A Method for Evaluation of the Management of Chronic Non-cancer Pain in Global Cities
Notice bibliographique
Résumé
This dissertation explores the outputs of structures and processes influencing clinical services for chronic non-cancer pain (CNCP) management globally. It focuses on facilities and services available in three global cities: Kuwait, Karachi, and Toronto. It develops and demonstrates qualitative and descriptive survey tools capable of assessing CNCP services and management, and associated barriers from the perspective of academic pain specialist involved in the delivery of CNCP services in those cities. Those tools are based on an original conceptual framework for guiding evaluation of CNCP services and management globally. In addition to a general introduction and discussion sections, the dissertation is made up of three sections. The first section integrates and reviews the literature on chronic diseases, CNCP management, and existing health care systems with respect to CNCP services generally and with a focus on the target global cities in particular. The second section consists of an analysis of methodological research options and development of a Structure Process Output evaluation frameworks based on a hybridization of Donabedian and Logistic evaluation frameworks (DL-Hybrid). Mixed methodology survey and interview instruments were designed to evaluate perspectives of pain clinic leader using that DL-Hybrid framework and organized to characterize three output domains: 1) infrastructure utilization, 2) clinical service delivery and 3) education and research activities. The third section reports on semi-structured interviews with academic pain specialists using those instruments. Four participants were recruited from each of the three global cities (8 men and 4 women). Data was analyzed both quantitatively and qualitatively. Krippendorffâ s thematic clustering was used to reveal themes within qualitative data. The three cities showed important differences in how the health system operated but pain specialist shared common training and professional goals and barriers. This qualitative survey provided insights into those goals and barriers. Similarities were observed across the three cities reflecting perhaps the fact that by definition global cities resemble each other economically. The biggest shared obstacle was a lack of resources for coordinating services and evaluating outputs as well as the lack of recognition of the significance of CNCP. The study highlights similarities and variation in perception of barriers. It demonstrates how a global cities lens and a systematic evaluation framework can reveal structural and process issues related to pain clinic outputs aimed at reducing the burden of chronic diseases such as chronic pain both locally and globally.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».