Social science & medicine
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Social science & medicine · Dec 2012
Benefit or burden? A sociotechnical analysis of diagnostic computer kiosks in four California hospital emergency departments.
High expectations for new technologies coexist with wide variability in the actual adoption and impact of information technology (IT) projects in clinical settings, and the frequent failure to incorporate otherwise "successful" projects into routine practice. This paper draws on actor-network theory to present an in-depth, sociotechnical analysis of one such project--a computer kiosk designed to diagnose and expedite treatment of urinary tract infections (UTI) in adult women. Research at a hospital urgent care clinic demonstrated the kiosk program's effectiveness at diagnosing UTI and reducing patient wait times, and the kiosk was subsequently adopted by the clinic for routine patient care. ⋯ However, the kiosk's "network" failed to stabilize as it encountered different patient populations, institutional politics, and the complex, pragmatic aspects of ED work at each site. The results of this evaluation challenge the persistent myth that a priori qualities and meanings inhere in technology regardless of context. The design and deployment of new IT projects in complex medical settings would benefit from empirically informed understandings of, and responses to, the contingent properties of human-technology relations.
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Social science & medicine · Dec 2012
The duty to care in an influenza pandemic: a qualitative study of Canadian public perspectives.
Ever since the emergence of SARS, when we were reminded that the nature of health care practitioners' duty to care is greatly contested, it has remained a polarizing issue. Discussions on the nature and limits of health care practitioners' duty to care during disasters and public health emergencies abounds the literature, ripe with arguments seeking to ground its foundations. However, to date there has been little public engagement on this issue. ⋯ Our analysis contributes a better understanding of the constitutive nature of the duty to care, defined in part by taking account of public views. This broadened understanding can further inform the articulation of acceptable norms of duty to care and policy development efforts. What is more, it illustrates the urgent need for policy-makers and regulators to get clarity on obligations, responsibilities, and accountability in the execution of HCPs' duty to care during times of universal vulnerability.
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Social science & medicine · Nov 2012
Revenue, relationships and routines: the social organization of acute myocardial infarction patient transfers in the United States.
Heart attack, or acute myocardial infarction (AMI), is a leading cause of death in the United States (U. S.). The most effective therapy for AMI is rapid revascularization: the mechanical opening of the clogged artery in the heart. ⋯ Transfer destination selection was primarily driven at an institutional level by organizational concerns and bed supply, rather than physician choice or patient preference. Transfer routinization emerged as a form of social order that invoked tradeoffs between process speed and efficiency and patient-centered, quality-driven decision making. We consider the implications of routinization and institutional imperatives for health policy, quality improvement and health informatics interventions.
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Social science & medicine · Nov 2012
Impact of gender-based career obstacles on the working status of women physicians in Japan.
Research has shown that women physicians work fewer hours and are more likely to become inactive professionally and to switch to part-time labor, compared with their male counterparts. The published literature suggests that a gender disparity still exists in medicine which may decrease work motivation among women physicians. The authors investigated whether the experience and the perception of gender-based career obstacles among women physicians in Japan are associated with their working status (i.e., full-time vs. part-time). ⋯ The scores for perception of gender-based career obstacles were statistically higher among part-time workers compared with full-time workers (mean difference = 1.20, 95% CI: 0.39-2.00). Adjusting for age, marital status, the presence of children, workplace, board certification, holding a PhD degree, overall satisfaction of being a physician, and household income, stepwise logistic regression models revealed that physicians with the strongest perception of gender-based career obstacles were more likely to work part-time rather than full-time (OR, 0.59; 95% CI: 0.40-0.88). Although the experience of gender-based obstacles was not associated with working status among women physicians, the results demonstrated that a strong perception of gender-based obstacles was associated with part-time practice rather than full-time practice.
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Social science & medicine · Nov 2012
Hidden costs: the direct and indirect impact of user fees on access to malaria treatment and primary care in Mali.
About 20 years after initial calls for the introduction of user fees in health systems in sub-Saharan Africa, a growing coalition is advocating for their removal. Several African countries have abolished user fees for health care for some or all of their citizens. However, fee-for-service health care delivery remains a primary health care funding model in many countries in sub-Saharan Africa. ⋯ The effects of user fees were amplified by conditions of poverty, as well as gender and health inequality; user fees in turn reinforced the inequalities created by those very conditions. The qualitative data reveal multi-faceted health and socioeconomic effects of user fees, and illustrate that user fees for health care may impact quality of care, health outcomes, food insecurity, and gender inequality, in addition to impacting health care utilization and household finances. As many countries consider user fee abolition policies, these findings indicate the need to create a broader evaluation framework-one that can measure the health and socioeconomic impacts of user fee polices and of their removal.