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In light of the rising regional inequalities in primary care provider supply, to ensure equitable access is a pressing issue in health policy. Most policy approaches fall short in considering the patient perspective when defining shortage areas. As a consequence, implementations of new service delivery models might fail to be responsive to patients' expectations. To explore regional differences in the relative importance of structure and process attributes as drivers of patient satisfaction with local primary care, we collected data from residents of three objectively well-supplied urban and six objectively worse-supplied rural areas in Germany and tested a multi-group structural equation model. The results suggest that the relative importance of care attributes is different among the regional conditions rural and urban. Regardless of regional constraints, the strongest determinants of satisfaction are not related to structural aspects but are concerned with the quality of the doctor-patient relationship. A lack of available choices and a higher tolerance in terms of distances provide possible explanations for the results. The high importance rural residents attribute to the interpersonal relation should not be neglected in the re-organization of traditional service delivery in rural areas., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Innovations in health care are costly and risky, but they also provide the opportunity for hospitals to increase quality of care, to distinguish themselves from competitors and to attract patients. While numerous hospitals strive to increase their innovativeness by adopting a costly innovation leader strategy, the question of whether this actually influences the patient's choice remains unanswered. To understand the role of innovativeness from the patient perspective, this study conceptualizes the construct of innovativeness reputation of hospitals and determines its relevance in patients' hospital choice decisions. In the pretest, we identified six dimensions of innovativeness reputation such as progressive work procedures and value added services. We then used three different quantitative multi-criteria decision-making methods to evaluate the relative importance of innovativeness reputation in patient choice. We collected data from 355 former German patients who had undergone elective non-emergency surgery. Overall, innovativeness reputation accounts for 11.6%-16.8% of the patient decision. Innovativeness reputation has a moderate influence on hospital choice and should be taken into account by managers. Since technical innovations are costly, hospitals should use other means to enhance their innovative image. Strategies such as emphasizing value added services can enable hospitals to increase their innovativeness reputation efficiently.

Objective: Research testing the concept of decision-making styles in specific contexts such as health care-related choices is missing. Therefore, we examine the contextuality of Scott and Bruce's (1995) General Decision-Making Style Inventory with respect to patient choice situations., Methods: Scott and Bruce's scale was adapted for use as a patient decision-making style inventory. In total, 388 German patients who underwent elective joint surgery responded to a questionnaire about their provider choice. Confirmatory factor analyses within 2 independent samples assessed factorial structure, reliability, and validity of the scale., Results: The final 4-dimensional, 13-item patient decision-making style inventory showed satisfactory psychometric properties. Data analyses supported reliability and construct validity. Besides the intuitive, dependent, and avoidant style, a new subdimension, called "comparative" decision-making style, emerged that originated from the rational dimension of the general model., Conclusions: This research provides evidence for the contextuality of decision-making style to specific choice situations. Using a limited set of indicators, this report proposes the patient decision-making style inventory as valid and feasible tool to assess patients' decision propensities., (© The Author(s) 2015.)

Background and Purpose: Despite efforts to provide comprehensive health care services and reduce inequalities, most developed countries face serious challenges in achieving comprehensive health care delivery in rural areas. The purpose of this study is to characterize health care shortages in the rural areas of developed countries and to comprehensively explore the underlying reasons for these shortages., Methods and Sample: To answer the research questions, we conducted a systematic literature review. The content analysis included 176 papers on the topic of rural health care. The thematic-analysis approach revealed key aspects of health care shortages in rural areas and evidence regarding the reasons for these shortages., Findings and Conclusion: Shortages of sufficient health care in rural areas were clustered into the following five categories: provider shortages, maldistribution, quality deficiencies, access limitations and the inefficient utilization of health care services. The reasons for the occurrence of these shortage problems are manifold and are related to physical/infrastructural, professional, educational, social-cultural, economic and political issues. This paper contributes to a comprehensive understanding of the health care problems in rural areas by creating an integrated framework that examines several aspects of shortages in sufficient health care in rural areas as well as their underlying reasons. The results provide directions for future research and specific advice for policy makers., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Decision makers in hospitals are regularly faced with choices about the adoption of new technologies. Wrong decisions lead to a waste of resources and can have serious effects on the patients' and hospital's well-being., Purpose: The goal of this research was to contribute to the understanding of decision making in hospitals. This study produced insights regarding relevant decision criteria and explored their specific relevance., Methodology/approach: An initial empirical survey was used to collect the relevant criteria for technological decision making in hospitals. In total, 220 experts in the field of health technology assessment from 34 countries participated in the survey. As a second step, the abovementioned criteria were used to form the basis of an analytic hierarchy process model. A group of 115 physicians, medical technical assistants, and other staff, all of whom worked in the field of radiooncology, prioritized the criteria. An analysis of variance was performed to explore differences among groups in terms of institutional and personal categorization variables., Findings: The first part of the research revealed seven key criteria for technological decision making in hospitals. The analytic hierarchy process model revealed that organizational impact was the most important criterion, followed by budget impact. The analysis of variance indicated that there were differences in the perceptions of the importance of the identified criteria., Practical Implications: This exploration of the criteria for technological decision making in hospitals will help decision makers consider all of the relevant aspects, leading to more structured and rational decisions. For the optimal resource allocation, all of the relevant stakeholder perspectives and local issues must be considered appropriately.

Research and practical guidelines have many implications for how to structure a health economic study. A major focus in recent decades has been the quality of health economic research. In practice, the factors influencing a study design are not limited to the quest for quality. Moreover, the framework of the study is important. This research addresses three major questions related to these framework aspects. First, we want to know whether the design of health economic studies has changed over time. Second, we want to know how the subject of a study, whether it is a process or product innovation, influences the parameters of the study design. Third, one of the most important questions we will answer is whether and how the study's source of funding has an impact on the design of the research. To answer these questions, a total of 234 health economic studies were analyzed using a correspondence analysis and a logistic regression analysis. All three categories of framework factors have an influence on the aspects of the study design. Health economic studies have evolved over time, leading to the use of more advanced methods like complex sensitivity analyses. Additionally, the patient's point of view has increased in importance. The evaluation of product innovations has focused more on utility concepts. On the other hand, the source of funding may influence only a few aspects of the study design, such as the use of evaluation methods, the source of data, and the use of certain utility measures. The most important trends in health care, such as the emphasis on the patients' point of view, become increasingly established in health economic evaluations with the passage of time. Although methodological challenges remain, modern information and communication technologies provide a basis for increasing the complexity and quality of health economic studies if used frequently.

Background: The lack of general practitioners in rural areas is a problem for many industrialised countries. There seems to be a promising solution among medical students. This was recognised in Saxony in 2009 and an appropriate sponsoring programme was set up. In this study we have examined the utility, the factors influencing the interest in this sponsorship and its acceptance., Methods: Answers to a written questionnaire sent to medical students in Saxony were evaluated with the help of descriptive statistics., Results: 25 of the total of 1 055 students who received the questionnaire stated that they used the sponsorship programme. Positive influencing factors for interest were above all a higher state of knowledge, the students' background, stage of studies and type of financial support. The primary reasons for rejecting the program were, besides fear of being bound by it (74%), the wish for advanced training in a different specialty (54%) and the wish to work in a hospital (33%)., Discussion: By adapting the conditions of the sponsorship programme and by targetted communications, it should be possible to increase its acceptance. Thus, financial compensation for not used sponsoring could induce more advanced students to accept aid. Students from rural districts should be specifically approached since they exhibit a higher affinity for choosing to practice in rural areas. It would also be helpful to focus more on students who finance their studies themselves. In general, it can be assumed that a higher density of information would also lead to a greater interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

In the present study, a chromogenic in situ hybridization for the identification of Giardia duodenalis in paraffin-embedded tissue samples was developed. The sensitivity and specificity of the probe was validated by testing it on cultured reference samples of different assemblages of G. duodenalis as well as culture and tissue samples containing other protozoa and infectious agents. The probe gave a positive reaction with the Giardia samples and a negative reaction with all other samples. Further, the probe was used for screening of histological slides of intestine from different animal species (99 canine samples, 85 feline samples, and 202 porcine samples) for the presence of G. duodenalis trophozoites. With this assay, the parasites were detected in samples from 8 dogs (8.08%), 6 cats (7.06%), and zero pigs. The results clearly indicate that the described method is useful for detection of Giardia trophozoites in routinely processed intestinal tissue of different animal species., (© 2011 The Author(s))