Cahiers de sociologie et de demographie medicales最新文献

{"title":"Human resources of the health system in Republic of Bulgaria.","authors":"Velichko Adamov, Kolyo Kolev, Danail Vrachovski, Andrey Zahariev, Anastasiya Marcheva","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75662,"journal":{"name":"Cahiers de sociologie et de demographie medicales","volume":"50 1","pages":"6-120"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29029175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health care professions in Catalonia: evidence for professionalism.","authors":"Olinda Anía, Joan Escarrabill, Mateu Huguet, Tino Martí, Josep Roma","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75662,"journal":{"name":"Cahiers de sociologie et de demographie medicales","volume":"49 4","pages":"377, 380-470"},"PeriodicalIF":0.0,"publicationDate":"2009-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28879152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Circumstances and structures of medical demography].","authors":"Laure Le Saux","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75662,"journal":{"name":"Cahiers de sociologie et de demographie medicales","volume":"49 3","pages":"363-9"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28554219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The numerus clausus system of the French medical training (1967-2009)].","authors":"Bui Dang Ha Doan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Medical schools in France are all state-owned or state-controlled. Prior to the 70's, admission is open to all \"bacheliers\", i.e. the teenagers who have successfully completed their secondary schooling. For various reasons, the number of these newcomers was soaring starting the mid-60's. About 6 years later, the boom reached those who were in residency and 2-3 years later the move became a \"graduate boom\". The fears of inundation were shared by both the hospitals (as the available posts for young doctors were not sufficient) and the ambulatory care sector (where the practitioners were fearful of severe competition from the newcomers). As a matter of fact, there was a strong oversupply of young doctors but everybody thought that oversupply was general. The numerus clausus was established in 1971 and the annual number of students admitted into medical schools started to decrease in 1978, until 1999. After two decades of decrease, a clear shortage of young doctors appeared and a volte-face was decided: starting 1999, the annual number of young students admitted to medical training followed an upward trend. This number reached 7400 in October 2009, from 3400 ten years earlier. This time, a second confusion was made: the shortage of young-doctors is now understood to be a general shortage of all the medical profession. Consequently, a strong policy for increasing the numerus clausus is implemented. As things are, in 15 years from now, the health system will be again in the situation it has known in the mid-70's.</p>","PeriodicalId":75662,"journal":{"name":"Cahiers de sociologie et de demographie medicales","volume":"49 3","pages":"341-63"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28554218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Task delegation in primary care: new roles to the nursing personnel in Catalunya].","authors":"O Anía,&nbsp;L J Martí,&nbsp;M Rigal,&nbsp;M Huguet","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A model of provision of primary care is experimented in a Catalan health centre. The model implies more varied roles and greater autonomy to nurses. They are the first contact of the patients coming to the health center. They base their decisions on a Guide for interventions on emergencies. The latter are distributed into 3 groups: (i) the cases which can be dealt with and finalized by the misusing the protocols previously established; (ii) the cases which require immediate care from the nurse, later intervention from the physician and common finalization at the end; (iii) the cases which require immediate intervention from the physician and, if the physician is not available, an evaluation from the nurse in the meanwhile. On 202 patients requesting a consultation on the same day, the data below are obtained:--70% cases have been resolved by the nurse using the Guide--14% cases have been resolved by the nurse after a telephone conversation with the physician--16% have been orientated to the relevant departments. Moreover, the on duty physician has been consulted in 6% The Guide appears therefore extremely useful. However, in the long range, the need for additional training in some specific domains were emerging, and that of constant interchange between physicians and nurses as well.</p>","PeriodicalId":75662,"journal":{"name":"Cahiers de sociologie et de demographie medicales","volume":"49 2","pages":"227-44"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28406277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Task delegation scenarios at national and regional levels of the French ambulatory care sector].","authors":"Danièle Lévy,&nbsp;Jeanne Pavot,&nbsp;Bui Dang Ha Doan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The French sector of ambulatory care is characterized by two features: (i) health care providers are mostly independent practitioners paid on a fee-for-service basis; (ii) a large consensus is observed as concerns the shortage of health workers, particularly physicians and nurses. In such a context, if a task delegation programme is envisaged, attention should be paid, not only to the competencies of task receivers, but equally to the reluctance of health workforce. Given the current doctor shortage, it is probable that the reluctance of physicians is not vigorous. But on the side of task receivers (nurses, physiotherapists, other auxiliary workers...) reluctance should be taken into account. Shortage of nurses and physiotherapists (and consequently their growing workload) lowers their acceptance level (i.e., the proportion accepting task delegation) and reduces the time each accepting worker can devote to the activities delegated by physicians. The model shows that, in the current situation, French physicians can only expect a small reduction of their workload i they undertake to transfer to nurses some parts of their activities. When physician working time is not excessively lengthy, the overall reduction would be between 0.7% and 3.1%. When doctors have to work harder (when their shortage is acute), paradoxically, the reduction is lower, between 0.5% and 2.3%. The fact is easily understood as the stock of task receivers (the nurses) remains unchanged, but the volume of worked hours becomes larger. Other things being equal, the model shows that French southern physicians may take more profit from a task delegation programme than their counterparts practising in the northern areas of the country. As in the southern areas, the nurse/physician ratio is higher, the potential task receivers are in higher numbers and the volume of the tasks transferred may be much broader than in the northern areas. The paradox is that the workload of northern physicians is heavier, their ratio to population being lower. In 2013, if the acceptance level of nurses and the time each o them devotes to transferred tasks remain unchanged, the physician workload would not be reduced more significantly, even in case of strong growth of the nursing profession. In other words, to obtain a clear-cut success, any task delegation process should be accompanied by a large range of generous inancial rewards aimed at strongly motivating the task receivers to work harder, during a longer time and with enlarged responsibilities. In France, as in most industrialized countries, health expenditures are predominantly financed by public money (taxes and contributions from employees and employers) and their share in the Gross Domestic Product is growing steadily for decades. The weight of the health sector upon the national economy is already extremely heavy. Does wisdom lie in launching action programmes aimed at uncertain returns? No doubt that the issue of task delegation is a pain","PeriodicalId":75662,"journal":{"name":"Cahiers de sociologie et de demographie medicales","volume":"49 2","pages":"167-203"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28406275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Differenciated function: prospects for the nursing profession in Belgium].","authors":"M Gobert,&nbsp;G Berckmans,&nbsp;L Alvarez Irusta,&nbsp;N Bouzegta,&nbsp;T Defloor","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The hospital and medical contexts are undergoing profound change. All professions must follow this evolution, in particular, the nurse profession. The care offer and the care demand are unbalanced: the clinical situations become more complex and the staff is insufficient quantity. The function differentiation can be a solution for the nurse profession. The aim of this study is to evaluate the feasibility of the function differentiation for the nurse profession in Belgium. Based on 364 \"patient situations a derived from hospital experiences, required activities and competencies are depicted by more 200 nurses; the complexity of each competency is also evaluated by standardized scales of complexity. A cluster analysis is performed in order to pool all identified competencies. For each department, four groups are identified; each group is relevant on the statistical level but also on the clinical level. The results speak for a function differentiation in a vertical way, but not in a horizontal way between several different departments, in particular for the competencies needed a clinical judgement because these competencies are too specific by department, In conclusion, a function differentiation can be envisaged for the nurse profession in Belgium. Several models from foreign countries set an example for the practical modalities. Several advices in terms of education, lawful framework, interdisciplinary, and collaboration are formulated</p>","PeriodicalId":75662,"journal":{"name":"Cahiers de sociologie et de demographie medicales","volume":"49 2","pages":"115-36"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28406274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A national survey on the activities performed by nurses and aids in Italian outpatients' services].","authors":"A Destrebecq,&nbsp;M Lusignani,&nbsp;S Terzoni","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Unlabelled: </strong>In Italy, the National Health System (SSN) grants healthcare to the citizens; its realization is up to the Government, the Regions and local institutions, with the participation of citizens. The Health Ministry determines the essential levels of care, and dictates the general guidelines for the activities of the SSN. On the whole national territory, a network of Local Healthcare Units (ASL) is present; such institutions, although belonging to the SSN, have local autonomy. Their activity is based upon principles of efficacy and efficiency; each one includes one or more Districts, which usually group a minimum of 60,000 citizens. Until 1999, Italian nurses have based their activity on a law that enumerated their tasks (DPR 225/74); nowadays, they work according to the indications of a professional profile (DM 739/94), a code of deontology, a law (L. 42/99) that has eliminated the old DPR, and university programmes. Apart from nurses, both in public and private healthcare facilities it is possible to find aids called OSS; their education consists of a twelve months programme, for which the regional institutions are responsible. Specific laws define their field of activity. For all these reasons, and also because of a major nursing shortage, in Italy it is not possible to talk about tasks delegations from doctors to nurses; we can, however, think about this process from nurses to aids and employees. Italy has the highest number of doctors in the world, with more than 6 every 1000 citizens in 2005 (approximately 370,000 units); nurses suffer from the opposite problem; nurses were 348,415 in 2005 and 360,874 in 2007, that is to say 5.4 nurses each 1000 citizens. This means a shortage of 60,000 nurses.</p><p><strong>Goals: </strong>Our research is aimed at: Studying the activities deployed by nurses in outpatients' facilities, that could be assigned to aids,; Identifying the tasks currently deployed by nurses, that are beyond their competence; Estimating how much time nurses could save, if they were not busy with activities that could be assigned to others.</p><p><strong>Materials and methods: </strong>Our study sample included only of manager nurses, who were responsible of nursing offices in ASLs which included outpatients. facilities on the whole territory ofl Italy. We choose to make a convenience sampling, choosing a manager nurse for each regional chief town. Our study is an observational, non-experimental quantitative research. To collect our data we used an anonymous questionnaire, based on a reference model, which had already been used in older studies. The model allowed a classification of the tasks performed by nurses in three categories: Nursing activities without chances of delegation; Nursing activities that could be assigned to aids; Activities beyond the competence of nurses. The questionnaire was articulated in 7 categories (general situation, booking, acceptation, preparation of patients' units, nursing ","PeriodicalId":75662,"journal":{"name":"Cahiers de sociologie et de demographie medicales","volume":"49 2","pages":"137-66"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28406268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Family practitioners in Switzerland by 2030: which roles for medical task delegation?].","authors":"Hélène Jaccard Ruedin,&nbsp;Laurence Seematter-Bagnoud,&nbsp;Maik Roth,&nbsp;Julien Junod,&nbsp;Brigitte Santos-Eggimann","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Due to population aging, by 2030 Switzerland may face a demand of 24 million family practitioner visits, a growth of 13 percent from the 2005 level. This result is based on the assumption that the per capita demand for doctor visits remains what was observed in 2005 by age groups and sex. During the same period, the total number of practitioners may decrease by 14 percent whereas the female proportion of such practitioners may double. These changes may cause a 33 percent decrease in the supply of physician visits to reach only 14 millions. The comparison of the demand and supply of family doctor visits reveals that by 2030, 10 million visits may be unmet which represents 40 percent of the demand. On the supply side, a full scale implementation of task delegation may partially reduce that gap (minus 2 millions). On the demand side, improved health status may bring in a larger decrease in the needs for visits (minus 4 million).</p>","PeriodicalId":75662,"journal":{"name":"Cahiers de sociologie et de demographie medicales","volume":"49 2","pages":"205-25"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28406272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[An opinion survey among French physicians in independent practice (Winter 2007-Spring 2008)].","authors":"Bui Dang Ha Doan,&nbsp;Danièle Lévy,&nbsp;Juan Teitelbaum,&nbsp;Hélène Allemand","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the French health care system, most of the ambulatory health services are provided by independent practitioners, GP's and specialists, paid on a fee-for-service basis. Nearly all French residents are enrolled in a public sickness insurance fund. The fund pays directly to the doctor (or reimburse to the patient) on the basis of a honorarium-scale, negotiated by the fund and the medical associations. The specialists working in a private hospital (called \"clinique\") are considered physicians in independent practice and paid on a fee-for-service basis, whereas the specialists working in public (or para-public) hospitals are salaried. In early 2008, approximately 60 percent of all the medical profession were in independent practice. Out of 100 independent practitioners, 52 declared that their workload was \"normal\" and 44 that their own was \"too heavy\". Only 2 percent declared that their workload was \"insufficient\". The survey showed no correlation between the number of independent physicians working in an area and the average workload of each of them. The competition among medical offices was rather low. At the time of the survey, the French health system was dominated by a wide feeling of medical workforce shortage. However, only one quarter of the independent physicians were convinced that shortage existed in their own area. Difficulties and problems arisen from the relationship with partners were mentioned by a great number of independent practitioners: exaggerate requests from the patients (mentioned by 62%), bureaucratic approaches from the sickness insurance fund (32%), working ties with the public or para-public hospitals (23%)...During the period 2005-2008, the proportion of practitioners having difficulties in their professional relations has increased, in particular among specialists. However, during the same period, there was a change in the mood of the medical profession. The proportion of independent physicians who estimated that their standards of living have remained unchanged or have improved reached 43% in 2008, from 17% three years earlier. This upward trend was even more noticeable among specialists. As concerns the means they used for continuing education, most independent practitioners mentioned the medical journals (87%), the medical textbooks (73%), the medical congresses (66%), the Internet (58%). The refreshing forums organized by professional associations had also a good ranking (64%).</p>","PeriodicalId":75662,"journal":{"name":"Cahiers de sociologie et de demographie medicales","volume":"49 1","pages":"3-98"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28211456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}