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In this study, the continuous use of knowledge-based clinical decision support systems (KB-CDSS) is examined. KB-CDSS not only provides advice to clinicians, but also integrates guidelines with patient information and provides clinicians with tools that facilitate the application of guidelines in patient care. Studying KB-CDSS as a continuous application is important because continuity is a prerequisite to the success of KB-CDSS implementations and is considered as an important motivator for knowledge translation. Previous research in the area of health information systems (HIS) use has focused on the acceptance of these systems through the use of mostly information systems related constructs. Therefore, the theoretical models that explain the use of HIS have been limited and they obfuscated other phases of HIS such as continuous use. Moreover, extant research has not, to a large extent, considered the influence of KB-CDSS use on knowledge translation, the application of clinical guidelines in practice. This study seeks to fill these gaps in the literature by first integrating context-related factors with IS factors. This supports the study of antecedents of continuous use of KB-CDSS systems, exploring the relationship between continuous use and knowledge translation, and exploring changes in system dynamics (how usage patterns change with time). In order to achieve these research objectives, a literature review of healthcare and IS research was conducted, resulting in a comprehensive theoretical model that explains the antecedents of continuous use and its relationship to knowledge translation. To validate this model, data were collected from different sources, including: A questionnaire deployed to 118 physicians using the McMaster Pain Assistant KB-CDSS in three academic clinics in South Western Ontario, followed by five focus groups to further explain the context of using the systems and antecedents of its use, and the analysis of system use through data obtained from system logs and patient charts. The findings of this study show that: (i) Threats to physician professional identity surpasses intention to continue using KB-CDSS, thus influencing its use by physicians in the first six months; (ii) The relationships between factors influencing continuous system use change with time; (iii) System use has a strong relationship with knowledge translation after 6 months of use, but this relationship diminishes after 12 months of use; and (iv) How patients are affected by the system positively influences physician satisfaction with the system and hence their use of the system. This study helps in explaining the theory of physicians’ continuous use of KB-CDSS and how the antecedents of use change with time. Methodologically, this study has discovered several techniques that can be used to improve HIS research and physician acceptance of IS methods. Finally, in practice this study presents several suggestions for improving the development and deployment of KB-CDSS to enhance its use during the knowledge translation process. / Thesis / Doctor of Philosophy (PhD)

Information and communication technology (ICT) can enhance communication among health care providers which may lead to various health system improvements, such as gains in efficiency. However, there is inadequate evidence regarding the extent to which ICT improves communication among specific groups of health care professionals. This dissertation incorporates a mix of methodological approaches across three interrelated research studies to address this gap. Study 1 consists of a systematic review which suggested that ICT can play an important role in enhancing health care related communication among physicians, but the extent of that benefit is influenced by: 1) the impact of ICT on existing work practices; 2) the availability of adequate resources for ICT implementation and use; and 3) the nature of institutional elements, such as privacy legislation. Study 2 consists of a document analysis that examined guidelines for health information protection when using ICT from the provincial regulatory colleges for physicians. These documents were notable for the considerable variation in the scope and detail of guidance provided, which may result in unequal and inequitable protection of health information across the provinces. Study 3 is a case study that examined the use of a relatively novel form of ICT, smartphones, for communication among postgraduate medical trainees (medical residents). Efficiency and convenience were identified as the main reasons that medical residents use smartphones to communicate health care related information with colleagues. In addition, by applying a neo-institutional perspective, it became clear that medical residents base their smartphone use primarily on normative elements (professional norms; what peers/staff are doing) and cultural-cognitive elements (beliefs/perceptions regarding facilitation of task completion). Regulative elements (guidelines/policies) around smartphone use play a smaller role in shaping behaviour, particularly when they: 1) lack clarity; 2) are not seen as credible/legitimate; or 3) are viewed as cumbersome and do not align with workflow needs. Taken together, these studies provide timely insights regarding the use of ICT by physicians, which can be drawn upon by a variety of decision-makers as efforts to improve health system performance continue. / Thesis / Doctor of Philosophy (PhD) / The goal of this doctoral dissertation was to develop a better understanding of how and why physicians are using information and communication technology (ICT) to exchange health care related information, along with the role of such communication in enhancing health system performance. Findings indicate that physicians use ICT in various circumstances as they perceive it to be more convenient and efficient. However, guidelines for the exchange of health information in digital/electronic format vary by jurisdiction and organization, which may result in different uses of ICT by physicians. Moreover, as these guidelines often lack clarity or are not seen as credible/legitimate, some physicians base their use of ICT primarily on what peers/colleagues are doing or by acting in a manner that they believe facilitates task completion and, hence, patient care. The insights gained from this work can be adopted by decision-makers to improve communication among physicians using ICT and, consequently, health system performance.

This study examined patient behavior in the emergency department and trained physicians to respond to that behavior. It demonstrated that physicians can increase patient satisfaction by responding to the thoughts, feelings and actions which the patients are experiencing. The literature provided variables for patient satisfaction and physician counseling techniques. These variables provided the base for a Patient Satisfaction Inventory (PSI) and a training module for the physicians. Patient behavior was evaluated through the clinical Thinking, Feeling and Acting interview, given to patients, before and after each patient was seen by the physician. This information was then provided to the physicians. For half of the patients, physicians responded according to patients thinking. feeling and acting components of behavior. For the others, physicians received no information other than the generic summary card summarizing thoughts, feelings and actions of the patients as a group. The PSI was completed by all patients after discharge from the emergency department. Pre and post training scores were compared on the PSI to determine if there was a difference in patient satisfaction. An increase in patient satisfaction was experienced after the physicians were trained to purposefully respond to patient behavior. On the PSI, patients perceived greater compassion, understood and communicated with the physician better, and perceived more accurate diagnoses and treatments. These increases in patient satisfaction were significant (p < .01) regardless of whether the physician had the actual patient information from the clinical TF A interview or just the generic summary. The physicians seemed to become sensitized to the patients needs by organizing the data they already had about the patients. Implications for the counseling field and training physicians to better serve their patients were discussed. / Ed. D.

The Medicare Participating Physician Program was enacted in 1984 in an effort to increase physician assignment of Medicare claims, and thereby reduce beneficiary out of-pocket expenses. The program offers the physician the security of near-certain payment on all claims, although at rates that are in many cases, at levels substantially, less than actual physician fees. This paper examines the economic factors that influence the physician's decision on participation. Physicians of the Medical Society of Prince William County, Virginia, were surveyed for information relevant to making the participation decision and the responses tabulated and used as input to a regression equation estimated using the logit technique. Physicians are more likely to participate the higher the relative price received for participating and the lower the probability of payment by Medicare-eligible patients. Additionally, salaried physicians are more likely to partiCipate than those who are self-employed. / Master of Arts

Yes / Primary health care (PHC) physicians' perceptions are vital to understand as they are the first-line health care providers in cardiovascular diseases (CVD) risk assessment and management. This study aims to explore PHC physicians' perceptions on their roles and their perceptions on management and risk reduction approaches on CVD risk reduction and management in Fiji. This is a qualitative study conducted in the Suva Medical area among 7 health centers from 1 August to 31 September, 2021. Purposive sampling was used to recruit physicians who worked in the Suva medical area as PHC physicians with at least 6 months' experience in the Special Outpatients Department clinics. In-depth interview were conducted using a semi-structured questionnaire over the telephone and recorded on a tablet device application. The interview content was then transcribed, and thematic analysis was done. This study included 25 PHC physicians. From the thematic analysis, 2 major themes emerged with 6 subthemes. Theme 1 was CVD management skills with 3 subthemes including education, experience and trainings, beliefs and attitudes of physicians, self-confidence and effectiveness in CVD risk reduction and management. Theme 2 was roles and expectations with 3 subthemes including perceptions of effective treatment, perceptions of physicians' roles and perceptions of patients' expectations. Physicians generally see their role as central and imperative. They perceive to be important and leading toward combating CVDs. Physicians' perceptions on their commitment to prevention and management of CVDs through their skills and knowledge, beliefs and motivation should be acknowledged. It is recommended that the physicians are updated on the current evidence-based medicine. Limitations include results that may not be the reflection of the entire physician and multidisciplinary community and the difficulties in face-to-face interviews due to the coronavirus diseases of 2019 pandemic.

This project seeks to clarify the historical significance of women in the American West between 1870 and 1930 through the education, careers, and personal lives of western women physicians. The narratives presented in the work provide alternative roles for western women aside from the stereotypical images found in popular culture and history, such as the "Bad Woman," the prostitute, and the obedient homesteading wife. This collective biography additionally demonstrates how women participated in American medical culture during the nineteenth and early twentieth centuries, emphasizing their agency as historical actors, and countering the common misconception that Victorian women were merely passive subjects of their time and place. The lives of four physicians named Ellis Reynolds Shipp, Mary Babcock Atwater, Mary Bennett Ritter, and Mary Canaga Rowland are available through memoirs, biographies, scholarly articles, newspapers, and other sources that contextualize their careers into the broader context of Western, medical, and nineteenth-century history. Through their personal and professional experiences, a greater story of female autonomy emerges in a period understood to be inherently oppressive to and unnavigable for women.

Thesis (MEdPsych (Educational Psychology))--University of Stellenbosch, 2006. / Attention-Deficit Hyperactivity Disorder (ADHD) is a common disorder affecting 4% to 5% of South African children. Recent studies revealed that 30% to 70% of children continue to experience problems related to ADHD in adulthood. Adults are becoming increasingly more aware of adult ADHD as a result of public awareness campaigns in the media. Their first line of action is to visit their family physician, but the question arises whether these practitioners are ready to take on the patients with ADHD. The aims of this study were to determine the familiarity, attitudes and practices of general practitioners in South Africa with regard ADHD in both children and adults and whether there are differences in children and adults with regard to depression and generalised anxiety disorders as comorbid disorders. The study also briefly explored the training models of general practitioners in South Africa. The research questions are addressed by means of a survey approach, using quantitative measures. An email message with a cover letter, explaining the purpose of the research project, provided a link to a Web-based questionnaire. It was broadcast to 6704 general practitioners on the database of the company MEDpages, who managed the broadcast. A questionnaire attached to an e-mail message was sent to all Departments of Family Health at universities in the country to obtain information with regard to the training models of general practitioners. This was followed up with structured telephone interviews if no response was received. The questionnaire was completed by 229 respondents. The data were statistically analysed using Statistica Version 7.0. The results revealed a significant need among general practitioners to increase their knowledge base with regard to ADHD, more so with regard to adults. Their knowledge and training with regard to depression and generalised anxiety disorders were significantly more extensive with regard to adults as opposed to children. Training with regard to ADHD in adults was almost non-existent. It was recommended that the limited knowledge base of general practitioners with regard to ADHD should be addressed by adapting the curriculum of undergraduate medical students and providing opportunities for continued medical education that focus on the diagnosis and management of ADHD in both children and adults. General practitioners should acknowledge the educational psychologist as an equal partner within a multi-disciplinary team

M.A. / This research aimed to design and develop an intervention that would maximise the coping resources of doctors working with trauma patients at Johannesburg General Hospital. Intervention Research methodology was used in order to achieve this objective. The study was divided in to three phases, namely, Diagnosis, Feedback and Discussion and Evaluation. The initial intervention comprised the Diagnostic as well as the Feedback and Discussion phase. The findings from the Diagnostic phase suggested that the doctors who had been working in the unit for less than three months, as well as the doctors who had less than four years medical practice experience, were most likely to show areas of vulnerability. This vulnerability related to their under-use of coping resources accompanied by elevated negative mood states, as identified by the Coping Resource Inventory and the Profile of Mood States questionnaire respectively. Other groups of doctors that shared this vulnerability included interns, medical officers, females and single doctors. The Feedback and Discussion phase brought to light themes relating to the stressors that the doctors’ experience in their work context. These themes along with the results of the Evaluation phase where used in order to re-design the Intervention for future use with doctors working with trauma patients. The findings from the Evaluation phase also confirmed that the doctors found the intervention to be beneficial.

Physician assistants are medical professionals educated in an allopathic medical education model in the United States. In order to successfully matriculate, educate and graduate safe and effective health care providers in a 2-year time frame, the 4-year M.D. curriculum has been abbreviated and condensed leading to an intense, full-time cohort educational experience that taxes physician assistant students to their limits. The demanding workload can lead to fluctuations in mood and morale along with increased levels of psychological distress. This dissertation explores this under examined student experience by first introducing the physician assistant profession and the process by which it educates its members. The cohort patterns of mood and morale observed by faculty during the educational process are described using the conceptual and theoretical models of transformative learning, transition, change and cross-cultural adaptation as explanations for the observed experience. A retrospective naturalistic research paradigm utilizing focus groups elucidated the student perspective of the cohort medical education experience over the course of the didactic curriculum, and study results highlight a three-stage experience consistent with stages-of-change theories from multiple disciplines. In addition, a prominent pattern of emotional subthemes provide a window into the psychological significance of this transformative experience. A better understanding of the effects of this academically rigorous and psychologically challenging medical education process on physician assistant students clarifies opportunities for amelioration of student challenges while simultaneously enhancing the ultimate goal of developing safe and effective health care providers.