ORCID Profile
0000-0002-9771-248X
Current Organisation
The University of Auckland
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Publisher: Elsevier BV
Date: 12-2000
DOI: 10.1016/S0277-9536(00)00057-5
Abstract: This paper defines quality of health care. We suggest that there are two principal dimensions of quality of care for in idual patients access and effectiveness. In essence, do users get the care they need, and is the care effective when they get it? Within effectiveness, we define two key components--effectiveness of clinical care and effectiveness of inter-personal care. These elements are discussed in terms of the structure of the health care system, processes of care, and outcomes resulting from care. The framework relates quality of care to in idual patients and we suggest that quality of care is a concept that is at its most meaningful when applied to the in idual user of health care. However, care for in iduals must placed in the context of providing health care for populations which introduces additional notions of equity and efficiency. We show how this framework can be of practical value by applying the concepts to a set of quality indicators contained within the UK National Performance Assessment Framework and to a set of widely used indicators in the US (HEDIS). In so doing we emphasise the differences between US and UK measures of quality. Using a conceptual framework to describe the totality of quality of care shows which aspects of care any set of quality indicators actually includes and measures and, and which are not included.
Publisher: SAGE Publications
Date: 02-2014
Abstract: While theory plays a variety of roles in forming the central argument of an academic work, it is often assigned a secondary status to that of research methods. The following paper focuses specifically on the benefits for psychology research students in engaging with the capacity of theory to enhance the coherence and originality of their academic works (such as theses or dissertations). Barriers to engagement with theory are identified and contributory factors discussed. General trends in academic environments are seen to play an important part in why many students view theory as difficult, unnecessary, and unconnected with the real world. The article then develops an account for understanding the dynamic and multilayered ways in which theory contributes to research enquiries. A framework involving six different layers of theory is described along with a model for understanding how these layers interact and the order in which they might be best addressed. The paper also considers some of the complications between these layers and possible changes to learning environments in psychology that could promote stronger involvement with theory.
Publisher: Wiley
Date: 10-2008
DOI: 10.1111/J.1365-2753.2007.00938.X
Abstract: General practice is increasingly expected to deliver population care to in idual patients. The feasibility and ethics of this policy shift have been challenged. Our aim is to suggest how to deliver population care while protecting personal care. We outline and discuss concepts of these types of care, their relation to the prevailing discourse regarding intervention benefits, and arguments for in idualized population care. In idualized population care can enable general practice to meet the health targets of in idual patients in the light of population-based goals. It unifies the concepts of personal care and whole population care. Personal care focuses on the in idual good in particular consultations. Whole population care focuses on the overall health good of a population without reference to the in iduality of each population member. These types of care constitute elements of a continuum that varies in purpose and objects of focus. The limitations of a crude dichotomy of personal care and population care are made explicit in a series of five arguments that lend support to the concept of in idualized population care. We advocate a constructive but critical attitude towards the idea of population-based interventions in everyday general practice. Traditional personal care and whole population care can theoretically be integrated into in idualized population care. However, this presupposes clinical-epidemiological expertise and moral awareness in practising clinicians.
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.SOCSCIMED.2010.11.029
Abstract: Women and the concept of homelessness are weakly connected in the international discourses on health and housing. This PhotoVoice study gave a s le of homeless women in central Auckland a camera with which to photograph their lives in order to voice their felt health needs as advocates and agents for positive change. Interviews explored the meanings given to street lives captured in the photographs and reveal threats to the women's mental health and worsening addictions. Their tight-knit, resilient community, including dogs, was seen as 'family' who provide support and protection. The women perceived social services as helping them survive and support their health, but not ending their homelessness. Barriers to them getting and staying off the street included a shortage of affordable, secure housing, which has also tended to become overcrowded. They identified their own leaders who could link with state housing services to implement and evaluate new homelessness programmes, such as Housing First.
Publisher: Wiley
Date: 02-2005
DOI: 10.1111/J.1365-2753.2004.00497.X
Abstract: According to Leape & Berwick (2000) the need to reduce medical errors is 'obvious and the mandate is clear'. My article questions this assertion. I go beyond the unknown incidence of medical errors in a general medical population to suggest that the meaning of medical errors is itself equivocal. I contest the assumption that the 'wrongness' of medical errors is always problematic, arguing instead for a distinction between desirable errors and undesirable errors. This distinction takes into account the consequences of errors, and why they may occur. Reasons include the inappropriateness of two cultural contexts--evidence-based medicine and continuous quality improvement--within which patient safety standards can be constructed and hence, medical errors can be defined.
Publisher: SAGE Publications
Date: 31-10-2014
Publisher: Wiley
Date: 05-2002
DOI: 10.1046/J.1365-2753.2002.00340.X
Abstract: Contesting that a debate on evidence-based health care has taken place, this article charts three paths to the future: continuing avoidance of debate by proponents of evidence-based medicine (EBM) conflict, which the EBM movement courts and critics have espoused, and dialogue. The last portal allows for integration, which would end the disagreement between EBM and its critics and make a debate unnecessary. In search of integration, I sketch a bridge whose construction requires not compromise but a win- win approach. The bridge is a medicine of meaning (MOM). Consolidating multiple pillars of evidence to unify questions that are not necessarily the same for protagonists and critics of EBM, a MOM contends that the purpose or meaning of medicine is always healing and helping, and each party finds meaning in medicine by contributing to this common purpose in its own distinctive way.
Publisher: Annals of Family Medicine
Date: 2009
DOI: 10.1370/AFM.914
Publisher: University of Buckingham Press
Date: 10-06-2011
Publisher: Oxford University Press (OUP)
Date: 05-06-2019
DOI: 10.1093/HER/CYZ019
Abstract: Alcohol use is common among Vietnamese students. Previous qualitative findings showed Vietnamese medical students believed they were not binge drinkers while reporting many binge drinking occasions they participated in or witnessed. This dichotomy warrants examination. This study aims to establish drinking patterns and examine the factors underlying Vietnamese medical students’ binge drinking intention and behaviour. This study used a prospective-correlational design, with two waves of data collection, drawing from established health behaviour models. At Time 1, 206 students completed the Alcohol Use Disorder Identification Test, the standard Theory of Planned Behaviour measures (attitude, subjective norm and perceived behavioural control) and their underlying beliefs, as well as group norm, role identity, drinking culture and past binge drinking behaviour. At Time 2, 156 medical students reported their binge drinking behaviour 2 weeks later. Only 6.8% of participants were classified as problematic drinkers and few participants reported binge drinking occasions at the 2-week follow-up. Perceived behavioural control, friends’ group norms, role identity as future doctors, and past behaviour significantly predicted binge drinking intentions and key beliefs were identified. This study indicated Vietnamese medical students’ limited engagement with binge drinking and identified key factors to address for those with risky drinking behaviour intentions.
Publisher: Annals of Family Medicine
Date: 09-2004
DOI: 10.1370/AFM.115
Abstract: Provider continuity is in need of an expanded definition that is not exclusively clinician centered. Currently, provider continuity is defined by visits over time to the same clinician. Many patients and informal caregivers, however, are co-providers of health care, not merely consumers. As a result, provider continuity will not happen if there is a lack of consistency in who attends with or for the patient during successive visits. Such fragmentation may weaken knowledge of the patient and information exchange. Consequently, there is a need to redefine provider continuity to mean that the same attendees visit the same clinician(s), service, or facility as an uninterrupted succession of events. More than semantic quibbling, the proposed reconceptualization challenges the foundation of family medicine in terms of the values and language by which the discipline defines itself in clinician-centered ways. The change required has implications for practice and research.
Publisher: Springer Science and Business Media LLC
Date: 09-11-2006
DOI: 10.1007/S10728-006-0018-4
Abstract: The expressions 'high quality care' and 'low quality care' are cognitive and linguistic artefacts that help to structure people's lives and thinking for ex le, moves are now afoot internationally to pay bonuses to health professionals for delivering high quality care. United States programmes, most conspicuously, are assuming that high quality care can be validly distinguished from low quality care, and incentivised through bonuses. This distinction is always at least implicit, for high quality care has no meaning without low quality care. Through a 'deconstructionist reading,' this article discusses limitations of categorising the quality of care as either high or low. The limitations of this 'binary opposition' can include a lack of defining attributes vagueness and fuzziness at the 'boundaries' between high quality care and low quality care concealment of quality as a continuum and use of the binary opposition to effect social order and control. Health policy implications of our analysis are discussed. Drawing upon the general medical services contract in the United Kingdom, we suggest an approach to overcoming the oversimplification and imprecision that categorisation tends to produce.
Publisher: Wiley
Date: 25-07-2006
Publisher: Wiley
Date: 05-2000
DOI: 10.1046/J.1365-2753.2000.00237.X
Abstract: Evidence is defined by its ability to establish or support conclusions. Evidence-based medicine (EBM) equates evidence with scientific evidence and views factors such as clinical expertise as important in moving from evidence to action. In contrast, we suggest that EBM should acknowledge multiple dimensions of evidence including scientific evidence, theoretic evidence, practical evidence, expert evidence, judicial evidence and ethics-based evidence. What EBM loses by not acknowledging these dimensions as evidence is the ability, among other things, to make and defend judgements based on understandings that complement science and are no less important than those science can offer. We argue for a new definition of EBM that, without forced accommodation or unacceptable compromise, acknowledges dimensions of evidence produced within and outside science.
Publisher: University of Buckingham Press
Date: 15-07-2014
Abstract: Deeply embedded in medical professionalism, the principle of primacy of patient welfare puts patient interests first. Despite the greater inherent dependence of patients on physicians than of physicians on patients, this principle acts against the right of physicians to be viewed as moral equals and can harm physicians, patients and health system performance. Referring to the current crisis in out-of-hours care provision in the United Kingdom, this paper therefore recommends people‑centred care informed by a principle of moral equality. Virtuous action is deemed necessary to apply this principle. It involves using deliberative dialogue to consider equal moral interests equally, make binding decisions to satisfy the interests likely to maximize overall welfare, and ensure that those whose interests are least satisfied are not worse off than before. This action addresses situationally the taken-for-granted assumption that the interests of the patient necessarily trump the interests of others.
Publisher: Informa UK Limited
Date: 28-05-2019
Publisher: Springer Science and Business Media LLC
Date: 05-2023
DOI: 10.1186/S12884-023-05640-3
Abstract: Despite recognition of the adverse impacts of the mistreatment of women during pregnancy, labour and birth, there remains limited evidence on interventions that could reduce mistreatment and build a culture of respectful maternity care (RMC) in health facilities. The sustainability of effective in idual interventions and their adaptability to various global contexts remain uncertain. In this systematic review, we aimed to synthesise the best available evidence that has been shown to be effective in reducing the mistreatment of women and/or enhancing RMC during women’s maternity care in health facilities. We searched the online databases PubMed, CINAHL, EBSCO Nursing/Academic Edition, Embase, African Journals Online (AJOL), Scopus, Web of Science, and grey literature using predetermined search strategies. We included cluster randomized controlled trials (RCTs) and pre-and-post observational studies and appraised them using JBI critical appraisal checklists. The findings were synthesised narratively without conducting a meta-analysis. The certainty of evidence was assessed using GRADE criteria. From the 1493 identified records, 11 studies from six sub-Sahara African countries and one study from India were included: three cluster RCTs and nine pre- and post-studies. We identified erse interventions implemented via various approaches including in idual health care providers, health systems, and policy amendments. Moderate certainty evidence from two cluster RCTs and four pre- and post-studies suggests that multi-component interventions can reduce the odds of mistreatment that women may experience in health facilities, with odds of reduction ranging from 18 per cent to 66 per cent. Similarly, women’s perceptions of maternity care as respectful increased in moderate certainty evidence from two cluster RCTs and five pre- and post-studies with reported increases ranging from 5 per cent to 50 per cent. Multi-component interventions that address attitudes and behaviors of health care providers, motivate staff, engage the local community, and alleviate health facility and system constraints have been found to effectively reduce mistreatment of women and/or increase respectful maternity care. Such interventions which go beyond a single focus like staff training appear to be more likely to bring about change. Therefore, future interventions should consider erse approaches that incorporate these components to improve maternal care.
Publisher: BMJ
Date: 12-2000
DOI: 10.1136/QHC.9.4.222
Abstract: (1) To describe the development of minimum review criteria for the general practice management in New Zealand (NZ) of two chronic diseases: stable angina and systolic heart failure, and (2) to compare the NZ angina criteria with a set produced in Manchester to assess the extent to which use of the same approach to criteria development yields similar criteria. A modified Delphi approach, based on the RAND consensus panel method, was used to produce minimum criteria for reviewing the recorded management of heart failure and angina in NZ general practice. The criteria for angina were compared with those produced in the UK, including assessment of the extent to which each set describes actions that the other panel agrees are necessary to record. For each condition we report minimum criteria describing actions rated as (a) necessary to record and (b) inappropriate to take but, if taken, necessary to record. Although strong scientific evidence underpins approximately one quarter and one third, respectively, of the final sets of NZ and UK angina criteria for actions necessary to record, the NZ criteria agree strongly with the UK criteria (33 of 39 criteria, 85%) but there is less UK agreement with the NZ angina criteria (28 of 40 criteria, 70%). Despite the lack of scientific evidence for up to three quarters of angina care in general practice, the RAND based approach to criteria development was used in NZ to reproduce most of the UK angina criteria for actions rated as necessary to record in general practice. It is important to make explicit whether ratings of necessity and appropriateness apply to the recording of actions or to the actions themselves.
Publisher: University of Buckingham Press
Date: 30-09-2011
Publisher: Public Library of Science (PLoS)
Date: 18-03-2015
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.MEHY.2010.02.013
Abstract: It is hypothesised that eating is regulated when eating pleasure fulfills (and thus extinguishes) the desire to eat and that eating pleasure is maximised when eating is prompted by an Empty Hollow Sensation (EHS). Absent, unrecognised, misinterpreted or false hunger sensations may account for non-regulated eating in many so-called normal eaters, not only in anorexic or obese people. As a regime in which the EHS is present before most meals, the EHS Meal Pattern (EHSMP) is suggested. Existing evidence to support its efficacy is reviewed. Obesity, diabetes and heart disease are among a range of conditions associated with excessive caloric intake owing to poorly regulated eating. If upheld, the EHSMP could assist people to maintain their own well being and could help to prevent and treat some of the major scourges of Western society.
Publisher: John Benjamins Publishing Company
Date: 14-09-2004
Publisher: Springer Science and Business Media LLC
Date: 2003
Publisher: Informa UK Limited
Date: 16-05-2014
DOI: 10.3109/09638288.2013.793749
Abstract: Abstract Purpose: Group singing could be a promising component of neurorehabilitative care. This article aims to conceptualize how group singing may enable people with Parkinson's disease (PD) to synchronize their movement patterns to musical rhythm and enhance quality of life. Spanning the medical and social sciences, the article draws conceptually on literature on PD, group singing and rhythm in music personal experience and reasoning. Conceptualizing PD in terms of disruptions to social and biological rhythms, we hypothesize how group singing may produce two socio-psychological states - connectedness and flow - that may entrain rhythm in people with PD. The states connect during group singing to elicit and enhance motor processes but may also reawaken after the group singing, through the recall and reactivation of the musical rhythms encoded during group singing. In people with PD, this continuity of flow is hypothesized to be conducive to rhythmic entrainment during and after group singing and in turn to reduced deficits in motor timing and emotional processing, and improvements in quality of life. Empirical studies are needed to test this hypothesis in people with movement disorders such as PD. Implications for Rehabilitation Musical rhythm in group singing may enhance quality of life, and rehabilitation, in people with PD. Use group singing to produce two socio-psychological states - connectedness and flow - that may yield these health benefits. Include people with PD in singing groups to facilitate perceptual exposure to familiar music with melodic distinctiveness and a regular beat.
Publisher: Wiley
Date: 25-07-2006
DOI: 10.1111/J.1365-2753.2006.00727.X
Abstract: The hypothesis is advanced that scholarly journals can find themselves in conflict of interest positions when they operate business strategies which for commercial reasons may militate against the publication of articles which question the usefulness of the products being sold. It is suggested on the basis of probabilistic reasoning that the more extensive the merchandizing and the greater the commercial profits, the greater is the potential for conflict of interest. The alternative hypothesis is advanced that such a conflict of interest position cannot possibly exist. The current Hypothesis paper is published in order to stimulate debate on the subject of study. The reader is referred to the Editor's Note p. 395.
Publisher: Wiley
Date: 09-1998
DOI: 10.1002/(SICI)1099-1042(199809)6:3<261::AID-HCA285>3.0.CO;2-6
Publisher: Springer Science and Business Media LLC
Date: 23-11-2010
Publisher: Wiley
Date: 12-2009
Publisher: Springer Science and Business Media LLC
Date: 09-1998
DOI: 10.1007/BF02678111
Publisher: Elsevier BV
Date: 12-2001
DOI: 10.1016/S0738-3991(01)00118-5
Abstract: This study describes the extent to which patients with heart failure in general practice understand the nature and seriousness of their condition, and want more or better information about it than they currently get. The study involved a random s le of 62 patients receiving care for chronic heart failure in 30 central Auckland, New Zealand, practices. The narrative texts of personal, semi-structured interviews in late 1999 were edited (explicitly and systematically reduced and reassembled) until their interpretation was complete. Approximately 40% of the patients interviewed appeared not to understand the nature and seriousness of their heart failure condition. Two patients had accidentally discovered the diagnosis from inappropriate sources. Eleven patients (18%) expressed wanting improved information about their condition. However, to avoid harm, we did not ask patients about wants for information relating to the seriousness of their heart failure. Through patient education and counselling, providers could help patients to produce an advance written directive of wants for information.
Publisher: Wiley
Date: 23-09-2011
Publisher: Emerald
Date: 21-03-2008
DOI: 10.1108/14777260810862399
Abstract: This paper aims to describe the introduction of pay‐for‐performance in New Zealand primary health care compare this policy development with analogous English initiatives discuss the risk of unintended, adverse consequences of the New Zealand programme and consider key lessons for the policy development of pay‐for‐performance in health care. This article is based on description and analysis of policy developments for performance management in New Zealand and England. It is not clear that the New Zealand Programme appropriately reflects the values and goals of primary health care providers. It encourages slow, incremental change by paying bonuses to Primary Health Organisations, rather than practices, for meeting targets on a small number of performance indicators. The bonuses account for a tiny proportion of the total income of PHOs and in general are for service improvement rather than to supplement practitioner incomes. It is important to align performance incentives with stakeholders' values and goals. The paper discusses New Zealand developments in pay‐for‐performance in the context of English policy initiatives and considers lessons for all health systems.
Publisher: Elsevier BV
Date: 2007
Publisher: SAGE Publications
Date: 2013
DOI: 10.1258/JHSRP.2012.012085
Abstract: Qualitative researchers commonly receive simplistic advice on pitfalls to avoid when conducting interviews. The pitfalls include saying too much and saying too little, yet their cogency depends on the role of the qualitative interviewer. This paper distinguishes between the roles of the miner, traveller, cleaner, and conductor. These roles are ‘ideal types’ that construct, as problematic or not, the use of contested interviewing practices such as ‘leading’ and assigning meaning to informant responses. The paper emphasizes how the ‘cleaner’ attempts to enable informants to interpret their own ubiquitous metaphors and symbolic language. However, acknowledging that in reality the qualitative interviewer may play all three idealized roles (miner, traveller, cleaner), the interviewer as conductor can orchestrate different roles as potential ‘conversational partners’.
Publisher: Informa UK Limited
Date: 22-07-2016
DOI: 10.3109/09638288.2015.1068875
Abstract: People with stroke or Parkinson's disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others. Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (total N = 23). Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options. CST participation was described as an enjoyable social activity, and participation was perceived as improving mood, language, breathing and voice. Choral singing was perceived by people with stroke and PD to help them self-manage some of the consequences of their condition, including social isolation, low mood and communication difficulties. Choral singing therapy (CST) is sought out by people with stroke and PD to help self-manage symptoms of their condition. Participation is perceived as an enjoyable activity which improves mood, voice and language symptoms. CST may enable access to specialist music therapy and speech language therapy protocols within community frameworks.
Publisher: Elsevier BV
Date: 2010
Publisher: University of Buckingham Press
Date: 04-2011
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.IJNURSTU.2018.09.013
Abstract: Nurses routinely engage in pattern recognition and interpretation in qualitative research and clinical practice. However, they risk spontaneously perceiving patterns among things that are not meaningfully related. Although all people are prone to this cognitive bias of "apophenia", nurses may be at increased risk because they commonly produce or at least use qualitative research that can be highly interpretive. Qualitative researchers have been silent on the risk of apophenia and hence on exploring how attention to apophenia could help to indicate and manage such unconscious biases. Therefore this conceptual paper suggests how, in disciplines like nursing, researchers could attend to and use reflexivity on signs of possible apophenia to help bring unconscious biases to awareness. Within safe communities of professional practice, the researchers could cooperate with trusted peers to reflect on how and why they may each perceive patterned phenomena from different perspectives. If one reason is that the researchers, for ex le, appear to exhibit particular unconscious biases, then dialogue could help them to become aware of, and reflect on the biases. This expansion of researchers' consciousness of bias could inform the management of apophenia and enhance the quality of qualitative research and modern nursing practice.
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.PARKRELDIS.2007.11.011
Abstract: We surveyed nationwide health needs for Parkinson's disease (PD) among New Zealand Parkinson's Society members with PD. Little literature assesses how people with PD perceive their health needs for this medical condition. Cross-sectional survey of health needs through personal, structured telephone interviews with a random s le of 500 Parkinson's Society members with PD. Many participants wanted improved access to specialist care but their reported attendance rates suggest provider adherence to guideline recommendations. More general practitioners (GPs) than specialists were said to offer less information than wanted. Getting enough information in usual care was the best predictor (odds ratio 3.44, 95% CI: 1.93-6.13, p=0.000) of seeing a specialist for PD as often as wanted. People with PD have an important perspective in assessments of their health needs. GPs require training support in providing patient information about PD. Our study results may apply to Parkinson's Society members in similar health systems.
Publisher: Elsevier BV
Date: 07-1997
DOI: 10.1016/S0277-9536(96)00342-5
Abstract: To help account for and address observed variations in medical practice, evaluations of "appropriateness" have sought to supplement incomplete evidence with professional opinion. This article contributes to an understanding and refinement of the construct of appropriateness by discussing how it has been defined and applied in studies of health care in general and prescribing in particular. We suggest that appropriateness is the outcome of a process of decision-making that maximises net in idual health gains within society's available resources. This definition distinguishes between (in)appropriate prescribing, as an outcome, and (ir)rational prescribing as a process. To assess appropriateness, we advocate combining explicit criteria with independent review in cases of uncertainty and disagreement. Refinements based on reviews using implicit criteria should draw on shared professional knowledge and post hoc state the process followed as explicitly as possible. The Medication Appropriateness Index is shown to provide a solid foundation for identifying dimensions of prescribing appropriateness.
Publisher: Wiley
Date: 15-10-2014
DOI: 10.1111/JEP.12262
Abstract: This paper suggests how a patient may be able to give and receive the caring he/she wants with respect to a clinician whose (in)action he/she perceives to be uncaring. The approach suggested draws on the philosophy and psychology of framing and adopting Hans Vaihinger's 'as if' theory. I draw on my own experience as a patient to apply this approach that requires imagining and acting as if an apparently uncaring clinician is caring. This fiction need not be objectively true but nor is it necessarily false because the as if theory assumes that the only world anyone can know is one of appearances. At least when the lack of caring appears objectively minor and uncertain to the person feeling it, the caring fiction can be morally important, both for its own sake and for its utility to the patient, the clinician and the maintenance of their relationship. Lastly I discuss the strengths and limitations of the as if approach for clinical practice.
Publisher: SAGE Publications
Date: 02-2005
Abstract: Confronted with uncertainty, who within social networks makes decisions and how? This article suggests a framework for answering these questions. It suggests that decision-making is distributed over time within and among network members. These ‘distributed decisions’ originate in, and develop from, initial decisions, termed ‘proto-decisions’. The process of development of distributed decisions is not merely a social activity. It involves the development over time of mental events by one or more persons through interaction. This framework is illustrated through specific reference to the ex le of who decides about child access to primary health care, and how. At the same time, it elaborates existing models of health service use. It questions the focus of the Social Organisation Strategy framework on one agent deciding about service utilization (albeit within limits set by the structure and content of social network ties) and on social relationships as the dominant influence on decision-making in social life.
Publisher: BMJ
Date: 08-2013
Publisher: Informa UK Limited
Date: 09-10-2021
DOI: 10.1080/15332640.2019.1670768
Abstract: Alcohol is a commonly used substance among Vietnamese medical students, especially males. Vietnamese male medical students drink more alcohol, report more intentions to binge drink, and experience more alcohol-related problems than females. As medical students' alcohol consumption may influence their attitudes and medical practice relating to alcohol counseling and prevention, research about the cultural and drinking norms underlying the drinking behavior of Vietnamese male medical students is warranted. This study aims to explore the norms underlying drinking behavior of Vietnamese male medical students. A qualitative study including 32 in-depth interviews with Vietnamese male medical students at a medical university. Thematic analysis was used to analyze the data. This study found Vietnamese male medical students considered alcohol consumption as a way to show their masculinity and become accepted by groups. Given these beliefs and adherence to norms, they followed rules to force others to consume more alcohol or be intoxicated in drinking occasions among medical students. This study showed the importance of gender and group norms in influencing Vietnamese male medical students' alcohol consumption. These norms should be considered in future research and interventions addressing alcohol use among this target population.
Publisher: Wiley
Date: 02-2004
DOI: 10.1111/J.1365-2753.2003.00426.X
Abstract: Approaches to time management in general practices characteristically focus on objective 'clock time', for ex le, through appointment scheduling. No less important, however, is how patients experience time duration. Time is experienced as having passed slowly (time prolongation), quickly (time compression) or in rough synchronization with clock time. Duration has been theorized to be positively associated with information processing. This paper builds on that theory to suggest how practices can influence patients' subjective experience of duration in the practice environment, for ex le, by making waiting times appear to quicken and consultations appear to slow.
Publisher: Informa UK Limited
Date: 03-1999
Abstract: This article discusses whether general practitioners (GPs) should give unsolicited antismoking advice to patients who smoke. Patient preferences and GP advice-giving are discussed with particular reference to professional roles. It is suggested that giving unsolicited advice against smoking at nearly every encounter is a competitive rather than collaborative behavior. General practitioners should ascertain patients' readiness for change before offering to help produce in idualized agreements of joint benefit on change. Three strategies for negotiation--bridging, trading, and logrolling--are discussed.
Publisher: Oxford University Press (OUP)
Date: 1994
DOI: 10.1093/IJE/23.4.818
Abstract: This study sought explanations for the proneness to respiratory events in young Australian children. Prospective respiratory symptom diaries on 836 children collected data on respiratory symptoms and episodes. Questionnaires to mothers and birth and pregnancy records provided 56 known and possible predictors which were tested against two summary respiratory outcomes in each of the first and second years of life. The two summary respiratory variables recorded for first and second year of life give four outcome variables. In fitting multivariate regression models to predict outcomes, use of child care in early childhood and mothers' experience of respiratory illness in the 12 months before birth were significant predictors for all four outcomes. Number of siblings was a predictor for three of the four outcomes. Sleep difficulty during pregnancy in the mother, and respiratory hospitalization of the infant in the first year, were significant predictors for both first-year outcomes. Unexpected and unexplained findings emerged for alcohol intake during pregnancy, passive smoking and breastfeeding in relation to the second year respiratory outcomes. Less than 9% of variance in outcome scores was explained in any of the four multiple regression models but this rose to between 24% and 31% when a corresponding score from the other year was added to the model. Proneness to respiratory illness is an important entity its determinants are largely unknown and events in pregnancy or the perinatal period explain only a small proportion of the between-infant variability.
Publisher: Wiley
Date: 16-08-2011
DOI: 10.1111/J.1365-2753.2011.01718.X
Abstract: Uncertainty is unavoidable in health care, yet frequently tacit. When uncertainty is acknowledged, it tends to be defined in terms of the unpredictable nature of the care, and limits to human knowledge. It is cast as a problem that evidence-based health care can minimize. Challenging that simplistic perspective, this paper reconstructs uncertainty as a property whose meaning derives from how people are relationally disposed to perceive it in the social context in which they are embedded. Five conditions are suggested to define a need to protect and cultivate uncertainty as a virtue or positive disposition. These conditions are that uncertainty is natural, promotes creativity and a critical attitude, can signify wisdom, nurtures safety, sustains hope and protects against excess. In contrast, certainty is a delusion. Believing in certainty is unscientific and antiscientific because it can obscure and devalue critique in scientific practice.
Publisher: SAGE Publications
Date: 06-07-2015
Abstract: To identify factors associated with differences between developed countries in reclassifying (switching) medicines from prescription to non-prescription availability. Cross-national qualitative research using a heuristic approach in the US, UK, Japan, Australia and New Zealand, supplemented by data from Canada, Denmark, the Netherlands and Singapore. In-depth interviews with 80 key informants (65 interviews) explored and compared factors in terms of barriers and enablers to reclassification of medicines in each country. Document analysis supplemented interview data. Each country had a unique mix of enablers and barriers to reclassification. Enablers included government policy (particularly in UK), pharmacist-only scheduling (particularly in Australia and New Zealand) and large market size (particularly in the US and Europe). Local barriers included limited market potential in small countries, the cost of a reclassification (particularly in the US), competition from distributors of generic medicines, committee inconsistency and consumer behavior. UK had more enablers than barriers, whereas in Australia the opposite was true. Different factors limit or enable reclassification, affecting consumer access to medicines in different countries. For countries attempting to reduce barriers to reclassification, solutions may include garnering government support for reclassification, support and flexibility from the medicines regulator, having a pharmacy-only and/or pharmacist-only category, providing market exclusivity, ensuring best practice in pharmacy, and minimizing the cost and delays of reclassification.
Publisher: Hindawi Limited
Date: 2010
DOI: 10.4061/2010/432983
Abstract: Background . Common but seldom published are Parkinson's disease (PD) medication errors involving late, extra, or missed doses. These errors can reduce medication effectiveness and the quality of life of people with PD and their caregivers. Objective . To explore lay perspectives of factors contributing to medication timing errors for PD in hospital and community settings. Design and Methods . This qualitative research purposively s led in iduals with PD, or a proxy of their choice, throughout New Zealand during 2008-2009. Data collection involved 20 semistructured, personal interviews by telephone. A general inductive analysis of the data identified core insights consistent with the study objective. Results . Five themes help to account for possible timing adherence errors by people with PD, their caregivers or professionals. The themes are the abrupt withdrawal of PD medication wrong, vague or misread instructions devaluation of the lay role in managing PD medications deficits in professional knowledge and in caring behavior around PD in formal health care settings and lay forgetfulness. Conclusions . The results add to the limited published research on medication errors in PD and help to confirm anecdotal experience internationally. They indicate opportunities for professionals and lay people to work together to reduce errors in the timing of medication for PD in hospital and community settings.
Publisher: Informa UK Limited
Date: 2008
Publisher: SAGE Publications
Date: 25-05-2012
Abstract: This paper draws lessons from the use of an emic–etic ethnographical technique in a grounded theory study of how New Zealand practice nurses use information. The technique was used to heighten theoretical sensitivity in this study. As a nurse practitioner, I (the lead author) could not step out of my emic perspective to provide an etic perspective of my own general practice. From my emic embodied subjectivity I constructed my work environment to fit with best practice. Conversely, in four other general practices, my lack of personal connection protected an etic sense of disembodiment. New insights into mental models guiding the emic and etic roles of ethnography are suggested. Emic and etic perspectives, along with embodied and disembodied feelings, are not binary opposites but rather sit along a philosophical continuum. Their position on this continuum depends on the role and relationships of the researcher(s) in the social and cultural context of the area of inquiry.
Publisher: Emerald
Date: 04-2003
DOI: 10.1108/09654280310467717
Abstract: Fear is seldom reported in the research literature on barriers to accessing general practitioner (GP) care. One reason may be that some patients are unwilling to admit to fear of this care. This is especially so for patients who, for social, cultural and historical reasons, have a poor sense of self, or do not wish to challenge professionals, or both. In New Zealand, the Maori and Pacific peoples are disproportionately characteristic of these patients and have poor access to GP care, including asthma in children. This paper contributes to the literature on using key informants to interpret another group’s needs, and integrates and adds to known patient attitudes that can hinder access to GP services.
Publisher: CMA Joule Inc.
Date: 12-11-2012
DOI: 10.1503/CMAJ.120422
Publisher: Annals of Family Medicine
Date: 11-2005
DOI: 10.1370/AFM.342
Publisher: Springer Science and Business Media LLC
Date: 29-06-2012
DOI: 10.1007/S10728-012-0214-3
Abstract: Cooperation and conversation in the public sphere may overcome historical and other barriers to rational argumentation. As an alternative to evidence-based medicine (EBM) and patient-centered care (PCC), the recent development of a modern version of person-centered medicine (PCM) signals an opportunity for a conversational pluralogue to replace parallel monologues between EBM and its critics, and the calls to EBM to debate its critics. This article draws upon elements of Habermas's theory of communicative action in order to suggest the kind of pluralogue that is required for stakeholders in modern medicine to benefit more from publicly conversing with each other than speaking alone or using debate to argue against each other. This reasoned perspective has lessons for all discourse when deep value-based and epistemological differences cannot be easily adjudicated.
Publisher: Wiley
Date: 12-2014
DOI: 10.1111/JEP.12275
Publisher: BMJ
Date: 05-2006
Publisher: Hindawi Limited
Date: 12-2011
DOI: 10.1111/J.1365-2710.2011.01316.X
Abstract: Safety events indicating medication-related errors in Parkinson's disease (PD) are common but seldom studied, particularly from lay perspectives. Our objective was to study the meaning and significance to people living with PD of their experience of safety events. Twenty qualitative interviews were conducted by telephone with purposively s led in iduals with PD, a proxy, or both, throughout New Zealand. Themes identified from the data included joint assessments of the objective and subjective severity of the in idual safety events. Most of the events indicated minor objective errors, whose severity was sometimes perceived as major, especially in the face of callous communication. Variation between objective and subjective assessments of the severity of possible errors indicated by safety events highlight the importance of distinguishing between, and using, both forms of assessment.
Publisher: Wiley
Date: 28-07-2011
DOI: 10.1111/J.1365-2753.2011.01722.X
Abstract: Pay-for-performance schemes reward standardized professional behaviours associated with effective care. However, they neglect the significance of virtue and devalue and erode professional motivation based on virtue. Pay for training to cultivate virtue, and/or pay-for-virtue, may mitigate these dangers. Although virtue is typically considered its own reward, and the assessment of virtue is problematic, pay-for-virtue could involve (1) stringent checks on the appropriateness of the standardized care currently rewarded by pay-for-performance for in idual patients or (2) pay for indicators of virtue. These indicators could be based on virtues identified from a framework of universal virtues and through logical inferences from features of practice. It is possible that pay-for-virtue could ultimately strengthen health professionals' intrinsic motivation for good practice, but this and the broader effects of pay-for-virtue would need careful investigation.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.JHIN.2014.11.010
Abstract: Patients could help to improve the hand hygiene (HH) compliance of healthcare professionals (HCPs) by reminding them to sanitize their hands. To review the effectiveness of strategies aimed at increasing patient involvement in reminding HCPs about their HH. A systematic review was conducted across Medline, EMBASE and PsycINFO between 1980 and 2013. Twenty-eight out of a possible 1956 articles were included. Of these, 23 articles evaluated the effectiveness of developed patient-focused strategies and five articles examined patients' attitudes towards hypothetical strategies. Sixteen articles evaluated single-component strategies (e.g. videos) and 12 articles evaluated multi-modal approaches (e.g. combination of video and leaflet). Overall, the strategies showed promise in helping to increase patients' intentions and/or involvement in reminding HCPs about their HH. HCP encouragement appeared to be the most effective strategy. However, the methodological quality of the articles in relation to addressing the specific aims of this review was generally weak. A number of strategies are available to encourage patients to question HCPs about their HH. Better controlled studies with more robust outcome measures will enhance understanding about which strategies may be most successful and why.
Publisher: Wiley
Date: 10-2008
Publisher: Springer Science and Business Media LLC
Date: 04-2018
DOI: 10.1007/S11017-018-9443-2
Abstract: Person-centered care offers a promising way to manage clinicians' conscientious objection to providing services they consider morally wrong. Health care centered on persons, rather than patients, recognizes clinicians and patients on the same stratum. The moral interests of clinicians, as persons, thus warrant as much consideration as those of other persons, including patients. Interconnected moral interests of clinicians, patients, and society construct the clinician as a socially embedded and integrated self, transcending the simplistic duality of private conscience versus public role expectations. In this milieu of blurred boundaries, person-centered care offers a constructive way to accommodate conscientious objection by clinicians. The constitutionally social nature of clinicians commits and enables them, through care mechanisms such as self-care, to optimize the quality of health care and protect the welfare of patients. To advance these conditions, it is recommended that the medical profession develop a person-centered culture of care, along with clinician virtues and skills for person-centered communication.
Publisher: Wiley
Date: 25-01-2016
DOI: 10.1111/JEP.12516
Publisher: University of Buckingham Press
Date: 11-02-2015
Abstract: Not required because the manuscript is an invited commentary.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.CLINTHERA.2012.04.019
Abstract: Medicines reclassification from prescription to nonprescription (switch) has slowed in some countries, including the United States. New thinking may be necessary to drive this area, including third-party reclassification and better use of the pharmacist, collaborative care, or innovative technologies. The goal of this study was to describe a recent, successful, third-party reclassification of topical calcipotriol, a treatment for psoriasis, including the process, challenges, and solutions. This case study used multiple sources of information, including an application to the Medicines Classification Committee (MCC) in New Zealand, the response letter from the MCC, published minutes of the relevant MCC meeting, and interview data. A heuristic qualitative approach was used that embraces the involvement and experiences of the lead researcher. The third-party reclassification of topical calcipotriol generated challenges, mainly due to initial manufacturer opposition. The greatest hurdle was an inability to change the label. However, requiring mandatory pharmacist consultation, with supply under specified conditions, overcame the barriers. Such conditions included supply only to adults with mild to moderate psoriasis, limits on weekly usage and pack size supplied, and the use of a collaborative care approach requiring previous physician diagnosis and advising the physician of usage. An algorithm for supply was developed. The flexibility of the MCC, an advisory committee, and the medicines regulator, both in considering a third-party approach and in allowing an exemption to prescription supply under specific conditions, was vital to the success of the reclassification. Third-party reclassification may be possible in some countries, particularly where supply can be limited to pharmacists only. A flexible approach may be needed from the committee and regulator to assist such reclassification. Given the multiple beneficiaries of reclassification, removing reliance on the pharmaceutical companies to drive reclassification and/or using new models of supply may provide impetus to the reclassification arena.
Publisher: BMJ
Date: 04-2018
Publisher: Springer Science and Business Media LLC
Date: 2001
Publisher: Oxford University Press (OUP)
Date: 03-2001
Abstract: Considering health as an alternative to ill-health ignores the multidimensionality of both concepts and invites neglect of health promotion as a multidimensional activity in persons with known ill-health. Drawing on the Ottawa Charter and Mäori perspectives of health, we interpret (ill) health according to people's ability to function in their environment by developing physical, psychological, social and spiritual resources for living. We use this framework to test empirically our hypothesis that although the concept of health promotion has always included people with ill-health, the practice of health promotion has continued to neglect them. Our exploratory review of articles published during 1989-99 and indexed on three electronic databases suggests widespread omission of people with ill-health from research on interventions for health promotion. Of 881 citations, approximately three-quarters included people without ill-health in any dimension. This finding could reflect a failure to include these people in health promotion, to describe activity to improve their health as health promotion, or both. Supporting the latter interpretation is uncertainty over the meaning of health, and the targeting of health promotion at groups at high risk of ill-health and 'all' persons. We need therefore to enable health promotion activity to include ill people explicitly.
Publisher: Wiley
Date: 15-07-2012
DOI: 10.1111/J.1464-5491.2011.03533.X
Abstract: To determine whether a diabetes annual review, independently of other care processes, is followed by improved patient clinical measurements. Audits conducted independently of the diabetes annual review were analysed for a time-trend in patient clinical measures. An interaction variable between the review and the year of audit was used to test for a change in gradient before and after a diabetes annual review. Each patient formed their own control. The data included 9471 audits on 3397 patients from 92 practices, and diabetes annual reviews from 2003 to mid-2008. Percentages of patients with raised HbA(1c) , systolic blood pressure and lipids improved from first to last audit. Predicted means after a diabetes annual review for HbA(1c) decreased by 0.13% (1.0 mmol/mol), for HDL cholesterol increased by 0.04 mmol/L and for triglyceride decreased by 0.2 mmol/L. Predicted systolic and diastolic blood pressure, total cholesterol and urinary albumin:creatinine ratio did not change significantly. Metabolic control improved over time but this was largely independently of the diabetes annual review, which appears to add little clinical value to existing New Zealand general practice care processes. Currently, general practitioners are paid to undertake a diabetes annual review and report the measurements collected. We would argue that payment needs to be directed to demonstrating appropriate changes in clinical management or achieving meaningful clinical goals, and that the annual review results should be part of systematic feedback to general practitioners, particularly directed at clinical inertia.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.SAPHARM.2018.06.004
Abstract: Widening access to medicines through reclassification ('switching') of medicines from prescription to non-prescription is an international trend generally welcomed by community pharmacists. Research has focused on scheduling and committee deliberations affecting reclassification, rather than industry aspects, despite industry's role in driving reclassifications. The research aimed to identify how pharmaceutical industry and product-related factors influence reclassification, and to explore stakeholder acceptability of government or third-party driven reclassifications. Sixty-five in-depth, semi-structured interviews were conducted with 80 key informants (including representatives from regulatory bodies, industry, pharmacy and medicine) in developed countries including the United States, the United Kingdom, Japan, Australia, and New Zealand. The questions explored barriers and enablers to reclassification at the local (micro-), regional (meso-) and global (macro-) levels. Analysis of transcribed interviews entailed descriptive and thematic approaches. Pharmaceutical industry decisions to drive medicine reclassification reflect characteristics of the company, product, and external environment at all levels. For the company, financial factors, company focus (e.g. on prescription business versus non-prescription business), and capability in non-prescription medicines and reclassification were common influences. Products with significant non-prescription market potential and a well-known prescription medicine brand name most suited reclassification, usually near patent expiry. Barriers included immediate generic entry post-reclassification, and a short-term profitability and/or prescription business focus. Some countries allow government or a third-party (including pharmacy) to drive reclassifications, with ex les of successful reclassifications ensuing. Some industry and other participants held concerns about this practice, particularly in the United States. Concerns included insufficient resourcing, and the pharmaceutical company's business, potentially encouraging product withdrawal or legal challenge. This study is the first to explore both pharmaceutical industry factors affecting reclassification and acceptability of alternate drivers of reclassification. Factors beyond clinical safety and efficacy and the local reclassification environment can influence reclassification. Pharmacy-driven reclassification might be one alternative.
Publisher: Wiley
Date: 04-1994
DOI: 10.1111/J.1468-2435.1994.TB00155.X
Abstract: "This article provides a broad overview of literature on some of the consequences of international migration for urban and, in particular, metropolitan areas in Australia and New Zealand. The focus therefore is erse highlighting similarities in the experiences of each country... and emphasizing long-term and permanent movements favoured by successive governments on both sides of the Tasman Sea.... The four sets of impacts discussed in this article relate to the population, labour force, residential and settlement patterns and social and cultural factors." (SUMMARY IN FRE AND SPA)
Publisher: Emerald
Date: 21-03-2008
DOI: 10.1108/14777260810862380
Abstract: This paper aims to analyze the development of “pay‐for‐performance” (P4P) programs implemented by Israel's two largest sick funds, insuring 78 percent of the population. Analysis of the main features and their evolution over time, the observed outcomes and concerns related to implementing these programs. Our analysis revealed that although implementation has been successful, both managers and physicians have voiced concerns regarding the effect of measuring clinical performance such as focusing attention on the measured areas while neglecting other areas, and motivating a statistical approach to patient care instead of providing patient‐centered care. The Israeli case provides an interesting ex le of nation‐wide, long‐term implementation of the pay‐for‐performance program. Therefore, it provides other countries with the opportunity to assess features that may facilitate successful implementation, as well as highlighting issues related to the outcomes of P4P programs.
Publisher: Wiley
Date: 25-07-2006
DOI: 10.1111/J.1365-2753.2006.00617.X
Abstract: Tough but constructive criticisms of evidence-based medicine (EBM) have without doubt informed the evolution and serial reconstitutions of this approach to clinical decision making and behaviour. Yet, concerns about EBM persist and as EBM changes in response to reflection and criticism, so too do the criticisms themselves. This paper describes our current understanding of EBM and, to identify opportunities for the continuing evolution of EBM, discusses some key attributes of EBM that still or now cause us concern. Specifically, these attributes are the nature of evidence in EBM the unknown effectiveness of EBM the clinician-centric focus of EBM and the potential of EBM to harm patients.
Publisher: David Publishing Company
Date: 28-04-2015
Publisher: Informa UK Limited
Date: 27-09-2007
DOI: 10.1080/07399330701563251
Abstract: To enhance understanding of how having a cervical smear can lead some women not to keep up-to-date with this test, a hermeneutic (interpretative) phenomenological study was undertaken. Participants were six purposively selected New Zealand women -- predominantly Māori -- at least 6 months overdue for a follow-up cervical screen in the previous 6 years. Each woman gave an in-depth interview. Transcribed and analyzed via a general inductive approach, the interviews suggested that the smears can violate women's positive aloneness with their bodies, and magnify aloneness as a negative state. Overdueness for the test avoids these effects. To minimize such effects, primary health care needs to acknowledge and address these issues, for ex le by providing an opportunity to connect the aloneness to trusted others.
Publisher: SAGE Publications
Date: 08-2007
DOI: 10.1111/J.1467-954X.2007.00723.X
Abstract: Some patients choose not to attend for health care despite health concerns or an opportunity for improved health. Social norms that privilege professional expertise, and good health, deem this choice irrational. However, this paper explores how a particular version of rational choice theory suggests ‘positive choices’ for such non-attendance. These are cognitive and subjectively rational decisions, which are made freely with potentially positive consequences and are not social problems if respect for personal autonomy trumps obligations to others. Specifically, Boudon's ‘cognitivist theory of action’ is used to conceptualise non-attendance as both a rational and irrational choice, from different perspectives. Because the perspective of non-attendees has been marginalised, the paper also suggests a typology of instrumental and non-instrumental ‘strong reasons’ for rational non-attendance. This may help groups such as professionals to understand and accept that non-attendance can be subjectively rational, without relinquishing their own perspective that it is irrational. Acceptance of the defensibility, if not the rightness, of the perspective of non-attendees is needed to show respect for non-attendees’ moral agency and to begin to repair relationships with these in iduals, who may seek help from health professionals in the future.
Publisher: Wiley
Date: 30-09-2021
DOI: 10.1111/JEP.13622
Abstract: Bias is an ambiguous term, defined in different ways. In conventional usage, it indicates unwarranted prejudice. However, in health research, the notion that bias is invariably bad is biased. Although research bias is an error that is always harmful, researcher bias is a tendency to think in a particular way that may obscure or illuminate attempts to address research questions. Researcher bias begins with pre‐judgements whose continuing evaluation infuses the subjectivity of researchers as persons who are socially situated in health sciences focusing on human subjects. Two sets of conditions can make this bias in health researchers useful. The first is volume control. Researchers can vary the loudness of their own and other voices in different research environments. The second condition is smart working. It balances researcher bias against analytic thinking to work creatively with irregularity and uncertainty. Thus, health researchers need to bring their biases to consciousness. A dialectical approach can then engage the biases as conversational partners to innovate health policy that is informed by principles including transparency, good faith and tolerance. Less critical than whether researchers are biased is whose interests their bias serves given their positionality and role.
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.PEC.2011.04.007
Abstract: Conceptualising the doctor-patient relationship as a 'window mirror' exposes care delivery from doctor to self, doctor to patient, patient to self, and patient to doctor. These directions have not been measured concurrently. We aimed to develop and validate a patient questionnaire informed by this model. A modified-Delphi exercise was conducted to develop, and face and content validate, the questionnaire. Stage 2 surveyed 495 patients in general practice to assess the internal consistency and construct validity of the questionnaire. The questionnaire is face and content valid. Its internal reliability and construct validity appear good. Patients who care more about their doctor also care more about themselves. A patient or doctor who cares about the other person is associated with increased self-care by that person. Further development and testing of the patient questionnaire is warranted to validate measurement of how patients perceive the caring they and their doctor give, and receive from, each other. From the patient perspective the questionnaire may increase awareness of the importance of family doctors and patients caring about each other and themselves. It may inform and evaluate medical students, educational programmes and caring in doctor-patient relationships.
Publisher: SAGE Publications
Date: 04-2010
DOI: 10.1258/JHSRP.2009.009081
Abstract: Thematic analysis is characteristic of most qualitative research. Themes are groups of codes that recur through being similar or connected to each other in a patterned way. Thematic analysis ignores codes that do not recur yet may nonetheless be important. This paper proposes the concept of ‘saliency analysis’ as an enhancement of thematic analysis. Saliency analysis assesses the degree to which each code recurs, is highly important or both. Codes of high importance are ones that advance understanding or are useful in addressing real world problems, or both. Thus saliency analysis can expose what is non-recurrent but potentially important to the aims of a study.
Publisher: Emerald
Date: 09-2001
Abstract: There is little evidence that treatment advances have improved the prognosis of heart failure in the community. One explanation is the failure of doctors to undertake necessary prescribing. Reports elsewhere how a modified Delphi approach, based on the RAND Health Services utilisation study method, was used to produce audit criteria for necessary prescribing for systolic heart failure in New Zealand (NZ) general practice. Reports experience of applying these criteria in late 1999 to the medical notes of a random s le of 70 patients with heart failure, as defined by a recorded diagnosis in 30 practices in central Auckland, NZ. Use of the audit criteria was feasible and appears valid, although the methods used to apply them need to be simplified to be of use as a practical means of promoting clinical governance. The small patient s le demands caution in interpreting the results. However, uncommon yet plausible findings, such as the high frequency of ACE inhibitor prescribing for heart failure, deserve further investigation.
Publisher: Elsevier BV
Date: 11-2004
Publisher: CMA Joule Inc.
Date: 17-06-2013
DOI: 10.1503/CMAJ.121457
Publisher: SAGE Publications
Date: 2007
DOI: 10.1258/135581907779497620
Abstract: Performance standards have become a driver for accountability and quality improvement in health care, sometimes as part of payment-for-performance programmes. This essay discusses the novel concept of performance standards for patients – specifically, standards for enrolled groups – and the option of payments for patient performance. Might these ideas define the next logical step to improve quality in health care and help reduce health inequalities between population groups? After considering some possible arguments for patient performance standards, we suggest what these standards might look like, discuss the main concerns regarding their possible development and use, and indicate how these concerns might be appropriately answered.
Publisher: Wiley
Date: 03-03-2011
Publisher: Wiley
Date: 28-04-2015
DOI: 10.1111/JEP.12370
Abstract: Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy 'at the bedside'? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions - about what we should do in any given situation - are embedded within whole understandings of the situation, inseparable from our beliefs about what is the case (metaphysics), what it is that we feel we can claim to know (epistemology), as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers ide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity ontology: questions about the nature of reality, what exists epistemology: concerning knowledge and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and erse, and that ersity is illustrated in the contributions to this thematic edition.
Publisher: Oxford University Press (OUP)
Date: 04-2003
Abstract: Our aim was to identify and account for areas of disagreement with GP care for moderate to severe child asthma among mothers who infrequently use this care. Identifying and understanding these areas of disagreement has the potential to improve child access to GP care. This qualitative study in Auckland, New Zealand, used a general inductive approach to analyse 23 semi-structured, personal interviews during March-October 2001 with s les of 11 mothers of children with moderate to severe asthma, and 12 medical providers (10 in general practice and two in hospital emergency departments). Disagreement was defined by mothers' non-acceptance or disapproval of aspects of GP care they reported getting for child asthma. Mothers and providers described four areas in which some mothers disagree with aspects of GP care for child asthma. Contributing to infrequent attendance, the areas are the validity of the diagnosis, the level of service provision, the effectiveness of care and the level of respect from practice staff. These areas revealed three groups of mothers. GP factors contributing to disagreements among mothers were reported to be inconsistent care information deficits on asthma and in idual children a lack of commitment to identifying the cause(s) and self-management of asthma in children and an unmet need for asthma management plans that incorporate families' knowledge, goals and preferences. Disagreement, among mothers, with areas of GP care for child asthma contributes to non-attendance for this care. This paper identifies opportunities for GPs to keep disagreements to a minimum and facilitate access.
Publisher: Oxford University Press (OUP)
Date: 10-2004
Publisher: BMJ
Date: 05-2005
Publisher: David Publishing Company
Date: 28-06-2016
Publisher: Wiley
Date: 19-07-2016
DOI: 10.1111/JEP.12586
Abstract: Despite its potential hazards, the activity of questioning theoretical frameworks and proposing solutions is necessary if progress is even to be possible. Intellectual history has by no means ended, so we cannot expect to have all the answers, and from time to time the activity of critical questioning will be frustrating. But intellectual progress requires us to continue the process of asking fundamental questions. The alternative to thinking in this way is indeed unthinkable.
Publisher: Elsevier BV
Date: 03-2010
DOI: 10.1016/J.MEHY.2009.06.035
Abstract: Approaches to personal behaviour change include contractual and negotiation models. This paper elaborates these partnership models by linking a religious act to desired behaviour change beyond narrow and specific domains, such as promotion of sexual abstinence. It discusses the hypothesis that oath-taking can facilitate positive, health-related behaviour change in human in iduals. The change must be desired by these in iduals when they nevertheless feel conflicted in their motives, and believe in a ine presence to which they can oath-take. In support of this meta-hypothesis of the effectiveness of oath-taking to a hypothetical inity, we first describe the nature of oaths and oath-taking, including legitimacy and satisfaction conditions, and then postulate how ten interrelated sets of mechanisms can be expected to facilitate oath-keeping. We playfully and heuristically express these mechanisms as 'ten commandments'. Constituting a ine prescription for health-related change, the mechanisms require oath-takers to: believe in the oath, recognise oath-taking as an established and legitimate social behaviour, crystallise the content of the oath, declare the oath aloud, oath-take privately if they prefer, commit to relationships that support oath-taking, replace their relationship with the unwanted behaviour, sanctify the ine presence, honour obligations produced by the oath-taking, and fear oath-breaking. Limitations of oath-taking are then considered as are some of the implications of our arguments.
Publisher: Annals of Family Medicine
Date: 09-2004
DOI: 10.1370/AFM.139
Abstract: We assessed the relationship between 4 attributes of the physician-patient relationship and medication compliance. We conducted a waiting room survey of patients consulting 22 general practitioners in 14 randomly selected practices in Auckland, New Zealand (81% response rate). A total of 370 consecutive patients (75% response rate) completed survey instruments about 4 attributes of the physician-patient relationship. Continuity of care (assessed from use of a usual physician, length of continuity, and perceived importance of continuity) and trust in the physician were ascertained before the consultation. After the consultation the Patient Enablement Index measured the physician's ability to enable patients in self-care, and concordance between the patient and physician was measured by a 6-item inventory of perceived agreement about the presenting problem and management, were ascertained immediately after the consultation. Compliance with prescribed medication therapy was ascertained by telephone follow-up 4 days after the consultation. Overall, 220 patients (61%) received a prescription, and 79% of these patients were taking the medication at follow-up. In a univariate analysis adjusted for clustering, only trust and physician-patient concordance were significantly related to compliance. In analysis further adjusted for health and demographic factors, physician-patient concordance was independently related to compliance (odds ratio = 1.34, 95% confidence interval, 1.04-1.72). Primary care consultations with higher levels of patient-reported physician-patient concordance were associated with one-third greater medication compliance. An emphasis on understanding and facilitating agreement between physician and patient may benefit outcomes in primary care.
Publisher: Springer Science and Business Media LLC
Date: 21-12-2017
DOI: 10.1007/S10912-017-9500-2
Abstract: Modern technologies sanction a new plasticity of physical form. However, the increasing global popularity of aesthetic procedures (re)produces normative beauty ideals in terms of perfection and symmetry. These conditions limit the semblance of freedom by people to control their own bodies. Cultural emancipation may come from principles in Eastern philosophy. These reveal beauty in authenticity, including imperfection. Wabi-sabi acclaims beauty in common irregularity, while kintsugi celebrates beauty in visible signs of repair, like scars. These principles resist pressure to medicalize dissatisfaction with healthy bodies and invite multi-sited interventions to educate taste and aesthetic choices.
Publisher: Wiley
Date: 21-09-2012
Publisher: Springer Science and Business Media LLC
Date: 22-09-2016
Abstract: Interest has grown in centering Parkinson’s disease (PD) care provision on the welfare of the patient with PD. By putting the welfare of patients first, this patient-centric focus tends to subordinate the welfare of others including clinicians and carers. A possible solution is person-centered care. Rather than remove the spotlight from the patients, it widens that light to illuminate moral interests of all healthcare participants as persons whose welfare is interdependent. It assumes that unwellness among clinicians, for ex le, can impact the quality of the PD care they provide, such that caring for clinicians may also optimize the welfare of persons with PD. For PD, we suggest how the two models differ and why these differences are important to understand and act on to optimize benefit for participating stakeholders.
Publisher: Wiley
Date: 21-05-2013
DOI: 10.1111/JEP.12060
Publisher: Public Library of Science (PLoS)
Date: 24-09-2014
Publisher: Elsevier BV
Date: 1995
DOI: 10.1016/0277-9536(94)E0074-3
Abstract: This article outlines a framework for answering four questions of national concern in Australia: what do patients want from general practice? What do GPs want from general practice? What do patients get from general practice? What do GPs get from general practice? These questions are posed with respect to four unique attributes of general practice care: first contact care, longitudinality, coordination and comprehensiveness. The nature of the doctor-patient relationship is also examined because, like the other attributes, it has been reported in the literature to be important to patients and GPs. The framework provides a basis for the empirical study of GP and patient perceptions of general practice care.
Publisher: Wiley
Date: 08-2005
DOI: 10.1111/J.1365-2753.2005.00543.X
Abstract: To reduce health inequalities and improve quality in health care, health policy initiatives in countries including New Zealand and the United Kingdom are expecting general practice to share responsibilities for a population approach to health care. This is giving increased emphasis to preventative care, including health promotion. Reasoned debate on this policy is overdue, not least in New Zealand, where clinicians within general practice appear to have been seduced by the lack of clarity in health policy into accepting this policy without question. They appear to disregard implications of the policy for redefining the nature and scope of their discipline (and of public health), including their own role as providers of personal care. This paper suggests that a population health approach is inappropriate in general practice when this approach weakens personal care and involves health promotion activity of unknown safety and effectiveness. The ex le of intentional weight loss to reduce overweight is used to illustrate these issues. We argue for a restricted range of general practice services.
Publisher: SAGE Publications
Date: 07-2007
DOI: 10.1258/135581907781543111
Abstract: Health care policy-makers and researchers need to pay more attention to understanding the influence of motivation on professional behaviour. Goal setting theory, including two hypotheses – the business case and the pride case – dominates current attempts to motivate professionals. However, the predominance of goal setting theory stifles other approaches to conceptualizing professional motivation. These approaches include other cognitive theories of motivation, such as self-determination theory (concerned with how to use extrinsic rewards that enhance intrinsic motivation), as well as content, psychoanalytic and environmental theories. A valuable opportunity exists to develop and test such theories in addition to possible hybrids, for ex le, by elaborating goal setting theory in health care. The results can be expected to inform health policy and motivate in idual professionals, groups, organizations and workforces to improve and deliver high quality care.
Publisher: Wiley
Date: 08-2007
Publisher: Elsevier BV
Date: 12-2021
Publisher: Springer Science and Business Media LLC
Date: 2008
Publisher: Springer Science and Business Media LLC
Date: 23-12-2016
DOI: 10.1007/S11096-016-0415-1
Abstract: Background In 2012, New Zealand reclassified trimethoprim to allow specially trained pharmacists to supply it without a prescription to women with symptoms suggesting uncomplicated cystitis, under strict criteria for supply. Objective To assess how this policy change allowing pharmacist supply of trimethoprim affected overall antibiotic supply. Setting Randomly selected community pharmacies throughout New Zealand. Methods Data were collected in pharmacies before the implementation ('baseline') and 1 year later ('post-implementation'). Pharmacy staff recorded prescription and nonprescription supplies for treatment or prevention of suspected urinary tract infections. Women with a prescription for treatment or prevention of presumed urinary tract infection or purchasing a non-prescription medicine for this purpose were invited to self-complete a questionnaire. National prescribing data were extracted for trimethoprim, nitrofurantoin and norfloxacin. Main outcome measure Antibiotic use in women with UTIs from dispensed prescriptions (baseline and post-implementation) and pharmacist-supplied trimethoprim (post-implementation), particularly focusing on women aged 16-65 years with an antibiotic for presumed cystitis without complicating features. Results Baseline data were provided by 139 pharmacies, 120 of which provided post-implementation data. In women with presumed cystitis without complicating features, prescriptions before and after the implementation were primarily for trimethoprim. Overall antibiotic use, and use of second-line agents did not increase post-implementation. Pharmacist-supplies of trimethoprim were modest nearly 1 year after the service started. Conclusion Supply of trimethoprim by specially trained pharmacists working within strict criteria for supply appeared to have little overall effect on antibiotic use. Further research on patient outcomes, resistance and changes over time is recommended.
Publisher: Wiley
Date: 12-03-2009
Publisher: Wiley
Date: 10-03-2010
DOI: 10.1111/J.1360-0443.2009.02815.X
Abstract: This paper critically appraises relationship arrangements among three broadly conceived sectors: the government sector, the health sector (including researchers) and addictive consumption industries (particularly tobacco, alcohol and gambling). Three models for involvement are examined. In the 'tripartite partnership model' health sector agencies engage as co-equals with the government and industry sectors in order to implement public health initiatives such as host responsibility and public education. In the 'non- association model' the health sector engages with government agencies but not with the industry sector. In the 'managed association model' the health sector engages for specific purposes with the industry sector but contact is monitored and managed by government agencies. Government and industry sectors commonly favour tripartite partnership arrangements. Health sector agencies that opt to engage in these partnership arrangements can encounter conflicts of interest and find their voice subsumed by dominant influences. Furthermore, their partnership compliance generates isions within the health sector, with partnership dissenters often silenced and excluded from policy processes and funding. The non-association model is the least hazardous to the health sector because it protects against compromise and dominance. The managed association model is an option only when the government sector as a whole is committed strongly and clearly to the public health objectives. In contexts where key parts of the government sector are conflicted over their public health responsibilities, health sector engagement in partnership arrangements entails too many risks.
Publisher: Annals of Family Medicine
Date: 05-2009
DOI: 10.1370/AFM.941
Publisher: Wiley
Date: 04-2014
DOI: 10.1111/JEP.12116
Abstract: Progress is being made in transitioning from clinicians who are torn between caring for patients and populations, to clinicians who are partnering with patients to care for patients as people. However, the focus is still on what patients and others can do for patients, however defined. For clinicians whose interests must be similarly respected for their own sake and because they are integrally related to those of patients, what can and should patients do? Patients can be exempted from some normal social roles but are generally recognized to have moral obligations in health care. One of these obligations is caregiving to clinicians within the limits of each patient's capability. My paper moves this obligation beyond the ceremonial order of etiquette characterizing public statements on how patients should relate to others. It goes beyond a patient-centred ethic that is consumerist in nature, to a person-centred one that recognizes patients typically as moral agents who are dignified by recognizing the obligation to give as well as receive care as sincere benevolence. This obligation derives objective justification from ine command. It is also consistent, however, both with what people, if ignorant of their social role, would objectively produce for a hypothetical social contract, and with virtues constitutive of human nature and a relational and communitarian understanding of what it is to be a person. Including sentiment (intuition) and personal conscience, this relational identity makes caregiving intrinsically meaningful, yet caregiving also has an instrumental value to patients and clinicians. Its self-enforcement by patients will depend on their moral code and on society making caregiving achievable for them. A moral obligation for patient caregiving may then be specified to require patients to reflect on and invest in relationships in which they can feel and show care for others sincerely and respectfully.
Publisher: Elsevier BV
Date: 2009
DOI: 10.1016/J.PEC.2008.07.053
Abstract: Forces for modernisation appear to have led to role convergence and reduced social distances between doctors and modern patients. This review aims to document and understand this process in theory and practice, and to consider the implications for modern patients in particular but also non-modern patients and doctors. Narrative review of published and grey literature identified from sources including electronic databases, the Internet and reference lists of retrieved works. Forces for role convergence between doctors and modern patients include consumerism and increased patient literacy socio-technological changes values convergence increased licence for doctors to use their emotions in patient care and structural changes in the social organisation of health care. As a result, modern patients appear to have gained more in health care than they have lost and more than have the non-modern (or less modern) patients. Doctors have lost authority and autonomy in patient care. The net impulse toward role convergence is, on balance, a positive development. The differential uptake of modernisation by patients has increased health inequalities between modern and non-modern patients. The need of doctors to accommodate these changes has contributed to a form of reprofessonalisation. A key challenge is to make available the benefits of modernisation, for ex le through patient education, to as many patients as possible while minimising the risk of harm. It is important therefore to elucidate and be responsive to patient preferences for modernisation, for ex le by enlisting the support of the modern patients in overcoming barriers to the modernisation of non-modern patients. There is also a need to support doctors as they redefine their own professional role identity.
Publisher: Hindawi Limited
Date: 2010
DOI: 10.1111/J.1365-2524.2009.00904.X
Abstract: We have previously reported a preliminary taxonomy of patient error. However, approaches to managing patients' contribution to error have received little attention in the literature. This paper aims to assess how patients and primary care professionals perceive the relative importance of different patient errors as a threat to patient safety. It also attempts to suggest what these groups believe may be done to reduce the errors, and how. It addresses these aims through original research that extends the nominal group analysis used to generate the error taxonomy. Interviews were conducted with 11 purposively selected groups of patients and primary care professionals in Auckland, New Zealand, during late 2007. The total number of participants was 83, including 64 patients. Each group ranked the importance of possible patient errors identified through the nominal group exercise. Approaches to managing the most important errors were then discussed. There was considerable variation among the groups in the importance rankings of the errors. Our general inductive analysis of participants' suggestions revealed the content of four inter-related actions to manage patient error: Grow relationships Enable patients and professionals to recognise and manage patient error be Responsive to their shared capacity for change and Motivate them to act together for patient safety. Cultivation of this GERM of safe care was suggested to benefit from 'in idualised community care'. In this approach, primary care professionals in idualise, in community spaces, population health messages about patient safety events. This approach may help to reduce patient error and the tension between personal and population health-care.
Publisher: David Publishing Company
Date: 28-09-2015
No related grants have been discovered for Stephen Buetow.