RESUMO
In low-income settings resource constraints force clinicians to make harsh choices. We examine the criteria Ethiopian physicians use in their bedside rationing decisions through a national survey at 49 public hospitals in Ethiopia. Substantial variation in weight given to different criteria were reported by the 587 participating physicians (response rate 91.7%). Young age, primary prevention, or the patient being the family's economic provider increased likelihood of offering treatment to a patient, while small expected benefit or low chance of success diminished likelihood. More than 50% of responding physicians were indifferent to patient's position in society, unhealthy behavior, and residence, while they varied widely in weight they gave to patient's poverty, ability to work, and old age. While the majority of Ethiopian physicians reported allocation of resources that was compatible with national priorities, more contested criteria were also frequently reported. This might affect distributional justice and equity in health care access.
Assuntos
Tomada de Decisão Clínica/ética , Alocação de Recursos para a Atenção à Saúde , Médicos/psicologia , Pobreza/ética , Adulto , Fatores Etários , Estudos Transversais , Cultura , Emprego , Etiópia , Feminino , Hospitais Públicos/ética , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: While healthcare reform has been a central attention for local governments, its impact on job satisfaction is poorly understood. This study aimed to determine the impact of healthcare reform on job satisfaction in the public healthcare sector in Ethiopia. METHODS: The study was designed as a facility-based cross-sectional survey of healthcare professionals and carried out in all public hospitals in central Ethiopia which have been implementing healthcare reform (n = 5). All healthcare professionals in the hospitals who were involved in the reform from the inception (n = 476) were purposively sourced to complete a self-administered questionnaire adapted from a framework proposed for measuring job satisfaction of health professionals in sub-Saharan Africa. Kaiser-Meyer-Olkin and Bartlett's tests were conducted to measure sampling adequacy and sphericity for factor analysis. Likert's transformation formula was used to numerically analyse the satisfaction level of the respondents and to determine the cut-off value of satisfaction levels. Non-parametric and multiple logistic regression analysis were conducted to determine predictors of job satisfaction. RESULTS: A total of 410 healthcare professionals completed the survey, representing an 88% response rate. The median and mean job satisfaction scores were 50 and 49, respectively, on a scale 1-100, which was equivalent to 'Job dissatisfied' on the Likert scale. Only 25% of respondents perceived job satisfaction due to implementation of the reform. Moral satisfaction (adjusted odds ratio (aOR), 177.65; 95% confidence interval (CI), 59.54-530.08), management style (aOR, 4.02; 95% CI, 1.49-10.83), workload (aOR, 2.42; 95% CI, 0.93-6.34), and task (aOR, 5.49; 95% CI, 2.31-13.07) were the most significant predictors. Job satisfaction results were significantly different among the study hospitals (χ 2 = 30.56, p < .001). CONCLUSIONS: The healthcare reform significantly and negatively influences public healthcare professionals' job satisfaction and its overall impact on job satisfaction was poor, which would hinder the 'Health Sector Transformation' movement of Ethiopia. Healthcare reform efforts are contingent on job satisfaction of healthcare professionals, and such efforts should balance the demand and supply of both patients and providers for improved healthcare outcomes.
Assuntos
Atitude do Pessoal de Saúde , Reforma dos Serviços de Saúde , Pessoal de Saúde , Hospitais Públicos , Satisfação no Emprego , Setor Público , Adulto , Estudos Transversais , Emprego , Etiópia , Feminino , Setor de Assistência à Saúde , Serviços de Saúde , Hospitais Públicos/ética , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Assistência ao Paciente , Inquéritos e Questionários , Trabalho , Recursos Humanos , Local de Trabalho , Adulto JovemRESUMO
BACKGROUND: The aim of this article is to identify the current state of hospital bioethics committees and local research ethics committees of the Mexican Institute of Social Security (IMSS). METHODS: A descriptive cross-sectional study was performed that included all hospitals of the IMSS (N = 262). Two self-administered questionnaires were e-mailed between october and november 2014 to the hospital directors: one for hospital bioethics committees and another for local research ethics committees. Both questionnaires had five sections: committee location, date of committee set up, activity situation, composition, functions, and experience. RESULTS: The response rate was 85 %. It was reported 150 active hospital bioethics committees and 67 active local research ethics committees. In both groups physicians and executive directors dominated committees' membership, and lay people were reported only in seven hospital bioethics committees. The primary function of hospital bioethics committees was case consultation, and their primary goal "to improve the quality of medical care". Local Research Ethics Committees reported as primary function "to evaluate health research protocols and rule of them", and as their primary goal "to protect the rights and wellbeing of the research subjects". CONCLUSIONS: Both groups of committees ought to be assessed regularly through audit cycles in order to identify the educative actions that enhance their efficiency.
Introducción: el objetivo es examinar la situación actual de los comités hospitalarios de bioética (CHB) y de los comités locales de investigación y ética en investigación en salud (CLIEIS) del Instituto Mexicano del Seguro Social (IMSS). Métodos: estudio cuantitativo, transversal descriptivo, realizado entre octubre y noviembre de 2014. Se enviaron por correo electrónico dos cuestionarios, autoadministrados o de autorreporte, a todos los hospitales del IMSS (N = 262): uno para los CHB y otro para los CLIEIS. Cinco apartados contenían ambos cuestionarios: localización del comité, fecha en la que fue constituido, estado actual de actividad, composición, funciones y experiencia. Resultados: la tasa de respuesta fue de 85 %. Se identificaron 150 CHB activos y 67 CLIEIS activos. En ambos grupos predominó la profesión médica y el personal directivo entre sus integrantes. Los representantes de la ciudadanía sólo fueron reportados en siete CHB. La función primaria reportada por los CHB fue la consultiva, y su meta primaria: "mejorar la calidad de la atención médica". Los CLIEIS señalaron como función primaria: "evaluar y dictaminar protocolos de investigación en salud" y dentro de sus metas el "proteger los derechos y el bienestar de los sujetos de investigación". Conclusiones: ambos grupos de comités debieran ser evaluados regularmente a través de ciclos de auditoría con el propósito de identificar las acciones educativas que promuevan su eficiencia.
Assuntos
Comissão de Ética/organização & administração , Hospitais Públicos/ética , Academias e Institutos , Membro de Comitê , Estudos Transversais , Comissão de Ética/estatística & dados numéricos , Feminino , Hospitais Públicos/organização & administração , Humanos , Masculino , México , Previdência Social , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The interaction between physicians and the pharmaceutical industry influences physicians' attitudes and prescribing behavior. Although largely studied in the US, this topic has not been well studied in resource-poor settings, where a close relationship between physicians and industry still exists. OBJECTIVE: To describe physician interactions with and attitudes towards the pharmaceutical industry in a public general hospital in Lima, Peru. DESIGN: Descriptive, cross-sectional study through an anonymous, self-filled questionnaire distributed among faculty and trainee physicians of five different clinical departments working in a Peruvian public general hospital. A transcultural validation of an existing Spanish questionnaire was performed. Exposure to marketing activities, motivations to contact pharmaceutical representatives and attitudes towards industry were studied. Collected data was analyzed by degree of training, clinical department, gender and teaching status. Attitudes were measured on a four-point LIKERT scale. RESULTS: 155 physicians completed the survey, of which 148 were included in the study sample. 94.5% of attending physicians reported ongoing encounters with pharmaceutical representatives. The most common industry-related activities were receiving medical samples (91.2%), promotional material (87.8%) and attending meetings in restaurants (81.8%). Respondents considered medical samples and continuing medical education the most ethically acceptable benefits. We found significant differences between attendings and residents, and teaching and non-teaching attendings. An association between the amount of encounters with pharmaceutical representatives, and attitudes towards industry and acceptance of medical samples was found. CONCLUSIONS: A close physician-industry relationship exists in the population under study. The contact is established mainly through pharmaceutical representatives. Medical samples are the most received and ethically accepted benefit. The attitudes of physicians on the ethical standards of acceptance of medical samples and other benefits are closely related with their exposure to the pharmaceutical industry. Future studies could explore the motivations of physicians working in resource-poor settings to maintain a close relationship with industry.
Assuntos
Atitude do Pessoal de Saúde , Ética Médica , Hospitais Públicos/ética , Relações Interprofissionais/ética , Médicos/ética , Padrões de Prática Médica/ética , Adulto , Conflito de Interesses , Estudos Transversais , Indústria Farmacêutica/economia , Indústria Farmacêutica/ética , Feminino , Doações/ética , Hospitais Gerais , Humanos , Masculino , Marketing/ética , Pessoa de Meia-Idade , Peru , Médicos/economia , Padrões de Prática Médica/economia , Inquéritos e QuestionáriosAssuntos
Clínicas Odontológicas/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Hospitais Públicos/organização & administração , Triagem/organização & administração , Clínicas Odontológicas/ética , Emergências , Acessibilidade aos Serviços de Saúde/ética , Necessidades e Demandas de Serviços de Saúde , Hospitais Públicos/ética , Humanos , Austrália do Sul , Fatores de Tempo , Odontalgia/terapiaRESUMO
BACKGROUND: SHARAP (the Hebrew acronym for private medical service) is an arrangement that allows patients in certain Israeli hospitals to choose their physicians in return for a fee paid, either privately or through some form of parallel insurance. At present, SHARAP is legally precluded from government hospitals but the issue is a source of public debate and the introduction of SHARAP into public hospitals owned by the government and health funds is supported by the Israel Medical Association and MK Yakov Litzman. While advantages to patients, hospitals and medical practitioners are acknowledged, these arrangements carry moral risks related to justice and fair allocation of resources, problems relating to conflicts of interests, the potential for exploitation of patients by physicians with private privileges and the potential for corrupt behaviors. AIM: To address the questions: Do the advantages of these arrangements justify the moral risks involved in the introduction of private medicine into public hospitals? Secondly, can these moral risks be mitigated through regulation without undermining the advantages accrued? METHOD: Ethical and public health policy evaluation based on empiric data and international experience. RESULTS: The potential advantages to patients, providers, hospitals and government of a SHARAP program in public hospitals may be undermined if the implementation does not incorporate regulatory structures. Appropriate regulatory precautions may mitigate most of these concerns adequately to allow all parties to enjoy benefits whilst diminishing actual harm incurred though injustice, conflicts of interest and exploitation.
Assuntos
Política de Saúde , Hospitais Públicos/organização & administração , Corpo Clínico Hospitalar/organização & administração , Conflito de Interesses/legislação & jurisprudência , Hospitais Públicos/ética , Hospitais Públicos/legislação & jurisprudência , Humanos , Israel , Privilégios do Corpo Clínico/ética , Privilégios do Corpo Clínico/legislação & jurisprudência , Privilégios do Corpo Clínico/organização & administração , Corpo Clínico Hospitalar/ética , Corpo Clínico Hospitalar/legislação & jurisprudênciaRESUMO
AIM: To investigate similarities and differences in the perception of hospital ethical practices using different seniority of doctors, nurses and administrators, and between these healthcare professionals (HCPs). IMPORTANCE: Intra- and inter-professional similarities and differences had implications for HCPs' morale, hospital ethics climate and quality of patient care. METHOD: HCPs (n = 1.910) with different levels of seniority in 14 Hong Kong public hospitals were randomly surveyed between November 2004 and April 2005. RESULTS: Intra-professional differences in perception between senior and junior doctors or nurses were found in nine ethical themes including: quality of care, patient satisfaction, disagreements among HCPs and between HCPs and patient family, end-of-life care, professional incompetence and misconducts and communication. Inter-professional similarities in perception were also found among different HCPs in senior positions and as a group they differ from the perceptions of junior HCPs. CONCLUSIONS: Significant intra-professional and inter-professional polarizations of perception of ethical practices between senior and junior HCPs were found and they potentially undermine the trusting relationships between HCPs. IMPLICATIONS: As nursing managers were found to align with senior doctors and administrators, junior nurses might feel unsupported, isolated and frustrated, creating a nursing management challenge that must be faced.
Assuntos
Ética em Enfermagem , Hospitais Públicos/ética , Cultura Organizacional , Relações Médico-Enfermeiro , Percepção Social , Análise de Variância , Competência Clínica , Intervalos de Confiança , Pesquisas sobre Atenção à Saúde , Hong Kong , Hospitais Públicos/organização & administração , Humanos , Relações Interprofissionais , Satisfação no Emprego , Qualidade da Assistência à Saúde , Estatística como Assunto , Inquéritos e QuestionáriosRESUMO
The relationship between the health care professional and the patient is universally seen, in medicine, as the core of medical practice. Through it, the doctor acquires professional abilities and pursues the objectives of medicine, among them, that of curing. This relation is contextualized here by using articles 47 and 48, from the chapter on Human Rights, found in the Code of Ethical Medicine of the Federal Council of Medicine of the Federative Republic of Brazil--both in the sense of the transformational link between two people, and as a relationship of interpersonal tolerance. The objectives of this article are: 1) to evaluate the asymmetry present in the clinical doctor-patient encounter, with respect to the doctor's social and political commitment regarding the patient. Recorded testimonies were used, of individuals who utilize medical assistance in Public Hospitals, carried out in the hallways of the 'das Clínicas Hospital' in Recife, Pernambuco; and 2) to weave an analogy with the book "Masters and Slaves" ('Casa Grande & Senzala'): 'Formation of the Brazilian Family under the Regime of a Patriarchal Economy', written by the Pernambucan sociologist Gilberto Freyre. Among the recorded talks, the resentment regarding discrimination and the authority of the doctor's position can be clearly observed. As a result, this power relation was considered the focus of our discussion--the same power relation as that which reigned over the Brazilian colonization period, in the times of "Masters and Slaves" (Casa Grande & Senzala).
Assuntos
Hospitais Públicos/ética , Corpo Clínico Hospitalar/ética , Paternalismo/ética , Direitos do Paciente/ética , Relações Médico-Paciente/ética , Poder Psicológico , Atitude Frente a Saúde , Autoritarismo , Brasil , Colonialismo , Barreiras de Comunicação , Análise Ética , Humanos , Papel do Médico , Ética Baseada em Princípios , Justiça Social/ética , Problemas Sociais/ética , Valores SociaisAssuntos
Tratamento de Emergência/economia , Emigração e Imigração , Hospitais Públicos/economia , Política Organizacional , Cuidado Pré-Natal , Tratamento de Emergência/estatística & dados numéricos , Emigração e Imigração/legislação & jurisprudência , Emigração e Imigração/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde , Hispânico ou Latino , Hospitais Públicos/ética , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Medicaid , Pessoas sem Cobertura de Seguro de Saúde , México/etnologia , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Recusa em Tratar , Texas , Estados UnidosRESUMO
Controlling for market and organizational characteristics, Catholic hospitals in 2001 offered more stigmatized and compassionate care services than investor-owned hospitals, and more stigmatized services than public hospitals. There were no differences between Catholic hospitals and other nonprofit hospitals, however, in the number of compassionate, stigmatized, and access services offered. This may reflect growing isomorphism in the nonprofit hospital sector.
Assuntos
Catolicismo , Hospitais Religiosos/organização & administração , Propriedade/classificação , Qualidade da Assistência à Saúde/tendências , Populações Vulneráveis , Empatia , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde , Hospitais com Fins Lucrativos/ética , Hospitais Públicos/ética , Hospitais Religiosos/ética , Hospitais Religiosos/estatística & dados numéricos , Hospitais Filantrópicos/ética , Humanos , Sistemas Multi-Institucionais/ética , Sistemas Multi-Institucionais/organização & administração , Objetivos Organizacionais , Distribuição de Poisson , Religião e Medicina , Justiça Social , EstereotipagemRESUMO
AIMS AND OBJECTIVES: Observational methods as part of a qualitative approach have been specifically employed in the study of drug error and have undeniable strengths. This position paper will examine some recent research raising a number of ethical, and tangentially, methodological issues concerning the qualitative study of drug errors within United Kingdom National Health Service hospitals. Reflections on the views and ethical conduct of other qualitative researchers are provided to contextualize the discussion. BACKGROUND: The impact of a drug error, and any resultant adverse event can be significant. The human and financial costs are considerable. Establishing an accurate estimation of the frequency of adverse event and reporting rates has been difficult; additionally, methodological weaknesses in medical error research have sometimes caused further difficulties. Unsurprisingly, observational studies and for that matter, a whole range of other methods are now being considered in the quest to establish both understanding and predictability in relation to medical error. RELEVANCE TO CLINICAL PRACTICE: It is argued here that any participants in medical error research should be treated in a way that takes account of the prevailing culture of health care and, in the United Kingdom, the current ethos of government policy on medical error. This requires gaining informed consent, promoting transparency in method, and providing the opportunity for participants to learn. Effective error researchers can clearly increase the available knowledge in this critical area but ethical considerations and their chosen methods should show an appropriate level of respect for their participants. Carefully implemented qualitative approaches can help realize such respect.
Assuntos
Ética em Pesquisa , Hospitais Públicos/ética , Erros de Medicação , Pesquisa Qualitativa , Ética em Enfermagem , Hospitais Públicos/organização & administração , Hospitais Públicos/normas , Humanos , Erros de Medicação/enfermagem , Pesquisa Metodológica em Enfermagem/ética , Cultura Organizacional , Gestão de Riscos , Medicina Estatal/ética , Reino UnidoAssuntos
Proposta de Concorrência/legislação & jurisprudência , Doações/ética , Serviço Hospitalar de Compras/legislação & jurisprudência , Proposta de Concorrência/ética , Ética Institucional , Sistemas de Informação Hospitalar/economia , Hospitais Públicos/economia , Hospitais Públicos/ética , Hospitais Públicos/legislação & jurisprudência , New York , Serviço Hospitalar de Compras/éticaAssuntos
Administração Financeira de Hospitais/economia , Hospitais Públicos/economia , Médicos/economia , Cuidados de Saúde não Remunerados/ética , Hospitais Públicos/ética , Seguro Saúde/economia , Pessoas sem Cobertura de Seguro de Saúde , Serviço de Farmácia Hospitalar/economia , Médicos/ética , Trombose/prevenção & controle , Cuidados de Saúde não Remunerados/economia , Varfarina/administração & dosagem , Varfarina/economia , Carga de Trabalho/economiaRESUMO
Ethical issues have always played a significant role in healthcare. Today, their relevance is even more critical as healthcare organizations contemplate the potential of public-private partnerships to bring private sector efficiency into the public healthcare system.
Assuntos
Atenção à Saúde/ética , Hospitais com Fins Lucrativos/ética , Hospitais Públicos/ética , Relações Interinstitucionais , Cuidados de Saúde não Remunerados/ética , Canadá , Comportamento Cooperativo , Acessibilidade aos Serviços de Saúde/ética , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Planos de Incentivos Médicos/ética , Formulação de Políticas , Setor Privado , Setor Público , Responsabilidade SocialRESUMO
Visiting, honorary and staff medical practitioners, to name but a few, provide medical treatment and services to a variety of "patients", including private, public, in-patients and out-patients. The legal implications arising from the often complex fact situations created by the interactions of these participants and the relationship between hospitals and these participants can lead to hospitals both incurring and avoiding liability for injuries sustained by patients from negligent medical treatment. This article discusses the legal principles governing hospitals' liabilities in this context on the more onerous non-delegable duty of care ground.
Assuntos
Relações Hospital-Paciente , Hospitais Privados/legislação & jurisprudência , Hospitais Públicos/legislação & jurisprudência , Obrigações Morais , Assistência ao Paciente/normas , Austrália , Serviços Contratados/ética , Serviços Contratados/legislação & jurisprudência , Emprego/ética , Emprego/legislação & jurisprudência , Hospitais Privados/ética , Hospitais Públicos/ética , Humanos , Responsabilidade Legal , Corpo Clínico Hospitalar/ética , Corpo Clínico Hospitalar/legislação & jurisprudência , Assistência ao Paciente/ética , Relações Médico-Paciente/éticaRESUMO
Among the major forms of corporate ownership, the not-for-profit ownership form is distinct in its behavior, legal constraints, and moral obligations. A new empirical analysis of the American Hospital industry, using eleven years of data for all urban general hospitals in the country, shows that corporate form accounts for large differences in the provision of specific medical services. Not-for-profit hospitals systematically provide both private and public goods that are in the public interest, and that other forms fail to provide. Two hypotheses are proposed to account for the findings, one legal and one moral. While no causal claims are made, not-for-profit hospital behavior is consistent with the behavior required by law and morality. The moral argument, developed as a preliminary theory of not-for-profit ethics, also provides a potential reason to prefer not-for-profit hospitals. The findings provide a new justification for the not-for-profit tax exemption for hospitals, and also suggest new uses for ownership categories as regulatory tools.