Thesis (M Med (Family Medicine)) -- University of Limpopo, 2010. / Background: Many patients move from one healthcare provider to another, disturbing the continuity of holistic patient care. Objectives: The aim of this study is; to investigate the reasons why patients leave their nearest clinic, and to determine if these patients are able to use the provided care when they need to. Methods: A cross-sectional, quantitative study was conducted during the winter of 2010. Questionnaires were given to 350 patients attending Karen Park Clinic. Patients completed the questionnaires in the presence of the researcher, who was able to assist where needed. Variables addressed in the questionnaire included: place where they stay; if they visited their nearest clinic; what services there are at their nearest clinic; would they go back to their nearest clinic and if not, what would be the reasons. Results: The majority of respondents stayed in Soshanguve, 153 (43.7%), Mabopane 92(26.3%)Garankuwa, 29(8.3%)and Hebron 20(5.7%), Most ofthe respondents were females 271(77.4%), with 177 (50.6%)aged between 26 and45years. Eighty percent of patients indicated that they visited their nearest clinic and 191(54.6%) said that they will not return to that clinic. The reasons for not returning to the nearest clinic were: - no medication, 39(11.1%); long queues, 59(16.9%); rude staff, 59(16.9%); long waiting time to be helped, 88(25.1%) and other, 63(18.0%). Conclusion: The researcher found that many patients, who first attended their nearest clinic, opted not to return. Reducing long waiting times and long queues at a primary health care centre can be achieved. Satisfied health care providers would provide quality service to patients. Training courses for management committee members could lead to improving the health center's management and patients could be redirected to their nearest clinic by giving them referrals or transfer letters. Purchasing enough medicine will reduce the problem of no medication and increase the capability of the health center. Staff should receive training about health care practices, to reduce the rude behaviors that drive patients away.

The study investigated the accessibility and use of health information within the lower echelons of Primary Health Care service delivery. Hence, it focused on women and health workers' experiences with information in rural Uganda. Face-to-face interviews were conducted using an interview schedule that consisted of open questions and one relating to health information critical incidents. The qualitative interviews added depth, detail and meaning at a very personal level of experience. A holistic inductive paradigm was used in the study with a grounded theory analysis. This approach was adopted because of its ability to generate findings inductively from empirical data. An 'Interaction-value model' emerged from the study. The model was driven by the value and impact of information unlike previous information models which have been driven by information needs. This study has demonstrated that although an information need could trigger off an information activity, the subsequent information process could only be sustained by the value of information. Hence, access and use of information depends on the value and impact of information to overcome or reduce constraints. The value of information is therefore the core category, while the moderation of constraints and interaction with sources for latent or apparent needs are the two main categories that make up the model. The study has also shown that not all information users are active seekers. The main difference between the two groups of interviewees was that health workers' needs were generally apparent and led to active information seeking, whereas the women's needs were generally latent. Women mainly accessed information passively. Passivity, however, was generally limited to the act of accessing information. After passive information access, the subsequent user behaviour was active. Hence, women passively accessed information, but actively used it. Women's information behaviour was therefore dynamic. This was confirmed throughout the study when, for example, their information needs changed from latent to active and vice versa. The difference in the findings appears to stem from the fact that for women, the process of information access and use was dependant on the relationship and interaction between their social and information environment in everyday life; while for the health workers, professional matters added a further dimension to their information activities. The ways in which women and health workers accessed and used information as elaborated in this study have a number of implications for improving information provision, policies, training of health workers, and further research.

O tempo é importante para o homem nas diversas áreas do conhecimento porque tem uma finalidade em cada área, por isso, é estudado, medido, analisado, avaliado de maneira tanto qualitativa como quantitativa. A questão do tempo de serviço, neste caso, o serviço de saúde, em algumas situações em que ocorre a demora no atendimento leva a formação de fila que faz a espera inevitável. A qualidade é reconhecida como um constructo multidimensional, com vários atributos e visões. Vários pesquisadores desenvolveram ou adaptaram um instrumento para medir qualidade de serviços de saúde e muitos estudos realizados revelaram que ainda ocorre a formação de longas filas para atendimento do paciente. O objetivo deste trabalho é a avaliação da perspectiva do paciente da qualidade de serviços de saúde na rede pública e privada de saúde, focada na análise do tempo de consulta médica. Visa fornecer informações para melhorar e auxiliar a tomada de decisão dos gestores de instituições de saúde sobre a qualidade de serviços de saúde prestados. A análise quantitativa de dados usou o teste de significância não-paramétrico, com o teste com sinais Wilcoxon, usado para pares conjugados e a análise qualitativa usou a técnica descritiva. O instrumento de coleta de dados baseou-se na SERVQUAL, utilizada para avaliação de qualidade de serviços de saúde. O desenvolvimento da pesquisa empírica ocorreu nas instituições de saúde da cidade de Ribeirão Preto devido sua importância no campo da saúde. Concluiu-se que as instituições de saúde que apresentaram o menor tempo de consulta médica também receberam um grau menor sobre a avaliação de qualidade em relação às outras instituições. / Time is important for the man in various areas of knowledge because it has a specific purpose in each area; therefore, time is studied, measured, analyzed and evaluated in a qualitative and quantitative way. The duration of the service provided by an organization, in this case a health care organization, sometimes leads to situations in which the delay in the appointments may result in queue lines, obliging the patients to wait, in order to receive health care assistance. The quality of the service provided by these organizations is mostly recognized as a multidimensional construct, with many attributes and points of view. Several researchers have developed or modified instruments to measure health care service quality and, most of the surveys conducted, have revealed that there is still formation of long queues for attendance of the patient. The objective of this study is the evaluation of the patient?s opinion about the quality of the health care service provided by public and private organizations, with emphasis on the analysis of the duration of medical consultation. This study also aims to gather data that could improve the decisions which have to be made by managers from health care institutions, regarding mainly the health care service quality rendered to patients. The quantitative data analysis, on one hand, was done using the significance test nonparametric, in addition with the Wilcoxon signed ranks test, which was used for conjugated pairs. The qualitative analysis, on the other hand, was done with the descriptive technique. The tool used to collect data was based on SERVQUAL, which evaluated the quality of health care services. The site chosen for the development of the empirical research was the city of Ribeirão Preto, state of São Paulo, Brazil, due to its importance in the area of health care assistance. The conclusion revealed that the health care facilities, which presented the shortest length during appointments with the patients, also received a smaller grade regarding the quality evaluation, in comparison to the other facilities.

O tempo é importante para o homem nas diversas áreas do conhecimento porque tem uma finalidade em cada área, por isso, é estudado, medido, analisado, avaliado de maneira tanto qualitativa como quantitativa. A questão do tempo de serviço, neste caso, o serviço de saúde, em algumas situações em que ocorre a demora no atendimento leva a formação de fila que faz a espera inevitável. A qualidade é reconhecida como um constructo multidimensional, com vários atributos e visões. Vários pesquisadores desenvolveram ou adaptaram um instrumento para medir qualidade de serviços de saúde e muitos estudos realizados revelaram que ainda ocorre a formação de longas filas para atendimento do paciente. O objetivo deste trabalho é a avaliação da perspectiva do paciente da qualidade de serviços de saúde na rede pública e privada de saúde, focada na análise do tempo de consulta médica. Visa fornecer informações para melhorar e auxiliar a tomada de decisão dos gestores de instituições de saúde sobre a qualidade de serviços de saúde prestados. A análise quantitativa de dados usou o teste de significância não-paramétrico, com o teste com sinais Wilcoxon, usado para pares conjugados e a análise qualitativa usou a técnica descritiva. O instrumento de coleta de dados baseou-se na SERVQUAL, utilizada para avaliação de qualidade de serviços de saúde. O desenvolvimento da pesquisa empírica ocorreu nas instituições de saúde da cidade de Ribeirão Preto devido sua importância no campo da saúde. Concluiu-se que as instituições de saúde que apresentaram o menor tempo de consulta médica também receberam um grau menor sobre a avaliação de qualidade em relação às outras instituições. / Time is important for the man in various areas of knowledge because it has a specific purpose in each area; therefore, time is studied, measured, analyzed and evaluated in a qualitative and quantitative way. The duration of the service provided by an organization, in this case a health care organization, sometimes leads to situations in which the delay in the appointments may result in queue lines, obliging the patients to wait, in order to receive health care assistance. The quality of the service provided by these organizations is mostly recognized as a multidimensional construct, with many attributes and points of view. Several researchers have developed or modified instruments to measure health care service quality and, most of the surveys conducted, have revealed that there is still formation of long queues for attendance of the patient. The objective of this study is the evaluation of the patient?s opinion about the quality of the health care service provided by public and private organizations, with emphasis on the analysis of the duration of medical consultation. This study also aims to gather data that could improve the decisions which have to be made by managers from health care institutions, regarding mainly the health care service quality rendered to patients. The quantitative data analysis, on one hand, was done using the significance test nonparametric, in addition with the Wilcoxon signed ranks test, which was used for conjugated pairs. The qualitative analysis, on the other hand, was done with the descriptive technique. The tool used to collect data was based on SERVQUAL, which evaluated the quality of health care services. The site chosen for the development of the empirical research was the city of Ribeirão Preto, state of São Paulo, Brazil, due to its importance in the area of health care assistance. The conclusion revealed that the health care facilities, which presented the shortest length during appointments with the patients, also received a smaller grade regarding the quality evaluation, in comparison to the other facilities.

Magister Public Health - MPH / Primary Health Care (PHC) services in Namibia are based on the principles of equity,availability, accessibility, affordability of services, and community participation and empowerment. According to the Namibian Constitution and the National Health Policy,all Namibians should have equal access to public health services at no cost to the patient.The government places a high premium on the involvement of communities in PHC through communication, consultation and respectful interaction between health workers and patients and communities in the interests of quality service delivery. Services provided at PHC facilities include immunisations, antenatal care, post-natal care, family planning, health education, tuberculosis and malaria treatment, outreach services, antiretroviral treatment (ART), and the Prevention of Mother to Child Transmission(PMTCT) programme. Numerous complaints have been received from patients relating to patients' admissions at clinics, long waiting hours, over-crowded facilities, poor communication between patients and nurses, and non-availability of some medications and medical officers at some of the PHC facilities.This study investigated patient satisfaction and the reasons for reported poor nursepatient relations at PHC facilities in Khomas region in Namibia. The objectives of the study were to describe patient’s perceptions concerning quality of service delivery at PHC clinics, to explore factors related to the clinic environment that might influence perceived quality of care and to describe the nature of nurse-patient relations. Methodology A descriptive, qualitative study was conducted among randomly selected patients (15) and registered nurses (5) at five purposively selected PHC clinics in Khomas region, in the Windhoek district. Five sisters-in-charge from the designated facilities were interviewed as key informants.Data was collected through key informant interviews and focused interviews with nurses and patients, respectively. Data on the participants’ experiences and perceptions of using the health services, as well as factors influencing nurse-patient relations and patient satisfaction was collected. Interview data was recorded on audiotape and transcribed verbatim. Data from key informants was captured in field notes. Thematic analysis of transcribed data was conducted.Results Low patient satisfaction with services was confirmed as a key problem facing four out of the five health facilities visited in Khomas region. Patient dissatisfaction was mostly related to the long waiting times, which in turn, was caused by increased patient numbers as a result of the escalating HIV/AIDS and tuberculosis (TB) epidemics, ART roll out and increased immigration to Windhoek. Other factors attributed to low patient satisfaction were poor communication between health providers and patients, nonavailability of family planning and immunisation services, and frequent stock-outs of some prescribed medicines.ConclusionsThe findings of this study support the need to rethink nurse-patient relations for greater patient satisfaction and quality of service delivery in the public Primary Health Care facilities in Khomas region. Greater care should be taken to inform patients about service days and the staffing limitations at health facilities, and to educate and empower patients for self-care. Communication strategies should target negative perceptions about service delivery at PHC clinics in the communities. In-service training in areas like case management, different PHC disciplines and communication skills are needed to improve the competency of nurses. In addition, motivation of nurses needs to be addressed through recognition and appreciation from management in order to avoid frustrations and negative attitudes towards patients. Motivation of nurses can be improved by paying attention to their work environment and the physical structure of health facilities.

Yes / This paper aims to evaluate the implementation of innovative programmes within the downstream domain of the pharmaceutical supply chain (PSC), with the aim of informing improved service provision. A mixed-method approach was used to assess to what extent innovation could be adopted by hospital and community pharmacies to improve the delivery process of pharmaceutical products. Unstructured interviews and 130 questionnaires were collected and analysed to identify factors that facilitate or prevent innovation within PSC processes. The analysis led to the creation of the innovative pharmaceutical supply chain framework (IPSCF) that provides guidance to health-care organisations about how supply chain management problems could be addressed by implementing innovative approaches. The results also indicated that the implementation of Lean and Reverse Logistics (RL) practices, supported by integrated information technology systems, can help health-care organisations to enhance their delivery in terms of quality (products and service quality), visibility (knowledge and information sharing), speed (response to customers and suppliers needs) and cost (minimisation of cost and waste). The study’s recommendations have potential implications for supply chain theory and practice, particularly for pharmacies in terms of innovation adoption. The IPSCF provides guidance to pharmacies and health-care organisations to develop more efficient and effective supply chain strategies. This research contributes to the academic literature as it adds novel theoretical insights to highly complex delivery process innovation.

No description available.

Introduktion: Våld i nära relationer är ett globalt fenomen och utgör ettåterkommande inslag i arbetet inom hälso- och sjukvården, polismyndigheten ochsocialtjänsten. Våld i nära relationer förekommer i alla samhällsklasser, åldrar,oavsett sexuell läggning och är inte relaterad till vare sig etnicitet, kulturell ellerreligiös bakgrund. Det finns flertal myndigheter som ger skydd och stöd tillvåldsutsatta. För att säkerställa ett professionellt omhändertagande av denvåldsutsatta måste de olika myndigheterna samverka. Forskning visar dock attsamverkan ofta brister vilket kan resultera i ett försämrat omhändertagande av dendrabbade individen.Syfte: Att undersöka vilka faktorer som är av betydelse för myndigheterssamverkan vid vuxnas utsatthet för våld i nära relationer, utifrån hälso- ochsjukvårdens, polismyndighetens, och socialtjänstens perspektiv.Metod: Studien är en integrativ litteraturstudie. Litteratursökningarna eftervetenskapliga artiklar genomfördes i databaserna Cinahl, Pubmed, Criminal justiceabstracts, Social services abstracts, Psycinfo och Social science premium collection.De för studien relevanta artiklarna har kvalitetsgranskats, kodats, kategoriserats ochanalyserats enligt gällande metod.Resultat: Resultatet baseras på tio vetenskapliga artiklar och visar att det finns ettflertal faktorer som har betydelse för myndigheters samverkan vid våld i närarelationer. Faktorer som kunskap, organisation, kommunikation och kultur har idenna studie visat sig vara särskilt utmärkande. Dessa faktorer kan verka bådehämmande och främjande beroende på rådande omständigheter inom respektivemyndighetSlutsats: Samverkan mellan myndigheter är en absolut förutsättning för ett adekvatomhändertagande av den individ som utsatts för våld i en nära relation. Fenomenetmedför en komplex problematik. Det finns ett uppenbart utbildningsbehov för flerayrkeskategorier, främst gällande identifikation och bemötande av den våldsutsattasamt klargörande kring de olika myndigheternas olika ansvarsområden ochbefogenheter. Arbetet bör i framtiden organiseras utifrån den drabbades behov avolika hjälpinsatser istället för att som idag utgå från de olika myndigheternasrespektive kompetensområde.

The rising complexity in healthcare, exacerbated by an ageing population, results in ineffective decision-making leading to detrimental effects on care quality and escalates care costs. Consequently, there is a need for smart decision support systems that can empower clinician's to make better informed care decisions. Decisions, which are not only based on general clinical knowledge and personal experience, but also rest on personalised and precise insights about future patient outcomes. A promising approach is to leverage the ongoing digitization of healthcare that generates unprecedented amounts of clinical data stored in Electronic Health Records (EHRs) and couple it with modern Machine Learning (ML) toolset for clinical decision support, and simultaneously, expand the evidence base of medicine. As promising as it sounds, assimilating complete clinical data that provides a rich perspective of the patient's health state comes with a multitude of data-science challenges that impede efficient learning of ML models. This thesis primarily focuses on learning comprehensive patient representations from EHRs. The key challenges of heterogeneity and temporality in EHR data are addressed using human-derived features appended to contextual embeddings of clinical concepts and Long-Short-Term-Memory networks, respectively. The developed models are empirically evaluated in the context of predicting adverse clinical outcomes such as mortality or hospital readmissions. We also present evidence that, surprisingly, different ML models primarily designed for non-EHR analysis (like language processing and time-series prediction) can be combined and adapted into a single framework to efficiently represent EHR data and predict patient outcomes.

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