Bibliography: leaves 494-519. / ix, 519 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Examines the influence of the medical profession on health policy in Australia. Case studies of policy struggles under Federal Labor governments since 1983 illustrate both the nature and scope of that influence. / Thesis (Ph.D.)--University of Adelaide, Dept. of Politics and Dept. of Community Medicine, 1994

Introduction Since the 1994 change in power in South Africa, there have been many necessary changes in health legislation (HL), in accordance with the principles enshrined in the Constitution, Such changes have been recognized as being both complex and fraught with stakeholder interests. There is a perception that private family practitioners (FP) generally harbour negative attitudes towards HL that has been brought into effect in recent years. It is also possible that FP, in general, lack knowledge regarding HL. The aim of the study was to assess the knowledge and attitudes of private family practitioners (FP) to health legislation (HL) within a localized geographical area of the eThekweni Metro, KwaZulu-Natal Province. The specific objectives were: To determine family practitioners’ knowledge of health legislation. To determine family practitioners’ attitudes towards health legislation. To assess the correlation between family practitioners’ knowledge and attitudes. To compare the self-reported knowledge of health legislation with the objective assessment of knowledge and attitudes. To establish practitioners’ perceptions of the future of the profession, and of family practice in particular. Methods A cross-sectional descriptive and analytical study was performed, using a pre-tested, validated, structured questionnaire. This instrument was personally hand-delivered to each of a group of private family practitioners practising within a confined geographical area. The sample comprised of 101 family practitioners. Data were analysed using SPSS version 15.0 (SPSS Inc., Chicago, Illinois). Results The study revealed that private FP possess limited knowledge about HL and have a negative attitude in general towards HL. The mean knowledge score was 55% (standard deviation 12.2%). The mean score for attitudes towards health legislation was 46,3% (standard deviation 4.2%). The correlation coefficient between knowledge and attitudes was 0.244 (p=0.022). Therefore, there was a weak positive, but statistically significant, correlation between knowledge and attitudes. Thus, in general, as knowledge increased, so did attitudes improve and become more positive. The self reported knowledge and attitudes of FPs seemed to show some unexpected though non-statistically significant anomaly, in that FPs who considered themselves “well aware” of certain parts of HL, together with those who were “not aware”, reporting a more negative attitude towards HL than those who considered themselves to be “aware”. FPs’ perceptions of the future of the profession, and of family practice in particular, were generally reported as being reasonable to poor. Financial viability and sustainability of FP, in particular, were reported as being reasonable to poor. The attractiveness of the profession to the youth of today was reported as being poorer than in the past. However, the majority of FP held the perception that medicine as a profession was distinct as it responds to a calling to serve society at large, giving this aspect of the question a ranking of “reasonable to good”. Conclusion and Recommendations The study revealed that this group of FPs attained an overall mean knowledge score of 55% with respect to HL. FPs’ knowledge of HL requires improvement, which can be achieved through effective education and training programmes. Private FPs need to embrace the change process, but also need to be more pro-active in vocalizing their opinions. The Health Ministry and relevant authorities and policymakers need to play a greater role in creating an atmosphere that embraces and facilitates change by involving iii relevant stakeholders. Lastly, it is recommended that this study serve as a template for a broader research project involving larger numbers of participants and a wider geographical area. In addition, an intervention tool should be devised. Such a tool could take the form of a structured education programme on HL, with an associated monitoring and evaluation aspect, which would enable an assessment of the intervention programme in terms of its value and the influence it has on improving knowledge and attitudes. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.

The way physicians are paid for the provision of care is a relevant aspect of health care systems. Fee-for-service (FFS) payment system has been criticized for affecting quality of care, contributing to the fragmentation of health care, and for rising costs of health care systems. Alternative payment plans (APP) have been introduced as options to the traditional FFS payment scheme. Despite the link between payment methods and behavior of physicians that has been established; there is a lack of evidence about the impact of payment systems on wellness of physicians, specifically on their perception of professional equity and daily distress of physicians. The purpose of this study was to explore the effects of APP on physicians’ perceptions of professional equity and daily distress. The following questions guided this dissertation: 1) Does professional equity perceived by physicians vary among practitioners paid by FFS, APP, or blended alternatives? 2) Is the payment method associated with daily distress of medical practitioners? and 3) Are levels of professional equity, daily distress, and career satisfaction of physicians different by gender and payment methods? In 2011, a cross-sectional study was conducted with physicians practicing in the Saskatoon Health Region (SHR), the largest health authority of Saskatchewan, Canada. Physicians completed a questionnaire evaluating their perceptions of professional equity and daily distress. Analyses of variances (ANOVA) were performed to assess differences in professional equity (overall and by its fulfillment, financial, and recognition dimensions) and daily distress among physicians paid by FFS, APP, and blended schemes. As multivariable analyses, a linear regression was used to test the interaction between specialty and payment methods on the perception of professional equity, controlling for the number of patients, gender, and age group. A mixed linear regression model was built to predict daily distress, testing demographics, workload, complexity of patients, payment method, career satisfaction, and practice profile; the random component of the model considered the influence of geographic area of practice. Also, a multivariate analysis of variance (MANOVA) was conducted to evaluate differences among professional equity, daily distress, and career satisfaction by payment method and gender. In total, 382 (48.1%) physicians participated in the study. Response bias was tested and found to be negligible (Appendix F). The ANOVA identified that physicians paid by APP perceived higher professional equity than those paid by FFS (p=0.005), as well as higher levels of income (p=0.03) and recognition (p=0.001) equity than those with FFS. In the multivariable analyses, a higher level of professional equity was predicted among family practitioners (FPs) paid by APP and blended schemes in comparison to those paid by FFS. Additionally, the payment method was a predictor of daily distress when adjusted by other factors. Lower levels of distress were found among physicians who had more than 75% of patients with complex conditions and were paid by APP compared to those paid by FFS and blended methods. The MANOVA identified that female physicians had poorer wellness indicators than male practitioners. Multiple comparisons identified higher levels of equity among male physicians paid by APP than those with FFS, although this benefit was not observed among female ones. In conclusion, physicians paid by APP perceived higher professional equity (fair economic rewards and appropriate recognition) in comparison to those paid by FFS. Particularly, FPs paid by APP perceived higher professional equity than those FPs paid by FFS. Additionally, the payment method was identified as an associated factor with distress; lower levels of daily distress were predicted among physicians paid by APP who see high proportions of patients with complex conditions. Notwithstanding, female physicians had poorer wellness indicators and the impact of APP on professional equity was only distinguished among males. A potential unequal impact of APP must be recognized between female and male physicians.

Darbo tikslas. Įvertinti N ligoninės gydytojų nuomonę apie klinikinius vaistinių preparatų tyrimus. Darbo uždaviniai. Įvertinti veiksnius veikiančius, gydytojų motyvaciją vykdyti klinikinius vaistinių preparatų tyrimus bei veiksnius, kurie kliudo gydytojams įsitraukti į juos Įvertinti gydytojų požiūrį į klinikinius vaistinių preparatų tyrimus. Palyginti dalyvavusių ir nedalyvavusių klinikiniuose vaistinių preparatų tyrimuose gydytojų požiūrį į juos. Tyrimo metodika. Buvo atlikta vienos iš Lietuvos ligoninės gydytojų anoniminė anketinė apklausa (n=133, atsako dažnis - 78 proc.). Duomenys buvo analizuojami naudojant SPSS statistinį duomenų analizės paketą bei Excel duomenų analizės paketą. Atskirų kokybinių rodiklių tarpusavio ryšys buvo vertinamas naudojant duomenų Chi kvadrato (χ2) testą. Ryšys buvo laikomas statistiškai reikšmingu, jei paklaidos tikimybė buvo p<0,05. Rezultatai. Pagal atliktą apklausą, klinikinius tyrimus vykdė 61, nevykdė 72 gydytojai. Beveik 46 proc. gydytojų, tiek vykdžiusių tiek nevykdžiusių klinikinius tyrimus, užteko turimų žinių apie juos, tačiau norėtų žinoti daugiau. Vidutiniškai su įstatymine klinikinių tyrimų baze buvo susipažinę 45,9 proc gydytojų kurie vykdė klinikinius tyrimus ir šiek tiek susipažinę 47,2 proc. gydytojų, kurie jų nevykdė. Reikalingumą mokyti studentus atskiros disciplinos apie klinikinius tyrimus jautė 59 proc. vykdžiusių ir 63,9 proc. nevykdžiusių klinikinių tyrimų gydytojų. Kad klinikiniai tyrimai duoda profesinės naudos manė... [toliau žr. visą tekstą] / Aim of the research. To evaluate the physicians‘ of N Hospital opinion on clinical trials of medicinal products. Objectives. To evaluate the factors affecting physicians' motivation to perform clinical trials of medicinal products as well as those that prevent the physicians getting involved in the trials. To assess physicians' attitude towards clinical trials of medicinal products. To compare the opinions of physicians who have and have’nt participated in clinical trials. Methods of research. An anonymous questionnaire survey of the physicians of one Lithuanian Hospital has been carried out (n = 133, response rate - 78%). The data were analyzed using SPSS statistical package and Excel data analysis package. Relations between qualitative indicators were assessed using the chi-squared (χ2) test. The association was considered to be statistically significant if p <0.05. Results. According to the survey, 61 physicians have conducted clinical trials and 72 physicians haven’t. Almost 46% of all physicians had sufficient knowledge about them, but would have liked to know more. On the average, 45.9% of those, who have conducted clinical trials, were familiar with their statutory basis and 47.2% of physicians, who haven’t conducted them, were somewhat familiar. The need to teach students about clinical trials as an individual discipline was implied by 59% of physicians who have conducted clinical trials and 63.9% of those who haven’t. Professional benefit from clinical trials... [to full text]

Diss. Uppsala : Univ., 2003.

Diss. Uppsala : Univ., 2004.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 5 uppsatser.

Thesis (Ph.D.) -- La Trobe University, 2003. Submitted to the School of Public Health, Faculty of Health Sciences. / Includes bibliographical references (leaves 341-378).

Quais os impactos de curto prazo ocorridos a partir dos ciclos iniciais de implantação do “Programa Mais Médicos” (PMM) em municípios do Rio Grande do Sul? Essa dissertação versa um sobre subtipo de ensaio comunitário acerca da problemática em questão, com estudo agregado com múltiplos grupos, longitudinal em série temporal retrospectiva, a partir de dados de fontes secundárias, com análise descritiva de propósito exploratório. Trata-se de 10 grupos conformados por agregados de municípios do Rio Grande do Sul, selecionados e estratificados em 5 faixas populacionais, estando pareados pela condição de implantação e não implantação do PMM. Realizou-se análise comparativa e descritiva de um conjunto selecionado de indicadores correlatos aos serviços de Atenção Primária à Saúde (APS). De um modo geral, observou-se o incremento de indicadores de estrutura nos agregados de municípios com implantação do PMM, notadamente nos agregados com faixas de menores populações. Em termos de indicadores de resultados observou-se discreto incremento na produção de serviços nos agregados com implantação do PMM, contudo, não foram identificadas diferenças significativas de internações por causas sensíveis e de outros indicadores de impacto próprios da APS. As hipóteses mais plausíveis para explicar os achados estão referidas ao exíguo tempo decorrido entre a implantação do PMM e a realização do estudo, além da constatação de que nos ciclos iniciais de implantação do programa houve predominância de caráter substitutivo de trabalho profissional médico nos municípios selecionados para o estudo. / What are the short-term impacts occurred in the early cycles implementation of the "More Doctors Program" (PMM) in municipalities of Rio Grande do Sul? This research focuses on one community trial subtype, added to multiple groups, in longitudinal retrospective time series, based on data from secondary sources, with descriptive analysis of exploratory purpose. It is conformed by 10 groups clusters of municipalities of Rio Grande do Sul, selected and stratified into five population groups, being matched by the deployment condition and not implementation of PMM. We carried out comparative and descriptive analysis of a selected set of indicators related to the services of Primary Health Care (PHC). In general, there was the structure of indicators of growth in clusters of municipalities with implementation of PMM, especially in conglomerates with smaller populations tracks. In terms of outcome indicators showed a slight increase in the production of services in conglomerates with implementation of PMM, however, significant differences in hospital admissions were identified by sensitive causes and other APS's own impact indicators. The most plausible hypotheses to explain the findings are referred to the narrow time between the implementation of the PMM and the study, besides the fact that in the early cycles of program implementation was substitute character predominance of medical professional working in selected municipalities to the study.

Quais os impactos de curto prazo ocorridos a partir dos ciclos iniciais de implantação do “Programa Mais Médicos” (PMM) em municípios do Rio Grande do Sul? Essa dissertação versa um sobre subtipo de ensaio comunitário acerca da problemática em questão, com estudo agregado com múltiplos grupos, longitudinal em série temporal retrospectiva, a partir de dados de fontes secundárias, com análise descritiva de propósito exploratório. Trata-se de 10 grupos conformados por agregados de municípios do Rio Grande do Sul, selecionados e estratificados em 5 faixas populacionais, estando pareados pela condição de implantação e não implantação do PMM. Realizou-se análise comparativa e descritiva de um conjunto selecionado de indicadores correlatos aos serviços de Atenção Primária à Saúde (APS). De um modo geral, observou-se o incremento de indicadores de estrutura nos agregados de municípios com implantação do PMM, notadamente nos agregados com faixas de menores populações. Em termos de indicadores de resultados observou-se discreto incremento na produção de serviços nos agregados com implantação do PMM, contudo, não foram identificadas diferenças significativas de internações por causas sensíveis e de outros indicadores de impacto próprios da APS. As hipóteses mais plausíveis para explicar os achados estão referidas ao exíguo tempo decorrido entre a implantação do PMM e a realização do estudo, além da constatação de que nos ciclos iniciais de implantação do programa houve predominância de caráter substitutivo de trabalho profissional médico nos municípios selecionados para o estudo. / What are the short-term impacts occurred in the early cycles implementation of the "More Doctors Program" (PMM) in municipalities of Rio Grande do Sul? This research focuses on one community trial subtype, added to multiple groups, in longitudinal retrospective time series, based on data from secondary sources, with descriptive analysis of exploratory purpose. It is conformed by 10 groups clusters of municipalities of Rio Grande do Sul, selected and stratified into five population groups, being matched by the deployment condition and not implementation of PMM. We carried out comparative and descriptive analysis of a selected set of indicators related to the services of Primary Health Care (PHC). In general, there was the structure of indicators of growth in clusters of municipalities with implementation of PMM, especially in conglomerates with smaller populations tracks. In terms of outcome indicators showed a slight increase in the production of services in conglomerates with implementation of PMM, however, significant differences in hospital admissions were identified by sensitive causes and other APS's own impact indicators. The most plausible hypotheses to explain the findings are referred to the narrow time between the implementation of the PMM and the study, besides the fact that in the early cycles of program implementation was substitute character predominance of medical professional working in selected municipalities to the study.