Biomedical subjects

R Cockerill

Publications and source records attributed to R Cockerill.

At least 19 recordsLinked to original sources

PubMed2000

The reliability and validity of two health status measures for evaluating outcomes of home care nursing.

The reliability, validity, and sensitivity of the Medical Outcome Study Short Form (SF-36) and the Quality of Life Profile: Senior Version (QOLPSV) for measuring outcomes of home care nursing were evaluated. Data were collected from 50 clients receiving home care nursing services. Twenty-two registered nurses and six registered practical nurses collected client and nursing data on each home visit. Client baseline and outcome measures were collected by two independent evaluators at admission and discharge from the home care service. Internal consistency reliability ranged from.76 to.94 for the eight subscales of the SF-36. Internal consistency reliability ranged from.47 to.82 for the nine subscales of the QOLPSV. The subscales of both instruments had minimal problems with missing responses. The SF-36 was found to be more sensitive than the QOLPSV to change over time. In addition, the subscales of the SF-36 were found to be more sensitive than the subscales of the QOLPSV to several of the nursing variables, such as intensity of the client's nursing condition and skill mix.

Community Health Nursing↗

PubMed1999

Adoption of a managerial innovation: a study of physician impact analysis.

This article examines the adoption of physician impact analysis (PIA) among active treatment hospitals in Ontario, Canada. The influence of variables from three different levels of analysis (individual, organizational and contextual) were included as well as measures of key stakeholders' (Chief Executive Officer (CEO) and Medical Chief of Staff) assessments of the attributes of the innovation. A number of conclusions were drawn. First, by adding information about the perceived attributes of the innovation the model was able to account for a larger percentage of explained variance than has been seen in related work. Secondly, the adoption of PIA within a context of written guidelines agreed to by senior management, specifying process and structure concerns, is most likely in organizations which are large and where the CEO positively evaluates the innovation.

Chief Executive Officers, Hospital↗

PubMed1999

Physician characteristics and the physician-patient relationship. Impact of sex, year of graduation, and specialty.

OBJECTIVE: To examine the association of physician sex, medical specialty, and year of graduation from medical school with attitudes and behaviours that define physician-patient relationships. Hypotheses tested are that women physicians, family physicians, and recent graduates spend more time discussing lifestyle and general health issues during patients' first visits; are more likely to report behaviours that are empathetic and that encourage communication with patients; are less likely to view their role as directive and problem-oriented; and are more supportive of patients' rights to information and participation in decision making. DESIGN: A survey was mailed to a stratified random sample of physicians between February and June 1996. SETTING: Physician practices in Ontario. PARTICIPANTS: Of 714 practising Ontario physicians, 405 (57%) responded. MAIN OUTCOME MEASURES: Proportion of time and actual time spent discussing a patient's lifestyle during a first visit, communication style, attitudes regarding a directive approach to care, and attitudes regarding patients' rights. RESULTS: Women physicians and family physicians spent significantly more time discussing lifestyle during a first visit. Women, family physicians, and recent graduates were significantly more likely to report an empathetic communication style. Women and recent graduates were significantly less likely to have a directive, problem-oriented approach to care. Family physicians were significantly less supportive of patients' rights than medical and surgical specialists were. CONCLUSIONS: Physicians in this study reported empathetic communication styles and attitudes that support information sharing and patients' rights.

Adult↗

PubMed1999

Determining Ontario's supply and requirements for ophthalmologists in 2000 and 2005: 1. Methods.

BACKGROUND: We performed a study to determine the supply of and requirements for ophthalmologists in Ontario in 2000 and 2005. In this paper we describe our methods. METHODS: The future supply of ophthalmologists was estimated by means of iterative multiple regression analysis using the baseline number of ophthalmologists, the number of ophthalmology residents and the numbers of ophthalmologists entering and exiting the workforce between 1989 and 2004. Data were obtained from the Ontario Physician Human Resource Data Centre, Statistics Canada, the Ontario Ministry of Finance and residency program directors of Ontario universities. We calculated requirements using four models. The physician:population ratio method used an ophthalmologist:population ratio (1:29,650) proposed by the Royal College of Physicians and Surgeons of Canada and Statistics Canada population projections for 2000 and 2005. The utilization-based, substitution and needs-based models used Ontario Health Insurance Plan data for 1995. The supply and requirements are expressed as full-time equivalents, defined as the average number of minutes worked by ophthalmologists in 1995. The 401 ophthalmologists practising in Ontario in 1995 accounted for 452 full-time equivalents. INTERPRETATION: Incorporating the results of several requirement models increases the reliability and acceptability of estimates of physician workforce requirements.

Female↗

PubMed1999

Determining Ontario's supply and requirements for ophthalmologists in 2000 and 2005: 2. A comparison of projected supply and requirements.

BACKGROUND: To determine whether the projected supply of ophthalmologists in 2000 and 2005 in Ontario will be matched by the predicted requirements. METHODS: Described in the accompanying paper (page 74). RESULTS: Multiple regression analysis predicted a supply of 485 +/- 15 full-time-equivalent (FTE) ophthalmologists in 2000 and 476 +/- 14 FTEs in 2005. Except for the needs-based method of determining requirements, which generated a figure of 524 +/- 16 to 533 +/- 16 FTEs, the requirement methods yielded estimates that were within the range of the projected supply for 2000 (physician:population ratio method 458, utilization-based method 500 +/- 15 and substitution method 470 +/- 14 to 490 +/- 15). For 2005, only the physician:population ratio method gave an FTE requirement estimate (489) that was in keeping with the projected supply. The other models gave FTE estimates that were higher than the projected supply (utilization-based model 559 +/- 17, substitution model 526 +/- 16 to 548 +/- 16, and needs-based model 585 +/- 18 to 596 +/- 18). INTERPRETATION: The reduction in the number of ophthalmology residents in Ontario that began in 1994 will not affect the short-term requirements for ophthalmologists but may result in fewer ophthalmologists than will be necessary to fulfil Ontario's requirements in 2005 and beyond. Possible solutions include doubling the number of residency positions beginning in 1999.

Female↗

PubMed1998

Community pharmacist perspectives on HIV/AIDS and interventions for injection drug users in Canada.

In several countries, community pharmacies play a major role in the provision of HIV prevention services to injection drug users (IDUs). In this study, results from a national Canadian Survey of Community Pharmacies and HIV/AIDS Prevention are used to describe pharmacists' perspectives on HIV/AIDS and services to IDUs, and explore the relationship between personal and organizational characteristics and the level of support for HIV/AIDS prevention initiatives. A mailed questionnaire was directed to a random sample of 2,017 pharmacist owner-managers. The response rate was 84.6%. Results suggest that current services to IDUs primarily are limited to discretionary needle and syringe sales to non-diabetics, with almost three-quarters supportive. Staff safety was an important consideration in the provision of this service (77%), while remuneration was the lowest (27%). Community pharmacists were most comfortable with the provision of counselling, advice and literature (X = 2.6) and environmental and technological interventions (X = 2.4) and least supportive of provision of services as part of a programme (X = 1.6) and legalization of drugs or prescription of methadone (X = 1.9). Female pharmacists were more likely to support preventive measures such as the provision of counselling or advice, and males were more likely to promote legislative change. Pharmacists appear generally willing to expand their services in the fight against HIV/AIDS. However, it is not feasible to expect uniform programmes to be immediately introduced. While organizational, educational and policy changes may facilitate programme development, individual pharmacy and pharmacist discretion remains important.

Canada↗

PubMed1998

Condom use among Aboriginal people in Ontario, Canada.

A survey of 658 Aboriginal men and women living in 11 reserve communities in Ontario, Canada, was utilized to collect data on patterns of condom use. Individuals who had sexual intercourse in the previous 12 months were included in the analysis (n=400). Descriptive statistics and multiple logistic regression were used to analyse condom use in the previous 12 months. Eight per cent always, 31% sometimes, and 61% never used condoms. Rates of condom use differed with the number of sex partners in the last year, age, gender, having a steady sex partner, and marital status. Multiple logistic regression revealed that people most likely to use condoms were under the age of 30, male, did not have a long-term steady sex partner, had more than one sex partner, worried about pregnancy, were knowledgeable about HIV/AIDS, and were not embarrassed to obtain condoms. Condom users who were knowledgeable about HIV/AIDS and who knew someone with HIV/AIDS were more likely to always use condoms. The most common reason for not using a condom was 'I was with my steady sex partner'. These results have implications for STD prevention efforts and for future research of sexual and STD preventive behaviour among Aboriginal people.

Adolescent↗

PubMed1997

Innovation theory and its applicability to our understanding of the diffusion of new management practices in health care organizations.

There has been a longstanding interest in understanding how new management practices and organizational structures are diffused through the health care system. This article reviews current literature on innovation and diffusion to provide insight into how new management practices and organizational structures are introduced into the system. Understanding the process may help in accommodating new developments and provide managerial opportunities to take a more active role in encouraging or discouraging their further evolution.

Canada↗

PubMed1997

Differences in sexual risk-taking behavior with state of inebriation in an aboriginal population in Ontario, Canada.

OBJECTIVE: This article describes the self-reported use of substances, participation in unprotected intercourse and differences in sexual risk-taking behavior with state of inebriation among a group of aboriginal (First Nations) people in Ontario. And, in so doing, attempts to answer some of the questions about the association between the use of alcohol and sexual risk taking in this population. METHOD: The project was developed in a partnership between an aboriginal steering committee and university researchers. Data were collected via interview from 658 randomly selected status First Nations people living within 11 reserve communities in the province. RESULTS: Of the 426 individuals included in the within subject analysis 9.6% reported variation in their participation in sex, 13.8% variation in their participation in intercourse and 10.3% variation in their participation in unprotected intercourse with inebriation. An examination of individual behavior across "sober" and "drunk or high" states showed that there were almost equal proportions of respondents who only participated in unsafe sex when sober and respondents who only participated in unsafe sex when drunk or high. Where significant differences occurred, individuals were more likely to report a shift towards no sex or no intercourse with inebriation, not towards unprotected intercourse. CONCLUSIONS: Since a large proportion of individuals in this study engage in unprotected intercourse, the small proportion of individuals reporting different sexual behavior were more likely to report participation in a safe activity rather than an unsafe activity while "drunk or high." Stereotypes and assumptions may lead educators and researchers to feel the need to focus their messages on the relationship between drug and alcohol consumption and unsafe sex; however, the amount of unsafe sexual intercourse that occurs only while individuals are inebriated suggests that this focus is not of principal concern.

Adolescent↗

PubMed1996

Physician impact analysis predictions in Ontario hospitals: does the emperor have clothes?

Physician impact analysis (PIA) is a human resource planning tool used to predict the impact on hospital resources of adding a new or replacement physician to a hospital's medical staff. This article describes the findings of a study which examined the extent to which PIAs are used in Ontario acute care hospitals and the accuracy of PIA predictions. The results suggest that although PIA appears to be widely used, there is no evidence that it meets the intended policy objective of accurately predicting physician hospital resource use.

Cross-Sectional Studies↗

PubMed1996

Interest among occupational therapy managers in measuring workload for case costing.

OBJECTIVES: Interest in costing health care delivery on an individual case basis has increased in recent years as concern with overall health care costs has heightened. Costing exercises have been largely oriented around medical classification systems. Measures to incorporate the contributions of allied health activities such as occupational therapy are relatively recent. The objective of this study was to examine the attitudes and opinions of senior occupational therapy managers toward workload measurement on the basis of case mix. METHOD: A survey was sent to all 198 senior occupational therapy managers in accredited Canadian facilities, which was completed by 182 respondents for a response rate of 92%. The questionnaire asked about workload measurement system(s) currently used, satisfaction with the system(s), and needs and expectations of workload systems in general. RESULTS: The majority of respondents were using a time recording workload measurement system and expressed relatively low levels of satisfaction with it. Current systems were unable to provide costing data, which respondents ranked as very important for themselves as managers. The majority of respondents believed that it would be useful or very useful to be able to cost occupational therapy services by a diagnostic grouping system and to establish standard protocols per diagnosis, standard times per procedure per institution, and standard times per procedure for the profession. CONCLUSION: There is support for developing or expanding current methods of measuring workload. Senior occupational therapy managers would like to be able to predict their workload prospectively, a step that will accommodate the move toward case costing and program management.

Attitude of Health Personnel↗

PubMed1996

The role of policy in community pharmacies' response to injection-drug use: results of a nationwide Canadian survey.

The response rate to this survey reflects the salience of the topic and the professional concern about and interest in issues presented by HIV. The HIV/AIDS epidemic has presented pharmacists with one of the greatest challenges to their professional training, ethics, and practice. It further expedites a current re-examination that is occurring among community pharmacies concerning their roles in community health practices. In response to HIV there have been dramatic and unprecedented changes in pharmacy policy and practices. Clearly, some community pharmacies have led the way and influenced policy and practices. In view of the recent introduction of many of these policies and practices, it is likely that change will continue. Survey respondents were, in general, very comfortable with an expanded role involving counseling, health promotion, and disease prevention, consistent with a broader role for community pharmacies in general that has been recently advocated. Community pharmacies serve all areas of the country, in communities large and small; many are open seven days a week, and some provide extended hours of service. Community pharmacies may provide an important complement to community outreach programs as a source of clean needles and syringes for IDUs in most communities, and as an alternative service in some communities where more elaborate programs are not feasible. Safer needle use, as part of a health-promotion approach, is divergent from conventional practice. While major changes have occurred, it appears that there has been some polarization of attitudes and response. The explanation for this is not simple, and further analysis is required to determine the full impact from several ethical perspectives that include professional, business, and public health viewpoints. We have highlighted the role that policy has in moving toward preventive and harm-reduction approaches. From a policy perspective, we have found that support from the federal government, regulatory bodies, and professional associations may be an important catalyst to pharmacists' participation in programs. Further, it does not appear to be possible to implement such policies without professional development and continuing education, and collaboration with the community. Based on data on knowledge and educational need, we believe that our study population's lowest levels of information were in such areas as the role of methadone in HIV prevention and the availability of needle-exchange programs. As with other health-promotion campaigns, additional skills training may be important. Movement forward with expanded preventive and harm-reduction strategies by pharmacies will require careful planning. It is anticipated that change in this area will be incremental in nature, and that it is necessary to introduce programs and services into community pharmacies gradually. Successful implementation will require extensive community development and collaboration with other health professionals, public health officials, police, groups who represent IDUs, and persons living with HIV/AIDS. Careful monitoring and evaluation of these programs will be necessary to enhance their effectiveness.

Canada↗

PubMed1994

Responding to workload measurement needs.

Workload measurement is a way of capturing and recording the time and/or activities of personnel in the performance of their health care duties. The traditional focus of workload systems in occupational therapy has been on resource allocation, activity tracking and long range planning. The systems are not organized to link with other institutional, financial and management tools to identify and cost client and programme resource use. The position taken in this paper is that occupational therapy workload measurement systems must be expanded to meet these new managerial responsibilities. Occupational therapists must be able to prospectively predict their workload to accommodate the move towards case costing and programme management. The paper also provides information from a national survey which indicates that there is support from the field for this position.

Canada↗

PubMed1993

A survey of workload measurement systems: the occupational therapy manager's perspective.

Interest in measuring workload for budget specific purposes has increased in recent years as health care managers are being forced to cope with the demands of cost containment and fiscal accountability. This paper reports on a survey of senior occupational therapy managers of Ontario facilities accredited by the Canadian Association of Occupational Therapists (CAOT). Respondents were surveyed on their experiences with, and attitudes toward, occupational therapy workload measurement systems and the ability of these systems to assist in management activities. The survey found that most departments were using the National Hospital Productivity Improvement Program (NHPIP) system. Seventy eight percent of managers indicated they were somewhat or very satisfied with the system, but 60% also indicated that it did not adequately meet all of their management needs. In terms of desirable features of a revised workload system, 87% of managers reported wanting a system based on diagnostic or case mix group recording. Client variables (91%), physical and psychosocial aspects of client care (89%) and therapist variables (85%) were also rated as important factors to address in developing new workload systems.

Attitude of Health Personnel↗

PubMed1993

Surviving the management game: workload measurement systems in a cost-conscious environment.

Using a procedure-based occupational therapy workload measurement system developed at, and applied by, Sunnybrook Health Science Centre, this paper explores the objectives of such a system from the point of view of the occupational therapy manager. It also takes into account the synergistic relationship between the occupational therapist and the administrative/business aspect of health care, paying special attention to past and present trends in health-care accountability. In this paper it is argued that occupational therapy managers must relate their procedures and overhead costs to actual client care, if they are to be included in programme management and client costing. The process used by occupational therapy to describe its own procedures for the system is outlined. The system was then developed in conjunction with other institutional, financial and management tools for the client cost conversion process. By using a procedure based workload measurement system, occupational therapy is able to accurately describe client costing, thereby articulating our role in client care.

Costs and Cost Analysis↗

PubMed1992

Different systems, different costs? An examination of the comparability of workload measurement systems.

This study examines the equivalence of the hours of care estimates of four patient classification/workload measurement systems. Although the hours of care estimates of the systems were similar, differences between the estimates could be as great as 4.53 hours per day for the same patient. The researchers developed relational statements that made hours of care estimates equivalent for all systems studied. System differences can have a profound impact on nursing unit and department budgets, if not adjusted.

Costs and Cost Analysis↗

PubMed1991

Emotional stress and coping in multiple sclerosis (MS) exacerbations.

Ninety-five pairs of MS patients in exacerbation and remission were compared on emotional stress in the previous three months. Patients in exacerbation scored higher on emotional disturbance and intensity of stressful events than patients in remission, but lower on frequency of compensating uplifts. There was also a tendency for more patients in exacerbation than remission to favour emotion-focused coping techniques over problem-solving or social support. Whether patients building to an exacerbation over-react to various events or unresolved emotional stress precipitates exacerbations, MS patients might benefit from counselling in stress reduction techniques.

Adaptation, Psychological↗

PubMed1991

Risk factors by onset age in multiple sclerosis.

Some investigators have suggested that there are different forms of multiple sclerosis (MS) based on onset age, and that each has a different etiology. 173 Canadian MS patients were matched to controls on age, gender, race and risk zone prior to age 15. Data were collected on: age at onset, gender, initial symptom, disability level, residence history and family background. Three onset age subgroups (early, intermediate and late) were derived. Matched-pair logistic regression analysis indicated that rural residence, use of well water and an MS family history distinguished between patients and controls overall, but showed no significant interaction with onset age. A family history of diabetes distinguished between patients and controls with evidence of age interaction, in that this risk factor decreased in importance as onset age increased.

Adolescent↗