Equity among physicians and the wish to reallocate time

Objective: To examine the relationship between perceptions of equity among physicians and the wish to reallocate time by creating a fitted, multistage model of the equity distress- wish to reallocate time pathway using structural equation modelling (SEM). Background: The reorganizing of work among various health care professionals and better management of scarce resources are seen as necessary for the delivery of effective and efficient health care. Physicians play a key role in the health care system, and any substantive changes in their work will require their cooperation. Gaining support from physicians for changes in the allocation of their time will depend, in part, on the degree to which these changes are seen to promote their professional and personal objectives. Whether physicians perceive their practice conditions to be equitable, and how they choose to respond to efforts by others to make changes in the work they do and the rewards they receive, has important implications for the successful reform of health care in Canada. Design: A modified panel study using questionnaires mailed to a stratified random sample of 840 physicians in Saskatchewan and British Columbia. A total of 384 physicians responded at baseline (110 from Saskatchewan and 274 from British Columbia). At follow-up, 240 usable questionnaires were returned from the remaining 371 eligible respondents for a response rate of 64.7% (72 from Saskatchewan and 168 from British Columbia). Measures: Reliable constructs were developed for: intrinsic and extrinsic equity; distress; coping with practice demands; and the four components of professional activity (patient care, teaching and research, continuing education, and administration). Latent variables were created for: local health care conditions; distributive equity; wish to reallocate professional time; and wish to reallocate administrative time. Results: SEM produced a well-fitted model (P = 0.112; NFI = 0.991; RMSEA = 0.029; P for Test of Close Fit =0.965; and Hoelter 0.05 Index =255) that explained a substantial amount of variance at each stage of the model, and supported the hypotheses of the main pathway. The contributions of practice condition variables to the model, however, were shown to relate almost exclusively to the equity stage of the model. Discussion/Conclusions: Inequity was significantly associated with distress. In turn, distress was significantly associated with the wish to reallocate time. The state of local health care contributed substantially to perceptions of equity among physicians. The physician's ability to cope with time demands was associated with the equity, distress, and wish to reallocate professional time (patient care, teaching & research, and continuing education). Wish to reallocate administrative time was associated with time already allocated to administrative duties, but was not associated with ability to cope with time demands. The impact of inequity on the allocation of time and the organization of the work of physicians and other health care practitioners over time should be examined in a larger study of a longitudinal design

Breaking down barriers: towards the development of a low-cost community dental clinic in Prince George, British Columbia

Access to dental care for all population groups in Canada is inequitable. While the overall dental health of Canadians is very good, there are disparities that primarily affect the financially disadvantaged in society. Current methods for delivering dental care demonstrate an economic gradient favoring more affluent members of society. An examination of the methods for financing dental care, both public and private, will be conducted to better understand the challenges to solving this dilemma. The role of government and dental professionals in providing access to dental care will be explored. The existing gaps in dental care delivery will be illustrated, and the current methods for providing dental care in northern British Columbia will be identified. While continued government support for disadvantaged groups is necessary, an investigation of alternative models of low-cost dental care delivery will be undertaken to determine the feasibility of these models in Prince George, British Columbia. Solutions that are being used in other nations will be considered to determine their applicability to our local situation in northern British Columbia. A preferred model will be proposed for implementation in Prince George. Ultimately, two questionnaires will be developed to assess the attitudes and preferences of dental professionals and social agencies in coming to a consensus on the best model for bridging the existing gaps in dental care. --Leaf i.The original print copy of this thesis may be available here: http://wizard.unbc.ca/record=b194713

Influencing Factors on Rural Maternity Care Practice

Background: Rural maternity care in Canada is in crisis, with many communities losing local services. This forces rural women and families to travel for care, leading to heightened stress, expenses, and adverse outcomes. Family physicians, often the primary providers of rural maternity care, are decreasing in numbers, exacerbating the problem. Without enough providers, rural communities struggle to offer safe and accessible maternity services, risking the health of expectant mothers and families. Objective: This research aims to gain a comprehensive understanding of the socio-ecological influences that shape the commitment of family physicians and residents to practice rural maternity care. Methods: A scoping review was conducted, and database searching occurred in Ovid Medline, Ovid Embase, Ovid Emcare, and Web of Science. Primary studies and literature reviews in English were included if they discussed family physicians' and residents' experiences and perspectives in practicing and training for rural maternity care. Articles were restricted to the past 30 years. Thematic analysis was applied to analyze the data, and results were reported in tabular format. Results: Influencing factors were categorized into themes and contextualized across the socio-ecological model: 1) individual factors (i.e. interests, attitudes, motivation, burnout, risk), 2) interpersonal factors (i.e. lifestyle, interprofessional relationships, mentors), 3) organizational factors (i.e. training and professional development, work environment and practice characteristics, resources, regulation and privileging), 4) community-level factors (i.e. practice setting and location, job availability, community context), and 5) systematic factors (healthcare system structure, public policy, legal and regulatory framework). Conclusion: The most salient influencing factors included challenges with Family Medicine residency training and role models, call schedule sustainability and interprofessional collaboration, as well as preserving clinical skills and financial stability with low procedural volume in rural communities. There is a need to implement evidence-based interventions targeting training, recruiting role models, interprofessional collaboration and call, and effective rural remuneration.ThesisMaster of Science (MSc)Family physicians (FP) are often the sole care providers of maternity care (MC) in rural communities. Unfortunately, there is a declining number of FPs choosing to provide comprehensive maternity care (CMC). In addition, centralization has resulted in rural maternity center closures across the country. Rural women and families that must travel to access MC experience increased levels of stress, personal costs, and increased rates of adverse outcomes. With fewer FPs available to provide CMC alongside maternity centre closures, rural communities face challenges in ensuring safe and accessible care for expectant mothers. Addressing this issue is vital to protecting the health and well-being of rural families. Although research exists regarding the challenges FPs encounter when providing CMC in rural areas and what influences resident practice intentions, there has yet to be a synthesis of the literature over the last 30 years. To address this, a scoping review was conducted to explore the research on the influences on FPs’ and residents’ commitment to practicing rural MC. This scoping review can help understand what factors have been most influential over time, emerging challenges, and what socio-ecological levels to target for intervention

Common Problems, Different Solutions : Learningfrom International Approaches to Improving MedicalServices Access for Underserved Populations

Canada shares with most OECD countries the problems associated with inequitable geographic access to physician services, and improving the geographic distribution of physicians is a policy preoccupation of all ministries of health in Canada today. Recent court challenges by newly-entering physicians to physician supply controls in B. C. and New Brunswick have brought the issue into sharp relief. The authors explore the degree to which the provinces have adopted common approaches to addressing these problems, and whether Canadian policy-makers have learned from international experience. The recent judgment in the Waldman case in B.C. is analyzed in terms of likely implications for future policies on the geographic distribution of physicians in Canada. The authors conclude that the B.C. and New Brunswick cases may lead to broad changes in health care policy direction by severely limiting the range of narrowly targeted policy options available to ministries of health across Canada

The Role of Medical Training Background in Patient Satisfaction

The number of international medical graduates (IMG) is increasing and their ability to satisfy patients has never been studied. The purpose of this study is to examine if there is a difference between the patient satisfaction scores of US medical graduates (USMGs) and IMGs. This is a retrospective study in which 2627 returned patient experience surveys of 55 physicians working in Medical Practice in South Western Mayo Health System were evaluated. These surveys were returned from August 2009 to August 2010. An independent t-test and t-inverse test was conducted with significance level of 0.05. The results of t-test lead to conclude with 95% confidence that there is no difference between the patient satisfaction scores of the two groups of physicians. T-inverse test confirms the results of t-test and lead to conclude with 95% confidence that the scores of the two groups of physicians are similar. It is concluded that USMGs and IMGs have similar capability to satisfy their patients and also that patients did not rate USMGs and IMGs differently

Business Plan to reconfigure Mediseen INC early strategy

El modelo comercial actual de MediSeen se centra en tener doctores en su plataforma virtual para que realicen visitas a domicilio. Sin embargo, esta estrategia no tiene una propuesta de valor direccionable para los doctores o para la compa??a que pueda conducir a un ?xito financiero sostenible. Adem?s, existe un grave riesgo de desintermediaci?n, es decir, los clientes recurren directamente a los proveedores de servicios despu?s de la primera transacci?n a trav?s de la plataforma de Mediseen. Para agravar a?n m?s el problema, MediSeen tiene efectivo limitado y solo puede sobrevivir hasta fines de 2019 sin recaudar capital adicional. MediSeen tiene dos posibles alternativas para abordar estos problemas estrat?gicos clave. Primero, MediSeen podr?a desviar su atenci?n de los doctores y limitarla solo al segmento de atenci?n m?dica aliada, que incluye servicios como masajes, fisioterapia, terapia de yoga, nutricionistas y entrenamiento personal. Al hacer este cambio, la estructura de la comisi?n tambi?n necesitar?a ser revisada para reducir el riesgo de desintermediaci?n y mantener a los proveedores de servicios motivados. Al final del a?o 2019, se deber?an lograr un total de 42,000 descargas de aplicaciones, 1,800 consultas y obtener 1,260 usuarios activos, que se traducir?n en $59,400 de ingresos para hacer viable esta alternativa, y lograr un EBITDA rentable en el a?o 2020. En segundo lugar, MediSeen podr?a salir del negocio cerrando sus operaciones. Como la compa??a no tiene acreedores, no es elegible para declararse en bancarrota (de acuerdo a la Ley Canadiense). Seg?n los valores de liquidaci?n t?picos de los activos, estimamos que el valor de liquidaci?n de MediSeen actualmente es de$ 550,000, lo que representa un retorno de 5.5 ? / $ para los inversionistas originales

Impact of general practitioner payment scheme on health care system in avoidable hospitalization for ambulatory care sensitive conditions.

This study compares the effectiveness of primary care interventions provided by general practitioners (GP) remunerated under the fee-for-service (FFS) or alternative payment plan (APP), using hospitalization rates for ambulatory care sensitive conditions (ACSC) in select Northern British Columbia (BC) communities. This study used BC Ministry of Health hospital separation data held at Population Data BC. Bivariate statistics were used to compare hospitalization rates for ACSC between both groups. The results indicate overall hospitalization rates of ACSC were higher in APP than FFS communities. Further, several ACSC showed varying hospitalization rates (asthma, pneumonia, COPD, diabetes, angina, gastroenteritis/dehydration and convulsion/epilepsy) and length of hospitalizations (convulsion/epilepsy and dental conditions) between both groups. In summary, this research informs policy on the effectiveness of GP remuneration adopted in Northern BC using hospitalization rates for ACSC. Further research is needed to further validate the findings of this study. --P. ii.The original print copy of this thesis may be available here: http://wizard.unbc.ca/record=b173819

Is Two-Tier Health Care the Future?

Canadians are deeply worried about wait times for health care. Entrepreneurial doctors and private clinics are bringing Charter challenges to existing laws restrictive of a two-tier system. They argue that Canada is an outlier among developed countries in limiting options to jump the queue. This book explores whether a two-tier model is a solution. In Is Two-Tier Health Care the Future?, leading researchers explore the public and private mix in Canada, Australia, Germany, France, and Ireland. They explain the history and complexity of interactions between public and private funding of health care and the many regulations and policies found in different countries used to both inhibit and sometimes to encourage two-tier care, such as tax breaks. This edited collection provides critical evidence on the different approaches to regulating two-tier care across different countries and what could work in Canada. This book is published in English

‘Not an Exact Science’: Medical Approaches to Age and Sexual Offences in England, 1850-1914

This thesis examines medical approaches to sexual offences in England between 1850 and 1914, with particular attention to law-making and judicial processes. It addresses two key research questions. Firstly, what was the place of medicine in shaping the law on sexual consent and in the implementation of laws on sexual crime? Secondly, can the analytical category of age be used to understand such medical roles? In addressing the first research question, the thesis shows that relationships between medicine, the law and wider society can be understood in terms of negotiation and shared pools of knowledge rather than impact. It demonstrates that medical ideas on sexual crime and sexual consent were deemed sufficiently valuable to be drawn upon widely by different groups, but they were not imposed ‘from above’ by a coherent medical profession. Medical roles thus need to be studied and understood rather than either oversimplified as ‘dominant’ or dismissed as non-existent. In addressing the second research question, the thesis argues that age has been unduly overlooked as a category of analysis in historiography. It shows that ideas about sexual crime shifted in relation to victims of different ages and that age can productively be situated in relation to other analytical categories, particularly class and gender. By moving beyond treating ‘children’ and ‘adults’ as homogeneous categories, this study opens up new ways of understanding histories of medico-legal relations and sexual crime.AHR