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PubMed2005

What barriers do primary care physicians face in the management of patients with chronic hepatitis B infection in primary care?

INTRODUCTION: Asymptomatic chronic hepatitis B virus (HBV) carriers, followed-up in primary care, present a challenge to primary care physicians as they encounter problems in monitoring this group of patients. The study aims to explore the barriers faced by primary care physicians in the management of patients with chronic hepatitis B infection in primary care. METHODS: Qualitative analysis of eight focus group discussions with 43 primary care physicians in Singapore was conducted. RESULTS: Primary care physicians highlighted the HBV carriers' poor compliance to disease monitoring as a major hurdle, attributing to their lack of understanding of the disease, state of denial, fear of stigmatisation in society, failure to perceive benefits, costs and reluctance of investigations due to physical discomfort. The carriers' health-seeking behaviour, such as doctor hopping and the use of traditional medication, were other barriers. The investigators noted that the physicians placed emphasis on passive disease monitoring, focusing on the investigation results when they reviewed the carriers. They were less proactive in explaining the disease's natural history nor discussing the possibility of definitive anti-viral treatment for suitable carriers. These physicians varied in their approaches in disease monitoring of chronic HBV infection. The fees-for-service healthcare system allowed the carrier to seek consultation from different doctors, which could result in disruption of disease surveillance. This was further compounded by the differential cost of investigations in private practices and government-aided polyclinics. The absence of a national HBV registry and recall system and waiting time for referral to specialist clinics in restructured hospitals, were other barriers. CONCLUSION: The management of HBV carriers in primary care could be enhanced by measures that eliminate the barriers involving the patient, doctor and healthcare system.

Adolescent↗
PubMed2005

Veterans of quality.

Explore the source record for details and available documents.

Hospital Restructuring↗
PubMed2005

A year in Bristol. Back from the red.

United Bristol Healthcare trust has pulled back from a predicted 3.5m pounds sterling deficit to achieve zero balance. It faces a raft of new challenges, ranging from tough cancer targets to censure over waiting-list breaches. The trust has cut the use of nursing agencies drastically, with 95 per cent of nurses now bank staff. Non-clinical issues such as litter, food and the appearance of buildings are also being tackled.

Decision Making, Organizational↗
PubMed2005

[Population's satisfaction with hospitals before and after a hospital reform in Norway].

BACKGROUND: We investigated patients' satisfaction with availability and quality of hospital services in 2000 and 2003, that is before and after the Norwegian hospital reform. MATERIAL AND METHODS: The data were collected from two national surveys in 2000 and 2003. The participants were asked about their satisfaction with availability (choice and waiting time for an appointment) and quality (result of treatment, professional skills, service-mindedness, punctuality, information and available time). For each question, changes in mean satisfaction from 2000 to 2003, corrected for changes in the composition of the sample, were estimated. RESULTS: A clear and statistically significant improvement in patient satisfaction with the availability and quality of hospital services took place from 2000 to 2003. In general, patients were more satisfied with the quality than with the availability of hospital services. INTERPRETATION: The hospital reform may have contributed to improved satisfaction with hospitals, though other factors may also have played a part.

Adolescent↗
PubMed2005

The economics of hospital reform from hierarchical to market-based incentives.

Heavy investment over the past 30 years has made the hospital sector the largest expenditure category of the health system in most developed and developing countries. In most countries hospitals remain a critical link to health care, providing both advanced and basic care for the population. Often, they are the provider 'of last resort' for the poor and critically ill. This article provides insights into recent hospital reforms undertaken throughout the world, with an emphasis on organisational changes such as increased management autonomy, corporatisation, and privatisation. It provides some insights about these popular reform modalities from a review of the literature, reform experiences in other sectors and empirical evidence from hospital sector itself. The material presented tries to answer three questions: (a) what problems did this type of reform try to address; (b) what are the core elements of their design, implementation and evaluation; and, (c) is there any evidence that this type of reform is successful in addressing problems for which they were intended? While this paper focuses on issues related to the design of the reforms, the paper also reports the findings from a larger study that examined the implementation and evaluation of such reforms so that they will be available to countries that are considering venturing down this reform path.

Developed Countries↗
PubMed1992

[Leadership and professionalism].

In 1990 a new organizational structure based on decentralization and team leadership, where the leader (usually a doctor) is responsible for the final decision, was introduced at the regional and university hospital of Tromsø. This structure replaces the traditional dual structure of leadership where the leaders (a doctor and a nurse) did not share responsibility for the whole department. In order to analyze organizational practices after the reform we constructed three different organization models of the hospital: the hierarchical model, the professional model and the workshop model. Of five teams, one functioned hierarchically, three resembled the professional model, and the fifth came close to the workshop model. The leader of the hierarchical team behaves autocratically and the employees are dissatisfied. In the three remaining teams conditions have changed very little compared with the situation before the reorganization. In the workshop team decisions are reached jointly. This team functions in an innovative way. Even though the new organizational structure has quite divergent consequences and some leaders have problems, the majority of the hospital employees support the new structure.

Clinical Competence↗