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Wang S, Li L, Jin Y, Liao R, Chuang YC, Zhu Z. Identifying Key Factors for Burnout Among Orthopedic Surgeons Using the Analytic Hierarchy Process Method. Int J Public Health 2023; 68:1605719. [PMID: 37206094 PMCID: PMC10188929 DOI: 10.3389/ijph.2023.1605719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives: To develop an evaluation model for, and identify key factors contributing to, burnout in orthopedic surgeons, providing a reference for the management of burnout among orthopedic surgeons in hospitals. Methods: We developed an analytic hierarchy process (AHP) model with 3 dimensions and 10 sub-criteria based on an extensive literature review and expert assessment. We used expert and purposive sampling and 17 orthopedic surgeons were selected as research subjects. The AHP process was then used to obtain the weights and to prioritize the dimensions and criteria for burnout in orthopedic surgeons. Results: The dimension of C 1 (personal/family) was the key factor affecting burnout in orthopedic surgeons, and in the sub-criteria, the top four sub-criteria were C 11 (little time for family), C 31 (anxiety about clinical competence), C 12 (work-family conflict), and C 22 (heavy work load). Conclusion: This model was effective in analyzing the key factors contributing to job burnout risk, and the results can inform improved management of the levels of burnout affecting orthopedic surgeons in hospitals.
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Affiliation(s)
- Shiqian Wang
- Business School, Dongguan City University, Dongguan, China
| | - Lin Li
- Business School, Dongguan City University, Dongguan, China
| | - Yanjun Jin
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Rui Liao
- Business College, Taizhou University, Taizhou, Zhejiang, China
| | - Yen-Ching Chuang
- Business College, Taizhou University, Taizhou, Zhejiang, China
- Institute of Public Health and Emergency Management, Taizhou University, Taizhou, Zhejiang, China
- Key Laboratory of Evidence-Based Radiology of Taizhou, Linhai, Zhejiang, China
- *Correspondence: Yen-Ching Chuang, ; Zhong Zhu,
| | - Zhong Zhu
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
- *Correspondence: Yen-Ching Chuang, ; Zhong Zhu,
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Derakhshani N, Maleki M, Pourasghari H, Azami-Aghdash S. The influential factors for achieving universal health coverage in Iran: a multimethod study. BMC Health Serv Res 2021; 21:724. [PMID: 34294100 PMCID: PMC8299681 DOI: 10.1186/s12913-021-06673-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/23/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The initial purpose of healthcare systems around the world is to promote and maintain the health of the population. Universal Health Coverage (UHC) is a new approach by which a healthcare system can reach its goals. World Health Organization (WHO) emphasized maximum population coverage, health service coverage, and financial protection, as three dimensions of UHC. In progress for achieving UHC, recognizing the influential factors allows us to accelerate such progress. Therefore, this study aimed to identify the influential factors to achieve UHC in Iran. METHODS This is a multi-method study was conducted in four phases: First, a systematic review of the literature was conducted to identify the factors in PubMed, Web of Science, Embase, Scopus, ProQuest, Cochrane library, and Science Direct databases, and hand searching google scholar search engine. For recognizing the unmentioned factors, a qualitative study consisting of one session of Focus Group Discussion (FGD) and five semi-structured interviews with experts was designed. The extracted factors were merged and categorized by round table discussion. Finally, the pre-categorized factors were refined and re-categorized under the health system's control knobs framework during three expert panel sessions. RESULTS Finally, 33 studies were included. Eight hundred two factors were extracted through systematic review and 96 factors through FGD and interviews (totally, 898). After refining them by the experts' panel, 105 factors were categorized within the control knob framework (financing 19, payment system7, Organization 23, regulation and supervision 33, Behavior 11, and Others 12). The majority of the identified factors were related to the "regulation and supervision" dimension, whilst the "payment system" entailed the fewest. The political commitment during political turmoil, excessive attention to the treatment, referral system, paying out of pocket(OOP) and protection against high costs, economic growth, sanctions, conflict of interests, weakness of the information system, prioritization of services, health system fragmented, lack of managerial support and lack of standard benefits packages were identified as the leading factors on the way to UHC. CONCLUSION Considering the distinctive role of the context in policymaking, the identification of the factors affecting UHC accompanying by the countries' experiences about UHC, can boost our speed toward it. Moreover, adopting a long-term plan toward UHC based on these factors and the robust implementation of it pave the way for Iran to achieve better outcomes comparing to their efforts.
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Affiliation(s)
- Naser Derakhshani
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Pourasghari
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Derakhshani N, Doshmangir L, Ahmadi A, Fakhri A, Sadeghi-Bazargani H, Gordeev VS. Monitoring Process Barriers and Enablers Towards Universal Health Coverage Within the Sustainable Development Goals: A Systematic Review and Content Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:459-472. [PMID: 32922051 PMCID: PMC7457838 DOI: 10.2147/ceor.s254946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/16/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study builds on previous successes of using tracer indicators in tracking progress towards Universal Health Coverage (UHC) and complements them by offering a more detailed tool that would allow us to identify potential process barriers and enablers towards such progress. PURPOSE This tool was designed accounting for possibly available data in low- and middle-income counties. METHODOLOGY A systematic review of relevant studies was carried out using PubMed, ISI Web of Science, Embase, Scopus, and ProQuest databases with no time restriction. The search was complemented by a scoping review of grey literature, using the World Bank and the World Health Organization (WHO) official reports depositories. Next, an inductive content analysis identified determinants influencing the progress towards UHC and its relevant indicators. The conceptual proximity between indicators and categorized themes was explored through three focus group discussion with 18 experts in UHC. Finally, a comprehensive list of indicators was converted into an assessment tool and refined following three consecutive expert panel discussions and two rounds of email surveys. RESULTS A total of 416 themes (including indicators and determinants factors) were extracted from 166 eligible articles and documents. Based on conceptual proximity, the number of factors was reduced to 119. These were grouped into eight domains: social infrastructure and social sustainability, financial and economic infrastructures, population health status, service delivery, coverage, stewardship/governance, and global movements. The final assessment tool included 20 identified subcategories and 88 relevant indicators. CONCLUSION Identified factors in progress towards UHC are interrelated. The developed tool can be adapted and used in whole or in part in any country. Periodical use of the tool is recommended to understand potential factors that impede or advance progress towards UHC.
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Affiliation(s)
- Naser Derakhshani
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Doshmangir
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Fakhri
- Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Vladimir Sergeevich Gordeev
- The Institute of Population Health Sciences, Queen Mary University of London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Pedersen LB, Allen T, Waldorff FB, Andersen MKK. Does accreditation affect the job satisfaction of general practitioners? A combined panel data survey and cluster randomised field experiment. Health Policy 2020; 124:849-855. [PMID: 32540210 DOI: 10.1016/j.healthpol.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/24/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
A critical question for policy makers in health care is whether external interventions have unintended consequences such as lowering professionals' job satisfaction. We investigate whether a non-monetary incentive, in the form of mandatory accreditation, affects the job satisfaction of Danish GPs. Accreditation of general practice in Denmark was introduced as a cluster randomised stepwise implementation from 2016 to 2018. We measure job satisfaction at three time points: before the randomisation took place, one year into the accreditation process and two years into the accreditation process. We use a balanced panel of GPs who have completed all three waves of the survey (n = 846) and estimate a series of random and mixed effects ordered logit models. Despite many GPs having negative attitudes towards accreditation, we find no evidence of accreditation affecting GP job satisfaction. However, there are negative associations between job satisfaction and perceiving accreditation as a tool for external control. Policy makers are therefore encouraged to carefully inform about new interventions and identify barriers to diminish pre-existing negative perceptions about the incentive.
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Affiliation(s)
- Line Bjørnskov Pedersen
- DaCHE - Danish Centre for Health Economics, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9B, 5000 Odense C, Denmark; Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9A, 5000 Odense C, Denmark.
| | - Thomas Allen
- Manchester Centre for Health Economics, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Frans Boch Waldorff
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9A, 5000 Odense C, Denmark
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Sibeoni J, Bellon-Champel L, Mousty A, Manolios E, Verneuil L, Revah-Levy A. Physicians' Perspectives About Burnout: a Systematic Review and Metasynthesis. J Gen Intern Med 2019; 34:1578-1590. [PMID: 31147982 PMCID: PMC6667539 DOI: 10.1007/s11606-019-05062-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/11/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Doctors' burnout is a major public health issue with important harmful effects on both the healthcare system and physicians' mental health. Qualitative studies are relevant in this context, focusing as they do on the views of the physicians of how they live and understand burnout in their own professional field. OBJECTIVE To explore physicians' perspectives on burnout by applying a metasynthesis approach, including a systematic literature review and analysis of the qualitative studies. DATA SOURCES Medline, PsycINFO, EMBASE, and SSCI from the earliest available date to June 2018 REVIEW METHODS: This metasynthesis follows thematic synthesis procedures. Four databases were systematically searched for qualitative studies reporting doctors' perspectives on burnout. Article quality was assessed with the Critical Appraisal Skills Program. Thematic analysis was used to identify key themes and synthesize them. RESULTS Thirty-three articles were included, covering data from more than 1589 medical doctors (68 residents and 1521 physicians). Two themes emerged from the analysis: (1) stress factors promoting burnout-ranked as organizational, then contextual and relational, and finally individual-factors and (2) protective factors, which were above all individual but also relational and organizational. CONCLUSIONS The individual and organizational levels are abundantly described in the literature, as risk factors and interventions. Our results show that doctors identify numerous organizational factors as originators of potential burnout, but envision protecting themselves individually. Relational factors, in a mediate position, should be addressed as an original axis of protection and intervention for battling doctors' burnout.
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Affiliation(s)
- Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 rue du LTC Prud'hon, 95107, Argenteuil, France. .,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, 75010, Paris, France.
| | | | - Antoine Mousty
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 rue du LTC Prud'hon, 95107, Argenteuil, France
| | - Emilie Manolios
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, 75010, Paris, France.,Service de Psychologie et Psychiatrie de Liaison et d'Urgences, Hôpital Européen Georges Pompidou AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France
| | - Laurence Verneuil
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, 75010, Paris, France
| | - Anne Revah-Levy
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 rue du LTC Prud'hon, 95107, Argenteuil, France.,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, 75010, Paris, France
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Sakarya S, Ünalan PC, Tursun N, Özen A, Kul S, Gültekin Ü. Family physicians' views on their role in the management of childhood obesity: a mixed methods study from Turkey. Eur J Gen Pract 2019; 24:229-235. [PMID: 30257121 PMCID: PMC6161596 DOI: 10.1080/13814788.2018.1503247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Childhood obesity (CO) is a high priority issue due to its serious health consequences and its rapid increase. OBJECTIVES To examine the views of primary care physicians (family physicians, FPs) in Turkey regarding their role in the management of CO and the barriers they perceive. METHODS Mixed methods approach. Data was collected in two major counties of Istanbul between February and May 2014. All Family Health Centres (FHCs) in the region were visited, and 180/284 FPs (63.4%) agreed to complete a structured questionnaire (22 questions). Of those, 48 FPs agreed to participate in in-depth interviews that were taken until saturation was 25. Quantitative data were analysed using descriptive statistics. For qualitative data, content analysis was applied to identify the themes. RESULTS Most of the FPs (93.3%) agreed that they have a role in managing CO. Almost all FPs (98.3%) agreed that for the 0-4-year-olds height and weight measures should be taken. However, only 67.6% recommended this for children aged 5-15 years. The most common barriers in the management of CO were reported as lack of time (68.9%) and FHCs not being utilized for the care of children aged 5-15 years old (53.3%) in Turkey. In-depth interviews showed that FPs tend to limit their role to identifying the problem and making the family aware of it. CONCLUSION Although FPs recognize primary healthcare as an appropriate setting for managing CO, they have concerns about being involved in the treatment.
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Affiliation(s)
- Sibel Sakarya
- a Medical Faculty, Public Health Department , Marmara University , Istanbul , Turkey
| | - Pemra C Ünalan
- b Medical Faculty, Family Medicine Department , Marmara University , Istanbul , Turkey
| | - Naz Tursun
- c Medical Faculty , Marmara University , Istanbul , Turkey
| | - Anıl Özen
- c Medical Faculty , Marmara University , Istanbul , Turkey
| | - Seda Kul
- c Medical Faculty , Marmara University , Istanbul , Turkey
| | - Ümit Gültekin
- c Medical Faculty , Marmara University , Istanbul , Turkey
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Özdemir R, Ural S, Karaçalı M. Challenges in Cancer Control Services Provided by Family Physicians in Primary Care: A Qualitative and Quantitative Study From Karabuk Province in Turkey. J Cancer Prev 2018; 23:176-182. [PMID: 30671400 PMCID: PMC6330987 DOI: 10.15430/jcp.2018.23.4.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/23/2018] [Accepted: 09/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background Family physicians (FPs) play an important role in cancer control. The aim of this study was to understand the functions of FPs in cancer control and to explore FPs’ perceptions of their own roles and the difficulties they face in cancer control in Karabuk province, Turkey. Methods The study consisted of two methodological parts. The qualitative part included a descriptive study in which data were collected from 87.5% (n=56) out of all FPs in Karabuk using a questionnaire. In the quantitative part, in-depth interviews with 15 FPs were conducted and analyzed through content analysis. Results Half of the FPs (50.0%) provided cancer prevention information for their registered people, focusing on especially smoking cessation. In the last three months, the proportion of FPs who had not invited anyone to screenings was 37.5% for the pap test, 26.8% for the mammography, 19.0% for the fecal occult blood test and 34.5% for the colonoscopy. Only 16.1% of them reported that they made home visits for cancer patients. In the qualitative part of study, the following themes were highlighted: the perceived responsibilities of FPs regarding cancer control; the effect of geographically undefined working area of FPs; the issues with coordination between FPs and specialists; the effect of the number of primary care team members. Conclusions Cancer control services provided by FPs have significant problems in terms of the FPs’ approach to the services and their content, continuity and coordination.
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Affiliation(s)
- Raziye Özdemir
- Department of Occupational Health and Safety, Karabuk University Faculty of Health Sciences, Demir Çelik Campus, Karabuk, Turkey
| | - Sevda Ural
- Department of Nursing, Karabuk University Faculty of Health Sciences, Demir Çelik Campus, Karabuk, Turkey
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Cevik C, Kilic B. Change from health center to family physician period in the Turkish health system: A qualitative study. Int J Health Plann Manage 2018; 33:e1022-e1036. [PMID: 30074648 DOI: 10.1002/hpm.2580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/20/2017] [Accepted: 06/29/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Health care reforms in Turkey have been implemented resolutely in the last 12 years. The shift from health center (HC) to a family physician (FP) approach is 1 of the basic interventions of these reforms. The goal of the current study is to evaluate opinions of patients, health care workers, and managers, using qualitative methods. METHODS In-depth interviews were conducted with patients who received health care services in both the FP and the HC periods, and with health care workers and managers in health care facilities that served in both periods. The interviews were recorded after obtaining permission, and then transcribed. Both health care staff that worked in the 2 periods and the patients that received health care services in the 2 periods reported that FP system was superior to HC system in attention showed by the family physicians, being followed by the same physician, and having confidence in physicians. RESULTS The current FP period is superior to HC in facilities such as patient records, computer, internet, and phone. The strengths of HC period include home visits, environmental health studies, and family planning services. According to health care workers who worked in the 2 periods, HC was superior to FP in team spirit, public service delivery, and surveillance of communicable diseases. CONCLUSION Public service delivery and environmental health studies and primary care practice in rural areas must be scrutinized in the context of the FP approach.
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Affiliation(s)
- Celalettin Cevik
- Department of Nursing, Faculty of Health Sciences, Balikesir University, Turkey
| | - Bulent Kilic
- Department of Public Health, Dokuz Eylul University Medical Faculty, Izmir, Turkey
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Bayraktar Ekincioğlu A, Demirkan K. Opinions of Community Pharmacists About Collaboration with General Practitioners: A Descriptive Pilot Study After New Legislation in Turkey. Turk J Pharm Sci 2018; 15:212-218. [PMID: 32454663 DOI: 10.4274/tjps.55376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/17/2017] [Indexed: 12/01/2022]
Abstract
Objectives Committed legal regulations in primary healthcare services have resulted in certain issues and requirements about community pharmacy practices in Turkey. A professional collaboration between general practitioners and pharmacists is essential for the continuity of care in primary care settings. Therefore, the aim of this was study to explore community pharmacists' opinions on collaborative care along with new primary care regulations. Materials and Methods A web-based questionnaire was implemented during a period of five months to a voluntary sample of community pharmacists. The questionnaire consisted of multiple-choice questions that allowed participants to select more than one answer wherever appropriate. Results One hundred ninety-seven community pharmacists responded to the questionnaire; 66% were younger than 39 years and had less than 15 years' experience in the profession. In general, the pharmacists are willing to be involved in maintaining continuity of care, especially in patient counselling. However, 10.7% of participants indicated that the main reasons for not being actively involved in patient care were 'mainly dealing with explaining prescription co-payment procedures' and 'having unfavorable attitudes of other healthcare professionals'. They believed that their contributions were restricted by laws and regulations (14.2%) as well as declined perceived reputation (53.8%) of the profession among the public. Conclusion Revealing misperceptions among patients and healthcare professionals, overcoming limitations of current practice and an understanding of each profession's responsibilities may lead to formation of a new and more effective model of care.
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Affiliation(s)
| | - Kutay Demirkan
- Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkey
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Zhang P, Liang Y. China's National Health Guiding Principles: a perspective worthy of healthcare reform. Prim Health Care Res Dev 2018; 19:99-104. [PMID: 28724463 PMCID: PMC6452970 DOI: 10.1017/s1463423617000421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 05/16/2017] [Accepted: 06/25/2017] [Indexed: 11/06/2022] Open
Abstract
For countries faced with much talk but little action on healthcare reform, China's National Health Guiding Principles (CNHGP), with its 60-year history, may provide a new perspective. There are four values of CNHGP for healthcare reform. First, these principles provide an innovative strategic framework for healthcare reform with three levels, from 'One priority population' to 'Four approaches' and then to 'Two aims.' The second is the importance of mass/grassroots participation, which runs through all three levels of CNHGP. The third value is that the CNHGP used nonspecific social approaches, an innovation in healthcare delivery that addressed the social determinants of health. The fourth value is the integration between Chinese traditional medicine and Western medicine.
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Affiliation(s)
- Ping Zhang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Cevik C, Sozmen K, Kilic B. How primary care reforms influenced health indicators in Manisa district in Turkey: Lessons for general practitioners. Eur J Gen Pract 2017; 24:74-83. [PMID: 29243549 PMCID: PMC5795632 DOI: 10.1080/13814788.2017.1410538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Turkish health reforms began in 2003 and brought some significant changes in primary care services. Few studies in Turkey compare the shift from health centres (HC) to family physicians (FP) approach, which was initiated by reforms. Objectives: This study compares health status indicators during the HC period before reforms (2003–2007) and the FP period after reforms (2008–2012) in Turkey. Methods: This study encompasses time series data consisting of the results of a 10-year assessment (2003–2012) in Manisa district. All the data were obtained electronically and by month. The intersection points of the regression curves of these two periods and the beta coefficients were compared using segmented linear regression analysis. Results: The mean number of follow-up per person/year during the HC period in infants (10.5), pregnant women (6.6) and women (1.8) was significantly higher than the mean number of follow-up during the FP period in infants (6.7), pregnant women (5.6) and women (0.9). Rates of BCG and measles vaccinations were significantly higher during the FP period; however, rates of HBV and DPT were same. The mean number of outpatient services per person/year during the FP period (3.3) was significantly higher than HC period (2.8). Within non-communicable diseases, no difference was detected for hypertension prevalence. Within communicable diseases, there was no difference for rabies suspected bites but acute haemorrhagic gastroenteritis significantly decreased. The infant mortality rate and under five-year child mortality rate significantly increased during the FP period. Conclusion: Primary care services should be reorganized and integrated with public health services.
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Affiliation(s)
- Celalettin Cevik
- a Department of Nursing , School of Health, Balikesir University , Balikesir , Turkey
| | - Kaan Sozmen
- b Department of Public Health , Katip Celebi University Medical Faculty , Izmir , Turkey
| | - Bulent Kilic
- c Department of Public Health , Dokuz Eylul University Medical Faculty , Izmir , Turkey
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Akman M, Sakarya S, Sargın M, Ünlüoğlu İ, Eğici MT, Boerma WGW, Schäfer WLA. Changes in primary care provision in Turkey: A comparison of 1993 and 2012. Health Policy 2016; 121:197-206. [PMID: 27932252 DOI: 10.1016/j.healthpol.2016.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/21/2016] [Accepted: 11/20/2016] [Indexed: 11/19/2022]
Abstract
Since the early 1990s, the primary care system in Turkey has undergone fundamental changes. In the first decade of the millennium family doctor scheme was introduced to the Turkish primary care sector and the name of the primary care doctors (PCDs) changed from "general practitioner" (GP) to "family doctor" (FD). This study aims to give an insight into those changes and to compare the service profiles of PCDs in 1993 and 2012. Data, based on cross sectional surveys among Turkish doctors working in primary care are derived from the 1993 European GP Task Profile study (n=199) and the 2012 Quality and Costs of Primary Care in Europe (QUALICOPC) study (n=299). The study focuses on the changes in the primary care service provision based on selected aspects such as the first contact of care, preventive care, and the knowledge exchange and collaboration with other health professionals. Compared to GPs in 1993, FDs in 2012 reported that their involvement in treatment of chronic diseases, first contact care, antenatal and child health care have increased. FDs have more contact with other primary healthcare workers but their contact with hospital consultants have decreased. Overall, the services provided by PCDs seem to be expanded. However, the quality of care given by FDs and its effects on health indicators are needed to be explored by further studies.
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Affiliation(s)
- Mehmet Akman
- Marmara University School of Medicine, Family Medicine Department, Istanbul, Turkey.
| | - Sibel Sakarya
- Marmara University School of Medicine, Public Health Department, Istanbul, Turkey
| | - Mehmet Sargın
- Medeniyet University Medical Faculty, Family Medicine Department, Istanbul, Turkey
| | - İlhami Ünlüoğlu
- Eskişehir Osmangazi University Medical Faculty, Family Medicine Department, Eskisehir, Turkey
| | - Memet Taşkın Eğici
- Şişli Hamidiye Etfal Research and Education Hospital, Family Medicine Clinic, Istanbul, Turkey
| | - Wienke G W Boerma
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, Netherlands
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