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PubMed1993

Alternative patient care delivery systems: a combined ophthalmic nursing unit and a cost effective ophthalmic surgery program.

To be competitive as a tertiary facility in today's healthcare environment, our institute implemented two nursing programs using the Continuous Quality Improvement (CQI) framework: a) creation of the Nursing and Trauma Center, a nursing unit with the flexibility to adjust to continuing changes in patient mix comprising three nursing units (eye emergency room, same day surgery unit, and inpatient unit) designed to consolidate and standardize care to ophthalmic patients and develop a multi-skilled nursing staff to provide nursing care to all ophthalmic patient populations; and b) creation of the Controlled Medical Intensity (CMI) program, in which certain ophthalmic surgeries are performed in the most cost effective and efficient manner (while maintaining quality care). Conceived to compete with surgi-centers, CMI surgery is performed under local retrobulbar anesthesia with minimal, one-time intravenous (IV) conscious sedation (administered by operating room/recovery room nurses according to a standard protocol). Surgical supplies are standardized. These expanded roles have given nurses the opportunity to practice professional autonomy using nursing judgment.

Ambulatory Surgical Procedures↗
PubMed1995

Acceptability to general practitioners of national health insurance and capitation as a reimbursement mechanism.

OBJECTIVE: To determine general practitioners' attitudes to national health insurance (NHI) and to capitation as a mechanism of reimbursement. To explore determinants of these attitudes. DESIGN: Cross-sectional survey by means of telephone interviews; four focus group discussions. SETTING: Cape Peninsula. PARTICIPANTS: 174 GPs randomly sampled from a total population of 874. MAIN OUTCOME MEASURES: Acceptance of NHI, acceptance of capitation. MAIN RESULTS: 63.3% approved of NHI. More than 81% approved of NHI if GPs would be able to maintain their independent status, e.g. own premises and working hours; 82.3% said NHI would be a more equitable system of health care, 88% approved of the fact that NHI would make care by GPs more accessible, and 73% said they would have the capacity to treat more patients. However, 61.3% of GPs disapproved of capitation as a form of reimbursement. CONCLUSIONS: Most GPs in the Cape Peninsula were amenable to some form of NHI. However, the proportion of GPs who approved the introduction of NHI varied depending on details of the NHI system such as payment mechanisms, workload, income and effects on professional autonomy. A national survey of medical practitioners is recommended. The implications of GPs' preferences concerning the reimbursement mechanism for the feasibility of implementing a NHI system in South Africa require serious consideration by policy-makers.

Adult↗
PubMed1995

General practitioner registrars' views about a career in general practice.

BACKGROUND: Current low morale in general practice and the fall in the number of general practitioner registrars (trainees) has led to concern about the decline in popularity of general practice as a career. AIM: A study was performed to evaluate the career intentions of general practitioner registrars and the factors underlying their decisions. METHOD: An anonymous postal questionnaire seeking both quantitative and qualitative data was sent to 138 registrars during June 1993. All were registrars at practices in the south west region of England. Outcome measures used were the popularity of different types of general practice work and identification of variables and emergent themes considered important in career choice. RESULTS: A total of 101 registrars returned questionnaires (73%). Of the respondents, 96% expressed an interest in general practice as a career. However, registrars expressed considerable uncertainty about the future of general practice and therefore their career. Continuity of care and a holistic approach were considered valued aspects of work in general practice. Increased workload, increased out-of-hours work and erosion of professional autonomy emerged as negative aspects of a career in general practice. Of the respondents, 91% considered time for leisure activities an important factor when considering future career, 72% would have been glad to do away with 24-hour cover and 99% agreed that general practitioners increasingly fear litigation. CONCLUSION: Although registrars were interested in general practice as a career they had many concerns and expressed uncertainties. The future popularity of general practice is likely to depend on addressing these concerns and on the clarification of the future direction of the profession.

Adult↗