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  • 1.
    Daniels, Karen
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV. Health Systems Research Unit, Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa .
    Van Zyl H, Hendrien
    Boland District Municipality, Stellenbosch, South Africa.
    Clarke, Marina
    Nursing Division, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, 7505, South Africa .
    Dick, Judy
    Health Systems Unit, Medical Research Council, Cape Town, South Africa.
    Johansson, Eva
    Nordiska ministerrådet, Nordic School of Public Health NHV. Department of Public Health Sciences, Division of International Health (IHCAR), Karolinska Institute, Stockholm, Sweden.
    Ear to the ground: listening to farm dwellers talk about the experience of becoming lay health workers.2005Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 73, nr 1, s. 92-103Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Ranking ninth in the world for its contribution to the global burden of tuberculosis (TB), South Africa continues to battle the disease. Within the framework of the World Health Organisation's Directly Observed Treatment Short Course (DOTS) strategy, attempts have been made to utilize lay health workers (LHWs) as TB treatment supporters. Previous research has highlighted the benefits and difficulties associated with such an approach, but little attention has been paid to the perceptions of LHWs themselves. A randomised control trial of a LHW intervention in TB treatment in the farming areas of the Western Cape, South Africa has shown a 19% improvement in TB treatment outcomes. This paper describes the experiences of those LHWs drawing on data collected through focus groups with incumbents. The data has shown that once trained, respondents were engaged in a wide range of activities, well beyond simple health care. In the majority LHWs were women. Becoming LHWs opened up their worlds, creating opportunities they would otherwise not have had. But while doing so, it also added extra responsibilities and stresses, which were not easy to manage. Respondents sustained themselves through support from each other, the intervention team, their employers and contact with the public health system. The question this study raises is given the obvious need for LHWs, how can they be motivated to participate in primary health care in such a way that maximises their access to resources while minimising their experience of the role as burdensome?

  • 2. Kalda, Rurth
    et al.
    Põlluste, Kaja
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Lember, Margus
    Patient satisfaction with care is associated with personal choice of physician.2003Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 64, nr 1, s. 55-62Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To evaluate whether choosing one's own primary care doctor is associated with patient satisfaction with primary health care. To evaluate factors related to population's satisfaction with primary health care.

    POPULATION: A random sample of Estonian adult population (N=997).

    STUDY DESIGN: Cross-sectional study using a pre-categorized questionnaire which was compiled by the research group of the University of Tartu and the research provider EMOR.

    RESULTS: Altogether 68% of the respondents had been listed in their personal physician. Their overall satisfaction with the physician as well as satisfaction with several aspects of primary health care were significantly higher compared with those of unregistered respondents. Although some other factors (practice size, patient age, health status) also influenced patient satisfaction, presence of a personal physician appeared the most important predictor of high satisfaction with physician's punctuality and understanding, effectiveness of prescribed therapy, clarity of explanations given by the physician as well as with overall satisfaction with the physician.

    CONCLUSION: Personal doctor system is associated with patient satisfaction with different aspects of care.

  • 3.
    Põlluste, Kaja
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Kalda, Ruth
    Lember, Margus
    Satisfaction with the access to the health services of the people with chronic conditions in Estonia.2007Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 82, nr 1, s. 51-61Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    UNLABELLED: After the implementation of the primary health care reform in Estonia, most of chronic conditions are managed by family doctors (FD) in collaboration with specialists. Although the general population has demonstrated the increase in satisfaction with health care after the reform, it has been questioned if people with chronic diseases have been left on a more disadvantaged position in the new system with some restrictions in the access to specialists.

    OBJECTIVE: To investigate the satisfaction of people with chronic conditions with the access to the health services and compare them to those who did not have a chronic illness.

    METHOD: In November 2005, a random sample of Estonian residents aged 15-74 were personally interviewed using structured questionnaires (n=1446), 29% of them reported to have a chronic illness.

    RESULTS: The people with chronic conditions were less satisfied with the access to the health services. They were more satisfied with their family doctors, but less with the health insurance system and they often reported their problems in seeing the specialist. Compared to other respondents, the people with chronic conditions visited their FDs and specialists more often, but no significant differences were found between their waiting times to see the FD or a specialist.

    CONCLUSION: In Estonia, the people with chronic conditions do not have organisational barriers in their access to the health services. As frequent users of health services, they perceive the shortages of the health system more obviously than the rest of the population and it may reflect their satisfaction with the different aspects of the health system as well as the access to the health services.

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