[THE INFLUENCE OF THE ISRAELI LEGISLATION ON THE RELATIONSHIP BETWEEN PHYSICIANS AND PHARMACEUTICAL COMPANIES].

Introduction: The relationship between physicians and pharmaceutical-companies raises many dilemmas. There are two types of solutions to these dilemmas: self-regulation and government regulation. Our goal was to review in what way legislative intervention and self-regulation standardize and affect the relationship.

Models for projecting supply and demand for nurses in Israel.

Background: Concern is growing over serious shortages in the nursing workforce and imbalance between supply and demand. Projections indicate that the demand for the nursing workforce will increase due to the aging population and an increase of the percentage of elderly people requiring assistance.

Study Goals: To examine the expected balance between supply and several demand projections for nurses in Israel in order to contribute to planning the nursing workforce.

Examining professional boundaries between nurses and physicians in neonatal intensive care units.

Background: Medical and technological developments, financial constraints and a shortage of physicians have made it necessary to re-examine professional boundaries between physicians and nurses. Israel's manpower shortage in Neonatal Intensive Care Units (NICUs) has changed the responsibility and authority of nurses. However, these changes have not evolved into a uniform policy defining the division of responsibility between physicians and nurses.

Work practices and the provision of mental-health care on the verge of reform: a national survey of Israeli psychiatrists and psychologists.

Background: The State of Israel is preparing to transfer legal responsibility for mental- health care from the government to the country's four competing, nonprofit health-plans. A prominent feature of this reform is the introduction of managed care into the mental-health system. This change will likely affect the service delivery patterns and care practices of professional caregivers in mental-health services.

Registered nurses in Israel - workforce employment characteristics and projected supply.

Background: Surveys of nursing supplies around the world have furnished a better understanding of the structure of the workforce, helped identify shortages, and plan professional training. This study aimed to examine the employment and workforce characteristics of registered nurses and the projected supply in Israel as a tool for planning.

Methods: 1.

[Identifying ways to address the crisis facing a medical specialty: a case study of general surgery].

Background: In a previous study we defined criteria for a medical specialty in crisis' and measures to assess the scale of the problem, and possible resolutions suggested based on experience abroad. This study seeks to gain further knowledge by exploring how front-line Israeli surgeons envisage the problems and possible solutions.

Objectives: To identify ways to address the workforce crisis in general surgery (GS) white focusing on issues that can be dealt with at the department and the hospital levels.

Turnover of registered nurses in Israel: characteristics and predictors.

Background: In an era of global and local nursing shortages, nursing turnover has negative consequences in terms of diminished quality of care, increased costs and economic losses and decreased job satisfaction.

Objective: To examine the turnover rate of registered nurses in Israel by assessing the varying degree of turnover between economic sectors, between hospital and community facilities, and/or between types of hospitals; and by examining potential predicting factors of turnover among registered nurses.

Methods: A national phone survey was undertaken in Israel consisting of a random sampling of registered nurses of working age (up to age 60).

[OFEK virtual medical records: an evaluation of an integrated hospital-community system].

Background: In 2005, an innovative system of hospital-community on-line medical records ("OFEK") was established at Clalit Health Services to reduce costs and improve medical care.

Goals: To examine the utilization of OFEK and its impact on quality indicators and medical-service utilization.

Method: Examining frequency of use of OFEK with OFEK's own track-log data; "before" and "after" data were used to compare changes in quality indicators and service utilization for experimental versus control groups.

Sources of distress during medical training and clinical practice: Suggestions for reducing their impact.

Background: Medical students and doctors experience several types of professional distress. Their causes ("stressors") are commonly classified as exogenous (adapting to medical school or clinical practice) and endogenous (due to personality traits). Attempts to reduce distress have consisted of providing students with support and counseling, and improving doctors' management of work time and workload.

The impact of an integrated hospital-community medical information system on quality of care and medical service utilisation in primary-care clinics.

Background: In 2005, an innovative system of hospital-community, on-line medical records (OFEK) was introduced in Clalit Health Services (CHS).

Goals: To examine OFEK's use and impact on quality indicators and medical-service utilisation in CHS primary-care clinics.

Methods: Examining the frequency of OFEK's use with its own track-log data; comparing 'before' and 'after' quality indicators and service utilisation of experimental versus control clinics.

The impact of an integrated hospital-community medical information system on quality and service utilization in hospital departments.

Purpose: In 2005, an innovative system of hospital-community on-line medical records (OFEK) was implemented at Clalit Health Services (CHS). The goals of the study were to examine the extent of OFEK's use and its impact on quality indicators and medical-service utilization in Internal Medicine and General Surgery wards of CHS hospitals.

Methods: Examining the frequency of OFEK's use with its own track-log data; comparing, "before" and "after", quality indicators and service utilization data in experimental (CHS patients) versus control groups (other patients).

Stress, work overload, burnout, and satisfaction among paramedics in Israel.

Introduction: The number of paramedics in Israel is increasing. Despite this growth and important role, the emergency medical organizations lack information about the characteristics of their work.

Objective: The objective of this study was to examine the characteristics of the paramedics' work, the quality of their working lives, the factors that keep them in the profession, or conversely, draw them away from it.

The Israeli mental health insurance reform--perspectives.

Background: At present, Israel's mental health system functions separately from its physical health system in terms of financing, planning, organization and practice setting. The government is responsible for the provision of mental health care, while the country's four, competing, non-profit health plans are responsible for physical health care. A reform effort is underway to transfer legal responsibility for the provision of mental health care from the government to the health plans.

[Criteria for a medical specialty in crisis: a case study of general surgery and internal medicine].

Background: Several clinical specialties in Israel appear to be experiencing an ongoing crisis. Recently, a Public Committee addressed this problem and recommended its further study. In this paper, the authors report a pilot case study of general surgery and internal medicine, which have been identified as "clinical specialties in crisis" in the medical literature, in the testimonies presented to the Public Committee, and during our preliminary interviews.

[Medical specialties in crisis: causes of the crisis and possible solutions].

Background: Several clinical specialties in Israel appear to be experiencing an ongoing crisis. In this paper the authors report a pilot case study of general surgery and internal medicine, which have been identified as "clinical specialties in crisis" in the medical literature, during preliminary interviews and in the testimonies presented to a Public Committee appointed by the Prime Minister (the Amorai Committee) that addressed this problem in 2002.

Objectives: To identify the causes of the crisis and possible solutions.

[Do the emergency medical services need more paramedics? An examination of supply and demand].

Background: Paramedics are a critical national resource. The paramedic workforce is dynamic and has never been studied, thereby limiting the possibility of appropriate planning.

Objectives: To examine the present and projected supply and demand for paramedics, the balance between supply and demand, and how this affects the planning of the paramedic workforce.

[Has the time come to transfer residency training from hospitals to the community? Lessons from other countries and implications for Israel].

Most medical practice has moved from the hospital to the community. Nevertheless, in the western world, including Israel, residency training in various specialties has remained mostly in the hospital. Residents have no opportunity to encounter the morbidity and the patient mix that they are likely to encounter in their future work life in the community, after their residency.

Overload, autonomy, and burnout as predictors of physicians' quality of care.

A model in which perceived overload and burnout mediated the relations of workload and autonomy with physicians' quality of care to their patients was examined. The study was based on data from 890 specialists representing six medical specialties. Including global burnout as well as its three first-order facets of physical fatigue, cognitive weariness, and emotional exhaustion improved the fit between the structural model and the data relative to an alternative model that included only global burnout.

[Modes of consultant employment in Israel].

Background: One of the features of modern clinical practice is the shift of secondary care from hospitals to the community clinics. This phenomenon and the competition among health plans, has accelerated the development of secondary medicine at the community level, and increased the activity of outpatient clinics in acute-care hospitals. Consequently, many consultants are working in more than one setting within the framework of different modes of employment.

[The relationship between job overload, burnout and job satisfaction, and the number of jobs of Israeli consultants].

Background: The locus of secondary medical care provision is changing. Services that once were provided solely in hospitals are now available in the community. This and the increased competition among health plans since implementation of the National Health Insurance Law have spurred the development of community-based consultant/specialty medicine in Israel.