Thesis (Ph.D.)--Ohio University, March, 2007. / Includes bibliographical references (leaves 114-120)

Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, / Typescript. Bibliography: leaves 83-89.

Thesis (doctoral)--Rijksuniversiteit te Utrecht.

This research study explores in general the nature of a private general medical practice [PGMP] and whether analysis of the PGMP as a social system can lead the Group Dynamics Practitioner towards developing interventions that will enhance group effectiveness in the PGMP support staff group. The main assumption is that, through the application of a framework of analysis based on that of G. C. Homans and the AGIL functional prerequisites developed by T. Parsons, a structured analysis of the external and internal variables that impact on the PGMP as a social system can be undertaken. The findings of the analysis would lead to the formulation of interventions that would improve the performance effectiveness of the PGMP as a social system. Following a two-questionnaire survey of 17 practices that provided demographic information as well as soft skills training needs, a single PGMP was identified for the case study. Data pertaining to the group as a social system were collected, and by using direct observation, content analysis and a sociometric test, the practice support staff sub-system, being the main focus of this research, could be analysed. By linking the findings to the elements of the framework of analysis, areas of ineffective group functioning could be identified and interventions suggested. This research indicates that the choice of soft skills is associated with the nature and size of the practice, as well as the dynamics of the sociometric patterns characteristic of the relations within the practice support staff subsystem; that while some practice support staff have preferences for sociometric task and socio-emotional relations outside their work clusters, these seem to serve as a buffer against clique forming, thus enhancing the function of integration within the social system as a whole; and that the physical practice layout, and the interaction dynamics that it creates, tend to hinder integration between the members of the practice support staff group, as a social subsystem.

The practice of midwifery by those other than physicians is illegal in Canada and despite recommendations of nursing, medical and consumer groups, no trials evaluating the effectiveness of the nurse-midwife as a member of the modern obstetrical team have occurred here. To demonstrate a nurse-midwifery model, four nurse-midwives provided primary care to forty-seven childbearing women and their families over a twenty-two month period in a maternity teaching hospital. This clinic presented a unique opportunity for comparing the prenatal care provided by nurse-midwives with that of general practitioners who attended deliveries in the same setting. Utilizing a retrospective chart audit, case control study design, the nurse-midwife cases (NM cases) were each matched to two general practitioner controls (GP controls) through the use of the hospital's prenatal data base. The matching characteristics included low risk status, date of delivery, age, parity, gravidity, previous pregnancy losses and census tract income. Prenatal criteria that had been developed and tested in "The Burlington Randomized Clinical Trial of the Nurse Practitioner" for assessing the quality of care were reviewed and updated for this study. With these criteria two blinded abstractors audited the prenatal record forms of all the subjects and scored them as either "superior", "adequate" or "inadequate". Seventy-seven percent of the records of the NM cases received a "superior" score, where as 60% of the GP controls' records received an "inadequate" score [mathematical formula omitted] Overall, the general practitioners' records indicated more erratic care than those of the nurse-midwives. Although the physicians met most of the initial assessment criteria, they failed to meet the criteria that evaluated the ongoing routine assessment process by recording an inadequate number of prenatal visits (36%), or by omitting urine test results (38$) and blood pressure readings (21%). No differences were found in variables relating to labour and delivery with the exception of the incidence of episiotomies. The results indicate that nurse-midwives as part of an obstetrical team are able to provide safe prenatal care to a low risk population in a Canadian urban context, and that their records are thorough and more consistent than those of general practitioners. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Diss. Linköping : Univ., 2005. / Härtill 5 uppsatser.

The work content and style of practice of family physicians in British Columbia has been evolving since the second world war. Since the late sixties, a reassessment of the role of family physicians has been underway, both in Canada and the United States. Primary health care has recently been given greater recognition in North America. The development of family practitioners’ tasks in the last twenty years is reviewed from the point of view of a practitioner. In Canada, the health care system has been changing since the forties, as a result of a series of federal-provincial agreements. It had become apparent that, despite constitutional deeding of health care to the provinces, federal incentives and funding were required to develop an appropriate nationwide system of health care. What was a joint private enterprise and local community sponsored health care system in the thirties, has now become a complex government-funded operation. Government involvement in third party payment schemes, for doctors particularly (the last of a series of national health insurance programs), has changed the relationship of doctors to their patients, because both became subject to the new rules of the Medical Care Act of 1967. Government involvement in payment for services has led to questions about accountability for spending. Subsequently, this led to the need for better planning, especially health manpower planning, which began to be considered very important in the early sixties. At that time, the Royal Commission on Health Services examined the prospects of bringing physicians’ services and allied health manpower services to all Canadians. The attempts to plan physician manpower in Canada and British Columbia in the sixties and seventies are considered and criticized. Conclusions are drawn regarding the prospects for future manpower planning for primary care to be given by family practitioners in British Columbia. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 1994. / Typescript. Includes bibliographical references (leaves 143-154).