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PubMed2003

Validating internet research: a test of the psychometric equivalence of internet and in-person samples.

This study evaluated the psychometric equivalency of Web-based research. The Sexual Boredom Scale was presented via the World-Wide Web along with five additional scales used to validate it. A subset of 533 participants that matched a previously published sample (Watt & Ewing, 1996) on age, gender, and race was identified. An 8 x 8 correlation matrix from the matched Internet sample was compared via structural equation modeling with a similar 8 x 8 correlation matrix from the previously published study. The Internet and previously published samples were psychometrically equivalent. Coefficient alpha values calculated on the matched Internet sample yielded reliability coefficients almost identical to those for the previously published sample. Factors such as computer administration and uncontrollable administration settings did not appear to affect the results. Demographic data indicated an overrepresentation of males by about 6% and Caucasians by about 13% relative to the U.S. Census (2000). A total of 2,230 participants were obtained in about 8 months without remuneration. These results suggest that data collection on the Web is (1) reliable, (2) valid, (3) reasonably representative, (4) cost effective, and (5) efficient.

Adult↗
PubMedDate not supplied

Divergent backgrounds, unified goals: continuing education program for multinational nurses in a hospital in the Middle East.

This article reports continuing education as one strategy used to resolve the competence issues of multinational nurses working in Saudi Arabia. Four categories of Staff Nurses (I, II, III, and IV), N = 111, recruited from eight countries participated in a study that describes the outcomes of a training session for nurses at one hospital in Dammam. An average of 12 to 13 nurses attended 1-day courses over a 9-day period to address urgent policies and procedures selected from the hospital's guidelines for patient care. Results from pretests and posttests completed by the participants yielded information that echo differences of the nurses in terms of country of origin and possibly educational background, rather than their recruitment status with which the employers determine remuneration and responsibilities. The findings suggest ways to ensure that future nurses derive more benefit, and that recruiters and employers reconsider the criteria used for recruitment and placement.

Cultural Diversity↗
PubMed2005

Comparing walk-in and call-responsive donors in a national and a private hospital in Nairobi.

BACKGROUND: The non-remunerated donors in many of Kenya's hospital blood banks are either call responsive (CR) or walk-in (WI) donors. These donors impact differently on the national blood transfusion services. OBJECTIVE: To examine the walk-in (WI) and call responsive (CR) donors' influence on the national blood transfusion services. DESIGN: A retrospective study. SETTING: A national referral and a private hospital in Nairobi, Kenya. MAIN OUTCOME MEASURES: Donor's age, sex, whether walk in or responded to a call to donate for a relative or emergency blood requirement and test results of; HIV, HBsAg, syphilis and HCV. RESULTS: Between April 1999 and April 2000, 10,295 persons donated blood either responding to a call or walked in. The national referral hospital had 8,563 (83%) and private hospital 1,732 (17%). In total, 2.5% were WI and 97.5% CR. The lowest age of donors were CR 15, and WI 18 years. Of 1,138 (11.1%) rejected were 4.6% WI and 11.2% CR donors. The infections 5.8% HIV, 4% HBSAg, 1.2% VDRL and 0.2% HCV were statistically significant in WI compared to CR (p=0.002), also in female compared to male donors (p=0.001). CONCLUSION: This study shows that walk in donors were fewer than call responsive but had less rates of transfusion associated infections.

Adolescent↗
PubMed2006

Pharmacy education in Jordan, Saudi Arabia, and Kuwait.

The practice of pharmacy, as well as pharmacy education, varies significantly throughout the world. In Jordan, Kuwait, and Saudi Arabia, the profession of pharmacy appears to be on the ascendance. This is demonstrated by an increase in the number of pharmacy schools and the number of pharmacy graduates from pharmacy programs. One of the reasons pharmacy is on the ascendance in these countries is government commitment to fund and support competitive, well-run pharmacy programs. In this report we describe pharmacy education in 3 Middle East countries: Jordan, Kuwait, and Saudi Arabia. All 3 countries offer bachelor of pharmacy (BPharm) degrees. In addition, 2 universities in Jordan and 1 in Saudi Arabia offer PharmD degree programs. The teaching methods in all 3 countries combine traditional didactic lecturing and problem-based learning. Faculties of pharmacy in all 3 countries are well staffed and offer competitive remuneration. All 3 countries have a policy of providing scholarships to local students for postgraduate training abroad. The majority of students in Jordan and Kuwait are female, while the ratio of male to female students in Saudi Arabia is even. Students' attitudes towards learning are generally positive in all 3 countries. In Saudi Arabia and Kuwait, most pharmacy graduates work in the public sector, while in Jordan, the majority work in the private sector.

Education, Pharmacy↗
PubMed1990

Emergency and after-hours work performed in country hospitals.

Country doctors perform emergency work in addition to their conventional general practice role. Over a one-month period 17 general practitioners in four Hunter Region towns recorded all emergency calls describing the time they were called, the severity of the patients' conditions, the skills used and the time taken. A scale to measure severity of illness was devised and tested for this purpose. There were 1197 emergency calls, mostly seen at the local hospital, either in the outpatients department or on the wards. They were unevenly distributed in time, with fewer calls at night, but the doctors were disturbed during nearly half of their nights on call. Of the calls 15% were for trivial reasons, 34% were for patients who needed standard general practice care, and 50% were for patients who needed the services of the hospital or were already inpatients. Most attendances were brief, but 15% took more than 30 minutes and some much longer. Counselling skills were used for 47% of patients and technical skills in 22%. The strain of the work involved and the disturbance of personal life justify extra payments to country doctors, and the adequacy of current pay schedules is questioned. However, the peculiarities of funding result in the State Health Department underwriting most emergency costs in country towns, whereas in the cities the Commonwealth Department of Health pays for a larger proportion, leading to concern about the high apparent costs of country hospitals. The information in this survey may help improve planning for training and remuneration of country doctors to help ease the current shortage.

Clinical Competence↗
PubMed1995

Differences in work activities between private and community health centre general practitioners.

OBJECTIVE: To investigate differences in the characteristics of general practitioners (GPs) and patients, referral rates, rates of prescribing and ordering of tests and x-rays, and types of counselling and consultation, between private and community health centre (CHC) GPs in Victoria. METHOD: All 51 full-time Victorian CHC GPs were invited to enrol in the Australian Morbidity and Treatment Survey (AMTS) developed by the Family Medicine Research Unit at the University of Sydney in 1992. The control group comprised the 114 Victorian GPs involved in this survey in 1991. RESULTS: Thirty-nine CHC GPs (76%) provided complete data. CHC GPs were more likely to be younger, female, and to have less experience in general practice. Patient age and gender distributions were similar. CHC GPs had higher rates of offering counselling and advice and of referral to allied health professionals, but similar rates of referral to medical specialists to those of private GPs. We found no differences in prescribing after multivariate analysis. CONCLUSIONS: Counselling, and referral to allied health professionals, were the only striking differences after multivariate analysis. It may be that any movement toward non-throughput-related remuneration may, in isolation, have less impact on general practitioner work patterns than imagined. Patient throughput was not measured, and this would be important in any future global assessment of the cost-effectiveness of CHC and private general practitioners.

Adult↗
PubMedDate not supplied

As time goes by: reflections on 40 years of academic medicine and biomedical research.

Professor Firkin of the Department of Medicine at Melbourne's Monash University says that, despite considerable advances, many unanswered questions remain in modern medicine. The bright medical minds that may answer these questions are being lost to the cause because of rigid postgraduate training schemes and inadequate remuneration.

Academic Medical Centers↗
PubMed1998

The stress of metropolitan general practice.

OBJECTIVE: To identify the work-related stressors of Australian metropolitan general practitioners (GPs). DESIGN AND SETTING: A descriptive postal survey of metropolitan GPs from all States and Territories selected at random from the Health Insurance Commission database. PARTICIPANTS: 296 of 464 GPs (64%) surveyed in June 1996; 67% were male; 87% worked full-time (more than 6 sessions per week). MAIN OUTCOME MEASURES: Frequency and severity of work stressors in general practice; overall feelings of stress at work in the past 12 months; effects of the stressors on work satisfaction; contribution of work stress to overall life stress; responses to the 12-item General Health Questionnaire (GHQ) as potential correlates of occupational stress. RESULTS: "Time pressure to see patients" was the most frequently reported stressor. Threat of litigation was perceived as the most severe stressor. Of the top 10 severe stressors, seven were also in the top 10 for stressor frequency. Work was the major stressor in GPs' lives. The GHQ scores did not correlate significantly with major stress outcome measures, but 12.8% of GPs had scores indicative of severe psychiatric disturbance. Fifty per cent of respondents had considered leaving their current workplace and 53% had considered abandoning general practice because of occupational stress. GPs working 6 or more sessions per week were more likely to be moderately or severely stressed than those working part-time (P< 0.02, Fisher's exact test). Those who had considered leaving their current workplace or careers were also more likely to be moderately or severely stressed (P< 0.0001, Fisher's exact test). CONCLUSIONS: The most frequent and relatively severe stressful events in general practice involved time pressures. There are implications for government, which, through remuneration policies, might influence GPs to work at a rate beyond their capacity to cope. Strategies are required to manage or prevent stress in metropolitan GPs.

Adult↗
PubMed2000

Public health and preventive healthcare in children: current practices of Victorian GPs and barriers to participation.

OBJECTIVES: To assess general practitioners' attitudes to and involvement in child public health activities and identify barriers affecting their participation. DESIGN: Cross-sectional written questionnaire survey of a representative sample of actively practising GPs. SETTING: General practices in the State of Victoria. PARTICIPANTS: 840 GPs returned questionnaires (65% response rate), and, of these, 792 (94%) saw children 0-12 years. MAIN OUTCOME MEASURES: Attitudes to and involvement in public health promotion; predictive factors for GPs' involvement. RESULTS: The odds of GPs' involvement in child public health issues were increased by being female (odds ratio [OR], 1.88), receiving basic medical qualifications outside Australia (OR, 1.55), attending continuing education and postgraduate training (OR, 1.60), and having confidence in dealing with newborns and infants (OR, 1.93) and preschool children (OR, 2.94) (both P < 0.05). Older GPs, compared with younger GPs, had significantly lower odds of involvement (P < 0.01). After adjustment, GPs had higher odds of involvement if they agreed it was important for them to take part in health promotion, or in screening and surveillance (OR, 2.76 and 1.94, respectively; P < or = 0.05); and lower odds if they agreed that screening and surveillance should be mainly done by maternal and child health nurses (OR, 0.60). The most common barriers to involvement were insufficient time, inadequate financial reimbursement for long consultations, inappropriateness of raising these issues in children presenting with illness, and lack of community resources. CONCLUSIONS: Increasing GPs' involvement in child public health will require attention to barriers (time, remuneration and perceived appropriateness), continuing education and changes in workforce composition and patterns.

Adult↗
PubMed2002

The balancing act: key issues in the lives of women general practitioners in Australia.

OBJECTIVE: To identify key issues affecting women general practitioners in their professional and non-professional lives. DESIGN: A qualitative study using the Delphi technique, with three rounds of data provision circulated to each participant. Coding was used to ensure anonymity. SETTING AND PARTICIPANTS: The participants were a purposive sample of 40 women GPs drawn from all Australian States and Territories. The study was conducted between October 1996 and January 1997. OUTCOME MEASURES: Key issues affecting the professional and non-professional lives of women GPs. RESULTS: Some of the key professional issues for women GPs were job satisfaction, balancing work and personal life, autonomy, availability of flexible and part-time work and training, affordability of professional expenses, fair remuneration, and having a voice in decision-making. Key non-professional issues included self-care; time for relationships with a partner, children, family and friends; and time management to allow pursuit of non-medical interests. CONCLUSIONS: The conflicting demands made on women GPs diminish their job satisfaction and lead to stress and imbalance in their lives. Recommendations to ameliorate the problems for women GPs include appropriate training, policy formation, financial and other support, and a change in cultural expectations of women GPs by the community, the profession and governments.

Adult↗
PubMed2003

The influence of geographical location on the complexity of rural general practice activities.

OBJECTIVES: To examine the complexity of activities undertaken in general practice in relation to degree of rurality of the practice. DESIGN AND SETTING: National mail questionnaire survey across non-metropolitan Australia in July 2002. PARTICIPANTS: 1498 respondents out of 4406 GPs providing at least 375 Medicare-rebatable consultations in rural and remote locations during January-March 2002 (response rate, 35%). MAIN OUTCOME MEASURES: Responses to five sentinel measures of practice complexity. RESULTS: In general, the proportion of GPs providing complex services increases with increasing rurality or remoteness. Isolated rural and remote GPs manage myocardial infarctions to a higher level than GPs in larger rural and regional centres, are more likely to administer cytotoxic drugs, perform forensic examinations, stabilise injured patients pending retrieval, and coordinate discharge planning more often. CONCLUSIONS: The more rural or remote the area, the more likely a GP is to be regularly engaged in complex care. These findings have implications for the workload, responsibility, vocational satisfaction, need for professional education and support, and costs and remuneration of practice.

Adult↗
PubMed2005

General practitioners with special interests: risk of a good thing becoming bad?

There is a long tradition of some general practitioners developing areas of special interest within their mainstream generalist practice. General practice is now becoming increasingly fragmented, with core components being delivered as separate and standalone services (eg, travel medicine, skin cancer, women's health). Although this fragmentation seems to meet a need for some patients and doctors, potential problems need careful consideration and response. These include loss of generalist skills among GPs, fewer practitioners working in less well-remunerated areas, such as nursing home visits, and issues related to standards of care and training.

Ambulatory Care Facilities↗
PubMed2005

Barriers to delivering asthma care: a qualitative study of general practitioners.

OBJECTIVES: To ascertain what general practitioners' priorities are for achieving optimal outcomes in people with asthma, and the barriers they face in delivering this care. DESIGN: A qualitative study using the Nominal Group Technique (a highly structured meeting to gain information from experts about a particular issue) was conducted between August 2002 and September 2003. GPs in six discussion groups were asked "What do you think is needed to achieve best outcomes for asthma care?" To augment analysis of the discussion, sessions were taped and transcribed. PARTICIPANTS: Forty-nine GPs were recruited: 34 from metropolitan and 15 from rural areas. RESULTS: All groups nominated asthma education for patients and continuing professional education for GPs as major priorities, but they also described educational and structural barriers to achieving these priorities. Other priorities were: medication adherence, facilitating regular patient review, negotiated treatment/management plans, making the correct diagnosis, increased remuneration and consultation time, and safer asthma medications and access to these. Health promotion initiatives and increased public awareness were also priorities. Spirometry was a significant cause of uncertainty. Overall, written asthma action plans were not considered a high priority. CONCLUSIONS: Remarkable consistency was found between GPs' priorities for delivering best asthma care. Our study identified barriers to asthma guideline adherence, including accessible, relevant education for GPs, and structural, time and cost barriers GPs must overcome in providing asthma treatment and patient education.

Asthma↗
PubMed2006

6. Doctor on the sidelines.

Effectively managing on-field emergencies is the most important role of the doctor on the sidelines. Pre-event preparation is essential and should include a formulated plan for dealing with emergencies and access to emergency equipment such as a stretcher and a bag and mask. Game day injuries should be assessed by adhering as closely as possible to a normal clinical consultation, with a proper history and examination being performed for all injuries. The athlete with an on-field head injury should be treated as having a concomitant cervical spine injury until proven otherwise. Athletes with any symptoms after head injury should be comprehensively and continuously assessed. Return-to-play decisions are made by balancing the risk of injury recurrence, the potential severity of injury recurrence and the benefits of returning to the field (which are higher at elite than amateur level). There is currently a shortage of doctors willing to cover sports events in Australia, which is partially explained by inadequate remuneration, inadequate facilities provided at venues, inadequate training opportunities in sports medicine, and fear of the medicolegal consequences in taking on the role as a team doctor.

Adult↗
PubMed2006

Primary health care research--essential but disadvantaged.

Primary health care is the foundation of effective, sustainable population health and is associated with higher patient satisfaction and reduced aggregate health spending. Although improving patient care requires a sound evidence base, rigorously designed studies remain under-represented in primary care research. The pace of research activity in general practice and the rate and quality of publications do not match the pace of structural change or the level of funding provided. Recruitment difficulties are a major impediment, fuelled by general practitioners' time constraints, lack of remuneration, non-recognition, and workforce shortages. Radical reform is required to redress imbalances in funding allocation, including: funding of GP Research Network infrastructure costs; formalising relationships between primary care researchers and academic departments of general practice and rural health; and mandating that research funding bodies consider only proposals that include in the budget nominal payments for GP participation and salaries for dedicated research nurses.

Australia↗
PubMed2006

Facing the challenges: general practice in 2020.

A strong primary medical care system is essential to the equity, efficiency and effectiveness of the health system as a whole. General practice in Australia faces significant challenges to its capacity to fulfil its role and function: in its financing, recognition, capacity to provide comprehensive care, and integration with the rest of the health system. Addressing these challenges requires a better system of remuneration for quality in general practice care, strengthening of the role of the generalist within the health system, involvement of Divisions of General Practice in service development, and establishment of collaborative networks and integrated primary health care services.

Australia↗
PubMed2006

Potential impact of AUSFTA on Australia's blood supply.

Australia is largely self-sufficient in its supply of safe, fresh blood products because of the goodwill of non-remunerated, volunteer donors, plus rigorous testing and processing standards. CSL Limited is the sole provider of plasma fractionation services in Australia, enjoying exclusive rights under the Plasma Fractionation Agreement with the Australian Government. In the Australia-United States Free Trade Agreement (AUSFTA), Australia agreed to review its current contract with CSL Limited, and to recommend to the states and territories that the process be opened up to overseas tender. Overseas tenders for off-shore fractionation services are likely to be highly competitive due to their low manufacturing costs and accumulated expertise. Off-shore fractionation could compromise the safety of Australia's blood supply through delays in processing and transportation, issues related to quality control, and even the siphoning of stock to overseas markets. This could compromise the long-term care of Australian patients and create a serious national security risk in the event of a terrorist attack or natural disaster. Australia's AUSFTA obligation to recommend changes does not equate to an obligation to actually proceed. The states and territories should carefully consider whether such changes would be in our national interest. The long-term security of the Australian people in the current security environment is dependent on continuance of an on-shore fractionation plant and appropriate back-up facilities.

Australia↗
PubMed1992

The Anti-Kickback Statute and hospital-physician financial arrangements.

Hospital-physician financial arrangements often involve transactions that could be construed by the government as illegal remuneration under the federal "anti-kickback" statute. This article discusses some of the questionable types of relationships that arise and explores the government's reaction to these arrangements as manifested by a recent Office of Inspector General management advisory report and proposed and final safe harbor regulations.

Crime↗