the hypotheses were then collected in three phases. Phase I was a review and scoring of data on medical school FD webpages using a webpage scoring index. Phase II was observation and informal interviews of two cohorts of educators attending a FD course followed by detailed interviews of 12 educators (six from each cohort) six months later. Phase III was interview of FD coordinators and educators at eight medical schools. Quantitative and qualitative data were collected. Data analysis Quantitative data were analysed by descriptive methods, slope diagrams, bi-axial constructs and statistical analysis with Fisher’s exact test. Qualitative data were analysed by categorising and connecting strategies followed by summarising the relevant data under each hypothesis to check if the hypothesis was supported, modified or refuted. Findings The literature review revealed a paucity of publications on FD in the UK, however the 30 medical schools webpages reviewed showed data on FD activities. Data from all three phases were used to identify and explain the contexts (participatory approach/reflective practice, needs identification, supportive setting and standardization of medical teaching) that facilitated FD mechanisms (engagement, motivation, positive perception and professionalization).These led to the outcomes of improved confidence, competence, credibility and career progression. Conclusion Four realist theories of FD were identified (engagement, motivation, positive perception and professionalization) confirming the effectiveness of FD both in the short and long term and important recommendations for all FD stakeholders (educators, FD developers, universities and policy makers). In addition, I also made recommendations for future medical education researchers who choose the realist evaluation model.
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Chan, Philip. "Undergraduate medical education funding in the UK : principles and effects." Thesis, University of Sheffield, 2015. http://etheses.whiterose.ac.uk/11760/.
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Undergraduate medical education in the UK is dually funded. There is University funding through the Higher Education Funding Council for England (HEFCE) or the devolved governments of the UK, and a second line of funding for the teaching of medical undergraduates in National Health Service (NHS) facilities, known as the service increment for teaching (SIFT). This study traced how these monies are actually spent, by investigating the allocation plans for these funds within both Universities and the NHS. Although the functions of Universities and healthcare providers are complex, and activities such as student teaching, clinical care and research are inter-related, most of this money is not actually spent on undergraduate medical education, but instead used as a kind of general subsidy for elite institutions, be they Universities or “teaching” hospitals. This work argues that both funders and providers of medical education realized, and indeed intended, that SIFT was used for purposes peripheral to undergraduate education, by examining the reporting systems for SIFT spending, and the nature of accountability for these large sums of money. This argument is situated in the history of higher education funding. The history and evolution of both medical University funding and NHS funding for medical undergraduate education are explored. The literature reviewed relates to the history, organization and funding policy of higher education in the post-war period in the UK, with medical education as a special case within this. The effects of this funding on undergraduate medical education are substantially negative. Although large sums are committed to this activity, most of the money is used for other purposes, leaving the core activity essentially unfunded, and relying on volunteerism to actually happen. This is explored in a review of the literature as well as fieldwork, interviewing senior figures in both University and NHS who are in charge of teaching or funding allocations. Probably no organisation or set of individuals meant to disadvantage undergraduate teaching in the NHS. However, the large sums involved discouraged any major change of the SIFT formula, for fear of destabilizing hospital finances and therefore their primary function, to treat the sick. In the University sector, it is an accepted modus operandi to use student funding to invest in prestigious and income-generating activities in the University. An understanding of why the NHS and Universities acted as they did is attempted, by drawing on the field of behavioural economics, using concepts of mental accounting and fungibility of monetary income. As the funds were poorly accountable, and could be considered a type of windfall income, attitudes to spending it, and accounting for the spending, were markedly different to regular, earned income. This exploration of economic behaviour might touch on some of the root causes of the consequences and unintended consequences of the funding system for undergraduate medical education.
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Surtees, Jennifer. "Interorganizational innovation and collaboration in the UK medical device sector." Thesis, Aston University, 2016. http://publications.aston.ac.uk/28864/.
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Interorganizational team research is a growing body of literature and research has started toexamine team related factors such as interorganizational trust (i.e. Stock, 2006) in theinterorganizational setting. This research applies insights from the intraorganizational teamfield into the interorganizational team setting in order to determine the team related factorspertaining to effective collaboration in medical device innovation projects. Interorganizational collaboration has been a persistent feature within the interorganizationalrelations literature, due to the added benefits that can come with working collaborativelytowards a common goal (Berg-Weger & Schnieder, 1998). While much research has exploredthe structures and performance outcomes of engaging in this cross-boundary working, theliterature is sparse with respect to interpersonal relationships, practices and processes leadingto effective collaboration (Bergenholtz & Waldstrom, 2011; Majchrzak, Jarvenpaa & Bargherz,2015). An interpretivist perspective has informed an exploratory mixed methods approach to datacollection, with contextual insights informing each phase of data collection. Three exploratoryphases of data collection have provided (1) qualitative ethnography data, (1i) qualitativeinterview data and (2) quantitative survey data. The NHS has recently set out agendas to increase innovative procurement (Department ofHealth, 2008), work more closely with industry and SMEs (Innovation and Procurement Plan:Department of Health, 2009) and to increase innovative practice (IHW: NHS, 2011). SMEsdeveloping novel medical devices require input from the NHS to ensure that their devices areclinically applicable and therefore will be adopted by the NHS. These contextual insightsprovide the backdrop for Studies 1i and 2. The findings suggest that the intraorganizational team literature can be extended into theinterorganizational collaboration literature, whilst also explaining the factors relating toeffectiveness and success of interorganizational team innovation.
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Hylton, P. Antoinette. "Blood pressure and lifestyle in UK African-Caribbeans." Thesis, City University London, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.363352.
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Almalik, Mona M. A. "A comparative evaluation of postnatal care for migrant and UK-born women." Thesis, University of Aberdeen, 2011. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=165719.
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The aim of this research was to explore perinatal clinical indicators and experiences of postnatal care among European and Middle Eastern migrant women, and to compare them with those of British women, at one tertiary hospital in the North East of Scotland. The numbers of non-British maternity service users increased over the period 2004 to 2008. This increase was not only in numbers but also in diversity of the countries of origins, religions, languages and specific cultural needs, which form new demands on the health services. European women were more likely to be younger, and primigravida and Middle Eastern women were more likely to be married, than British women. Both these migrant groups were more likely to breastfeed at birth and at discharge than British women. However, there was no significant difference in maternal postnatal length of stay in hospital between the study groups. The data do not suggest poorer processes of care or birth outcomes for the new migrant groups. Both migrant and British women reported positive experiences of postnatal care when their needs, those considered basic and essential for each woman after giving birth, were met. Negative postnatal experiences were explored among women from both groups when there were shortcomings in meeting those essential needs. The acceptance of and the expectations about the postnatal care provided differed between migrant and British women, due to their previous experiences in different countries. Although both migrant groups were first generation in Aberdeen and shared some needs and preferences, each migrant group had its own specific needs and beliefs that reflected the women’s culture, religion and country of origin.
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Page, Michael Thomas John. "Workplace-based assessment in clinical radiology in the UK : a validity study." Thesis, University of Stirling, 2016. http://hdl.handle.net/1893/24790.
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In 2010, the Royal College of Radiologists introduced workplace-based assessments to the postgraduate training pathway for clinical radiologists in the UK. Whilst the system served the purpose of contributing to high-stakes annual judgements about radiology trainees’ progression into subsequent years of training, it was primarily intended to be formative. This study was prompted by an interest in whether the new system fulfilled this formative role. Data collection and analysis spanned the first three years of the new system and followed a multi-methods approach. Descriptive statistical analysis was used to explore important parameters such as the timing and number of assessments undertaken by trainees and assessors. Using the literature and an iterative analysis of a large sample of trainee data, a coding framework for categories of feedback quality enabled assessors’ written comments to be explored using deductive and inductive qualitative analysis, with inferential statistical analysis of coded assessor feedback statements. For example, Ragin’s (1987, 2000, 2008) qualitative comparative analysis, QCA, was used to explore whether the assessments met necessary and/or sufficient conditions for high quality feedback. Pairs of assessor-trainee feedback comments were also analysed to establish whether any dialogic feedback interactions occurred. The study presents evidence that despite its intentions, the new system is generally failing to meet its primary, formative aim. As a consequence, the influence of negative washback on assessment practice was reflected in a number of findings. For example, there was evidence of trainees taking an instrumental approach to the assessments, undertaking only the prescribed minimum of assessments or completing assessments in the later stages of placements. Combined with evidence of retrospective assessment, i.e. after completion of the placements, the observed patterns of assessment over the three years are consistent with a box-ticking approach. This study explores the contextual policy and practice dimensions underpinning these and related findings and discusses the implications and recommendations for future arrangements.
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Anderson, Mindi S. "Integrating Emergency Medical Services Into the Patient-Centered Medical Home." Thesis, Capella University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10288192.
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Abstract Emergency medical services (EMS) for nonemergent or low-acuity calls is a new normal. EMS agencies spend a majority of time providing primary care services through the 911 system. They are utilized currently to fill the primary care gap subconsciously. The EMS system is activated as a patient navigator for primary care services. EMS agencies in the state where the research occurred have responded to the gap in care management by creating innovative programs such as community health emergency medical services (CHEMS). Creation of CHEMS programs have become one of the most monumental concepts for change in the field on both a state and national level. EMS has sought ways to meet the goals of the Triple Aim by exploring CHEMS as the state transitions to value-based care. Leaders are searching for innovative ways to close the gap in the primary health care system through a patient-centered medical home (PCMH) model. The action research study stimulated innovative thinking to support coordinated care across the evolving continuum of the health care system. The study captured the current awareness from community health care leaders who have had a recent opportunity to explore the idea of integrating EMS into the PCMH model through semi-structured interview sessions. Major findings in the thematical analysis discovered the current way both EMS and a PCMH function in a silo system that could potentially utilize each other to effectively provide managed care. Joint efforts could offset overutilization of EMS services for calls that have no apparent life threats. EMS would allow for a PCMH to conform to the Patient Protection and Affordable Care Act standards of care management, contributing to the integration of Triple Aim objectives. Collaboratively, EMS and an established PCMH will impact the delivery of preventative, quality and cost-efficient care. The theory of organizational culture change is based on three common characteristics: culture is shared, is intangible, and affects human behavior. The conceptual framework of the research study was based on the chronic care model. Patients with comorbidities potentially utilize the health care system more than a healthy patient to seek reassurance that their health is managed.
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Gordon, Adam L. "Does Comprehensive Geriatric Assessment (CGA) have a role in UK care homes?" Thesis, University of Nottingham, 2012. http://eprints.nottingham.ac.uk/12619/.
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UK care home residents are frail, dependent and multimorbid. General practitioners (GPs) provide their healthcare but there is evidence that existing provision fails to meet their needs. Comprehensive Geriatric Assessment (CGA) comprises comprehensive multidisciplinary assessment, goal setting and frequent review. This thesis considers a possible role for CGA in UK care homes through three research projects. The Care Home Literature Review (CHoLiR) was a systematic mapping review of randomized controlled trials (RCTs) in care homes. It found no evidence supporting CGA as a whole but described some CGA components supported by RCTs: advanced care planning; interventions to reduce prescribing; staff education around dementia and end-of-life; calcium/vitamin D and alendronate in preventing fractures and osteoporosis; vaccination/neuraminidase inhibitors in preventing influenza; functional incidental and bladder training for incontinence; and risperidone/olanzapine for agitation. The Care Home Outcome Study (CHOS) was a longitudinal cohort study recording dependency, cognition, behaviour, diagnoses, prescribing, nutrition and healthcare resource use in 227 residents across 11 care homes over six months. It reported high levels of dependency, cognitive impairment, malnutrition, multimorbidity and frequent behavioural disturbance. Polypharmacy and prescribing errors were common. Variability between homes and individuals was significant for most baseline and outcome measures. Staff Interviews in Care Homes (STICH) was a qualitative interview study of 32 staff working with care homes including: GPs; care home managers and nurses; NHS community nurses and specialist practitioners. It described care defined by discontinuity and lack-of-anticipation; driven by communication failure, inadequate training and expertise in frail older patients, and arbitrary boundaries between care homes and the NHS which interfered with care. Using the findings of these studies, the author proposes a model of care which is multidisciplinary, guided by comprehensive assessment, reinforced by frequent review and delivered by experts in the care of frail older patients: CGA has a role in UK care homes.
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Ning, Jing. "Innovation in social care markets with reference to the UK and China." Thesis, University of Liverpool, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.533954.
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Bourantani, Eleni Anna. "Re-gendering care in the UK : the experiences of male primary carers." Thesis, University of Southampton, 2018. https://eprints.soton.ac.uk/419533/.
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Childcare is a set of practices laden with gender and other inequalities, as it is constructed on the conceptual dualism of paid work/unpaid work that privileges one end of the binary and devalues the other. Feminist authors have highlighted the necessity of making men’s lives more like women’s in combining work and care. This study uses ethnographic methods to explore the experiences of fathers (n=27) who are the main carers of their children. The purpose is to provide an understanding of the places in which childcare challenges the gendered work/non-work binary and is thus “queered”. I use the philosophical building blocks of Deleuze and Guattari (2004) to discuss the participants’ “becomings”: the unmaking of identities and the constant re-making of new ones that are fluid and emerge from practices. The study is comprised of three areas of focus that revolve around three major obstacles in male primary caring: work-based masculinities, the mother as the quintessential carer, and the lack of childcare spaces that are not gender-coded. First, I discuss the role of paid work to the participants’ lives. Despite the strong association between masculinities and paid work, the participants seemed to actively challenge neoliberal work ethic and to carve out their own spaces that allowed them to prioritize and value childcare. Second, I looked into the participants’ embodied experiences of childcare and how they built bonds with their children that were as intimate as the mothers’. They employed the same haptic and affective means as mothers do and engaged in a ‘becoming-carer’, a process that challenges binary distinctions and allows identities to emerge instead of prescribing them. Finally, I discussed the experiences that the participants had in the various places they frequented. Moving in feminized places proved to be both a blessing and a curse, as they were received with overwhelming praise and, at the same time, treated as ‘aliens’. The lack of connection to both mothers and other fathers was indicative of their in-betweeness, of their liminal position that challenged binary spaces and urged them to create new ones. These findings contribute to the geographies of childcare in the UK and add to a journey towards the democratization care through the cultivation of a growing care ethic.
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Tong, Thaison. "Broadening the perspective of economic evaluation in health care : a case study in dementia care in the UK." Thesis, University of Sheffield, 2017. http://etheses.whiterose.ac.uk/19372/.
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My thesis is an investigation of the methods to implement a broader societal perspective in economic evaluation. I proposed two potential approaches that could be used to implement a societal perspective in economic evaluation: An extended cost-per-QALY approach and a CCA-MCDA approach. The investigation was conducted in a case study of dementia care. The case study concerned the evaluation of 4 mutually exclusive options for primary care to early detect people with dementia. I reviewed previous economic evaluation studies in dementia and developed a new cost-effectiveness model for this evaluation. The model provided estimates for costs including health care, government-funded social care, privately funded social care and informal care. Benefits were measured in terms of patient QALYs and carer QALYs. Using the model’s estimates as the initial basis, I applied the principles of the extended cost-per-QALY approach and the CCA-MCDA to implement a broader societal perspective in the economic evaluation in the case study.
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Fong, Ho-nam. "A comparison of the colonial medical systems in British Hong Kong (1841-1914) and German Qingdao(1897-1914)." Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/B35051073.
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Boles, Brian Nelson. "An examination of relationships among indicators of socioeconomic status, health status, and selected health care utilization for fund allocation /." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq21255.pdf.
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Chan, Hung-yee. "Health care delivery and financing in Hong Kong." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk:8888/cgi-bin/hkuto%5Ftoc%5Fpdf?B23294735.
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Wong, Chit-ming. "Risk modelling methods and their application to three health care studies /." [Hong Kong : University of Hong Kong], 1992. http://sunzi.lib.hku.hk/hkuto/record.jsp?B13282566.
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Milnes, Linda Jane. "Development of a self-care guide to support teenagers in preparing for primary care consultations." Thesis, University of Manchester, 2010. http://www.manchester.ac.uk/escholar/uk-ac-man-scw:95591.
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Tighe, Maria. "Transnational intimacies: an ethnographic study of the UK-Chinese medical encounter." Thesis, University of Bristol, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.492642.
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Traditional Chinese medicine (TCM) is a rapidly developing global health care practice. This reflexive ethnographic study is one of the first to explore the transnational identity processes that align practitioner and consumer relations in the UK-Chinese medical encounter.
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Hobson, Rachel Jane. "Investigation into early implementation of non medical prescribing in the UK." Thesis, University of Bath, 2008. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.492288.
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Introduction: Prescribing by non medical personnel (NMP) has been introduced in the UK. The objectives of this study were to a) describe pharmacist discharge prescription transcription service (PDPTS) provided in UK hospitals prior to NMP, b) investigate the implementation of supplementary prescribing (SP) by pharmacists in England, c) explore patient opinions on development of pharmacists and nurses as independent prescribers (IP). Methods: Two postal questionnaires were undertaken, one of hospital clinical pharmacy managers (Q1) and one of PCTPs and CPs (Q2). Depth interviews with patients were also used. Ethics approval was obtained. Key Findings: For Q1 the response rate was 66% (135/206). PDPTS was offered by 49/135 (36%) of hospitals and was the most common prescribing activity undertaken. The majority of pharmacists wrote
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Byrd, Rebekah J. "Culturally competent medical care of LGBTQ patients." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/911.
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Öhman, Mattias. "Essays on Cognitive Development and Medical Care." Doctoral thesis, Uppsala universitet, Nationalekonomiska institutionen, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-305627.
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This thesis consists of four self-contained papers. Essay I (with Linuz Aggeborn): Fluoridation of the drinking water is a public policy whose aim is to improve dental health. Although the evidence is clear that fluoride is good for dental health, concerns have been raised regarding potential negative effects on cognitive development. We study the effects of fluoride exposure through the drinking water in early life on cognitive and non-cognitive ability, education and labor market outcomes in a large-scale setting. We use a rich Swedish register dataset for the cohorts born 1985-1992, together with drinking water fluoride data. To estimate the effects, we exploit intra-municipality variation of fluoride, stemming from an exogenous variation in the bedrock. First, we investigate and confirm the long-established positive relationship between fluoride and dental health. Second, we find precisely estimated zero-effects on cognitive ability, non-cognitive ability and education for fluoride levels below 1.5 mg/l. Third, we find evidence that fluoride improves later labor market outcomes, which indicates that good dental health is a positive factor on the labor market. Essay II: I study the associations between cognitive and non-cognitive abilities and mortality using a population-wide dataset of almost 700,000 Swedish men born between 1950 and 1965. The abilities were measured at the Swedish military enlistment at age 18-20. In addition, I investigate if income and education are good proxies for the abilities. The results suggest that both cognitive and non-cognitive abilities are strongly associated with mortality, but that non-cognitive ability is a stronger predictor. The associations are only partly mediated through income and education. For middle and high income earners and individuals with a college education there are no associations with mortality. However, for low income earners and individuals without a college education, both abilities are strongly associated with mortality. The associations are mainly driven by the bottom of the distributions. Essay III (with Matz Dahlberg, Kevin Mani and Anders Wanhainen): We examine how health information affects individuals' well-being using a regression discontinuity design on data from a screening program for an asymptomatic disease, abdominal aortic aneurysm (AAA). The information provided to the individuals is guided by the measured aorta size and its relation to pre-determined levels. When comparing individuals that receive information that they are healthy with those that receive information that they are in the risk zone for AAA, we find no effects. However, when comparing those that receive information that they have a small AAA, and will be under increased surveillance, with those who receive information that they are in the risk zone, we find a weak positive effect on well-being. This indicates that the positive information about increased surveillance may outweigh the negative information about worse health. Essay IV: I estimate the effect of SSRI antidepressants on the risk of mortality for myocardial infarction (MI) patients using Propensity Score Matching on individual health variables such as pharmaceutical drug prescription, patient history and severity of the MI. The effect of antidepressants on mortality is a heavily debated topic. MI patients have an elevated risk of developing depression, and antidepressants are among the most common treatments for depression and anxiety. However, there are indications that some classes of antidepressants may have drug-induced cardiovascular effects and could be harmful for individuals with heart problems, but there is a lack of large-scale studies using credible identification strategies. My findings indicate no increased risk of two-year mortality for MI patients using SSRI. The results are stable for several specifications and robustness checks.
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Armbruster, Susanne. "Versorgungsnetzwerke im französischen und deutschen Gesundheitswesen : eine vergleichende Studie unter Berücksichtigung rechts- und gesundheitswissenschaftlicher Aspekte /." Stuttgart : Ibidem-Verl, 2004. http://www.gbv.de/dms/sbb-berlin/46191977X.pdf.
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