How has NHS Direct changed primary care provision?

We studied a general practice cooperative in west London that served 900,000 patients. The telephone triage service subsequently became a pilot for the national service, NHS Direct. Both quantitative and qualitative data were used for the study. The quantitative data consisted of the (anonymized) patient computer records available on the telephone triage service for the first two weeks in December 1998, December 1999 and December 2000. Two significant events were identified. The first, which emerged principally from analysis of the quantitative call data, were changes in patient outcomes during the period that spanned the arrival of NHS Direct. The second, revealed mainly through analysis of the qualitative data, were changes in the behaviour, perceptions and work experience of the triage nurses. Significant behavioural and attitudinal transitions occur when primary care organizations are modified.     

Short- and medium-term effects of informal care provision on female caregivers’ health

In this paper, we present estimates of the effect of informal care provision on female caregivers’ health. We use data from the German Socio-Economic Panel and assess effects up to seven years after care provision. The results suggest that there is a considerable negative short-term effect of informal care provision on mental health which fades out over time. Five years after care provision the effect is still negative but smaller and insignificant. Both short- and medium-term effects on physical health are virtually zero throughout. A simulation analysis is used to assess the sensitivity of the results with respect to potential deviations from the conditional independence assumption in the regression adjusted matching approach.     

How can we achieve global equity in provision of renal replacement therapy?

There is a significant emerging burden of chronic and end-stage kidney disease in low- and middle-income countries, driven by population ageing and the global epidemic of type 2 diabetes. Sufferers of end-stage kidney disease require ongoing dialysis or kidney transplantation to survive; however, in many low- and middle-income countries, treatment options are strictly limited or unaffordable. Low numbers of maintenance dialysis patients and transplant recipients reflect profound economic and service provision challenges for health-care systems in low- and middle-income countries in sustaining renal replacement therapy programmes. Underdeveloped organ donor and transplant programmes, health system and financing issues, ethical regulation of transplantation and the cost of pharmaceuticals commonly pose additional barriers to the delivery of efficient and cost-effective renal replacement therapy. Development of locally appropriate transplant programmes, effective use of nongovernmental sources of funding, service planning and cost containment, use of generic drugs and local manufacture of dialysis consumables have the potential to make life-saving renal replacement therapy available to many more in need. Select low- and middle-income countries demonstrate more equitable provision of renal replacement therapy is possible outside high-income countries. For other low- and middle-income countries, education, the development of good public policy and a supportive international environment are critical. Prevention of end-stage kidney disease, ideally as part of an integrated approach to chronic vascular diseases, must also be a key objective.     

Health care providers’ perspectives on the provision of prenatal care to immigrants

In addition to facing barriers to health care and experiencing poor health status, immigrants to Canada and Sweden tend to have more negative birth outcomes than the native-born population, including low birth weight and perinatal mortality rates. Explored through interviews with health care professionals, including midwives, nurse practitioners, social workers and obstetrician gynaecologists, this paper evaluates their experiences in providing prenatal care to immigrants in Hamilton, Ontario, Canada. Results reveal the complexity of delivering care to immigrants, particularly with respect to expectations surrounding language, culture and type and professionalism of care. The paper concludes by discussing future research options and implications for the delivery of prenatal care to this population.     

Surviving decentralisation? Impacts of regional autonomy on health service provision in Indonesia

The paper aims to assess the impacts of decentralisation and privatisation reforms on access to and quality of health services in Indonesia. The research draws on qualitative and quantitative data from interviews, focus group discussions, and household surveys in four selected districts. The main conclusions are three-fold; the local administration of health care services is without transparency and accountability, health centres are turned into profit centres, and the increasing roles of private actors tend to reduce concerns over preventive health care and the conditions for poor people. Our policy recommendations include increased government spending to maintain public efforts in environmental and preventive health and in maintaining a minimum health service for the poor.     

Health care provision for illegal migrants: may health policy make a difference?

Illegal migrants in Europe are, generally, only entitled to emergency care and services for children and pregnant women. In 2002 legal changes in Spain made accessible medical cards and free medical care for illegal migrants in similar terms than the legal migrants or the Spanish population. We interviewed 380 migrants to assess whether there were differences on health services utilization by legal status. We did not find differences in the utilization of health services when ill between legal and illegal migrants. However, a significantly lower utilization of health services was associated with less education (RP = 0.4; 95% CI: 0.2-0.9).     

Thinking ahead? Exploring adult social care provision with older people in Northern Ireland

A plethora of government policies impacting older people in the United Kingdom (UK) have been strongly influenced by the rhetoric that service users should be actively involved in their social care; including decisions and delivery. User involvement is integral to the government's current drive to make service more “person‐centred” or “personalised” in adult social care. However, there has been little engagement with the broader Northern Ireland public on future adult social care policies. It has been suggested that knowing preferences for the type of future care and where and how it should be provided can be valuable for service users, providers and policy‐makers. Using a qualitative approach, this paper draws on data collected from three focus groups with people aged over 60 who are not in receipt of social care services. The focus groups took place between April 2016 and January 2017. The findings demonstrate that participants had limited knowledge and understanding of the current social care system in Northern Ireland. In addition, participants had not thought about their possible future care needs. The findings emphasise the importance of promoting and engaging the public in social care debates, particularly at a time when the need for reform of the health and social care system has been identified in Northern Ireland.     

Midwifery provision in two districts in Indonesia: how well are rural areas served?

Attention has focused recently on the importance of adequate and equitable provision of health personnel to raise levels of skilled attendance at delivery and thereby reduce maternal mortality. Indonesia has a village-based midwife programme that was intended to increase the rate of professional delivery care and redress the urban/rural imbalance in service provision by posting a trained midwife in every village in the country. We present findings on the distribution of midwifery provision in our study area: 10% of villages do not have a midwife but a nurse as a midwifery provider; there is a deficit in midwife density in remote villages compared with urban areas; those assigned to remote areas are less experienced; midwives manage few births and this may compromise their capacity to maintain professional skills; over 90% of non-hospital deliveries take place in the woman's (64%) or the midwife's (28%) home; three-quarters of midwives did not make regular use of the fee exemption scheme; midwives who live in their assigned village spend more days per month on clinical work there. We conclude that adequate provider density is an important factor in effective health care and that efforts should be made to redress the imbalance in provision, but that this can only contribute to reducing maternal mortality in the context of a supportive professional environment and timely access to emergency obstetric care.     

Does government provision of healthcare explain the relationship between income inequality and low birthweight?

This paper estimates the relationship between state and county income inequality and low birthweight (LBW) in the U.S. It examines whether more unequal societies are also less healthy because such societies have lower investment in population health. The model includes an extensive list of community and individual controls and community fixed-effects. Results show that unequal states in fact have greater social investments, and absent these investments children born in such states would be more likely to be LBW. Using alternate measures of inequality reveals that income inequality in the upper tail of the income distribution is not related to LBW; but inequality in the lower tail of the income distribution is associated with increased LBW where the supply of healthcare mitigates the effect of income inequality. Consistent with prior findings, county income inequality is not significantly related to LBW.     

Ethnic variation in cancer patients’ ratings of information provision,communication and overall care

Objective. Ethnic inequalities in cancer patient experience exist but variation within broad ethnic categories is under-explored. This study aimed to describe variation by ethnic sub-category in experiences of information provision and communication (key domains of patient experience) using National Cancer Patient Experience Survey (NCPES) data.

Design. The NCPES 2012–2013 contained responses from 68,737 cancer patients treated at 155 NHS Trusts in England. Multivariate logistic regression was used to investigate associations between ethnicity and patients’ ratings of overall care, information provision and communication.

Results. Variation by and within broad ethnic categories was evident. Non-White patients (particularly Asian patients (OR_adj:0.78; 95%CI:0.67-0.90, p=0.001)) were less likely than White patients to receive an understandable explanation of treatment side effects. Among Asian patients, those of Bangladeshi ethnicity were least likely to receive an understandable explanation.

Conclusions. Effective communication and information provision are important to ensure patients are well informed, receive the best possible care and have a positive patient experience. However, ethnic inequalities exist in cancer patients’ experiences of information provision and communication with variation evident both between and within broad ethnic categories. Further work to understand the causes of this variation is required to address ethnic inequalities at practice and policy level.     

Do income effects mask social and behavioural factors when looking at universal health care provision?

Summary Objectives: To investigate whether permanent and transitory income effects mask the impact of unobservable factors on the uptake of health check-ups in Britain. Methods: We used a secondary data representative of the British population, the British Household Panel Survey. Outcome variables included uptake of dental health check-ups, eyesight tests, blood pressure checks, cholesterol tests, mammograms and cervical smear tests. Transitory income was measured as monthly household income and permanent income as average income over 13 years. Estimation method applied dynamic random effect probit model. Results: Results showed the absence of permanent and transitory effects on the uptake of eyesight tests, cholesterol tests, mammograms and cervical smear tests. Permanent income was associated with dental check-ups and transitory income with uptake of blood pressure tests. Conclusions: The presence of income effects on the uptake of blood pressure checks may be due to factors associated with income, such as stress or lifestyles, rather than income per se. A permanent income effect on dental health care in Britain, which is not free of charge, could indicate the possibility of economic constraints to service uptake, but it does not guarantee that income is the only factor that matters as there may important cultural and behavioural barriers. Submitted: 8 August 2006; Revised: 18 April 2007; Accepted 18 July 2007     

Can the hospices survive the market? A financial analysis of palliative care provision in Scotland

Hospices are undergoing changes in the way they are funded by health boards as a result of the change to a contract-setting regime in the NHS. This may have implications for the overall funding position of the hospices; particularly there is a concern as to whether charitable giving to these bodies will decrease as a result. Analyses the accounts of Scottish voluntary sector hospices over the transition period as a means of identifying any such changes. Finds no immediate threat to the continued functioning of the hospices, on a financial basis.     

Does provision of an evidence‐based information change public willingness to accept screening tests?

Objective

To investigate whether the willingness of the general population to undergo a screening test of questionable effectiveness for pancreatic cancer is influenced by the quality and the extent of the information provided.

Design

Randomised study.

Setting

Switzerland.

Participants

Representative sample (N=1000) of the general population aged over 20.

Interventions

Participants were randomly allocated into two groups (N=500 each), with one group to receive basic and the other extended quality of information. The information was presented in two hypothetical scenarios about implicit and explicit benefits and adverse events of the screening test. Response rates were, respectively, 80.2% (N=401) and 93.2% (N=466).

Main outcome measures

Stated willingness to undergo the screening test.

Results

Out of the 401 participants receiving the basic information scenario, 241 (60%) stated their willingness to accept the test, as compared to the 63/466 (13.5%) exposed to the extended one (P < 0.001). After adjusting for respondent characteristics through a logistic regression model, the ‘information effect’, expressed in terms of odds‐ratio (OR), shows that provision of additional information was related to a 91% (OR 0.09; 95CI: 0.07 – 0.13) relative reduction in the likelihood of accepting the screening test.

Conclusion

The quality and the extent of the information provided about the implicit and explicit benefits and adverse events on hypothetical scenarios of a screening test may dramatically change the willingness of people to participate in the testing. This study suggests that provision of full information on the yield of health care interventions plays an important role in protecting the public from being exposed to procedures of questionable effectiveness.