published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

No-show appointments, also referred to as missed appointments, occur 23% to 34% annually in general practice care settings. Missed appointments can lead to reduction in appointment availability, decrease in provider/staff productivity, patient/provider discordance, disruption in continuity of care, and reduced quality of care. There is a gap in the nursing literature regarding effective interventions to reduce missed appointments. The purpose of this quality improvement, secondary analysis project was to determine whether implementation of an evidence-based no-show, nurse-led intervention would reduce missed appointment rates in a family medicine practice. The health belief model and the plan, do, study, act model guided this no-show project. Convenience sampled, password-secured quantitative data from nurse practitioner schedules were analyzed using a check-sheet tool and spreadsheet software. Data showed that after implementation of the evidence-based, nurse-led interventions, there was a reduction of no-shows with a decline from 23.5% in September and November 2017 to 17% in September and November 2018. Results of this no-show project might promote positive social change by increasing awareness of evidence-based interventions that are effective for reducing missed appointments in primary care practices.

Aims: The purpose of the qualitative study was to gain insight into the way parents experience and manage the waiting process following a referral to a Child and Adolescent Mental Health Service. The aim was to use the information for future service delivery and therapeutic engagement. Method: 6 parents whose child had been referred to a Child and Adolescent Mental Health Service and had been waiting for more than eight weeks were recruited using a purposive sampling method and participated in a semi-structured interview. The interviews were transcribed and analysed using the principles of Pidgeon & Henwood’s (1992) grounded theory techniques, facilitating the development and refinement of a theoretical model. Results: The resulting model highlights the waiting experience as fraught by loneliness, abandonment and self blame resulting in an interchanging role of being active or passive and the subsequent cycle they subside into. Some parents use the waiting time effectively by searching for their own answers but may eventually become passive following a belief that their parenting is insufficient. The disempowerment and self blame that is perpetuated through waiting intensifies the parents’ helplessness and results in a wide disparity between a negative self view and the idealised view of the professional. Conclusion: This study described the difficult experiences parents face while waiting for their child’s initial appointment. Parents need to be offered support, information and empowerment while waiting with ongoing communication from the service. Recommendations for future service and clinical delivery are provided.

published_or_final_version / abstract / toc / Social Work and Social Administration / Master / Master of Philosophy

nÃo hà / The purpose of this study is to identify the existence of group effects, known as peer effects, at the demand for dental appointments in collective contracts that are exclusively dental health plans. This paper compares the number of dental appointments of each person with the amount of dental appointments in the group, despising the history appoint of the analyzed individual. In order to test empirically if the group effect is important, a model of traditional counting was used, with the introduction of the variable that indicates of group effect, particularly, the model of binomial negative counting for panel with random effects, embracing both the effect of over-dispersion and the time dependence of the use for the same person. The companies were divided into five groups according to their size, as follows: 2 to 20, 21 to 50, 51 to 100, 101 to 200 and more than 200 beneficiaries. The results showed that the group effects increased successively according to the size of the company, in which companies with more than 200 beneficiaries were the ones most affected. / O objetivo deste estudo à identificar a existÃncia de efeitos de grupo, ou peer effect, na demanda por consultas odontolÃgicas dentro de contratos coletivos de planos saÃde exclusivamente odontolÃgicos. O trabalho compara a quantidade de consultas odontolÃgicas de cada indivÃduo com a quantidade de consultas odontolÃgicas do grupo, desconsiderando o histÃrico de consultas do indivÃduo analisado. Para testar empiricamente se o efeito de grupo à importante, foram utilizados modelos de contagem tradicionais com a introduÃÃo da variÃvel indicadora de efeito de grupo, em particular, o modelo de contagem binomial negativo para painel com efeito aleatÃrio para acomodar tanto o efeito sobre-dispersÃo quanto à dependÃncia temporal do uso para o mesmo indivÃduo. As empresas foram divididas em 5 grupos de acordo com seu porte, sendo: 2 a 20, 21 a 50, 51 a 100, 101 a 200 e mais de 200 beneficiÃrios. Os resultados mostraram que os efeitos de grupo aumentaram sucessivamente de acordo com o aumento do porte da empresa, sendo as empresas com mais de 200 beneficiÃrios aquelas mais afetadas pelos efeitos de grupo.

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Bakgrund: Sjuksköterskor driver självständigt egna mottagningar inom primärvården. Det bidrar till ökad livskvalité och hälsa för patienter. När en sjuksköterskeledd mottagning ställs in kan såväl patientens situation som sjuksköterskans arbetssituation påverkas. Det var därför angeläget att undersöka hur sjuksköterskor erfar och hanterar när sjuksköterskeledd mottagning ställs in.    Syfte: Syftet var att beskriva hur sjuksköterskor erfar och hanterar kritiska incidenter vid inställd sjuksköterskeledd mottagning inom primärvården.    Metod: En kvalitativ studie med Critical Incident Technique (CIT) genomfördes med induktiv ansats där 28 sjuksköterskor som är yrkesverksamma inom primärvården i Region Skåne besvarade utformat frågeformulär.    Resultat: Sjuksköterskorna erfor att inställda sjuksköterskeledda mottagningar skapade merarbete. De beskrev stress, irritation, ilska men även till viss del förståelse. Inställd sjuksköterskeledd mottagning drabbade inte bara patienterna utan även deras anhöriga samt sjuksköterskestudenter. Sjuksköterskorna hanterade inställd sjuksköterskeledd mottagning genom att de prioriterade sitt arbete och att de använde sin yrkeserfarenhet för att lösa situationen. De anpassade sig till underbemanningen och lyfte detta i arbetsgruppen för att förbättra arbetsmiljön.   Slutsats: Region Skåne hade arbetsvilliga och kompetenta sjuksköterskor. När sjuksköterskeledd mottagning ställdes in fick patienterna minskad kontinuitet och ibland fördröjd diagnossättning. Detta berodde till stor del på underbemanning inom primärvården och arbetsgivaren kunde inte ge den arbetsmiljö som sjuksköterskorna behövde. / Background: Nurses independently run their own clinics within primary care. It contributes to increased lifequality and health for patients. When a nurse-led clinical appointments is cancelled, both the patient situation and the nurse's work situation can be affected. Therefore, important to investigate how nurses experience and manage when nurse-led clinical appointments are cancelled. Purpose: The purpose was to describe how nurses experience and handle critical incidents during cancelled nurse-led clinical appointments in primary care.       Method: A qualitative study with the Critical Incident Technique (CIT) was carried out with an inductive approach where 28 nurses who are professionals in primary care in Region Skåne answered a designed questionnaire.   Results: The nurses' experience of cancelled nurse-led clinical appointments was that it created extra work. They described stress, irritation, anger but also to some extent understanding. Cancelled nurse-led appointments affected not only the patients but also their relatives and nursingstudents. The nurses managed cancelled nurse-led appointments by prioritizing their work and using their professional experience to resolve the situation. They adapted to the understaffing and raised this in the work group to improve the work environment.     Conclusion: Region Skåne had willing and competent nurses. When nurse-led clinical appointments were cancelled, patients experienced reduced continuity and sometimes delayed diagnosis. This was largely due to understaffing in primary care and the employer could not provide the working environment that the nurses needed.

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Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The objectives of this study were to explore patients’ experiences about long waiting time at the Vanguard Community Health Care Centre in the Western Cape and to explore possible solutions for this problem from the patients’ perspective. A qualitative research approach was applied. A sample size of (n=12) was drawn from a total population of 2829 (N=2829) using a non-random convenient sampling technique. A semi-structured interview guide was designed based on the objectives of the study and validated by experts in the field before data collection took place. Approval for the study was obtained from the Ethics Committee at the faculty of Health Sciences, Stellenbosch University and from the facility manager of health centre where the study was to be undertaken. The presentation of the results was categorised into themes and sub-themes that emerged from the data analysis. According to the findings in chapter 4 the themes that emerged were: Causes of long waiting time Areas of concern where waiting occurs most Emotions experienced when waiting long for service Possible solutions to waiting long for service The findings support the conceptual framework developed for the purpose of this study which includes the Patient’s Bill of Rights, the Principles of Batho Pele, Quality Care, Patients’ Representation and Patient satisfaction. The results of the study suggests that the conceptual framework needs to be implemented as a guideline to address the problems of long waiting time with the input from the participants’ opinions about possible solutions to be incorporated to the problem of long waiting time at the community health centre. / AFRIKAANSE OPSOMMING: Die doelwitte van die studie was om pasiente se gevoelens oor lang wagtye by Vanguard Gemeenskapsgesondheidsentrum in die Wes-Kaap te ondersoek en om moontlike oplossings vir hierdie probleem vanaf die pasient se perspektief te bepaal ‘n Kwalitatiewe navorsingsbenadering is gebruik. ‘n Steekproefgrootte van (n=12) is verkry vanaf ‘n totale bevolking van 2829 (N= 2829) deur die gebruik van ‘n nie-ewekansige gerieflike steekproefneming tegniek. ‘n Semi-gestruktureerde onderhoudgids is ontwerp gebaseer op die doelwitte van die studie. Die onderhoudgids is geldig bevind deur spesialiste in die gebied voor data insameling plaasgevind het. Goedkeuring vir die studie is verkry van die Etiese Komitee by die Fakulteit Gesondheidswetenskappe, Stellenbosch Universiteit en van die bestuurder van die gesondheidsentrum waar die studie uitgevoer sou word. Resultate is rangskik in temas en subtemas wat afgelei is van die data analise. Die volgende temas is bepaal vanuit Hoofstuk 4 se bevindinge: Redes vir lang wagtye Areas waar lang wagtye voorkom Emosies ondervind wanneer lank gewag moet word vir diens Moontlike oplossings vir lang wagtye Die bevindinge ondersteun die konseptuele raamwerk ontwikkel vir die doel van die studie wat die Handves van Regte vir pasiente, die beginsels van Batho Pele, Kwaliteitsorg, Pasient verteenwoordiging en Pasienttevredenheid insluit. Die bevindinge van die studie dui aan dat die konseptuele raamwerk geimplementeer moet word as riglyn om die probleme wat ervaar word met lang wagtye aan te spreek. Die deelnemers se menings oor moontlike oplossings moet deel moet wees van die aanspreek van die probleem van lang wagtye in die gemeenskapsgesondheidsentrum.