General Practice and Primary Care - Theses
Permanent URI for this collection
Search Results
1 - 5 of 5
-
ItemA prospective study of body size and composition and the risk of cancer(University of Melbourne, 2006)
-
ItemReconceptualising case management in theory and practice: a front-line perspective( 1999-12)This thesis is a qualitative study exploring the role of case managers in the evolving Australian case management models. It represents the perspectives of front-line case managers based on their first-hand knowledge of the models’ effect on their own role as well as the perceived effects on the clients. A cross-sectional design was chosen for this study involving 51 semi-structured, in-depth interviews with front-line case managers from three different Victorian, Australian long-term care case management models. Informants came from a range of professional disciplines including general practice, nursing, psychology, occupational therapy, social work, and other related fields. Purposive and incidental sampling were employed. The major findings identify the discrepancy between theory and practice in regard to case management being 'client centred'. Instead, case management is concluded to be 'system centred' based on a unilateral approach taken by each of the three models. Case managers had a limited ability to attain necessary services for clients depending on their skills and experience, relationship with the client, degree of job satisfaction, level of influence in the health and social system, and ability to collaborate with relevant professionals. It reviews the relationship between three primary influences (system, model, client) affecting the case managers' pursuit of attaining appropriate client services. A reconceptualised theoretical framework, a 'neo-process centred' case management, is proposed comprising a multidimensional approach, which can be applied to existing and new models in their aspiration of improving client care within existing constraints.
-
ItemOrganisational challenges: the boundary spanning role of divisions of general practice in Victoria, 1993-2006( 2007)This qualitative study investigates the evolving role of Divisions of General Practice (Divisions) in linking general practitioners (GPs) and general practice with the wider health sector in Australia. The work draws on boundary role theory within organisations, integration theories, empirical research on service integration involving general practice, and structural interests theory to develop the conceptual framework on which the research was based. The data for the research came from both documentary and interview sources that gave voice to Divisions in the state of Victoria, Australia. The documents used represented the core working documents of Divisions, and the semi-structured interviews involved 30 key informants, these being leaders in all Victorian Divisions.
-
ItemChronicity and character: patient centredness and health inequalities in general practice diabetes care( 2006)This study explores the experiences of General Practitioners (GPs) and patients in the management of type 2 diabetes in contemporary Australia. I focus on the way the socioeconomic position of patients is a factor in that experience as my underlying interest is in exploring how health inequalities are understood, approached and handled in general practice. The study is thus a practical and grounded exploration of a widely debated theoretical issue in the study of social life, namely the relationship between the micro day-to-day interactions and events in the lives of individuals and the broad macro structure of society and the position of the individual within that. There is now wide acceptance and evidence that people’s social and economic circumstances impact on their health status and their experiences in the health system. However, there is considerable debate about the role played by primary medical care. Nevertheless, better theoretical understanding of the importance of psychosocial processes in generating social inequalities in health suggests medical care may well be important, as such processes are crucial in the care of chronic illnesses such as diabetes which are now such a large part of general practice work. I approach this study through an exploration of patient centred clinical practice. Patient centredness is a pragmatic, idealised prescriptive framework for clinical practice, particularly general practice. Patient centredness developed in part in response to critiques of biomedicine, and is premised on a notion of a more equal relationship between GP and patient, and one that places importance on the context of patients’ lives. It contains an implicit promise that it will help GP and patient engage with and confront social disadvantage.
-
ItemSame-sex attracted women and their relationship with GPs: identity, risk and disclosure( 2009)Patient-doctor relationships between same-sex attracted women and general practitioners (GPs) have been presented as problematic in the literature. The problems arise from women’s concerns about the potential for negative attitudes amongst GPs. They also relate to GPs’ concerns about offending patients if they ask about sexual orientation due to the stigmatised nature of minority sexual orientation. As a result, disclosure of sexual orientation can be difficult and the patient-doctor relationship can be compromised. The aim of this study was to explore the nature of patient-doctor relationships in this context and how optimal relationships can be achieved. Using a critical hermeneutic approach, I conducted in-depth interviews with 33 same-sex attracted women and 28 doctors. This included 24 pairs of people in a current patient-doctor relationship. I found that women commonly experienced silencing of their minority sexual orientation within general practice settings, but that this was occasionally desired and not problematic for some women and most GPs. For other women and for many GPs, the silence resulting from a lack of disclosure was a response to perceived risks to women’s personal identity and GPs’ professional identity. Few GPs asked directly about sexual orientation, placing the burden of responsibility for disclosure on same-sex attracted women. Building reciprocal trust could overcome the perceived risks inherent in revealing minority sexual orientation. I initially defined optimal patient-doctor relationships in terms of existing models of cultural competence and patient-centredness; however I found that such relationships were built on cultural sensitivity rather than cultural competence, and relationship-centredness rather than patient-centredness. I developed a new model of sexual identity disclosure that demonstrated the key influences on disclosure of sexual orientation to GPs for same-sex attracted women. These influences were women’s sexual identity experience, risk perceptions, and the level of knowing within the patient-doctor relationship. The model depicts women’s range and fluidity of sexual identity experiences and challenges current assumptions that disclosure is essential for effective health care. The model has transformative potential for general practice education and research. It could assist GPs to understand that not all women desire disclosure, but that the majority of women are happy to disclose if asked. GPs would be encouraged to take note of the socio-political environment in which women live and its influence on women’s fears and actual experiences of discrimination. Finally, understanding the role of trust and reciprocal knowing in mitigating perceived risks would encourage GPs to focus more on relationship building. This could also assist GPs to overcome their own perceptions of risk and encourage them to broach the subject of sexual orientation, ultimately enhancing the patient-doctor relationship.