https://www.um.edu.mt/library/oar/handle/123456789/8433 2026-04-21T02:12:06Z https://www.um.edu.mt/library/oar/handle/123456789/8653 Title: Patients’ access to cross-border healthcare : the Maltese perspective Abstract: Background: The purpose of the present study is to analyse the willingness of Maltese patients to access cross-border healthcare. This study seeks to analyze factors and level of willingness to access cross-border health care by evaluating patients’ behaviours, attitudes, experiences and expectations. The purpose is to include patients who did and did not experience treatment, which could possibly present variants in willingness to access cross-border healthcare. This population provides evidence on sociodemographic issues, financial issues, literacy on cross-border healthcare, patients’ experiences and patients’ expectations which are domains that affect willingness to access cross-border healthcare. This study creates a continuum with recommendations from previous studies such as using patients' experiences via the current arrangements that Malta has with the United Kingdom as research ground Objectives: The objectives of this study are to identify: 1) factors that influence the willingness of Maltese patients to access cross-border healthcare in Malta and 2) the level of willingness to access cross-border healthcare in Malta. Methodology: This study employed a quantitative cross-sectional approach to measure willingness to access cross-border health care by patients in Malta and to identify the factors that are associated with willingness. The target population includes patients from the outpatients department of the public hospital. The fieldwork was implemented in a public hospital, which is an acute general teaching hospital offering a full range of hospital services. The research tool is a self-designed survey which was developed via expert and focus group analysis and piloted prior to the commencement of data collection. The data was collected between January 2015 and March 2015. It was analysed using IBM SPSS Software© and it was analysed via descriptive analysis and non-parametric tests. Results: Age (p-value=0.006), education (p-value=0.008), language literacy (pvalue= 0.000), literacy on cross-border healthcare (p-value=0.000) and financial resources (p-value=0.000) were found to have a significant association with willingness to access cross-border healthcare. Gender, employment status, and occupation were found not to be significantly associated with willingness to access cross-border healthcare. Maltese patients who participated in this study are willing to access treatment abroad. There is no significant difference in willingness to access crossborder healthcare between the respondents who have never received treatment abroad and those who did experience institutionalised exits. Respondents base their decisions to access treatment abroad on the information provided by their specialist and General Practitioner and they access treatment abroad for specialised care. These findings are context specific. Conclusions: The respondents of the study are willing to access cross-border healthcare and are knowledgeable of their cross-border rights as EU/Maltese citizens. They respondents are more likely to access treatment abroad for specialised care rather than to by-pass long waiting times in Malta. The respondents are willing to access foreign care related to the existing arrangements in the Maltese health system. Knowledge on cross-border care needs to be improved in Malta and it is country specific. Description: M.SC.HEALTH SERVICES MANGT. 2015-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/8652 Title: Managing migrant nurses in Malta : an assessment of their integration and competencies in the health system Abstract: Purpose: The purpose of this study is to determine the extent to which these recruits have become integrated into the Maltese healthcare system as well as to assess migrant nurses’ competencies and identify any clinical differences in the competencies between migrant nurses and Maltese nurses. Background: The recruitment of migrant nurses in Malta is inevitable as demographically, the Maltese population is in better health and is living longer and the demand for healthcare is continuously on the rise. As a consequence of this, healthcare providers are likely to continue to recruit nurses from overseas. The need for the provision of more long-term care beds is an issue that must be faced and tackled continuously. However, such needs should not be based on our current policies and practices which present nothing but a major lacuna when it comes to the provision of community care support. According to available literature on the subject, nursing shortages are not only experienced locally but are actually a global problem. On two occasions over the past five years, the Maltese health authorities have taken to step to recruit migrant nurses. At the time of this study, nursing shortages still existed but to a much lesser degree and this shortfall is generally filled with the new Maltese graduate nurses. Method: To reach the aim of this study, a mixed method approach was adopted which includes both qualitative and quantitative methods. The methods chosen were selfadministered structured questionnaires and in-depth interviews. Questionnaires were distributed to 260 migrant nurses and 68 responded, however seven questionnaires were excluded since they did not include enough details. Seventy five questionnaires were then distributed to Maltese nurses so as to have significant number of participants in each group. Interviews were carried out with three hospital managers, three Maltese and three migrant nurses from each hospital. These methods were conducted in parallel and only brought together once the data were being analysed. Discussion and recommendations: The results revealed that there was only a statistically significant difference from the domains of the tool in communication which was also highlighted in the interviews by the participants. Several aspects concerning human resources and nurse shortages in Malta were also highlighted. Results revealed that migrant nurse recruitment should lead to a better match between the skills of the migrant nurses and the needs of the local hospitals. Often, migrant nurses are not working in their fields of expertise. This study shows that the Maltese health authorities also need to focus more on other sensitive topics, such as racism and cultural differences. Several recommendations for further studies were identified to include the need to have specific structured adaptation programmes according to the country of origin of the migrant nurses and an evaluation of the impact of migrant nurses in the Maltese health care system. Finally this study highlighted the importance of encouraging more Maltese students to opt for a career of nursing. Description: M.SC.HEALTH SERVICES MANGT. 2015-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/8651 Title: Attitude and perception of doctors in Malta towards revalidation Abstract: After triggering global interest, revalidation of physicians seems to be spreading across Europe. Consequently all the doctors across the continent may be duly asked to provide evidence of their competence (Murphy et al., 2012). Throughout the years, doctors' selfassessment has become questionable and thereby raising quite a few eyebrows. Both governments and the public have expressed the need for high quality care which is provided by competent doctors. Developing measures to assess doctor's performance is complicated and challenging. It is being argued that there is a need for revalidation schemes which are reliable, effective and which support reflective practice (Merkur & World Health Organization, 2008). However, it is not yet clear what impact the revalidation system will have on doctors' free movement within the European Union (Murphy et al., 2012). There is a growing pressure in some countries within the European Union to assure that practicing doctors are up- to- date with current practice and provide a high quality patient care. This pressure was driven by several factors among which is the accumulating evidence of medical errors. Moreover, the accelerated development in technology and knowledge poses doctors an ongoing challenge (Merkur & World Health Organization, 2008). Nevertheless, in the light of these ongoing advancements, doctors are being given support, encouraged or even required to participate in lifelong learning so that they would enhance their competence and keep abreast with what is happening in the field. This may take several forms like identifying relevant learning needs, improving knowledge and skills and assessing performance (Mladovsky, Merkur, Mossialos, & McKee, 2009). A review of some European countries, USA, Canada, New Zealand and Australia shows that there is a variety of methods to assure doctors' competence. The outcome of these approaches may lead to re-licensing or recertification (Southgate & Pringle, 1999). Revalidation is a comprehensive term that includes all the methods that are used for assuring that doctors are competent. It may comprise methods of assessing whether doctors are fit to practice or may stretch further to include interventions should doctors underperform (Merkur & World Health Organization, 2008). There are simple and more complex forms of re-certification. The simple forms of recertification may merely include engagement in Continuous Medical Education (CME) programs. Such programs would provide a variety of methods carefully designed to keep doctors aware of with what is happening in the medical field. In addition to CME, the wider model of Continuing Professional Development (CPD) focuses on the development of managerial, social and personal skills. More complex forms of re-certification may include other tools, for instance external evaluation, practice assessment and peer review (Merkur & World Health Organization, 2008). This study aims to explore the attitude and perception of doctors in Malta towards revalidation and their opinion regarding the introduction of such a program. Moreover, the study also purports to discover the doctors’ point of view about the potential benefits and problems it might have, as well as which method of doctors’ performance evaluation is most beneficial and feasible. Description: M.SC.HEALTH SERVICES MANGT. 2015-01-01T00:00:00Z