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A popular refrain in many countries is that people with mental illnesses have “nowhere to go” for care. But that is not universally true. Previously unexplored international data shows that some countries provide much higher levels of public mental health care than others. This puzzling variation does not align with existing scholarly typologies of social or health policy systems. Furthermore, these cross-national differences are present despite all countries’ shared history of psychiatric deinstitutionalization, a process that I conceptualize and document using an original historical data set. I propose an explanation for countries’ varying policy outcomes and discuss an empirical strategy to assess it. The research design focuses on the cases of the United States and France, along with Norway and Sweden, in order to control for a range of case-specific alternative hypotheses. The chapter ends with brief descriptions of contemporary mental health care policy in each of the four countries examined in this book.
To analyse the outcomes of telephone consultation, including patient satisfaction, for two-week-wait head and neck cancer referrals.
Methods
Analysis of the data of this prospective study was centred on outcomes of the consultation, patient satisfaction and preference for telephone consultation.
Results
Patient satisfaction and preference for telephone consultation were influenced by patient awareness of cancer referral. When comparing the three most common presenting symptoms, patients with sore throat were more satisfied than those with neck mass. Regarding telephone consultation outcomes, patients with neck mass were less likely to be discharged and more likely to require investigations than those with sore throat or hoarseness. Patients with hoarseness more often required a face-to-face appointment.
Conclusion
Telephone consultation might be a valid initial encounter for the majority of two-week-wait head and neck cancer referrals, especially when the referral symptoms are considered. This work shows the validity and safety of telephone consultation for two-week-wait head and neck cancer referrals.
This cross-sectional study is the first one to explore the collaboration of the influencing factors thereof amongst general practitioners (GPs) and gynaecologists (Gyns) working in primary care in urban and rural settings in Germany.
Background:
The number of women aged ≥ 50 years is predicted to increase in the next years in Germany. This coincides with the ageing of primary care specialists providing outpatient care. Whereas delegation of tasks to nurses as a form of interprofessional collaboration has been the target of recent studies, there is no data regarding collaboration amongst physicians in different specialisations working in primary care. We explored collaboration amongst GPs and Gyn regarding the healthcare provision to women aged ≥ 50 years.
Methods:
A quantitative postal survey was administered to GPs and Gyns in three federal states in Germany, focusing on care provision to women aged ≥ 50 years. A total of 4545 physicians, comprising 3514 GPs (67% of the total GP population) randomly selected, and all 1031 Gyns practicing in these states received the postal survey in March 2018. A single reminder was sent in April 2018 with data collection ending in June 2018. Multiple logistic regressions were performed for collaboration, adjusted by age and sex, alongside descriptive methods.
Findings:
The overall response rate was 31% (1389 respondents): 861 GPs (25%) and 528 Gyns (51%), with the mean respondent age being 54.4 years. Seventy-two per cent were female. Key competencies of collaboration are associated with working in rural federal states and with network participation. Physicians from rural states [odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.2, 1.9] and physicians in networks (OR = 3.0, CI = 2.3, 3.9) were more satisfied with collaboration. Collaboration to deliver services for women aged ≥ 50 years is more systematic amongst GPs and Gyns who are members of a network; increased networking could improve collaboration, and ultimately, outcomes too.
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