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Biomedical subjects

R Lepnurm

Publications and source records attributed to R Lepnurm.

7 recordsLinked to original sources
PubMed2001

The closure of rural hospitals in Saskatchewan: method or madness?

On April 14, 1993 the Minister of Health of the Province of Saskatchewan announced the closure of 52 of the 112 small hospitals using the criteria of: size, utilization for two consecutive years and distance to the nearest-neighbouring hospital. Amazingly, that government was re-elected. This study compared two models of reasons for hospital closure: the government criteria; and historical population, resource, and utilization factors, gathered for the year prior to closure and a decade earlier. Of the 112 small hospitals in Saskatchewan, the 10 hospitals in the frontier area were not included. Hospitals in the settled part of the province were divided into two distinct zones. The Northern zone, with 53 hospitals is characterized by rich dark soil and prosperous trade centres and the Southern zone, with 49 hospitals is characterized by light brown sandy soil and oil and gas exploration centres. Two discriminant models were developed. The government model consisted of size, two years of utilization and distance. The historical model consisted of population, resource, and utilization factors for the years 1981/1982 and 1991/1992. The dependent variable for both models was hospital status (open = 1 and closed = 0). The government model accurately predicted 91.18% of the closure decisions. The historical model had a classification accuracy of 95.10% for the whole of settled Saskatchewan, 96.23% for the Northern zone, and 95.92% for the Southern zone. The historical model was more accurate than the government model. Closing a hospital is a sad event. The manner in which the government closed nearly half of the small hospitals in Saskatchewan and gained re-election is an important account of responsible public policy. The historical model developed to examine this story takes public policy one step further in that it is possible for governments to recognize signals that indicate when communities should undertake orderly transitions in the operation of their health services facilities.

Decision Making, Organizational↗
PubMed2000

Wellness activities address inequities.

The medical model is no longer accepted by many as the best means of achieving optimal health. Financial constraints are pushing more efficient and effective ways to deliver services. In Saskatchewan, greater emphasis is being placed on wellness activities (preventive medical counselling, clinical work with other professionals, training, teaching and research and institutional medical administrative duties). We sought to determine if predicted support for these activities was related to equity of income as perceived by physicians. The study design was a cross-sectional study of all 1462 physicians actively practising in Saskatchewan during 1991/1992. The data were originally collected by Lepnurm and Henderson during the summer of 1992. ANOVA tests were conducted between predicted support for wellness activities and income equity to determine if there were significant interactions. Predicted support for wellness activities was measured by four items: preventive medicine counselling activities during office visits, clinical work with other health professionals, teaching and research, and, institutional medical administrative duties. The first income equity construct was based on: satisfaction with income, fairness of fee-for-service between general practitioners and specialists, fairness of fee-for-service between cognitive and procedural/technical specialists, and the current method of payment reflected factors important to physicians. To increase sample size a second equity construct was created by dropping fairness of fee-for-service between cognitive and procedural/technical specialists. The main effect and significant interactions with control variables were subjected to further analysis using Tukey's test. Significant relationships were found between changes in wellness activities under fee-for-service and income equity (p = 0.001 and p = 0.033) and between changes in wellness activities under salary and income equity (p = 0.002 and p = 0.037). No significant relationships (p = 0.858 and p = 0.610) were found between support for wellness activities under capitation and income equity. The findings of this study demonstrate a relationships between perceived equity of income and predicted support for wellness activities. The authors suggest that these findings were not merely a reflection of the desire by physicians to modify their tasks to accommodate perceived inequity associated with their method of remuneration. Physicians were given the option of considering which method of payment (fee-for-service, salary or capitation) best reflected factors important to them. We suggest that many physicians value wellness activities and would prefer to modify their current patterns of practice, whether they are paid by fee-for-service or by salaried methods.

Adult↗
PubMed1996

The objectives of paying doctors: views from Saskatchewan.

Physicians in Saskatchewan still favor the fee-for-service method of payment over salaries, capitation, and sessional contract. However, there appear to be two camps. Fee-for-service adherents felt that this method best ensured clinical autonomy, practice location, control over work schedule, and adequate income. Proponents of salaries felt that such methods best ensured adequate time with patients, clinical teamwork, preventive activities, teaching and research, continuing medical education, and administrative simplicity.

Attitude of Health Personnel↗
PubMed1995

Consumer-sponsored health centers and health reforms in Canada.

The community health center movement, begun in Saskatchewan, is central to successsfully reforming the Canadian health care system. The arguments of 30 years ago are relevant today. Canadian Medicare is at the crossroads. The evidence shows that the provision of primary health care through community health centers is cost effective and that the quality of care is at least as high in these settings as in traditional fee-for-service settings. Each province must encourage the development of a network of community health centers capable of providing services to every resident who wishes to receive all of his or her primary care "under one roof."

Canada↗
PubMed1995

Modeling a chiropractor:population ratio.

OBJECTIVE: As the cost of disability from musculoskeletal conditions increases, more attention needs to be directed toward the number of health care practitioners required to effectively treat these problems. This study describes a methodology to estimate the number of chiropractors needed to effectively serve a given population. DATA SOURCES: The data on the utilization of chiropractic services over time comes from the Saskatchewan Medical Care Insurance Branch. STUDY SELECTION: A Medline search was performed using these key words: musculoskeletal, back pain, neck pain, headaches and prevalence. Chiropractic journals were reviewed for the analysis of the kinds of conditions treated by chiropractors. DATA SYNTHESIS: Saskatchewan data shows a steady increase in the percentage of the population treated by chiropractors in response to an increase in the number of chiropractors. A regression function was defined using the number of chiropractors as the independent variable and the number of patients treated annually as the dependent variable, where all Saskatchewan patients with musculoskeletal conditions could be treated by chiropractors. CONCLUSION: Of the general population, 36.1% annually suffer from some sort of musculoskeletal problem. In Saskatchewan, this means that 366,848 people could be treated by chiropractors if enough chiropractors were available. Saskatchewan needs 391 chiropractors to effectively serve the musculoskeletal problems of the general population. This is an ideal chiropractor:population ratio of 1:2,588. Health care policymakers should design incentives to channel the appropriate patients into chiropractic offices.

Adolescent↗
PubMed1989

Satisfaction of country doctors.

A survey of doctors in Saskatchewan communities with fewer than 5,000 residents was conducted to determine which factors were important in maintaining job satisfaction. The response rate was 57 percent. A three-item measure of satisfaction linked the doctors' responses to a 62-item questionnaire covering professional and non-professional issues related to their rural practice. Individual variables of importance in explaining satisfaction were family factors ranging from spousal employment to children's education, availability of recreational facilities or activities and entertainment, the opportunity for social interaction, ability to have periodic rests, workload and compensation.

Data Collection↗