CONTEXTE : Les critères de jugement prenant en compte le ressenti des patients, tels que la qualité de vie, deviennent des éléments déterminants pour l’évaluation des prises en charge et l’aide à la décision. Bien que les troubles mentaux représentent un fardeau considérable tant en termes de prévalence que de conséquences économiques, les connaissances sur la qualité de vie des patients pris en charge par les services de psychiatrie sont limitées, ce qui complexifie la prise de décisions éclairées dans le champ de la santé mentale.OBJECTIFS : Nos objectifs étaient d’évaluer la qualité de vie, mesurée par des scores d’utilité, des patients souffrant de troubles mentaux en France, de mesurer la perte de qualité de vie attribuable à ces troubles et d’identifier les facteurs qui y sont associés.MATERIEL ET METHODES : Après une revue de la littérature décrivant les instruments de mesure de la qualité de vie utilisés en santé mentale, nous avons évalué la qualité de vie des patients pris en charge par le secteur de psychiatrie générale en mobilisant deux instruments permettant le calcul de scores d’utilité : le SF-36, permettant le calcul de scores d’utilité via le SF-6D, et l’EQ-5D. Nous avons comparé leurs performances et avons évalué leur concordance. Nous avons confronté la qualité de vie des patients souffrant de troubles mentaux à celle de la population générale en mobilisant les données du volet « ménages » de l’enquête Handicap-Santé. Enfin, nous avons recouru à des outils de modélisation adaptés aux spécificités des distributions des scores d’utilité pour étudier les caractéristiques sociodémographiques, cliniques et les prises en charge psychiatriques des patients qui y sont associées.RESULTATS : Notre enquête a inclus 212 patients. Leurs scores d’utilité moyens s’élevaient à 0,684 dans le cas d’une mesure par le SF-6D et à 0,624 dans le cas de l’EQ-5D et étaient inférieurs de 11% à ceux de la population générale. Le fait d’être une femme et le fait d’être sévèrement malade étaient associés à des scores d’utilité plus faibles. Les patients ayant été librement hospitalisés à temps plein, par rapport à ceux ne l’ayant pas été, avaient tendance à avoir des scores SF-6D plus faibles tandis que les patients pris en charge à temps partiel présentaient des scores SF-6D plus élevés. Les scores d’utilité SF-6D et EQ-5D n’étaient pas concordants. Si les deux instruments étaient comparables en termes d’acceptabilité et de validité discriminante et convergente, l’EQ-5D était moins sensible, présentant un effet plafond, et les modèles mis en œuvre pour identifier les facteurs associés à ce score présentaient des performances modestes.CONCLUSION : Nos travaux ont permis d’objectiver l’impact négatif des troubles mentaux sur la qualité de vie des personnes atteintes. Les différences importantes identifiées entre les scores d’utilité SF-6D et EQ-5D font du choix de l’instrument le plus adapté un enjeu majeur. Le manque de sensibilité du score d’utilité EQ-5D et les difficultés rencontrées pour trouver un modèle statistique adapté aux spécificités de ce score suggèrent une meilleure adéquation du SF-6D au champ de la santé mentale. Cependant, des travaux menés sur des échantillons de taille plus conséquente seront mis en œuvre pour préciser nos résultats. / BACKGROUND: Assessment criteria which take patients’ perceptions into account, such as quality of life, are becoming increasingly important in health services assessment and policy and clinical decision-making. Despite the fact that mental disorders represent a significant burden in terms of prevalence and economic consequences, there is a lack of knowledge regarding quality of life of patients cared for by mental health care services which impedes informed decision-making in the field of psychiatry.OBJECTIVES: Our objectives were to measure quality of life using utility scores of people cared for by mental health care services in France; to assess the loss of quality of life attributable to mental disorders; and to identify factors associated with quality of life.MATERIAL AND METHODS: After a literature review describing quality of life tools used in the field of mental health, we undertook a survey to measure the quality of life of people suffering from mental disorders who were treated in the general psychiatric sector using two tools and the corresponding utility scores: the SF-36, allowing calculation of utility scores by the SF-6D, and the EQ-5D. We compared them in terms of performance, and we assessed their consistency. We evaluated the quality of life loss attributable to mental disorders considering data from the French general population-based survey on health and disabilities as a reference. Finally, we used several models adapted to the specificities of the utility score distributions to identify socio-demographic, clinical and mental health care utilization characteristics associated with quality of life.RESULTS: 212 patients were included. The mean utility score was 0.684 when assessed by the SF-6D, and 0.624 when assessed by the EQ-5D. Utility scores of patients suffering from mental disorders were 11% lower than those of the general population. Being a woman and being severely ill were factors associated with lower utility scores using both tools. In comparison with no hospitalization, voluntary hospitalization within the past 12 months was associated with lower SF-6D utility scores, whereas part-time hospitalization was linked with higher SF-6D utility scores. SF-6D and EQ-5D utility scores showed poor agreement in measuring quality of life. These instruments were similar in terms of acceptability as well as discriminant and convergent validity; however, the EQ-5D showed lower sensitivity, illustrated by a ceiling effect, and the models used to study factors associated with this score showed poor performances.CONCLUSION: We objectivized the negative impact of mental disorders on quality of life. Considering the significant differences identified between the SF-6D and EQ-5D utility scores, the choice of the most adapted instrument constitutes a major issue. The lack of sensitivity of the EQ-5D and the difficulties experienced in finding a model adapted to the specificities of this score would suggest that the SF-6D is better suited to the field of mental health. However, our results must be confirmed by analysis on larger samples.

After the Republic of Kosovo's declaration of independence in 2008, new municipal structures were created with the charge of monitoring the delivery of health care services; yet, no mechanism for monitoring performance was ever implemented. With the public value theory as the foundation, the purpose of this multiple case study of 3 Kosovo municipalities was to understand issues surrounding the capacity of local government health department to monitor their performance related to the delivery of services. Relevant data were collected through focus-group discussions with 10 nurses, 9 directors of family medicine centers, and 12 municipal program managers. Purposeful semistructured interviews were conducted with 3 elected officials, 3 leaders of health care services, 3 policy leaders of relevant central-level ministries, and 9 participants from the national coalition of civil society organizations. All data were transcribed and coded per thematic analysis procedures. Results indicated that integrating the threefold value system of business value, social value, and governance value into municipal work plans and policy considerations will likely create a more solution-oriented service delivery at the municipal level. Furthermore, service delivery in the 3 municipalities appears to have improved over the past 5 years because of the pressure from active citizens, increased community engagement, and the institutionalization of home visits. Positive social change implications stemming from this study include the recommendation to central and local policy makers to fully integrate performance-based reporting systems into local legislation and policies. Such efforts can result in sustainable, equitable, and inclusive development, leading to stability and prosperity in Kosovo.

The prevalence of heart failure is increasing. This is affecting the health care system; thus, making it important with change to meet the new demands. Many effective ways of treating heart failure exists, but changes are required in order to implement them. Before changes can be made, it is important to find current problem areas within the existing heart failure health care system. This study aimed to present an image of current problem areas within the heart failure health care system; in order to do so, it was necessary to speak with both care providers and heart failure patients. A total of 26 heart failure patients and 27 care providers working with heart failure patients in Stockholm County participated in the study. The participants answered survey questions concerning the heart failure care. The results from the care providers were consistent; they thought the patients’ heart failure awareness and the patient education they had received were problems within the heart failure care. In addition, they thought it was necessary for the patients to be active in their care and meet with different professions within the health care. Heart failure patients showed to be a diverse group of individuals; they wanted different kind of care and showed differences in how active they wanted to be. The results also showed differences between the care providers and patients’ perception of the heart failure care. The heart failure care needs to be more individualized to meet each heart failure patients’ needs. It is important with more patient education and to actively work with self-care. In addition, it is important that care providers get sufficient heart failure knowledge and to offer the patients the opportunity to meet with different care provider professions. / Utbredningen av hjärtsvikt ökar, vilket påverkar sjukvårdssystemet. För att möta de nya behoven är det nödvändigt med förändringar. Det finns idag många effektiva behandlingsmetoder för hjärtsvikt, men för att dessa behandlingsmetoder ska kunna implementeras behöver sjukvårdssystemet förändras. Innan dessa förändringar kan genomföras är det viktigt att identifiera problem inom hjärtsviktsvården. Målet med denna studie var att identifiera befintliga problemområden inom hjärtsviktsvården. För att kunna göra detta var det nödvändigt att prata med både sjukvårdspersonal och hjärtsviktspatienter. Sammanlagt har 26 patienter och 27 vårdgivare från Stockholms Län delaktigt. Alla delatagare har svarat på enkätfrågor rörande hjärtsviktsvården. Resultaten från vårdgivarna var konsekventa, de ansåg att patienternas kännedom om hjärtsvikt och den hjärtsviktsutbildning de fått var problemområden. Vårdgivarna ansåg vidare att det var viktigt för patienterna att vara delaktiga i sin vård, samt att de skulle få träffa olika typer av vårdgivare. Hjärtsviktspatienterna visade sig vara en blandad grupp, de ville ha olika typ av vård samt vara olika mycket aktiva i egenvård. Resultaten visade också att det fanns skillnader mellan vårdgivarnas och patienternas uppfattning av hjärtsviktsvården. Hjärtsviktsvården behöver bli mer individualiserad för att kunna tillgodose varje patients behov. Det är viktigt att utbilda patienterna samt att aktivt arbeta med egenvård. Det är även viktigt att vårdgivarna får tillräckligt med kunskap om hjärtsvikt, samt att patienterna erbjuds möjligheten till möten med olika typer av vårdgivare.

The prevalence of heart failure is increasing. This is affecting the health care system; thus, making it important with change to meet the new demands. Many effective ways of treating heart failure exists, but changes are required in order to implement them. Before changes can be made, it is important to find current problem areas within the existing heart failure health care system. This study aimed to present an image of current problem areas within the heart failure health care system; in order to do so, it was necessary to speak with both care providers and heart failure patients. A total of 26 heart failure patients and 27 care providers working with heart failure patients in Stockholm County participated in the study. The participants answered survey questions concerning the heart failure care. The results from the care providers were consistent; they thought the patients’ heart failure awareness and the patient education they had received were problems within the heart failure care. In addition, they thought it was necessary for the patients to be active in their care and meet with different professions within the health care. Heart failure patients showed to be a diverse group of individuals; they wanted different kind of care and showed differences in how active they wanted to be. The results also showed differences between the care providers and patients’ perception of the heart failure care. The heart failure care needs to be more individualized to meet each heart failure patients’ needs. It is important with more patient education and to actively work with self-care. In addition, it is important that care providers get sufficient heart failure knowledge and to offer the patients the opportunity to meet with different care provider professions. / Utbredningen av hjärtsvikt ökar, vilket påverkar sjukvårdssystemet. För att möta de nya behoven är det nödvändigt med förändringar. Det finns idag många effektiva behandlingsmetoder för hjärtsvikt, men för att dessa behandlingsmetoder ska kunna implementeras behöver sjukvårdssystemet förändras. Innan dessa förändringar kan genomföras är det viktigt att identifiera problem inom hjärtsviktsvården. Målet med denna studie var att identifiera befintliga problemområden inom hjärtsviktsvården. För att kunna göra detta var det nödvändigt att prata med både sjukvårdspersonal och hjärtsviktspatienter. Sammanlagt har 26 patienter och 27 vårdgivare från Stockholms Län delaktigt. Alla delatagare har svarat på enkätfrågor rörande hjärtsviktsvården. Resultaten från vårdgivarna var konsekventa, de ansåg att patienternas kännedom om hjärtsvikt och den hjärtsviktsutbildning de fått var problemområden. Vårdgivarna ansåg vidare att det var viktigt för patienterna att vara delaktiga i sin vård, samt att de skulle få träffa olika typer av vårdgivare. Hjärtsviktspatienterna visade sig vara en blandad grupp, de ville ha olika typ av vård samt vara olika mycket aktiva i egenvård. Resultaten visade också att det fanns skillnader mellan vårdgivarnas och patienternas uppfattning av hjärtsviktsvården. Hjärtsviktsvården behöver bli mer individualiserad för att kunna tillgodose varje patients behov. Det är viktigt att utbilda patienterna samt att aktivt arbeta med egenvård. Det är även viktigt att vårdgivarna får tillräckligt med kunskap om hjärtsvikt, samt att patienterna erbjuds möjligheten till möten med olika typer av vårdgivare.

For too many of us, the implications of a worldwide pandemic unfolded in graduated stages of understanding that seemed too sluggish for the opponent we faced. For too many of us, even those of us in health care, the unfolding was terrifying; we felt blindsided and unprepared. If coronavirus disease 2019 (COVID-19) were a bully picking a fight, they got the first punch in before we even raised a fist. Now, many rounds in, health care teams will have an opportunity to deploy a new weapon against COVID-19. Vaccines are coming. We do not know when, who will pay for them, or the logistical aspects (e.g., storage and administration). We do not even know how effective they will be. Moreover, we must plan for mass vaccination in a chaotic and politically charged context that bears little resemblance to the ones with which we have experience. Nevertheless, in this fight, vaccines could be our winning blow. We are getting better at working with unknowns and in disrupted environments during COVID-19. We have some time to prepare, and we have some extant knowledge and experience in vaccine distribution and uptake. Health care teams can use these to best their adversary, and we can and should begin now. The aim of this article is to discuss how to mobilize interprofessional teams within systems of care to engage best practices in vaccine dissemination and uptake in the unique COVID-19 context. We begin by discussing challenges to dissemination and uptake and then provide solutions using our experiences in the primary care system.

Выпускная квалификационная работа (магистерская диссертация) посвящена исследованию финансирования здравоохранения населения в Сингапуре. Предметом исследования являются медицинские накопительные счета Сингапура, которые играют основную роль в финансировании здравоохранения страны. Основной целью магистерской диссертации является рассмотрение успешного опыта финансирования здравоохранения в Сингапуре, которой возможно применить в отечественной системе здравоохранения. В заключении обозначены рекомендации по совершенствованию дальнейшего улучшения отечественной системы финансирования здравоохранения. / The final qualifying work (master's thesis) is devoted to the study of the financing of public health in Singapore. The subject of study is Singapore's medical savings accounts, which play a major role in financing the country's health care. The main purpose of the master's thesis is to consider the successful experience of financing health care in Singapore, which can be applied in the domestic health care system. In the conclusion, recommendations for improving the further improvement of the domestic system of health care financing are indicated.

Thesis / The objective of this study is to assess the nature of women’s empowerment promoted by the Sudanese Women General Union (SWGU) in Sudan as a strategy for simultaneously addressing both poverty alleviation and women's empowerment using microcredit as a tool in the fight against poverty and women's empowerment at the household level during the period 1999-2005. The SWGU directed its development efforts towards promoting the women's cause officially and unofficially through the whole spectrum of governmental institutions and non-governmental organizations. Therefore, the government support these initiatives of women development processes and assisted in establishing the SWGU in 1990 as a strategic planning and coordination mechanism for poverty alleviation through the lead of the Ministry of Welfare and Social Development and with the cooperation from other ministries, government and non-government organisations at national, state and grassroots levels. The problem of the research reveals that majority of women in Sudan live with low or no income; economically they are dependent on their husbands' income; burdened with their household activities and responsibilities to feed; educate and take care of many children, encounter a core problem which is lack of access to credit and financial services to economically, socially and politically empower themselves and improve their status. The study reviewed the relevant literature, the context of women's poverty in Sudan, Sudan poverty strategies and policies, SWGU's role in strategic planning, coordination and implementation of the microcredit programmes. The achievements of the study on the socioeconomic empowerment of women at the household levels, the constraints and the recommendations were summarised. The researcher carried out this study during the period 2005-2009, to add to the body of the empirical literature of women studies in particular to the SWGU's microcredit projects best ii practices and lessons learned. In addition the study could help in conducting further womenstudies in Sudan and other developing counties. / Development Studies / D.Litt. et Phil. (Development Studies)

The purpose of this study is to demonstrate that within the United States health care system, a number of institutions have evolved which have given rise to a perverse set of incentives that direct technological change. As a result of these incentives, the diffusion and utilization of new and existing technologies is carried out in a random and indiscrete fashion, subsequently placing upward pressure on the costs of health care. This analysis relies on the empirical work, observations, and writings of a large number of physicians, social scientists, hospital administrators, and federal bureaucrats.

Cette étude exploratoire a pour but d’identifier les facteurs pouvant influencer l’implantation des adjoints au médecin dans le système de santé québécois, selon les perceptions de médecins omnipraticiens et de médecins spécialistes. La collecte de données pour cette étude qualitative s’est effectuée à l’aide d’entrevues semi-structurées effectuées auprès de 13 omnipraticiens et spécialistes provenant d’hôpitaux de Montréal et de la clinique médicale des Forces canadiennes de St-Jean (Québec). L’étude a démontré que des obstacles perçus, tels que le corporatisme et le manque d’information sur la profession, pourraient interférer avec l’intégration des adjoints au médecin au Québec. Cependant, les participants s’entendent pour dire que ces obstacles ne seraient pas insurmontables et ont, par la même occasion, identifié de nombreux éléments pouvant faciliter cette intégration. Les adjoints au médecin ont des compétences uniques et travaillent déjà dans d’autres provinces canadiennes qui ont un réseau de santé similaire au nôtre. Cette étude permet donc d’approfondir les connaissances à l’égard de cette profession, en plein essor au pays, dans l’éventualité d’une intégration de ce groupe professionnel au Québec. / The intent of this exploratory study is to identify the factors that could influence the implementation of Physician Assistants in Quebec's medical system based on the opinions of General Physicians and Medical Specialists. The data were collected from semi-structured interviews conducted with 13 generalists and specialists from hospitals in the Montréal area and from the military clinic located in the Canadian Forces Base St-Jean (Québec). The study showed that perceived obstacles such as corporatism and the lack of information about the profession could interfere with physician assistant integration. However, participants agreed that these obstacles could be overcome. They have, at the same time, identified many very positive factors in favour of this integration. Physician assistants have unique skills and are already fully integrated in provincial health care systems in other Canadian provinces. This study offers a better understanding and greater awareness of this expanding profession in our country and the progress towards its possible integration in Québec.

The thesis examines health care system in the United Kingdom of Great Britain and Northern Ireland. In the beginning there is characterised the United Kingdom and its present structure of health care system including assessment of individual functions of system's parts. Then there are analysed sources of finance and their development between 1999 and 2009. The thesis continues with analysis of expenditures where is traced their development between 1999 and 2009 including international comparison. Next there are introduced methods of financial resource allocation into segments of health care system. In the last chapter there are pointed pros and cons of British health care system out and chosen certain components for application in Czech Republic.