No description available.

No description available.

There is a paucity of research about the uptake and utilisation of antenatal care by pregnant adolescents in New Zealand. Media coverage, public perceptions and societal values often presume that adolescents when compared to other women, generally initiate antenatal care if at all and have adverse outcomes related to pregnancy, such as low birth weight and preterm deliveries compared to other woman. This research aims to assess the variations that may exist in the utilisation of and outcomes from antenatal care maternity services for adolescents compared to the pregnant adult population in Christchurch, between 1st July 2004 and the 30th June 2005.

No description available.

Thesis (Ph.D.) - University of Queensland, 2003. / Includes bibliography.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1969. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

This thesis explores the way General Practice trainees and early career General Practitioners describe their training environment in General Practice, the meaning they attach to the notion of preparedness and their perceptions of the impact of the training environment on their preparedness. The study was informed by the interpretivist paradigm. I conducted 27 in-depth semi-structured interviews with 15 early career General Practitioners and 12 General Practice trainees at the end of their training. Interview data were transcribed and analysed thematically, drawing partially on the grounded theory approach of data analysis. Interviewees described their training environment in terms of their sense of being included in the Practice, the Practice ethos, the importance of training within the Practice, the trainer and their relationship with the trainer. There was no unanimous way in which interviewees talked about preparedness, however the meanings attributed to preparedness centred around two central elements ‘confidence’ and ‘adaptability’ and included: working independently and being self directed; knowledge of business and partnership issues; ability to manage patients and workload; good consultation skills and effective time management; and adequate knowledge and passing the RCGP CSA examination. The way the training Practice can impact on trainees’ preparedness was explained drawing on Bandura’s theory of ‘self efficacy’ and Lave and Wenger’s theory of ‘situated learning’. Inclusive training Practices, characterised by less hierarchical relationships between the doctors, particularly vis-à-vis trainees, were better at preparing trainees for their future role by affording them greater opportunities to take part in a wider range of General Practice work. The role of the trainer was also pivotal in preparing trainees through effective teaching. Supervision tailored to trainees’ needs, and guided decision making enhanced confidence of trainees in their ability to work independently.

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Patient feedback about practitioners’ and practices’ care is commonly used in UK general practice, sometimes by practitioner choice but often embedded in quality assurance and quality improvement programmes. Significant resources in NHS Scotland are spent gathering and reporting on patients’ reported experiences of care using a national GP patient experience survey – Better Together. There is however limited reference in current health policies to strong evidence demonstrating that this is an effective strategy to stimulate improvements in practice and patients’ experiences of care. This research study used realist review of existing literature to understand the impact of patient feedback at practice and practitioner level on patients’ experiences of general practice care, and realist evaluation of three general practices to understand how patient feedback is viewed and used for quality improvement in everyday general practice. Findings from the realist review indicate that there is little or no evidence that practice or practitioner level patient feedback leads to improvements in patients’ experiences of general practice care. The realist evaluation demonstrated great variance in how practice teams gather and respond to patient feedback and significant concerns about the validity of the Better Together survey. Variance in the strategies used to gather feedback and responses to it were predominantly influenced by collective staff beliefs about the quality of service they provided, their estimates of patients’ views of the service and their perceptions of patients’ preferences for providing feedback. While GPs mostly perceived that patients would be likely to tell someone in the practice when dissatisfied, interviews with patients indicated they had little understanding of how they could give feedback and an overall preference for doing this anonymously. One practice team was seen to initiate significant changes aimed at improving patients’ experiences but their ability to demonstrate improvements in experience were limited by changes in their workforce, conflicting externally set targets and methodological limitations of current patient experience measures. Further research is needed to understand how the findings from this study apply to general practice across Scotland and how practices can be best supported to use patient feedback to improve services.

Prescribing accounts for 11% of the total NHS budget. In the UK, there is an aging population who receive nearly half of all prescriptions, with the increasing age of the population, the prevalence of long-term conditions, cost and complexity of prescribing is likely to rise. Prescribing is influenced by numerous factors such as new drugs; aging populations; polypharmacy; and increased concern about adverse reactions. Although numerous initiatives are targeted at general practitioners to encourage application of research evidence the significant variation in prescribing quality and cost is difficult to explain. Previous studies have explored the influences of type of drug, focused clinical area, guidelines and the doctor/patient relationship. No study was found which has explored the details of the prescribing process using the ethnographic approach. This ethnographic study of three different general practices, involved participant observation, documentary review and semi-structured interviews. Analysis was an iterative process conducted in Atlas.ti by borrowing on grounded theory techniques and interpretative description. Practices were selected using prescribing quality indicators developed by Audit Scotland via PRISMS (Prescribing Information System for Scotland), which collects prescribing data for all practices in Scotland. Two practices which were ranked highly and one practice which was ranked low were observed. Practices made two different kinds of prescribing decision; macro and micro. Macro prescribing decisions are strategic, influenced by EBM and practice data, and consider the „average patient?. Micro prescribing decisions are made with an individual patient, considering their unique biology, context and perspectives. Practice pharmacists were instrumental in leading prescribing quality improvement in the larger practices and had an important role interpreting practice level data in light of the changing evidence. In the high ranking practices these changes were formulated into macro prescribing policy to rationalise and standardise their prescribing. The lower ranking practice suggested practices had to value collective decision-making and consistency in their prescribing behaviour to formulate a macro prescribing policy. Consistency in prescribing behaviour was facilitated by effective communication, which was important for shared values and practice identity. Practice identity influenced practice values, communication and organisation thus had a direct impact on their macro prescribing policy formulation and implementation. GPs used mindlines when making prescribing decisions at the micro prescribing level. GPs did not refer to explicit sources when seeking information but used personal prescribing formularies. These mindlines were iteratively developed from social networks with colleagues, secondary care and patient specific information from the practice pharmacist and from past experience. Through effective communication with colleagues these mindlines were shared.In conclusion, practices made two different kinds of prescribing decision; macro and micro. Both types of prescribing were dependent on effective communication channels, organisation, values and practice identity, illustrating the importance of communication for shared values, collective behaviour and prescribing decision-making.