Previous research has examined patients’ level of satisfaction with the care, in an attempt to develop health care services that match patients’ expectations and needs. Nevertheless, there is still considerable debate among researchers over conceptual and methodological issues. This research programme investigated factors that contribute to patient satisfaction with health care in two fairly different European health care systems (the UK’s NHS and Greece’s ESY). A further aim was to develop a scale to assess patient satisfaction and health care evaluations within these two cultural contexts. In order to achieve those aims, a sequential exploratory strategy incorporating, qualitative and quantitative designs was used to explore patient health care evaluations, patient satisfaction, expectations, health care experiences, interpersonal qualities of the doctor-patient relationship and health care contextual factors at both micro and macro level. Three studies were conducted: Studies 1a and 1b examined levels of patient satisfaction with health care delivery in Greece and the UK respectively. More similarities than differences were found between the two samples, but aspects of health system evaluation differed. The data obtained from this study informed the development of the Patient Expectation and Satisfaction Scale (PESS). The psychometric properties of the preliminary version of the scale were subsequently tested in non clinical populations in Greece and the UK (Studies 2a and 2b). The pilot testing of the PESS was based on a proposed theoretical framework suggesting that patients’ expectations depend on the nature of past experiences and current expectations. The variable that influences some of the differences between the two countries is health culture in terms of contextual health care differences. Although findings revealed similarities between the two cultures, differences were found relating to dissatisfaction, health care evaluations, expectations and the quality of the doctor-patient relationship. A revised version of the PESS, based on these findings, was administered to hospital outpatient populations in both countries (Study 3). The Patient Satisfaction and Expectation Model that emerged from this analysis incorporated three levels of patient satisfaction: at the micro level, the macro level and the interpersonal level. The importance of patients’ understanding of professional competence and its salience as a predictor of the effectiveness of the doctor-patient relationship was highlighted. The quality of the doctor-patient relationship emerged as an important determinant of patient satisfaction and adherence. The overall findings of this research programme suggest that patient satisfaction is multidimensional; despite contextual differences between the two health care systems, a universal concept exists that includes health care expectations, health care experiences, interpersonal qualities and aspects relating to operational and organisational structures at both micro and macro level.

Tyrimo tikslas – įvertinti psichikos ligomis sergančių asmenų subjektyviai vertinamo santykio su savo gydytoju psichiatru, jo nurodymų laikymosi bei pasitenkinimo sveikatos priežiūros paslaugomis sąsajas. Tyrime dalyvavo: 140 įvairiomis psichikos ligomis sergančių pacientų (66 vyrai ir 74 moterys), besigydantys VŠĮ. Pakaunės PSPC. Šio darbo naujumas bus surasti ir parodyti sociodemografinius, klinikinius veiksnius, kurie daro įtaką pozityvesniam požiūriui į vaistus ir atsakingesniam jų vartojimui. Taip pat surasti psichikos ligomis sergančių asmenų subjektyviai vertinamo santykio su gydytoju psichiatru ir gydytojo nurodymų laikymosi bei pasitenkinimo sveikatos priežiūros paslaugomis sąsajas. / The aim of the research is to evaluate the connection among the subjectively perceived relationship with one’s doctor psychiatrist, adherence to his/ her instructions and the satisfaction with the services provided by the healthcare institution from the point of view of individuals suffering from psychiatric illnesses. 140 patients (66 males and 74 females) with various psychiatric illnesses treated at Public Enterprise Pakaunė PSPC (Primary Healthcare Center) took part in the research. The novelty of this paper lies in the identification and highlighting of socio demographical and clinical factors contributing to a more positive attitude towards medication and its more responsible consumption. Besides, the discovery of the connection among the subjectively evaluated relationship with the treating doctor psychiatrist from the point of view of patients with psychiatric illnesses, adherence to his/ her instructions and satisfaction with the services provided by a healthcare institution is also innovative.

Vakarų pasaulio šalys, dažnai laikomos pasiekusiomis aukštą kultūrinį lygį ir liberalumo bei laisvės skelbėjomis, įteisino eutanaziją valstybinais įstatymais, leisdamos nužudyti žmogų dėl ligos ar senatvės. Lietuvoje kaip ir daugumoje Senojo Žemyno šalių, mažėjantis gimstamumas, senstanti visuomenė ir besikeičiantis jos požiūris į gyvybę, į senatvę, į ligą, į kančią verčia liberalią visuomenę diskutuoti apie įvairias mirties formas ir ypač eutanaziją. Gyvenimo tempams bėgant beprotišku greičiu ir dėl to žmogui patiriant daugybę įvairių traumų, kurios dažnai padaro žmogų neįgaliu; ligos, kurios vis dar lieka nepagydomomis, verčia atkreipti dėmesį į silpnuosius ir reikalingus pagalbos, jiems siūlant ne mirtį, o gyvenimą. Silpnųjų pusėn tokioje situacijoje ir stoja paliatyvioji pagalba kaip alternatyva eutanazijai. Temos problematiškumas kyla iš bandymų įteisinti eutanaziją, teismuose įrodyti „teisę numirti“ nepateikiant jokios kitos išeities tokiai pozicijai. Plintant tokiai laikysenai, pridengtai gailestingumu, alternatyva randama paliatyvioje pagalboje ir slaugoje. Lietuva yra paskutinė valstybė Europoje, kuri įteisino paliatyvią pagalbą – ligonio, sergančio pavojinga gyvybei, nepagydoma, progresuojančia liga, ir jo artimųjų gyvenimo kokybės gerinimo priemones, užkertančias kelią kančioms ar jas lengvinanti, padedanti spręsti kitas fizines, psichosocialines ir dvasines problemas. Ši tema ypatingai aktuali įrodyti, kad liga ir senatvė nesunaikina asmens ir todėl neleista jo... [toliau žr. visą tekstą] / The western countries often considered as those, which had achieved high cultural level and that are the announcers of liberalism and freedom, have legitimized euthanasia with national law by allowing killing a person for a disease or old age. In Lithuania as in the majority of countries of the Old Continent, the decreasing rate of birth, the obsolescent society and its changing attitude towards life, old age and pain force a liberal society to discuss about various forms of death and particularly euthanasia. As the life pace is running in a breathtaking speed causing many human traumas, which often make a person disabled; the diseases that still remain incurable force us to pay attention to the weak people who need help by providing them not with death but life. In this case the palliative help as an alternative to euthanasia stands for the weak. The problem of the topic rises from the intentions to legalize euthanasia, to prove „the right to die“in the court without submitting any other solutions to such a position. When spreading such the posture covered by mercy, the alternative is found in palliative help and care. Lithuania is the last country in Europe, which legalized palliative help – the tools of life quality improvement of the patient suffering from the dangerous, incurable and progressing disease and his relatives. These tools prevent from torment and palliate them, help to solve other physical, psychosocial and spiritual problems. This topic is particularly... [to full text]

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

In un contesto in cui il coinvolgimento e la partecipazione dei consumatori/clienti di prestazioni sanitarie è oggi più che mai all’ordine del giorno, il concetto di “patient engagement” si è sempre più imposto nella letteratura scientifica e manageriale come call to action in risposta alle sfide epidemiologiche – legate all’aumento della cronicità – ed economiche – connesse all’aumento dei costi sanitari e alla riduzione delle risorse disponibili - a cui i sistemi sanitari contemporanei devono necessariamente rispondere per evitare il collasso. Per ciò, a fronte di una letteratura sul tema ancora parziale e frammentata, definire il concetto di “patient engagement” e le sue implicazioni a vari livelli diviene cruciale per passare da una dichiarazione di intenti ad una concreta strategia di azioni volte a promuoverlo. Alla luce di queste premesse, il progetto di ricerca ambisce a rispondere ad una necessità fondativa sia da un punto di vista teroico che empirico di questo concetto e ad evidenziare possibili linee di sviluppo e ricadute applicative per una rinnovata professionalizzazione dei clinici che devono oggi riadattare le proprie pratiche professionali e ripensare alla propria identità in funzione di un paziente sempre più attivo e partecipe rispetto alle scelte legate alla gestione della propria salute. / The expectancy of patient living with chronic disease has improved significantly in the recent years due to advances in medical sciences. To address the burden of this growing demand of care, patient engagement is considered crucial as it contributes to improve health outcomes and control healthcare costs. However, many gaps still exist for its implementation starting from the lack of a shared definition and shared guidelines for medical practice based on the direct patients' care experience. In the light of this premises this dissertation will propose a sequential research design generally aimed at improving the knowledge and understanding of patient engagement and its implications for the medical practice and professionalism. To answer the overall aim of this thesis both literature reviews and qualitative methodology were used. Chapter 1 was aimed to set scene and give the readers an overview of the global cultural and societal scenario that justifies the need to deal with the topic of patient engagement. Chapter 2 and 3 consist in in-depth literature reviews aimed at shading light on the concepts featuring the participatory medicine movement and, more specifically, the one of patient engagement. An in-depth qualitative study according to the grounded theory principles was conducted and reported in chapter 4 and was aimed at deepening the heart failure patient’s perspective towards engagement in their care in order to build and experience-based model of this phenomenon. The last two chapters, based on the insights emerged from both the literature analysis and the grounded theory study, were aimed at discussing the implications of patient engagement for the clinical decision making process (chapter 5), and for training health professionals in patient engagement strategies and improving the effectiveness of their communication and relational habits with this aim (chapter 6).

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

In this thesis research, we investigate the usability of hand-held display (Tablet PC) and wearable head-mounted display (Google Glass) interfaces and their effect on doctor-patient interaction during clinical ward round in the hospital. We looked at existing literature to identify existing research about our topic. Using a User Centered Interaction Design process we developed a prototype hybrid system that used both a hand-held and head-mounted display. An evaluation of this prototype with a hand-held system and a paper based interface was performed in a simulated patient room with 20 doctors and 5 patients. The participants were observed, surveyed, and interviewed about their experiences. Generally, the patients had a high satisfaction rate and felt the interfaces were not causing the doctors to lose focus on them. The doctors found the hand-held display by itself and existing paper-based interface to be the most usable and least distracting interfaces for accessing patient information during clinical ward rounds.

The purpose of the study is to establish the critical need for stage action in order to understand fully the theme of Marlowe's Doctor Faustus. Marlowe's primary intent is to invert the morality play, illustrating the distortions and ambiguities of a systematized religion and to establish the human dilemma when man is faced with moral choices. To illustrate this inversion, Marlowe uses emblematic action for an effect opposite to that of the traditional moralities: Often this action goes beyond the emblem, becoming a metaphor for Marlowe's theme, man as a victim, conflicting within himself and within the system which governs his morality.Chapter one introduces this theme and the crucial need for staging Marlowe's ideas. The first chapter also establishes a compromise of the textual problems inherent within any study of Doctor Faustus. Since the study argues that audience reaction is important to Marlowe's intent, attention is paid to how audience response governs the play's interpretation.Chapter two is a critical review of the historical staging practices which must be considered when studying the dramatic text. Included are stage size, costuming, and special effects.Chapter three is the advancement of the thesis in a scene by scene analysis of the text with special attention to the action as metaphor. Considered is how audience reaction represents part of Marlowe's purpose; the increasing tension of the audience furthers Marlowe's concept of the ambiguities present when humans are faced with moral choices. This purpose is traced scene by scene with specific attention to how it is metaphorically portrayed on stage.Chapter four is separate as a director's book, with the text reproduced, together with the researcher's marginal notes on specific blocking and with footnotes emplacing and expanding on the metaphorical action as it appears in the text. / Department of English

Vertinami šeimos gydytojų kompiuteriniai įgūdžiai ir poreikiai Kauno, Klaipėdos ir Tauragės PSP įstaigose. Taip pat BPG naudojamasis IT darbe; įgūdžių tobulinimo galimybės. / Evaluate computer skills of general physicians and their needs in Kaunas, Klaipėda and Tauragė cities. Also IT needs at their work places, opportunities for computer skills improvement.

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