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Objective: Evaluate The Ottawa Hospital Viral Hepatitis Program (TOHVHP) telemedicine (TM) program for patient retention, treatment initiation and sustained virologic response (SVR) rates. Methods: Retrospective analysis of TOHVHP cohort data for patients entering HCV care between 2012 and 2016. Logistic regression modeling was used to assess characteristics associated with patient retention, treatment initiation, and achieving SVR. TM outcomes were compared to the standard outpatient clinic and mixed delivery outcomes. Results: Treatment initiation rates were comparable between TM and the outpatient clinic. TM delivered Direct Acting Antiviral treatments achieved high SVR outcomes across all patient populations. Patient retention was lower among TM patients. Conclusion: TOHVHP TM program engaged patients facing barriers to traditional HCV care models. Efforts to improve TM retention are needed.

The private health care market in the United Kingdom is a multi-billion pound industry whose dynamics remain largely unexamined. This is so even though the boundaries between the public and private sectors are becoming increasingly blurred, particularly in England. Given the growing importance of this sector, the policy community needs to know more about the nature of private health care in the UK, how well the private market operates and how successful have been the various attempts within it to improve value for money and health care quality, given that private health care has traditionally been seen by many citizens as unaffordable. In particular this thesis traces recent efforts by the British United Provident Association (Bupa) to reshape the UK private healthcare market. The account provided draws on the author's experience as a senior Bupa manager involved in planning and implementing such changes. The thesis describes a series of Bupa initiatives designed to change provider behaviour in pursuit of improved quality and value-for-money, and the difficulties and obstacles encountered. The latter often centred on tensions or confrontation between the insurer and professional providers that are discussed in relation to the wider literature on the social and economic organisation of health care markets. An attempt has been made to draw some general conclusions via an empirical study of the role and limitations of market-based changes within the UK private sector. The broad conclusion is that the private market in the UK exemplifies those features of health care seen throughout the developed world that create imperfect market conditions. As such the market is highly resistant to insurer initiatives that would reverse the longstanding trend for premiums to rise above the rate of inflation. It is considered unlikely given the current market structure that any insurer, including Bupa, can escape these constraints in the short term. However, Bupa has implemented some successful initiatives that suggest that longer-term incremental change is possible.

PhD, Faculty of Health Sciences, University of the Witwatersrand / The aim of the study was to explore the practice of antiretroviral (ARV) therapy services, specifically regarding the patients’ issues and experiences, as well as the experiences of the health care providers rendering these services. Qualitative research methods were used, including a metasynthesis of qualitative research articles on human immunodeficiency virus (HIV) positive patients on ARV therapy, and phenomenological methods of inquiry. The study objectives were to conduct a metasynthesis of qualitative research on HIV-positive people on ARV therapy; to investigate the experiences of HIV-positive people who are on ARV therapy; to identify the constraints faced by HIV-positive people receiving ARV therapy; and to explore adherence to ARV therapy. The study was conducted in eThekwini district in KwaZulu Natal (KZN) province. The district was chosen considering the number of clinics rolling out ARV therapy. Three institutions initiating ARV therapy participated in the study; one urban, one semi-urban and one rural clinic, to ensure representation of each type. Participants were recruited from two initiating hospitals and one Community Health Centre providing ARV therapy. The metasynthesis revealed a shared set of four themes viz.: 1. Acceptance of, and coping with, HIV positive status 2. Social support and disclosure 3. Experiences and beliefs about HIV medication and health care 4. Provider relationships and health system factors Qualitative analyses of interviews with clients indicated their experiences and concerns, and were summarized in these themes: 1. Life before and after knowing HIV status 2. Initiating and continuing ARV therapy 3. Adherence to, and side effects of, the ARV therapy treatment 4. Social support for people on ARV treatment vi 5. Positive outcomes of being on ARV treatment 6. Improving access to ARV treatment services Analyses of in-depth interviews with health care providers specified their experiences, and were categorized into three themes viz.: 1. Establishing and maintaining a good client-provider relationship 2. Facilitators of and adherence to ARV treatment 3. Barriers to access to treatment

Abstract Many studies about medial outcomes in rural areas or medial resource deficient areas have been published, but few discuss outcomes in areas deficient in oral medical resources. The program, improving underserved dental health care resources, has been implemented for near ten years, but no study explores the business models in different areas that are underserved dental health care resources. The purpose of this study is to compare different models of operating the program ¡§improving underserved dental health care resources¡¨. As to the business model, the program ¡§improving underserved dental health care resources¡¨ is executed in two main models. One is execution in fixed sites. The advantage of this model is high stability. Dentals can plan and set the equipments that they need to use. The other is medical tour. The advantage of this model is high flexibility, which let dentals can provide services as far as possible for patients in medial resource deficient areas. Finally, based on the research findings, this study proposes some suggestions, including that to use the medical-tour model as the major business to implement the program, to carefully assess the site for exestuation need, to consider the financial support on equipments (especially the dental mobile medical vehicle ), to strengthen local infrastructure investment is prior to plunge into health care resources, and so on. Keywords: Remote area, Health care delivery, No-dentist Rural Areas

This research investigates the applicability of thin client in a hospital environment. First, a set of thin client application criteria in terms of hardware, function characteristics, network, and application platform are identified. Second, we analyze the healthcare delivery process in terms of operation process, hardware, and application platform. Third, we evaluate the fitness of thin client application by matching the above two sets of criteria. A case study was conducted to valid the applicability of this approach. These results provide great insight for practitioners and scholars for enhancing their understanding of thin client implementation and provide implication guidelines to help practitioners adapt thin client in health care industry.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Saudi Arabia has experienced a number of changes due to revolutionary new findings and technologies, discoveries and new research in the health care arena, which has proven and contradicted a new approach to health care delivery. Demands by patients who have become more educated, the emergence of new or modern disease profiles which demand a new way of approach and a quickening in the pace of change, hurled unfamiliar and often demanding and challenging conditions at management One such change, as addressed in this study, is the change from a paper-based patient record system to a computer based patient information system to which all healthcare professionals in the multidisciplinary team had access to. However, not all change is welcomed, accepted or viewed as necessary by those who have to carry out or use new technologies. Change is harsh, and part of the problem is identifying factors that influence change initiatives. This study addresses the perceptions of nursing personnel of the process of change from a paper-based to a computer based (Quadramed) patient record system. The study design used a quantitative and descriptive approach in which a structured, self-designed questionnaire was used to obtain data from 117 professional nurses at a selected healthcare facility in the Eastern province of the Kingdom of Saudi Arabia. The theoretical framework used for this study was the Model for Change Management as designed by the Prosci Institute for Research, also referred to as the ADKAR Model of Change Management (Awareness, Desire, Knowledge, Ability and Reinforcement). The major findings of this study revealed that 97.44% of the respondents were non-Saudi individuals, and were mainly from the Philippines (69.24%), with (95.65% being female with an average age of 37-42 years. Most (47%) were in possession of specialty qualifications in medical, surgical nursing and experience between 8-10 years, of which 2-3 years had been in Saudi Arabia. In regard to 61.3% of the respondents it was found that they had no prior knowledge of computerised patient records. The nurse managers played a vital role in providing the most information and support to adjust to the system. With reference to the aspect of patient safety, positive feedback about the QCPR was provided by the majority of respondents. Most of the respondents experienced change positively, and 70% indicated that being involved played a major role in their positive attitude. Recommendations include that reasons for change should be more clearly communicated, suggestions for change should be valued more by managers and rumours and uncertainties about change should be addressed as and when appropriate. / AFRIKAANSE OPSOMMING: Saoedi-Arabië het 'n aantal veranderinge ondervind as gevolg van revolusionêre nuwe bevindings en tegnologie, ontdekkings en nuwe navorsing in die gesondheidsorg arena, wat 'n nuwe benadering tot die lewering van gesondheidsorg bewys en weerspreek. Eise deur pasiënte wat meer geletterd is, en nuwe en moderne siekte profiele eis 'n nuwe benadering tot verandering. Die versnelling in die tempo van verandering is dikwels onbekend, veeleisend en uitdagende vir die bestuur van gesondheidsinstellings. Een so 'n verandering, soos dit in hierdie studie aangespreek word, is die verandering van 'n papier-gebaseerde na 'n rekenaar-gebaseerde pasiënt inligting stelsel wat aan alle lede van die multidissiplinêre gesondheidsorg span toegang verleen. Nogtans word nie alle verandering verwelkom, aanvaar of as nodig beskou deur diegene wat die dienste uitvoer of die nuwe tegnologie moet gebruik nie. Verandering is gekompliseerde proses, en deel van die probleem is die identifisering van faktore wat 'n invloed op die veranderings inisiatiewe het. Hierdie studie fokus op die persepsies van die verpleegpersoneel tydens die proses van verandering van 'n papier-gebaseerde tot 'n rekenaar gebaseerde (Quadramed) pasiënt rekord stelsel. Die studie-ontwerp gebruik 'n kwantitatiewe, beskrywende benadering wat 'n gestruktureerde, self-ontwerpte vraelys gebruik om data te verkry van 117 professionele verpleegsters by 'n geselekteerde gesondheidsorg fasiliteit in die Oostelike Provinsie van die Koninkryk van Saoedi-Arabië. Die teoretiese raamwerk wat gebruik word vir hierdie studie was die model vir veranderingsbestuur soos ontwerp deur die Prosci Instituut vir Navorsing, waarna ook verwys word as die “ADKAR Model of Change Management” (Awareness, Desire, Knowledge, Ability and Reinforcement). Die belangrikste bevindings van hierdie studie het aan die lig gebring dat 97,44% van die respondente was nie-Saoedi-individue nie, en was hoofsaaklik van die Filippyne (69,24%), met (95,65%) vroue met 'n gemiddelde ouderdom van 37-42 jaar. Die meeste (47%) was in besit van gespesialiseerde kwalifikasies in mediese, chirurgiese verpleeging. Die meeste van die respondente het tussen 8-10 jaar ervaring in verpleegkunde gehad, waarvan 2-3 jaar in Saoedi-Arabië was. Met betrekking tot 61,3% van die respondente dit is gevind dat hulle geen vorige kennis van die gerekenariseerde pasiënt rekords gehad het nie. Die saal bestuurder het 'n belangrike rol gespeel in die verskaffing van die meeste inligting en ondersteuning om aan te pas tot die nuwe stelsel. Met verwysing na die aspek van die veiligheid van pasiënte, is positiewe terugvoer oor die QCPR voorsien deur die meerderheid van die respondente. Die meeste van die respondente het ook die verandering positief ervaar, en 70% het aangedui dat hul betrokkenheid 'n belangrike rol gespeel het in hul positiewe gesindheid. Aanbevelings sluit in dat die redes vir verandering duidelik gekommunikeer behoort te word, voorstelle vir verandering moet erkenning kry deur bestuurders en gerugte en onsekerhede oor verandering moet aangespreek word soos en wanneer toepaslik.

“Telemedicine” denotes medicine at a distance using telecommunications and information technologies. The aim of the thesis is to reveal determinants and outcomes of telemedicine diffusion—that is, the spread of telemedicine in time and space. Telemedicine is examined both at the national level and in a regional case study. At the national level, quantitative methodology is utilized to analyze the emergence of health care facilities using telemedicine to receive medical assistance. The regional case study examines the diffusion and outcomes of telemedicine networks in Northern Sweden based on non-quantitative data sources. The first telemedicine applications in Sweden emerged between hospitals in southern Sweden in the 1970s. It was in the 1990s, however, that the practice of telemedicine took off on a larger scale. By the year 2000, the number of remote sites was quite evenly distributed across the country and between specialist and primary care facilities. In northern Sweden, telemedicine was first implemented in the mid-1980s, and is now carried out in all counties in the region. The telemedicine networks in northern Sweden primarily concern teleradiology, general telemedicine, and telepathology. Commonly, telemedicine is carried out within counties in hierarchical hub and spoke-type networks connecting specialist and primary care facilities. The study shows that existing telemedicine facilitates its further diffusion at the regional level, but shows a lack of the obvious neighborhood effect that could be expected in light of many previous diffusion studies and geographical diffusion theory. The health care system in Sweden is characterized by a high degree of regional autonomy. Contacts between medical staff, and thus dissemination of information and opinions concerning telemedicine, are therefore likely to be more prevalent within than between the regional health care organizations. The health care organizations are also decision-making bodies with different telemedicine policies. In addition, already implemented telemedicine programs tend to expand within the health care organization in which they originated. Although no traditional neighborhood effect to speak of can be noticed in Swedish telemedicine diffusion, distance matters in the diffusion process in a quite different respect. The study shows that health care facilities located far from more specialized care are especially likely to adopt telemedicine. Another local factor, facility size, is also positively correlated with telemedicine diffusion. This correlation between facility size and telemedicine adoption, as well as the circumstance that the diffusion process started with, and has progressed the furthest in, specialist care, suggest that the diffusion of telemedicine exhibits hierarchical characteristics. The development of telemedicine technology significantly influences the rate of telemedicine diffusion. In a simulation of the diffusion process, it is shown that—given that computers and information technology continue to develop according to the present trend—there will be a significant increase in the number of primary care facilities functioning as remote telemedicine sites during the first decade of the 21st century. / digitalisering@umu