Do waiting list initiatives discriminate in favour of those in a higher socioeconomic group?

The UK has a publicly funded health care system with open access to all. In the past, demand for services overwhelmed the resources available. Recent government initiatives have attempted to address this. To achieve shorter waiting times (and guaranteed waiting times), access to additional services has been purchased from the private sector under short-term initiatives, often at sites firth of the home health board. There has been a suspicion that patients from higher socioeconomic groups have benefited differentially from this by rapid access to private health care facilities, due to ease of transport. The aim of this study was to analyse whether a patient's socioeconomic group influenced their access to, and place of, surgery. Patients undergoing a primary total hip or knee arthroplasty in a single health region over a three-year period were identified and their social group was determined by postcode address. Analysis of 3888 patients operated on in four different treatment centres comparing the distribution of patients according to their social group, revealed no bias in the provision of treatment. The study group was comparable to the control population in that health region. In conclusion, the introduction of health policies to reduce time to orthopaedic treatment within one health board area has not resulted in patient bias.     

How does asthma influence the daily life of children? Results of focus group interviews

Background  

Health-related quality of life (HRQL) brings together various aspects of an individual's subjective experience that relate both directly and indirectly to health, disease, disability, and impairment. Although asthma is the most common chronic disease in childhood, information on pediatric patients' views on asthma-specific HRQL has not been described before. The aim of this study was to establish the components of asthma-specific HRQL, as experienced by primary school-aged asthmatic children. The generated components will be used to develop an individualized HRQL instrument for childhood asthma.     

Can a house call by a public health nurse improve the quality of the discharge process for geriatric patients?

OBJECTIVE: To determine whether there was any benefit from a single house call by a health visitor (a public health nurse) to an elderly person after discharge home from a geriatric hospital. METHODS: A randomized controlled trial with blind assessments at 28 days was conducted. Subjects included residents of Bath, England, with an average age of 83 years, who were discharged consecutively from a geriatric hospital to their homes. Intervention was a single visit by a health visitor 72 hours after discharge, to ensure the patient was settled at home, or normal post-discharge care. Outcome measures taken at 28 days by a research nurse included survival, hospital readmissions, nursing home admissions, cognitive and physical function, services requested and supplied, and drug therapy. RESULTS: There were no important differences between the intervention and control groups at 28 days on any of the outcome measurements. The control subjects did better than the study subjects on many of the outcome measures. CONCLUSION: A house call by a health visitor to elderly patients after discharge from geriatric wards does not measurably improve the quality of the discharge.     

Does participation in clinical trials influence the costs of future management of patients?

Background

An earlier study showed that from a societal perspective it was less expensive to encourage patients to self-regulate their medication for GERD (gastro-esophageal reflux disease) by treating patients on-demand.

Objective

The objective was to investigate whether physician involvement in a clinical trial financed by the pharmaceutical industry subsequently results in higher health care costs.

Study design

An open, observational, multicenter study compared direct medical costs and total costs for three groups of patients with different exposure to the clinical trial; (1) Dual exposed, where both the patients and the GP participated in the former clinical trial, (2) GP exposed, where only the GP participated in the former clinical trial and (3) nonexposed, where neither the patients nor the GP participated in the former clinical trial.

Results

We did not find any statistically significant differences in neither direct medical nor total costs. However, we did observe a numerical difference in direct medical costs of 24% higher in the dual exposed group compared to the nonexposed group mainly due to a higher consumption of prescribed medication. The higher direct medical cost in the dual exposed group was however counterbalanced by lower observed direct nonmedical and indirect costs.

Conclusion

Although we did not find any statistical significant differences in health care costs, we did observe a higher consumption of prescribed medication and lower costs of work hours lost if both patient and GPs participated in a former clinical trial. The results may be limited due to a lower number of patients included than expected.     

How does the culture of medical group practices influence the types of programs used to assure quality of care?

OBJECTIVE: It is widely acknowledged that the culture of medical group practices greatly influences the quality of care, but little is known about how cultures are translated into specific types of programs focused on quality. This study explores this issue by assessing the influence of the organizational culture on these types of programs in medical group practices in the upper Midwest. DESIGN AND METHODS: Data were obtained from two surveys of medical group practices. The first survey was designed to assess the culture of the practice using a nine-dimension instrument developed previously. The second survey was designed to obtain organizational structure data including the programs identified by the literature as important to the quality of care in medical practices. Completed surveys were obtained from eighty-eight medical groups. The relationship of the group practice culture to structural programs focused on quality of care was analyzed using logistic regression equations. RESULTS: Several interesting patterns emerged. As expected, practices with a strong information culture favor electronic data systems and formal programs that provide comparative or evidence-based data to enhance their clinical practices. However, those with a quality-centered culture appear to prefer patient satisfaction surveys to assess the quality of their care, while practices that are more business-oriented rely on bureaucratic strategies such as benchmarking and physician profiling. Cultures that emphasize the autonomy of physician practice were negatively (but not at a statistically significant level) associated with all the programs studied. Practices with a highly collegial culture appear to rely on informal peer review mechanisms to assure quality rather than any of the structural programs included in this analysis. CONCLUSION: This study suggests that the types of quality programs that group practices develop differ according to their cultures. Consequently, it is important for practice administrators and medical directors to develop quality assurance programs that fit their cultures if they are to gain buy-in by their clinicians. Future research should assess the effect of culture-structure fit on quality and safety outcomes.     

Can family caregivers of terminally ill patients be a reliable source of information about the severity of patient symptoms?

This study examines the reliability of family caregivers' assessments of a terminally ill patient's symptoms and identifies patient and caregiver characteristics that affect the reliability of caregiver reports. It compares the reports of 143 patients in home hospice units with those of their family caregiver about patient symptoms during the 3 days preceding the interview (Edmonton scale). Correlation coefficients between the patients' and proxies' reports were 0.5 to 0.8, indicating moderate-to-high agreement. Characteristics that had an independent effect on identical reporting were the patient being fully disabled, the care-giver being a woman in good health, the caregiver living with the patient, and the caregiver providing assistance with activities of daily living and medical care. These results suggest that primary caregivers can be a good source of information about a patient's symptoms, although their reports should be used with caution.     

Measuring patients’ perceptions of communication with healthcare providers: Do differences in demographic and socioeconomic characteristics matter?

Background  National governments across the globe have set goals to improve healthcare delivery. Understanding patient–provider communication is essential for the development of policies that measure how well a healthcare system delivers care.
Objectives  This study was designed to determine which, if any, demographic factors were independently associated with how US patients perceive various aspects of communication with their healthcare providers.
Design and methods  The study was a secondary, cross-sectional analysis of nationally representative data from the 2002 Medical Expenditure Panel Survey (MEPS). Among US adults with a healthcare visit in the past year ( n  = approximately 16 700), we assessed the association between several covariate demographic and socioeconomic factors and four dependent measures of patient perceptions of communication with their healthcare providers.
Results  Across all four measures of communication, older patients were more likely to report positively. Having health insurance and a usual source of care were consistent predictors of positive perceptions of communication. Hispanic patients also reported better perceptions of communication across all four measures. The most economically disadvantaged patients were less likely to report that providers always explained things so that they understood. Male patients were more likely to report that providers always spent enough time with them.
Conclusions  This study suggests that patient perceptions of communication in healthcare settings vary widely by demographics and other individual patient characteristics. In this paper, we discuss the relevance of these communication disparities to design policies to improve healthcare systems, both at the individual practice level and the national level.     

When is a group a group? The case of university medical practice plans

A discussion of the background information on university practice plans and a number of the major issues that occupy the energies of the practice plan administrator.