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Estudo da rede de atenção ao diabetes mellitus em Juiz de Fora, Minas Gerais: avaliação da atenção primária à saúde quanto às dimensões de estrutura, processo e resultado e caracterização da população admitida na atenção secundária à saúdeSimão, Christiane Chaves Augusto Leite 28 July 2016 (has links)
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Previous issue date: 2016-07-28 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / Introdução: O diabetes mellitus é uma condição com elevada morbimortalidade. A
complexidade do manejo da doença requer mudanças no sistema de saúde, cuja
assistência deve estar em concordância com o Modelo de Atenção a Condições
Crônicas. O objetivo do presente estudo é descrever indicadores da qualidade da
assistência ao indivíduo com diabetes mellitus no município de Juiz de Fora, Minas
gerais, e explorar associações entre eles. Métodos: Em estudo observacional
transversal realizado em 14 Unidades de Atenção Primária à Saúde, foi aplicado um
questionário a médicos, gerentes e agentes comunitários de saúde, contemplando
perguntas sobre estrutura e processo da assistência. Além disso, foram colhidos
dados clínico-laboratoriais de prontuários dos pacientes com diabetes mellitus nas
Unidades de Atenção Primária à Saúde e de pacientes encaminhados a um centro
multiprofissional de Atenção Secundária à Saúde. As variáveis categóricas e
quantitativas foram analisadas de forma descritiva. A exploração de associações
entre elementos da Estrutura e Processo das Unidades de Atenção Primária à
Saúde e os parâmetros clínicos dos usuários em sua admissão na Atenção
Secundária à Saúde foi realizada através de Regressão Linear de Efeitos Aleatórios.
Resultados: Em relação à estrutura das Unidades de Atenção Primária à Saúde,
observou-se insuficiência de consultórios para atendimento multiprofissional e de
medicamentos para dispensação. Merece destaque a carência de profissionais, com
53,8% das equipes da Estratégia de Saúde da Família incompletas, além da elevada
proporção de médicos e enfermeiros que informam problemas com o
encaminhamento para a Atenção Secundária à Saúde (70,0%). Como indicador de
processo, destaca-se a baixa disponibilidade (51,2%) de resultado de hemoglobina
glicada (HbA1c) registrado nos prontuários. Na análise dos prontuários da Atenção
Secundária à Saúde, 18,7% dos pacientes apresentavam HbA1c < 7% e 43,9%
tinham níveis de pressão arterial inferiores a 140 x 90 mmHg em sua consulta inicial.
Não foi encontrada associação entre elementos da estrutura e processo das
Unidades de Atenção Primária à Saúde e os resultados da assistência apresentados
na consulta inicial na Atenção Secundária à Saúde. Conclusão: Embora tenham sido
detectados déficits importantes na estrutura e processo da assistência ao usuário
com diabetes mellitus nas Unidades de Atenção Primária à Saúde, estes não se
relacionaram ao estado clínico dos pacientes ao ingressarem na Atenção
Secundária à Saúde. / Introduction: Diabetes mellitus is a condition with high morbidity and mortality. The
complexity involved in managing patients with Diabetes mellitus requires changes in
the health system that must be aligned with the Model of Care for Chronic
Conditions. The objective of this study was to describe indicators of quality care for
individuals with Diabetes mellitus in a medium-sized municipality in Brazil and to
explore associations among these indicators. Methods: In this cross-sectional,
observational study, physicians, managers, and community health agents filled out a
questionnaire addressing issues related to health care structure and process at 14
primary health care units. We collected clinical and laboratory data from medical
records of patients with Diabetes mellitus attending the primary health care units and
from those referred to a multiprofessional secondary health care center. Categorical
and quantitative variables were analyzed descriptively. Using random-effects linear
regression, we explored the associations between structure and process elements at
the primary health care units and clinical parameters of the users upon their
admission to the secondary health care center. Results: Regarding the structure of
the primary health care units, we observed an insufficient number of both offices
available for multiprofessional care and amount of medications available to the
patients. There was a shortage of professionals, with 53.8% of incomplete teams in
the Family Health Strategy program, as well as a high proportion of problems
reported by physicians and nurses regarding referrals to the secondary health care
unit (70.0%). Also, there were a low percentage (51.2%) of glycosylated hemoglobin
(HbA1c) results (a process indicator) in the medical records. In the medical records
at the secondary health care unit, 18.7% of the patients presented HbA1c levels <
7% and 43.9% had blood pressure levels below 140x90 mmHg. There was no clear
association between structure and process indicators at the primary health care units
and the results of care recorded in the secondary health care units. Conclusion:
Although we detected important structure and process problems in the care of
patients with Diabetes mellitus at the primary health care units, these problems were
not associated with the clinical status of the patients upon their admission to the
secondary health care unit.
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Avaliação da Atenção Primária à Saúde utilizando o indicador de Internações por Condições Sensíveis à Atenção Primária (ICSAP) na perspectiva dos usuários e seus itinerários terapêuticosLomeu, Ana Cláudia de Faria Alves 06 July 2017 (has links)
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Previous issue date: 2017-07-06 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A Atenção Primária à Saúde (APS) configura-se como uma das formas mais abrangentes dos serviços de saúde, contemplando a assistência à população por meio de ações de prevenção e promoção da saúde assim como através de cuidados às doenças crônicas mais prevalentes na população; sendo a Estratégia Saúde da Família (ESF) sua forma de atuação mais próxima da realidade dos usuários. Diante da relevância da APS no cenário de saúde pública atualmente, se fazem presentes muitos estudos que objetivam avaliá-la, sendo abordada neste estudo a avaliação da APS através do indicador de Internações por Condições Sensíveis à Atenção Primária (ICSAP). As ICSAP podem ser definidas como internações por doenças preveníveis através de uma APS eficaz e resolutiva, e os números elevados de ICSAP trazem à tona significados relacionados a problemas pertinentes à APS e como os usuários as vivenciam. Esta vivência dos usuários pelos serviços de APS, abordando as ICSAP torna-se possível através da análise dos caminhos percorridos pelos usuários em busca de cuidados de saúde: os Itinerários Terapêuticos (IT). Diante disto, optou-se por construir um trabalho de pesquisa qualitativa com os objetivos de avaliar a APS baseado no indicador de ICSAP sob a perspectiva do usuário tendo como base os itinerários terapêuticos por eles vivenciados; conhecer os IT percorridos pelos usuários e discutir os fatores relacionados às internações. O cenário do estudo foi o município de Cataguases, Minas Gerais, contemplando trinta participantes que sofreram hospitalizações por CSAP. A partir das histórias ouvidas durante as entrevistas e analisadas através da Análise de Conteúdo de Bardin permitiu-se extrair as seguintes categorias de análise: caracterização dos participantes; a APS na perspectiva dos usuários dos serviços de saúde; os aspectos relacionados ao processo de internação e a análise da APS embasada nos IT percorridos pelos usuários dos serviços de saúde. Os resultados apontaram que a maioria dos participantes se internou por doenças cerebrovasculares (23,3%). Os usuários relataram algumas dificuldades de acesso, bem como nos serviços de referência a consultas especializadas e aporte de exames. Em relação aos aspectos relacionados ao processo de internação observou-se que os usuários mantinham hábitos de vida não saudáveis como tabagismo, e não possuíam conhecimento e adesão às atividades de prevenção e promoção da saúde desenvolvidas pelas ESF do município. Ao analisar intimamente os IT foi possível compreender que os usuários recorrem em sua maioria ao Pronto Socorro (PS) como principal porta de entrada, sendo este fator significativo para repensarmos as políticas voltadas ao entendimento dos usuários acerca da diferenciação da assistência à saúde, bem como de melhorias empregadas na APS. / The Primary Health Care (PHC) is one of most embracing ways of the health service, contemplating the assistance to population by prevention actions and promotion of health as well as care to the most prevalent chronic diseases in the population; being the Family Health Strategy (FHS) the closest form from user’s reality. Given the relevance of PHC in the public health scenario nowadays, there are many studies that aim to evaluated it, being approached in this study the evaluation of PHC through the indicator of Hospitalization Primary Care Sensitivity (HPCS). The HPCS can be defined as the Hospitalizations for preventive diseases through effective and resolutive PHC, and the high numbers of HPCS brings up meanings related to relevant issues to PHC and how users experience it. The users experience by PHC services, approaching HPCS becomes possible through the analysis of the paths covered by the users searching for health care: the Therapeutic Itineraries (TI). In light of this, it was decided to do a qualitative research paper work aiming the evaluation of the PHC basing at the HPCS indicator under user’s perspective grounded on the therapeutic itineraries they experienced; knowing the TI covered by users and discuss the related factors to hospitalizations. The case scenario was the city of Cataguases, Minas Gerais, embracing thirty participants who had been hospitalized for HPCS. From the stories heard during the interviews and analysed through the Bardin Content Analysis was allow to extract the follow analysis categories: participants characterizations, the PHC under user’s perspective; aspects related to the admissions process and PHC analysis based on the TI covered by users. The results indicate that the majority of participants were hospitalized for cerebrovascular diseases (23,3%). Users reported some access difficulties, as well as reference services to specialized consultations and exams fee. Regarding the aspects related to the admissions process, it was observed that the users maintained unhealthy lifestyle habits like smoking, and did not have knowledge and adherence to the prevention and health promotion activities developed by the city's FHS. By analysing TI closely, it was possible to understand that users mostly use the First-Aid Post as the main gateway, being this a significant factor to rethinking the policies aimed the user’s understanding about the differentiation of health care, as well as improvements made in PHC.
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Organizace práce ve zdravotnictví. Případová studie zavádění zaměstnaneckého manuálu na standardním lůžkovém oddělení Nemocnice Pelhřimov / The work organization in health care. The case study implementation of employee manual for standard ward Hospital of PelhřimovPalánová, Anna January 2016 (has links)
The diploma thesis "The organization of work in health care. Case study of implementing employee manual on standard hospital wards Pelhřimov "manual describes the creation of employment for nurses working in inpatient department standard and the introduction of this manual into practice. The work is divided into theoretical part, which consists of five chapters and practical. The theoretical part of the information, human resources management, teamwork, employee evaluation, problem solving and team work quality in healthcare facilities. The practical part describes the process of creating the manual setting of the main goals and sub-goals and progress of cooperation author of the thesis members of the team formed for the creation of the manual. We'll also find an evaluation questionnaire, finding an employee satisfaction nurses manual and usability of information for practice. The result of the research is to determine employee satisfaction to employee maual. Powered by TCPDF (www.tcpdf.org)
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Avalia??o longitudinal do impacto da sa?de bucal na estrat?gia sa?de da fam?lia em NatalLeit?o, Lidiany Vasconcelos 16 May 2012 (has links)
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Previous issue date: 2012-05-16 / As a result of the financial incentive provided by the GM / MS 1.444, since 2000, Brazil has experienced a substantial increase in the number of oral health services at the Family Health Strategy. There is, however, evidence that these teams have produced qualitatively different experiences which do not translate necessarily into improved quality of life and health. Thus, evaluative research of great importance. This study aims to assess the impact of the Family Health Strategy in oral health in a longitudinal perspective natalense the years 2006 and 2009. This is an intervention study whose design is a community trial in parallel, nearly randomized. The sample consisted of census tracts covered by oral health teams in the Family Health and the Traditional Model (Basic Health Units and non-FHS Program of Community Health Agents and areas not covered.) The sample was determined by drawing ten census tracts to form the experimental group and ten other sectors for the control group by pairing intentional based on socio-economic and geographic. To check the net effect of the intervention was performed multivariate analysis by Poisson regression. As a result of cross-sectional analysis of year 2009, it was found that the effects of the ESF in Natal were satisfactory only for the variables of injuries and for other purposes without and with negative impact on stock coverage reclaimers. However, the longitudinal analysis revealed that the ESB / ESF improved their performance in dealing with grievances, access and coverage of the type of actions and this fact is independent of age, sex and social and economic conditions. In other employees' words are related to the presence of the Family Health Strategy in the region. However it does not say that both models under study (the Family Health Strategy Model and Traditional) are different in terms of performance and it is pertinent to reflect on the need for further development of evaluation studies that use other approaches able to clarify the dynamics of the process whose results can come to the knowledge of the actors responsible for leading the ESF and encourage them to incorporate the assessment in their routine / Como resultado do incentivo financeiro estabelecido pela Portaria GM/MS n? 1.444, desde 2000, o Brasil tem apresentado um aumento substancial do n?mero de equipes de sa?de bucal na Estrat?gia Sa?de da Fam?lia. H?, no entanto, evid?ncias de que essas equipes v?m produzindo experi?ncias qualitativamente diferentes que n?o se traduzem, necessariamente, em melhorias na qualidade de vida e sa?de da popula??o. Desse modo, pesquisas avaliativas assumem grande relev?ncia. Este estudo se prop?e a avaliar o impacto da Estrat?gia Sa?de da Fam?lia na sa?de bucal da popula??o natalense numa perspectiva longitudinal dos anos 2006 e 2009. Trata-se de um estudo de interven??o cujo desenho ? um ensaio comunit?rio em paralelo, quase randomizado. A amostra constou de setores censit?rios cobertos pelas Equipes de Sa?de Bucal na Estrat?gia Sa?de da Fam?lia e pelo Modelo Tradicional (Unidades B?sicas de Sa?de com e sem ESF, com Programa de Agentes Comunit?rios de Sa?de e ?reas n?o cobertas). A amostra foi definida por sorteio de dez setores censit?rios para compor o grupo experimental e outros dez setores para o grupo controle atrav?s de emparelhamento intencional baseando-se no perfil s?cio-econ?mico e geogr?fico. Para verificar o efeito l?quido da interven??o foi realizada an?lise multivariada atrav?s da Regress?o de Poisson. Como resultado da an?lise transversal do ano 2009, verificou-se que os efeitos da ESF em Natal foram satisfat?rios apenas para as vari?veis de agravos sendo sem efeitos para as demais e com impacto negativo na cobertura de a??es recuperadoras. Contudo a an?lise longitudinal revelou que as ESB/ESF melhoraram seu desempenho nas quest?es relativas aos agravos, acesso e tipo de cobertura das a??es e este fato independe da idade, sexo e condi??es sociais e econ?micas. Em ouras palavras, est?o relacionadas com a presen?a da Estrat?gia Sa?de da Fam?lia na regi?o. Todavia ainda n?o cabe afirmar que ambos os modelos em estudo (Estrat?gia de Sa?de da Fam?lia e Modelo Tradicional) s?o diferentes do ponto de vista da atua??o. Desse modo, ? pertinente a reflex?o sobre a necessidade de elabora??o de mais estudos avaliativos que utilizem outras abordagens capazes de esclarecer as din?micas do processo cujos resultados possam chegar ao conhecimento dos atores respons?veis pela condu??o da ESF e motiv?-los a incorporar a avalia??o no seu cotidiano
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Aplicação do instrumento worksite health scorecard para avaliar programas de promoção da saúde no ambiente de trabalho de indústrias catarinensesAdão, Izaltina 06 June 2018 (has links)
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Previous issue date: 2018-06-06 / As doenças crônicas não transmissíveis são um problema crescente nos países. Os custos econômicos relacionados ao adoecimento e afastamentos do trabalho não param de aumentar. Empregadores estão implementando programas de promoção da saúde no local de trabalho para melhorar a saúde dos trabalhadores, a produtividade e reduzir os custos com os adoecimentos. Neste sentido, o objetivo principal deste Trabalho Aplicado foi avaliar os programas de promoção da saúde no ambiente de trabalho, oferecidos em uma amostra composta por 114 indústrias do Estado de Santa Catarina. Para isso, aplicou-se o instrumento Worksite Health ScoreCard (HSC) para avaliar o resultado dos programas de promoção da saúde. Foi possível identificar na revisão da literatura que a avaliação dos programas deve se concentrar em questões relevantes e úteis, promover um ciclo contínuo de melhorias de qualidade, eficiência e eficácia dos investimentos, além de identificar lacunas potenciais nas atuais ofertas. O resultado da pesquisa permitiu analisar que, a amostra de 114 indústrias atingiu 23,58% da pontuação máxima possível entre as estratégias e intervenções promotoras de saúde no ambiente de trabalho avaliadas com o HSC. Sobretudo, a pesquisa evidenciou que, os programas de saúde ofertados pelas indústrias participantes, em sua maioria, não correspondem aos conceitos de programas abrangentes, com estratégias e intervenções integradas às principais necessidades de saúde populacional. Notou-se que as estratégias e intervenções promotoras de saúde, aconteceram de forma isolada e não foram priorizadas de acordo com aquelas que são capazes de contribuir com melhores resultados organizacionais e nos comportamentos de saúde, e que refletem nas principais causas de adoecimentos e afastamentos do trabalho. / Chronic non-communicable diseases are a growing problem in many countries. Economic costs related to worker illness and absences continue to rise. Employers are implementing health promotion programs at the workplace to improve worker health, productivity and reduce costs related to illness. In this context, the main objective of this Applied Study was to evaluate health promotion programs at the workplace, offered in a sample composed of 114 industrial sectors in Santa Catarina state. To do so, the Worksite Health ScoreCard (HSC) was used to evaluate the results of health promotion programs. A review of the literature indicated that the evaluation of programs should be focused on relevant and useful issues, promote a continuous cycle of improvements in quality, efficiency and effectiveness of investments, and identify potential gaps in currently offered measures. The study revealed that the sample of 114 industrial sectors attained 23.58% of the maximum possible score for the strategies and interventions they use to promote health at the workplace that were evaluated with the HSC. Above all, the study revealed that most of the healthcare programs offered by participating companies do not correspond to the concepts found in broad programs with strategies and interventions that are integrated to the population’s main health needs. It was found that strategies and interventions that promote health are implemented in an isolated manner and were not given priority by those who are capable of contributing to better results at a company and in health-related behavior. This is reflected in the main causes of illness and work absence.
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Mehrebenen-Evaluation von Maßnahmen der betrieblichen GesundheitsförderungFritz, Sigrun 01 December 2004 (has links)
Die Dissertation beschreibt am Beispiel einer Längsschnittstudie in der Papierindustrie, wie Effekte von Maßnahmen der betrieblichen Gesundheitsförderung in geschätzten ökonomischen Nutzen übertragen werden können. Ausgangspunkt der Untersuchung ist das Variablen-Modell nach Locke und Latham (1990). Darauf aufbauend wurden geeignete Indikatoren und Messinstrumente ausgewählt und in mehreren Voruntersuchungen überprüft. Hauptinstrument ist ein Fragebogen, der im quasiexperimentellen Design zur Ist-Analyse und nach Umsetzung der Maßnahmen eingesetzt wurde. An der ersten Befragung im Oktober 2000 nahmen 320 Gewerbliche und Angestellte des Unternehmens (Rücklauf 89%), an der zweiten drei Jahre später 402 Mitarbeiter (Rücklauf 91%) teil. Für den Längsschnitt standen die Fragebögen von 118 Mitarbeitern zur Verfügung. Neben den Fragebogendaten wurden personbezogene Daten zum Krankenstand erhoben, die auf freiwilliger Basis mit den Fragebogendaten verknüpft wurden, worauf sich 71% der im Jahr 2000 Befragten und 80% der im Jahr 2003 Befragten einlassen konnten. Zur Absicherung der Validität kamen weitere Untersuchungsmethoden zum Einsatz: für 19 Tätigkeiten wurde eine objektive arbeitspsychologische Tätigkeitsanalyse (Pohlandt, Schulze, Jordan &amp; Richter, 2002) durchgeführt, die beteiligten Bereiche wurden in einem Rankingverfahren durch betriebliche Experten eingeschätzt, die organisationale Einbindung der betrieblichen Gesundheitsförderung wurde zu beiden Untersuchungszeitpunkten mit Hilfe des Fragebogens von Breucker (Prävention online, 2000) erfasst, es fanden 22 strukturierte Interviews mit den Beschäftigten zur Einschätzung der durchgeführten Maßnahmen statt. Die Ergebnisse der ersten Mitarbeiterbefragung wurden zurückgemeldet, diskutiert und zu 12 Maßnahmen verdichtet. Diese 12 Maßnahmen wurden in die Zweitbefragung mit aufgenommen, wobei die aktive Beteiligung an ihnen und die Zufriedenheit mit ihrer Umsetzung eingeschätzt werden sollten. Zur Ermittlung der Effizienz wurden eine erweiterte Kosten-Nutzen-Analyse (nach Schmidt, Hunter &amp; Pearlman, 1982) und eine Kosten-Nutzwert-Analyse (nach Rinza &amp; Schmitz, 1992) durchgeführt. Fast alle im Fragebogen erfassten Variablen hatten sich zwischen der ersten und zweiten Befragung signifikant verbessert (Arbeitsintensität, Tätigkeitsspielraum, Motivationspotenzial der Tätigkeit, soziale Unterstützung, sozialen Stressoren, Commitment, Arbeitszufriedenheit, allgemeines Befinden, psychosomatische Beschwerden). Nicht signifikant waren die Änderungen beim (multimodal beeinflussten) Krankenstand, sowie bei der Einschätzung der Führung. Bezüglich der Effektstärke konnte bei 9 der 12 Maßnahmen mindestens ein positiver Unterscheidungseffekt aufgezeigt werden. Bei der Ermittlung des (subjektiv erlebten) Nutzwertes der Maßnahmen kamen alle 12 Maßnahmen in den positiven Bereich. Mit der Kosten-Nutzen-Analyse wurde ein positives Kosten-Nutzen-Verhältnis für 6 der 9 verbleibenden Maßnahmen (zwischen 1:71 und 1:1,5) ermittelt. Diese Ergebnisse wurden kritisch hinterfragt und durch Einbeziehung von Diskontierung, spezifischen Effizienzkriterien, Sensitivitätsanalysen und Worst-Case-Berechnung relativiert (vgl. Anforderungen nach Drummond, O´Brien, Stoddart &amp; Torrance, 1987/1997). Im Vergleich zur Kosten-Nutzen-Analyse wurden bei der Kosten-Nutzwert-Analyse deutlich andere Rangreihen ermittelt. Die kritische Gesamtschau der Ergebnisse ermöglicht spezifische Empfehlungen für fünf Maßnahmengruppen. Es zeigte sich, dass die gemeinsame Erörterung von Kosten-Nutzen-Analyse und Nutzwert zusätzliche und bisher nicht erfasste Aspekte beim Umgang mit den Maßnahmen eröffnet. / The thesis illustrates a longitudinal study in the paper industry. It shows how effects resulting from measures of occupational health promotion may be translated into an estimated economic advantage. The starting point of the study is the high performance cycle (Locke &amp; Latham: 1990). Proceeding from that, appropriate indicators and measuring instruments were selected and tested in several pre-studies. The main instrument is a questionnaire, used in a comparative design before and after the translation of the measures into practice. 320 white- and blue-collar workers took part in the first survey in October 2000 (response rate 89%), whereas 402 workers participated in the second survey which was conducted three years later (response rate 91%). After all, complete data sets for the longitudinal analysis were available from 118 participants. Apart from that personal data concerning absenteeism were used, which were then connected to the questionnaire data on a voluntary basis. Whereas in 2000, in the first survey, 71% of the participants agreed to the connection of their personal data with the questionnaire, 80% agreed to it in the second survey, in 2003. To guarantee the questionnaire?s validity an array of additional methods was used: an objective occupational job analysis (Pohlandt, Schulze, Jordan &amp; Richter, 2002) of 19 different occupations was carried out and the company?s experts evaluated the branches involved by ranking. Furthermore the organizational embedding of occupational health promotion measures was investigated in both surveys with the help of Breucker?s questionnaire (Prevention online, 2000) and additionally 22 structured interviews with the employees took place in order to evaluate the acceptance of the measures conducted. The results of the first employee survey were reported back, discussed and condensed into 12 measures. These 12 measures were then included in the second survey when the employees? active participation in the measures? implementation and their satisfaction with the measures? effects should be evaluated. To determine the measures? actual efficiency an extended cost-benefit-analysis (with reference to Schmidt, Hunter &amp; Pearlman: 1982) and a cost-utility-analysis (with reference to Rinza &amp; Schmitz: 1992) were conducted. Nearly all variables investigated in the questionnaire had significantly improved between the first and the second survey (indicators of job demands, occupational scope, motivational potential of occupation, social support, social stressors, commitment, job satisfaction, well-being, psychosomatic complaints). Changes in (multi-modally influenced) absenteeism and in the evaluation of the management?s style of leadership were not significant. Referring to the effects? impact 9 out of 12 measures proved to be positively significant in at least one criterion, whereas referring to (subjectively felt) utility all 12 measures turned out to be positively significant. In six of the remaining nine measures the cost-benefit-analysis resulted in a positive cost-benefit-relation (between 1:71 and 1:1,5). These results were critically discussed and taking into account discounting, specific result-criteria, sensitivity analyses and worst case assessment (see quality principles by Drummond, O´Brien, Stoddart &amp; Torrance, 1987/1997) finally adjusted. Comparing the cost-benefit and cost-utility analyses resulted in significantly different rankings. The critical overall view allows for specific recommendations for five measure-groups. Finally, the joint discussion of the cost-benefit analysis and utility turned out to open up additional aspects of how to conduct the measures in future, which have not been described so far.
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