Social science & medicine
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Social science & medicine · May 2002
Meanings of immediate: the practical use of the Patient's Charter in the accident and emergency department.
The publication of the Patient's Charter in Britain enabled patients to have access to a series of documented standards relating to health care provision in a variety of situations. However since its introduction much discussion has taken place as to its application in clinical practice. An initial interest in the accomplishment of routine accident and emergency (A& E) nursing work led to the identification of issues associated with the use of the Patient's Charter standards; particularly those associated with immediate assessment in the A & E department. ⋯ Firstly, the meanings of immediate assessment continue to remain open to interpretation and therefore difficult to capture and manage. Secondly, the Patient's Charter standards, associated with immediate assessment, deal with one aspect of the work only and yet the accomplishment of A & E work is dependent upon maintaining a perception of order and shape throughout the whole department. Ultimately both issues have an impact on nurses' recognition and management of what they know to be the normal appearances and shape of routine work.
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Social science & medicine · May 2002
Dynamics of change in local physician supply: an ecological perspective.
The purpose of this study is to employ an ecological framework to identify factors that have an impact on change in local physician supply within the USA. A particular specialty type of patient care physicians in a local market is defined as a physician population. Four physician populations are identified: generalists, medical specialists, surgical specialists, and hospital-based specialists. ⋯ For example, both hospital consolidation and managed care penetration showed significant positive eflects on growth of the generalist population but suppressing effects on growth of the specialist population. The percentage of physicians in a particular specialty population in 1985 was negatively related to change in the size of that specialty population between 1985 and 1994, suggesting the existence of competition. Overall, the findings of this study facilitate a better understanding of the complexity of physician workforce supply.