Thesis--PlanB (M.S.)--University of Wisconsin--Stout, 2001. / Includes bibliographical references.

Thesis (Ph. D.)--York University, 2000. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 152-157). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pNQ56231

Thesis (doctoral)--Universität Breslau.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1983. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 257-277).

Thesis (Ph. D.)--University of Wisconsin, 1974. / Description based on print version record. Includes bibliographical references (leaves 332-338).

Thesis (M.S.)--University of Wisconsin--Madison, 1974. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

The objective of this thesis was to determine whether the development of a regionalized health care system in Quebec has enabled this province to meet the health services needs of its citizens in the face of Federal cuts to health care. This was accomplished through the quantitative analysis of the relationship between the incidence of family physician use and self-assessed health status (a proxy for need for care) in Quebec. The data for this study came from the 1987 and 1992-93 Santé Quebec which is a weighted random sample of the citizens living in Quebec aged 15 years and over. Using Aday and Andersen's (1974) framework for the study of access to medical care, the relationship between physician utilization and need, predisposing and enabling characteristics of individuals were analyzed for both years of the survey. The results at the provincial level revealed that need was the most important determinant of use and further that those with higher levels of need had a greater probability of use. Yet, non-need variables were also important in determining use. Specifically, the importance of predisposing factors increased from 1987 to 1992-93. The data were also partitioned by need level and by health region (15 of the 18 health regions in Quebec were included in the Santé Quebec survey). These results showed that need level was important in influencing the associations between the enabling and predisposing variables and utilization. When the data were disaggregated to the regional level, a complex pattern of utilization behaviour appeared which was not apparent at the provincial level. The results of this analysis show that while regionalization has allowed the province of Quebec to better identify the health care needs of Quebec residents, variations in utilization still exist. It has also shown that while socio-economic barriers to use have diminished, the importance of socio-demographic characteristics have increased over time. There are three important conclusions which can be drawn from this analysis; 1) need is an important determinant of physician use, 2) temporal and spatial data analysis should be included in investigations of this type as they can reveal important variations which would otherwise be unnoticed, and 3) further research in this area should incorporate the use of both qualitative and quantitative analysis in order to better identify the individual processes involved in using physician services. / Thesis / Master of Arts (MA)

This was a study of physicians' narratives regarding their medical experiences with children with persistent medically unexplained physical illness. The goal was to better understand those attitudes and beliefs that are involved in the construction of meaning regarding the child's symptoms of illness or pain. The study also sought to learn more about physicians' early life experiences with health and illness and their potential to shape diagnostic thinking and treatment. Ten physician participants were interviewed using an open-ended, semistructured interview methodology. Interviews were analyzed using an alternative narrative approach described by Mishler (1986, 1991) to identify key themes within and across interviews for comparative analysis. The subjective experience and dynamic discourse between interviewer and participant were also analyzed (Mishler, 1991; Paget, 1983). Four key themes emerged: (1) the experience of certainty and uncertainty; (2) physician search for restitution; (3) the path to truth and the construction of the physician's illness narrative; and (4) the parallel anxiety between physician and parent. Findings suggested a "stages of training" model or developmental career theme associated with the ways in which physicians make meaning of persistent medically unexplained illness or pain in the child. Implications for diagnosis and treatment include the possibility that the nature of the relationship between physicians and parents-- particularly the ability to negotiate trust, intimacy, and power--may lead to a hidden and collaborative meaning making of symptoms that occurs in exclusion, of the child, Certain early life experiences of the physician may also be brought to bear in the medical encounter with parent and child. Physicians would benefit from training in neutrality and negotiation of therapeutic goals with parents of sick children, as well as training to enhance self-awareness and understanding of the ways in which alliances and conflicts with patients and parents may occur as a result of family of origin issues.

Canadian cancer clinics are straining to keep up with growing numbers of patients and, as a result, the capacity to provide follow-up care to cancer patients is being stretched. The Saskatchewan Cancer Agency has structured its community follow-up program to ensure the routine follow-up of patients who have finished active cancer treatments. Follow-up letters are routinely sent to family physicians and some specialists requesting information on the disease status of their cancer patients. For this thesis, I conducted a mail survey of 925 Saskatchewan physicians serving 21,000 patients to learn about general practitioners' and specialists' views of the follow-up program. A 52.5% response rate was achieved. <p>The program was considered useful for 91.5% of physicians, with the follow-up letter serving an important role in reminding physicians to see their cancer patients for follow-up. High percentages of physicians indicated a need for additional patient-specific information (59.3%), clinical information (73.0%) and training (34.9%) to do follow-up. Logistic regression analyses found female gender, a specialty in general practice and lower physician confidence in following cancer to be associated with the need for additional patient information. Lower physician confidence was associated with the need for additional clinical information and a specialty in general practice and lower physician confidence were associated with the need for more training.<p>Percentages of physicians saying they were very confident in following various cancers ranged widely from 19.1% for lymphomas to 54.2% for breast cancer. All regression models regarding physician confidence in following six different cancers had a common correlate: the need for additional training. A physician�s number of follow-up patients was a significant correlate in four of the six regression models and physician specialty was included in half of the models.<p> The results suggest areas of the program and physician need that should be addressed to ensure the delivery of quality follow-up care and the survey findings will be helpful in devising strategies to this end. At the same time, responses indicate the program to be an essential component in the delivery of community-based follow-up care in Saskatchewan.

Canadian cancer clinics are straining to keep up with growing numbers of patients and, as a result, the capacity to provide follow-up care to cancer patients is being stretched. The Saskatchewan Cancer Agency has structured its community follow-up program to ensure the routine follow-up of patients who have finished active cancer treatments. Follow-up letters are routinely sent to family physicians and some specialists requesting information on the disease status of their cancer patients. For this thesis, I conducted a mail survey of 925 Saskatchewan physicians serving 21,000 patients to learn about general practitioners' and specialists' views of the follow-up program. A 52.5% response rate was achieved. <p>The program was considered useful for 91.5% of physicians, with the follow-up letter serving an important role in reminding physicians to see their cancer patients for follow-up. High percentages of physicians indicated a need for additional patient-specific information (59.3%), clinical information (73.0%) and training (34.9%) to do follow-up. Logistic regression analyses found female gender, a specialty in general practice and lower physician confidence in following cancer to be associated with the need for additional patient information. Lower physician confidence was associated with the need for additional clinical information and a specialty in general practice and lower physician confidence were associated with the need for more training.<p>Percentages of physicians saying they were very confident in following various cancers ranged widely from 19.1% for lymphomas to 54.2% for breast cancer. All regression models regarding physician confidence in following six different cancers had a common correlate: the need for additional training. A physician�s number of follow-up patients was a significant correlate in four of the six regression models and physician specialty was included in half of the models.<p> The results suggest areas of the program and physician need that should be addressed to ensure the delivery of quality follow-up care and the survey findings will be helpful in devising strategies to this end. At the same time, responses indicate the program to be an essential component in the delivery of community-based follow-up care in Saskatchewan.