Patients' non-adherence to treatment is a widespread phenomenon in healthcare. Time preferences (how individuals value outcomes over time) are one cause for non-adherence. Using quasi-hyperbolic discounting, two options in the future are weighted consistently. However, when the early option becomes available the weighting changes. This creates the potential for non-adherence. The agency relationship that exists between patients and doctors implies hidden information. When the patient's time preferences are hidden from the doctor, the doctor must choose how to recommend treatments. Exploring how doctors make treatment decisions when time preferences are hidden from them, and how this impacts adherence, is therefore important. The first contribution of the thesis is to outline a model of the patient-doctor interaction incorporating quasi-hyperbolic discounting and hidden information. This shows that doctors should adapt to non-adherence when the probability a patient is present-biased is large enough. Secondly, a national survey of Scottish GPs explores whether doctors have different time preferences for themselves or their patients. Doctors do have the same private and professional time preferences, but value the health state differently between frames. Lastly, a laboratory experiment tests whether students in the role of a doctor adapt to non-adherence in the way predicted by the model. Students find the socially optimal level of treatment on average. Adaptation is stronger when using a performance payment, and results did not vary along demographic characteristics. The thesis highlights the importance of the patient-doctor interaction for generating nonadherence, not just patient preferences. It also shows that GPs' private time preferences may suitably substitute their preferences for patients. Finally, it points towards potential incentives for doctors to improve patient outcomes.

This thesis was undertaken to provide practice relevant information for educational planning within Family Medicine in Indiana. The basic aim was to determine the current practice patterns in family medicine and to develop profiles for selected career patterns. All All Indiana doctors with a career choice in family medicine comprised the population for this statewide study. The data were collected through the use of a validated questionnaire. The data were statistically analyzed by computer and reported in narrative and tabular form.Ball State UniversityMuncie, IN 47306

Background: In South Africa there data is lacking on the health of the older population. This study aims to report on actions taken by general practitioners on abnormal blood pressure, blood glucose and osteoporosis screen identified by registered nurses, conducting home based visits to older clients. Methods An agency piloted the Comprehensive geriatric assessment (CGA) tool in an urban affluent population. In this cross sectional secondary study analysis, 465 participants aged 60 years and over had a nurse visit in their homes and a subsequent General Practitioner (GP) visit. The prevalence of specific geriatric problems was assessed as well as the frequency of initiated procedures by the GP. This study will focus on initiated actions by the General Practitioners in response to abnormal blood pressures, blood glucose, and osteoporosis screen. Results Frequency tables were utilised to identify prevalence of the abnormal blood pressures, blood glucose and osteoporosis screen. . Abnormal blood pressures were detected (230/465, 49%) of the subjects , the GP initiated actions on only 15/465 (3.2%) of clients. Abnormal blood sugars were detected 106/465 (23%) of the GP initiated actions on 23/465 (5%) of clients. Clinical risk factors for the development of osteoporosis were detected in 252 /465 (54%) subjects GP initiated actions on 11/465 (3%) Conclusion This study explored the relationships between comprehensive geriatric assessment and subsequent GP actions and found using the CGA in this population will be successful in identifying abnormal health findings which will enable intervention. However, due to challenges in the communications and marketing of this service, GP’s were not well informed of their role and did not act on majority of the abnormal findings detected by nurses / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

Bibliography: p. 379-394. / xi, 394 p. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 1988

Thesis (Ph.D.)--Victoria University (Melbourne, Vic.), 2008.

Thesis (Ed. D.)--West Virginia University, 1998. / Title from document title page. Document formatted into pages; contains x, 126 p. Includes abstract. Includes bibliographical references (p. 81-87).

Thesis (MFamMed)--Stellenbosch University, 2014. / BACKGROUND:Family physicians are trained to enable them to staff community health centres and primary care hospitals. Part of this training is teaching them procedural skills for anaesthetics and surgery. Knysna hospital is a training facility for family medicine registrars and this article aims to evaluate if sufficient learning opportunities exist in Knysna hospital’s theatre to teach family medicine registrars procedural skills. METHODS:A descriptive study was undertaken of the number and type of procedures performed in Knysna hospital theatre for a one year period, and compared with the required skills,as stipulated in the national training outcomes, for the discipline. RESULTS:Three thousand seven hundred and forty one procedures were performed during the study period. Anaesthesia was the most common procedure, followed by caesarean section. There were adequate opportunities for teaching most core skills. CONCLUSIONS: There were sufficient opportunities for a registrar to be taught all the core skills that are exclusive to theatre. Further research is needed to evaluate Knysna hospital as a training facility for all procedural skills. / AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.

The purpose of this thesis is to examine the relationship between consultants and general practitioners, particularly as far as hospital in-patient care is concerned. How has the role of each of them evolved? What is the effect of the division between consultants and general practitioners on in-patient care? What is the role of the general practitioner as far as in-patient care is concerned, particularly in general practitioner units? In order to examine these questions the historical origin of the general practitioner and consultant is described, and the results of two surveys are presented. The first survey was carried out in 1970 in a teaching hospital, The Radcliffe Infirmary, Oxford, and is called the Radcliffe Survey. The second was carried out in 1970-71 and consisted of a survey of all medical admissions from one general practice in Wantage to Wantage Hospital and consultant wards in the United Oxford Hospitals; this is called the Wantage Survey. The results of these surveys are used to examine a number of hypotheses. These will be stated in detail, but broadly speaking the aim of the surveys was to try to discover how much hospital care can be provided in a general practitioner hospital as an alternative to consultant care, how the admissions to the two types of hospital are selected and how they differ. Obstetrics is not included in either survey because the role of G.P. obstetric units has been well covered in a number of publications. The Radcliffe Survey was concerned with medical and surgical patients, but it is medical admissions that form the largest part of in-patient care in general practitioner hospitals and, at the same time, the least investigated. Therefore, the Wantage Survey was concerned almost exclusively with medical admissions.

The study was designed to explore the proposition that conduct of and participation in research by general practitioners in British Columbia would be both desirable and feasible. Desirability was defined in terms of benefits for knowledge, for the medical practice, and for society at large. Feasibility was defined in terms of being acceptable for the general practitioner, for the patient, for the practice, and for the requirements of research. To answer specific questions related to desirability and feasibility of research by general practitioners, information was obtained from the literature, from a questionnaire survey of the total general practitioner population of British Columbia, and from a random sample of patients in practices selected at random from respondents to the questionnaire to general practitioners. In the survey of general practitioners, 2,344 questionnaires were mailed. Of the 563 (24%) which were returned, 508 were available for analysis. Five were returned by the post-office undelivered, seven were too late for analysis, and forty-three were returned with information indicating that the respondent was not in general practice. Forty- eight respondents were anonymous, and the remainder identified themselves. The response of general practitioners represented a variety of geographic locations, ages, types of practice, and medical schools. Members of the College of Family Physicians of Canada had a response rate of 39%. In the survey of patients, 15 out of 20 general practitioners who were contacted agreed to submit questionnaires to their patients. Of the patients surveyed, approximately 90% completed the questionnaires. Most were regular patients of the doctors, and represented a full range of ages, and both sexes. General practitioners and their patients agreed that research by general practitioners was desirable, and suggested many areas suitable for research. The benefits of research to the general practitioners, patients, and society were considered to be incentives, encouraging research activity. Important among the benefits were the discovery of new knowledge and the contribution to the academic base of general practice. The feasibility of research was explored in terms of the conditions required for its conduct. Attitudes were receptive to the concept of research, as many of the general practitioners had previously been involved in projects. Major deterrents were heavy workload and lack of time, for the general practitioners, and in their practices the high overhead and pressure of work on the staff were problems. Training for research was variable, with some general practitioners having none and a few having much training. Inadequacy of the usual office records was recognized, so that research would usually require special methods. General practitioners had little awareness of resources available for help, advice or financing, but most were aware of the need for such resources. Patients were willing to cooperate in studies. They suggested that the cost of research should be borne primarily by governments, and to a lesser extent by foundations and the public. Recommendations were made for the support of research, to help overcome the problems which decrease its feasibility. There should be encouragement of training in research methods, at both undergraduate and postgraduate levels. This would include presentation of research findings to scientific meetings of medical societies, and visits to and from eminent research workers in general practice. Some assistance should be given to the general practitioners, such as help in developing office records for research or payment for time spent on research. Resources for help in planning studies and processing results should be readily available, including both consultant advice and the provision of grants. Conclusions from the study were that research by general practitioners in British Columbia is desirable, and that it is feasible but has several major deterrent factors which can inhibit research activity. Because of these factors, the great potential for research in British Columbia is still far from being realized. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Thesis (PhD)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: District hospitals play a pivotal role in the district health system of the Western Cape and other provinces of South Africa. It is a dual role, supporting both primary health care services and serving as a gateway to higher levels of care. Most district hospitals are in rural areas, staffed by generalist medical practitioners who provide health services often supplied by specialists in urban areas. There is a paucity of research and published material on the scope of practice of district hospital practitioners in South Africa, as well as the factors influencing the performance of their duties. There were two main objectives for this study. Firstly, to identify the professional knowledge and skills of medical practitioners delivering district hospital services in the Western Cape and to compare these with service platform needs. Secondly, to use the information gathered to make recommendations regarding human resource development and appropriate education and training and continuing professional development of these doctors. The study was conducted in three phases to ensure coherent evolution of investigation, co-ordination and response. Phase One was a comprehensive survey, utilising district hospital data, medical officer questionnaires and in-depth interviews to determine the professional knowledge and skills of medical practitioners working in district hospitals in the Western Cape. This information gathering endeavour resulted in a skills and knowledge compendium being formulated. It established that the spectrum of functions required of these doctors was extremely wide - ranging from the management of undifferentiated problems to performing complex surgical procedures, as well as providing a vital public health function. Two main factors influenced their performance, namely their working conditions and the education and training which they received.In common with rural practice in other countries, it was apparent that the working environment had a major impact on attitudes and functioning. These findings were developed into a conceptual framework depicting the negative influences that can build up and result in these doctors opting out of rural practice. In addition, other influences were established having a profound effect on doctors’ satisfaction, mainly in the realm of education and training. This gave rise to a second more comprehensive framework being evolved, encapsulating the positive and negative factors enhancing or retarding efficiency and satisfaction in the workplace. Phase Two of the study consisted of the validation of the findings of the basic research data. In keeping with the second aim of the study, the education and training perspectives of rural and district hospital practice were explored. The deficiencies exposed have implications for undergraduate and postgraduate education and training, as well as for continuing professional development programmes. Phase Three concentrated on the exploration of ways and means of defining and maintaining ongoing professional competence for district hospital practice. This was approached by using the data captured in Phase One and refined in Phase Two to pose a series of educational problems to a group of experts. Using the Delphi Technique, a series of electronic exchanges achieved consensus on a range of topics varying from educational content to learning modalities and modern adult teaching techniques applicable to district hospital practice. This research presents information defining the circumstances, experiences and needs of medical practitioners working in district hospitals in the Western Cape province of South Africa. It reveals clear challenges to the capacity, attitudes, costs, isolation, political will, monitoring and organisation which will be crucial in the development of future human resource strategies.It, furthermore, defines the educational objectives, content and methods required to establish and maintain the ongoing professional competence of medical practitioners delivering district hospital services in the Western Cape. / AFRIKAANSE OPSOMMING: Distrikshospitale speel ‘n sentrale rol in die distriksgesondheidstelsel van die Wes- Kaap en ander provinsies in Suid-Afrika. Dit is ‘n dubbele rol wat beide primêre gesondheidsorgdienste ondersteun en optree as ‘n deurgang vir verwysing na hoër vlakke van sorg. Die meeste distrikshospitale is te vinde in plattelandse gebiede. Dit is hier waar die algemene geneeskundige praktisyn dienste lewer wat gewoonlik deur spesialiste in stedelike gebiede verrig word. Daar is ‘n gebrek aan bestaande navorsing en publikasies oor die omvang van praktyk van geneeshere in distrikshospitale in Suid- Afrika, sowel as onvoldoende inligting in verband met faktore wat die funksionering van hierdie praktisyns beïnvloed. Hierdie studie het twee hoofdoelwitte vervat. Die eerste doelwit was die bepaling van die professionele kennis en vaardighede van geneeshere werksaam in distrikshospitale in die Wes-Kaap, en die vergelyking daarvan met die behoetes van die diensplatform. Die tweede doelwit was om hierdie inligting te gebruik om aanbevelings te doen aangaande menslike hulpbronontwikkeling en toepaslike onderrig, opleiding en voortgesette professionele ontwikkeling vir hierdie geneeshere. Die studie is in drie fases uitgevoer om samehangende ontwikkeling van ondersoek, koördinasie en respons te verseker. Fase Een het bestaan uit ‘n omvattende opname van die professionele kennis en vaardighede van geneeshere werksaam in distrikshospitale in die Wes-Kaap deur die gebruik van distrikshospitaaldata, vraelyste vir geneeshere, en in-diepte onderhoude. Die resultate is gebruik om ‘n omvattende stel kennis en vaardigheidsareas te identifiseer. Fase Een het bewyse gelewer dat die rol en funksie van dokters in distrikshospitale uitsonderlik wyd is en wissel tussen die hantering van ongedifferensieërde probleme en die uitvoer van komplekse chirurgiese prosedures, sowel as ‘n belangrike rol in openbare gesondheid. Werksomstandighede en onderrigen opleiding is geïdentifiseer as die twee belangrikste invloede wat die uitvoer van hierdie praktisyns se pligte beïnvloed. Soortgelyk aan plattelandse praktyke in ander lande, het dit duidelik geword dat werksomstandighede ‘n groot invloed op houdings en funksionering het. Hierdie bevindings is saamgevoeg in ‘n konseptuele raamwerk om die negatiewe invloede toe te lig wat veroorsaak dat hierdie geneeshere die plattelandse diens verlaat. Ander faktore wat ‘n beduidende uitwerking op praktisyns se werksbevrediging gehad het, veral wat onderrig en opleiding betref, is saamgevat in ‘n tweede en omvattende raamwerk wat die positiewe en negatiewe invloede op effektiwiteit van dienslewering en werksverrigting uitspel. Fase Twee van die studie het bestaan uit die bevestiging van die bevindings van die basiese navorsingsinligting. Perspektiewe in die onderrig en opleiding vir plattelandse praktyk is ondersoek in oorleg met die tweede doelwit van die studie. Verskeie implikasies vir voorgraadse en nagraadse onderrig en opleiding en voortgesette professionele ontwikkelingsprogramme is uit ontblote tekortkomings geïdentifiseer. Die omskrywing en die behoud van professionele bevoegdheid is in Fase Drie ondersoek. Data verkry in Fase Een, en verfyn in Fase Twee, is gebruik in die ontwikkeling van ‘n reeks opvoedkundige vraagstukke. ‘n Groep deskundiges is daarna die taak gestel om konsensus te bereik oor ‘n spektrum van onderwerpe, insluitend toepaslike inhoud, metodes van leer en moderne volwasse onderrigtegnieke vir distrikshospitaal praktykvoering. Die Delphi tegniek met herhalende elektroniese rondtes is hiervoor gebruik. Hierdie navorsing lewer inligting wat die omstandighede, ondervindings en behoeftes van geneeshere werksaam in distrikshospitale in die Wes-Kaap provinsie van Suid- Afrika beskryf.Die navorsing onthul duidelike uitdagings vir die kapasiteit, houdings, koste, isolasie, politieke wilskrag, monitering en organisasie van strategieë vir die ontwikkeling van menslike hulpbronne. Dié navorsing definieër hierbenewens die opvoedkundige doelwitte, inhoude en metodes wat nodig is vir die vestiging en instandhouding van die professionele bevoegdheid van distrikshospitaalpraktisyns in die Wes-Kaap.