Subordinating careers to market forces? A critical analysis of European career guidance policy

This study explores language regarding career and career development in European policy documents on career guidance in order to disclose underlying view(s) of these phenomena conveyed in the texts. Qualitative content analysis was used to approach the subject in the texts, followed by a sender-oriented interpretation. Sources for interpretation include several sociological and pedagogical approaches based upon social constructionism. These provide a framework for understanding how different views of career phenomena arise. The characterization of career phenomena in the documents falls into four categories: contextual change, environment-person correspondence, competence mobility, and empowerment. An economic perspective on career dominates, followed by learning and political science perspectives. Policy formulations convey contradictory messages and a form of career \u27contract\u27 that appears to subordinate individuals\u27 careers to global capitalism, while attributing sole responsibility for career to individuals. (DIPF/Orig.

Can economic evaluation in telemedicine be trusted? A systematic review of the literature

<p>Abstract</p> <p>Background</p> <p>Telemedicine has been advocated as an effective means to provide health care services over a distance. Systematic information on costs and consequences has been called for to support decision-making in this field. This paper provides a review of the quality, validity and generalisability of economic evaluations in telemedicine.</p> <p>Methods</p> <p>A systematic literature search in all relevant databases was conducted and forms the basis for addressing these issues. Only articles published in peer-reviewed journals and written in English in the period from 1990 to 2007 were analysed. The literature search identified 33 economic evaluations where both costs (resource use) and outcomes (non-resource consequences) were measured.</p> <p>Results</p> <p>This review shows that economic evaluations in telemedicine are highly diverse in terms of both the study context and the methods applied. The articles covered several medical specialities ranging from cardiology and dermatology to psychiatry. The studies analysed telemedicine in home care, and in primary and secondary care settings using a variety of different technologies including videoconferencing, still-images and monitoring (store-and-forward telemedicine). Most studies used multiple outcome measures and analysed the effects using disaggregated cost-consequence frameworks. Objectives, study design, and choice of comparators were mostly well reported. The majority of the studies lacked information on perspective and costing method, few used general statistics and sensitivity analysis to assess validity, and even fewer used marginal analysis.</p> <p>Conclusion</p> <p>As this paper demonstrates, the majority of the economic evaluations reviewed were not in accordance with standard evaluation techniques. Further research is needed to explore the reasons for this and to address how economic evaluation in telemedicine best can take advantage of local constraints and at the same time produce valid and generalisable results.</p

From Paper to E-Prescribing of Multidose Drug Dispensing: A Qualitative Study of Workflow in a Community Care Setting

E-prescribing is now widespread and, in some countries, has completely replaced paper prescriptions. In Norway, almost all prescribing is electronic, except for multidose drug dispensing (MDD), which is still sent to the pharmacy by fax or ordinary mail. MDD is an adherence aid used by one-third of all patients receiving home care services. In this paper, we present results from a qualitative study evaluating the introduction of e-prescribing for MDD in a community health care setting. The focus is on the work and workflow for the pharmacists and nurses involved in the medication-handling process. We used the pragmatic process evaluation framework and the systematic text condensation method to analyse the data. We conducted 12 interviews with 34 nurses and pharmacists. This study shows that the e-prescribing of MDD led to greater integration between systems, both within the existing MDD system and across care levels, potentially improving patient safety. However, the structured prescriptions increased the need for clarifications, resulting in an increased overall workload. A greater understanding of the roles and responsibilities of the different professionals in the medication management chain and their needs would improve the workflow of the nurses and pharmacists involved

From paper-based to electronic prescribing of multidose drug dispensing — effects on pharmacy workload

Since 2014, an electronic prescribing system has been piloted for patients receiving medications as multidose drug dispensing; a system commonly used in home care services. In this longitudinal study of 499 patients, we investigate workload at the pharmacies, measured as the number of times pharmacists assess prescriptions. In the 26-week period before the implementation, 17% of the patients got their prescriptions assessed by a pharmacist every 2 weeks, in the 42 weeks after, this increased to 47%. This considerably increases the pharmacy workload, with an estimated additional 602.000 pharmacist assessments every year if all eligible patients get the new prescribing system

CO2 Storage Modelling and Capacity Estimation for the Trøndelag Platform, Offshore Norway - using a Basin Modelling Approach

AbstractThere are several approaches to estimate possible storage capacities for aquifers and traps in sedimentary basins, ranging from static theoretical capacities estimates to more detailed methods involving dynamic modelling. In this paper, we used a modified version of the basin modelling software SEMI [1,2] which applies a ray tracing technique to migrate CO2 within a carrier bed below a sealing cap-rock. We present a modelling strategy for a systematic modelling of maximum trap storage capacities and a mapping of possible “safe” injection localities for a storage unit. Two end-member models regarding the influence of faults were tested. The basin modelling results are compared and validated with results obtained from an reservoir simulation software.Simulations were carried out for the Trøndelag Platform, offshore Norway covering an area of ca. 15,000 km2. The slightly north-westwards dipping Middle Jurassic Garn Formation (Fm.) is considered as a good candidate for CO2 storage. It is widely deposited at the Trøndelag Platform, with a thickness around 120 m and shallow buried (<2 km). It is overlain by a thick shale- mudstone sequence (the Middle Jurassic Viking Group), and thick Cretaceous shales favouring a low risk for caprock leakage.Two simulation approaches were tested. First, injection in the Garn Fm. over the whole study area were simulated, to get the maximum total trap storage capacity. The modelling showed a storage capacity of 2.0 Gt with no faults and 5.2 Gt using interpreted faults at top Garn Fm. level as input to the simulations. Secondly, simulations were carried out with 38 CO2 injection sites. From these, the injection sites which caused migration out of the study area (e.g. upward to the rim of the storage unit, with only Quaternary coverage), where removed. Finally, 7 sites with very low probability for migration out of the area were selected. These “safe” injection sites were mainly mapped in the centre of the Trøndelag Platform where only a few faults are mapped

The effectiveness and cost effectiveness of the PAtient-Centred Team (PACT) model: Study protocol of a prospective matched control before-and-after study

Background: The present study protocol describes the evaluation of a comprehensive integrated care model implemented at two hospital sites at the University Hospital of North Norway (UNN). The PAtient Centred Team (PACT) model includes proactive, patient-centred interdisciplinary teams that aim to improve the continuum and quality of care of frail elderly patients and reduce health care costs. The main objectives of the evaluation are to analyse the effectiveness and cost effectiveness of using patient-centred teams as part of routine service provision for this patient group. The evaluation will analyse the effect on patient health and functional status, patient experiences and hospital utilisation, and it will conduct an economic evaluation. This paper describes the PACT model and the rationale for and design of the planned effectiveness and cost-effectiveness study. Methods/design: This is a prospective, non-randomised matched control before-and-after intervention study. Patients in the intervention group will be recruited from the hospital sites that have implemented the PACT model. The controls will be recruited from two hospitals without the model. The control patients and the index patients will be matched according to sex, age and number of long-term conditions. The study aims to include 600 patients in each group, which will provide sufficient power to detect a clinical change in the primary outcome. The primary outcome is the physical dimension of the Short Form Health Survey (SF-36). Secondary outcomes are the Patient Generated Index (PGI), the Patient Activation Measure (PAM), the Patient Assessment of Chronic Illness Care (PACIC), hospitalisation and length of stay. The cost-effectiveness study takes a health provider perspective and calculates the cost per quality-adjusted life-years (QALYs) gained. The data will be collected at baseline, 6 and 12 months. The data will be analysed using techniques and models that recognise the lack of randomisation and the correlation of cost and effect data. Discussion: The study results will provide knowledge about whether the integrated care model implemented at UNN improves the quality of care for the frail elderly with multiple conditions. The study will establish whether the PAC. T model improves health and functional status and is cost effective compared to the usual care for this patient group

An economic analysis of email-based telemedicine: A cost minimisation study of two service models

<p>Abstract</p> <p>Background</p> <p>Email-based telemedicine has been reported to be an efficient method of delivering online health services to patients at a distance and is often described as a low-cost form of telemedicine. The service may be low-cost if the healthcare organisation utilise their existing email infrastructure to provide their telemedicine service. Many healthcare organisations use commercial-off-the-shelf (COTS) email applications. COTS email applications are designed for peer-to-peer communication; hence, in situations where multiple clinicians need to be involved, COTS applications may be deficient in delivering telemedicine. Larger services often rely on different staff disciplines to run their service and telemedicine tools for supervisors, clinicians and administrative staff are not available in COTS applications. Hence, some organisations may choose to develop a purpose-written email application to support telemedicine. We have conducted a cost-minimisation analysis of two different service models for establishing and operating an email service. The first service model used a COTS email application and the second used a purpose-written telemedicine application.</p> <p>Methods</p> <p>The actual costs used in the analysis were from two organisations that originally ran their counselling service with a COTS email application and later implemented a purpose-written application. The purpose-written application automated a number of the tasks associated with running an email-based service. We calculated a threshold at which the higher initial costs for software development were offset by efficiency gains from automation. We also performed a sensitivity analysis to determine the effect of individual costs on the threshold.</p> <p>Results</p> <p>The cost of providing an email service at 1000 consultations per annum was $19,930 using a COTS email application and$31,925 using a purpose-written application. At 10,000 consultations per annum the cost of providing the service using COTS email software was $293,341 compared to$272,749 for the purpose-written application. The threshold was calculated at a workload of 5216 consultations per annum. When more than 5216 email consultations per annum are undertaken, the purpose-written application was cheaper than the COTS service model. The sensitivity analysis showed the threshold was most sensitive to changes in administrative staff salaries.</p> <p>Conclusion</p> <p>In the context of telemedicine, we have compared two different service models for email-based communication – purpose-written and COTS applications. Under the circumstances described in the paper, when workload exceeded 5216 email consultations per annum, there were savings made when a purpose-written email application was used. This analysis provides a useful economic model for organisations contemplating the use of an email-based telemedicine system.</p

Internet Use for Obtaining Medicine Information: Cross-sectional Survey

Background: The internet is increasingly being used as a source of medicine-related information. People want information to facilitate decision-making and self-management, and they tend to prefer the internet for ease of access. However, it is widely acknowledged that the quality of web-based information varies. Poor interpretation of medicine information can lead to anxiety and poor adherence to drug therapy. It is therefore important to understand how people search, select, and trust medicine information. Objective: The objectives of this study were to establish the extent of internet use for seeking medicine information among Norwegian pharmacy customers, analyze factors associated with internet use, and investigate the level of trust in different sources and websites. Methods: This is a cross-sectional study with a convenience sample of pharmacy customers recruited from all but one community pharmacy in Tromsø, a medium size municipality in Norway (77,000 inhabitants). Persons (aged ≥16 years) able to complete a questionnaire in Norwegian were asked to participate in the study. The recruitment took place in September and October 2020. Due to COVID-19 restrictions, social media was also used to recruit medicine users. Results: A total of 303 respondents reported which sources they used to obtain information about their medicines (both prescription and over the counter) and to what extent they trusted these sources. A total of 125 (41.3%) respondents used the internet for medicine information, and the only factor associated with internet use was age. The odds of using the internet declined by 5% per year of age (odds ratio 0.95, 95% CI 0.94-0.97; P=.048). We found no association between internet use and gender, level of education, or regular medicine use. The main purpose reported for using the internet was to obtain information about side effects. Other main sources of medicine information were physicians (n=191, 63%), pharmacy personnel (n=142, 47%), and medication package leaflets (n=124, 42%), while 36 (12%) respondents did not obtain medicine information from any sources. Note that 272 (91%) respondents trusted health professionals as a source of medicine information, whereas 58 (46%) respondents who used the internet trusted the information they found on the internet. The most reliable websites were the national health portals and other official health information sites. Conclusions: Norwegian pharmacy customers use the internet as a source of medicine information, but most still obtain medicine information from health professionals and packet leaflets. People are aware of the potential for misinformation on websites, and they mainly trust high-quality sites run by health authorities

The costs and potential savings of a novel telepaediatric service in Queensland

BACKGROUND: There are few cost-minimisation studies in telemedicine. We have compared the actual costs of providing a telepaediatric service to the potential costs if patients had travelled to see the specialist in person. METHODS: In November 2000, we established a novel telepaediatric service for selected regional hospitals in Queensland. Instead of transferring patients to Brisbane, the majority of referrals to specialists in Brisbane were dealt with via videoconference. Since the service began, 1499 consultations have been conducted for a broad range of paediatric sub-specialities including burns, cardiology, child development, dermatology, diabetes, endocrinology, gastroenterology, nephrology, neurology, oncology, orthopaedics, paediatric surgery and psychiatry. RESULTS: During a five year period, the total cost of providing 1499 consultations through the telepaediatric service was A$955,996. The estimated potential cost of providing an outpatient service to the same number of patients at the Royal Children's Hospital in Brisbane was A$1,553,264; thus, telepaediatric services resulted in a net saving of approximately A$600,000 to the health service provider. CONCLUSION: Telepaediatrics was a cheaper method for the delivery of outpatient services when the workload exceeded 774 consultations. A sensitivity analysis showed that the threshold point was most sensitive to changes related to patient travel costs, coordinator salaries and videoconference equipment costs. The study showed substantial savings for the health department, mainly due to reduced costs associated with patient travel