Mit der vorliegenden Arbeit sollte untersucht werden, ob die Selbstausfüller-Version des STEP (Standardised assessment of elderly people in primary care in Europe) praktikabel und verständlich ist, ob sie von Patienten und Ärzten akzeptiert wird und ob sie nützlich ist, bisher unbekannte gesundheitliche Probleme der Patienten zu entdecken. 1007 von 1540 Patienten über 65 Jahren, die in 28 sächsische Hausarzt-praxen kamen, beantworteten die Selbstausfüller-Version des STEP. Ermittelt wurde, dass 95,8% der teilnehmenden Patienten den Fragebogen ohne Hilfe ausfüllen konnten. Die durchschnittliche Zeit zum Beantworten des Fragebogens nahm, abhängig vom Alter der Patienten, von 17 bis 25 Minuten zu. Vierzehn der 75 Fragen der Selbstausfüller-Version wurden von mehr als 9% der Patienten nicht beantwortet. Die Patienten gaben bei acht der 14 häufig nicht beantworteten Fragen Verständnisprobleme an. Bei einer Stichprobe von 257 zufällig ausgewählten Patienten wurden 281 gesundheitliche Probleme (1,1 pro Patient) entdeckt, die den Hausärzten noch nicht bekannt gewesen waren. Die Hausärzte gaben an, dass 16,4% dieser neuen Probleme eine Konsequenz hatten, vordergründig die physischen Probleme. Bemerkenswert war, dass die neu entdeckten psycho-sozialen Probleme keinerlei Konsequenzen hatten. Die Selbstausfüller-Version war praktikabel, nützlich und wurde von den meisten Patienten gut akzeptiert. Einige Fragen sollten hinsichtlich der Verständlichkeit überprüft werden. Weitere Studien müssen zeigen, warum einige neu entdeckte Probleme keine Konsequenzen hatten, ob diese Probleme gebessert werden können und ob es nötig ist, diese Probleme zu ermitteln. / The study was designed to evaluate the acceptance of the self-rated version of the Standardized Assessment of Elderly People in primary care in Europe (STEP) by patients and general practitioners, as well as the feasibility, comprehensibility, and usefulness in gaining new information. In all, 1007 of 1540 patients aged 65 and above, from 28 different Saxon general practices took part. We recognized that 96% of the patients were able to fill in the questionnaire by themselves. It took them an average of approximately 20 minutes to do so. Further analysis of 257 randomly selected patients identified 281 previously unknown problems (1.1 per patient). In the practitioners’ opinion, 16% of these problems, particularly physiological and mental ones, could lead to immediate consequences. Remarkably, newly identified psychosocial problems were not followed by any consequences. Fourteen of the 75 questionnaire items were not answered by more than 9% of the participants. Eight of the 14 frequently unanswered items were marked as difficult to understand by the patients. Altogether the self-rating version of the STEP was found to be feasible and useful. It was well accepted among patients; however, some questions need further review to improve their comprehensibility. Furthermore, it should be investigated why some identified problems do not have consequences and whether there is a need to record these issues at all.

Submitted in partial fulfilment of the requirements for the degree of Masters in Business Administration (MBA), Business Studies Unit, Durban University of Technology, 2008 / The pharmaceutical industry is in the midst of a fundamental transformation. Time and cost constraints are forcing marketers to search for new ways to maintain and grow brand awareness. The amount of time that doctors allow for representatives to market their products is becoming less and less and as a result products are not getting the exposure they used to. Organisations that find innovative ways to maintain exposure of their products may gain a competitive advantage over those organisations that rely on traditional marketing methods. The prolific increase in the use of the internet may provide pharmaceutical organisations with a complementary channel to market their products. The objective of this study is to determine the levels of internet technology adoption among general practitioners. The Technology Acceptance Model (TAM) is one of the most influential research models in studies of the determinants of information systems/ information technology (IS/IT) acceptance. In TAM, perceived usefulness and perceived ease of use are hypothesised and empirically supported as fundamental determinants of user acceptance of a given IS/IT. Using TAM, this study sets out to determine general practitioners’ intention to use the internet as a source of pharmaceutical information. The literature review provides an extensive evaluation on the development of TAM and its application in different technologies. Based on these findings, the researcher developed this study to investigate internet technology acceptance in the pharmaceutical industry. Use is made of the descriptive survey method and data is retrieved from a sample of 105 general practitioners in Kwazulu-Natal. The observation is made via the benefit of a questionnaire. The process of sampling is that of convenient sampling. The analysis is quantitative and makes use of statistical analysis appropriate for the data. Analysis of the survey results produces useful insights into the factors influencing internet technology adoption by general practitioners. When analysing the independent variables, respondents were not in strong agreement about the perceived usefulness nor the perceived ease of use of internet technology as a source of pharmaceutical information. However, positive results from the relationships between the independent (perceived usefulness and perceived ease of use) and dependent variables (attitude and intention to use) provide valuable data with which organisations may develop internet-based marketing strategies. Based on the survey findings, recommendations using the Beynon-Davies (2004) Internet Adoption Model are suggested.

<p>Diss. Umeå : Umeå universitet, 1999, Härtill 7 uppsatser.</p> / digitalisering@umu

Over the last seven years the recruitment of overseas trained doctors (OTDs) has formed a significant part of Australia’s policy to address the medical workforce issue of geographic maldistribution to ensure that communities in rural and remote Australia have access to adequate general practice (GP) services. This policy has not been without problems, particularly in the areas of assessment of skills and qualifications, appropriate orientation and integration into Australian communities, and retention of these doctors within rural and remote communities. To date there has been little evidence-based research on the role of OTDs in the medical workforce in Australia. This study explores the service provision and quality of care provided by OTDs using the 5 Year OTD Scheme as the case study. In doing so, it assesses the adequacy of this strategy and discusses the implications for future workforce policies and programs. A mixed method design was used in the study. The quantitative component involved secondary analysis of Medicare Australia data for all OTDs participating in the 5 Year OTD Scheme in 2002 and all Australian trained doctors (ATDs) practising in rural and remote Australia in the same year. A log Poisson regression model was used to assess the interactive effect of the various GP characteristics, such as age, sex, experience and practice location with OTD/ATD status on the rate of a particular service item per patient, adjusted for patient age and sex. The qualitative component involved two focus groups with OTDs which were used to help explain the relationships between variables found in the quantitative component of the study. Template analysis was used to identify themes from the focus group. Significantly different rates per patient between OTDs and ATDS were found across most service items and GP characteristics examined. The greatest variation was found among items relating to in-surgery consultations and non-surgery consultations such as nursing home visits. Fewer differences were found between groups relating to pathology, imaging or procedural services. Analysis of surrogate quality items identified few differences between OTDs and ATDs. The focus group identified a number of other factors that influenced their patterns of service and accounted for some of the differences identified in the quantitative analysis. These factors included knowledge of the health care system in Australia, cultural and communication influences, health conditions of patients, patient and community attitudes, remuneration influences and training influences. These had varying degrees of influence on their patterns of service. The reasons for the differences found between OTDs and ATDs are partially explained by the characteristics of the GPs examined and partially explained by other external influences that relate to the particular circumstances of the OTDs, such as knowledge of the Australian health care system and cultural and communication issues. Understanding the nature of practice is central to ensuring appropriate professional support measures. The study findings highlight the need for a targeted training program for OTDs that address the areas that have the greatest influence on patterns of service to ensure that rural and remote communities receive the same quality of service from OTDs as provided by ATDs. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1320385 / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

This thesis defines the time impact of precepting medical students on rural general practitioners and explains how and why they commit the time to precept. To answer this question, original research was undertaken within the context of the innovative community-based medical education program, the Parallel Rural Community Curriculum (PRCC), using the parallel consulting model. Chapters One to Three detail the context of this study, appraise the existing evidence in the literature, and establish the rigour of the study design. In line with the constructivist theoretical perspective presented by the author, a case study methodology was chosen for this study. The thesis is constructed in two parts. Results from a prospective cohort study of GPs� videotaped consulting, with and without students, are described in Chapters Four and Five. No increase in consultation time or non-consulting time was found when precepting medical students. GPs� activities changed, suggesting they adapted their behaviour when students were present. An interpretive study, using a grounded theory approach, was used to explain the �how� and �why� of the research question. Interview data from GP preceptors, practice managers and students was used to construct a transferable explanatory theory as it emerged from the data. These results are presented in Chapters Six and Seven. The majority of GPs considered precepting more time consuming than consulting alone. This finding was not consistent with the videotaped data. GPs consistently experienced time pressure in their roles due to constant intrusion of competing priorities. This increased when precepting students. Frequent descision making by GPs as a response to their drive to remain on time was found to be a significant contributing factor to the changes found in consultation activities. Although many types of professional enrichment were identified by GP preceptors as adding value to precepting, the doctor-student relationship was clearly defined as the most important motivator for precepting in this study. The case study analysis explains how and why this occurred, and documents the maturation of the doctor-student repationship over time in the year long PRCC attachments. Through a grounded theory analysis of the data, four precepting consultation models emerged: student observer, teacher-healer, doctor orchestrator and doctor advisor. In Chapter Eight, the study defines these models in the context of legitimate peripheral participation of a novice member of the rural GP community of practice. The corroborative evidence from the literature suggests that these models may be applicable to other settings, particularly other community-based medical education sites.

Thesis (M.Info.Tech.)--University of Wollongong, 2006. / Typescript. "Includes an observation study" Includes bibliographical references: p. [135-141].

Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005. / Includes publications published as a result of ideas developed in this thesis, inserted at end. "April 2005" Includes bibliographical references (leaves 210-242).

Thesis (Ph.D.)--Flinders University, School of Medicine. / Typescript bound. Includes bibliographical references: (leaves 204-216) Also available in electronic format.

Electronic medical record databases (e.g. the Clinical Practice Research Datalink, CPRD) are increasingly used in epidemiological research. The CPRD has two formats of data: coded, which is the sole format used in almost all research; and free-text (or ‘hidden’), which may contain much clinical information but is generally unavailable to researchers. This thesis examines the ramifications of omitting free-text records from research. Cases with bladder (n=4,915) or pancreatic (n=3,635) cancer were matched to controls (n=21,718, bladder; n=16,459, pancreas) on age, sex and GP practice. Coded and text-only records of attendance for haematuria, jaundice and abdominal pain in the year before cancer diagnosis were identified. The number of patients whose entire attendance record for a symptom/sign existed solely in the text was quantified. Associations between recording method (coded or text-only) and case/control status were estimated (χ2 test). For each symptom/sign, the positive predictive value (PPV, Bayes' Theorem) and odds ratio (OR, conditional logistic regression) for cancer were estimated before and after supplementation with text-only records. Text-only recording was considerable, with 7,951/20,958 (37%) of symptom records being in that format. For individual patients, text-only recording was more likely in controls (140/336=42%) than cases (556/3,147=18%) for visible haematuria in bladder cancer (χ2 test, p<0.001), and for jaundice (21/31=67% vs 463/1,565=30%, p<0.0001) and abdominal pain (323/1,126=29% vs 397/1,789=22%, p<0.001) in pancreatic cancer. Adding text records reduced PPVs of visible haematuria for bladder cancer from 4.0% (95% CI: 3.5–4.6%) to 2.9% (2.6–3.2%) and of jaundice for pancreatic cancer from 12.8% (7.3–21.6%) to 6.3% (4.5–8.7%). Coded records suggested that non-visible haematuria occurred in 127/4,915 (2.6%) cases, a figure below that generally used for study. Supplementation with text-only records increased this to 312/4,915 (6.4%), permitting the first estimation of its OR (28.0, 95% CI: 20.7–37.9, p<0.0001) and PPV (1.60%, 1.22–2.10%, p<0.0001) for bladder cancer. The results suggest that GPs make strong clinical judgements about the probable significance of symptoms – preferentially coding clinical features they consider significant to a diagnosis, while using text to record those that they think are not.

En autorisant tout médecin à prescrire du Subutex, la législation française désigne les généralistes comme acteurs essentiels d’une politique publique liée aux drogues : la dispensation de traitements de substitution aux opiacés (TSO). Cette thèse vise à comprendre comment la médecine générale compose avec cette prérogative. L’appropriation des TSO par les généralistes se décline à un niveau collectif – à quelles conditions cette mission peut-elle être assumée par ce groupe professionnel ? –, et sur le plan interactionnel – comment une personne dépendante devient-elle le patient d’un généraliste ? La question de l’appropriation d’une politique publique rejoint donc celle de l’acquisition du statut de "patients" pour des individus socialement stigmatisés, relevant parallèlement d’une politique pénale. Ce travail, fondé sur des entretiens et observations de consultations, montre que les généralistes s’approprient les TSO au moyen d’un processus de tri des patients et des tâches accomplies. Loin de manifester un refus de mettre en œuvre la politique substitutive, le tri vise à la rendre compatible avec les valeurs et modes d’organisation propres à la médecine générale. Cependant, les critères de sélection produisent des inégalités d’accès aux traitements : tous les "toxicomanes" ne deviennent pas des patients dans les mêmes conditions. L’ethnographie des consultations suggère que le statut de patient s’acquiert au cours de la construction d'une relation où la prescription devient progressivement routinière. Cette thèse invite à confronter plusieurs échelles d’analyse, en envisageant la mise en œuvre d’une politique de santé au prisme des interactions médecin-patient. / French legislation allows any physician to prescribe Subutex. Consequently, general practitioners are key actors of a public policy related to drug use: providing opiate substitution treatments (OST). This thesis aims to understand how general practice copes with this prerogative. Appropriation of OST by general practitioners comes at a collective level – how can this mission be assumed by this professional group? –, and also at an interactional level – how does an opiate addicted person become the patient of a general practitioner? The issue of appropriating a public policy is related to that of acquisition of patient status for socially stigmatized persons, who are, at the same time, the subjects of a penal policy. Our qualitative study (interviews and observations) shows that general practitioners appropriate OST by a sorting process. Sorting is a heuristic notion to describe practitioners’ adaptations with extension of their prerogatives by public policies: they don’t refuse to implement the substitution policy. On the contrary, they try to make it compatible with their values and their professional daily organization. However, selection criteria produce inequalities in access to treatments: every addict doesn’t become a patient in the same conditions. Consultations ethnography suggests that the patient status can be acquired while building a relationship with the doctor, in which the prescription is gradually becoming routine. This thesis invites to confront multiple scales and levels of analysis, by studying the implementation of a health policy through the prism of doctor-patient relationship.