PubMed · 15077387
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2004. Diatribe.. https://pubmed.ncbi.nlm.nih.gov/15077387/
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BACKGROUND: Due to the complexity of health system reform in the post-conflict, post-disaster, and development settings, attempts to restructure health services are fraught with pitfalls that are often unanticipated because of inadequate preliminary assessments. Our proposed Integrated Multimodal Assessment - combining quantitative and qualitative methodologies - may provide a more robust mechanism for identifying programmatic priorities and critical barriers for appropriate and sustainable health system interventions. The purpose of this study is to describe this novel multimodal assessment using emergency medicine in post-conflict Serbia as a model. METHODS: Integrated quantitative and qualitative methodologies--system characterization and observation, focus group discussions, free-response questionnaires, and by-person factor analysis--were used to identify needs, problems, and potential barriers to the development of emergency medicine in Serbia. Participants included emergency and pre-hospital personnel from all emergency medical institutions in Belgrade. RESULTS: Demographic data indicate a loosely ordered network of part-time emergency departments supported by 24-hour pre-hospital services and an academic emergency center. Focus groups and questionnaires reveal significant impediments to delivery of care and suggest development priorities. By-person factor analysis subsequently divides respondents into distinctive attitudinal types, compares participant opinions, and identifies programmatic priorities. CONCLUSIONS: By combining quantitative and qualitative methodologies, our Integrated Multimodal Assessment identified critical needs and barriers to emergency medicine development in Serbia and may serve as a model for future health system assessments in post-conflict, post-disaster, and development settings.
BACKGROUND: Health differences between people from lower and higher social classes increase. The accessibility of the health care system is one of the multiple and complex causes. The Physician's perceptions, beliefs and attitudes towards the patient are in this context important determinants. OBJECTIVES: To explore the general practitioners' definition of poverty and their perception of the deprived patients' attitude towards health and health care, to get insight into the ways general practitioners deal with the problem of poverty and to present the proposals general practitioners make to improve health care for the deprived. METHOD: The study involved qualitative methodology using 21 semi-structured interviews. The interviews were recorded and transcribed verbatim. The transcripts were coded using Framework Analysis techniques. Interviews were undertaken with general practitioners in primary care, working in a deprived area in the city of Ghent. RESULTS: In the definition of poverty, three concepts can be identified: socioeconomic aspects, psychological and individual characteristics, and socio-cultural concepts. General practitioners adopt different types of approaches to deal with deprived patients in practice: adaptation of the doctor-patient communication, lowering of the financial threshold, referral to specialists and other health care professionals. CONCLUSION: Including the issue of poverty and poverty in the curriculum of the medical students and in the in-service training for practicing doctors could have a positive impact on their attitude towards this patient group. Further research is needed into the barriers in the accessibility of the health care system for the deprived, exploring qualitatively and quantitatively the experiences and the living conditions of deprived patients and the perceptions of health care providers.
OBJECTIVE: A study was set up to assess usefulness and acceptability of a method of assessing professional behaviour of undergraduate dental students. SETTING: The first year preclinical course at the Department of Dentistry and Oral Hygiene, University of Groningen, the Netherlands. MATERIALS AND METHOD: A form was developed with an ordinal scale to assess undergraduate professional behaviour. A standard means of carrying out assessment was then undertaken and subsequently used to give feedback to the students at the end of each of three terms. The students' self-assessment was then compared to that of the staff. RESULTS: Descriptive analysis of the results was carried out per term. The response rate was 80-85%. The significant difference which existed between the scores of students and staff at the start of the study was reduced to reasonable agreement over two of the three criteria. CONCLUSIONS: The study indicated that the initial difference in assessment of their professional behaviour by first year dental students and by staff, was reduced by the forms and procedure used. This indicates the usefulness of the procedure as a teaching aid. The high participation rate confirms this to be an acceptable means of assessment of dental students' professional behaviour.