HSR: disciplines which answer ‘we know what should be happening in healthcare system but what actually happens?’, production, organisation, distribution & impact of services on status, illness & disability

Features HSR: methodological pluralism
Multidisciplinary approach: no single discipline (epi or clinical) able to answer research q’s, theoretical & analytical approaches epi, sociology, economics, psychology to give knowledge on performance of system
Multimethod approach: no single method predominates e.g. quantitative & qualitative approaches equally valid contributions to answering q

Features HSR: conducted various levels (individual, fam, profession, organisational, institutional, com, pop), clinicians, pts & funding agencies together for greatest gain

Examples HSR q’s: how can we measure outcomes of care? Is hsystem benefitting users? Who is using services? What’s being provided? system fair? system value for money? How do alt tx approaches compare? Best workforce mix?

HSR NZ: Characteristics of dent practice (workforce, practising behaviour, pt care – diabetics, older ppl, chemoprophylaxis, aesthetic dent, new tech, immigrant experiences), outcomes of dent care (measuring OH rather than disease, outcomes of tx under GA, is dent care good for us?)

Early example – retrospective audit: review case notes kids treated GA @ hosp dent unit 1989-94, caries primary reason, SDB funding, hosp dentist rather than OMFS cases, waiting time diff consultation vs GA, mean wait time incr from 1.1 months to 2.4 months, cases/session incr from 1.7 to 2.6

Dent & stress: physical & mental problems, poor working relationships , low job satisfaction, burn-out, premature retirement, >10% burn-out

Relevant domains: time-related pressures, heavy workload, $ concerns, difficult patients, inflicting pain, staff problems, breakdowns, defective materials, poor working conditions, med emergencies, boredom

Interesting diffs: av 7 constant stressors (NZ-trained = 6, overseas-trained = 10), higher % males stressed by high levels conc 46%, 35%, causing pain 35%, 24%, working w kids 34%, 27%), new CPD req only 15% (higher among busier)

Coping w stress: alc 28%, eating 22%, sports 64%, restings 59%, hobbies 47%, spending money 20%, forgetting work 59%, interactions w people 78%, coping strategies 30% (by sex, graduating cohort)

Most common stressors tx difficult kids, time pressure, & high levels conc, overseas-trained more stressed, sexes diff in stress management

Treating older ppl: DHB sector lacks capacity to deal w prob itself, long-term care sector ill-equipped, gen dent practitioners part of system of oral care for older in institutions, know little about barriers for GDPs providing care, GDPs’ beliefs RE OH of older, probs older face in access, degree willingness of long-term care sector to face prob

Study NZ dentists’ perceptions of barriers to caring for older, beliefs RE oral diseases among older, vs those w what we know from epi evidence, postal survey random sample 700 GDPs, 1st wave forms April 2006, 2nd wave nonresponders May 2006, response = 64.5%