Negotiating Medical Dominance: The Social Construction of the Care Coordinator within the Tasmanian Coordinated Care Trials

2001 ◽  
Vol 7 (2) ◽  
pp. 62
Author(s):  
Simon Kitto
Keyword(s):  
Health Care ◽  
General Practitioners ◽  
Health Care Systems ◽  
Coordinated Care ◽  
Care Coordinator ◽  
The Social ◽  
Care Systems ◽  
Medical Dominance ◽  
Systemic Health ◽  
Induced Changes

State and corporate induced changes to health care systems are occurring globally. These changes are altering the environment, which previously supported the medical profession's dominance over all health matters. Health care occupations, in conjunction with systemic health care changes, also threaten the autonomy of general practitioners through new opportunistic attempts to expand their occupational territory. Using a symbolic interactionist approach in tandem with Bucher's natural history framework to trace the emergence of an occupation, this paper analyses the social processes involved in the construction of the care coordinator occupation within the context of the Coordinated Care Trial in Tasmania. An analysis of both the occupational encroachment and defensive strategies employed by government health agencies, general practitioners, nurses, and pharmacists during the construction of the position description of the care coordinator is undertaken. Specifically, the focus of this paper is on how the general practitioners acted to retain their preeminent position within the health care system when facing a dual challenge from above (the state) and below (nursing, pharmacy).

scholarly journals Older multimorbid patients’ experiences on integration of services: a systematic review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lilian Keene Boye ◽  
Christian Backer Mogensen ◽  
Tine Mechlenborg ◽  
Frans Boch Waldorff ◽  
Pernille Tanggaard Andersen
Keyword(s):  
Health Care ◽  
Continuity Of Care ◽  
Health Care Services ◽  
Health Care Systems ◽  
Easy Access ◽  
Ageing Population ◽  
Health Providers ◽  
Care Coordinator ◽  
Care Services ◽  
Care Systems

Abstract Background Half of the older persons in high-income counties are affected with multimorbidity and the prevalence increases with older age. To cope with both the complexity of multimorbidity and the ageing population health care systems needs to adapt to the aging population and improve the coordination of long-term services. The objectives of this review were to synthezise how older people with multimorbidity experiences integrations of health care services and to identify barriers towards continuity of care when multimorbid. Methods A systematic literature search was conducted in February 2018 by in Scopus, Embase, Cinahl, and Medline using the PRISMA guidelines. Inclusion criteria: studies exploring patients’ point of view, ≥65 and multi-morbid. Quality assessment was conducted using COREQ. Thematic synthesis was done. Results Two thousand thirty studies were identified, with 75 studies eligible for full text, resulting in 9 included articles, of generally accepted quality. Integration of health care services was successful when the patients felt listened to on all the aspects of being individuals with multimorbidity and when they obtained help from a care coordinator to prioritize their appointments. However, they felt frustrated when they did not have easy access to their health providers, when they were not listened to, and when they felt they were discharged too early. These frustrations were also identified as barriers to continuity of care. Conclusions Health care systems needs to adapt to people with multimorbidity and find solutions on ways to create flexible systems that are able to help older patients with multimorbidity, meet their individual needs and their desire to be involved in decisions regarding their care. A Care coordinator may be a solution.

Il "quadrilatero" di Ardigň: genealogia e sviluppo di un paradigma emergente

2009 ◽  
pp. 217-237
Author(s):  
Guido Giarelli
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Medical Sociology ◽  
Health Care Systems ◽  
New Paradigm ◽  
Scientific Debate ◽  
The Social ◽  
Care Systems ◽  
Sociology Of Health ◽  
Cultural Origins

- After describing the context in which the ‘quadrilateral'of Ardigň was conceived as an innovative gnoseological tool aimed to characterize the rising Italian Health Sociology in comparison with the much more well established tradition of the Northern American and British Medical Sociology, the essay tries to trace its cultural origins: which are found, at the level of scientific debate, in the ‘great coupure' or epistemological turning point of the Thirties, which Ardigň considers the framework from which to move; and, on the other side, in the micro-macro debate which characterized the sociological discipline during the Seventies and the Eighties with the opposition between the Sociologies of the subjective action versus the Sociologies of the social system, and the attempt to get over it by making a ‘paradigm of exit from the postmodern' which could deal in depth with the intrinsic double face and the ambivalence of the social stuff. In the last part, the developments of the ‘quadrilateral'are traced in the attempts of further elaboration by its critical application to different fields of the Sociology of Health (health care systems, health reforms, quality of health care services, health inequalities) which shape an emerging new paradigm of connectionist type.Keywords: "quadrilateral", Sociology of Health, Medical Sociology, ambivalence, connectionist paradigm, postmodern.Parole chiave: "quadrilatero", sociologia della salute, medical sociology, ambivalenza, paradigma connessionista, postmoderno.

scholarly journals Need, competence and compliance: Selective empowering in the distribution of medical technologies in the Norwegian health care system

2020 ◽  
pp. 000169932097674
Author(s):  
Emil Øversveen
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Medical Decision ◽  
Social Production ◽  
Medical Technologies ◽  
The Social ◽  
Care Systems ◽  
Sociological Studies ◽  
Care Costs

The development of medical technologies is often assumed to improve medical treatment, but may also reproduce health inequalities if their benefits are unequally distributed. Sociological studies have shown that social and moral evaluations matter for medical decision making, and that inequalities in access and outcome exist even in universal health care systems. This article uses the distribution of medical technologies in the treatment of type 1 diabetes as a case for examining the social production of health care inequalities. Drawing on observational data and in-depth interviews with physicians and nurses working in a Norwegian hospital, I demonstrate that medical staff evaluate patients based on a combination of medical, social and moral criteria. The concept of selective empowering is then elaborated and refined as a term for the practice in which medical professionals steer resources towards patients based on evaluations of need, competence and compliance. While previous studies of inequalities in medical care have often focused on medical staff’s cognitive dispositions, I argue that selective empowering may be interpreted as a reflexive response to increasing health care costs and a structural dependency on expensive and commercially produced medical technologies.

Being Heard and Remembered: Young Adults’ Experiences of Recognition in the Social and Health Care Systems in Denmark

Ethos ◽  
2021 ◽  
Author(s):  
Julie Høgsgaard Andersen ◽  
Tine Tjørnhøj‐Thomsen ◽  
Susanne Reventlow ◽  
Annette Sofie Davidsen
Keyword(s):  
Health Care ◽  
Young Adults ◽  
Health Care Systems ◽  
The Social ◽  
Care Systems

scholarly journals Older multimorbid patients’ experiences on integration of services: A systematic review

2019 ◽  
Author(s):  
Lilian Keene Guldhammer Boye ◽  
Christian Backer Mogensen ◽  
Tine Mechlenborg ◽  
Frans Boch Waldorff ◽  
Pernille Tanggaard Andersen
Keyword(s):  
Health Care ◽  
Continuity Of Care ◽  
Health Care Services ◽  
Health Care Systems ◽  
Easy Access ◽  
Ageing Population ◽  
Health Providers ◽  
Care Coordinator ◽  
Care Services ◽  
Care Systems

Abstract Background Half of the older persons in high-income counties are affected with multimorbidity and the prevalence increases with older age. To cope with both the complexity of multimorbidity and the ageing population health care systems needs to adapt to the aging population and improve the coordination of long-term services. The objectives of this review were to synthezise how older people with multimorbidity experiences integrations of health care services and to identify barriers towards continuity of care when multimorbid. Methods A systematic literature search was conducted in February 2018 by in Scopus, Embase, Cinahl, and Medline using the PRISMA guidelines. Inclusion criteria: studies exploring patients’ point of view, ≥65 and multi-morbid. Quality assessment was conducted using COREQ. Thematic synthesis was done. Results 2030 studies were identified, with 75 studies eligible for full text, resulting in 9 included articles, of generally accepted quality. Integration of health care services was successful when the patients felt listened to on all the aspects of being individuals with multimorbidity and when they obtained help from a care coordinator to prioritize their appointments. However, they felt frustrated when they did not have easy access to their health providers, when they were not listened to, and when they felt they were discharged too early. These frustrations were also identified as barriers to continuity of care. Conclusions Health care systems needs to adapt to people with multimorbidity and find solutions on ways to create flexible systems that are able to help older patients with multimorbidity, meet their individual needs and their desire to be involved in decisions regarding their care. A Care coordinator may be a solution.

scholarly journals The ageing of populations in Belgium: Current situation and perspectives

2018 ◽  
Vol 5 (2) ◽  
pp. 69-114
Author(s):  
Mélanie Bourguignon ◽  
Jean-Paul Sanderson ◽  
Catherine Gourbin
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Demographic Ageing ◽  
Healthy Life ◽  
The Third ◽  
The Social ◽  
The Family ◽  
Spatial Differences ◽  
Care Systems

For many decades now, population ageing is observed in every Western countries, as the result of the demographic transition. This article focuses on these issues through the particular lens of the demographer. The first section is focused on the evolution of ageing since 1970, situating Belgium in its wider context as a European nation and analysing spatial differences within Belgium according to standard demo-graphic indicators. The increase in the population over 60 and especially over 80 comes along with a transformation in the population profile. In the second section we look at consequences of ageing in terms of health through an indicator that has now become standard, that of healthy life expectancy. With death taking place at ever older ages, the chance of experiencing health problems has also risen. If to-day’s health-care systems are vitally important in helping older people remain at home for longer, we have focused on the role of the family caregiver, a vital facet of health-care systems for the old. Finally, the third section is devoted to the socioec-onomic consequences of demographic ageing, especially in terms of the resilience of the social security system. Where possible, we draw comparisons with the situation in other European countries.    

Health and Care of an Ageing Population: Alignment of Health and Social Systems to Address the Need

2021 ◽  
pp. 097206342199499
Author(s):  
Sangay Thinley
Keyword(s):  
Health Care ◽  
Older People ◽  
Long Term Care ◽  
Health Care Systems ◽  
Population Ageing ◽  
Demographic Shift ◽  
Term Care ◽  
The Social ◽  
Care Systems

Population ageing is both an achievement and challenge, an achievement as longevity is the result of successful prevention and control of diseases, decreasing fertility rates and overall socio-economic development. It is at the same time a challenge as the increasing number of older people and the resultant demographic shift are accompanied by the need to adjust and scale up the social and health care systems. The challenges are of particular relevance to the developing world where the demographic shift is occurring much faster. Comprehensive efforts based on country contexts are required in the following areas: (a) older persons and development, (b) health and well-being and (c) enabling and supportive environments to address population ageing needs. This article, however, focuses only on three most crucial issues, that is, livelihood, health care systems and care of the older dependent people. Measures to sustain the livelihood of older people, to align the health systems to provide care and to develop long-term care systems are highlighted. Person-centred care, integration and functional capacity are advocated. Further, ageing in place or living in one’s own home, community or a place with the closest fit with the person’s needs and preferences is considered very important for healthy ageing. In terms of enhancing livelihood, major policy changes and reforms to improve the social security systems and expanding coverage as well as increasing the amounts to minimum subsistence levels are highlighted. Another area which needs to be strengthened is the tradition of existing family support systems. The health systems alignment required are reflected for each health system building block, and focuses mainly on (a) developing and ensuring access to services that provide older-person-centred care; (b) shifting the clinical focus from disease to intrinsic capacity; and (c) developing or reorienting the health workforce to provide care as per alignment. Long-term care systems would best meet the needs of dependent older people if families, communities, civil society organisations and private sector are equally involved while governments play leadership roles in setting up and monitoring quality.

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