Bmc Health Serv Res
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Bmc Health Serv Res · May 2019
Building general practice training capacity in rural and remote Australia with underserved primary care services: a qualitative investigation.
Australians living in rural and remote areas have access to considerably fewer doctors compared with populations in major cities. Despite plentiful, descriptive data about what attracts and retains doctors to rural practice, more evidence is needed which informs actions to address these issues, particularly in remote areas. This study aimed to explore the factors influencing General Practitioners (GPs), primary care doctors, and those training to become GPs (registrars) to work and train in remote underserved towns to inform the building of primary care training capacity in areas needing more primary care services (and GP training opportunities) to support their population's health needs. ⋯ This study provides important new evidence to support development of high-quality GP training and supervision in remote contexts where there is a need for more GPs to provide primary care services for the population.
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Bmc Health Serv Res · May 2019
Comparative Study Controlled Clinical TrialA complex health services intervention to improve medical care in long-term care homes: study protocol of the controlled coordinated medical care (CoCare) study.
Deficits in general and specialized on-site medical care are a common problem in nursing homes and can lead to unnecessary, costly and burdensome hospitalizations for residents. Reasons for this are often organizational obstacles (such as lack of infrastructure or communication channels) and unfavorable compensation structures, which impede the implementation of adequate medical care. The purpose of this study is to evaluate a complex intervention aiming to improve the coordination of medical care in long-term care nursing homes in Germany. The project aims to optimize the collaboration of nurses and physicians in order to reduce avoidable hospital admissions and ambulance transportations. ⋯ This study will provide evidence regarding the efficacy of a complex intervention to positively influence the quality of medical care and supply efficiency as well as provide cost-saving effects. Its feasibility will be evaluated in a controlled inter-regional design.
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Bmc Health Serv Res · May 2019
Multicenter Study Observational StudyIncorporating ex-vivo lung perfusion into the UK adult lung transplant service: an economic evaluation and decision analytic model.
An estimated 20-30% of end-stage lung disease patients awaiting lung transplant die whilst on the waiting list due to a shortage of suitable donor lungs. Ex-Vivo Lung Perfusion is a technique that reconditions donor lungs initially not deemed usable in order to make them suitable for transplantation, thereby increasing the donor pool. In this study, an economic evaluation was conducted as part of DEVELOP-UK, a multi-centre study assessing the clinical and cost-effectiveness of the Ex-Vivo Lung Perfusion technique in the United Kingdom. ⋯ DEVELOP-UK base-case results suggest that incorporating Ex-Vivo Lung Perfusion into the UK adult lung transplant service is more effective, increasing the number of donor lungs available for transplant, but would not currently be considered cost-effective in the UK using the present NICE threshold. However, results were sensitive to change in some model parameters and in several plausible scenario analyses results indicate that a service incorporating Ex-vivo lung perfusion would be considered cost-effective .
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Bmc Health Serv Res · May 2019
Referral of patients to diabetes prevention programmes from community campaigns and general practices: mixed-method evaluation using the RE-AIM framework and Normalisation Process Theory.
Each year around 5-10% of people with non-diabetic hyperglycaemia will develop type 2 diabetes mellitus. Diabetes prevention is a national and global public health concern. Diabetes Prevention Programmes, which seek to identify at-risk individuals and support entry to health improvement initiatives, recognise that enhanced identification and referral of at-risk individuals is required within primary care and beyond, through community-focused prevention approaches. We report an evaluation of a demonstrator site for the NHS Diabetes Prevention Programme in the UK, which piloted an enhanced Primary Care referral programme (sampling from patients identified as at-risk from general practice databases) and a Community identification programme (sampling from the general population through opportunistic identification in community locations) in an effort to maximise participation in prevention services. ⋯ The study demonstrates the interaction of components, with effective Adoption and Implementation necessary to support Reach. The NPT analysis demonstrated the importance of consensus around not only the need for such programmes but agreement on how they can be delivered. Future programmes should support inter-agency communication and collaboration, and focus identification efforts on areas of high-risk.
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Bmc Health Serv Res · May 2019
The role of organizational attractiveness in an internal market-oriented culture (IMOC): a study of hospital frontline employees.
Hospitals need to understand how to reduce their frontline employees' turnover rate as well as how to positively engage them and improve their service. Central to these issues, we find, is the employees' perception of their organization's attractiveness. This objective of this paper is to clarify how the role of organizational attractiveness relates to frontline employees' perception of their internal market-oriented culture as well as their turnover rate, engagement, and service quality. To our knowledge, no previous research has explored the role of organizational attractiveness from a frontline employee perspective in health-service organizations. ⋯ This study proves that organizational attractiveness is vital for hospital managers to focus on, as it affects employees' perception of whether the organizations is a great place to work. It reveals the need for those same managers to develop an internal market-oriented culture (IMOC) directed toward hospital frontline employees, as it has both a direct effect on organizational attractiveness and an indirect effect on employees' engagement, turnover intention, and service quality.