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PubMed1998

Toward implementation: managed care and delivery systems.

The Oxford Health Plans Foundation seeks to create an environment that fosters innovation and encourages new solutions to old problems. That philosophy drives all of the initiatives discussed in this paper. Oxford is optimistic and enthusiastic regarding the potential of many of these collaborative relationships and believes that they can dramatically improve the health status of inner-city populations.

Cooperative Behavior↗
PubMed2004

General practitioners and the National Strategy on Sexual Health and HIV.

To determine general practitioners' knowledge of, and opinions on, the National Strategy for Sexual Health and HIV and whether they intend to provide Level 1 and 2 HIV/STI services, a self-administered questionnaire was sent to one partner from 155 general practices in Sheffield and North Derbyshire in November 2001. Response rate was 57% (88). Forty-eight (55%) GPs aware of strategy but 53 (60%) had no knowledge of what it involved. LEVEL 1. Sixty-two (71%) felt confident in providing advice on STI prevention and 46 (52%) on HIV. Nine (10%) GPs provide HIV testing and 29 (33%) anticipate doing so but 24 (83%) require staff training and 20 (70%) increased funding. All Level 1 STI services are provided by 60 (68%) practices and 72 (82%) anticipate providing. LEVEL 2. Thirty-nine (45%) anticipate testing and treating STIs but only nine (10%) will undertake partner notification. Resources required are training, nine (60%) and funding, nine (60%). The main reasons for not offering in the future were too busy 58 (72%) and lack of demand 25 (31%). Many GPs are unaware of the strategy but most anticipate providing Level 1 STI services. Less than half anticipate offering HIV testing. Although 45% of GPs may provide Level 2 care, it is unlikely to include partner notification. Many GPs are too busy and require extra training and funding. These needs must be addressed if the Strategy is to be implemented.

Attitude of Health Personnel↗
PubMed1995

Towards evaluation of the quality of care in health centres.

There is wide acknowledgement that quality assurance is desirable in primary health care. Considerable success has been achieved in this field by the Iberian Programme of Training and Implementation of Quality Assurance Activities in Primary Health Care, the basis for which is outlined below.

Health Facilities↗
PubMed2003

[Cost analysis of task implementation at the regional occupational medicine centers].

In this paper, the considerations on setting the costs of the tasks to be implemented by provincial occupational medicine centers (POMCs) are continued (Med Pr 2001; 3: 197-201). Under the research project carried out by the Nofer Institute of Occupational Medicine, the method of setting costs has been elaborated and implemented in selected POMCs. At the implementation stage, a set of forms to collect and process data on costs involved was prepared. These forms together with the instruction were distributed among the selected centers. The data collected were analyzed, and the conclusions concerning the factors responsible for shaping relevant costs in POMCs, as well as the barriers hindering the implementation of this new method were formulated. The introduction of new principles of isolating so called "cost phases" was necessary only for setting full costs of health promotion and postgraduate education programs. The method of setting values for the remaining POMC costs has been implemented without its modification. The collected data on costs show that the wages of physicians and medium-level personnel affects mostly the costs of tasks in a given center, however, indirect costs also have a substantial share in unit costs. In addition, the range of specialistic consultations and diagnostic tests performed in or outside POMCs also exert some effect on the differentiation of unit costs.

Costs and Cost Analysis↗
PubMed2004

[The relationship between job overload, burnout and job satisfaction, and the number of jobs of Israeli consultants].

BACKGROUND: The locus of secondary medical care provision is changing. Services that once were provided solely in hospitals are now available in the community. This and the increased competition among health plans since implementation of the National Health Insurance Law have spurred the development of community-based consultant/specialty medicine in Israel. Consequently, many consultants took part-time jobs in addition to their primary full-time job, usually in community care. OBJECTIVES: To examine the relationship between the number of jobs of the consultant and overload, burnout, and job satisfaction. METHODS: A mail survey was conducted during the latter half of 2001 among a random sample of 50% of physicians in six areas of specialization: ophthalmology, dermatology, otolaryngology, gynecology, cardiology, and general surgery. A total of 890 physicians responded to the questionnaire (response rate: 63%). RESULTS: The number of jobs and weekly work hours were independently and positively correlated with job overload and burnout. The number of jobs was negatively correlated with job satisfaction. It was found that employment as an independent physician, age, and having completed one's medical education in the former Soviet Union were negatively correlated with job overload and burnout. Employment as an independent physician, age, and an academic post were positively correlated with job satisfaction. CONCLUSIONS: Holding multiple jobs and working many hours were found to have a negative impact on the consultants' quality of work life. Enlightened employers concerned with this effect c ould consider the option of reducing or limiting the number of jobs consultants may hold.

Burnout, Professional↗
PubMedDate not supplied

Regional planning implementation and its impact on integration of a mental health care network.

This article questions the effectiveness of a managerial tool in changing a health-care system. The process of implementing regional planning and its impact on creating integrated service networks is examined, using a case study and a multi-dimensional analytic model. This model highlights the influence of contextual, structural, cultural and dynamic factors on forming networks. The regional planning developed in the province of Québec (Canada), aimed at a major transformation of the mental health-care system. In each district, organizations working with people who have serious mental disorders were mobilized to plan and implement a more coordinated, continuous and diversified supply of services, under the direction of a regional health body. This study outlines the limitations of regional planning as a tactic for transforming the system. It recommends instead developing more diversified integration strategies to further the process of forming integrated service networks within a complex system. In conclusion, a brief discussion deals with the difficulties related to the study of systemic change implementation.

Delivery of Health Care, Integrated↗
PubMed2005

Electronic health records within integrated care in Germany.

The planned introduction of an electronic health card is seen as a milestone in the dissemination of extended electronic health records in Germany. This paper deals with the main issues likely to result from the use of the electronic health insurance card. The role of the patient in the health care process and the patients enhanced access to his or her personal medical record are reflected. A high level of acceptance of the electronic health insurance card and extended electronic documentation procedures can be expected if ethical, legal, and technological concerns of the public are addressed and appropriate incentives are established. Finally, the electronic health insurance card can serve as a useful aid to support the ongoing implementation of disease management programs for the most important chronic conditions in Germany.

Attitude to Health↗
PubMed2001

Why tuberculosis control in an unstable country is essential: desperate TB patients embrace DOTS in Angola.

After decades of war, the tuberculosis situation in Angola is alarming. The author describes his experiences with the implementation of a DOTS TB programme adapted to the difficult circumstances in a town partly inhabited by displaced people. The high motivation of both patients and health care workers is an important factor for its successful implementation. The need for international support of tuberculosis control programmes also in war-ridden countries is stressed.

Adult↗