This thesis applies the econometric projection approach to forecast the numbers of general practitioners (GPs) in Saskatchewan for the next 15 years at both provincial and the Regional Health Authorities (RHAs) levels. The projection results will provide the estimated level of GPs up to 2021 for policy makers to adjust their decision on health professionals planning.<p> Three hypothesized scenarios, which include the changes in population proportion, average income for GPs and a combination of both, are used for projections based on the regression results. The projections suggest a 4.34% expected annual increase of GPs if the proportions of children and seniors increase or decrease according to prediction for the next 15 years for Saskatchewan. At the RHAs level, 4.5% to 10.7% expected annual rate of increase for numbers of GPs is projected for the northern RHAs and Saskatoon RHA, while the expected increase for other urban RHAs will experience less than 1.5% increases.<p> The predicted changes in average income for GPs show insignificant effect for the expected changes in numbers of GPs. However, the second and third scenarios are not extended to the RHAs level due to lack of information, which requires additional data for both Saskatchewan physicians and population for further projection analysis.

Several factors inform health professionals decisions to migrate from developing to developed countries to practice their profession. This study explores the Push and Pull factors that informed African-trained physicians decisions to migrate to the province of Saskatchewan, how well they integrated into their new working environments upon arrival and how that might contribute to future migration and retention in Saskatchewan. Based on questionnaire surveys and face-to-face interviews, this study identified differences in the relative importance of precipitating factors for physicans from South, North and Other African nations. Although the majority of African-trained physicians for the study indicated that profession-related push factors were the precipitating factors for their migration, a smaller number did not cite these as important. Most respondents for the study integrated well into the health care system and have remained at their current location of practice because of the support they received from colleagues at their work places.

För att säkra patientsäkerheten krävs att kommunikationen mellan vårdpersonal främjas, de har visat sig att kommunikationen har ett samband med de misstag som sker i patientvården. Ett speciellt behov av vidare forskning på kommunikationen mellan sjuksköterska och läkare finns, detta för att professionernas kommunikation sinsemellan är en stor del av patientens vård och säkerhet. Syftet med denna litteraturstudie var att belysa faktorer som påverkar kommunikation mellan läkare och sjuksköterska relaterat till patientsäkerheten. Studien utfördes som en litteraturstudie. Resultatet visade att C-HIP och SBAR ansågs vara användbara för att främja en god kommunikation mellan professionerna och för att främja patientsäkerheten. För att främja kommunikationen professionerna emellan krävs god kvalitet av information och att informationen är relevant. Humor, empati, förståelse och öppenhet är faktorer i beteendet som främjar en god kommunikation. Hierarkin som fortfarande råder i sjukvården påverkar kommunikationen mellan sjuksköterskan och läkaren negativt. Att höja rösten, nedvärdera varandra och att uppvisa ett respektlöst beteende är också faktorer som hindrar kommunikationen. Fler kurser behöver införas i sjuksköterskan och läkarens utbildning för att främja kommunikationen dem emellan. Ett förslag kan vara att införa en gemensam kurs där professionerna kan öva och även få en inblick i varandras arbetsuppgifter. / It requires better communication between medical staff to ensure patient safety. It’s proved that communication is linked to the mistakes that occur in patient care. A special need for further research on communication between nurses and doctors are needed, this for the communication between them is a big part of patient care and safety. The purpose of this study was to illuminate factors that affect communication between doctors and nurses related to patient safety. The study was conducted as a literaturestudy. The results showed that C-HIP and SBAR were useful methods for promoting good communication between the professions and to promote patient safety. It requires good quality of the information and relevant information to foster good communication. Humor, empathy, understanding and openness are factors in behavior that promotes good communication. The hierarchy that still exists is affecting communication between the nurse and doctor negative. Raising his voice, depreciate each other and show a disrespectful behavior are barriers that effects the communication. More courses need to be introduced in the nurse and physician education to promote communication. One suggestion might be to introduce a common course in which professions can practice and also get an insight into each other's work.

The study aimed to investigate the acute medical chain consisting of SOS operator, ambulance nurse, emergency nurse and emergency physician with regard to the assessment and prioritization of the victim. The design of this journal study is retrospective with descriptive approach. Data were collected from all ambulance missions carried out in Uppsala county 2009-01-01 between the hours 00:00 to 12:00. Sample period was chosen because the prerequisite for high frequency on the ambulance mission was supposed to be good. In order to be able to systematize the compilation of data a protocol were prepared and used. Applicable data were collected from three databases SOS Alarms, ambulance operations, and the University Hospital in Uppsala. The study was divided into three stages and record documents usefulness was assessed individually based on inclusion criteria's. During the measurement period the SOS operator assessed need of an ambulance at 62 occasions in Uppsala County. Of these 62 ambulance missions there were 18 that could be followed during the whole acute medical chain. The results showed that the participants of the acute medical chain most of the time did the same assessment of the victim main problem/symptom and thus the criterion. Without considering the priority it appeared that the criteria were the same in 83% of all 18 included ambulance missions. SOS operator assessed ambulance mission as a priority one in 39% (7/18), and the ambulance nurse judged that priority one on the way to the hospital was justified in 17% (3/18). Of the 18 victims who were transported by ambulance to the emergency department at the University Hospital in Uppsala 72% (13/18) went home the same day. / Studiens syfte var att undersöka den akutmedicinska vårdkedjan bestående av SOS operatör, ambulanssjuksköterska, akutsjuksköterska och akutläkare med avseende på bedömning och prioritering av drabbad. Designen på denna journalstudie är retrospektiv med deskriptiv ansats. Data insamlades från samtliga ambulansuppdrag som genomfördes i Uppsala län 2009-01-01 mellan klockan 00:00 - 12:00. Urvalsperioden valdes därför att förutsättningen för hög frekvens på ambulansuppdrag förmodades vara goda. För att systematisera sammanställningen av data utarbetades och användes ett protokoll. Tillämpbara uppgifter inhämtades från tre databaser SOS Alarms, ambulansverksamhetens och Akademiska sjukhusets. Studien delades upp i tre steg och journalhandlingarnas användbarhet bedömdes var för sig utifrån inklusionskriterier. Under mätperioden bedömde SOS operatören behov av ambulans vid 62 tillfällen i Uppsala län. Av dessa 62 ambulansuppdrag gick 18 att följa under hela vårdkedjan. Resultatet visade att aktörerna i akutmedicinska vårdkedjan för det mesta gjorde samma bedömning av den drabbades huvudproblem/symtom och därmed kriteriet. Utan hänsyn taget till prioritet så visade det sig att kriterierna övrrensstämde vid 83% av alla 18 inkluderade ambulansuppdrag. SOS operatören bedömde ambulansuppdraget som prioritet ett i 39% (7/18) och ambulanssjuksköterskan bedömde att prioritet ett på väg till sjukhus var motiverat i 17% (3/18). Av de18 drabbade som transporterats med ambulans till akutmottagningen på Akademiska sjukhuset fick 72% (13/18) åka hem samma dag.

Electronic medical records (EMR) and computerized provider order entry (CPOE) are recognized as a means to improve quality of care and patient safety. This research examines factors that contribute to clinician acceptance of an EMR implemented in a pediatric hospital system and applies this knowledge to improve implementation methods to ensure they foster acceptance. A framework for User-Centered Implementation (UCI) was developed based on previous EMR and CPOE, technology acceptance, user-centered design, and change management research. The UCI framework identifies tools from change management and user-centered design and links them to the systems development lifecycle stage(s) at which they can be applied to achieve improved user acceptance. Next, a study examined clinician EMR acceptance in a pediatric hospital system at various points during their EMR implementation which employed a UCI-based methodology. Surveys before and after implementation of each phase examined physician, nurse, and other staff perceptions about the systems usefulness (performance expectancy (PE)) and ease of use (effort expectancy (EE)). Results indicate users had positive perceptions of system ease of use (EE) after implementation. Post-implementation PE ratings were neutral or positive for most users. Pre- and post-implementation regression models indicate the factors that influence PE change over time. Compatibility with clinician work practices was important both before and after implementation. Before implementation, users who perceived a greater need for the system and felt their needs were represented during design had higher expectations of system usefulness. After implementation, system characteristics including how well it supports clinical decision making and how easy it is to use influenced PE. Support provided by super users positively influenced both PE and EE after implementation. Based on these findings, guidelines for using UCI to improve clinician acceptance of EMR are presented. Designing EMR systems that are usable within the clinical work context enables clinicians to focus on the patient, rather than the system. Accomplishing this in practice is difficult given the complexity of EMRs and the dynamic clinical processes they support. This studys results indicate the UCI framework can be effectively applied to EMR implementations to improve the usability, utility, and, consequently, acceptance of these systems.

Cutaneous laser and intense pulsed light treatments are two of the most popular aesthetic treatment modalities. More and more physicians regardless of their training background are providing such profitable services because there is still no regulation on the cosmetic procedures a physician can perform. The purpose of the present study was to find out the relative strength and weakness of different medical specialties in providing laser and intense pulsed light treatment. Major decision factors for physician selection were extracted from 19 physician choice criteria with factor analysis. Using analytic hierarchy process, the relative weight of these factors and that of dermatologists, plastic surgeons and aesthetic practitioners in each factor were calculated. After reading the training curricula of dermatologists and plastic surgeons, respondents were asked to rate again the 3 medical specialties. Our results indicated that medical competence (0.3296) was the most important major decision factor followed by recommendation (0.2198), friendliness (0.1350), cost (0.1307), complete service (0.0984) and physical attribute of the physician (0.0865). Compared with plastic surgeons and aesthetic practitioners, dermatologists had an advantage in all factors except complete service, which was the strength of plastic surgeons. New patients, aged under 40, with a college degree and a monthly allowance less than 20000 NTD were more likely to change their rating in favor of dermatologists after reading the curriculum profile..

In recent years, the re-distribution of medical resources conducted by the government in general renders physicians to be anxious about the stability and fairness of their income. The worries are even aggravated by the policies such as ¡§secret in payment¡¨ or ¡§personalized payment¡¨ that are currently preceded by the hospitals. Since the as mentioned worries may affect physicians¡¦ attitudes toward their patients, factors affecting physicians¡¦ satisfaction in their income based on the stand point of ¡§salary justice¡¨ are thus important and will be the focus of the present research. Meanwhile, the influences of ¡§total budget system¡¨ on ¡§salary justice¡¨ and ¡§salary satisfaction¡¨ are also studied. The overall consequences to the physicians ¡§work attitude¡¨ are finally evaluated and analyzed in the present study. The research was conducted by distributing 319 questionnaires to the physicians belonging to eight hospitals in the middle area of Taiwan. Among these distributed questionnaires, 108 of them were retrieved. The retrieval rate is thus calculated as 33.9%. The results are presented as follows: 1.Gender, salary and position do not possess any influence on ¡§salary satisfaction¡¨ and ¡§working attitude¡¨. 2.A negative correlation is observed between ¡§age¡¨ and ¡§salary justice¡¨. This implies the elders demand higher base in their salary. 3.The more open in salary information and communications, the better in ¡§salary satisfaction¡¨. 4.The ¡§structure of income¡¨ should be consistent with one¡¦s recognition on the source of his or her salary. Together with a fair distribution in overall benefits would help in motivating positive work attitude. 5.More understanding in the method of benefit distribution as proposed in the ¡§total budget system¡¨ could lead to more negative attitude in working. 6.The ¡§total budget system¡¨ is still in the embryonic stage. No effects on ¡§salary justice¡¨ and ¡§salary satisfaction¡¨ have been observed yet. 7.A physician would possess a stronger commitment in job fair and team involvement when he/she feels satisfactory with the payment.

This paper considers the adoption of Health Information Technology (HIT) by physician clinics with ten or fewer physicians. The paper considers the theoretical economics literature on technology adoption for a new technology and has a place in the empirical tests of these models. The two major hypotheses tested in the paper are that the probability of adopting HIT increases with the number of physicians working at the clinic and if the clinic is part of a chain of clinics, and that it also increases with increased competition at the market level measured by the number of clinics per 10,000 residents in a county. To test these hypotheses, the paper first estimates a baseline logit model followed by three hazard rate models. In each case, clinic size is found to have positive though not significant effect on the probability of adoption (in the logit model) or to decrease the predicted time to adoption for the clinic (in the hazard rate models), being in a chain of clinics is found to have a strong positive and significant on the probability of adoption, and increased competition is found to have a positive though not significant effect on the probability of adoption.

Many patients with end-stage renal disease come to rely on catheters as their only means of hemodialysis when other options are no longer viable. These patients have a very poor quality of life due to their chronic illness as well as many long-term complications related to the use of tunneled catheters. Many prior attempts have been made to understand these catheter-related problems. Yet, they continue to be a major cause of morbidity and mortality in chronic catheter-reliant patients. We hope to examine the rate as well as long term time course of these complications such that in future, we may decrease their occurrence. We predict that over time, chronic catheter use decreases the mean indwell time for each catheterization and increases the incidence of complications. To study this, we conducted a retrospective study looking at all patients who had three or more tunneled catheter exchanges between July 2003 and July 2008. We collected information from Yale IDX database on the patients age and gender, the type of catheter used, the indwell time of the catheter, the vessel used as access, the indication for catheter removal, whether the procedure was performed by a medical doctor (M.D.) or physicians assistant (P.A.) and whether it was a de novo insertion or over-the-wire exchange. We collected a total of 764 data points on 191 patients (89 males and 102 females). They ranged from 8 to 87 years old with a median age of 56 years. Infection was the number one indication for catheter removal at 37%. The rate of infection was 3.34 per 1,000 catheter days. There was no difference in the rate of complications by the side of vessel accessed nor by type of catheter. However, right-sided catheters had a longer indwell time of 117 + 159 days compared to left-sided catheters, 87 + 124 days (p =0.008). There was no significant difference in the indwell duration of first catheter in comparison to all subsequent placements. There was also no difference in complications whether the catheter was exchanged over the wire or placed de novo. Nor were complication rates different among M.D. versus P.A. conducted procedures. We conclude that our rates of infection are similar to other institutions and the vessels located on the right-side of the neck are preferable to left-sided vessels to increase catheter longevity. Future research is needed to better assess how rates and incidences of complications change with long standing catheter-reliance.

Thesis supervisor: Garrett Stewart. Includes bibliographic references (p. 193-202).