Social science & medicine
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Social science & medicine · Apr 2017
When high pressure, system constraints, and a social justice mission collide: A socio-structural analysis of emergency department social work services.
The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. ⋯ All of these forces were at play in patient-social worker interactions and impacted service provision. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. A conceptual model of ED social work and the influences on the patient-social worker interactions was developed to assist in guiding innovative research and practice models to improve services and outcomes in the complex, fast-paced ED.
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Social science & medicine · Apr 2017
Effects of Payment for Performance on accountability mechanisms: Evidence from Pwani, Tanzania.
Payment for Performance (P4P) aims to improve provider motivation to perform better, but little is known about the effects of P4P on accountability mechanisms. We examined the effect of P4P in Tanzania on internal and external accountability mechanisms. We carried out 93 individual in-depth interviews, 9 group interviews and 19 Focus Group Discussions in five intervention districts in three rounds of data collection between 2011 and 2013. ⋯ P4P resulted in improvements in internal accountability measures through improved relations and communication between stakeholders that were incentivised at different levels of the system and enhanced provider autonomy over funds. P4P had more limited effects on external accountability, though attitudes towards patients appeared to improve, community engagement through health facility governing committees remained limited. Implementers should examine the lines of accountability when setting incentives and deciding who to incentivise in P4P schemes.
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Social science & medicine · Apr 2017
New Zealand Healthline call data used to measure the effect of travel time on the use of the emergency department.
Telephone triage is a health tool increasingly used to connect geographically distant populations. Such services are also utilised to address issues of Emergency Department (ED) overuse. New Zealand's tele-triage service, Healthline, has existed since 2001 but is yet to be the focus of analysis. ⋯ Travel time to ED was found to influence the impact of Healthline advice upon callers but this was not confounded by deprivation. Those living closest to the ED were more likely to attend when advised to, and less likely to stay away if told to avoid the ED. Different time brackets showed stronger trends, suggesting that callers at varying distances from EDs may be more or less influenced by both travel time and Healthline advice.