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Biomedical subjects

R Deber

Publications and source records attributed to R Deber.

At least 19 recordsLinked to original sources
PubMed2001

The disconnect: infertility patients' information and the role they wish to play in decision making.

OBJECTIVE: To determine the preferred role in medical decision making of women undergoing fertility treatments and to establish whether their knowledge of treatments is adequate to inform their choices. METHODS: Self-report survey of 404 women undergoing fertility treatments in 2 university hospitals and a private fertility clinic in Canada. RESULTS: The women had been in fertility treatment for 2.3 +/- 2.6 years; 67.8% reported taking fertility drugs. Most (61.7%) women wanted to share knowledge equally with their doctors about possible fertility treatments. However, about half wanted to decide alone or mostly by themselves about the acceptability of treatment risks and benefits (56%), what treatments should be selected (49.8%), and when to conclude treatments (54.3%). In addition, 55.1% of the women did not know their personal eventual chances of pregnancy with fertility treatment or thought it was 50% or greater. Over half of the women (57.2%) who had taken fertility drugs were unaware of a possible link between fertility drugs and increased ovarian cancer risk. The majority of women (61.8%) who knew of this possible association reported that they learned about it from the print media. Women who knew of the association had a poor understanding of the strength of the evidence or the ability to detect or treat ovarian cancer successfully, and 88.3% thought they could reduce cancer risk by following their doctors' advice. CONCLUSIONS: Despite these women's wishes to actively participate in fertility treatment decisions, they lacked the necessary information to do so meaningfully. Public health policymakers, professional and advocacy organizations, physicians, other healthcare providers, and women themselves must find ways to improve the general public's and patients' understanding about fertility treatment outcomes and risks.

Female↗
PubMed1999

Why not private health insurance? 1. Insurance made easy.

How realistic are proposals to expand the financing of Canadian health care through private insurance, either in a parallel stream or an expanded supplementary tier? Any successful business requires that revenues exceed expenditures. Under a voluntary health insurance plan those at highest risk would be the most likely to seek coverage; insurers working within a competitive market would have to limit their financial risk through such mechanisms as "risk selection" to avoid clients likely to incur high costs and/or imposing caps on the costs covered. It is unlikely that parallel private plans will have a market if a comprehensive public insurance system continues to exist and function well. Although supplementary plans are more congruous with insurance principles, they would raise costs for purchasers and would probably not provide full open-ended coverage to all potential clients. Insurance principles suggest that voluntary insurance plans that shift costs to the private sector would damage the publicly funded system and would be unable to cover costs for all services required.

Canada↗
PubMed1999

Why not private health insurance? 2. Actuarial principles meet provider dreams.

What do insurers and employers feel about proposals to expand Canadian health care financing through private insurance, in either a parallel stream or a supplementary tier? The authors conducted 10 semistructured, open-ended interviews in the autumn and early winter of 1996 with representatives of the insurance industry and benefits managers working with large employers; respondents were identified using a snowball sampling technique. The respondents felt that proposals for parallel private plans within a competitive market are incompatible with insurance principles, as long as a well-functioning and relatively comprehensive public system continues to exist; the maintenance of a strong public system was both socially and economically desirable. With the exception of serving the niche market for the private management of return-to-work strategies, respondents showed little interest in providing parallel coverage. They were receptive to a larger role for supplementary insurance but cautioned that they are not willing to cover all delisted services. As business executives they stated that they are willing to insure only services and clients that will be profitable.

Canada↗
PubMed1999

Canadian health expenditures: where do we really stand internationally?

There are different ways to measure how much Canada spends on health care and the quality of these measurements may vary. This paper examines Organization for Economic Cooperation and Development data for 3 common standards of measure: health expenditures as a proportion of gross domestic product (GDP), nominal spending per capita (US dollars) and spending per capita in purchasing power parities (PPP) equivalents. In 1994, the most recent year for which there were firm data. Canada spent 9.9% of its GDP on health care (rank 3 of 29), and $1999 PPPs per capita (rank 3). However, actual spending was only US$1824 per capita (rank 14). In the same year Japan spent 7% of GDP on health care (rank 22), $1478 in PPPs per capita (rank 16), but actually spent US$2614 per capita (rank 3). Although each measure is suitable for some policy purposes, Canadian spending remains modest by international standards.

Canada↗
PubMed1999

Impact of a shared decision-making program on patients with benign prostatic hyperplasia.

OBJECTIVES: To determine patient views about the Shared Decision-Making Program (SDP), an interactive videodisk program designed to inform patients with benign prostatic hyperplasia (BPH) about their condition and treatment options and to determine its impact on perceived knowledge and treatment preference. METHODS: Six hundred seventy-eight patients with symptomatic BPH from eight Canadian centers viewed the SDP. Before and after viewing the video, patients answered questionnaires designed to assess treatment preference, knowledge gained, and satisfaction with this educational format. A 1-year follow-up survey was also conducted. RESULTS: Most patients showed a high desire for information and high satisfaction with the SDP; this satisfaction persisted at 1 year. Patients' self-reported knowledge increased significantly (P <0.0001). However, the SDP did not alter initial treatment preferences among those with already formed preferences, although it aided almost half of those initially undecided in forming a preference. Viewing the SDP also appeared to enhance the physician-patient relationship. CONCLUSIONS: Patients saw the SDP as an effective method for teaching patients about BPH and the risks and benefits of various treatments, clarifying particular areas about which many patients appear to have a desire for more information than is often provided. Patients were enthusiastic about the educational value of the program, and their active participation in the decision-making process may actually enhance the physician-patient relationship. Contrary to other studies, we found no significant alterations in treatment preferences. Problems relating to the cost and timely updating of the software need to be addressed for these kinds of programs to realize their full potential.

Aged↗
PubMed1997

Regulating biotechnology: a rational-political model of policy development.

While technology assessment is seen as a mechanism for achieving effective and efficient use of health care resources, it has not as yet made the impact on policy decisions that its potential would suggest. Considerable barriers have been encountered in translating assessment results into policy concerning the adoption and use of technologies, with 'political' factors often being decisive. This paper places technology assessment in the content of the policy process to clarify both (a) how conflicting interests and organizational features can often hinder the selection of optimal policies, and (b) the potential roles technology assessment could nonetheless play. The resulting framework is termed the 'rational-political' model of policy development. The paper uses the example of policy making about the regulation of biotechnology, drawing on information from a survey of decision-makers (n = 561) involved in issues concerning the development, approval, and payment for pharmaceutical products.

Biotechnology↗
PubMed1996

Downsizing in the hospital system: a restructuring process.

In an effort to maintain fiscal viability, hospitals have been undergoing major restructuring. This article reports on a study that examined innovative downsizing strategies used by 20 acute care hospitals in Ontario. The study team reviewed hospital operating plans and analysed the results of interviews conducted with administrators and employees about the downsizing process. Results revealed no uniformity of approach to downsizing. Although many administrators expressed the need for a cooperative approach, downsizing was typically conducted in a top down fashion, and was perceived very differently by staff and administrators. The authors suggest ways to improve restructuring efforts and put forward questions to guide future research.

Attitude of Health Personnel↗
PubMed1996

Family and physicians' views of surrogate decision-making: the roles and how to choose.

Physicians and family members were compared on the roles played in surrogate decision-making and their views as to how choices should be made by surrogate decision-makers. Thirty-six family members of patients with Alzheimer's disease, 35 family members of patients with schizophrenia, and 34 physicians from a diversity of specialties were the respondents. There was general agreement that shared decision-making was preferred. Physicians seem to make surrogate decisions in accordance with contemporary views about their roles. Families believed they had a strong subjective appreciation of the patient's overall good. The burden of decision-making was greater for families, but that depended to some degree on the diagnosis of the patient.

Activities of Daily Living↗
PubMed1995

Technology acquisition in Canadian hospitals: how are we doing?

We surveyed attitudes of decision makers involved in making decisions about technology acquisition in hospitals, receiving replies from 989 (72%) anglophone respondents and 201 (68%) from francophone respondents. Respondents split on whether to try unverified procedures, strongly agreed that medical technology should be evaluated, and expressed a desire for technology assessment data. The quality of health care, need, and compatibility with the institution's role and mission were seen as the most important factors affecting acquisitions. Our study suggests that half the battle has been won; decision makers appear convinced that technologies must be evaluated. Organizational mechanisms, however, may still be required to ensure implementation.

Adult↗
PubMed1994

Technology acquisition in Canadian hospitals: how is it done, and where is the information coming from?

A 1990 nation-wide survey on technology acquisition in Canadian hospitals, based on 509 Anglophone and 55 Francophone hospital questionnaires and 193 hospital equipment request forms, revealed that 53% of capital funds were used to replace existing equipment, with the remainder spent on new purchases. However, very little regional planning was taking place. Most of the institutional acquisition decisions were made by committees, 17% of which were classified as medical staff, 25.1% as administrative, 32.4% as board committees and 22.5% as mixed. Although administration was heavily represented, medical staff were frequently present and nursing was just as likely to have at least minimal representation. However, technical experts usually played a minimal role. This omission, combined with the limited information asked for on equipment request forms and the limited availability and use of technology assessment information, suggests that acquisition decisions in many Canadian hospitals are likely to be based on inadequate information.

Canada↗
PubMed1993

Physician characteristics affecting referral decisions following an exercise tolerance test.

OBJECTIVE: To examine whether physician background and attitudes were altered to the decision to refer a patient with chronic angina to a cardiologist following the results of an exercise tolerance test. DESIGN: Mailed questionnaire asking family physicians and internists how they would make referral decisions for a patient with classic angina in a detailed case vignette. PARTICIPANTS: Two hundred sixty-five family physicians and 105 internists. OUTCOME MEASURES: Physician referral decisions following results of an exercise tolerance test. RESULTS: Only 15% of the respondents believed that the patient should have been directly referred for cardiac catheterization without conducting an exercise tolerance test previously. Data on the remaining 85% of physicians were analyzed to identify factors influencing referral decisions. These physicians were significantly more likely to refer a patient if they were concerned about a lawsuit (68% vs 53% following a test result suggesting coronary disease and 40% vs 24% following a normal test result). Referral decisions were significantly more likely to be changed on the basis of the test result if the test was administered to determine the need for cardiac catheterization (50% vs 34%) or if the physician was a family practitioner rather than an internist (47% vs 24%). A physician's number of years in practice, experience with patients with angina, and board certification were not associated with referral decisions. CONCLUSIONS: Many physicians with very different attitudes and backgrounds order diagnostic tests for reasons other than to make referral decisions. This problem appeared to be less prevalent among family physicians than internists, and it may partly be due to fear of lawsuits or lack of knowledge about how the test should be used.

Angina Pectoris↗
PubMed1992

Regulatory intensity, hospital size and the formalization of medical staff organization in hospitals.

Using a theory of organizational response to regulation, this study examined the effects of regulatory intensity and hospital size on the formalization of medical staff organization in Canadian hospitals. The general hypothesis was that, in provinces with greater regulatory intensity, hospitals would exhibit greater formalization of medical staff, and greater involvement of physicians in hospital governance and management; larger hospitals would have greater formalization of medical staff than smaller hospitals. Data from 574 hospitals indicated that both hospital size and provincial regulatory intensity were important factors predictive of the overall formalization of medical staff organization. Depending upon the provincial location, hospitals have developed different patterns of formalizing their medical staff structures.

Canada↗
PubMed1989

The limits of decision analysis for rapid decision making in ICU nursing.

In a study examining rapid decisions in ICU nursing in the context of decision analysis, 40 nurses in 2 ICUs were asked to describe their decisions for six pretested vignettes, suggest alternatives and answer questions about case characteristics. Later, ICU charge nurses and educators were asked to rate the nurses' responses using a modified Q-sort. The nurses did not perceive a finite set of alternatives; the 40 nurses gave 36 to 40 unique sequences that did not cluster. The experts could not agree on which alternatives were good (no "gold standard"). The assumptions of decision analysis appear to be violated when (a) there is not a small finite set of mutually exclusive alternatives; (b) the merit of an intervention cannot be agreed on; or (c) the link between intervention and outcome is unclear. Not only nursing but other process-oriented areas of medical care as well may not fit the decision analysis model.

Choice Behavior↗
PubMed1988

Multidisciplinary teams in health care: lessons from oncology and renal teams.

An indepth study conducted on units treating renal disease and cancer clinics determined that multidisciplinary teams are relatively commonplace in these areas. Developing four team organizational structures--sequential, primary, nucleus and dynamic--the authors hypothesize that each varies on a continuum in terms of how highly structured they are. The framework suggests that the ideology of equal participation on the team is the most difficult to sustain, and that difficulties typically arise as organization requirements become more complex. More research seems to be indicated to develop a comprehensive organizational framework, and the probable effect of organizational form on team performance. One of the key issues addressed is team leadership.

Canada↗
PubMedDate not supplied

How physicians use the stress test for the management of angina.

The authors examined physicians' reasons for ordering an exercise tolerance test and the influence of the test results on management decisions. Subjects of this study included 265 family physicians in Pennsylvania who completed a questionnaire on the management of a patient with typical chronic stable angina. Eighty-one percent of the respondents reported they would order a noninvasive stress test as a first step in the management of the patient. Of these physicians, 40% would refer the patient to a cardiologist only if the exercise tolerance test were strongly positive, 8% would refer only if it were negative, and 53% would not change their referral decisions on the basis of test results. No more than 57% of the physicians rated as very important any given reason for ordering a noninvasive diagnostic test. The results suggest that a test may be ordered routinely but without a consensus as to why it is ordered and without an effect on clinical management decisions.

Angina Pectoris↗