A contributing factor in the rising costs of the Military Healthcare System (MHS) budget is the pharmacy benefit. In efforts to reduce or contain the costs associated with this benefit, the MHS has implemented several cost saving strategies that were adopted directly from private health care organizations. These strategies include formulary restrictions, generic substitutions, and beneficiary cost sharing that uses a tiered co-payment structure. These strategies are primarily designed to save costs by influencing the behaviors and attitudes of beneficiaries, restricting their access to options with higher costs, and directly shifting a portion of the programs cost through co-payments. This thesis concludes that by implementing these utilization management strategies, the MHS has experienced results that are as good as or better than those experienced by the civilian sector. However, Tricare pharmacy expenditures continue to increase at a faster rate than other components of the MHS demonstrating that the implementation of these strategies, though successful when compared to civilian benchmarks, have not sufficiently contained Tricare pharmacy expenditures. To be successful, the DoD must use a multifaceted approach to contain these escalating expenditures. Ultimately, dramatic cost shifting may be the only way to lower expenditures

The introduction of a primary care clinical psychology service into one Scottish Health District is described and evaluated. The service was widely used by G.P.s, and the volume of referrals increased each year. After 5 years of operation 83% of G.P.s had referred cases. The types of problems referred are described, two thirds of patients were suffering from generalised anxiety or phobias. The patients were a chronic population, the average length of problem being 6.9 years. G.P. and psychiatrist referred patients were compared, the latter had longer histories and there were differences in the types of problem referred. Outcome was evaluated using a number of measures. Consultation rate fell significantly post treatment and a significant proportion of patients stopped psychotropic medication. There were significant reductions in psychologist ratings of severity and in handicap, and in patient self-ratings of severity and General Health Questionnaire scores. Patient satisfaction with treatment 6 months post discharge was surveyed. The G.P.s satisfaction with the service was surveyed and found to be high. At follow up G.P.s rated 69% of patients as receiving "definite benefit" and 31% as "unchanged". A study of treatment of the commonest problem referred, generalised anxiety, was conducted using a waiting-list control group. Treatment group patients improved significantly on self rating questionnaires, controls did not change, but showed a similar order of treatment response when they did enter treatment. The costs of the service are compared to another report in the literature, and it is concluded that the service was cost-effective. A number of recommendations are made for further research in the field. It is concluded that primary care psychology services are feasible in terms of staffing levels, and also lead to significant patient benefit.

M.A. / In terms of the new Constitution (Act 108 of 1996) South Africa has 11 official languages (RSA, 1996: 4). Because of past political imperatives, this de facto and constitutional multilingualism makes South Africa one of many countries experiencing language problems. Difficulties in the realm of language policy are therefore not unique to South Africa. To South Africans language is an emotional issue. Many believe that English, being a universally understandable language, should be the exclusive medium for communication. There is a great need to study language requirements and difficulties in multilingual hospitals (especially hospitals catering for the needs of people speaking African languages). The aim of this thesis is to study shortcomings and needs that may exist and to make recommendations for appropriate RDP intervention. The principle of multilingualism and of advancing the use of all official languages in South Africa is supported in this thesis. The main area of focus is therefore the identification of difficulties and the suggestion of remedies for these problems. To be able to make suggestions, it is necessary to identify the problems in health care. Because language planning is concerned with solutions to language-related problems, this study should be regarded as a language planning activity. To this end, the principles of language planning are discussed, with the focus on definitions of language planning, the types of language planning, the steps of language planning (mainly step 1, data accumulation), the responsibilities of the language planner and language planning already done in South Africa. An analysis of language needs will show that communication between physician and patient is unsuccessful in multilingual hospitals, because the parties involved do not understand each other's languages. To solve the problem, hospital staff and other individuals are being used as interpreters. However, this causes a multitude of difficulties, which are highlighted in the empirical study in chapter 4. The biggest problem in respect of interpreting is that the people who perform this function are not trained as interpreters. This leads to further problems, like misinterpreting as well as resistance to the fact that these people have to perform this function without remuneration. The opinions of hospital staff are reflected in the answers given to the questionnaires which they completed. These opinions are discussed in detail along with the problems referred to earlier as well as other problems identified. Because translation and interpreting are so closely related and because interpreting is the main focus of this thesis, a distinction between the two concepts is made. Criteria which interpreters must meet, as well as a literary overview concerning problems in health care with regard to interpreting, are addressed. From the information accumulated, suggestions are made in chapter 5 as to how these language problems might be solved. The most important suggestion to solve these problems in the field of interpreting is to make use of well-trained interpreters. A wide spectrum of aspects surrounding the training of interpreters is discussed and recommendations are made in chapter 5.

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Introduction: Management of complex systems is facilitated through effective information systems that provide real-time data to decision makers. For example, instrument panels in airplanes ensure that pilots have well-designed feedback concerning the status of mission-critical variables. Problem: While pilots have dashboards for feedback and communication, healthcare executives may be unaware of effective use of evidence-based guidelines within their healthcare system. Purpose: The first objective of this research was to design and implement an automated intranet dashboard reporting performance measures for a geographically dispersed health system. The second objective was to describe how this dashboard might increase cooperation and coordination for individuals and organizations involved with healthcare delivery. Design: This research was exploratory in nature, employing descriptive research approaches. A convenience sample of healthcare executives completed a baseline survey at the start of the study assessing levels of communication and cooperation. After three months of exposure to the dashboard, participants were asked to complete a follow-up survey. All visits to the dashboard were recorded in a web server log file. Semistructured qualitative exit interviews were also conducted to explore reactions to the dashboard, experiences with receiving outcome reports, and barriers to communicating and coordinating with counterparts. Results: Descriptive analysis of paired survey scores found substantial increases on a number of survey items, suggesting that the dashboard contributes toward increased communication and coordination for healthcare executives. This finding is balanced by the limited rigor in the research design and an analysis of the web server log file, which found few visitations to the dashboard by research participants. Qualitative data analysis suggests that current reporting mechanisms are suboptimal for healthcare executives and that one solution is the use of dashboards. Conclusion: This study resulted in a number of important discoveries and avenues for further research. A more rigorous research design is needed to explore the role of intranet dashboards in healthcare settings. / Graduation date: 2004

Thesis (Ed. D.)--Oregon State University, 1975. / Typescript (photocopy). Includes bibliographical references. Also available online.

Thesis (M.P.H.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 55-64).

Thesis--University of Washington. / Vita. Another copy has number: Thesis 27068. Bibliography: leaves [285]-297.

Thesis (Ph. D.)--University of Texas at Austin, 2000. / Vita. Includes bibliographical references (leaves 150-157). Available also in a digital version from Dissertation Abstracts.

published_or_final_version / Nursing Studies / Master / Master of Nursing