Introduction/ Objectives: Stroke, the third leading cause of death in Canada, is projected to rise in the next 20 years as the population ages and obesity rates increase. Family caregivers fulfill pertinent roles in providing support for family members who have survived a stroke, from onset to re-integration into the community. However, the transition from rehabilitation to home is a crucial transition for both the stroke survivor and family caregiver. As the stroke survivor transitions home from a rehabilitation facility, family caregivers provide different types of support, including assistance with navigating the stroke rehabilitation system. They also are a constant source of support for the stroke survivor providing them with continuity during the transition. In this exploratory study we examined family caregivers’ perceptions and experiences navigating the stroke rehabilitation system. The theories of continuity care and complex adaptive systems were used to examine the transition home from hospital or stroke rehabilitation facility, and in some cases back to hospital. Methodology: Family caregivers (n=14) who provide care for a stroke survivor were recruited 4-12 weeks following the patient’s discharge from a stroke rehabilitation facility. Interviews were conducted with family caregivers to examine their perceptions and experiences navigating the stroke rehabilitation system. Directed content analysis was used to explore the perceptions of family caregivers as they reflected on the transitions home. The theories of continuity of care and complex adaptive systems were used to interpret their experiences. Results/Conclusions: During the transition home from a rehabilitation facility, family caregivers are a constant source of support, providing the stroke survivor with continuity. Emergent themes highlight the importance of the caregiving role, and barriers and facilitators that impact the role, and influence continuity of care. Also, supports and services in the community were limited or did not meet the specific needs of the family caregiver. The acknowledgment of the unique attributes of each case will ensure supports and services are tailored to the family caregiver’s needs. Mitigation of systemic barriers would also decrease complexity experienced at the micro-level in the stroke rehabilitation system, and better support the family caregiver during the transition home from a stroke rehabilitation facility.

Health-care delivery involves clinical handover processes that occur at many levels of inpatient care. These processes are essential to an effective health-care system due to their role in achieving efficient communication, reducing transmission time, and lowering costs. Ensuring safe and effective handover requires the coordination of multiple care providers that work together to deliver patient care efficiently. Poor coordination during handover can have major effects on patient care, leading to loss of information and contributing to adverse events. As health-care delivery evolves to become more patient-centered, handovers from short- to long-term care need to maintain a strong communication, which in turn will depend on the evolution of support systems for that communication. Due to the wide range of care providers and patient needs, there has so far been a lack of research work on handover processes. This study aims to explore the clinical handover process for patients moving from a cardiology unit to home and community care settings, and how they are affected by varying degrees of communication. It relies on literature review and a case study conducted at Montfort Hospital, Ontario, to identify and analyze the major factors involved in this type of handover, and to form suggestions about how this process could be improved. This thesis analyzes process scenarios arising in the case study, modeling them using business process management (BPM) tools and techniques to identify problems and formulate solutions. A model of the existing process is created and analyzed using business process management notation (BPMN), and is then subjected to analysis, the results of which identify several communication issues with a potential to cause delays and information loss. The findings highlight the importance of collaboration among care providers, and indicate the potential uses of BPM methodology to choreograph that collaboration. The study ultimately shows how improvements to collaboration and information exchange can increase the communication effectiveness in handover processes and reduce the probability of adverse patient events.

The master thesis deals with the health care systems of Spain and Portugal. The theoretical part of the thesis describes the general types of health care systems and the way they compare. In the next part the health systems of both countries are introduced with a focus on the financing, provision of services and health care reforms. The practical part of the thesis aims to analyse the relation between health expenditures and selected indicators of quality of health care in Spain and Portugal. For this purpose is used the correlation coefficient and the cost effectiveness analysis, which provides a comparison of the two countries with selected OECD countries.

This diploma thesis explains how the Swedish health care system is financed. First, the health care system in Sweden is introduced. Next part of the thesis analyses the health care foundation of Sweden. The important part of the thesis is the analysis of health care quality. This part includes the cost effectiveness analysis, which is compared with selected OECD countries. Finally few changes are recommended.

This thesis explores the possibility of using the Collective System Design Methodology to design systems that will improve the health of people. The focus of the thesis is on the reversal of type-2 diabetes.

Introduction/background: Ayurveda is an ancient holistic medical system largely used in India. Complementary and alternative forms of medicine (CAM) like Ayurveda is starting to spread to the western parts of the world. In Sweden, there is an ongoing project of integrating CAM methods in Swedish health care. Research has shown that this has been beneficial for patients and can reduce care costs. Despite the popularity of CAM methods, knowledge of the methods might be deficient among Swedish healthcare staff. Aim: The aim of this study was to examine registered nurses’ perception of the use of ayurvedic medicine compared to western medicine in a hospital in Kerala, India. Method: A qualitative method was used with an inductive design. Data was collected through semi-structured interviews with five registered nurses. A thematic analysis was used to analyze the data. Result: The analysis resulted in three themes: Pros and cons, To combine or not? and Negotiating the use of Ayurveda. Conclusion: Ayurveda can be helpful in treating less critical conditions. Western medicine was seen as more relevant when treating more serious illnesses. Ayurvedic treatments was perceived to take longer and have more side effects. A combination of the two medical approaches was not recommended, however, Ayurveda could work as a complement to western medicine in terms of less acute conditions.

The author studied the welfare state typology in China from a health care perspective. This study aims to figure out what type of welfare typology works in Chinese health care system through comparative welfare state typology, specifically the decommodification principle proposed by Esping-Andersen (2019) and health care decommodification index put forward by Bambra (2006). Studying the classification of Chinese welfare state typology by analysing the Chinese health care system and comparing it with other countries in the world within the scope of welfare state typology, helps China enhancing the public administration. The author found that China belongs to medium decommodification group which means it is the same decommodification level as Conservative-Corporatist regimes, but also indicates there's a huge improvement potential to high decommodification group in the future. Keywords Welfare State Typology; China; Chinese Health Care System; Health Decommodification Index Range of the Thesis: 66 pages

The present study involved the implementation of one component, Community Health Status Assessment, of a comprehensive, strategic planning tool, Mobilizing for Action through Planning and Partnerships (MAPP), to qualitatively uncover the perceptions of the quality of life and local health care system of 28 residents in New River Valley (NRV), Virginia. The current study represents the initial qualitative study utilizing MAPP in Virginia. Interviewees perceived an overall good quality of life (e.g., ample green space, safe neighborhoods), with an urgent need for health care reform, affordable insurance, and transportation, particularly for after-hours medical care. The current study also reviews the specific findings from the one-on-one interviews, and provides a step-by-step look at the MAPP process for potential users as applied to a real-world community, specifically, the NRV. / Ph. D.

Cartas al editor / Revisión por pares

La France est caractérisée par un bon état de santé global et d'importantes inégalités sociales de santé. Le renouveau d'intérêt pour ces dernières est l'occasion de questionner une définition univoque centrée sur les résultats au détriment des procédures, dans un pays qui a axé ses politiques de lutte sur le système de soins. La médecine générale y a une place particulière par son apparition récente en tant que spécialité universitaire et la nécessité de se définir qui s'ensuit. Elle est décrite tout à la fois comme pivot du système de soins, agent de santé publique ou chantre d'une relation inter-individuelle et d'une prise en charge globale. Si la médecine est fondée sur les données de la science, elle est aussi une profession prudentielle en ce qu'elle prend en compte des situations singulières, générant de l'incertitude dans la pratique. Parmi les sources de singularité, l'aspect social, tant du patient que du médecin, est à considérer. Dans sa pratique, ce dernier éprouve cependant une diversité de social. Tantôt obstacle à son activité professionnelle et vu comme extérieur au médical, tantôt élément apparenté aux données de la science par l'épidémiologie, il peut aussi être une brique de la construction individuelle du patient sur laquelle s'appuyer, conduisant parfois à une moralisation des conduites et des identités. Les caractéristiques sociales du médecin sont quant à elles souvent oubliées, comme s'il était neutre ou simple représentant de la science. C'est pourtant dans l'interaction entre ces deux mondes que se jouent aussi les inégalités sociales de santé et tout se passe comme si le médecin ne pouvait bien soigner que ses semblables. / France is characterized by a good overall health status and high social inequalities in the health sector. The renewed interest in health inequalities is the opportunity to question a unique definition focused on results at the expense of processes, in a country where policies on tackling inequalities are based on the health care system. General practice has a particular position in this system, as a new academic speciality, which still needs to figure out how to define itself. It is described simultaneously as a heath care system gatekeeper, a public health officer or an advocate for inter-individual relationship and holistic care. While medicine is based on scientific evidence, it is also a prudential profession as it considers singular situations, generating uncertainty in practice. Among singular sources, social characteristics of both patients and doctors have to be considered. However, in their practice, physicians experience a diversity of social. Sometimes a barrier to the professional activity and considered external to the medical world, sometimes considered as part of scientific evidences by epidemiology, it could also be considered as a component of the individual construction of the patient on which the physician can rely, with the potential to lead to a moralization of behaviours and identities. The physician's social characteristics are often omitted, as if doctors were neutral or mere representatives of science. It is however in the interaction between these two worlds that social determinants of health inequalities can be found, and it seems that a physician could only provide good care to patients sharing the same similarities.