Since 1993, a budding community health information network (CHIN) has been in operation in the Comox Valley in Canada. A general hospital and three multi-doctor clinics are linked electronically. The clinics operate without paper charts using a comprehensive clinic information system. The link is provided by RSALink, a commercial message exchange service, based on Health Link, a system developed at the University of Victoria (McDaniel et al., Can. Med. Inform. 1 (1994) 40-41; McDaniel, Dissertation, University of Victoria, Canada, 1994). Health Link is a highly adaptable message exchange service with rich functionality. Despite this, the system is used exclusively to receive laboratory results transmitted by the hospital's laboratory system (RSAStat). The results are deposited in the patient data base of a commercial clinic information system (CliniCare). This case is instructive because the users' selection of services available through Health Link allows us to observe the preferences in this informational sophisticated environment. Laboratory data transmission is appreciated as highly beneficial. The reliability, security and ample privacy protection and authentication features of Health Link, in contrast, are used in a black box mode and are not consciously exploited. This is consistent with our experience of the use of other systems which have operated for a substantial time, essentially without serious protection features. Our experience suggests that security and confidentiality features are exploited only to the extent that they do not require additional effort or conscientious intervention. This puts the system provider in the difficult position of either offering interactive systems that nobody will use, or providing automated features that nobody is aware of and that are therefore not used to full advantage--if at all.
It is interesting and often useful to compare and contrast individuals from different countries who decide on careers in dentistry. Such data can help provide a broadened perspective from which inferences about future patterns of specialization and distribution of manpower in America may be made. This study compares the backgrounds and plans for dental practice of dental students in the United States and Sweden. The similarities that American and Swedish dental students share relate to strong parental influence, time of decision to attend dental school, origins in urbanized areas, interest in direct patient care, uncertainty about specialty training, and a lack of prior health-related experience among males in both countries. The differences in the dental students of the two nations are more pervasive and may be explained in part by the ways the two countries have organized and financed dental education and dental care.
INTRODUCTION: Due to shortage of general practitioners, it may be necessary to improve productivity. We assess the association between productivity, list size and patient- and practice characteristics. MATERIAL AND METHODS: A regression approach is used to perform productivity analysis based on national register data and survey data for 1,758 practices. Practices are divided into four groups according to list size and productivity. Statistical tests are used to assess differences in patient- and practice characteristics. RESULTS: There is a significant, positive correlation between list size and productivity (p
Rosser and Kasperski build upon and consolidate several earlier reports to put forward a "bottom-up" model for the integration of health services for Ontario that establishes the family physician as the focal point of entry to the healthcare system. The essential features of this model are as follows: 1. Each person in the province should choose a family physician and formalize a partnership with this physician. 2. Each family physician should be in some form of group practice or practice network ranging in size from 7 to 30 physicians. 3. Urgent care would be provided by the members of the physician group on a 24-hour-a-day/7-days-per-week basis. 4. The family physician would be responsible for maintaining a comprehensive record for each patient through the use of information technology. 5. All providers in the system with whom a patient had contact would be required to forward copies of all reports and associated information from that contact to the family physician. 6. The group model will be characterized by collaboration, with the use of nurse practitioners and family-practice nurses to provide preventative and chronic care, the use of midwives to augment the provision of obstetrical, prenatal and postnatal care, and community access and hospital-in-the-home services. 7. Family physicians would be supported by a geographically defined group of specialists providing secondary care, such as psychiatrists, pediatricians and obstetricians, who would also coordinate tertiary care. 8. Every family physician should be an active staff member of his or her local hospital. 9. At some level of aggregation a family physician would be responsible for facilitating/implementing quality-improvement programs for community physicians. 10. Family physicians would be supported through a blended funding model.
Comment On: Healthc Pap. 1999 Winter;1(1):5-2112606855
To explore the dimensions of family physician resilience.
Qualitative study using in-depth interviews with family physician peers.
Purposive sample of 17 family physicians.
An iterative process of face-to-face, in-depth interviews that were audiotaped and transcribed. The research team independently reviewed each interview for emergent themes with consensus reached through discussion and comparison. Themes were grouped into conceptual categories.
Four main aspects of physician resilience were identified: 1) attitudes and perspectives, which include valuing the physician role, maintaining interest, developing self-awareness, and accepting personal limitations; 2) balance and prioritization, which include setting limits, taking effective approaches to continuing professional development, and honouring the self;3) practice management style, which includes sound business management, having good staff, and using effective practice arrangements; and 4) supportive relations, which include positive personal relationships, effective professional relationships, and good communication.
Resilience is a dynamic, evolving process of positive attitudes and effective strategies.
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