Darbo tikslas – įvertinti šeimos gydytojo pasirinkimą ir keitimą lemiančius veiksnius priklausomai nuo įstaigos tipo. Uždaviniai :1. Nustatyti ir įvertinti PSP paslaugų teikėjo pasirinkimą lemiančius veiksnius priklausomai nuo įstaigos tipo. 2. Įvertinti ir palyginti šeimos gydytojo keitimą įtakojančius motyvus priklausomai nuo įstaigos tipo. 3. Įvertinti ir palyginti pacientų elgseną ir pasitenkinimą paslaugomis priklausomai nuo įstaigos tipo. Tyrimo metodika. Tyrimas atliktas 2013m. sausio- kovo mėn. Naudota anoniminė anketinė viešosiose: Prienų rajono PSPC ir Birštono PSPC bei privačiose PSP įstaigose besilankančių pacientų apklausa( n═247). Atsakas dažnumas 81,5 proc. Tyrimo rezultatų statistinė analizė atlikta naudojant SPSS 17.0 ( Statistical Package of Social Scienles ) for Windows statistinių duomenų paketą. Ryšiai tarp požymių vertinti pagal Chi kvadrato ( x2 ) kriterijų. Rodiklių skirtumas laikytas statistiškai reikšmingu, kai p< 0,05. Rezultatai. Pacientų tyrimo rezultatų analizė atskleidė, jog (48 proc.) privačių PSPC ir (46 proc.) viešųjų PSP įstaigų pacientų yra patenkinti šeimos gydytojo teikiamomis paslaugomis. Tyrimo metu nustatyta, kad statistiškai šeimos gydytojo paslaugų vertinimas neturi sąsajų su išsilavinimu, socialiniu statusu ir mokėjimu už paslaugas. Privačiose gydymo įstaigose (40 proc.) respondentų nepasirenka šeimos gydytojo dėl nepatenkinamų paslaugų kokybės, o (75 proc.) viešųjų PSP centrų respondentų - dėl netinkamo šeimos gydytojo... [toliau žr. visą tekstą] / The aim of the study is to assess factors that determine the choice and change of family doctor depending on the type of institution. Objectives: 1. To identify and assess factors that determine the choice of a primary healthcare service provider depending on the type of institution. 2. To assess and compare motives that influence the change of a family doctor depending on the type of institution. 3. To assess and compare patientes behaviour and satisfaction depending on the type of institution. Methods of the research. The research was conducted in between January and March, 2013. An anonymous survey was performed on patients who visit public institutions of Prienai district primary health care and Birštonas primary health care and also private primary health care institutions (n=247). The response in public primary health care institutions was 81.5%. The statistical analysis of the research results was performed using SPSS 17.0 (Statistical Package for Social Sciences). The relationships between the features were assessed using x2 criterion. Results. The analysis of patient research results showed that 48% of patients of private primary healthcare and 46% of public healthcare institutions are satisfied with the services provided by family doctors. During the research it was found that statistically the assessment of family doctor service quality does not have connection with education, social status or payment for services, 40% of respondents do not choose family doctor... [to full text]

O Sistema Único de Saúde (SUS), sistema público de saúde brasileiro, tem evoluído continuamente para se adaptar aos novos desafios da área de saúde e as novas necessidades da população. Entre os aprimoramentos para atender a esses desafios está a oferta de medicamentos de alto custo à população por meio de farmácias de medicamentos especializados como a de Ribeirão Preto, que atende aos residentes no município e também as pessoas das cidades englobadas pela DRS XIII. Com o objetivo de analisar o processo de uma farmácia de medicamentos especializados, identificando os problemas e propondo melhorias foi aplicada a metodologia lean healthcare. Inicialmente foi realizada uma pesquisa juntamente aos usuários desse serviço em busca de uma definição do valor no serviço prestado pela farmácia. Os resultados encontrados mostram que receber todos os medicamentos solicitados, a correta orientação em relação as dúvidas, pouco tempo de espera na fila e o bom atendimento são os itens mais valorizados por eles. A partir dessa definição de valor, de entrevistas com funcionários da farmácia e de observações no local, foram criados mapas do fluxo de valor do processo de trabalho da farmácia, identificando os desperdícios praticados e apontando sugestões de melhorias através da aplicação da metodologia lean healthcare. Após a finalização dessa etapa foram criadas propostas para a melhoria do fluxo contínuo, para o estabelecimento da demanda puxada e para a melhoria contínua. Além disso, realizou-se uma análise crítica dos resultados obtidos em que se pôde perceber que as soluções aos problemas vivenciados pela farmácia possuem diferentes graus de dificuldade de implantação, porém, apresentam grande potencial para a melhoria do valor entregue ao público da farmácia. Verificou-se também que a má distribuição do seu espaço físico, a divisão dos estoques em diferentes unidades e a falta de medicamentos são origens de grandes desperdícios. Assim, foi sugerida a inclusão de outras etapas ao modelo de implantação do lean utilizado para que seja alcançada a maior participação da equipe de trabalho da farmácia e para que o lean healthcare seja implantado de maneira completa, com foco na busca da perfeição e não se limitando a solução de problemas pontuais. / The Unified Health System (SUS), the Brazilian public health system, has continuously evolved to adapt to the new challenges of the healthcare and the new requirements of the population. The offering of the high-cost medicines is between the enhancements to meet these challenges and it`s dispensation is conducted to the population through specialized medicine pharmacies like the Ribeirão Preto pharmacy, which serves the people of this city and also the people of the cities encompassed by the DRS XIII. In order to analyze the process of specialized medicines pharmacy identifying problems and proposing improvements was applied the lean methodology healthcare. Initially a survey was conducted among the users of that service aiming the definition of what was most important to them in the services provided by the pharmacy. The results show that receive all required medicines, be well oriented about the doubts, stay a short time in the queue and be well attended are the most valued items by them. From this definition, interviews with pharmacy staff and on-site observations, the value stream maps were created enabling to understand the pharmacy work process, identify the waste and aiming suggestions for improvements through the application of lean healthcare tools. After this stage, proposals were designed to improve the continuous stream, for the establishment of the pull demand and the continuous improvement. In addition, was conducted a critical analysis of the results and is possible to realize that the solutions to the problems experienced by the pharmacy features different degrees of difficulty implementation, however, offers a great potential to improve the value delivered to the pharmacy public. It was also found that the poor distribution of its physical space, the division of stocks in different units and lack of medicines are the major sources of the waste observed. Thus, was suggested the inclusion of other steps to the lean implementation model, in order to reach greater involvement of the pharmacy work team and to implement the lean healthcare completely, focusing on the pursuit of perfection and not limiting the solution of specific problems.

Depuis vingt-cinq ans, les centres hospitaliers universitaires français connaissent un mouvement sans précédent de regroupement de leurs activités médicales qui les conduit à désaffecter puis à vendre de nombreux sites hospitaliers.La reconversion de ces anciens hôpitaux est un enjeu majeur pour les établissements publics de santé comme pour les collectivités. Les premiers doivent valoriser au mieux leur patrimoine pour financer la modernisation ou la construction des hôpitaux en activité. Les secondes doivent réussir la transformation des grands enclos ainsi libérés et garantir leur bon usage au bénéfice des populations des métropoles concernées.Après avoir mis en lumière les mécanismes de décision et de gestion propres à chacun des acteurs et souligné la diversité des attentes, le travail s’appuyant sur l’analyse comparée de neuf opérations situées à Lyon, Marseille, Montpellier, Paris, Poitiers et Saint-Etienne, s’attache à identifier les potentiels de développement urbain des anciens hôpitaux, leurs valeurs parfois paradoxales, enfin le rôle de l’établissement de santé, de la ville ou de l’agglomération, ainsi que de la société civile dans la production des opérations.Cette approche croisée et quantifiée conduit à esquisser des axes de travail d’intérêt général. Ceux-ci concernent aussi bien les centres hospitaliers dans la préparation et la conduite du processus de désaffectation et de cession que les collectivités dans la définition des besoins et la mise en œuvre des opérations. Est mis en avant pour finir le rôle de l’Etat pour réduire les contradictions, aider à la juste évaluation des biens et accélérer les processus de transformation urbaine. / In the past 25 years, French teaching hospitals have had to concentrate their activities as never before, leading to many hospital sites being closed down and sold off. The redevelopment of these former hospitals is a major issue for public healthcare establishments and local authorities alike. The former need to enhance their property to raise funds to modernise and build hospitals in use. The latter need to oversee the transformation of the huge complexes newly available and ensure they benefit the inhabitants of the cities involved. After examining the decision-making process and management implemented by all players and highlighting the sheer diversity of expectations, a comparative analysis of nine operations located in Lyon, Marseille, Montpellier, Paris, Poitiers and Saint-Etienne pinpoints potential urban development of former hospitals, their sometimes contradictory values and the role of the healthcare establishment, city council and civil society in the production of the operations. This comparative approach, backed with figures, leads to some general-interest suggestions. These involve not only the hospitals which prepare and lead the closing process and transfer, but also the local authorities which define requirements and implement operations. Finally, the government’s role of reducing contradictions, helping to properly assess the property and speeding up the processes of urban transformation is also covered.

A utilização de bases de dados para estudos epidemiológicos, avaliação da qualidade e quantidade dos serviços de saúde vem despertando a atenção dos pesquisadores no contexto da Saúde Pública. No Brasil, as bases de dados do Sistema Único de Saúde (SUS) são exemplos de repositórios importantes que reúnem informações fundamentais sobre a Saúde. Entretanto, apesar dos avanços em termos de coleta e de ferramentas públicas para a pesquisa nessas bases de dados, tais como o TABWIN e o TABNET, esses recursos ainda não fazem uso de técnicas mais avançadas para a produção de informação gerencial, como as disponíveis em ferramentas OLAP (On Line Analytical Processing) e de mineração de dados. A situação é extremamente agravada pelo fato dos dados da Saúde Pública, produzidos por vários sistemas isolados, não estarem integrados, impossibilitando pesquisas entre diferentes bases de dados. Consequentemente, a produção de informação gerencial torna-se uma tarefa extremamente difícil. Por outro lado, a integração dessas bases de dados pode constituir um recurso indispensável e fundamental para a manipulação do enorme volume de dados disponível nesses ambientes e, assim, possibilitar a produção de informação e conhecimento relevantes, que contribuam para a melhoria da gestão em Saúde Pública. Acompanhar o seguimento de pacientes e comparar diferentes populações são outras importantes limitações das atuais bases de dados, uma vez que não há um identificador unívoco do paciente que possibilite executar tais tarefas. Esta Tese teve como objetivo a construção de um armazém de dados (data warehouse), a partir da análise de dez anos (período de 2000 a 2009) das principais bases de dados do SUS. Os métodos propostos para coleta, limpeza, padronização das estruturas dos bancos de dados, associação de registros ao paciente e integração dos sistemas de informação do SUS permitiram a identificação e o seguimento do paciente com sensibilidade de 99,68% e a especificidade de 97,94%. / The use of databases for epidemiologic studies, quality and quantity evaluation of health services have attracted the attention of researchers in the context of Public Health. In Brazil, the databases of the Sistema Único de Saúde (SUS) are examples of important repositories, which store fundamental information about health. However, despite of the advances in terms of load and public tools for research in those databases, such as TABWIN and TABNET, these resources do not use advanced techniques to produce management information as available in OLAP (On Line Analytical Processing) and data mining tools. The situation is drastically increased for the fact that data in public health, produced for different systems, are not integrated. This makes impossible to do research between different databases. As a consequence, the production of management information is a very difficult task. On the other hand, the integration of these databases can offer an important and fundamental resource to manipulate the enormous volume of data available in those environments and, in this way, to permit the production of relevant information and knowledge to improve the management of public health. The patient follow up and the comparison of different populations are other important limitations of the available databases, due to the absence of a common patient identifier. The objective of this Thesis was the construction of a data warehouse to analyze ten years (period from 2000 to 2009) of the principal databases of SUS. The proposed methods to load, clean, database structure standardization, patient record linkage and SUS information systems integration have been permitted patient identification and follow up with sensitivity of 99.6% and specificity of 97.94%.

Climate change, a reality, a myth, a conspiracy, remains a point of research and concern, specifically with regards to the impact it has on human health. Reports concerning climate change are accepted by many but are also rejected by prominent figures of society and powerful enterprises flourishing in the race for economic development. Yet all living organisms on Earth are dependent on its natural resources and delicate balance of co-existence. A disruption of ecological balance will bring about changes to biomes and niches. These changes will affect disease patterns and well-being for all. Vulnerable groups will be most affected. If these changes have occurred and continue to occur what provision should be made to reduce population vulnerability? What investment should be made to public healthcare to assist vulnerable population groups and improve adaptability? This study was conducted with the aide of the South African Red Cross Society in three large South African provinces, Limpopo, Mpumalanga and Kwa-Zulu Natal, each known for its rich diverse ecologies and tropical to sub-tropical climates. The study aimed to determine the level of awareness amongst the healthcare workers with emphasis on education. The participants were counsellors working closely with the National Department of Health and local clinics. A total of 101 participants completed a close-ended questionnaire. The results indicated a strong workforce of young people with post-matric qualifications and strong views. Qualitative research was used with descriptive statistics to analyse and describe the data collected. It was, therefore, recommended that investment be made into this growing workforce in healthcare, as well as healthcare as a whole, since climate change, as documented, will threaten food security and water availability, see altered diseases patterns including emerging and re-emergence of infectious diseases and cardiovascular concerns brought on by heat stress. Funding must support education and training to strengthen awareness and preparedness so as to empower this workforce so that they may assist local populations to better adapt to the changes, become more resilient and, thereby, reduce their vulnerability and risk / Health Studies / M.Sc. (Life Sciences)

Autism spectrum disorders (ASD) are characterized by deficits in the areas of communication and social interaction, stereotypic behaviour and changes in the sensory processing. These symptoms pose challenges to everyday situations such as visits to the doctor's office, which are more stressful for children with ASD and their parents than for the general population. Furthermore, more than one-third of parents have encountered refusal to provide medical care for their child because of ASD. In our diploma project, we combined the parent's reports with an analysis of international sources to create a project called AutFriendly which aims to increase the knowledge of the Czech healthcare practitioners about ASD. In the presented thesis, we summarize the theoretical background in the field of healthcare provision for people with ASD and we review current Czech and international literature to show how the topic of ASD is addressed in the education of healthcare practitioners. In the practical part of the thesis, we summarize our two-year experience with the AutFriendly project. First, we created a two- hour AutFriendly workshop for the students of secondary schools of nursing and we put it into practice with more than 250 participating students of the Czech secondary schools of nursing. Second, we...

The thesis focuses on multilingual communication in healthcare centres in Prague. One of its main objectives is to compare and contrast the situation in the public- and the private sector. The theoretical part of the thesis presents interpreting in healthcare settings as one of the most important and most frequent types of community interpreting. The authors focus mainly on the current state of research in diverse world regions, and subsequently analyse the specific aspects of interpreting situations in the setting in question. An integral constituent of the theoretical part of the thesis is a global overview of the current situation in terms of quantity of foreign patients in Prague hospitals, including selected relevant demographic data. In conclusion of the theoretical part, the authors briefly elaborate on the phenomenon of medical tourism. The empirical part of the thesis is based on a questionnaire survey carried out among hospital employees in Prague, the aim of which was to analyse the current situation in terms of communication with foreign country nationals and to compare and contrast the public- and the private sector in this respect. The main focus of the research is to find out how the respondents perceive the situation and whether they are satisfied with it and to what extent this is...

Bakgrund: Ljumskbråck är den vanligaste operationen inom allmänkirurgin, varje år utförs nästan 20 000 operationer i Sverige. I Östergötland utförs ljumskbråcksoperationer på tre ställen inom ramen för dagkirurgi; vid Aleris Specialistvård i Motala (ASM), Närsjukvården i Finspång (NiF) samt Medicinskt Centrum i Linköping (MCL). Det finns en teori om att privata vårdgivare är mer tidseffektiva än offentliga vårdgivare. De privata anses kunna utföra fler operationer under en given tid, men ingen studie har gjorts på tidseffektiviteten kring operationerna hos respektive vårdgivare. Denna studie har genomförts för att detektera om det finns en skillnad i hur lång tid olika moment tar att utföra och vad denna skillnad i sådana fall beror på, samt om patientunderlaget skiljer sig mellan klinikerna. Metod: Studien omfattade 70 patienter fördelade på tre kliniker; ASM, MCL och NiF. Ljumskbråcksoperationerna delades upp i flertalet moment som mättes med digital klocka. Dessutom samlades uppgifter in om patientens ålder, ASA-klass, BMI samt information om vilka som närvarade i operationssalen. Statistisk analys gjordes enligt Kruskal-Wallis. Programvaran som användes var SPSS version 22. Resultat: Studien fann ingen signifikant skillnad i BMI, ASA-klass eller ålder mellan klinikernas patienter (p &gt; 0,05 för samtliga). Däremot fanns stora skillnader vad gäller hur lång tid ett flertal av momenten under ljumskbråcksoperationen tog. Slutsats: Studien påvisar att det finns stora skillnader i olika moment vid ljumskbråcksoperationer. De privata klinikerna var alltid snabbare än den offentliga kliniken. Då det saknas studier inom området vore det intressant att se om det finns liknande skillnader vid andra ingrepp som utförs av olika aktörer. / Background: Inguinal hernia surgery is one of the most common surgeries within general surgery, with approximately 20 000 surgeries per year in Sweden. There are three places in Östergötland County where inguinal hernias are executed within outpatient surgery; at Aleris Specialistvård in Motala (ASM), Närsjukvården in Finspång (NiF) and at Medicinskt Centrum in Linköping (MCL). There is a theory that private health care providers are more time-efficient than public health care providers. The private health care providers are considered to perform more operations over a given time though no studies has been done on time efficiency. This study was performed to detect if there is a difference in time in the various steps during the surgery between the clinics, what causes these differences and if the patients differ. Methods: The study includes 70 patients distributed on three outpatient surgery clinics; ASM, MCL and NiF. The inguinal hernia operations were divided into shorter steps measured with a digital watch.  Furthermore, data were noted about the patients’ age, ASA-score, BMI and who were present in the operating room. Statistical analyses were performed with the Kruskal-Wallis one-way analysis of variance. The software used was SPSS version 22. Results: The study found no significant difference in BMI, ASA-score and age between the health care providers (p &gt; 0,05). However, regarding the time efficiency, there were significant differences between the clinics. Conclusions: The study concludes that there are big differences in time, within the various steps in the inguinal hernia surgeries, between the clinics. The private health care providers were always faster than the public health care provider. Since no earlier studies have been made in this area, it would be interesting to see if there are similar differences in other types of surgeries.

Submitted by Mariana Baleeiro Martins Carrera (marianacarrera@hotmail.com) on 2014-09-22T15:17:00Z No. of bitstreams: 1 TESE VERSÃO FINAL - MARIANA CARRERA 22.09.2014.pdf: 1391085 bytes, checksum: a0380a49f7b6d3c7112ffd16f2715714 (MD5) / Approved for entry into archive by PAMELA BELTRAN TONSA (pamela.tonsa@fgv.br) on 2014-09-22T16:03:09Z (GMT) No. of bitstreams: 1 TESE VERSÃO FINAL - MARIANA CARRERA 22.09.2014.pdf: 1391085 bytes, checksum: a0380a49f7b6d3c7112ffd16f2715714 (MD5) / Made available in DSpace on 2014-09-22T16:04:04Z (GMT). No. of bitstreams: 1 TESE VERSÃO FINAL - MARIANA CARRERA 22.09.2014.pdf: 1391085 bytes, checksum: a0380a49f7b6d3c7112ffd16f2715714 (MD5) Previous issue date: 2014-08-22 / The goal of this study is to understand the merit evaluation models of PPP projects and to study existing projects in the healthcare sector in Brazil, as of June, 2014. The methodology was a qualitative research of exploratory nature, through a bibliography and document review, interviews with key stakeholders and analysis of projects. It also involved the study of national and international merit assessment models – Value for Money. Key parameters presented by VFM are: discussions of projects based on results, competition, risk transfer to the private initiative, innovation and responsibility sharing. It is composed of three basic elements: economy, efficacy and efficiency. However, achieving economy and efficiency is meaningless if the efficacy (guaranteeing that a given activity achieves its goals) is not observed. The results point out that the utilization of PPPs is, slowly, becoming more frequent in the healthcare sector in Brazil. Nevertheless, such partnerships need to mature and to improve their administration, technical, managerial and political aspects. As such, it intends to contribute for a better knowledge and understanding of PPP as a new institutional way to manage healthcare, documenting the early stages of this process and presenting the most critical dimensions for the success of its implementation in the healthcare sector in Brazil. / O presente trabalho tem como objetivo compreender a análise do mérito de projetos de PPP, com ênfase no setor saúde. A metodologia utilizada foi a pesquisa qualitativa de natureza exploratória, com levantamento bibliográfico e documental, entrevistas com os principais stakeholders e análise de projetos. Foram estudados, também, modelos nacionais e internacionais de análise de mérito – Value for Money. O VFM apresenta como principais parâmetros a discussão sobre contratos baseados em resultados, competição, transferência de risco para a iniciativa privada, inovação e divisão de responsabilidades. São três seus elementos básicos: economia, eficácia e eficiência. Porém, a obtenção de economia e eficiência não tem valor se a eficácia (garantia de que uma determinada atividade alcance os resultados desejados) não for observada. Os resultados apontam que a utilização de PPP está, progressivamente, se tornando mais freqüente no setor saúde no Brasil. No entanto, essas parcerias necessitam de amadurecimento e aperfeiçoamento administrativo, técnico, gerencial e político. Com isso, pretende-se contribuir para o maior conhecimento e entendimento da PPP como uma nova modalidade institucional para a gestão da saúde, documentando um momento ainda inicial desse processo e apresentando as dimensões mais críticas para o sucesso da sua implantação no setor saúde no Brasil.