Showing papers by "Toomas Timpka published in 1995"

Dilemmas in sickness certification among Swedish physicians

Abstract: Despite a growing concern for matters related to sick-leave and its economical and human consequences, little Is still known of the practice of sickness certification. To remedy this, a study based on the critical incident technique was designed to explore dilemmas experienced by physicians when issuing sickness certificates. A questionnaire was distributed to 170 general practitioners (GPs), private physicians and psychiatrists in the Swedish county of Ostergotland asking about sickness certification dilemmas, the consequences of the dilemma and how the situation was resolved. Through a semi-qualitative analysis, 2 main types of dilemma were identified. Insurance-associated dilemmas were the most frequent and concerned the grading of work incapacity, the duration of a sick-leave period and the difficulties in interpreting the sickness insurance legislation. The focus on biomedical diagnosis in the sickness certificate was found to complicate the certification routines, since working capacity may be reduced even though a diagnosis has not been confirmed. The primary medical dilemmas consisted of difficulties related to encountered obstacles In the clinical management, e.g. in subjective medical history, diagnosis or patient compliance. It is concluded that the physicians' role in the insurance system makes it necessary to give the medical diagnosis a social interpretation. The development of standards for grading of work incapacity is needed as well as routines for closer cooperation between the different actors in the sickness insurance system.

Participatory design of computer-supported organizational learning in health care: methods and experiences.

Abstract: This paper outlines a Computer-Supported Co-operative Work (CSCW) system for primary care and presents from its participatory design process time consumption, costs, and experiences. The system integrates a hypermedia environment, a computerized patient record, and an electronicmessage system. It is developed to coordinate organizational learning in primary care from micro to macro levels by connecting strategic planning to monitoring of patient routines. Summing up design experiences, critical issues for making CSCW systems support cost-effectiveness of health care are discussed.

Decentralized diagnostics of beta haemolytic streptococci group A--introduction of a developmental model for microbiological consultation in primary health care.

Abstract: Objective - To define and evaluate forms for introduction of decentralized diagnosis in primary care.Design - the study was divided into three phases.Intervention I. An intensive course on microbiological diagnostics in cases of tonsillitis with information about rapid EIA-based test kits for beta haemolytic streptococci group A.Intervention II. External quality assurance of the decentralized test. Evaluation. Recording of changes in work practice and attitude regarding decentralized diagnosis by means of a questionnaire.Participants - Thirty-three GPs and 36 laboratory technicians from 37 primary health care centres (PHC) in the county of Ostergotland, Sweden. Results - Thirty-one of the responding GPs (94%) considered that the information gained from quality assurance was useful. Twenty-nine GPs (88%) reported that they had changed their clinical practice to some extent, and 26 of the responding laboratory technicians (72%) reported that they had changed method after the interventions.Conclusion - Unifo...