This collection of work represents an interest in education in palliative care over the last ten years. These papers are written either by myself or in collaboration with colleagues in Britain and New Zealand. During those years the way in which palliative care is taught and learned has changed and continues to change. The overview of the work submitted here describes the rationale behind the development of new approaches to the teaching and learning of care at the end of life. In many ways this collection represents a personal journey - one that involves investigation, growth, research and evaluation. By publishing these papers and promoting discussion in this area of education I have made an original contribution to the changing way in which doctors are taught and learn to care for people who are dying and into our understanding of the nature of learning to care for those people. The papers are listed here in chronological order. Throughout the text of the overview they are referenced along with other relevant papers but appear in the reference list in bold. I declare that I am the author of the papers contained in thesis unless otherwise stated. All references documented have been consulted in the writing of these papers. References appear in the texts in the form required for each individual journal. The papers have all been published in peer reviewed journals. MacLeod, R.D., Nash, A.: 1991 : Teaching palliative care in General Practice - a survey of education needs and preferences. Journal of Palliative Care 7: 4, 9-12. (reference 6) (RDM 70% - AN 30%) MacLeod, R.D., Nash, A.: 1992 : "Taking the lid off1 -observations of the process of palliative care education for General Practitioners. Postgraduate Education for General Practice 3, 28-3 (reference 9) (RDM 60% - AN 40%) James, C., and MacLeod, R.D.: 1993 : The problematic nature of education in palliative care. Journal of Palliative Care 9:4, 5-10 (reference 10) (RDM60%-CRJ-40%) MacLeod, R.D.: 1993 : Education in palliative medicine : a review. Journal of Cancer Education 8: 4, 309-312 (reference 11) MacLeod, R.D., Nash, A.: 1994 : Multidisciplinary palliative care education. Journal of Interprofessional Care 8:3.283-288 (reference 12) (RDM 70% - AN 30%) MacLeod, R.D., Nash, A. and Charny, M.: 1994 : Evaluating education in palliative medicine. European Journal of Cancer Care 3: 163-168 (reference 14) (RDM 60% - AN 30% - MC 10%) MacLeod, R.D.: 1997 : Teaching holism in palliative care and hospice. American Journal of Hospice & Palliative Care 14:1, 12-16 (reference 36) MacLeod, R.D., James, C.R.: 1997 : Improving the effectiveness of palliative care education. Palliative Medicine 11:5, 375-380 (reference 38) (RDM 60% - CRJ 40%) MacLeod, R.D., Robertson, G.: 1999: Teaching about living and dying. Education for Health 12:2,185-192 (reference 65) (RDM 80% - GR 20%) MacLeod, R.D.: 2000 : Learning to care: a medical perspective. Palliative Medicine 14:3, 209-216 (reference 66) MacLeod, R.D.: 2001 : On reflection: how doctors learn to care for people who are dying. Social Science & Medicine 52,1719-1727 (reference 67).

Population health is concerned with analyzing the factors that determine the uneven distribution of health in a population and it also proposes interventions to narrow health inequalities. Kindig has proposed a population health management strategy that would engage the health and other sectors on population health improvement through a financial incentive linked to health outcomes. Proposed elements of a population health approach in health care at the patient encounter level include paying attention to health determinants for the patient and ensuring interprofessional collaboration; at the system level the approach includes developing and advocating for interventions that address health inequalities, such as delivering services to under-serviced areas and vulnerable populations. There has been virtually no research among frontline clinicians on the awareness and salience of a population health approach. In order to address this gap an exploratory study was conducted among family physicians in Primary Care Networks (PCNs) in Alberta, Canada. PCNs include capitation funding that is used to purchase services such as nursing, pharmacy and dietetics. The physicians were able to describe their patient populations in terms of a full range of social determinants and the health status inequalities they produce. They emphasized the importance of preventive screening and counseling in contributing to the health of their patients, and cited the key contributions of other team members to these activities, as well as the electronic medical record (EMR). They reported ambivalence toward the effectiveness of financial incentives for population health improvement, and while there was some collaboration with schools, inter-sectoral collaboration has yet to develop outside the health sector. This thesis has demonstrated the potential for primary care physicians to adopt a population health approach. However, there is a considerable distance to go in introducing an incentive approach for outcome-based population health management, as envisioned by Kindig.

Thesis (Ph. D.)--Rand Graduate School, 2001. / Includes bibliographical references.

Population health is concerned with analyzing the factors that determine the uneven distribution of health in a population and it also proposes interventions to narrow health inequalities. Kindig has proposed a population health management strategy that would engage the health and other sectors on population health improvement through a financial incentive linked to health outcomes. Proposed elements of a population health approach in health care at the patient encounter level include paying attention to health determinants for the patient and ensuring interprofessional collaboration; at the system level the approach includes developing and advocating for interventions that address health inequalities, such as delivering services to under-serviced areas and vulnerable populations. There has been virtually no research among frontline clinicians on the awareness and salience of a population health approach. In order to address this gap an exploratory study was conducted among family physicians in Primary Care Networks (PCNs) in Alberta, Canada. PCNs include capitation funding that is used to purchase services such as nursing, pharmacy and dietetics. The physicians were able to describe their patient populations in terms of a full range of social determinants and the health status inequalities they produce. They emphasized the importance of preventive screening and counseling in contributing to the health of their patients, and cited the key contributions of other team members to these activities, as well as the electronic medical record (EMR). They reported ambivalence toward the effectiveness of financial incentives for population health improvement, and while there was some collaboration with schools, inter-sectoral collaboration has yet to develop outside the health sector. This thesis has demonstrated the potential for primary care physicians to adopt a population health approach. However, there is a considerable distance to go in introducing an incentive approach for outcome-based population health management, as envisioned by Kindig.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2015-04-07T14:44:21Z No. of bitstreams: 1 Josue Souza Gleriano.pdf: 2299806 bytes, checksum: 46cc3937b0e1b2301d90df1d031803e4 (MD5) / Made available in DSpace on 2015-04-07T14:44:23Z (GMT). No. of bitstreams: 1 Josue Souza Gleriano.pdf: 2299806 bytes, checksum: 46cc3937b0e1b2301d90df1d031803e4 (MD5) Previous issue date: 2014-11-03 / Introduction: The intersection between health, education and work permeates the institutionalization of the NHS since its proposed construction. The professional health education leads to permanent health education and the centrality of care practices and technologies. The axis training to practice and practice to the service becomes the object of this study. Objective: To characterize the profile of doctors and nurses working in health units belonging to the Primary Care of Guarujá SP Method: This was a study approved by the Ethics and Research Committee No. 452 727 / CEP UNAERP / 2013 prepared by A cross-sectional study. Participating physicians and nurses in health centers were to link the level of Primary Health, who were not on vacation or away for health reasons, answering a self-administered structured questionnaire developed by Brazil Telehealth and was drafted by a complementary conducted a descriptive analysis of all variables of the study. A descriptive analysis of all variables of the study was conducted. Qualitative variables were presented in terms of their absolute and relative values. Quantitative variables in terms of their values of central tendency and dispersion. To evaluate the association between categories of health professionals (doctors, nurses) and qualitative variables the Chi-square and Fisher's exact test was used. For quantitative variables, the normality and homogeneity of variances were assessed using Kolmogorov-Smirnov and Levene tests, respectively. As these two variables were not satisfied principles, the nonparametric Mann-Whitney U test was used. The significance level was 5%. Statistical package used was SPSS for Windows 17.0. Results: In relation to the research subjects shows that the professionals linked to units of family health were more accepted to participate. Regarding age, one realizes that professional family health (USAFA) are younger than those of basic health units (BHU) (p <0.05) sequence that also references the type of employment in the city. Regarding the type of employment shows that the higher prevalence in the APS will occur by CLT (p <0.05). The satisfaction expressed by health professionals when analyzed in the context of increased prevalence is a good level, highlighting only with respect to the health service system of the municipality which is rated as fair (p <0.05). Regarding the light for the job-analysis technologies in general feels empowered to play a familiar approach, community, the multidisciplinary work group activities and home visits (p <0.05). Conclusion: The knowledge of the profile of professional members of the body of human resources in health services points need qualification, first exposed in continuing education scenario and lack of introductory courses and approaches to the labor process in APS. The scenario might propose in relation to working technologies then requested the validation of professional a weakness in what is expected for the level of attention. The stability of the employment relationship must be worked with professionals especially in relation to the supervision of labor and production for the attention, remembering that the spaces of care are not just specific to a pathological clinical look. The reflection of the expanded clinic should be treated, in question, as a human resources policy not only to UBS. / Introdução: A interseção entre saúde, educação e trabalho permeia a institucionalização do SUS desde a sua proposta de construção. A educação profissional em saúde conduz a formação permanente em saúde e a centralidade das práticas e nas tecnologias do cuidado. O eixo formação para a prática e prática para o serviço torna-se objeto desse estudo. Objetivo: Caracterizar o perfil de médicos e enfermeiros que trabalham nas unidades de saúde pertencentes à Atenção Primária do município de Guarujá S.P. Método: Tratou-se de uma pesquisa aprovada pelo Comitê de Ética e Pesquisa nº 452.727/CEP- UNAERP/2013 elaborada mediante a um estudo transversal. Participaram médicos e enfermeiros das Unidades de Saúde que estavam com vínculo no nível de Atenção Primária a Saúde, que não estavam de férias ou afastados por motivos de saúde, respondendo um questionário estruturado auto-aplicado, desenvolvido pelo Telessaúde Brasil e um complementar elaborado pelos Foi realizada a análise descritiva de todas as variáveis do estudo. As variáveis qualitativa foram apresentadas em termos de seus valores absolutos e relativos. As variáveis quantitativas em termos de seus valores de tendência central e de dispersão. Para se avaliar a associação entre as categorias de profissionais de saúde (médicos, enfermeiros) e as variáveis qualitativas foi utilizado o teste de Qui-quadrado e o teste exato de Fisher. Para as variáveis quantitativas a normalidade e homogeneidade das variâncias foram avaliadas através de Kolmogorov-smirnov e Levene respectivamente. Como as variáveis não apresentaram esses dois princípios satisfeitos, foi utilizado o teste não paramétrico U Mann-Whitney. O nível de significância foi de 5 %. Pacote estatístico utilizado foi SPSS for Windows 17.0. Resultados: Em relação aos sujeitos da pesquisa exibe que os profissionais vinculados às unidades de saúde da família tiveram maior aceite em participar. Em relação à faixa etária percebe-se que os profissionais de saúde da família (USAFA) são mais novos que os das unidades básicas de saúde (UBS) (p<0,05) sequência que também faz referência ao vínculo de trabalho no município. Em relação ao vínculo de trabalho apresenta que a maior prevalência na APS dar-se-á por CLT (p<0,05). A satisfação expressa pelos profissionais de saúde quando analisadas em âmbito de maior prevalência é de um nível bom, destacando apenas com relação ao sistema de serviço de saúde do município que é avaliado como regular (p<0,05). Em relação às tecnologias leves para o trabalho em análise geral sente-se capacitados em desempenhar a abordagem familiar, comunitárias, o trabalho multiprofissional, as atividades de grupo e visitas domiciliares (p<0,05). Conclusão: O conhecimento do perfil desses profissionais integrantes do corpo de recursos humanos dos serviços de saúde aponta necessidade de qualificação, primeiramente exposto no cenário de educação continuada e pela falta de cursos introdutórios e de abordagens para o processo de trabalho na APS. O cenário pode propor em relação às tecnologias de trabalho então solicitadas na validação dos profissionais uma fragilidade no que se espera para o nível de atenção. A estabilidade do vínculo empregatício deve ser trabalhada com os profissionais principalmente em relação à supervisão do trabalho e da produção para com a atenção, lembrando que os espaços de atendimento não são apenas específicos de um olhar clínico patológico. A reflexão da clínica ampliada deve ser tratada, em questão, como uma política de recursos humanos não somente para a UBS.

Objective: The prevalence of childhood overweight and obesity in southern Appalachia is among the highest in the United States (US). Primary care providers are in a unique position to address the problem; however, little is known about attitudes and practices in these settings. Methods: A 61-item healthcare provider questionnaire assessing current practices, attitudes, perceived barriers, and skill levels in managing childhood overweight and obesity was distributed to physicians in four primary care clinics. Questionnaires were obtained from 36 physicians. Results: Physicians' practices to address childhood overweight and obesity were limited, despite the fact that most physicians shared the attitude that childhood overweight and obesity need attention. While 71% of physicians reported talking about eating and physical activity habits with parents of overweight or obese children, only 19% reported giving these parents the tools they needed to make changes. Approximately 42% determined the parents' readiness to make small changes for their overweight or obese children. Physicians' self-perceived skill level in managing childhood overweight and obesity was found to be a key factor for childhood overweight- and obesity- related practices. Conclusion: Primary care physicians in southern Appalachia currently play a limited role in the prevention or intervention of childhood overweight and obesity. Training physicians to improve their skills in managing childhood overweight and obesity may lead to an improvement in practice.

Some managers of primary care provider (PCP) facilities lack the strategies to implement electronic health records (EHRs), which could decrease healthcare costs and enhance the efficiency and quality of healthcare that patients receive. The purpose of this single-case study was to explore the strategies PCP managers used to implement EHRs to decrease healthcare costs. The population consisted of 5 primary care managers with responsibility for the administration, oversight, and direct working knowledge of EHRs in Central Florida. The conceptual framework was the technology acceptance model. Data were collected from semistructured face-to-face interviews and the review of company documents, including training logs, activity records, and cost information. Methodological triangulation was used to validate the creditability and interpretation of the data in transcribing themes. Three themes emerged from the analysis of study data: implementation of EHRs, costs of implementing EHRs, and perceived usefulness of EHRs. Participants indicated that the implementation of EHRs depended on motivation, financial cost, and the usefulness of EHRs relating to training that reflected user-friendliness. The implications of this study for social change include the potential to lower the cost and improve the efficiency of healthcare for patients. The use of EHR systems could enhance the quality of care delivered to patients through improved accessibility, elimination of duplicative tests, and retrieval of accurate patient information. The use of EHRs can lead to a comprehensive preventative healthcare system resulting in a healthier environment.

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

Thesis (Ph. D.)--Rand Graduate School, 2002. / Title from web page (viewed Aug. 27, 2003). Includes bibliographical references.

Thesis (M.App.Sc.) - Carleton University, 2005. / Includes bibliographical references (p. 79-85). Also available in electronic format on the Internet.