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Designing a better place for patients: professional struggles surrounding satellite and mobile dialysis units.

https://arctichealth.org/en/permalink/ahliterature162837
Source
Soc Sci Med. 2007 Oct;65(7):1536-48
Publication Type
Article
Date
Oct-2007
Author
Pascale Lehoux
Geneviève Daudelin
Blake Poland
Gavin J Andrews
Dave Holmes
Author Affiliation
GRIS Montreal, Que., Canada. pascale.lehoux@umontreal.ca
Source
Soc Sci Med. 2007 Oct;65(7):1536-48
Date
Oct-2007
Language
English
Publication Type
Article
Keywords
Cooperative Behavior
Health Services Accessibility - organization & administration
Health Services Research
Hemodialysis Units, Hospital - organization & administration
Hospitals, Satellite - organization & administration
Humans
Internal Medicine
Interprofessional Relations
Kidney Failure, Chronic - therapy
Mobile Health Units - organization & administration
Models, organizational
Physician-Nurse Relations
Point-of-Care Systems
Quebec
Regional Medical Programs
Renal Dialysis
Sociology, Medical
Telemedicine
Abstract
The professional claims and struggles involved in the design of non-traditional health care places are rarely problematized in applied health research, perhaps because they tend to fade away once the new design is implemented. This paper offers insights into such professional tensions and their impact on health care delivery by examining the design of two dialysis service delivery models in Quebec, Canada. The satellite units were hosted in two small hospitals and staffed by recently trained nurses. The mobile unit was a bus fitted to accommodate five dialysis stations. It was staffed by experienced nurses and travelled back and forth between a university teaching hospital and two sites. In both projects, nephrologists supervised from a distance via a videoconferencing system. In this paper, we draw mainly from interviews with managers (mostly nurses) and physicians (n=18), and from on-site observations. Nephrologists, medical internists, and managers all supported the goal of providing "closer-to-patient" services. However, they held varying opinions on how to best materialize this goal. By comparing two models involving different clinical and spatial logics, we underscore the ways in which the design of non-traditional health care places opens up space for the re-negotiation of clinical norms. Instead of relatively straightforward conflicts between professions, we observed subtle but inexorable tensions within and beyond professional groups, who sought to measure up to "ideal standards" while acknowledging the contingencies of health care places.
PubMed ID
17590488 View in PubMed
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Focus group research and "the patient's view".

https://arctichealth.org/en/permalink/ahliterature168670
Source
Soc Sci Med. 2006 Oct;63(8):2091-104
Publication Type
Article
Date
Oct-2006
Author
Pascale Lehoux
Blake Poland
Genevieve Daudelin
Author Affiliation
GRIS, Department of Health Administration, University of Montreal, Branch Centre Ville, Montreal, Canada H3C 3J7. pascale.lehoux@umontreal.ca
Source
Soc Sci Med. 2006 Oct;63(8):2091-104
Date
Oct-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Chronic Disease - psychology
Female
Focus Groups - methods
Health Knowledge, Attitudes, Practice
Health Services Research
Home Care Services
Humans
Life Change Events
Male
Middle Aged
Patient Acceptance of Health Care
Research Design
Abstract
A clear emphasis on the patient's view is discernible in the health services research literature of the past decades. Such a switch to patients' perspectives has been greatly facilitated by a wider acceptance and use of qualitative methods. In particular, focus groups are often used to uncover the range and depth of experiences of health services users and chronically ill individuals. Although this method contributes to a better understanding of patients' perspectives and practices, a number of analytical considerations have been overlooked. The aim of this paper is to consider how to conceptualise and analyse interactions in focus group research. We argue that focus groups are social spaces in which participants co-construct the "patient's view" by sharing, contesting and acquiring knowledge. Focus groups conducted with home care patients in Quebec, Canada (on antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy) are used to illustrate three interactive processes at work in focus groups: (1) establishing oneself as experienced and knowledgeable; (2) establishing oneself as in search of information and advice; and (3) validating or challenging one another's knowledge claims. We develop an analytical template focused on the subtle dynamics underpinning the various and at times competing claims of patients. This template acknowledges the processes through which participants attribute authority to the claims of others, including the focus group moderator. We find that focus group research does not derive epistemological authority simply from the identity of its participants. Rather, an emerging consensus about what constitutes the patient's view is the result of context-dependent social interactions that need to be scrutinised.
PubMed ID
16797811 View in PubMed
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The integration of citizens into a science/policy network in genetics: governance arrangements and asymmetry in expertise.

https://arctichealth.org/en/permalink/ahliterature139764
Source
Health Expect. 2011 Sep;14(3):261-71
Publication Type
Article
Date
Sep-2011
Author
Geneviève Daudelin
Pascale Lehoux
Julia Abelson
Jean L Denis
Author Affiliation
Institute of Public Health Research at the University of Montreal (IRSPUM), Canada.
Source
Health Expect. 2011 Sep;14(3):261-71
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Biomedical Research - organization & administration
Canada
Consumer Participation - methods
Genetics, Medical - organization & administration
Humans
Policy Making
Public Policy
Social Support
Abstract
OBJECTIVE While there are increasing calls for public input into health research and policy, the actual obtaining of such input faces many challenges in practice. This article examines how a Canadian science/policy network in the field of genetics integrated citizens into its structure and then managed their participation. METHODS Our ethnographic case study covers a 5-year period (2003-08) and combines four data sources: observations of the network's meetings and informal activities, debriefing sessions with the network's leaders, semi-structured interviews with network members (n = 20) and document analysis. RESULTS When setting up the network, the leaders wanted to include a range of perspectives (research, clinical and policy) to increase the relevance of their research production and knowledge-transfer activities. After 2 years of operation, the network's members agreed to also include citizens who were not knowledgeable in genetics and policy issues. As neither the structure nor the dynamics of the network were modified, the citizens very soon started to feel uncomfortable with their role. They doubted the relevance of their contribution, pointing to an asymmetry in knowledge between them and the expert members. There were significant tensions in the network's governance and the citizens' concerns during the process were not fully addressed. CONCLUSION The integration of citizens into transdisciplinary networks requires recognizing and addressing the asymmetry of expertise that underpins such a collaborative endeavour. It also requires understanding that citizens may feel uncomfortable adopting the pre-defined role ascribed to them, may need a space of their own or may even withdraw if they feel being used.
PubMed ID
21029284 View in PubMed
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