Thesis (Ph.D.) - University of St Andrews, April 2009.

Thesis (Ph.D.)--University of Missouri-Columbia, 2004. / Typescript. Vita. Includes bibliographical references (leaves 296-305). Also available on the Internet.

Thesis (M. A.)--University of British Columbia, 2006. / Includes bibliographical references.

Thesis (M.S.)--State University of New York at Binghamton, Department of Systems Science and Industrial Engineering, 2007. / Includes bibliographical references.

The aim of operations management in health care is to enhance the provision of services to patients and to decrease costs. Overall worldwide health care expenditures represent around 10.5% of the global GDP and are projected to increase at an annual rate of 5.3% from 2015 to 2017 [74]. In order to investigate how to curb health care costs, I study the English NHS, a health care system that provided universal care to around 54 million people in 2014 [243]. The NHS has launched many initiatives to improve the performance of hospital operations such as the "QIPP" program, which has the objective to save £20 billion of costs by 2015 [98]. Given this framework, this research aims to contribute to the theory that is guiding these operational changes, using data on all admissions to hospitals and focussing on the inguinal hernia, one of the most common surgical procedures [86]. In the next chapters, this research describes inguinal hernia care delivery in the English NHS, examines the impact of spillovers and complementarities on costs, and investigates the effects of length of stay reduction on risk of re-admission and risk of death. The findings of this thesis indicate that one of the possible problems in the delivery of inguinal hernia care in the NHS is the decrease in the number of elective operations performed and the increase in readmission rates. They also clarify how decisions on allocation of resources can affect hospital expenditures by showing that loss in focus can increase health care costs and by pointing out that there is little evidence to support the theory of spillovers and complementarities in the surgical context. Finally, the results of this research can be used to suggest the logic of a policy to decrease length of stay that can inform hospital decisions and can decrease hospital costs.

The retention of persons on an HIV programme has been a global challenge. The success of any strategy to optimize adherence to anti-retroviral therapy (ART) depends on the intensive and effective adherence counselling and strategies. It is important to research whether persons receiving anti-retroviral therapy in public hospitals in Ghana are receiving the needed service that would optimize their adherence to the anti-retroviral therapy. Therefore, this study explored and described the experiences of healthcare professionals providing care, support and guidance to persons on ART at public hospitals in Ghana, as well as the best-practice guideline that could contribute to facilitating the ART adherence of patients. This study also explored and described the experiences of persons living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) on ART, regarding their adherence to the therapy. The study was organized into three phases. In Phase One: a qualitative, exploratory, descriptive and contextual design was employed. The research population included healthcare professionals, providing services at the HIV clinic at the public hospitals in Ghana, namely the Korle-Bu Teaching Hospital; the 37 Military Hospital and the Ridge Hospital. The healthcare professionals comprised of doctors, nurses, pharmacists and trained counsellors employed in any of the three public hospitals. Persons receiving ART at any of the three public hospitals were also part of the research population. Semi-structured interviews were conducted with healthcare professionals and persons receiving ART. Data were collected from healthcare professionals in relation to their experiences regarding the provision of ART services, their understanding of evidence-based practice and best-practice guidelines, as well as data on the experiences of persons receiving ART in relation to their adherence to the therapy. The data were analysed using Creswell’s six steps of data analysis; and the coding of the data was done according to Tesch’s eight steps of coding. Trustworthiness was ensured by using Lincoln and Guba’s framework which comprised credibility, transferability, dependability, confirmability and authenticity. Ethical principles such as beneficence and non-maleficence, respect for human dignity, justice, veracity, privacy and confidentiality were considered in the study. In phase two, the literature was searched by using an integrative literature review approach and critically appraising the methodological quality of the guidelines in order to identify the best available evidence related to adherence to ART. In Phase Three, a best-practice guideline for facilitating adherence to ART was developed for public hospitals in Ghana based on the findings of the empirical research of Phase One and the integrative literature review in Phase Two. The guideline was submitted to an expert panel for review; and it was modified, according to the recommendations of the panel.

Orientador: Luiz Carlos de Oliveira Cecilio / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T00:32:05Z (GMT). No. of bitstreams: 1 Pereira_JoceleneBatista_D.pdf: 38372542 bytes, checksum: 4bb3070c799aff463c9e2d4d0f4156f2 (MD5) Previous issue date: 2006 / Resumo: O presente trabalho estudou a assistência aos portadores de hipertensão arterial, sob a ótica da integralidade do cuidado, na região de abrangência da Coordenação de Saúde de São Miguel Paulista, no município de São Paulo-SP. Foram realizadas entrevistas estruturadas com 804 usuários do serviço de urgência/emergência do Hospital Municipal Tide Setúbal, referência hospitalar da região, identificando potenciais hipertensos e investigando suas referências para a assistência, possíveis complicações, adesão ao tratamento e eventuais mudanças no estilo de vida em decorrência da doença. Os resultados mostraram prevalência de 18% de potenciais hipertensos no pronto-socorro, utilizando-se como critério de corte os valores de 140x90mmHg (associados ou isolados), segundo recomendações do protocolo da Sociedade Brasileira de Hipertensão Arterial, sendo que metade desconhecia sua condição de risco para hipertensão arterial.Também foram realizados grupos focais com médicos e gerentes das unidades de saúde da região, visando fazer uma caracterização da visão dos mesmos com relação à doença, ao comportamento dos pacientes e às dificuldades para se tratar a hipertensão arterial. Os pacientes que fizeram o diagnóstico na UBS/PSF mencionaram maior adesão aos medicamentos (80%) e menor proporção de internações (19,5%), quando comparados com aqueles que fizeram diagnóstico no pronto-socorro ou outro serviço Só houve associação estatística significante entre o local de diagnóstico UBS/PSF e hábitos que adotou após saber da HA, com os itens ir ao médico regularmente e fazer exames complementares de controle. Não se encontrou uma associação estatística significante entre local de diagnóstico e outros hábitos, como diminuição do sal, diminuição de gorduras, prática de exercícios físicos regulares, emagrecimento e controle do estresse Mas diminuir sal e gorduras na alimentação, emagrecer, ir ao médico regularmente e fazer exames complementares de controle da HA, apareceram como associadas estatisticamente a menores índices de internação No entanto, 10% dos hipertensos entrevistados durante a pesquisa declararam que não farão seguimento ambulatorial. Nos grupos focais, a necessidade de vínculo, escuta e equipe multidisciplinar é reconhecida pelos profissionais de saúde, mas prevalece uma marcada opinião de que os pacientes são "rebeldes", "resistentes" e não "obedecem" ao tratamento proposto, o que denota uma visão ainda muito normativa e autoritária dos profissionais em relação aos usuários que são acompanhados nos serviços de saúde, possivelmente dificultando o reconhecimento de suas necessidades singulares Os profissionais reconhecem a dificuldade de integração da equipe para o trabalho coletivo, mostrando contradição entre a prática efetiva cotidiana e o discurso idealizado da necessária integração e complementariedade do trabalho dos profissionais de saúde. O estudo permite afirmar que não há integralidade na atenção prestada aos hipertensos da região estudada, não havendo a configuração de uma rede articulada de serviços que assuma, efetivamente, a responsabilização e acompanhamento dos hipertensos / Abstract: This paper deals with the attendance to the hypertensive people, from the point of view of the care integrality, in the area of São Miguel Paulista Health Coordination, São Paulo city. State of São Paulo. Structured interviews were accomplished with 804 users of the urgency and emergency service of the Municipal Hospital Tide Setúbal, a reference hospital in the region, in order to identify potential hypertensive people and to investigate their references about the attendance, any possible disease complications, their adhesion to the treatment and occasional lifestyle changes resulted from the disease The results showed prevalence of 18% potential hypertensive people in the hospital emergency room - using the reference value of 140x90mmHg (associated or isolated), according to the protocol of the Brazilian Society of Arterial Hypertension recommendations - half of them ignoring their risk condition for the disease. The methodology also accomplished focal groups with doctors and managers of the health units in the area, focusing to characterize their vision about the disease, about the patients' behavior and about the difficulties of treating arterial hypertension The patients diagnosed by UBS/PSF mentioned larger adhesion to the medicines (80%) and smaller proportion of hospitalization (19,5%), when compared with those that were diagnosed in the emergency room or other services. There only was significant statistical association between the diagnosis place (UBS/PSF) and the habits adopted after knowing that they have HA, such as going regularly to the physician office and doing complementary control exams. There was no significant statistical association between the diagnosis place and other habits, such as salt and fat decreasing, regular exercising, loss of weigh and stress control. But, decreasing salt and fat, losing weight, attending regularly the physician and doing complementary control exams are events statistically associated to smaller hospitalization indexes. However, 10% of the hypertensive people interviewed during the research declared that they won't submit themselves to ambulatory follow up. The members of the focal groups recognized the necessity of the linkage between patients and physicians, the importance of hearing them and the existence of a multidisciplinary equip, but it prevailed the opinion that the patients are "rebellious", "resistant" and do not "obey" the proposed treatment, what denotes a still very normative and authoritarian vision of the professionals towards the patients attended by the health services, what may difficult the recognition of their singular needs. The professionals recognized the difficulty to integrate the team for collective tasks, showing contradiction between the daily effective practice and the idealized speech about the work integration. The results of this paper allows to affirm that there is no integrality in the attention offered to the hypertensive people of the studied area, and also that there is no articulate net of services that effectively should assume the responsibility on and the accompaniment of the hypertensive people / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

Orientadores: Maria Cecília Marconi Pinheiro Lima, Maria de Fátima de Campos Françozo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T01:04:00Z (GMT). No. of bitstreams: 1 ArdinghiBrollo_MariaLuiza_M.pdf: 3510871 bytes, checksum: 5b33da3ad30af3f705aead6a6043024c (MD5) Previous issue date: 2014 / Resumo: Vários aspectos da estrutura social estão envolvidos com a construção das políticas de saúde. As tensões decorrentes de olhares distintos para problemas comuns, a organização das ações e a escolha das prioridades, o exercício continuado das relações de poder. Estudar as políticas de saúde e a organização dos serviços não é tarefa pouco complexa. No caso das políticas de saúde voltadas às pessoas com deficiência, uma diretriz importante é um maior grau de equidade no acesso desta população às ofertas de saúde para satisfazer suas necessidades na busca de bem estar físico e psíquico. Este trabalho se propôs a analisar a implantação da Câmara Técnica de Reabilitação da Secretaria Municipal de Saúde de Campinas, como um instrumento de gestão pública. Para tanto, foi realizado um estudo qualitativo, por meio de pesquisa de fontes documentais relacionadas com a atenção à pessoa com deficiência desta secretaria. Dentre os documentos estudados, encontravam-se prospectos, atas de reuniões, relatórios e manuais, buscando-se neles os fatos e acontecimentos relacionados com a implantação da Câmara Técnica. Além disso, foram analisados questionários aplicados pelo gestor da área de reabilitação aos trabalhadores do Centro de Referência em Reabilitação, cuja finalidade era, na época, avaliar o trabalho realizado pelo grupo e planejar futuras ações. Os resultados permitiram a elaboração de um breve histórico da reabilitação no município de Campinas, contextualizando a concepção da Câmara Técnica; evidenciaram a área de reabilitação se organizando e adquirindo visibilidade na estrutura da Secretaria Municipal de Saúde; destacaram o estudo de um manual que evidenciou a organização de uma rede de atenção pautada na colaboração entre seus serviços; permitiram, na leitura das atas das reuniões da Câmara Técnica, a correlação das propostas apresentadas com fatos descritos na época. A análise dos conteúdos dos questionários ressaltou três eixos principais: a percepção de uma rede de serviços voltada à reabilitação; a constatação de mudanças internas, subjetivas nos trabalhadores que participaram da Câmara Técnica e a compreensão da interdisciplinaridade e intersetorialidade pelos mesmos. Nas falas dos trabalhadores foi possível evidenciar a autonomia do grupo técnico e de seus usuários na medida em que conheceram seus pares e se organizaram numa rede de ações e saberes. Nas falas desses trabalhadores percebemos a figura do trabalhador-cidadão que se sente parte integrante do problema e da solução / Abstract: Various aspects of social structure are involved in the construction of health policies. Tensions arising from distinct looks for common problems, the organization of actions and the choice of priorities, the continued exercise of power relations. Studying health policies and the organization of services is not just a complex task. In the case of health policies for people with disabilities, an important guideline is a greater degree of equity of this population to access health offering in order to meet their needs in the search of physical and mental well-being. This work proposed to analyze the implantation of the Municipal Secretary Health of Campinas¿ Technical Chamber of Rehabilitation as an instrument of public management. Thus, it was done a qualitative study, based on the research of documentary sources relating to the care for people with disabilities inside this organization. Among the documents studied, there were leaflets, minutes of meetings, reports and manuals, seeking in them the facts and events related to the implantation of the Technical Chamber. In addition, questionnaires applied by the rehabilitation area manager to the workers of the Rehabilitation Reference Center, whose purpose was, at the time, to evaluate the work done by the group and to plan activities for the coming year. The results allowed, in principle, the survey of a brief history of rehabilitation in the borough of Campinas, contextualizing the conception of the Technical Chamber; showed the area of rehabilitation being organized and getting visibility inside the Municipal Secretary of Health's structure; emphasized the study of a manual that showed the organization of a care network based in the collaboration between its services; allowed, in the reading of the minutes of the Technical Chamber's meetings, the correlation of proposals with facts described at the time. The analyses of the content of the questionnaires highlighted three main axes: the perception of a network of services aimed at rehabilitation; the finding of internal and subjective changes of the Technical Chamber's workers and the understanding of interdisciplinarity and intersectoriality by them. In the speeches of workers was possible to point the autonomy of the technical group and its members as they knew their peers and have organized a network of actions and knowledge. In the speeches of these workers we realized the image of the worker-citizen who feels part of the problem as well of the solution / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

M.Cur. / Quality health service delivery is a necessity in any health care service and is the responsibility of the management, but it is often not accomplished due to a variety of reasons. The most important determinant is the personnel of the health care service and their level of motivation to provide quality service. The aim of this study was the describing of motivation guidelines for the delivery of quality health service. The study was qualitative and contextual. The research strategy was explorative and descriptive. The study is based on the Botes research model and the Nursing Theory of Wholeness. Several measurements were taken to increase credibility. It is regarded as a prerequisite to explore, describe and implement a quality improvement programme for the specific health service, before motivation guidelines could be described for quality health service delivery. The quality improvement programme was based on literature, with recognition of the context of the health service. The determinants of quality health service delivery were discussed as well as the aim, reasons, prerequisites, contents and principles of the quality improvement programme and the quality improvement process. The realisation of the quality improvement programme was also discussed. The exploring, description and implementation of the quality improvement programme in the health care service is followed by the exploring and describing of factors which motivate and/or demotivate personnel to deliver quality health care service, by means of naive sketches obtained from open questionnaires of two samples. It was verified for accuracy during a feedback interview. The results are used to describe motivation guidelines which is confirmed by literature.

No description available.