For several decades, the cost of medical care in the United States has increased exponentially. Congress enacted the Patient Protection and Affordable Care Act (PPACA) of 2010 to ensure affordable healthcare to the citizens of the United States. The purpose of this case study was to explore physicians' perspectives regarding physician-centric business models evolving under the requirements of PPACA legislation. Complex adaptive systems formed the conceptual framework for this study. Data were gathered through face-to-face, semistructured interviews and e-mail questionnaires with a purposeful sample of 20 participants across 14 medical specialties within Northeast Texas. Participant perceptions were elicited regarding opinions of PPACA legislation and the viability of business models under the PPACA. In addition, a word cloud was used to identify 3 prevalent or universal themes that emerged from participant interviews and questionnaires, including (a) use of mid-level practitioners, (b) changes to provider practices, and (c) lack of business education. The implications for positive social change include the potential to develop innovative models for the delivery of medical care that will improve the health of the aggregate population. Healthcare leaders may use the findings to advance the evolution of physician business models that meet the needs of healthcare stakeholders. These findings may also inform healthcare leaders of the need to develop cost-effective and innovative organizational models that are distinct to individual patient populations.

Strong evidence has been found to link the diagnosis of CHD with depression, and patients with all CHD-related diagnoses and co-morbid depression display higher morbidity and mortality from CHD than those individuals without depression. Screening and treatment of depression by cardiology clinicians continues to be limited due to poor symptom recognition and lack of desire to treat perceived primary care conditions in specialty practice. The American Heart Association has designated timely assessment and treatment/referral of depression as primary goals for high-quality evidenced-based cardiology care to improve patient outcomes in CHD.This study employed a quasi-experimental descriptive pretest-posttest study design for the purposes of (1) understanding diagnostic and treatment practices for depression in the presence of CHD by nurse practitioner and physician cardiology providers (n=35) in a large metropolitan private outpatient cardiology practice and; (2) adaptation of a valid and reliable depression screening tool (Patient Health Questionnaire-9) to an existing electronic medical record system for use in the sample practice.Findings from the study showed that even though all providers (100%) believed that depression inhibited patients' ability to make positive CHD risk-reducing lifestyle changes, and the majority (73.7%) felt that depression contributed to the progression of CHD, no formal screening for depression was being performed. Less than half (42.1%) of providers in the sample treated depression in their clinic practice, and the large majority (89.5%) referred patients back to primary providers for all depression care.Since 2008 guidelines for depression care by cardiology providers were recommended by the American Heart Association (endorsed by the American Psychiatric Association), it is questionable if these recommendations are filtering down to outpatient cardiology practice. Provider education to improve confidence with depression screening and treatment, and provision of concise easy-to-use care templates in outpatient EMR systems may help to improve compliance with recommendations while maximizing patient outcomes for depressed CHD patients.Advanced practice nurses have been consistently instrumental in the development and management of performance-enhancing processes that improve care quality and patient outcomes. As nursing practice leaders, nurse practitioners should be progressive in supporting implementation of best-practice for depression care in outpatient cardiology practice settings.

The purpose of the study was to determine whether it was possible to predict the socio-demographic characteristics of physicians who adopt a new paradigm in medicine, wellness. A major objective of the research was to test the "marginal man" hypothesis. The literature suggested that there are at least three types of innovations: technological, organizational, and paradigmatic. Literature on the diffusion of innovations in medicine showed that high status physicians adopt technical innovations; more marginal, particularly young physicians and those of a liberal political orientation, most often adopt organizational innovations. Few studies dealing with paradigmatic innovations were found. Historical evidence supports the notion that family practitioners might be more accepting of the new paradigm. Physicians in Tucson, Arizona were surveyed concerning their attitudes and practices in the areas of health education and wellness, examples of the new paradigm in medicine. They were also asked about hospital-based health education services and competition between physicians and hospitals, examples of organizational innovation. The analyses revealed that family practitioners, women and government physicians were most supportive of wellness, affirming the research hypothesis and the "marginal man" hypothesis. The analysis also suggested that younger and more liberal physicians were more favorably disposed toward hospital involvement in health education. Liberal physicians were also not concerned about competition in health education service. These findings are similar to those found by other researchers of organizational innovations in medical care. Several methodological problems were noted, which render the findings suggestive rather than conclusive. The findings do suggest, however, that physician resistance to wellness will continue because of a medical paradigm conflict.

This investigation explored the role of informational and psychological privacy in the health context by examining the relationship between type of relationship (physician versus acquaintance), type of observation (self-report versus observation), and communication strategies used to restore or preserve privacy (interaction control, dyadic strategies, expressions of negative arousal, blocking and avoidance, distancing, and confrontation). It was hypothesized and confirmed that individuals report exhibiting more behaviors to restore or preserve informational privacy in response to an informationally privacy-invasive question posed by an acquaintance than by a physician. The hypothesis that presentation of an informationally privacy invasive question by the physician causes patients to exhibit more communication strategies after the privacy invasive question than before, was unsupported. Finally, the hypothesis that individuals actually exhibit more privacy restoration behaviors than they report using in a similar situation with their physician was also unsupported. Patients reported using more communication strategies than they actually exhibited. One confound to the self reports was that videotaped participants reported the use of fewer direct privacy restoring communication strategies than non-videotaped.

Raktažodžiai: gydytojų požiūris, nuomonė, vakcinacija Pagrindimas: Lietuvoje atlikta labai mažai tyrimų apie medikų požiūrį į vakcinaciją, tačiau daugėjant žiniasklaidoje medicininį išsilavinimą turinčių specialistų skeptiškų pasisakymų apie vakcinaciją, tampa aišku, kad ši sritis paveikta tam tikrų mitų apie vakcinaciją ir antivakcininių judėjimų mados tampa problematiška. Tyrimo tikslas: nustatyti Vilniaus poliklinikose dirbančių gydytojų požiūrį į vakcinaciją. Tyrimo uždaviniai: 1. Įvertinti gydytojų požiūrį į vakcinacijos pagrįstumą, infekcinės ligos rizikos suvokimą, vakcinacijos saugumą, efektyvumą, būtinumą, naudingumą, vaikų skiepijimą pagal skiepų kalendorių 2. Įvertinti gydytojų požiūrį į vakcinaciją: nuo difterijos, stabligės, pneumokokinės infekcijos, gripo bei žmogaus papilomos viruso 3. Įvertinti veiksnius galinčius turėti įtakos medikų požiūriui į vakcinaciją. Metodai: iš Vilniaus miesto poliklinikų atsitiktinės atrankos būdu atrinktos 7 poliklinikos, kuriose anketiniu būdu apklausti įvairių specializacijų gydytojai. Duomenų analizei panaudotos 393 užpildytos anketos. Duomenų analizė atlikta SPSS 16.0 for Windows, naudojant aprašomąją statistiką, neparametrinius ir parametrinius kriterijus, bei binarinę logistinę regresiją. Rezultatai: kad vakcinacija nepakankamai pagrįsta moksliniais tyrimais sutiko 86 (24,00%) apklaustieji. Kad vakcinacija sukelia daugiau sveikatos problemų nei nuo jų apsaugo sutiko tik 29 (7,60%) apklaustieji. Kad persirgti infekcine liga... [toliau žr. visą tekstą] / Problem of the study: There is very little research on the medical approach to vaccination in Lithuania, but the increasing number of statements of specialists with medical education with skeptical remarks about the vaccination in media, it becomes clear that their approach to vaccination is affected by a number of myths about vaccination and that this area is problematic. Aim of the study: identification of the attitude to vaccination of doctors working in the outpatient clinics of Vilnius. Tasks of the study: 1. Evaluate the attitude of the physitians to safety, benefit, efficiency of vaccination, and the calendar of children’s vaccination. 2. Evaluate the attitude of the physitians to vaccination against: diphtheria, tetanus, pneumococcal infection, flu, human papillomavirus infection. 3. Evaluate the factors capable to have influence on the attitude of the physitians to vaccination. Methods: 7 outpatient clinics were randomly selected out of outpatient clinics located in city of Vilnius. A special questionnaire was composed for this purpose and doctors of various fields of specializations were questioned. 393 questioners were processed for analysis of the data. Data analysis was performed using 16.0 for Windows, implementing descriptive statistics, nonparametric and parametric criteria, as well as binary logistic regression. Results: 86 (24.00%) agreed that vaccination is not sufficiently evidence based. Only 29 (7.60%) agreed that vaccination induces more related health... [to full text]

Aim and objectives: To describe the ideal doctors' shift handover process in a systematic fashion, and to identify tasks that should be performed, but are not consistently done. To understand the types of communication problems that may occur during the handover process, their causes, their likelihood of occurrence and their effect on patient safety. Method: Three studies were conducted in two, Scottish Acute Medical Units. A Hierarchical Task Analysis was performed and data was collected by means of interviews and focus groups. Observations of doctors' actual shift handover process were compared against the description of doctors' ideal handover process. To examine potential failures modes, a Healthcare Failure Modes and Effects Analysis was performed using focus group interviews. Results: The handover process entailed the pre-handover, the handover, and the post- handover phases. Multiple critical steps in the process were omitted by outgoing shift doctors. The pre-handover was particularly vulnerable to information omission, with over 50% of its critical tasks not being performed across a total of 62 observations. Nonetheless, most of these omissions were typically caught during the handover meeting, especially if incoming doctors participated in pre-handover activities. Post-handover activities involved prioritizing and delegating clinical tasks. However these were observed not to happen consistently due to multiple interruptions. Thirty-four failure modes were identified, with eight of them posing a significant risk to patient safety. The studies found that interruptions, patient workload, and a lack of standardised procedures were the biggest causes for information loss during the handover process. Conclusions: There are key critical tasks necessary for an ideal doctors' shift handover process. A simple, handover process checklist may ensure critical handover tasks have been achieved prior to any shift change. Interruptions, patient workload, peer trust, and a lack of standard operating procedures are areas that future handover research should examine.

Mini-dissertation'submitted in partial compliance with the requirements for the Master's Degree in Technology: Homoeopathy, Durban Institute of Technology, 2005. / Homoeopathy in South Africa is a relatively new health profession, and there seems to be limited awareness of homoeopathy amongst the public and healthcare authorities. The national health care system in South Africa is currently undergoing major restructuring, with the focus on primary health care. The homoeopathic community needs to reflect on its role in public health care. However, in order to gain acceptance and understanding from other health care professions, meaningful research needs to be conducted. There is an urgent need to investigate the views of conventional health care professionals towards homoeopathy. A survey method was employed to investigate the perceptions of homoeopathy of two major groups in the medical community in the Greater Durban area: General Practitioners (GPs) and pharmacists. The study was carried out by using a questionnaire as a measuring tool. The sample of GPs was drawn from the medical pages of the Durban Telephone Directory (October 2003/2004) and the sample of pharmacists was drawn from the Durban Yellow Pages (October 2003/2004). A total of 484 questionnaires were distributed and a total of 155 responses were received. The percentage of return of questionnaires was 32,02%. The original sample size was 370 for GPs and 114 for pharmacists. A total of 97 GPs and 58 pharmacists responded. The response rate was 26,22% for GPs and 50,87% for pharmacists. / M

Demands on physicians in the workplace are growing, as are the occupational and psychosocial stressors they encounter. However, there is scant research regarding physicians, their patient care, and strategies that enhance their well-being. Mindfulness, the ability to be present in the moment, is increasingly being encouraged among healthcare workers for personal benefits and possible positive effects for patients. Thus, the present study examined (a) the health, well-being, and patient care practices of oncologists, (b) the relationship between oncologists’ mindfulness and health indicators (general health and sleep problems) with three outcomes (satisfaction with life [SWL], job satisfaction, and suboptimal patient care), and (c) whether mindfulness moderated the relationship between health and outcome variables. Survey data were collected from oncologists who were members of the American Society of Clinical Oncologists (N = 114, response rate of 29%). Participants were predominantly male (76%), Caucasian (78%), and married (84%), and featured a mean age of 52 years and an average work week of 58 hours. Half (51%) reported sleeping 6 or fewer hours per night and the mean sleep duration was 6.3 hours. Thirty-five percent reported not getting adequate sleep and 57% believed that lack of sleep interfered with daily functioning. They reported very good general health, high levels of trait mindfulness, and satisfaction with their lives and jobs. They reported engaging in occasional suboptimal patient care practices and attitudes. About 20% endorsed some degree of burnout, but only 12% were considering changing jobs in the next 5 years. Hierarchical multiple regressions indicated that general health predicted greater SWL, greater job satisfaction, and less suboptimal patient care, whereas mindfulness predicted greater SWL and less suboptimal patient care beyond the variance accounted for by general health. Sleep problems predicted less SWL, whereas mindfulness predicted less suboptimal patient care, beyond the variance accounted for by sleep problems. Finally, mindfulness moderated the relationship between oncologists’ sleep problems and suboptimal patient care; as sleep problems increased for oncologists with low mindfulness, they reported that their patient care actually improved. Possible explanations for findings are presented and implications for oncologists’ health, well-being and patient care are discussed.

Illegible written prescriptions and “Doctor’s handwriting” may have been synonymous, but this stereotype has begun to change with the gradual uptake of e-prescriptions. These eprescriptions are electronically captured and delivered prescriptions, and are touted as the solution to the many medical risks caused by written prescriptions. Whilst there is published support for the benefits of e-prescriptions, the uptake of e-prescribing has been too gradual for all patients to enjoy these benefits. The inadequate research into physicians’ adoption of e-prescribing systems presents a need for further study in this area, in an effort to improve the general use of these systems. Based on a review of literature, this study proposes six factors which may explain physicians’ intentions to use e-prescribing systems. These factors are based upon the Unified Theory of Acceptance and Use of Technology (UTAUT). This model is extended in this study by Social Dominance Theory, Commitment-Trust Theory and the Product Evaluation Model. Quantitative data was collected to test the proposed hypotheses. This data was gathered from physicians who have had some exposure to an e-prescription system. 72 usable responses were obtained for this study. The results of the study suggest that Performance Expectancy and Price Value have the highest influence on Behavioural Intention. Effort Expectancy and Social Influence had no direct influence on Behavioural Intention when in the presence of other variables, but they, along with Trust, had an indirect effect on Behavioural Intention through Performance Expectancy. Surprisingly, Social Dominance Orientation was not found to have an influence on Behavioural Intention. Implications, contributions and further research are discussed.

Studies across low- and middle-income countries document quality shortfalls in both public and private sector health care. They notably highlight a “know-do” gap in primary care delivery: doctors possess requisite medical knowledge but do not expend adequate effort to treat patients. In explaining low quality, researchers have largely emphasized transactional aspects of health care, viewing doctors’ actions as shaped by their skills and incentives to perform and arguing that the micro-institutions that drive doctors’ clinical behavior are faulty. In contrast, in this project I analyze the social and political conditions in which public sector doctors deliver primary care in urban India. Viewing the doctors as both medical practitioners and state agents, I argue that health service outcomes depend on how doctors interpret policy mandates and relate to the communities they serve. I conceptualize their actions not just as medical transactions but also as social acts, shaped by the meanings they attach to their experiences and informed by the institutional history and social imaginary of state-provided care. During a year of ethnographic fieldwork (2013-2014), I observed clinical and non-clinical encounters of doctors employed in municipal government clinics and hospitals in a midsize Indian city; interviewed doctors, other health workers, elected officials, administrators, and staff of non-governmental organizations; and examined policies and administrative arrangements for urban health care since India’s independence. I demonstrate that municipal doctors confront a trifecta of challenges: a legal obligation to deliver urban primary care from within an outdated urban governance structure; a largely unregulated private sector that residents widely prefer; and rising commercialization in medical practice, under which specialized medicine has crowded out primary care in popular ideas about “good” medical care. Unable to remedy the low legitimacy of their services, doctors circumscribe their actions, seeking, as one doctor put it, only to ensure the ordinary. My findings suggest that transaction-specific interventions to improve quality, such as focused on skills and incentives alone, may do little to circumvent these local effects of the policy neglect of urban health care.