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1.
Health Care Manage Rev ; 46(2): 135-144, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33630505

RESUMO

BACKGROUND: Critical access hospitals (CAHs) are small hospitals in rural communities in the United States. Because of changes in rural population demographics, legacy financial obligations, and/or structural issues in the U.S. health care system, many of these institutions are financially distressed. Indeed, many have closed due to their inability to maintain financial viability, resulting in a health care and economic crisis for their communities. Employee recruitment, retention, and turnover are critical to the performance of these hospitals. There is limited empirical study of the factors that influence turnover in such institutions. PURPOSE: The primary purpose of the study was to study relationships between interpersonal support, supervisory support, employee engagement, and employee turnover intentions in CAHs. A secondary purpose was to study how financial distress affects these relationships. METHODOLOGY: Based on a survey of CAH employees (n = 218), the article utilizes mediated moderation analysis of a structural equation model. RESULTS: Interpersonal support and supervisory support are positively associated with employee engagement, whereas employee engagement mediates the relationships between both interpersonal support and supervisory support and employee turnover intentions. Statistically significant differences are found between these relationships in financially distressed and highly financially distressed institutions. CONCLUSIONS: Our results are consistent with the social exchange theory upon which our hypotheses and model are built and demonstrate the value of using the degree of organizational financial distress as a contextual variable when studying motivational factors influencing employee turnover intentions. PRACTICAL IMPLICATIONS: In addition to advancing management theory as applied in the CAH context, our study presents the practical insight that employee perceptions of their employer's financial condition should be considered when organizations develop employee retention strategies. Specifically, employee engagement strategies appear to be of greater value in the case of highly financially distressed organizations, whereas supervisory support seems more effective in financially distressed organizations.

2.
J Rural Health ; 2020 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-33118217

RESUMO

PURPOSE: In 2016, Georgia implemented a rural hospital tax credit program through a legislative mandate that allows individuals and corporations to donate to qualifying rural hospitals in exchange for state income tax credit. The study examines the importance, success, and challenges of the program, and opportunities for improvement, from the perspective of Georgia rural hospital executives. METHODS: The study was a qualitative study using data from key informant telephone interviews with 21 hospital executives and administrators of eligible rural hospitals. FINDINGS: Hospital executives described the program as a valuable lifeline for struggling rural hospitals and an instrument for community engagement. They provided recommendations for legislative and programmatic modifications to ensure stability, transparency, and accountability. CONCLUSION: Results highlight the popularity of the program among rural hospital leaders, but they also identify potential areas for improvement. The findings of the study can inform policy-making efforts targeted at improving the nation's rural health infrastructure.

3.
Health Mark Q ; 37(1): 10-21, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31984874

RESUMO

Effective use of social media by hospitals has the potential to improve hospitals' financial performance by facilitating customer service and providing hospitals with a low-cost marketing platform. This cross-sectional study explored the relationship between hospital Facebook engagement and patient revenue in a simple random sample of United States short-term acute care hospitals. There was a positive relationship between Facebook engagement and hospital patient revenue for rural hospitals, but not for urban hospitals. Additional research is needed to identify the mechanisms through which hospitals' social media presence influences consumer health purchasing behavior and profitability.


Assuntos
Hospitais/estatística & dados numéricos , Marketing/economia , Mídias Sociais , Estudos Transversais , Humanos , Estados Unidos
4.
Artigo em Inglês | MEDLINE | ID: mdl-31219911

RESUMO

BACKGROUND: Critical access hospitals (CAHs) are small hospitals in rural communities in the United States. Because of changes in rural population demographics, legacy financial obligations, and/or structural issues in the U.S. health care system, many of these institutions are financially distressed. Indeed, many have closed due to their inability to maintain financial viability, resulting in a health care and economic crisis for their communities. Employee recruitment, retention, and turnover are critical to the performance of these hospitals. There is limited empirical study of the factors that influence turnover in such institutions. PURPOSE: The primary purpose of the study was to study relationships between interpersonal support, supervisory support, employee engagement, and employee turnover intentions in CAHs. A secondary purpose was to study how financial distress affects these relationships. METHODOLOGY: Based on a survey of CAH employees (n = 218), the article utilizes mediated moderation analysis of a structural equation model. RESULTS: Interpersonal support and supervisory support are positively associated with employee engagement, whereas employee engagement mediates the relationships between both interpersonal support and supervisory support and employee turnover intentions. Statistically significant differences are found between these relationships in financially distressed and highly financially distressed institutions. CONCLUSIONS: Our results are consistent with the social exchange theory upon which our hypotheses and model are built and demonstrate the value of using the degree of organizational financial distress as a contextual variable when studying motivational factors influencing employee turnover intentions. PRACTICAL IMPLICATIONS: In addition to advancing management theory as applied in the CAH context, our study presents the practical insight that employee perceptions of their employer's financial condition should be considered when organizations develop employee retention strategies. Specifically, employee engagement strategies appear to be of greater value in the case of highly financially distressed organizations, whereas supervisory support seems more effective in financially distressed organizations.

5.
J Health Care Poor Underserved ; 29(4): 1438-1454, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30449756

RESUMO

Individuals with sickle cell disease (SCD) often struggle to transition from pediatric to adult-centered medical environments. One probable cause is that many transition programs do not focus on what happens when patients leave the medical environment and return to their communities. Little is known about how individuals with SCD define community. Therefore, we worked with health care providers at four rural Georgia SCD outreach clinics to conduct qualitative interviews with 21 individuals who had transitioned to adult SCD care. The biopsychosocial ecological model was the framework for the study. Findings indicated that individuals with SCD describe five aspects of community that span across the family, community, and society-levels of the biopsychosocial ecological model: 1) immediate family, friends, and social circle; 2) relationships with medical providers; 3) geographic community/neighbors; 4) church/spiritual support; and 5) society. Interventions designed to improve SCD in rural communities may be most effective if they include not only support from family but also enhanced neighborhood supports and links between adults with SCD and relevant community organizations.


Assuntos
Anemia Falciforme/psicologia , Características de Residência , População Rural , Rede Social , Transição para Assistência do Adulto , Adolescente , Adulto , Feminino , Georgia , Humanos , Entrevistas como Assunto , Masculino , Relações Profissional-Paciente , Pesquisa Qualitativa , Religião , Índice de Gravidade de Doença , Adulto Jovem
6.
Glob Public Health ; 13(5): 545-555, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-27533753

RESUMO

The World Bank estimates that at least 25 countries in the Sub-Saharan region of Africa experience chronic power outages. However, the implications of power shortages are often discussed within the context of industrial and economic disruptions, with little attention given to the health impact. Using a nationally representative data of healthcare facilities from the 2012 Ghana Access, Bottlenecks, Cost and Equity (ABCE) Health Facility Survey, this study aims to assess the impact of power outages on in-healthcare facility mortality in Ghana, a country that has experienced worsening energy crises in the last few decades. Findings revealed a positive association between the frequency of power outages and in-facility mortality, with the risk for mortality estimated to increase by 43% for each day the power was out for over 2 h. Further, when compared to an urban healthcare facility experiencing the same frequency of power outages, the risk of mortality was found to be lower in the rural facility. These findings call for a concerted effort among all stakeholders to ensure the availability of consistent power supply in healthcare facilities, in order to provide the necessary environment for the successful provision of healthcare for the citizens of Ghana.


Assuntos
Fontes de Energia Elétrica/estatística & dados numéricos , Mortalidade Hospitalar , Gana/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos
7.
J Rural Health ; 34(1): 103-108, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27273735

RESUMO

PURPOSE: Considering the high prevalence of heart failure and the economic burden of the disease, factors that influence in-hospital mortality are of importance in improving outcomes of care for this patient population. The purpose of this study was to examine the determinants of in-hospital mortality for adult heart failure patients. METHODS: The study design is a retrospective observational study design using the 2010 Nebraska Hospital Discharge data set including 4,319 hospitalizations for 3,521 heart failure patients admitted to 79 hospitals in Nebraska. Hierarchical logistic regression models including patient- and hospital-specific random intercepts were analyzed. Covariates included in the analysis were patient age in years, gender, comorbidity status, length of stay, primary payer, type and source of admission, transfers, and rurality of county of residence. RESULTS: Overall, 3.5% of heart failure patients died during their hospital stay. In logistic regression analysis that adjusted for age, sex, and comorbidities, the odds of dying in hospital for heart failure patients increased with age (OR = 1.03, 95% CI: 1.01-1.04), co-morbidity (OR = 1.15; 95% CI: 1.05-1.25) and length of stay (OR = 1.03, 95% CI: 1.01-1.05). The patient's gender, payer source, rurality of county of residence, source, and type of admission were not risk factors for in-hospital death. CONCLUSION: Increasing age, comorbidity and length of stay were risk factors for in-hospital death for heart failure. An understanding of the risk factors for in-hospital death is critical to improving outcomes of care for heart failure patients.


Assuntos
Insuficiência Cardíaca/mortalidade , Mortalidade Hospitalar/tendências , Admissão do Paciente/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/epidemiologia , Hospitalização , Humanos , Cobertura do Seguro/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Nebraska , Razão de Chances , Estudos Retrospectivos , Fatores de Risco
8.
J Behav Health Serv Res ; 45(2): 204-218, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28815375

RESUMO

This study examined disparities in emergency department (ED) wait time for patients with mental health and substance-related disorders (PwMHSDs), using data from the 2009-2011 National Hospital Ambulatory Medical Care Survey (NHAMCS). Wait time was defined as the time between arrival at ED and being seen by an ED provider. Results from multivariable regression models show racial disparities, with non-Hispanic Black PwMHSDs experiencing longer ED wait time, compared to non-Hispanic White PwMHSDs. A temporal decline in ED wait time was also observed over the study period. The findings of this study have implications for informing the development of policies tailored at facilitating the delivery of equitable emergency care services to all PwMHSDs.


Assuntos
Afro-Americanos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Listas de Espera , Adulto , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Transtornos Mentais/terapia , Saúde Mental , Pessoa de Meia-Idade , Análise de Regressão , Transtornos Relacionados ao Uso de Substâncias/terapia , Fatores de Tempo , Estados Unidos
9.
Int Health ; 9(5): 310-316, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28911126

RESUMO

Background: Despite the significant increase in the incidence of diabetes in Ghana, research in this area has been lagging. The purpose of the study was to assess the risk factors associated with diabetes in the Cape Coast metropolis of Ghana, and to describe nutritional practices and efforts toward lifestyle change. Methods: A convenient sample of 482 adults from the Cape Coast metropolis was surveyed using a self-reported questionnaire. The survey collected information on the demographic, socioeconomic characteristics, health status and routine nutritional practices of respondents. The aims of the study were addressed using multivariable regression analyses. Results: A total of 8% of respondents reported that they had been diagnosed with diabetes. Older age and body weight were found to be independently associated with diabetes. Individuals living with diabetes were no more likely than those without diabetes to have taken active steps at reducing their weight. Conclusion: The percentage of self-reported diabetes in this population was consistent with what has been reported in previous studies in Ghana. The findings from this study highlight the need for more patient education on physical activity and weight management.


Assuntos
Diabetes Mellitus/epidemiologia , Dieta/psicologia , Estilo de Vida , Adolescente , Adulto , Dieta/estatística & dados numéricos , Feminino , Gana/epidemiologia , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
10.
Alzheimer Dis Assoc Disord ; 31(3): 244-248, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28296666

RESUMO

OBJECTIVES: The aim of this study was to assess rural-urban differences and temporal trends in length of inpatient stay among patients diagnosed with Alzheimer disease and related dementia (ADRD). MATERIALS AND METHODS: The study sample comprised 27,313 ADRD and 27,313 matched non-ADRD inpatient discharges from Nebraska hospitals from 2005 to 2011. Descriptive statistics and multivariable regression models were used to assess rural-urban variations and temporal trends in length of stay (LOS). RESULTS: LOS was found to be similar for ADRD and non-ADRD-related hospitalizations. No rural-urban differences in LOS were observed for ADRD-related hospitalizations. However, there was a temporal decline in LOS for ADRD-related hospitalizations. CONCLUSIONS: LOS for ADRD-related hospitalizations was found to be influenced mostly by patient-level demographic and clinical factors. Hospital-level factors were not associated with LOS.


Assuntos
Doença de Alzheimer/epidemiologia , Doença de Alzheimer/terapia , Tempo de Internação/tendências , População Rural/tendências , População Urbana/tendências , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Arkansas/epidemiologia , Feminino , Humanos , Masculino , Fatores de Tempo
11.
J Cancer Educ ; 32(3): 556-565, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26801510

RESUMO

The purpose of this study was to examine the impact of race, cancer history, and their interaction on emotional distress among a nationally representative sample of US adults. Data utilized for this analysis were obtained from the first, second, and fourth iterations of the fourth cycle of the Health Information National Trends Survey (HINTS). The study sample included 3959, 3630, and 3677 respondents for the years 2011, 2012, and 2014, respectively, for a total sample size of 11,266. A multivariable ordered logistic regression model was used to assess the relationship between emotional distress, race, and cancer history. The effect of cancer history on emotional distress was found to be moderated by race. Specifically, emotional distress was significantly higher among African American cancer survivors. Factors found to be protective against emotional distress included healthy lifestyle, older age, and higher income. Factors associated with high levels of emotional distress included poor general health status, low self-efficacy, and being female. The authors recommend the design, advancement, and implementation of evidence-based culturally sensitive interventions aimed at effectively screening and managing psychological distress symptoms, particularly among African American long-term cancer survivor patient populations.


Assuntos
Afro-Americanos/estatística & dados numéricos , Sobreviventes de Câncer/psicologia , Disparidades nos Níveis de Saúde , Neoplasias/etnologia , Afro-Americanos/psicologia , Emoções , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Estresse Psicológico , Estados Unidos
13.
Am J Hosp Palliat Care ; 33(10): 996-1012, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26518351

RESUMO

Hospice care is coordinated through an interdisciplinary team (IDT), which assures that a holistic care plan based on the patient's wishes is implemented. The extent to which an IDT provides quality care may be associated with how effectively they communicate within the team as well as with patients, caregivers, and families. This review seeks to characterize communication strategies among hospice IDT members and to determine how such strategies impact patient care. Although the existing literature sheds some light on communication within hospice IDTs, further research is needed. Inquiry into the communicative process of IDTs in settings other than team meetings, such as during patient visits or informal settings, would provide a more comprehensive representation of how communication influences IDT dynamics and overall team functioning.


Assuntos
Comunicação , Cuidados Paliativos na Terminalidade da Vida/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Comportamento Cooperativo , Processos Grupais , Humanos , Qualidade da Assistência à Saúde/organização & administração
14.
J Cancer Educ ; 31(3): 554-8, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-25900672

RESUMO

Although lung cancer is the leading cause of cancer death in the USA, there have been few studies on patient-centered advanced lung cancer treatment practices. As part of a larger research study on how to use a patient-inclusive approach in late-stage lung cancer treatment, this present study describes patient, caregiver, and provider perspectives on the role of the health care system in helping patients cope with an advanced stage lung cancer diagnosis. Four focus group sessions were conducted with six to eleven participants per group for a total of 36 participants. Two focus groups were held with patients and family members/caregivers and two with physicians and nurses. A major theme that emerged concerned coping with an advanced lung cancer diagnosis, which is the subject of this paper. The patients, caregivers, and providers spoke passionately about interactions with the health care system and volunteered examples of supportive and non-supportive relationships between patients and clinicians. They advocated for better patient-provider communication practices as well as the expanded use of patient navigation and new patient orientation programs. This study contributes additional knowledge by including the perspectives of caregivers and providers who live and work closely with patients with advanced lung cancer. The findings can inform the development of comprehensive patient-centered care plans for patients living with an advanced lung cancer diagnosis.


Assuntos
Cuidadores/psicologia , Tomada de Decisões , Assistência à Saúde/organização & administração , Pessoal de Saúde/psicologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/psicologia , Assistência Centrada no Paciente , Adaptação Psicológica , Comunicação , Feminino , Grupos Focais , Humanos , Neoplasias Pulmonares/terapia , Masculino , Avaliação de Resultados da Assistência ao Paciente , Relações Médico-Paciente , Inquéritos e Questionários
15.
Am J Hosp Palliat Care ; 33(3): 256-63, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25366181

RESUMO

PURPOSE: Using a longitudinal sample of freestanding Medicare-certified hospices in the 50 US states and the District of Columbia, this study sought to explore the factors associated with volunteer demand and describe how volunteer use has changed from 2000 to 2010. RESULTS: A temporal decline in the extent of use of volunteers in freestanding hospices was observed over the study period. Findings indicated that both organizational and environmental factors influence the use of volunteers in US freestanding hospices. CONCLUSION: Given the importance of volunteers, both in the preservation of hospices' philanthropic traditions and in reducing health care expenditure at the end of life, research is needed to further evaluate the factors associated with this decline. Emphasis should be placed on improving the retention of the existing hospice volunteer workforce.


Assuntos
Hospitais para Doentes Terminais/organização & administração , Hospitais para Doentes Terminais/tendências , Voluntários/estatística & dados numéricos , Meio Ambiente , Humanos , Estudos Longitudinais , Medicare , Propriedade , Características de Residência , Fatores de Tempo , Estados Unidos
16.
Front Public Health ; 3: 161, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26157789

RESUMO

INTRODUCTION: In 2012, the Great Plains Public Health Training Center (Grant #UB6HP22821) conducted an online survey of state and local health departments and the American Indian (tribal clinics, tribal health departments, and urban Indian clinic) public health workforce across three professional levels. The objectives of the needs assessment were to determine the competency levels of the state's public health workforce, assess gaps in public health competencies, identify public health training interests, needs, and preferences, and to determine the barriers and motivators to participate in public health training. METHODS: The assessment was developed using the Council on Linkages Between Academia and Public Health Practice, Core Competencies for Public Health Professionals survey (1). The final assessment was created and piloted by numerous individuals representing practice and academia. RESULTS: Respondents identified cultural competency and communication skills as the two most important public health competency domains. Although the public health professionals perceived that they were least proficient in the area of policy development and program planning, participants identified the greatest needs for training in financial planning and management skills and analytical/assessment skills. In general, respondents preferred instructor-led interactive training sessions offered as onsite multi-day workshops or computer-based courses. Respondents identified obesity, health disparities, physical activity, chronic diseases, and diabetes as the top five public health topical areas. CONCLUSION: These priorities align with State and National public health plans. The findings of the needs assessment were used to tailor educational opportunities to build the capacity of Nebraska's public health system. Additionally, the results were used to develop workforce development plans for numerous local health departments throughout Nebraska.

17.
J Rural Health ; 31(3): 300-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25693748

RESUMO

PURPOSE: There is a dearth of literature evaluating the effectiveness of programs aimed at recruiting and retaining physicians in rural Nebraska. Taking advantage of the Nebraska Health Professional Tracking System, this study attempts to comparatively assess the effectiveness of the J-1 visa waiver and state loan repayment programs in the recruitment and retention of physicians in rural Nebraska. METHODS: A mixed methods approach was used. We tracked 240 physicians who enrolled in the J-1 visa waiver and state loan repayment programs between 1996 and 2012 until 2013. In addition, key informant interviews were conducted to obtain perspectives on the recruitment and retention of physicians in rural Nebraska through the 2 programs. FINDINGS: Results from multilevel survival regression analysis indicated that physicians enrolled in the J-1 visa waiver program were more likely to leave rural Nebraska when compared with those enrolled in the state loan repayment program. Participants in the qualitative study, however, cautioned against declaring one program as superior over the other, given that the 2 programs addressed different needs for different communities. In addition, results suggested that fostering the integration of physicians and their families into rural communities might be a way of enhancing retention, regardless of program. CONCLUSION: The findings from this study highlight the complexity of recruitment and retention issues in rural Nebraska and suggest the need for more holistic and family-centered approaches to addressing these issues.


Assuntos
Médicos Graduados Estrangeiros/economia , Reorganização de Recursos Humanos/economia , Planos de Incentivos Médicos/economia , Área de Atuação Profissional/economia , Serviços de Saúde Rural/economia , Apoio ao Desenvolvimento de Recursos Humanos/economia , Atitude do Pessoal de Saúde , Feminino , Médicos Graduados Estrangeiros/estatística & dados numéricos , Humanos , Masculino , Nebraska , Reorganização de Recursos Humanos/estatística & dados numéricos , Planos de Incentivos Médicos/estatística & dados numéricos , Área de Atuação Profissional/estatística & dados numéricos , População Rural/estatística & dados numéricos , Governo Estadual , Apoio ao Desenvolvimento de Recursos Humanos/estatística & dados numéricos , Recursos Humanos
18.
Health Care Manage Rev ; 40(2): 148-58, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-24727679

RESUMO

BACKGROUND: The hospice industry has experienced rapid growth in the last decade and has become a prominent component of the U.S. health care delivery system. In recent decades, the number of hospices serving nursing facility residents has increased. However, there is paucity of research on the organizational and environmental determinants of this strategic behavior. PURPOSE: The aim of this study was to empirically identify the factors associated with the adoption of a nursing facility focus strategy in U.S. hospices. A nursing facility focus strategy was defined in this study as a strategic choice to target the provision of hospice services to skilled nursing facility or nursing home residents. METHODOLOGY/APPROACH: This study employed a longitudinal study design with lagged independent variables in answering its research questions. Data for the study's dependent variables are obtained for the years 2005-2008, whereas data for the independent variables are obtained for the years 2004-2007, representing a 1-year lag. Mixed effects regression models were used in the multivariate regression analyses. FINDINGS: Using a resource dependence framework, the findings from this study indicate that organizational size, community wealth, competition, and ownership type are important predictors of the adoption of a nursing facility focus strategy. PRACTICE IMPLICATIONS: Hospices may be adopting a nursing facility focus strategy in response to increasing competition. The decision to focus the provision of care to nursing facility residents may be driven by the need to secure stability in referrals. Further empirical exploration of the performance implications of adopting a nursing facility focus strategy is warranted.


Assuntos
Hospitais para Doentes Terminais/organização & administração , Tamanho das Instituições de Saúde/organização & administração , Tamanho das Instituições de Saúde/estatística & dados numéricos , Hospitais para Doentes Terminais/estatística & dados numéricos , Humanos , Estudos Longitudinais , Modelos Organizacionais , Propriedade/organização & administração , Propriedade/estatística & dados numéricos , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Estados Unidos
19.
Int Health ; 6(3): 208-12, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24958784

RESUMO

BACKGROUND: A significant number of physicians from developing nations emigrate to developed nations in search of better career opportunities. In addition to crippling the health systems of developing nations, the emigration of physicians from sub-Saharan African (SSA) countries results in a loss of return on investment to these nations. The purpose of this study was to identify the relationship between career satisfaction and the intention of active Ghanaian physicians to leave the country within the next 5 years. METHODS: This study was a cross-sectional correlational study using data from a survey of practicing physicians in Ghana. The primary independent variables examined were dimensions of career satisfaction, assessed using an abridged form of the Physician Work Life Survey. RESULTS: Data from the multivariate ordered logistic regression model indicated that physicians who were house officers or medical officers and those who reported dissatisfaction with their compensation were more likely to report that they were thinking about leaving Ghana within the next 5 years. CONCLUSIONS: Health policies aimed at increasing monetary compensation and providing junior physicians with the resources needed to excel in their careers may improve the retention of physicians in Ghana.


Assuntos
Emigração e Imigração , Satisfação no Emprego , Médicos/psicologia , Adulto , Escolha da Profissão , Estudos Transversais , Feminino , Gana , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Médicos/provisão & distribução , Inquéritos e Questionários
20.
J Cancer Educ ; 29(4): 796-801, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24744120

RESUMO

Participatory and patient-centered approaches to cancer research have been highlighted as the most appropriate means of engaging patients in the conduct of clinical research. However, there is a paucity of patient-centered outcomes research (PCOR) on lung cancer. Previous studies seeking to define lung cancer treatment success have generally not included patients' and caregivers' perceptions and views in treatment decision-making. Additionally, little is known about effective strategies for the engagement of lung cancer patients in PCOR. We sought to gain insights into the perceptions of patients, caregivers, and providers on lung cancer treatment success, as well as on strategies for patient engagement in lung cancer PCOR. Four focus groups were conducted with provider, patient, and caregiver participants from four cancer centers in Nebraska and South Dakota. A total of 36 providers, patients, and caregivers participated in this study. Patients and caregivers confirmed that survival alone should not be the measure of lung cancer treatment success and that definitions of treatment success should emphasize factors such as effective clinical guidance throughout treatment, symptom management, functionality, and quality of life. Clinician participants noted that the definition of treatment success evolved over time and appeared to be linked to patients' experiences with chemotherapy. Participants identified barriers to and facilitators of research participation and suggested strategies for the recruitment and retention of research participants. Our study indicates that patients can successfully play active and engaged roles in clinical research, ranging from participant to partner. Judging from the enthusiasm of our focus group attendees, patients and caregivers want to participate and be engaged in clinical research.


Assuntos
Cuidadores , Tomada de Decisões , Pessoal de Saúde , Neoplasias Pulmonares/prevenção & controle , Avaliação de Resultados da Assistência ao Paciente , Participação do Paciente , Assistência Centrada no Paciente/métodos , Grupos Focais , Humanos , Cuidados Paliativos , Relações Médico-Paciente , Qualidade de Vida , South Dakota
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