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PubMed1993

Creating organized delivery systems: the barriers and facilitators.

An organized delivery system is a network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the outcomes and the health status of the population served. As such, organized delivery systems are at the center of efforts to implement health care reform. Based on analysis of 12 such systems, this article identifies key characteristics that influence what organized delivery systems are able to do, outlines the major obstacles or challenges to achieving greater levels of integration, and then discusses a number of approaches for effectively dealing with these obstacles.

Administrative Personnel↗
PubMedDate not supplied

The challenge for women physician executives.

After half a century of constituting 5 percent of the physician population, women will soon make up more than one-third of U.S. physicians. Women now practice in virtually every specialty. This enormous change has created both opportunities and tensions. Within the broader context of the changing role of women in U.S. society, women physicians are exploring new career paths--paths that are both similar to and different from those of their male colleagues. A future challenge for women physicians will be achieving significant representation in the medical management ranks.

Career Mobility↗
PubMedDate not supplied

[The meaning of the new way of life of individuals with permanent intestinal ostomy].

The research aims to identify and analyze the main modifications that affect the way of life of an ostomate, and strategies developed to face the situation of having an ostomy. The method used was oral history of topic life. Ten semi-structured interviews were conducted with permanent ostomates. For data analysis, the method used was thematic content analysis. Five themes emerged from the analysis of the interviews: the experience of signs and symptoms and the need for an ostomy; learning to live with an ostomy, the pouching system, and the search for alternatives to replace the usage of the pouching system; facing the changes caused by an ostomy in terms of feeding, clothing and sex life; the search for social reintegration, the challenge of facing death, and the search for future perspectives; the search for a social support network: religious and spiritual beliefs, family and the ostomates association.

Adaptation, Psychological↗
PubMed1994

Accuracy of self reporting malaria in Orissa--a case study.

For rapid assessment of malaria in difficult forested areas in Orissa a study on the accuracy of self-reporting of malaria showed 72 per cent accuracy along with the sensitivity and specificity values of 46 per cent and 76 per cent respectively. The study clearly indicates its utility in the ongoing national malaria eradication programme and can be effectively used for rapid assessment of the disease prevalence. The information so gathered can be used for rapid assessment by the planners and programme managers in devising the strategies for the containment of malaria in the forested areas of Orissa.

Evaluation Studies as Topic↗
PubMed2002

"I'd rather go and know": women's understanding and experience of DEXA scanning for osteoporosis.

OBJECTIVE: To explore women's knowledge and understanding of osteoporosis and of dual energy x-ray absorptiometer (DEXA) scans; the factors influencing their decision to have a scan and their experience of undergoing a DEXA scan. DESIGN: In-depth interviews (using a topic guide) were carried out with 12 women [before a DEXA scan and after they had discussed the results with their general practitioner (GP)] and with three women who chose not to have a scan. SETTING: Stoke-on-Trent, Staffordshire, UK. PARTICIPANTS: Women who responded to a primary-care based questionnaire were purposively selected for interview. RESULTS: The women interviewed had varied levels of understanding of osteoporosis. For the majority of participants the scan was an overwhelmingly positive experience, despite some women's negative expectations. Findings are also explored in terms of the influences on women's decision-making about whether to have a scan and the concept of "knowing" one's risk status. CONCLUSIONS: The main implication for primary care is how to improve women's understanding of osteoporosis and DEXA scans in order to promote the strategy of scanning high-risk women.

Absorptiometry, Photon↗
PubMedDate not supplied

Interviewing job applicants for a staff opening.

It can be very challenging to identify a potentially strong employee for your practice based upon a resume or written application alone. That is why a well-structured and carefully prepared interview is such an important part of the recruitment process. However, many interviewers have vague interview goals or do not know how to make their limited time with the applicant count. This article describes the key ingredients for a successful interview and offers practical tips for interview preparation. Sample interview questions, legal considerations, and interview follow-up tips are offered, as well as practical advice about involving members of your staff in the interview process.

Guidelines as Topic↗
PubMed2005

Exploring the ethical issues of the research interview in the cancer context.

This paper sets out to reflect on ethical issues in the context of a study exploring cancer patients', relatives' and nurses' experience of a day hospital chemotherapy service. Interviewing can be considered as a well-used approach within qualitative methodology, yet little attention has been paid to a many of the ethical deliberations that are inherent when adopting this approach, particularly in the context of cancer. It is the intention of the authors that this paper might raise awareness of these issues, contribute to the ongoing debate about conducting research interviews on sensitive topics and provide a 'real-world' application of these principles. It is considered that the article potentially raises more questions that answers and illustrates that there are not always quick-fix solutions for the 'real-world' problems qualitative researchers' experience.

Attitude of Health Personnel↗
PubMed1999

Barriers to improving endodontic care: the views of NHS practitioners.

AIMS: Concerns have been expressed about the technical quality of NHS endodontic treatment. Bringing performance into line with guidelines for good practice needs to be underpinned by an understanding of barriers to compliance. To this end, our research involved an exploratory investigation of the factors influencing the behaviour of general dental practitioners in their practice of endodontics. MATERIALS AND METHODS: Subjects 12 dental practitioners, representative of varying levels of professional experience and status, and of compliance with good practice guidelines. Data collection In-depth interviews, following a topic guide. Analysis Identification, abstraction and charting of major themes. FINDINGS: Informants' responses suggested that general dental practitioners' endodontic practice is influenced by a complex web of factors. A key barrier to high quality treatment is the NHS remuneration scheme. Undergraduate and postgraduate education and training are also highly influential on practice. Dentists reported employing a range of strategies to manage the time-cost tensions imposed by the remuneration system. Perceived deficiencies in the content and delivery of postgraduate training were highlighted by our informants. CONCLUSIONS: There was a perception among our informants that the NHS fee structure needs to be revised. Their views suggest that a system which rewards quality rather than volume may be more appropriate, but, we believe, such a system would need to take into account efficiency as well as effectiveness. Modification of the current system of postgraduate training in endodontics is also indicated by the views expressed in the interviews. From the diversity of views and from a critical review of the literature, we conclude that flexibility is the key note in changing practice, with no single strategy likely to be universally appropriate.

Attitude of Health Personnel↗
PubMedDate not supplied

Comparison of three inducement techniques to improve compliance in a health survey conducted by telephone.

The use of telephone interviews for epidemiologic and public health studies has increased in recent years. Since telephone surveys are susceptible to lower response rates than personal interviews, several attempts have been reported to increase respondents' compliance using various precontact procedures. This investigation evaluates the comparative effectiveness of three techniques to enhance compliance with a relatively long telephone interview on epidemiologic topics. The theoretical and practical applications in the domain of telephone surveys of two techniques, the foot-in-the-door and the low ball, commonly considered nonpressure techniques, are discussed. A newly suggested, combined compliance procedure is also introduced and tested. Results show that compliance was greater for the new method when compared with each of the other two methods. Moreover, each of the three methods outperformed a control condition. The theoretical models developed to devise and explain the new techniques received empirical support in a public health survey employing 335 adult residents of Tel Aviv, Israel, in May 1988.

Adult↗
PubMed2005

Adversity among drug users: relationship to impulsivity.

Illicit substance users experience adverse life events, but few studies have examined the role of impulsivity in these events. The present investigation sought to establish a link between negative life experiences and a trait measure of impulsivity and demonstrate that this association remains even accounting for potential confounds. Participants were 330 heroin and cocaine users recruited from the community for a health service research study. Participants completed a structured interview that assessed topics including drug and alcohol use, impulsivity, and negative life events. This group of drug users reported high rates of adverse life events in the 6 months prior to the assessment. No specific substance abuse/dependence diagnosis or combination of diagnoses was associated with adversity. Number of substance-related diagnoses was associated with adverse life events, but not when adjusting for impulsivity. Experience of these events was significantly associated with impulsivity (p<.001), above and beyond the shared relation with demographic variables, substance abuse and dependence, and number of substance-related diagnoses. These findings document the high frequencies of recent adverse life events among illicit drug users and indicate that trait impulsivity is associated with increased risk of these life events.

Adult↗
PubMed2004

Knowledge, beliefs and attitudes of squash venue operators relating to use of protective eyewear.

Sports venues are in a position to potentially influence the safety practices of their patrons. This study examined the knowledge, beliefs and attitudes of venue operators that could influence the use of protective eyewear by squash players. A 50% random sample of all private and public squash venues affiliated with the Victorian Squash Federation in metropolitan Melbourne was selected. Face-to-face interviews were conducted with 15 squash venue operators during August 2001. Interviews were transcribed and content and thematic analyses were performed. The content of the interviews covered five topics: (1) overall injury risk perception, (2) eye injury occurrence, (3) knowledge, behaviors, attitudes and beliefs associated with protective eyewear, (4) compulsory protective eyewear and (5) availability of protective eyewear at venues. Venue operators were mainly concerned with the severe nature of eye injuries, rather than the relatively low incidence of these injuries. Some venue operators believed that players should wear any eyewear, rather than none at all, and believed that more players should use protective eyewear. Generally, they did not believe that players with higher levels of experience and expertise needed to wear protective eyewear when playing. Only six venues had at least one type of eyewear available for players to hire or borrow or to purchase. Operators expressed a desire to be informed about correct protective eyewear. Appropriate protective eyewear is not readily available at squash venues. Better-informed venue operators may be more likely to provide suitable protective eyewear.

Australia↗
PubMed2000

Perceived inability to cope and care-seeking in patients with toothache: a qualitative study.

AIMS: To explore the subjective experience of a sample of patients attending a dental teaching hospital emergency clinic with toothache. MATERIALS AND METHODS: Subjects 21 female and 14 male dental patients, of different ages, marital status, employment status and levels of education, presenting with toothache at a dental teaching hospital emergency clinic. Data collection Unstructured in-depth interviews, following a topic guide. Analysis Transcribing, sifting, indexing and charting data according to key issues and themes. FINDINGS: A dimension of toothache pain that emerged was the perceived inability to cope. Patients reported a dependency on a dentist or other person to alleviate their pain, suggesting connotations of helplessness, disempowerment and incapacitation. The perceived inability to cope was also expressed in terms of loss of control, despair and isolation. A number of care-seeking patterns for toothache was identified: repeated visits to the same dentist for emergency care, repeated visits to different dentists, attendance at the dental hospital emergency clinic and consulting non-dental health workers such as doctors and pharmacists. CONCLUSIONS: The perceived inability to cope and care-seeking patterns are two unexplored dimensions of the toothache pain experience. Both dimensions may be associated with pain intensity, the clinical conditions that manifest as toothache, quality of treatment provided and management of demand for emergency dental care. A conceptual framework is proposed for future research to investigate these relationships.

Adolescent↗
PubMed2000

The potential of various foods to serve as a carrier for micronutrient fortification, data from remote areas in Indonesia.

OBJECTIVE: To estimate the potential of various industrially produced foods, to serve as a carrier for micronutrient fortification based on the frequency of their consumption in different socio-economic strata; to determine the role of fortified instant noodles as a source of micronutrients; to assess the contribution of plant foods, animal foods and fortified foods to vitamin A intake. SETTING: A survey was conducted in rural South Sulawesi and urban South Kalimantan between November 1996 and January 1997. SUBJECTS: Households (1500 in South Sulawesi; 2112 in South Kalimantan) were selected randomly by multi-stage cluster sampling. From each household, data were collected from the mother and her youngest child (0-5 y). DATA COLLECTION: Mothers were interviewed on various topics, including socio-economic status, food consumption, receipt of high-dose vitamin A capsules, health and nutritional status. RESULTS: Monosodium glutamate and salt were consumed daily in almost all households in both areas, and consumption was not associated with socio-economic status. Instant noodles were consumed in nearly all households in both areas, but consumption of fortified noodles was related to socio-economic status; it was highest among households of government employees and private investors, and lowest among farmers and share-croppers. Vegetables were the most important source of vitamin A in rural South Sulawesi, while foods of animal origin were the most important source in urban South Kalimantan. CONCLUSIONS: The results support double or triple fortification of salt and/or monosodium glutamate with iodine, vitamin A and/or iron. Efforts to overcome associated technical and logistical difficulties are urgently needed. SPONSORSHIP: Opportunities for Micronutrient Interventions (OMNI); United States Agency for International Development (USAID). European Journal of Clinical Nutrition (2000) 54, 822-827

Adult↗