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‣ Bioética e crença religiosa: estudo da relação médico-paciente Testemunha de Jeová com potencial risco de transfusão de sangue; Bioethics and religious belief: a study on the physician-Jehovah's Witness patient at potential risk of blood transfusion

Chehaibar, Graziela Zlotnik
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 13/07/2010 Português
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As Testemunhas de Jeová têm preceitos religiosos que sustentam a recusa da transfusão de sangue e, frequentemente, vivenciam situações nas quais essa recusa pode ser sustentada por aspectos científicos, legais e bioéticos. Este estudo teve como objetivo analisar a relação médico-paciente Testemunha de Jeová, sob a potencial recomendação de transfusão de sangue durante a internação hospitalar. Além disso, também buscou investigar o momento e a forma da identificação do paciente Testemunha de Jeová; analisar a conduta dos médicos frente a um eventual impasse na relação com os pacientes e analisar as escolhas dos pacientes na relação com os médicos; verificar as condutas realizadas após o processo de tomada de decisão entre médico e seu paciente; e verificar se os médicos conhecem o parecer n.º 007/2004 - "Orientação sobre Recusa de Transfusão de Sangue da Testemunha de Jeová", da Comissão de Bioética (CoBi) do Hospital das Clínicas da FMUSP. A pesquisa foi realizada no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) no período de fevereiro de 2007 a maio de 2009. Foram selecionados 46 pacientes e 48 médicos, buscando-se entrevistar o paciente e seu respectivo médico. Trata-se de um estudo de caso exploratório...

‣ The physician-patient relationship in dialysis

Pinheiro, Joaquim; Maia, Manuela; Alves, Hélder
Fonte: Universidade Católica Portuguesa Publicador: Universidade Católica Portuguesa
Tipo: Artigo de Revista Científica
Publicado em //2013 Português
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Despite many technical and scientific advances in haemodialysis, the outcomes in patients with end stage renal disease are far from reaching the desired targets. How can they be improved? The doctor-patient relationship is a key issue in the healthcare provided to patients with end stage chronic kidney disease on dialysis. Patients and Methods: We, therefore, built a patient-centred biopsychosocial personalized approach to enhance patient autonomy and self-care as an alternative to the conventional medical approach to dialysis patients. We compared patient satisfaction achieved in both approaches using a patient satisfaction questionnaire, and we assessed the correlation between satisfaction and social, clinical and biological outcomes. Results and Conclusion: The alternative physician-patient relationship approach achieved better outcomes than the conventional one, and so it must be the choice approach for these patients.

‣ Community paediatrics in Ontario: 1996 paediatric physician resource study

Issenman, Robert M
Fonte: Pulsus Group Inc Publicador: Pulsus Group Inc
Tipo: Artigo de Revista Científica
Publicado em //1998 Português
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Physician resource planning is a basic underpinning of the management of the health care system. Accurate data on physician numbers and distribution are essential to the process of planning. This paper presents the results of a study commissioned by the Paediatric Executive of the Ontario Medical Association to provide an updated profile of the number and distribution of paediatricians in Ontario in 1995/96.

‣ Training in Male Sexual and Reproductive Health for a Primary Care Physician

Shaiful, BI
Fonte: Academy of Family Physician of Malaysia Publicador: Academy of Family Physician of Malaysia
Tipo: Artigo de Revista Científica
Publicado em 30/04/2008 Português
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In 2006, I was awarded a scholarship from Universiti Sains Malaysia for Fellowship training at Monash University (MU) for one year. The objective of the training programme was to develop knowledge and skills in several areas, including androgen deficiency, male infertility, prostate disease, testicular tumours, sexual dysfunction and sexually transmitted diseases. The training programme consisted of attachments with clinical specialists, completion of a course work module and a research project. After completion of the training programme, I believe that Primary Care Physicians (PCPs) will benefit from undertaking the training programme that I had completed. It will enable PCPs to assume leadership roles in this multidisciplinary area. The ability of PCPs in handling sexual and reproductive health issues in men will definitely be a more cost effective form of care for patients, particularly as the number of specialists is limited, and even more importantly, it will be satisfying for the patient and the physician.

‣ Physician Burnout: Coaching a Way Out

Gazelle, Gail; Liebschutz, Jane M.; Riess, Helen
Fonte: Springer US Publicador: Springer US
Tipo: Artigo de Revista Científica
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ABSTRACT Twenty-five to sixty percent of physicians report burnout across all specialties. Changes in the healthcare environment have created marked and growing external pressures. In addition, physicians are predisposed to burnout due to internal traits such as compulsiveness, guilt, and self-denial, and a medical culture that emphasizes perfectionism, denial of personal vulnerability, and delayed gratification. Professional coaching, long utilized in the business world, provides a results-oriented and stigma-free method to address burnout, primarily by increasing one’s internal locus of control. Coaching enhances self-awareness, drawing on individual strengths, questioning self-defeating thoughts and beliefs, examining new perspectives, and aligning personal values with professional duties. Coaching utilizes established techniques to increase one’s sense of accomplishment, purpose, and engagement, all critical in ameliorating burnout. Coaching presumes that the client already possesses strengths and skills to handle life’s challenges, but is not accessing them maximally. Although an evidence base is not yet established, the theoretical basis of coaching’s efficacy derives from the fields of positive psychology, mindfulness...

‣ A Mechanistic Explanation for Physician Responses to Patient Requests

Wojtesta, Matthew Adam ; Phelps, Charles E. ; Veazie, Peter J.
Fonte: University of Rochester Publicador: University of Rochester
Tipo: Tese de Doutorado
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Thesis (Ph.D.)--University of Rochester. School of Medicine & Dentistry. Dept. of Community and Preventive Medicine, 2012.; Variation in physicians’ responses to patients’ requests impacts policy-relevant outcomes such as patient satisfaction, treatment compliance, prescribing rates, patient trust in the physician, rates of malpractice suit and patient health status. Models have been developed to understand this phenomenon, but most stop at the level of empirical association and fail to account for sizeable portions of response variation. Two factors strongly associated with response variation are physician communication styles and time pressures. Role theory and economics mechanistically explain the influence of communication style and time pressure on physician responses. Role theory implies that there are discrete distributions across measures of physician communication behavior, and that whichever distribution dominates within a given physician-patient interaction will shape the way physicians respond to patient requests. Economics implies that time pressure influences physician decisions as a cost that increases with elapsed time within a physician-patient interaction, and that physicians handle this increasing cost by appropriately shaping their dialogue...

‣ Encontro clínico no modelo biopsicossocial: autopercepção dos acadêmicos de medicina da Pontifícia Universidade Católica de Goiás; Pacient-physician encounter in biopsychosocial model: selfconcept of medicine students on Pontifical Catholic University of Goiás

CARVALHO, Gélcio Sisteroli de
Fonte: Universidade Federal de Goiás; BR; UFG; Doutorado em Ciencias da Saude; Ciencias da Saude Publicador: Universidade Federal de Goiás; BR; UFG; Doutorado em Ciencias da Saude; Ciencias da Saude
Tipo: Tese de Doutorado Formato: application/pdf
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Introduction: The Pontifical Catholic University of Goiás pedagogical project for its medical course has stemmed from a thirty year long dream. It came into existence in 2005 following the authorization granted by the National Council of Education after the homologation of the National Curricular Guidelines. The present study shows the need to further investigate the development of assessment processes which are used to identify, follow and materialize changes in medical training. The theory used lies on the possibility of quantifying the medical performance in the patient-physician encounter. Objective: to evaluate some components of the patient-physician encounter based on biopsychosocial model; to create an assessment tool to measure the self-perception of this encounter; to test the effectiveness of this tool in this scenario; and to quantify the category variables of the research in a Pontifical Catholic University of Goiás medical course. Materials and Methods: This was a quantitative, longitudinal and cohort study. The study group presented 39 medical students from 5th Class of the Pontifical Catholic University of Goiás Medical School Course and the investigation was divided into two stages with a year interval between the application of the required academic protocols preceded by a medical semiological conclusion. The dimensions under observation were the following: biomedical...

‣ Physician assistants: employing a new health provider in the South Australian health system

Ho, P.; Maddern, G.
Fonte: Australasian Med Publ Co Ltd Publicador: Australasian Med Publ Co Ltd
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
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New health roles and models are needed to address future workforce shortages in Australian health care. A pilot trial of introducing two United States-trained physician assistants (PAs) at Queen Elizabeth Hospital, from October 2008 to October 2009, demonstrated difficulties in introducing PAs into the South Australian health system. Unforeseen delays in planning and implementing the trial occurred. This led to a loss of personnel and a second round of recruitment. The PAs’ scope of practice was limited, and they could not demonstrate their work as they do in the US. Full use of their prescribing licence was not allowed until 3 months into the trial, and their authority to order radiology tests was limited. The issues faced at Queen Elizabeth Hospital could be avoided in future trials, ensuring a smoother trial period.; Phyllis B. Ho and Guy J. Maddern

‣ Physician suicide

Austin, A.; Van Den Heuvel, C.; Byard, R.
Fonte: Amer Soc Testing Materials Publicador: Amer Soc Testing Materials
Tipo: Artigo de Revista Científica
Publicado em //2013 Português
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Pathology files at Forensic Science South Australia were examined over a 14-year period, from January 1997 to March 2011 for cases of physician suicide. Nine cases were identified (ages, 30-69 years; median = 41 years; M:F = 3:1). Three cases (33.3%) had a history of prescription drug abuse, and eight cases (88.9%) died from lethal drug self-administration. Intravenous administration of drugs was the favored method in seven cases. In only one case was an alternative method used, involving jumping from a high building. A history of depression and/or suicidal ideation was noted in six cases (66.7%). The methods of self-destruction contrasted with the general population where hanging, carbon monoxide poisoning, and gunshot wounds are more common. Availability and knowledge of lethal effects have been shown to be important determinants in the choice of methods of suicide. Access to drugs should therefore be carefully monitored in physicians with histories of depression and/or substance abuse.; Amy E. Austin, Corinna van den Heuvel and Roger W. Byard

‣ The impact of pay on Navy physician retention in a health care reform environment

Lane, Michael N.; Melody, Brendan T.
Fonte: Monterey, California. Naval Postgraduate School Publicador: Monterey, California. Naval Postgraduate School
Tipo: Tese de Doutorado Formato: xvii, 184 p.;28 cm.
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Approved for public release; distribution is unlimited; Physicians are the most difficult health care professional group to retain on active duty beyond their first obligated tour. A major problem is the disparity between military and civilian physician income. In fiscal year 1997, the Department of the Navy spent approximately $135 million in specialty pay on the Navy's 4,000 active duty physicians. Health care reform has altered the demand for specialty and primary care physicians, accelerating the movement toward managed care. In this thesis, the authors quantify the role of the pay differential using a multivariate logistic model and conclude that the civilian- military pay differential has a significant influence on the probability that a physician remains in the Navy. Physician personnel and earnings data were gathered from the Defense Manpower Data Center, the American Association of Medical Colleges, and the Hay Group. Results indicate that recent shifts in demand have resulted in a greater sensitivity of retention to pay for primary care physicians. Specialty specific elasticities can be applied to analyze the expected impact of pay on retention of representative pay plans. Increases in pay to the civilian median level would substantially increase retention...

‣ Improving hospital productivity: an analysis of the contribution of administrative/clerical staff to physician productivity

Nixon, Cynthia A.
Fonte: Monterey, California. Naval Postgraduate School Publicador: Monterey, California. Naval Postgraduate School
Tipo: Tese de Doutorado Formato: 81 p.
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Approved for public release; distribution is unlimited.; During the mid 1980s, Navy medicine was under constant criticism by its users, and members of Congress. Between FY85 and FY88, the number of outpatient visits decline 21 percent within Navy Medical Treatment Facilities (MTFs), while CHAMPUS outpatient visits increased 78 percent. During this same period, fleet operational assignments tripled and other programs were implemented that reduced Navy's ability to provide patient care in the U.S. In addition, between fiscal years 1980 through 1988, physician retention rates within Navy declined to 43 percent, lower than the rates for Army and Air Force. According to the GAO, one of the chief complaints of all military physicians is inadequate levels of administrative/clerical support. Thus, it has become increasingly important that Navy manpower requirements be determined with increased accuracy to maximize MTF productivity. This study uses regression analysis to evaluate the functional relationship between administrative staff mix and physician productivity across similar hospitals, focusing on workcenters in the primary care areas, where the need is greatest. Data used in this study is from the Medical Expense and Performance Reporting System (MEPRS). Unfortunately...

‣ A descriptive analysis of the 1992 active-duty physician asset: with comparisons to the Kaiser-Permanente physician staff model data

Pellack, James J.
Fonte: Monterey, California. Naval Postgraduate School Publicador: Monterey, California. Naval Postgraduate School
Tipo: Tese de Doutorado Formato: 92 p.
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Approved for public release; distribution is unlimited; In a time of declining military budgets, DoD is reducing health care costs while insuring available, accessible, and quality health care. One area which impacts these factors is physician staffing levels. The problem for DoD is one of maintaining a cadre of active-duty physicians, which is generally based on wartime requirements, while providing peacetime medical care to over eight million beneficiaries. This thesis examines this problem by using data from the Defense Manpower Data Center and the Kaiser-Permanente HMO, northern CA region, in Oakland, CA (K-P). A baseline assessment of the 1992 active-duty physician asset is done by first analyzing each Service's number of active-duty physician specialists and then by comparing DoD active-duty physician staffing levels to the corresponding physician staffing levels of K-P. Additionally, beneficiary demographics are analyzed and compared between each Service, as well as, DoD and K-P. Similarities and differences in physician staffing levels between the Services and between DoD and K-P are discussed; http://archive.org/details/descriptiveanaly00pell; Lieutenant, United States Navy

‣ Implications for the military health care system in utilizing non-physician providers. Part II, the utilization and staffing implications.

Clark, Bobby Gene
Fonte: Escola de Pós-Graduação Naval Publicador: Escola de Pós-Graduação Naval
Tipo: Tese de Doutorado
Português
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Approved for public release; distribution unlimited; This thesis is a continuation of a subject initiated by Lieutenant Brian R. Colfack, Medical Service Corps, U.S. Navy, who approached the utilization of Non Physician Providers (NPP) from the perspective of cost implications (Ref. 1). Colfack also discussed the history of the NPP movem.ent and the present mix of providers in the military sector. That thesis and the present work were undertaken as a part of the Naval Postgraduate School research project entitled "Navy Health Care Systems Professional and Paraprofessional Personnel Mix Study" sponsored by the Office of the Assistant Secretary of the Navy for Manpower. The thesis begins with an examination of the civilian and military physician's assistant (PA) and nurse practitioner (NP) utilization patterns. Then, to the extent that information was available, staffing models for the non-physician health care provider from the civilian and military sector are discussed. Implications for military utilization of NPPs follow. Staffing implications are then discussed in light of the models examined. Finally, a summary and conclusions chapter attempt to generalize the findings of the literature and draw upon the findings presented by Colfack.; http://archive.org/details/implicationsform00clar; Lieutenant...

‣ Physician-Community Integration: A Case Study of Practitioner Experiences and Retention Challenges on British Columbia's Haida Gwaii/Queen Charlotte Islands

FRASER, CATHERINE
Fonte: Quens University Publicador: Quens University
Tipo: Tese de Doutorado Formato: 625850 bytes; application/pdf
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Social life, and particularly health care delivery, in a small isolated community is more complex and nuanced than has been reflected in much of the literature on physician retention, which has never extended the notion of the “workload” past the physician’s formal role in the health care setting. Despite having been acknowledged by provincial and national government policies, few of what Anderson and Rosenberg (1990) describe as “unidimensional solutions” have resolved the “multidimensional issues” of physician retention in northern Canada. This thesis employs a qualitative framework to investigate the practice and lifestyle experiences of general practitioners on the Queen Charlotte Islands (Haida Gwaii) to provide a local analysis of physician retention problems experienced by isolated communities. By including both physicians and community members as key informants, the project attempts to determine whether a difference exists between physicians’ perceptions of place and their roles and the voiced expectations of the communities they serve. The research uses a combination of in-depth interviews and questionnaires with physicians (n=6) and community members (n=12) to determine the various roles played by a physician in a small community. It queries whether the community in question expects physician to take up roles outside of the medical space...

‣ The Communicative Process in the Physician-Terminal Patient Relationship; El proceso comunicativo en la relación médico-paciente terminal; O processo comunicativo na relação médico-paciente terminal

Gajardo-Ugas, Alejandra; Universidad Santo Tomás; Lavados-Montes, Claudio; Universidad Católica Silva Henríquez
Fonte: Universidad de la Sabana Publicador: Universidad de la Sabana
Tipo: Artigo de Revista Científica
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Medical practice involves a specifi c type of interpersonal relationship in which health professionals must be able to use communicative methods and procedures effectively. These elements are essential to fulfi lling a professional role, achieving the goals of medical practice and recognizing the human being as a person. The communicative process is central in human behavior and development, contributing its complexity and specifi city and being a determining factor in all interpersonal relations. In personal development, each individual acquires experiences through his or her activities, in which the world is represented and given specifi c meaning. Through communication with other human beings, representations and meanings are modifi ed. Communication has a transforming and enriching impact on one’s personality and is of vital importance in the physician–patient relationship, as it can help to iron out differences and to facilitate subsequent communication, even in the case of terminally ill patients. This makes it a major therapeutic tool.; El quehacer médico es un tipo específico de relación interpersonal donde resulta imprescindible que el profesional de salud sea capaz de utilizar métodos y procedimientos efectivos de comunicación...

‣ The Intensive-care Physician in the Face of Patient Autonomy: An Approach Based on Several Clinical Cases; El médico intensivista ante la autonomía del paciente: una aproximación a partir de algunos casos clínicos…; O médico intensivista ante a autonomia do paciente: uma aproximação a partir de alguns casos clínicos

Juliarena, Alejandra; Hospital Universitario Austral Pilar; Cosenza, Sebastián; Pratresi, Pablo; Pineda, Rafael
Fonte: Universidad de la Sabana Publicador: Universidad de la Sabana
Tipo: Artigo de Revista Científica
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Three clinical cases are introduced and analyzed in this article to clarifying the scope and limits of the principle of patient autonomy and the physician's responsibility when it comes to making therapeutic decisions regarding patients who are involved in intensive therapy. The conclusion is that informed consent does not relieve the physician of the obligation to discern what is best in each case for each patient.   The medical team must respect the patient’s autonomy, provided the patient’s decision is not unethical.; En este artículo se presentan y analizan tres casos clínicos con el objetivo de clarificar los alcances y límites del principio de autonomía del paciente y la responsabilidad del médico a la hora de tomar decisiones terapéuticas en los pacientes internados en terapia intensiva. Se concluye que el consentimiento informado no le ahorra al médico la obligación de discernir qué es lo mejor en cada caso para cada paciente. El equipo médico debe respetar la autonomía del paciente siempre que la decisión de este no sea contraria a la ética.; Neste artigo, apresentam-se e se analisam três casos clínicos com o objetivo de esclarecer os alcances e limites do princípio de autonomia do paciente e da responsabilidade do médico na hora de tomar decisões terapêuticas nos pacientes internados em terapia intensiva. Conclui-se que o consentimento informado não exime o médico da obrigação de discernir o que é o melhor em cada caso para cada paciente. A equipe médica deve respeitar a autonomia do paciente sempre que a decisão deste não for contrária à ética.

‣ PHYSICIAN PRESCRIBING PRACTICES AND ADVERSE DRUG REACTIONS: A Proposal for Further FDA Regulation of Prescription Drugs

Corrigan, Kerry A.
Fonte: Harvard University Publicador: Harvard University
Tipo: Paper (for course/seminar/workshop)
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In 1938 the Food and Drug Administration (FDA) adopted regulations which created a category of prescription drugs to be distributed only by order of a physician or other licensed medical personnel. This categorization, along with the extensive regulation of the approval, labelling and marketing of human drugs, has substantially reduced the risks which accompanied self-medication. However, the current regulatory regime does not place any limits on physician prescribing. This shortfall in regulation fails to protect patients from poor prescribing practices and exposes these patients to otherwise preventable adverse drug reactions (ADRs). Attempts to remedy this shortfall have been unsuccessful. Under the existing Food, Drug and Cosmetic Act (FD&C Act) and its judicial interpretation in An~rican Pharmaceutical Ass 'n v. Weinberge , the FDA seemingly does not have the authority to regulate physician prescribing practices.

‣ Patient, Physician, and Payment Predictors of Statin Adherence

Chan, David Chimin; Shrank, William H.; Cutler, David M.; Jan, Saira; Fischer, Michael Adam; Liu, Jun; Avorn, Jerry Lewis; Solomon, Daniel Hal; Brookhart, Alan; Choudhry, Niteesh K
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
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BACKGROUND: Although many patient, physician, and payment predictors of adherence have been described, knowledge of their relative strength and overall ability to explain adherence is limited. OBJECTIVES: To measure the contributions of patient, physician, and payment predictors in explaining adherence to statins RESEARCH DESIGN: Retrospective cohort study using administrative data SUBJECTS: 14,257 patients insured by Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) who were newly prescribed a statin cholesterol-lowering medication MEASURES: Adherence to statin medication was measured during the year after the initial prescription, based on proportion of days covered (PDC). The impact of patient, physician, and payment predictors of adherence were evaluated using multivariate logistic regression. The explanatory power of these models was evaluated with C statistics, a measure of the goodness of fit. RESULTS: Overall, 36.4% of patients were fully adherent. Older patient age, male gender, lower neighborhood percent black composition, higher median income, and fewer number of emergency department (ED) visits were significant patient predictors of adherence. Having a statin prescribed by a cardiologist, a patient's primary care physician...

‣ Measuring Medicaid Physician Participation Rates & Implications for Policy

Sommers, Benjamin Daniel; Kronick, Richard
Fonte: Duke University Press Publicador: Duke University Press
Tipo: Artigo de Revista Científica
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Policymakers continue to debate Medicaid expansion under the ACA, and concerns remain about low provider participation in the program. However, there has been little research on how various measures of physician participation may reflect different elements of capacity for care within the Medicaid program, and how these distinct measures correlate with one another across states. Our objective was to describe several alternative measures of provider participation in Medicaid using recently publicly available data; to compare state rankings across these different metrics; and to discuss potential advantages and disadvantages of each measure for research and policy purposes. Overall, we find that Medicaid participation as measured by raw percentages of physicians taking new Medicaid patients is only weakly correlated with population-based measures that account for both participation rates and the numbers of physicians per capita or physicians per Medicaid beneficiary. Participation rates for all physicians versus primary care physicians also offer different information about state-level provider capacity. Policymakers should consider multiple dimensions of provider access in assessing policy options in Medicaid, and further research is needed to evaluate the linkages between these provider-based measures and beneficiaries’ perceptions of access to care in the program.

‣ Determining the Perceived Relative Importance of Physician Roles in Palliative Care through Best-Worst Scaling

Jiang, Weixi
Fonte: Universidade Duke Publicador: Universidade Duke
Tipo: Tese de Doutorado
Publicado em //2014 Português
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Introduction: A wide of range of physician roles in palliative care have been recognized by doctors in many countries. However, while the demand for palliative care keeps increasing in Singapore, there is a lack of understanding of Singaporean physicians' perceptions on their roles in palliative care. Assessment on the perceived relative importance of these physician roles is also needed for a thorough understanding of physicians' views on palliative care.

Method: Nine physician roles were evaluated through twelve best-worst tasks. The worst counts were subtracted from best counts to develop a B-W score for each physician role. Paired model and marginal model were adopted to obtain an estimation of the coefficient of each role through conditional logit regression. Covariate-adjusted latent class cluster analysis was performed to investigate the heterogeneity among physicians and explore what physician characteristics are associated differences in perception patterns.

Results: "Treating pain and physical symptoms" (1), "discussing end-of-life care preferences with patients" (2) rank top two, while "extending the patient's life as long as possible (8) and "withholding diagnosis if asked by family members" (9) are at the bottom regarding their perceived relative importance by respondents. The largest discrepancies regarding physicians' perceptions lie in "addressing patients' psychological needs"...