Care Sector (care + sector)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Care Sector

  • aged care sector
  • health care sector


  • Selected Abstracts


    Health Care Supply Chain Design: Toward Linking the Development and Delivery of Care Globally,

    DECISION SCIENCES, Issue 2 2009
    Kingshuk K. Sinha
    ABSTRACT This article is motivated by the gap between the growing demand and available supply of high-quality, cost-effective, and timely health care, a problem faced not only by developing and underdeveloped countries but also by developed countries. The significance of this problem is heightened when the economy is in recession. In an attempt to address the problem, in this article, first, we conceptualize care as a bundle of goods, services, and experiences,including diet and exercise, drugs, devices, invasive procedures, new biologics, travel and lodging, and payment and reimbursement. We then adopt a macro, end-to-end, supply chain,centric view of the health care sector to link the development of care with the delivery of care. This macro, supply chain,centric view sheds light on the interdependencies between key industries from the upstream to the downstream of the health care supply chain. We propose a framework, the 3A-framework, that is founded on three constructs,affordability, access, and awareness,to inform the design of supply chain for the health care sector. We present an illustrative example of the framework toward designing the supply chain for implantable device,based care for cardiovascular diseases in developing countries. Specifically, the framework provides a lens for identifying an integrated system of continuous improvement and innovation initiatives relevant to bridging the gap between the demand and supply for high-quality, cost-effective, and timely care. Finally, we delineate directions of future research that are anchored in and follow from the developments documented in the article. [source]


    Providing early intervention services for the primary care sector: the PMHT approach

    ACTA PSYCHIATRICA SCANDINAVICA, Issue 2002
    A. McGovern
    Primary Mental Health Teams are a state-wide initiative of the government of Victoria to address identified gaps in mental health service delivery namely early intervention for psychosis and mental health services for high prevalence disorders. This poster will outline this dynamic community based approach to supporting and enhancing services for clients with mental health issues that are currently provided by the primary care sector. Specifically, the poster will focus on the development of a local cross sectorial approach to early psychosis with the dual aims of decreasing the duration of untreated psychosis and adopting best practice guidelines for improved outcomes for this high risk population. [source]


    Movement and change: independent sector domiciliary care providers between 1995 and 1999

    HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2001
    Patricia Ware
    Abstract Promoting the development of a flourishing independent sector alongside good quality public services was a key objective of the community care reforms of the last decade. This paper charts some of the ways the independent domiciliary care sector is changing, as local authorities shift the balance of their provision toward independent sector providers and away from a reliance on in-house services. Two surveys of independent domiciliary care providers were carried out in 1995 and 1999. The aims of the studies were to describe the main features of provider organisations, such as size of business, client group and funding sources; to examine the nature of provider motivations and their past and future plans; to consider how local authorities manage the supply side of social care markets; and to examine the effects on providers of the development of the mixed economy. The first survey in 1995 was conducted in eight local authority areas, which by 1999 had increased to 11 because of the creation of three new unitary authorities. The findings are based on 261 postal surveys together with 111 interviews between the two studies. The research illustrates a domiciliary care market that is still relatively young with many small but growing businesses. There are considerable differences in the split between in-house and independent sector services in individual authorities and a common perception among independent providers that in-house services receive favourable treatment and conditions. Spot or call-off contracts continue to be the most common form of contract although there are moves toward greater levels of guaranteed service and more sophisticated patterns of contracting arrangements. There remains an ongoing need to share information between local authorities and independent providers so that good working relationships can develop with proven and competent providers. [source]


    Monitoring political decision-making and its impact in Austria

    HEALTH ECONOMICS, Issue S1 2005
    Adolf Stepan
    Abstract The range of services provided by the Austrian health care system has been greatly extended over the last few decades. The accompanying measures for long-term care bring the situation closer to the ideal concept of a ,seamless web' between primary, secondary and tertiary care. Due to the expansion in services it has become increasingly difficult to ensure the balance between the financing and degree of usage of the services. The reiterated political aim has been to achieve balanced financing via legally fixed social health insurance (SHI) contributions and taxation. A steadily expanding part is contributed by the private sector. In the 1980s, measures for SHI expenditure containment were implemented; in 1997 a new hospital financing system based on flat rates was introduced. In order to guarantee hospital financing, the historical financing shares of the SHI for the hospitals were introduced in the form of valorised global budgets. The contradictory incentives arising from the flat rates and global budgets lead hospitals to shift services to the primary and tertiary care sector, causing additional expenditure for SHI. Currently, attempts are being made to secure the financing by increasing the SHI contribution rates and patients' co-payments. Copyright 2005 John Wiley & Sons, Ltd. [source]


    Wage policy in the health care sector: a panel data analysis of nurses' labour supply

    HEALTH ECONOMICS, Issue 9 2003
    Jan Erik Askildsen
    Abstract Shortage of nurses is a problem in several countries. It is an unsettled question whether increasing wages constitute a viable policy for extracting more labour supply from nurses. In this paper we use a unique matched panel data set of Norwegian nurses covering the period 1993,1998 to estimate wage elasticities. The data set includes detailed information on 19 638 individuals over 6 years totalling 69 122 observations. The estimated wage elasticity after controlling for individual heterogeneity, sample selection and instrumenting for possible endogeneity is 0.21. Individual and institutional features are statistically significant and important for working hours. Contractual arrangements as represented by shift work are also important for hours of work, and omitting information about this common phenomenon will underestimate the wage effect. Copyright 2003 John Wiley & Sons, Ltd. [source]


    Effectiveness of general practice nurse interventions in cardiac risk factor reduction among adults

    INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2007
    Elizabeth Halcomb RN BN(Hons) Grad Cert.
    Abstract Background, Cardiovascular disease is the leading cause of death for adults in Australia. In recent years there has been a shift in health service delivery from institutional to community-based care for chronic conditions, including cardiovascular disease. The general practice setting is seen to offer greater flexibility, higher levels of efficiency and more client focused healthcare delivery than is possible in the acute care sector. It has been suggested that practice nurses represent a useful adjunct to current models of cardiovascular disease management. To date, significant descriptive research has been conducted exploring the demographics, roles, educational needs and issues facing practice nurses. However, there is a need to evaluate the effectiveness of practice nurse interventions in terms of patient outcomes, clinician satisfaction and cost-effectiveness. Objectives, This review seeks to present the best available evidence regarding the efficacy of general practice nurse interventions for cardiac risk factor reduction in healthy adults, as well as those with established cardiovascular disease or known cardiac risk factors. Search Strategy, A systematic literature search was performed using Medline (1966 , 2005), CINAHL (1982 ,2005), Cochrane Controlled Trials Register (Issue 4, 2005) and the Joanna Briggs Institute Evidence Library. In addition, the reference lists of retrieved papers, conference proceedings and the Internet, were scrutinised for additional trials. Selection Criteria, This review considered any English language randomised trials that investigated interventions conducted by the practice nurse for cardiovascular disease management or reduction of cardiac risk factors. Interventions conducted by specialist cardiac nurses in general practice were excluded. Outcomes measured included blood pressure, smoking cessation, total cholesterol, exercise, body weight/body mass index and cost-effectiveness. Results, Eighteen trials, reported in 33 papers, were included in the review. Ten trials investigated multifaceted interventions, while the remaining eight trials reported targeted interventions. Of the trials that reported multifaceted interventions, three trials investigated risk reduction in those with established cardiovascular disease, four trials focused on those with known cardiovascular disease risk factors and three trials included the general community. The eight trials which examined the efficacy of targeted interventions focused upon dietary intake (two trials), smoking cessation (three trials), weight reduction (one trial) and physical activity (two trials). The effect of both the multifaceted and targeted interventions on patient outcomes was variable. However, both the multifaceted and targeted interventions demonstrated similar outcome trends for specific variables. Improvements were demonstrated by most studies in blood pressure, cholesterol level, dietary intake and physical activity. The variation in outcome measures and contradictory findings between some studies makes it difficult to draw definitive conclusions. Conclusions, While interventions to reduce cardiovascular disease risk factors have produced variable results, they offer significant potential to assist patients in modifying their personal risk profile and should be developed. The public health importance of these changes is dependant upon the sustainability of the change and its effect on the health outcomes of these individuals. Further well-designed research is required to establish the effectiveness of practice nurse interventions for cardiovascular disease management and risk factor reduction in terms of patient outcomes and cost-effectiveness. [source]


    Factors associated with constructive staff,family relationships in the care of older adults in the institutional setting

    INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2006
    Emily Haesler BN PGradDipAdvNsg
    Abstract Background, Modern healthcare philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's well-being. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family involvement in the healthcare of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the healthcare environment to benefit from the involvement of their family members, healthcare professionals need an understanding of the issues surrounding family presence in the healthcare environment and the strategies to best support it. Objectives, The objectives of the systematic review were to present the best available evidence on the strategies, practices and organisational characteristics that promote constructive staff,family relationships in the care of older adults in the healthcare setting. Specifically this review sought to investigate how staff and family members perceive their relationships with each other; staff characteristics that promote constructive relationships with the family; and interventions that support staff,family relationships. Search strategy, A literature search was performed using the following databases for the years 1990,2005: Ageline, APAIS Health, Australian Family and Society Abstracts (FAMILY), CINAHL, Cochrane Library, Dare, Dissertation Abstracts, Embase, MEDLINE, PsycINFO and Social Science Index. Personal communication from expert panel members was also used to identify studies for inclusion. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language. Selection criteria, The review was limited to studies involving residents and patients within acute, subacute, rehabilitation and residential settings, aged over 65 years, their family and healthcare staff. Papers addressing family members and healthcare staff perceptions of their relationships with each other were considered for this review. Studies in this review also included those relating to interventions to promote constructive staff,family relationships including organisational strategies, staff,family meetings, case conferencing, environmental approaches, etc. The review considered both quantitative and qualitative research and opinion papers for inclusion. Data collection and analysis, All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Appraisal forms and data extraction forms designed by the Joanna Briggs Institute as part of the QARI and NOTARI systematic review software packages were used for this review. Findings, Family members' perceptions of their relationships with staff showed that a strong focus was placed on opportunities for the family to be involved in the patient's care. Staff members also expressed a theoretical support for the collaborative process, however, this belief often did not translate to the staff members' clinical practice. In the studies included in the review staff were frequently found to rely on traditional medical models of care in their clinical practice and maintaining control over the environment, rather than fully collaborating with families. Four factors were found to be essential to interventions designed to support a collaborative partnership between family members and healthcare staff: communication, information, education and administrative support. Based on the evidence analysed in this systematic review, staff and family education on relationship development, power and control issues, communication skills and negotiating techniques is essential to promoting constructive staff,family relationships. Managerial support, such as addressing workloads and staffing issues; introducing care models focused on collaboration with families; and providing practical support for staff education, is essential to gaining sustained benefits from interventions designed to promote constructive family,staff relationships. [source]


    Treating late-life depression with interpersonal psychotherapy in the primary care sector

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2007
    Herbert C. Schulberg
    Abstract Background Interpersonal psychotherapy (IPT) is an empirically-validated intervention for treating late-life depression. Objective To determine the manner in which IPT is utilized by primary care physicians in relation to antidepressant medications. Methods The authors reviewed treatment logs prepared by care managers during the first 12 months of a patient's participation in the PROSPECT clinical trial to determine initial and longitudinal treatment patterns utilized by physicians, and clinical outcomes associated with initial treatment assignment. Results Primary care physicians in practices randomized to PROSPECT's intervention arm initially prescribed an antidepressant medication for 58% of eligible patients and referred only 11% of them to IPT. Over time, however, 27% of patients participated in IPT as monotherapy or augmentation therapy. Initial treatment assignment was not associated with depressive status at 4 and 12 months nor with suicidal ideation at 4, 8, and 12 months. Conclusion IPT is an effective treatment for late-life depression whose greater use by primary care physicians should be encouraged. Copyright 2006 John Wiley & Sons, Ltd. [source]


    The dynamics of the health labour market

    INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2006
    Marko Vujicic
    Abstract One of the most important components of health care systems is human resources for health (HRH),the people that deliver the services. One key challenge facing policy makers is to ensure that health care systems have sufficient HRH capacity to deliver services that improve or maintain population health. In a predominantly public system, this involves policy makers assessing the health care needs of the population, deriving the HRH requirements to meet those needs, and putting policies in place that move the current HRH employment level, skill mix, geographic distribution and productivity towards the desired level. This last step relies on understanding the labour market dynamics of the health care sector, specifically the determinants of labour demand and labour supply. We argue that traditional HRH policy in developing countries has focussed on determining the HRH requirements to address population needs and has largely ignored the labour market dynamics aspect. This is one of the reasons that HRH policies often do not achieve their objectives. We argue for the need to incorporate more explicitly the behaviour of those who supply labour,doctors, nurses and other providers,those who demand labour, and how these actors respond to incentives when formulating health workforce policy. Copyright 2006 John Wiley & Sons, Ltd. [source]


    A stratified first order logic approach for access control

    INTERNATIONAL JOURNAL OF INTELLIGENT SYSTEMS, Issue 9 2004
    Salem Benferhat
    Modeling information security policies is an important problem in many domains. This is particularly true in the health care sector, where information systems often manage sensitive and critical data. This article proposes to use nonmonotonic reasoning systems to control access to sensitive data in accordance with a security policy. In the first part of the article, we propose an access control model that overcomes several limitations of existing systems. In particular, it allows us to deal with contexts and to represent the two main kinds of privileges: permissions and prohibitions. This model will then be formally encoded using stratified (or prioritized) first-order knowledge bases. In the second part of the article, we discuss the problem of conflicts due to the joint handling of permissions and prohibitions. We show that approaches proposed for solving conflicts in propositional knowledge bases are not appropriate for handling inconsistent first-order knowledge bases. 2004 Wiley Periodicals, Inc. Int J Int Syst 19: 817,836, 2004. [source]


    Strategic giving and the nursing shortage,

    INTERNATIONAL JOURNAL OF NONPROFIT & VOLUNTARY SECTOR MARKETING, Issue 1 2006
    Steven G. Ullmann
    Health care organizations in the United States face a significant nursing shortage, which seriously impacts the quality and availability of health care. Confronting this challenge requires involvement from organizations beyond the public sector. This paper explores an initiative by Blue Cross and Blue Shield of Florida, exemplifying the concept of ,strategic philanthropy,' to contribute their financial resources and strong institutional ties to respond to the current and future shortage of nurses in Florida. Through this intervention, the company and partnering organizations hope to benefit the health care sector, the public, and themselves from the outcomes associated with the generation of a greater supply of nurses. Copyright 2006 John Wiley & Sons, Ltd. [source]


    Current situation of German care homes

    INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 4 2008
    Barbara Klein Dipl-Soz, Dr. Phil
    Aim., The aim of this paper is to explore the situation of and current developments in the German care home sector. Background., Germany, like other Western countries, faces demographic change and subsequently tries to develop structures and processes to achieve a care system which can tackle the increasing number of people in need of care with a variety of quality services. Policy strives to set up structures and instruments to enhance the quality of service provision. Discussion., Figures show that the structures in the care sector are changing in favour to increased privatization of homes, a slight increase in size and improved building structures. In order to tackle the expected changes, a mix of low and high skilled qualification and new job profiles arise in the care sector. Other changes to be observed are the development of new living arrangements and the utilization of new technologies to support the care process. Conclusion., This contribution looks at the socio-demographic changes in care, the statutory developments and the structures of care homes as well as current discussions on future developments. [source]


    Is there an association between referral population deprivation and antibiotic prescribing in primary and secondary care?

    INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2008
    Christopher Curtis head of pharmaceutical services
    Objective The study was designed to explore the presence of any relationship between NHS secondary care antibiotic prescribing rates or primary care antibiotic prescribing rates and the levels of deprivation experienced within the referred primary care population. The study also aimed to determine whether the antibiotic prescribing rates for each care sector were correlated. Method The study was conducted in 12 English hospital trusts of mixed size and case-mix. Antibiotic usage data (Anatomical Therapeutic Chemical (ATC) category J01) for the financial year, ending March 2001/2002 were used to calculate hospital trust prescribing rates (using the defined daily dose/finished consultant episode indicator). Primary care antibiotic prescribing data were obtained from the Prescription Pricing Authority (antibiotic items prescribed per 1000 residents) for the year 2001/2002. Index of Multiple Deprivation (IMD) 2000 deprivation data were obtained from the regional public health observatory websites for each of the primary care trusts within the relevant study areas. Key findings No correlation could be established between the weighted index of multiple deprivation of the treated population and antibiotic prescribing rates at each hospital trust. Primary care antibiotic prescribing rates were not found to correlate with antibiotic prescribing rates in the geographically associated hospital trust. Data from all 12 sites showed that the IMD 2000 measures and primary care prescribing rates were weakly correlated, with higher antibiotic prescribing rates being generally observed in areas of primary care exhibiting the worst levels of deprivation Conclusions The likely explanations for the present findings are that deprivation-related illnesses are principally treated within primary care, whereas hospital antibiotic prescribing principally results from procedures isolated within secondary care or through the additional influence of nosocomial infection. Therefore, medicines management measures geared to controlling antibiotic prescribing in secondary care should not focus upon the levels of deprivation in the referred population, whereas those in primary care should. [source]


    Downsizing and reorganization: demands, challenges and ambiguity for registered nurses

    JOURNAL OF ADVANCED NURSING, Issue 2 2004
    Anna Hertting MD
    Background., The 1990s were characterized by substantial financial cuts, and related staff redundancies and reorganizations in the Swedish health care sector. A large hospital in Sweden was selected for the study, in which downsizing had occurred between 1995 and 1997. The number of staff in the hospital was reduced by an average of 20%, and 10% were relocated to other departments. Objective., The aims of this study were to explore registered nurses' experiences of psychosocial ,stressors' and ,motivators', and how they handled their work situations, following a period of personnel reductions and ongoing reorganization. Method., Interviews were undertaken with 14 nurses working in one Swedish hospital. Nurses were interviewed in 1997 about the recent and last round of redundancies, and were followed up 1 year later in 1998 and again in 2001. Interviews were audiotaped, transcribed and analysed for thematic content. Results., Five themes emerged in relation to nurses' perceived stressors, motivators, and coping options: ,distrust towards the employer', ,concurrent demands and challenges', ,professional ambiguity, ,a wish for collaboration', and ,efforts to gain control'. A common feature was duality and ambiguity in nurses' descriptions of the phenomena studied, meaning that identified themes had underlying sub-themes with both negative and positive dimensions. Conclusions., The concurrence of ,ever-growing job demands' and ,work going unrewarded' contributed to a feeling of being taken advantage of by the employer. The ,waste of human resources' and ,competence drain' that followed redundancies provoked anger. Unfulfilled collaboration with doctors was a major stress producer, which related to both the downsized work organization, and the complex ,deference-dominance' doctor,nurse relationship. The well-being of nurses depends on being an equal/parallel health professional in a comprehensive team that shares knowledge and improves collaborative care of patients. A consciously formulated nursing philosophy emerged as a health-promoting resource. This study demonstrates the importance of analysing feelings relating to professional ambiguity and gaining influence in a gender-related, hierarchical environment, and the need to support professional assertiveness in relation to superiors and doctors. It is also important to stress considerations that relate to differences in the age, care philosophy, and psychosocial health conditions of nurses. [source]


    Crossing boundaries, re-defining care: the role of the critical care outreach team

    JOURNAL OF CLINICAL NURSING, Issue 3 2002
    MAUREEN COOMBS BSc MSc PhD RN
    ,,There is clear indication that both government and professional policy in the United Kingdom supports a radical change in the role of healthcare practitioners, with a move towards a patient-focused service delivered by clinical teams working effectively together. ,,Recent health service imperatives driving the agenda for flexible clinical teams have occurred simultaneously with an increased public and political awareness of deficits in availability of critical care services. ,,Against this policy backdrop, working across professional and organizational boundaries is fundamental to supporting quality service improvements. In the acute care sector, the development of critical care outreach teams is an innovation that seeks to challenge the traditional support available for sick ward patients. ,,Activity data and observations from the first 6-month evaluation of two critical care outreach teams identify the need for clinical support and education offered by critical care practitioners to ward-based teams. ,,The experiences from such flexible clinical teams provides a foundation from which to explore key issues for intradisciplinary and interdisciplinary working across clinical areas and organizational boundaries. ,,Adopting innovative approaches to care delivery, such as critical care outreach teams, can enable clinical teams and NHS trusts to work together to improve the quality of care for acutely ill patients, support clinical practitioners working with this client group, and develop proactive service planning. [source]


    Models of Quality-Adjusted Life Years when Health Varies Over Time: Survey and Analysis

    JOURNAL OF ECONOMIC SURVEYS, Issue 2 2006
    Kristian Schultz Hansen
    Abstract., Quality-adjusted life year (QALY) models are widely used for economic evaluation in the health care sector. In the first part of the paper, we establish an overview of QALY models where health varies over time and provide a theoretical analysis of model identification and parameter estimation from time trade-off (TTO) and standard gamble (SG) scores. We investigate deterministic and probabilistic models and consider five different families of discounting functions in all. The second part of the paper discusses four issues recurrently debated in the literature. This discussion includes questioning the SG method as the gold standard for estimation of the health state index, re-examining the role of the constant-proportional trade-off condition, revisiting the problem of double discounting of QALYs, and suggesting that it is not a matter of choosing between TTO and SG procedures as the combination of these two can be used to disentangle risk aversion from discounting. We find that caution must be taken when drawing conclusions from models with chronic health states to situations where health varies over time. One notable difference is that in the former case, risk aversion may be indistinguishable from discounting. [source]


    Collaborative partnerships for nursing faculties and health service providers: what can nursing learn from business literature?

    JOURNAL OF NURSING MANAGEMENT, Issue 3 2006
    DIANE BROWN PhD
    Collaborative partnerships between nursing faculties and health service providers are the cornerstone of successful clinical experience for nursing students. The challenge of providing an optimal learning environment can be enormous given the turbulent and rapidly changing environment in health. The present study uses the business literature to examine what nursing can learn from business about the development of successful collaborative partnerships. The characteristics of sound partnerships are described and a set of best practice guidelines is developed. The guidelines summarize the factors considered to be essential for the effective development of collaborative partnerships. In these times of nursing shortages and high turnover high quality, collaborative partnerships between nursing faculties and the health care sector are seen as a possible solution to optimize clinical learning and therefore graduate preparedness. [source]


    Changing GPs' prescription patterns through guidelines and feedback.

    PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 6 2007
    Intervention study
    Abstract Purpose To investigate whether and how a multi-dimensional intervention including clinical guidelines on the choice of medical treatment in the primary and the secondary health care sector, and individual feedback to general practices about their own and other practices' prescription patterns in five Anatomical Therapeutic Chemical classification system (ATC)-groups was followed by changes in the practices' prescription pattern. Methods Prospective historical registry study and a questionnaire study of GPs' self-reported use of guidelines and feedback. Results In every ATC-group the number of prescribed defined daily doses (DDDs) kept growing after the intervention, while potential savings by DDD decreased. Individual practices' changes in the prescription pattern differed by ATC-group and practices with high potential savings/DDD before the intervention showed the greatest relative reduction in potential savings/DDD. The county's average cost/DDD for the five ATC-groups declined from above the Danish average before the intervention to a level below the average cost/DDD after the intervention. In the questionnaire study (response rate: 79%), 69% of respondents had read the guidelines and 78% reported that the feedback influenced their prescription of drugs. Conclusions The observed changes in drug costs and potential savings were not due to volume effects but a combination of price effects, including generic substitution and choice of less expensive analogues, demonstrating that it is possible to change GPs' prescription patterns without interfering with patients' access to treatment or with GPs' clinical freedom.' Copyright 2007 John Wiley & Sons, Ltd. [source]


    Jump-Starting Collaboration: The ABCD Initiative and the Provision of Child Development Services through Medicaid and Collaborators

    PUBLIC ADMINISTRATION REVIEW, Issue 3 2008
    Carolyn Berry
    Many policy problems require governmental leaders to forge vast networks beyond their own hierarchical institutions. This essay explores the challenges of implementation in a networked institutional setting and incentives to induce coordination between agencies and promote quality implementation. It describes the national evaluation of the Assuring Better Child Health and Development program, a state-based program intended to increase and enhance the delivery of child development services for low-income children through the health care sector, using Medicaid as its primary vehicle. Using qualitative evaluation methods, the authors found that all states implemented programs that addressed their stated goals and made changes in Medicaid policies, regulations, or reimbursement mechanisms. The program catalyzed interagency cooperation and coordination. The authors conclude that even a modest level of external support and technical assistance can stimulate significant programmatic change and interorganizational linkages within public agencies to enhance provision of child development services. [source]


    Managers' Active Support when Implementing Teams: The Impact on Employee Well-Being

    APPLIED PSYCHOLOGY: HEALTH AND WELL-BEING, Issue 3 2009
    Karina Nielsen
    Research has shown that a variety of organisational change interventions can be effective but the powerful positive results of an intervention do not always generalise to other similar settings. Problems with implementation and a difficult intervention context have been shown to undermine the effectiveness of promising interventions. The impact that middle managers have on the change process and intervention outcomes has not been widely researched. This longitudinal intervention study was carried out in the elderly care sector in a large Danish local government organisation (N = 188), where poor social support, and lack of role clarity and meaningful work had been identified as significant problems. To tackle these problems, teamwork was implemented, with teams having some degree of self-management. It examined whether middle managers' active support for the intervention mediated its impact on working conditions, well-being and job satisfaction. Structural equation modelling showed that middle managers' active involvement in implementing the change partially mediated the relationship between working conditions at time 1 and time 2. Working conditions at time 2 were in turn related to time 2 job satisfaction and well-being. These results suggest that the degree to which employees perceive their middle managers to play an active role in implementing change is related to intervention outcomes. [source]


    Leadership and management in the aged care sector: A narrative synthesis

    AUSTRALASIAN JOURNAL ON AGEING, Issue 2 2010
    Yun-Hee Jeon
    The aim of this study is to examine the issues and the progress being made in leadership and management with relevance for the residential aged care workforce. A systematic review was conducted using scientific journal databases, hand searching of specialist journals, Google, snowballing and suggestions from experts. After a seven-tiered culling process, we conducted a detailed review of 153 papers relevant to leadership and management development in aged care. Strong, effective leadership and management promotes staff job satisfaction and retention, high care quality and the well-being of care recipients, and reduces associated costs. Good leadership and effective management also play a key role in bringing about a successful change to a positive workplace culture through innovative programs and research projects. Organisational investment in improving leadership and management skills and capabilities can only improve outcomes for staff stability and productivity, care quality and budgets, and better prepare the aged care sector. [source]


    Developing recommendations for implementing the Australian Pain Society's pain management strategies in residential aged care

    AUSTRALASIAN JOURNAL ON AGEING, Issue 1 2008
    Ruth McConigley
    Objective:,This study aimed to develop recommendations and a related implementation resource ,toolkit' to facilitate implementation of pain management strategies in Australian Residential Aged Care Facilities (RACFs). Methods:,This qualitative study used written materials, focus groups and individual interviews to gather data from participants. Thirty-four health-care professionals with experience in the aged care sector were recruited from five Western Australian RACFs. General practitioners who had an interest in aged care were contacted via local general practice networks. Results:,Findings indicated that focused education sessions were needed to support implementation. A tailored toolkit was developed to assist the process. Funding and workforce constraints were found to be threats to complete implementation in some facilities. Conclusions:,A multifaceted approach is needed to promote the implementation of pain management strategies in RACFs. In particular, unlicensed care workers, who may have responsibility for recognising and reporting signs of pain, require further education to support their role in the pain management process. [source]


    Relationships between the health care sector and the media

    AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2006
    Daryl Pedler
    No abstract is available for this article. [source]


    Predictors of Chain Acquisition among Independent Dialysis Facilities

    HEALTH SERVICES RESEARCH, Issue 2 2010
    Alyssa S. Pozniak
    Objective. To determine the predictors of chain acquisition among independent dialysis providers. Data Sources. Retrospective facility-level data combined from CMS Cost Reports, Medical Evidence Forms, Annual Facility Surveys, and claims for 1996,2003. Study Design. Independent dialysis facilities' probability of acquisition by a dialysis chain (overall and by chain size) was estimated using a discrete time hazard rate model, controlling for financial and clinical performance, practice patterns, market factors, and other facility characteristics. Data Collection. The sample includes all U.S. freestanding dialysis facilities that report not being chain affiliated for at least 1 year between 1997 and 2003. Principal Findings. Above-average costs and better quality outcomes are significant determinants of dialysis chain acquisition. Facilities in larger markets were more likely to be acquired by a chain. Furthermore, small dialysis chains have different acquisition strategies than large chains. Conclusions. Dialysis chains appear to employ a mix of turn-around and cream-skimming strategies. Poor financial health is a predictor of chain acquisition as in other health care sectors, but the increased likelihood of chain acquisition among higher quality facilities is unique to the dialysis industry. Significant differences among predictors of acquisition by small and large chains reinforce the importance of using a richer classification for chain status. [source]


    The operation and management of agency workers in conditions of vulnerability

    INDUSTRIAL RELATIONS JOURNAL, Issue 5 2010
    Sonia McKay
    ABSTRACT This article focuses on the operation and management of agency labour by employers and observes that there are strong contradictions between the employers' stated reasons for using agency labour and the employment agencies' perceptions of why such labour is utilised. While discussing agency labour generally, the article also takes account of the position of migrant workers within the agency sector, since agencies have represented a significant route into employment for migrant labour. It draws primarily on 22 in-depth interviews with employers and employment agencies mainly in the food processing, cleaning and care sectors. The research revealed that while some employers were using agency staff to cover for specific peaks in production, others had used it as an alternative method of dealing with vacancies that otherwise might have resulted in permanent employment. [source]


    The implementation of intravenous tissue plasminogen activator in acute ischaemic stroke , a scientific position statement from the National Stroke Foundation and the Stroke Society of Australasia

    INTERNAL MEDICINE JOURNAL, Issue 5 2009
    Ad Hoc Committee representing the National Stroke Foundation, the Stroke Society of Australasia
    Abstract Intravenous tissue plasminogen activator (tPA) has been licensed in Australia for thrombolysis in selected patients with acute ischaemic stroke since 2003. The use of tPA is low but is increasing across Australia and national audits indicate efficacy and safety outcomes equivalent to international benchmarks. Implementing tPA therapy in clinical practice is, however, challenging and requires a coordinated multidisciplinary approach to acute stroke care across prehospital, emergency department and inpatient care sectors. Stroke care units are an essential ingredient underpinning safe implementation of stroke thrombolysis. Support systems such as care pathways, therapy delivery protocols, and thrombolysis-experienced multidisciplinary care teams are also important enablers. Where delivery of stroke thrombolysis is being planned, health systems need to be re-configured to provide these important elements. This consensus statement provides a review of the evidence for, and implementation of, tPA in acute ischaemic stroke with specific reference to the Australian health-care system. [source]


    Workplace violence: Differences in perceptions of nursing work between those exposed and those not exposed: A cross-sector analysis

    INTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 2 2010
    Desley Hegney RN PhD
    Hegney D, Tuckett A, Parker D, Eley RM. International Journal of Nursing Practice 2010; 16: 188,202 Workplace violence: Differences in perceptions of nursing work between those exposed and those not exposed: A cross-sector analysis Nurses are at high risk of incurring workplace violence during their working life. This paper reports the findings on a cross-sectional, descriptive, self-report, postal survey in 2007. A stratified random sample of 3000 of the 29 789 members of the Queensland Nurses Union employed in the public, private and aged care sectors resulted in 1192 responses (39.7%). This paper reports the differences: between those nurses who experienced workplace violence and those who did not; across employment sectors. The incidence of workplace violence is highest in public sector nursing. Patients/clients/residents were the major perpetrators of workplace violence and the existence of a workplace policy did not decrease levels of workplace violence. Nurses providing clinical care in the private and aged care sectors experienced more workplace violence than more senior nurses. Although workplace violence was associated with high work stress, teamwork and a supportive workplace mitigated workplace violence. The perception of workplace safety was inversely related to workplace violence. With the exception of public sector nursing, nurses reported an inverse relationship with workplace violence and morale. [source]


    Public and Private Provision of Health Care

    JOURNAL OF ECONOMICS & MANAGEMENT STRATEGY, Issue 1 2002
    Pedro Pita Barros
    One of the mechanisms that are implemented in the cost containment movement in the health care sectors in western countries is the definition, by the third-party payer, of a set of preferred providers. The insured patients have different access rules to such providers when ill. The rules specify the copayments patients must pay when using an out-of-plan care provider. This paper studies the competitive process among providers in terms of both prices and qualities. Competition is influenced by the status of providers as in-plan or out-of-plan care providers. Also, there is a moral hazard of provider choice related to the trade-off between freedom to choose and the need to hold down costs. It is possible to achieve the first-best allocation by an appropriate definition of the reimbursement scheme when decisions on prices and qualities are taken simultaneously (as in primary health care sectors). In contrast, some type of regulation is needed to achieve the optimal solution when decisions are sequential (as in specialized health care sectors). We also derive normative conclusions on how price controls should be implemented in some European Union member states. [source]


    Providing inbuilt economic resilience options,,

    CANCER, Issue S12 2008
    An obligation of comprehensive cancer care
    Abstract For many, a cancer death in the family is the immediately obvious part of what is actually a double devastation. Overwhelming financial damage also results for many families, from the cost of medical care and from the loss of earning power by the patient and family. For some families, the consequences may be multigenerational and can affect the health of the survivors. Although this situation is not limited to cancer, the authors argue that oncology can take a lead in attending to these consequences of cancer as an integral part of its commitment to comprehensive cancer care. They make this case for both the national and the international settings. They also articulate and illustrate the notion of inbuilt options for economic resilience (IERs), which the authors suggest the medical industry, and its cancer care sectors in particular, should be providing to all patients and their families if they are at risk for damaging financial losses. After describing key features to IER, the authors illustrate it with 1 type of approach for households of the terminally ill: hospice care with provision of supplementary training and certification to the family caregiver. Such programming could generate a low-technology, semiskilled healthcare service economy as trained family caregivers provide support to other households in need, thereby both providing a recovery option for themselves and reduced economic devastation to the households which, by receiving the services, can stay in the workforce. Finally, the authors call for invigorated research on the economic impact of cancer on families and for the modeling, demonstration, and study of options for economic resilience, including IER programs. Cancer 2008;113(12 suppl):3548,55. 2008 American Cancer Society. [source]