Community Med
· 1989 Aug · PMID 2605891
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This paper considers management options for limiting general practitioner use of open access radiology - a service for which there is increasing demand which is difficult to meet. In the current climate of cost containme...This paper considers management options for limiting general practitioner use of open access radiology - a service for which there is increasing demand which is difficult to meet. In the current climate of cost containment, restriction of general practitioner access to these expensive diagnostic facilities has management appeal. However, it is difficult to justify blanket restriction of access to radiology services as there is no evidence that it would be economically or clinically sensible. An explicit quota system is unlikely to be feasible because of the small number of referrals made by general practitioners and the element of chance which will inevitably enter into the referral process. Managers should examine more closely the manipulation of incentives and costs which are used, often implicitly, to balance the conflicting desires of clinicians and managers. The best management option would appear to involve a re-evaluation of the role of the radiologist to include responsibility for managing the service. This should include assessment of appropriateness of referral by reference to guidelines for investigation and the behaviour of acknowledged good practitioners.
Community Med
· 1989 Aug · PMID 2514068
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This paper describes one of the first attempts at an economic evaluation of a community care initiative for elderly mentally infirm people and their carers. It is demonstrated that community support provided mainly throu...This paper describes one of the first attempts at an economic evaluation of a community care initiative for elderly mentally infirm people and their carers. It is demonstrated that community support provided mainly through an innovative Family Support Unit (FSU) is almost three times more costly than that which would otherwise be provided. However, FSU support results in prolonged life at home for elderly mentally infirm people, thus saving costly long-term care beds. If life at home is preferable to long-term care, FSU care can be judged cost effective. However, regarding implementation of such schemes, cash-limited local authorities appear to be forced to take on schemes which, despite being cost effective when taking a broad range of resources into account, cost more than they save as far as the local authority itself is concerned.
Madeley RJ, Gillies PA, Power FL
… +1 more, Symonds EM
Community Med
· 1989 May · PMID 2787722
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In the largest survey of smoking in pregnancy to date in the United Kingdom, 3882 women attending the two antenatal clinics in Nottingham during July and August 1986, were asked about their smoking habits. Thirty-seven p...In the largest survey of smoking in pregnancy to date in the United Kingdom, 3882 women attending the two antenatal clinics in Nottingham during July and August 1986, were asked about their smoking habits. Thirty-seven per cent of pregnant women were smoking and only one in four of these was successful at stopping at some point during pregnancy. However, 55 per cent of the mothers who smoked at the start of pregnancy claimed to smoke less during pregnancy. No change was reported in the habits of one-quarter of the mothers who smoked during pregnancy and this proportion may represent an 'irreducible minimum'. Mothers were more likely to continue to smoke if younger (14-20 years), single, living with a partner who smoked, who left school at 16 years and were from manual working families. Those who succeeded in giving up smoking during pregnancy were more likely to be from professional and managerial families. Antenatal booklets about the dangers of smoking were the source of information cited most frequently. Half of the smoking mothers claimed not to have received advice from their family practitioners about the hazards of smoking nor information about how to give up the habit. Even fewer received such advice from hospital doctors, or midwives. This represents a major challenge to professional training in health education.
Bennett P, Blackall M, Clapham M
… +3 more, Little S, Player D, Williams K
Community Med
· 1989 May · PMID 2752725
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The South Birmingham Coronary Prevention Project is described, in which health checks by practice nurses in GPs' surgeries are combined with direct patient access to a secondary referral system. Where appropriate, health...The South Birmingham Coronary Prevention Project is described, in which health checks by practice nurses in GPs' surgeries are combined with direct patient access to a secondary referral system. Where appropriate, health check attenders are offered the choice of either (a) counselling by the practice nurse, (b) direct referral to their GP, or (c) direct referral to secondary intervention, including specialist dietary advice for patients with high (greater than 6.5 mmol/l) serum cholesterol, stress management training for mild hypertension (diastolic blood pressure greater than 90 less than 105 mmHg), and smoking cessation groups. Significant reductions in blood pressure (p less than 0.005) and serum cholesterol levels (p less than 0.001) have been achieved. Further, substantial numbers of smokers have ceased since attending smoking cessation groups. This multidisciplinary approach to the identification and modification of risk factors for coronary heart disease may provide a powerful adjunct to wider ranging population interventions.
Community Med
· 1989 May · PMID 2752722
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Published research shows people of Asian origin to be less healthy than the white population. Most of the studies have not taken account of differences in employment between populations of white and Asian origin. Also, l...Published research shows people of Asian origin to be less healthy than the white population. Most of the studies have not taken account of differences in employment between populations of white and Asian origin. Also, little research has been carried out on the patients' perceived health. This study, based on 215 patients from an inner-city general practice in Bradford, looks at the influence of ethnicity and unemployment on the perceived health of the sample. The Nottingham Health Profile was used as the measure of perceived health. In the study population, twice as many Asians as white people were unemployed, and significant differences in perceived health were observed between the employed and the unemployed. After controlling for employment, Asian males had significantly better perceived health than white males in the 16-34 age group. Perceived health of Asian and white females was similar on most morbidity dimensions.
Community Med
· 1989 May · PMID 2752720
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People living in 102 rural households on private water supplies, and their matched controls on mains water, were asked about their health in a postal questionnaire. People using private water supplies were more likely to...People living in 102 rural households on private water supplies, and their matched controls on mains water, were asked about their health in a postal questionnaire. People using private water supplies were more likely to be from farming families (and so in socioeconomic class II) and less likely to be retired than their controls on mains water. Families using contaminated private supplies ('dirty' water) reported lower rates of colds and respiratory illnesses than people using mains water or uncontaminated private supplies ('clean' water). The mains-water users had visited their general practitioners more often in the last three months. There was no difference in the incidence of acute abdominal symptoms recorded in a diary kept by survey participants. Considering children, who are more susceptible to infectious illnesses, the only difference in health was that children in the families with 'dirty' private water took more medication (though reported illness less often) than others. In conclusion, the study indicated that private water is not harmful to health, but the results must be put in the context of evidence from other work.
Community Med
· 1989 Feb · PMID 2721149
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Research shows consistently wide variations in all aspects of general medical practice. Extreme variations in rates of referral to hospital have recently been highlighted, but remain largely unexplained. New information...Research shows consistently wide variations in all aspects of general medical practice. Extreme variations in rates of referral to hospital have recently been highlighted, but remain largely unexplained. New information systems now make it possible to identify GPs with very high or very low rates of referral so that their behaviour can be reviewed. Before using this information politicians, managers and doctors should give careful thought to what it means and its limitations. The rate of referral provides no indication of the appropriateness of referrals. Any intervention designed to improve the referral mechanism should aim to increase the proportion of people who are appropriately referred to hospital and to reduce the proportion who are inappropriately referred. This is unlikely to be achieved by focusing attention on GPs with high or low rates regardless of how they are made up.