L’aumento dei costi in sanità, l’aumentata prevalenza delle patologie croniche, le disuguaglianze attuali, evidenziano la domanda crescente di una popolazione fragile che richiede una risposta globale ai bisogni della persona nel suo insieme, attraverso la costruzione di un sistema sanitario integrato che ne garantisca una presa in carico efficace. Riuscire a gestire le patologie croniche in modo appropriato è la sfida a cui sono chiamati i professionisti socio-sanitari; ma quali sono gli elementi per riuscirci? Le evidenze scientifiche dimostrano che è fondamentale l’integrazione tra i professionisti e lo sviluppo dei Percorsi Diagnostici Terapeutici Assistenziali (PDTA). In quest’ottica, in Italia e in particolare in Emilia-Romagna e nell’Azienda USL di Bologna si sono succeduti, e ancora si stanno evolvendo, diversi modelli di organizzazione per migliorare la gestione appropriata delle patologie croniche e l’aderenza alle linee guida e/o ai PDTA. Il ruolo del medico di medicina generale (MMG) è ancora fondamentale e il suo contributo integrato a quello degli gli altri professionisti coinvolti sono imprescindibili per una buona gestione e presa in carico del paziente cronico. Per questo motivo, l’Azienda USL di Bologna ha sviluppato e implementato una politica strategica aziendale volta a disegnare i PDTA e incoraggiato la medicina generale a lavorare sempre di più in gruppo, rispetto al modello del singolo medico. Lo studio ha individuato nelle malattie cardiovascolari, che rimangono la causa principale di morte e morbilità, il suo focus prendendo in esame, in particolare,lo scompenso cardiaco e il post-IMA. L’obiettivo è verificare se e quanto il modello organizzativo, le caratteristiche del medico e del paziente influiscono sul buon management delle patologie croniche in esame valutando la buona adesione alla terapia farmacologica raccomandata dalle linee guida e/o PDTA dello scompenso cardiaco e post-IMA. / The rising health care costs, the increasing prevalence of chronic conditions, the existing inequalities in access to care highlight the growing demand for a response to the needs of a fragile population, through the construction of an integrated health system that could ensure an effective provision of care. Managing chronic diseases appropriately is a challenge for health care professionals, but which are the key elements to achieve it? Scientific evidence indicates that the integration between professionals and the development of Integrated Care Pathways are fundamental. In Italy and especially in Emilia Romagna and in Local Health Authority of Bologna, different models of organization have been implemented and are still evolving to improve the management of chronic diseases, the appropriateness and adherence to guidelines and/or pathways. The role of the general practitioner is still vital and his/her contribution together with that of other health care professionals are essential for the appropriate treatment of chronic diseases. . For this reason, the Local Health Authority of Bologna has pursued a policy aimed at developing integrated care pathways and encouraged general practitioners to work together rather than running individual practices. The study has chosen cardiovascular diseases, and specifically heart failure and acute myocardial infarction, as its focus because these diseases are the leading cause of death and morbidity. The goal is to determine if and how the organizational models, the characteristics of the physician and of the patient are associated with the good management of chronic cardiovascular diseases and whether the different collaborative organizational models of general practitioners are also associated with adherence to the pharmacological treatments recommended by the guidelines and/or the integrated care pathways for heart failure and acute myocardial infarction.

Abstract The aim of this dissertation is to analyse the process of change in management accounting in public-sector health care. The change is examined through the implementation of a nationally homogeneous Diagnosis Related Grouping (DRG) system. The DRG system is used to classify health-care diagnoses into groups for service productisation and pricing. The system has been proposed as a solution for cost accounting and budgeting. The practical motivation of the dissertation is to analyse the embedding of change in organisations´ practises. The theoretical motivation of the dissertation is to extend the investigation of change by analysing the process of implementation of a nationally homogeneous system. The research data comprise 39 interviews conducted between 2006 and 2011 with hospital district representatives, the representatives of the company managing the DRG system, the DRG system supplier, and the representatives of the National Institute for Health and Welfare and the Association of Finnish Local and Regional Authorities. In addition to interviews, the data consists of participative observations, telephone inquiries, and newspaper articles. This dissertation consists of four essays that analyse the data through the lens of two theories: the Actor Network (ANT) and Institutional theory (NIS). The results indicate how the use of multiple theories (ANT ja NIS) as a methodology enriches and extends the insight into the change process in management accounting. For instance, the analysis of the homogeneous use of the DRG system, without investigating the practices of actors by making use of the ANT, the results could have been different in this respect. Especially, this dissertation indicates how important it is that actors’ actions are also examined in the processes of change in the implementation of public-sector management accounting systems. The idea for the DRG system was introduced to Finland almost twenty years ago. However, the results indicate that it has spread very slowly. According to earlier research, an institutional environment is considered to exercise pressure on organisations in order to make them adopt new practices that are homogeneous with other institutional practices. There is indirect pressure in decentralised health care in Finland, though its power for change is weak. This dissertation shows how the decentralisation of responsibilities in large-scale institutions, such as the health-care system in Finland, also slows down and decentralises reforms. As institutional power becomes weaker, the power of organisations to promote things seems to grow stronger, however. / Tiivistelmä Tämän väitöskirjatyön tarkoituksena on analysoida johdon laskentatoimen muutosprosessia julkisen sektorin terveydenhoidossa. Muutosta tarkastellaan kansallisesti yhtenäisen diagnoosiperustaisen ryhmittelyjärjestelmän (Diagnosis Related Grouping, DRG) käyttöönottoprosessin kautta. DRG on järjestelmä, jossa luokitellaan terveydenhoidon diagnoosit ryhmiin palvelujen tuotteistusta ja hinnoittelua varten. Järjestelmää on esitetty ratkaisuna kustannuslaskentaan ja budjetointiin. Väitöskirjatyön käytännön motivaationa on analysoida muutoksen asettumista organisaatioiden käytäntöihin. Väitöskirjatyön teoreettisena motivaationa on laajentaa muutostutkimusta tarkastelemalla kansallisesti yhtenäisen järjestelmän käyttöönottoa. Tutkimuksen aineisto koostuu 39 haastattelusta, joita on kerätty vuosien 2006 ja 2011 välillä. Tutkimuksessa on haastateltu sairaanhoitopiirien henkilökuntaa, DRG-järjestelmän hallinnoiman yhtiön edustajia, järjestelmän toimittajaa, Terveyden ja hyvinvoinnin laitoksen sekä Kuntaliiton edustajia. Aineisto sisältää haastattelujen lisäksi osallistuvaa havainnointia, puhelinkyselyjä sekä lehtiartikkeleita. Tämä väitöskirjatyö koostuu neljästä esseestä, joissa analysoidaan aineistoa kahden eri teorian, toimijaverkostoteorian (ANT) ja institutionaalisen teorian (NIS), avulla. Tulokset tuovat esille, kuinka kahden teorian (ANT ja NIS) metodologinen käyttö rikastuttaa ja laajentaa näkemystä johdon laskentatoimen muutosprosessista. Esimerkiksi analysoitaessa DRG-järjestelmän yhtenäistä käyttöä tutkimatta toimijoiden toimintaa toimijaverkostoteoriaa hyödyntäen, tulokset voisivat tältä osin olla erilaiset. Erityisesti tämä väitöskirjatyö osoittaa, kuinka tärkeää julkisen sektorin johdon laskentajärjestelmien käyttöönoton muutosprosessia tutkittaessa on tutkia myös toimijoiden toimintaa. Idea DRG-järjestelmästä esitettiin Suomessa melkein kaksikymmentä vuotta sitten. Tulokset osoittavat kuitenkin, että sen leviäminen on ollut hyvin hidasta. Aikaisempien tutkimusten mukaan institutionaalisen ympäristön katsotaan painostavan organisaatioita, jotta ne ottaisivat käyttöön uusia menetelmiä, jotka ovat yhdenmukaiset muiden institutionaalisten käytänteiden kanssa. Suomen hajautetussa terveydenhoidossa esitetään epäsuoraa painetta, mutta sen voima muutokseen ei ole vahva. Väitöskirjatyö tuo esille miten suurien instituutioiden, kuten Suomen terveydenhoidon, vastuun hajautuessa myös reformit hidastuvat ja hajautuvat. Institutionaalisten voimien heikentyessä organisaatioiden voima ajaa asioita näyttää kuitenkin vahvistuvan.

Thesis (PhD)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: The South African primary health care (PHC)system is in a period of transition. This, and the growing HIV epidemic, place tremendous strain on PHCworkers in public health services. Staff morale is low and this results in turnover and poor quality of care. Therefore, staff need to be supported, so that they are better equipped to provide quality care for patients. This dissertation describes a process of action research that aimed to explore possibilities for staff-support interventions to health teams in the public PHCsector. Data were collected through in-depth interviews, group interviews, focus group discussions and consultation sessions, with health staff and middle managers. Data were analysed using a grounded theory approach, with the assistance of the Atlas.ti 4.1 software package.The interpretation of data was informed by psychoanalytic and open systems theories. Four cycles of action research were conducted. The first action stage involved a qualitative assessment of the nature of stressors in the PHC system. The second action stage describes the experiences of two staff teams from a health prevention clinic and a day hospital (curative service) as they prepared to merge and integrate aspects of service delivery. In the third action stage the research team explored the feasibility of a short programme aimed at building capacity amongst middle and facility level managers to act as containers for staff stresses. However, due to external factors the programme was not completed. The final action stage describes interviews with selected participants to reflect on the effects of the current action research process on them and their work. The current research suggests that a psychodynamic approach may be a useful component of action research in health settings. This approach makes room for interpretation of unconscious processes in the stress experiences of health workers, and has the potential to move health staff and management to alternative modes of functioning and coping. / AFRIKAANSE OPSOMMING: Primêre gesondheidsdienste in Suid Afrika is tans in 'n proses van transisie. Die toenemende druk wat die VIGS-epidemie op gesondheidsdienste plaas, maak dit eweneens moeilik vir gesondheidswerkersom aan te pas by 'n gedurig-veranderende stelsel. Dit bring mee dat moraal laag is, baie werkers die publieke sektor verlaat en gehalte van dienslewering verswak. Hierdie situasie noodsaak dat programme ontwikkel moet word om gesondheidswerkerste ondersteun in hul werk, sodat hulle beter toegerus is om kwaliteit sorg aan pasiënte te verleen. Hierdie proefskrif beskryf aksienavorsing wat gedoen is met die doelom ondersteuningsprogramme vir gesondheidswerkers en hulpwerkers in openbare primêre gesondheidsdienste te ontwikkel. Individuele en in-groepsverband in-diepte onderhoude, asook fokusgroepbesprekings en konsultasies met gesondheidswerkers en middelvlak-bestuurders is gevoer om data in te samel. Data-ontleding was gedoen volgens die gegronde teorie aanslag en die Atlas.ti 4.1 sagteware pakket Is vir hierdie doel gebruik. Teorieë van psigoanalise en oop stelsels is deurgans geraadpleeg met die interpretasie van bevindinge. Die navorsingsproses bestaan uit vier siklusse van aksienavorsing. In die eerste navorsingsiklus is ~ie aard van stress in the publieke primêre gesondheidstelsel ondersoek. Die tweede siklus behels 'n beskrywing van die ervaringe van twee personeelgroepe soos hulle gereed gemaak het om aspekte van hulonderskeie dienslewering te integreer met die oprigting van 'n gemeenskaplike gesondheidsentrum. Die derde siklus beskryf die implementering van 'n kort program wat gerig is daarop om middel-vlak en diens-bestuurdersvaardighede aan te leer om personeel beter te ondersteun. Eksterne invloede het meegebring dat hierdie opleidingsprogram nie ten volle uitgevoer kon word nie. In die finale siklus is onderhoude met geselekteerde deelnemers gevoer om te bepaal hoe deelname aan die aksienavorsingsproses hulle in hul persoonlike hoedanigheid asook In die uitvoering van hul pligte beïnvloed het. Die huidige navorsing stel voor dat die psigodinamiese benadering 'n gepaste komponent van aksienavorsing in publieke gesondheidsomgewingskan wees, omdat hierdie benadering Insig kan verleen tot die onbewuste prosesse wat gesondheidswerkersse belewenis van stres beïnvloed, en verder ook die potensiaal het om gesondheidswerkers en bestuurders tot alternatiewe funksionering en hantering van stres te motiveer.

Thesis (MA)--Stellenbosch University, 2010. / ENGLISH ABSTRACT: Hypertensive disorders are one of the leading causes of maternal morbidity and mortality in South Africa. The morbidity and mortality rate can be decreased by early detection and management of hypertensive disorders at primary health care Level. The midwives should therefore be knowledgeable and competent in the assessment and diagnosis of pregnant women who are at risk of developing a hypertensive disorder, and be able to manage the problem. The purpose of the study was to investigate scientifically the knowledge of the registered midwives managing hypertensive disorders in pregnancy working at primary health care level in the Eastern Cape. The objectives set for the study were to investigate the knowledge of the registered midwives in the following areas: • Knowledge about hypertensive disorders • Assessment • Diagnosis • Management A descriptive correlational research design was applied with a quantitative approach to investigate scientifically the knowledge of the registered midwives managing hypertensive disorders in pregnancy. The target population included all the registered midwives working permanently in primary health care clinics in the Buffalo City Local Service Area. A stratified random sample of n=43 (44%) of a population of N=98 clinics both in rural and urban were selected together with a sample of n=101(44%) of N=228 registered midwives working in these clinics. A questionnaire consisting of predominantly closed questions was used for the collection of data, collected personally by the researcher. Ethical approval was obtained from Stellenbosch University, Department of Health and individual informed consent. A pilot study, which did not form part of the study, was conducted to test the questionnaire at the clinics. A 10% (n=10) sample of the registered midwives of 4 clinics participated in the pilot study. The validity and reliability was assured through the pilot study, the use of a statistician, as well as experts in midwifery, nursing and a research methodologist. The data was analysed and presented in tables and histograms. Statistical correlational tests were done to determine any correlations between the variables. Findings obtained show that inadequate knowledge exists among participants with specific reference to knowledge, assessment, diagnosis and management about hypertensive disorders. A statistical correlation was shown between the presence of doctors and the knowledge of the midwives using the Mann-Whitney statistical test (p=0.04). In clinics where there are no doctors’ visits, the knowledge of the staff was higher (0.691), than the total knowledge mean score (0.666). Where doctors are regularly visiting the clinics the mean knowledge score is lower (0.656). These results show that where midwives do not have any additional support as when there are doctors present, individual effort is made to keep up to date as they are practising as independent practitioners. Recommendations are based on the scientific evidence which emphasis further education in advanced midwifery, workshops, conferences, updating their knowledge and weekly in-service training, introduction of a quality assurance and patient education programmes. In conclusion empowering the midwives with the required knowledge about hypertensive disorders will contribute towards decreasing the mortality and morbidity rates. / AFRIKAANSE OPSOMMING: Siektetoestande gekoppel aan hipertensie is een van die vernaamste oorsake van sieklikheid en moedersterftes in Suid-Afrika. Die siektetoestand en sterftekoers kan afneem deur vroeë opsporing en bestuur van hipertensietoestande op primêre gesondheidsorgvlak. Die kraampersoneel behoort dus kundig en bekwaam te wees tydens die assessering en diagnose van swanger vroue wat die risiko loop om ’n toestand van hipertensie te ontwikkel en daartoe in staat te wees om die probleem te kan hanteer. Die doel van die studie is om die kennis van geregistreerde vroedvroue wetenskaplike te ondersoek wat hipertensiewe toestande tydens swangerskap hanteer op Primêre Gesondheidssorgvlak in die Oos-Kaap. Die doelstellings wat uiteengesit is vir die studie, is om die kennis van geregistreerde kraampersoneel in die volgende areas te ondersoek: • Kennis van hipertensiewe toestande • Assessering • Diagnose • Hantering. ’n Beskrywende korrelerende navorsingsontwerp is toegepas met ’n kwantitatiewe benadering om die kennis van die geregistreerde kraampersoneel wat hipertensiewe versteurings in swangerskappe hanteer, wetenskaplik te ondersoek. Die teikengroep het al die geregistreerde kraampersoneel wat permanent in die primêre gesondheidssorgklinieke in die Buffalo City Plaaslike Diensarea werk, ingesluit. ’n Gestratifieerde ewekansige steekproef van n=43 (44%) gekies uit ’n gesamentlike plattelandse en stedelike bevolking van N=98 klinieke met ’n steekproef van n=101 (44%) van N=228 geregistreerde vroedvroue wat in die klinieke werk. ’n Vraelys wat hoofsaaklik uit geslote vrae bestaan, is gebruik vir die insameling van data wat persoonlik deur die navorser ingesamel is. Etiese toestemming is verkry van die Universiteit Stellenbosch, die Departement van Gesondheid asook individuele ingeligte toestemming. ’n Loodsondersoek is uitgevoer om die vraelys te toets by die klinieke wat nie deel van die studie was nie. ’n 10% (n=10), steekproef van die geregistreerde vroedvroue van 4 klinieke het deelgeneem aan die loodsondersoek. Die geldigheid en betroubaarheid is verseker deur die loodsondersoek, die gebruik van ’n statistikus asook kundiges in kraamverpleging en ’n navorsingsmetodoloog. Die data is geanaliseer en weergegee in tabelle en histogramme, statistiese korrelasietoetse is gedoen om korrelasies te bepaal tussen die veranderlikes. Die bevindings, bewys dat ongenoegsame kennis bestaan by deelnemers met spesifieke verwysing na kennis, assessering, diagnose en hantering ten opsigte van aangaande toestande van hipertensiewe toestande. ’n Statistiese korrelasie is getoon tussen die teenwoordigheid van geneeshere en die kennis van vroedvroue deur gebruik te maak van die Mann-Whitney statistiese toets (p=0.04). In klinieke waar daar geen doktersbesoeke is nie, is die personeelkennis beter (0.691) as die totale gemiddelde kennistelling (0.666). Waar geneeshere gereeld die klinieke besoek, is die gemiddelde kennistelling laer (0.656). Hierdie resultate bewys dat waar die vroedvroue geen bykomende ondersteuning deur die teenwoordigheid van geneeshere het nie, het individuele moeite gedoen om op die hoogte te bly, aangesien hulle as onafhanklike praktisyns optree. Aanbevelings is gebaseer op wetenskaplike bewyse wat verdere onderrig beklemtoon in gevorderde kraamverpleging, werkswinkels, konferensies, die bywerk van kennis en weeklikse indiensopleiding, die instel van ’n kwaliteitsversekering en opvoedingsprogramme vir pasiënte. Ten slotte die bemagtiging van vroedvroue wat oor die vereiste kennis beskik van toestande van hipertensiewe toestande, sal bydra tot die afname van sterfte- en siektesyfers.

Darbo tikslas: Ištirti personalo valdymą Kauno miesto pirminės asmens sveikatos įstaigose. Tyrimo metodika: Tyrimo metu apklausti Kauno miesto pirminės asmens sveikatos priežiūros įstaigų (PASPĮ): viešųjų ir privačių vadovai. Tyrimas buvo atliekamas dviem etapais. Pirmame etape atliktas kokybinis tyrimas. Apklausti 4 atsitiktinai pasirinktų įstaigų (2 viešųjų ir 2 privačių) vadovai. Tyrimas buvo atliekamas interviu metodu, pateikiant iš anksto apgalvotus klausimus. Kokybinio tyrimo tikslas – išsiaiškinti kokios yra personalo valdymo funkcijos PASPĮ. Antrame etape atliktas kiekybinis tyrimas. Iš viso buvo išplatintos 43 anketos visose Kauno miesto pirminės asmens sveikatos priežiūros įstaigose Atgal sugrįžo 41 anketa: 7 iš 9 viešųjų ir 34 iš 34 privačių pirminę asmens sveikatos priežiūrą teikiančių įstaigų. Tai sudaro 95,3% nuo visų išplatintų anketų. Į 35 anketas atsakė patys įstaigų vadovai, o į 6 įstaigų administratoriai. Uždaviniai: 1. Ištirti pirminės asmens sveikatos įstaigos vadovų kompetenciją personalo valdymo srityje. 2. Ištirti ir palyginti kaip atliekamos personalo valdymo funkcijos viešosiose ir privačiose pirminės asmens sveikatos įstaigose. 3. Nustatyti esmines personalo valdymo tendencijas ateityje įstaigų vadovų požiūriu. Rezultatai: Personalo vadovas yra visose 7 viešosiose PASPĮ, o tuo tarpu iš 34 privačių PASPĮ personalo vadovą turi tik 5,9 proc. Savo kompetenciją personalo valdyme aukščiau įvertino viešųjų PASPĮ vadovai. Išvados: 1. Savo kompetenciją... [toliau žr. visą tekstą] / Aim of work: to analyze the management of personnel at Kaunas city primary health care institutions. Methodology of the work: during the research, the heads of both public and private Kaunas city primary personal health care institutions (PPHCI) were polled. The research was made in two stages. In the first stage the qualitative research was made. 4 heads of accidentally chosen institution (2 public and 2 private) were polled. The research was made in the form of interview, given the questions considered in advance. The aim of qualitative research is to find out what are the functions of personnel management at PPHCI. In the second stage a quantitative research is made. There were 43 questionnaires distributed in all Kaunas city primary personal health care institutions. 41 questionnaires were returned: 7 from 9 from public and 34 from 34 from private institutions, providing primary personal health care. It makes 95,3% of all questionnaires that were distributed. 35 questionnaires were answered by the heads of these institutions and 6 by their administrators. Tasks: 1. To analyze the expertise of the heads of primary personal health care institutions in the field of personnel management. 2. To analyze and to compare how the personnel management functions are carried out in public and private primary personal health care institutions. 3. To find out fundamental future tendencies of personnel management from a viewpoint of the heads. Conclusions: 1. The respondents in... [to full text]

Darbo tikslas - įvertinti pacientų motyvaciją renkantis šeimos gydytoją viešojoje ar privačiose pirminės sveikatos priežiūros įstaigose Jonavos mieste. Uždaviniai: 1. Nustatyti motyvacinius veiksnius, sąlygojančius pacientų pasirinkimą gydytis pas šeimos gydytoją. 2. Palyginti pacientų motyvacinius veiksnius renkantis šeimos gydytoją viešojoje ar privačiose PSP įstaigose. 3. Pateikti pasiūlymus PSP įstaigoms, pacientų motyvacijai gerinti. Tyrimo metodika. Tyrimas atliktas 2007 metų birželio mėn. naudota anketinė, anoniminė Jonavos viešojoje PSP ir privačiose įstaigoje besilankančių pacientų apklausa (n=400). Atsakas viešojoje PSPĮ – 80 proc., o privačiose PSP įstaigose – 84 proc. Tyrimo duomenų statistinė analizė atlikta naudojant MS Excel'XP bei SPSS 12.0 statistinių duomenų analizės paketą. Ryšiai tarp požymių vertinti pagal 2 kriterijų. Rezultatai. Respondentai svarbiausiais motyvaciniais privalumais, pasirenkant gydymo įstaigą ir šeimos gydytoją, laikė gerą paslaugų kokybę, nuoširdų bendravimą ir patogią įstaigos vietą. Nustatyta, kad Jonavos privačiose gydymo įstaigose lankosi pacientai (64 proc.), kurių sveikata yra gera, o VšĮ Jonavos PSPC – vidutinės sveikatos tiriamieji (42 proc.). Privačias gydymo įstaigas renkasi 49 proc. tiriamųjų, todėl, kad yra girdėję gerus atsiliepimus apie ten dirbančius gydytojus, o respondentai VŠĮ Jonavos PSPC gydymo įstaigą renkasi dėl to, kad ten tradiciškai lankosi visa šeima. Daugiausia, t.y. 60 proc. VšĮ Jonavos PSPC pasirinkusių... [toliau žr. visą tekstą] / Aim of study. To asses patients motivation in choosing primary health care doctor in public or private primary health care institutions in Jonava city. Objectives. 1. To assess factors of patients motivation, determining the choice of the doctor 2. To compare the factors of patients motivation in choosing the doctor in public or private health care institutions 3. To develop proposals for primary health care institutions for improvement of patients motivations. Methods. The study was carried out in June, 2007. 400 patients of public and private health care institutions of Jonava were involved in the survey. Response rate in public health care institution was 80% and in private health care institutions - 84 %. Statistical analysis was carried out using statistical package for social sciences - SPSS 12.0 for Windows. Associations between the variables were assessed by Chi square test. Results. The respondents considered good quality of services, sincere interaction and a convenient location of an institution as the main motivating advantages in choosing primary health institution and family doctor. It has been determined that patients of Jonava city who considered their health as good (64%) visit private health institutions, and Public Institutions Jonava primary health care center – who considered (42%) their health as normal visit public health institutions. 49% of the respondents chose private health institutions because they have heard good responses on doctors work there... [to full text]

Darbo tikslas. Ištirti pacientų požiūrį į pirminės sveikatos priežiūros įstaigose (PSPĮ) teikiamas paslaugas. Uždaviniai: 1. Ištirti privačios ir viešosios PSPĮ pacientų požiūrį į teikiamas paslaugas. 2. Palyginti privačios ir viešosios PSPĮ pacientų nuomonę apie gydytojo teikiamą informaciją susijusią su ligos diagnoze ir gydymu. 3. Palyginti privačios ir viešosios PSPĮ pacientų požiūrį į teikiamas paslaugas. Tyrimo metodika. Viešosios ir privačios pirminės sveikatos priežiūros įstaigų pacientų anoniminė anketinė apklausa, kurios metu išdalinta 800 anketų (350 privačioje ir 450 viešojoje gydymo įstaigoje). Privačioje gydymo įstaigoje atsako dažnis 92,6 proc., viešojoje – 63,1 proc. Anketiniai duomenys apdoroti ir analizuoti naudojant statistinį duomenų analizės paketą SPSS 13.0. Rezultatai. 94,4 proc. pacientų teigiamai vertina bendrosios praktikos gydytojų darbą. 30,2 proc. pacientų mano, jog šeimos gydytojo konsultacijos laukia per ilgai ir 36,5 proc. mano, jog gydytojo specialisto konsultacijos laukia per ilgai. 39,4 proc. sutinka jog laukimo eilės prie gydytojų kabinetų susidaro dėl prasto darbo organizavimo. 15,1 proc. nuomone, visada sunku gauti siuntimą pas gydytoją specialistą, kartais sunku - 43,9 proc. Viešojoje (68,7 proc.) ir privačioje (64,0 proc.) įstaigoje teigia, jog šeimos gydytojas visada tariasi dėl gydymo galimybių pasirinkimo, tačiau viešosios (6,7 proc.) o privačios (0,3 proc.) įstaigos pacientų teigia, jog gydytojas niekada nesitaria. 53,8 proc... [toliau žr. visą tekstą] / Aim of the work. To examine patients attitude towards services provided in primary health care institutions (PHCI). Objectives: 4. To investigate patients attitude towards services provided in primary health care institutions. 5. To compare patients of private and public primary health care institutions opinion about the information on their diagnosis and cure that doctors provide. 6. To make a comparison of the private and public primary health care institutions to provided services. Research methodology. It was done an anonymous questionnaire survey of public and private primary health care institutions patients, distributed 800 of questionnaires ( 350 in private and 450 in public primary health care institutions). In private health care institution 92,6% of answers were received, in public institution - 63,1%. Data of the questionnaire were processed and analysed using statistical data analysis packet SPSS 13.0. Results. 94,4% of patients positively evaluated the work of family doctors. 30,2% of patients think, that they have to wait too long for family doctors consultations, 36,5% think, that they wait too long for the consultation of specialist. 39,4% agree that they have to wait long because of bad work planning. 15,1% of respondents think that, it is always difficult to get a committal to the specialists, sometimes difficult - 43,9%. 68,7% of public and 64,0% of private institutions respondents says that, family doctor always consults about choosing a cure, but 6... [to full text]

Darbo tikslas – įvertinti pacientų nuomonę ir požiūrį apie atliekamų paslaugų saugą PSP grandyje. Uždaviniai: Išanalizuoti pacientų nuomonę apie atliekamų medicininių paslaugų saugą PSP įstaigoje. Įvertinti paciento požiūrį apie gydymo vaistais saugumą. Išanalizuoti, paciento ir gydytojo tarpusavio pasitikėjimo aspektus, siekiant efektyvaus ir saugaus gydymo. Ištirti pacientų požiūrį į nepageidaujamų įvykių priežastis ir jų registravimo sistemą. Tyrimo metodika. Kiekybinis momentinis tyrimas. Tyrimo laikas: 2013 m. sausio - balandžio mėn. Tyrimo vieta - UAB „Šilainių šeimos sveikatos centras“. Tiriamoji imtis 378 respondentai. Atsako dažnis - 94,5 proc. Rezultatai. Respondentams svarbus sveikatos priežiūros paslaugų prieinamumas ir jų savalaikiškumas (22,49 proc. ir 20,37 proc., atitinkamai). 63,49 proc. pacientų žino, kas yra pacientų sauga, todėl vertina komunikavimą su gydytoju, teiraujasi apie paskirtus vaistus, jų pašalines reakcijas, domisi paskirtu gydymu. 38,89 proc. respondentų nuomonė apie antibiotikų skyrimo pagrįstumą yra teigiama, o juos vartoja pagal gydytojo rekomendacijas. Bendravimo tarp personalo ir paciento analizė, parodė, kad visais analizuotais atvejais tarpusavio bendravimas tarp personalo ir paciento yra vertinamas pakankamai gerai. Jaunesni respondentai žymiai dažniau nei vyresni linkę reikšti savo nuomonę, dažniau teiraujasi apie savo sveikatą, dalyvauja jiems svarbių sprendimų priėmime. Respondentai mano, kad dažniausia... [toliau žr. visą tekstą] / Objective of the work – to assess the patients’ opinion and attitude to the safety in the primary health care. Tasks: To analyze the patients’ opinion about the safety of medical services provided in the primary health care facilities. To evaluate the patient’s attitude to the safety of conservative treatment. To analyze the aspects of mutual trust of doctor and patient in order to achieve effective and safe treatment. To examine the patients’ attitude to the reasons of undesirable events and their registration system. Research methodology. Quantitative survey. Study time: January-April 2013. Place of research – Silainiai Family Health Center Ltd. Analyzed sample – 378 respondents. Response frequency – 94,5 percent. Results. The respondents find the accessability and timeliness of the health care services important (22,49 percent and 20,37 percent accordingly). 63,49 percent of the patients are familiar with the safety of patients, thus they appreciate communication with the doctor, inquire about the prescribed medicine, their side effects, and show interest in the prescribed treatment. 38,89 –percent of respondents think that prescription of antibiotics is reasonable and they use antibiotics according to the recommendations of the doctor. The analysis of the communication of the patient and the doctor revealed that in all the analyzed cases the interrelations between the staff and the patient are evaluated quite well. The younger respondents tend to... [to full text]

Tyrimo tikslas – ištirti gydytojų ir slaugytojų paslaugų kokybės vertinimą pirminės sveikatos priežiūros centruose. Tyrimo uždaviniai: 1. Įvertinti sveikatos priežiūros paslaugų techninę ir funkcinę kokybę pirminės sveikatos priežiūros centruose gydytojų ir slaugytojų požiūriu. 2. Išanalizuoti gydytojų ir slaugytojų išorinio teikiamų paslaugų efektyvumo vertinimą. 3. Ištirti, koks yra gydytojų ir slaugytojų požiūris į pacientų pasitenkinimą pirminės sveikatos priežiūros paslaugų kokybe. 4. Palyginti gydytojų ir slaugytojų pirminės sveikatos priežiūros darbuotojų kompetencijos vertinimą. Tyrimo metodika. Tyrimas buvo atliktas 5 Kauno PSPC 2012 metų gruodžio-2013 metų vasario mėn. Tyrime dalyvavo 113 gydytojų ir 137 slaugytojos. Klausimynas sudarytas remiantis Ferguson ir kt. Gautas bioetikos leidimas vykdyti tyrimą. Rezultatai. Gydytojai ir slaugytojai visus techninės ir funkcinės paslaugų kokybės aspektus įvertino teigiamai, t.y. palankiai. Techninės ir funkcinės kokybės vertinimas priklausomai nuo gydytojų bei slaugytojų darbo stažo taip pat buvo teigiamas. Vertinant techninę paslaugų kokybę dėl dviejų teiginių buvo suabejota – 35,4 proc. gydytojų ir 31,4 proc. slaugytojų teigė, kad nei sutinka, nei nesutinka su teiginiu, kad patalpos, skirtos gydymui, yra aukščiausio lygio ir 36,3 proc. gydytojų bei 39,2 proc. slaugytojų teigė, kad nei sutinka, nei nesutinka su teiginiu, kad įranga, reikalinga tyrimams ir gydymui, yra aukščiausio lygio. Vertinant funkcinę paslaugų kokybę... [toliau žr. visą tekstą] / The aim of this study – to investigate of doctors and nurses services quality evaluation in primary health care system centers. Objectives: 1. To evaluate technical and functional quality of services by attitude of primary health care system centers doctors and nurses. 2. To analyze evaluation of doctors and nurses external services effectiveness evaluation. 3. To investigate doctors and nurses attitude to quality of patients satisfaction primary health care. 4. To compare doctors and nurses primary health care employer’s competition evaluation. Method’s. Research was held in five Kaunas primary health centers in Dec 2012 - February 2013. Questionnaire was made according to Ferguson etc. (1999) questionnaire about primary health care quality evaluation. Results. There were participating 113 doctors and 137 nurses in this research. Doctors and nurses all the technical and functional aspects of service quality review were assessed as positive, both by doctors and nurses. Technical and functional assessment of the quality depends on the doctors and nurses work experience has also been positive. The technical quality of the two statements has been questioned - 35.4 percent. physicians and 31.4 percent nurses said that neither agree nor disagree with the statement that the premises for treatment, is the highest level and 36.3 percent doctors and 39.2 percent nurses said that neither agree nor disagree with the statement that the equipment is necessary for research and treatment of... [to full text]

Text in English with summaries in English, Afrikaans and Zulu / Bibliography: leaves 102-115 / The study investigated the management of medical records in the Primary Health Care services (PHCs) of Diepsloot. The study investigated the regulatory framework, records infrastructure, records security, records management staff skills and the filing system. A qualitative design guided by the interpretive paradigm was used to guide the case study. Interviews, focus groups, and observations generated data from 50 participants. The study revealed that the regulatory instruments used to manage records lack implementation and compliance. There was a lack of security measures, a shortage of records management infrastructure and inconsistency in the filing system. There is a low level of skill in the records management staff. The study recommended the implementation of a regulatory policy that will guide and ensure effective governance of records in PHCs. Records should be secure from misuse by unscrupulous individuals. PHC records need to be managed by experienced professionals. The filing system should be easily accessible. / Die studie het ondersoek ingestel na die bestuur van mediese rekords in die Primêre Gesondheidsorgdienste (PHC's) van Diepsloot. Die studie het ondersoek ingestel na die regulatoriese raamwerk, rekord van infrastruktuur, rekord sekuriteit, vaardighede vir rekordbestuur en die liasseerstelsel. 'n Kwalitatiewe ontwerp gelei deur die interpretatiewe paradigma is gebruik om die gevallestudie te lei. Onderhoude, fokusgroepe en waarnemings het gegewens van 50 deelnemers gegenereer. Die regulatoriese instrumente wat gebruik word om rekords te bestuur, het geen implementering en nakoming nie. Die studie het aan die lig gebring dat daar 'n gebrek aan veiligheidsmaatreëls was, 'n tekort aan infrastruktuur vir rekordbestuur en teenstrydigheid in die liasseringstelsel. Die personeel in rekordbestuur het 'n lae vlak van vaardigheid. Die studie het die implementering van 'n regulatoriese beleid aanbeveel wat die doeltreffende bestuur van rekords in PHC's sal lei en verseker. Rekords moet beskerm word teen misbruik deur gewetenlose individue. PHC-rekords moet deur ervare professionele persone uitgevoer word. Die liasseerstelsel moet maklik toeganklik wees. / Lolu cwaningo luphenywe ngokuphathwa kwamarekhodi ezokwelashwa emnyangweni Wezokunakekelwa kwempilo okuyisisekelo (i-PHCs) eDiepsloot. Ucwaningo luphenywe ngohlaka lokulawula, ingqalasizinda yamarekhodi, ukuphepha kwamarekhodi, amakhono okuphathwa kwamarekhodi nohlelo lokufayila. Umklamo olungaqanjwa uqondiswa yi-paradigm yokutolika wasetshenziselwa ukuqondisa ucwaningo lwesigameko. Izingxoxo, amaqembu okugxila kanye nokubukwa kukhiqize idatha evela kubahlanganyeli abangu 50. Izinsizakusebenza zokulawula ezisetshenziselwa ukuphatha amarekhodi zingenakho ukusebenza nokuhambisana. Ucwaningo luveze ukuthi bekukhona ukuntuleka kwezindlela zokuphepha, ukushoda kwengqalasizinda yokuphathwa kwamarekhodi kanye nokungahambelani ohlelweni lokugcwalisa. Kunezinga eliphansi lekhono kubasebenzi bokuphathwa kwamarekhodi. Ucwaningo lincome ukusetshenziswa kwenqubomgomo yokulawula ezohola futhi iqinisekise ukuphathwa kwamarekhodi kuma-PHCs ngendlela efanele. Amarekhodi kufanele avikeleke ekusetshenzisweni kabi ngabantu abangathembekile. Amarekhodi we-PHC adinga ukuqhutshwa ngochwepheshe abanolwazi. Uhlelo lokufayila kufanele lutholakale kalula. / Information Science / M. Inf.