Book Review: Doing Qualitative Research

This paper deals with the some of the important variable factors relating to health care in Saudi Arabia, with special emphasis on primary health. Other aspects considered are the financial influen...

<div class="WordSection1"><p>I am honored for being an alumnus of KEMC, and am delighted to write this editorial for the Annals. I have, ever since done my research and taught qualitative methods, felt that clinical methods are quite akin to qualitative research. Then, why only few clinical researchers use qualitative methods? A witness to this assumption is the research published in the Annals. In this treatise, I try to identify some parallels between the two types of methods and argue for the clinicians to invest in learning qualitative research methods to practice clinical methods well.</p><p> Qualitative research is to identify and interpret issues from the perspective of participants, their experience of: illness or disability, using health service, and to appreciate the meanings they give to the behaviour, events or objects in the context of their social and cultural norms. In this type of research, the emphasis is on exploring the associations and understanding the phenomenon in its holism; and not, like in quantitative research, from an outsider’s perspective and for certain specific aspects.<sup>1</sup> It requires participants with specific characteristics, selected purposely that can best inform the research topic. More participants, identified inductively during data collection, are added to develop full and multiple perspectives about the cases.<sup>2</sup></p><p> No preset data collection tool is used, instead qualitative researcher guided by a research question acts as an instrument, since the line of enquiry he changes during data collection as new understanding is gained and/or the situation changes.<sup>3</sup> The data for research is derived from the observation, interviews or verbal interactions, focus group discussions, document reviews, life histories etc. and the researcher asks why, how and under what circumstances things occur; and not just what, where and when. It is recorded in words or pictures and log book is used to record notes arising from interviews, observations, extracts from documents etc.</p><p> In health care settings patients are the subjects for clinical methods. The clinician, even prior to any verbal communication, observes the patient, e.g. for his gait and appearance. If in a bed or examination couch, his posture could give some clue to the illness. Inspection, a clinical method, is like systematic observation, which is qualitative method, should be holistic. In my third year during bedside teaching, Professor (late) Rashid Ahmed Qureshi said, <em>“patient has come to you as a whole and not his stomach in a tray”</em>, when a student straight went to examine abdomen of a patient with acute abdomen. History taking, another clinical method, is like conducting semi structured in depth interview – a qualitative research method. In both disciplines, we are told, <em>“not to ask leading, but follow up and probing questions”; </em>and Professor (late) Alamgir Khan, while teaching clinical methods, would add, <em>“if a good history is taken, you will establish diagnosis in over 65% of cases”. </em>Likewise, as part of history taking, documents related to patient’s illness history and treatment are reviewed similar to document review in qualitative research.</p><p> The two approaches however differ in how the data is analysed. In clinical practice, diagnosis is established based on the pathophysiological knowledge or patient’s clinical condition is discussed in clinicopathological conference.<sup>4</sup> On the other hand, qualitative research employs meaning based data analysis, whereby the qualitative data is transformed into some form of explanation, understanding or interpretation of people and situation that is investigated.<sup>5,6</sup></p><p> In conclusion, the history, the observation and the review of document related to patient are since obtainned using qualitative methods, the clinician trained in these methods could not only conduct these methods well but also interpret the data to identify and detect obstacles to the change in clinical condition and the reasons why improvement does or does not occur.<sup>7</sup> Finally, while it is heartening that research forums are organised in the institutions affiliated with KEMU, in order the research is richer, the researchers’ skills in qualitative research methods should be built.</p></div>

Improved understanding of multimorbidity (MM) treatment adherence in primary health care (PHC) in Brazil is needed to achieve better healthcare and service outcomes. This study explored experiences of healthcare providers (HCP) and primary care patients (PCP) with mental-physical MM treatment adherence. Adults PCP with mental-physical MM and their primary care and community mental health care providers were recruited through maximum variation sampling from nine cities in São Paulo State, Southeast of Brazil. Experiences across quality domains of the Primary Care Assessment Tool-Brazil were explored through semi-structured in-depth interviews with 19 PCP and 62 HCP, conducted between April 2016 and April 2017. Through thematic conent analysis ten meta-themes concerning treatment adherence were developed: 1) variability and accessibility of treatment options available through PHC; 2) importance of coming to terms with a disease for treatment initation; 3) importance of person-centred communication for treatment initiation and maintenance; 4) information sources about received medication; 5) monitoring medication adherence; 6) taking medication unsafely; 7) perceived reasons for medication non-adherence; 8) most challenging health behavior change goals; 9) main motives for initiation or maintenance of treatment; 10) methods deployed to improve treatment adherence. Our analysis has advanced the understanding of complexity inherent to treatment adherence in mental-physical MM and revealed opportunities for improvement and specific solutions to effect adherence in Brazil. Our findings can inform research efforts to transform MM care through optimization.

The rising burden of multiple chronic diseases requires countries to change the reactive approach of their health systems, originally designed to cure acute illness, to a proactive approach that scales up preventive interventions and integrates cure (health care) and care (long term care and social care). This requires a central coordination role for primary health care (PHC). PHC is the foundation for delivering health services to the population. It mainly encompasses the first level of professional health care and includes PHC practitioners and other health workers. Together, PHC providers can satisfy most curative and preventative health needs, ideally providing integrated services. In this way, PHC has the potential to agilely respond to population health needs; help individuals navigate their way to good health and stay healthy; prevent disease by identifying risk factors; and manage chronic disease outside of hospital settings. Yet PHC in many countries is not designed to fully realize these promises and ongoing reforms aim to strengthen it. Meanwhile, this potential was on display in several countries during the COVID-19 pandemic, when primary care doctors played a key role in making an early diagnosis; helping vulnerable people cope with their anxiety about the virus; reducing the demand for hospital services; and delivering vaccinations-all while reaching out to vulnerable patients and maintaining access to essential (non-COVID) services for the wider population using new in-person protocols or new digital solutions. This workshop will update the audience on recent PHC reforms across the EU and provide insights from three key examples-Estonia, Poland, and Slovenia. An introductory presentation sets the stage by putting PHC reforms in a wider context of reforms introduced across the 31 countries of the Health Systems and Policy Monitor network of the European Observatory on Health Systems and Policies between 2018 and 2021. A second presentation describes how Estonia has introduced a series of PHC reforms over time and used financial incentives to encourage multidisciplinary care. A third presentation looks to Poland, which from mid-2018 through 2021 piloted a multi-professional model of PHC organization in around 40 PHC practices, with an emphasis on care coordination and disease prevention. A final presentation highlights Slovenia, where a multidisciplinary, community-based, prevention-oriented service delivery model is being expanded to play a larger role in the prevention and management of chronic diseases as well as the country's COVID-19 response. The workshop concludes with an audience discussion on lessons learned from the three case studies and potential implications for other countries.Key messages• Strengthening primary health care is a key priority of many countries as they seek to improve integration of care.• Implementation of primary care reforms in shaped by the legacy of care delivery and requires a strong workforce, ongoing financial support, sustained policy focus, and collaborative governance.

Introduction. The main goal of the state policy in the field of healthcare is to form a system that ensures the availability of medical care and increases the efficiency of medical services. The volume, type and quality of medical care must correspond to the level of morbidity, the needs of the population and the advanced achievements of medical science. Primary health care is the backbone of the health care delivery system. The problem of it improvement, including in rural areas, is a priority and has national significance. The development of measures to increase the availability of primary health care according to the territorial principle is an urgent scientific and practical problem.The purpose of the study — based on the analysis, methodologically substantiate and develop measures to increase the availability and improve the system of organizing the provision of primary health re to the rural population on a territorial basis.Materials and methods. Mathematical-statistical and analytical (quantitative, structural, comparative) research methods were used.Results and Discussion. In the Chelyabinsk Region, there are disproportions in the provision of the population with medical personnel: the provision of the urban population with doctors and l personnel is significantly higher than that of the rural population. The indicator of staffing with paramedical personnel in full-time positions of feldsher-obstetric stations is 20.1% lower than in the Russian Federation. The index of "combination rate" among doctors working in outpatient departments is 1.2 times higher than the target indicator of the National Health Project, and in rural areas it is 1.1 times. In order to unify the organizational and methodological approaches, the authors proposed a classification of medical stations and their organizational and functional structure.Conclusions. The organization of the provision of primary health care to the rural population according to the territorial-district principle with the formation of an organizational model of the rural medical district will increase the availability of primary medical health care to the rural population.

There is evidence that the Australian Government is embracing a more integrated approach to health, with implementation of initiatives like primary health networks (PHNs) and the Government’s Health Care Homes program. However, integration of community pharmacy into primary health care faces challenges, including the lack of realistic integration in PHNs, and in service and remuneration models from government. Ideally, coordinated multidisciplinary teams working collaboratively in the community setting are needed, where expanding skills are embraced rather than resisted. It appears that community pharmacy is not sufficiently represented at a local level. Current service remuneration models encourage a volume approach. While more complex services and clinical roles, with associated remuneration structures (such as, accredited pharmacists, pharmacists embedded in general practice and residential aged care facilities) promote follow up, collaboration and integration into primary health care, they potentially marginalize community pharmacies. Community pharmacists’ roles have evolved and are being recognized as the medication management experts of the health care team at a less complex level with the delivery of MedChecks, clinical interventions and medication adherence services. More recently, vaccination services have greatly expanded through community pharmacy. Policy documents from professional bodies highlight the need to extend pharmacy services and enhance integration within primary care. The Pharmaceutical Society of Australia’s Pharmacists in 2023 report envisages pharmacists practising to full scope, driving greater efficiencies in the health system. The Pharmacy Guild of Australia’s future vision identifies community pharmacy as health hubs facilitating the provision of cost-effective and integrated health care services to patients. In 2019, the Australian Government announced the development of a Primary Health Care 10-Year Plan which will guide resource allocation for primary health care in Australia. At the same time, the Government has committed to conclude negotiations on the 7th Community Pharmacy Agreement (7CPA) with a focus on allowing pharmacists to practice to full scope and pledges to strengthen the role of primary care by better supporting pharmacists as primary health care providers. The 7CPA and the Government’s 10-year plan will largely shape the practice and viability of community pharmacy. It is essential that both provide a philosophical direction and prioritize integration, remuneration and resources which recognize the professional contribution and competencies of community pharmacy and community pharmacists, the financial implications of service roles and the retention of medicines-supply roles.

This paper presents service provider perspectives about primary health care services for refugee and refugee claimant mothers when their preschool child had an acute and minor illness. Information was collected from primary health care providers in Hamilton Ontario between August 2004 and February 2006 as part of a larger study about the health of children in recently arrived refugee and refugee claimant families. Primary health care providers in this study represented the full array of primary health care services available at the time. Information included details of services available and preparation of staff to work with a diverse population including immigrants in general and refugees in particular. The main finding was that primary health care providers and staff had little or no training and preparation for working with refugee or refugee claimant families and had little understanding about health insurance or their entitlement to health care. Services were significantly reduced in number and variety after 5pm and during nights or weekends; most providers reported that they would accept refugees and fewer reported that they would accept refugee claimants as clients. The conclusion of this study was that primary health care providers need training for working with culturally diverse populations and in particular clear information about health insurance for refugee and refugee claimant families. Disparities in health care have been associated with limited cultural sensitivity, lack of knowledge or awareness of support systems including health insurance for refugees and refugee claimants and failures in understanding. These factors limit access to needed health care services and diminish the effectiveness of services provided. Recent changes to health insurance eligibility for refugees and refugee claimants are concerning as entitlements to health insurance have been reduced or eliminated.

Primary health care is the foundation of a health system and has a strong influence on the efficiency of the health system as a whole. For children in Europe, it is defined by three primary health care models: paediatric; mixed paediatrician and family physician; and family physician. There is much debate in Europe about which model is most appropriate for children. The Lithuanian model is mixed, although health policy is geared towards the promotion of family physicians, with a decline in the number of primary paediatricians in clinical practice. To review the children's primary health care system in Lithuania, compare the indicators of primary care by family physicians and paediatricians in Lithuania, and identify parents' perceptions of the primary health care model for children. A retrospective longitudinal study was performed of children's primary health care indicators for quantity and quality in 2014-2018. A representative opinion survey of 1000 adult respondents was conducted. A total of 3.5 million children's visits to primary care physicians (6.7± 3 visits for each child) were registered in Lithuania in 2018. During a recent 5-year period (2014-2018), the number of visits did not change significantly. Visits to paediatricians accounted for 41% of all children's visits to primary care physicians in 2018. Visits to Emergency Departments increased by 20%. The results of the survey showed that 72.3% of the respondents would prefer their children be treated by a primary care paediatrician. The mixed paediatrician and family physician health care model gives parents the right to choose. The results showed a decreased number of paediatricians in primary care; paediatric primary care is more frequent than family physician care; and parents tend to trust paediatricians more. The study also showed differences in the models of service used and patterns between regions in Lithuania.

In the current era of artificial intelligence, large language models such as ChatGPT and BARD are being increasingly used for various applications, such as language translation, text generation, and human-like conversation. The fact that these models consist of large amounts of data, including many different opinions and perspectives, could introduce the possibility of a new qualitative research approach: Due to the probabilistic character of their answers, “interviewing” these large language models could give insights into public opinions in a way that otherwise only interviews with large groups of subjects could deliver. However, it is not yet clear if qualitative content analysis research methods can be applied to interviews with these models. Evaluating the applicability of qualitative research methods to interviews with large language models could foster our understanding of their abilities and limitations. In this paper, we examine the applicability of qualitative content analysis research methods to interviews with ChatGPT in English, ChatGPT in German, and BARD in English on the relevance of computer science in K-12 education, which was used as an exemplary topic. We found that the answers produced by these models strongly depended on the provided context, and the same model could produce heavily differing results for the same questions. From these results and the insights throughout the process, we formulated guidelines for conducting and analyzing interviews with large language models. Our findings suggest that qualitative content analysis research methods can indeed be applied to interviews with large language models, but with careful consideration of contextual factors that may affect the responses produced by these models. The guidelines we provide can aid researchers and practitioners in conducting more nuanced and insightful interviews with large language models. From an overall view of our results, we generally do not recommend using interviews with large language models for research purposes, due to their highly unpredictable results. However, we suggest using these models as exploration tools for gaining different perspectives on research topics and for testing interview guidelines before conducting real-world interviews.

Primary Health Care Matters.

Transferable strategies and actions for increasing health assessments for people with an intellectual disability In Australia, people living with an intellectual disability comprise about 1–3% of the population and, compared with the general population, experience worse health outcomes.1 Poorer participation in primary health care of people with an intellectual disability contributes to high levels of undetected and unmanaged health issues and premature deaths from preventable causes.2 A positive development to address these inequities is the roll-out of a $6.5 million Primary Care Enhancement Program over 4 years (2020–2024). The Enhancement Program will be developed through four lead Primary Health Networks (PHNs), with a view to a national rollout across all PHNs. The aim of the Enhancement Program is to increase the skills and ability of general practitioners and other health care professionals to provide effective primary health care for people with intellectual disability.3 To achieve this aim, a key focus of the Enhancement Program is to increase the uptake of the existing Medicare Benefits Schedule (MBS) preventive health assessments to strengthen equity of primary health care access and to support the delivery of evidence-based preventive health to people with intellectual disability (Supporting Information).3 In Australia, there is some evidence to support the use of preventive health assessments for people with an intellectual disability.4 The evidence suggests that yearly preventive health assessments performed in the primary health care setting pick up on unmet health needs in the area of health screening, health promotion, and identification of unrecognised disease.4 Health assessments are a mechanism to support the delivery of evidence-based preventive health care. While people with intellectual disability might in general seem to share few characteristics with Aboriginal and Torres Strait Islander people (hereafter respectfully referred to as Indigenous), these groups have some common challenges when accessing primary health care. These include complexity of health needs, limitations on identification of being Indigenous or having an intellectual disability in clinical information systems, discrimination, clinical inertia, and communication barriers. For both groups, effective clinical practice requires attention to social determinants of health as well as specific medical needs.5, 6 As part of a long-standing Indigenous primary health care continuous quality improvement (CQI) research collaboration, we have knowledge of the barriers to and enablers of the uptake of preventive health assessments — specifically, the MBS item 715 for Indigenous people.7, 8 As such, we have identified some positive actions that may potentially be transferrable to people living with an intellectual disability, along with strategies to inform the effective roll-out of this new program. There is currently no dedicated MBS item on health assessments for people living with an intellectual disability. The 2009 Medicare review resulted in the merging of MBS items dedicated to health assessments for people with intellectual disability with four time-based MBS items (MBS 701, brief; 703, standard; 705, long; or 707, prolonged) for other target groups.9 With the collapse of different health assessments into the single newer MBS item, the ability to identify the extent to which health assessments are being provided to different target groups, such as people living with an intellectual disability, has been lost.9 Given this, PHNs now cannot track uptake or implementation of health assessments for people with an intellectual disability. It is impossible to extract the relevant data from administrative systems at the primary health care level or Department of Health level. Having a dedicated Indigenous-specific health assessment (MBS item 715) has enabled research and evaluation on barriers and enablers of implementation, and data about uptake have informed subsequent policy development.5 Reinstatement of a dedicated and adequately remunerated MBS item is vital to building the evidence base to inform health policy and the provision of health services for people with an intellectual disability through contributing to understanding of who is receiving health assessments and who is not. This will in turn enable development of targeted strategies for increasing uptake. The inability of existing primary health care electronic clinical information systems to systematically identify people living with an intellectual disability will limit the ability of primary health care to identify eligible patients and invite them for a health assessment. Therefore, we recommend that clinical information systems in primary health care are upgraded to enable the easy identification of people living with an intellectual disability, and that primary health care staff are appropriately trained to use these systems. Any patient identifier established in the primary health care setting should be able to be linked to other relevant data systems. Identifying people living with intellectual disability in data systems is particularly important for piloting the new Australian National Disability Data Asset, which will bring together data from multiple sources, including primary health care, to improve the ability to measure and improve outcomes for people with disability.10 A useful point of reference for Australian primary health care is the United Kingdom model, in which people with intellectual disability must be identified at primary health care services. This requirement is supported by a legislative framework and is part of a long term National Health Service plan for providing targeted health services.11 It has been observed that Indigenous health assessments do not necessarily reflect the health aspirations and goals of Indigenous people.12 This learning can be used to ensure that health assessments for people living with intellectual disability are evidence-based, developed with input from people with intellectual disability and carers, and reviewed regularly. Electronic templates can be developed for use in common general practice clinical information systems. With appropriate ethics approval and consent, the data collected can be used for CQI and research purposes to improve implementation of health assessments and ultimately health outcomes. Implementing CQI processes has been shown to be effective in improving the delivery of Indigenous-specific health assessments and evidence-based preventive health care.8 We therefore recommend supporting CQI activities to increase the uptake of health assessments for people living with an intellectual disability. This could include a target in the Practice Incentive Program Quality Improvement program (such as, proportion of people living with an intellectual disability who have had a health assessment), or supporting primary health care to develop locally relevant CQI processes. Although prevalence studies have identified that certain medical conditions and risk factors occur more frequently in people with intellectual disability, there are currently no national clinical guidelines for the delivery of best practice primary health care for people living with an intellectual disability.1 Furthermore, there have been recent calls for the inclusion of intellectual disability into standard clinical guidelines as a specific population that requires distinctive consideration.13 Such guidelines would be a reference point for assessing quality of care for improvement purposes and for building the capacity of GPs and other providers, similar to the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.14 Although there has been increased uptake of Indigenous-specific health assessments, there are continuing gaps in providing appropriate follow-up care, which is essential for ensuring benefit from health assessments.7, 8, 15 We recommend increasing awareness of relevant follow-up MBS items, in addition to health assessments. Investment in the Enhancement Program appears primarily targeted at improving skills and abilities of GPs to improve the quality of care for people with intellectual disability. Yet, there is clear evidence of the value of addressing both demand- and supply-related determinants to improve access to health assessments.5 For example, an effective strategy in increasing the uptake of Indigenous-specific health assessments has been marketing campaigns targeted at community members to increase their awareness of the importance and availability of the assessments. Therefore, we recommend a similar awareness campaign targeting community, carers and disability service providers about the availability of these health assessments for people living with intellectual disability. Naturally, not all learning from experience of Indigenous health assessments is transferable. For example, a preference for health assessments to be conducted by a clinician of the same culture or experience may not apply. While discrimination may be a common factor affecting health and wellbeing, it will be experienced and manifest in different forms to influence health assessment implementation. Australia lacks legislative, policy and regulatory frameworks required to support or enact improving health outcomes for people with intellectual disability. People living with disability are neglected, as a group with specific needs, in both the current draft of the 10-year National Preventive Health Strategy and Australia's Long Term National Health Plan.16, 17 Recognition in relevant frameworks would be a pivotal starting point for addressing the health needs of people living with an intellectual disability. In conclusion, we welcome this commitment to investing in improving access to primary health care and health outcomes for people living with an intellectual disability. We believe there is a unique opportunity to reflect on, and learn from, the experience of implementing Indigenous-specific health assessments, and to apply these learnings to the campaign for increased access to health assessments for this important group. Despite emerging evidence of the benefits of health assessments, there is a clear need to continue to evaluate their effectiveness in different contexts. Multifaceted strategies and action are required at the primary health care centre and service level, in the community, and at patient and policy levels to increase health assessments and follow-up for people living with an intellectual disability. The development of this manuscript would not have been possible without the active support, enthusiasm and commitment of staff in participating primary health care services, and members of the Centre for Research Excellence in Strengthening Systems for Indigenous Health Care Equity and the Centre for Research Excellence in Disability and Health. No relevant disclosures. Not commissioned; externally peer reviewed. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Demographics and meta-analysis of complementary and alternative medicine in health care systems 1. Said Ibrahim Shalaby Department of Complementary Medicine, Medical Division, National Research Center, Cairo, Egypt 2. Mosleh Abd Elrahman Ismail Family Medicine Department, Faculty of Medicine, Suez Canal University, Cairo, Egypt 3. Mohammed Salem Nasrallah Family Medicine Department, Faculty of Medicine, Suez Canal University, Cairo, Egypt 4. Eman Ebraheem Mahmoud Darwish Family Medicine Department, Faculty of Medicine, Suez Canal University, Cairo, Egypt 5. Neelima Gupta # guptagrawal at rediffmail dot com Department of Animal Science, MJP Rohilkhand University, Bareilly 243006, UP, India # : corresponding author DOI http://dx.doi.org/10.13070/rs.en.1.749 Date 2014-04-30 Cite as Research 2014;1:749 License CC-BY Abstract Awareness of Complementary and Alternative Medicine (CAM) among physicians is not widespread. Our objective was to conduct a cross sectional study on primary health care physicians working in 26 primary health care centers and units in Port Said assess the knowledge, attitude and practice of physicians in primary care towards CAM in Port Said, Egypt. The attitude of physicians towards CAM therapy is very supportive if delivered by a specialized and qualified CAM practitioner. According to a questionnaire, 82.1% of physicians defined CAM appropriately and acquired knowledge from television

The purpose of this focused issue is to advance understanding of qualitative research methods in the international business context. Debates on qualitative research methods in the key international business (IB) journals have been rare. There has been no focused issue on this topic previously, either in mir or in other journals in the field, making this a 'special' issue. During the process of editing a recent handbook on qualitative research methods (Marschan-Piekkari/Welch 2004), we realized that while this collection covered many topics, often for the first time in the IB field, there were many others still outstanding. There was thus scope for continuing a dialogue about qualitative methods in the IB research community. The challenge of making qualitative research count in the quantitative world of IB remains. Qualitative research is difficult to define, since the term encompasses many different research traditions, research strategies and methods for data collection and analysis (Prasad 2005). A typical definition is that everything non-numerical is qualitative research (Marschan-Piekkari/Welch 2004, p. 19). However, even this very simplistic definition soon breaks down, since research strategies which are typically considered to be qualitative, such as case studies, can combine numerical with non-numerical data (Hurmerinta-Peltomaki/Nummela 2004). There is also no clear divide between qualitative and quantitative research in terms of research traditions, with much qualitative research in management and IB sharing the positivist assumptions of quantitative research (Prasad/Prasad 2002). This focused issue is not about reporting the empirical findings of IB studies applying qualitative methods; rather it is about the process of undertaking qualitative research in the IB field. Of course, there is a large volume of literature on qualitative research methods already. However, we would argue that the IB context warrants special treatment. As the authors of this focused issue discuss, the distinctiveness of the field stems from its multiple linguistic and cultural settings; organizational complexity; and its intellectual roots in post-War academic institutions in the USA. These issues receive little treatment in general texts on qualitative methodology. There has been some methodological debate in previous issues of mir. Earlier articles in mircan be grouped into three categories: first, reviews of existing methodological practices in IB publications (e.g., Cavusgil/Das 1997, Nasif et al. 1991); second, proposals for new quantitative techniques (e.g., the use of key informants in cross-cultural studies, as proposed by Lenartowicz and Roth 2004 and a linguistic-based measure of cultural distance as developed by West and Graham 2004); and third, calls for new methodological approaches (Boddewyn/Iyer 1999). The absence of qualitative research methods in this debate perhaps reflects the limited amount of empirical qualitative research published in this journal. A recent analysis of mir issues between 1990 and 1999 revealed that only 5 percent of articles published in this period used qualitative methods (Welch/Welch 2004). This focused issue is therefore a response to those, such as Boddewyn and Iyer (1999) in this journal, who have called for alternatives to surveys and secondary data analysis. This focused issue attracted 39 submissions from more than 15 countries. Given that there have been limited outlets for methodological articles in IB, this is a considerable number. It perhaps suggests a level of interest to which IB journals have not responded to date. Of the total number of submissions, 11 were selected for review. On the basis of reviewers' comments, six of these papers were ultimately rejected. The final five papers underwent two and, in some cases, up to four rounds of revisions. In selecting the articles, we used the following criteria: appropriateness of the topic for the focused issue; demonstrated knowledge of IB and methodological literature; quality of argument; originality and innovativeness of the contribution to IB methodology; organization and clarity of the paper; and potential application to research practice in IB. …

Introduction: The Norwegian Coordination Reform was implemented January 1. 2012 with a changed distribution of tasks and responsibility between primary and specialist health care. For the specialist health care the aim was to concentrate to a greater extent on their specialized tasks. Aim: The aim of this study was to examine how health care professionals in a university hospital have experienced the implementation of the Coordination Reform. Method: A qualitative study with three focus group interviews and 3 individual interviews with nurses, physicians and hospital managers. Results: Lack of information within the hospital concerning the Coordination Reform made the informants feel unprepared for the changes that followed, especially in terms of the new guidelines for notifying the municipalities about patients in need of municipal follow-up after discharge. The informants experienced an increased focus on economy, because errors in the notification process led to less income for the hospital. The impression among the informants was that patients without complex care needs were faster received by the larger municipalities, unlike those with complex care needs. According to the informants this affected their work in relation to use of resources and lead to poorer communication. Discussion: Other studies on implementation of the implementation of the Norwegian Coordination reform in primary care have found that their main focus is on their ability to receive patients ready for discharge. The reason is that they have to pay the hospital more than $600 per day if there is a delayed discharge. Both the findings in this and the other studies indicates that the organisations focus is on this topic rather than other aspect of the coordination reform like treating more patients in primary care, health promotion and competency transfer. Conclusion: The key findings was that the aim for the specialist health care to focus more on their specialist competence and an improved coordination with the primary health care has not yet been achieved according to the informants in this study. Lessons learned: The economic incentives to reduce the number of patients ready for discharge in the hospitals have overshadowed other central aspects of the Norwegian Coordination reform. World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116611– http://www.ijic.org/ Limitations: The sample only included informants from one large department at one university hospital. Suggestions for future research: This study indicates that there is a further need for examining health care professionals in relation to the implementation of the Coordination Reform. One interesting aspect concerns the hospitals and specialization – more specialization or are they specialized enough. Another aspect is the work with developing patient pathways and ICTsolutions what are the effects on communication between the hospitals and the municipalities?

BackgroundThe recent Austrian Primary Care Act established new primary health care units (PHCUs) and obliged them to draw up a “care strategy” specifying their focal care tasks and objectives and emphasizing the health care needs of the population in their catchment area with its specific local health and epidemiological profile. The main purpose of these care strategies is thus to ensure that care-providers meet the local needs, but they also provide a rationale for evaluation and organizational development. To assist new PHCUs in establishing care strategies it was necessary to develop a method for automatically generating comprehensive local case studies for any freely definable location in Austria.ResultsWe designed an interactive report generator capable of producing location-specific regional health care profiles for a PHCU located in any of Austria’s 2122 municipalities and of calculating the radius of its catchment area (defined by different levels of maximum car-travelling times). The reports so generated, called “regional health care profiles for primary health care” (RHCPs/PHC), are in comprehensive PDF report format. The core of each report is a set of 35 indicators, classified under five health and health service domains. The reports include an introductory text, definitions, a map, a graphic and tabular presentation of all indicator values, including information on local, supra-regional and national value distribution, a ranking, and numbers of service providers (e.g. pharmacies, surgeries, nursing homes) located within the catchment area.ConclusionsThe RHCPs/PHC support primary health care planning, efforts to improve care-effectiveness, and strategic organizational development by providing comprehensive information on the health of the population, the utilization of health services and the health care structures within the catchment area. In addition to revealing the scope and nature of the health care needed, they also provide information on what public health approaches are necessary. RHCPs/PHC for different locations have already been distributed to numerous stakeholders and primary health care providers in Austria.