Adolescence is a very important transition stage between childhood and adulthood. In this stage, due to rapid change physically and mentally, adolescents are more likely to occur physical, psychological, and social problems. Therefore, providing adolescents fine health service is critical. To do so, having a better understanding of the factors associated with health service utilization can help a lot. The main purpose of this study is to understand adolescents¡¦ behavior of health service utilization. Based on Andersen¡¦s behavior model of health service utilization, this study investigated the associations of predisposing characteristics, enabling resource characteristics, and needing characteristics with health service utilization of adolescents. The data used in these analyses were drawn from students in junior high schools of Tainan Providence, of which seven schools were randomly selected and then anonymous questionnaires were distributed to all students. 2,242 of 3,591 students were collected, for a response rate of 55.39%, and the final sample was 1,989. ANOVA and t test were employed to examine health service utilization of adolescents, and multiple regression was used to investigate the factors associated with health service utilization. Several results were found in this study as follows: First, significant differences did exist among junior high students, which indicated that second graders and third graders went to see doctors more times than first graders did. Second, there were 21% and 12% of respondents with experience of hospitalization and operation respectively. Students with hospitalization and operation experience utilized more health services. Third, students with national health insurance were more likely to utilize health services than those without national health insurance. Last, with regard to the relationship between self-perception of health status and health service utilization, the more respondents perceived themselves with problem of physical health or adolescent development, the more health services they utilized. In addition, the perception of emotional problem was negatively related to the utilization of health services. Several suggestions are proposed. First, establish adolescent clinics in all hospitals that are in the level of district hospitals and above to improve medical accessibility. Second, advocate the system of family physician to emphasize continuity and integrity of health care. Moreover, design appropriate clinical education for adolescents to educate them with adequate concept of health care and health utilization, making them understand the idea of health gradient to receive the right treatment in the right place. Last but not least, the health and education administration should reinforce adolescents¡¦ ability of emotional management, provide assistance for them to find out their emotional problems, and help them to receive appropriate health treatment through psychological consultation of adolescent clinics as soon as possible.

Health care quality become an important issue of hospital¡¦s management while the change of external environment such as the National Health Insurance program implementation and continuously reformed. The medical market turned into the highly-competitive, and patients are more concern their right and the quality of health care. By health quality improvement, hospitals can reduce medical malpractice and decrease the costs of medical administration. Health service quality is also an important factor of patient satisfaction. Increasing health service quality not only can improve patient satisfaction but also increase patient loyalty. And patient can get better medical care through the improvement of health service quality. It will increase their satisfaction and loyalty of hospital. The long-term relationship between hospitals and patients will help hospitals built their better image and reputation. This study applies PZB model and health quality factors to survey gaps of health service, the difference of service quality, patient satisfaction and patient loyalty. The result shows that service quality and satisfaction have positive effect of loyalty. At last, according to critical study findings, this thesis proposes certain suggestion. Wish medical managers can use these results to explore the key problem of health service. Through improvement of health service quality, it may raise patient satisfaction and increase patient loyalty to the hospitals.

Despite growing evidence that anxiety can be a significant problem in late-life, information regarding the use of mental health services by older adults for anxiety is lacking. The current research project consists of three studies focusing on this issue. The first study examines the rates of mental health service use among older adults with anxiety disorders and high levels of anxiety symptoms, as well as individual characteristics associated with this use. The second study examines various aspects of social support as correlates of anxiety disorders in older adults, and the role of social support as an enabling resource for mental health service use. Finally, the third study examines three important outcomes of service use among older adults: treatment satisfaction, perceived treatment effectiveness, and dropout. The data for these studies came from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), a national population-based survey that includes 12,792 respondents aged 55+ years. This research found that older adults with significant anxiety were less likely to use services than those with mood disorders, and that indicators of need for services were the strongest predictors of use. Lower levels of functional social support were related to the presence of anxiety disorders among older adults, and lower levels of perceived emotional/informational support and positive social interactions predicted greater use of services for adults throughout the lifespan. Finally, older adults were generally satisfied with services, perceived them as helpful, and were likely to remain in treatment. Analyses indicated that individual characteristics likely play only a small role in these outcomes. In general, this project provides new and important information that can inform policy, clinical work, and future research regarding late-life anxiety.

Despite growing evidence that anxiety can be a significant problem in late-life, information regarding the use of mental health services by older adults for anxiety is lacking. The current research project consists of three studies focusing on this issue. The first study examines the rates of mental health service use among older adults with anxiety disorders and high levels of anxiety symptoms, as well as individual characteristics associated with this use. The second study examines various aspects of social support as correlates of anxiety disorders in older adults, and the role of social support as an enabling resource for mental health service use. Finally, the third study examines three important outcomes of service use among older adults: treatment satisfaction, perceived treatment effectiveness, and dropout. The data for these studies came from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), a national population-based survey that includes 12,792 respondents aged 55+ years. This research found that older adults with significant anxiety were less likely to use services than those with mood disorders, and that indicators of need for services were the strongest predictors of use. Lower levels of functional social support were related to the presence of anxiety disorders among older adults, and lower levels of perceived emotional/informational support and positive social interactions predicted greater use of services for adults throughout the lifespan. Finally, older adults were generally satisfied with services, perceived them as helpful, and were likely to remain in treatment. Analyses indicated that individual characteristics likely play only a small role in these outcomes. In general, this project provides new and important information that can inform policy, clinical work, and future research regarding late-life anxiety.

Palliative radiotherapy (PRT) is proven to be effective in palliation of symptoms for end-stage cancer patients. However, little is known about its utilization at the end of life. This research aims to examine the utilization and the practice patterns of PRT at the end of life for cancer patients in British Columbia using population-based data. The pattern observed for PRT1Y dose-fractionation practice in BC are in line with published clinical guidelines and evidence from the literature, which advises “proper” use of PRT in BC as delivered to cancer patients at the end of life. However, after controlling for age, primary cancer site, and survival time, geographic access is found to be significantly associated with PRT1Y utilization. Variations found in PRT1Y rates by geographic access, which is operationalized by the Health Services Delivery Area (HSDA) and travel time, suggests potential underutilization of PRT1Y for patients with suboptimal access. / Graduate / 0992 / 0769 / 0574 / jinhuang@uvic.ca

The factors that influence the ultimate level of success or failure of systems development projects have received considerable attention in the academic literature. Two particularly significant areas of interest have been the importance of applying best practice during systems development and the need to explicitly consider organisational issues to ensure a positive organisational impact. However, despite the existence of a well developed best practice literature and an emergent organisational issues literature, many projects still fail. The record of the NHS has been particularly poor in terms of the successful development and implementation of information systems and it was thought that this area would provide a fertile domain for information system research. Whilst the use of information systems in community healthcare has increased greatly over the last ten years the majority of existing research has been conducted in acute hospital environments with little attention devoted to the community sector. Consequently, this research project has two main aims: To identify the key best practice variables and areas of organisational impact associated with the development, implementation and use of a Community Information System (CIS) in National Health Service Trusts; and to examine the relationships between these two sets of variables and the system's resultant level of effectiveness. This research project has a number of positive methodological attributes in that it studies a homogenous organisational sector using a common type of information system and so minimises the potentially confounding influences of sector and system. In addition, the research design involves a three stage approach, combining both quantitative and qualitative research approaches. The research project has produced several key findings. A positive relationship was identified between the adoption of best practice and system effectiveness and similarly, there was a positive relationship between the level of organisational impact and system effectiveness. In order to ensure a positive organisational impact it was found that the successful treatment of key organisational issues is required. In addition, two new variables have been identified, user ownership and positive user attitudes, that play an important mediating role in ensuring system effectiveness. Finally, it was also recognised that the adoption of best practice variables had a dual role, directly influencing the level of perceived system effectiveness but also as a method of effectively managing organisational issues, user ownership and user attitudes. In summary, this study has emphasised the importance of adopting best practice and assessing and managing organisational impact during a community information system development project to ensure system success. These results will be of particular interest to practising IM&T Managers in the NHS and to the wider academic community. A series of practical recommendations are presented at the end of the thesis.

Thesis (Ph. D.)--University of New South Wales, 2004. / Also available online.

Orientador: Antonio Luiz Caldas Junior / Resumo: A condição da acessibilidade aos serviços básicos de atenção à saúde envolve um conjunto de variáveis, tais como: distância entre a moradia e o serviço de saúde, a capacidade de oferta do serviço, a receptividade do funcionário para com o usuário, o intervalo de tempo entre o agendamento e a obtenção da ação de saúde requerida pelo usuário, a necessidade do usuário, entre outras. Como estas variáveis se apresentam e se relacionam entre si, merece ser conhecido, analisado e disponibilizado a todos aqueles que se interessam pelo bom funcionamento do sistema de saúde. O presente trabalho reúne informações que contextualizam teórica e conjunturalmente o objeto de estudo, qual seja, acessibilidade à rede pública de atenção básica à saúde de Botucatu, que aqui é estudada analisando-se o Centro de Saúde "Dr. Sebastião de Almeida Pinto". Para o desenvolvimento deste estudo, realizaram-se 269 entrevistas domiciliares entre moradores da área de abrangência do Centro de Saúde. Também foram coletadas opiniões dos membros da equipe deste serviço estudado através de questionário. Os resultados obtidos indicam, entre outros aspectos, que dos moradores entrevistados na área de abrangência do serviço estudado, 69,5% (IC 90% 64,9% - 74,1%) são usuários e 30,5% (25,9% - 35,1%) não são usuários. Quanto às características demográficas dos moradores entrevistados, tanto usuários, quanto não usuários se concentram na faixa etária compreendida entre 20 e 50 anos de idade. Em relação ao sexo, entre os usuários, a clientela é majoritariamente feminina 84,5% (80,2% - 88,8%), ao passo que entre os não usuários, a distribuição do sexo é mais... (Resumo completo clicar acesso eletrônico abaixo) / Abstract: The accessibility to primary health care comprises a set of variables such as: distance between the house of the user and the health service, service offer, receptivity of the employee towards the user, the time spent between setting the appointment and the assistance required by the user and his necessities. How these variables occur and relate to one another is not only worth being studied and analyzed but it should also be provided to those interested in the appropriate management of the health system. This research gathers information which contextualize in theory and in practice the object of study that is, accessibility to public health service in Botucatu, which is studied through the evaluation of the Health Center "Dr. Sebastião de Almeida Pinto". Two hundred and sixty nine interviews were made in the houses of the population of the area assisted by the Health Center and the opinion of the staff of this service was heard through questionnaires. The results show that among the dwellers of this area 69,5% (CI 90% 64,9% - 74,1%) are users, and 30,5% (25,9% - 35,1%) are non users. As to demographic characteristics, users as well as non-users, the age ranges from 20 to 50 years old. As to gender, among the users, the clientele is mostly female 84,5% (80,2% - 88,8%) but among the non-users sex distribution is more balanced 40,2% (31,4% - 49,1%) men and 59,8% (50,9% - 68,6%) women. Considering the relationship to the Health Center mainly the... (Complete abstract click electronic access below) / Mestre

This thesis is a critical and post-structural exploration of the discourse of managerialism in the NHS secondary care sector in Wales. Its central intent is to destabilise the dominant thinking about NHS management practice and to evoke intellectual debate about alternative discourses of management that ontologically perceive the organisation as a complex adaptive human system. The emergent theoretical framework conjoins the discipline of Complexity with post-structural conjecture, posing a novel conceptualisation of a fractal self where relations of power are seen as essential for harmonising diverse influences and legitimising a local discourse that informs and regulates practice. Using Foucault’s insights on power and knowledge the thesis critiques the strategic nature of NHS discourse, exposing the discursive dominance of managerialism and its inherent relations of power and debates what this predicates for a local negotiation and a flexible, safe and innovative environment. The methodological approach employs a reflexive and micro-level interpretative strategy to emphasise the singularity of agents and to explore the way in which the discursive constitution of the self influences agent practice. My profound experience of the secondary care system requires I situate my self reflexively within the context where I explore and liberate my own voice in conjunction with my participants. The research adopts a biographical narrative method of data collection and uses Foucauldian discourse analysis as a framework for exploring the underlying discourse in agent stories. The findings demonstrate the polyphonic nature of the secondary care context and reveal the demonstrate the polyphonic nature of the secondary care context and reveal the diverse ways in which agents legitimise, negotiate or resist the conflicting truth claims of various discourse in order to strategically sustain an image of health care historically constituted in their self. The results portray a web of discourses that endorse conformity or complicity through oppressive mechanisms of disciplinary control and surveillance, perpetuating authoritative and dualist structures, dissipating relations of trust and removing intellectual thinking from the front-line. The conclusion asserts that this significantly jeopardises the ability of agents to legitimise local ‘discourse’, severely limiting their capacity for adaptive practice and the generation of new order.

There is growing evidence that the way patients and families relate to healthcare professionals influences their experience of illness and healthcare, and may affect their psychological and physical wellbeing. Relationships between professional groups may also have a significant impact on healthcare provision to children and families. Previous research has focused on dyadic relationships within paediatric healthcare (mother and child, nurse and parents, doctors and nurses), but little has been published concerning the complex inter-relationships and roles of family members, doctors and nurses. The aim of this research was to undertake a systemic analysis of the roles and relationships of nurses and doctors with children, adolescents and families. A qualitative methodology was used to explore how the three groups (nurses, doctors and families) understand their respective roles and relationships in the care of ill children within a tertiary paediatric hospital. While systemic and social constructionist theory informed the overall conception of the study, grounded theory was the method used for structuring data collection and analysis. Data collection involved semi-structured interviews with doctors, nurses and families. These were audio-taped and each set of transcripts analysed according to grounded theory principles. Theoretical coding then allowed comparisons to be made across each set of data. Two theoretical categories describing key processes involved in the care of ill children emerged from the analysis. These were: “Building emotional connections and focusing on medical goals: complementary or contradictory relationship discourses for families and staff?” and “Shifting relationships around expertise and power: the gains and losses associated with new positionings” The first category highlights that both professionals and families appear to draw on particular societal discourses to inform their roles and relationships. These discourses (about the therapeutic value of emotional connections between staff and families and the need for ‘medical professionalism’) can appear at odds with each other. creating tensions and dilemmas for each group. The second theoretical category highlights that power relationships between nurses, doctors and families are in a process of change. Fundamental change may be hard to achieve however, as each group may experience losses and well as gains in their emerging positions. It is further argued that changes in government policy relating to these core processes creates challenges for each participant group as they struggle to balance positive working relationships, the medical care of the child and status and power issues. Change in any one aspect of these professional and family roles and relationships may have both adverse and beneficial effects, which need to be recognised. These findings raise important questions about the feasibility and desirability of family centred care. The implications of this research for training, consultation and future research are explored. The research adds to a small but growing body of literature focusing on the interface between professionals, patients and families in healthcare settings.