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At least 1,063 records · Page 59Linked to original sources
PubMed1996

Shared care: a review of the literature.

This review examines broad issues of concern regarding the primary/secondary care interface. The main purpose was to identify areas of good practice which could be adapted for more general use. One of the most fundamental aspects identified was communication, which is discussed in some detail. Also covered are shared prescribing and disease management. The data suggest that the most effective system(s) of shared care has yet to be established. Further qualitative and economic evaluations are required, taking into account patient preferences. Although the literature does describe certain practice exemplars, it is clear that inter- and intra-professional communication continues to be a problem. Whilst information technology may provide some of the solutions, it is concluded that a culture change, which compels health professionals to make sharing of patient information a much higher priority, is required.

Continuity of Patient Care↗
PubMed1999

How well do GPs and hospital consultants work together? A survey of the professional relationship.

BACKGROUND: The professional relationship between GPs and hospital consultants (sometimes referred to as 'specialists') is important in a healthcare system based upon the generalist as the first point of contact for patients and the gate-keeper for hospital services. This relationship has been the subject of considerable interest over the years, but little empirical research. OBJECTIVES: We aimed to compare the attitudes of GPs and specialists to key issues, and to produce a validated objective measure of their ability to work together. METHODS: We conducted a Likert-style survey based upon statements made in qualitative interviews with GPs and specialists working in the South and West of England. The questionnaire was modified and validated during a multi-stage pilot and was distributed to a stratified random sample of 800 clinicians. RESULTS: GPs and specialists demonstrate a good level of agreement, mutual understanding and respect, though there are significant differences between the two branches of the profession in terms of attitude towards financial parity and direct access to special investigations. CONCLUSIONS: A measure of the ability of GPs and specialists to work together has been developed, with acceptable internal consistency and validity. It may be used in other geographical areas to assess a relationship which is central to the efficient and effective operation of the National Health Service.

Analysis of Variance↗
PubMed1998

Teaching professionalism: passing the torch.

Changes in medicine brought on by health care reform will increasingly pressure physicians and physicians-in-training to adopt business or trade strategies in the name of cost containment and of competition in the health care marketplace. These strategies run directly counter to the professional standards and are a potential threat to medicine's status as a profession. A challenge for this generation of students is not to let this emphasis on finances erode medicine's professionalism. Medical faculty must ensure that their students properly understand the nature of the relationships that permit medicine to enjoy the benefits of being a profession (rather than a trade) and that they learn the appropriate balance between financial and professional considerations. Faculty can and should place financial considerations in proper perspective. Students should learn the basic components of professionalism, how physicians in the past have not always met the full criteria for professionalism, how the current emphasis on cost containment could threaten medicine's status as a profession, appropriate goals for health care reform, the need to form new alliances to meet those goals, and criteria for forming appropriate alliances. Armed with this knowledge, the generation of physicians now in training can understand the delicate balance that must be maintained between financial exigencies and professional imperatives. They will then be prepared to participate in the reform process, embrace its positive aspects, and argue effectively against its negative ones.

Cost Control↗
PubMed2001

Understanding Net Generation employees.

The Net Generation is the digitally-savvy generation born between the years of 1980 and 1999. People born during this time are predicted to seek careers in the helping professions, be open to job stability and working in organizations, and intolerant of coworkers and leaders who are not technically competent. The Net Generation persona and its work-related skills and values are explored and implications are posed in this article for nurse administrators.

Career Choice↗
PubMedDate not supplied

Manager-physician relationships: an organizational theory perspective.

Manager-physician relationships are a critical determinant of the success of health care organizations. As the health care industry is moving toward a situation characterized by higher scarcity of resources, fiercer competition, more corporitization, and strict cost-containment approaches, managers and physicians should, more than ever, work together under conjoint or shared authority. Thus, their relationship can be described as one of high rewards, but also of high risk because of the wide range of differences that exist between them: different socializations and trainings resulting in different worldviews, value orientation and expectations and different cultures. In brief, managers and physicians represent different "tribes," each with its language, values, culture, thought patterns, and rules of the game. This article's main objective is to determine the underlying factors in the manager-physician relationship and to suggest ways that make this relationship more effective. Four different organizational perspectives will be used. The occupational perspective will give insights on the internal characteristics of the occupational communities of managers and physicians. The theory of deprofessionalization of physicians will also be discussed. The structuring perspective will look at the manager-physician relationship as a structure in the organization and will determine the effects of contextual factors (size, task uncertainty, strategy, and environment) on this relationship and the resulting effect on performance and effectiveness of the organization. The culture and control perspective will help detect the cultural differences between managers and physicians and how these interact to affect control over the decision-making areas in the hospital. The power, conflict, and dialectics perspective will shed the light on the conflicting interests of managers and physicians and how these shape the "power game" in the organization. Consequently, a theoretical model of manager-physician relationships that encompasses all these perspectives is developed.

Cooperative Behavior↗
PubMed1993

Compliance perceived by Dutch periodontists and hygienists.

Compliance is defined here as the extent to which a patient's behavior is in accordance with the health advice he has received. On the basis of factors which could affect compliance, a quantitative survey was conducted for a group of 38 periodontists and their senior dental hygienists. The opinions of periodontists and hygienists in perceiving compliance were examined. Although there was agreement between periodontists and hygienists on some well-established aspects of compliance, the survey revealed that the rôle of the hygienist is of considerable consequence: hygienists appear to be more patient-oriented than periodontists. Furthermore, it is stated that poor understanding of recommendations by patients needs more attention.

Attitude of Health Personnel↗
PubMed1998

The role of unrecognized ambivalence: the mirroring of family conflicts within the professional and legal network.

This paper raises some questions about the deleterious effects of unrecognized (unconscious) ambivalence running through child care systems, the Children Act and the adversarial legal system. It is postulated that unrecognized ambivalence may become one of the powerful unconscious dynamics contributing to the mirroring of the family conflicts within the professional network. A detailed clinical example, in which we acted as expert witnesses within a child psychiatry hospital team, is used to illustrate how the denial of ambivalence in a highly complex case, that of a large family involved in care proceedings, led to a state of polarization between the family and a team of professionals which was replicated and amplified within the wider welfare and legal system. It is our view that a state of polarization is likely to produce 'all or nothing decisions' which may not be in the best interest of both children and parents. It is argued that the adversarial nature of the legal process and some underlying assumptions in the Children Act, may contribute to ambivalence being unrecognized. Then it is suggested that ambivalence is inevitable both for professionals and families, particularly in highly complex cases, but with its recognition, a resolution may take place. The conclusions contain some suggestions to promote this process.

Adult↗
PubMed2003

Joint consultation of general practitioner and rheumatologist: does it matter?

OBJECTIVE: To assess the effects of joint consultation on referral behaviour of general practitioners (GPs) in a prospective cohort study. METHODS: All patients with rheumatological complaints that 17 participating GPs, from the area of the University Hospital Maastricht, wanted to refer during a two year inclusion period (n=166) were eligible for inclusion. These patients were either referred to the outpatient clinic, or presented at a joint consultation held every six weeks at the practice of the GP, where groups of three GPs presented their patients to a visiting, consulting rheumatologist. The number of patients referred by each GP a year at the end of the trial, comparing participating and non-participating GPs, was the main outcome measure. RESULTS: During two years of inclusion, the 17 participating GPs presented 166 patients. The number of patients referred by each GP a year decreased for the participating GPs by 62% at the end of the whole study. By contrast, non-participating GPs maintained the same rate of referral. The range of diagnoses remained proportionally the same throughout the study, with the exception of fibromyalgia. The referral rate of this diagnosis decreased significantly (p=0.001). CONCLUSIONS: Joint consultation seems to be a good strategy in influencing the referral behaviour of GPs in the area of rheumatology. The decrease in referral is substantial and can subsequently lead to a reduction of waiting lists.

Adult↗