scholarly journals Medical hybridity and beyond: professional transitions in Italian outpatient settings

2020 ◽  
Author(s):  
Federico Sofritti
Keyword(s):  
Medical Profession ◽  
Outpatient Setting ◽  
Medical Professional ◽  
Public Healthcare ◽  
Local Health ◽  
Structured Interviews ◽  
Organizational Issues ◽  
Professional Transitions ◽  
Outpatient Settings ◽  
Professional Ethos

AbstractThe marketization of public healthcare has brought about organizational transformations, affecting health professionals' ways of working in hospitals and outpatient organizations. As a result of the reforms in the 1990s, the principle of business-like healthcare has been introduced in the Italian health system. This paper presents the main findings of a study of specialist doctors working in two local health organizations in the Tuscany region. Drawing on semi-structured interviews with specialist doctors working in an outpatient setting, the article examines the manifold reactions to changes of the medical profession within outpatient settings. In particular, the combination of professional and organizational dimensions has been taken into consideration. The results show that a change is involving outpatient specialist doctors' identity: organizational change affects several dimensions of the medical professional ethos. The change has been understood by categorizing three major types of approaches to medical professionalism, which are aimed to understand the complexity of the domain and to summarize professionals' reactions: the first is linked to a traditional model of professionalism; the second accepts partially business-like organizational issues, while trying to create individual spaces of autonomy in daily tasks; the third co-opts new organizational issues, which become part of the medical professional ethos.

scholarly journals Psychosomatic–psychotherapeutic treatment in an evening clinic: a qualitative examination of patients’ expectations and experiences

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
F. Brunner ◽  
U. Dinger ◽  
M. Komo-Lang ◽  
H. C. Friederich ◽  
H. Schauenburg ◽  
...  
Keyword(s):  
Qualitative Content Analysis ◽  
Outpatient Setting ◽  
Coping Resources ◽  
Full Time ◽  
Structured Interviews ◽  
Psychotherapeutic Treatment ◽  
Therapeutic Setting ◽  
The One ◽  
Outpatient Settings ◽  
The University

Abstract Background Over a course of 10 weeks the psychosomatic–psychotherapeutic evening clinic at the University of Heidelberg offers an intensive and multimodal 3-h treatment program on three evenings a week. The clinic aims at accommodating patients who on the one hand do not fit the criteria of partial or full-time inpatient therapy, but on the other hand requires a more intensified therapy dose than the usual German outpatient settings can cater for. In the presented monocentric, qualitative study, we wanted to examine this treatment concept with regard to the patients’ specific concerns, expectations, and individual experiences. By contrasting differences in intensity of outpatient and inpatient treatment, we aimed to identify those characteristics of the evening clinic setting that were perceived as especially helpful. Method Each of the 25 patients was interviewed twice, using semi-structured interviews. The interviews took place before (T0) and after (T1) the 10-week treatment interval. A qualitative content analysis of the transcribed interviews was performed using the software “MaxQDA”. Results We identified a total of 1609 separate codes and grouped them into 33 topics and 5 overarching categories. Here, we found some aspects independent of the therapeutic setting, and others concerning the patients’ specific expectations and experiences resulting from the particularities of the evening clinic as an outpatient setting including certain inpatient characteristics. This included the possibility of patients continuing to work and being able to fulfil social obligations, i.e. childcare or caring for relatives, while at the same time undergoing intensive psychotherapeutic treatment. Conclusions Our results show that the evening clinic concept is particularly suitable for patients with mental and psychosomatic disorders who require intensified multimodal therapy while continuing to meet their obligations in their private and working lives. However, in comparison to other therapeutic methods, this concept generated greater stress and time challenges. Patients should therefore have a reasonably good standard of functioning in everyday life and sufficient coping resources. This is especially important for patients who continue working in their jobs while undergoing treatment. So far, there is a lack of quantitative data which would be needed to evaluate the effectiveness of this novel setting.

The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting

2019 ◽  
Author(s):  
Mike R Kohut ◽  
Sara C Keller ◽  
Jeffrey A Linder ◽  
Pranita D Tamma ◽  
Sara E Cosgrove ◽  
...  
Keyword(s):  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Structured Interviews ◽  
Related Factors ◽  
Directed Content Analysis ◽  
The Face ◽  
Outpatient Settings

Abstract Background Perceived patient demand for antibiotics drives unnecessary antibiotic prescribing in outpatient settings, but little is known about how clinicians experience this demand or how this perceived demand shapes their decision-making. Objective To identify how clinicians perceive patient demand for antibiotics and the way these perceptions stimulate unnecessary prescribing. Methods Qualitative study using semi-structured interviews with clinicians in outpatient settings who prescribe antibiotics. Interviews were analyzed using conventional and directed content analysis. Results Interviews were conducted with 25 clinicians from nine practices across three states. Patient demand was the most common reason respondents provided for why they prescribed non-indicated antibiotics. Three related factors motivated clinically unnecessary antibiotic use in the face of perceived patient demand: (i) clinicians want their patients to regard clinical visits as valuable and believe that an antibiotic prescription demonstrates value; (ii) clinicians want to avoid negative repercussions of denying antibiotics, including reduced income, damage to their reputation, emotional exhaustion, and degraded relationships with patients; (iii) clinicians believed that certain patients are impossible to satisfy without an antibiotic prescription and felt that efforts to refuse antibiotics to such patients wastes time and invites the aforementioned negative repercussions. Clinicians in urgent care settings were especially likely to describe being motivated by these factors. Conclusion Interventions to improve antibiotic use in the outpatient setting must address clinicians’ concerns about providing value for their patients, fear of negative repercussions from denying antibiotics, and the approach to inconvincible patients.

scholarly journals Organisational Justice and Political Agency among Nurses in Public Healthcare Organisations: A Qualitative Study Protocol

2021 ◽  
Vol 18 (17) ◽  
pp. 9110
Author(s):  
Camelia López-Deflory ◽  
Amélie Perron ◽  
Margalida Miró-Bonet
Keyword(s):  
Critical Discourse Analysis ◽  
Primary Objective ◽  
Political Agency ◽  
Public Healthcare ◽  
Data Generation ◽  
Structured Interviews ◽  
Organisational Justice ◽  
The Social ◽  
Nurses Perceptions ◽  
Professional Ethos

Nurses are rarely treated as equals in the social, professional, clinical, and administrative life of healthcare organisations. The primary objective of this study is to explore nurses’ perceptions of organisational justice in public healthcare institutions in Majorca, Balearic Islands, Spain, and to analyse the ways in which they exercise their political agency to challenge the institutional order when it fails to reflect their professional ethos. An ethnomethodological approach using critical discourse analysis will be employed. The main participants will be nurses occupying different roles in healthcare organisations, who will be considered central respondents, and physicians and managers, who will be considered peripheral respondents. Data generation techniques include semi-structured interviews, a sociodemographic questionnaire, and the researcher’s field diary. This is one of the first studies to address organisational justice in healthcare organisations from a macrostructural perspective and to explore nurses’ political agency. The results of this study have the potential to advance knowledge and to ensure that healthcare organisations are fairer for nurses, and, by extension, for the patients in their care.

Continuum of Care Following Sports-Related Concussion

2020 ◽  
Vol 29 (3) ◽  
pp. 1389-1403
Author(s):  
Jessica Brown ◽  
Kelly Knollman-Porter
Keyword(s):  
Young Adults ◽  
Life Span ◽  
Sports Injuries ◽  
Continuum Of Care ◽  
Medical Professional ◽  
Structured Interviews ◽  
Youth Athletes ◽  
Speech Language Pathologist ◽  
History Of ◽  
Injury Reporting

Purpose Although guidelines have changed regarding federally mandated concussion practices since their inception, little is known regarding the implementation of such guidelines and the resultant continuum of care for youth athletes participating in recreational or organized sports who incur concussions. Furthermore, data regarding the role of speech-language pathologists in the historic postconcussion care are lacking. Therefore, the purpose of this retrospective study was to investigate the experiences of young adults with history of sports-related concussion as it related to injury reporting and received follow-up care. Method Participants included 13 young adults with history of at least one sports-related concussion across their life span. We implemented a mixed-methods design to collect both quantitative and qualitative information through structured interviews. Participants reported experiencing 42 concussions across the life span—26 subsequent to sports injuries. Results Twenty-three concussions were reported to a parent or medical professional, 14 resulted in a formal diagnosis, and participants received initial medical care for only 10 of the incidents and treatment or services on only two occasions. Participants reported concussions to an athletic trainer least frequently and to parents most frequently. Participants commented that previous experience with concussion reduced the need for seeking treatment or that they were unaware treatments or supports existed postconcussion. Only one concussion incident resulted in the care from a speech-language pathologist. Conclusion The results of the study reported herein shed light on the fidelity of sports-related concussion care management across time. Subsequently, we suggest guidelines related to continuum of care from injury to individualized therapy.

scholarly journals Comparing burnout and work-life balance among specialists in internal medicine: the role of inpatient vs. outpatient workplace

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Felix S. Hussenoeder ◽  
Erik Bodendieck ◽  
Franziska Jung ◽  
Ines Conrad ◽  
Steffi G. Riedel-Heller
Keyword(s):  
Outpatient Setting ◽  
Work Life ◽  
Work Life Balance ◽  
Full Time ◽  
Life Balance ◽  
Specific Factors ◽  
Physician Mental Health ◽  
Outpatient Settings ◽  
Subsequent Patient

Abstract Background Compared to the general population, physicians are more likely to experience increased burnout and lowered work-life balance. In our article, we want to analyze whether the workplace of a physician is associated with these outcomes. Methods In September 2019, physicians from various specialties answered a comprehensive questionnaire. We analyzed a subsample of 183 internists that were working full time, 51.4% were female. Results Multivariate analysis showed that internists working in an outpatient setting exhibit significantly higher WLB and more favorable scores on all three burnout dimensions. In the regression analysis, hospital-based physicians exhibited higher exhaustion, cynicism and total burnout score as well as lower WLB. Conclusions Physician working at hospitals exhibit less favorable outcomes compared to their colleagues in outpatient settings. This could be a consequence of workplace-specific factors that could be targeted by interventions to improve physician mental health and subsequent patient care.

scholarly journals Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hannah Maria Jennings ◽  
Joanna Morrison ◽  
Kohenour Akter ◽  
Hassan Haghparast-Bidgoli ◽  
Carina King ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Care Providers ◽  
Low Income ◽  
Diabetes Management ◽  
Local Health ◽  
Care Seeking ◽  
Care Providers ◽  
Structured Interviews ◽  
Rural Bangladesh

Abstract Background Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered. Methods Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient. Results People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence. Conclusion People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care. Trial registration ISRCTN41083256. Registered on 30/03/2016.

scholarly journals Network governance forms in healthcare: empirical evidence from two Italian cancer networks

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anna Romiti ◽  
Mario Del Vecchio ◽  
Gino Sartor
Keyword(s):  
Healthcare System ◽  
Governance Structure ◽  
Network Governance ◽  
Public Healthcare ◽  
Structured Interviews ◽  
General Validity ◽  
Regional Administration ◽  
Trade Offs ◽  
Italian Regions ◽  
Cancer Networks

Abstract Background This study focuses on the application of Provan and Kenis’ modes of network governance to the specific field of public healthcare networks, extending the framework to an analysis of systems in which networks are involved. Thus, the aim of this study is to analyze and compare the governance of two cancer networks in two Italian regions that underwent system reconfiguration processes due to reforms in the healthcare system. Methods A qualitative study of two clinical networks in the Italian healthcare system was conducted. The sample for interviews included representatives of the regional administration (n = 4), network coordinators (n = 6), and general and clinical directors of health organizations involved in the two networks (n = 25). Data were collected using semi-structured interviews. Results Our study shows that healthcare system reforms have a limited impact on network governance structures. In fact, strong inertial tendencies characterize networks, especially network administrative organization models (NAO). Networks tend to find their own balance with respect to the trade-offs analyzed using a mix of formal and informal ties. Our study confirms the general validity of Provan and Kenis’ framework and shows how other specific factors and contingencies may affect the possibility that cancer networks find positive equilibria between competing needs of inclusivity and efficiency, internal and external legitimacy, and stability and flexibility. It also shows how networks react to external changes. Conclusions Our study shows the importance of considering three factors and contingencies that may affect network effectiveness: a) the importance of looking at network governance modes not in isolation, but in relationship to the governance of regional systems; b) the influence of a specific network’s governance structure on the network’s ability to respond to tensions and to achieve its goals; and c) the need to take into account the role of professionals in network governance.

scholarly journals Knights and Knaves in the English Medical Profession: the Case of Clinical Excellence Awards

2015 ◽  
Vol 45 (1) ◽  
pp. 83-99 ◽  
Author(s):  
MARK EXWORTHY ◽  
PAULA HYDE ◽  
PAMELA MCDONALD-KUHNE
Keyword(s):  
Health Policy ◽  
National Health Service ◽  
Health Service ◽  
Medical Profession ◽  
Clinical Excellence ◽  
Medical Professional ◽  
Policy Makers ◽  
Written Responses ◽  
Private Interests ◽  
The Uk

AbstractWe elaborate Le Grand's thesis of ‘knights and knaves’ in terms of clinical excellence awards (CEAs), the ‘financial bonuses’ which are paid to over half of all English hospital specialists and which can be as much as £75,000 (€92,000) per year in addition to an NHS (National Health Service) salary. Knights are ‘individuals who are motivated to help others for no private reward’ while knaves are ‘self-interested individuals who are motivated to help others only if by doing so they will serve their private interests.’ Doctors (individually and collectively) exhibit both traits but the work of explanation of the inter-relationship between them has remained neglected. Through a textual analysis of written responses to a recent review of CEAs, we examine the ‘knightly’ and ‘knavish’ arguments used by medical professional stakeholders in defending these CEAs. While doctors promote their knightly claims, they are also knavish in shaping the preferences of, and options for, policy-makers. Policy-makers continue to support CEAs but have introduced revised criteria for CEAs, putting pressure on the medical profession to accept reforms. CEAs illustrate the enduring and flexible power of the medical profession in the UK in colonising reforms to their pay, and also the subtle inter-relationship between knights and knaves in health policy.

scholarly journals The Barriers and Facilitators to the Adoption of New Technologies in Public Healthcare Sector: A Qualitative Investigation

2016 ◽  
Vol 12 (1) ◽  
pp. 159 ◽  
Author(s):  
Waleed KH Mohamed AL-Hadban ◽  
Shafiz Affendi Mohd Yusof ◽  
Kamarul Faizal Hashim
Keyword(s):  
Information Systems ◽  
New Technologies ◽  
Healthcare Sector ◽  
Public Healthcare ◽  
Structured Interviews ◽  
Healthcare Information ◽  
Healthcare Information Systems ◽  
Healthcare Information System ◽  
Public Healthcare Sector ◽  
Healthcare Practice

The use of new technologies and information systems within healthcare practice provides several advantages and functionalities for healthcare institutions. However, the use of these advanced technologies is not an easy task and the literature has documented several cases of resistance to adopting such technologies by the healthcare staff. Furthermore, governmental reports stated that Iraq healthcare sector is enduring challenges in this regard. For this reason, the current study explored the opinions of healthcare professionals using semi-structured interviews to highlight the important factors and issues that influence the use and adoption of new technologies within Iraq public healthcare sector. To our best knowledge, this empirical study is the first to employ a qualitative approach to address the issue of healthcare information system adoption in Iraq healthcare domain. Twenty six themes have emerged in the findings of this qualitative study which can be helpful for healthcare seniors in order to overcome the present challenges related to the adoption of healthcare information systems and to improve the healthcare practice in general.

scholarly journals Quantitative ethnopharmacological documentation and molecular confirmation of medicinal plants used by the Manobo tribe of Agusan del Sur, Philippines

2020 ◽  
Author(s):  
Mark Lloyd Granaderos Dapar ◽  
Grecebio Jonathan Duran Alejandro ◽  
Ulrich Meve ◽  
Sigrid Liede-Schumann
Keyword(s):  
Medicinal Plants ◽  
Medicinal Plant ◽  
Plant Genetic Resources ◽  
Traditional Healers ◽  
Conservation Strategies ◽  
Public Healthcare ◽  
Structured Interviews ◽  
Plant Use ◽  
Healthcare Improvement ◽  
Use Categories

Abstract Background Philippines is renowned as one of the species-rich countries and culturally megadiverse in ethnicity worldwide. Ethnomedicinal knowledge of Indigenous Cultural Communities/Indigenous Peoples (ICCs/IPs) is vital for biodiversity conservation and healthcare improvement. This study aims to document the traditional practices, medicinal plant use, and knowledge; to determine the relative importance, consensus, and the extent of all medicinal plants used; and to integrate molecular confirmation to some medicinal plants used by the Agusan Manobo. Methods Quantitative ethnopharmacological data were obtained using semi-structured interviews, group discussions, field observations, and guided field walks with a total of 335 key informants comprising of tribal chieftains, traditional healers, community elders and residents of the community with their traditional medical knowledge. The use categories (UC), use report (UR), fidelity level (FL), and informant consensus factors (ICF) were quantified. The informants' medicinal plant use knowledge and practices were statistically analyzed using the descriptive and inferential statistics Mann-Whitney U and Kruskal-Wallis tests. Results A total of 122 medicinal plant species belonging to 108 genera and 51 families, used in 16 use categories, were collected and identified. Integrative molecular approach confirmed 24 species with uncertain identity using multiple universal markers. The highest ICF (0.96) was cited for the category of abnormal signs and symptoms (ASS). The maximum FL values of 100% were found for Carica papaya L., Premna odorata Blanco, Cinnamomum mercadoi S.Vidal, Tinospora crispa (L.) Hook.f. & Thomson, and Ficus concinna (Miq.) Miq. used for the treatment of dengue fever, cough with phlegm, stomach trouble, joint pain, and fracture and dislocation, respectively. The highest UR (1134) and UC (12) was reported for Anodendron borneense (King & Gamble) D.J.Middleton. Statistically, the medicinal plant knowledge among respondents was significantly different ( p <0.001) when grouped according to education, gender, position, occupation, civil status, and age but not significantly different ( p =0.379) when grouped according to location. Conclusion Documenting such traditional knowledge of medicinal plants and practices is highly important for future management and conservation strategies of these plant genetic resources. This quantitative ethnopharmacological study will serve as a future reference not only for more ethnopharmacological documentation but also for further pharmacological studies and public healthcare improvement.

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