Cahiers de sociologie et de demographie medicales最新文献

In Portugal, the design and the implementation of models of primary care teams has a history of 30 years. The evolution observed is from individual medical work, in Health Centres, supported on an ad hoc basis by other health professionals, to health centres integrating a diversity of formal working groups, including primary care/family health teams called "Family Health Units" (FHU). This evolution included the creation and gradual affirmation of the speciality of family medicine and the experimentation with different models of primary health care provision: voluntary primary care health teams without financial incentives (Alfa project), voluntary primary care health teams with a performance-related-remuneration system and the current phase of scaling up FHU. The process described here illustrates how a group of physicians has established a non-formal strategy of reform throughout 30 years. This strategy involves mobilization policies and the development of field experiences by individual leaders, groups and organizations.

In Portugal, the healthcare sector demand for professionals has traditionally outweighed the supply for physicians, nurses and health technicians. However, the capacity of the National Health Service, the main healthcare sector employer, to absorb new professionals is apparently decreasing, and the demand for professionals in the private sector is unclear, but it seems to be growing. With regard to physicians, demand seems to persistently exceed supply, as many physicians work in several institutions or work overtime in the public sector, and the number of foreign physicians practicing in Portugal is increasing. In recent years, the number of medical schools and medical graduates increased, but it may not be sufficient to meet future needs. This paper is limited by the lack of comprehensive data on the private sector and on the number of professionals moving between the public and private sectors. These data are important for the planning and the decision-making process. Human resources policies, supported by an adequate health information system, are fundamental steps for the improvement of the performance of the healthcare system.

The patient classification system presented here is a tool to manage and plan nursing staff allocation in accordance with nursing care needs. This case study has an ecologic analytical design and its main purpose is to investigate how the improvement of nursing staff management efficiency can decrease adverse patient outcomes. Data were collected retrospectively in one hospital and differences between medical, surgical and orthopedic units are discussed. The main determinants of patient outcomes were three management variables: nursing care hours needed (NCHN), staffing variance (SV) combined with nursing care utilization rate (NCUR) and some proxy measures of need, like age of patient, and month of observation. The most important result of this study was the demonstration of an effective correlation between nursing care management and patient outcomes variables.

Several studies have shown that healthcare professionals are at greater risk than the rest of the population of having certain health problems due to the specificity of their workplace and the physical and psychological demands of their work. Additionally, healthcare professionals seem to behave differently when seeking health care. Several studies also indicate that the health of healthcare professionals has an impact on the performance of services and on the health of the population. The present paper analyzes morbidity patterns, health behaviors and lifestyles, self-perceived health status and health service utilization among healthcare professionals, by using the Portuguese 1999 National Health Survey. Results differ from those found in international studies. Portuguese healthcare professionals did not suffer more from some health problems than non-healthcare professionals. Healthcare professionals tended to assess their health as good and better as that of other workers. They also reported healthier behaviors (smoked less, drank less and practiced exercise more often) and missed fewer workdays due to sickness. The percentage of healthcare professionals suffering from back pain was lower than the percentage of other workers but they started to complain earlier.

This paper reports on multiple employment among Portuguese health sector workers, using data obtained from six studies. The methodological aspects of these studies are briefly summarized. The prevalence among the study populations varies between 5 and 80%. When the first job is in the public sector, the site of additional employment is most frequently another public sector facility. Multiple employment is more prevalent among hospital workers; it is more frequent among those working shifts or part-time, and least frequent among professionals with a contract that requires exclusivity. Physicians with multiple jobs were more likely to have low expectations of getting promoted and to assess the rewards for their work as inadequate. For most nurses the salary increment resulting from multiple employment was less than their public sector salary. For both groups, improving income levels and higher job satisfaction were important reasons to seek additional employment. For physicians working in public services, access to more professional autonomy was an important reason for seeking additional employment in the private sector.

In Portugal, for the last thirty years, there have been major developments in the human resources for health (HRH) situation, which are described as part of three waves of reforms. Portugal remains without a formal explicit and comprehensive HRH medium to long-term strategy. Consequently serious problems of scarcity, geographical misdistribution, and imbalances between levels of healthcare provision as well as in the ratios between professional groups and specialties still exist. Professional councils however have recognized the need for performance management and life-long recertification and have acknowledged the importance of an adequate skills mix and of complementarities through team work in the health sector. Professional associations have greatly contributed to the changes observed through a process of non-formal strategizing.

Research on the provision of care is mostly based on household sample surveys, which cannot measure the prevalence of caregiving in the general population. In order to appraise the individuals' involvement in the provision of informal care, specific questions on the care provided were included in Belgium's 2001 Census. Using data from the census we aim at analyzing how the provision and the amount of informal care, varies with respect to the individual's socio-economic characteristics. We found that 1 out 10 Belgians provide informal care. As expected, most caregivers can be found among middle-aged women. Yet, the percentage of men and women providing informal care at home is quite similar. The education level has an unexpected influence on the provision of care: more educated individuals are more likely to be caregivers while lesser educated individuals are more likely to provide more hours of care. Given that informal care is a valuable resource for meeting the care needs of today's societies, more attention should be given to the consequences of providing it. Indeed, not considering the negative aspects of providing informal care, such as the deterioration in the health status of caregivers or the competing demands between working and caring, can lead to a reduction of the amount of informal care provided.

Several OECD countries have capped the number of physicians to be licensed to practice. However, a relevant cap must take into account changes in physician activities. We set out to study the transitions leading physicians to leave health care or to stop any activity in health system. These transitions were assessed using a register of medical practice. We studied changes in activity between 1994 and 2002 for about 19,840 physicians who in 1994 were already working for 5 years and were in 2002 less than 65 years old. After 8 years of career, one physician out of 20 were inactive in health system. Some medical specialties such as surgery and radiotherapy had a greater risk of leaving health care while GP's had a lower risk. Gender differences in leaving health system were mostly non-existant in younger age groups but then increased with age. Among physicians aged 55 and over, women were more likely to leave health system. We conclude that the percentage of physicians leaving health care after 5 years of practice is significant and deserve being taken into account for manpower planning and that planning should be aware of that some groups of physicians are more at risk than others to leave health care. Qualitative studies would help understand better this drop out.

In most countries, oral and dental problems (decay, gingivitis, parodontitis,..) are frequent and impact on overall health. Such problems can often be avoided and treated. Health professionals and patients become gradually more aware of the importance of oral health. Oral hygiene and other measures may prevent several problems, which is beneficial to individuals and to public health, since the consequences of oral diseases are very expensive for all. Our study aims to analyze the features of the profession and to assess their possible evolution in the future. The design of our study combines two approaches: a quantitative study -based on data of the national health insurance scheme regarding utilization of care- and a qualitative study based on deep-interviews of dentists. According to the latter, dental care is expensive for the patient and also for professionals. The workload becomes heavier because patients expect too much. It is expanding, due to longer life expectancy and to medical progress which enables to conserve natural dentition, thus requiring extra care for the surviving teeth. These factors explain the increase of dental services which we highlight for the last 20 years; for the future, most of services are expected to expand, mainly for elderly (65 + years), One exception is noticeable: a probable decrease of "traditional care" for young and adult populations (<65 years). The authorities should take these trends into account in order to cover such new requirements, while also introducing measures in order to limit potential undue demand. However, a few socioeconomic groups remain out of the care system: all disabled persons living in institutions (inter alia elderly in nursing homes); furthermore, the population of low socioeconomic status is unaware of the benefits of a good oral hygiene; professionals denounce these gaps of the system and suggest improvements. Education about oral hygiene should also be promoted; consequently, the profession of oral hygienist should obtain an official license.